Phthalates and bisphenol do not accumulate in human follicular fluid.

OBJECTIVE: To determine if phthalates and bisphenol A accumulate in human follicular fluid after brief exposure to medical plastics during an IVF cycle STUDY DESIGN: Prospective collection of follicular fluid from five infertile women undergoing oocyte retrieval at a University IVF laboratory and analysis of Phthalate & Bisphenol A levels. RESULTS: All phthalate levels were detected at levels less than 15 ng/mL and Bisphenol A levels were undetectable in all five samples. The concentrations of phthalates are 200-1000 fold less than the minimum levels reported to cause reproductive toxicity in vitro to cumulus-oocyte complexes of laboratory animals. CONCLUSIONS: In reproductive age women undergoing infertility treatments there is little transfer or accumulation of phthalates, phthalate metabolites or bisphenol A into the microenvironment of the human preovulatory oocyte and the levels are not clinically significant. Further investigation of phthalate and bisphenol A accumulation in vivo in human follicular fluid may not be productive.

Use of in-cycle antimüllerian hormone levels to predict cycle outcome.

OBJECTIVE: The goal of this work is to expand the usefulness of antimüllerian hormone (AMH) in predicting in vitro fertilization cycle outcome by demonstrating that AMH concentration obtained in an ongoing treatment cycle predicts both oocyte number and pregnancy. STUDY DESIGN: Serum samples were obtained from 190 in vitro fertilization patients at onset of follicle-stimulating hormone stimulation. These were analyzed retrospectively during a single cycle in which clinicians were blinded to the results. Our major outcome measures were the number of oocytes obtained and ongoing pregnancy. RESULTS: Patients with an initial AMH concentration of >3 ng/mL were found to produce a mean of 19.8 oocytes and had an ongoing pregnancy rate of 60.3%. In contrast, those with AMH values of ≤1 ng/mL yielded a mean of 6.2 oocytes and had an ongoing pregnancy rate of 23.4% (P < .0001 for both). CONCLUSION: Greater AMH serum concentration strongly predicts an increased number of oocytes and ongoing pregnancy (P ≤ .0001).

In vitro maturation of oocytes via the pre-fabricated self-assembled artificial human ovary.

PURPOSE: create a 3-Dimensional artificial human ovary to mature human oocytes. METHODS: theca and granulosa cells were isolated from antral follicles of reproductive-aged women, seeded into micro-molded gels and self-assembled into complex 3D microtissues. Immunohistochemistry and live-dead staining confirmed theca cell identity and cellular viability at one week respectively. Placement of granulosa cell spheroids or cumulus-oocyte complexes into theca cell honeycomb openings resulted in creation of an artificial human ovary. Oocytes from this construct were assessed for polar body extrusion. RESULTS: theca and granulosa cells self-assembled into complex microtissues, remaining viable for one week. At 72 h after artificial human ovary construction, theca cells completely surrounded the granulosa spheroids or COCs without stromal invasion or disruption. Polar body extrusion occurred in one of three COCs assessed. CONCLUSIONS: an artifical human ovary can be created with self-assembled human theca and granulosa cell microtissues, and used for IVM and future oocyte toxicology studies.

Partial hypogonadotropic hypogonadism associated with the Leu266Arg and Gln106Arg mutation of the gonadotropin-releasing hormone receptor.

We describe a patient with partial hypogonadotropic hypogonadism caused by a compound heterozygous GnRH-R mutation. She is a 20-year-old tall, eunuchoid female referred for evaluation of primary amenorrhea. Spontaneous thelarche occurred at the age of 15 years. Breast and pubic hair were at Tanner stages 3 and 4, respectively. Evaluation revealed low plasma estradiol level and absence of withdrawal bleeding after progestin challenge. Pelvic ultrasonography showed a small uterus and ovaries. Bone age was delayed at 14.5 years. Bone mineral density showed osteopenia. Endogenous LH secretory pattern was abnormal with low amplitude and frequency, but responded to pulsatile GnRH administration. The coding exons of the GnRH-R gene were amplified and the PCR products were sequenced bidirectionally. Two different mutations were identified: one in exon 1 (Gln106Arg) and the other in exon 3 (Leu266Arg).

Reproductive performance after ectopic pregnancy.

Reproductive performance may be an important variable in treatment selection for unruptured ectopic pregnancy. The impact of treatment choice on reproductive performance is not known. We searched the literature and then tabulated published case reports on laparoscopic salpingostomy, multiple-dose methotrexate, single-dose methotrexate, and expectant management. From this analysis, we are unable to conclude any clinically detectable differences in the efficacy of these four most common treatments for unruptured ectopic pregnancy. Even more recent reports using life tables are inconclusive because the studies are not randomized. We conclude that concern for long-term reproductive performance should not be a factor in selecting between any of these four commonly used treatments for unruptured ectopic pregnancy.

Expression and localization of the novel and highly conserved gametocyte-specific factor 1 during oogenesis and spermatogenesis.

