Fertility News

Bioengineering repairs uterus resulting in live births in rabbits

Bioengineering repairs uterus resulting in live births in rabbits

Researchers looking for an alternative to uterus transplants successfully restored uterine structure and function in rabbits using bioengineered uterine tissue.

The research, published in Nature Biotechnology, showed that the engineered tissue developed native tissue-like structures and was able to support pregnancies leading to live births.

‘The study shows that engineered uterine tissue is able to support normal pregnancies, and fetal development was normal,’ said author Professor Anthony Atala from the Wake Forest Institute for Regenerative Medicine in North Carolina. ‘With further development, this approach may provide a pathway to pregnancy for women with an abnormal uterus‘.

In the study, 78 rabbits were randomly assigned to four different groups: groups one to three had most of their uterine tissue removed. Group four was a normal control group, where animals underwent a sham surgery but no tissue was removed.

In group one the excision was repaired with a synthetic polymer scaffold containing cells collected from the tissue that was removed; group two underwent repair with the polymer scaffold only; in group three no extra material was added and the remaining edges were stitched together.

The polymer scaffolds degraded after three months. At six months the group that had repair with the scaffold only developed a thin uterine wall, but the group that received the scaffold seeded with cells had developed native tissue-like structures including distinct endometrium and myometrium tissue layers, and were expressing progesterone and oestrogen hormone receptors. The excision-only group formed scar tissue.

The rabbits were mated naturally with fertile males six months after the procedures. Four out of ten rabbits from the tissue-engineered group had normal PREand gave birth to healthy offspring with normal body weights. No fetal development occurred in the scaffold-only or excision-only groups.

‘This is a highly significant finding with great potential for future human application. For women who suffer infertility due to a severely damaged uterus or because of a hysterectomy then adaptations of this approach may well find clinical application,’ said Professor Darren Griffin from the University of Kent, who was not involved in the study.

Uterus transplantation became a viable treatment following the first successful transplant which led to a live birth in 2014. However, this treatment is associated with a range of issues including lack of donors, transplant rejection and the risk of disease transmission. Bioengineered uteri could be an alternative treatment method for women with uterine infertility; however, more preclinical studies need to be carried out before clinical trials can be performed in humans.

Read more: https://www.nature.com/articles/s41587-020-0547-7

Response to stimulation in IVF may predict longer term health risks

Response to stimulation in IVF may predict longer term health risks

Low ovarian reserve with few eggs collected associated with a higher risk of chronic disease.

A follow-up study of almost 20,000 young women who had a first cycle of IVF in Denmark between 1995 and 2014 indicates that those who responded poorly to treatment, with few eggs collected, are at a significantly increased risk of later age-related diseases.

The findings, according to investigator Mette Wulf Christensen from Aarhus University in Denmark, suggest an “association with early ovarian ageing and an accelerated ageing process in general.”

The results, she explains, are consistent with what we know so far about early menopause, which has been shown in several studies to be associated with an increased risk of cardiovascular diseases, osteoporosis and mortality.

Identifying women at risk of early menopause may thus allow early preventive health initiatives in terms of a healthy lifestyle,” says Christensen.

This is the first time that the yield of eggs in IVF as a measure of ovarian ageing — and thus as a risk predictor of age-related ill-health and mortality — has been investigated in a large-scale cohort study. The results were presented online by Ms Christensen, a PhD student, at the virtual Annual Meeting of ESHRE.

The study was based on the national registries of Denmark in which each individual has their own identifying number, thus allowing cross-linkage between various registries of health outcomes and treatments.

In this case women below the age of 37 who had a first cycle of IVF or ICSI in Denmark between 1995 and 2014 were divided into one of two groups according to their response to ovarian stimulation: those who had produced five or fewer eggs for collection, defined as “early ovarian ageing“; and those who responded normally with at least eight eggs. The number of eggs harvested was thus used as a marker of ovarian reserve. There were 1,234 women in the former group, and 18,614 in the latter.

During the six-year average period of follow-up, the incidence of chronic disease in the two groups was analysed from the cross-linked registry data, providing a real-life estimate of risk for cardiovascular disease, osteoporosis, type-2 diabetes, cancer, and all-cause mortality.

