P20Early membrane funnelling may occur from 16 weeks onwards and carries a worse prognosis

Background Sonographic screening for cervical incompetence during pregnancy is currently a routine procedure. However, no consensus exists on the optimal gestational age to perform such screening. Method Serial transvaginal ultrasound examinations of the uterine cervix were routinely performed from 12 weeks onwards. The screening was considered positive when membrane funnelling was present or the cervical length was < 2 cm. Therapeutic measures included bed rest, antibiotics, tocolytic treatment and a modified McDonald's cervical suture (up to 25 weeks). Results Membrane funnelling was detected between 16 and 22 weeks (group A) in 9 women (31%); between 23 and 28 weeks (group B) in 11 women…

Increased doses of vaginal progesterone for the prevention of preterm birth in twin pregnancies: a randomised controlled double-blind multicentre trial

Objective  Previous trials have shown little benefit for preventing preterm birth in twin pregnancies using 90–200 mg of daily vaginal natural progesterone. Higher doses have not been tested. Our aim was to determine the efficacy and safety of two different daily doses of vaginal natural progesterone (200 and 400 mg), compared with placebo, for preventing preterm birth in unselected twin pregnancies. Design  Randomised controlled double-blind multicentre trial (1:1:1). Setting  The study was carried out in five university centres from Valencia, Murcia and Alicante (Spain). Population  Women with dichorionic diamniotic twin pregnancies. Methods  The women self-inserted two vaginal pessaries …

Doubtful association between TAR syndrome and increased nuchal translucency in the first trimester of pregnancy

Impact of chronic endometritis in infertility: a SWOT analysis

Chronic endometritis is a pathology often associated with reproductive failure, but there are still no clear recommendations on whether its inclusion in the initial study of infertile couples is necessary. In this discussion paper, based on a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis, the different aspects of the repercussions of chronic endometritis in fertility are evaluated. To avoid possible subjectivity in the analysis and results of this study, the researchers followed the Oxford criteria for the evaluation of evidence. The results from the evaluation of the reviewed literature seem to indicate that, pending new evidence, it would be advisable not to include chroni…

Cumulative newborn rates increase with the total number of transferred embryos according to an analysis of 15,792 ovum donation cycles

Objective To measure the success of in vitro fertilization (IVF) of donated ova according to cumulative newborn rates (CNBR) per number of embryos required to achieve at least one newborn (EmbR), considering in addition the relevance of age and infertility etiology. Design Survival curves and Kaplan-Meier methods were employed to analyze CNBR with respect to the number of EmbR in a retrospective cohort of oocyte donation recipients. Setting University-affiliated infertility center. Patient(s) Infertile couples undergoing IVF with oocyte donation. Intervention(s) None. Main Outcome Measure(s) CNBR per EmbR. Result(s) The CNBR increased radically (up to 64.8%) between 1 and 5 EmbR, moderately…

Obesity and assisted reproductive technology outcomes.

Obesity is a rising health problem in Western societies. It has been related to increased morbidity and mortality rates due to several pathologies. In the field of gynaecology and reproduction, obesity is associated with menstrual disorders, hirsutism, infertility, miscarriage and obstetric complications. It is known to impair human reproduction through different mechanisms such as insulin resistance, hyperandrogenism and elevated leptin levels. Weight management and dietary intervention can reverse this situation and improve reproductive function. Obesity can also impair the outcome of assisted reproductive technologies. The lower probability of a healthy live birth described in obese wome…

Cumulative live-birth rates per total number of embryos needed to reach newborn in consecutive in vitro fertilization (IVF) cycles: a new approach to measuring the likelihood of IVF success.

Objective To report the use of cumulative live-birth rates (CLBRs) per ovarian stimulation cycle to measure the success of IVF is proving to be the most accurate method for advising couples who failed to conceive, although the accuracy yielded is relatively low, and cycle outcome is highly dependent on the number of embryos replaced. Our aim with this work is to report the CLBRs of IVF as a function of the number of embryos required to reach a live birth (EmbR), considering age, day of ET, and infertility etiology. Design Survival curves and Kaplan-Meier methods to analyze CLBR in a retrospective cohort with respect to the number of EmbR. Setting University-affiliated infertility center. Pa…

Computerized analysis of normal fetal heart rate pattern throughout gestation.

Objective To analyze the evolution of computerized cardiotocography (cCTG) parameters throughout gestation in a large archive of traces from healthy fetuses. Methods This was a cross-sectional study of the first cCTG record from 4412 singleton fetuses with good pregnancy outcome. Normal ranges of cCTG parameters for 25 to 42 weeks were derived from analysis of only one cCTG record per fetus, and the relationship between the parameters and gestational age was investigated. Results Fetal heart rate (FHR) accelerations, short- and long-term variation overall, duration of episodes of high and low variation and variation in high episodes increased with advancing gestation. In contrast, maternal …

Similar morphokinetic patterns in embryos derived from obese and normoweight infertile women: a time-lapse study.

