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Induced abortion in the Nordic countries: special emphasis on young women.

BACKGROUND: To analyze the trends in legally induced abortions among women younger than 30 years in the five Nordic countries, Denmark, Finland, Iceland, Norway and Sweden, since the liberalized abortion laws came into force. METHODS: Data stem from national registrations of vital events. Some have been published in the national vital statistics while others have been retrieved for this study. General and age-specific abortion rates are used to analyze the trends. Further, an index has been calculated by dividing the age-specific abortion rates by the Nordic average. RESULTS: The analysis reveals an overall reduction in the general abortion rates in the Nordic countries, apart from Iceland. The rates have been highest in Denmark and Sweden and lowest in Finland since the early 1980s. In the mid-1980s, the abortion rates increased among 15-19-year-old women in Sweden and among 20-24-year-old women in Denmark, Norway and Sweden, followed by a reduction. In Iceland the very low age-specific abortion rates for all age groups under 30 years at the beginning of the study period increased and Iceland had the highest rate for 15-19-year-old women in the late-1990s. CONCLUSIONS: The relatively low abortion rates in Finland demonstrate effective preventive efforts, although the recent increase challenges further studies on the relationship between abortion rates and counseling activities. The rise in abortion rates in Iceland indicate a need for improved sex education, contraceptive services and availability of contraceptive methods for young people.

Abortion, Induced↗

Patterns in the socioeconomic characteristics of women obtaining abortions in 2000-2001.

CONTEXT: Information about the socioeconomic characteristics of women obtaining abortions in the United States can help policymakers and family planning providers determine which groups of women need better access to contraceptive services. METHODS: A representative sample of more than 10,000 women obtaining abortions from a stratified probability sample of 100 U.S. providers were surveyed in 2000-2001; survey data are used to examine the demographic characteristics of women who terminate pregnancies. This information, along with other national-level data, is used to estimate abortion rates and ratios for subgroups of women and examine recent changes in these measures. RESULTS. In 2000, 21 out of every 1,000 women of reproductive age had an abortion. Women who are aged 18-29, unmarried, black or Hispanic, or economically disadvantaged-including those on Medicaid-have higher abortion rates. The overall abortion rate decreased by 11% between 1994 and 2000. The decline was greatest for 15-17-year-olds, women in the highest income category, those with college degrees and those with no religious affiliation. Abortion rates for women with incomes below 200% of poverty and for women with Medicaid coverage increased between 1994 and 2000. The rate of decline in abortion among black and Hispanic adolescents was lower than that among white adolescents, and the abortion rate among poor teenagers increased substantially. CONCLUSIONS: Increased efforts are needed to help both adolescent women and adult women of all economic statuses avoid unintended pregnancies.

Abortion, Legal↗

Outcome of pregnancy in one Norwegian county 3 years prior to and 3 years subsequent to the Chernobyl accident.

Pregnancy outcome was studied in a county in Norway 3 years prior to and 3 years subsequent to the Chernobyl nuclear plant accident on 26th April 1986. More detailed analyses have been performed for the 12 months prior to and subsequent to the accident. A significant increase in the spontaneous abortion rate the first year after the accident was followed by a slight decrease during the second and third years, but figures were still higher than the period prior to the accident. The rate of legal abortions was unchanged. During the entire observation period the number of births increased continuously, with the exception of a decrease in the last 2 months of 1986 and the first month of 1987. A higher incidence of spontaneous abortions was found for pregnancies conceived during the first 3 months after the accident. This increase in the spontaneous abortion rate is noteworthy, and more especially its long-term persistence, which cannot be the result of external radiation. The internal radiation from food polluted by radioactive fallout is a possible explanation. Changes in nutrition in order to avoid polluted food may also be of importance.

Abortion, Legal↗

Semen selenium and human fertility.

