Anti-Müllerian hormone as a predictor of IVF outcome

Serum anti-Müllerian hormone (AMH) concentration and antral follicle count (AFC) are two increasingly popular static measures used to predict ovarian reserve prior to IVF treatment. While they have been shown to be good predictors of oocyte yield during ovarian stimulation, their status as indicators of oocyte quality and pregnancy rates is currently uncertain. The present study measured baseline concentrations of serum AMH and FSH, and AFC from 126 women undergoing IVF treatment. These data were then related to IVF outcomes. As expected, patients with lower serum AMH and AFC produced a significantly (P < 0.001) lower number of oocytes compared with patients with higher serum AMH/AFC. Fertilization rates in patients with lower serum AMH were significantly inferior compared with patients with higher serum AMH, irrespective of whether IVF (P = 0.043) or intracytoplasmic sperm injection (P = 0.006) was used to achieve fertilization. These low AMH patients yielded fewer oocytes, had lower fertilization rates, generated fewer embryos, and had a higher incidence of miscarriage during fresh transfers, ultimately culminating in a halving of the pregnancy rate per IVF cycle compared with the high AMH group.     

Fetal inflammatory response syndrome (FIRS) and outcome of preterm neonates – a prospective analytical study

Objectives: To estimate the incidence of fetal inflammatory response syndrome (FIRS) in preterm neonates and correlate it with immediate and one-year neurodevelopmental outcome.

Materials and methods: This prospective observational analytical study, in preterm neonates with gestational age between 26 and 34 weeks was conducted from May 2014 to December 2015 in a tertiary care hospital in South India. FIRS was defined as the presence of either elevated levels of interleukin-6 (IL-6) in cord blood ≥11?pg/ml and/or the placental histopathology showing evidence of fetal inflammatory response. One hundred and twenty neonates were recruited. During delivery 2?ml cord blood for interleukin-6 and placenta were collected and stored appropriately. Based on presence/absence of FIRS (IL-6 in cord blood ≥11?pg/ml and or features of placental fetal inflammation), neonates were grouped into two groups. The neonatal and maternal characteristics between two groups were compared. The short-term outcome parameters during NICU stay and neurodevelopmental outcome at one year of corrected age was compared between groups.

Results: Among the 120 infants studied, 19 expired. Out of 101 babies discharged, 87 were followed up till corrected 1 year of age. On examination of placenta and cord blood, 50 neonates had evidence of FIRS (41.6%). So there were 50 neonates in FIRS and 70 in NO-FIRS group. The mean gestational age, birth weight, and gender distribution were comparable between the two groups. Mortality [OR: 2.44 (CI: 1.14–5.26)] and early hypotension [OR: 2.13 (CI: 1.1–4.2)] were significantly higher in the FIRS group. The neurodevelopmental assessment at corrected age of 1 year showed that infants with FIRS had lower mean motor developmental quotient by developmental assessment scale for Indian infants (DASII) [87.6?±?9.15 versus 93.07?±?9.3, p?Conclusions: FIRS has a significant role on survival and neurodevelopmental outcome of preterm infants.     

Does stress affect IVF outcomes? A prospective study of physiological and psychological stress in women undergoing IVF

Research questionWhat are the effects of physiological and psychological stress on fertility outcomes for women undergoing IVF?DesignA prospective cohort study of 72 patients undergoing IVF in 2017 and 2018. Physiological stress was assessed by salivary cortisol measurements: (i) pretreatment, when the patient received the IVF protocol; (ii) before oocyte retrieval (follicular cortisol was also measured); and (iii) before embryo transfer. Emotional stress was evaluated at each assessment with the State-Trait Anxiety Inventory and a 1–10 Visual Analogue Scale (VAS, referred to as the ‘Stress Scale’. Correlations between cortisol concentrations, psychological stress and IVF outcome were assessed.ResultsSalivary cortisol concentrations increased by 28% from pretreatment phase (0.46 ± 0.28 μg/dl) to maximum concentration on oocyte retrieval day (0.59 ± 0.29 μg/dl, P = 0.029) and then decreased by 29% on embryo transfer day (0.42 ± 0.23 μg/dl, P = 0.0162). On embryo transfer day, cortisol among women in their first cycle was higher than women who underwent more than one treatment (P = 0.024). Stress Scale score increased by 39% from pretreatment to a maximum score on oocyte retrieval day and then decreased by 12% on embryo transfer day. Salivary cortisol and Stress Scale were not related to subsequent embryo transfer, fertilization rate, embryo quality or clinical pregnancy rate. Follicular cortisol concentration was positively correlated with fertilization rate (r = 0.4, P = 0.004).ConclusionIt can be cautiously concluded that physiological and psychological stress do not negatively affect IVF outcomes. Moreover, high follicular cortisol concentrations might have positive effects on pregnancy rates.     

