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Pretreatment with mifepristone followed by treatment with misoprostol resulted in a higher likelihood of successful management of first-trimester pregnancy loss than treatment with misoprostol alone. (Funded by the National Institute of Child Health and Human Development; PreFaiR ClinicalTrials.gov number, NCT02012491 .).

L. crispatus may have a beneficial effect on the burden of HPV in both HIV-infected and HIV-uninfected women (independent of pH).

Background HIV-seropositive women face high risk for infection with oncogenic human papillomavirus (oncHPV) types, abnormal Pap test results, and precancer, but cervical cancer risk is only modestly increased. Human papillomavirus (HPV)16 is highly oncogenic but only weakly associated with HIV status and immunosuppression, suggesting HPV16 may have a greater innate ability to evade host immune surveillance than other oncHPV types, which in turn should result in a greater relative increase in the prevalence of other oncHPV types among women with cervical precancer. Objective We sought to assess whether the underrepresentation of HPV16 among HIV-seropositive relative to HIV-seronegative women remains among those with cervical precancers. Study Design HIV-seropositive and HIV-seronegative women in the Women's Interagency HIV Study were screened for cervical intraepithelial neoplasia (CIN) grade ≥3 (CIN3+). DNA from >40 HPV types was detected by polymerase chain reaction in cervicovaginal lavage specimens obtained at the visit at which CIN3+ was diagnosed. Results HPV16 was detected in 13 (62%) of 21 HIV-seronegative women with CIN3+ but only 44 (29%) of 154 HIV-seropositive women with CIN3+ (P = .01). The lower prevalence of HPV16 in CIN3+ among HIV-seropositive women persisted after controlling for covariates (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.08–0.78). The prevalence of other members of the HPV16-related alpha-9 oncHPV clade as a group was similar in HIV-infected and uninfected women with CIN3+ (OR, 1.02; 95% CI, 0.53–1.94). The prevalence of non-alpha-9 oncHPV types was increased in HIV-seropositive vs HIV-seronegative women with CIN3+ (OR, 3.9; 95% CI, 1.3–11.8). Conclusion The previously demonstrated increase in CIN3+ incidence among HIV-seropositive women is associated with lower HPV16 and higher non-alpha-9 oncHPV prevalence. This is consistent with prior reports that HIV has a weak effect on infection by HPV16 relative to other oncHPV and supports use of nonavalent HPV vaccine in HIV-seropositive women.

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OBJECTIVE: Serum biomarkers of ovarian reserve have been utilized in non-RPL cohorts to stratify patients who may benefit from PGT-A. The goal of this study was to determine if AMH levels are predictive of outcomes in RPL patients pursuing PGT-A. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Unexplained RPL patients undergoing PGT-A at two fertility centers from 2009-2018 were included. All patients with the intent to perform PGT-A (trophectoderm biopsy and 24 chromosome screening) were included regardless of final cycle outcome. Pregnancy loss was defined as loss of pregnancy from conception (bHCG level >5mIU/ mL) through twenty weeks gestation. RESULTS: 157 patients underwent 191 retrievals (RET), 146 of which completed PGT-A. Patient demographics and outcomes stratified by AMH<1 ng/mL and AMH R1 ng/mL are shown in Table 1. Patients with AMH < 1 ng/mL were significantly older with similar BMI and number of prior losses compared to patients with AMH R1 ng/mL. Patients with AMH <1 ng/mL had fewer oocytes (p<0.01) and a higher average aneuploidy rate (p¼0.02) compared to patients with AMH R1 ng/mL. In a regression model adjusting for age, AMH is not a significant predictor of having at least one euploid blastocyst (p¼0.10, CI 0.97-1.43), reaching ET (p¼0.97, CI 0.84-1.18), achieving pregnancy (p¼0.42, CI 0.82-1.09), achieving live birth (p¼0.12, CI 0.86-1.02) or undergoing pregnancy loss (p¼0.42, CI 0.90-.28). CONCLUSIONS: Although ovarian reserve is associated with IVF success rates, we report that RPL patients with diminished ovarian reserve (DOR) have similar likelihood of achieving pregnancy and live birth with PGT-A compared to RPL patients with AMH > 1 ng/mL. Future studies should incorporate total cycle potential in evaluation of clinical outcomes and consider a lower AMH cutoff for evaluating DOR. Reference: None. SUPPORT: None.

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