Results showed that women in the early ovarian ageing group had an increased overall risk (by 26%) of all-cause disease when compared to those with a normal ovarian response. This higher risk was statistically significant, and evident in cardiovascular diseases (39% higher) and osteoporosis (more than double).

The two groups were also cross-checked with the “early retirement benefit” register, in which the early ovarian ageing group were also more likely to be listed.

The risk of cancer, other age-related diseases and all-cause death was not significantly different.

Commenting on the implications of the results, Ms Christensen said that, although the common biological mechanisms behind ovarian and general ageing are “somewhat obscure,” the data from this study demonstrate that young women with early ovarian ageing — defined as low oocyte output after FSH stimulation — have an increased risk of age-related morbidity and possibly mortality, “and strongly support the hypothesis that low ovarian reserve may be a useful marker of later health problems.”

Counseling this group of patients at fertility clinics, she added, “may, therefore, be important for introducing preventive measures such as lifestyle changes or the use of HRT to reduce the adverse health risks which follow an earlier menopause.”

Source: European Society of Human Reproduction and Embryology.

Fertility preservation is effective in female cancer patients

Fertility preservation is effective in female cancer patients

The largest study looking at long-term outcomes of fertility preservation in female cancer patients has demonstrated how successful it can be, in particular for breast cancer patients.

The research, presented at the virtual meeting of the European Society of Human Reproduction and Embryology 2020 followed 879 young female patients (mean age 33.8) over a period of 19 years (2000-2019) – the longest reported follow-up of fertility preservation in cancer patients.

‘Currently, there is limited long-term outcome data [on fertility preservation] and this makes it difficult to counsel patients about the likelihood of success.’ said study author Dr Dalia Khalife from Guy’s and St Thomas’ Hospital, London. ‘Our study offers the largest cohort and longest follow-up of fertility preservation in female cancer patients… Around one in six of those who stored their gametes had a good outcome.’

However, she noted that there is a need for longer follow-up of patients and that early referral for fertility treatment is vital.

After counselling, 373 patients (42 percent) chose to have fertility preservation using one of three fertility preservation techniques: egg freezing (53 percent), embryo freezing (41 percent) and ovarian tissue cryopreservation (1%); with 5% using both egg and embryo freezing.

A total of 61 patients (16.4 percent) returned to use their eggs and 44 of them were successful following fertility treatment (live birth rate 72.1 percent).

Women diagnosed with breast cancer were the most likely to return for treatment and also had the highest live birth rate (70 percent versus 30 percent for lymphoma patients).

‘A fertility preservation service must be integral to a modern cancer care pathway. Fertility preservation with eggs and embryos has been beyond experimental for some time. And it’s important that clinicians across the world continue to collect and share data on long-term outcome for all methods, including ovarian tissue preservation, to provide patients with robust information’ said Dr Khalife.

Commenting on the study, Dr Melanie Davies, consultant obstetrician and gynaecologist at University College London Hospitals NHS trust and chair of Fertility Preservation UK, :

‘This is fantastic news – proof positive that fertility preservation is effective and worthwhile. It gives excellent outcomes for those women who return to use frozen eggs/embryos, as 44 of 61 achieved successful pregnancies and births. The proportion of patients who came back to the fertility clinic to use their frozen eggs/embryos (16 percent) is notably higher than for men who store sperm. More will return as the years pass. These results confirm that young women with a new diagnosis of cancer should be offered fertility preservation as part of their treatment pathway as long as they are well enough and time allows.’

Read more: https://www.eshre.eu/ESHRE2020/Media/2020-Press-releases/Khalife

Female hormone in hair could predict response to ovarian stimulation for IVF

Female hormone in hair could predict response to ovarian stimulation for IVF

The prospect of a non-invasive test of ovarian reserve is a little closer following results from a study showing that measurement of a fertility hormone can be accurately taken from a sample of human hair.

Anti-Mullerian hormone — or AMH — has become a key marker in the assessment of how women may respond to fertility treatment.

