Differences in female and male perception of information and decision-making in single-embryo transfer in in vitro fertilization in Sweden

Purpose The aim of this study was to evaluate the information and the factors that contribute to the decision to accept and choose single embryo transfer (SET) in females and males. Materials and methods Fifty-four females and males undergoing SET were interviewed separately using a structured questionnaire. Results The women were significantly more satisfied with the information than the men (odds ratio 3.3), but the decision to accept SET was nevertheless more difficult for women (OR 3.1). Only one-third of both female and males were aware of the increased maternal risks with twin pregnancies. There was a tendency that the women who accepted SET had previous children, shorter duration of infertility, and were younger. Cryopreservation of embryos and a good pregnancy chance were important irrespective of gender. Conclusion The female needs more support to choose SET. The male needs better information and further involvement in decision-making. The females were more aware of the fetal risks, but the awareness of the increased maternal risks with twin pregnancies was low. The female need more support to accept and choose single embryo transfer, compared to the male and information should in some areas be directed differently to females and males.     

Changes in beta-endorphin in fetal membranes and placenta in normal and pathological pregnancies

Several studies indicated that trophoblast tissue synthesizes pro-opiomelanocortin-related peptides. These peptides are also present in amniotic fluid, but their origin remains unknown. The present study evaluated the presence of and the possible changes in beta-endorphin (beta-EP) in amnion and chorion during pregnancy, at parturition and in spontaneous abortion. Amnion, chorion and placental tissues were isolated and homogenized from a total of 46 pregnant women between 4th and 42 th week of pregnancy. Beta-EP was separated on a Sephadex G-75 column and measured by RIA with specific antiserum. The identity of the endogenous opioid with its corresponding reference molecule was confirmed by high performance liquid chromatography. In all tissues, the concentration of beta-EP in the first trimester was significantly higher than in the second trimester. A negative correlation between opioid levels and gestational age was observed in the first two trimesters. At delivery, the beta-EP content of all tissues was greater than in the second trimester. In tissues collected at term, in the absence of labor, beta-EP levels were very low in comparison with those collected after vaginal delivery. Low beta-EP contents were found in membranes collected from spontaneous abortion in 1st trimester. From these data one can surmise the existence of a local endogenous opioid system in fetal adnexes. This system seems sensitive to the stress of vaginal delivery and could be involved in the mechanisms leading to spontaneous abortion.     

瘦素在子癎前期患者胎盘和血清的表达和意义

目的 探讨子癎前期患者胎盘和血清中瘦素的表达变化及其和子癎前期发病的关系.方法 采用免疫组化SP法检测45例子癎前期患者(研究组,其中重度组28例,轻度组17例)和30例同期正常妊娠妇女(对照组)胎盘瘦素水平,并用酶联免疫吸附实验检测两组孕妇产前血清瘦素水平.结果 (1)两组胎盘瘦素均在合体滋养细胞胞浆表达,随病情加重,染色逐渐加深,胎盘瘦素与子癎前期存在线性相关关系.(2)研究组、轻度组、重度组和对照组血清瘦素浓度分别为(10.41±4.78)ng/ml、(6.33±1.87)ng/ml、(12.88±4.27)ng/ml、(5.73±2.19)ng/ml,轻度组稍高于对照组但无统计学意义(P>0.05),研究组和对照组、轻和重度组、重度组和对照组相比,均有性统计学意义(P<0.01),瘦素表达水平和病情严重程度呈正相关.(3)血清瘦素与体重指数无相关性(P>0.05);但其与收缩压、舒张压及平均动脉压均呈正相关(r=0.602、0.566和0.585,P均<0.05).结论 瘦素在子癎前期患者胎盘和血清中均高表达,高瘦素水平参与子癎前期的发生和发展.     

