Was the Military Operation “Protective Edge” a Risk Factor for Pregnancy Complications?

Objective During July–August 2014, the military operation “Protective Edge” presented Israel with a threat of missile attacks. We aimed to investigate the influence of the “Protective Edge” operation on the rate of pregnancy complications among the population exposed to missile attacks, compared to the population not exposed. Study Design This was a retrospective study. Pregnancy outcomes were compared between women who during pregnancy were exposed to the stress of the military operation (exposed group, n=4,673) and gave birth at the Wolfson Medical Center, and women who gave birth in the previous year (unexposed group, n=4,735). Results Rates of pregnancy complications did not differ between the groups. Conclusion Exposure to environmental stress during pregnancy, for a period of almost two months, was not found to be associated with increased risk for pregnancy complications

Should ICSI be implemented during IVF to all advanced-age patients with non-male factor subfertility?

Abstract Backgroud In order to maximize In vitro fertilization (IVF) success rates in advanced- age patients, it has been suggested to favor the use of intracytoplasmic sperm injection (ICSI) over conventional insemination (CI), with the notion that ICSI would serve as a tool to overcome interference in sperm oocyte interaction and sperm oocyte penetration issues that can be related to maternal age and are not due to sperm abnormalities. We therefore aim to evaluate the role of ICSI in the treatment of non-male factor infertile patients aged ≥35 in terms of fertilization and top-quality embryo rates. Methods In this retrospective cohort study, data were collected and analyzed for all patients with non-male factor infertility, aged ≥35 treated, undergoing their first IVF cycle attempt with 6 or more oocytes yield, in whom a 50% ICSI-CI division was performed. Results Five hundreds and four oocytes were collected from 52 eligible patients. Overall, 245 oocytes underwent ICSI and 259 oocytes underwent CI. The fertilization rate was 71.0% following ICSI, compared to 50.1% in the CI treated oocytes (P < 0.001). The top quality embryo rate was 62.8% following ICSI compared to 45.5% following CI (P < 0.001). Subdividing the study population to two age groups revealed that the above differences remained significant in patients aged 35–39 yrs., whereas in those aged 40–45 yrs., the differences were non-significant but still inclined in favor of ICSI. Conclusions This study favors the use of ICSI in the older IVF population in order to increase both the fertilization rate and the number of top quality embryos that result per IVF cycle. Further studies are needed to establish our observations and use ICSI as the preferred approach to overcome egg sperm abnormal interactions related to advanced maternal age

The effect of pregnancy on maternal cognition

Abstract To determine whether there are differences in measures of cognitive function between second and third trimester pregnant women compared to non-pregnant controls. This prospective study comprised 40 pregnant and 40 non-pregnant women, 20–40 years old, native-Hebrew speakers who were recruited from the outpatient clinics during a period of nearly 2 years. The patients underwent cognitive and affective evaluation. The performance on the three following tests: difficult and total items of Verbal Paired Associates, the Digit Span—forward and the Naming Objects and Fingers test scores were significantly better among non- pregnant women. All the other test results were similar between the two groups, including the depression scores. On multivariate linear regression analysis, after adjusting for age and years of education , Verbal Paired Associates total score (p = 0.04), and Naming Objects and Fingers (p = 0.01) remained significantly associated with pregnancy, but not Digit Span (p = 0.09). Our study demonstrates an impairment in memory among pregnant women. Furthermore language skills, particularly naming, were also impaired, a finding which has not been previously described

Can Fetal Echocardiographic Measurements of the Left Ventricular Outflow Tract Angle Detect Fetuses with Conotruncal Cardiac Anomalies?

Objectives: The angle between the inter-ventricular septum and the ascending aorta can be measured during a sonographic fetal survey while viewing the left ventricular outflow tract (LVOT angle). Our aim was to compare the LVOT angle between fetuses with and without conotruncal cardiac anomaliesrmations. Methods: In this prospective observational study, we compared the LVOT angle between normal fetuses, at different gestational age, and fetuses with cardiac malformations. Results: The study included 302 fetuses screened at gestational age of 12–39 weeks. The LVOT angle ranged from 127 to 163 degrees (mean 148.2), in 293 fetuses with normal hearts, and was not correlated with gestational age. The LVOT angle was significantly wider in fetuses with D-transposition of the great arteries (D-TGA, eight fetuses) and valvar aortic stenosis (AS, three fetuses), than in fetuses with normal hearts (164.8 ± 5.0 vs. 148.2 ± 5.4, respectively, p p < 0.001). On ROC analysis, an angle of 159.6 degrees or higher had a sensitivity of 100% and a specificity of 97.3% for the detection of TGA or AS, whereas an angle of 128.8 degrees or lower had a sensitivity of 100% and a specificity of 99.7% for the detection of AVC defect. Conclusions: The LVOT angle is constant during pregnancy, and differs significantly in fetuses with TGA/AS, and AVC, compared to fetuses with normal hearts (wider and narrower, respectively)

#290 : Does Extending the Time Interval Between hCG Trigger and Oocyte Retrieval from 36 to 37 Hours Affect the Rate of Euploid Blastocysts?

