Luteal phase hormonal profile in prediction of pregnancy outcome after assisted reproduction

The clinical efficacy of luteal phase hormones including estradiol and progesterone in the prediction of pregnancy and its outcome in ICSI-ET cycles was evaluated. In 121 ICSI-ET cycles, serial estradiol and progesterone levels were measured in the luteal phase. The day of ovum pick-up was designated as day 0. All the patients had luteal support with vaginal progesterone suppositories after embryo transfer (ET). Serial estradiol measurements were performed on days 8, 11 and 13 and progesterone level on day 11. A single dose of hCG was given for corpus luteum rescue 5000 IU, if day 8 estradiol level <200pg/ml; 2000IU, if estradiol between 200 and 800pg/ml; no hCG if estradiol level >800pg/ml). On day 15, beta-hCG level was measured to detect pregnancy and if positive, injected on day 17. Fifty-seven pregnancies were achieved in 121 cases after ET (47%). Clinical pregnancy rate and ongoing pregnancy rate per ET were 37.1 and 30%, respectively. While there was no difference between progesterone levels measured on day 11, estradiol levels on days 11 and 13 were significantly higher in women who became pregnant. In 40 patients taking only progesterone and in 81 cases taking hCG plus progesterone, estradiol levels on days 11 and 13 were significantly higher in women who became pregnant. Progesterone levels on day 11, in progesterone treated groups, did not differ between pregnant and non-pregnant patients. Estradiol and progesterone levels on day 11 and estradiol levels on day 13 showed a big overlap between pregnant and non-pregnant patients. The efficacy of serial testing was evaluated. An increase in estradiol level from day 11 to 13 was associated with 71% pregnancy rate (72% ongoing). In the case of a decrease in estradiol level, the pregnancy rate was 18% of which 80% had to implant. Rising estradiol in the late luteal phase is associated with higher pregnancy rate and more successful pregnancy outcome.     

Evidence of gonadal and gonadotropin antibodies in women with a suboptimal ovarian response to exogenous gonadotropin

Failure to respond to human menopausal gonadotropin (hMG) with adequate ovarian stimulation is associated with a poor prognosis in subsequent cycles in women participating in an in vitro fertilization/embryo transfer program. Sera from 26 menstruating women (mean age 38 +/- 4.3 years) identified as "low responders" with either tubal or male factor infertility, mean baseline FSH values of 11 mIU/mL, and peak serum estradiol levels lower than 300 pg/mL were assessed for specific antibodies to human ovary and gonadotropins. Twenty-five infertile women with tubal or male factor infertility with a good response to hMG served as controls. Ninety-two percent of low responders had antibodies to FSH and 65% had antibodies to LH when assessed by enzyme-linked immunosorbent assay. Similarly, 77% of low responders had ovarian antibodies. No hepatic antibodies were found in the sera of low responders, indicating that the positivity was not a general interaction with cell components. None of the "good responders" had antibodies to gonadotropins or to ovarian or liver tissue. The significant differences in antibodies between the groups supports a possible immunologic cause for low ovarian stimulation response to gonadotropin.     

Angiotensin II levels in hypertensive and normotensive pregnancies

We measured circulating angiotension II by radioimmunoassay in women with pregnancy-induced hypertension (n = 54), and compared these values with those obtained in women with normal pregnancy (n = 18) and in non pregnant women (n = 20). Pregnant women had statistically significantly higher plasma angiotensin II [mean (SD): 41.3 (12.6) pg/ml] than non-pregnant women [29.2 (11.3) pg/ml; P less than 0.004]. Angiotensin II concentrations in women with pregnancy-induced hypertension [mean (SD): 31.7 (16.2) pg/ml] were, on average, 25% lower than in normal pregnancy (P less than 0.003) and resembled those obtained in non-pregnant women. The lowest angiotensin II levels were found in women with more severe forms of pregnancy-induced hypertension, such as proteinuric or superimposed pregnancy-induced hypertension. Review of the published studies on angiotensin II and our data suggest that the conflict among studies on angiotensin II levels in pregnancy-induced hypertension is largely due to the heterogeneity of the study populations in the various reports.     