Selenium (Se) was measured in the semen of 125 men from couples consulting for infertility. A mean concentration of 71.3 +/- 29.7 ng/ml of semen was found, with a range of 7 to 230 ng/ml. More than 85% of the Se is in the seminal plasma. There was a significant positive correlation between sperm count and semen Se. Sperm motility was maximal at semen Se levels ranging between 50 and 69 ng/ml; above and below this range, motility was decreased and the incidence of asthenospermia was high. This result suggests an optimal range for semen Se. A follow-up of 4.5 to 5 years after the initial assay of Se revealed that low semen Se levels (less than or equal to 35 ng/ml) were associated with male infertility. A Se level between approximately 40 and 70 ng/ml was optimal for reproductive performance (high pregnancy rate and low abortion rate). Semen Se levels greater than or equal to 80 ng/ml were associated with a high abortion rate and signs of ovarian dysfunction in the partner (both partners usually have the same diet and environmental exposure). These results attest to the role of Se in human reproduction, a well-established fact in several animal species. The semen Se level appears to be a useful indicator of Se status versus reproductive function. Further studies are warranted concerning the general aspects of metabolism and mechanism of action of Se in infertile couples before any therapeutic modification of intake of this element can be contemplated.

Abortion, Spontaneous↗

The cycle pregnancy rate is normal in baboons with stage I endometriosis but decreased in primates with stage II and stage III-IV disease.

OBJECTIVES: To test the hypothesis that fertility is reduced in baboons with endometriosis. DESIGN: Prospective controlled follow-up study. SETTING: Institute of Primate Research, Nairobi Kenya. SUBJECTS: Seventy-one baboons, including 34 controls (normal pelvis) and 37 animals with histologically proven endometriosis (16 spontaneous and 21 induced). Baboons with endometriosis had minimal (n = 9), mild (n = 14), moderate (n = 7), or severe (n = 7) disease. INTERVENTIONS: Seventy-one baboons were mated during 286 cycles. MAIN OUTCOME MEASURES: Cycle fecundity rate, cycle pregnancy rate, cycle abortion rate. RESULTS: Cycle pregnancy rate (excluding spontaneous abortions) was 15% (44/286) and was comparable between controls (19%, 20/104) and baboons with endometriosis (13%, 24/182). The cycle pregnancy rates were 24%, 10%, 7.5%, and 12.5% in animals with minimal, mild, moderate, and severe endometriosis, respectively. The cycle pregnancy rate was significantly lower in baboons with stage III-IV endometriosis (9%, 6/64) and with stage II disease (10%, 7/73) than in animals with stage I endometriosis (24%, 11/45) or in controls with a normal pelvis (19%). CONCLUSION: The normal cycle pregnancy rate in baboons with stage I endometriosis and the decreased cycle pregnancy rate in baboons with stage II and stage III-IV disease suggest that fertility decreases with the stage of endometriosis in baboons.

Abortion, Veterinary↗

A farming systems study of abortion in dairy cattle on the Atherton Tableland. 3. Metabolic factors.

An association with a rank correlation of 0.55 (p = 0.06) was obtained between monthly rainfall and monthly abortions for a group of 24 farms in tropical Australia where cows grazed predominantly summer rain-dependent pasture. A similar association was found among cows grazing nitrogen-fertilised, irrigated pasture in winter in the same area. On farms with irrigated pasture the first service conception and abortion rates in herds which grazed intensively during the night (abortion 8.9%; first service conception 42.9%) differed significantly from those which grazed during the day (abortion 6.4%; first service conception 52.9%), and this suggested that increased abortion rates and decreased first conception rates may be part of the one syndrome. An hypothesis was developed that the feeding of immature nitrogen-fertilised pasture, rich in protein and stimulated by rain or irrigation, is associated with an increased abortion rate and a depressed conception rate. Other evidence included an increased susceptibility of first lactation cows to abortion, a lower abortion rate in late pregnant dry cows fed more mature pasture, a 20% repeat abortion rate in the population sampled and the lack of conclusive evidence for infectious and selected non-infectious agents. There were no other observed clinical signs in most aborting cows.

