Lactobacillus crispatus-dominated vaginal microbiome and Acinetobacter-dominated seminal microbiome support beneficial ART outcome.

INTRODUCTION: Despite the considerable progress made in assisted reproductive technologies (ART), the implantation rate of transferred embryos remains low and in many cases, the reasons for failure remain unclear. We aimed to determine the potential impact of female and male partners' reproductive tract microbiome composition on ART outcome. MATERIAL AND METHODS: The ART couples (n = 97) and healthy couples (n = 12) were recruited into the study. The smaller healthy group underwent a careful selection according to their reproductive and general health criteria. Both vaginal and semen samples were subjected to 16S rDNA sequencing to reveal the bacterial diversity and identify distinct microbial community types. Ethics statement The study was approved by the Ethics Review Committee on Human Research of Tartu University, Tartu, Estonia (protocol no. 193/T-16) on 31 May 2010. Participation in the research was voluntary. Written informed consent was obtained from all study participants. RESULTS: The men with Acinetobacter-associated community who had children in the past, had the highest ART success rate (P < 0.05). The women with bacterial vaginosis vaginal microbiome community and with L. iners-predominant and L. gasseri-predominant microbiome had a lower ART success rate than women with the L. crispatus-predominant or the mixed lactic-acid-bacteria-predominant type (P < 0.05). The 15 couples where both partners had beneficial microbiome types had a superior ART success rate of 53%, when compared with the rest of the couples (25%; P = 0.023). CONCLUSIONS: Microbiome disturbances in the genital tract of both partners tend to be associated with couple's infertility as well as lower ART success levels and may thus need attention before the ART procedure. The incorporation of genitourinary microbial screening as a part of the diagnostic evaluation process may become routine for ART patients if our results are confirmed by other studies.

Trends in teenage delivery and abortion rates in Estonia over more than two decades: a nationwide register-based study.

BACKGROUND: In the last 30 years, Estonia has undergone major socio-economic changes, including profound educational and healthcare reforms. The study aimed to analyse trends in teenage delivery and induced abortion rates among younger and older teens, including Estonians and non-Estonians, and to study trends in repeat teenage pregnancies in more detail. METHODS: The register-based study included data on 29 818 deliveries (1992-2019) and 25 865 (1996-2019) induced abortions among 15-19-year-old girls. Delivery and abortion rates per 1000 girls were calculated by age group, ethnicity and reproductive history. Poisson regression models were applied to estimate average annual percentage changes in delivery and abortion rates over the whole period and in two sub-periods with change points in the trend in 2007. RESULTS: The delivery rate decreased by 5.3% per year, from 49.9 in 1992 to 8.4 in 2019; the abortion rate decreased by 6.0% per year, from 42.4 in 1996 to 8.6 in 2019. A faster decline in delivery rates took place among Estonians than non-Estonians, but the opposite trend occurred in abortion rates. Delivery rates for first and repeat pregnancies decreased nearly at the same pace, while abortion rates for repeat pregnancies decreased faster than those for first pregnancies. CONCLUSIONS: A decreasing trend in teenage births is evident in parallel with society becoming wealthier. A remarkable decline in teenage abortions occurs when young people's rights to safe abortion, contraception, mandatory sexuality education and youth-friendly services are ensured. There always remains a small group of adolescents who repeatedly become pregnant.

ISIDOG Consensus Guidelines on COVID-19 Vaccination for Women before, during and after Pregnancy.

INTRODUCTION: Sars-CoV-2 infection poses particular problems in pregnancy, as the infection more frequently causes severe complications than in unaffected pregnant women or nonpregnant women with SARS-CoV-2 infection. Now that vaccination is available and rapidly being implemented worldwide, the question arises whether pregnant women should be vaccinated, and if so, whether they should receive priority. METHODS: Available scientific data and available guidelines about vaccination against SARS-CoV-2 were collected by the Guideline Committee of the International Society of Infectious Diseases in Obstetrics and Gynecology (ISIDOG) and were analyzed, discussed and summarized as guidelines for healthcare workers caring for pregnant women. Concluding statements were graded according to the Oxford evidence-based medicine grading system. RESULTS: There is evidence to consider pregnancy as a risk factor for serious complications of COVID-19 infection, even in the absence of additional risk factors, such as hypertension, diabetes and obesity which increase these risks even more in pregnancy. Currently available data slightly favor mRNA-based vaccines above vector-based vaccines during pregnancy and breastfeeding, until more safety data become available. CONCLUSION: ISIDOG advises policy makers and societies to prioritize pregnant women to receive vaccination against SARS-CoV-2 and favor the mRNA vaccines until further safety information becomes available.

Quality of IVF status registration in the Estonian Medical Birth Registry: a national record linkage study.

