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Closed blastocyst vitrification of biopsied embryos: evaluation of 100 consecutive warming cycles

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

The aim of this study was to analyse the outcome of closed blastocyst vitrification of embryos biopsied at the cleavage stage.

METHODS

Vitrification of supernumerary blastocysts was performed using the closed CBS-VIT High Security straws. Warming cycles (n= 100) for patients with preimplantation genetic diagnosis (PGD) and/or aneuploidy screening in the fresh cycle were analysed. The outcome parameters were morphological survival and transfer rates after warming, clinical pregnancy rate and implantation rate (with fetal heart beat). Clinical outcome was compared with two control groups of (i) vitrified/warming transfer cycles without embryo biopsy and (ii) fresh Day 5 transfer of biopsied embryos.

RESULTS

In total, 131 blastocysts were warmed with a morphological survival of 83.2% (109/131) and a transfer rate of 79.4% (104/131). Day 5 blastocysts survived significantly better (90.4%) than Day 6 blastocysts (70.8%, P< 0.01). No difference in survival rate was observed between early cavitating (89.2%) and full/expanded blastocysts (93.3%). In nine cycles, no blastocyst was available for transfer. The clinical pregnancy rate was 19.2% (15/78) after single-embryo transfer (SET) and 38.5% (5/13) after double-embryo transfer (DET). In SET, the implantation rate for blastocysts frozen on Day 5 was 13.7% (7/51), which was not different from the implantation rate of Day 6 blastocysts (18.5%, 5/27). The overall implantation rate of vitrified PGD biopsied blastocysts (14.4%) was comparable with that of vitrified blastocysts without biopsy (20.4%), but lower than the implantation rate obtained in the fresh PGD cycles (24.4%).

CONCLUSION

Blastocysts on Day 5 and Day 6 of development derived from biopsied embryos can be successfully vitrified using a closed system.

Recommendation and review posted by G. Smith

Vaginal misoprostol prior to insertion of an intrauterine device: an RCT

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

Misoprostol is an agent that may ripen the cervix in nonpregnant women. Here, we investigate whether vaginal misoprostol administered prior to intrauterine device (IUD) insertion reduces the number of failed insertions, insertion-related complications and pain during insertion.

METHODS

We conducted a double-blinded, multicenter randomized controlled trial among patients requesting an IUD. Nulli- and multi-parous women were included, and both copper-containing and levonorgestrel-releasing IUDs were used. Participants were allocated to either 400 µg misoprostol or placebo (administered 3h prior to IUD insertion). The primary outcome measure was failed insertion. Secondary outcome measures were insertion-related complications, pain, difficulty of insertion and side-effects.

RESULTS

Two hundred and seventy participants were randomized. After drop out for various reasons (mainly no show), 199 participants had an IUD inserted; 102 received misoprostol and 97 received placebo. Only three insertions failed; two in the misoprostol group and one in the placebo group [P = 0.59, relative risk (RR) 1.9, 95% confidence interval (CI) 0.2–20.6]. The overall incidence of insertion-related complications was 21.8% in the misoprostol versus 19.1% in the placebo group (mainly vasovagal-like reactions) and did not differ between groups (P = 0.65, RR 1.1, 95% CI 0.7–2.0). No difference in pain scores between groups was found. Side-effects were more common in the misoprostol group (P = 0.05, RR 1.3, 95% CI 1.0–1.7).

CONCLUSION

The study showed no benefit for use of misoprostol prior to IUD insertion. However, there is a tendency of possible harm regarding side-effects. Therefore, we would not recommend standard pretreatment with misoprostol.

The trial was registered in the European Clinical Trials Database EudraCT 2006-006897-60.

Recommendation and review posted by G. Smith

Combined oral contraceptives and body weight: do oral contraceptives cause weight gain? A primate model

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

The aim of this study was to determine if oral contraceptive (OC) use affects body weight, body composition and metabolism in primates.

METHODS

Reproductive-age female rhesus monkeys of normal and obese BMI were studied to document baseline weight stability, then treated continuously with an OC (dosed to achieve equivalent human serum levels for a 30 µg ethinyl estradiol/150 µg levonorgestrel preparation) for 237 days. Monkeys were monitored for changes in body weight, levels of physical activity (measured by a triaxial Actical accelerometer), food/caloric intake, percent body fat (dual energy X-ray absorptiometry, DEXA) and metabolism (24 h metabolic rate and serum metabolic substrate and hormone concentrations).

RESULTS

All 10 monkeys completed the study protocol with no adverse events. While body weight (–0.73% change) and percent body fat (–1.78% change) of the normal BMI group did not significantly decrease from baseline, obese monkeys showed a significant decrease in body weight (–8.58% change, P < 0.01) and percent body fat (–12.13% change P = 0.02) with OC treatment. In both the obese (P = 0.03) and the normal BMI (P = 0.01) groups, there was a significant increase in basal metabolic rate with OC use. No changes were seen in food intake, activity level or % lean muscle mass with OC use for either BMI-based group.

CONCLUSIONS

Overall, OC use appears to cause a slight increase in basal metabolic rate in female monkeys, leading to a decrease in body weight and percent body fat in obese individuals.