Global progress in PMTCT and paediatric HIV care and treatment in low- and middle-income countries in 2004-2005

A growing number of countries are moving to scale up interventions for prevention of mother-to-child transmission (PMTCT) of HIV in maternal and child health services. Similarly, many are working to improve access to paediatric HIV treatment. This paper reviews national programme data for 2004-2005 from low- and middle-income countries to track progress in these programmes. The attainment of the UNGASS target of reducing HIV infections by 50% by 2010 necessitates that 80% of all pregnant women accessing antenatal care receive PMTCT services. In 2005, only seven of the 71 countries were on track to meet this target. However PMTCT coverage increased from 7% in 2004 (58 countries) to 11% in 2005 (71 countries). In 2005, 8% of all infants born to HIV positive mothers received antiretroviral prophylaxis for PMTCT, up from 5% in 2004, though only 4% received cotrimoxazole. 11% of HIV positive children in need received antiretroviral treatment in 2005. In 31 countries that had data, 28% of women who received an antiretroviral for PMTCT also reported receiving antiretroviral treatment for their own health. Achieving the UNGASS target is possible but will require substantial investments and commitment to strengthen maternal and child health services, the health workforce and health systems to move from pilot projects to a decentralised, integrated approach.     

GnRHR与ER在子宫腺肌病在位及异位内膜的表达及意义

目的探讨促性腺激素释放激素受体（GnRHR）和雌激素受体（ER）在子宫腺肌病在位内膜与异位内膜的表达、相关性及意义。方法收集51例行全子宫切除手术的子宫腺肌病患者，取其在位内膜为研究组A，异位内膜为研究组B，同期30份正常子宫内膜作为对照组。采用免疫组织化学方法测定各组内膜腺细胞中GnRHR与ER的表达，根据阳性率和表达强度进行量化评分（免疫组化评分），并做相关性分析。结果①研究组AGnRHR与ER的表达均显著高于研究组B和对照组，差异有统计学意义（P〈0.05）；②研究组A及正常子宫内膜中，GnRHR表达有周期性，分泌期显著高于增生期，差异有统计学意义（P〈0.01），而在研究组B中增生期与分泌期相比较差异无统计学意义；③GnRHR与ER在各组内膜的表达水平无相关性（P〉0.05）。结论GnRHR在子宫腺肌病在位内膜、异位内膜及正常子宫内膜中均有不同程度的表达；GnRHR在子宫腺肌病在位内膜及正常子宫内膜中分泌期表达显著高于增生期；推测促性腺激素释放激素（GnRH）可能通过其受体介导，对异位内膜细胞的种植和生长直接产生作用，在正常子宫内膜，则可能与受精卵着床及胚胎早期发育有关。     

HSP70与FasL在子宫内膜异位症中的表达

目的 :探讨热休克蛋白 70 (HSP70 )和Fas配体 (FasL)在子宫内膜异位症(EM)发病中的作用。方法 :采用免疫组化链霉菌抗生物素蛋白 -过氧化物酶染色法 (S P法 )检测子宫内膜异位症 5 6例的异位内膜与在位内膜 (30例 )中HSP70和FasL蛋白的表达 ,并以正常子宫内膜为对照 (2 5例 )。结果 :异位内膜组织中HSP70与FasL均呈高表达 ,与正常内膜组差异有高度显著性 (P <0 .0 1) ,而且二者失去在正常内膜组织中表达的周期性变化。但在卵巢子宫内膜异位症 (OEM)与子宫腺肌症 (AM)的表达差异无显著性 (P>0 .0 5 )。结论 :异位内膜组织中HSP70和FasL蛋白均过度表达 ,可能在EM的发病中起重要作用     

Antiphospholipid antibodies and pregnancy rates and outcome in in vitro fertilization patients

Objective: To determine the relationship between antiphospholipid antibodies and pregnancy rates (PRs) and outcome among IVF patients.

Design: Prospective collection of all serum samples with assays for immunoglobulin G (IgG), IgA, and IgM antibodies for anticardiolipin, antiphosphatidyl serine, antiphosphatidyl ethanolamine, antiphosphatidyl choline, antiphosphatidyl inositol, antiphosphatidyl glycerol, and anti-phosphatidic acid being done following completion of all treatment cycles.

Setting: A tertiary care teaching hospital.

Patient(s): Seven hundred ninety-three patients attempting to conceive through IVF.

Main Outcome Measure(s): Pregnancy rates (PRs) and pregnancy loss rates relative to each of the various antiphospholipid antibodies that were measured.

Result(s): There were 528 pregnancies for an overall PR of 66%. Pregnancy rates were equal among patients with positive and negative antiphospholipid antibodies for each of the 21 measured antibodies. Use of receiver operator characteristic curves and logistic regression further confirmed that there was no relationship between PRs or outcome based on antiphospholipid antibodies for any definable threshold value.

Conclusion(s): Elevated antiphospholipid antibody levels are not associated with any change in PRs or pregnancy loss rates in patients attempting to conceive through IVF.     