BACKGROUND: Information regarding in vitro fertilization (IVF) as a pregnancy risk factor (yes/ no) is stored in each birth record of the Estonian Medical Birth Registry (EMBR). This study aimed to assess the validity of registration of newborns' IVF status in the EMBR. METHODS: To identify the newborns conceived by IVF, the birth records in the EMBR were compared to individual records on the embryo transfer procedures in the Estonian Health Insurance Fund (EHIF) database as a reference. Maternal age was restricted to 40 years, the age limit for IVF treatment covered by the EHIF. The embryo transfer procedures, that dated up to eight weeks before pregnancy, were additionally checked in the infertility treatment clinics. The validity of IVF status was measured by sensitivity, specificity, positive and negative predictive values (PPV and NPV). Relative risk (RR) of unrecorded IVF status among IVF mothers by socio-demographic characteristics and birth plurality was estimated using modified Poisson regression models. RESULTS: There were 3198 newborns identified as conceived by IVF in the EMBR in 2005-2014. Eight of them were incorrectly entered as born after IVF. The record linkage with the EHIF database revealed 1014 newborns with unrecorded IVF status in the EMBR. A total of 4204 newborns were verified as conceived by IVF, 24.1% of them were not categorized as born after IVF. The sensitivity of the IVF status registration was poor (75.9%), specificity (100.0%), PPV (99.8%) and NPV (99.3%) were high. The misclassifications were significantly more common among mothers of younger age or non-Estonians or with singleton birth. CONCLUSION: Information based on mother's self-report or her antenatal chart does not accurately identify the newborn's IVF status. The lack of a specialized country-wide assisted reproductive technology register in Estonia requires routine record linkage of the EMBR, EHIF and the infertility treatment clinics' databases to obtain adequate information regarding IVF status in the EMBR. Electronic record linkages between databases would help considerably to improve the validity of data to be used in medical decision making, in research and for statistical purposes.

Endometrial transcriptome analysis indicates superiority of natural over artificial cycles in recurrent implantation failure patients undergoing frozen embryo transfer.

Little consensus has been reached on the best protocol for endometrial preparation for frozen embryo transfer (FET). It is not known how, and to what extent, hormone supplementation in artificial cycles influences endometrial preparation for embryo implantation at a molecular level, especially in patients who have experienced recurrent implantation failure. Transcriptome analysis of 15 endometrial biopsy samples at the time of embryo implantation was used to compare two different endometrial preparation protocols, natural versus artificial cycles, for FET in women who have experienced recurrent implantation failure compared with fertile women. IPA and DAVID were used for functional analyses of differentially expressed genes. The TRANSFAC database was used to identify oestrogen and progesterone response elements upstream of differentially expressed genes. Cluster analysis demonstrated that natural cycles are associated with a better endometrial receptivity transcriptome than artificial cycles. Artificial cycles seemed to have a stronger negative effect on expression of genes and pathways crucial for endometrial receptivity, including ESR2, FSHR, LEP, and several interleukins and matrix metalloproteinases. Significant overrepresentation of oestrogen response elements among the genes with deteriorated expression in artificial cycles (P < 0.001) was found; progesterone response elements predominated in genes with amended expression with artificial cycles (P = 0.0052).

Youth sexual health improvement in Estonia, 1990-2009: the role of sexuality education and youth-friendly services.

OBJECTIVES: A new school curriculum was introduced in Estonia in 1996 comprising for the first time sexuality education (SE) topics. The first youth counselling centres (YCCs) addressing sexual health matters were set up in 1991-1992. This study describes the development of school-based SE and YCCs in 1992 - 2009, and explores the concurrent changes in sexuality-related knowledge, behaviour, and sexual health indicators. METHODS: The analyses are based on 12 population-based surveys. Data on births, abortions and sexually transmitted infections, including HIV, are taken from national registers. RESULTS: By the middle of the past decade SE was well established. There has been a trend towards younger age at first sexual intercourse, and increased usage of condoms and reliable contraceptive methods. The abortion rate among 15-19-year-olds declined by 61% and their fertility rate by 59%. The annual number of registered new HIV cases among 15-19-year-olds dropped from 560 in 2001 to 25 in 2009, new syphilis cases from 116 in 1998 to two in 2009, and gonorrhoea cases from 263 in 1998 to 20 in 2009. CONCLUSIONS: This study documents considerable improvements in sexual health indicators of youths, and indicates that these run parallel to the development of school-based SE and YCCs.

Individual and familial factors associated with teenage pregnancy: an interview study.

