Zygotic splitting following embryo biopsy: a cohort study of 207 697 single-embryo transfers following IVF treatment.

OBJECTIVE: To evaluate the risk of monozygotic splitting with embryo biopsy during in vitro fertilisation (IVF). DESIGN: A cohort study. SETTING: Anonymised assisted reproductive technology national data from the Human Fertilisation and Embryology Authority, UK. POPULATION: Women undergoing single-embryo transfer (SET) following either pre-implantation genetic testing (PGT) involving embryo biopsy or IVF without PGT. METHODS: Data on women undergoing SET either following PGT and non-PGT IVF treatment in 2000-2016 were analysed to compare the risk of zygotic splitting and monozygotic twining. Logistic regression analysis was performed adjusting for potential confounders. MAIN OUTCOMES: Monozygotic spitting, monozygotic twin birth. RESULTS: Data comprising a total of 207 697 SET cycles (4544 following PGT and 203 153 following non-PGT IVF) were analysed. The live birth rate per embryo transfer was 31.9% (95% confidence interval [CI] 30.5-33.2%) following PGT and 26.9% (95% CI 26.7-27.1%) following non-PGT IVF. The incidence of zygotic splitting following PGT was 2.4% (95% CI 1.7-3.3%) versus 1.5% (95% CI 1.4-1.6%) following non-PGT IVF. There was a significantly higher risk of zygotic splitting with PGT versus non-PGT IVF cycles (odds ratio [OR] 1.64, 95% CI 1.19-2.27). The higher risk of zygotic splitting with PGT cycles remained significant after adjusting for potential confounders (adjusted OR 1.51, 95% CI 1.06-2.15). CONCLUSIONS: The present study demonstrated an increased risk of monozygotic splitting with embryo biopsy. Given the current sparse literature, it is important to accumulate further evidence to validate the findings. TWEETABLE ABSTRACT: A likely increased risk of monozygotic splitting following embryo biopsy.

Effectiveness of spontaneous ovulation as monitored by urinary luteinising hormone versus induced ovulation by administration of human chorionic gonadotrophin in couples undergoing gonadotrophin-stimulated intrauterine insemination: a randomised controlled trial.

OBJECTIVE: To compare effectiveness of spontaneous ovulation monitored by urinary luteinising hormone (LH) versus induced ovulation by administration of human chorionic gonadotrophin (hCG) in couples undergoing gonadotrophin-stimulated intrauterine insemination (IUI). DESIGN: Randomised controlled trial. SETTING: University-level infertility unit. POPULATION: Couples with unexplained infertility, mild endometriosis, mild male factor infertility and polycystic ovarian syndrome. METHODS: Couples were randomised to an LH group (Group A), in which urinary LH was measured daily to detect spontaneous ovulation, or an hCG group (Group B), in which urinary hCG was administered as a trigger. MAIN OUTCOME MEASURES: Clinical pregnancy rate. Secondary outcomes - ongoing pregnancy, live birth, multiple pregnancy and miscarriage rates. RESULTS: A total of 392 couples were randomised with 196 in each arm. The clinical pregnancy rate per woman randomised was 14/196 (7.1%) in the LH arm versus 15/196 (7.6%) in the hCG arm (P = 0.847, which was not statistically significant). Similarly, the ongoing pregnancy rates [13/196 (6.6%) versus 14/196 (7.1%); P = 0.84] and the live birth rates [13/196 (6.6%) versus 14/196 (7.1%); P = 0.84] between the two groups did not show any significant difference. The duration of stimulation and gonadotrophin dosage also did not differ significantly between the two methods. CONCLUSION: There was no significant difference in clinical pregnancy rates when urinary LH and hCG trigger were compared as methods to time insemination in women undergoing gonadotropin-stimulated IUI. TWEETABLE ABSTRACT: A randomised controlled study showing similar effectiveness between two different methods of timing IUI.

Sensory profiles in adults with and without ADHD.