IL-1β and TGF-β weaken the placental barrier through destruction of tight junctions: An in vivo and in vitro study

Introduction

Chorioamnionitis is a gestational pathological condition characterized by acute inflammation of the amniochorionic membranes and placentas leading to high concentrations of IL-1β, Il-6, Il-8 and TGF-β in the amniotic fluid. In normal conditions, the permeability of foeto-maternal barrier is due to the assembly and maintenance of different cellular junctional domains.

Methods

In the present study, first we aimed to evaluate the protein expression (by immunohistochemistry and western blotting) and mRNA (by real time PCR) levels of the molecular components of tight junctions (Zonula occludens-1 and occludin), and of adherent junctions (VE-cadherin and β-catenin) in placentas from chorioamnionitis compared to that in normal pregnancies.

Results

Western blotting results showed a significant down-regulation of occludin in placentas affected with chorioamnionitis. No differences were detected for the other proteins analysed. We evaluated whether occludin expression was regulated by IL-1β, IL-6, IL-8 and TGF-β by means of in vitro studies using HUVEC cultures and demonstrated a key role of IL-1β and TGF-β in the disappearance of occludin at cellular border. Conclusions. We conclude by suggesting a pivotal role of these two cytokines in facilitating intra-placental infection via para-cellular way due to the disassembly of tight junctions at trophoblastic and endothelial cells in placental tissues.     

Safe total intrafascial laparoscopic (TAIL™) hysterectomy: a prospective cohort study

This study directly compares total intrafascial laparoscopic (TAIL™) hysterectomy with vaginal (VH) and abdominal (AH) hysterectomy with regard to safety, operating time and time of convalescence. The study is a prospective cohort study (Canadian Task Force classification II-2), including data from patients of a single university-affiliated teaching institution, admitted between 1997 and 2008 for hysterectomy due to benign uterus pathology. Patient data were collected pre-, intra- and postoperatively and complications documented using a standardised data sheet of a Swiss obstetric and gynaecological study group (Arbeitsgemeinschaft Schweizerische Frauenkliniken, Amlikon/Switzerland). Classification of complications (major complications and minor complications) for all three operation techniques, evaluation of surgeons and comparison of operation times and days of hospitalisation were analysed. 3066 patients were included in this study. 993 patients underwent AH, 642 VH and 1,431 total intrafascial hysterectomy. No statistically significant difference for the operation times comparing the three groups can be demonstrated. The mean hospital stay in the TAIL™ hysterectomy, VH and AH groups is 5.8 ± 2.4, 8.8 ± 4.0 and 10.4 ± 3.9 days, respectively. The postoperative minor complications including infection rates are low in the TAIL™ hysterectomy group (3.8%) when compared with either the AH group (15.3%) or the VH group (11.2%), respectively. The total of minor complications is statistically significant lower for TAIL™ hysterectomy as for AH (O.R. 4.52, CI 3.25–6.31) or VH (O.R. 3.16, CI 2.16–4.62). Major haemorrhage with consecutive reoperation is observed statistically significantly more frequent in the AH group when compared to the TAIL™ hysterectomy group, with an O.R. of 6.13 (CI 3.05–12.62). Overall, major intra- and postoperative complications occur significant more frequently in the AH group (8.6%) when compared to the VH group (3%) and the TAIL™ hysterectomy group (1.8%). The incidence of major complications applying the standardised TAIL™ hysterectomy technique is not related to the experience of the surgeons. We conclude that a standardised intrafascial technique of total laparoscopic (TAIL™) hysterectomy using an anatomically developed special uterine device is associated with a very low incidence of minor and major intra- and postoperative complications. The direct comparison of complication rates with either vaginal or abdominal hysterectomy favours the total laparoscopic technique, and therefore, this technique can be recommended as a relatively atraumatic procedure. The operation times are comparable for all three techniques without any statistically significant differences. This technique for laparoscopic hysterectomy is shown to be equally safe when applied by experienced gynaecologic surgeons or by residents in training.     

