The effects of sperm quality on embryo development after intracytoplasmic sperm injection

Purpose : To explore the possible relationship between sperm quality and embryo development, pregnancy and implantation rates, in patients undergoing intracytoplasmic sperm injection (ICSI). Methods : Fertilization and cleavage rates, quality of embryos, blastocyst development, pregnancy and implantation rates were analyzed in 1020 embryos from 219 couples undergoing first ICSI treatment cycle. The couples were allocated in five groups, according to semen parameters: Group 1: patients with normal semen parameters, Group 2: patients with mild oligo-astheno-teratozoospermia, Group 3: patients with severe oligo-astheno-teratozoospermia, Group 4: patients with obstructive azoospermia, Group 5: patients with non-obstructive azoospermia. Results : Fertilization and cleavage rates, quality of embryos as well as blastocyst development rates were significantly reduced, as semen quality decreased. However, no significant differences were observed in clinical pregnancy and implantation rates. Conclusion : Overall, a negative relationship was observed between semen quality and embryo development, even before activation of the embryonic genome, suggesting that sperm can affect embryogenesis from a very early stage.     

Laparoscopic treatment of premenopausal patients with benign adnexal pathology

The aim of this study was to evaluate the laparoscopic approach to benign adnexal masses in 211 premenopausal patients selected with strict preoperative clinical and ultrasound diagnosed criteria. Most patients were successfully managed with operative laparoscopy (98.2%). Four patients underwent laparotomy (1.8%). The rate of unexpected adnexal malignancy was 0.48%. We believe that operative laparoscopy is a safe and effective procedure for treating most benign adnexal masses in premenopausal women. To reduce the possibility of encountering an unexpected malignancy when approaching an adnexal cyst by laparoscopy, appropriate preoperative selection of patient candidates for laparoscopic treatment is mandatory. If an unexpected malignancy arises during laparoscopy, a team with specific oncologic training should be available for a possible immediate staging laparotomy in order not to affect the patient’s prognosis.     

Unrecognized spontaneous bilateral ampullary pregnancy treated by laparoscopy

We report on a 35-year-old woman with spontaneous bilateral tubal pregnancy. This is a rare and complex condition with uncertain etiology. Despite preoperative work-up that included clinical examination, serial ultrasound investigation, and serial quantitative beta human chorionic gonadotropin testing, the bilateral disease was not accurately diagnosed until laparoscopy. A bilateral laparoscopic linear salpingostomy was performed along with extraction of the conception products from both tubes. There were no intraoperative or postoperative complications, and the patient was discharged on the 1st postoperative day. Subsequent histopathology confirmed bilateral ectopic pregnancy. To avoid misdiagnosing bilateral ectopic pregnancy, we emphasize the need to combine clinical, sonographic, and laparoscopic investigation when the clinical picture is confusing.     

Evacuation of the cervix after methotrexate administration in the treatment of cervical pregnancy: five cases

Case studies of five consecutive patients with cervical pregnancy treated with a standard protocol are presented. The aim was to evaluate the place of evacuation with curettage followed or not by cervical tamponade as an additional modality in patients with cervical pregnancies treated initially with methotrexate (MTX). The five patients with cervical pregnancies were treated with local injection and systemic administration of MTX, while in four of them additional cervical evacuation was performed. In two patients, with a gestational age of more than 9 weeks, cervical tamponade was additionally applied. No complications occurred during evacuation with curettage after MTX, and two women managed to become pregnant spontaneously and progressed to full term.     

Fetal abdominal subcutaneous tissue thickness measured by ultrasound at term is associated with birth weight and mode of delivery

PURPOSE: To determine if measurement of fetal abdominal subcutaneous tissue thickness (FASTT) at term can predict birth weight, mode of delivery and perinatal outcome. METHODS: A prospective study with 352 normal, singleton pregnancies in the vertex presentation examined with real-time ultrasound at 37-39 weeks' gestation. RESULTS: FASTT was positively correlated with birth weight (Pearson's, r = 0.784, p < 0.001). Fetuses with low FASTT were more likely to be delivered through normal vaginal delivery (7.8 +/- 0.1 mm), while higher FASTT was correlated with operative vaginal delivery (7.9 +/- 0.2 mm) and cesarean section (8.6 +/- 0.3 mm) (ANOVA, p = 0.034). In contrast, FASTT was not correlated with intrapartum CTG, labor duration and Apgar scores. CONCLUSIONS: In normal pregnancies, FASTT at term is positively associated with birth weight. With increasing FASTT the likelihood of operative vaginal and cesarean delivery increases. FASTT is not associated with perinatal outcome.     

