Do combined psychological stress examinations predict pregnancy outcome in an assisted reproductive technology program?

PURPOSE OF INVESTIGATION: To investigate prospectively if the pregnancy outcome in infertile women undergoing assisted reproductive technology (ART) is predictable by a combination of psychological stress examinations on the day of embryo/blastocyst transfer. MATERIALS AND METHODS: From April 2012 to May 2012, 114 women aged 42 years old or less underwent transfer of morphologically-good embryo/blastocyst(s) in the present in vitro fertilization (IVF) center. Immediately before the transfer, salivary secretion was obtained and frozen. α-amylase and cortisol concentrations were quantified using biochemical assays. In addition, patients were asked to answer General Health Questionnaire 28 (GHQ28) and Zung's Self Rating Depression Scale (SDS) following transfer. The results were compared between the pregnant group and non-pregnant group. RESULTS: There were no significant differences in the age of the infertile couples between the pregnant group and non-pregnant group as well as body mass index of the infertile women. The GHQ28 and SDS scores were similar between the two groups, as were the salivary α-amylase and cortisol concentrations. CONCLUSION: This prospective study failed to demonstrate the predictivity of the pregnancy outcome by psychological stress examinations in infertile women in an ART program, even though these tests were used in combination.

A pilot survey on obstetric complications in pregnant women with a history of repeated embryo implantation failure and those undergoing single local endometrial injury.

PURPOSE OF INVESTIGATION: To assess if a history of repeated implantation failure (RIF) or local endometrial injury (LEI) for RIF affects the pregnancy course in women who conceived in the subsequent in vitro fertilization (IVF)-embryo/blastocyst transfer (ET/BT) cycle. MATERIALS AND METHODS: Of 42 pregnant women with a history of three consecutive failed ET/BT cycles with negative pregnancy tests, 11 patients had a clinical pregnancy in the immediate subsequent ET/BT cycle following (the RIF group), whereas 31 patients had a clinical pregnancy in the subsequent ET/BT cycle following single curettage LEI in the proliferative phase of the preceding spontaneous cycle (the RIF/LEI group). Information on the obstetric complications were retrieved from medical records and compared with that of women who had a live birth in the first ET/BT attempt (the control group). Results: The clinical pregnancy rate, ongoing pregnancy rate, and live birth rate were significantly higher in the RIF/LEI group than in the RIF group (p < 0.010). There were no significant differences in the incidence of pregnancy of unknown location, ectopic pregnancy, miscarriage, stillbirth, preterm birth, premature rupture of the membranes, placenta previa, placental abruption, preeclampsia, pregnancy-induced hypertension, gestational diabetes, fetal growth restriction, caesarean section, and blood transfusion were similar between the three groups (p > 0.31). CONCLUSION: In this pilot survey, neither a history of RIF nor LEI intervention for RIF increased the incidence of obstetric complications in the women who conceived in the subsequent ET/BT cycle.

Diclofenac suppository pretreatment in prevention of vasovagal reflex-associated complications for infertile women undergoing local endometrial injury.

PURPOSE OF INVESTIGATION: To assess the effects of the diclofenac suppository pretreatment in prevention of vasovagal reflex-associated complications for infertile women undergoing local endometrial injury (LEI). MATERIALS AND METHODS: Eighty-six infertile outpatients with repeated implantation failure following transfer of morphologically good embryos and/or blastocysts underwent single curettage LEI to improve the pregnancy outcome in the subsequent embryo/blastocyst transfer cycle. Of them, 35 patients chose diclofenac suppository administration prior to LEI, whereas 51 patients did not. The occurrence of palpitations, bradycardia, hypotension, presyncope, and requirement of bed rest was compared between the two groups. RESULTS: There were no significant differences in the demographics between the two groups. The prevalence of presyncope and requirement of bed rest was significantly lower in the diclofenac suppository group than in the control group. The pregnancy outcome was similar between the two groups. CONCLUSION: The diclofenac suppository administration is a low-cost effective method to reduce the risk of the vasovagal reflex-associated complications in infertile women undergoing LEI.

Recovery from endometrial thinning and successful pregnancy following vitamin E and C supplementation in infertile woman undergoing myomectomy for diffuse leiomyomatosis of the uterus: a case report.

The authors here report a case of an infertile woman with diffuse leiomyomatosis of the uterus, which is a rare benign pathological condition in which the myometrium is occupied by innumerable small fibroid nodules. Due to the progressive abdominal distension of the patient and the desire for pregnancy of the couple, myomectomy was performed as a primary treatment. Urgent relaparotomy was required for hematoma debridement on the following day. Despite the evidence of the follicular growth and cyclic ovarian steroid secretion, the patient had postoperative endometrial thinning that was unresponsive to hormone replacement therapy. Supplementation of oral tocopherol nicotinate/vitamin E and ascorbic acid/vitamin C was effective for immediate recovery of withdrawal bleeding and gradual gain of endometrial thickness. The patient had a successful pregnancy in an in vitro fertilization-embryo transfer program and gave a birth to a healthy baby.