Grandmultiparity and pregnancy outcome in Aba,Nigeria: a case–control study

Objective  

To compare the incidence of antenatal and intrapartum complications and perinatal outcomes among women who had delivered five or more times (grandmultiparous) with those of age-matched controls who had delivered two to four times (multiparous).     

Women and men’s psychological adjustment after abortion: a six months prospective pilot study

Background

The psychological impact of abortion is a controversial issue. While some studies indicate that women who had elective abortions present lower psychological distress when compared with those who had spontaneous or therapeutic abortions, other studies found abortion to be associated with significant psychological distress.

Objectives

To assess psychological adjustment (emotional disorder, trauma symptoms and couple relationship) one and six months after abortion, and gender differences regarding psychological adjustment, and to assess the moderation role of couple relationship in the effect of the etiology of abortion on emotional disorder and trauma symptoms.

Methods

Women (n=50) with different etiologies of abortion agreed to participate, as well as 15 partners (N=65). Assessments took place one and six months after abortion. Measures included the Brief Symptoms Inventory, the Impact of Event Scale-Revised and the Relationship Questionnaire.

Results

A decrease in emotional disorder for all etiologies of abortion and an increase in perceived quality of couple relationship in therapeutic abortion were observed over time. Couple relationship moderates the effect of the etiology of abortion on trauma symptoms one month after abortion.

Conclusion

Psychological adjustment after abortion seems not to be exclusively related to its etiology, being influenced by other factors such as couple relationship.     

Natural cycle IVF: a question of semantics?

Recently there has been much discussion and presentation on IVF protocols using less stimulation or indeed none at all. Our experience with controlled natural cycle IVF over the last few years has convinced us that this is a powerful tool for many patients in the treatment of infertility. The protocol we employ has raised some questions as to whether it is natural cycle or stimulated cycle. We have reported a large series of cycles and seen no stimulatory effects of the medications used to control the cycle, thereby confirming our position that controlled natural cycle IVF is a valid option as an assisted reproduction treatment.     

The long-term effects of endometrioma surgery on ovarian reserve: a prospective case–control study

The objective of this study was to evaluate the long-term effects of endometrioma excision on ovarian reserve. This study evaluated the long-term effects of endometrioma excision on ovarian reserve. A total of 63 women were enrolled in this prospective case–control study; 21 women had histories of endometrioma surgery (study group), 21 women had diagnoses of endometrioma, and 21 healthy age-matched women served as controls. Participants were recruited from the Department of Obstetrics and Gynecology, Inonu University Faculty of Medicine, between January 2007 and January 2016. The mean follow-up duration after endometrioma surgery was 30.4?±?18.0?months for the study group. The mean follicle-stimulating hormone, luteinizing hormone and estradiol levels were similar among groups, but the anti-Müllerian hormone (AMH) level was significantly lower in the surgery group than in the control group (p?p?=?.080 and p?=?.160, respectively). Endometrioma has a detrimental effect on ovarian reserve, and decreased ovarian reserve compared with that in healthy fertile subjects without endometrioma is evident shortly after endometrioma excision. However, the endometrioma excision procedure does not significantly decrease the ovarian reserve in the long term.     

Italian women’s childbirth: a prospective longitudinal study of delivery predictors and subjective experience

Background: Previous research has demonstrated that negative childbirth expectations adversely influence perinatal outcomes. The current research builds on this with Italian mothers-to-be. Objective: The present study (1) explored the influence of cognitive and emotional variables on labour and delivery outcomes and (2) examined how individual characteristics, couple adjustment, and medical factors influence the childbirth experience. Method: 121 Italian primiparous women participated in a prospective longitudinal study where participants completed a set of questionnaires between the 32nd and 37th week of pregnancy and again 30–40 days post-delivery. Results: Binary logistic regression analyses revealed that women with negative childbirth expectations were three times more likely to experience an emergency C-section or an instrumental vaginal delivery. Furthermore, childbirth expectations predicted subjective birth experience. This relationship between expectations and delivery type and the subjective childbirth experience was weak while other variables (such as anxiety, depression, couple adjustment) did not significantly influence delivery type or the subjective childbirth experience. Conclusions: The weak relationship between childbirth expectations and perinatal outcomes renders it necessary to question the nature of the relationship found in previous research, especially considering inconsistencies of the literature on the subject. The current research makes it clear that further research is needed to understand better the relationship between expectations and perinatal outcomes in order to better improve the well-being of mothers-to-be during labour and delivery.     