Primary ovarian angiosarcoma--review of the literature and report of a case with coexisting chylothorax

BACKGROUND: Primary ovarian angiosarcoma is a very rare gynaecologic malignancy with poor prognosis and uncertain, up-to-date, treatment options. Its exact diagnosis is challenging for surgeons and difficult for pathologists. There are only a few cases reported in the international literature. CASE: We report a case of primary pure ovarian angiosarcoma with coexisting chylothorax which is, to the best of our knowledge, the first reported case. An extensive review of the literature analyzing all clinical and pathological parameters related to this condition is presented. RESULT: In spite of all therapeutic efforts, surgical and medical, prognosis of ovarian angiosarcoma remains very poor in most cases. CONCLUSION: Primary ovarian angiosarcoma is a rare and aggressive malignancy. The report of such cases is interesting in order to exchange knowledge and experience, and possibly to further improve our diagnostic and therapeutic capabilities.     

Among patients treated with FSH and GnRH analogues for in vitro fertilization, is the addition of recombinant LH associated with the probability of live birth? A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to assess whether the addition of recombinant luteinizing hormone (LH) increases live birth rate, among patients treated with follicle stimulating hormone (FSH) and gonadotrophin-releasing hormone (GnRH) analogues for in vitro fertilization (IVF). Eligible studies were randomized controlled trials (RCTs) answering the research question that contained sufficient information to allow ascertainment of whether randomization was true and whether equality was present between the groups compared, regarding baseline demographic characteristics, gonadotrophin stimulation protocol, number of embryos transferred and luteal phase support administered. A literature search identified seven RCTs (701 patients) that provided the information of interest, among which five reported agonist and two antagonist cycles. The reported outcome measure, clinical pregnancy, was converted to live birth using published data in one study. No significant difference in the probability of live birth was present with or without rLH addition to FSH (odds ratio [OR]: 0.92, 95% confidence interval (CI): 0.65-1.31; P = 0.65). This finding remained stable in subgroup analyses that ordered the studies by dose of rLH added, the type of analogue used to inhibit premature LH surge, the time rLH was added during the follicular phase, the age of patients analysed, the presence of allocation concealment and by the way the information on live birth was retrieved. In conclusion, the available evidence does not support the hypothesis that the addition of recombinant LH increases the live birth rate in patients treated with FSH and GnRH analogues for IVF.     

Factor V leiden and prothrombin G20210A mutations, but not methylenetetrahydrofolate reductase C677T, are associated with recurrent miscarriages

The aim of this study was to investigate the relationship between recurrent miscarriages and factor V Leiden, prothrombin G20210A and C677T methylenetetrahydrofolate reductase (MTHFR) mutations. In this case-control study the prevalence of factor V Leiden, prothrombin G20210A and C677T methylenetetrahydrofolate reductase mutations was determined in a consecutive series of 80 recurrent miscarriage patients and 100 controls. Fifteen of 80 recurrent miscarriage patients and four out of 100 controls carried the factor V Leiden mutation (19 versus 4%, P = 0.003, odds ratio 5.5, 95% confidence interval (CI): 1.7-17). Seven of 80 recurrent miscarriage patients and two of 100 controls were carriers of the prothrombin G20210A mutation (9 versus 2%, P = 0.038, odds ratio 4.6, 95% CI: 0.9-23.2). Six of 80 recurrent miscarriage women and 15 of 100 controls were homozygotes for the C677T MTHFR mutation (8 versus 15%, P = 0.134, odds ratio: 0.4, 95% CI: 0.1-1.2). Our results suggest that the presence of factor V Leiden and prothrombin G20210A polymorphism, but not MTHFR C677T homozygosity, could be additional risk factors for recurrent miscarriages. Furthermore, it was suggested that the prevalence of factor V Leiden and prothrombin G20210A mutations is more prominent in second trimester, primary fetal losses and it is independent of the existence of additional pathology predisposing to recurrent fetal losses.