Abortion, Veterinary↗

Pregnancy results after ovum donation following one to seven embryo transfers.

OBJECTIVE: To determine whether failure to achieve pregnancy after repeated ET after ovum donation was due to an endometrial defect or to the embryo quality. DESIGN: Retrospective data analysis. SETTING: A private infertility center. PATIENT(S): Four hundred sixty-seven donors (513 cycles) undergoing IVF donating oocytes to 266 recipients (423 cycles). INTERVENTION(S): Hormonal endometrial preparation with increasing dosages of valerate E2 (2,4, and 6 mg) and 100 mg of P. MAIN OUTCOME MEASURE(S): Pregnancy rates (PRs) and abortion rates in patients undergoing one to seven ETs after ovum donation. RESULT(S): Pregnancy rates in recipients that had one or two ETs were significantly higher (34.8%) compared with those of recipients having three or more ETs (15.1%). Abortion rates were significantly higher (54.5%) in recipients repeating more than three ETs than in the recipients having one or two ETs (29.1%). CONCLUSION(S): Recipients that had failed to establish a pregnancy after two ETs had a lower PR in successive attempts, possibly because of a defect of their endometrial lining.

Abortion, Spontaneous↗

Induced abortion in Italy: levels, trends and characteristics.

Subsequent to the legalization of abortion in Italy in 1978, abortion; rates among Italian women first rose and then declined steadily, from a peak of 16.9 abortions per 1,000 women of reproductive age in 1983 to 9.8 per 1,000 in 1993. Abortion rates vary considerably by geographic region, with rates typically highest in the more secular and modernized regions and lowest in regions where traditional values predominate. Data from 1981 and 1991 indicate that age-specific abortion rates decreased during the 1980s for all age-groups, with the largest declines occurring in regions with the highest levels of abortion. Moreover, a shift in the age distribution of abortion rates occurred during the 1980s, with women aged 30-34 registering the highest abortion rate in 1991, whereas in 1981 the highest level of abortion occurred among those aged 25-29. The abortion rate among adolescent women was low at both times (7.6 per 1,000 in 1981 and 4.6 per 1,000 in 1991). These data are based only on reported legal abortions; the number of clandestine abortions remains unknown.

Abortion, Induced↗

Analysis of the outcome of 124 pregnancies produced during NFP.

The outcome of 124 pregnancies produced during the use of CM (Billings) of NFP is analyzed. The spontaneous abortion rate was 8%. The women who became pregnant in the less fertile period (+/- 3 days from peak day) presented a higher rate of spontaneous abortions (13.9%) than the women who became pregnant during the most fertile period (peak day +/- 2 days), who presented a 4.3% spontaneous abortion rate. Among the 115 living infants (one twin pregnancy) there was one congenital malformation (0.8%), a cleft palate. The sex ratio of the infants was 0.59 (48 females and 67 males), which is not significantly different from the 0.51 sex ratio expected. When conception occurred during the most fertile period, the sex ratio was 0.37, in contrast to the sex ratio of 0.76 when conception occurred in the less fertile period; this is a highly significant difference (P less than 01).

Abortion, Spontaneous↗

[Outcome of pregnancy following amniocentesis in the prenatal diagnosis of genetic birth defects].

