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OBJECTIVE: To evaluate the impact of double embryo vitrification on clinical outcomes. METHODS: This retrospective cohort study included data from January 2013 to March 2021. The study group included women aged 33.3±5.7 years with double-vitrified embryos (n=381), while the control group included women aged 32.1±6.7 years with embryos vitrified once (n=780), all transferred at the blastocyst stage. The primary endpoint was live birth rate (LBR), and secondary endpoints included percent positive ßHCG test, clinical/ongoing pregnancy rates, miscarriage/biochemical pregnancy rates and birthweight. RESULTS: LBR was significantly lower in double-vitrified embryos (30.2%) than in embryos vitrified once (45.6%, p<.05). Similarly, double-vitrified embryos were associated with significantly lower positive ßHCG tests (46% vs. 63.3%, p<.05) and clinical (34.9% vs. 52.2%, p<.05) and ongoing pregnancy (31.3% vs. 47.3%, p<.05) rates compared to embryos vitrified once. However, biochemical pregnancy (double vitrified: 24.1% vs. vitrified once: 17.9%, p>.05) and miscarriage rates (double vitrified: 10.2% vs. vitrified once: 9.4%, p>.05), as well as mean birthweight (double-vitrified embryos: 2950g vs. embryos vitrified once: 2837g, p>.05) did not differ significantly between two groups. On a secondary comparison, amongst double-vitrified embryos, the subgroup that was cultured for more than 24 hours between warming and second vitrification achieved significantly higher positive ßHCG tests (49%) and clinical pregnancy (38%) rates, compared to embryos re-vitrified on the same day of warming (31.8% and 20.5%, respectively, p<.05). Nevertheless, LBR did not differ significantly amongst these study-group embryos (embryos that remained in culture for more than 24 hours: 32.2% vs. embryos that were re-vitrified on warming day: 20.5%, p>.05). CONCLUSIONS: Double vitrification of embryos adversely affects clinical outcomes. However, it represents a valuable option concerning embryo wastage, with acceptable success rates.

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OBJECTIVE: To evaluate the impact of possible maternal and paternal prognostic factors and ovarian stimulation protocols on clinical pregnancy and live birth rates in intrauterine insemination (IUI) cycles. METHODS: Retrospective observational study of 341 IUI cycles performed from January 2016 to November 2020 at the Assisted Reproduction Service of the Clinics Hospital of the Ribeirão Preto Medical School, University of São Paulo. Clinical pregnancy and live birth rates and their potential prognostic factors were evaluated. Wilcoxon's non-parametric test was used to compare quantitative variables, and the chi-square test to compare qualitative variables, adopting a significance level of p<0.05. A logistic regression model was performed to verify which exploratory variables are predictive factors for pregnancy outcome. RESULTS: The ovulation induction protocol using gonadotropins plus letrozole (p=0.0097; OR 4.3286, CI 1.3040 - 14.3684) and post-capacitation progressive sperm ≥ 5million/mL (p=0.0253) showed a statistically significant correlation with the live birth rate. Female and male age, etiology of infertility, obesity, multifollicular growth, endometrial thickness ≥ 7 mm, and time between human chorionic gonadotropin administration and IUI performance were not associated with the primary outcomes. In the group of patients with ideal characteristics (women aged< 40 years, BMI < 30 kg/m2, antral follicle count ≥ 5, partner aged< 45 years, and post-capacitation semen with progressive spermatozoa ≥ 5 million/mL), the rate of clinical pregnancy was 14.8%, while that of live birth, 9.9%. CONCLUSIONS: In this study, the ovulation induction protocol with gonadotropins plus letrozole and post-capacitation progressive sperm ≥ 5 million/mL were the only variables that significantly correlated with intrauterine insemination success.

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Introducción: La tasa de mortalidad infantil es un indicador importante y sensible del bienestar y la calidad de vida de una población, muy usado para medir su estado de salud. Objetivo: Caracterizar la mortalidad infantil según semestres en la provincia de Santiago de Cuba durante 2008-2022. Métodos: Se realizó un estudio observacional descriptico y transversal sobre la mortalidad infantil en la provincia de Santiago de Cuba durante los años 2008-2022. Para ello se analizó la relación existente entre los semestres de cada año respecto a los nacimientos, las defunciones y su incidencia en la tasa del país. Resultados: Se observó una disminución de los nacimientos y un incremento de las defunciones en cada quinquenio estudiado respecto al anterior. El número de fallecidos menores de un año fluctuó, con una tendencia al aumento a partir del 2019; asimismo, los indicadores de mortalidad infantil fueron inestables, con propensión al incremento, sobre todo en el segundo semestre, y peores resultados en el 2021 y 2022. Existió un descenso mantenido de los nacimientos a partir del 2011, que alcanzó 25,6 % en el 2022. Respecto a los semestres, en el segundo hubo mayor número de nacimientos, defunciones y tasas. Conclusiones: La provincia de Santiago de Cuba influye de forma directa en los resultados de la mortalidad infantil nacional, con una tasa superior a la exhibida por el país. El segundo semestre es el período en el que se incrementan los nacimientos y las defunciones, lo que incide en la elevación de las tasas respectivas.

