Pregnancy outcomes of Chinese women undergoing IVF with embryonic cryopreservation as compared to natural conception

Pregnancy outcomes of Chinese women undergoing IVF with embryonic cryopreservation as compared to natural conception | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Pregnancy outcomes of Chinese women undergoing IVF with embryonic cryopreservation as compared to natural conception jingxue wang, qiwei liu, Boer Deng, fang chen, xiaowei liu, jiumei cheng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.13384/v6 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jan, 2021 Read the published version in BMC Pregnancy and Childbirth → Version 6 posted 7 You are reading this latest preprint version Show more versions Abstract Background: To examine differences in the maternal characteristics and pregnancy outcomes of Chinese women with various causes of infertility who underwent in vitro fertilization (IVF) with embryonic cryopreservation treatment. Methods: Cases were pregnancies after IVF-ET with embryonic cryopreservation; controls were spontaneously conceived pregnancies. Subgroup analysis was carried out according to etiology of infertility. The IVF treatment group was divided into 5 subgroups according to infertility etiology as follows: ovulation disorder, tubal disease, male infertility, endometriosis, and mixed infertility. Data on demographic characteristics, medical history, laboratory tests, and delivery were reviewed. Logistic regression analysis was performed for pregnancy and perinatal complications and neonatal outcomes. The multivariable model was adjusted for potential confounders. Results: Among singleton pregnancies, compared with spontaneous pregnancies, IVF pregnancies were associated with significant increases in the rates of the following: gestational diabetes mellitus (GDM) (aOR 1.76[95% CI 1.33-2.33]), preeclampsia (2.60[1.61-4.20]), preterm preeclampsia (4.52[2.03-10.06]), postpartum hemorrhage (1.57[1.04-2.36]), intrahepatic cholestasis of pregnancy (3.84[1.06-13.94]), preterm premature rupture of membranes (2.11[1.17-3.81]), preterm birth (1.95[CI 1.26-3.01]), low birthweight (1.90[1.13-3.20]), macrosomia (1.53[1.03-2.27]), and neonatal intensive care unit (NICU) admission (1.69[1.22-2.34]) in the ovulation disorder group; GDM (1.50[1.21-1.86]), placenta previa (2.70[1.59-4.59]), placenta accreta (1.78[1.10-2.89]), postpartum hemorrhage (1.61[1.19-2.18]), macrosomia (1.60[1.21-2.13]) and 5-minute Apgar score ≤7 (4.09[1.04-16.08]) in the tubal disease group; placenta previa (9.33[4.22-20.62]), small for gestational age (2.29[1.04-5.08]), macrosomia (2.00[1.02-3.95]) and NICU admission (2.35[1.35-4.09]) in the endometriosis group; placenta previa (4.14[2.23-7.68]) and placenta accreta (2.05[1.08-3.87]) in the male infertility group; and GDM (1.85[1.15-2.98]), placenta previa (4.73[1.83-12.21]), placental abruption (3.39[1.20-9.56]), chorioamnionitis (2.93[1.04-8.26]), preterm birth (2.69[1.41-5.15]), and 1-minute Apgar score ≤7 (4.68[1.62-13.51]) in the mixed infertility group. Among multiple pregnancies, most of the differences that were significant in singleton pregnancies were less extensive or had disappeared. Conclusions: Infertility etiology within the IVF population was found to affect maternal and neonatal outcomes among all births. During the perinatal period, infertility etiology appears to be an additional risk factor for abnormal pregnancy outcomes besides the use of IVF techniques compared with spontaneous pregnancies. Higher risk was found for ovulation disorders, and lower risk was found for male infertility. Maternal & Fetal Medicine reasons for IVF infertility etiology adverse pregnancy outcomes neonatal outcomes Figures Figure 1 Background The number of pregnancies and births after assisted reproductive technology (ART) has increased exponentially over the past 40 years. In China, ART contributes to 1% of all births[1]. Indeed, ART, such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), has become among the most important treatments for infertility. However, in recent years, evidence has emerged that ART pregnancies are at an increased risk of maternal complications and adverse pregnancy outcomes, including pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), placenta previa, placental abruption, postpartum hemorrhage, preterm birth, low birth weight, and small for gestational age, in both multiple pregnancies and singleton pregnancies[2-7]. In addition, some research has shown that infants conceived after ART have a higher prevalence of certain birth defects. Assisted hatching and the diagnosis of an ovulation disorder are marginally associated with increased risks for nonchromosomal birth defects[8-10]. However, other research has shown that ART is associated with a slightly elevated risk of birth defects and that the risks vary depending on the exposure[11]. However, other studies have concluded that the ART procedures associated with IVF are not responsible for adverse perinatal complications[12] because subfertile women who conceived without the aid of ART exhibited an increased risk for these adverse outcomes. Several maternal factors associated with infertility may contribute to adverse obstetric and perinatal outcomes. Despite the widespread application of ART, concerns about potential health implications remain, and the results of previous studies are controversial, partly because of their different study designs, ethnic group compositions, ART protocols and techniques used, and maternal biometric characteristics. The reasons for the increase in adverse pregnancy outcomes with ART are unknown. It is difficult to identify whether the adverse outcomes observed with ART are the direct result of the patients’ characteristics, including type of subfertility or other factors such as cardiovascular maladaptation. One hypothesis is that an infertility-related diagnosis in a woman undergoing ART contributes directly to adverse outcomes, and excess perinatal morbidities have been associated with the infertility-related diagnosis in both ART-treated and non-ART-treated women[13]. However, after adjustments for maternal characteristics, other studies have reported few cases in which underlying infertility directly contributed to adverse outcomes[14]. Another possibility is that adverse outcomes result from the ART procedure itself, including the artificial induction of ovulation; exposure of oocytes, sperm, and embryos to the environment outside of the body; and freezing and manipulation of oocytes and embryos. In several prior studies, age-matching of patients between the ART and spontaneous conception groups was not performed. Knowledge of ART pregnancy outcomes in China is limited, and few studies have examined the relationship between infertility etiology and pregnancy outcomes. The aim of this retrospective cohort study was to explore the impact of infertility etiology of frozen-thawed IVF on pregnancy outcomes, adjusting for maternal characteristics. Methods Data source and study sample We conducted a large retrospective, hospital-based cohort study in couples who underwent IVF treatment at Beijing Obstetrics and Gynecology Hospital between January 2009 and May 2018. We applied the STROBE guidelines in the methods. All IVF-derived pregnancies were randomly matched to a sample of spontaneous pregnancies for maternal age and birth year. The inclusion criteria were as follows: 1) all patients were Chinese; 2) all patients in each group had live births and a gestational age of ≥28 weeks (since the perinatal period starts at 28 complete weeks in China, only gestational ages above 28 weeks are included); 3) the IVF-ET method was frozen-embryo transfer, including both blastocyst transfer and cleavage-stage embryo transfer; and 4) the infertility diagnosis was an ovulation disorder, tubal disease, endometriosis, male infertility, or mixed infertility (meaning multiple infertility-related diagnoses). The exclusion criteria were as follows: 1) the use donor oocytes/sperm or embryos, to ensure that all embryos transferred were autologous; 2) the use of preimplantation genetic testing (PGT); 3) the existence of chronic prepregnancy complications, to ensure that only patients with complications that occurred during pregnancy were studied; 4) unexplained infertility, since in our system, the diagnosis of unexplained infertility not only includes the diagnosis of infertility that did not find clear reasons but also includes the diagnosis of ovulation disorder, tubal disease, endometriosis, or male infertility, which may not be recorded clearly; if we include the unknown infertility diagnosis in our study group, bias may be introduced; 5) ICSI and other methods of conception different from IVF; or 6) women who smoked or consumed alcohol during pregnancy, to prevent confounding effects on outcomes by these factors. Overall, a total of 8773 deliveries were subjected to this retrospective analysis. Among the women, 21% (1843) had received IVF treatment. The IVF group consisted of 1241 singleton and 602 twin pregnancies. The spontaneously conceived group consisted of 6832 singleton and 98 twin pregnancies. All data, including infertility diagnosis, pregnancy, and obstetric and neonatal outcomes, were obtained from records of the patients’ visits to hospitals. The demographic and selected maternal characteristics, pregnancy and labor complications and neonatal outcomes were compared between the two groups. Variables of interest and definition of main outcomes The selected maternal and pregnancy characteristics and pregnancy outcomes included the following: gestational hypertension (BP ≥140/90 mmHg after 20 weeks in previously normotensive women), preeclampsia (hypertension and proteinuria, evidence of other maternal organ dysfunction, or uteroplacental dysfunction), preterm pre-eclampsia (if preeclampsia occurred at <37 gestational weeks)[15], GDM (diabetes diagnosed during pregnancy)[16], delivery method, intrahepatic cholestasis of pregnancy (ICP, characterized by an underlying elevation in circulating bile acids and liver derangement)[17], placenta previa (lower placenta edge within 2 cm from the internal os)[18], placenta accreta (a spectrum disorder ranging from abnormally adherent to deeply invasive placental tissue)[18], placental abruption (a premature separation of the placenta before delivery)[19], preterm premature rupture of membranes (pPROM, membrane rupture before labor and before 37 weeks of gestation)[20], chorioamnionitis (histological or clinical)[21], postpartum hemorrhage (an estimated blood loss in excess of 500 ml after a vaginal birth or a loss of greater than 1000 ml after a caesarean birth)[22], polyhydramnios (US assessment showing a largest, deepest pool of AF greater than 8 cm or an amniotic fluid index greater than 25 cm), oligohydramnios (US assessment showing a largest, deepest pool of AF less than 2 cm or an amniotic fluid index less than 2 cm)[23], preterm birth (PB or PTB, delivery after at least 28 weeks’ gestation but no more than 37 weeks’ gestation)[24], low birthweight (LBW, birthweight <2500 g)[24], macrosomia (birth weight ≥4000 g)[25], small for gestational age (SGA, defined as birth weight below the 10th percentile of a standard optimal reference population for a given gestational age and sex)[26], Apgar score at 1 minute, Apgar score at 5 minutes and neonatal intensive care unit (NICU) admission. Ethics approval This study was approved by the local institutional ethics committee, namely, The Beijing Obstetrics and Gynecology Hospital committee (ethics approval number: 2019-KY-024-01), and was conducted in accordance with the Declaration of Helsinki. Due to the retrospective study design, consent for participation was not required. Nevertheless, private information was well-protected during the study. Statistical analysis SPSS statistical software (version 20.0) was used for data analysis. We first compared baseline characteristics between all IVF groups vs natural pregnancies. Quantitative data are presented as the mean and SD (mean ± SD). Fisher’s exact tests, t tests and Pearson’s chi-square tests were performed to evaluate differences in the proportions of categorical variables between two or more groups. Second, we assessed the effect of infertility diagnosis on adverse perinatal and neonatal outcomes by comparing the prevalence rates of adverse perinatal and neonatal outcomes in different infertility diagnosis subgroups and natural pregnancies. Logistic regression analysis was conducted to calculate approximate relative risks of adverse outcomes and to identify possible predictors of pregnancy complications. The multivariable model was adjusted for maternal age, gravidity, parity, prepregnancy obesity (body mass index≥28 kg/m 2 )[27], birth plurality, and history of previous caesarean section; the results are reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Centiles birthweight were calculated from reference equation of published dataset on similar population and study groups[28, 29]. P values of less than 0.05 were considered statistically significant. The methods were carried out in accordance with approved guidelines. Results Figure 1 shows the flow chart of the participants who were either included in the main analysis or excluded for failing to meet the inclusion criteria. The diagnosis for IVF-treated deliveries included ovulation disorders (N=404), tubal disease (N=803), endometriosis (N=107), male infertility (N=403), and mixed infertility (N=126). The number of natural pregnancies was 6930. Table 1 summarizes the background characteristics of the women who were included in the main analysis. Women with IVF pregnancies were more likely to have significantly higher rates of prepregnancy obesity, caesarean section, and multiple pregnancy and a lower rate of previous caesarean delivery than women with spontaneous pregnancies ( P<0.001 ). The spontaneous pregnancy group also had a significantly higher number of second gravidity and pregnancies than the IVF group ( P<0.001 ). Table 2 shows the pregnancy outcomes among different infertility etiologies for IVF vs spontaneous pregnancies in singleton pregnancies. Table 3 shows the neonatal outcomes among different infertility etiologies for IVF vs spontaneous pregnancies in singleton pregnancies. The associations between different infertility etiologies and maternal/perinatal complication or adverse outcomes were assessed using a logistic regression, with women who conceived spontaneously serving as a reference (Table 4). In the same way, the associations between different infertility etiologies and neonatal complications or adverse outcomes were assessed using a logistic regression, with women who conceived spontaneously serving as a reference (Table 5). Among singleton pregnancies, women with ovulation disorders who conceived by IVF had higher risks of preeclampsia (aOR 2.60 [95% CI 1.61-4.20]), preterm preeclampsia (aOR 4.52 [95% CI 2.03-10.06]), GDM (aOR 1.76 [95% CI 1.33-2.33]), ICP (aOR 3.84 [95% CI 1.06-13.94]), pPROM (aOR 2.11 [95% CI 1.17-3.81]), postpartum hemorrhage (aOR 1.57 [95% CI 1.04-2.36]), PB (aOR 1.95 [95% CI 1.26-3.01]), low birthweight (aOR 1.90 [95% CI 1.13-3.20]), macrosomia (aOR 1.53 [95% CI 1.03-2.27]), and NICU admission (aOR 1.69 [95% CI 1.22-2.34]) than those who conceived spontaneously. Additionally, women with tubal disease who conceived by IVF had a higher risk of GDM (aOR 1.50 [95% CI 1.21-1.86]), placenta previa (aOR 2.70 [95% CI 1.59-4.59]), placenta accreta (aOR 1.78 [95% CI 1.10-2.89]), postpartum hemorrhage (aOR 1.61 [95% CI 1.19-2.18]), macrosomia (aOR 1.60 [95% CI 1.21-2.13]), and a 5-minute Apgar score ≤7 (aOR 4.09 [95% CI 1.04-16.08]) than those who conceived spontaneously. Women with endometriosis who conceived by IVF had a higher risk of placenta previa (aOR 9.33 [95% CI 4.22-20.62]), SGA (aOR 2.29 [95% CI 1.04-5.08]), macrosomia (aOR 2.00 [95% CI 1.02-3.95]), and NICU admission (aOR 2.35 [95% CI 1.35-4.09]) than those who conceived spontaneously. Women with male infertility who conceived by IVF had a higher risk of placenta previa (aOR 4.14 [95% CI 2.23-7.68]) and placenta accreta (aOR 2.05 [95% CI 1.08-3.87]). Women with mixed infertility who conceived by IVF had a higher risk of GDM (aOR 1.85 [95% CI 1.15-2.98]), placenta previa (aOR 4.73 [95% CI 1.83-12.21]), placental abruption (aOR 3.39 [95% CI 1.20-9.56]), chorioamnionitis (aOR 2.93 [95% CI 1.04-8.26]), PB (aOR 2.69 [95% CI 1.41-5.15]), and a 1-minute Apgar score ≤7 (aOR 4.68 [95% CI 1.62-13.51]) than those who conceived spontaneously. However, when twin pregnancies were compared with spontaneous pregnancies, only the rates of the following were significantly increased: GDM in the ovulation disorder and mixed infertility groups and 1-minute Apgar score ≤7 in the mixed infertility group; the other differences that were significantly higher in the singleton pregnancy cohort had narrowed or disappeared in the twin pregnancy cohort (see Supplementary Tables 1-4). Discussion Summary of key findings Through this retrospective, hospital-based cohort study of pregnant Chinese women, we verified that infertility etiologies within the IVF population were found to affect maternal and neonatal outcomes among all births. Among singleton pregnancies, compared with spontaneous pregnancies, IVF pregnancies with ovulation disorders have higher risks of adverse pregnancy and perinatal outcomes. The rates of the following were significantly increased: GDM (1.8-fold), preeclampsia (4.5-fold), postpartum hemorrhage (1.6-fold), pPROM (2.1-fold), and preterm birth (2-fold), while IVF pregnancies with male infertility have lower risks of adverse pregnancy and perinatal outcomes. Interpretation Our study shows that ovulation disorders were associated with higher risks of many pregnancy and neonatal complications. The results are consistent with prior studies[13, 30, 31]. As the use of IVF increases and newer technologies continue to push the boundaries of science, it is important to consider the clinical safety of these approaches. One possible explanation is that a high proportion of women with ovulation disorders have polycystic ovarian syndrome (PCOS), and many of them have multiple metabolic abnormalities. Growing evidence demonstrates that PCOS has a negative impact on fertility and pregnancy outcomes, such as GDM, gestational hypertensive disorders, and PB[32]. GDM is evidently related to the delivery of an infant with macrosomia, so the incidence of macrosomia is significantly higher for pregnant women with PCOS[31]. In addition, neonates of women with PCOS are at greater risk of neonatal complications, including perinatal mortality, prematurity, SGA, lower birth weight and higher NICU admission[33]. Current evidence also suggests that prepregnancy hormonal dysfunction, including hyperandrogenism, progesterone resistance and hyperinsulinism, impairs uterine placentation mechanisms, which may lead to a greater risk of adverse obstetric and neonatal outcomes[33]. In our study, compared with spontaneous pregnancies, IVF pregnancies in patients who had tubal infertility had increased risks of GDM, placenta previa, placenta accreta, postpartum hemorrhage, macrosomia, and a 5-minute Apgar score ≤7. One study reported that infertility, particularly due to an ovulatory disorder or tubal blockage, was associated with an increased GDM risk; specifically, women with a history of infertility due to tubal blockage had an 83% greater risk[34], consistent with our