Sexuality in Assisted Reproductive Technology Couples.

BACKGROUND: Sexuality is a complex social and psychological phenomenon even more complicated in the setting of Assisted Reproductive Technology (ART). SUBJECTS AND METHODS: In total 192 participants entered the study (96 couples) in the process of ART. Participants filled up anonymous questionnaire while waiting routine procedure. At the time of questionnaire males and females were in separate rooms without knowledge about partners answers. RESULTS: The frequency of sexual intercourse was not related to the sociodemographic variables in women but was related to education level and work status. More educated men who were employed had more frequent sexual intercourses. Moreover, the frequency of the sexual intercourse was not related to the duration of the relationship nor the infertility treatment. The correlational analyses showed that the frequency of sexual masturbation was not related to the sociodemographic variables, except for place of living. Both women and men from more urban areas reported to engage in masturbation more often. The frequency of specific sexual activities did not differ between reports by women and men for vaginal, oral, anal, and foreplay activities. However, men reported engaging in masturbation more often than women. CONCLUSION: The frequency of sexual activities is similar in women and men for vaginal, oral, anal, and foreplay activities. However, men reported engaging in masturbation more often than women. ART could only slightly affect quality of sexual life. Both partners should be informed.

The effect of maternal exercise during pregnancy on abnormal fetal growth.

AIM: To assess the effect of maternal physical activity during pregnancy on abnormal fetal growth. METHODS: The study group of 166 women in gestational week 6-8 exercised regularly three days per week at submaximal intensity during their entire pregnancy and the control group of 168 women received standard antenatal care. The main outcomes were macrosomia and intrauterine growth restriction. RESULTS: The study group had a lower frequency of macrosomia in newborns (6.0% vs 12.5%, P=0.048) and gestational diabetes (1.8% vs 8.3%, P=0.008) than the control-group, but there was no significant difference in intrauterine growth restriction (7.2% vs 6.5%). There was also no significant differences in other perinatal outcomes. CONCLUSIONS: The beneficial effect of maternal physical activity on fetal growth may be caused the impact of aerobic exercise on glucose tolerance. Fitness trainers and kinesiologists, as well as health care providers, should be educated on the benefits of regular exercise during pregnancy and safe physical exercise for pregnant women.

Infertility-related stress and sexual satisfaction: a dyadic approach.

PURPOSE OF THE STUDY: to examine whether women's and men's infertility-related stress, and specifically its sexual concerns aspect, is related to their and their partner's sexual satisfaction. MATERIALS AND METHODS: In a cross-sectional study, 94 couples experiencing infertility filled out the New Sexual Satisfaction Scale and Fertility Problem Inventory, which measures infertility-related stress with dimensions of social, sexual and relationship concerns, rejection of childfree lifestyle, and need for parenthood. Dyadic analyses were performed following the Actor-Partner Interdependence Model (APIM). RESULTS: The dyadic analysis revealed that women's and men's greater infertility-related stress contributed to their lower levels of sexual satisfaction (actor effect). Moreover, women's and men's greater sexual concerns (as the aspect of infertility-related stress) contributed to their own and their partner's lower levels of sexual satisfaction (actor and partner effect). CONCLUSIONS: The findings suggest that both individual and relational processes are important in the association between the specific dimension of infertility-related stress and sexual satisfaction. These findings could guide the psychosocial support for couples experiencing infertility.

Oral micronized progesterone combined with vaginal progesterone gel for luteal support.

The aim of the present study was to compare the efficacy and satisfaction rate of combined therapy of oral micronized progesterone capsules and vaginal progesterone gel versus monotherapy with vaginal progesterone gel in luteal support. A case-control study was performed on a total number of 370 women aged <45 years undergoing IVF-ET treatment. The patients received either combination of Crinone 8% vaginal gel, 90 mg daily dose and Utrogestan oral capsules 3 x 100 mg, or Crinone 8% vaginal gel, 90 mg daily. Progesterone supplementation begun on the day of oocyte retrieval and continued until pregnancy was tested and in the case of pregnancy until week 8. The comparable rates of ongoing pregnancies were noted with use of combined-progesterone therapy (39.5%) and progesterone-monotherapy (33.5%). Abortion rate (6.4% vs. 15.6%) was significantly lower with the use of combined therapy. Tolerability and satisfaction of both supplements was almost equal but bleeding occurred more frequently in the progesterone-monotherapy group. In conclusion, the efficacy, satisfaction and tolerability of combined and vaginal progesterone supplements were comparable, but bleeding in early pregnancy and abortion rate presented more frequently with the use of vaginal progesterone.

