Oocyte cryopreservation in mosaic Turner syndrome with polycystic ovaries.

Objective: To report a case of a patient with Turner syndrome (TS) mosaicism and polycystic ovarian syndrome (PCOS), who underwent successful ovarian stimulation, oocyte retrieval, and cryopreservation. Design: Case report. Subjects: A female patient with mosaic TS (45,X [24%]/46,XX [76%]) and a paternally inherited balanced reciprocal translocation t(2:6) diagnosed with PCOS. Interventions: Controlled ovarian stimulation, oocyte retrieval, and cryopreservation. Main outcome measures: Successful oocyte retrieval and cryopreservation. Results: We report an interesting case of a patient with TS mosaicism 45,X [24%]/46,XX [76%] and a paternally inherited t(2:6) balanced reciprocal translocation, who was diagnosed with PCOS on the basis of oligomenorrhea and ultrasound polycystic ovary morphology (antral follicle count of 17 and >20, left and right ovaries, respectively), underwent 2 cycles of ovarian stimulation, oocyte retrieval, and cryopreservation, resulting in 19 cryopreserved oocytes. Conclusions: Our case highlights the importance of early counseling regarding fertility options in patients with mosaic TS and the need for careful monitoring of ovarian reserve during this process, which could be done by measuring the anti-müllerian hormone or antral follicle count. It also underscores the possibility of women with mosaic TS being affected by PCOS.

The sperm donor programme over 11 years at Newcastle Fertility Centre.

The UK national sperm donor shortage is well known. We aimed to analyse the trends in various aspects of the sperm donor programme at Newcastle Fertility Centre (NFC) between 2000 and 2010. A retrospective review of the assisted conception treatments with donor sperm was performed. A decline in the numbers of donors recruited alongside a declining trend in the number of patients treated with donor sperm and donor insemination (DI) treatment cycles carried out was apparent. There was an accompanying rising trend in donor IVF cycles and in same-sex couples and single women coming for treatment. The transfer of sperm to local peripheral centres ceased during this time and an increasing number of patients imported sperm from overseas commercial sperm banks. A waiting list for treatment was set up in 2007 with a gradual increase in waiting time to 18 months in 2010. Overall, there was a significant change in the sperm donor programme at NFC with fewer donors recruited, fewer patients receiving treatment, increasing sperm import and longer waiting times for treatment over the study period.

Uterine natural killer cells in peri-implantation endometrium from women with repeated implantation failure after IVF.

Several studies have suggested that endometrial uNK (CD56+) cells may play a role in implantation. The aim of this study was to investigate the number of CD56+, CD16+ and CD69+ cells in the unstimulated endometrium of women with recurrent implantation failure after IVF. The percentage of stromal cells positive for CD56, CD16 and CD69 was identified by immunocytochemistry in endometrial biopsies from 15 normal control women and 40 women with recurrent implantation failure. All biopsies were obtained on days LH+7 to LH+9. The density of CD56+ cells in endometrium from women with repeated implantation failure after IVF [median (range) CD56+ cell density=14.5% (1.5-71.4%)] was significantly higher (P=0.005) than in endometrium from control women [5% (2.1-19.2%)]. There was no significant difference in the densities of CD16+ and CD69+ cells in the endometrium from women in the two groups. The increased density of CD56+ cells in the endometrium of women with recurrent implantation failure suggests that these cells are directly involved in the implantation process; alternatively this may indicate a general endometrial defect in these women, which leads to the inability of the embryo to implant.

Preliminary prospective study of the endocrinology of conception cycles and early pregnancy in women with antiphospholipid syndrome treated with low molecular weight heparin.

OBJECTIVE: To examine whether there were any differences in the endocrinological profiles during conception cycle and early pregnancy between a control group and women with a history of recurrent miscarriage that was caused by antiphospholipid syndrome and that was treated with aspirin and low molecular weight heparin. DESIGN: Prospective observational study. SETTING: Recurrent Miscarriage Clinic, Department of Obstetrics and Gynaecology in a tertiary care centre. PATIENT(S): Five women with recurrent pregnancy loss were recruited as cases, whereas another five women having natural cycle donor insemination were used as control. INTERVENTION(S): Serial measurement of serum beta-hCG, activin A, and inhibin A was performed from postovulatory day 12 until 11 weeks of gestation. MAIN OUTCOME MEASURE(S): Comparison of levels of beta-hCG, activin A, and inhibin A at the time of conception onwards till 11 weeks in the two groups. RESULT(S): There were no significant differences between the two groups. CONCLUSION(S): There does not appear to be any obvious endocrinological alteration in the conception cycle of women with antiphospholipid syndrome compared with a control group. Furthermore, the initiation of heparin does not produce a significant change in activin A and inhibin A levels.

Absence of follicular phase defect in women with recurrent miscarriage.