The hormone is produced by small cells surrounding each egg as it develops in the ovary, and is thus seen as a measure of ovarian reserve. Although studies have not correlated AMH levels to a reliable chance of live birth (nor to forecasting the time of menopause), AMH measurement has become an intrinsic marker in assessing how a patient will respond to ovarian stimulation for IVF — as a normal responder, poor responder (with few eggs), or over-responder (with many eggs and a risk of ovarian hyperstimulation syndrome, OHSS).

AMH is presently measured in serum taken from a blood sample drawn intravenously. The readings represent a measurement at a short moment in time and are relatively invasive to complete.

Now, a new study presented at the online Annual Meeting of ESHRE has tested the quantification of AMH from human hair and found it to be a less invasive and a “more appropriate representation of hormone levels” than from an “acute” source like serum.

The results are presented this week in a poster from PhD student Sarthak Sawarkar, working in the laboratory of Professor Manel Lopez-Bejar in Barcelona, with collaborators from MedAnswers Inc in the USA.

The study, which still continues, now reports results from 152 women from whom hair and blood samples were routinely collected during hospital visits. AMH measured in serum from the same subjects was used to provide a control, as was an ultrasound count of developing follicles in the ovary (AFC) as a further measure of ovarian reserve.

“Biologically relevant” AMH levels were successfully detected in the hair samples, with levels declining with patient age, as expected. As ovarian reserve declines with age, so do AMH levels. The AMH levels from hair strongly correlated with both serum levels and AFC.

It was also seen that the hair test was able to detect a wide range of AMH levels within individuals from a similar age cohort, suggesting a greater accuracy than from a single blood sample.

Hormones accumulate in hair shafts over a period of months, while hormone levels in serum can change over the course of hours.

“So hair,” explain the authors, “is a medium that can accumulate biomarkers over several weeks, while serum is an acute matrix representing only current levels. While hormone levels in blood can fluctuate rapidly in response to stimuli, hormone levels measured in hair would represent an accumulation over several weeks. A measurement using a hair sample is more likely to reflect the average hormone levels in an individual.”

Among the other advantages of a hair test, the authors note that hormone levels are assessed non-invasively, which reduces testing stress and offers a less expensive assay. Testing can be done without visiting a clinic, and thus makes this type of test available to a broader range of women.

“Finally,” explains Mr Sawarkar, “as hair offers a look at the long-term accumulation of hormones, this measurement may allow a better understanding of an individual’s hormone levels — unlike blood-based assays, which can only measure the hormone at the moment of the testing.”

AMH has so far had an important — though sometimes controversial — role in reproductive medicine. Thus, while its role as a measure of ovarian reserve in predicting response to ovarian stimulation for IVF now seems beyond question, there has been doubt over its broader application as a measure of female fertility in the general population.

Commenting on the biology of the test, Mr Sawarkar explains that hormones are incorporated into the matrix of hair before the growing hair reaches the skin surface, thereby allowing an accumulating measurement of hormone concentration.

Story Source: European Society of Human Reproduction and Embryology

Embryo vitrification is safe but longer storage reduces chances of pregnancy success

Embryo vitrification is safe but longer storage reduces chances of pregnancy success

Freezing and storing embryos during fertility treatment using a technique called vitrification is safe, although women are less likely to become pregnant and have a live birth the longer the embryos are stored, according to new research published in Human Reproduction, one of the world’s leading reproductive medicine journals.

There have been concerns that vitrification technology could be unsafe for the embryo, leading to complications at the time of birth and later, including preterm birth, low or high birthweight and birth defects.

Until now, it was also unclear whether storage time after vitrification affected embryo viability, pregnancy outcomes or neonatal outcomes. The study, which is the largest to investigate these questions, found that the chances of becoming pregnant and giving birth to a live baby significantly decreased with longer storage time.

The researchers from the Shanghai Ninth People’s Hospital (Shanghai, China) analysed outcomes from 24,698 patients who had vitrified embryos transferred for the first time between January 2011 and December 2017.

They compared patients who had vitrified embryos stored for up to three months (group one) with patients whose embryos were stored for 3-6 months (group two), 6-12 months (group three) and 12-24 months (group four). They found that the implantation rate fell from 40% in group one to 26% in group four; the clinical pregnancy rate fell from 56% in group one to 26% in group four; and the live birth rate fell from 47% in group one to 26% in group four.

