Live birth and perinatal outcomes using cryopreserved oocytes: an analysis of the Human Fertilisation and Embryology Authority database from 2000 to 2016 using three clinical models.

STUDY QUESTION: Are live birth (LB) and perinatal outcomes affected by the use of frozen own versus frozen donor oocytes? SUMMARY ANSWER: Treatment cycles using frozen own oocytes have a lower LB rate but a lower risk of low birth weight (LBW) as compared with frozen donor oocytes. WHAT IS KNOWN ALREADY: A rising trend of oocyte cryopreservation has been noted internationally in the creation of donor oocyte banks and in freezing own oocytes for later use in settings of fertility preservation and social egg freezing. Published literature on birth outcomes with frozen oocytes has primarily utilised data from donor oocyte banks due to the relative paucity of outcome data from cycles using frozen own oocytes. STUDY DESIGN, SIZE, DURATION: This was a retrospective cohort study utilising the anonymised database of the Human Fertilisation and Embryology Authority, which is the statutory regulator of fertility treatment in the UK. We analysed 988 015 IVF cycles from the Human Fertilisation and Embryology Authority (HFEA) register from 2000 to 2016. Perinatal outcomes were assessed from singleton births only. PARTICIPANTS/MATERIALS, SETTING, METHODS: Three clinical models were used to assess LB and perinatal outcomes: Model 1 compared frozen own oocytes (n = 632) with frozen donor oocytes (n = 922); Model 2 compared frozen donor oocytes (n = 922) with fresh donor oocytes (n = 24 706); Model 3 compared first cycle of fresh embryo transfer from frozen donor oocytes (n = 917) with first cycle of frozen embryo transfer created with own oocytes and no prior fresh transfer (n = 326). Preterm birth (PTB) was defined as LB before 37 weeks and LBW as birth weight <2500 g. Adjustment was performed for confounding variables such as maternal age, number of embryos transferred and decade of treatment. MAIN RESULTS AND THE ROLE OF CHANCE: The LB rate (18.0% versus 30.7%; adjusted odds ratio (aOR) 0.61, 95% CI 0.43-0.85) and the incidence of LBW (5.3% versus 14.0%; aOR 0.29, 95% CI 0.13-0.90) was significantly lower with frozen own oocytes as compared with frozen donor oocytes with no significant difference in PTB (9.5% versus 15.7%; aOR 0.56, 95% CI 0.26-1.21). A lower LB rate was noted in frozen donor oocyte cycles (30.7% versus 34.7%; aOR 0.69, 95% CI 0.59-0.80) when compared with fresh donor oocyte cycles. First cycle frozen donor oocytes did not show any significant difference in LB rate (30.1% versus 19.3%; aOR 1.26, 95% CI 0.86-1.83) or PTB, but a higher incidence of LBW (17.7% versus 5.4%; aOR 3.77, 95% CI 1.51-9.43) as compared with first cycle frozen embryos using own oocytes. LIMITATIONS, REASONS FOR CAUTION: The indication for oocyte freezing, method of freezing used (whether slow-freezing or vitrification) and age at which eggs where frozen were unavailable. We report a subgroup analysis of women using their own frozen oocytes prior to 37 years. Cumulative LB rate could not be assessed due to the anonymous nature of the dataset. WIDER IMPLICATIONS OF THE FINDINGS: Women planning to freeze their own eggs for fertility preservation or social egg freezing need to be counselled that the results from frozen donor egg banks may not completely apply to them. However, they can be reassured that oocyte cryopreservation does not appear to have a deleterious effect on perinatal outcomes. STUDY FUNDING/COMPETING INTEREST(S): No specific funding was sought for the study. The authors have no relevant conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.

Enzymes for pharmaceutical and therapeutic applications.

Enzymes are highly efficient and selective biocatalysts, present in the living beings. They exist in enormous varieties in terms of the types of reactions catalyzed by them for instance oxidation-reduction, group transfers within the molecules or between the molecules, hydrolysis, isomerization, ligation, bond cleavage, and bond formation. Besides, enzyme based catalyses are performed with much higher fidelity, under mild reaction conditions and are highly efficient in terms of number of steps, giving them an edge over their chemical counter parts. The unique characteristics of enzymes makes them highly applicable fora number of chemical transformation reactions in pharmaceutical industries, such as group protection and deprotection, selective acylation and deacylation, selective hydrolysis, deracemization, kinetic resolution of racemic mixtures, esterification, transesterification, and many others. In this review, an overview of the enzymes, their production and their applications in pharmaceutical syntheses and enzyme therapies are presented with diagrams, reaction schemes and table for easy understanding of the readers.

Superfertility is more prevalent in obese women with recurrent early pregnancy miscarriage.

