The effect of fertility treatment on adverse perinatal outcomes in women aged at least 40 years

OBJECTIVE

To compare perinatal outcomes between spontaneous conception and assisted reproductive technologies (ART) among patients of advanced maternal age.

METHODS

The present retrospective study included data from singleton pregnancies of women aged at least 40 years who delivered between January 1, 1991, and December 31, 2013, at Soroka University Medical Center, Beer Sheva, Israel. Demographic, obstetric, and perinatal data were compared between pregnancies conceived with ART (in vitro fertilization [IVF] or ovulation induction) and those conceived spontaneously. Multiple regression models were used to define independent predictors of adverse outcomes.

RESULTS

A total of 8244 singleton pregnancies were included; 229 (2.8%) following IVF, 86 (1.0%) following ovulation induction, and 7929 (96.2%) were spontaneous. Preterm delivery (P<0.001), fetal growth restriction (FGR) (P<0.001), and cesarean delivery (P<0.001) demonstrated linear associations with the conception mode; the highest rates for each were observed for IVF, with decreased rates for ovulation induction and spontaneous conception. The incidence of gestational diabetes and hypertensive disorders were highest among pregnancies following ART. No association was observed between conception mode and perinatal mortality. Multivariate logistic regression demonstrated that IVF was independently associated with increased odds of preterm delivery (P<0.001) and FGR (P=0.027) compared with spontaneous conception.

CONCLUSIONS

Among patients of advanced maternal age, ART were independently associated with increased FGR and preterm delivery rates compared with spontaneous pregnancies; perinatal mortality was comparable.

[Visual acuity at twilight and contrast vision in patients with bifocal IOL]

After cataract extraction by phacoemulsification, the True Vista bifocal lens (group I; Storz Ophthalmics, St. Louis, Missouri, USA) was implanted in 20 eyes, and the Accurasee bifocal lens (group II; Alcon, Forth Worth, Texas, USA) was implanted in 14 eyes. Following a 4-6 month postoperative period, both groups were checked with respect to visual acuity, mesopic acuity, and thresholds of contrast under mesopic light conditions. As mean values, group I demonstrated a distance acuity without correction of 0.77 (+/- 0.17), group II of 0.73 (+/- 0.14); the average near acuity without correction in group I was 0.84 (+/- 0.17), and in group II, 0.85 (+/- 0.15). The near acuity, with distance correction only, was determined to be 0.94 (+/- 0.09) in group I, and 0.91 (+/- 0.01) in group II. Examination of mesopic visual acuity by means of the Mesoptometer II (Oculus Company, Dutenhofen) revealed 0.25 (+/- 0.08) for the True Vista bifocal lens, and 0.26 (+/- 0.07) for the Accurasee bifocal lens. Under reduced field luminance, both groups of lenses showed comparable results while testing contrast thresholds were under 0.1 cd/m2; under 0.032 cd/m2 and 0.1 cd/m2 with permanent glare, however, group I demonstrated a slight advantage.

The conjugated estrogens. II. A new method for isolating estriol monoglucosiduronide from normal human pregnancy urine

Estriol glucosiduronide has been prepared from normal pregnancy urine both as sodium salt and as the free carbonyl forms by a new and simple five-step procedure: (i) precipitation by ammonium sulfate of the conjugated estrogens from the urine; (ii) preparation of a methanol–acetone (M–A) solution of the conjugated estrogens from the ammonium sulfate precipitate; (iii) filtration through columns of Sephadex G 25 of the combined M–A residues from large batches of urine, which yielded the starting material for the work presented in this paper, namely peak four of the six estrogen peaks thus obtained; (iv) the conversion to the carbonyl form by a "Kellie" extraction at pH 2.0–2.5; and (v) crystallization of the acid or of its sodium salt from the semi-crystalline residue.

The effect of myocardial ischemia on internal mammary artery implant patency: a controlled experimental cineangiographic study

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