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Perinatal outcome of pregnancies after assisted reproduction and natural conception
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Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
1.3 (95% CI = 0.7; 2.1) after considering the confounders. The highest percentage of aneuploid embryos occurred in the subgroup of oocytes with vacuoles (100%) followed by the oocytes with dark cytoplasm (73.1%), centrally located granular cytoplasm (66.7%) and SERc (65.2%) (Table 1). The most frequent type of aneuploidy was chromosomal polysomy. The prevalence of all of the types of polysomies was much higher in the group of women with cytoplasmic dysmorphisms. Discussion: Aneuploidies of the gametes are not only the limiting factors for human fertility but are also for the medical treatment of infertility. Morphological assessments of oocytes are the most common method for evaluating oocyte quality in routine practice. Oocyte dysmorphisms are correlated with impaired embryo quality and thus poor clinical outcomes, which may be related to high aneuploidy rates in oocytes with dysmorphisms. We recommend that woman with oocyte dysmorphisms, especially a centrally located granular cytoplasm, SERc and a dark cytoplasm, be subjected to additional genetic counseling to improve the effectiveness of IVF cycles and reduce the risk of giving birth to children with congenital defects. http://dx.doi.org/10.1016/j.ejogrb.2016.07.289 Endometriosis Poster Presentation Malignant transformation of adenomyosis with coexisting ovarian cancer: case report Sarolta Szegedi 1,∗ , Sarolta Szegedi 1,2 , Miklós Koppán 1,2,4 , Tamás Varga 1 , Krisztina Kovács 3 , Hans-Rudolf Tinneberg 4 , József Bódis 1,2 1 University of Pécs, Faculty of Medicine, Department of Obstetrics and Gynaecology, Pécs, Hungary 2 MTA-PTE Human Reproduction Research Group, University of Pécs, Pécs, Hungary 3 University of Pécs, Faculty of Medicine, Department of Pathology, Pécs, Hungary 4 University of Giessen, Department of Obstetrics and Gynecology, Giessen, Germany E-mail address: [email protected] (S. Szegedi).
Adenomyosis is a condition when endometrial tissue exists within and grows into the muscular wall of the uterus. The incidence of adenomyosis is about 8–30%. Its malignant transformation is quite rare and the mechanism how it develops is currently unclear. According to our current knowledge these transformed tumors are mostly well differentiated with low malignancy. The primary treatment option is surgery. In our case we present a 73 year old female patient who underwent a laparotomy due to abdominal pain and a mass in the lesser pelvis. We performed hysterectomy along with bilateral adnexectomy and omentum resection. The histological examination of the specimens verified an endometrial adenocarcinoma formed on the basis of adenomyosis and the endometrial adenocarcinoma of the left ovary. Because of the rarity of such cases, it is highly recommended to gather and publish all available data of similar clinical entities to provide ground for better understanding the development, as well as for establishing appropriate therapeutic modalities for these kind of malignancies. http://dx.doi.org/10.1016/j.ejogrb.2016.07.290
Assisted reproduction Oral Presentation Perinatal outcome of pregnancies after assisted reproduction and natural conception Szilvia Csehely 1,∗ , Andrea Kovacs 1 , Monika Orosz 1 , Tamas Deli 1 , Eszter Farkas 2 , Gyorgy Bacsko 2 , Robert Poka 1 , Attila Jakab 1 1 Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Hungary 2 Hospital Kenézy Gyula, Debrecen, Hungary E-mail address: [email protected] (S. Csehely).
