Comparative influence of inappropriate gestational weight gain on pregnancy outcomes in IVF-conceived and spontaneously conceived twin pregnancies.

OBJECTIVE: To investigate the influence of inappropriate gestational weight gain (GWG) on pregnancy outcomes in twin pregnant women with in vitro fertilization (IVF) treatment. METHODS: This retrospective cohort study included 2992 twin pregnant women and categorized the participants as follows: (i) they were classified into spontaneous conception (SC) or IVF groups based on whether they received IVF treatment, and (ii) they were categorized into inadequate, optimal, or excessive GWG groups according to the International Organization for Migration Twin Pregnancy Guidelines. Initially, the study investigated the separate effects of IVF treatment and different levels of GWG on the outcomes of twin pregnancies. Subsequently, after adjusting for confounding factors, multifactorial logistic regression analysis was performed to further investigate the impact of IVF treatment and high GWG on twin pregnancy outcomes. Based on this, the analysis was stratified by whether IVF was used to explore the effects of different GWG levels on each subgroup (those who underwent IVF and those who conceived spontaneously). Finally, potential multiplicative interactions between IVF and different GWG categories were examined to identify their combined effect on pregnancy outcomes. RESULTS: The results showed that women with twin gestations conceived via IVF exhibited significantly higher maternal age, pre-pregnancy body mass index, and a greater incidence of GWG beyond recommended guidelines compared to the SC group. Furthermore, both IVF treatment and inappropriate GWG increased the risk of adverse pregnancy outcomes, respectively. Following adjustments for confounding variables through multifactorial logistic regression, it was demonstrated that both IVF treatment and high GWG significantly elevated the risk of adverse outcomes in twin pregnancies, such as admission to the neonatal intensive care unit. It is noteworthy that inappropriate GWG, combined with IVF treatment, will stepwise increase the incidence of intrahepatic cholestasis of pregnancy, respiratory failure, respiratory distress, pre-eclampsia, maternal intensive care unit admission, and postpartum hemorrhage risk. However, these outcomes were less affected by inappropriate GWG in the SC group. Lastly, this study did not unveil a significant interaction between the IVF procedure and disparate levels of GWG in relation to the adverse outcomes. CONCLUSION: A high incidence of inappropriate GWG in twin pregnancies with IVF treatment and inappropriate GWG conferred more adverse twin pregnancy outcomes in the IVF group relative to the SC group. This study indicates that proper management of GWG may be a breakthrough in reducing adverse outcomes in twin pregnancies associated with IVF. Therefore, implementing proactive interventions such as supervised exercise programs, prescribed physical or dietary plans, enhanced weight management, or personalized counseling, holds promise for lowering the risks associated with inappropriate GWG in twin pregnancies resulting from IVF.

Uptake and Persistence of Safer Conception Strategies Among South African Women Planning for Pregnancy.

Safer conception strategies can minimize HIV acquisition during periconception periods among women living in HIV-endemic areas. We examined uptake and predictors of persistent use of the same safer conception strategy among a cohort of HIV-uninfected South African women ages 18-35 years planning for pregnancy with a partner living with HIV or of unknown HIV-serostatus. The safer conception strategies we evaluated included oral PrEP, condomless sex limited to peak fertility, and waiting for a better time to have a child (until, for example, the risks of HIV acquisition are reduced and/or the individual is prepared to care for a child); persistence was defined as using the same safer conception strategy from the first visit through 9 months follow-up. Modified Poisson regression models were used to examine predictors of persistent use of the same strategy. The average age of 227 women in our cohort was 24.6 (range: 18.0, 35.7) years. In this cohort, 121 (74.2%) women reported persisting in the same strategy through 9 months. Employment and HIV knowledge were associated with the persistent use of any strategy. Our results highlight the need to provide safer conception services to women exposed to HIV during periconception periods. Findings also offer some insights into factors that might influence persistent use. Further research is needed to better understand how to involve male partners and how their involvement might influence women's consistent use of safer conception strategies during periconception periods.

The Diatomite Grinding Technology Concept for the Protection of Diatomite Shells and the Control of Product Grading.