results. GDM is closely related to the birth of an infant with macrosomia; therefore, the rate of macrosomia in tubal infertility is also significantly increased. Tubal-factor infertility is always associated with reproductive inflammation, which may lead to an imbalance in immune-endocrine crosstalk among the endometrium, myometrium and cervix and between the decidua and trophoblasts, predisposing patients to pregnancy complications, such as placenta previa, placenta accreta and postpartum hemorrhage, which could affect neonatal outcomes. Our data showed that endometriosis was significantly associated with placenta previa, SGA, and NICU admission, similar to the findings of previous studies[35-38]. Endometriosis is a common reason for infertility and may cause chronic inflammation and adhesions in the pelvis of reproductive-aged women. Moreover, women with endometriosis exhibit defective deep placentation because of defective remodeling of the spiral arteries[39]. P Cavoretto found that in a longitudinal cohort study of uterine artery Doppler in singleton pregnancies, different uterine arteries perfusion(with lower pulsatility index) occurring in frozen as compared to fresh embryo transfer pregnancy from the first to the third trimester, related to higher birth weight in frozen as compared to fresh IVF/ICSI[28]. Which may indicate that pregnancy outcomes are affected by uterine arteries prefusion. These factors may explain why endometriosis is possibly a crucial factor for increased negative outcomes in IVF pregnancy. However, Benaglia L found that women with endometriosis who conceived via IVF do not face an increased risk of preterm birth[40], similar to our findings. In addition, we found that IVF pregnancies in patients with endometriosis had a higher rate of macrosomia (2-fold) than those who conceived naturally. Regrettably, we have not found any literature on the relationship between endometriosis and macrosomia. This controversial result still needs to be further studied by expanding the sample size. In the male infertility subgroup, the rates of placenta previa and placenta accreta were also increased, but this has not been universally reported. One possible explanation is that the increased risks of placenta previa and placenta accreta are caused by factors related to IVF[41, 42]. Indeed, the intrauterine operation and manipulation of embryonic cells in IVF might induce uterine contraction, leading to higher frequencies of implantation in the lower uterine segment, which may increase the risk of placenta previa. The changes to the endometrium wrought by IVF treatment protocols, and the use of hormone therapy to promote embryo implantation, may increase the risk of placenta accreta. In this research, the risk of placenta previa increased in all subgroups except for the ovarian disorder subgroup, which was similar to previous research[41]. Interestingly, there were no significant differences in neonatal outcomes between IVF and spontaneous conception in the male infertility subgroup. Vannuccini S found that in uncomplicated term pregnancies following ART, infants born after ART had similar birthweights, Apgar scores and arterial blood pH values as those of spontaneously conceived infants[43]. These findings might indicate that the factors associated with infertility are more likely to be associated with adverse neonatal complications rather than the ART procedure itself, which is consistent with a previous study[44]. Overall, the results require further analysis in larger cohorts, adjustments for as many confounders as possible and further preclinical studies. Recent evidence with meta-analysis show the impact of IVF/ICSI pregnancy which more than doubles the rate of iatrogenic preterm birth[45]. In our study, indirect subanalysis, on cryopreservation fail to achieve statistical significance for iatrogenic preterm birth, however use of cryopreservation present possible association with reduction of the rate of spontaneous preterm birth. Our study also showed increased risks for GDM, placenta previa, chorioamnionitis, PB, and a 1-minute Apgar score ≤7 in the mixed infertility subgroup compared with corresponding controls. When there are mixed reasons for parental infertility, pregnancy complications and parental and neonatal outcomes might differ, but perinatal morbidities will always increase. In addition, in twins, the differences in perinatal and neonatal outcomes between IVF pregnancies and natural pregnancies mostly narrowed or disappeared, which may indicate that pregnancy outcomes are greatly affected by multiple pregnancies, regardless of whether they are IVF or natural pregnancies. This finding may also be the result of the small number of cases. Limitation and strength of the study The major strength of our study is the assessment of different infertility etiology on maternal characteristics and pregnancy outcomes in China. China has abolished the “one child” policy, and, since 2016, it has entered into the two-child policy era. As a result, the number of infants is expected to increase greatly, which may promote the demand for IVF[46]. Our findings have extremely important clinical implications and may provide guidance for couples and obstetricians in determining whether IVF is useful as a first-line treatment or as a last resort. Moreover, these findings may help in identifying likely perinatal and neonatal complications relating to different infertility etiologies and provide information for the underlying pathogenic mechanisms. However, there are a few limitations of this study. First, the numbers of stillbirths and neonatal deaths were few; hence, these figures were not included in the main analysis, which may have given rise to the possibility of residual confounding in our results. Therefore, we could not accurately determine the severity of the effects of different infertility diagnoses on neonatal outcomes, nor could we identify the high-risk factors related to the long-term prognosis of the newborn. Another gap in the data that were available was the severity and treatment process of infertility. For example, data on the stage of endometriosis, baseline endocrine level, body mass index, duration of infertility, and ovarian stimulation protocol were incomplete. Although the IVF-ET method in our research was only frozen-embryo transfer, the data include both blastocyst and cleavage-stage embryo transfer. Additionally, each number of blastocysts and cleavage-stage embryos transferred was unknown, which would introduce bias in our results. Additionally, since the perinatal period starts at 28 complete weeks in China, the records of infants born before 28 weeks of gestational age are relatively incomplete. Therefore, only gestational ages above 28 weeks are included in this research. As a result, the exclusion of preterm birth between 24 and 28 weeks may lead to a reduction in the prevalence of PTB. In addition, we excluded unknown infertility diagnosis in the methods. Because of the substantial number of excluded cycles, those excluded due to unknown cause of infertility may introduce bias in the results. Moreover, we lack specific BMI data and have only data on prepregnancy obesity (BMI ≥28 kg/m 2 ), which means higher BMI. Therefore, we could not add BMI as a continuous variable in the study groups. Finally, some information about environmental exposure (educational level, income level) was not included in this study, which may lead to bias. Further studies, particularly systematic reviews of observational studies such as the current study and prospective studies with adjustments for important confounders, will be required to confirm these initial findings. We are aware that some subgroups presents a limited sample size and likely limited statistical power. Conclusions Taken together, through this retrospective, hospital-based cohort study, we verified that infertility etiology within the IVF population can affect maternal and neonatal outcomes among all births. Infertility etiology appears an additional risk factor for abnormal pregnancy outcomes besides the use of IVF techniques. Compared with natural pregnancies, IVF pregnancies with ovulation disorders have higher risks of adverse pregnancy and perinatal outcomes, as the rates of GDM, preeclampsia, postpartum hemorrhage, pPROM, and preterm birth were significantly increased, while IVF pregnancies with male infertility have lower risks of adverse pregnancy and poor perinatal outcomes. Doctors should fully inform patients of possible adverse pregnancy outcomes before they receive IVF. In addition, obstetricians should not only be aware of the increased risk of adverse outcomes with IVF but also pay attention to the specific complications related to the cause of infertility and provide timely treatment. These findings need to be considered with caution given the small sample size in some subgroups(particularly endometriosis and mixed infertility). Further studies, including prospective studies, are needed to confirm the role of the underlying infertility etiology and the severity of infertility in the increase in adverse outcomes with IVF after adjusting for important confounders. Declarations Ethics approval and consent to participate All procedures performed in studies involving human participants were approved by the local institutional ethics committee of the Beijing Obstetrics and Gynecology Hospital committee (ethics approval number: 2019-KY-024-01). Due to the retrospective study design, consent for participation was not required. Nevertheless, private information was well-protected during the study. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no conflicts of interest. Funding This study was not funded. Authors’ contributions JXW and JMC contributed to the study conception and design. QWL, BED and FC examined the data integrity and accuracy. JXW and XWL performed the data analysis. JXW drafted the manuscript, and JMC revised the manuscript. All the authors read and approved the final manuscript. Acknowledgments Not applicable Abbreviations ART: Assisted reproductive technology IVF: In vitro fertilization BMI: Body mass index GDM: Gestational diabetes mellitus ICP: Intrahepatic cholestasis of pregnancy pPROM: Preterm premature rupture of membranes PB or PTB: Preterm birth LBW: Low birthweight SGA: Small for gestational age NICU: Neonatal intensive care unit CI: Confidence interval aOR: Adjusted odds ratio cOR: Crude odds ratio NC: Not calculated due to low numbers References Yang X, Li Y, Li C, Zhang W. Current overview of pregnancy complications and live-birth outcome of assisted reproductive technology in mainland China. Fertil Steril. 2014; 101(2):385-391. 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Pregnancy outcome in women with endometriosis achieving pregnancy with IVF. Human Reproduction. 2016; 31(12):2730-2736. Romundstad LB, Romundstad PR, Sunde A, von During V, Skjaerven R, Vatten LJ. Increased risk of placenta previa in pregnancies following IVF/ICSI; a comparison of ART and non-ART pregnancies in the same mother. Hum Reprod. 2006; 21(9):2353-2358. Esh-Broder E, Ariel I, Abas-Bashir N, Bdolah Y, Celnikier DH. Placenta accreta is associated with IVF pregnancies: a retrospective chart review. Bjog. 2011; 118(9):1084-1089. Vannuccini S, Ferrata C, Perelli F, Pinzauti S, Severi FM, Reis FM, et al. Peripartum and postpartum outcomes in uncomplicated term pregnancy following ART: a retrospective cohort study from two Italian obstetric units. Hum Reprod Open. 2018; 2018(3):hoy012. Romundstad LB, Romundstad PR, Sunde A, von During V, Skjaerven R, Gunnell D, et al. Effects of technology or maternal factors on perinatal outcome after assisted fertilisation: a population-based cohort study. Lancet. 2008; 372(9640):737-743. Cavoretto PI, Giorgione V, Sotiriadis A, Viganò P, Papaleo E, Galdini A, et al. IVF/ICSI treatment and the risk of iatrogenic preterm birth in singleton pregnancies: systematic review and meta-analysis of cohort studies. J Matern Fetal Neonatal Med. 2020:1-10. Cheng PJ, Duan T. China's new two-child policy: maternity care in the new multiparous era. Bjog. 2016; 123 Suppl 3:7-9. Tables Table 1. Maternal and pregnancy characteristics of the ART and spontaneous pregnancy groups. Ovulation disorder Ovulation disorder disorder Tubal disease Endometriosis Male infertility Mixed infertility All ART Controls P value* Number of patients 404 803 107 403 126 1843 6930 Maternal age 33.6±4.15 33.33±3.10 34.11±3.58 33.41±3.50 33.27±3.50 33.40±3.50 33.39±2.96 0.11 Gravidity <0.001 G1 258 (63.9%) 436 (54.3%) 74 (69.2%) 289 (71.7%) 75 (59.5%) 1132 (61.4%) 2879 (41.6%) G≥2 146 (36.1%) 367 (45.7%) 33 (30.8%) 114 (28.3%) 51 (40.5%) 711 (38.5%) 4048 (58.4%) Parity <0.001 P1 382 (94.6%) 762 (94.9%) 104 (97.2%) 389 (96.5%) 124 (98.4%) 1761 (95.6%) 5055 (73%) P≥2 22 (5.4%) 41 (5.1%) 3 (2.8%) 14 (3.5%) 2 (1.6%) 82 (4.4%) 1872 (27%) Pre-pregnancy obesity <0.001 Yes 15 (3.7%) 13 (1.6%) 1 (0.9%) 7 (1.7%) 4 (3.2%) 40 (2.2%) 61 (0.9%) No 389 (96.3%) 790 (98.4%) 106 (99.1%) 396 (98.3%) 122 (96.8%) 1803 (97.8%) 6869 (99.1%) Birth plurality <0.001 Singleton 271 (67.1%) 542 (67.5%) 74 (69.2%) 267 (66.3%) 87 (69%) 1241 (67.3%) 6832 (98.6%) Multiple 133 (32.9%) 261 (32.5%) 33 (30.8%) 136 (33.7%) 39 (31%) 602 (32.7%) 98 (1.4%) Previous caesarean delivery <0.001 Yes 6 (1.5%) 17 (2.1%) 3 (2.8%) 6 (1.5%) 2 (1.6%) 34 (1.8%) 772 (11.1%) No 398 (98.5%) 786 (97.9%) 104 (97.2%) 397 (98.5%) 124 (98.4%) 1809 (98.2%) 6158 (88.9%) Delivery method <0.001 Vaginal delivery 115 (28.5%) 227 (28.3%) 24 (22.4%) 115 (28.5%) 27 (21.4%) 508 (27.6%) 3547 (51.2%) Caesarean section 261 (64.6%) 538 (67%) 75 (70.1%) 276 (68.5%) 91 (72.2%) 1241 (67.3%) 3100 (44.7%) Operative vaginal delivery 28 (6.9%) 38 (4.7%) 8 (7.5%) 12 (3%) 8 (6.3%) 94 (5.1%) 283 (4.1%) Number of embryos transferred 1 274 (67.2%) 545 (67.0%) 74 (67.9%) 271(66.1%) (66.1%) 89 (68.5%) ≥2 134 (32.8%) 268 (33%) 35 (32.1%) 139(33.9%) (33.9%) 41 (31.5%) Note: Data are presented as means±SDs for continuous variables and n (%) for dichotomous variables Mixed infertility refers to a multiple infertility-related diagnosis. Both blastocyst transfer and cleavage stage embryos transfer are included. * P values were assessed by using the Pearson’s chi-square test, Fisher’s exact test or the t test between all IVF group vs controls ; Obesity means BMI≥28 kg/m2. Table 2. Pregnancy outcomes among different infertility etiologies for IVF compared to spontaneous pregnancies in singleton pregnancies. Control Ovulation disorder Tubal disease Endometriosis Male infertility Mixed infertility Singleton pregnancies N % N % N % N % N % N % Maternal outcomes 6832 271 542 74 267 87 Gestational hypertension 271 4 13 4.8 18 3.3 3 4.1 18 6.7^ 2 2.3 Preeclampsia 193 2.8 22 8.1* 23 4.2 2 2.7 9 3.4 4 4.6 Mild 63 0.9 8 3* 7 1.3 0 0 2 0.2 1 1.1 Severe 130 1.9 14 5.2* 16 3 2 2.7 7 2.6 3 3.4 Preterm preeclampsia 46 0.7 8 3* 5 0.9 0 0 3 1.1 2 2.3 GDM 1132 16.6 76 28* 129 23.8* 15 20.3 57 21.3^ 25 28.7^ Placenta previa 94 1.4 3 1.1 18 3.3^ 8 10.8^ 13 4.9* 5 5.7* Placental abruption 92 1.3 7 2.6 7 1.3 2 2.7 2 0.7 4 4.6^ pPROM 154 2.3 13 4.8^ 19 3.5 3 4.1 11 4.1 3 3.4 Placenta accreta 148 2.2 7 2.6 20 3.7^ 3 4.1 11 4.1^ 3 3.4 Postpartum haemorrhage 574 8.4 31 11.4 59 10.9^ 6 8.1 21 7.9 9 10.3 ICP 16 0.2 3 1.1^ 4 0.7^ 0 0 1 0.4 0 0 Polyhydramnios 61 0.9 4 1.5 7 1.3 1 1.4 5 1.9 0 0 Oligohydramnios 247 3.6 14 5.2 18 3.3 4 5.4 12 4.5 2 2.3 Chorioamnionitis 91 1.4 7 2.6 10 1.8 2 2.7 3 1.1 4 4.6^ Note: GDM= Gestational diabetes mellitus; pPROM=preterm premature rupture of membranes; ICP=intrahepatic cholestasis of pregnancy; Mixed infertility refers to multiple infertility-related diagnosis. Data are presented as n (%) for dichotomous variable, P values were assessed by using the Pearson’s chi-square test, or Fisher’s exact test between each infertility subgroup vs controls ; P≤0.001=*; P<0.05=^. Nonsignificant numbers have not symbol. Control Ovulation disorder Tubal disease Endometriosis Male infertility Mixed infertility Singleton Pregnancies N % N % N % N % N % N % 6832 271 542 74 267 87 Gestational weeks 38.8±1.5 38.3±1.8* 38.5±1.6* 38.3±1.8^ 38.5±1.8^ 38.1±1.9* Preterm birth 355 5.2 25 9.2^ 36 6.6 7 9.5 20 7.5 11 12.6^ 34≤PTD<37 wk 267 3.9 17 6.3 29 5.4 5 6.8 16 6 9 10.3^ 28≤PTD<34 wk 88 1.3 8 3^ 7 1.3 2 2.7 5 1.9 2 2.3 Birthweight, g( Mean±SD) 3370±474 3379±580 3382±498 3244±502^ 3335±519 3278±518 Birthweight centile （ Mean ±SD ） 57.29±24.81 59.51±26.60 57.29±26.02 51.84±27.97 55.28±26.80 57.37±26.53 <2500 g 236 3.5 17 6.3^ 21 3.9 4 5.4 13 4.9 6 6.9 <1500 g 38 0.6 4 1.5 3 0.6 0 0 3 1.1 1 1.1 SGA 281 4.1 18 6.6^ 21 3.9 7 9.5^ 12 4.5 5 5.7 Macrosomia 521 7.6 31 11.4^ 64 11.8* 10 13.5 20 7.5 6 6.9 Body length, cm 50.55±41.78 49.85±2.37 50.02±1.88 49.73±2.01 49.92±2.04 49.63±2.12^ 1-Minute Apgar score≤7 64 0.9 5 1.8 4 0.7 0 0 4 1.5 4 4.6* 5-Minute Apgar score≤7 10 0.1 1 0.4 3 0.6* 0 0 0 0 0 0 NICU admission 728 10.7 48 17.7* 72 13.3 17 23* 33 12.4 15 17.2^ Table 3. Neonatal outcomes among different infertility etiologies for IVF compared to spontaneous pregnancies in singleton pregnancies. Note: PTD=preterm delivery; SGA=small for gestational age( birthweight below the 10th percentile for gestational age); Macrosomia=birth weight ≥ 4000g; Mixed infertility refers to multiple infertility-related diagnosis. Data are presented as means±SDs for continuous variables and n (%) for dichotomous variables. P values were assessed by using the Pearson’s chi-square test, Fisher’s exact test or the t test between each infertility subgroup vs controls ; P≤0.001=*; P<0.05=^. Nonsignificant numbers have not symbol. Ovulation disorder Tubal disease Endometriosis Male infertility Mixed infertility SP cOR aOR 95% CI cOR aOR 95% CI cOR aOR 95% CI cOR aOR 95% CI cOR aOR 95% CI GH 0.63 0.93 0.52 1.68 0.91 0.72 0.44 1.19 1.06 0.90 0.28 2.89 0.55 1.49 0.90 2.47 1.76 0.45 0.11 1.85 Preeclampsia 0.26 2.60 1.61 4.20 0.44 1.40 0.89 2.21 0.75 0.90 0.22 3.74 0.44 1.10 0.55 2.20 0.60 1.39 0.50 3.90 Mild 0.30 2.67 1.23 5.79 0.57 1.20 0.54 2.68 0.99 NC NC NC 0.93 0.67 0.16 2.77 0.80 0.98 0.13 7.19 Severe 0.25 2.46 1.36 4.44 0.40 1.51 0.88 2.59 0.67 1.42 0.34 5.92 0.35 1.36 0.62 2.99 0.54 1.62 0.49 5.29 PPE 0.10 4.52 2.03 10.06 0.22 1.38 0.54 3.54 0.72 NC NC NC 0.18 1.66 0.50 5.49 0.29 3.37 0.79 14.46 GDM 0.43 1.76 1.33 2.33 0.72 1.50 1.21 1.86 0.73 1.20 0.67 2.13 0.72 1.31 0.96 1.77 0.49 1.85 1.15 2.98 Placenta previa 1.40 0.93 0.29 3.00 0.47 2.70 1.59 4.59 0.14 9.33 4.22 20.62 0.39 4.14 2.23 7.68 0.23 4.73 1.83 12.21 Placental abruption 0.68 1.89 0.86 4.17 1.36 0.92 0.42 2.01 0.72 1.90 0.46 7.97 1.82 0.55 0.13 2.25 0.28 3.39 1.20 9.56 pPROM 0.23 2.11 1.17 3.81 0.36 1.52 0.93 2.49 0.47 1.76 0.55 5.70 0.27 1.79 0.95 3.37 0.65 1.49 0.46 4.80 Placenta accreta NC 1.29 0.59 2.80 NC 1.78 1.10 2.89 NC 2.00 0.62 6.48 NC 2.05 1.08 3.87 NC 1.70 0.53 5.48 PH 0.65 1.57 1.04 2.36 0.65 1.61 1.19 2.18 0.66 1.11 0.46 2.68 0.73 1.17 0.73 1.88 0.80 1.61 0.77 3.36 ICP 0.13 3.84 1.06 13.94 0.16 2.77 0.89 8.60 NC NC NC NC 0.19 1.36 0.17 10.58 NC NC NC NC Polyhydramnios 0.51 1.72 0.60 4.89 0.80 1.56 0.70 3.48 0.96 1.79 0.24 13.24 0.45 2.27 0.88 5.82 NC NC NC NC Oligohydramnios 0.91 1.19 0.68 2.10 1.55 0.75 0.46 1.22 0.97 1.17 0.42 3.25 1.13 1.01 0.55 1.83 1.59 0.48 0.12 1.96 Chorioamnionitis 0.53 1.64 0.74 3.63 0.97 1.19 0.61 2.32 0.71 1.76 0.42 7.38 1.80 0.75 0.23 2.40 0.28 2.93 1.04 8.26 Table 4. cORs, aORs and 95% CIs of pregnancy and delivery outcomes among different infertility etiologies compared to spontaneous pregnancies in singleton pregnancies. Note: *Logistic regression analysis was adjusted for age, gravidity, parity, pre-pregnancy obesity, birth plurality, and history of previous caesarean section. The reference group of logistic regression is spontaneous control pregnancy. CI=confidence interval; cOR=crude odds ratio; aOR=adjusted odds ratio. Mixed infertility refers to multiple infertility-related diagnosis; SP=singleton pregnancies; GH=gestational hypertension; PPE=preterm preeclampsia; GDM=gestational diabetes mellitus; pPROM=preterm premature rupture of membranes; PH=postpartum haemorrhage; ICP=intrahepatic cholestasis of pregnancy; Bold indicates significant differences; NC=not calculated due to low numbers. Ovulation disorder Tubal disease Endometriosis Male infertility Mixed infertility SP cOR aOR 95% CI cOR aOR 95% CI cOR aOR 95% CI cOR aOR 95% CI cOR aOR 95% CI Preterm birth 0.18 1.95 1.26 3.01 0.27 1.33 0.93 1.91 0.27 1.97 0.89 4.34 0.21 1.52 0.95 2.44 0.20 2.69 1.41 5.15 34≤PTD<37 wk 0.19 1.73 1.03 2.89 0.27 1.42 0.95 2.11 0.27 1.83 0.73 4.61 0.22 1.61 0.95 2.73 0.20 2.88 1.42 5.84 28≤PTD<34 wk 0.21 2.49 1.17 5.29 0.38 1.06 0.48 2.31 0.34 2.24 0.53 9.38 0.24 1.52 0.60 3.83 0.26 1.88 0.45 7.84 Birthweight <2500 g 0.12 1.90 1.13 3.20 0.14 1.12 0.71 1.78 0.14 1.59 0.57 4.42 0.12 1.42 0.80 2.54 0.13 2.04 0.88 4.76 Birthweight <1500 g 0.18 3.31 1.34 9.60 0.28 1.09 0.33 3.59 0.29 NC NC NC 0.18 2.29 0.69 7.64 0.17 2.38 0.32 17.81 SGA 0.28 1.60 0.97 2.65 0.30 0.90 0.57 1.42 0.23 2.29 1.04 5.08 0.33 1.03 0.57 1.88 0.24 1.36 0.54 3.40 Macrosomia 0.99 1.53 1.03 2.27 0.95 1.60 1.21 2.13 0.80 2.00 1.02 3.95 1.58 0.97 0.60 1.55 1.65 0.86 0.37 2.00 1-Minute Apgar score≤7 0.37 1.84 0.72 4.73 0.94 0.77 0.28 2.15 0.50 NC NC NC 0.37 1.70 0.61 4.80 0.19 4.68 1.62 13.51 5-Minute Apgar score≤7 0.20 2.39 0.27 20.34 0.29 4.09 1.04 16.08 NC NC NC NC 0.20 NC NC NC 0.18 NC NC NC NICU admission 0.26 1.69 1.22 2.34 0.34 1.24 0.95 1.61 0.28 2.35 1.35 4.09 0.31 1.17 0.80 1.70 0.31 1.61 0.92 2.84 Table 5. cORs, aORs and 95% CIs of neonatal outcomes among different infertility etiologies compared to spontaneous pregnancies in singleton pregnancies. Note: *Logistic regression analysis was adjusted for age, gravidity, parity, pre-pregnancy obesity, birth plurality, and history of previous caesarean section. CI=confidence interval; cOR=crude odds ratio; aOR=adjusted odds ratio. Mixed infertility refers to multiple infertility-related diagnosis; SP=singleton pregnancies; PTD=preterm delivery; SGA=small for gestational age( birthweight below the 10th percentile for gestational age); NICU= neonatal intensive care unit ； Macrosomia=birth weight ≥ 4000g ； The reference group of logistic regression is spontaneous control pregnancy; Bold indicates significant differences; NC=not calculated due to low numbers. 