Prostacyclin and thromboxane in gynecology and obstetrics

The gynecologic and obstetric implications of the smooth muscle-relaxing, antiaggregatory prostacyclin and its endogenous antagonist, thromboxane A2, are reviewed. In addition to the vascular wall and circulating platelets, which are primary sources for prostacyclin and thromboxane A2, respectively, reproductive tissues produce great amounts of these prostanoids, evidently for the regulation of the vascular tone and/or vascular platelet interaction. Several gynecologic and obstetric disorders are characterized by abnormalities in prostacyclin and/or thromboxane A2. In primary menorrhagia the uterine release of prostacyclin is increased, and consequently menstrual blood loss can be reduced with various prostaglandin synthesis inhibitors. Prostacyclin relaxes the nonpregnant myometrium in vitro and may also do so in vivo, although intravenous infusion of prostacyclin has no effect upon the uterine contractility in nonpregnant or pregnant subjects. Patients with pelvic endometriosis may have increased levels of prostacyclin and thromboxane A2 metabolites in the peritoneal fluid. The prostacyclin/thromboxane A2 balance shifts to thromboxane A2 dominance in patients with gynecologic cancer. During pregnancy the production of prostacyclin and thromboxane A2 increases in the mother and fetoplacental tissue. Preeclampsia and other chronic placental insufficiency syndromes are accompanied by prostacyclin deficiency in the mother and in fetomaternal tissues and by an overproduction of thromboxane A2, at least in the placenta. These changes may account for the vasoconstriction and platelet hyperactivity, which are pathognomonic for hypertensive pregnancies. By directing the prostacyclin/thromboxane A2 balance to prostacyclin dominance (by dietary manipulation, administration of prostacyclin and/or its analogues, drugs with prostacyclin-stimulating and/or thromboxane A2-inhibiting action), it may be possible to prevent and/or treat hypertensive pregnancy complications in the future.     

Differences in preterm delivery rates and outcomes in Jews and Bedouins in Southern Israel

OBJECTIVE: (1) To compare the preterm delivery rates in the Bedouin versus the Jewish population. (2) To compare risk factors for preterm delivery in the two populations. (3) To compare outcomes of preterm delivery between the two groups. STUDY DESIGN: 41669 Jewish singletons births of whom 2816 delivered preterm (23-36 weeks) and 26495 Bedouin singletons in whom 2064 preterm deliveries occurred, were compared. All births took place in Soroka University Medical Center. Data were obtained from the computerized database of birth discharge records. RESULTS: The incidence of preterm delivery in Bedouin women was significantly higher than the rate in Jewish women (7.8 vs. 6.8%, P<0.01). The grand multiparity rate was higher among Bedouin women (P<0.001), as was the rate of teenage (<19 years) mothers (P<0.001). Gestational diabetes, PIH, and PROM rates were higher in the Jewish population (P<0.001, P=0.017, P<0.001, respectively). A bad obstetric history and previous perinatal mortality is more common in the Bedouin population (P<0.001 for both). In a logistic regression model including all these factors, the ethnic difference in the incidence of preterm delivery remained significant. The neonatal mortality rate was higher in the Bedouin population (P<0.001), as was the rate of congenital malformations (P<0.001). The perinatal mortality of Bedouins was nearly twice that of Jewish neonates with congenital malformations. However, no difference was found when neonates without congenital malformations were compared. Congenital malformations were found to be the strongest predictor of mortality. Ethnicity per se was no longer a predictor of mortality once congenital malformations were included in a logistic regression model, but the interaction of Bedouin ethnicity and congenital malformation was a significant predictor of mortality. CONCLUSION: The incidence of preterm delivery was significantly higher in Bedouin women than in Jewish women. A full explanation for this difference was not found. However, there were significantly higher rates of congenital malformations in the Bedouin preterm delivered infants. There was a much higher rate of neonatal mortality in the Bedouin population and this ethnic difference was fully explained by the presence of congenital anomalies.     

