Background: Overweight and obesity are major risk factors for gestational diabetes among U.S. wom... more Background: Overweight and obesity are major risk factors for gestational diabetes among U.S. women. Evidence suggests that longer duration of breastfeeding among women with a history of gestational diabetes is associated with lower incidence of developing type 2 diabetes after pregnancy. Women may potentially benefit from a lifestyle change program that includes breastfeeding education and support. Purpose: To describe the design and justification of a combined breastfeeding, national Diabetes Prevention Program (DPP)-based feasibility randomized controlled trial, the electronic Monitoring Of Mom's Schedule (eMOMS TM) study. eMOMS TM compares the feasibility and efficacy of three interventions on six-month postpartum weight loss among women with a BMI �25. Methods: The intervention is delivered via Facebook and includes three groups: DPP and breastfeeding (eMOMS1); DPP only (eMOMS2); and Usual Care (eMOMS3). Recruitment is ongoing at two clinical sites (rural and urban). A total of 72 women, 24 per group, will be randomly assigned to one of the three groups. It is anticipated that women in eMOMS1 will have greater weight loss and increased length of breastfeeding at three and six months postpartum compared to women in eMOMS2 and eMOMS3. Additional data will be collected on metabolic markers, anthropometrics, physical activity, nutrition, breastfeeding, and depression. Program cost will be compared to that of traditionally scheduled group meetings. Expected study completion date: October 2021. Conclusions: This study has the potential to define a high impact, cost effective intervention that can improve public health by reducing negative health outcomes associated with gestational diabetes among an at-risk population.
unclear is the reproducibility of this aneuploidy phenomenon with repeated IVF/PGD cycles and the... more unclear is the reproducibility of this aneuploidy phenomenon with repeated IVF/PGD cycles and the predictive value in these women with respect to reproductive outcome. DESIGN: Prospective analysis of IVF-PGD cycles in a tertiary care ART facility. MATERIALS AND METHODS: Nineteen consecutive patients with repeated implantation failure (Ͼ3 failed IVF-ET cycles) who underwent 2 or more IVF/PGD cycles for aneuploidy testing of pre-embryos prior to ET were included in the study. The mean maternal age for the study group was 37 years. Women were categorized into good prognosis and poor prognosis after the first IVF/PGD cycle based on the availability of at least one euploid embryo for transfer. There was an equal distribution in both groups of women greater or less than 38 years of age. Biopsies were performed on day 3. One cell was removed from each pre-embryo and fixed; cells were analyzed by multicolor FISH for chromosomes X and Y, 13, 15, 16, 17, 18, 21, and 22. RESULTS: Three hundred and nine embryos were biopsied. In the good prognosis group, 15 of the 19 patients (79%) had at least 1 euploid embryo for transfer with the first IVF/PGD cycle. Of the 15 patients, 11 patients (73%) also had at least one euploid embryo available for transfer with the second IVF/PGD cycle and 4 patients (27%) had none. Of the 4 patients with no euploid embryos available for transfer with the second IVF/PGD cycle, 2 had a third cycle of IVF/PGD and both had euploid embryos available for transfer. Six of the 11 patients (55%) who had euploid embryos on the second IVF/PGD cycle conceived. The ongoing pregnancy rate and implantation rate in the women with euploid embryos available for both the first and second IVF/PGD was 36% and 17%, respectively. The average number of embryos transferred in the women who achieved a pregnancy was 1.8. No pregnancy was achieved in the women who had a third IVF/PGD cycle despite euploid embryos being transferred. In the poor prognosis group, 4 of the 19 patients (21%) had no euploid embryos available for transfer on the first IVF/PGD cycle. On the second IVF/PGD cycle, 2 patients had euploid embryos for transfer and 2 did not. Of the 2 patients with no euploid embryos available for the second IVF/PGD cycle, 1 patient had a third IVF/PGD cycle with no euploid embryos available for transfer. Only one pregnancy was achieved among this group of women but it resulted in a miscarriage. Among both groups of women with euploid embryos available in either the first or second PGD cycle, but not both, no ongoing pregnancy was achieved. CONCLUSION: In women with recurrent implantation failure, two consecutive euploid IVF/PGD cycles is associated with a high ongoing pregnancy and implantation rate. The presence of euploid embryos in the initial IVF/PGD cycle is highly predictive of euploid embryos being available for the second cycle and predictive of a good reproductive outcome. Contrary to a subgroup of these women where the presence of one or more IVF/PGD cycles with no euploid embryos available for transfer is predictive of a poor reproductive outcome, even in the presence of a euploid cycle.