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cheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYDACCRDBAyIZGx8wGABpZhK0NBuQoAUC2CRwK0MC/LObjz38ImORuLa9ua2ap+AOg3w778EPDDU20TgtuXMs3ViGRyJx25mDbbd5DJ4xGBzmS5ZgOJaW24BDi4FEjpm0BEjLjcS2mzMMDjMYMPMYSDA2HMajJf8bRMv9h22FIC3yzTzGP/BryWGT/AC2hbGN4QNQC8NhHjO8tkjcSDOTBgay8bYzic0SHwye8RgAtVgk4PEL/4zkZ5I/e+pktx0//vBDwp87cvL9Z4xvfKixwakFBJh5e+DsAzxgKgGPchBg/PEDoYWA2lEwCkbBKBiJAAA0xFdC2mB40wAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-8799-1887","institution":"","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"jiumei","middleName":"","lastName":"cheng","suffix":""}],"badges":[],"createdAt":"2019-08-20 12:50:48","currentVersionCode":6,"declarations":"","doi":"10.21203/rs.2.13384/v6","doiUrl":"https://doi.org/10.21203/rs.2.13384/v6","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-020-03486-7","type":"published","date":"2021-01-09T15:02:20+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":3703339,"identity":"91b16a26-3470-4094-b4ce-0a535d438b76","added_by":"auto","created_at":"2020-11-19 18:32:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":123840,"visible":true,"origin":"","legend":"Flow chart of participants in the analysis","description":"","filename":"F1.png","url":"https://assets-eu.researchsquare.com/files/rs-4096/v6/259d508f08b3b6a826779e2b.png"},{"id":13616784,"identity":"c370bf80-305f-4b9c-ba43-0c3249bc8afe","added_by":"auto","created_at":"2021-09-17 06:51:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":583672,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4096/v6/2c0239b8-15b6-4c8f-9063-57641ce98574.pdf"},{"id":3703338,"identity":"c86cdd52-58ae-45a6-9f88-eae7fcbf17ee","added_by":"auto","created_at":"2020-11-19 18:32:32","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":67232,"visible":true,"origin":"","legend":"","description":"","filename":"Datafortwinpregnancies.docx","url":"https://assets-eu.researchsquare.com/files/rs-4096/v6/ee8e89021bf1b4e0cf66a4d4.docx"}],"financialInterests":"","formattedTitle":"\u003cp\u003ePregnancy outcomes of Chinese women undergoing IVF with embryonic cryopreservation as compared to natural conception\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThe number of pregnancies and births after assisted reproductive technology (ART) has increased exponentially over the past 40 years. In China, ART contributes to 1% of all births[1]. Indeed, ART, such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), has become among the most important treatments for infertility. However, in recent years, evidence has emerged that ART pregnancies are at an increased risk of maternal complications and adverse pregnancy outcomes, including pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), placenta previa, placental abruption, postpartum hemorrhage, preterm birth, low birth weight, and small for gestational age, in both multiple pregnancies and singleton pregnancies[2-7]. In addition, some research has shown that infants conceived after ART have a higher prevalence of certain birth defects. Assisted hatching and the diagnosis of an ovulation disorder are marginally associated with increased risks for nonchromosomal birth defects[8-10]. However, other research has shown that ART is associated with a slightly elevated risk of birth defects and that the risks vary depending on the exposure[11]. However, other studies have concluded that the ART procedures associated with IVF are not responsible for adverse perinatal complications[12] because subfertile women who conceived without the aid of ART exhibited an increased risk for these adverse outcomes. Several maternal factors associated with infertility may contribute to adverse obstetric and perinatal outcomes. Despite the widespread application of ART, concerns about potential health implications remain, and the results of previous studies are controversial, partly because of their different study designs, ethnic group compositions, ART protocols and techniques used, and maternal biometric characteristics.\u003c/p\u003e\n\u003cp\u003eThe reasons for the increase in adverse pregnancy outcomes with ART are unknown. It is difficult to identify whether the adverse outcomes observed with ART are the direct result of the patients\u0026rsquo; characteristics, including type of subfertility or other factors such as cardiovascular maladaptation. One hypothesis is that an infertility-related diagnosis in a woman undergoing ART contributes directly to adverse outcomes, and excess perinatal morbidities have been associated with the infertility-related diagnosis in both ART-treated and non-ART-treated women[13]. However, after adjustments for maternal characteristics, other studies have reported few cases in which underlying infertility directly contributed to adverse outcomes[14]. Another possibility is that adverse outcomes result from the ART procedure itself, including the artificial induction of ovulation; exposure of oocytes, sperm, and embryos to the environment outside of the body; and freezing and manipulation of oocytes and embryos. In several prior studies, age-matching of patients between the ART and spontaneous conception groups was not performed. Knowledge of ART pregnancy outcomes in China is limited, and few studies have examined the relationship between infertility etiology and pregnancy outcomes.\u003c/p\u003e\n\u003cp\u003eThe aim of this retrospective cohort study was to explore the impact of infertility etiology of frozen-thawed IVF on pregnancy outcomes, adjusting for maternal characteristics.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eData source and study sample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a large retrospective, hospital-based cohort study in couples who underwent IVF treatment at Beijing Obstetrics and Gynecology Hospital between January 2009 and May 2018. We applied the STROBE guidelines in the methods. All IVF-derived pregnancies were randomly matched to a sample of spontaneous pregnancies for maternal age and birth year. The inclusion criteria were as follows: 1) all patients were Chinese; 2) all patients in each group had live births and a gestational age of \u0026ge;28 weeks (since the perinatal period starts at 28 complete weeks in China, only gestational ages above 28 weeks are included); 3) the IVF-ET method was frozen-embryo transfer, including both blastocyst transfer and cleavage-stage embryo transfer; and 4) the infertility diagnosis was an ovulation disorder, tubal disease, endometriosis, male infertility, or mixed infertility (meaning multiple infertility-related diagnoses). The exclusion criteria were as follows: 1) the use donor oocytes/sperm or embryos, to ensure that all embryos transferred were autologous; 2) the use of preimplantation genetic testing (PGT); 3) the existence of chronic prepregnancy complications, to ensure that only patients with complications that occurred during pregnancy were studied; 4) unexplained infertility, since in our system, the diagnosis of unexplained infertility not only includes the diagnosis of infertility that did not find clear reasons but also includes the diagnosis of ovulation disorder, tubal disease, endometriosis, or male infertility, which may not be recorded clearly; if we include the unknown infertility diagnosis in our study group, bias may be introduced; \u0026nbsp;5) ICSI and other methods of conception different from IVF; or 6) women who smoked or consumed alcohol during pregnancy, to prevent confounding effects on outcomes by these factors. Overall, a total of 8773 deliveries were subjected to this retrospective analysis. Among the women, 21% (1843) had received IVF treatment. The IVF group consisted of 1241 singleton and 602 twin pregnancies. The spontaneously conceived group consisted of 6832 singleton and 98 twin pregnancies. All data, including infertility diagnosis, pregnancy, and obstetric and neonatal outcomes, were obtained from records of the patients\u0026rsquo; visits to hospitals. The demographic and selected maternal characteristics, pregnancy and labor complications and neonatal outcomes were compared between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables of interest\u003c/strong\u003e\u003cstrong\u003e and definition of main outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe selected maternal and pregnancy characteristics and pregnancy outcomes included the following: gestational hypertension (BP \u0026ge;140/90 mmHg after 20 weeks in previously normotensive women), preeclampsia (hypertension and proteinuria, evidence of other maternal organ dysfunction, or uteroplacental dysfunction), preterm pre-eclampsia (if preeclampsia occurred at \u0026lt;37 gestational weeks)[15], GDM (diabetes diagnosed during pregnancy)[16], delivery method, intrahepatic cholestasis of pregnancy (ICP, characterized by an underlying elevation in circulating bile acids and liver derangement)[17], placenta previa (lower placenta edge within 2 cm from the internal os)[18], placenta accreta (a spectrum disorder ranging from abnormally adherent to deeply invasive placental tissue)[18], placental abruption (a premature separation of the placenta before delivery)[19], preterm premature rupture of membranes (pPROM, membrane rupture before labor and before 37 weeks of gestation)[20], chorioamnionitis (histological or clinical)[21], postpartum hemorrhage (an estimated blood loss in excess of 500 ml after a vaginal birth or a loss of greater than 1000 ml after a caesarean birth)[22], polyhydramnios (US assessment showing a largest, deepest pool of AF greater than 8 cm or an amniotic fluid index greater than 25 cm), oligohydramnios (US assessment showing a largest, deepest pool of AF less than 2 cm or an amniotic fluid index less than 2 cm)[23], preterm birth (PB or PTB, delivery after at least 28 weeks\u0026rsquo; gestation but no more than 37 weeks\u0026rsquo; gestation)[24], low birthweight (LBW, birthweight \u0026lt;2500 g)[24], macrosomia (birth weight \u0026ge;4000 g)[25], small for gestational age (SGA, defined as birth weight below the 10th percentile of a standard optimal reference population for a given gestational age and sex)[26], Apgar score at 1 minute, Apgar score at 5 minutes and neonatal intensive care unit (NICU) admission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the local institutional ethics committee, namely, The Beijing Obstetrics and Gynecology Hospital committee (ethics approval number: 2019-KY-024-01), and was conducted in accordance with the Declaration of Helsinki. Due to the retrospective study design, consent for participation was not required. Nevertheless, private information was well-protected during the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS statistical software (version 20.0) was used for data analysis. We first compared baseline characteristics between all IVF groups vs natural pregnancies. Quantitative data are presented as the mean and SD (mean \u0026plusmn; SD). Fisher\u0026rsquo;s exact tests, \u003cem\u003et \u003c/em\u003etests and Pearson\u0026rsquo;s chi-square tests were performed to evaluate differences in the proportions of categorical variables between two or more groups. Second, we assessed the effect of infertility diagnosis on adverse perinatal and neonatal outcomes by comparing the prevalence rates of adverse perinatal and neonatal outcomes in different infertility diagnosis subgroups and natural pregnancies. Logistic regression analysis was conducted to calculate approximate relative risks of adverse outcomes and to identify possible predictors of pregnancy complications. The multivariable model was adjusted for maternal age, gravidity, parity, prepregnancy obesity (body mass index\u0026ge;28 kg/m\u003csup\u003e2\u003c/sup\u003e)[27], birth plurality, and history of previous caesarean section; the results are reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Centiles birthweight were calculated from reference equation of published dataset on similar population and study groups[28, 29]. \u003cem\u003eP\u003c/em\u003e values of less than 0.05 were considered statistically significant. The methods were carried out in accordance with approved guidelines.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFigure 1 shows the flow chart of the participants who were either included in the main analysis or excluded for failing to meet the inclusion criteria. The diagnosis for IVF-treated deliveries included ovulation disorders (N=404), tubal disease (N=803), endometriosis (N=107), male infertility (N=403), and mixed infertility (N=126). The number of natural pregnancies was 6930. Table 1 summarizes the background characteristics of the women who were included in the main analysis. Women with IVF pregnancies were more likely to have significantly higher rates of prepregnancy obesity, caesarean section, and multiple pregnancy and a lower rate of previous caesarean delivery than women with spontaneous pregnancies (\u003cem\u003eP\u0026lt;0.001\u003c/em\u003e). The spontaneous pregnancy group also had a significantly higher number of second gravidity and pregnancies than the IVF group (\u003cem\u003eP\u0026lt;0.001\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eTable 2 shows the pregnancy outcomes among different infertility etiologies for IVF vs spontaneous pregnancies in singleton pregnancies. Table 3 shows the neonatal outcomes among different infertility etiologies for IVF vs spontaneous pregnancies in singleton pregnancies. The associations between different infertility etiologies and maternal/perinatal complication or adverse outcomes were assessed using a logistic regression, with women who conceived spontaneously serving as a reference (Table 4). In the same way, the associations between different infertility etiologies and neonatal complications or adverse outcomes were assessed using a logistic regression, with women who conceived spontaneously serving as a reference (Table 5). Among singleton pregnancies, women with ovulation disorders who conceived by IVF had higher risks of preeclampsia (aOR 2.60 [95% CI 1.61-4.20]), preterm preeclampsia (aOR 4.52 [95% CI 2.03-10.06]), GDM (aOR 1.76 [95% CI 1.33-2.33]), ICP (aOR 3.84 [95% CI 1.06-13.94]), pPROM (aOR 2.11 [95% CI 1.17-3.81]), postpartum hemorrhage (aOR 1.57 [95% CI 1.04-2.36]), PB (aOR 1.95 [95% CI 1.26-3.01]), low birthweight (aOR 1.90 [95% CI 1.13-3.20]), macrosomia (aOR 1.53 [95% CI 1.03-2.27]), and NICU admission (aOR 1.69 [95% CI 1.22-2.34]) than those who conceived spontaneously. Additionally, women with tubal disease who conceived by IVF had a higher risk of GDM (aOR 1.50 [95% CI 1.21-1.86]), placenta previa (aOR 2.70 [95% CI 1.59-4.59]), placenta accreta (aOR 1.78 [95% CI 1.10-2.89]), postpartum hemorrhage (aOR 1.61 [95% CI 1.19-2.18]), macrosomia (aOR 1.60 [95% CI 1.21-2.13]), and a 5-minute Apgar score \u0026le;7 (aOR 4.09 [95% CI 1.04-16.08]) than those who conceived spontaneously. Women with endometriosis who conceived by IVF had a higher risk of placenta previa (aOR 9.33 [95% CI 4.22-20.62]), SGA (aOR 2.29 [95% CI 1.04-5.08]), macrosomia (aOR 2.00 [95% CI 1.02-3.95]), and NICU admission (aOR 2.35 [95% CI 1.35-4.09]) than those who conceived spontaneously. Women with male infertility who conceived by IVF had a higher risk of placenta previa (aOR 4.14 [95% CI 2.23-7.68]) and placenta accreta (aOR 2.05 [95% CI 1.08-3.87]). Women with mixed infertility who conceived by IVF had a higher risk of GDM (aOR 1.85 [95% CI 1.15-2.98]), placenta previa (aOR 4.73 [95% CI 1.83-12.21]), placental abruption (aOR 3.39 [95% CI 1.20-9.56]), chorioamnionitis (aOR 2.93 [95% CI 1.04-8.26]), PB (aOR 2.69 [95% CI 1.41-5.15]), and a 1-minute Apgar score \u0026le;7 (aOR 4.68 [95% CI 1.62-13.51]) than those who conceived spontaneously. However, when twin pregnancies were compared with spontaneous pregnancies, only the rates of the following were significantly increased: GDM in the ovulation disorder and mixed infertility groups and 1-minute Apgar score \u0026le;7 in the mixed infertility group; the other differences that were significantly higher in the singleton pregnancy cohort had narrowed or disappeared in the twin pregnancy cohort (see Supplementary Tables 1-4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eSummary of key findings \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThrough this retrospective, hospital-based cohort study of pregnant Chinese women, we verified that infertility etiologies within the IVF population were found to affect maternal and neonatal outcomes among all births. Among singleton pregnancies, compared with spontaneous pregnancies, IVF pregnancies with ovulation disorders have higher risks of adverse pregnancy and perinatal outcomes. The rates of the following were significantly increased: GDM (1.8-fold), preeclampsia (4.5-fold), postpartum hemorrhage (1.6-fold), pPROM (2.1-fold), and preterm birth (2-fold), while IVF pregnancies with male infertility have lower risks of adverse pregnancy and perinatal outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study shows that ovulation disorders were associated with higher risks of many pregnancy and neonatal complications. The results are consistent with prior studies[13, 30, 31]. As the use of IVF increases and newer technologies continue to push the boundaries of science, it is important to consider the clinical safety of these approaches. One possible explanation is that a high proportion of women with ovulation disorders have polycystic ovarian syndrome (PCOS), and many of them have multiple metabolic abnormalities. Growing evidence demonstrates that PCOS has a negative impact on fertility and pregnancy outcomes, such as GDM, gestational hypertensive disorders, and PB[32]. GDM is evidently related to the delivery of an infant with macrosomia, so the incidence of macrosomia is significantly higher for pregnant women with PCOS[31]. In addition, neonates of women with PCOS are at greater risk of neonatal complications, including perinatal mortality, prematurity, SGA, lower birth weight and higher NICU admission[33]. Current evidence also suggests that prepregnancy hormonal dysfunction, including hyperandrogenism, progesterone resistance and hyperinsulinism, impairs uterine placentation mechanisms, which may lead to a greater risk of adverse obstetric and neonatal outcomes[33].