Leptin and pre-eclampsia in black African parturients

Objective To measure serum concentrations of the hormone leptin during late pregnancy in Black African women with pre-eclampsia, healthy normotensive pregnant women as controls and healthy normotensive non-pregnant women; secondly, to explore the relationship between leptin and obesity.
Design Observational, cross sectional study.
Setting Antenatal clinics, antenatal wards, gynaecology out patient and family planning clinics of a tertiary hospital, Durban, South Africa.
Population Pregnant and non-pregnant Black African women.
Method Serum leptin was measured by a homologous radio-immunoassay technique. Simple anthropometric parameters were used to explore the relationship between leptin and obesity. In each group, leptin levels were compared between obese (body mass index,  BMI ≥ 30 kg m⁻²  ) and lean women.
Main outcome measures Serum leptin concentrations, anthropometric parameters, mean blood pressures and proteinuria.
Results There were 68 women with pre-eclampsia, 92 healthy normotensive pregnant women (controls) and 32 healthy normotensive non-pregnant women. Serum leptin levels were higher in pregnant compared with non-pregnant women [26.66 (1.96) and 25.89 (1.65) vs 17.97 (2.11) ng/mL,   P = 0.02  ]. Weight and BMI showed the greatest correlation with leptin both in pregnant (   r = 0.61 and r = 0.58, respectively  ) and non-pregnant women (   r = 0.74 and 0.79, respectively  ). There was no significant difference in the mean concentrations of leptin between women with and those without pre-eclampsia [26.66 (1.96) vs 25.89 (1.65) ng/mL, respectively,   P = 0.95  ].
Conclusion Pregnancy is a hyperleptinaemic state. There is no difference in serum leptin levels between Black African women with pre-eclampsia and healthy normotensive pregnant women. Serum leptin concentration is largely determined by the degree of adiposity.     

Elevated C-reactive protein and pro-inflammatory cytokines in Andean women with pre-eclampsia.

OBJECTIVE: To investigate the concentration of markers of inflammation in non-pregnant women, women with normal pregnancy and women with pre-eclampsia. METHODS: Pregnant women (n=26), women with pre-eclampsia (n=25) and non-pregnant normotensive women (n=21) were included in the study. C-reactive protein was measured by latex-enhanced immunoturbidimetric assay, serum tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) by high sensitivity ELISA. Kruskal-Wallis non-parametric analysis of variance followed by the Mann-Whitney U-test were used for statistical analyses. RESULTS: Higher values (mean+/-S.E.M.) of C-reactive protein were found in pre-eclampsia (4.11+/-0.37 mg/dl) compared with normal pregnant women (2.49+/-0.26 mg/dl) and non-pregnant controls (1.33+/-0.15 mg/dl). TNF-alpha was significantly higher in women with pre-eclampsia (15.74+/-5.09 pg/ml), in relation to the control group (2.76+/-0.41 pg/ml) and women with normal pregnancy (8.31+/-1.55 pg/ml). IL-6 levels were significantly higher in pre-eclamptic women (12.91+/-1.29 pg/ml) compared with normal pregnant (5.07+/-0.423 pg/ml) and control women (1.25+/-0.13 pg/ml). CONCLUSIONS: The results of this cross-sectional study in a high-risk Andean population show that both C-reactive protein and pro-inflammatory cytokines are present in higher concentrations in women with pre-eclampsia. The study was undertaken in women with established pre-eclampsia and it is not possible to determine whether the increased concentrations of C-reactive protein and pro-inflammatory cytokines were a cause or consequence of the disease.     

The influence of body mass index on in vitro fertilization outcome

Objective

To examine whether body mass index (BMI) influences the outcome of in vitro fertilization (IVF).

