Influence of intracervical and intravaginal seminal plasma on the endometrium in assisted reproduction: a double-blind, placebo-controlled, randomized study.

OBJECTIVE: To investigate the effect of intracervical and intravaginal application of seminal plasma on the endometrium, as assessed by endometrial/subendometrial vascularization and endometrial volume between the day of oocyte retrieval and the day of embryo transfer in an in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle. METHODS: This was a double-blind, placebo-controlled, randomized study including patients undergoing a first or second IVF/ICSI cycle. Homologous seminal plasma or placebo (sodium chloride) was injected into the cervix and posterior vaginal fornix just after follicle aspiration. Three-dimensional power Doppler examination was performed 30 min before oocyte retrieval and 30 min before embryo transfer. Main outcome measures were changes in vascularization flow index (VFI), flow index (FI) and vascularization index (VI) of the endometrium/subendometrium using VOCAL™ (Virtual Organ Computer-aided AnaLysis) and endometrial volume. RESULTS: One hundred patients agreed to participate in the study. Twenty-three patients were excluded, mainly as a result of canceled embryo transfer. Data were analyzed from 40 patients receiving seminal plasma and 37 receiving placebo. No significant differences between the two groups were seen in VFI, FI or VI of the endometrium or subendometrium or in endometrial volume on the day of oocyte pick-up and on the day of embryo transfer. CONCLUSION: Neither endometrial/subendometrial vascularization parameters nor endometrial volume seem to be affected by the application of seminal plasma in patients undergoing their first or second IVF/ICSI cycle.

Blood clots in the cumulus-oocyte complex predict poor oocyte quality and post-fertilization development.

Assessment of oocyte maturity and quality (morphological appearance) at the time of retrieval is difficult as the egg is obscured by a large cumulus mass that hinders adequate scoring. Since no data are available on the possible relationship between the cumulus-oocyte complex (COC) and oocyte morphology, this prospective intracytoplasmic sperm injection study was set up in 87 consecutive patients. COC were grouped according to expansion of both corona radiata and cumulus matrix. Special emphasis was placed on recording morphological anomalies of COC (inclusion of blood clots and amorphous clumps). For all mature ovae, quality was assessed and preimplantation development followed up to blastocyst stage if fertilized. The risk of not harvesting an oocyte was higher in COC with blood clots compared with normal cumulus matrices (P = 0.004). COC expansion did not allow for prediction of either nuclear status or quality of the egg. The presence of blood clots within the cumulus matrix was associated with reduced oocyte quality (dense central granulation), fertilization rate and blastocyst formation, compared with unaffected COC (P < 0.05). It may be postulated that COC showing blood inclusions derive from poor quality follicles, which has a detrimental effect on oocyte quality and further cleavage to blastocyst stage. Consequently, mechanical removal of blood clots cannot rescue the corresponding embryo.

Growth in children from the Wosera subdistrict, Papua New Guinea, in relation to energy and protein intakes and zinc status.

In a cross-sectional study of 123 children aged 24-120 mo from the Wosera subdistrict of Papua New Guinea, height, weight, hematocrit, hemoglobin, hair zinc, and presence of malaria were measured. Two 24-h recalls were undertaken in 67 of the children aged 72-120 mo; 52%, 73%, and 76% had energy, protein, and zinc intakes, respectively, less than two-thirds of the FAO/WHO/UNU recommendations. Stunting was prevalent (29%); 16% were moderately wasted. The prevalence of stunting and hair zinc concentrations less than 1.68 mumol/g was gender related; 38% of males vs 20% of females had Z scores for height-for-age (HAZ scores) less than -2 (P = 0.04); 26% of males vs 11% of females had hair zinc less than 1.68 mumol/g (P less than 0.05). Analysis of variance showed that age, sex, hemoglobin, and log hair zinc influenced HAZ scores, depending on the age group; both sex and the log of the hair zinc values were significant factors in the older children. Stunting in Worsera children was related to chronic deficits in energy and protein and was excerbated in the older male children by suboptimal zinc status.

Role of three-dimensional ultrasonographic measurement of endometrium volume as a predictor of pregnancy outcome in an IVF-ET program: a preliminary study.