\u003c/p\u003e\n\u003cp\u003eIn our study, compared with spontaneous pregnancies, IVF pregnancies in patients who had tubal infertility had increased risks of GDM, placenta previa, placenta accreta, postpartum hemorrhage, macrosomia, and a 5-minute Apgar score \u0026le;7. One study reported that infertility, particularly due to an ovulatory disorder or tubal blockage, was associated with an increased GDM risk; specifically, women with a history of infertility due to tubal blockage had an 83% greater risk[34], consistent with our results. GDM is closely related to the birth of an infant with macrosomia; therefore, the rate of macrosomia in tubal infertility is also significantly increased. Tubal-factor infertility is always associated with reproductive inflammation, which may lead to an imbalance in immune-endocrine crosstalk among the endometrium, myometrium and cervix and between the decidua and trophoblasts, predisposing patients to pregnancy complications, such as placenta previa, placenta accreta and postpartum hemorrhage, which could affect neonatal outcomes.\u003c/p\u003e\n\u003cp\u003eOur data showed that endometriosis was significantly associated with placenta previa, SGA, and NICU admission, similar to the findings of previous studies[35-38]. Endometriosis is a common reason for infertility and may cause chronic inflammation and adhesions in the pelvis of reproductive-aged women. Moreover, women with endometriosis exhibit defective deep placentation because of defective remodeling of the spiral arteries[39]. P Cavoretto found that in a longitudinal\u0026nbsp; cohort study of uterine artery Doppler in singleton pregnancies, different uterine arteries perfusion(with lower pulsatility index) occurring in frozen as compared to fresh embryo transfer pregnancy from the first to the third trimester, related to higher birth weight in frozen as compared to fresh IVF/ICSI[28]. Which may indicate that pregnancy outcomes are affected by uterine arteries prefusion. These factors may explain why endometriosis is possibly a crucial factor for increased negative outcomes in IVF pregnancy. However, Benaglia L found that women with endometriosis who conceived via IVF do not face an increased risk of preterm birth[40], similar to our findings. In addition, we found that IVF pregnancies in patients with endometriosis had a higher rate of macrosomia (2-fold) than those who conceived naturally. Regrettably, we have not found any literature on the relationship between endometriosis and macrosomia. This controversial result still needs to be further studied by expanding the sample size.\u003c/p\u003e\n\u003cp\u003eIn the male infertility subgroup, the rates of placenta previa and placenta accreta were also increased, but this has not been universally reported. One possible explanation is that the increased risks of placenta previa and placenta accreta are caused by factors related to IVF[41, 42]. Indeed, the intrauterine operation and manipulation of embryonic cells in IVF might induce uterine contraction, leading to higher frequencies of implantation in the lower uterine segment, which may increase the risk of placenta previa. The changes to the endometrium wrought by IVF treatment protocols, and the use of hormone therapy to promote embryo implantation, may increase the risk of placenta accreta. In this research, the risk of placenta previa increased in all subgroups except for the ovarian disorder subgroup, which was similar to previous research[41]. Interestingly, there were no significant differences in neonatal outcomes between IVF and spontaneous conception in the male infertility subgroup. Vannuccini S found that in uncomplicated term pregnancies following ART, infants born after ART had similar birthweights, Apgar scores and arterial blood pH values as those of spontaneously conceived infants[43]. These findings might indicate that the factors associated with infertility are more likely to be associated with adverse neonatal complications rather than the ART procedure itself, which is consistent with a previous study[44]. Overall, the results require further analysis in larger cohorts, adjustments for as many confounders as possible and further preclinical studies.\u003c/p\u003e\n\u003cp\u003eRecent evidence with meta-analysis show the impact of IVF/ICSI pregnancy which more than doubles the rate of iatrogenic preterm birth[45]. In our study, indirect subanalysis, on cryopreservation fail to achieve statistical significance for iatrogenic preterm birth, however use of cryopreservation present possible association with reduction of the rate of spontaneous preterm birth.\u003c/p\u003e\n\u003cp\u003eOur study also showed increased risks for GDM, placenta previa, chorioamnionitis, PB, and a 1-minute Apgar score \u0026le;7 in the mixed infertility subgroup compared with corresponding controls. When there are mixed reasons for parental infertility, pregnancy complications and parental and neonatal outcomes might differ, but perinatal morbidities will always increase. In addition, in twins, the differences in perinatal and neonatal outcomes between IVF pregnancies and natural pregnancies mostly narrowed or disappeared, which may indicate that pregnancy outcomes are greatly affected by multiple pregnancies, regardless of whether they are IVF or natural pregnancies. This finding may also be the result of the small number of cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation and strength of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe major strength of our study is the assessment of different infertility etiology on maternal characteristics and pregnancy outcomes in China. China has abolished the \u0026ldquo;one child\u0026rdquo; policy, and, since 2016, it has entered into the two-child policy era. As a result, the number of infants is expected to increase greatly, which may promote the demand for IVF[46]. Our findings have extremely important clinical implications and may provide guidance for couples and obstetricians in determining whether IVF is useful as a first-line treatment or as a last resort. Moreover, these findings may help in identifying likely perinatal and neonatal complications relating to different infertility etiologies and provide information for the underlying pathogenic mechanisms.\u003c/p\u003e\n\u003cp\u003eHowever, there are a few limitations of this study. First, the numbers of stillbirths and neonatal deaths were few; hence, these figures were not included in the main analysis, which may have given rise to the possibility of residual confounding in our results. Therefore, we could not accurately determine the severity of the effects of different infertility diagnoses on neonatal outcomes, nor could we identify the high-risk factors related to the long-term prognosis of the newborn. Another gap in the data that were available was the severity and treatment process of infertility. For example, data on the stage of endometriosis, baseline endocrine level, body mass index, duration of infertility, and ovarian stimulation protocol were incomplete. Although the IVF-ET method in our research was only frozen-embryo transfer, the data include both blastocyst and cleavage-stage embryo transfer. Additionally, each number of blastocysts and cleavage-stage embryos transferred was unknown, which would introduce bias in our results. Additionally, since the perinatal period starts at 28 complete weeks in China, the records of infants born before 28 weeks of gestational age are relatively incomplete. Therefore, only gestational ages above 28 weeks are included in this research. As a result, the exclusion of preterm birth between 24 and 28 weeks may lead to a reduction in the prevalence of PTB. In addition, we excluded unknown infertility diagnosis in the methods. Because of the substantial number of excluded cycles, those excluded due to unknown cause of infertility may introduce bias in the results. Moreover, we lack specific BMI data and have only data on prepregnancy obesity (BMI \u0026ge;28 kg/m\u003csup\u003e2\u003c/sup\u003e), which means higher BMI. Therefore, we could not add BMI as a continuous variable in the study groups. Finally, some information about environmental exposure (educational level, income level) was not included in this study, which may lead to bias. Further studies, particularly systematic reviews of observational studies such as the current study and prospective studies with adjustments for important confounders, will be required to confirm these initial findings. We are aware that some subgroups presents a limited sample size and likely limited statistical power.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTaken together, through this retrospective, hospital-based cohort study, we verified that infertility etiology within the IVF population can affect maternal and neonatal outcomes among all births. Infertility etiology appears an additional risk factor for abnormal pregnancy outcomes besides the use of IVF techniques. Compared with natural pregnancies, IVF pregnancies with ovulation disorders have higher risks of adverse pregnancy and perinatal outcomes, as the rates of GDM, preeclampsia, postpartum hemorrhage, pPROM, and preterm birth were significantly increased, while IVF pregnancies with male infertility have lower risks of adverse pregnancy and poor perinatal outcomes. Doctors should fully inform patients of possible adverse pregnancy outcomes before they receive IVF. In addition, obstetricians should not only be aware of the increased risk of adverse outcomes with IVF but also pay attention to the specific complications related to the cause of infertility and provide timely treatment. These findings need to be considered with caution given the small sample size in some subgroups(particularly endometriosis and mixed infertility). Further studies, including prospective studies, are needed to confirm the role of the underlying infertility etiology and the severity of infertility in the increase in adverse outcomes with IVF after adjusting for important confounders.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were approved by the local institutional ethics committee of the Beijing Obstetrics and Gynecology Hospital committee (ethics approval number: 2019-KY-024-01). Due to the retrospective study design, consent for participation was not required. Nevertheless, private information was well-protected during the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJXW and JMC contributed to the study conception and design. QWL, BED and FC examined the data integrity and accuracy. JXW and XWL performed the data analysis. JXW drafted the manuscript, and JMC revised the manuscript. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eART:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Assisted reproductive technology\u003c/p\u003e\n\u003cp\u003eIVF:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; In vitro fertilization\u003c/p\u003e\n\u003cp\u003eBMI:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Body mass index\u003c/p\u003e\n\u003cp\u003eGDM:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Gestational diabetes mellitus\u003c/p\u003e\n\u003cp\u003eICP:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Intrahepatic cholestasis of pregnancy\u003c/p\u003e\n\u003cp\u003epPROM:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Preterm premature rupture of membranes\u003c/p\u003e\n\u003cp\u003ePB or PTB:\u0026nbsp; Preterm birth\u003c/p\u003e\n\u003cp\u003eLBW:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Low birthweight\u003c/p\u003e\n\u003cp\u003eSGA:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;Small for gestational age\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNICU:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;Neonatal intensive care unit\u003c/p\u003e\n\u003cp\u003eCI:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Confidence interval\u003c/p\u003e\n\u003cp\u003eaOR:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Adjusted odds ratio\u003c/p\u003e\n\u003cp\u003ecOR:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Crude odds ratio\u003c/p\u003e\n\u003cp\u003eNC:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Not calculated due to low numbers\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYang X, Li Y, Li C, Zhang W. 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An epidemiological survey on low birth weight infants in China and analysis of outcomes of full-term low birth weight infants. BMC Pregnancy Childbirth. 2013; 13:242.\u003c/li\u003e\n\u003cli\u003ePan XF, Tang L, Lee AH, Binns C, Yang CX, Xu ZP, et al. Association between fetal macrosomia and risk of obesity in children under 3 years in Western China: a cohort study. World J Pediatr. 2019; 15(2):153-160.\u003c/li\u003e\n\u003cli\u003eLuo X, Liu L, Gu H, Hou F, Xie X, Li X, et al. Pathways linking socioeconomic status to small-for-gestational-age (SGA) infants among primiparae: a birth cohort study in China. BMJ Open. 2018; 8(6):e020694.\u003c/li\u003e\n\u003cli\u003eHu L, Huang X, You C, Li J, Hong K, Li P, et al. Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in southern China. PLoS One. 2017; 12(9):e0183934.\u003c/li\u003e\n\u003cli\u003eCavoretto PI, Farina A, Gaeta G, Sigismondi C, Spinillo S, Casiero D, et al. Uterine artery Doppler in singleton pregnancies conceived after in-vitro fertilization or intracytoplasmic sperm injection with fresh vs frozen blastocyst transfer: longitudinal cohort study. Ultrasound Obstet Gynecol. 2020; 56(4):603-610.\u003c/li\u003e\n\u003cli\u003eFenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013; 13:59.\u003c/li\u003e\n\u003cli\u003eGrigorescu V, Zhang Y, Kissin DM, Sauber-Schatz E, Sunderam M, Kirby RS, et al. Maternal characteristics and pregnancy outcomes after assisted reproductive technology by infertility diagnosis: ovulatory dysfunction versus tubal obstruction. Fertil Steril. 2014; 101(4):1019-1025.\u003c/li\u003e\n\u003cli\u003ePalomba S, de Wilde MA, Falbo A, Koster MPH, La Sala GB, Fauser BCJM. Pregnancy complications in women with polycystic ovary syndrome. Human Reproduction Update. 2015; 21(5):575-592.\u003c/li\u003e\n\u003cli\u003eYu HF, Chen HS, Rao DP, Gong J. Association between polycystic ovary syndrome and the risk of pregnancy complications: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2016; 95(51):e4863.\u003c/li\u003e\n\u003cli\u003eVannuccini S, Clifton VL, Fraser IS, Taylor HS, Critchley H, Giudice LC, et al. Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome. Hum Reprod Update. 2016; 22(1):104-115.\u003c/li\u003e\n\u003cli\u003eTobias DK, Chavarro JE, Williams MA, Buck Louis GM, Hu FB, Rich-Edwards J, et al. History of infertility and risk of gestational diabetes mellitus: a prospective analysis of 40,773 pregnancies. Am J Epidemiol. 2013; 178(8):1219-1225.\u003c/li\u003e\n\u003cli\u003eFujii T, Wada-Hiraike O, Nagamatsu T, Harada M, Hirata T, Koga K, et al. Assisted reproductive technology pregnancy complications are significantly associated with endometriosis severity before conception: a retrospective cohort study. Reprod Biol Endocrinol. 2016; 14(1):73.\u003c/li\u003e\n\u003cli\u003eVercellini P, Parazzini F, Pietropaolo G, Cipriani S, Frattaruolo MP, Fedele L. Pregnancy outcome in women with peritoneal, ovarian and rectovaginal endometriosis: a retrospective cohort study. Bjog. 2012; 119(12):1538-1543.\u003c/li\u003e\n\u003cli\u003eYuri T, Yutaka O, Akihisa F, Nagisa O, Ryo T, Minako K, et al. Increased risk of placenta previa is associated with endometriosis and tubal factor infertility in assisted reproductive technology pregnancy. Gynecological Endocrinology. 2013; 29(2):113-115.\u003c/li\u003e\n\u003cli\u003eZullo F, Spagnolo E, Saccone G, Acunzo M, Xodo S, Ceccaroni M, et al. Endometriosis and obstetrics complications: a systematic review and meta-analysis. Fertil Steril. 2017; 108(4):667-672.e665.\u003c/li\u003e\n\u003cli\u003eBrosens I, Derwig I, Brosens J, Fusi L, Benagiano G, Pijnenborg R. The enigmatic uterine junctional zone: the missing link between reproductive disorders and major obstetrical disorders? Hum Reprod. 2010; 25(3):569-574.\u003c/li\u003e\n\u003cli\u003eBenaglia L, Candotti G, Papaleo E, Pagliardini L, Leonardi M, Reschini M, et al. Pregnancy outcome in women with endometriosis achieving pregnancy with IVF. Human Reproduction. 2016; 31(12):2730-2736.\u003c/li\u003e\n\u003cli\u003eRomundstad LB, Romundstad PR, Sunde A, von During V, Skjaerven R, Vatten LJ. Increased risk of placenta previa in pregnancies following IVF/ICSI; a comparison of ART and non-ART pregnancies in the same mother. Hum Reprod. 2006; 21(9):2353-2358.\u003c/li\u003e\n\u003cli\u003eEsh-Broder E, Ariel I, Abas-Bashir N, Bdolah Y, Celnikier DH. Placenta accreta is associated with IVF pregnancies: a retrospective chart review. Bjog. 2011; 118(9):1084-1089.\u003c/li\u003e\n\u003cli\u003eVannuccini S, Ferrata C, Perelli F, Pinzauti S, Severi FM, Reis FM, et al. Peripartum and postpartum outcomes in uncomplicated term pregnancy following ART: a retrospective cohort study from two Italian obstetric units. Hum Reprod Open. 2018; 2018(3):hoy012.\u003c/li\u003e\n\u003cli\u003eRomundstad LB, Romundstad PR, Sunde A, von During V, Skjaerven R, Gunnell D, et al. Effects of technology or maternal factors on perinatal outcome after assisted fertilisation: a population-based cohort study. Lancet. 2008; 372(9640):737-743.\u003c/li\u003e\n\u003cli\u003eCavoretto PI, Giorgione V, Sotiriadis A, Vigan\u0026ograve; P, Papaleo E, Galdini A, et al. IVF/ICSI treatment and the risk of iatrogenic preterm birth in singleton pregnancies: systematic review and meta-analysis of cohort studies. J Matern Fetal Neonatal Med. 2020:1-10.\u003c/li\u003e\n\u003cli\u003eCheng PJ, Duan T. China's new two-child policy: maternity care in the new multiparous era. Bjog. 2016; 123 Suppl 3:7-9.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style='font-size: 14px; font-family: \"Times New Roman\", serif; color: rgb(0, 0, 0);'\u003eTable 1. Maternal and pregnancy characteristics of the ART and spontaneous pregnancy groups.