Methods

We studied 516 IVF cycles, 438 undergone by nonobese (BMI ≤ 30) and 78 by obese (BMI > 30) women who all had an a priori favorable prognosis (age < 40 years and first, second, or third IVF cycle).

Results

Pregnancy was achieved in 122 (27.9%) nonobese and 12 (15.4%) obese women. The obese women required significantly longer stimulation and more gonadotropin ampoules, and had lower peak estradiol levels and a significantly lower fertilization rate; obese poor responders had a significantly lower pregnancy rate than nonobese poor responders; and the prevalence of poor responders was significantly higher among obese than nonobese women (28.2% vs 16.9%, P < 0.04).

Conclusion

While the likelihood of poor responders was increased among obese women, reasonable conception rates were achieved in nonobese poor responders, and were comparable to the rates in nonobese and obese normal responders.     

Angiotensin II levels in hypertensive and normotensive pregnancies

Summary. We measured circulating angiotension II by radioimmunoassay in women with pregnancy-induced hypertension (  n = 54  ), and compared these values with those obtained in women with normal pregnancy (  n = 18  ) and in non pregnant women (  n = 20  ). Pregnant women had statistically significantly higher plasma angiotensin II [mean (SD): 41.3 (12.6) pg/ml] than non-pregnant women [  29.2 (11.3) pg/ml; P < 0.004  ]. Angiotensin II concentrations in women with pregnancy- induced hypertension [mean (SD): 31.7 (16.2) pg/ml] were, on average, 25% lower than in normal pregnancy (   P < 0.003  ) and resembled those obtained in non-pregnant women. The lowest angiotensin II levels were found in women with more severe forms of pregnancy-induced hypertension, such as proteinuric or superimposed pregnancy-induced hypertension. Review of the published studies on angiotensin II and our data suggest that the conflict among studies on angiotensin II levels in pregnancy-induced hypertension is largely due to the heterogeneity of the study populations in the various reports.     

A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with severe acute respiratory syndrome

OBJECTIVE: To compare the clinical courses and outcomes of pregnant severe acute respiratory syndrome (SARS) patients and non-pregnant SARS patients. DESIGN: A case-control study. SETTING: Tertiary Hospital for Infectious Disease. Sample Ten pregnant and 40 non-pregnant female patients infected with SARS. METHODS: Clinical course and outcomes of pregnant SARS patients were compared with a group of non-pregnant SARS patient. Cases and controls were matched with respect to sex, age, timing of contracting SARS, health care workers status and underlying illness. MAIN OUTCOME MEASURES: The incidence of intensive care unit admission, intubation, medical complications and death rate. RESULTS: Pregnancy had no discernible impact on clinical symptoms and presentation delay. Four out of the 10 pregnant patients, nevertheless, required endotracheal intubation and six were admitted to the intensive care unit (ICU), as compared with 12.5% intubation rate (P= 0.065) and 17.5% ICU admission rate (P= 0.012) in the non-pregnant group. More pregnant SARS patients developed renal failure (P= 0.006) and disseminated intravascular coagulopathy (P= 0.006), as compared with non-pregnant SARS group. There were three deaths in the pregnant group, whereas there was no death in the non-pregnant control group (P= 0.006). CONCLUSION: Pregnant women with SARS experience a worse clinical course and poorer outcomes compared with non-pregnant women.     