From 1973 to 1982, genetic amniocenteses were performed in 2548 women with singleton pregnancies. Of the cases done up to the end of 1979 the outcome of the pregnancy is on record in 1163 of 1232 cases. Of the cases done from 1980 to 1982 the outcome up to three weeks after the amniocentesis is known in all cases. The final outcome of the pregnancy is known in 25% of these cases. The over-all abortion rate due to the amniocentesis was 0.5%. In the first group, the abortion rate was 0.8% for ultrasound guided amniocenteses and 2.9% for blind punctures. The fetal loss rate from abortion and stillbirth was 3.5%. The abortion rate was correlated to the maternal age, threatened abortions prior to the amniocentesis, the placental site and the technique of puncture. Because of pathological findings, the pregnancy was terminated in 3.2% of the cases. The majority of the amniocenteses was performed between the 16. and 18. week of gestation. Repeat punctures were required in 1.9% of the women. The incidence of discoloration of the amniotic fluid was 2.0%. The rate of frankly blood stained fluid was 2.2%. The frequency of minimally blood stained fluid was 3.2%. Blood stained samples of amniotic fluid were significantly more often obtained with larger canulas , blind punctures and in cases with anterior placentas. A feto-maternal transmission of red blood cells was detected in 10 of 699 tested cases (1.4%). Serious maternal complications or fetal injuries did not occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗

Abortion services in the United States, 1984 and 1985.

In 1984 and 1985, the number of abortions, the abortion rate and the abortion ratio stayed at approximately the same levels as in the previous three years. Just under 1.6 million abortions were performed, about three percent of women of reproductive age obtained an abortion, and about 30 percent of pregnancies (excluding those ending in stillbirths and miscarriages) were terminated by abortion. However, the number of abortion providers declined by five percent between 1982 and 1985, and the geographic distribution of abortion services continued to be markedly uneven. Eighty-two percent of all U.S. counties--50 percent of those classified as metropolitan and 91 percent of those classified as nonmetropolitan--lacked an abortion provider in 1985. The long-term trend away from hospital abortions persisted during the period: Eighty-seven percent of the abortions performed in 1985 were done in nonhospital facilities, an increase of five percentage points over the 1982 level. Although abortion clinics constituted only 15 percent of all providers, they were responsible for 60 percent of the procedures performed in 1985. Among all abortion facilities, only 43 percent provided services to women after the 12th week of pregnancy. Abortion clinics were far more likely to offer second-trimester procedures than were other types of abortion providers (75 percent, compared with 13-50 percent). As of mid-1986, charges for a first-trimester nonhospital abortion ranged from $75 to nearly $900. The average amount paid was $213. In 1985, only 39 percent of nonhospital abortion facilities accepted state reimbursement for abortions provided to low-income women, and only 55 percent of facilities offered some reduction in charges to such women.

Abortion Applicants↗

Idiopathic recurrent spontaneous abortion. Evidence of a familial predisposition.

Pregnancy outcome was investigated: 1) in fifteen women suffering from idiopathic recurrent spontaneous abortion (RSA) and who had experienced pregnancies with two different partners, and 2) in the mothers, the sisters and wives of the brothers of 90 consecutively referred women with RSA. After adjusting for ascertainment bias, the patients with 2 partners had an abortion rate of 72% with the first spouse (significantly increased compared with the expected rate) and a nearly 100% abortion rate with the second spouse. This suggests that, in the main, RSA is not partner-specific. The sisters of the patients had suffered a significantly increased miscarriage rate (25.3%) compared with the observed rate in a Danish control group. The wives of the brothers had an abortion rate of 18.8%, which was not significantly increased vis-à-vis the controls. The sisters showed a lifetime incidence of RSA (10.6%) which was significantly greater than comparable estimates in the literature. These results suggest the existence of a familial predisposition to spontaneous abortion in families where RSA occurs.

Abortion, Habitual↗

Outcome of pregnancies derived from assisted reproductive technologies: IVF versus ICSI.

