Serum prolactin response to embryo transfer during human in vitro fertilization and embryo transfer

Serum prolactin (PRL) concentrations around the time of embryo transfer (ET) have not been studied, despite the fact that transient hyperprolactinemia regularly occurs in response to laparoscopy for oocyte recovery and ET itself may be stressful enough to induce a PRL rise. Hyperprolactinemia might compromise luteal support for implantation and contribute to the limited success of ET. We measured serum PRL concentrations in 10 normoprolactinemic women immediately before, during, and after ET and compared the PRL response around ET to that induced by laparoscopy as a measure of the competency of the stress-prolactin axis. Nine of ten patients demonstrated a significant PRL response to surgery. The mean (±SEM) intraoperative PRL concentration (124.0±19.6 ng/ml) was significantly higher than the preoperative level (12.3±2.4 ng/ml) (P<0.01). Three hours after surgery PRL levels had decreased (44.8±11.5 ng/ml) but remained above baseline. All subjects were normoprolactinemic 48 hr after laparoscopy. Serum PRL concentration did not change significantly in response to ET, with levels of 10.4±1.7, 12.4±1.1, and 10.6±1.8 ng/ml immediately before, during, and 3 hr after ET, respectively. While laparoscopy for in vitro fertilizationembryo transfer commonly induces hyperprolactinemia, the PRL rise is transient, with no carryover to the time of ET. Embryo transfer itself does not induce a significant PRL rise.     

Transvaginal and transabdominal ultrasound for monitoring of follicular development in an in vitro fertilization and embryo transfer program: Patient response

Summary Patients' response to daily ultrasound scanning by either a transvaginal or a transabdominal method for the purpose of monitoring the ovarian response to gonadotropin therapy in an in vitro fertilization and embryo transfer program has been evaluated. A questionnaire was used to determine various aspects of these two procedures, sources of discontent, and the patients' preference. The vast majority of patients reported less discomfort and generally preferred the transvaginal over the transabdominal scanning method. The transvaginal method is easy to perform, affords excellent visualization of the pelvic organs, and in addition, is clearly preferred by patients over the transabdominal technique. We recommend its use in patients monitored for IVF-ET and for a variety of other clinical conditions requiring detailed evaluation of the pelvic organs.     

Weight of babies conceived in vitro

Summary Recent studies suggested that infants delivered after in vitro fertilization and embryo transfer IVFET had low birth weights. To assess further the relationship between birth weight and EGA in these offspring, a review was made of all infants delivered at our institution from May 1, 1983 to July 15, 1986. Forty-five infants in 39 deliveries were identified. Seventeen of 37 (46%) were delivered vaginally, 20 by cesarean section. Forty-two infants were delivered at term (after 36 weeks). The six sets of twins delivered at 254±7 days (mean, 36 weeks). Eighteen of 39 deliveries (46%) delivered at or beyond 40 weeks EGA. The mean weight at delivery for the term infants was 3225±90 g. Thirtyeight infants were size appropriate for dates as assessed by the Lubchenco scale, while the weight in the remaining seven infants exceeded the 90th percentile for their gestational age. We conclude that infants conceived through IVF-ET are not predisposed per se to a low birth weight or delivery at an early gestational age. However, prior studies suggesting lower birth weights for IVF infants may have resulted in part from early delivery due to patient pressure and anxiety.     

Potential association between male infertility and occupational psychological stress

The purpose of this work was to investigate the influence of working conditions, occupational exposures to potential reproductive toxic agents, and psychological stress on male fertility. The study population consisted of 202 consecutive male patients attending a fertility clinic. Of those, 106 patients had attended the clinic because of a male infertility problem (case group), 66 patients had attended the clinic because of a female infertility problem (control group), and 30 patients had a combined infertility problem (male and female). Male infertility was associated with working in industry and construction as compared with other occupations (78.6% vs 58.3%, P = 0.044). Industry and construction workers were of lower educational level than the other workers (mean: 12.1 vs 13.4 years, P = 0.021). These patients also tended to smoke more than the other workers (OR = 2.53, 95% CI = 1.08 to 5.98), more often worked in shifts (OR = 3.12, 95% CI = 1.19 to 8.13), reported physical exertion in work (OR = 3.35, 95% CI = 1.44 to 7.80), and were more exposed to noise and welding (OR = 3.84, 95% CI = 1.63 to 9.14, OR = 4.40, 95% CI = 1.11 to 1.76, respectively). Male infertility (case group) was found to be statistically related to higher marks in all four measures of burnout as compared with the controls. The largest difference was obtained in the measure of cognitive weariness (mean: 2.9 vs 2.1, P < 0.001). In a multiple logistic regression analysis, industry and construction jobs (adjusted OR = 2.2, 95% CI 1.2 to 2.7) and cognitive weariness (adjusted OR = 1.8, 95% CI = 1.03 to 4.6) were found to be independent risk factors for male infertility problems. Male infertility was independently associated with industry and construction jobs as well as job burnout.     