This means that among women who had embryos stored for less than three months, 47 out every 100 women would achieve a live birth. Whereas among women who had embryos stored for between 12-24 months, 34 out of every 100 women would achieve a live birth.

The rate of miscarriages and ectopic pregnancies also increased with longer storage time. However, these associations were not statistically significant after taking into account factors that could affect the results such as the mother’s age, mother’s body mass index, the cause of infertility, parity and embryo quality and stage of development. There was no evidence that storage time affected neonatal outcomes.

Groups three and four had a greater proportion of older women or patients with a poor prognosis due to smaller numbers of available eggs than groups one and two; so the researchers carried out a second analysis to investigate whether it could be the women’s ages and the amount of viable eggs they had in their ovaries at the time of vitrification and embryo transfer that led to the lower pregnancy and birth rates.

They analysed a subset of 7,270 women who were younger than 36 years and whose infertility was caused by blocked or damaged fallopian tubes. This produced similar results; there was a 50% live birth rate among women in group one, compared to a 38% live birth rate in group four.

Dr Qianqian Zhu is a research assistant who led the study. She said: “We think the results from this sub-analysis support our main results about the relationship between the duration of storage with pregnancy and neonatal outcomes.”

Co-author, Professor Qifeng Lyu is deputy director of the department of assisted reproduction at the hospital. He said: “Our study suggests that although the storage time of vitrified embryos negatively affected pregnancy outcomes, including clinical pregnancy and live birth rates, it did not affect neonatal outcomes. Concerns have arisen over the safety of prolonged storage time of vitrified embryos worldwide following the wide application of vitrification, and neonatal health is related to growth, development and health in childhood, adolescence and adulthood. Our study demonstrated the safety of using long-stored embryos after vitrification on neonatal health.

This is reassuring news for couples seeking fertility treatment. The reduction in live birth rates can be overcome through additional embryo transfer cycles. If we had found that neonatal health was adversely affected by vitrification, it would impose a heavy burden on individuals, family and society.”

The study is unable to show the effect of storing embryos for longer than 24 months, and the researchers did not undertake long-term follow-up of babies, so do not have information about their growth and development. As the study was retrospective, the researchers say that prospective studies with long-term follow-up are needed to investigate the safety of vitrification for longer periods of time.

Dr Zhu said: “Our results suggest that clinicians should consider the effect of storage duration before making decisions about the numbers of embryos to freeze and store. This is especially important for cancer patients, who may have their ovaries destroyed by cancer therapies and who have to delay fertility treatment until they have recovered from their disease.”

Vitrification involves placing embryos briefly in a solution to dehydrate them before they are rapidly frozen into a glass-like state. Chemicals called cryoprotectants are used during this process to prevent ice crystals forming, which could damage the embryos. Then the embryos are immediately exposed to liquid nitrogen to freeze them rapidly, ready for storage. When needed, this process is reversed to thaw and warm the embryos quickly. Vitrification is a simple, fast and inexpensive technique, which has become a fundamental tool in fertility treatments in recent years because of its higher embryo survival rates and better clinical outcomes.

Read more: https://academic.oup.com/DocumentLibrary/humrep/PR_Papers/deaa136.pdf

Sperm alterations caused by obesity are not detected in traditional tests

Sperm alterations caused by obesity are not detected in traditional tests

An analysis of sperm from men who were part of a couple whose partner was undergoing in-vitro fertilization (IVF) identified differences in samples between obese vs nonobese men. Specifically, there were differences in the levels of 27 proteins contained in the sperm.

Importantly, all 10 men in these infertile couples (5 obese men and 5 nonobese men) had clinically normal semen, lead study author Taylor Pini, PhD, a postdoctoral scientist at the Colorado Center for Reproductive Medicine, Lone Tree, Colorado said.

That is, the men all had normal sperm concentration, motility, morphology, and DNA fragmentation, which indicates that “these changes in obese men with no overt andrological diagnosis…suggest that traditional clinical semen assessments fail to detect important biochemical changes in spermatozoa which may compromise fertility,” the authors write.