Maternal-neonatal transfusion compatibility irrespective of ABO mismatch – a prospective observational study

Abstract

Objective: To determine transfusion compatibility of maternal RBCs for her neonate up to 4 weeks of age, irrespective of maternal-neonatal ABO mismatch.

Methods: This was a prospective observational study involving eligible mothers with their neonates delivered in participating site from 1 July 2012 till 31 December 2012. Mother’s blood was collected before child birth. Neonatal blood sample was collected from placental end, shortly after birth. Blood Groups of mother–baby pair were individually tested for ABO and Rh-D groups. Pairs with negative Rh-D antigen/s or with same ABO blood groups were excluded. Thus, 28 pairs with both maternal and neonatal samples positive for Rh-D antigen and with different maternal neonatal ABO blood groups were included in the study. Blood samples were collected at birth and at 4 weeks. Cross matching was done at birth and at 4 weeks for each pair with standard blood bank protocols.

Results: All 28 pairs showed positive compatibility with standard blood bank cross-matching protocols at birth and at 4 weeks.

Conclusions: Maternal blood irrespective of ABO compatibility might be a viable and potentially acceptable option for her new born baby in neonatal period. This may be especially important in developing world with limited blood bank resources.     

Temperature variations within and between incubators—a prospective,observational study

Purpose

To determine if there is a temperature variation within and between incubators.

Methods

This prospective, experimental trial with external controls was performed at an Assisted Reproductive Technology laboratory in a tertiary-care, university hospital. Temperature values were taken at various locations within and between incubators.

Results

Even though they were both set to 37.0 °C, the same make and model incubators had significantly different internal temperatures. Temperatures differed significantly among top, middle and bottom shelves and between fronts and backs of shelves.

Conclusion(s)

We found temperatures differed within and between our front-loading incubators. Thus, laboratory personnel should evaluate their incubators for temperature variations within and between incubators and, if temperatures differ significantly, develop a plan to deal with discrepancies.     

Interleukin-1β in the bronchoalveolar lavage fluid of premature neonates: a marker for maternal chorioamnionitis and predictor of adverse neonatal outcome

Objective: To determine whether the presence of the proinflammatory cytokine interleukin (IL)-1β in the lungs of preterm infants immediately after birth was associated with maternal inflammation and could predict adverse neonatal outcome. Study design: Prospective evaluation of serially obtained tracheal aspirates for the presence of IL-1β in 25 preterm infants (birth weight 595-1700 g; gestational age 24-32 weeks) with respiratory distress syndrome. The initial tracheal aspirate was obtained within 1 h after delivery. Results: An initial tracheal aspirate positive for IL-1β had a highly significant correlation with documented maternal chorioamnionitis for the given patient. In addition, the presence of IL-1β correlated significantly with elevated total cell count (2.62 vs. 0.96 × 10⁶/ml, p = 0.0097), granulocyte count (2.12 vs. 0.22 × 10⁶/ml, p = 0.001), macrophage count (0.28 vs. 0.01 × 10⁶/ml, p = 0.02) and the presence of proinflammatory cytokines IL-6, IL-8 and tumor necrosis factor (TNF)-α. Preterm neonates positive for IL-1β in their initial sample were on prolonged assisted ventilation (38 vs. 16 days, p = 0.013) and oxygen supplementation (62 vs. 40.5 days, p = 0.0462) and required prolonged hospitalization (69 vs. 46 days, p = 0.0165). Conclusions: The concentration of IL-1β in the initial tracheal aspirate obtained from the lungs of preterm infants within the first hour of life may serve as a marker of antenatal/perinatal inflammation, probably due to maternal chorioamnionitis, and could predict an adverse clinical course and short-term outcome.     

IL-1β up-regulates expression of IL-8 in endometrial stromal cells in vitro

Endometriosis(EMs),which presents a majorchallenge to gynecologist,is a common disease amongreproductive-aged women and its morbidity increases inrecent years.Besides genetic,hormonal,and environ-mental factors involved in the development,many stud-ies on endometriosis indicate that there are more cellsrelevant to the immunoinflammatory process and vari-ous cytokines infiltrating into ectopic and eutopic endo-metrium of endometriosis than into endometrium ofhealthy women[1].IL-1β,one of the …     

Decreased placental thickness and impaired Doppler indices in idiopathic polyhydramnios: a prospective case–control study

Objective: To evaluate placental thickness, Doppler velocimetry, biophysical profile and perinatal outcomes in pregnancies complicated by idiopathic polyhydramnios.