BACKGROUND: Our previous work demonstrates that adults with ADHD produce more force at the fingertips compared to adults without ADHD. One possibility is that somatosensation is impaired in ADHD. However, ADHD is often comorbid with anxiety, and anxiety influences sensory responsivity. AIMS: The goal of the current work was to evaluate differences in the self-report of sensory experiences in adults with and without ADHD, while controlling for internalizing behaviors. METHODS AND PROCEDURES: Forty-five adults (23 with ADHD) completed a semi-structured interview for the diagnosis of ADHD, the Adolescent/Adult Sensory Profile (AASP), and the Achenbach Adult Self Report (ASR). OUTCOMES AND RESULTS: Adults with ADHD reported more hyper- and hypo- sensitivity compared to adults without ADHD, even when controlling for internalizing behaviors. Specifically, between group differences were found for low registration, sensation seeking, and sensory sensitivity scores, but not for sensation avoiding, and for movement, visual, touch, activity, audition, or taste/smell. CONCLUSIONS AND IMPLICATIONS: These findings demonstrate that sensory hyper- and hypo- sensitivity may be features of ADHD in adults. Further, they demonstrate that internalizing behaviors influence the perception of sensory experiences and thus should be accounted for in studies of sensory processing, integration, and modulation in adults with ADHD.

In vivo growth inhibitory effect of Withania somnifera (Ashwagandha) on a transplantable mouse tumor, Sarcoma 180.

Withania somnifera is a medicinal plant used in the treatment of a variety of ailments in the Ayurvedic system. Alcoholic extract of the root of the plant was injected(ip) at daily doses of 200 to 1000 mg/kg body wt for 15 days starting from 24 hr after intradermal inoculation of 5 x 10(5) cells of S-180 in BALB/c mice. Solid tumor growth was monitored for 100 days. Doses of 400 mg/kg and above produced complete regression of tumor after an initial growth, the percentage of complete response (CR) increasing with increasing drug dose. A 55% CR was obtained at 1000 mg/kg drug administration, but this dose also produced some mortality among the animals. A significant increase in the volume doubling time and growth delay was seen when the drug dose was increased from 500 to 750 mg/kg body wt, but further increase in drug dose to 1000 mg/kg did not produce any significant increase in these responses. Cumulative doses of 7.5 to 10 g at daily doses of 500 or 750 mg/kg seems to produce a good response in this tumor.

Drug safety reports on complementary and alternative medicines (ayurvedic and homeopathic medicines) by a spontaneous reporting program in a tertiary care hospital.

OBJECTIVES: The objectives of this study were to initiate a pharmacist-coordinated program to improve the adverse drug reaction (ADR) reporting on complementary and alternative medicines (CAM) in a tertiary care hospital and to evaluate the pattern of the reported ADRs. DESIGN: A targeted approach was taken in increasing the ADR reporting to CAM in a tertiary care hospital in South India. Suspected ADRs to CAM spontaneously reported over a period of 24 months were selected for evaluation. Reported ADRs were evaluated for patient demographics, reaction and drug characteristics, causality, severity, and outcome. RESULTS: A total of 12 ADRs to CAM were reported, which included 9 to Ayurvedic and 3 to homeopathic medicines, which accounted for 1.5% of the ADRs reported to the ADR reporting unit. ADR resulted in hospitalization in 5 patients. The system organ class most commonly involved included skin and appendage disorders (58.3%). Only four of the reactions were previously reported in the literature. The mean time for onset of the ADR after the administration of the drug was 27.8 +/- 36.1 days. The suspected drug was withdrawn in all the reports that resulted in recovery, with mean time for recovery 5.9 +/- 3.6 days. The majority (66.6%) were moderate in severity and 2 were severe in nature. On causality assessment, 6 were probable in nature and the remaining were possible. CONCLUSIONS: Even though there were fewer ADRs reported by this spontaneous reporting system, it gave valuable information regarding the potential for adverse effects with these agents. The study has reinstated the potential role of spontaneous reporting in identifying lesser reported ADRs, including those to CAM. Such hospital-based programs can contribute much in increasing the safety-related data of these agents.