The researchers identified 2034 sperm proteins, of which 24 were significantly less abundant and 3 were more abundant in the obese men than in the men with a healthy weight (P < .05 for both).

The sperm proteins that were less plentiful in the obese men are involved in oxidative stress, inflammation, protein translation, DNA damage repair, and sperm function, and those that were more plentiful are involved in oxidative stress.

“These results suggest that oxidative stress and inflammation are closely tied to reproductive dysfunction in obese men,” the researchers concluded.

These processes likely impact protein translation and folding during spermatogenesis, leading to poor sperm function and subfertility.

Pini noted that “a lot more emphasis has been placed on female as opposed to male obesity” in couples going for infertility work-up, “but I think it is worth considering on the male side as well.”

“It would be worth counseling patients, especially in the very early stages of trying to conceive, that overall health and particularly things like obesity are really worth considering prior to conception,” she emphasized.

The study was published online in the Journal of Assisted Reproduction and Genetics.

An estimated 38% of men of reproductive age (20 to 59 years) in the United States have obesity (body mass index [BMI] ≥30 kg/m2), Pini and colleagues note.

However, it is unclear how obesity may affect male fertility on a molecular level.

Previous studies of sperm proteins in obese men either used a less sensitive method (two-dimensional difference gel electrophoresis), or the more sensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) but with a very small sample (3 men) including men with diabetes or smokers.

Pini and colleagues identified 5 obese men (BMI ≥ 30 kg/m2) and 5 non-obese men (BMI ≤ 25 kg/m2) seen at their reproductive medicine center who had clinically normal semen and did not smoke or have diabetes.

They collected semen samples from the men on the day of the oocyte retrieval in the men’s partners, and they used LC-MS/MS to determine the protein content of the sperm.

The control patients had a mean BMI of 24, and the obese patients had a mean BMI of 33. On average, the men in each group were 39 years old (range 33 to 46).

Obese and nonobese men had similar rates of average sperm concentration (88 x 106), total motility (62%), normal morphology (2.9%), and DNA fragmentation (3.3%).

Among the 27 proteins with altered abundance in obese vs normal-weight men, some were involved in oxidative stress (5), inflammation (2), protein translation (3), DNA damage repair (1), and sperm function (3).

The LC-MS/MS findings were confirmed for several proteins by qualitative immunofluorescence and a quantitative protein immunoassay.

“We have shown that obesity significantly impacts the human sperm proteome, potentially to the detriment of important spermatogenic processes and the function of mature spermatozoa,” the researchers report.

“These changes may be both symptoms of, and contributors to, the inflammation and oxidative stress associated with obesity, and may help to explain why obese men may have altered semen parameters, potentially leading to altered fertility.”

“While some of the problems created by paternal obesity may be overcome by assisted reproduction techniques, the swath of implications following fertilization remains to be rigorously investigated,” they note.

The authors conclude the study by writing that efforts should be directed toward the implementation of treatments to correct or limit the observed changes “when weight loss prior to conception is neither practical nor realistic.”

Read more: https://link.springer.com/article/10.1007/s10815-020-01707-8

Human eggs use chemical attraction to ‘choose’ sperm

Human eggs use chemical attraction to ‘choose’ sperm

The fluid that surrounds an egg when it is released from the ovary acts as a chemical attractant to sperm, but may also select sperm from certain males over others.

Researchers from the universities of Manchester and Stockholm showed that follicular fluid contains chemical signals that improve the chances of successful fertilisation in humans.

‘Human eggs release chemicals called chemoattractants that attract sperm to unfertilised eggs. We wanted to know if eggs use these chemical signals to pick which sperm they attract,’ said lead author Dr John Fitzpatrick from Stockholm University.

The team used samples of sperm and follicular fluid from 16 couples undergoing assisted reproductive treatment. Sperm were able to swim towards either of two follicular fluids in a dish, or one follicular fluid and a control substance. Sperm swim through follicular fluid on their way to reach an unfertilised egg.

The researchers found that each woman’s follicular fluid attracted more sperm from some men than others. There was no obvious pattern to explain which man’s sperm would be attracted to a woman’s follicular fluid; it appeared to be random and didn’t necessarily correlate with a woman’s chosen partner.