Neonatal outcome of IVF singletons versus naturally conceived in women aged 35 years and over.

PURPOSE: To compare the delivery and neonatal outcome of IVF singleton pregnancies with those conceived spontaneously in primiparous women ≥ 35 years of age. METHODS: Data were collected by the hospital's obstetrics and pediatric staff at the time of examination, hospitalization, delivery and discharge. A total of 283 women with in vitro fertilization (IVF) singleton deliveries were matched according to ethnicity, age, gravidity, smoking habits, body mass index, weight gain in pregnancy, site and time of delivery with consecutive 283 women conceived spontaneously. The outcome measures were mode of delivery, birth weight, preterm birth and perinatal mortality. RESULTS: Cesarean delivery rate was more common in IVF pregnancies (39.9% vs. 25.1%; p < 0.001). Preterm delivery rate, specifically of spontaneous onset was significantly higher in IVF group (18.7%) than in spontaneous conception group (10.3%; p < 0.008). No difference was found in birth weight records (SGA, VLBW, LBW and LGA) or perinatal mortality rate. However, average gestational birth weight was lower among infants conceived after IVF (3,050 ± 587 g vs. 3,130 ± 524 g; p < 0.05). CONCLUSIONS: Singleton IVF pregnancies in primiparous women ≥ 35 years of age have increased perinatal risk associated with higher rates of cesarean section, preterm births and infants of lower average birth weight. Nevertheless, pregnancy and delivery complications, number of infants with low or very low birth weight, small or large birth weight for appropriate gestation did not differ from those of the spontaneous conceptions.

Influence of seasonal variations on in-vitro fertilization success.

This study was designed to investigate the influence of seasonal variations on the number of retrieved ova, fertilization rate, embryo quality rates and pregnancy rate in IVF cycles. Prospective cohort study was conducted on a total number of 2140 cycles in infertile patients undergoing their first IVF cycle between 2000 and 2007 in IVF policlinic. Chi2-test, Pearson's correlation coefficient and one-way analysis of variance were used for statistical analyses. Overall fertilization rate was 77.96% and pregnancy rate 29.15 +/- 2.72% per cycle. Seasonal prevalence of pregnancy rate was highest during fall 33.8 +/- 4.5% and lowest during summer 23.4 +/- 6.2%, but these differences did not reach statistical significance. The study did not show any statistically significant differences in the number of retrieved oocyte, fertilization, and embryo quality according to season. Therefore seasonal changes should not be taken into account in everyday IVF practice.

Oral dydrogesterone versus vaginal progesterone gel in the luteal phase support: randomized controlled trial.

OBJECTIVES: To compare efficacy, satisfaction and tolerability of oral dydrogesterone and micronized vaginal progesterone gel used for luteal supplementation. STUDY DESIGN: Randomized controlled trial. A total of 853 infertile women undergoing IVF/ICSI treatment in University Hospital Center "Sisters of Mercy", Zagreb, Croatia. Luteal support was provided as Crinone 8%(®) vaginal progesterone gel (90mg) administered daily, or oral dydrogesterone Duphaston(®) (2× 10mg) administered two times daily. Progesterone was administered from the day of oocyte retrieval (day 0) till pregnancy test or in a case of pregnancy, until week 10. RESULTS: The on-going pregnancy rates were comparable between Crinone 8%(®) vaginal progesterone gel and oral dydrogesterone - Duphaston(®) (28.1% versus 30.3%; OR 1.11 (0.82-1.49 with 95% CI)). Overall satisfaction and tolerability were significantly higher in the dydrogesterone group than in the Crinone group. Vaginal bleeding, interference with coitus and local adverse side effects such as vaginal irritation and discharge occurred significantly more in Crinone group than in dydrogesterone group. CONCLUSIONS: Oral dydrogesterone is effective drug, well tolerated and accepted among patients and can be considered for routine luteal support. CLINICAL TRIAL REGISTRATION NUMBER: NCT01178931; www.clinicaltrials.gov.

Treatment of ectopic pregnancy with methotrexate.