Study question Does female obesity affect the dynamic parameters of embryo quality assessed by time-lapse analysis? Summary answer Female obesity does not affect the dynamic embryo quality as determined by image acquisition and time-lapse analysis. What is known already Female obesity impairs natural and assisted reproduction but there is no agreement on the specific contribution of gametes, embryos or endometrial receptivity. In this preliminary study the dynamic parameters of embryo quality are assessed for the first time by time-lapse analysis. Study design, size, duration Two-year cohort retrospective study comparing embryos from three groups of patients according to the presence of inf…

Examination of the fetal brain by transabdominal three-dimensional ultrasound: potential for routine neurosonographic studies

Objective To evaluate the role of transabdominal three-dimensional (3D) ultrasound in the assessment of the fetal brain and its potential for routine neurosonographic studies. Methods We studied prospectively 202 consecutive fetuses between 16 and 24 weeks' gestation. A 3D ultrasound volume of the fetal head was acquired transabdominally. The entire brain anatomy was later analyzed using the multiplanar images by a sonologist who was expert in neonatal cranial sonography. The quality of the conventional planes obtained (coronal, sagittal and axial, at different levels) and the ability of the 3D multiplanar neuroscan to visualize properly the major anatomical structures of the brain were eva…

In vitro fertilization in underweight women: focus on obstetric outcome.

Additive effect of factors related to assisted conception on the reduction of maternal serum pregnancy-associated plasma protein A concentrations and the increased false-positive rates in first-trimester Down syndrome screening.

Objective To analyze whether assisted conceptions need adjustments in first-trimester Down syndrome screening and why modifications in screening markers occur. Design Eleven-year cohort retrospective analysis. Setting Maternal-fetal medicine unit. Patient(s) Two thousand eleven naturally conceived normal singleton pregnancies and 2,042 normal singleton pregnancies achieved with assisted conception: 350 by IUI and 1,692 with IVF (n = 328) or intracytoplasmic sperm injection (ICSI; n=1,364), using nondonor (n = 1,086) or donated ova (n = 606), with fresh (n = 1,432) or frozen (n = 260) embryos. Intervention(s) Comparison of ultrasound and biochemical markers of first-trimester Down syndrome s…

P01.28: Analysis of nuchal translucency measurements in pregnancies achieved by assisted reproduction techniques

Y chromosome microdeletions, sperm DNA fragmentation and sperm oxidative stress as causes of recurrent spontaneous abortion of unknown etiology.

Background The aim of the present study was to evaluate the implication of male factor, in terms of sperm DNA oxidation and fragmentation, and Y chromosome microdeletions in recurrent spontaneous abortion (RSA) of unknown origin in a strictly selected cohort. Methods A prospective cohort study was carried out in a private university-affiliated setting. Three groups, each comprised of 30 males, were compared. The first was formed by healthy and fertile sperm donors (SD) with normal sperm parameters (control group), the second by men presenting severe oligozoospermia (SO) without RSA history, and the third by men from couples who had experienced idiopathic RSA. Frequency of Y chromosome micro…

Effects of prandial glycemic changes on objective fetal heart rate parameters

Background. There is confusion in the literature about the potential effect of maternal glucose levels on the fetal heart rate (FHR) cardiotocographic interpretation.Methods. Study design: prospective clinical descriptive study. Subjects: 21 pregnant women with diabetes mellitus, 23 women with gestational diabetes and 18 healthy non-diabetic pregnant volunteers (control group). Treatment: maternal capillary glucose measurement and objective FHR analysis (Oxford System 8002) pre- and 1 h post-meal. Statistical analysis: descriptive statistics, Student t-tests and Pearson correlation studies.Results. Maternal capillary glucose levels ranged between 2.7–10.5 mmol/l pre-meal and 4.2–14.8 mmol/l…

OC2.01: Examination of the fetal brain by three-dimensional ultrasound: potential for routine neurosonographic studies

Objective: To evaluate the role of three-dimensional (3D) ultrasound in the assessment of the fetal brain and its potential for routine neurosonographic studies. Methods: We studied prospectively 202 consecutive brain fetuses between 16 and 24 weeks’ gestation. A 3D-ultrasound volume of the fetal head was acquired transabdominally. The entire brain anatomy was later analyzed by a sonologist expert in neonatal cranial sonography using the multiplanar images. The quality of the conventional planes obtained (coronal, sagittal and axial, at different levels) and the ability to visualize properly the major brain anatomic structures were evaluated. Results: Acceptable rendered cerebral volumes we…

Posters
Early pregnancy
P01First trimester normograms for a wide variety of ultrasound, hemodynamic and serum parameters

Background The aim of the study was to assess prospectively the evolution of multiple clinical parameters throughout the first trimester of pregnancy. Method A transvaginal ultrasound examination and a blood test was weekly performed until the 13th gestational week in a group of healthy volunteers. A total of 25 spontaneously conceived singleton pregnant women with good pregnancy outcome finally completed the study. The evolution of 10 transvaginal ultrasound parameters, 5 Doppler measurements and 6 serum parameters was studied. Results An increasing trend with advancing gestation was evident for the mean gestational sac (MSD) and amniotic sac (AS) diameters, trophoblastic rim, CRL and seru…

Can antepartum computerized cardiotocography predict the evolution of intrapartum acid-base status in normal fetuses?