It was a real surprise,” says Fitzpatrick. “This is the first time this has been described in humans It is possible that eggs are more attracted to genetically compatible sperm, which may increase the chance that they are fertilised”.

The researchers measured the number of sperm that were able to move into each follicular fluid sample. They found that the average difference in sperm count between the fluid that attracted the most and the least sperm was approximately 18 per cent.

Eggs attracting around 18 per cent more sperm from specific males would likely be pretty important during fertilisations inside the female reproductive tract”, since only a small fraction of sperm reach the egg after sex, says Fitzpatrick.

The chemical interactions between eggs and sperm after sex may also play a role in why some people have difficulty conceiving. In around one in three couples who have fertility problems, there is no clear cause, says Fitzpatrick.

‘The idea that eggs are choosing sperm is really novel in human fertility,‘ said senior author Professor Daniel Brison, from the Department of Reproductive Medicine at Saint Marys’ Hospital, Manchester. ‘Research on the way eggs and sperm interact will advance fertility treatments and may eventually help us understand some of the currently ‘unexplained’ causes of infertility in couples.’

Future studies need to explore whether the same interactions are also present in regular mammalian (particularly human) reproductive cycles, away from the context of assisted reproductive treatment.

The research was published in the Proceedings of the Royal Society.

Read more: https://royalsocietypublishing.org/doi/10.1098/rspb.2020.0805

Fresh donor eggs appear to be better for IVF than frozen

Fresh donor eggs appear to be better for IVF than frozen

Donor eggs provide the best chance of success for many women undergoing IVF. But it wasn’t clear whether using fresh or frozen donor eggs in IVF improves the chances of success, so a team from the University of Colorado and Duke University analyzed nearly 37,000 IVF cycles using donor eggs over three years.

According to the largest comparison of donor egg IVF cycles to date, using fresh donated eggs for IVF leads to slightly better birth outcomes than frozen.

Data from nearly 37,000 IVF cycles in the US between 2012 and 2015 showed that fresh eggs resulted in a slightly greater chance of a good birth outcome, which the researchers defined as a single, non-premature baby delivered at a healthy birth weight.

‘Our study found that the odds of a good birth outcome were less with frozen than with fresh, but it was a small difference’, says lead author Dr Jennifer Eaton, of Duke Fertility Centre in North Carolina.

When the quality of fertilised eggs and the age of both mother and donor were taken into account, the team found that fresh eggs led to good birth outcomes in 24 percent of cycles compared to 22 percent of the cycles with frozen eggs.

Fresh eggs had a much higher likelihood of implantation and birth than frozen eggs, the study found. Compared to frozen eggs, fresh eggs were associated with almost 25% better chance of live birth and a 10% higher odds for good outcomes.

The rates of embryo implantation, pregnancy and live birth were all significantly higher among the women using fresh eggs compared to frozen, but fresh eggs also led to a 37 percent higher chance of multiple births, which could pose greater risk for both mothers and babies.

Donor eggs are often used for older women or women who have a decreased egg supply. This has led to an increased demand for frozen donor eggs which are a cheaper and faster option than fresh donor eggs. But it was previously unknown which type provides the best birth outcomes.

Although this study is the first to show an advantage of fresh donor eggs over frozen, the researchers say that doctors should take the other benefits of using frozen eggs into account when discussing the best option with patients.

‘Given that frozen eggs have many benefits such as ease, cost, and speed, the decision to use fresh or frozen donor eggs should be made on an individual basis after consultation with a physician’, said Dr Eaton.

In Greece, we do not have egg banks. Therefore, the fresh donor eggs are fertilised by the husband’s sperm. We then proceed to either fresh embryo transfer if the recipient is synchronised with the donor. Otherwise, we perform embryo transfer after thawing the frozen embryos in the future, once the recipient is ready. Success rates are similar in both cases.

The study was published in the journal Obstetrics and Gynaecology: https://journals.lww.com/greenjournal/Abstract/2020/03000/Prevalence_of_a_Good_Perinatal_Outcome_With.27.aspx

Placentas from COVID-19-positive pregnant women show injury

Placentas from COVID-19-positive pregnant women show injury

Findings suggest abnormal blood flow between mothers and babies in utero

The placentas from 16 women who tested positive for COVID-19 while pregnant showed evidence of injury, according to pathological exams completed directly following birth.