OBJECTIVE: To investigate the effects of obesity on superfertility. DESIGN: Retrospective observational study. SETTING: A tertiary referral implantation clinic. POPULATION: Four hundred and fourteen women attending a tertiary implantation clinic with a history of recurrent miscarriage (RMC), over a 4-year period. METHODS: Pattern of pregnancy loss and time to pregnancy intervals for each pregnancy were collected by medical staff from women with RMC. The women were categorised into normal, overweight and obese according to their body mass index (BMI). Kaplan-Meier curves were constructed estimating the cumulative probability of a spontaneous pregnancy over time. The pregnancy loss patterns were correlated with BMI and data were compared between the categories using the Kruskal-Wallis test. MAIN OUTCOME MEASURES: Pregnancy loss pattern and time to pregnancy intervals. RESULTS: Overall, 23.2, 51.4 and 64.2% of women conceived within first 1, 3 and 6 months, respectively. Obese women had cumulative pregnancy rates of 65.2 and 80% by three and 6 months, respectively, which was more than the cumulative pregnancy rates for women with normal BMI (49.2 and 65.8%). Comparison of survival curves indicated a significant difference in time to conceive for obese when compared with normal and overweight women (*P = 0.01), suggesting a higher prevalence of superfertility in obese women with RMC. CONCLUSIONS: Our findings suggest that obese women may have a greater efficacy to achieve pregnancy, but with an increased risk of miscarriage, which may suggest the possible metabolic effects of obesity on endometrium.

Maximum bladder volume as surrogate screening test for detrusor overactivity.

Maximum bladder volume could be a simple surrogate measure to screen for detrusor overactivity (DO) which manifests with a frequency and small volume voids. Urodynamic traces from 577 women were reviewed. Maximum bladder volume was obtained from bladder diary. The urodynamic traces were reviewed for data and were categorised as normal, urodynamic stress incontinence, mixed incontinence and DO. The urodynamic data and maximum voided volume were compared between different categories and Receiver operating characteristic (ROC) curves were constructed. The median value for maximum-voided volume for women with DO was not significantly different from the other categories, whereas significant differences were found for the median values for urodynamic variables. ROC curves demonstrated extremely poor sensitivity and specificity for recorded maximum bladder volume and for urodynamic variables. The maximum-voided volume recorded on a three-day bladder diary is not discriminatory as a screening test for DO.

Orbital character of the spin-reorientation transition in TbMn6Sn6.

Ferromagnetic (FM) order in a two-dimensional kagome layer is predicted to generate a topological Chern insulator without an applied magnetic field. The Chern gap is largest when spin moments point perpendicular to the kagome layer, enabling the capability to switch topological transport properties, such as the quantum anomalous Hall effect, by controlling the spin orientation. In TbMn6Sn6, the uniaxial magnetic anisotropy of the Tb3+ ion is effective at generating the Chern state within the FM Mn kagome layers while a spin-reorientation (SR) transition to easy-plane order above TSR = 310 K provides a mechanism for switching. Here, we use inelastic neutron scattering to provide key insights into the fundamental nature of the SR transition. The observation of two Tb excitations, which are split by the magnetic anisotropy energy, indicates an effective two-state orbital character for the Tb ion, with a uniaxial ground state and an isotropic excited state. The simultaneous observation of both modes below TSR confirms that orbital fluctuations are slow on magnetic and electronic time scales < ps and act as a spatially-random orbital alloy. A thermally-driven critical concentration of isotropic Tb ions triggers the SR transition.

PSO Method for Fitting Analytic Potential Energy Functions. Application to I-(H2O).

In this work a particle swarm optimization (PSO) algorithm was used to fit an analytic potential energy function to I-(H2O) intermolecular potential energy curves calculated with DFT/B97-1 theory. The analytic function is a sum of two-body terms, each written as a generalized sum of Buckingham and Lennard-Jones terms with only six parameters. Two models were used to describe the two-body terms between I- and H2O: a three-site model H2O and a four-site model including a ghost atom. The fits are compared with those obtained with a genetic/nonlinear least-squares algorithm. The ghost atom model significantly improves the fitting accuracy for both algorithms. The PSO fits are significantly more accurate and much less time-consuming than those obtained with the genetic/nonlinear least-squares algorithm. Eight I----H2O potential energy curves, fit with the PSO algorithm for the three- and four-site models, have RMSE of 1.37 and 0.22 kcal/mol and compute times of ∼20 and ∼68 min, respectively. The PSO fit for the four-site model is quite adequate for determining densities of states and partition functions for I-(H2O) n clusters at high energies and temperatures, respectively. The PSO algorithm was also applied to the eight potential energy curves, with the four-site model, for a short time ∼8 min fitting. The RMSE was small, only 0.37 kcal/mol, showing the high efficiency of the PSO algorithm with retention of a good fitting accuracy. The PSO algorithm is a good choice for fitting analytic potential energy functions, and for the work presented here was able to find an adequate fit to an I-(H2O) analytic intermolecular potential with a small number of parameters.

Role of the male partner in the lower genitourinary tract infection of female.