\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 109%;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20.08%;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 43.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.04%;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 43.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eOvulation disorder \u0026nbsp;Ovulation disorder \u0026nbsp;disorder\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 43.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eTubal\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003edisease\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.36%;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 43.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eEndometriosis\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.26%;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 43.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eMale infertility\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.3%;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 43.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eMixed infertility\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.36%;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 43.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAll ART\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.98%;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 43.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eControls\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.74%;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 43.05pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cem\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eP\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;value*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20.08%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eNumber of patients\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.04%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e404\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp 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21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e33\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e(30.8%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.26%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e(40.5%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.36%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e711\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20.08%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eParity\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.04%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.36%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.26%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.3%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.36%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.98%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.74%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20.08%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp 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21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.74%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20.08%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eSingleton\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.04%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e271\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan 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21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e74\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e(69.2%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.26%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e(69%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.36%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1241\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20.08%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eMultiple\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.04%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e133\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e(32.9%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times 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style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e(30.8%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.26%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e136\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e(33.7%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.3%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e39\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e(31%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.36%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e602\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e(32.7%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.98%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e98\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e(1.4%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.74%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20.08%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003ePrevious caesarean delivery\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.04%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.36%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.26%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e274 (67.2%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e545 (67.0%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.36%;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp 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\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20.08%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026ge;2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.04%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e134 (32.8%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e268 (33%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.36%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e35 (32.1%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.26%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e139(33.9%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e(33.9%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.3%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e41 (31.5%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.36%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.98%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.74%;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:150%;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eNote:\u0026nbsp;Data are presented as means\u0026plusmn;SDs for continuous variables and n (%) for dichotomous variables\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:150%;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eMixed infertility refers to a multiple infertility-related diagnosis.\u003cspan style=\"text-decoration: underline;\"\u003e\u003cins cite=\"mailto:Microsoft%20Office%20User\" datetime=\"2020-06-29T19:27\"\u003e\u0026nbsp;\u003c/ins\u003e\u003c/span\u003eBoth blastocyst transfer and cleavage stage embryos transfer are included.\u003c/span\u003e\u003cstrong\u003e\u003cspan style='font-size:10px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:150%;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e*\u003cem\u003eP\u003c/em\u003e values were assessed by using the Pearson\u0026rsquo;s chi-square test, Fisher\u0026rsquo;s exact test or the t test between all IVF group vs controls ; Obesity means BMI\u0026ge;28 kg/m2.\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:150%;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:150%;\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTable 2. Pregnancy outcomes among\u0026nbsp;different\u0026nbsp;infertility etiologies\u0026nbsp;for IVF\u0026nbsp;compared to spontaneous pregnancies in singleton pregnancies.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 5.9e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.1pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-family:DengXian;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77.3pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eControl\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eOvulation disorder\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 72.8pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eTubal disease\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 69.45pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eEndometriosis\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 78.9pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eMale infertility\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 84.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eMixed infertility\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.1pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eSingleton pregnancies\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.75pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37.55pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e%\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.35pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41.65pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e%\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37.8pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e%\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.45pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e%\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.8pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.1pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e%\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41.95pt;border: none;padding: 0in 5.4pt;height: 24.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e271\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41.65pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41.95pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e87\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.55pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.1pt;border: none;padding: 0in 5.4pt;height: 21.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eGestational hypertension\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.75pt;border: none;padding: 0in 5.4pt;height: 21.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New 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21.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e4.8\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35pt;border: none;padding: 0in 5.4pt;height: 21.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e18\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37.8pt;border: none;padding: 0in 5.4pt;height: 21.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.55pt;border: none;padding: 0in 5.4pt;height: 21.35pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2.3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.1pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003ePreeclampsia\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.75pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e193\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37.55pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2.8\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e28*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e129\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37.8pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e25\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.55pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e28.7^\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.1pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e18\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37.8pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e3.3^\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.45pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e5.7*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.1pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003ePlacental abruption\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.75pt;border: none;padding: 0in 5.4pt;height: 21.9pt;vertical-align: top;\"\u003e\n \u003cp 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style='font-family:\"Times New Roman\",serif;'\u003e1.9\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41.95pt;border: none;padding: 0in 5.4pt;height: 19.15pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.55pt;border: none;padding: 0in 5.4pt;height: 19.15pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.1pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eOligohydramnios\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.75pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e247\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37.55pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e3.6\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.35pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e14\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41.65pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e5.2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e18\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37.8pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e3.3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.45pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e5.4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.8pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e12\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.1pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e4.5\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41.95pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.55pt;border: none;padding: 0in 5.4pt;height: 28.6pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2.3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 120.1pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eChorioamnionitis\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.75pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e91\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37.55pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e1.4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.35pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e7\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2.6\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e10\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37.8pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e1.8\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e2.7\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.8pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.1pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e1.1\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41.95pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.55pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.7pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e4.6^\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eNote: GDM= Gestational diabetes mellitus; pPROM=preterm premature rupture of membranes; ICP=intrahepatic cholestasis of pregnancy; Mixed infertility refers to multiple infertility-related diagnosis. Data are presented as n (%) for dichotomous variable, \u003cem\u003eP\u003c/em\u003e values were assessed by using the Pearson\u0026rsquo;s chi-square test, or Fisher\u0026rsquo;s exact test between each infertility subgroup vs controls ; P\u0026le;0.001=*; P\u0026lt;0.05=^. Nonsignificant numbers have not symbol.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-family: \"Times New Roman\", serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable style=\"width: 7.9e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.35pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 99.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eControl\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113.35pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eOvulation disorder\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 120.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eTubal disease\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 106.35pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eEndometriosis\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 106.3pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eMale infertility\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113.15pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 15.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eMixed infertility\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.35pt;border: none;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eSingleton Pregnancies\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border: none;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e%\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78pt;border: none;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border: none;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e%\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;border: none;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e%\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e%\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eN\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.3pt;border: none;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e%\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.35pt;border: none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:10px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.05pt;border: none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e6832\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78pt;border: none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e542\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border: none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;border: none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e74\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e267\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e87\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.3pt;border: none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.35pt;border: none;padding: 0in 5.4pt;height: 16.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eGestational weeks\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.05pt;border: none;padding: 0in 5.4pt;height: 16.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e38.8\u0026plusmn;1.5\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 16.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 16.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e38.3\u0026plusmn;1.8*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border: none;padding: 0in 5.4pt;height: 16.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78pt;border: none;padding: 0in 5.4pt;height: 16.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e38.5\u0026plusmn;1.6*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border: none;padding: 0in 5.4pt;height: 16.