Detection of feto-maternal infection/inflammation by the soluble receptor for advanced glycation end products (sRAGE): results of a pilot study

Abstract Objective: The receptor for advanced glycation end products, RAGE, plays an important role in the pathogenesis of several diseases. sRAGE, soluble receptor for advanced glycation end products, is an inhibitor of the pathological effect mediated via RAGE. The aim of this study was to assess the usefulness of measuring sRAGE concentration in pregnant women with threatening preterm labor. Methods: Serum levels of sRAGE, interleukin-6 (IL-6) and routine markers of inflammation were determined in 46 pregnant women with threatening preterm labor, 35 healthy pregnant women and 15 non-pregnant controls. Results: Serum levels of sRAGE in healthy pregnant women were significantly lower than in non-pregnant controls (669+/-296 vs. 1929+/-727 pg/mL, P<0.05). Women with threatening preterm birth had a significantly higher concentration of serum sRAGE in comparison with healthy pregnant women (819+/-329 pg/mL vs. 669+/-296 pg/mL, P<0.05). Conversely, patients with PPROM had significantly lower levels of sRAGE compared with patients with threatening premature labor (600+/-324 pg/mL, P<0.05). sRAGE correlated negatively with leukocyte counts (r=-0.325, P<0.05). Conclusions: sRAGE might be a new and promising marker of premature labor, especially with the symptoms of PPROM.     

Exogenous Luteinizing Hormone (LH) Increases Estradiol Response Patterns in Poor Responders with Low Serum LH Concentrations

Purpose: Our purpose was to investigate whether the addition of exogenous leuteinizing hormone (LH) increases estradiol secretion in LH-depleted women undergoing controlled ovarian hyperstimulation (COH) with purified follicle stimulating hormone (FSH). Methods: We carried out case series and retrospective analysis of midfollicular serum LH concentrations and estradiol response patterns in COH cycles. All patients initially received gonadotropins containing purified FSH. Human menopausal gonadotropin containing LH was added to poor responders with low midfollicular LH concentrations. Results: The addition of exogenous LH to the COH regimen significantly increased estradiol secretion in poor responders with low midfollicular endogenous LH concentrations. This was confirmed statistically by an average change in the slope of the estradiol patterns from 27.54 to 85.49 after the addition of exogenous LH. Furthermore, patients with midfollicular serum LH concentrations <3.0 mIU/ml had significantly lower midfollicular and peak estradiol (E ₂ ) concentrations compared to patients with LH concentrations 3.0 mIU/ml (352.3 and 2094.3 vs 855.6 and 3757.1 pg/ml, respectively). Conclusions: The addition of exogenous LH increases E ₂ response patterns in poor responders with low midfollicular serum LH concentrations. Low midfollicular serum LH concentrations are associated with significantly lower midfollicular and peak E ₂ concentrations.     

Tumor necrosis factor and pregnancy - a contribution to the immunology of reproduction

Summary Serum levels of the cytokine TNF (tumor necrosis factor) were determined in pregnant women during the first trimester and compared with levels in a control group of non-pregnant healthy women. A new immunoradiometric assay (IRMA) was used. In pregnant women we found a very low mean value of 2.5 pg/ml. The value was significantly higher 16.2 pg/ml in the non-pregnant group. This finding suggests supression of macrophage activity which could favour the fetal allograft.     

The utility of serum leptin and follicular fluid leptin, estradiol, and progesterone levels during an in vitro fertilization cycle

PURPOSE: To prospectively evaluate serum and follicular fluid leptin, estradiol, and progesterone levels during in vitro fertilization. METHODS: Prospective observational study measuring serum levels at six points during the IVF cycle and follicular fluid at the time of retrieval. RESULTS: Serum leptin and estradiol levels both significantly increased for the individual patients during the IVF stimulation process. None of the leptin levels differed based on pregnancy outcome. BMI significantly correlated with all leptin levels. Follicular fluid estradiol correlated with serum estradiol only in pregnant patients (r = 0.97, p<0.01) and was unrelated in non-pregnant patients (r=-0.15, p=0.81). CONCLUSION: Serum and follicular leptin levels are highly correlated. Leptin levels increase during the IVF cycle and vary between patients based on maternal BMI, but do not correlate with other serum hormone levels or pregnancy outcome. Pregnancy outcome success was reflected in the relationship between follicular fluid and serum levels of estradiol, independent of leptin levels.     