Background. To study the relationship between antepartum computerized cardiotocography (cCTG) and the evolution of intrapartum fetal acid-base balance in a low-risk population. Methods. Forty-nine healthy fetuses were prospectively followed up by antepartum cCTG (Oxford System 8002), fetal scalp blood sampling at the onset of the active phase of dilatation (3 cm) and at the beginning of the second stage of labor (10 cm) and study of acid-base status at birth in the umbilical cord. Correlation studies and linear regression analysis were performed. Results. Normal prelabor cCTG was followed by normal fetal acid-base balance in the different study periods. No relationship was found between cCT…

The Maternal Cytokine and Chemokine Profile of Naturally Conceived Gestations Is Mainly Preserved duringIn VitroFertilization and Egg Donation Pregnancies

This prospective longitudinal study aimed at comparing maternal immune response among naturally conceived (NC;n=25),in vitrofertilization (IVF;n=25), and egg donation (ED;n=25) pregnancies. The main outcome measures were, firstly, to follow up plasma levels of interleukin (IL) 1beta, IL2, IL4, IL5, IL6, IL8, IL10, IL17, interferon gamma, tumor necrosis factor-alpha (TNFα), transforming growth factor-beta (TGFβ), regulated upon activation normal T-cell expressed and secreted (RANTES), stromal cell-derived factor 1 alpha (SDF1α), and decidual granulocyte-macrophage colony-stimulating factor (GM-CSF) during the three trimesters of pregnancy during the three trimesters of pregnancy; secondly, t…

GnRH Analogues in the Prevention of Ovarian Hyperstimulation Syndrome

The GnRH analogue (agonist and antagonist GnRH) changed ovarian stimulation. On the one hand, it improved chances of pregnancy to obtain more oocytes and better embryos. This leads to an ovarian hyper-response, which can be complicated by the ovarian hyperstimulation syndrome (OHSS). On the other hand, the GnRH analogue can prevent the incidence of OHSS: GnRH antagonist protocols, GnRH agonist for triggering final oocyte maturation, either together or separately, coasting, and the GnRH analogue may prove useful for avoiding OHSS in high-risk patients. We review these topics in this article.

First trimester biochemical screening for Down's syndrome in singleton pregnancies conceived by assisted reproduction

BACKGROUND: Serum biochemical markers [free betahCG (fbetahCG); pregnancy-associated plasma protein-A (PAPP-A)] used in first trimester Down's syndrome screening have not been fully investigated in pregnancies achieved by assisted reproduction techniques. We present data on pregnancies conceived by all types of assisted reproduction techniques, including pregnancies following ovum donation (OD) and a large sample by ICSI. METHODS: First trimester Down's syndrome screening was performed in 1054 normal singleton pregnancies: natural conception (n = 498), ovulation induction (OS, n = 97), IVF (n = 47), ICSI (n = 222) and OD (n = 190). RESULTS: No differences in maternal levels of fbetahCG and …

Female underweight and risk of ectopic pregnancy.

Limited implantation success of direct-cleaved human zygotes: a time-lapse study.

Objective To evaluate embryos with direct cleavage (≤5 hours) from two to three cells (DC2–3) and correlate this morphokinetic parameter to implantation and ongoing pregnancy. Design Clinical multicenter retrospective study. Setting Private in vitro fertilization (IVF) centers. Patient(s) From three clinics, a total of 979 treatments including 5,225 embryos using autologous or donated oocytes, of which 1,659 embryos were transferred. Intervention(s) None. Main Outcome Measure(s) Clinical pregnancy confirmed by ultrasound in week 7. Result(s) Of the total embryo cohort, 715 (13.7%) underwent direct cleavage from two to three cells, 1,659 embryos were transferred to recipients, and 109 of the…

Clinical validation of embryo culture and selection by morphokinetic analysis: a randomized, controlled trial of the EmbryoScope.

Objective To determine whether incubation in the integrated EmbryoScope time-lapse monitoring system (TMS) and selection supported by the use of a multivariable morphokinetic model improve reproductive outcomes in comparison with incubation in a standard incubator (SI) embryo culture and selection based exclusively on morphology. Design Prospective, randomized, double-blinded, controlled study. Setting University-affiliated private in vitro fertilization (IVF) clinic. Patient(s) Eight hundred forty-three infertile couples undergoing intracytoplasmic sperm injection (ICSI). Intervention(s) No patient intervention; embryos cultured in SI with development evaluated only by morphology (control …

P01.46: The incidence and characteristics of first-trimester fetal lateral neck cysts

Antral follicle count (AFC) can be used in the prediction of ovarian response but cannot predict the oocyte/embryo quality or the in vitro fertilization outcome in an egg donation program

To verify whether the antral follicle count (AFC) could predict ovarian response, oocyte/embryo quality, and IVF outcome.Prospective study.Instituto Universitario-Instituto Valenciano de Infertilidad, Valencia, Spain.One thousand seventy-four donors and 975 oocyte recipient cycles.Controlled ovarian hyperstimulation (COH), endometrial preparation, IVF/intracytoplasmic sperm injection, ET.COH and oocyte/embryo quality parameters and IVF outcome.We observed lower E(2) levels and fewer mature retrieved oocyte numbers among donors who showed an AFC that was10. These donors also showed significantly higher cancellation and no-donation rates; poor and/or insufficient response was the principal ca…