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;border: none;padding: 0in 5.4pt;height: 16.25pt;vertical-align: top;\"\u003e\n \u003cp 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e57.37\u0026plusmn;26.53\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.3pt;border: none;padding: 0in 5.4pt;height: 34.5pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.35pt;border: none;padding: 0in 5.4pt;height: 14pt;vertical-align: top;\"\u003e\n \u003cp 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e4.1\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 16.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e18\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border: none;padding: 0in 5.4pt;height: 16.2pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 19.85pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 19.85pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e1.5\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 19.85pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.3pt;border: none;padding: 0in 5.4pt;height: 19.85pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e4.6*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.35pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: bottom;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e5-Minute Apgar score\u0026le;7\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.05pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e10\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.1\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e1\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.6*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.3pt;border: none;padding: 0in 5.4pt;height: 16pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127.35pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: bottom;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eNICU admission\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.05pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e728\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e10.7\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e48\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e17.7*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e72\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e13.3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e17\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e23*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e33\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e12.4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e15\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.3pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e17.2^\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Table 3. Neonatal outcomes among different infertility etiologies for IVF compared to spontaneous pregnancies in singleton pregnancies.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eNote: PTD=preterm delivery; SGA=small for gestational age( birthweight below the 10th percentile for gestational age); Macrosomia=birth weight\u003c/span\u003e\u003cspan style=\"font-size:11px;\"\u003e\u0026ge;\u003c/span\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e4000g;\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eMixed infertility refers to multiple infertility-related diagnosis.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eData are presented as means\u0026plusmn;SDs for continuous variables and n (%) for dichotomous variables. \u003cem\u003eP\u003c/em\u003e values were assessed by using the Pearson\u0026rsquo;s chi-square test, Fisher\u0026rsquo;s exact test or the \u003cem\u003et\u0026nbsp;\u003c/em\u003etest between each infertility subgroup vs controls ; P\u0026le;0.001=*; P\u0026lt;0.05=^. Nonsignificant numbers have not symbol.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 7.9e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 17.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 141.35pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 17.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eOvulation disorder\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 135.05pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 17.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eTubal disease\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 134.4pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 17.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eEndometriosis\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 163pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 17.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eMale infertility\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 134.7pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 17.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eMixed infertility\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eSP\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003ecOR\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.4pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eaOR\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 70.5pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e95% CI\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.2pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003ecOR\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.2pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eaOR\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 66.65pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e95% CI\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.5pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003ecOR\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.65pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eaOR\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e95% CI\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003ecOR\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eaOR\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 92.1pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e95% CI\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003ecOR\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003eaOR\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 63.8pt;border: none;padding: 0in 5.4pt;height: 21.45pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e95% CI\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eGH\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.63\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.4pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.93\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.1pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.52\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.4pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.68\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.2pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.91\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.2pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.72\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.2pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.44\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.19\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.5pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.06\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.65pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.90\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.7pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.28\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.55pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e2.89\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.55\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.49\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border: none;padding: 0in 5.4pt;height: 11.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.96\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eChorioamnionitis\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border-top: none;border-right: none;border-left: none;border-image: 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Roman\",serif;'\u003e1.19\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.61\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e2.32\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.71\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.76\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.7pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.42\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.55pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e7.38\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.80\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.75\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.23\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e2.40\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.28\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e2.93\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28.35pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.04\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 20.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e8.26\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family: \"Times New Roman\", serif;'\u003eTable 4. \u0026nbsp;\u003c/span\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003ecORs, aORs and 95% CIs of pregnancy and delivery outcomes among different\u0026nbsp;infertility etiologies compared to spontaneous pregnancies in singleton pregnancies.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eNote: *Logistic regression analysis was adjusted for age, gravidity, parity, pre-pregnancy obesity, birth plurality, and history of previous caesarean section. The reference group of logistic regression is spontaneous control pregnancy.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eCI=confidence interval; cOR=crude odds ratio;\u0026nbsp;aOR=adjusted odds ratio. Mixed infertility refers to multiple infertility-related diagnosis; SP=singleton pregnancies;\u0026nbsp;GH=gestational hypertension; PPE=preterm preeclampsia; GDM=gestational diabetes mellitus; pPROM=preterm premature rupture of membranes; PH=postpartum haemorrhage; ICP=intrahepatic cholestasis of pregnancy;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eBold indicates significant differences; NC=not calculated due to low numbers.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 7.8e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 26.85pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 134.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 26.85pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eOvulation disorder\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 144.6pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 26.85pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTubal disease\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 139.1pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 26.85pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eEndometriosis\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 139.85pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 26.85pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMale infertility\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 141.45pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 26.85pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eMixed infertility\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eSP\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.8pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ecOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eaOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 67.7pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e95% CI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.15pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ecOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.15pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eaOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77.3pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e95% CI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.55pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ecOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.55pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eaOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 68pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e95% CI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.5pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ecOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.05pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eaOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 70.3pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e95% CI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.05pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ecOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.05pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eaOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 70.35pt;border: none;padding: 0in 5.4pt;height: 22.95pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:center;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e95% CI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 76pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003ePreterm birth\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31.8pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e0.18\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e1.95\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.2pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e1.26\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38.5pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e3.01\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.15pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e0.27\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.15pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e1.33\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33.45pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e0.93\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43.85pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e1.91\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.55pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e0.27\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.55pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e1.97\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.5pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e0.89\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.5pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e4.34\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.5pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e0.21\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.05pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e1.52\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.05pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e0.95\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.25pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e2.44\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.05pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e0.20\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.05pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e2.69\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.05pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e1.41\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.3pt;border: none;padding: 0in 5.4pt;height: 17.65pt;vertical-align: top;\"\u003e\n \u003cp 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rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e0.92\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35.3pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.5pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:14px;font-family:\"Times New Roman\",serif;'\u003e2.84\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;padding:0in 0in 0in 0in;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;text-align:justify;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-family: \"Times New Roman\", serif;'\u003eTable 5.\u0026nbsp;\u003c/span\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003ecORs, aORs and 95% CIs of neonatal outcomes among different\u0026nbsp;infertility etiologies compared to spontaneous pregnancies in singleton pregnancies.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eNote: *Logistic regression analysis was adjusted for age, gravidity, parity, pre-pregnancy obesity, birth plurality, and history of previous caesarean section. CI=confidence interval; cOR=crude odds ratio; \u0026nbsp;aOR=adjusted odds ratio.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:16px;font-family:SimSun;margin:0in;line-height:23.0pt;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eMixed infertility refers to multiple infertility-related diagnosis; SP=singleton pregnancies; PTD=preterm delivery; SGA=small for gestational age( birthweight below the 10th percentile for gestational age); NICU= neonatal intensive care unit\u003c/span\u003e\u003cspan style=\"font-size:11px;\"\u003e；\u003c/span\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eMacrosomia=birth weight\u003c/span\u003e\u003cspan style=\"font-size:11px;\"\u003e\u0026ge;\u003c/span\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003e4000g\u003c/span\u003e\u003cspan style=\"font-size:11px;\"\u003e；\u003c/span\u003e\u003cspan style='font-size:11px;font-family:\"Times New Roman\",serif;'\u003eThe reference group of logistic regression is spontaneous control pregnancy; Bold indicates significant differences; NC=not calculated due to low numbers.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"reasons for IVF, infertility etiology, adverse pregnancy outcomes, neonatal outcomes","lastPublishedDoi":"10.21203/rs.2.13384/v6","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.13384/v6","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e To examine differences in the maternal characteristics and pregnancy outcomes of Chinese women with various causes of infertility who underwent in vitro fertilization (IVF) with embryonic cryopreservation treatment.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Cases were pregnancies after IVF-ET with embryonic cryopreservation; controls were spontaneously conceived pregnancies. Subgroup analysis was carried out according to etiology of infertility. The IVF treatment group was divided into 5 subgroups according to infertility etiology as follows: ovulation disorder, tubal disease, male infertility, endometriosis, and mixed infertility. Data on demographic characteristics, medical history, laboratory tests, and delivery were reviewed. Logistic regression analysis was performed for pregnancy and perinatal complications and neonatal outcomes. The multivariable model was adjusted for potential confounders.