Diatomite deposits in Poland are located in the Podkarpackie Voivodeship, and the only active deposit is in Jawornik Ruski. Therefore, it is a unique material. Improved rock processing methods are constantly in demand. In the research presented here, we have used research methods such as X-ray diffraction (XRD), scanning electron microscope (SEM), particle shape analysis, and appropriate sets of crushing machines. Diatomite comminution tests were carried out on test stands in different crushers (jaw crusher, hammer crusher, high-pressure roller press, ball mill) using different elementary crushing force actions: crushing, abrasion, and impact, occurring separately or in combination. The machines were tested with selected variable parameters to obtain products with a wide range of grain sizes ranging from 0 to 10 mm. The ball mill (yield 87%, system C3) and the hammer crusher with HPGR (high-pressure grinding roller) (yield 79%, system D2 + D3) have the greatest impact on diatom shell release and accumulation in the finest 0-5 µm and 5-10 µm fractions. For commercial purposes, it is important to obtain very fine fractions while keeping the shells undisturbed.

Evaluation of the Management and Outcome of Patients with Retained Products of Conception after Gestational Week 23+0: A Retrospective Cohort Study.

Background: Retained products of conception after childbirth or miscarriage are associated with an increased rate of maternal complications, such as abnormal vaginal bleeding and infections. Late complications may also include intrauterine adhesions, causing infertility. Surgical interventions carry a certain risk. Thus, conservative management is often discussed as an alternative. The aim of this study was to assess the clinical outcomes of patients with retained products of conception, comparing a primary surgical approach to conservative management. Methods: We conducted a retrospective cohort study of 88 patients diagnosed with retained products of conception after 23+0 weeks of gestation at the Medical University Vienna between 2014 and 2022. Results: Forty-seven (53.4%) patients underwent primary surgical management and 41 (46.6%) primary conservative management. After primary conservative treatment, a complication could be observed in 10 (24.4%) women. In contrast, complications occurred in 32 (68.1%) women in the group with primary surgical treatment (p < 0.001). The most common complication in both groups was the ongoing suspicion of retained products of conception. Patients after primary surgical treatment were significantly more likely to require a secondary change in treatment (p < 0.001). Ultimately, secondary conservative management was applied in 30 (63.8%) patients. In contrast, only nine (21.95%) patients with primary conservative management required secondary surgical management. Conclusions: Due to the high risk of complications and persistent retained products of conception, primary surgical management should only be prioritized in hemodynamically instable or septic patients.

Association between endometrial protein expression of IFN-γ and delayed conception after parturition in dairy cows.

The cytokine context present in the reproductive tract of cows is closely involved in normal uterine functions, including the estrous cycle and the establishment and maintenance of pregnancy. However, the roles of some cytokines in the uterus, and their relation with reproductive performance remain to be elucidated. Thus, this study aimed to examine the protein expression of several cytokines such as TNFα, IL-6, IL-8, IFNγ, IL-4, and TGF-ß3 in endometrial biopsies previous to conception, to evaluate the possible association with delayed conception in dairy cows. Protein expression levels were evaluated by immunohistochemistry. Results showed that the protein expression levels of TNFα, IL-6, IL-4 and TGF-ß3 were not associated with the parturition-conception interval, whereas the high protein expression levels of IFNγ were associated with the parturition-conception interval. Finally, the low protein expression of IL-8 showed a statistical tendency to be associated with delayed conception. This is the first report about the protein expression of IFN-γ in the endometrium of dairy cows and also, this cytokine could enhance the favorable conditions to achieve an early pregnancy.

A missed Nobel: Dr Subhas Mukhopadhyay (1931-1981), the Father of Indian IVF.

The Indian journey of assisted reproductive therapy began in Calcutta on 3 October 1978, when Dr Subhas Mukhopadhyay discovered the technique of in vitro fertilisation (IVF) only 67 days following the birth of the world's first IVF baby, Louise Brown in the United Kingdom by Edwards and Steptoe. While Edwards won the Nobel Prize in 2010 for his groundbreaking work, Mukhopadhyay, the man behind the genesis of 'Durga', India's first IVF baby, never received any recognition. Instead, he faced severe humiliation from his peers. His colleagues and the government dismissed his claims and unable to live with dishonour and disgrace, he tragically took his life on 19 June 1981. Today his innovative techniques of cryopreservation, gonadotropin stimulation and transvaginal oocyte retrieval are used worldwide across millions of fertility clinics, helping childless couples live the dream of parenthood.

Sonographic evaluation of retained products of conception within 48 h following delivery: a retrospective cohort study.