Background: Number of children born from pregnancies after assisted reproductive techniques (ART, IUI + IVF) has been increased reaching 5% of all deliveries in the developed countries. However, there are concerns about the perinatal outcomes of ART pregnancies and the ART children health due to bypassing the natural gamete selection and elevated number of multiple pregnancies in the ART practice. Aim: To compare the obstetric outcome measures of pregnancies after ART and spontaneous conception. Settings: A tertiary referral university medical centre and county hospital in County Town Materials and methods: Retrospective analysis of computer database containing records of deliveries and neonates reported to the National Health Care Provider Centre (National Institute for Quality and Organizational Development in Healthcare and Medicine) from 2010 to 2014. Maternal age, number of previous pregnancies, gestational age at delivery, birthweight, rate of prematurity, rate of multiple deliveries, mode of delivery, admission to Neonatal Intensive Care Unit (NICU) and sex ratio of newborns were analysed. Student T-test and Pearsonchi-square test were used to examine differences between the parameters of ART and spontaneously conceived pregnancies. Results: In the examined period, 583 deliveries after ART (mean maternal age 33 ± 4.1) and 22,923 deliveries (mean maternal age 28.9 ± 5.8) after spontaneous conception were recorded in the two institutions. Maternal age was higher in ART pregnancies (p < 0.05), while the number of previous pregnancies lower (0.22 ± 0.47, median 0 vs. 0.97 ± 1.37, median 1). Rate of multiple pregnancies was considerably higher after ART (31.9% vs. 1.5% p < 0.001). The gestational age at delivery was lower after ART (36.6 ± 3.5 weeks vs. 38.4 ± 2.2, p < 0.05), as well as the birth weight (mean 2588 ± 1350 grs vs. 3207 ± 1456 grs, p < 0.05). Rate of prematurity and perinatal mortality was highly elevated after ART (33.6% vs. 9.9% and 10.0‰ vs. 2.1‰, respectively, p < 0.001). Similarly, there were more admission to NICU after ART pregnancies (48.3% vs. 10.3, p < 0.001). Caesarian sections were performed in higher rate after ART (68.3% vs. 30.1%, p < 0.001). Interestingly, the sex ratio of boys over girls was 1.07 after natural conception, but reversed to 0.87 after ART. Conclusions: In pregnancies after ART all perinatal outcome measures show considerably adverse trend as compared to natural conception, with special regard of birth weight, prematurity, perinatal mortality and admission to NICU. This happens despite of more than two fold Caesarian frequency, and mainly can be explained by the twenty times higher rate of multiple pregnancies and higher maternal age. Unfavourable results can be improved with reduction of multiple births. http://dx.doi.org/10.1016/j.ejogrb.2016.07.291
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
1.3 (95% CI = 0.7; 2.1) after considering the confounders. The highest percentage of aneuploid embryos occurred in the subgroup of oocytes with vacuoles (100%) followed by the oocytes with dark cytoplasm (73.1%), centrally located granular cytoplasm (66.7%) and SERc (65.2%) (Table 1). The most frequent type of aneuploidy was chromosomal polysomy. The prevalence of all of the types of polysomies was much higher in the group of women with cytoplasmic dysmorphisms. Discussion: Aneuploidies of the gametes are not only the limiting factors for human fertility but are also for the medical treatment of infertility. Morphological assessments of oocytes are the most common method for evaluating oocyte quality in routine practice. Oocyte dysmorphisms are correlated with impaired embryo quality and thus poor clinical outcomes, which may be related to high aneuploidy rates in oocytes with dysmorphisms. We recommend that woman with oocyte dysmorphisms, especially a centrally located granular cytoplasm, SERc and a dark cytoplasm, be subjected to additional genetic counseling to improve the effectiveness of IVF cycles and reduce the risk of giving birth to children with congenital defects. http://dx.doi.org/10.1016/j.ejogrb.2016.07.289 Endometriosis Poster Presentation Malignant transformation of adenomyosis with coexisting ovarian cancer: case report Sarolta Szegedi 1,∗ , Sarolta Szegedi 1,2 , Miklós Koppán 1,2,4 , Tamás Varga 1 , Krisztina Kovács 3 , Hans-Rudolf Tinneberg 4 , József Bódis 1,2 1 University of Pécs, Faculty of Medicine, Department of Obstetrics and Gynaecology, Pécs, Hungary 2 MTA-PTE Human Reproduction Research Group, University of Pécs, Pécs, Hungary 3 University of Pécs, Faculty of Medicine, Department of Pathology, Pécs, Hungary 4 University of Giessen, Department of Obstetrics and Gynecology, Giessen, Germany E-mail address: [email protected] (S. Szegedi).
