Estimates of human fertility and pregnancy loss

Zinaman, Michael J.; Clegg, Eric D.; Brown, Charles; O’Connor, John F.; Selevan, Sherry G.

doi:10.1016/s0015-0282(16)58144-8

Cited by 471 publications

(99 citation statements)

References 12 publications

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“…Estimates for FEC HCG of 30% 7 and 40% 8 , and for FEC CLIN of 30% 8 and 25% 6 probably underestimate the fecundability of reproductively healthy women owing to a mixed fertile/sub-fertile population in these studies. The object of the present analysis was to determine whether the published aggregate data supported this hypothesis and to estimate fecundability for any sub-cohorts identified.…”

Section: Introductionmentioning

confidence: 75%

“…Three well-designed studies (henceforth referred to as the Wilcox 6 , Zinaman 7 and Wang 8 studies) have shown that approximately two-thirds of menstrual cycles in which elevated human chorionic gonadotrophin (hCG) is detected approximately 1 week after ovulation proceed to a live birth. hCG is produced by the trophoblast cells of the embryo 9 and its earliest detection indicates that implantation has commenced 10– 12 .…”

Section: Introductionmentioning

confidence: 99%

“…Clearly, as fecundability increases, the range of plausible values for embryo mortality narrows. Crude estimates of live birth fecundability can be calculated from prospective study data: 19.2% (136 births from 707 cycles 6 ), 18.2% (79 births from 432 cycles 7 ) and 23.9–25.9% (373 births and 31 ongoing pregnancies from 1,561 cycles 8 ). These represent lower limits for fecundability, since optimal conditions for reproductive success were not achieved in every cycle 17 .…”

Section: Introductionmentioning

confidence: 99%

“…Subjects either had “no known fertility problems” 6 , or were excluded if they had any “known risk factors for infertility” 7 or “had tried unsuccessfully to get pregnant for ≥1 year at any time in the past” 8 . However, such criteria cannot guarantee complete exclusion of sub-fertile or infertile couples, and in each study pregnancy rates declined in successive cycles as the presumed proportion of sub-fertile women remaining increased.…”

Section: Introductionmentioning

confidence: 99%

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Estimating limits for natural human embryo mortality

Jarvis

2016

F1000Res

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Natural human embryonic mortality is generally considered to be high. Values of 70% and higher are widely cited. However, it is difficult to determine accurately owing to an absence of direct data quantifying embryo loss between fertilisation and implantation. The best available data for quantifying pregnancy loss come from three published prospective studies (Wilcox, Zinaman and Wang) with daily cycle by cycle monitoring of human chorionic gonadotrophin (hCG) in women attempting to conceive. Declining conception rates cycle by cycle in these studies indicate that a proportion of the study participants were sub-fertile. Hence, estimates of fecundability and pre-implantation embryo mortality obtained from the whole study cohort will inevitably be biased. This new re-analysis of aggregate data from these studies confirms the impression that discrete fertile and sub-fertile sub-cohorts were present. The proportion of sub-fertile women in the three studies was estimated as 28.1% (Wilcox), 22.8% (Zinaman) and 6.0% (Wang). The probability of conceiving an hCG pregnancy (indicating embryo implantation) was, respectively, 43.2%, 38.1% and 46.2% among normally fertile women, and 7.6%, 2.5% and 4.7% among sub-fertile women. Pre-implantation loss is impossible to calculate directly from available data although plausible limits can be estimated. Based on this new analysis and a model for evaluating reproductive success and failure it is proposed that a plausible range for normal human embryo and fetal mortality from fertilisation to birth is 40-60%.

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Section: Introductionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Estimating limits for natural human embryo mortality

Jarvis

2016

F1000Res

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“…Successful implantation requires an implantation competent blastocyst and a receptive endometrium, both of which are precisely regulated by ovarian hormones, estrogen and progesterone [2, 3]. Embryo implantation is low-efficiency process, because the maximum chance of natural pregnancy or in vitro fertilization (IVF) pregnancy occurring in a menstrual cycle is approximately 30%, largely due to implantation failure [4, 5]. In addition, an emerging concept is that early pregnancy loss and various pregnancy complications are rooted in suboptimal embryo implantation [6].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Embryo-Induced Transcriptomic Changes in Hamster Uterus Using RNA-Seq