OBJECTIVE: Early diagnosis of retained products of conception (RPOC) is critical for directing clinical management and for preventing associated complications. This study aimed to evaluate the utility of post-delivery ultrasound in patients with risk factors for RPOC. STUDY DESIGN: A retrospective cohort-study was conducted in a single tertiary university-affiliated hospital (January 2016-September 2022). Sonographic evaluation, including endometrium thickness measurement and color Doppler, were reviewed of women with risk factors for RPOC: postpartum hemorrhage, a hemoglobin drop > 4 g/dl, manual removal of the placenta, and suspicious placenta. Results of early postpartum ultrasound (within 48 h), misoprostol administration and hysteroscopies were evaluated. RESULTS: Of the 591 women included, RPOC was suspected in 141 (24%). Endometrial thickness > 5 mm was associated with sonographic RPOC diagnosis in 58%. Suspected sonographic RPOC was concluded for 100%, 92% and 7% of the women with marked, moderate, and undetectable vascularity, respectively, p < 0.001. Misoprostol 1000 mcg per rectum (PR) was administered to 86% of those with suspected RPOC; only 11% of them needed an operative hysteroscopy for removal of the RPOC. RPOC on a pathology report was confirmed for 71% of those who underwent hysteroscopy. CONCLUSIONS: Postpartum transabdominal ultrasonography within 48 h of delivery was effective for assessing RPOC. For appropriate triage, color Doppler grading increased the accuracy of RPOC diagnosis. Misoprostol treatment was successful in 88% of women with suspected sonographic RPOC. The combination of sonographic evaluation and misoprostol treatment for suspected RPOC might lower the rate of unnecessary invasive procedures.

Comparing risk factors and neonatal outcomes in women with intrahepatic cholestasis of pregnancy between assisted reproductive technology and spontaneous conception.

OBJECTIVE: The aim of the present study was to investigate the incidence of intrahepatic cholestasis of pregnancy (ICP) as well as neonatal outcomes between conception via in vitro fertilization (IVF) compared with spontaneous conception (SC) and screen the risk factors of ICP in IVF. METHODS: This retrospective cohort study included 4467 puerperae who conceived via IVF, and 28 336 puerperae who conceived spontaneously and linked the information from neonates. The general linear model (GLM), multivariate logistic regression analysis, a forest plot, and nomogram were used to assess impact factors and risk prediction. RESULTS: Logistic analysis adjusted for confounders revealed significant differences in the ICP rate of singleton delivery (4.24% vs 3.41%, adjusted OR [aOR] = 1.26; 95% confidence interval [CI] 1.03-1.53, P = 0.025) and in groups with total bile acids (TBA) ≥40 and <100 µmol/L (14.77% vs 10.39%, aOR = 1.31; 95% CI: 1.06-1.63, P = 0.023) between IVF and SC. When we divided newborns into singleton and twins delivery, the GLM revealed a higher rate with Apgar score <7 (13.44% vs 3.87%, aOR = 3.85; 95% CI: 2.07-7.17, P < 0.001) and fetal distress for IVF in comparison with SC (19.32% vs 5.55%, OR = 3.48; 95% CI: 2.39-6.95, P < 0.001) in the singleton group. In multivariate logistic regression analysis, body mass index (BMI) (aOR = 1.29; P = 0.031), number of embryo transfers (ET) (single ET vs double ET, aOR = 2.82; P < 0.001), E2 level on the ET day (aOR = 2.79; P = 0.011), fresh ET which compared with frozen ET (FET) (aOR = 1.45; P = 0.014), embryo stage (cleavage embryo vs blastocyst, aOR = 1.75; P = 0.009) and severe ovarian hyperstimulation syndrome (OHSS) which compared with non-OHSS (aOR = 3.73; P = 0.006) were independent predictors of ICP. These predictive factors in the logistic regression model were integrated into the nomogram (C-index = 0.735; 95% CI: 0.702-0.764); for each patient, higher total points indicated a higher risk of ICP. CONCLUSION: We observed that the ICP rate of singleton delivery was higher in IVF than in SC. In ICP patients, there were higher rates of neonatal Apgar score <7 and fetal distress in IVF than SC and found the predictors of ICP in IVF.

Current practice of ultrasound in the management of postpartum hemorrhage: a secondary analysis of a national survey.