Αccording to the findings of a new Northwestern Medicine study, the type of injury seen in the placentas shows abnormal blood flow between the mothers and their babies in utero, pointing to a new complication of COVID-19. The findings, though early, could help inform how pregnant women should be clinically monitored during the pandemic.

The study was published in the journal American Journal of Clinical Pathology. It is the largest study to examine the health of placentas in women who tested positive for COVID-19.

“Most of these babies were delivered full-term after otherwise normal pregnancies, so you wouldn’t expect to find anything wrong with the placentas, but this virus appears to be inducing some injury in the placenta,” said senior author Dr. Jeffrey Goldstein, assistant professor of pathology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine pathologist.

“It doesn’t appear to be inducing negative outcomes in live-born infants, based on our limited data, but it does validate the idea that women with COVID should be monitored more closely.”

This increased monitoring might come in the form of non-stress tests, which examine how well the placenta is delivering oxygen, or growth ultrasounds, which measure if the baby is growing at a healthy rate, said co-author Dr. Emily Miller, assistant professor of obstetrics and gynecology at Feinberg and a Northwestern Medicine obstetrician.

“Not to paint a scary picture, but these findings worry me,” Miller said. “I don’t want to draw sweeping conclusions from a small study, but this preliminary glimpse into how COVID-19 might cause changes in the placenta carries some pretty significant implications for the health of a pregnancy. We must discuss whether we should change how we monitor pregnant women right now.”

Fifteen patients delivered live infants in the third trimester, however one patient had a miscarriage in the second trimester. “That patient was asymptomatic, so we don’t know whether the virus caused the miscarriage or it was unrelated,” Goldstein said, “We are aware of four other cases of miscarriage with COVID. The other reported patients had symptoms and three of four had severe inflammation in the placenta. I’d like to see more before drawing any conclusions”, Goldstein said.

The placenta is the first organ to form in fetal development. It acts as the fetus’ lungs, gut, kidneys and liver, taking oxygen and nutrients from the mother’s blood stream and exchanging waste. The placenta also is responsible for many of the hormonal changes within the mother’s body.

Examining a woman’s placenta allows a pathologist to follow a retroactive roadmap of a woman’s pregnancy to learn what happened to the baby in utero or what could happen to both the mother and the infant after birth.

“The placenta acts like a ventilator for the fetus, and if it gets damaged, there can be dire outcomes,” Miller said. “In this very limited study, these findings provide some signs that the ventilator might not work as well for as long as we’d like it to if the mother tests positive for SARS-CoV2.”

The placentas in these patients had two common abnormalities: insufficient blood flow from the mother to the fetus with abnormal blood vessels called maternal vascular malperfusion (MVM) and blood clots in the placenta, called intervillous thrombi.

In normal cases of MVM, the mother’s blood pressure is higher than normal. This condition is typically seen in women with preeclampsia or hypertension. Interestingly, only one of the 15 patients in this study had preeclampsia or hypertension.

“There is an emerging consensus that there are problems with coagulation and blood vessel injury in COVID-19 patients,” Goldstein said. “Our finding support that there might be something clot-forming about coronavirus, and it’s happening in the placenta.”

Between 30 and 40 patients deliver at Prentice daily. The team began testing placentas of COVID-19-positive mothers in early April. Fourteen of the live-born infants in the study were born full term and with normal weights and Apgar scores. One live-born infant was premature.

“They were healthy, full-term, beautifully normal babies, but our findings indicate a lot of the blood flow was blocked off and many of the placentas were smaller than they should have been,” Miller said. “Placentas get built with an enormous amount of redundancy. Even with only half of it working, babies are often completely fine. Still, while most babies will be fine, there’s a risk that some pregnancies could be compromised.”

Read more: https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa089/5842018

Benefits of exercise during pregnancy

Benefits of exercise during pregnancy

Physical fitness is important for pregnant women. It also helps to keep anxiety at bay and maintain the well-being.

The more active and fit you are during a normal pregnancy, the easier it will be for you to adapt to your changing shape and weight gain. It will also help you to cope with labour and get back into shape after the birth.