Materials and methods: This prospective case–control study was conducted on 139 pregnant women, of these 70 patients with idiopathic polyhydramnios comprised the study group and 60 pregnant women comprised the control group. Risk factors recorded were; age, parity, body mass index (BMI), gestational weeks, amniotic fluid index (AFI), biophysical profiles (BPP), placental thickness, middle cerebral artery pulsatility index (MCA PI), umbilical artery Doppler velocimetry (Umb A S/D) values and perinatal outcomes.

Results: Sixty-nine of the cases had mild-moderate (AFI: 250–450?mm) polyhydramnios (%98.5) and one of the cases had severe polyhydramnios (>450?mm) in study group. There was no statistically significant difference between the groups in terms of age, parity, BMI, gestational weeks, fetal birth weights and BPP (p?>?0.05). Placental thickness, MCA PI and UA S/D values showed statistically significant difference between the groups (p?<?0.05). The fetuses with lower placental thickness had lower scores of biophysical profile. There were negative correlations between placental thickness and AFI (r?=??0.265), umbilical artery S/D and placental thickness (r?=??0.212), MCA PI and AFI (r?=??171, p?=?0.44). However there was a positive correlation between AFI and umbilical artery Doppler values (r?=?0.450).

Conclusion: Idiopathic polyhydramnios is associated with decreased placental thickness, impaired uterine, umbilical and middle cerebral artery flow.     

Anti-Müllerian hormone does not predict time to pregnancy: results of a prospective cohort study

In order to study whether ovarian reserve tests (ORTs) can predict time to ongoing pregnancy, we conducted a prospective cohort study in a cohort of healthy pregnancy planners. A total of 102 pregnancy planners were followed for 1?year, or until ongoing pregnancy occurred, after cessation of contraceptives). A baseline measurement of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH) and antral follicle count (AFC) was conducted. At the end of follow-up, a semen analysis was performed and chlamydia antibody titres were assessed. A univariate prediction model demonstrated age and the AFC to be significantly capable of predicting time to pregnancy (hazard ratio 0.92, 95% CI 0.87–0.98, p?=?0.01; 1.04, 95% CI 1.01–1.07, p?=?0.02 respectively). In the multivariate model, however, correcting for female age, we found no predictive effect of AMH, basal FSH or the AFC for time to ongoing pregnancy (hazard ratios 1.43, 95% CI 0.84–2.46, p?=?0.36; 0.96, 95% CI 0.86–1.06, p?=?0.43; 1.03, 95% CI 1.00–1.07, p?=?0.08, respectively). This was confirmed by the low C-statistic. We therefore concluded that baseline AMH, AFC or FSH levels do not predict time to ongoing pregnancy in a cohort of healthy pregnancy planners. These results limit the usability of these ORTs in the assessment of current fertility.     

The relationship between maternal–fetal attachment and maternal self-efficacy in Iranian women: a prospective study

Introduction: This prospective study was conducted to determine the relationship between maternal–fetal attachment and maternal self-efficacy. Maternal self-efficacy contributes significantly to the mental health of the mother and infant. Maternal–fetal attachment facilitates maternal role attainment and might improve maternal self-efficacy.

Methods: This study was conducted on 242 women. The data collection tools used included a socio-demographic and obstetric questionnaire, Cranley’s Maternal–Fetal Attachment Scale, the Edinburgh Postnatal Depression Scale and the Maternal Self-Efficacy Scale. A multivariate linear regression was used to estimate the extent to which maternal–fetal attachment affects maternal self-efficacy.

Results: Pearson’s correlation test showed a moderate but significant positive correlation between maternal–fetal attachment and self-efficacy (r = 0.48, P < 0.001). The highest correlation with self-efficacy was observed in the domain of ‘differentiation of self from fetus’ (r = 0.43) and the lowest in the domain of ‘giving of self’ (r = 0.25). According to the multivariate linear regression, the domain of ‘Interaction with fetus’ had a significant relationship with maternal self-efficacy (P = 0.009).

Conclusion: Maternal–fetal attachment would appear to be a factor related to postpartum maternal self-efficacy which suggests identifying and supporting women with low self-efficacy may increase maternal–fetal attachment and thereby maternal self-efficacy.