Reliability of second trimester triple screening for Down syndrome in rhesus-negative women.

OBJECTIVE: To find out whether there is considerable influence on second trimester serum concentrations owing to the rhesus status. STUDY DESIGN: This retrospective cohort study was performed at the Perinatology Unit of the GATA Haydarpasa Teaching Hospital. During the study interval, 2265 pregnancies met inclusion criteria. The blood samples were collected in 117 pregnancies with a maternal rhesus-negative blood group status. The control group consisted of 2148 pregnancies with a maternal rhesus-positive blood group status. Statistical analysis was performed by SPSS 11.0 statistical software. RESULTS: Pregnancies with a maternal rhesus-negative blood group status were identified in 117 patients. The overall prevalence of pregnancies with a maternal rhesus-negative blood group status were 5.1% in our study. Only unconjugated estriol multiples of the median values were significantly decreased in rhesus-negative women (P<0.001). Alpha-fetoprotein and human chorionic gonadotrophin multiples of the median values did not differ significantly (P>0.05). CONCLUSION: We conclude that if second trimester screening test to be used in Rh negative pregnancies, either the corrected value should be referred or double test result should be considered ignoring the unconjugated estriol result. Another option is the first trimester Down syndrome screening test.

Combination of hypoosmotic swelling/eosin Y test for sperm membrane integrity evaluation: correlations with other sperm parameters to predict ICSI cycles.

The objective of our study was to evaluate the accuracy of the combination of hypoosmotic swelling (HOS) and eosin Y (Ey) exclusion tests to predict the ICSI cycles' outcome and its correlations with other sperm parameters. The functional and structural integrity of sperm membrane was evaluated with the combined HOS/Ey test in 95 ICSI cycles and the results were correlated with other sperm parameters, including concentration, motility, strict morphology, and total motile sperm count. The combined HOS/Ey test was evaluated for the prediction of the ICSI cycles' outcome parameters including fertilization, cleavage, and pregnancy rates. The HOS/Ey test presented significant relationships with concentration, motility, and strict morphology (p < 0,0001) but it couldn't predict the fertilization, cleavage, and pregnancy outcomes of ICSI cycles. The combined HOS/Ey test has strong correlations with motility and strict morphology parameters of sperm samples but is not sufficiently sensitive to estimate the outcome of ICSI cycles.

The effects of analytical factors on second trimester risk estimations.

OBJECTIVE: Triple test with measured maternal serum alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol combination as a routine procedure for fetal Down's syndrome, trisomy 18 and neural tube defect screening has some intrinsic problems, such as precision. The aim of this study was to evaluate the effect of analytical variation of triple test on prenatal risk estimation. METHOD: Five different serum pools were prepared and triple test was performed seven times for within run and five times for between run precision determination. RESULT: Within run and between run, precision values of risk estimations by measuring the same sample for Triple test were calculated to be 7.9-21.4% and 14.1-31.0% for trisomy 21, 13.2-23.7% and 14.2-15.1% for trisomy 18, 47.2 and 42.0 % for neural tube defect, respectively. CONCLUSION: These results demonstrated that analytical variations have great impact on second trimester risk estimation procedures; therefore, triple test analyses should be carried out in laboratories using strict internal and external quality control programs. Moreover, triple test results should always be interpreted by considering analytical and biological variations.

Clomiphene citrate-resistant polycystic ovary syndrome. Preventing multifollicular development.

OBJECTIVE: To determine the efficiency and comparison of two different protocols, human menopausal gonadotropin (hMG) plus gonadotropin-releasing hormone analog (GnRH-a) and low-dose hMG to reduce multifollicular development in clomiphene-resistant polycystic ovary syndrome (PCOS) patients. STUDY DESIGN: Prospective comparative and pilot study in 20 patients for 31 cycles. The first group (n = 10) was treated with buserelin acetate, 600 micrograms/d, for six weeks before ovulation induction with hMG in conventional doses for 14 cycles. The other group (n = 10) was treated only with low-dose hMG for 17 cycles. All cycles were compared in terms of the number of follicles per cycle, cycles human chorionic gonadotropin withheld, estradiol level on ovulation day, treatment duration and number of ampules used per cycle. In addition, the outcome of cycles and complications of multifollicular development, ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy were determined. RESULTS: As compared with the GnRH-a + hMG protocol, the low-dose hMG protocol yielded less multifollicular (57.1% vs. 17.6%) and more monofollicular (35.7% vs. 70.6%) development. Consequently, less OHSS (21.4% vs. 0%) and multiple pregnancy (10% vs. 0%) occurred in the low-dose group. CONCLUSION: Low-dose hMG therapy has distinct advantages in eliminating multifollicular development and related complications in clomiphene citrate-resistant PCOS patients. The addition of GnRH-a to gonadotropins does not change the incidence of multifollicular development.