Background and Aims: Data are lacking regarding the optimal time interval between human chorionic gonadotropin (hCG) administration and ovum pick-up (hCG-OPU interval), and its impact on blastocyst euploidy. Our aim was to compare the blastocyst euploidy rate between IVF cycles with hCG-OPU interval of 36 and 37 h. Method: In this historic cohort study, we reviewed all hCG-triggered, PGT-A, IVF cycles performed in a single clinic, between 2018 and 2022. Commencing in September 2021, clinicians gradually changed the hCG-OPU interval from 37 to 36 h. We compared the outcomes of cycles with hCG-OPU interval of 36 h (35.5-36.5) to 37 h (36.6-37.5). The primary outcome was the number of euploid embryos. Cycles with oocyte donation, and cycles utilized GnRH-agonist triggers or dual-triggers were excluded. Results: The euploidy rates were similar between the 36-h group (n=2,584) and 37 h group (n=5,575; 39.7% vs. 38.8%, respectively, p=0.42). Compared to the 36-h group, patients in the 37-h group were characterized by higher numbers of total oocytes collected (15.9±8.9 vs. 17.3±9.8, respectively, p<0.001), mature (MII) oocytes (8.3±8.2 vs. 9.6±9.6, respectively, p<0.001) and 2PN embryos (9.8±5.5 vs. 10.3±6.4, respectively, p<0.001). On multivariate logistic regression analysis, the hCG-OPU interval was not associated with euploidy (aOR 0.91, 95% CI 0.82-1.01), after controlling for female and male ages, female BMI, and number of oocytes collected. Conclusion: hCG-OPU intervals of 36 and 37 h resulted in similar blastocyst euploidy rates in IVF cycles. This finding has the potential to aid the decision-making processes when managing IVF procedures. The 37-h group was characterized by a lower female age and higher doses of gonadotropins and consequentially more eggs collected, mature eggs and 2PN embryos compared to the patients of the 36 h group. Nonetheless, the two groups had comparable rates of euploid embryos reinforcing our primary finding. Data are presented as mean ± standard deviation or n (%); hCG- Human chorionic gonadotropin; OPU- ovum pickup; BMI- BMI kg/m2, Gonadotropins- in IU; ICSI- Intra cytoplasmic sperm injection. Data are presented as mean ± standard deviation or n (%); hCG- Human chorionic gonadotropin; OPU- ovum pickup; 2PN- 2 Pronuclei

Obstetric outcomes following ovarian hyperstimulation syndrome in IVF – a comparison with uncomplicated fresh and frozen transfer cycles

Abstract Background We aimed to assess the correlation between ovarian hyperstimulation syndrome (OHSS) in the early course of in vitro fertilization (IVF) pregnancies and obstetric outcomes. Methods We identified records of patients admitted due to OHSS following IVF treatment at our institution between 2008 and 2020. Cases were included if pregnancy resulted in a live singleton delivery (OHSS group). OHSS cases were matched at a 1:5:5 ratio with live singleton deliveries following IVF with fresh embryo transfer (fresh transfer group) and frozen embryo transfer (FET group), according to maternal age and parity. Computerized files were reviewed, and maternal, obstetric and neonatal outcomes compared. Results Overall, 44 OHSS cases were matched with 220 fresh transfer and 220 FET pregnancies. Patient demographics were similar between the groups, including body mass index, smoking and comorbidities. Gestational age at delivery, the rate of preterm births, preeclampsia and cesarean delivery were similar between the groups. Placental abruption occurred in 6.8% of OHSS pregnancies, 1.4% of fresh transfer pregnancies and 0.9% of FET pregnancies (p=0.02). On post-hoc analysis, the rate of placental abruption was significantly higher in OHSS pregnancies, compared with the two other groups, and this maintained significance after adjustment for confounders. Birthweights were 3017 ± 483, 3057 ± 545 and 3213 ± 542 grams in the OHSS, fresh transfer and FET groups, respectively (p=0.004), although the rate of small for gestational age neonates was similar between the groups. Conclusions OHSS in the early course of IVF pregnancies is associated with an increased risk of placental abruption