The patient with autoimmune disorders

First-trimester diagnosis of thrombocytopenia-absent radius (TAR) syndrome in a triplet pregnancy

Blastocyst formation is similar in obese and normal weight women: a morphokinetic study

Abstract STUDY QUESTION Does the embryo cleavage pattern and rate of blastocyst formation differ between normal weight and obese women undergoing IVF? SUMMARY ANSWER Embryo morphokinetic development, final blastocyst formation rate and blastocyst morphology do not differ between obese and normal weight women. WHAT IS KNOWN ALREADY Female obesity has been related to impaired IVF outcomes. Although the mechanisms responsible for this detrimental effect are thought to include impaired oocyte and embryo quality and reduced endometrial receptivity, they are yet to be confirmed. Embryo quality has been commonly assessed using static morphological criteria. Only three studies have analysed the pro…

Ovarian stimulation for ovulation induction and in vitro fertilization in patients with systemic lupus erythematosus and antiphospholipid syndrome.

Objective To review the current evidence regarding the relationship between systemic lupus erythematosus (SLE) and antiphospholipid syndrome and female infertility, as well as the risks associated with ovarian stimulation for ovulation induction and IVF. To establish, based on this information, guidelines for safe and successful assisted reproductive technology (ART). Design A MEDLINE computer search was performed to identify relevant articles. Result(s) Systemic lupus erythematosus and antiphospholipid syndrome are not related to infertility, except for cases of amenorrhea accompanying severe flares, renal insufficiency-related hypofertility, and ovarian failure secondary to cyclophosphami…

The role of thrombophilia and thyroid autoimmunity in unexplained infertility, implantation failure and recurrent spontaneous abortion.

The role of thrombophilia and thyroid autoimmunity in unexplained infertility (UI), implantation failure (IF) and recurrent spontaneous abortion (RSA) is controversial and poorly understood.From March, 2004 to January, 2007, 119 women were prospectively included: 32 oocyte donors, 31 patients with UI, 26 with IF and 30 with RSA. The IF and RSA groups presented normal preimplantation genetic screening. Protein C, protein S, antithrombin III, lupus anticoagulant, activated protein C resistance (APCR), immunoglobulin M and G anticardiolipin antibodies, homocystine, Factor V Leiden, prothrombin G20210A mutation, methylentetrahydrofolate reductase C677T mutation, thyroid-stimulating hormone (TSH…

The impact of cigarette smoking on the health of descendants

This paper presents a review of the literature on the effects of cigarette smoking on the health of descendants and the possible mechanisms that lead to them. The evidence of the effects of prenatal cigarette smoke exposure on neonatal morbidity is clear. A number of birth defects have their incidence raised by maternal cigarette smoking during pregnancy. Prenatal smoke exposure also increases the risk of infant irritability, inattention, decreased response to inanimate auditory stimuli and hypertonia. In addition, the prevalence of obesity in preschool children is higher if the mother smoked during pregnancy, as well as the presence of male or female subfertility/infertility in adult life.…

Day-3 embryo metabolomics in the spent culture media is altered in obese women undergoing in vitro fertilization

Objective To determine whether the global metabolomic profile of the spent culture media (SCM) of day-3 embryos is different in obese and normoweight women undergoing in vitro fertilization (IVF). Design Prospective cohort analysis. Setting IVF clinic. Patient(s) Twenty-eight young, nonsmoking women with normoweight, nonsmoking male partners with mild/normal sperm factors undergoing a first IVF attempt for idiopathic infertility, tubal factor infertility, or failed ovulation induction: obese ovulatory women (n = 12); obese women with polycystic ovary syndrome (PCOS; n=4); normoweight ovulatory women (n = 12). Intervention(s) Fifty μl of SCM collected from two day-3 embryos of each cohort. M…

La Senserrá : sarsuela valensiana en un acte y cuatre cuadros, inspirá en la novéla de D. Visént Blasco Ibáñez La cencerrada ...

"... estrená ... en el Teatro de la Princesa la nit del 12 de chiner de 1901" A la coberta: Número extraordinari

GnRH agonist administration at the time of implantation does not improve pregnancy outcome in intrauterine insemination cycles: a randomized controlled trial.

Objective To assess whether GnRH agonist administration in the luteal phase improves pregnancy outcome in intrauterine insemination (IUI) cycles. Design Single-center, randomized, single-blind, placebo-controlled trial. Setting University-affiliated infertility clinic, between February 2005 and December 2007. Patient(s) Three hundred forty-four women undergoing IUI owing to mild to moderate male factor or donor sperm indication. Intervention(s) Random administration to either a single subcutaneous injection of 0.1 mg triptorelin (group A; n = 172) 8 days after hCG administration, or solvent only (group B; n=172) at the same time. Main Outcome Measure(s) Pregnancy rate was the primary outcom…

Endometrial gene expression in the window of implantation is altered in obese women especially in association with polycystic ovary syndrome

Objective To determine whether luteal phase endometrial transcriptome is altered in obese women during the window of implantation (WOI), considering the presence of infertility, fat distribution and association with polycystic ovary syndrome (PCOS). Design Prospective study. Setting University-affiliated infertility clinic, between May 2007 and March 2009. Patient(s) One control group of women with normal weight (n = 4), and four study groups of obese women (n = 6 each one) according to the association with infertility, PCOS, and ovarian stimulation. Intervention(s) The endometrium was biopsied 7 days after LH surge or hCG administration in 28 women. Main Outcome Measure(s) Endometrial gene…

P04.29: Is the finding of a central gall bladder an anatomic variant?