OBJECTIVES: Although frequently employed in the delivery room, current guidelines do not recommend the use of ultrasound in the setting of postpartum hemorrhage (PPH). The aim of this survey was to evaluate the routine use of ultrasonography during PPH. METHODS: A questionnaire, composed by a series of questions that assess participant characteristics and ultrasound use during PPH, was sent to members of the Italian Society of Ultrasound in Obstetrics and Gynecology currently employed in obstetrical units. Answers were subsequently grouped based on participant characteristics. RESULTS: Based on the responses of 200 participants it was found that ultrasound was routinely employed by 67 % of participants during PPH, by 85 % if Retained Products of Conception (RPOC) was suspected, by 67 % during Bakri balloon placement and by 69 % during curettage procedures. Routine ultrasound use was higher amongst participants working in hospitals with a higher number of deliveries, by those with more years of experience using ultrasound in labor, and by those that had attended specific postgraduate training courses. CONCLUSIONS: Despite the lack of recommendations in the current guidelines, the results of this survey show that ultrasound seems to be commonly employed by maternal fetal medicine practitioners in the management of PPH.

Examining the impact of solid organ transplantation on family planning: pre- and post-transplantation pregnancy evaluations for both women and men.

PURPOSE: The aim of this study was to collect and analyze information from pregnancies of organ transplanted women and partners of organ transplanted men. The goal was to enhance counseling regarding pregnancy planning and management and to enable more targeted monitoring to improve maternal and child health. METHODS: In this retrospective, multicenter cohort study, women and men aged 18 to 45 who had undergone organ transplantation in Germany, Austria, and Switzerland were surveyed about their pregnancies before and after transplantation by using a self-developed questionnaire. RESULTS: Even through transplanted women planned their pregnancies more carefully than before transplantation, they still experienced more pregnancy complications afterward. The live birth rate for pregnancies of partners of transplanted men, especially men who received a thoracic organ, was lower compared to before transplantation. Furthermore, this study showed that pregnancies of the partners of male transplant recipients occurred significantly less by spontaneous conception in comparison to pregnancies of transplanted women. CONCLUSION: Pregnancies after organ transplantation are possible but associated with an increased risk of pregnancy complications. Therefore, early counseling for transplanted women and men who wish to have children, along with extensive monitoring during pregnancy, is necessary.

Expression of Exploratory Activity of Rat Offspring Depends on the Expression of Exploratory Activity of Their Parents at the Moment of Mating.

The aim of this work was to study the, so far, unexplored possibility that non-genetic inheritance of animal behavioral characteristics could depend on the state of the parents at the time of conception. In this study, we measured the levels of motor and exploratory activity in rats at the ages of 2 and 5 months. Male and female rats were mated at the age of 5 months. The following groups were used: male and female rats with high motor activity at ages of 2 and 5 months (ACT+); male and female rats with high activity at the age of 2 months, but low activity at the age of 5 months (ACT-); male and female rats with low activity at the ages of 2 and 5 months (PAS-); male and female rats with low activity at the age of 2 months, but high activity at the age of 5 months (PAS+). It was found that both males and females ACT+ had significantly higher motor activity, which was observed in the first 10minutes, in the next 20-60minutes, in the center of the cage and more rearings as compared with PAS-rats. Significant differences in the severity of exploratory activity were found between the male offspring of ACT+ and ACT- rats. Differences between the offspring of PAS+ and PAS- rats were observed in both the male and female rats. The motor activity of animals in the period from 20minutes after the start of registration did not differ between groups. Thus, it can be considered that individual characteristics of general motor activity are due to genetically inherited factors, while differences in the level of exploratory activity, apparently, are formed due to non-genetic influences from parents during mating.

The Donor Conception Identity Questionnaire: Associations with mental health and searching for and finding donor connections.