Objective: To evaluate factors predictive of clinical pregnancy and of pregnancy loss from assist... more Objective: To evaluate factors predictive of clinical pregnancy and of pregnancy loss from assisted reproductive technology (ART) using data from the Society for Assisted Reproductive Technology database for 2004-2006. Design: Retrospective cohort. Setting: Clinic-based data. Patient(s): The study population included 225,889 fresh embryo transfer cycles using autologous oocytes and partner semen. Intervention(s): None. Main Outcome Measure(s): Clinical intrauterine gestation (presence of gestational sac) and live birth (R22 weeks gestation and R300 g birth weight). Result(s): Increasing maternal age was significantly associated with a reduced odds of conception and increased fetal loss until 19 weeks gestation, but not with later pregnancy loss. Intracytoplasmic sperm injection (ICSI), assisted hatching, and increasing number of embryos transferred had significant positive effects on the odds of conception and pregnancy continuation through the first trimester, but did not affect the risk of later loss. Blacks, Asians, and Hispanics had significantly lower odds of clinical pregnancy compared with whites. Also compared with whites, Hispanics and Asians had a significantly greater risk of pregnancy loss in the second and third trimesters, and blacks had a significantly greater risk of pregnancy loss in all trimesters. Conclusion(s): Certain demographic and ART treatment parameters influenced chance of conception and early pregnancy loss, whereas black race and Hispanic ethnicity were also significantly associated with late pregnancy loss in ART-conceived pregnancies.
Couples with fertility problems seeking treatment with assisted reproductive technologies (ART) s... more Couples with fertility problems seeking treatment with assisted reproductive technologies (ART) such as in vitro fertilization should receive preconception counseling on all factors that are provided when counseling patients without fertility problems. Additional counseling should address success rates and possible risks from ART therapies. Success rates from ART are improving, with the highest live birth rates averaging about 40% per cycle among women less than 35 years old. A woman's age lowers the chance of achieving a live birth, as do smoking, obesity, and infertility diagnoses such as hydrosalpinx, uterine leiomyoma, or male factor infertility. Singletons conceived with ART may have lower birth weights. Animal studies suggest that genetic imprinting disorders may be induced by certain embryo culture conditions. The major risk from ovarian stimulation is multiple gestation. About one-third of live-birth deliveries from
9 Laparoscopic management of ectopic pregnancy Anthony Davies and Adam L. Magos There has been a ... more 9 Laparoscopic management of ectopic pregnancy Anthony Davies and Adam L. Magos There has been a worldwide increase in the ... been responsible for earlier diagnosis are: (1) Sensitive radioimmunoassays (RIA) for the (i-subunit of human chorionic gonadotro-phin (p-hCG ...
Objective: To determine trends in assisted reproductive technology (ART) in black and white women... more Objective: To determine trends in assisted reproductive technology (ART) in black and white women by comparing Society for Assisted Reproductive Technology (SART) database outcomes for 2004-2006 with previously reported outcomes for 1999 and 2000. Design: Retrospective, cohort study. Setting: The SART member clinics that performed at least 50 cycles of IVF and reported race in more than 95% of cycles. Patient(s): Women receiving 158,693 IVF cycles. Intervention(s): In vitro fertilization using nondonor embryos. Main Outcome Measure(s): Live birth rate per cycle started. Result(s): Reporting of race increased from 52% to 60%. The proportion of black, non-Hispanic (BNH) women increased from 4.6% to 6.5%. For BNH women using fresh embryos and no prior ART, significant increasing trends were observed for older age, male factor, uterine factor, diminished ovarian reserve, and ovulation disorders. The BNH women were 2.5 times more likely to have tubal factor for those cycles with no prior ART. The proportion of live births per cycle started increased across all groups over time, although greater increases occurred for white women. Conclusion(s): There seems to be widening disparities in IVF outcomes between BNH and white women, perhaps attributable to poor prognostic factors among black women. Race continues to be a marker for prognosis for ART outcomes and should be reported. (Fertil Steril Ò 2010;93:626-35. Ó2010 by American Society for Reproductive Medicine.