Introduction: The infant mortality rate is an important and sensitive indicator of the well-being and life quality of a population, very used to measure the health state. Objective: To characterize the infant mortality in Santiago de Cuba province during the period 2008-2022. Methods: An observational descriptive and cross-sectional study about the infant mortality was carried out in Santiago de Cuba during the years 2008-2022. The existent relationship among the semesters of every year regarding births, deaths and their incidence in the country rate was analyzed. Results: A decrease of births and an increment of deaths were observed in each five year period studied regarding the previous one. The number of deceased children under one year fluctuated, with a tendency to the increase starting from 2019; also, the indicators of infant mortality were unstable, with tendency to the increment, mainly in the second semester, and worse results in 2021 and 2022. There was a maintained decrease of births since 2011 that reached 25.6% in 2022. In relation to semesters, in the second one there was a higher number of births, deaths and rates. Conclusions: Santiago de Cuba province influences in a direct way on the results of national infant mortality, with a superior rate to the one exhibited by the country. The second semester is the period in which births and deaths are increased, what impacts in the elevation of the respective rates.

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RESEARCH QUESTION: Is endometriosis detrimental to embryo implantation? DESIGN: A retrospective matched case-control study of women with a surgical or ultrasound diagnosis of endometriosis at Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano between 2015 and 2021. Women with endometriosis who underwent a 'freeze-all' cycle during an IVF treatment were eligible to be included. They were matched to patients without the disease, who also underwent cryopreserved blastocyst transfer cycles, in a 1:1 ratio by age (±1 year), and number (=) and quality (±1 top versus low) of cryopreserved blastocysts. All women underwent single frozen embryo transfer, and assisted reproductive technology outcomes suggested by the Core Outcome Measure for Infertility Trials initiative were evaluated. The main outcome was the cumulative live birth rate per cycle. RESULTS: One hundred and one women with endometriosis and 101 matched unaffected women were included. Cumulative live birth rate per cycle did not vary between women with and without endometriosis (50% versus 58%, respectively; P = 0.32). On the basis of the Kaplan-Meier analysis, the predicted success rates over four embryos transferred were also similar (74% versus 82%, respectively; P = 0.67). CONCLUSION: In women with moderate or severe endometriosis, these retrospective results seem to indicate no or a limited effect of the disease on endometrial receptivity.

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BACKGROUND: Infertility is caused by heterogeneous risks, but most of them are unexplained. The sperm DNA Fragmentation Index (DFI) was increasingly acknowledged as a parameter for the evaluation of male infertility. This study aimed to investigate the association between sperm DFI and laboratory and clinical outcomes in a population with unexplained infertility. METHODS: The clinical data of an infertile population was collected for the selection of reproductive patients with unexplained infertility. The authors classified the patients with normal sperm parameters in a control group (DFI < 25%) and an observation group (DFI ≥ 25%) and compared the difference in basal characteristics, laboratory, and clinical outcomes between the two groups. The authors conducted a correlation analysis to examine the relationship between DFI and the number of D3 good-quality embryos, as well as the clinical pregnancy rate and live birth rate. A total of 176 cases were enrolled in the retrospective study. RESULTS: The observation group (n = 88) showed advanced male age, lower sperm concentration, progressive motility, and morphology assessment than the control group. In addition, lower No. of D3 good-quality embryos, clinical pregnancy rate, and the live birth rate were shown in the observation group. A negative correlation between the DFI and No. of D3 good-quality embryos (rs = -0.347, p < 0.001) or live birth rate (rs = -0.185, p = 0.028) was shown. CONCLUSIONS: Sperm DFI was a good indicator for the prediction of D3 good-quality embryos in unexplained infertility couples, but it did not provide sufficient information regarding clinical pregnancy outcome but live pregnancy outcome.