We studied the relationships of selected microbes and the role of consorts in the causation of vaginal discharge which may be due to cervicitis or vaginitis. A total of 93 consecutive patients in the reproductive age group with symptoms of vaginal discharge along with their sexual partners were studied. Samples were collected from the cervix and posterior fornix of the female patients and from the urethra and sub-prepucial area of the male partner for culture of Neisseria gonorrhoeae, Gardnerella vaginalis, Mycoplasma hominis, ureaplasma, candida, aerobic and anaerobic organisms. Apart from cultures, KOH and Gram stain of the discharge were made. Predominant pathogen isolated was Ureaplasma urealyticum from 40 (43.01%) females and 23 (24.7%) males. The next common pathogenic organisms isolated were candida species from 11 (11.8%) females and 5 (5.4%) males and Chlamydia trachomatis in 3 (3.2%) females and 1 (1.1%) male. Various organisms were more frequently isolated from the 29 of 43 (67.4%) couples who had had sexual intercourse 7 days prior to the recruitment as compared to 14 of 43 (32.6%) who had had coitus more than 7 days prior to their recruitment. This may be due to the spontaneous disappearance or decrease in the number of organisms to the level that they could be detected by culture. In our study, 6 (6.5%) of male partners carrying pathogenic organisms were asymptomatic, indicating that their screening and treatment is vital.

HIV disease presenting as parotid lymphoepithelial cysts: a presumptive diagnosis of diffuse infiltrative lymphocytic syndrome (DILS).

Diffuse infiltrative lymphocytic syndrome (DILS), is a rare manifestation of human immunodeficiency virus (HIV) disease which is characterized by a diffuse visceral CD8 lymphocytic infiltration, a persistent CD8 lymphocytosis, bilateral parotid swelling and cervical lymphadenopathy. We describe a case of a HIV positive female, who had bilateral parotid swelling and CD8 lymphocytosis, to illustrate this rare clinical entity.

Kawasaki disease--Indian perspective.

Kawasaki disease is a syndrome of unknown etiology affecting children below 5 years of age and is a leading cause of acquired heart disease in many developed countries. Incidence of this disease in India is extremely low as evidenced by the meagre case reports. Complications due to this disease in Indian patients are still rarer. Here we report two cases of Kawasaki disease both of whom had a benign course. A comparison of this disease in Indian and Western literature shows that the incidence of cardiac complications in the Indian patients is about 10% while in the west it is reported at around 30%. This paucity of complications in the Indian patients may be the reason of poor reporting of this disease in our country.

Acute respiratory failure in a 35-year-old woman following preterm vaginal delivery.

A 35-year-old woman, a non-smoker with a normal body mass index, 'felt wheezy' and developed profound hypoxia 30 min after preterm vaginal delivery at 24+ weeks of gestation. She denied other symptoms, had no fever but was tachycardic and tachypnoeic with normal blood pressure. Pulmonary embolism, amniotic fluid embolism, cardiomyopathy, arrhythmias, sepsis and non-cardiogenic pulmonary oedema were considered as differential diagnoses. Chest X-ray showed an increased pulmonary vasculature, but the blood tests, ECG, echocardiogram and CT pulmonary angiogram were essentially normal. She was managed on a high dependency area with high-flow oxygen and intravenous antibiotics. She improved dramatically and the oxygen requirements dropped to 2 L over the next 4 h. It is plausible that this woman had acute non-cardiogenic pulmonary oedema secondary to a combination of risk factors. This case highlights the importance of a methodical and multidisciplinary approach for a prompt diagnosis and successful treatment of an acutely ill parturient.

Cervical cancer in women aged less than 25: East Kent experience.

The National Health Service Cervical Screening Programme (NHSCSP) guidelines raised the initiation of screening age from 20 to 25 years of age in 2004, on the basis that only 1.3% of cervical cancers occur in this age group. Between 2003 and 2005, cervical cancer was diagnosed in six women under 25 years in East Kent, 6.25% of 96 cervical cancers cases. All except one patient in our series presented with a cervical smear abnormality. High-grade cervical smear abnormalities were identified and treated in 187 women under 25 years during this period. Adoption of the guidelines may increase the incidence of invasive disease in young women, the stage at diagnosis and radicality of treatment required.

Microbial flora of women with chronic cervicitis.

The present study comprised 50 patients of chronic cervicitis attending gynaecological clinic of Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. The aim of the study was to isolate some of the common sexually transmitted disease (STD) pathogens in chronic cervicitis. Cervical swabs were taken from the patients. The swabs were analysed by various microbiological techniques. Most (78%) of the patients harboured infection, no growth of any organism was found in 22% cases. Ureaplasma urealyticum was the predominant organism isolated in 56% of cases. It was isolated singly in 38% of cases. Various other organisms isolated singly were Chlamydia trachomatis in 2% of cases, candida species in 2% of cases, Staphylococcus epidemidis in 4% of cases, lactobacillus in 4% of cases, and Staphylococcus aureus in 2% of cases. Multiple organisms were isolated in 26% of cases.