OBJECTIVE: To determine the onset of gametocyte-specific factor 1 (Gtsf1) expression in embryogenesis and its relation to Nobox; and to determine its localization during gonadal development and gametocyte maturation. DESIGN: Developmental animal study. SETTING: University reproductive biology laboratory. ANIMAL(S): Mice ranging in age from embryonic day 12.5 to 8 weeks. INTERVENTION(S): Polymerase chain reaction and quantitative polymerase chain reaction were performed to determine the onset of and relative messenger RNA expression. Western blot was performed to confirm protein expression and antibody specificity. In situ hybridization and immunohistochemistry were used determine localization of expression. MAIN OUTCOME MEASURE(S): Gtsf1 messenger RNA expression levels during embryogenesis through adulthood in wild-type mice and in newborn Nobox knockout mice; GTSF1 expression and localization in postnatal mice. RESULT(S): Gtsf1 functions downstream of Nobox and is highly expressed in embryonic male and female gonads, localizing to germ cells throughout development. GTSF1 expression is confined to the cytoplasm in all stages of postnatal oocyte maturation and to prespermatogonia during early postnatal testicular development. CONCLUSION(S): The expression pattern of Gtsf1 and its high conservation suggests that it may play an important role in germ cell development. Further characterization of Gtsf1 may elucidate mechanisms involved in premature ovarian failure.

Prevalence of premature urinary luteinizing hormone surges in women with regular menstrual cycles and its effect on implantation of frozen-thawed embryos.

OBJECTIVE: To determine the frequency and effect of premature luteinizing hormone (LH) surges on pregnancy rates in women with regular menstrual cycles. DESIGN: Retrospective cohort study. SETTING: Assisted Reproductive Technology Program at private medical college. PATIENT(S): Regularly menstruating women undergoing frozen embryo transfer (ET). INTERVENTION(S): Detection of urinary LH surges with an RIA kit during natural-cycle frozen-embryos transfer. MAIN OUTCOME MEASURE(S): Incidence of premature LH surges and pregnancy outcomes. RESULT(S): Eighty-eight (46.8%) of 188 regularly menstruating women had premature LH surges and 33 (37%) of those 88 had multiple premature LH surges. Pregnancy rates per ET are similar between women with and without premature LH surges. CONCLUSION(S): A high percentage of normally cycling women demonstrate premature urinary LH surges without an effect on outcome of frozen-thawed ETs.

Comparative genomic hybridization of ectopic pregnancies that fail methotrexate therapy.

Ectopic pregnancies that fail methotrexate therapy are predominantly euploid by comparative genomic hybridization (CGH). This feasibility study also confirms that formalin-fixed paraffin-embedded gestational tissue can successfully undergo CGH.

Isolated low second-trimester maternal serum beta-human chorionic gonadotropin is not associated with adverse pregnancy outcome.

OBJECTIVE: We investigated whether low human chorionic gonadotropin from maternal serum screening is associated with adverse pregnancy outcome. STUDY DESIGN: Women between 15 and 20 completed weeks of gestation who had a maternal serum screen performed from June 1999 to November 2001 were studied. Cases included women with human chorionic gonadotropin values of 0.5 and <2.0 multiples of the median, and estriol values of >0.6 and <2.0 multiples of the median. Control subjects were selected randomly from the population of women with normal values for all three analytes. RESULTS: There were 146 case subjects and 292 control subjects. There was no increased risk in the study group compared with the control subjects for preterm delivery, intrauterine fetal death, low birth weight, abruptio placentae, preeclampsia, or preterm premature rupture of membranes. CONCLUSION: An isolated low human chorionic gonadotropin level from second-trimester maternal serum screening is not associated with adverse pregnancy outcome.

Hypertensive disease in twin pregnancies: a review.

Reports over the past seventy years show that twin gestations lead to an increased risk of hypertensive disorders. Numerous studies discuss the incidence of hypertensive disease in twin versus singleton gestations, as well as effects of parity, race, age, income level, smoking, zygosity and heritability on this condition. The range of relative risk of gestational hypertension, preeclampsia and eclampsia for twin compared to singleton gestations is 1.2 to 2.7, 2.8 to 4.4 and 3.4 to 5.1 respectively. Parity, African-American ethnicity, and young maternal age are all factors that increase the relative risk of acquiring hypertensive disease to 4.0, 1.8 and 1.5 in mothers of twin gestations. Factors such as maternal smoking, income level and zygosity have a negligible effect on the relative risk of acquiring hypertensive disease in twin gestations. In addition to twin mothers exhibiting a higher incidence of hypertensive disease compared to their singleton counterparts, they also exhibit an earlier onset of hypertensive disease at both 35 and 37 weeks of gestation comparatively. Uric acid levels measured at 30-31 weeks of gestation in twin mothers predicted the onset of preeclampsia with a sensitivity of 73% and a specificity of 74%. The range of risks presented in the literature is wide and the therapies avocated are diverse. We therefore decided to summarize the risks in a comparative fashion and to review current therapeutic strategies for the convenience of clinicians who confront increasing numbers of multiple pregnancies. The tables bring all recent published risks together in the first comparative analysis in which the data has been converted to relative risks and confidence intervals. Because the literature is relatively silent on specific management of hypertensive disease in twin pregnancies, general management recommendations for singleton gestations should be used by practitioners caring over twin gestations.