Nutritional status of pregnant and lactating women in Japan: a comparison with non-pregnant/non-lactating controls in the National Nutrition Survey

AIM: To describe the nutritional status in Japanese pregnant and lactating women at a national level, through a comparison with their non-pregnant/non-lactating controls. MATERIAL AND METHODS: Pooled data from five years (1995-1999) of the National Nutrition Survey, Japan. Data on 330 pregnant and 388 lactating women, and their one-by-one matched non-pregnant/non-lactating controls, were used for analysis. RESULTS: There were fewer smokers, drinkers, and exercisers in pregnant women compared to their controls (P < 0.01). Both pregnant and lactating women showed significantly higher intakes of carbohydrates, calcium and vitamin B2. Mean iron intakes ranged 10.3-11.5 mg in the four groups, all being lower than the recommended intake level for non-pregnant/non-lactating women (12mg/day). Pregnant women consumed more fruits, milk and milk products, and less alcohol beverages and fish/shellfish compared to controls. Lactating women consumed more grain, vegetables, milk and milk products, and less alcohol beverages. There were 22.9% anemic subjects (Hb < 11 g/dL) in pregnant women, and 11.1% anemic subjects (Hb < 12g/dL) in lactating women and 15.7% in non-pregnant/non-lactating women. None of the pregnant subjects was severely anemic (Hb < 8 g/dL). No significant differences were observed in iron intakes between anemic and non-anemic women in each group. CONCLUSION: Pregnant and lactating women in Japan were aware of adopting healthy behaviors, such as smoking less, drinking less, and taking more milk or milk products compared to controls. Prevalence of mild anemia in pregnant women may have been partly due to plasma volume expansion in pregnancy.     

Ovarian response of individuals to different doses of human menopausal gonadotropin

Hormonal profiles were compared in 14 ovulatory women who were treated with two different doses of gonadotropins in successive in vitro fertilization cycles. All patients suffered from mechanical causes of infertility. Serum estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and progesterone (P) were measured daily during the follicular phase. Women were arbitrarily classified as high responders (E2 greater than 1000 pg/ml on the day of human chorionic gonadotropin administration, n = 8) or as low responders (E2 less than 1000 pg/ml, n = 6), according to the peak E2 levels during the cycle when they received 3 ampules of human menopausal gonadotropin (hMG). When patients were treated with 3 ampules of hMG, serum FSH, LH, and P concentrations increased significantly during the follicular phase in high responders but remained unchanged in low responders. When these patients were treated with 2 ampules of hMG, the temporal profiles of the hormones were similar, but the magnitude of increases in serum levels of gonadotropins and sex steroids was significantly reduced in high responders. The authors conclude that temporal individuality of endocrine profiles cannot be altered by varying the dose of gonadotropin. Increases in hormone levels accompanying a high response to hMG can, however, be dampened by lowering the dose. In contrast, hormone concentrations are not influenced by changing the dose of hMG in low responders.     

Inhibin B response to EFORT is associated with the outcome of oocyte retrieval in the subsequent in vitro fertilization cycle

Objective: To examine whether the magnitude of the rise in inhibin B levels after gonadotropin challenge is associated with subsequent response to ovarian stimulation during IVF.

Design: Inhibin B serum levels after EFORT (exogenous follicle-stimulating hormone ovarian reserve test).

Setting: Academic clinical practice.

Patient(s): Serum samples from women who had undergone ovarian reserve screening with FSH in preparation for IVF. Thirteen of these women had a poor response in IVF (canceled cycle for low estradiol and/or no oocytes retrieved), and 19 had a good response (≥10 oocytes retrieved).

Intervention(s): EFORT test.

Main Outcome Measure(s): Baseline (day 3) serum E₂ (bE₂), FSH (bFSH), and inhibin B (bInhB) levels and inhibin B and E₂ levels 24 hours after EFORT (ΔInhB and ΔE₂).