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Introducción: La infertilidad afecta hasta un 15 por ciento de las parejas en edad reproductiva en el mundo y es uno de los factores que inciden en la baja natalidad de Cuba. Antes del 2016 no existían consultas de infertilidad en todos los municipios y era bajo el número de embarazos logrados, lo que motivó la decisión de extenderlas a todos los municipios del país. Objetivo: Describir los resultados de las consultas municipales de infertilidad en los primeros cuatro años de su implementación (2017-2020). Métodos: Estudio observacional transversal de casos, atendidos en las 82 consultas municipales de infertilidad existentes antes del 2016 y después de su generalización a todos los municipios del país. Resultados: En las consultas municipales han sido atendidas 81,3 por ciento de las parejas infértiles que lo demandan, se incrementó el número de consultas ofrecidas de 24 215 en el año 2016 a 140 183 en el 2020. En ese período se elevó en 10 por ciento los embarazos obtenidos, 63,5 por ciento de los logrados en todos los niveles de atención. Conclusiones: Las consultas municipales incrementaron sus resultados entre el año 2017 al 2020 y los nacimientos obtenidos pueden ser considerados como una contribución del sector salud a reducir la baja natalidad que experimenta el país(AU)

Introduction: Infertility affects up to 15percent of couples of reproductive age in the world and is one of the factors affecting the low birth rate in Cuba. Before 2016, infertility consultations did not exist in all municipalities and the number of pregnancies achieved was low, which motivated the decision to extend them to all municipalities in the country. Aim: To describe the results of municipal infertility consultations in the first four years of their implementation (2017-2020). Methods: Cross-sectional observational study of cases, attended in the 82 municipal infertility consultations existing before 2016 and after their generalization to all municipalities in the country. Results: 81.3percent of the infertile couples requesting treatment were attended in the municipal consultations. The number of consultations offered increased from 24 215 in 2016 to 140 183 in 2020. In that period, pregnancies obtained increased by 10 percent, 63.5 percent of those achieved at all levels of care. Conclusions: Municipal consultations increased their results from 2017 to 2020 and the births obtained can be considered as a contribution of the health sector to reduce the low birth rate experienced by the country(AU)

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OBJECTIVE: Embryo transfer on day-5 has been associated with higher success rates, therefore our IVF clinics started to extend embryo culture until blastocyst stage. This study aimed to compare the success rates of day-3 vs. day-5 embryo transfers. METHODS: We had 266 patients included, all having undergone ICSI, with 221 patients having undergone day-3 embryo transfers, and 45 patients having undergone day-5 embryo transfers. Patients with more than five good quality embryos on day-3 were chosen to prolong the culture of embryos into day-5. RESULTS: There were no significant differences in patient characteristics, including baseline LH, FSH, Prolactin and Estradiol hormone levels. In addition, there were also no significant differences in rFSH total dosage and duration of stimulation day. Final estradiol levels, number of follicles, retrieved oocytes, matured oocytes, fertilized oocytes and number of embryos were significantly higher in day-5 compared to day-3 embryo transfer groups. Number of embryos transferred on day-3, were significantly higher compared to day-5. Neither group showed any significant differences in clinical pregnancy, implantation, multiple pregnancy or living birth rates. There were no differences in birth weights and lengths, head circumstances and Apgar Scores between both groups either in singleton or twin group. CONCLUSIONS: Transferring embryos at day-3 may provide the same benefits as day-5 embryo transfers to patients. However, more embryos were required to be transferred to achieve these comparable results.

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OBJECTIVE: To evaluate reproductive outcomes after hysteroscopic adhesiolysis for patients with Asherman syndrome (AS) who presented with infertility and/or subfertility. METHODS: A retrospective study was conducted in the Women's Specialized Hospital, King Fahad Medical City, from December 2010 to December 2018. The medical records were reviewed for all infertile women who had hysteroscopic adhesiolysis. The specific study's main reproductive outcomes included: [1] the overall rate of conception, [2] the overall rate of conception according to the severity degree of intrauterine adhesions (IUAs), [3] the reproductive methods for achieving conception, and [4] pregnancy outcomes. Reproductive methods for conception included spontaneous conception, ovulation induction (OI), intrauterine insemination (IUI), and in-vitro fertilization (IVF) with/without intracytoplasmic sperm injection (ICSI). Outcomes of pregnancy included ectopic pregnancy, miscarriage, and live birth events. RESULTS: Forty-one patients (n=41) were analyzed. Their mean age was 32.2±4.6 years. The most common menstrual pattern amongst these patients was hypomenorrhea 46.4%. All patients resumed regular menstrual cycles after the adhesiolysis procedure. The overall conception rate during the 24 months follow up was 53.6%, and the overall live birth rate was 34.2%. Of the 22 patients who conceived, 12 patients (29.2%) conceived spontaneously, 2 (4.9%) with IUI, and 8 (19.5%) with IVF-ICSI. The patients with minimal IUAs had a significantly higher pregnancy rate (71.4%) when compared to those with moderate (47%) and severe (40%) IUA (two-tailed log-rank test, p=0.041). CONCLUSIONS: The spontaneous cumulative conception rate following hysteroscopic adhesiolysis was higher in patients with minimal IUAs than those with moderate and severe IUAs.