Adenomyosis is a condition when endometrial tissue exists within and grows into the muscular wall of the uterus. The incidence of adenomyosis is about 8–30%. Its malignant transformation is quite rare and the mechanism how it develops is currently unclear. According to our current knowledge these transformed tumors are mostly well differentiated with low malignancy. The primary treatment option is surgery. In our case we present a 73 year old female patient who underwent a laparotomy due to abdominal pain and a mass in the lesser pelvis. We performed hysterectomy along with bilateral adnexectomy and omentum resection. The histological examination of the specimens verified an endometrial adenocarcinoma formed on the basis of adenomyosis and the endometrial adenocarcinoma of the left ovary. Because of the rarity of such cases, it is highly recommended to gather and publish all available data of similar clinical entities to provide ground for better understanding the development, as well as for establishing appropriate therapeutic modalities for these kind of malignancies. http://dx.doi.org/10.1016/j.ejogrb.2016.07.290
Assisted reproduction Oral Presentation Perinatal outcome of pregnancies after assisted reproduction and natural conception Szilvia Csehely 1,∗ , Andrea Kovacs 1 , Monika Orosz 1 , Tamas Deli 1 , Eszter Farkas 2 , Gyorgy Bacsko 2 , Robert Poka 1 , Attila Jakab 1 1 Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Hungary 2 Hospital Kenézy Gyula, Debrecen, Hungary E-mail address: [email protected] (S. Csehely).
Background: Number of children born from pregnancies after assisted reproductive techniques (ART, IUI + IVF) has been increased reaching 5% of all deliveries in the developed countries. However, there are concerns about the perinatal outcomes of ART pregnancies and the ART children health due to bypassing the natural gamete selection and elevated number of multiple pregnancies in the ART practice. Aim: To compare the obstetric outcome measures of pregnancies after ART and spontaneous conception. Settings: A tertiary referral university medical centre and county hospital in County Town Materials and methods: Retrospective analysis of computer database containing records of deliveries and neonates reported to the National Health Care Provider Centre (National Institute for Quality and Organizational Development in Healthcare and Medicine) from 2010 to 2014. Maternal age, number of previous pregnancies, gestational age at delivery, birthweight, rate of prematurity, rate of multiple deliveries, mode of delivery, admission to Neonatal Intensive Care Unit (NICU) and sex ratio of newborns were analysed. Student T-test and Pearsonchi-square test were used to examine differences between the parameters of ART and spontaneously conceived pregnancies. Results: In the examined period, 583 deliveries after ART (mean maternal age 33 ± 4.1) and 22,923 deliveries (mean maternal age 28.9 ± 5.8) after spontaneous conception were recorded in the two institutions. Maternal age was higher in ART pregnancies (p < 0.05), while the number of previous pregnancies lower (0.22 ± 0.47, median 0 vs. 0.97 ± 1.37, median 1). Rate of multiple pregnancies was considerably higher after ART (31.9% vs. 1.5% p < 0.001). The gestational age at delivery was lower after ART (36.6 ± 3.5 weeks vs. 38.4 ± 2.2, p < 0.05), as well as the birth weight (mean 2588 ± 1350 grs vs. 3207 ± 1456 grs, p < 0.05). Rate of prematurity and perinatal mortality was highly elevated after ART (33.6% vs. 9.9% and 10.0‰ vs. 2.1‰, respectively, p < 0.001). Similarly, there were more admission to NICU after ART pregnancies (48.3% vs. 10.3, p < 0.001). Caesarian sections were performed in higher rate after ART (68.3% vs. 30.1%, p < 0.001). Interestingly, the sex ratio of boys over girls was 1.07 after natural conception, but reversed to 0.87 after ART. Conclusions: In pregnancies after ART all perinatal outcome measures show considerably adverse trend as compared to natural conception, with special regard of birth weight, prematurity, perinatal mortality and admission to NICU. This happens despite of more than two fold Caesarian frequency, and mainly can be explained by the twenty times higher rate of multiple pregnancies and higher maternal age. Unfavourable results can be improved with reduction of multiple births. http://dx.doi.org/10.1016/j.ejogrb.2016.07.291