PURPOSE: To compare the course and outcome of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies. METHODS: A retrospective study was conducted in a university-affiliated IVF unit with 200 patients who conceived in 1996-1997, 100 with ICSI and 100 with IVF. Data were retrieved from our prospectively created computerized database. In addition, all patients were interviewed by telephone, and the interviewing physician completed a detailed questionnaire. Findings for the IVF and ICSI pregnancies were compared. The main outcome measures were maternal age, implantation rate, early pregnancy complications, clinical abortion rate, multiple pregnancy delivery rate, gestational age at delivery, mode of delivery, and birth weight. RESULTS: In all, 238 children were born, including 104 singleton infants (45 IVF, 59 ICSI), 49 twin pairs (28 IVF, 21 ICSI), and 12 triplet sets (3 IVF, 9 ICSI). Statistically significant differences between the ICSI and IVF groups were noted for maternal age (31.3 +/- 4.4 vs. 33.4 +/- 4.8, respectively, P < 0.005) and clinical abortion rate (11% vs. 24%, respectively, P < 0.05). CONCLUSIONS: ICSI pregnancies in our series were characterized by a lower clinical abortion rate than IVF pregnancies, probably because of the mean younger age of the ICSI group.

Abortion, Spontaneous↗

In vitro studies of transcript initiation by Escherichia coli RNA polymerase. 3. Influences of individual DNA elements within the promoter recognition region on abortive initiation and promoter escape.

Abortive initiation and promoter escape are two principal biochemical reactions occurring in the latter stage of transcript initiation. We have analyzed the influences of individual DNA elements within the promoter recognition region (PRR) on these reactions by measuring the quantitative initiation parameters that describe abortive initiation and promoter escape; these parameters are the abortive rate, the productive rate, the abortive:productive ratio, the abortive probability, and the maximum size of abortive transcripts. Changes in the individual DNA elements within the PRR can have a substantial effect on each of these parameters. The discriminator region and the -10 element primarily influence the abortive probability at positions 2-5 and 6-10, respectively, while the -10 and -35 conserved hexamers and the spacer region affect the abortive probability at positions 11-15. Surprisingly, transcription of a consensus promoter invariably gives a higher abortive yield, a higher abortive probability, a longer abortive ladder, and a lower productive rate than promoter variants carrying even a single deviation in the consensus hexamers. These results suggest that strong RNA polymerase-PRR interactions stall the polymerase at the promoter, thereby reducing the rate of promoter escape and consequently enhancing the extent of abortive initiation.

Adenosine Triphosphate↗

The effect of insemination/injection time on the results of IVF and ICSI.

BACKGROUND: The aim of this study was to investigate whether a pre-incubation time between oocyte retrieval and insemination or injection had any effect on the success rate of IVF or intracytoplasmic sperm injection (ICSI). Based on previously published data, many laboratories retain a time interval of several hours between oocyte retrieval and insemination/injection. In our setting, insemination and injection times are dependent only on the laboratory workload. METHODS: Totals of 881 IVF and 432 ICSI cycles performed between 1997 and 1999 were analysed retrospectively. Oocyte retrieval occurred 36 h after human chorionic gonadotrophin administration, and insemination or injection took place 1--7 or 0.5--8 h after oocyte retrieval respectively. RESULTS: No statistically significant differences were found between these time periods and outcome of IVF and ICSI with respect to fertilization rate, embryo quality, implantation rate, abortion and ongoing pregnancy rates, except for the abortion rate after IVF. As this finding may be due to chance and no differences were found in the ongoing pregnancy rates, this finding was considered to be of less importance. CONCLUSIONS: If laboratory control and efficiency demands early insemination or injection, it could be performed without reservation.

Abortion, Spontaneous↗

Spontaneous abortions among female industrial workers.

Previous descriptive epidemiologic studies have indicated that women working in some industrial settings might experience more spontaneous abortions than the average woman. This study, based on reproductive and work histories obtained by interviews, describes the abortion experience of 4121 women while working in the following industrial productive sectors: textiles, electromechanics, light bulbs, pharmaceuticals, plastics and rubber, thread and wool. Abortion rates experienced (no. of pregnancies spontaneously terminated before the 28th week of gestation per 100 pregnancies) are compared with abortion rates experienced by the same women in previous work settings or in pregnancies when they were home makers. The overall abortion rate is 10.8%. The abortion rate of pregnancies while the woman held her present industrial job was 11.5%. The abortion rate for previous pregnancies was 10.4% while working as a homemaker, and 9.6% while working in other types of work. The only two productive sectors that seem associated with a higher abortion risk are the production of pharmaceuticals and the production of plastics and rubber. The increased risk for abortion in this last sector was observed in all three factories included in the study, and is more evident in the second and third birth orders and in women over 25. The findings are discussed and compared with those of previous studies.