Second-generation preimplantation genetic testing for aneuploidy in assisted reproduction: a SWOT analysis.

Second-generation preimplantation genetic testing for aneuploidy (PGT-A 2.0) in patients with an unfavourable reproductive and IVF prognosis is becoming common practice, with the aim of improving reproductive outcomes. However, there is still no clear evidence on the possible advantages and drawbacks with regard to this procedure. In this discussion paper, based on a SWOT (strengths, weaknesses, opportunities, threats) analysis, the different aspects of this strategy are evaluated. Current evidence suggests that PGT-A 2.0 should not at present have an indiscriminate application, but it might be indicated in cases in which the risk of aneuploidy is increased.

Gene polymorphisms and HLA-G expression in spontaneous abortions

Abstract Introduction HLA-G and HLA-E are claimed to play a role in establishing maternal–fetal immune tolerance and in maintaining pregnancy. The presence of polymorphism in the HLA-G gene could cause a deficient or excessive expression of the HLA-G and HLA-E molecules. These anomalies could eventually cause pregnancy losses. Materials and methods Clinical study. A total of 90 patients were included in this study. These patients suffered spontaneous abortions between weeks 6 and 11 of pregnancy. We have analysed the most important polymorphisms of the HLA-G gene through different genetic studies and HLA-G and HLA-E expression through immunostaining in human cytotrophoblast cells from first…

Implantation failure of endometrial origin: what is new?

To review recent findings related to possible causes of recurrent implantation failure of endometrial origin in normal uterus.Recent evidences suggest that in apparently normal endometria, RIF may associate with molecular and functional changes in the uterus such as abnormal endometrial microbiota, including the presence of chronic endometritis, poor synchronization between the blastocyst and endometrium, and/or excessive uterine peristalsis. An altered endometrial microbiota detected by molecular techniques has been recently related to poorer embryo implantation, even in apparently normal endometria. The use of the endometrial receptivity analysis test to obtain an objective signature of e…

Innovations in assisted reproductive technologies: impact on contemporary donor egg practice and future advances.

Innovations in assisted reproductive technologies (ART) have driven progress in the donor egg field since the birth of the first baby derived from a donor egg in 1983. Over time, donor oocytes have become an increasingly used option for patients unable to conceive with autologous oocytes. In donor egg, the unique separation of the oocyte source and recipient uterus has created a model that has propelled advances in ART. Progressive ART innovations that have optimized the oocyte donor and resulting embryo include the following: evaluation of ovarian reserve, controlled ovarian hyperstimulation regimens that reduce the risk of ovarian hyperstimulation syndrome, blastocyst culture, oocyte cryo…

Potential pitfalls in fetal neurosonography

Objective To present anatomic variants of the fetal brain and artifacts related to scanning techniques that could be misinterpreted as abnormalities on prenatal neurosonographic studies. Methods The findings were derived from fetal neurosonographic studies performed routinely from 16 to 36 weeks' gestation during the last 3 years, supervised by a sonologist specialized in neonatal cranial sonography. Results The pitfalls were divided into three groups: brain parenchyma, ventricular system and choroid plexus. We provide images of these pseudolesions and clues to their differentiation from true brain pathology. Conclusions Knowledge of misleading images seen on fetal neurosonographic studies …

An anatomical fetal brain structure and a normal variant mimicking anomalies on routine neurosonographic imaging: report of two cases

We present two cases in which an anatomical structure, the calcar avis, and a normal variant, a bifid choroid plexus, mimicked abnormalities on routine prenatal ultrasound examination. To the best of our knowledge these pitfalls have only been described in neonates. A familiarity with these false images is important to avoid erroneous diagnoses.

Female obesity increases the risk of miscarriage of euploid embryos.

Objective To determine whether female body mass index (BMI) is associated with an increased risk of miscarriage after euploid embryo transfer. Design A retrospective, observational, multicenter cohort study. Setting University-affiliated in vitro fertilization center. Patient(s) In this study, 3,480 cycles of in vitro fertilization with preimplantation genetic testing for aneuploidy (PGT-A) in the blastocyst stage and euploid embryo transfer were divided into four groups according to patient BMI. Intervention(s) In vitro fertilization with PGT-A. Main Outcome Measure(s) The primary outcome was the miscarriage rate, which included both biochemical and clinical miscarriages. Secondary outcome…

Early pregnancy loss in women stimulated with gonadotropin-releasing hormone antagonist protocols according to oral contraceptive pill pretreatment.