Vaginal preparation with povidone iodine disinfection and saline douching as a safe and effective method in prevention of oocyte pickup-associated pelvic inflammation without spoiling the reproductive outcome: evidence from a large cohort study.

PURPOSE OF INVESTIGATION: The aim of this study was to investigate if vaginal preparation procedure affects the occurrence of oocyte pickup-associated pelvic inflammation (OPU-PI) and the reproductive outcome in an in vitro fertilization (IVF) program. MATERIALS AND METHODS: The occurrence of OPU-PI and the reproductive outcome were compared between 956 infertile patients undergoing vaginal preparation with saline douching alone versus 1,216 infertile patients undergoing a combination ofpovidone iodine disinfection and subsequent saline douching in an IVF program. RESULTS: OPU-PI occurred in four patients (0.042%) in the saline douching alone group, whereas there were no cases in the combination group (p = 0.016). There were no significant differences in the rate of fertilization, morphologically good embryo acquisition, clinical and ongoing pregnancy between the two groups (p > 0.23). CONCLUSIONS: This large cohort study demonstrated that a combination of vaginal povidone iodine disinfection and subsequent saline douching is more effective procedure than saline douching alone to prevent OPU-PI, without spoiling the oocyte quality.

Single curettage endometrial biopsy injury in the proliferative phase improves reproductive outcome of subsequent in vitro fertilization-embryo transfer cycle in infertile patients with repeated embryo implantation failure.

PURPOSE OF INVESTIGATION: To evaluate the effectiveness of single curettage endometrial biopsy injury (EBI) in the proliferative phase for in vitro fertilization-embryo transfer (IVF-ET) outcome of the subsequent cycle in infertile patients with repeated embryo implantation failure (EIF). MATERIALS AND METHODS: Of 89 patients who repeated EIF three times following transfer of morphologically good embryos and/or blastocysts, 40 patients chose curettage EBI prior to the subsequent IVF-ET cycle. Using a three-mm wide curette, EBI was performed once between days 6 and 12 of the spontaneous cycle. Their IVF-ET outcomes in the subsequent cycle were compared with those in 49 patients who did not opt for EBI. RESULTS: The clinical pregnancy rate (37.5% vs 12.2%), embryo implantation rate (23.6% vs 6.3%), and ongoing pregnancy rate (25.0% vs 8.2%) were significantly higher in the EBI group than in the non-EBI group. No serious complaints and complications were noted. CONCLUSION: Single curettage EBI in the proliferative phase of the preceding cycle significantly improved IVF-ET outcome in infertile patients with repeated EIF.

Localization of interferon regulatory factor-1 in human endometrium throughout the menstrual cycle.

OBJECTIVE: To determine the expression and localization of IRF-1 in human endometrium throughout the menstrual cycle. DESIGN: A comparative study. SETTING: Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine. PATIENTS: Thirty-eight women aged 33 to 46 years, with regular menstrual cycles and nonpathological endometrium, undergoing hysterectomy. INTERVENTION(S): Endometrial tissues were obtained from operative samples. MAIN OUTCOME MEASURE(S): Expression of IRF-1 mRNA throughout the menstrual cycle was investigated using semiquantitative reverse transcription-polymerase chain reaction. Localization of IRF-1 protein was determined using immunohistochemistry. RESULT(S): IRF-1 mRNA was expressed in the human endometrium at each phase of the menstrual cycle. The immunoreactivity for IRF-1 was observed in the extranuclear compartment of the surface and glandular epithelial cells, both during the proliferative and secretory phases, as well as in the gland secretion during the secretory phase. In contrast, stromal cells were nearly unstained. CONCLUSION(S): IRF-1 was localized in the human endometrium, implying that this nuclear protein plays some role other than as a transcription factor.

IL-15 expression at human endometrium and decidua.

A large number of natural killer (NK) cells appear in human uterine mucosa during the secretory phase and first trimester pregnancy. We investigated the expression of interleukin (IL)-15, a possible stimulator for these NK cells, in human endometrium and first trimester decidua. Semiquantitative reverse transcriptase-polymerase chain reaction revealed that IL-15 mRNA expression was stronger during the secretory phase and first trimester pregnancy than during the proliferative phase. Immunohistochemistry revealed that immunoreactivity for anti-IL-15 was higher during the secretory phase than it was during the proliferative phase. This was prominent in the perivascular stromal cells around invading spiral arteries during the mid- to late-secretory phase. In first trimester decidua, endothelial cells were also stained as strongly as stromal cells. A membrane-bound IL-15 molecule was detected on the surface of first trimester decidual cells by flow cytometry. Progesterone stimulated the release of soluble IL-15 in the supernatant of cultured decidual cells. These results suggest that IL-15 expression in human uterine mucosa corresponds to the fluctuation of uterine NK cells and that its production is hormonally controlled, especially by progesterone.