Huang¹,

Zhang²,

Zhao³

et al. 2018

Cell Physiol Biochem

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Background/Aims: The mouse is widely used as an animal model for studying human embryo implantation. However, the mouse is unique in that both ovarian progesterone and estrogen are critical to implantation, whereas in the majority of species (e.g. human and hamster) implantation can occur in the presence of progesterone alone. Methods: In this study, we analyzed embryo-induced transcriptomic changes in the hamster uterus during embryo implantation by using RNA-seq. Differentially expressed genes were characterized by bioinformatic analysis. Results: We identified a total of 781 differentially expressed genes, of which 367 genes were up-regulated and 414 genes were down-regulated at the implantation site compared to the inter-implantation site. Functional clustering and gene network analysis highlighted the cell cycle process in uterus upon embryo implantation. By examining of the promoter regions of differentially expressed genes, we identified 7 causal transcription factors. Additionally, through connectivity map (CMap) analysis, multiple compounds were identified to have potential anti-implantation effects due to their ability to reverse embryo-induced transcriptomic changes. Conclusion: Our study provides a valuable resource for in-depth understanding of the mechanism underlying embryo implantation.

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Early Pregnancy Loss Management in the Emergency Department vs Outpatient Setting

et al. 2023

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ImportanceEarly pregnancy loss (EPL), or miscarriage, is the most common complication of early pregnancy, and many patients experiencing EPL present to the emergency department (ED). Little is known about how patients who present to the ED with EPL differ from those who present to outpatient clinics and how their management and outcomes differ.ObjectiveTo compare the management and outcomes of patients with EPL who present to the ED vs outpatient clinics.Design, Setting, and ParticipantsThis retrospective cohort study used the IBM MarketScan Research Database, a national insurance claims database. Participants were pregnant people aged 15 to 49 years in the US who presented to either an ED or outpatient clinic for initial diagnosis of EPL from October 2015 through December 2019. Data analysis was performed from May 2021 to March 2022.ExposuresThe primary exposure was location of service (ED vs outpatient clinic). Other exposures of interest included demographic characteristics, current pregnancy history, and comorbidities.Main Outcomes and MeasuresThe primary outcome was EPL management type (surgical, medication, or expectant management). Complications, including blood transfusion and hospitalization, and characteristics associated with location of service were also evaluated. Bivariable analyses and multivariable logistic regression were used for data analysis.ResultsA total of 117 749 patients with EPL diagnoses were identified, with a mean (SD) age of 31.8 (6.1) years. Of these patients, 20 826 (17.7%) initially presented to the ED, and 96 923 (82.3%) presented to outpatient clinics. Compared with the outpatient setting, patients in the ED were less likely to receive surgical (2925 patients [14.0%] vs 23 588 patients [24.3%]) or medication (1116 patients [5.4%] vs 10 878 patients [11.2%]) management. In the adjusted analysis, characteristics associated with decreased odds of active (surgical or medication) vs expectant management included ED (vs outpatient) presentation (adjusted odds ratio [aOR], 0.46; 95% CI, 0.44-0.47), urban location (aOR, 0.87; 95% CI, 0.82-0.91), and being a dependent on an insurance policy (vs primary policy holder) (aOR, 0.71; 95% CI, 0.67-0.74); whereas older age (aOR per 1-year increase 1.01; 95% CI, 1.01-1.01), established prenatal care (aOR, 2.35; 95% CI, 2.29-2.42), and medical comorbidities (aOR, 1.05; 95% CI, 1.02-1.09) were associated with increased odds of receiving active management. Patients in the ED were more likely than those in outpatient clinics to need a blood transfusion (287 patients [1.4%] vs 202 patients [0.2%]) or hospitalization (463 patients [2.2%] vs 472 patients [0.5%]), but complications were low regardless of location of service.Conclusions and RelevanceIn this cohort study of privately insured patients with EPL, differences in management between the ED vs outpatient setting may reflect barriers to accessing comprehensive EPL management options. More research is needed to understand these significant differences in management approaches by practice setting, and to what extent EPL management reflects patient preferences in both outpatient and ED settings.

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Estimates of human fertility and pregnancy loss

Cited by 471 publications

References 12 publications

Estimating limits for natural human embryo mortality

Estimating limits for natural human embryo mortality

Assessment of Embryo-Induced Transcriptomic Changes in Hamster Uterus Using RNA-Seq

Early Pregnancy Loss Management in the Emergency Department vs Outpatient Setting

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