Who will conceive with IVF?

When considering the chances of establishing a healthy ongoing pregnancy after in vitro fertilization (IVF), the cause of infertility plays a relatively minor role. In recent years, there has been a shift from determining the diagnosis to the individual prognosis for a given patient. A number of prognostic factors were identified, which enabled clinicians to appropriately counsel patients. Patient-determined factors are of crucial importance and some are amenable to intervention such as lifestyle and nutritional advice. However, the attention of clinicians remains on seeking adjuvant therapeutic interventions designed to improve the outcomes of IVF treatment. In this article, the patient-determined factors underlying the individual chance of conceiving and the more commonly prescribed empirical medical therapies prescribed to enhance outcomes are reviewed. It is concluded that greater attention to optimizing the health of the couple before starting IVF treatment may be more beneficial than adjuvant medical therapies during treatment.     

备孕期高血压的规范管理

近年来由于生活压力的增加,我国越来越多的育龄期男女罹患高血压,因此如何规范管理备孕期高血压已成为当前的焦点。本文从备孕期间血压的监测与评估和降压药的使用两方面分别对育龄期男性和女性备孕期间的血压规范管理进行阐述,强调女性备孕期间的高血压管理应同时考虑母体和胎儿的安全性,选择相对安全的降压药,如甲基多巴、拉贝洛尔、硝苯地平等;男性备孕期间的高血压管理应同时考虑降压药的疗效及其对性功能和精子的影响,推荐奈必洛尔、血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）和钙离子通道阻滞剂（CCB）类药物,旨在为临床备孕期高血压的管理提供指导并为未来研究提供参考方向。     

重庆市孕前生殖健康与出生结局队列：设计简介与建设概况

出生队列是研究生命早期暴露对健康结局影响的重要工具, 但目前缺乏有力支撑孕前暴露特别是父系暴露对生殖健康和妊娠结局影响研究的大型队列平台。重庆市孕前生殖健康与出生结局队列研究是起始于孕前阶段, 同等关注男女双方的环境、心理、行为等暴露因素对生殖健康和不良妊娠结局影响的前瞻性队列研究。项目于2019年正式启动, 计划招募有生育意愿的育龄夫妇20 800人。通过随访, 调查志愿者2年内是否自然受孕。对进入妊娠期的女性志愿者, 在孕早、中、晚期进一步随访, 并对分娩的子代随访至2岁, 监测早产、低出生体重、出生缺陷、神经功能发育障碍等结局发生情况。各阶段分别采集相应的数据信息和生物样本, 包括精液、外周血、尿液、胎盘、脐带、脐带血、口腔拭子等。截至2022年1月, 已纳入志愿者8 698人, 分布于重庆市所有38个区/县。本队列建设目标是成为涵盖父母双方的前瞻性大样本孕前出生队列, 将以独特的设计和更加全面的视角阐明全生育周期特别是孕前期暴露因素对生殖健康和不良出生结局的影响及机制。     

Optimizing Preconception Health among Young Women: What Are We Missing?

Study ObjectiveTo evaluate whether receipt of specific preconception counseling topics differs between teen, young adult, and older mothers.Design, Setting, Participants, Interventions, and Main Outcome MeasuresA survey of 291 primarily low-income, minority mothers with young children at pediatric practices in Baltimore, Maryland was conducted. Multivariable logistic regression models generated relative odds of preconception counseling receipt comparing teens (ages 14-19 years) and young adults (ages 20-24 years) to adult women (age ≥25 years) controlling for demographic characteristics, parity, and pregnancy intention.ResultsTeen mothers were less than half as likely to be counseled about taking folic acid, 4 times more likely to be counseled about vaccines, and twice as likely to be counseled about mental health before pregnancy compared with adult mothers.ConclusionAdolescent preventive care might promote some aspects of preconception health, but topics related specifically to pregnancy outcomes might be missed. Because of the high rate of unplanned teen pregnancy in the United States, additional strategies to promote preconception health in this population are warranted.     

Are zona pellucida laser drilling and polar body biopsy safe for in vitro matured oocytes?

Introduction  

Preconception diagnosis requires first polar body biopsy. When the hole in the zona pellucida is made with a laser beam, heat propagation could, like the biopsy itself, be deleterious. Our aim was to evaluate the effect of this technique on human in vitro matured oocyte and embryo development.     

外出务工妇女与户籍妇女孕前保健知识知晓及服务获得情况比较分析

目的:调查外出务工育龄妇女对出生缺陷预防和孕前优生健康检查的知晓和服务获得状况,为建立适宜高效的一级预防干预模式提供技术支持和依据。方法:对2013年3~8月在广东部分地区计划生育技术服务机构接受孕前优生健康检查服务的育龄妇女进行出生缺陷预防知识和孕前优生健康检查服务相关问卷调查。结果:调查对象外出务工组378名,户籍地常住组401名。779名对象年龄25.19±3.34岁。两组对象年龄、受教育程度和职业构成均无统计学差异(P均0.05)。调查对象对于出生缺陷的原因和预防措施及孕前优生服务项目等了解不全面。户籍地常住组对象对于如何获取这些免费服务的认知程度以及对孕前优生健康检查中地中海贫血筛查的意义知晓度明显高于外出务工组(P均0.05)。户籍地常住组对象出生缺陷预防知识得分高于外出务工组,且得分与对象受教育程度明显相关。结论:加强流动人口流入地出生缺陷相关知识科普宣传和孕前保健服务的提供,有利于提高目标人群出生缺陷一级预防效果。     

育龄妇女孕前心理压力状况及相关因素分析

目的:研究旨在考察育龄妇女孕前的心理压力状况及其影响因素。方法:对2010~2013年参加国家免费孕前优生健康检查项目的540 500名育龄妇女的基本信息、既往史和心理压力调查数据进行分析,并采用logistic回归分析对孕前心理压力的相关影响因素进行探讨。结果:3%的育龄妇女感到孕前心理压力较大,且不同社会人口学变量的心理压力分布比例差异显著。多因素分析显示,在有患病史、不良妊娠史以及不良行为习惯的育龄人群中,孕前心理压力大的发生率约为无疾病史、无不良妊娠史以及不吸烟、不饮酒的育龄妇女的2倍。结论:我国少部分育龄妇女孕前感到心理压力较大,年龄、职业、文化程度以及既往患病史、不良行为习惯是影响育龄妇女孕前心理压力的重要因素。希望该研究能够引起人们对育龄妇女孕前心理压力的重视,并为孕前心理保健服务提供参考依据。     

孕前保健对某地区出生缺陷及其他不良妊娠结局影响的观察

目的探讨孕前保健对广州市番禺区出生缺陷及其他不良妊娠结局的影响。方法选择1000个样本量进行研究,将进行孕前保健的500例设为观察组,未进行孕前保健的500例设为对照组,比较两组观察对象优生知识知晓率、叶酸服用情况、产前检查与治疗及不良妊娠结局等指标。结果观察组优生知识知晓率、叶酸服用率、慢性病的治疗覆盖率均明显优于对照组（P〈0.05）;观察组孕4周内妊娠确诊率、出生缺陷产前筛查覆盖率明显高于对照组,妊娠早期主要危险因素暴露水平明显低于对照组（P〈0.05）;观察组早产及过期妊娠率、新生儿窒息发病率、出生缺陷发生率均明显低于对照组（P〈0.05）,产后出血量明显低于对照组,差异有统计学意义（P〈0.05）。结论孕前保健可减少出生缺陷,改善妊娠结局,应进一步推进孕前保健工作的顺利开展。