Unexplained repeated pregnancy loss is associated with altered perceptual and brain responses to men's body-odor.

Mammalian olfaction and reproduction are tightly linked, a link less explored in humans. Here, we asked whether human unexplained repeated pregnancy loss (uRPL) is associated with altered olfaction, and particularly altered olfactory responses to body-odor. We found that whereas most women with uRPL could identify the body-odor of their spouse, most control women could not. Moreover, women with uRPL rated the perceptual attributes of men's body-odor differently from controls. These pronounced differences were accompanied by an only modest albeit significant advantage in ordinary, non-body-odor-related olfaction in uRPL. Next, using structural and functional brain imaging, we found that in comparison to controls, most women with uRPL had smaller olfactory bulbs, yet increased hypothalamic response in association with men's body-odor. These findings combine to suggest altered olfactory perceptual and brain responses in women experiencing uRPL, particularly in relation to men's body-odor. Whether this link has any causal aspects to it remains to be explored.

Progestogens in luteal support.

Progestational agents are often prescribed to increase the clinical pregnancy rate in assisted reproduction. Progestogens affect implantation, cytokine balance, natural killer cell activity, arachidonic acid release and myometrial contractility. Progesterone production from the corpus luteum is essential for reproduction, but assisted reproductive technologies (ART) can impair luteal function. ART cycles can be classified into three, fresh cycles in which there may or may not be luteal insufficiency, agonist or antagonist cycles in which there is luteal insufficiency, and luteal support is essential, and donor cycles, in which there is no corpus luteum, and a luteal phase has to be created. However, there is no adequate diagnostic test for luteal insufficiency. This article summarises the effect of various progestogens, progesterone itself whether administered vaginally, intra-muscularly, rectally or subcutaneously, and the effect of the progestogen, dydrogesterone. The time of commencement and cessation of therapy are also discussed. Progestogens are also often used to treat threatened and recurrent miscarriage. In these patients progestogen supplementation may need to be prolonged. In threatened miscarriage, until after all bleeding stops, and in recurrent miscarriage, at least as long as the luteo-placental shift.

Steroid hormone hypersensitivity: clinical presentation and management.

Hypersensitivity to estrogens and progestogens is often undiagnosed. The condition has many manifestations, including premenstrual syndrome, dysmenorrhea, and impaired fertility. Diagnosis is confirmed by skin testing for inflammatory responses to small doses of the hormone, and desensitization with small doses of the hormone is the most appropriate form of management.

Is there a place for adjuvant therapy in IVF?

OBJECTIVES: To review studies of adjuvant therapies for in vitro fertilization (IVF), and to establish the role of adjuvant therapy for women with repeated failure to conceive with IVF. DESIGN: Review of the literature. Articles were identified through a PubMed, Medline, EMBASE, Cochrane library, and the national research Register literature search according to preset criteria followed by a cross-reference of published data. MAIN OUTCOME MEASURE(S): Clinical pregnancies and live births. RESULT(S): Most adjuvant therapies for IVF are empirical, and prescribed without a clear diagnosis of whether the failure to conceive is due to a maternal or fetal factor. Although some randomized controlled trials are available, the results are conflicting. CONCLUSION(S): No adjuvant therapy has been shown to be definitively advantageous. At present the diagnosis of IVF failure is not specific enough to indicate a certain adjuvant therapy. Hence, some unconfirmed therapies might be highly efficacious for subgroups with particular characteristics. The use of endometrial biopsy with a pipelle is promising, but like other therapies, requires additional testing. Chromosomal aberrations present a confounding factor for maternal adjuvant therapies that are difficult to exclude. TARGET AUDIENCE: Obstetricians & Gynecologist, Family Physicians. LEARNING OBJECTIVES: After completion of this educational activity, the reader will be able to interpret the proven scientifically significant studies of the various forms of adjuvant therapy in IVF. Assess shortcomings in many of the different types of adjuvant therapy and interpret potential dangers in some forms of adjuvant therapy.