OBJECTIVE: To evaluate the role of three-dimensional (3D) ultrasonographic measurement of the endometrium in predicting pregnancy in an IVF-ET program. DESIGN: Prospective study. SETTING: Center for assisted reproductive techniques. PATIENT(S): 65 women undergoing controlled ovarian hyperstimulation for IVF. INTERVENTION(S): Ultrasonographic examination on the day of hCG administration. MAIN OUTCOME MEASURE(S): Endometrial volume, endometrial thickness, and pregnancy rate. RESULT(S): The mean (+/-SD) endometrium volume (4.16 +/- 1.97 mL), endometrium thickness (11 +/- 2 mm), and estradiol level (1686.82 +/- 1057.10 pg/mL) in 21 pregnant women on the day of hCG administration did not differ statistically differ from the respective values in 44 nonpregnant women (4.53 +/- 1.79 mL; 11 +/- 2 mm, 1883.56 +/- 1147.21 pg/mL). Receiver-operating characteristic curves showed that the area under curve (AUC) was 0.57 for endometrial volume and 0.48 for endometrial thickness. Using a cut-off value of 2.5 mL for endometrial volume to predict pregnancy, results of the Fisher exact test were statistically significant. No significant cut-off value was found for endometrial thickness. CONCLUSION(S): Endometrial volume and thickness on the day of hCG administration did not predict occurrence of pregnancy. A minimum volume of 2.5 mL appeared to favor pregnancy. The predictive value of 3D ultrasonographic measurement of endometrial volume and thickness was better than that of 2D measurement.

Embryo fragmentation in vitro and its impact on treatment and pregnancy outcome.

OBJECTIVE: To determine the impact of embryo fragmentation on pregnancy, obstetric, and perinatal outcome. DESIGN: Retrospective analysis of embryo transfers that were homogeneous in regard to the degree of fragmentation. SETTING: Fertility center. PATIENT(S): A cohort of 460 fresh embryo transfers. INTERVENTION(S): A total of 164 pregnancies were analyzed for the incidence of antepartum complications during gestation, obstetric (multiple pregnancy, preterm delivery, cesarean section), and perinatal outcome (sex, birth weight, admission to neonatal intensive care unit, malformations). MAIN OUTCOME MEASURE(S): Implantation and clinical pregnancy rate, obstetric and perinatal outcome. RESULT(S): Embryo fragmentation and number of embryos per transfer showed a significant influence on clinical pregnancy and implantation rate. No such relation was found concerning complications, multiple pregnancy rate, incidence of cesarean section, gestation week, birth weight, and average time at the neonatology. On the other hand, pregnancies derived from bad-quality embryos had a significantly higher rate of malformations. CONCLUSION(S): The higher percentage of malformations found in bad-quality embryos may be due to a higher percentage of apoptotic features and chromosomal disorders. For ethical reasons, the transfer of embryos with >50% fragmentation should be considered only after consultation with the patient.

Elective transfer of embryos selected on the basis of first polar body morphology is associated with increased rates of implantation and pregnancy.

OBJECTIVE: To determine the relationship between first polar body morphology and implantation rate and pregnancy rate (PR), to facilitate decision making concerning elective ET. DESIGN: Prospective, randomized study. SETTING: Fertility center. PATIENT(S): One hundred fifty-eight consecutive patients (173 intracytoplasmic sperm injection cycles) resulting in embryo transfers. INTERVENTION(S): In our study group, priority in ET was given to embryos derived from well-shaped first polar bodies, whereas selection of embryos for transfer in the control group was based exclusively on the degree of embryo fragmentation. MAIN OUTCOME MEASURE(S): Total numbers of implantations and pregnancies, PR and implantation rate, and rates of multiple pregnancy and miscarriage. RESULT(S): In the study cohort, 212 embryos were transferred. In the control group, 313 embryos were transferred. The implantation rate and PR were significantly lower in the control group than in the study cohort. In addition, the rate of multiple pregnancy was significantly higher in the study group. CONCLUSION(S): Elective transfer of embryos selected on the basis of first polar body morphology results in higher implantation and pregnancy rates. Multiple pregnancy can be avoided by transferring a reduced number of embryos selected on the basis of first polar body morphology.

Detection of splenosis by radionuclide scanning.

Splenosis is the autotransplantation of splenic tissue following trauma. The presence of residual nodules following splenectomy has been investigated by a sensitive scanning method employing reinjection of 99Tcm-labelled, heat-damaged autologous erythrocytes. Splenosis was detected in 11 of 19 patients who had had splenectomy for traumatic rupture of spleen. Four of them had multiple nodules, the others a single nodule. In one case, the splenic nodule did not take up the sulphur colloid, although it could be visualised on selective splenic scan. We found no splenic nodules in 23 patients who had splenectomy for non-traumatic reasons. It is concluded that the key factor in splenosis is trauma.