This study evaluated the effect of gender mix (the gender combinations of twin pairs) on fetal gr... more This study evaluated the effect of gender mix (the gender combinations of twin pairs) on fetal growth and length of gestation, and reviewed the literature on the long-term effects of this altered fetal milieu on cancer risk. In singletons, it is well established that females weigh less than males at all gestations, averaging 125-135 g less at full term. This gender difference is generally believed to be the result of the effect of androgens on fetal growth. The gender difference in fetal growth is greater before the third trimester and less towards term, with males growing not only more, but also earlier than females. Plurality is a known risk factor for reduced fetal growth and birthweight. Compared with singletons, the mean birthweight percentiles of twins fall substantially (by 10% or more) below the singleton 10th percentile by 28 weeks, below the singleton 50th percentile by 30 weeks, and below the singleton 90th percentile by 34 weeks. In unlike-gender twin pairs, it has been reported that the female prolongs gestation for her brother, resulting in a higher birthweight for the male twin than that of like-gender male twins. Other researchers have demonstrated that females in unlikegender pairs had higher birthweights than females in like-gender pairs. Analyses from our consortium on 2491 twin pregnancies with known chorionicity showed longer gestations and faster rates of fetal growth in both males and females in unlike-gender pairs compared with like-gender male or female pairs, although these differences were not statistically significant. The post-natal effects for females growing in an androgenic-anabolic environment include increased sensation-seeking behaviour and aggression, lowered visual acuity, more masculine attitudes and masculinising effects of the auditory system and craniofacial growth. In contrast, there is no evidence to suggest that there might be a similar feminising effect on males from unlike-gender pairs. This hormonal exposure in utero may influence adult body size and susceptability to breast cancer.
American Journal of Obstetrics and Gynecology, 2003
CONCLUSION: These data demonstrate the importance of the early diagnosis of placental chorionicit... more CONCLUSION: These data demonstrate the importance of the early diagnosis of placental chorionicity, because monochorionicity is associated with a 2-fold increase in birth weight discordancy in twin gestations.
American Journal of Obstetrics and Gynecology, 2008
Male reproductive proteins (MRPs), associated with sperm and semen, are the moieties responsible ... more Male reproductive proteins (MRPs), associated with sperm and semen, are the moieties responsible for carrying male genes into the next generation. Evolutionary biologists have focused on their capacity to control conception. Immunologists have shown that MRPs cause female genital tract inflammation as preparatory for embryo implantation and placentation. These observations argue that MRPs are critically important to reproductive success. Yet the impact of male reproductive proteins on obstetrical outcomes in women is largely unstudied. Epidemiologic and clinical observations suggest that shorterduration exposure to MRPs prior to conception may elevate the risk for preeclampsia. A limited literature has also linked sexual behavior to bacterial vaginosis and preterm birth. We offer a clinical opinion that MRPs may have broad implications for successful reproduction, potentially involved in the composition of vaginal microflora, risks of preterm birth and preeclampsia, and success of assisted reproduction.
American Journal of Obstetrics and Gynecology, 2004
OBJECTIVE: Hispanic women have consistently better singleton pregnancy outcomes than other racial... more OBJECTIVE: Hispanic women have consistently better singleton pregnancy outcomes than other racial and ethnic groups in the United States, despite significant socioeconomic disadvantages. It is unknown if this improved outcome is also present with twin pregnancies. Our objective was to compare length of gestation, rates of fetal growth midgestation (20-28 weeks) and late gestation (after 28 weeks), and birthweight by ethnicity and pregravid weight in twins. STUDY DESIGN: Three thousand thirty six twin pregnancies of 28 weeks gestation were divided by ethnicity (white, black, and Hispanic), and pregravid body mass index (BMI) [underweight+normal weight, BMI !25.0 vs over-weight+obese, BMI 25.0]. Outcomes were modeled using multiple regression, controlling for confounders. RESULTS: Overall, compared to white women, Hispanic women had significantly longer gestations (+7.8 days) and faster fetal growth midgestation (+17.4 g/week) and late gestation (+5.3 g/week), whereas black women had slower rates of fetal growth (ÿ5.7 g/week and ÿ4.5 g/week, respectively), and lower birthweights (ÿ81 g). Among nonobese women, black women had significantly longer gestations (+4.4 days), but slower rates of fetal growth midgestation and late gestation (ÿ9.4 g/week and ÿ5.1 g/week, respectively) and lower birthweights-for-gestation (ÿ91 g). Hispanic women also had significantly longer gestations (+7.9 days), but a faster rate of fetal growth midgestation (+18.1 g/week). Among overweight and obese women, black women had significantly lower birthweights-for-gestation (ÿ73.1 g), whereas Hispanic women had longer gestations (+7.8 days), and faster rate of fetal growth midgestation (+14.4 g/week). CONCLUSION: Among twin pregnancies, Hispanic women had longer gestations and faster fetal growth, and black women had slower fetal growth and lower birthweights, particularly among nonobese women compared to white women. These findings in twins reflect the racial and ethnic disparities previously shown in singletons, including the Hispanic paradox of longer gestations and higher rates of fetal growth.