Objective To evaluate and compare the risk of early pregnancy loss in patients stimulated with GnRH antagonist protocols according to oral contraceptive pill (OCP) pretreatment. Design Retrospective case–control study. Setting Instituto Valenciano de Infertilidad. University of Valencia. Spain. Patient(s) One thousand five hundred thirty-nine patients, aged Intervention(s) Reproductive outcome was compared based on the application (or not) of OCP pretreatment: 944 women were included in the OCP group and 595 in the non-OCP group. The Student's t test was used for statistics. Main Outcome Measure(s) Pregnancy, biochemical pregnancy, ectopic pregnancy, early clinical pregnancy loss, early pre…

GnRH agonist versus recombinant HCG in an oocyte donation programme: a randomized, prospective, controlled, assessor-blind study.

The use of gonadotrophin-releasing hormone (GnRH) agonists for triggering ovulation remains controversial. The primary objective of this study was to evaluate the incidence of ovarian hyperstimulation syndrome (OHSS) following GnRH agonist versus recombinant human chorionic gonadotrophin (HCG) as methods for triggering ovulation. A second aim was to compare the clinical outcome and embryo quality according to the two procedures. The cycle characteristics of 100 oocyte donors undergoing ovarian stimulation and IVF outcomes of their 100 oocyte recipients were analysed. Donors were prospectively randomized into two groups on the last day of ovarian stimulation: Group I received a single bolus …

Obesity and poor reproductive outcome: the potential role of the endometrium

Objective To analyze the potential role of extraovarian factors such as endometrium in the reproductive outcome of obese patients. Design Retrospective study. Setting University-affiliated infertility clinic, between January 2001 and July 2005. Patient(s) Women undergoing a total of 2656 first ovum donation (OD) cycles with good quality embryos. Intervention(s) The oocyte donors underwent controlled ovarian hyperstimulation, and recipients received a well-established hormonal replacement therapy for endometrial preparation. In vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) was performed according to semen characteristics. All first cycles (n = 2656) of ovum donation us…

Implantation is apparently unaffected by the dopamine agonist Cabergoline when administered to prevent ovarian hyperstimulation syndrome in women undergoing assisted reproduction treatment: a pilot study

Background Ovarian hyperstimulation syndrome (OHSS) is a result of ovarian overexpression of vascular endothelial growth factor (VEGF) and its receptor 2 (VEGFR2). VEGF/VEGFR2 binding disrupts cellular junctions and increases vascular permeability (VP), a characteristic of OHSS, but enhances angiogenesis, which is a fundamental step in implantation. In animals, the dopamine agonist Cabergoline (Cb2) prevents VP without affecting angiogenesis. In humans, Cb2 averts OHSS, but a possible detrimental effect on angiogenesis and implantation has not been explored. A pilot study was designed to analyze whether or not Cb2 administration, as a procedure for preventing OHSS, affects the outcome of as…

Blood group and ovarian hyperstimulation syndrome.

Blood group does not constitute a risk factor for the onset of the early form of ovarian hyperstimulation syndrome in women "at risk."

F33Application of early sonographic markers of Down syndrome to pregnancies achieved by assisted reproduction techniques

Is ovarian reserve related to blood type?

Impact of parental over- and underweight on the health of offspring.

Parental excess weight and especially pregestational maternal obesity and excessive weight gain during pregnancy have been related to an increased risk of metabolic (obesity, type 2 diabetes, cardiovascular disease, metabolic syndrome) and nonmetabolic (cancer, osteoporosis, asthma, neurologic alterations) diseases in the offspring, probably mediated by epigenetic mechanisms of fetal programming. Maternal underweight is less common in developed societies, but the discrepancy between a poor nutritional environment in utero and a normal or excessive postnatal food supply with rapid growth catch-up appears to be the main candidate mechanism of the development of chronic diseases during the off…

Introduction

This issue's of Views and Reviews considers the origins of lifetime health established around the time of conception in some prevalent conditions related to infertility. Reviews will look at the effects of advanced paternal and maternal age, the influence of the severe sperm factor, and the impact of some endocrinopathies commonly seen in infertile couples, especially women, like polycystic ovary syndrome, under- and overweight, diabetes, and thyroid disorders. The aim of this Views and Reviews section is to summarize current evidence on the consequences of these conditions on postnatal health to encourage research in this field and the need to develop strategies and preventative measures t…

Evidence-based medicine is gaining momentum

The value of the short-term fetal heart rate variation for timing the delivery of growth-retarded fetuses.

OBJECTIVE: To assess the clinical value of the short-term fetal heart rate variation (STV) for timing the delivery of severely growth-retarded fetuses, many associated with pre-eclampsia. DESIGN: Retrospective cohort study. SETTING: John Radcliffe Maternity Hospital, Oxford, UK. POPULATION: Two hundred and fifty-seven fetuses with a birthweight less than third percentile and a last computerised cardiotocography performed within 24 h of delivery. METHODS: Analysis of the relationship between antepartum STV and the perinatal outcome. MAIN OUTCOME MEASURES: Stillbirth rate and the acid-base status at birth. RESULTS: There were no stillbirths or neonatal deaths (NNDs) within 24 h in the study p…

Similar endometrial development in oocyte donors treated with either high- or standard-dose GnRH antagonist compared to treatment with a GnRH agonist or in natural cycles.