[Fetal outcome in reduced flow in the ductus venosus during atrial contraction]. / Das Schicksal des Feten mit reduziertem Fluss des Ductus venosus während der Vorhofkontraktion.

OBJECTIVE: To document the fetal outcome in cases with pathologic Doppler findings in the fetal ductus venosus. METHODS: The outcome of 12 fetuses with reduced velocities in the ductus venosus during atrial contraction was analyzed retrospectively and compared with that of a group of 57 fetuses with normal flow velocities in the umbilical artery and in the fetal ductus venosus. RESULTS: The perinatal mortality was higher in the group with pathologic Doppler findings. There was no significant difference of pH (7.20 vs. 7.24) and Apgar scores (7.57 vs. 8.36) of survivors between the two groups. All 12 fetuses showed increased retrograde velocities in the inferior vena cava. Seven fetuses showed umbilical vein pulsations. CONCLUSIONS: The diagnosis of altered velocities in the ductus venosus may influence prenatal decisions. Therefore Doppler examinations of the fetal ductus venosus should be performed in high-risk pregnancies.

Three-dimensional power Doppler in the diagnosis of ovarian torsion.

Recent advances in ultrasound technology have enabled the diagnosis of overall tissue vascularization by three-dimensional (3D) power Doppler. This case report describes 3D power Doppler characteristics of unilateral ovarian torsion 2 weeks after embryo transfer in a pregnant patient with bilateral hyperstimulated ovaries. Before laparoscopic treatment the twisted right ovary showed the following 3D power Doppler indices: mean grayness index, 15.66; vacularization index, 0.24; flow index, 21.99; vascularization flow index, 0.05. One hour after laparoscopic treatment 3D power Doppler indices of the untwisted ovary were as follows: mean grayness index, 25.61; vacularization index, 3.81; flow index, 42.800; vascularization flow index, 1.63. The resistance index of the ovarian vessels before and after laparoscopy showed no significant difference (5.1 vs. 5.2). The diagnosis of ovarian torsion can be better made with 3D power Doppler sonography than with two-dimensional Doppler sonography.

[Venous Doppler in non-immunologic hydrops fetalis]. / Venöser Doppler beim nichtimmunologischen Hydrops fetalis.

Fifteen fetuses with nonimmune hydrops underwent venous Doppler examinations of inferior vena caval flow. The results were analysed retrospectively. Increased retrograde inferior vena caval flow was defined as pathological (> 15% as anterograde flow). This finding correlates with reduced fetal cardiac output. Nine of fifteen fetuses had increased retrograde flow of inferior vena cava. In comparison to the group with physiologic Doppler parameters the perinatal mortality was significantly higher (p < 0.027) in the group with increased retrograde flow of the inferior vena cava. This and other results as well as the rate of remission underline the value of venous Doppler in predicting fetal outcome.

[Tetralogy of Fallot with absent pulmonary valve--prenatal diagnosis and management in the 2nd trimester]. / Fallotsche Tetralogie mit fehlender Pulmonalklappe--pränatale Diagnose und Management im II. Trimester.

Tetralogy of Fallot with absent pulmonary valve is a rare congenital cardiac malformation detected in 3% to 6% of tetralogy of Fallot patients. The prognosis depends on respiratory complications. In the present case the diagnosis was made at 18 week's gestation with two-dimensional and Doppler echocardiography. A ventricular septal defect and overriding aorta, absent valve echo, pulmonary regurgitation, and cystic pulsatile dilatation of the left pulmonary artery were the main diagnostic criteria. Severe respiratory complications were assumed in combination with a hyperechogenic left lung and termination of pregnancy was performed at 20 weeks' of gestation.

[The polyhydramnios symptom: analysis of 56 cases]. / Das Symptom Polyhydramnion: Analyse von 56 Fällen.