Short-term methyltestosterone administration had no significant effects on the fasting levels of ... more Short-term methyltestosterone administration had no significant effects on the fasting levels of glucose, insulin, c-peptide, glucagon, or glucose turnover. During the hyperglycemic clamp studies, the mean glucose level during the final hour was 203 ± 2 and 201 ± 1 mg/dL in ...
To assess the safety and effectiveness of the Minerva Endometrial Ablation System for the treatme... more To assess the safety and effectiveness of the Minerva Endometrial Ablation System for the treatment of heavy menstrual bleeding in premenopausal women. Design: Multicenter, randomized, controlled, international study (Canadian Task Force classification I). Setting: Thirteen academic and private medical centers. Patients: Premenopausal women (n 5 153) suffering from heavy menstrual bleeding (PALM-COEIN: E, O). Intervention: Patients were treated using the Minerva Endometrial Ablation System or rollerball ablation. Measurements and Main Results: At 1-year post-treatment, study success (alkaline hematin %80 mL) was observed in 93.1% of Minerva subjects and 80.4% of rollerball subjects with amenorrhea reported by 71.6% and 49% of subjects, respectively. The mean procedure times were 3.1 minutes for Minerva and 17.2 minutes for rollerball. There were no intraoperative adverse events and/or complications reported. Conclusion: The results of this multicenter randomized controlled trial demonstrate that at the 12-month follow-up, the Minerva procedure produces statistically significantly higher rates of success, amenorrhea, and patient satisfaction as well as a shorter procedure time when compared with the historic criterion standard of rollerball ablation. Safety results were excellent and similar for both procedures.
Objective: To evaluate ethnic differences in assisted reproductive technology (ART) outcomes in t... more Objective: To evaluate ethnic differences in assisted reproductive technology (ART) outcomes in the United States. Design: Historical cohort study. Setting: Clinic-based data. Patient(s): A total of 139,027 ART cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System online database for 2004-2006, limited to white, Asian, black, and Hispanic women. Intervention(s): None. Main Outcome Measure(s): Logistic regression was used to model the odds of pregnancy and live birth; among singletons and twins, the odds of preterm birth and fetal growth restriction. Results are presented as adjusted odds ratios, with white women as the reference group. Result(s): The odds of pregnancy were reduced for Asians (0.86), and the odds of live birth were reduced for all groups: Asian (0.90), black (0.62), and Hispanic (0.87) women. Among singletons, moderate and severe growth restriction were increased for all infants in all three minority groups (Asians [1.78, 2.05]; blacks [1.81, 2.17]; Hispanics [1.36, 1.64]), and preterm birth was increased among black (1.79) and Hispanic women (1.22). Among twins, the odds for moderate growth restriction were increased for infants of Asian (1.30) and black women (1.97), and severe growth restriction was increased among black women (3.21). The odds of preterm birth were increased for blacks (1.64) and decreased for Asians (0.70). Conclusion(s): There are significant disparities in ART outcomes according to ethnicity. (Fertil Steril Ò 2010; 93:382-90. Ó2010 by American Society for Reproductive Medicine.