Result(s): The mean bInhB and ΔInhB levels were significantly higher in good vs. poor responders. The odds ratio of having a good response for women with a ΔInhB of 202 pg/mL was 51.8 times (95% CI = 6.1–1,244) the corresponding odds for women with a ΔInhB of 49 pg/mL. As expected, ΔE₂ was also significantly higher in good vs. poor responders; however, combination of ΔE₂ plus ΔInhB did not improve the odds for predicting IVF response.

Conclusion(s): Our data suggest that ΔInhB after EFORT may provide a method for predicting ovarian response to hyperstimulation in a subsequent IVF cycle.     

Hemopatías malignas en el embarazo

Objective

To analyze the incidence of hematological malignancies, their obstetric and medical management, and maternal and perinatal outcomes in pregnant women.

Subjects and methods

Medical histories were reviewed, and all cases of women diagnosed with hematologic malignancies during pregnancy from 2000 to 2005 were analyzed.

Results

We found five cases (two leukemias and three lymphomas, two of which were Hodgkin's disease), in distinct trimesters of pregnancy. The women consulted mainly because of B symptoms. Blood tests and histological data were highly variable. In all patients, complete remission was achieved after proper staging and treatment.

Conclusions

Pregnancy does not alter the development of hematological malignancies. Long-term disease-free survival is similar in both pregnant and non-pregnant women with the same disease.     

The incidence of transient hyperprolactinemia in gonadotropin-stimulated cycles for in vitro fertilization and its effect on pregnancy outcome

The incidence of transient hyperprolactinemia and its impact on in vitro fertilization (IVF) were determined in 151 euprolactinemic women with tubal infertility undergoing an identical gonadotropin stimulation for IVF. Prolactin (PRL) levels were measured on the morning of cycle day 3, days of human chorionic gonadotropin (hCG) administration, and peak estradiol (E2), and in the midluteal phase. Women were divided into high (H: peak E2 greater than 1,000 pg/mL, n = 51), intermediate (I:peak E2: 500 to 800 pg/mL, n = 50), or low (L:peak E2 less than 400 pg/mL, n = 50) E2 response groups. There was no difference in the incidence of hyperprolactinemia on cycle day 3 between the response groups (H:16%, I: 12%, and L:8%). However, high responders had a higher incidence of hyperprolactinemia than intermediate or low responders on all other study days. The incidence of hyperprolactinemia was greater than baseline (cycle day 3) only in the high responders on the day of peak E2. Serum prolactin was strongly correlated with peak E2 (r = 0.41). There were no differences in the number of preovulatory oocytes retrieved or fertilized or the pregnancy rates between hyperprolactinemic and euprolactinemic patients in each response group or when all hyperprolactinemic and euprolactinemic patients, regardless of E2 response, were compared. Transient hyperprolactinemia during gonadotropin stimulation for IVF occurs and correlates with E2 response but has no impact on IVF outcome.     

Low estradiol responses in oocyte donors undergoing gonadotropin stimulation do not influence clinical outcomes

Purpose

To examine the effect of low and very low estradiol responses in oocyte donors receiving gonadotropins on clinical outcomes of donor in vitro fertilization (IVF) cycles and to identify possible mechanisms responsible for low estradiol response.

Methods

This is a retrospective cohort study of oocyte donors undergoing antagonist IVF cycles with progression to oocyte retrieval between January 2010 and December 2016 at a single urban academic fertility center. Oocyte yield, fertilization rate, blastocyst rate, percentage of normal embryos on preimplantation genetic screening (PGS), pregnancy outcomes, and follicular fluid steroid profiles were compared between donors with normal estradiol response and those with low estradiol response.