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Among singleton pregnancies, compared with spontaneous pregnancies, IVF pregnancies were associated with significant increases in the rates of the following: gestational diabetes mellitus (GDM) (aOR 1.76[95% CI 1.33-2.33]), preeclampsia (2.60[1.61-4.20]), preterm preeclampsia (4.52[2.03-10.06]), postpartum hemorrhage (1.57[1.04-2.36]), intrahepatic cholestasis of pregnancy (3.84[1.06-13.94]), preterm premature rupture of membranes (2.11[1.17-3.81]), preterm birth (1.95[CI 1.26-3.01]), low birthweight (1.90[1.13-3.20]), macrosomia (1.53[1.03-2.27]), and neonatal intensive care unit (NICU) admission (1.69[1.22-2.34]) in the ovulation disorder group; GDM (1.50[1.21-1.86]), placenta previa (2.70[1.59-4.59]), placenta accreta (1.78[1.10-2.89]), postpartum hemorrhage (1.61[1.19-2.18]), macrosomia (1.60[1.21-2.13]) and 5-minute Apgar score ≤7 (4.09[1.04-16.08]) in the tubal disease group; placenta previa (9.33[4.22-20.62]), small for gestational age (2.29[1.04-5.08]), macrosomia (2.00[1.02-3.95]) and NICU admission (2.35[1.35-4.09]) in the endometriosis group; placenta previa (4.14[2.23-7.68]) and placenta accreta (2.05[1.08-3.87]) in the male infertility group; and GDM (1.85[1.15-2.98]), placenta previa (4.73[1.83-12.21]), placental abruption (3.39[1.20-9.56]), chorioamnionitis (2.93[1.04-8.26]), preterm birth (2.69[1.41-5.15]), and 1-minute Apgar score ≤7 (4.68[1.62-13.51]) in the mixed infertility group. Among multiple pregnancies, most of the differences that were significant in singleton pregnancies were less extensive or had disappeared.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eInfertility etiology within the IVF population was found to affect maternal and neonatal outcomes among all births. During the perinatal period, infertility etiology appears to be an additional risk factor for abnormal pregnancy outcomes besides the use of IVF techniques compared with spontaneous pregnancies. Higher risk was found for ovulation disorders, and lower risk was found for male infertility.\u003c/p\u003e","manuscriptTitle":"Pregnancy outcomes of Chinese women undergoing IVF with embryonic cryopreservation as compared to natural conception","msid":"","msnumber":"","nonDraftVersions":[{"code":6,"date":"2020-11-19 18:32:31","doi":"10.21203/rs.2.13384/v6","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept","date":"2020-12-08T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-11-28T00:00:00+00:00","index":1,"fulltext":"Recommendation: Accept without revision\nForm responses:\n---\n\nComments to Author:\n---\nThe authors resolved all issues correctly.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. 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Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-11-26T00:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-11-25T00:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-11-17T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-11-16T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-11-16T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":5,"date":"2020-10-20 15:10:14","doi":"10.21203/rs.2.13384/v5","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2020-10-22T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-10-22T12:00:00+00:00","index":1,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-22T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nMost corrections were done appropriately and the paper is not ready for publication.\nI have only one final concern related to BW centiles added in table 3. How can standard deviation of BW centile be grater than the mean BW centile and particularly in most cases greater than 100? This is impossible. Centiles renge is 1-100. 326 (and others above 100) is out of range. In addition, mean centiles BW are not plausible: it is not possible to have for tubal disease mean BW centile 98. This would mean that these fetuses are all masive which is not true. Endometriosis, mixed, male are grosly wrong cince mean BW centile is above 100 (this is impossible: range is 1-100). Please correct both centiles and standard deviation which shoud be proportional to the centiles.\nSummary of key findings should be short (few lines) Afterwards use Interpretation as a header for the resmaining part of the chapter up to limitatin section. (up to pag 7 line 27)* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"decision","content":"Major revision","date":"2020-10-22T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-10-08T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-10-07T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-10-07T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":4,"date":"2020-08-04 16:13:29","doi":"10.21203/rs.2.13384/v4","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-09-07T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-08-19T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nThe paper was improved after further rervison by the authors. However, I believe that some modifications and corrections are still required before publication.\n\nPlease add in the title mention of the control group \" as compared to natural conception\" and remove \"maternal characteristics\" (there are confounders or mediators, not an outcome). The correct title of this paper is: \"Pregnancy outcomes of Chinese women undergioing IVF with embryonic criopreservation as compared to natural conception\".\n\n\nPag 3 lines 3-4. This sentence is wrong. How can infertility etiology have impact on maternal characteristics? I believe that the correct sentence is:\n\"The aim of this retrospective cohort study was to explore the impact of infertility etiology of frozen-thawed IVF on pregnancy outcomes, adjusting for maternal characteristics.\" Please correct.\n\nSome of the essential references suggested in my previous reviews were neither adequately considered, nor discussed by the authors. In particolar they did not mention the novel and interesting issue of different uterine arteries perfusion (with lower pulsatility index) occurring in fresh as compared to frozen embryo transfer pregnancy from the first to the third trimester, related to higher birthweight in frozen as compared to fresh IVF/ICSI (doi.org/10.1002/uog.21969). Please add this concept to the discussion.\n\nRecent evidences with meta-analysis show the impact of IVF/ICSI pregnancy which more than doubles the rate of iatrogenic preterm birth. Indirect subanalysis on criopreservation fail to achieve statistical significance for iatrogenic PTB, however use of criopreservation present possible association with reduction of the rate of spontaneous PTB. This concept need to be cited and discussed (doi.org/10.1080/14767058.2020.1771690)\n\nThe indication concerning the use birtweight centiles was misunderstood by the authors. It is irrelavent to build up group-specific centiles of birtweight in table 3. What would be the meninng of this analysis? Remove this line from the table please. The final intention in my previos review was to indicate transformation of birtweight (all cases, all groups) into global centiles in order to provide a meaningfluf comparison of birthweight between groups with correction for gestational age. In order to do so the authors need to use a global database with data of absolute birtweight of the whole cohort and transofrming all birthweights into centiles. After that thay need to compare the mean centiles obtained in the different groups providing group-specific means and SDs. The centiles can be even determined by the study gropus (the sample size is sufficient) or taken from reference of standar population. An example of this approach can be seen in the reference paper cited above (doi.org/10.1002/uog.21969) which need to be considered by the authors.\n\nAdd in the methods that ICSI and other methods of conception different from IVF were excluded please\n\nDiscussion.\nMove the first sentence below at line 26.\nAdd a header \"Summary of key findings\" at beginning of discussion as previously suggested and reccomended by STROBE indications.\nSeparate a header with limitation and strenght of the study as suggested by the STROBE guidelines (from line 18 pag 9 onwards)\n\n\nPlease add the sentence in the conclusion of the paper:\"\nThese findings need to be considered with caution given the small sample size in some subgroups (particularly endometriosis and mixed infertility)\". If the authors are choosing to avoid power calculation and post-hoc sample size analysis in the limitation section this needs to be aknowledged adding a sentence such as :\"We are aware that some subgroups presents a limited sample size and likely limited statistical power.\"\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewersInvited","content":"","date":"2020-08-17T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-08-17T12:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2020-07-26T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-07-25T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-07-25T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":3,"date":"2020-05-27 19:11:12","doi":"10.21203/rs.2.13384/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-06-23T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-06-13T12:00:00+00:00","index":3,"fulltext":"Recommendation: Accept after discretionary revisions\nForm responses:\n---\n\nComments to Author:\n---\nThe manuscript was significantly improved in this revised manuscript. I have only minor points which would be considered before publication. \n\n1. About question 2: The author should include the reason for excluding unknown infertility diagnosis in the methods section. Further, because of the substantial number of excluded cycles, those exclusion due to unknown cause for infertility may introduce bias in the results. This point should also be mentioned in the limitation section. \n\n2. Figure: the author should state IVF with embryonic cryopreservation in the figure. \n\n3. The number of tables are too many. Several tables which are not main results of the study such as Table 3, 4, 6, 8, 9 and 11 would be better to move onto supplemental tables. * Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **None.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n"},{"type":"editorInvitedReview","content":"","date":"2020-05-26T12:00:00+00:00","index":1,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nThe authors improved further the manuscript. However, there are still several major problems that hinder publication in the present form. Several points require improvements and corrections before even considering the paper for publication. Should the authors fail to revise accordingly at this second round I am afraid that the paper will need to be discarded.\n\n1. I still cannot see a summary of key findings in the beginning of the discussion. This is also reccomended by STROBE guidelines\nsee STROBE checklist: https://www.strobe-statement.org/fileadmin/Strobe/uploads/checklists/STROBE_checklist_v4_combined.pdf.\nThis is also essential given the quantity of results of this paper. The authors need to summarize in a narrative fashion significant results emerging fromt their study.\n2. The aim of the study is still unclear. Is the primary aim to compare outcomes of IVF with embrionic criopreservation with those of control group with spontaneous conception? The conclusions does not include any evidence of this analysis. The secondary outcomes are to related to subgroup analysis in relation to different infertility etiology. Please clarify. Please report results and conclusions in strict alignement with the study aim(s).\n4. My comment on Odds ratio and fold of risk increase was misundertood by the authors. In fact this method of fold-increase is neither elegant nor formal to be used troughout the manuscript, this can be used when the authors are summarizing in a narrative fashion their results in the summary of results section (still to be done), however in other sections it is better to use OR or RR in general.\n5. English Language revision needs to be improved, it is still insufficient.\n6. When they resubmit the revised version please add both the track changes version and a clean version of the masnuiscript (otherwise it becomes impossible to navigate trough all your correstions, changes and modifications).\n\nAbstract\n1.The sentence: \"In order to reduce the research error, we deliberately removed the fresh ET cycles and ICSI cycles at the beginning, so in our data the IVF-ET method was frozen-embryo transfer\" is cumbersome. Please delete. Add a similar sentence: \"cases were pregnancies after IVF-ET with embryonic cryopreservation, controls were spontaneoutly conceived pregnancies. Subgoup analysis was carried out according to etiology of infertility\" or similar…\n2.Methods. In the methods there is no mention of the subgroup analysis for infertility etiology. This is a major mistake that needs to be corrected.\n3. The first sentence of the results is in fact a methodological description, please move it to the methods.\n4. Also in the methods it is quite obvious the output of logistic regression is OR with 95%CI, please delete.\n5. Results: The sentence \"we verified that ART IVF with embryonic cryopreservation pregnancies are related to increased risks of adverse perinatal outcomes\" is too generic. Please describe which pregnancy outcomes. Add the magnitude of the effects found for each outcome (ORs).\n6. the conclusion of the abstract does nor present mention of the primary outcome (comparison of IVF and controls?), this conclusion is limited to the secondary outcome is it?.primary outcome was related to differences in pregnancy outcome between IVF and spontaneous. Was it?\n\nMain text\nMain text, introduction. \"Infertility reasons\" is unacceptable medical jergon. Please use infertility etiology.\nThe authors state: We are sorry, in this paper, we lack specific BMI data, only data on pre-pregnancy obesity(BMI≥28kg/m2), which means higher BMI. So we could not add BMI as a continuous variable in the study groups.\" Add this limitation to the limitations section of the paper please.\nThe conclusion is not based focussed on authors results. Please mention the outcomes with higher risk, for clinicians Readers, they to be aware of what?\n\nTables.\nTable 1. both the Pearson chi square test and Fisher test assess two groups. Therefore these p values (I assume) are relative to comparison of all IVF vs controls? Is it correct? Please add mention of which comparison is in object here, as previously requested. Does \"nomber of embryos\" mean \"number of embryo transferred in the pregnancy\" Or doeas it mean number of embryos available? Please include the age of the embryo? Are they cleavage stage or blastocysts? This is an essential information to be added.\nTable2. I do not understand the title of this table. This is not a brief summary, is it? This is a detailed data description. Please modify table title. Placental abruptio is not a subgroup of placenta previa, this is a different diagnosis. Why the authors removed it?\nMy comment \"Since all tables are very busy and cumbersome, I would reccomend to create a summary of results section to be put in the beginning of the discussion with brief summary of essential findings of this paper\" was misinterpreted by the authors. I did not request to delete data fromt he tables. I requested a narrative SUMMARY OF RESULTS, as requested by STROBE Guidelines, guiding Readers in asessing the most important issues arising from this paper. Which are the most interesting and important results of this paper? This is an essential requisite for publication.\nTable 4. Use twins not gemellary\nTable 5. Centiles birthweight were not added.\nTable 7. Add that reference group of logistic regression is spontaneous control pregnancy. Where are crude odds ratios? I just see the adjusted ORs.\nI did not understand what the authord did in tables 7 and 9. Why did they split the table? Is is extremely difficuilt to read them now\nUse the word twins not gemellary.\n\n* Are the methods appropriate and well described?: **No**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n"},{"type":"editorInvitedReview","content":"","date":"2020-05-26T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept without revision\nForm responses:\n---\n\nComments to Author:\n---\nPlease include all comments for the authors in this box rather than uploading your report as an attachment. Please only upload as attachments annotated versions of manuscripts, graphs, supporting materials or other aspects of your report which cannot be included in a text format.\nPlease overwrite this text when adding your comments to the authors.* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n"},{"type":"reviewerAgreed","content":"","date":"2020-05-22T12:00:00+00:00","index":3,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-05-21T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-05-20T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-05-20T12:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2020-05-17T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-05-16T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-05-16T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-03-10 16:35:14","doi":"10.21203/rs.2.13384/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-03-24T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-03-19T12:00:00+00:00","index":3,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nAlthough the authors responded to my questions in this revised version of the manuscript, there are still major concerns that have to be amended before publication. \n\nQuestion 1. The author responded to my question that there are two main purposes of the study. If so, please clearly write the two main purposes in the revised manuscript. \n\nQuestion 2. Although the author excluded cycles with unexplained infertility, I still feel it is necessary to include those cycles. Including those cycles would provide a reasonable reference to evaluate whether the increased risks in the analysis is due to each infertility diagnosis or not. \n\nQuestion 3. The author described that ART method was IVF-ET, and IVF-ET method was frozen-thawed embryo transfer of the early cleavage stage embryos. Were there no fresh ET cycles? Similarly, where ICSI cycles were gone? Please clearly state this point. \n\nQuestion 4. In the flow chart of the participants, please describe each number of cycles for preimplantation genetic testing, donor oocytes/sperm/embryos, respectively. Similarly, please explain how numbers from 8422 naturally conceived patients were finally selected to6930 neonates. Each number of samples for exclusion is needed. Also, please adda figure legend for an explanation. \n* Are the methods appropriate and well described?: **No**\n* Does the work include the necessary controls?: **No**\n* Are the conclusions drawn adequately supported by the data shown?: **No**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **Not relevant to this manuscript**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: ** I agree to the open peer review policy of the journal**\n"},{"type":"editorInvitedReview","content":"","date":"2020-03-12T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after discretionary revisions\nForm responses:\n---\n\nComments to Author:\n---\nAgain, I am grateful upon the authors efforts towards the current status of their manuscript.\nThe manuscript needs revision for some typographical errors* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: ** I agree to the open peer review policy of the journal**\n"},{"type":"reviewerAgreed","content":"","date":"2020-03-08T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-03-08T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nI believe that the paper is significantly improved now, after the first revision. However, there are still some points that needs to be clarified:\nMajor comments\nAs far as I understand from the methods, in this study there are no IVF from fresh cycles but the work includes only IVF afret transfer of cleavage stage embryos. Is it correct? If this is true it shoud be mabe clear this paper is about IVF with embryonic cryopreservation. Please modofy the title of the paper adding cryopreservation and add this essential datum in the abstract and clarify further in the methods (exclusion of all fresh? Does the center adopt a freeze all strategy?)