Objective: To compare success rates in black and white women undergoing IVF. Design: Retrospectiv... more Objective: To compare success rates in black and white women undergoing IVF. Design: Retrospective cohort study. Setting: Society for Assisted Reproductive Technology member clinics in 1999-2000 that performed R50 cycles of IVF and reported race/ethnicity in >95% of cycles. Patient(s): Women receiving 80,309 IVF cycles. Intervention(s): IVF using nondonor embryos. Main Outcome Measure(s): Live-birth rate per cycle started. Result(s): Black, white, and other race/ethnicity women underwent 3666 (4.6%), 68,607 (83.5%), and 8036 (11.9%) IVF cycles, respectively. Spontaneous abortions were more common among black women. The live-birth rate was 26.3% (95% confidence interval [CI], 25.9%-26.7%) among white women compared with 18.7% (95% CI, 17
Background: Overweight and obesity are major risk factors for gestational diabetes among U.S. wom... more Background: Overweight and obesity are major risk factors for gestational diabetes among U.S. women. Evidence suggests that longer duration of breastfeeding among women with a history of gestational diabetes is associated with lower incidence of developing type 2 diabetes after pregnancy. Women may potentially benefit from a lifestyle change program that includes breastfeeding education and support. Purpose: To describe the design and justification of a combined breastfeeding, national Diabetes Prevention Program (DPP)-based feasibility randomized controlled trial, the electronic Monitoring Of Mom's Schedule (eMOMS TM) study. eMOMS TM compares the feasibility and efficacy of three interventions on six-month postpartum weight loss among women with a BMI �25. Methods: The intervention is delivered via Facebook and includes three groups: DPP and breastfeeding (eMOMS1); DPP only (eMOMS2); and Usual Care (eMOMS3). Recruitment is ongoing at two clinical sites (rural and urban). A total of 72 women, 24 per group, will be randomly assigned to one of the three groups. It is anticipated that women in eMOMS1 will have greater weight loss and increased length of breastfeeding at three and six months postpartum compared to women in eMOMS2 and eMOMS3. Additional data will be collected on metabolic markers, anthropometrics, physical activity, nutrition, breastfeeding, and depression. Program cost will be compared to that of traditionally scheduled group meetings. Expected study completion date: October 2021. Conclusions: This study has the potential to define a high impact, cost effective intervention that can improve public health by reducing negative health outcomes associated with gestational diabetes among an at-risk population.
unclear is the reproducibility of this aneuploidy phenomenon with repeated IVF/PGD cycles and the... more unclear is the reproducibility of this aneuploidy phenomenon with repeated IVF/PGD cycles and the predictive value in these women with respect to reproductive outcome. DESIGN: Prospective analysis of IVF-PGD cycles in a tertiary care ART facility. MATERIALS AND METHODS: Nineteen consecutive patients with repeated implantation failure (Ͼ3 failed IVF-ET cycles) who underwent 2 or more IVF/PGD cycles for aneuploidy testing of pre-embryos prior to ET were included in the study. The mean maternal age for the study group was 37 years. Women were categorized into good prognosis and poor prognosis after the first IVF/PGD cycle based on the availability of at least one euploid embryo for transfer. There was an equal distribution in both groups of women greater or less than 38 years of age. Biopsies were performed on day 3. One cell was removed from each pre-embryo and fixed; cells were analyzed by multicolor FISH for chromosomes X and Y, 13, 15, 16, 17, 18, 21, and 22. RESULTS: Three hundred and nine embryos were biopsied. In the good prognosis group, 15 of the 19 patients (79%) had at least 1 euploid embryo for transfer with the first IVF/PGD cycle. Of the 15 patients, 11 patients (73%) also had at least one euploid embryo available for transfer with the second IVF/PGD cycle and 4 patients (27%) had none. Of the 4 patients with no euploid embryos available for transfer with the second IVF/PGD cycle, 2 had a third cycle of IVF/PGD and both had euploid embryos available for transfer. Six of the 11 patients (55%) who had euploid embryos on the second IVF/PGD cycle conceived. The ongoing pregnancy rate and implantation rate in the women with euploid embryos available for both the first and second IVF/PGD was 36% and 17%, respectively. The average number of embryos transferred in the women who achieved a pregnancy was 1.8. No pregnancy was achieved in the women who had a third IVF/PGD cycle despite euploid embryos being transferred. In the poor prognosis group, 4 of the 19 patients (21%) had no euploid embryos available for transfer on the first IVF/PGD cycle. On the second IVF/PGD cycle, 2 patients had euploid embryos for transfer and 2 did not. Of the 2 patients with no euploid embryos available for the second IVF/PGD cycle, 1 patient had a third IVF/PGD cycle with no euploid embryos available for transfer. Only one pregnancy was achieved among this group of women but it resulted in a miscarriage. Among both groups of women with euploid embryos available in either the first or second PGD cycle, but not both, no ongoing pregnancy was achieved. CONCLUSION: In women with recurrent implantation failure, two consecutive euploid IVF/PGD cycles is associated with a high ongoing pregnancy and implantation rate. The presence of euploid embryos in the initial IVF/PGD cycle is highly predictive of euploid embryos being available for the second cycle and predictive of a good reproductive outcome. Contrary to a subgroup of these women where the presence of one or more IVF/PGD cycles with no euploid embryos available for transfer is predictive of a poor reproductive outcome, even in the presence of a euploid cycle.