Analysis of 56 CASES: 56 cases of polyhydramnios, which were diagnosed sonographically over a period of three years, were analysed retrospectively in this study. In 9334 births, the prevalence of this symptom was 0.6%. Malformations were the most common cause (26.7%) of polyhydramnios (p < 0.001). In comparison to our normal patient group gestational diabetes, twin pregnancies with elevated amniotic fluid of one twin, virus infections, fetal chromosome abnormalities were diagnosed at a significantly higher rate (p < 0.001). The perinatal mortality rate (28.5%) in comparison to our normal collective (1.6%) was also significantly higher. Because of the high mortality, polyhydramnios must be assessed precisely and treated if possible. Fetal karyotyping should be routinely performed in the second trimester.

[Pulsations of the umbilical vein: pathophysiologic aspects and fetal outcome]. / Pulsationen der Nabelvene: pathophysiologische Aspekte und fetal outcome.

Continuous forward flow to the fetal heart in the umbilical vein is a normal Doppler finding. Altered fetal hemodynamics can cause a pulsatile flow pattern in the umbilical vein. Pulsations in the umbilical vein were diagnosed in 14 pregnancies complicated by fetal hydrops, cardiac malformations, arrhythmia or severe intrauterine growth retardation. To document the fetal outcome, the results were analysed retrospectively. Compared with a normal Doppler group (N = 56), a significantly higher rate of perinatal death (Alpha < 1%), (64% vs 1.75%) was diagnosed, when pulsations in the umbilical vein were present. The Apgar-score was significantly lower (4.5 vs 8.4) (p < 0.0002) in the group with pulsations in the umbilical vein. There was no significant difference of pH between the newborns of the two groups. Eight fetuses developed hydrops. Thirteen fetuses had increased reverse flow in the inferior vena cava. The vena cava of the acardiac fetus could not be identified. The knowledge of the poor outcome and the pathophysiologic relationships of fetal hemodynamics may be useful in clinical management. Therefore Doppler examination of the umbilical vein should be performed in high-risk pregnancies.

[Doppler ultrasound of the umbilical vein in fetal 3rd degree atrioventricular block]. / Doppler der Nabelvene beim fetalen AV-Block 3. Grades.

A 21 week fetus was diagnosed with complete heart block. From the first diagnosis until 38 weeks gestation, umbilical venous pulsations occurred during ventricular systole. The ventricular frequency was 49 bpm. The venous pulsations corresponded with the ventricular frequency. At 38 weeks venous pulsations also occurred during ventricular diastole. Umbilical pulsations during diastole were associated with a decrease of ventricular frequency to 28 bpm and fetal hydrops. The venous pulsations during ventricular systole seem to be characteristic of complete heart block. The pulsations during ventricular diastole reflect the fetal heart failure. Doppler ultrasound aids in the diagnosis and surveillance of the fetus with complete heart block.

[Spontaneous constriction of the fetal ductus arteriosus]. / Spontane Konstriktion des fetalen Ductus arteriosus.

The case report describes the pre- and postnatal clinical and sonographic findings of a fetus with spontaneous constriction of Ductus arteriosus at 39 weeks gestation. An abnormal four-chamber view due to a hypertrophied and enlarged right ventricle, increased peak systolic (2.39 m/sec), increased peak diastolic (0.88 m/sec) velocities and the decreased pulsatility index of 0.92 were the diagnostic criteria. The flow of the right pulmonary artery was retrograde. After birth estimated pulmonary pressure was 50 mmHg. It is concluded that constriction of the fetal ductus arteriosus may also occur spontaneously in the absence of maternal drugs.

Sources of family size attitudes and family planning knowledge among rural Turkish youth.

Family planning programs in developing countries may have unexpected and long-term impact on youth in terms of their own later fertility behavior. This paper presents data indicating the effect of an adult-oriented family planning program on the family size attitudes and fertility-related knowledge of rural Turkish youth. Unmarried males and females living in villages exposed to different levels of family planning activities, as well as those in a control area, were sampled. A multivariate approach to the analysis was used to control for demographic and socioeconomic characteristics and for certain psychological variables. Females desire fewer children than males and know more about contraception, particularly the IUD. The hypothesis of indirect learning as a result of the adult-oriented family planning program, is confirmed for females, but not for males. The findings have implications for both program planning and for a more accurate measurement of the impact of family planning programs.

Population learning among rural Turkish youth from an adult-oriented family planning program.

This study indicates that rural Turkish youth learn indirectly from family planning programs directed toward adults. Female youth in villages, however, seem to pick up much more family planning information than male youth. Two program implications emerge: first, that unmarried youth should be included in ongoing family planning program efforts and second, that stronger efforts must be made to reach adolescent males who eventually will be major decision-makers on family size.