\nDeclare in the methods that STROBE guidelines were applied.\nTable 1. Declare as a footnote to which comparison these p values applies.\nSince all tables are very busy and cumbersome, I would reccomend to create a summary of results section to be put in the beginning of the discussion with brief summary of essential findings of this paper.\nThe discussion also needs to be enriched with more references related to the outcomes of IVF with embrionic criopreservation highlighting relevant concepts emerging from recent research on this topic:\n1. endometrial preparation and absence of corpus luteum in frozen embryo transfer might predispose to adverse obstetric outcomes such as hypertensive disorders, PE, postpartum hemorrhage, accreta, postterm\nbirth and macrosomia (ref n 1,2)\n2. IVF/ICSI pregnancies with frozen blastocyst transfer as compared to fresh blastocyst transfer present lower uterine pulsatility index from 7 to 37 weeks and greater fetal growth. ( ref n 3)\n3. Critical role of corpus luteum in favoring the physiological transformation of the maternal cardiovascular system in early gestation was shown, demonstrating increased risk of preeclampsia and reduced aortic compliance with frozen embryo transfers and absent corpus luteum (ref 4,5)\n\nClarify that in China local guidelines do not favour resuscitation of fetuses below 28 weeks, therefore only GA above 28 weeks are included. This is a limitation of the study add also the concept in the appropriate section. In fact this exclusion of preterm Birth between 24 and 28 weeks determines a reduction of the prevalence of PTB in the authors series (add this concept, as well).\n\nMinor comments\nIntroduction: pag 3 live 11-13: \"It is difficult to identify whether the adverse outcomes observed with ART are the direct result of the procedure itself or a result of….\" I would suggest for the remaining part of the sentence to rephrase as: \" the patients' characteristics, including type of subfertility or other factors such as carviovascular maladaptation\"\nMethods: clarify definition of abnormal umbilical cordo insertion please. Non central umbilical cord insertion may well be paracentral insertion, which is completely normal, define please the limit in centimeters from insertion to placental edge to define marginal or velamentous insertion and adjust the study group in object.\n\nReferences\n1. Wei D, Liu JY, Sun Y, Shi Y, Zhang B, Liu JQ, Tan J, Liang X, Cao Y, Wang Z, Qin Y, Zhao H, Zhou Y, Ren H, Hao G, Ling X, Zhao J, Zhang Y, Qi X, Zhang L, Deng X, Chen X, Zhu Y, Wang X, Tian LF, Lv Q, Ma X, Zhang H, Legro RS, Chen ZJ. Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial. Lancet. 2019;393:1310-1318.\n2. Ishihara O, Araki R, Kuwahara A, Itakura A, Saito H, Adamson GD. Impact of frozenthawed single-blastocyst transfer on maternal and neonatal outcome: an analysis of 277,042 single-embryo transfer cycles from 2008 to 2010 in Japan. Fertil Steril 2014; 101: 128-133.\n3. Cavoretto P, Farina A, Gaeta G, Sigismondi C, Spinillo S, Casiero D, Pozzoni M, Vigano P, Papaleo E, Candiani M. Longitudinal cohort study of uterine artery Doppler in singleton pregnancies obtained by IVF/ICSI with fresh or frozen blastocyst transfers in relation to pregnancy outcomes. Ultrasound Obstet Gynecol. 2020 Jan 7. doi: 10.1002/uog.21969. [Epub ahead of print] PubMed PMID: 31909549.\n4. Conrad KP, Petersen JW, Chi YY, Zhai X, Li M, Chiu KH, Liu J, Lingis MD, Williams RS, Rhoton-Vlasak A, Larocca JJ, Nichols WW, Segal MS. Maternal Cardiovascular Dysregulation During Early Pregnancy After In Vitro Fertilization Cycles in the Absence of a Corpus Luteum. Hypertension. 2019;74:705-715.\n5. von Versen-Höynck F, Schaub AM, Chi YY, Chiu KH, Liu J, Lingis M, Stan Williams R, Rhoton-Vlasak A, Nichols WW, Fleischmann RR, Zhang W, Winn VD, Segal MS, Conrad KP, Baker VL.. Increased Preeclampsia Risk and Reduced Aortic Compliance With In Vitro Fertilization Cycles in the Absence of a Corpus Luteum. Hypertension. 2019;73:640-649.* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: ** I agree to the open peer review policy of the journal**\n"},{"type":"reviewerAgreed","content":"","date":"2020-03-08T12:00:00+00:00","index":3,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-03-05T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-03-05T12:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2020-03-03T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-03-02T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-03-02T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2019-08-22 14:47:04","doi":"10.21203/rs.2.13384/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-01-30T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-01-18T12:00:00+00:00","index":3,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **I declare that I have no competing interests**\n\nComments to Author:\n---\nThis study aims at examining differences in maternal characteristics and pregnancy outcomes among Chinese women with infertility due to various reasons who underwent assisted reproductive technologies. The study topic is interesting, the manuscript il relatively well-written, the sample size is adequate (thoug requires clarification - see comment below) and the results are consistent with other evidences published. However, I have a number of constructive criticisms for the authors related to several metodological concerns and issues to be carefully evaluated.\n\nMajor criticisms\n1. The introduction should focus on the fact that ART pregnancy present worst outcome as compared to spontaneous, before discussing the origin of that differences. We agree with the author statement that this is likely multifactorial. Please consider recent relevant literature supporting differences of outcomes. In particular increased risk of prematurity, fetal abnormalities, pre-eclampsia, SGA (1-4).\n2. The authors do not consider differences in the methodologies of ART procedures. At least cyopreservation should be taken into account with a subanalisys since there is evidences of major differences of outcome in relation to this variable (5-6). I reccomend to do an extra table for embryo cryopreservation (yes or no) in relation to differences in the outcomes described in table 2.\n3. Please adapt reporting of this observational study to what presented in the STROBE guidelines (https://strobe-statement.org/index.php?id=strobe-home)\n4. Since the authors wish to publish in an international Journal they should report outcomes in relation to internationally recognized standards. Please add a reference in English Language from an international source besides that of local souces (reffs n 7 pag 4 line 2).\n5. Tables need to be simplified, they are very difficult to read and cumbersome (see below).\n6. Avoid repetitions between text and tables (result section).\n7. Please describe in the methods the extent of use of embryonic cryopreservation vs fresh embryo transfer, blascocyst transfer vs clevage stage embryos transfer and describe the ART protocol used and possible variations among study groups. Was PGT-A or PGT-M performed? If so in which proportion? The authors may do an extra table 1b describing the festures of IVF described herein.\n\nMinor criticisms\nAbstract: the first sentence of the conclusion is cumbersome: I would rephrase as: \"maternal caracteristics, in particular type of infertility, appears an additional risk factor for abnormal pregnancy outcomes besides use of IVF tecniques. Lower risk is found in male infertility and higher risk for ovulation disorders and.............\"\nIntroduction: pag 2 line 28. I do not see \"country\" as a frequent covariate within this types of studies. More often are considered differences in etnic groups composition, ART protocols and tecniques, maternal biometric characteristics all of which are reflected in different proportions within different contries. Please rephrase as appropriate.\nMethods. Why did the authors restrict the recruitment to pregnancies above 28 wks? generally it is best use the threshold of 24 weeks and I would encourage them to include this important part of prematurity which otherwise contrunite to underestimation of the related outcomes. I would also suggest to include intrauterine fetal deaths and miscarriages above a predefined threshold (eg 12-14 weeks). All outcome measures presented in the \"main outcome measures\" chapted need to be clearly defined (Eg Polyhydramnios= US assessment showing largest deepest pool of AF greater than 8 cm, etc.….)\nThe authors state :\"The methods were carried out in accordance with approved guidelines\": please be more specific, clarify.\n\nResults. It is unclear how many ART pregnancies are present. At line 16 pag 4 the authors state that 21% (1843) had received ART treatment, and few lines below they state that the ART group consisted of 2651 singleton and 1185 twins pregnancies. Please clarify.\nIt is interesting to note that in the spontaneous pregnancies group a large proportion were delivered by CS (44,7%). This looks a high risk group. Was there any selection of cases? Which was the methodology for intrapartum monitoring?\nThere is a lack of maternal characteristics in table 1: ethnic Group (is it all asian-cinese?), BMI, smoking- Are all chronic diseases excluded? Please add details to what are the exclusion xcriteria as far as pre-existing diseases are concerned.\nDiscussion Pag 6 lines 6-7. If the authors wish to simplify using \"fold\" rather than actual OR I would reccoment to avoid decimals and to round the effect to the closer half unit (e.g. 2 fold or 2.5 fold or 3 fold etc).\nTable 1. In order to simplify the table and facilitate reading: \"multiple infertility releted diagnosis\" can be described as Mixed infertility (put a table footnote to explain). ART means \"All ART\".\nTable 2. I would suggest to simplify the table. Placenta previa doees not require three subgroups, please define previa according to international guidelines (7) and remove subgroups. Separate neonatal outcomes producing Table 3, separate from table 2. In table 3 add PTB\u003c37 and PTB below a lower threshold (choose 34/32 and or 28), possibly add actual birthweight and their centiles as c ontinuous variable. Define LBW, SGA and macrosomia as a footnote to the table as well as in the methods and provide reference from international sources.\nPlease add preterm pre-eclampsia if available (PE\u003c37 wks) if not possible add in the limitation section.\nAmong neonatal outcome add stillbirth and neonatal Death. If not available, this is a majhor limitation of the study that needs to be disclosed int he limitation section and discussed in the main text as well. Please provide accurate definitions of all outcomes ot table 2 and 3 (port partum haemorrage,m abnormal insertion of cord. This may also be done with an extra table (supplemental) or in writing in the mathods with all references as appropriate. Is chorionamnionitis istological or clinical or both? Please define.\nPlease highlight significant odds ratio (bold, asterisk, etc...). Deletion of the 5 colums of P values in table 2 and using asterisk or symbols to describe statistical significace may help the authors to save space in the table make it more echonomic without loosing important content and reducing it to a one page table (e.g. p\u003c0.001=*; p\u003c0.05=^ ; no symbol if no significance).\n\nPlease clarify in the methods what does it mean obesity and possiby add BMI as a continuous variable in the study groups, as well.\nEnglish language requires revision by a native speaker with experience in medical research.\nReferences:\n1. Cavoretto P, Candiani M, Giorgione V, Inversetti A, Abu-Saba MM, Tiberio F, Sigismondi C, Farina A. Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF/ICSI treatment: meta-analysis of cohort studies. Ultrasound Obstet Gynecol. 2018 Jan;51(1):43-53. doi: 10.1002/uog.18930. Review. PubMed PMID: 29114987.\n2: Giorgione V, Parazzini F, Fesslova V, Cipriani S, Candiani M, Inversetti A, Sigismondi C, Tiberio F, Cavoretto P. Congenital heart defects in IVF/ICSI pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018 Jan;51(1):33-42. doi: 10.1002/uog.18932. Review. PubMed PMID: 29164811.\n3. McDonald SD, Han Z, Mulla S, Murphy KE, Beyene J, Ohlsson A; Knowledge Synthesis Group. reterm birth and low birth weight among in vitro fertilization singletons: a systematic review and meta-analyses. Eur J Obstet Gynecol ReprodBiol. 2009 ;146:13848.\n4. Pandey S, Shetty A, Hamilton M, Bhattacharya S, Maheshwari A. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update. 2012;18:485-503. 5.\n5. Pinborg A, Henningsen AA, Loft A, Malchau SS, Forman J, Andersen AN. Large baby syndrome in singletons born after frozen embryo transfer (FET): is it due to maternal factors or the cryotechnique? Hum Reprod. 2014 Mar;29:618-27.\n6. Cavoretto P, Farina A, Gaeta G, Sigismondi C, Spinillo S, Casiero D, Pozzoni M, Vigano P, Papaleo E, Candiani M. Longitudinal cohort study of uterine artery Doppler in singleton pregnancies obtained by IVF/ICSI with fresh or frozen blastocyst transfers in relation to pregnancy outcomes. Ultrasound Obstet Gynecol. 2020 Jan 7. doi: 10.1002/uog.21969. [Epub ahead of print] PubMed PMID: 31909549.\n7. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg27a/\n\n"},{"type":"reviewerAgreed","content":"","date":"2020-01-08T12:00:00+00:00","index":3,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-01-01T12:00:00+00:00","index":2,"fulltext":"Recommendation: Reject\nForm responses:\n---\n* Are the methods appropriate and well described?: **No**\n* Does the work include the necessary controls?: **No**\n* Are the conclusions drawn adequately supported by the data shown?: **No**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare that I have no competing interests**\n\nComments to Author:\n---\nThis study investigates the infertility diagnosis in ART and pregnancy outcomes among Chinese women using a hospital-based retrospective cohort study. The study included 8773 deliveries at Beijing OBGY Hospital between 2009 and 2018. The author found compared with natural conception, women with ovulation disorder demonstrated significantly increased risk for GDM, preeclampsia, pPROM, postpartum hemorrhage and chorioamnionitis, while women with male factor infertility demonstrated significantly higher increased risk for placenta previa. The author concluded perinatal morbidities are higher in women undergoing ART with women not using ART. There were several critical problems in the study design, so I do not recommend for publication to BMC Pregnancy and Childbirth. \n\n\n\u003cMajor points\u003e \n1. The research question for the study is very ambiguous. If the study's purpose is to investigate the impact of infertility diagnosis in ART on perinatal outcomes, the author should not compare women with each infertility diagnosis with natural conception, but compare with women undergoing ART without any infertility diagnosis (i.e. unexplained infertility). Comparing risks for perinatal outcomes with natural conception and discussing risks are different among each infertility diagnosis sounds very obscure. \n\n2. Treatment information for ART is highly lacked. Importantly, the number of embryo transferred, IVF/ICSI, frozen/fresh cycles, blastocyst embryo transfer would definitely impact on perinatal outcomes, and those treatments must not be balanced among women with a different infertility diagnosis, which would introduce bias in their results. As a result, they failed to evaluate the risks of maternal underlying infertility separate from treatment. Without controlling for the treatment effect, all they discussed in the manuscript do not have a concrete basis in fact. At least, they should stratify perinatal outcomes according to fresh/frozen status. \n\n3. Twin pregnancy must impact on perinatal outcomes, so they should analyze singleton and twin pregnancies separately. \n\n4. Although the selected controls matched with maternal age and birth year, there are no detailed methods for matching. Was it 1:1 or 1:2 matching? A flow chart for sample selection is definitely needed. \n\n5. There are too many outcomes, which would raise problems for multiple comparisons. Although they mentioned that all diagnoses were based on the third edition of Chinese Obstetrics and Gynecology. How each outcome was confirmed should be mentioned. \n\n\u003cMinor points\u003e\n1. Results: the author wrote ART pregnancies were more likely to have higher BMIs, there is no information on BMI in Table 1. "},{"type":"reviewerAgreed","content":"","date":"2019-12-16T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2019-08-31T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **Not relevant to this manuscript**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare that I have no competing interests**\n\nComments to Author:\n---\nReviewer: Richard KALISA\n\nThanks for the opportunity to review your work.\n\u2028\nThis paper is one of the few studies from Asia, results of which add importantly to the literature about ART especially in view of ovarian disorders, its associated increased morbidities and long-term health problems even beyond infertility.\n\nUnder abstract you can add an additional sentence on data analysis on to the methods\n\nLine 17, page 4 it was not clear how you got 2651 singletons and 1185 gemellary pregnancies in ART group which even does not reflect in Table 1\n\nLine 26, page 4 the sentence is incomplete or may require rephrasing\n\nConsider changing the title of table 2 to Pregnancy, delivery and neonatal outcomes among specific infertility causes compared to spontaneous pregnancies.\n\nLine 12, page 6 you can consider changing it to \"may lead to a greater risk of adverse obstetric and neonatal outcomes [8, 10]\". \u2028\n\nYou can replace 'diagnoses' to 'diagnosis' through out the entire manuscript.\n\nI noted that you used different reference style so kindly use only BMC pregnancy and childbirth reference style through out the entire manuscript.\n\nAdd possible recommendations at the end of the conclusions and further studies\n\n\n"},{"type":"reviewerAgreed","content":"","date":"2019-08-21T12:00:00+00:00","index":1,"fulltext":""},{"type":"checksComplete","content":"","date":"2019-08-20T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2019-08-20T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2019-08-20T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2019-08-19T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2019-07-28T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b85475e5-9a75-4262-9dc3-1d3b6a8eb10a","owner":[],"postedDate":"November 19th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":1141889,"name":"Maternal \u0026 Fetal Medicine"}],"tags":[],"updatedAt":"2021-01-10T15:05:50+00:00","versionOfRecord":{"articleIdentity":"rs-4096","link":"https://doi.org/10.1186/s12884-020-03486-7","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2021-01-09 15:02:20","publishedOnDateReadable":"January 9th, 2021"},"versionCreatedAt":"2020-11-19 18:32:31","video":"","vorDoi":"10.1186/s12884-020-03486-7","vorDoiUrl":"https://doi.org/10.1186/s12884-020-03486-7","workflowStages":[]},"version":"v6","identity":"rs-4096","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-4096","version":["v6"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}