OBJECTIVE: To understand how the Donor Conception Identity Questionnaire (DCIQ) correlates with mental health and explore differences on the DCIQ between donor conceived people who were actively searching for donor connections to those who were not and those who had found their donor connections to those who had not. DESIGN: Cross sectional survey. SUBJECTS: 88 donor conceived adults ranging in age from 18 to 70 (Mean = 34.27 years, median = 31 years). 39 participants were actively searching for their donor connections, and 49 were not. EXPOSURE: Donor conception identity was measured using a questionnaire and scores were correlated with existing measures of mental health. MAIN OUTCOME MEASURES: Participants completed the DCIQ and measures of wellbeing, satisfaction with life, identity, pride and stigma. RESULTS: Factor analysis of items from the DCIQ identified four domains: 1. Concern and preoccupation, 2. Internalised stigma, 3. Pride and acceptance, and 4. Openness and understanding. The identified factors correlated with scales of psychological and social wellbeing. Active searchers scored higher than non-active searchers on 'Concern and preoccupation' F(1, 79) = 7.543, p = .007 and 'internalised stigma' (F(1, 79) = 4.355, p = .040). Donor conceived individuals who had found their donor connections scored lower on 'internalised stigma' F(1, 79) = 7.071, p =.009 and higher on 'openness and understanding' (F(1, 79) = 6.083, p = 0.016) compared to those who had not found their donor connections. CONCLUSION: The findings of the present study show that cores on the DCIQ correlate with existing measures of psychological and social wellbeing. Furthermore, donor conceived individuals searching for their donor connections differ from those not actively searching on key domains of the DCIQ. Implications for future avenues of study, and for support for donor conceived people are discussed.

Back-Health Knowledge and Misconceptions Related to the Daily Life Activities of Secondary School Students.

High school students with better knowledge about back care have fewer problems, but conceptual errors can hinder the acquisition of essential knowledge necessary for developing healthy habits. This study analyzed secondary school students' declarative knowledge and misconceptions related to back care in daily activities. An exploratory cross-sectional study was conducted with 80 girls and 89 boys aged 14-18 years (M = 15.68, SD = 2.12). The Health Questionnaire on Back Care Knowledge in Activities of Daily Living was used to evaluate knowledge using the true answer model (TAM) and the misconception model (MM). Using the test-retest method, both models' reliability was confirmed (TAM = 0.75; MM = 0.77), while only a minimal measurement error was identified (TAM = -0.01; MM = -0.07). The average scores were 6.23 for the TAM and 2.29 for the MM. The results showed no significant differences in both models. The analysis indicated that students had the most accurate knowledge of the location and function of the spine, whereas misconceptions regarding anatomical understanding and body posture usage were common. An analysis of the results under Reassumption Theory emphasizes the significance of comprehending concepts such as load transmission and spinal stability to maintain back health, thus highlighting the need for improved education in these areas to address misconceptions and enhance overall back-care knowledge.

Personhood Begins at Birth: The Rational Foundation for Abortion Policy in a Secular State.

The struggle over legal abortion access in the United States is a religious controversy, not a scientific debate. Religious activists who believe that meaningful individual life (i.e., "personhood") begins at a specific "moment-of-conception" are attempting to pass laws that force this view upon all pregnant persons, irrespective of their medical circumstances, individual preferences, or personal religious beliefs. This paper argues that such actions promote a constitutionally prohibited "establishment of religion." Abortion policy in a secular state must be based upon scientifically accurate biology, not unprovable theological presuppositions. The scientific facts regarding human pregnancy do not support the position that personhood begins with fertilization-at which point a pregnancy does not yet even exist. Abortion policy should regard the embryo/fetus as part of the pregnant individual's body until delivery. We argue that individual "personhood" only begins when the latent potentialities of the fetal nervous system are actualized in the newborn after delivery. The paper argues that instantiating non-scientific beliefs concerning embryonic/fetal "personhood" into the law as the basis for abortion policy establishes a state-sponsored religion. The protection of religious liberty requires that abortion be decriminalized. Abortion should be treated like any other medical procedure and regulated similarly. To protect both religious freedom and sound medical practice, individual legal personhood should be recognized as beginning only at birth.

Comparative Analysis of Two NGS-Based Platforms for Product-of-Conception Karyotyping.