Background This descriptive study evaluates the impact on endometrial development of standard and high doses of a GnRH antagonist in stimulated cycles compared with GnRH agonist and natural cycles. Methods Thirty-one oocyte donors were treated with a combination of rFSH and 0.25 mg/day ganirelix (standard dose), 2 mg/day ganirelix (high dose) or 0.6 mg/day buserelin (long protocol). Vaginal progesterone (200 mg/day) was administered in the luteal phase. Endometrial biopsies were performed 2 and 7 days after HCG administration. Additional biopsies were carried out in a subset of 12 subjects, 2 and 7 days following the LH peak of their previous natural cycle. Biopsies were evaluated histologi…

Doubtful association between progesterone therapy and fetal nuchal translucency

Does an Increased Body Mass Index Affect Endometrial Receptivity in Infertile Patients? A Functional Genomics Analysis

Radicales libres de oxígeno y su relación con enfermedades específicas del embarazo

Resumen De forma reciente se han publicado estudios que relacionan los radicales libres de oxigeno con enfermedades especificas del embarazo. En el parto pretermino, el oxido nitrico puede estar involucrado en la quiescencia fisiologica del utero y la colagenolisis asociada con el reblandecimiento tisular del cervix. Respecto a la rotura prematura de membranas, se conoce que la fuerza del amnios deriva del colageno; que su degradacion es controlada por las metaloproteinasas de la matriz, y que una alteracion del balance entre los pro y los antioxidantes aumenta la actividad de estas ultimas. En la preeclampsia, la placentacion defectuosa produce vasoconstriccion, con baja perfusion placenta…

Obesity and poor reproductive outcome: female and male body weight matter

Reply: Endometrial scratching for women with repeated implantation failure.

Obesity reduces uterine receptivity: clinical experience from 9,587 first cycles of ovum donation with normal weight donors

Objective To analyze the reproductive outcome of recipients of donated ova according to their body mass index (BMI). Design Twelve-year retrospective cohort analysis. Setting Fertility clinics. Patient(s) 9,587 first cycles of ovum donation with ova from normoweight donors. Intervention(s) Recipients divided according to their BMI to analyze IVF laboratory and outcome parameters: lean with BMI 2 (n = 1,458; 15.2%); normoweight with BMI 20–24.9 kg/m 2 (n = 5,706; 59.5%), overweight with BMI 25–29.9 kg/m 2 (n = 1,770; 18.5%), and obese with BMI ≥30 kg/m 2 (n = 653; 6.8%). Main Outcome Measure(s) Implantation, biochemical and clinical pregnancy, miscarriage, and live-birth rates. Result(s) In …

A prospective, randomized, controlled trial comparing three different gonadotropin regimens in oocyte donors: ovarian response, in vitro fertilization outcome, and analysis of cost minimization

Objective To compare the efficacy of three different gonadotropin regimens in an oocyte donation program. The analysis of cost minimization also was evaluated. Design Prospective, randomized, controlled study. Setting Instituto Universitario–IVI, Valencia, Spain. Patient(s) One thousand twenty-eight donors undergoing a GnRH agonist protocol were assigned randomly to one of three groups: group 1 (n = 346), only recombinant FSH (rFSH); group 2 (n = 333), only highly purified menotropin (HP-hMG); and group 3 (n = 349), rFSH plus HP-hMG. One thousand seventy-nine oocyte recipients. Intervention(s) Controlled ovarian stimulation. Main Outcome Measure(s) Controlled ovarian stimulation parameters,…

First-trimester reversed end-diastolic flow in the umbilical artery is not always an ominous sign

We report five cases of first-trimester reversed end-diastolic flow in the umbilical artery. Diagnoses were performed between 8 and 12 gestational weeks. All but one case appeared as a transient early finding. Second-trimester fetal demise occurred in two cases. One case delivered at 32 weeks with severe growth restriction but recovered well. The other two cases had a good pregnancy outcome. Our experience suggests that this early Doppler finding is not always an ominous sign.

P09.25: 2D/3D ultrasound diagnosis of ectrodactyly at 14 weeks of gestation

Female overweight is not associated with a higher embryo euploidy rate in first trimester miscarriages karyotyped by hysteroembryoscopy.

Overweight women (body mass index ≥ 25 kg/m(2)) present an embryo euploidy rate in first trimester miscarriages similar to normoweight controls after a selective biopsy and karyotyping of embryo and/or chorion samples taken by hysteroembryoscopy.

