RESUMO
OBJECTIVE: To understand how the risk of different assisted reproductive technology (ART) failure types varies by ethnic group and explore the role of mediation by maternal age and suspected etiology. DESIGN: An observational study of 48,750 women who undertook treatment with ART in the United Kingdom between January 2017 and December 2018. SETTING: The Human Fertilisation and Embryology Authority national ART registry of the United Kingdom. PATIENT(S): Women who commenced a first cycle of ART for the purpose of primary fresh embryo transfer using their own oocytes were included. INTERVENTION(S): Maternal ethnic group. MAIN OUTCOME MEASURE(S): The ART failure types were modeled on the maternal ethnic group using the Poisson regression to produce relative risks (RRs) with 95% confidence intervals. The potential indirect effects of maternal age and etiology of subfertility were estimated, and the RRs with 95% confidence intervals were produced. RESULT(S): Black women were at greater risk of treatment failure with respect to live birth than women who were white: cycle cancellation, RR of 2.15 (1.78-2.62); failed fertilization, RR of 2.36 (1.90-2.93); unintended freeze-all, RR of 1.71 (1.43-2.05); failed implantation, RR of 1.23 (1.12-1.34); and pregnancy loss, RR of 1.38 (1.15-1.64). Women who were Asian were at moderately increased risk: RRs of 1.31 (1.17-1.47), 1.60 (1.42-1.80), 1.25 (1.14-1.38), 1.11 (1.07-1.16), and 1.13 (1.03-1.23), across the same outcomes, respectively. Inequality may have been reduced had women of all ethnicities initiated treatment at the same age. CONCLUSION(S): Black women were at greatest risk of all failure types, and women who were Asian were at intermediate risk compared with women who were white. Some of the risks among women who were black may be mediated by maternal age.
Assuntos
Etnicidade , Dados de Saúde Coletados Rotineiramente , Gravidez , Humanos , Feminino , Técnicas de Reprodução Assistida/efeitos adversos , Nascido Vivo , FertilizaçãoRESUMO
It is suggested that heparin given in the peri-implantation period may improve clinical outcomes in women undergoing assisted reproduction techniques (ART). This systematic review evaluates the use of heparin in subfertile women undergoing ART.
Assuntos
Heparina de Baixo Peso Molecular/uso terapêutico , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Técnicas de Reprodução Assistida/estatística & dados numéricos , Anticoagulantes/administração & dosagem , Terapia Combinada , Medicina Baseada em Evidências , Feminino , Fármacos para a Fertilidade Feminina/administração & dosagem , Humanos , Gravidez , Prevalência , Resultado do TratamentoRESUMO
A 36-year-old amenorrhoeic patient presented with vague abdominal discomfort, and haemodynamic instability, a large haemoperitoneum was identified on transvaginal ultrasound. Ruptured tubal ectopic pregnancy was suspected. At laparotomy ruptured primary tubal ectopic pregnancy was identified, with 12-14 week secondary abdominal pregnancy implanted onto the omentum, confirmed by histopathology. Salpingo-oophrectomy with peritoneal washout was performed, and three units blood transfusion was required. The patient had an uneventful recovery to health.