Cytogenetic information about the product of conception (POC) is important to determine the presence of recurrent chromosomal abnormalities that are an indication for preimplantation genetic testing for aneuploidy or structural rearrangements. Although microscopic examination by G-staining has long been used for such an evaluation, detection failures are relatively common with this method, due to cell-culture-related issues. The utility of low-coverage whole-genome sequencing (lcWGS) using short-read next-generation sequencing (NGS) has been highlighted recently as an alternative cytogenomic approach for POC analysis. We, here, performed comparative analysis of two NGS-based protocols for this purpose based on different short-read sequencers (the Illumina VeriSeq system using a MiSeq sequencer and the Thermo Fisher ReproSeq system using an Ion S5 sequencer). The cytogenomic diagnosis obtained with each NGS method was equivalent in each of 20 POC samples analyzed. Notably, X chromosome sequence reads were reduced in some female samples with both systems. The possibility of low-level mosaicism for monosomy X as an explanation for this was excluded by FISH analysis. Additional data from samples with various degrees of X chromosome aneuploidy suggested that it was a technical artifact related to X chromosome inactivation. Indeed, subsequent nanopore sequencing indicated that the DNA in the samples showing the artifact was predominantly unmethylated. Our current findings indicate that although X chromosome data must be interpreted with caution, both the systems we tested for NGS-based lcWGS are useful alternatives for the karyotyping of POC samples.

Psychological well-being and family functioning following identity-release gamete donation or standard IVF: follow-up of parents with adolescent children.

This study sought to investigate if heterosexual-couple parents with adolescent children following identity-release oocyte donation (OD), sperm donation (SD) or standard IVF differed with regard to psychological distress, family functioning, and parent-child relationships. The prospective longitudinal Swedish Study on Gamete Donation consists of couples recruited when starting treatment between 2005 and 2008 from seven Swedish university hospitals providing gamete donation. This study concerns the fifth wave of data collection and included a total of 205 mothers and fathers with adolescent children following OD (n = 73), SD (n = 67), or IVF with own gametes (n = 65). OD/SD parents had used identity-release donation and most had disclosed the donor conception to their child. Parents answered validated instruments measuring symptoms of anxiety and depression (HADS), family functioning (GF6+) and parent-child relationship. Results found that parents following OD or SD did not differ significantly from IVF-parents with regard to symptoms of anxiety and depression, family functioning, and perceived closeness and conflicts with their child. Irrespective of treatment group, most parents were within normal range on psychological distress and family functioning and reported positive parent-child relationships. However, SD mothers to a larger extent reported anxiety symptoms above cut-off compared to OD mothers (31% vs. 7.3%, p = 0.018). In conclusion, the present results add to previous research by including families with adolescent children following identity-release oocyte and sperm donation, most of whom were aware of their donor conception. Largely, our results confirm that the use of gamete donation does not interfere negatively with mothers' and fathers' psychological well-being and perceived family functioning.

Effect of preconception multiple micronutrients vs. iron-folic acid supplementation on maternal and birth outcomes among women from developing countries: a systematic review and meta-analysis.

Background: Maternal malnutrition affects the somatic growth of the fetus and subsequent adverse events during infancy and childhood period. Though trials have been conducted on multiple micronutrient (MMN) supplements initiated during the preconception period, there is no collated evidence on this. Materials and methods: We performed a systematic review of published trials with the application of Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The searches were conducted until 30 September 2023. Meta-analysis was performed using Review Manager 5 software. The primary objective was to compare the effect of preconception MMN vs. iron-folic acid (IFA) supplementation on newborn anthropometric parameters at birth. Results: Of the 11,832 total citations retrieved, 12 studies with data from 11,391 participants [Intervention = 5,767; Control = 5,624] were included. For the primary outcome, there was no significant difference in the birth weight [MD, 35.61 (95% CI, -7.83 to 79.06), p = 0.11], birth length [MD, 0.19 (95% CI, -0.03 to 0.42), p = 0.09], and head circumference [MD, -0.25 (95% CI, -0.64 to -0.14), p = 0.22] between the MMN and control groups. For all the secondary outcomes [except for small for gestational age (SGA) and low birth weight (LBW)], the difference between the MMN and control groups was not significant. The GRADE evidence generated for all the outcomes varied from "very low to moderate certainty." Conclusion: A "very low certainty" of evidence suggests that MMN supplementation may not be better than routine IFA supplementation in improving newborn anthropometric parameters (weight, length, and head circumference). The adverse events resulting from the supplementation were not significant. We need better quality uniformly designed RCTs before any firm recommendation can be made.Systematic review registration: identifier (CRD42019144878: https://www.crd.york.ac.uk/prospero/#searchadvanced).

A retrospective analysis of conception per embryo transfer in dairy cattle in South Korea.