The aim of the present study was to analyze retrospectively the safety and success rates of single- and two-dose methotrexate (MTX) protocols for the treatment of hemodynamically stable cases of ectopic pregnancy at University Department of Gynecology and Obstetrics, Zagreb University Hospital Center, during a five-year period. The study evaluated MTX treatment efficacy in 35 women with ectopic pregnancies in relation to the initial levels of human chorionic gonadotropin (hCG) and progesterone. Successful treatment was recorded in 32/35 women, 24/25 on single dose MTX and 8/10 on double dose MTX, whereas 3/35 patients underwent laparoscopy. The mean initial hCG level in all 35 patients on day 0 was 657.54 +/- 592.4 IU/L; 572.99 +/- 488.10 IU/L in those successfully treated with MTX and 1560.30 +/- 890.70 IU/L in those requiring additional laparoscopy (p < 0.005). The mean initial hCG level was 393.10 +/- 305.9 IU/L in patients successfully treated with a single dose of MTX and 973.5 +/- 722.40 IU/L in those with an additional dose of MTX (p < 0.002). The mean initial progesterone level was 16.36 +/-10.70 nmol/L in 35 MTX-treated ectopic pregnancy patients, 13.64 +/- 8.89 nmol/L in those with treatment success and 28.45 +/- 11.32 nmol/L in cases of treatment failure (p < 0.05). The mean level of progesterone on day 0 was 12.74 +/- 830 nmol/L in patients successfully treated with a single dose of MTX and 26.10 +/- 18.80 nmol/L in patients treated with double-dose MTX (p < 0.006). It is concluded that pretreatment values of hCG and progesterone are inversely related to medicamentous treatment success in selected cases ofhemodynamically stable patients, thus they may be used as an important predictor in the management of ectopic pregnancy treated with MTX.

Heterotopic triplet pregnancy complicated with ovarian hyperstimulation syndrome following in vitro fertilization.

Heterotopic pregnancy is a rare event that occurs in less than 1% of pregnancies following in vitro fertilization and embryo transfer, especially when complicated with ovarian hyperstimulation syndrome. We report a case of a 31-year-old woman in the 6th gestational week of pregnancy achieved after in vitro fertilization, who was complaining of acute lower abdominal pain and distension, breathing difficulties and vaginal spotting. Transvaginal ultrasound examination and laboratory tests confirmed the ovarian hyperstimulation syndrome in the presence of two viable gestational sacs. The patient's condition worsened five days later with sudden onset of sharp abdominal pain, nausea and vomiting, along with impaired laboratory test values. Laparoscopy was attempted, but enlarged ovaries and adhesions prevented further procedure, which was then converted to mini-laparotomy. Operative removal of the right tubal pregnancy resulted in uncomplicated course of the intrauterine twin pregnancy and delivery of two healthy neonates by cesarean section at 37 weeks of gestation. Clinicians need to be aware of this rare complication where ovarian hyperstimulation syndrome coexists with heterotopic pregnancy after in vitro fertilization and embryo transfer procedure. Enlarged ovaries may mask accurate ultrasound diagnosis, but timely surgical intervention can prevent fatal consequences and result in normal course and outcome of intrauterine pregnancy.

Comparative study of the efficacy and tolerability of two vaginal progesterone formulations, Crinone 8% gel and Utrogestan capsules, used for luteal support.

OBJECTIVE: To compare the efficacy and tolerability of two different types of vaginal progesterone (P), Crinone 8% gel (Fleet Laboratories Ltd., Watford, United Kingdom) and Utrogestan capsules (Laboratories Besins International, Paris, France), used for luteal support after in vitro fertilization (IVF) cycles. DESIGN: Cohort study. SETTING: In Vitro Fertilization Polyclinic, Zagreb, Croatia. PATIENTS: A total of 285 women aged < or =37 years undergoing IVF-embryo transfer treatment. INTERVENTIONS: Patients were treated with either Crinone 8% vaginal P gel (90 mg) administered daily, or Utrogestan vaginal capsules (2 x 100 mg) administered three times daily. Progesterone was administered from the day of oocyte retrieval (day 0) to menses or, in a case of pregnancy, until week 12. MAIN OUTCOME MEASURE: Clinical pregnancy rate. The tolerability and acceptability of both preparations were determined by a questionnaire given to patients. RESULTS: The similar rates of clinical pregnancies (33.1% vs. 30.9%) [corrected] were obtained by using either Crinone 8% vaginal P gel or Utrogestan vaginal capsules. Overall tolerability and acceptability were significantly better in the Crinone group than in the Utrogestan group. CONCLUSIONS: The efficacy of the two vaginal P formulations was nearly the same, but the tolerability and acceptability of Crinone 8% gel were superior, in the opinion of patients.