Ephia Yasmin

This retrospective cohort study was conducted in a single center to investigate the influence of paternal age on oocyte recipient cycles. 320 IVF/ICSI oocyte recipient cycles resulting in embryo transfers between 01/2015- 06/2022 and meeting the inclusion criteria: donors ≤35 years, endometrial thickness 6mm and normal endometrial cavity were analyzed. Donor or surgically retrieved sperm or PGT-A cycles were excluded. Paternal and recipient ages were grouped according to previous literature for comparability. Primary outcome was live birth rate, and secondary outcomes were clinical pregnancy and miscarriage rates. The median recipient, paternal and donor ages were 42 (IQR: 19-50), 43 (IQR: 38-46) and 26 years (IQR: 23-29). 55.6% [N=178] of the cycles were fresh and 44.3% [N=142] were frozen embryo transfers. Univariate and multivariate logistic regression, adjusted for semen WHO criteria, recipient age, IVF/ICSI and fresh/frozen cycles highlighted reduced odds of live birth by 79%, OR 0.21 [95%CI 0.11 to 0.38]; P<0.0001, clinical pregnancy by 58%, OR 0.42 [95%CI 0.31 to 0.89]; P<0.0001 and increased odds of miscarriage by 108%, OR 2.08 [95%CI 1.91 to 3.01]; P<0.0001 in those of paternal age 51 years compared to fathers ≤35 years. Our study identifies the negative impact of advanced paternal age.

Does maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the first trimester affect the risk of miscarriage before 13 week’s gestation? Pregnant women with self-reported diagnosis of SARS-CoV-2 in the first trimester had a higher risk of early miscarriage. Viral infections during pregnancy have a broad spectrum of placental and neonatal pathology. Data on the effects of the SARS-CoV-2 infection in pregnancy are still emerging. Two systematic reviews and meta-analyses reported an increased risk of preterm birth, caesarean delivery, maternal morbidity and stillbirth. Data on the impact of first trimester infection on early pregnancy outcomes are scarce. This is the first study, to our knowledge, to investigate the rates of early pregnancy loss during the SARS-CoV-2 outbreak among women with self-reported infection. This was a nationwide prospective cohort study of pregnant women in the community recruited using social media between 21 May and 31 December 2020. We recruited 3545 women who conceived during the SARS-CoV-2 pandemic who were P = 0.02). After adjusting for age, BMI, ethnicity, smoking status, GA at registration and the number of previous miscarriages, the risk of early miscarriage appears to be higher in the ‘presumed infected’ group (relative rate 1.7, 95% CI 1.0–3.0, P = 0.06). We relied on self-reported data on early pregnancy loss and SARS-CoV-2 infection without any means of checking validity. Some women in the ‘presumed uninfected’ and ‘uncertain’ groups may have had asymptomatic infections. The number of ‘presumed infected’ in our study was low and therefore the study was relatively underpowered. This was a national study from the UK, where infection rates were one of the highest in the world. Based on the evidence presented here, women who are infected with SARS-CoV-2 in their first trimester may be at an increased risk of a miscarriage. However, the overall rate of miscarriage in our study population was 8%. This is reassuring and suggests that if there is an effect of SARS-CoV-2 on the risk of miscarriage, this may be limited to those with symptoms substantial enough to lead to a diagnostic test. Further studies are warranted to evaluate a causal association between SARS-CoV-2 infection in early pregnancy and miscarriage risk. Although we did not see an overall increase in the risk of miscarriage, the observed comparative increase in the presumed infected group reinforces the message that pregnant women should continue to exercise social distancing measures and good hygiene throughout their pregnancy to limit their risk of infection This study was supported by a grant from the Elizabeth Garrett Anderson Hospital Charity (G13-559194). The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. J.A.H. is supported by an NIHR Advanced Fellowship. A.L.D. is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support to J.A.H. and A.L.D. as above; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. N/A.

BACKGROUND: The objective of the survey was to evaluate sedation and anaesthetic practice employed for oocyte collection in the different assisted conception units in the UK and whether the guidelines of safe sedation were adhered to. METHODS: A survey was carried out by means of a postal questionnaire sent out to the 100 reproductive medicine units of the UK, and 67 of the units responded. RESULTS: A response rate of 67% was achieved. Seventy-seven percent of responding units were part of hospitals with resuscitation facilities; 23% were free-standing without an in-house resuscitation team. Intravenous sedation was the preferred method of sedation for oocyte collection, being used in 62.4% of units. General anaesthesia was the primary method in 24.6% of units. A total of 47.4% of units used a medical member of the reproductive medicine team for administering sedation; 69% of cases were performed in a facility within the unit. One-hundred percent of respondents had oxygen, suction and tilting trolleys. It was reported that 23% of units were free standing, without cover from a resuscitation team. Sedation was performed by non-anaesthetic doctors in 46% and by nurses in 8.2%. In 69%, collections were performed outside of a general operating theatre environment. Also, 4.8% of units had no resuscitation trolley and 21.4% no defibrillator. CONCLUSION: Though most units complied with the guidelines of safe sedation and anaesthesia, gaps have been observed in the safe provision of sedation services for women undergoing oocyte retrieval in some units.