Recommendation and review posted by G. Smith

Elevated immunoreactivity to tissue factor and its association with dysmenorrhea severity and the amount of menses in adenomyosis

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

Heavy menstrual bleeding and dysmenorrhea are two top complaints from women with symptomatic adenomyosis, yet their etiology is poorly understood. Tissue factor (TF) has been shown to be upregulated in endometriosis and at the endometrial bleeding sites of women with long-term progestin only contraception. We sought to investigate the expression and localization of TF in eutopic and ectopic endometrium of women with adenomyosis and in endometrium of women without adenomyosis. We also sought to determine the relationship, if any, between TF immunoreactivity and the amount of menses, uterus size and severity of dysmenorrhea.

METHODS

We retrieved tissue samples of eutopic and ectopic endometrium from 50 women with adenomyosis and of endometrium from 18 women without adenomyosis. The tissue sections were subjected to immunostaining and microscopic evaluation to assess the presence and localization of TF in both proliferative and secretory phases in both eutopic and ectopic endometrium and normal endometrium. Information on the amount of menses, severity of dysmenorrhea and other information were collected.

RESULTS

We found that TF immunoreactivity was significantly increased in both eutopic and ectopic endometrium as compared with normal endometrium. In addition, we found that the elevated TF immunoreactivity is associated with heavy menses and increased severity of dysmenorrhea.

CONCLUSIONS

These results suggest that TF is involved in adenomyosis-associated heavy menstrual bleeding and dysmenorrhea and thus may be a potential therapeutic target in treating symptomatic adenomyosis and perhaps also chronic pelvic pain in women with adenomyosis.

Recommendation and review posted by G. Smith

Value of thin-section oblique axial T2-weighted magnetic resonance images to assess uterosacral ligament endometriosis

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

Thin-section oblique axial magnetic resonance imaging (MRI) is useful in staging endometrial and cervical carcinomas but there are no data on its contribution to assessing deep endometriosis. We evaluated the contribution of this MRI technique to diagnosis of uterosacral ligament (USL) endometriosis.

METHODS

In this retrospective study, two radiologists, who were blinded to the surgical and histological results, compared the results from conventional sagittal and axial MRI with those from conventional plus thin-section (3 mm) oblique axial MRI in 100 symptomatic patients. Descriptive statistical analyses including sensitivity, specificity, positive and negative predictive values, accuracy and positive and negative likelihood ratios were performed. Kappa for inter-observer agreement was calculated.

RESULTS

Conventional MR images for the diagnosis of left/right USL endometriosis revealed accuracies of 69/76 and 59/75%, sensitivities of 66/71 and 52/71% and specificities of 76/86 and 76/82% for senior and junior readers, respectively. The combination of conventional and thin-section oblique axial MR images revealed accuracies of 82/87 and 74/81%, sensitivities of 89/93 and 73/81% and specificities of 61/72 and 76/79%, for senior and junior readers, respectively. When conventional MRI combined with oblique axial T2-weighted MRI was compared with conventional MRI use only, significant differences in diagnostic accuracies were observed for right (P= 0.04) and left (P= 0.01) USL endometriosis.

CONCLUSIONS

Thin-section oblique axial T2-weighted imaging can improve the success of conventional MRI for assessment of USL endometriosis. Further prospective studies are required before this new MR protocol is performed routinely for suspected pelvic endometriosis.

Recommendation and review posted by G. Smith

Pregnancy outcomes and prognostic factors from tubal sterilization reversal by sutureless laparoscopical re-anastomosis: a retrospective cohort study

Posted: January 22, 2011 at 6:12 pm

BACKGROUND

Female sterilization is a widely used contraceptive method but in a small group of women, post-sterilization regret occurs. A dilemma for these women is the choice between surgical re-anastomosis and IVF. We evaluated the factors that affected pregnancy rate after laparoscopic tubal re-anastomosis for sterilization regret.

METHODS

We included women who underwent a laparoscopic tubal re-anastomosis between January 1997 and March 2008 at Máxima Medical Centre, The Netherlands, in a retrospective cohort study. Microsurgical laparoscopic re-anastomosis was performed using a serosa-muscular fixation/biological glue technique. The primary outcome was time to clinical pregnancy (TTP). Other outcomes were ongoing pregnancy and ectopic pregnancy. We studied whether clinical characteristics, including age, fertility history, BMI, semen quality, remaining tubal length and type of anastomosis, could predict the chance of pregnancy.

RESULTS

Data from 127 patients were analysed. The 40-month cumulative clinical pregnancy rate was 74%, whereas the ongoing pregnancy rate was 59%. There were five ectopic pregnancies (3.9%). Only age was found to influence the probability of a positive pregnancy test, hazard rate ratio (HRR): 0.32 [95% confidence interval (CI) 0.12–0.88] and ongoing pregnancy [HRR 0.21 (95% CI 0.05–0.87)]. Previous pregnancy increased pregnancy probability [HRR: 2.2 (95% CI 0.51–9.8)]. A total sperm motility count of <20 million was related to prolonged TTP.

CONCLUSIONS

Sutureless laparoscopic tubal re-anastomosis is an effective treatment for women who regret sterilization. Age, previous pregnancies and sperm quality should be considered when counselling for tubal sterilization reversal versus IVF. A randomized prospective trial comparing success rates of surgical reversal and IVF after sterilization regret should be conducted.

Recommendation and review posted by G. Smith


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