Results

Three hundred sixty-six antagonist oocyte donor IVF cycles were identified: 42 cycles had a normal estradiol response (NE2), defined as peak serum estradiol (E2) of over 200 pg/mL per retrieved oocyte; 140 cycles had an intermediate estradiol response (iE2), defined as peak serum E2 between 100 and 200 pg/mL per retrieved oocyte; 110 cycles had a low estradiol response (LE2), defined as peak serum E2 between 50 and 100 pg/mL per retrieved oocyte; and 74 cycles had a very low estradiol response (vLE2), defined as peak serum E2 less than 50 pg/mL per retrieved oocyte. LE2 cycles resulted in a greater number of mature oocytes (22.4 vs. 13.6, p?<?0.017), and fertilizations versus NE2 donors (18.5 vs. 10.7, p?<?0.017), although the number of transferred or cryopreserved blastocysts were similar between groups (8.6, 6.9 vs. 4.8, p?=?0.095, p?=?1). The percentage of chromosomally normal embryos after PGS was similar between LE2, vLE2, and NE2 cycles (66.4, 71.8 vs. 63.1%, p?=?0.99, p?=?1). Pregnancy outcomes were similar between LE2, vLE2, and NE2 cycles. Serum AMH obtained on the day of peak E2 was similar to baseline serum AMH and did not differ between LE2 versus NE2 cycles. Follicular fluid E2 levels paralleled serum E2 levels and were lower in LE2 cycles versus NE2 cycles.

Conclusion

The prevalence of very low E2 responses in donors appears to be high (20.2%). In contrast to autologous IVF cycles, LE2 does not portend poor outcomes in oocyte donors.

     

Serum CA-125 and inhibin B levels in the prediction of ovarian response to gonadotropin stimulation in in vitro fertilization cycles

There is much controversy about the relationship between serum CA-125 levels during in vitro fertilization (IVF) cycles and ovarian function. To evaluate the prognostic value of serum CA-125 and inhibin B measurements in predicting ovarian response to gonadotropin stimulation, we compared the CA-125 and inhibin B levels of poor and normal responders on the first day of ovarian stimulation, on the day of ovulation induction (OI) and at oocyte pick-up. Sixteen patients with poor ovarian response (???3 oocytes, serum estradiol (E₂) ??900?pg/ml at OI) in IVF/intracytoplasmic sperm injection cycles were matched with normal responders (???6 oocytes, E₂ ??1800?pg/ml) by age, spontaneous cycle day-3 follicle-stimulating hormone level and cause of infertility. Inhibin B concentrations were significantly lower at all three time points in poor responders, but CA-125 levels were not. No statistically significant correlation was found between CA-125 levels and any of the clinical or laboratory parameters examined. Thus, CA-125 measurements during stimulation are not useful in predicting or identifying poor ovarian response to gonadotropin stimulation in IVF cycles. The lack of difference in CA-125 concentrations between poor and normal responders and lack of correlation with E₂ or inhibin B levels suggest that ovarian steroidogenesis and other granulosa cell functions do not influence the production of CA-125. Inhibin B, however, seems to predict ovarian response as early as at the start of stimulation.     

Characteristics of pregnant vs. non-pregnant women physicians: findings from the women physicians' health study.

OBJECTIVE: Many young physicians are women, and many are in their childbearing years. Knowing pregnant physicians' status is useful for epidemiological and workforce reasons, yet no studies have compared pregnant with same-age, non-pregnant physicians, an especially appropriate comparison group. STUDY DESIGN: Data from the Women Physicians' Health Study, a national questionnaire-based survey. We compare 87 pregnant with 1148 non-pregnant women physicians, ages 30-40. RESULTS: Pregnant physicians ate more fat, fruits and vegetables, and cheese, but not more dairy than non-pregnant women physicians. While nearly half consumed alcohol, they reported drinking an average of only 0.4 drinks/week, and none smoked. Nearly all took vitamin supplements. Pregnant physicians exercised as much as non-pregnant physicians, and pregnant physicians' self-reported health status was better. Work amount, desire to work less, perceived work control, career satisfaction, and work stress did not significantly differ by pregnancy status. CONCLUSION: The prenatal period may be a time of especially healthy habits and considerable productivity for female physicians.