Emotional aspects and support in in vitro fertilization and embryo transfer programs

Little is known about the emotional demands upon women of the step-by-step procedures characteristic of involvement in an in vitro fertilization/embryo transfer (IVF-ET) program. In this study, 77 women provided their perceptions of the emotional demands of IVF-ET and explanations for failed attempts, as well as describing their coping strategies and sources of emotional support. Nominated as the two most difficult stages of IVF were the wait for a possible pregnancy after the procedure and the blood tests and injections prior to hospitalization. Women were overly optimistic with a first attempt, with 70% being moderately to highly optimistic about success. Levels of optimism, however, generally declined across attempts. About half of the women intended to stop after four attempts, and almost all would stop after six treatment cycles. Women attributed their lack of success to a wide range of factors, including the low success rate, being anxious or stressed, bad luck, or problems associated with their condition and the procedure. Asked how they coped with the program, the women reported that the major strategy was to adopt the attitude that they might be successful in the long term. Other coping strategies involved keeping busy, staying calm, and seeking the support of other IVF women and husbands. Husbands were listed as the major source of emotional support, followed by other infertile women and nurses, counselors, and doctors. Finally, the majority of women believed that although they would be less fulfilled if they did not have a child through IVF-ET, nevertheless there were alternative sources of satisfaction which they would pursue. For most, continued infertility was not seen as detrimental to the quality of their marriages.     

Differences in fat and lean mass proportions in normal and growth-restricted fetuses

OBJECTIVE: The purpose of this study was to assess fetal subcutaneous fat and lean mass areas as predictors of fetal growth restriction. STUDY DESIGN: Seventeen severe fetal growth-restricted (abdominal circumference, < 2 SD) fetuses and 20 control fetuses underwent ultrasound measurements of subcutaneous fat, lean mass, and standard biometry. Thigh subcutaneous fat and lean mass were measured on enlarged ultrasound axial images (subcutaneous fat area = total cross sectional area - lean mass area [bone + muscle areas]). Subcutaneous fat and lean mass areas were expressed as a percentage of the total cross-sectional area and were normalized to femur length and head circumference. Measurements were modeled as a function of fetal growth-restriction status and week of gestation with multiple linear regression. RESULTS: Fetal growth-restriction fetuses showed reductions in fat and lean mass (in standard biometry) and showed a disproportionate reduction in fat mass compared with lean mass. These were all associated significantly with fetal growth restriction. CONCLUSION: Fetal growth-restricted fetuses have reduced subcutaneous fat and lean mass compared with control fetuses; a further reduction occurs in subcutaneous fat concentration compared with the reduction in lean mass when fat is normalized for body size, with either head circumference or femur length. Fat-to-bone proportions may be useful in distinguishing the small for gestational age fetus who is truly fetal growth restriction from the constitutionally small fetus.     

子宫内膜异位症患者血浆及组织中骨桥蛋白表达及其作用机制的研究

目的:检测子宫内膜异位症(endometriosis,EM)组织中骨桥蛋白(osteopon-tin,OPN)、血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达,探讨子宫内膜异位症的发病机制,OPN在子宫内膜异位症血浆中的含量以及OPN在子宫内膜异位症诊断及鉴别诊断方面的应用。方法:用免疫组化SP法检测56例子宫内膜异位症患者异位内膜及在位内膜中OPN、VEGF的表达,用酶联免疫吸附方法检测患者术前血浆OPN含量。结果:(1)异位内膜OPN表达主要分布于腺上皮细胞细胞膜,阳性(++~+++)表达率与在位内膜相似,明显高于对照内膜,差异有显著性(P<0.01),异位内膜细胞大多受挤压萎缩,缺乏典型的周期性改变;(2)VEGF在异位内膜胞浆染色,呈棕色颗粒,表达阳性,其中阳性(++~+++)表达率明显高于在位内膜及对照内膜(P<0.01);(3)异位内膜组织中OPN、VEGF表达有相关性(rs=0.596,P<0.01)。在子宫肌瘤对照内膜组织OPN、VEGF的表达则无相关性(rs=0.153,P=0.507);(4)子宫内膜异位症患者术前血浆OPN均值46.26±8.72ng/m l(15.54~139.12ng/m l),高于良性肿瘤及正常对照组(P<0.01),后二者无显著差异。卵巢癌患者术前血浆OPN均值81.32±14.41ng/m l(22.72~197.94ng/ml),较内异症患者水平高(P<0.01)。结论:OPN在异位内膜细胞高表达,可能推动异位内膜黏附和侵袭,OPN、VEGF可能通过促血管生成,共同促进异位内膜种植与生长,在子宫内膜异位症发生发展中起重要作用;OPN在盆腔包块鉴别诊断方面有一定应用价值。