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Abstract Background Infertility is caused by heterogeneous risks, but most of them are unexplained. The sperm DNA Fragmentation Index (DFI) was increasingly acknowledged as a parameter for the evaluation of male infertility. This study aimed to investigate the association between sperm DFI and laboratory and clinical outcomes in a population with unexplained infertility. Methods The clinical data of an infertile population was collected for the selection of reproductive patients with unexplained infertility. The authors classified the patients with normal sperm parameters in a control group (DFI < 25%) and an observation group (DFI ≥ 25%) and compared the difference in basal characteristics, laboratory, and clinical outcomes between the two groups. The authors conducted a correlation analysis to examine the relationship between DFI and the number of D3 good-quality embryos, as well as the clinical pregnancy rate and live birth rate. A total of 176 cases were enrolled in the retrospective study. Results The observation group (n = 88) showed advanced male age, lower sperm concentration, progressive motility, and morphology assessment than the control group. In addition, lower No. of D3 good-quality embryos, clinical pregnancy rate, and the live birth rate were shown in the observation group. A negative correlation between the DFI and No. of D3 good-quality embryos (rs = -0.347, p < 0.001) or live birth rate (rs = -0.185, p = 0.028) was shown. Conclusions Sperm DFI was a good indicator for the prediction of D3 good-quality embryos in unexplained infertility couples, but it did not provide sufficient information regarding clinical pregnancy outcome but live pregnancy outcome.

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Embryo transfer (ET) is the final step of in vitro fertilization (IVF). Different strategies have been proposed to increase the likelihood of implantation, such as post-transfer bed rest. The objective of this manuscript was to compare the clinical outcomes of embryo transfers after IVF of patients offered rest vs. early ambulation. The patient, intervention, comparison, and outcome(s) (PICO) model was used to select the study population, which included women/couples submitted to IVF and prescribed bed rest or early ambulation. Only studies including live birth (LB) as an outcome were included (www.crd.york.ac.uk/PROSPERO/CRD42020188716) A systematic search for studies was conducted on MEDLINE, ClinicalTrials.gov, PubMed, and the Cochrane Library. A librarian coordinated the searches in May 2020, which considered articles published since 1995. All original peer-reviewed articles in English were included, regardless of study design. The search retrieved 27 citations, of which 14 were eligible for full-text analysis and four accepted for inclusion. The studies included data on 21,598 patients/cycles (rest: 20,138; early ambulation: 1,460). Patients prescribed bed rest had an LB rate of 43.6% vs. 52.5% in the individuals not offered bed rest. The meta-analysis yielded an odds ratio of 0.77 (95% CI 0.5-1.2), which means patients on bed rest were 23% less likely to have a LB; nevertheless, this difference was not statistically significant. Considering that there is no difference between the two strategies, there is no evidence to recommend bed rest after embryo transfer.

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OBJECTIVE: To determine whether elective frozen embryo transfer (eFET), or the 'freeze-all' strategy, associated with better cumulative clinical outcomes compared with fresh embryo transfer (ET). METHODS: A total of 7,236 IVF cycles that were followed by a fresh ET or eFET between 2013 and 2017. The patients were subjected to controlled ovarian stimulation (COS) with a gonadotropin-releasing hormone (GnRH) antagonist protocol and cleavage-stage ET. Embryo cryopreservation was performed on day 3 by vitrification using an open system. A comparison of cumulative outcomes between the eFET (n=4,065cycles) and the fresh ET groups (n=3,171cycles) were performed. The analysis was performed in four groups of patients based on the number of retrieved oocytes: Group 1: poor responders (1-3 oocytes); Group 2: suboptimal responders (4-9 oocytes); Group 3: normal responders (10-15 oocytes); and Group 4: hyper-responders (>15 oocytes). The primary outcome was the cumulative live birth rate (CLBR) per stimulated cycle. RESULTS: There were a total of 10,283 ETs (n=5,639 eFET group; n=4,644 fresh group). The freeze-all strategy is associated with improved CLBRs in normal and hyper-responders, but not in suboptimal and poor responders. In Group 1, there were 351 IVF cycles and 387 ETs in total, and the CLBR was 14.3% and 17.7% (p=0.584) for the eFET and fresh group, respectively. In Group 2, there were 2,074 IVF cycles and 2,465 ET in total, and the CLBR was 25.1% and 23.3% (p=0.083) in the eFET and fresh group, respectively. There was a significant difference in the CLBR in Groups 3 and 4, favouring the eFET strategy. In Group 3, 2226 IVF cycles and 3243 ET were performed. The CLBR was 40.5% in the eFET and 36.6% in the fresh group (p<0.001). In Group 4, there were 2547 IVF cycles and 3,188 ET in total, and the CLBR was 52.2% and 47.7% (p<0.001) in the eFET and fresh group, respectively. The number needed to treat to achieve one additional live birth was 25.9 in Group 3 and 22.3 in Group 4. CONCLUSIONS: The implementation of the freeze-all strategy should be individualized. The freeze-all strategy is associated with improved CLBRs in normal and hyper-responders, but not in suboptimal and poor responders.