Objective: To evaluate factors predictive of clinical pregnancy and of pregnancy loss from assist... more Objective: To evaluate factors predictive of clinical pregnancy and of pregnancy loss from assisted reproductive technology (ART) using data from the Society for Assisted Reproductive Technology database for 2004-2006. Design: Retrospective cohort. Setting: Clinic-based data. Patient(s): The study population included 225,889 fresh embryo transfer cycles using autologous oocytes and partner semen. Intervention(s): None. Main Outcome Measure(s): Clinical intrauterine gestation (presence of gestational sac) and live birth (R22 weeks gestation and R300 g birth weight). Result(s): Increasing maternal age was significantly associated with a reduced odds of conception and increased fetal loss until 19 weeks gestation, but not with later pregnancy loss. Intracytoplasmic sperm injection (ICSI), assisted hatching, and increasing number of embryos transferred had significant positive effects on the odds of conception and pregnancy continuation through the first trimester, but did not affect the risk of later loss. Blacks, Asians, and Hispanics had significantly lower odds of clinical pregnancy compared with whites. Also compared with whites, Hispanics and Asians had a significantly greater risk of pregnancy loss in the second and third trimesters, and blacks had a significantly greater risk of pregnancy loss in all trimesters. Conclusion(s): Certain demographic and ART treatment parameters influenced chance of conception and early pregnancy loss, whereas black race and Hispanic ethnicity were also significantly associated with late pregnancy loss in ART-conceived pregnancies.
Couples with fertility problems seeking treatment with assisted reproductive technologies (ART) s... more Couples with fertility problems seeking treatment with assisted reproductive technologies (ART) such as in vitro fertilization should receive preconception counseling on all factors that are provided when counseling patients without fertility problems. Additional counseling should address success rates and possible risks from ART therapies. Success rates from ART are improving, with the highest live birth rates averaging about 40% per cycle among women less than 35 years old. A woman's age lowers the chance of achieving a live birth, as do smoking, obesity, and infertility diagnoses such as hydrosalpinx, uterine leiomyoma, or male factor infertility. Singletons conceived with ART may have lower birth weights. Animal studies suggest that genetic imprinting disorders may be induced by certain embryo culture conditions. The major risk from ovarian stimulation is multiple gestation. About one-third of live-birth deliveries from
9 Laparoscopic management of ectopic pregnancy Anthony Davies and Adam L. Magos There has been a ... more 9 Laparoscopic management of ectopic pregnancy Anthony Davies and Adam L. Magos There has been a worldwide increase in the ... been responsible for earlier diagnosis are: (1) Sensitive radioimmunoassays (RIA) for the (i-subunit of human chorionic gonadotro-phin (p-hCG ...
Objective: To determine trends in assisted reproductive technology (ART) in black and white women... more Objective: To determine trends in assisted reproductive technology (ART) in black and white women by comparing Society for Assisted Reproductive Technology (SART) database outcomes for 2004-2006 with previously reported outcomes for 1999 and 2000. Design: Retrospective, cohort study. Setting: The SART member clinics that performed at least 50 cycles of IVF and reported race in more than 95% of cycles. Patient(s): Women receiving 158,693 IVF cycles. Intervention(s): In vitro fertilization using nondonor embryos. Main Outcome Measure(s): Live birth rate per cycle started. Result(s): Reporting of race increased from 52% to 60%. The proportion of black, non-Hispanic (BNH) women increased from 4.6% to 6.5%. For BNH women using fresh embryos and no prior ART, significant increasing trends were observed for older age, male factor, uterine factor, diminished ovarian reserve, and ovulation disorders. The BNH women were 2.5 times more likely to have tubal factor for those cycles with no prior ART. The proportion of live births per cycle started increased across all groups over time, although greater increases occurred for white women. Conclusion(s): There seems to be widening disparities in IVF outcomes between BNH and white women, perhaps attributable to poor prognostic factors among black women. Race continues to be a marker for prognosis for ART outcomes and should be reported. (Fertil Steril Ò 2010;93:626-35. Ó2010 by American Society for Reproductive Medicine.