’-omics’ technology and human reproduction: reproductomics

The success of assisted reproduction technology is highly dependent on a precise selection of gametes and embryos and determining the best endometrial window for embryo implantation. For many years, morphological criteria have constituted the only way to assess spermatozoon, oocytes, embryos and endometrial samples in order to improve outcomes. However, this approach has reached a ceiling of success and has been related to unacceptably high rates of multiple pregnancies. New technologies have been developed in order to improve the results and reduce risks via better selection of those gametes and embryos with the highest pregnancy potential, and of more favorable endometrial environments fo…

Scratching beneath 'The Scratching Case': systematic reviews and meta-analyses, the back door for evidence-based medicine

Endometrial scratching or injury was first suggested a decade ago as a simple intervention to improve endometrial receptivity in patients undergoing ART. More than a decade later, based on weak evidence some doctors have adopted this strategy, although there is not yet agreement about its real benefit. In this opinion paper, we analyze the methodological and plausibility problem beneath 'the Scratching Case'. This is also applicable to several other examples of spurious associations reported in the literature. In particular, we emphasize what should be done so as not to dilute evidence-based medicine by a vicious circle created by the over-exploitation of inadequate or insufficient data to …

New options in assisted reproduction technology: the Cryotop method of oocyte vitrification

The Cryotop vitrification method has been shown to be a very useful tool for oocyte cryopreservation, giving excellent results regarding survival and clinical outcome. There are several clinical situations in which oocyte cryopreservation provides solutions that have not been available to date. This report describes three of these situations: (i) a low-responder patient who needed a single gene diagnosis due to the presence of a genetic disease; (ii) a patient undergoing endometrial bleeding on the day of oocyte retrieval who was also affected by a genetic disorder; and (iii) a patient who failed to become pregnant after the donation of vitrified oocytes and subsequently had the re-vitrifie…

P03.04: The influence of mode of conception, fetal gender and twin pregnancy in the development of cerebral structures: a fetal brain 3D ultrasound study

Interactions of the hormones leptin, ghrelin, adiponectin, resistin, and PYY3-36 with the reproductive system.

Objective To summarize the effects of novel hormones (leptin, ghrelin, adiponectin, resistin, and PYY3-36) secreted from adipose tissue and the gastrointestinal tract that have been discovered to exert different effects on several reproductive functions, such as the hypothalamic–pituitary–gonadal axis, embryo development, implantation physiology, and clinically relevant conditions. Design A MEDLINE computer search was performed to identify relevant articles. Result(s) Leptin and ghrelin exert important roles on body weight regulation, eating behavior, and reproduction, acting on the central nervous system and target reproductive organs. As a marker of adequate nutritional stores, these horm…

Female obesity: short- and long-term consequences on the offspring

The worldwide prevalence of obesity has risen over the past few decades and women are currently more likely than ever to enter pregnancy obese. Pre-pregnancy obesity and excessive gestational weight gain increase miscarriage rates and obstetric and neonatal complications, which result in a lower healthy live birth rate. In addition to its negative consequences for the mother, obesity has been shown to be an important risk factor for chronic illnesses, such as cardiovascular disease, metabolic syndrome and type 2 diabetes in the adolescence and adulthood of the offspring. Moreover, maternal obesity causes psychological problems, physical disabilities and higher healthcare costs. Fetal progra…

Live birth after embryo transfer in an unresponsive thin endometrium.

A healthy term livebirth in a 35-year-old woman with ovarian failure, hypoplastic uterus and atrophic endometrium after cancer treatment with chemotherapy and radiotherapy was achieved by ovum donation. The detection of a receptive endometrium using a new diagnostic tool of endometrial receptivity encouraged the medical team to carry on with this poor prognosis case. To the best of our knowledge, here we report the thinnest endometrium to date in which a healthy, full term live birth has been described in assisted conception.

Proteomics and Metabolomics Studies and Clinical Outcomes

Abstract The application of proteomics and metabolomics to the field of human reproduction arose as a result of the need to identify new diagnostic and therapeutic tools that improve fertilization, implantation, and live birth rates in assisted reproduction cycles. A better understanding of the molecular mechanisms underlying the physiology of germ cells, embryos, and the endometrium has been made possible through the identification of their proteomic and metabolomic profiles. This has led to the discovery of specific biomarkers for the diagnosis, treatment, and counseling of several infertility-related conditions and for a more objective selection of the best gametes and embryos and the mo…

Female obesity impairs in vitro fertilization outcome without affecting embryo quality.

Objective To compare embryo quality and reproductive outcome in our IVF program according to the women's body mass index (BMI). Design Retrospective study. Setting University-affiliated infertility clinic, between January 2001 and April 2007. Patient(s) Women undergoing a total of 6,500 IVF–intracytoplasmic sperm injection (ICSI) cycles. Intervention(s) Six thousand five hundred IVF-ICSI cycles were included and divided into four groups: lean ( 2 ; n=1,070; 16.5%); normal (20–24.9 kg/m 2 ; n=3,930; 60.5%); overweight (25–29.9 kg/m 2 ; n=1,081; 16.6%); and obese (≥30 kg/m 2 ; n=419; 6.4%). Main Outcome Measure(s) Comparison of embryo quality and reproductive outcome (implantation, pregnancy,…

Ovarian stimulation for oocyte vitrification does not modify disease-free survival and overall survival rates in patients with early breast cancer

Research question: Does ovarian stimulation for oocyte vitrification affect disease-free survival and overall survival rates in women with early breast cancer? Design: This cohort study included 259 patients with early breast cancer; 148 patients underwent ovarian stimulation, whereas 111 patients did not. Patients were treated between January 2008 and December 2016. To calculate the disease-free survival time and overall survival rate, the time of definitive surgery was defined as the starting point. The follow-up was conducted up to 5 years. Results: Exposed and non-exposed groups were comparable in tumour, node and metastases classification, Nottingham grade, hormonal receptor status, tu…