OBJECTIVE: The study was designed to compare the follicular phase of women with recurrent pregnancy loss and a healthy control group. It is possible that a defective or aberrant follicular phase may be associated with poor oocyte quality leading to a production of an embryo with compromised quality and hence early pregnancy loss. DESIGN: Prospective case-control study. SETTING: A tertiary care hospital of Sheffield, UK. PATIENT(S): Thirty-four women with recurrent miscarriage and 10 women with no previous history of miscarriage and regular menstrual cycles (control group) were recruited. INTERVENTION(S): The characteristics studied included Doppler assessment of blood flow to the follicle and the endometrium. Simultaneously, serum concentrations of biochemical markers such as anti-Müllerian hormone, inhibin B, FSH, LH, and P were compared in the two groups. MAIN OUTCOME MEASURE(S): Differences in the two groups. RESULT(S): We were unable to detect significant differences in various biochemical and ultrasound measurements in the follicular phase between women with recurrent miscarriage and a control group; however, the expected correlation between ovarian and pituitary hormones, which was observed in the control group, was absent in women with recurrent miscarriage. CONCLUSION(S): There may be subtle derangements of the feedback mechanism responsible for regulation of follicle development in this group of women. However, there were no obvious differences in the follicular phase of women with recurrent miscarriage and a healthy control group.

A study of luteal phase expression of inhibin, activin, and follistatin subunits in the endometrium of women with recurrent miscarriage.

OBJECTIVE: To compare the luteal phase endometrial expression of inhibin, activin, and follistatin subunits in women with recurrent miscarriage compared to a control group. Other parameters of luteal function assessed included Doppler blood flow, serum biochemical markers, and histopathology. DESIGN: This was a prospective case control study. SETTING: The study was conducted in a tertiary care hospital of Sheffield, United Kingdom. PATIENT(S): Thirty-three women with recurrent miscarriage and 10 women with no previous history of miscarriage (control group) were recruited. INTERVENTION(S): Histologic assessment of the luteal phase endometrium was done using Noyes criteria followed by immunohistochemical analysis for expression of inhibin, activin, and follistatin subunits. Doppler analysis for perifollicular and endometrial blood flow was also done. Simultaneously serum concentrations of E(2), LH, FSH, P, and inhibin B at the time of LH surge and at LH +7 days were measured. MAIN OUTCOME MEASURES: Difference in endometrial expression of inhibin, activin, and follistatin subunit in the two groups. RESULT(S): Endometrial expression of follistatin and beta A in the endometrial stromal cells of women with recurrent miscarriage was significantly lower than in control women. There were no differences in results of the Doppler studies or the hormonal profiles between cases and controls. CONCLUSION(S): The lower expression of follistatin and beta A subunit in women with recurrent miscarriage may imply an altered activity of activin A at the time of decidualization, which may lead to poor pregnancy outcome in the form of miscarriage.

Expression of integrins in the endometrium of women with recurrent miscarriage.

Immunostaining intensity for alpha(1), alpha(4), alpha(v)beta(3), and beta(3) was assessed by H score in timed peri-implantation endometrium from 21 women with unexplained recurrent miscarriage and 16 healthy fertile women. No significant difference in H scores in gland epithelium, luminal epithelium, stroma, or blood vessels was observed between the two groups, suggesting that alpha(1), alpha(4), alpha(v)beta(3) and beta(3) integrins are expressed normally in the endometrium of women with unexplained recurrent miscarriage.

Inhibin A and activin A may be used to predict pregnancy outcome in women with recurrent miscarriage.

OBJECTIVE: To look at the role of inhibin and activin in predicting pregnancy outcome in patients with history of recurrent miscarriage. DESIGN: Observational clinical study. SETTING: Recurrent miscarriage clinic of a tertiary care teaching hospital. PATIENT(S): Patients with history of recurrent miscarriage. INTERVENTION(S): Serial serum inhibin A and activin A concentrations were measured in weeks 5 though 8 of pregnancy. MAIN OUTCOME MEASURE(S): Serum concentrations of inhibin A and activin A levels. RESULT(S): Mean inhibin A concentration at 5 to 6 weeks for women who miscarried and those who had live births was 33 and 51 pg/mL, respectively; activin A at same gestation for the two groups was 534 and 643 pg/mL, respectively. After 2 weeks, mean inhibin A concentration for women who miscarried and those who had live births was 66 and 145 pg/mL, respectively, and activin A was 747 and 1,123 pg/mL, respectively. CONCLUSION(S): It is possible that inhibin A and activin A may be used as markers to predict pregnancies that are likely to miscarry.

DNA polymorphism in north indian isolates of Entamoeba histolytica detected by PCR fingerprinting.

Entamoeba histolytica infection in humans is still one of the leading causes of parasitic diseases among the developing countries, including India. It therefore becomes extremely important to characterize this parasite with the aim of preventing and controlling the amoebiasis which it causes. The present study describes for the first time the ability of random amplified polymorphic DNA (RAPD)-PCR fingerprinting strategies to subtype amoebae and to detect considerable genetic variability present among the various North Indian isolates of E. histolytica studied. The number of rapdemes generated by the application of arbitrary primers in RAPD-PCR showed a significant variation in these isolates, both in the size and number of bands, thus revealing the presence of considerable genetic polymorphism in them. Hence, this rapid and easy method could suitably be employed in carrying out significant molecular epidemiological studies and also in the large-scale epidemiological typing of this parasite.