This study evaluated the effect of gender mix (the gender combinations of twin pairs) on fetal gr... more This study evaluated the effect of gender mix (the gender combinations of twin pairs) on fetal growth and length of gestation, and reviewed the literature on the long-term effects of this altered fetal milieu on cancer risk. In singletons, it is well established that females weigh less than males at all gestations, averaging 125-135 g less at full term. This gender difference is generally believed to be the result of the effect of androgens on fetal growth. The gender difference in fetal growth is greater before the third trimester and less towards term, with males growing not only more, but also earlier than females. Plurality is a known risk factor for reduced fetal growth and birthweight. Compared with singletons, the mean birthweight percentiles of twins fall substantially (by 10% or more) below the singleton 10th percentile by 28 weeks, below the singleton 50th percentile by 30 weeks, and below the singleton 90th percentile by 34 weeks. In unlike-gender twin pairs, it has been reported that the female prolongs gestation for her brother, resulting in a higher birthweight for the male twin than that of like-gender male twins. Other researchers have demonstrated that females in unlikegender pairs had higher birthweights than females in like-gender pairs. Analyses from our consortium on 2491 twin pregnancies with known chorionicity showed longer gestations and faster rates of fetal growth in both males and females in unlike-gender pairs compared with like-gender male or female pairs, although these differences were not statistically significant. The post-natal effects for females growing in an androgenic-anabolic environment include increased sensation-seeking behaviour and aggression, lowered visual acuity, more masculine attitudes and masculinising effects of the auditory system and craniofacial growth. In contrast, there is no evidence to suggest that there might be a similar feminising effect on males from unlike-gender pairs. This hormonal exposure in utero may influence adult body size and susceptability to breast cancer.
American Journal of Obstetrics and Gynecology, 2003
CONCLUSION: These data demonstrate the importance of the early diagnosis of placental chorionicit... more CONCLUSION: These data demonstrate the importance of the early diagnosis of placental chorionicity, because monochorionicity is associated with a 2-fold increase in birth weight discordancy in twin gestations.
American Journal of Obstetrics and Gynecology, 2008
Male reproductive proteins (MRPs), associated with sperm and semen, are the moieties responsible ... more Male reproductive proteins (MRPs), associated with sperm and semen, are the moieties responsible for carrying male genes into the next generation. Evolutionary biologists have focused on their capacity to control conception. Immunologists have shown that MRPs cause female genital tract inflammation as preparatory for embryo implantation and placentation. These observations argue that MRPs are critically important to reproductive success. Yet the impact of male reproductive proteins on obstetrical outcomes in women is largely unstudied. Epidemiologic and clinical observations suggest that shorterduration exposure to MRPs prior to conception may elevate the risk for preeclampsia. A limited literature has also linked sexual behavior to bacterial vaginosis and preterm birth. We offer a clinical opinion that MRPs may have broad implications for successful reproduction, potentially involved in the composition of vaginal microflora, risks of preterm birth and preeclampsia, and success of assisted reproduction.
American Journal of Obstetrics and Gynecology, 2004
OBJECTIVE: Hispanic women have consistently better singleton pregnancy outcomes than other racial... more OBJECTIVE: Hispanic women have consistently better singleton pregnancy outcomes than other racial and ethnic groups in the United States, despite significant socioeconomic disadvantages. It is unknown if this improved outcome is also present with twin pregnancies. Our objective was to compare length of gestation, rates of fetal growth midgestation (20-28 weeks) and late gestation (after 28 weeks), and birthweight by ethnicity and pregravid weight in twins. STUDY DESIGN: Three thousand thirty six twin pregnancies of 28 weeks gestation were divided by ethnicity (white, black, and Hispanic), and pregravid body mass index (BMI) [underweight+normal weight, BMI !25.0 vs over-weight+obese, BMI 25.0]. Outcomes were modeled using multiple regression, controlling for confounders. RESULTS: Overall, compared to white women, Hispanic women had significantly longer gestations (+7.8 days) and faster fetal growth midgestation (+17.4 g/week) and late gestation (+5.3 g/week), whereas black women had slower rates of fetal growth (ÿ5.7 g/week and ÿ4.5 g/week, respectively), and lower birthweights (ÿ81 g). Among nonobese women, black women had significantly longer gestations (+4.4 days), but slower rates of fetal growth midgestation and late gestation (ÿ9.4 g/week and ÿ5.1 g/week, respectively) and lower birthweights-for-gestation (ÿ91 g). Hispanic women also had significantly longer gestations (+7.9 days), but a faster rate of fetal growth midgestation (+18.1 g/week). Among overweight and obese women, black women had significantly lower birthweights-for-gestation (ÿ73.1 g), whereas Hispanic women had longer gestations (+7.8 days), and faster rate of fetal growth midgestation (+14.4 g/week). CONCLUSION: Among twin pregnancies, Hispanic women had longer gestations and faster fetal growth, and black women had slower fetal growth and lower birthweights, particularly among nonobese women compared to white women. These findings in twins reflect the racial and ethnic disparities previously shown in singletons, including the Hispanic paradox of longer gestations and higher rates of fetal growth.