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Resumen: OBJETIVO: Determinar la frecuencia de embarazos mediante la tasa de nacidos vivos en el grupo etario de 15 a 19 años y su asociación con el Índice de Desarrollo Humano (2016 a 2021). MATERIALES Y MÉTODOS: Estudio observacional, ecológico, exploratorio y correlacional efectuado con base en la información del Sistema de Registro del Certificado de Nacido Vivo en Línea y el Índice de Desarrollo Humano, que son datos por departamento, provincias y municipios. Se incluyeron todas las mujeres residentes en Perú con un recién nacido entre 2016 y 2021. Los datos registrados fueron: total de recién nacidos por departamento, región, provincia y distrito, divididos por grupos etarios de 15 a 19 años. Para el análisis de los datos se utilizaron regresión lineal y correlación de Pearson. RESULTADOS: En el periodo de estudio se registraron 2,843,903 nacimientos de los que 324,654 (11.41%) correspondieron a mujeres menores de 20 años. En el 2017 se registró la más alta cantidad de nacimientos en este grupo etario (n = 58,841). En 2016 el porcentaje más alto de nacimientos de hijos de adolescentes fue de 12.36% y el más bajo (10.51%) se registró en el 2020. CONCLUSIÓN: El porcentaje de adolescentes embarazadas disminuyó levemente en los últimos años, aunque hubo un ligero aumento en el 2021, sobre todo en la región de la selva, que es la de mayor proporción en comparación con las otras. El índice de desarrollo humano provincial y municipal está inversamente relacionado con la proporción de embarazos en adolescentes.

Abstract OBJECTIVE: To determine the frequency of pregnancies through the live birth rate in the 15-19 age group and its association with the Human Development Index (2016 to 2021). MATERIALS AND METHODS: Observational, ecological, exploratory, and correlational study carried out based on information from the Online Live Birth Certificate Registration System and the Human Development Index, which are data by department, provinces and municipalities. All women residing in Peru with a newborn between 2016 and 2021 were included. The data recorded were total newborns by department, region, province and district, divided by age groups from 15 to 19 years. Linear regression and Pearson correlation were used for data analysis. RESULTS: In the study period, 2,843,903 births were registered, of which 324,654 (11.41%) corresponded to women under 20 years of age. In 2017, the highest number of births was recorded in this age group (n = 58,841). In 2016, the highest percentage of births to teenagers was 12.36% and the lowest (10.51%) was recorded in 2020. CONCLUSION: The percentage of pregnant adolescents decreased slightly in recent years, although there was a slight increase in 2021, especially in the jungle region, which has the highest proportion compared to the others. The provincial and municipal human development index is inversely related to the proportion of teenage pregnancy.

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Introducción: A nivel mundial la tasa de natalidad desde las últimas décadas ha venido en declive, por lo que adquiere relevancia investigar sus cambios. Objetivos: Cuantificar la tendencia de nacimientos en Chile según rango etario de la madre y sexo biológico del recién nacido en el periodo 2015-2020. Metodología: Se realizó un estudio observacional y ecológico, con los datos obtenidos del banco mundial y DEIS, para la población y nacimientos respectivamente. Los datos se dividieron según las edades maternas en tres grupos: <18 años, 18-34 años y ≥ 35 años. No se requirió comité de ética debido a que no se interviene con personas. Los autores no presentan conflicto de interés. Resultados: Se observó una disminución de los nacimientos del 22,6%, pasando de 244.626 el 2015 a 189.250 el 2020. Los nacimientos en el grupo etario de madres menores a 18 años disminuyeron un 82,13%, reduciéndose de 17.505 a 3.129, el rango de edad materna correspondiente al segundo grupo de 18 a 34 años, ubicó la mayor cantidad de nacimientos, manteniéndose alrededor de un 77,75% (neto), el rango ≥ 35 años, presentó un alza de un 17%, aumentando de 34.648 nacimientos a 40.539. Discusión: En Chile hay un descenso en los nacimientos dado a que la maternidad se está postergando, lo cual puede deberse a la educación sexual implementada en el país y la mayor participación de mujeres en ámbito laboral, esto sugiere una transición de una demografía estable a una regresiva.