BACKGROUND: The determinants of teenage sexual health, including pregnancies, can be addressed from social, familial and individual level perspectives. The main objective of this study was to examine whether pregnancy among 18 years old and younger girls were associated with selected individual (age at coitarche, score of sexual health knowledge, dislike of school) and family (mother's education) and family functioning (alcohol abuse in the family, parents' acceptance of sexual relationship) characteristics. METHODS: An interview survey in two medical institutions in Estonia among 279 18 year old and younger girls, who: (i) used contraception, had been sexually active for at least 6 months and had not pregnancies--(148 girls); (ii) came for termination of pregnancy--abortion group; (iii) planned to deliver and came for prenatal care--delivery group. The last two groups were analysed together as the 'pregnancy group'--131 girls. Multivariate analysis, by means of logistic regression models, was used to explore whether the associations were sustained after adjusting for other variables. Crude odds ratios (ORs), adjusted ORs and their 95% confidence intervals (CIs) were estimated, with girls having no pregnancies as the reference group. RESULTS: Risk factors associated with teenage pregnancy were low score of sexual health knowledge (adjusted ORs 3.07; 95% CIs 1.73-5.46), dislike of school (adjusted ORs 1.96; 95% CIs 1.08-3.54), alcohol abuse by family members (adjusted ORs 2.03; 95% CIs 1.16-3.54). CONCLUSION: Sexual knowledge of teenagers, their attitude towards school, alcohol abuse in the family are factors associated with teenage pregnancies.

Previous history of surgically induced abortion and complications of the third stage of labour in subsequent normal vaginal deliveries.

OBJECTIVE: To estimate the risk of complications of the third stage of labour needing manual revision of uterine cavity or curettage in deliveries following one or multiple induced abortions in nulliparous women who had singleton live births in Estonia in 1994-2002. METHODS: Registry study using the data from the Estonian medical birth registry: 32,652 women had not had any abortions, 7,333 women had had one and 2,383 women had had two or more surgically induced abortions before their first delivery. Multiple logistic regression analysis was performed to estimate crude odds ratios (OR), adjusted ORs and their 95% confidence intervals, with women having had no abortions as the reference group. Adjustment was made for maternal age, sex and weight of infant, labour induction/augmentation. RESULTS: In the single abortion group, the crude OR was 1.25 (95% confidence intervals (CI) 1.12-1.40), the adjusted OR was 1.23 (95% CI 1.10-1.38); in the multiple abortion group the crude OR was 1.28 (95% CI 1.06-1.53), the adjusted OR was 1.24 (95% CI 1.03-1.49). CONCLUSIONS: Our findings suggest a positive association between one or more first trimester abortion(s) and the risk of complications in the third stage of labour in subsequent singleton delivery.

Is a poor pregnancy outcome related to young maternal age? A study of teenagers in Estonia during the period of major socio-economic changes (from 1992 to 2002).

OBJECTIVE: To assess the risk of low birth weight, preterm birth, stillbirth, neonatal and postneonatal death among primiparous teenagers having singleton births, compared to a similar group of women aged 20-24 years in Estonia during the period of major socio-economic changes. STUDY DESIGN: Registry study using the data from the Estonian Medical Birth Registry (EMBR) for years 1992-2002; EMBR data were linked with infant deaths in the Estonian Mortality Database. Study population included 51,890 women aged 13-24 years, arranged into three groups: < or =17, 18-19, and 20-24. Crude odds ratios (OR), adjusted ORs and their 95% confidence intervals (CI) for the different outcomes were estimated using multiple logistic regression analysis. RESULTS: Compared with women aged 20-24 years, the risk of low birth weight and preterm birth was higher among teenagers. The risk of low birth weight and preterm birth within the study group as a whole did not change during the study period. Increased risks in neonatal and postneonatal death among younger teenagers of an age of 17 years and less seem to be a result of prematurity. CONCLUSIONS: Despite major socio-economic changes resulting in improvements in obstetric care and growth in incomes, teenagers remained a higher risk group.

Impact of rapid socio-economic changes on teenage pregnancies in Estonia during 1992-2001.

BACKGROUND: Major socio-economic changes, including health care reforms and changes in the school curriculum, took place in Estonia after the country regained its independence in 1991. These changes affected people's reproductive behavior in many ways. In this article, the impact of the changes on the reproductive behavior of teenage girls, measured by adolescent fertility and abortion rates between 1992 and 2001, is analyzed. METHODS: National data on abortions and births were obtained from official medical statistics, particularly from the Estonian Abortion Registry and the Estonian Medical Birth Registry. Female population denominators for the age group 15-19 were obtained from the Statistical Office of Estonia. RESULTS: In teenagers, the birth rate decreased more than two times, from 49.7 per 1000 in 1992 to 23.8 per 1000 in 2001. The abortion rate per 1000 decreased from 55.5 in 1992 to 30.4 in 2001. Compared with all women of fertile age (15-49 years), at the beginning of the decade, teenagers decided more often to have a baby, and, at the end of the decade, they decided more often to terminate the pregnancy. Two-thirds of all pregnancies in teenagers end in abortion--either legally induced abortion (legal abortion and therapeutic abortion) or spontaneous abortion. In 2001, the abortion ratio was 116.4 among ethnic Estonians and 147.9 among non-Estonians. CONCLUSIONS: The case in Estonia again proves that the availability of information, contraceptives, services and education, and the existence of other goals in life besides childbearing, have an impact on teenage birth and abortion rates. Successful health promotion activities should take into consideration the differences in the reproductive behavior of different ethnic groups.