Short-term methyltestosterone administration had no significant effects on the fasting levels of ... more Short-term methyltestosterone administration had no significant effects on the fasting levels of glucose, insulin, c-peptide, glucagon, or glucose turnover. During the hyperglycemic clamp studies, the mean glucose level during the final hour was 203 ± 2 and 201 ± 1 mg/dL in ...
To assess the safety and effectiveness of the Minerva Endometrial Ablation System for the treatme... more To assess the safety and effectiveness of the Minerva Endometrial Ablation System for the treatment of heavy menstrual bleeding in premenopausal women. Design: Multicenter, randomized, controlled, international study (Canadian Task Force classification I). Setting: Thirteen academic and private medical centers. Patients: Premenopausal women (n 5 153) suffering from heavy menstrual bleeding (PALM-COEIN: E, O). Intervention: Patients were treated using the Minerva Endometrial Ablation System or rollerball ablation. Measurements and Main Results: At 1-year post-treatment, study success (alkaline hematin %80 mL) was observed in 93.1% of Minerva subjects and 80.4% of rollerball subjects with amenorrhea reported by 71.6% and 49% of subjects, respectively. The mean procedure times were 3.1 minutes for Minerva and 17.2 minutes for rollerball. There were no intraoperative adverse events and/or complications reported. Conclusion: The results of this multicenter randomized controlled trial demonstrate that at the 12-month follow-up, the Minerva procedure produces statistically significantly higher rates of success, amenorrhea, and patient satisfaction as well as a shorter procedure time when compared with the historic criterion standard of rollerball ablation. Safety results were excellent and similar for both procedures.
Objective: To evaluate ethnic differences in assisted reproductive technology (ART) outcomes in t... more Objective: To evaluate ethnic differences in assisted reproductive technology (ART) outcomes in the United States. Design: Historical cohort study. Setting: Clinic-based data. Patient(s): A total of 139,027 ART cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System online database for 2004-2006, limited to white, Asian, black, and Hispanic women. Intervention(s): None. Main Outcome Measure(s): Logistic regression was used to model the odds of pregnancy and live birth; among singletons and twins, the odds of preterm birth and fetal growth restriction. Results are presented as adjusted odds ratios, with white women as the reference group. Result(s): The odds of pregnancy were reduced for Asians (0.86), and the odds of live birth were reduced for all groups: Asian (0.90), black (0.62), and Hispanic (0.87) women. Among singletons, moderate and severe growth restriction were increased for all infants in all three minority groups (Asians [1.78, 2.05]; blacks [1.81, 2.17]; Hispanics [1.36, 1.64]), and preterm birth was increased among black (1.79) and Hispanic women (1.22). Among twins, the odds for moderate growth restriction were increased for infants of Asian (1.30) and black women (1.97), and severe growth restriction was increased among black women (3.21). The odds of preterm birth were increased for blacks (1.64) and decreased for Asians (0.70). Conclusion(s): There are significant disparities in ART outcomes according to ethnicity. (Fertil Steril Ò 2010; 93:382-90. Ó2010 by American Society for Reproductive Medicine.
Objective: To compare success rates in black and white women undergoing IVF. Design: Retrospectiv... more Objective: To compare success rates in black and white women undergoing IVF. Design: Retrospective cohort study. Setting: Society for Assisted Reproductive Technology member clinics in 1999-2000 that performed R50 cycles of IVF and reported race/ethnicity in >95% of cycles. Patient(s): Women receiving 80,309 IVF cycles. Intervention(s): IVF using nondonor embryos. Main Outcome Measure(s): Live-birth rate per cycle started. Result(s): Black, white, and other race/ethnicity women underwent 3666 (4.6%), 68,607 (83.5%), and 8036 (11.9%) IVF cycles, respectively. Spontaneous abortions were more common among black women. The live-birth rate was 26.3% (95% confidence interval [CI], 25.9%-26.7%) among white women compared with 18.7% (95% CI, 17
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