Introduction: The birth rate has been declining worldwide since the last decades, so it is important to investigate its changes. Objectives: To quantify the trend of births in Chile according to age range of the mother and biological sex of the newborn in the period 2015-2020. Methodology: An observational and ecological study was conducted, with data obtained from the World Bank and DEIS, for population and births respectively. Data were divided according to maternal ages into three groups: <18 years, 18-34 years and ≥ 35 years. No ethics committee was required due to the fact that we did not intervene with individuals. The authors have no conflict of interest. Results: A decrease in births of 22.6% was observed, from 244,626 in 2015 to 189,250 in 2020. Births in the age group of mothers under 18 years decreased by 82.13%, decreasing from 17,505 to 3,129, the maternal age range corresponding to the second group from 18 to 34 years, located the highest number of births, remaining around 77.75% (net), the range ≥ 35 years, presented a rise of 17%, increasing from 34. Discussion: In Chile there is a decrease in births due to the fact that motherhood is being postponed, which may be due to the sexual education implemented in the country and the greater participation of women in the labor market, suggesting a transition from a stable demography to a regressive one.

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BACKGROUND: We aimed to identify the 2001-2013 incidence trend, and characteristics associated with adolescent pregnancies reported by 20-24-year-old women. METHODS: A retrospective analysis of the Cuatro Santos Northern Nicaragua Health and Demographic Surveillance 2004-2014 data on women aged 15-19 and 20-24. To calculate adolescent birth and pregnancy rates, we used the first live birth at ages 10-14 and 15-19 years reported by women aged 15-19 and 20-24 years, respectively, along with estimates of annual incidence rates reported by women aged 20-24 years. We conducted conditional inference tree analyses using 52 variables to identify characteristics associated with adolescent pregnancies. RESULTS: The number of first live births reported by women aged 20-24 years was 361 during the study period. Adolescent pregnancies and live births decreased from 2004 to 2009 and thereafter increased up to 2014. The adolescent pregnancy incidence (persons-years) trend dropped from 2001 (75.1 per 1000) to 2007 (27.2 per 1000), followed by a steep upward trend from 2007 to 2008 (19.1 per 1000) that increased in 2013 (26.5 per 1000). Associated factors with adolescent pregnancy were living in low-education households, where most adults in the household were working, and high proportion of adolescent pregnancies in the local community. Wealth was not linked to teenage pregnancies. CONCLUSIONS: Interventions to prevent adolescent pregnancy are imperative and must bear into account the context that influences the culture of early motherhood and lead to socioeconomic and health gains in resource-poor settings.

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OBJECTIVE: To identify low prognosis in-vitro fertilization (IVF) patients treated at Centro de Fertilidad y Ginecología del Sur (CFGS) based on the POSEIDON criteria. METHODS: This retrospective study included 412 IVF patients and assessed them based on the POSEIDON criteria to describe the cumulative live birth rates seen in each group. RESULTS: 13.1% of patients met the POSEIDON criteria, and the proportion of cases in POSEIDON groups 1, 2, 3 and 4 were 20.4%, 31.5%, 14.8%, and 33.3%, respectively. The cumulative live birth rate for the individuals meeting the POSEIDON criteria was 25.9%, while for patients in POSEIDON groups 1, 2, 3, and 4 the rates were 45.5%, 29.4%, 25.0%, and 11%, respectively. The differences were not statistically significant due to the small number of cases. CONCLUSIONS: Patients belonging to the four POSEIDON groups were described at CFGS. Age and number of retrieved mature oocytes were determining parameters in the prognosis of pregnancy in IVF/ICSI patients.

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OBJECTIVE: To determine the rate of live birth per blastocyst based on morphology and oocyte age using data from a single center. METHODS: This is a mathematical analysis and model building study of autologous blastocyst stage embryo transfers at a University-affiliated center. A total of 448 blastocyst stage embryos were transferred in 244 fresh and frozen embryo transfers from May 2015 through April 2018. Blastocyst morphology was divided into good, fair, and poor overall morphology grades. Each embryo transfer was modeled as an equation equating the sum of the unknown live birth rates of the transferred embryos to the number of live births that resulted. The least squares solution to the system of embryo transfer equations was determined using linear algebra. RESULTS: Trophectoderm morphology was a better predictor of live birth rate than inner cell mass morphology. Embryos graded AA/AB/BA (good) had the highest live birth rates followed by BB/CB (fair), and BC/CC (poor). In our youngest age group (25-32 years) live birth rates per embryo were 51% for good, 39% for fair, and 25% for poor quality embryos. In our oldest age group (40-44 years) the live birth rates per embryo were 22% for good, 14% for fair, and 8% for poor quality embryos. CONCLUSIONS: These techniques can help analyze small datasets such as those from individual clinics to aid in determining the ideal number of embryos to transfer to achieve live birth while limiting the risk of multiple gestations.