Keep up your normal daily physical activity or exercise (sport, running, yoga, walking) for as long as you feel comfortable.

Exercise is not dangerous for your baby. There is some evidence that active women are less likely to experience problems in later pregnancy and labour.

You should always ask your doctor if exercise is recommended for you during pregnancy.

Exercise tips for pregnancy

  • Do not exhaust yourself. You may need to slow down as your pregnancy progresses or if your maternity team advises you to.

  • As a general rule, you should be able to hold a conversation as you exercise when pregnant. If you become breathless as you talk, then you’re probably exercising too strenuously.

  • If you were not active before you got pregnant, do not suddenly take up strenuous exercise. If you start an aerobic exercise programme begin with no more than 15 minutes of continuous exercise, 3 times a week. Increase this gradually to daily 30-minute sessions.

  • Remember that exercise does not have to be strenuous to be beneficial.

It is important to remember:

  • always warm up before exercising, and cool down afterwards

  • try to keep active on a daily basis – 30 minutes of walking each day can be enough, but if you cannot manage that, any amount is better than nothing

  • avoid any strenuous exercise in hot weather

  • drink plenty of water and other fluids

  • exercises that have a risk of falling, should only be done with caution Falls carry a risk of damage to your baby

Exercises to avoid in pregnancy:

  • do not lie flat on your back for long periods, particularly after 16 weeks, because the weight of your bump presses on the main blood vessel bringing blood back to your heart and this can make you feel faint

  • do not take part sports where there’s a risk of being hit

Exercises for a fitter pregnancy

If you are pregnant, try to fit the exercises listed in this section into your daily routine. These types of exercise will strengthen your muscles to help you carry the extra weight of pregnancy. They’ll also make your joints stronger, improve circulation, ease backache, and generally help you feel well.

Stomach-strengthening exercises

As your baby gets bigger, you may find that the hollow in your lower back increases and this can give you backache. These exercises strengthen stomach (abdominal) muscles and may ease backache, which can be a problem in pregnancy:

  • start in a box position (on all 4s) with knees under hips, hands under shoulders, with fingers facing forward and abdominals lifted to keep your back straight

  • pull in your stomach muscles and raise your back up towards the ceiling, curling your trunk and allowing your head to relax gently forward, do not let your elbows lock

  • hold for a few seconds then slowly return to the box position

  • take care not to hollow your back: it should always return to a straight/neutral position

  • do this slowly and rhythmically 10 times, making your muscles work hard and moving your back carefully

  • only move your back as far as you can comfortably

Pelvic tilt exercises

  • stand with your shoulders and bottom against a wall

  • keep your knees soft

  • pull your belly button towards your spine, so that your back flattens against the wall: hold for 4 seconds then release

  • repeat up to 10 times

Pelvic floor exercises

Pelvic floor exercises help to strengthen the muscles of the pelvic floor, which come under great strain in pregnancy and childbirth. The pelvic floor consists of layers of muscles that stretch like a supportive hammock from the pubic bone (in front) to the end of the backbone (spine).

If your pelvic floor muscles are weak, you may find that you leak urine when you cough, sneeze or strain. This is quite common, and there is no reason to feel embarrassed. It’s known as stress incontinence and it can continue after pregnancy.

You can strengthen these muscles by doing pelvic floor exercises. This helps to reduce or avoid stress incontinence after pregnancy. All pregnant women should do pelvic floor exercises, even if you’re young and not suffering from stress incontinence now.

How to do pelvic floor exercises:

  • close up your bottom, as if you’re trying to stop yourself going to the toilet

  • at the same time, draw in your vagina as if you’re gripping a tampon, and your urethra as if to stop the flow of urine

  • at first, do this exercise quickly, tightening and releasing the muscles immediately

  • then do it slowly, holding the contractions for as long as you can before you relax: try to count to 10

  • try to do 3 sets of 8 squeezes every day: to help you remember, you could do a set at each meal

As well as these exercises, practice tightening the pelvic floor muscles before and during coughing and sneezing.

Source: https://www.nhs.uk/conditions/pregnancy-and-baby/pregnancy-exercise

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