Abortion, Spontaneous↗

[Rate of spontaneous abortion in relation to the time of fetal viability assessment].

For the first time, the rate of spontaneous abortion is reported in a multicenter study of three different gynecological centers. In 1987 und 1988, the average spontaneous abortion rate in 315 pregnancies was 3.3%, after foetal heart actions had been verified by ultrasonic examination between the 7th and 12th week of gestation. A statistical significance has been calculated between the spontaneous abortion rate of 6.3%, if foetal heart beats were seen between the 7th and 9th week, and the spontaneous abortion rate of 1.0% with an evidence of foetal life (p less than 0.01) between the 10th to 12th week of gestation. The rate of spontaneous abortion of women above 34 years of age (8.9%) is statistically different (p less than 0.01) to that of women under 35 (1.9%). In women older than 34, the spontaneous abortion rate before the 10th week of gestation is 22.2% in contrast to 3.2% of women younger than 35 (p less than 0.01). Considering the evidence of foetal heart actions between the 10th and 12th week, the spontaneous abortion rate of women above the age of 34 is 1.9%, compared to 0.8% of women younger than 35. The statistical higher spontaneous abortion rate of women above the age of 34 before the 10th week of gestation and the lack of statistical difference of the abortion rate in this defined age group for foetal life to be proven from the 10th week on, should be an argument in favour of the 10th week of gestation as the earliest date of prenatal diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗

Improved in vitro fertilization embryo quality and pregnancy rates with intracytoplasmic sperm injection of sperm from fresh testicular biopsy samples vs. frozen biopsy samples.

OBJECTIVE: To compare the outcomes of first-attempt IVF-intracytoplasmic sperm injection (ICSI) cycles when using fresh testicular biopsy samples vs. frozen biopsy samples. DESIGN: Retrospective chart review of 92 consecutive first-attempt IVF-ICSI cycles. SETTING: Two IVF programs. PATIENT(S): Forty consecutive first-attempt IVF-ICSI patients using sperm from fresh testicular biopsy samples and 52 consecutive first-attempt IVF-ICSI cycles using frozen testicular biopsy samples. INTERVENTION(S): Testicular biopsy, IVF-ICSI with fresh and frozen-thawed spermatozoa. MAIN OUTCOME MEASURE(S): Fertilization rates, embryo quality, pregnancy, delivery, and spontaneous abortion rates. RESULT(S): A significantly increased ICSI fertilization percentage was obtained with frozen testicular biopsy samples (76.5% +/- 3.1%) vs. fresh biopsy samples (68.3% +/- 2.6%). However, embryo quality, pregnancy, and delivery rates were higher in the fresh biopsy group. Mean embryo score was 4.54 +/- 0.31 and 3.62 +/- 0.2 in the fresh vs. frozen group, respectively. Chemical pregnancy rates (60% vs. 49.1%), clinical pregnancy rates (56.4% vs. 41.2%), and delivery rates (48.7% vs. 31.2%) were each higher in the fresh group vs. frozen group. Accordingly, the spontaneous abortion rate was lower in the fresh group (21.7%) vs. the frozen group (33.3%). CONCLUSION(S): Although the use of frozen biopsy samples has logistical advantages, we conclude it may be advantageous to use fresh testicular biopsy samples in IVF-ICSI cases whenever possible, as fresh specimens yielded significantly improved embryo quality, generally higher pregnancy rates, and lower spontaneous abortion rates.

Abortion, Spontaneous↗