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OBJECTIVE: The use of Gonadotrophin releasing hormone agonist (GnRHa), with freeze-all strategy followed by frozen embryo transfer (FET) has been found to eliminate the risk of ovarian hyperstimulation syndrome (OHSS) in women with polycystic ovarian syndrome (PCOS) undergoing IVF cycles. However, physicians still hesitate to routinely use GnRHa as a trigger, replacing human chorionic gonadotrophin (hCG), for concerns of compromised cycle outcome. We aimed to evaluate outcomes following the transfer of embryos in FET cycles obtained from GnRHa trigger in comparison with hCG trigger in PCOS patients of Asian origin. METHODS: Prospective observational cohort study. 210 PCOS patients undergoing IVF in an antagonist protocol who were randomized in the previous study (to evaluate if GnRHa trigger is a better alternative than hCG in PCOS patients to prevent OHSS; Group A: GnRHa trigger (n=92)] and Group B: hCG trigger (n=101)], were followed up in FET cycles to assess the outcomes. RESULTS: The odds of cumulative live birth rate per stimulation cycle favors GnRHa trigger against the hCG trigger [OR=2.15; (CI 1.2-3.83); p=0.008]. A significantly higher number of mature oocytes (19.1±11.7 versus 14.1±4.3; p<0.001) and blastocysts (4.2±1.63 versus 3.26±1.22; p<0.001) were available in the GnRHa group as compared to the hCG group. CONCLUSION: The cumulative live birth rate was better following transfer of frozen-thawed embryos generated from GnRHa-triggered cycles compared to hCG trigger. Hence, in PCOS undergoing IVF, as a good practice point, hCG trigger should be replaced by a GnRHa trigger with vitrification of all embryos followed by FET.

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ABSTRACT Objective: To analyze the temporal trends in the fertility rate, proportion of antenatal consultations and caesarean sections in Brazilian adolescents aged 15 to 19, between 2000 and 2015. Methods: The fertility rate, proportion of prenatal consultations and proportion of routes of birth were calculated using data from DATASUS. The trend analysis was performed using the Prais-Winsten regression model and the annual percentage change. Results: There was a trend of reduction of 3.5% per year in the fertility rate among adolescents (p<0.05), in addition to an increasing trend of 6% per year in the proportion of more than six antenatal consultations (p <0.0001) and an increasing trend of 6.8% per year in the proportion of caesarean sections (p<0.0001). Conclusion: Despite the decreasing trend in fertility rates among Brazilian adolescents, they remain high. Also noteworthy is the growing trend for caesarean sections, even with improved access to antenatal care.

RESUMEN Objetivo: Analizar las tendencias temporales de la tasa de fertilidad, proporción de consultas de prenatal y cesarianas en adolescentes brasileñas de 15 a 19 años, entre 2000 y 2015. Métodos: La tasa de fertilidad, proporción de consultas de prenatal y proporción de vías de nacimiento fueran calculadas con datos del DATASUS. Análisis de tendencia realizada utilizándose modelo de regresión de Prais-Winsten y la tasa de variación media anual. Resultados: Observó tendencia de reducción de 3,5% al año de la tasa de fertilidad entre las adolescentes (p<0,05), además de tendencia creciente de 6% al año de la proporción de más de seis consultas de prenatal (p<0,0001) y tendencia creciente de 6,8% al año de la proporción de cesarianas (p<0,0001). Conclusión: Aunque la tendencia decreciente de la tasa de fertilidad en adolescentes brasileñas, ellas aún permanecen elevadas. Destaca también la tendencia creciente de cesarianas, mismo con la mejoría del acceso al prenatal.

RESUMO Objetivo: Analisar as tendências temporais da taxa de fertilidade, proporção de consultas de prénatal e cesarianas em adolescentes brasileiras de 15 a 19 anos, entre 2000 e 2015. Métodos: A taxa de fertilidade, proporção de consultas de pré-natal e proporção de vias de nascimento foram calculadas com dados do DATASUS. A análise de tendência foi realizada utilizando-se o modelo de regressão de Prais-Winsten e a taxa de variação média anual. Resultados: Observou-se tendência de redução de 3,5% ao ano da taxa de fertilidade entre as adolescentes (p<0,05), além de tendência crescente de 6% ao ano da proporção de mais de seis consultas de pré-natal (p<0,0001) e tendência crescente de 6,8% ao ano da proporção de cesarianas (p<0,0001). Conclusão: Apesar da tendência decrescente da taxa de fertilidade nas adolescentes brasileiras, elas ainda permanecem elevadas. Destaca-se também a tendência crescente de cesarianas, mesmo com a melhoria do acesso ao pré-natal.

