What is the risk? Perspectives of prenatal diagnosis

The term 'risk' may be seen under multiple aspects. First of all, there is the risk of giving birth to a disabled child. Secondly, prenatal diagnosis itself constitutes a risk. Last but not least, there is a risk for society when presuming that everything is feasible. However 'risk' does not only mean danger, it also implies the notion of venture and responsibility. Responsibility towards society consists in opposing wrong developments. Responsibility towards the disabled child is often a pretext for not being able to bear misery. Life has to be lived; each other concept is contrary to nature. The only justification for not running the risk of having a disabled child lies in the responsibility towards one's own family. But often it is only in view of the task that we are assigned that we come to know our fortitude.     

Recurrent miscarriages: What is the role of cytokines?

Recurrent miscarriage is defined as three or more consecutive miscarriages before 20 weeks of gestation. This condition is a frequent reproductive problem worldwide, affecting up to 1% of couples. Immune effector cell dysfunction has been implicated in the pathogenesis of early pregnancy loss. This dysfunction may involve defects in cytokines, growth factors and immunosuppressive factors at the maternofetal interface. This is a growing research field, especially the role of cytokines in recurrent miscarriage.     

What is the purpose of launching the World Journal of Obstetrics and Gynecology?

World Journal of Obstetrics and Gynecology (WJOG) is a new member of the World Series journals and is launched in June 10, 2012. WJOG is an open access peer-reviewed bimonthly journal that will cover obstetrics and gynecology including reproductive medicine. The intention of WJOG is to publish papers that describe and influence the situation all around the world. The journal will publish both basic research and well as clinical findings. The focus shall be on translational work. Please send your important findings and comments to WJOG.     

What does basic science tell us about the use of uterotonics?

Pharmacotherapy with uterotonics remains the mainstay of the management for post-partum haemorrhage. Clinical studies evaluating the efficacy of these drugs are fraught with confounders, which may influence uterine contractility and blood loss. For this reason, a range of techniques have been developed to study myometrial function in vitro, allowing for the comparison of various drugs in a controlled-simulated physiological environment.In this review, we focus on the main classes of uterotonic drugs and outline their molecular and physiological basis of action. We explore the evidence related to appropriate drug dosing and relative efficacy, and compare the evidence gleaned from clinical and in vitro studies. We discuss the mechanism of oxytocin desensitisation and how basic science has helped us understand this phenomenon. We also discuss the in vitro research findings for each of the main classes of uterotonic drugs that have contributed to an improved understanding of the management of post-partum haemorrhage and, ultimately, better care for mothers.     

What is the contribution of embryo-endometrial asynchrony to implantation failure?

Purpose

The synchronized development of a viable embryo and a receptive endometrium is critical for successful implantation to take place. The aim of this paper is to review current thinking about the importance of embryo-endometrial synchrony in in vitro fertilization (IVF).

Methods

Detailed review of the literature on embryo-endometrial synchrony.

Results

By convention, the time when the blastocyst first attaches and starts to invade into the endometrium has been defined as the ‘window of implantation’. The term window of implantation can be misleading when it is used to imply that there is a single critical window in time that determines whether implantation will be successful or not. Embryo maturation and endometrial development are two independent continuous processes. Implantation occurs when the two tissues fuse and pregnancy is established. A key concept in understanding this event is developmental ‘synchrony’, defined as when the early embryo and the uterus are both developing at the same rate such that they will be ready to commence and successfully continue implantation at the same time. Many different events, including controlled ovarian hyperstimulation as routinely used in IVF, can potentially disrupt embryo-endometrial synchrony. There is some evidence in humans that implantation rates are significantly reduced when embryo-endometrial development asynchrony is greater than 3 days (±1.5 days).

Conclusions

Embryo-endometrial synchrony is critical for successful implantation. There is an unmet need for improved precision in the evaluation of endometrial development to permit better synchronization of the embryo and the endometrium prior to implantation.

     

What is the role of amnioinfusion in modern day obstetrics?

Amniotic fluid (AF) is a dynamic medium that plays a significant role in fetal well-being. It is production and amount varies with gestational age. It plays a vital role in fetal life as it contains antimicrobial factors, growth factors and it help the fetal lung to grow and expand. Amnioinfusion can be performed either transabdominally or transvaginal. Amnioinfuion can be done antenatally and during labor. Aminoinfusion can be used for diagnostic purposes to enable better visualization of the fetus as liquor is very important acoustic widow for better fetal examination. Amnioinfusion have some therapeutic benefits in conditions like early premature rupture of membrane and may help cases of external cephalic version for breech presentation at term. Amnioinfusion has been shown to reduce the incidence of variable deceleration due to cord compression, reduces the risk of meconium aspiration and it will help reduce cesarean delivery.     

What is the optimal condition for fertilization of IVM oocytes?

Application of in vitro maturation (IVM) is recently increasing for human infertility, especially to rescue patients of polycystic ovarian syndrome and ovarian hyperstimulation syndrome. To increase the application of IVM oocytes for embryo production and the efficiency of successful production of babies using IVM oocytes, quality control of oocytes and achievement of fertilization in the most suitable condition may be very important. In this paper, suitable conditions for fertilization of IVM oocytes will be discussed with recent knowledge about IVM and in vitro fertilization of oocytes in domestic animals. Currently, human oocytes are collected mainly from patients' ovaries 36 h following mild gonadotropin stimulation and used for IVM for 24–26 h. However, asynchronous progression of those oocytes to reach the metaphase-II stage may have occurred during the IVM culture. In the oocytes that have already progressed to the metaphase-II stage, sudden aging such as reduction in maturation promoting factor and MAP kinases will start to occur. Application of specific inhibitors of phosphodiesterase to control intracellular cAMP (cyclic adenosine monophosphate) level may be effective to synchronize timings of the germinal vesicle breakdown and consequently the meiotic progression of oocytes, and to improve the developmental competence. Furthermore, treatment of aging oocytes with caffeine appears to rescue them from reductions in maturation promoting factor and MAP kinases and to improve the developmental competence. Assessment methods to select oocytes with good quality may also be important to improve the successful rates.     

What is the role of assisted reproduction technology in the management of age-related infertility?

Although in the UK the upper age limit for National Health Service (NHS) provision of in?vitro fertilisation (IVF) is 39 years of age there has been an increase in number of women having fertility treatment in their 40s. However, the success rates of IVF and intra-uterine insemination (IUI) in this group remain low. Human Fertilisation and Embryology Authority (HFEA) data from 2006 showed that the live-birth rate from IVF in the UK was 11% in the age group 40-42, 4.6% in the age group 43-44 and less than 4% in women over 44. We performed a literature search for studies using terms and combinations of terms in online databases and published meta-analyses reporting the outcome of interventions in older women. This review showed that assisted reproduction technologies (ARTs) continue to have low live-birth rates in women over 40. Trials showed that assisted hatching may increase the chance of pregnancy in women with poor history. Blastocyst transfer is associated with better outcome, whereas application of pre-implantation genetic screening (PGS) in older women has not increased the success rates. It appears that, with the exception of egg-donation, ART has no answer yet to age-related decline of female fertility.