The bovine embryo production industry has seen significant growth over the past two decades, particularly in the production of in vitro produced embryos. This growth, driven by advancements in cryopreservation, in vitro culture mediums, ovum pick-up (OPU) procedures, ultrasonography devices, and embryo transfer (ET) has been notable. Particularly, ET is crucial for disseminating high genetic merit and amplifying foreign breeds by importing frozen embryos. This retrospective study aimed to assess factors affecting conception per embryo transfer (CPET) in Holstein-Friesian cattle in South Korea from October 2008 to July 2022. We evaluated type of embryo breed, type of embryo production (fresh and frozen; in vitro and in vivo production), recipient conditions including estrus type, corpus luteum quality, parity (nulliparous heifers, primiparous, and multiparous cows), and the daily mean temperature-humidity index (THI) as an index for heat stress. Type of embryo breed and estrus had no significant impact on CPET. However, we observed higher CPET in recipients with good quality corpus luteum, nulliparous heifers, and surrogates receiving fresh in vitro and frozen in vivo embryos. Importantly, CPET was not adversely affected by mild heat stress conditions (up to daily mean THI 76), indicating that using frozen in vivo embryos produced by multiple ovulation embryo transfer and fresh in vitro embryos by OPU-ET can help alleviate the subfertility issues in dairy cattle caused by global warming in Korea.

"We chose PrEP because I wanted to be sure that this child my wife was going to conceive was indeed mine." Factors influencing the choice of safer conception methods and experiences with its use: a qualitative study among HIV sero-discordant couples in Zimbabwe.

BACKGROUND: Safer conception services are needed to minimize HIV transmission among HIV sero-discordant couples desiring pregnancy. Few studies have evaluated the choices couples make when they are offered multiple safer conception methods or real-world method acceptability. This paper addresses an important knowledge gap regarding factors that influence the choice of safer conception methods, couples' actual experiences using safer conception methods, and why some couples switch safer conception methods. METHODS: Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples who exited the SAFER study-a pilot safer conception study for HIV sero-discordant couples in Zimbabwe that offered couples a choice of ART with monthly viral load monitoring (ART/VL), oral PrEP, vaginal insemination, and semen washing. All couples in SAFER had used at least two safer conception methods. RESULTS: We found that safer conception method choice often centered around a desire for intimacy, condomless sex, and certainty in the conception process, particularly for men. Method-related attributes such as familiarity, perceived ease of use, side effects, and perceived level of effectiveness in preventing HIV and achieving pregnancy influenced method choice, switching, and satisfaction. Concerns were expressed about each safer conception method and couples were willing to try different methods until they found method(s) that worked for them. The majority of participants reported having positive experiences using safer conception, especially those using ART/VL + PrEP, citing that they were able to attempt pregnancy for the first time with peace of mind and experienced joy and satisfaction from being able to achieve pregnancy safely. CONCLUSIONS: The differences in method preferences and experiences voiced by participants in this study and in other studies from the region point to the importance of having a variety of safer conception options in the service delivery package and addressing concerns about paternity, intimacy, and method-related attributes to enable HIV sero-discordant couples to safely achieve their reproductive goals.

[Can environmental impact be considered as a dimension of the proper use of medicines? From the 5th Forum of the Association for the Proper Use of Medicines]. / L'impact environnemental peut-il être considéré comme une dimension du bon usage des médicaments ? Retour sur le 5e Forum de l'Association Bon Usage du Médicament.

Through their footprint throughout their life cycle, from production to use, medicines have a significant impact on the environment. Reducing this impact is rarely considered from the perspective of the choices that healthcare professionals might have to make when prescribing or dispensing medicines. Should we consider environmental impact, alongside effectiveness and tolerance, one of the dimensions of the proper use of medicines? To address this question, the 5th Forum of the Association for the Proper Use of Medicines highlighted the main sources of pharmaceutical pollution: the carbon footprint linked to production, greenhouse gas emissions, the impact of residues on water and waste from packaging. While the eco-design of medicines should make it possible to limit their environmental impact upstream, there are still few initiatives aimed at their use. The Swedish "Hazard Score" assessment tool, which classifies compounds according to their potential to pollute the aquatic environment, was presented as a tool for guiding prescription choices. Through the exchanges between the various stakeholders (public authorities, doctors, pharmacists, manufacturers, patients) during this forum, recommendations were drawn up both on scientific and ethical grounds.