RESUMO

ABSTRACT Objective: To analyze the temporal trends in the fertility rate, proportion of antenatal consultations and caesarean sections in Brazilian adolescents aged 15 to 19, between 2000 and 2015. Methods: The fertility rate, proportion of prenatal consultations and proportion of routes of birth were calculated using data from DATASUS. The trend analysis was performed using the Prais-Winsten regression model and the annual percentage change. Results: There was a trend of reduction of 3.5% per year in the fertility rate among adolescents (p<0.05), in addition to an increasing trend of 6% per year in the proportion of more than six antenatal consultations (p <0.0001) and an increasing trend of 6.8% per year in the proportion of caesarean sections (p<0.0001). Conclusion: Despite the decreasing trend in fertility rates among Brazilian adolescents, they remain high. Also noteworthy is the growing trend for caesarean sections, even with improved access to antenatal care.

RESUMEN Objetivo: Analizar las tendencias temporales de la tasa de fertilidad, proporción de consultas de prenatal y cesarianas en adolescentes brasileñas de 15 a 19 años, entre 2000 y 2015. Métodos: La tasa de fertilidad, proporción de consultas de prenatal y proporción de vías de nacimiento fueran calculadas con datos del DATASUS. Análisis de tendencia realizada utilizándose modelo de regresión de Prais-Winsten y la tasa de variación media anual. Resultados: Observó tendencia de reducción de 3,5% al año de la tasa de fertilidad entre las adolescentes (p<0,05), además de tendencia creciente de 6% al año de la proporción de más de seis consultas de prenatal (p<0,0001) y tendencia creciente de 6,8% al año de la proporción de cesarianas (p<0,0001). Conclusión: Aunque la tendencia decreciente de la tasa de fertilidad en adolescentes brasileñas, ellas aún permanecen elevadas. Destaca también la tendencia creciente de cesarianas, mismo con la mejoría del acceso al prenatal.

RESUMO Objetivo: Analisar as tendências temporais da taxa de fertilidade, proporção de consultas de prénatal e cesarianas em adolescentes brasileiras de 15 a 19 anos, entre 2000 e 2015. Métodos: A taxa de fertilidade, proporção de consultas de pré-natal e proporção de vias de nascimento foram calculadas com dados do DATASUS. A análise de tendência foi realizada utilizando-se o modelo de regressão de Prais-Winsten e a taxa de variação média anual. Resultados: Observou-se tendência de redução de 3,5% ao ano da taxa de fertilidade entre as adolescentes (p<0,05), além de tendência crescente de 6% ao ano da proporção de mais de seis consultas de pré-natal (p<0,0001) e tendência crescente de 6,8% ao ano da proporção de cesarianas (p<0,0001). Conclusão: Apesar da tendência decrescente da taxa de fertilidade nas adolescentes brasileiras, elas ainda permanecem elevadas. Destaca-se também a tendência crescente de cesarianas, mesmo com a melhoria do acesso ao pré-natal.

RESUMO

ABSTRACT Objective: In humans, males' births exceed females' births. This ratio is conventionally referred to as M/F and is used to denote male births divided by total births. This ratio is influenced by a large number of factors and has been shown to exhibit seasonality. This study was carried out in order to ascertain whether seasonal variation in M/F exists in the United States of America and whether such variations are influenced by race. Materials and Methods: Data on births by gender and race from 2003 to 2013 were obtained from Centres for Disease Control and Prevention Wonder section as four races: White, Black/African American, Asian/Pacific Islander and American Indian/Alaska Native. ANOVA and ARIMA tests were carried out. Results: This study analysed 45 103 146 live births (M/F 0.51182) over 2003 to 2013. M/F was highest in Asian/Pacific Islander (p < < 0.0001), followed by White (p = 0.002), American Indian/Alaska Native (p = 0.04) and Black/African American. Significant seasonality was present overall, with a peak in June, for Whites more than Black/African American. Conclusion: Parental stress lowers M/F, and lower M/F found in Black/African and American Indian/Alaskan births may be stress related. The dampened seasonality noted in Black/African American births may also be due to this phenomenon. More males were born in spring, as in other species, with interesting inter-racial differences.

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