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Wang L, Wang L, Yang X, Jin P, Zhang R, Jiang Y, Zhang X. Risk factors related to early pregnancy loss in fresh IVF/ICSI: An analysis of 954 embryo transfer cycles. Medicine (Baltimore) 2022; 101:e30166. [PMID: 36042604 PMCID: PMC9410683 DOI: 10.1097/md.0000000000030166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Early pregnancy loss (EPL) is a common complication of assisted reproductive technology treatment; however, the exact factors involved in EPL are not fully understood. This study aimed to evaluate the risk factors for EPL in fresh in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles. This retrospective cohort study was conducted on all couples who underwent clinical pregnancy in fresh IVF/ICSI cycles from January to December 2019 at a single large reproductive medical center. In total, 954 cycles were included in this study. Univariate and multivariate logistic regression analyses were performed to evaluate relevant risk factors for EPL. Curve fitting and threshold analyses were used to explore the association between risk factors and EPL. Compared with women with a normal total antral follicle count (AFC) (≥10, <15), those with a low AFC (<10) had a higher risk of EPL (odds ratio 2.97, 95% confidence interval: 1.38-6.38, P < .05). Patients with an estradiol/progesterone ratio (E2/P) ≥ 1.1 had significantly lower odds of EPL than women with E2/P < 1.1 (odds ratio 0.51, 95% confidence interval 0.28-0.91, P < .05). E2/P and serum human chorionic gonadotropin (hCG) levels negatively correlated with EPL. By using a 2-piecewise regression model, the inflection point of serum hCG level was 599.9 IU/L. Our results showed that lower AFC, E2/P, and serum hCG levels were associated with a higher EPL risk in fresh IVF/ICSI cycles.
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Affiliation(s)
- Liyan Wang
- The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Reproductive Medicine and Embryo, Gansu Province, Lanzhou, China
| | - Lin Wang
- Education Examinations Authority, Gansu Province, Lanzhou, China
| | - Xia Yang
- The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Reproductive Medicine and Embryo, Gansu Province, Lanzhou, China
| | - Panpan Jin
- The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Reproductive Medicine and Embryo, Gansu Province, Lanzhou, China
| | - Rui Zhang
- The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Reproductive Medicine and Embryo, Gansu Province, Lanzhou, China
| | - Yanbiao Jiang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Xuehong Zhang
- The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Reproductive Medicine and Embryo, Gansu Province, Lanzhou, China
- *Correspondence: Xuehong Zhang, Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou 730000, PR China (e-mail: )
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Pellico-López A, Paz-Zulueta M, Manjón-Rodríguez JB, Sánchez Movellán M, Ajo Bolado P, García-Vázquez J, Cayón-De las Cuevas J, Ruiz-Azcona L. Evolution of Legislation and the Incidence of Elective Abortion in Spain: A Retrospective Observational Study (2011-2020). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9674. [PMID: 35955037 PMCID: PMC9368144 DOI: 10.3390/ijerph19159674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND According to the WHO, "unsafe abortion occurs when a pregnancy is terminated either by people lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both". AIM To review the legislation that ensures access to elective abortion and the main indicators of elective abortion in Spain. METHODS A retrospective observational study was conducted across all regions of Spain from 2011 to 2020. The regulations of each region on the creation of the clinical committee and the creation of the registry of conscientious objector professionals were identified. Data were collected on rates of elective abortions per 1000 women, type of health center where the intervention was performed, interval of weeks of gestation, and cause. RESULTS After Law 2/2010 entered into force, the Spanish regions created a clinical committee; however, very few regions have a registry of conscientious objectors. During the study period, the average annual rate in Spain was 11.10 elective abortions per 1000 women between 15 and 44 years of age, showing a decreasing trend (annual percentage change of -1.92%). Only 10.67% of abortions were performed at public centers. In 90.18% of the cases, abortions were performed at the woman's request. CONCLUSION Spain legislated late compared to most European Union countries. The current law is similar to that of other member states, allowing abortion at the woman's request in the first fourteen weeks and thereafter for medical reasons. Most abortions are performed at private centers, although many territorial inequalities are observed.
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Affiliation(s)
- Amada Pellico-López
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain
- Cantabria Health Service, Avda. Derechos de la Infancia 31, 39340 Cantabria, Spain
| | - María Paz-Zulueta
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Derecho Sanitario y Bioética (GRIDES), C/Cardenal Herrera Oria s/n, 39011 Cantabria, Spain
| | | | - Mar Sánchez Movellán
- Sección de Programas de Salud de la Mujer, Dirección General de Salud Pública, Consejería de Sanidad, Gobierno de Cantabria, C/Federico Vial 13, 39009 Cantabria, Spain
| | - Purificación Ajo Bolado
- Sección de Programas de Salud de la Mujer, Dirección General de Salud Pública, Consejería de Sanidad, Gobierno de Cantabria, C/Federico Vial 13, 39009 Cantabria, Spain
| | - José García-Vázquez
- Consejería de Salud de Asturias, C/Ciriaco Miguel Vigil, 9, CP, 33005 Oviedo, Spain
| | - Joaquín Cayón-De las Cuevas
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Derecho Sanitario y Bioética (GRIDES), C/Cardenal Herrera Oria s/n, 39011 Cantabria, Spain
- Departamento de Derecho Privado, Universidad de Cantabria, Avda, de los Castros s/n, 39005 Santander, Spain
| | - Laura Ruiz-Azcona
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain
- Global Health Research Group, Universidad de Cantabria, Avda. Valdecilla, s/n, 39008 Santander, Spain
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