Chronic disease prevalence in immigrants to Israel from the former USSR

The purpose of this study was to evaluate the prevalence of chronic health conditions in the Russian population who immigrated to Israel during 1989–1992. Interviewer-supported self-administered questionnaires were distributed to a 50% random sample of 1710 immigrants residing in the city of Nazareth-Ilit in Northern Israel. The final study group included 897 adults after a 3.5% of noncompliance. The study participants were asked to report all chronic diseases from a list of 11 disease states. The data were coupled with their demographic data and are presented as age/sex-specific prevalence rates. Self-reported disease prevalence rates among the Russian immigrants to Israel were found to be very high (62.2% of the males and 68.7% of the females reported a mean 3–3.5 diseases per person). These reported rates were significantly higher for immigrants from the European republics (67.1%) than for those from Asian republics (55.6%). The highest reported age-specific disease prevalence rates were for musculoskeletal diseases (389/1000), ischemic heart disease (340/1000), gastrointestinal diseases (269/1000), and hypertension (226/1000). A higher rate among females was found for almost all disease states. The prevalence rates reported by the Russian Jews in this study are much higher than commonly observed in Western countries. This is in accordance with a similar difference in reported mortality rates between Western countries and the former USSR. The etiologic explanation of this finding is yet to be studied. In addition, and in light of the mass immigration of Eastern European residents to the West it is of major importance for local health authorities to respond appropriately to the differences in health status of these immigrating populations.     

Short-term treatment of post-traumatic stress disorder with naltrexone: an open-label preliminary study

Eight patients (6 men and 2 women) with chronic post-traumatic stress disorder (PTSD) were treated with naltrexone 100-200 mg/day. Seven patients completed 2 weeks of treatment. A subtle and clinically insignificant improvement was noted in intrusive and hyperarousal symptoms (p < 0.05 for both), but not in avoidance symptoms. All patients demonstrated side effects which limited the targeted dose. It is suggested that the subtle positive effect of naltrexone and the hypersensitivity of these patients to its side effects do not encourage the use of naltrexone in the treatment of PTSD patients.     

Vascular disorders preceding diagnosis of cancer: distinguishing the causal relationship based on Bradford-Hill guidelines

The literature investigating the association between vascular disorders and malignant neoplasms does not comprehensively review the full spectrum of vascular disorders associated with cancer, or provide proof that cancer is an etiologic factor in the development of these disorders. This paper investigates the causal role of cancer in the pathogenesis of vascular disorders, based on the Bradford-Hill criteria of causation. The Medline database was searched for articles on vascular disorders preceding the diagnosis of cancer (VDPCD). Included in the analysis were vascular disorders caused either by direct tumoral involvement of vessels or by paraneoplastic mechanisms. Vascular disorders caused by adverse reactions to anticancer therapy were excluded from analysis. Seven categories of VDPCDs were recognized: venous thromboembolism, arterial thrombosis and embolism, nonbacterial thrombotic endocarditis, migratory superficial thrombophlebitis, vasculitis, thrombotic microangiopathy, and leukothrombosis. To establish causality of the association between VDPCDs and malignancy, the degree of fulfillment of the Bradford-Hill criteria was assessed. A strong association was found in the literature between venous thromboembolism and cancer (OR 2.3-14.9 and SIR 1.3-4.4). Consistency and temporality of the association were confirmed in all VDPCD variants. Seven Bradford-Hill criteria were fulfilled for cancer associated with venous thromboembolism, six criteria for superficial phlebitis and cancer, and five criteria for each of the other VDPCDs. In conclusion, these data support the causal role of cancer in the pathogenesis of all seven categories of VDPCDs. Recognition of such a causal link between cancer and various vascular disorders may promote an earlier cancer diagnosis.     

Time to ambulation after hip fracture surgery: relation to hospitalization outcomes

OBJECTIVE: To test the hypothesis: Time to ambulation (walking) after hip fracture surgery impacts the frequency of postoperative complications and length of hospital stay. METHODS: A retrospective observational study of a cohort of all patients admitted to a university teaching hospital with a principal International Classification of Diseases-9 diagnosis of a hip fracture during 3 calendar years. RESULTS: A total of 131 participants were identified (68% were aged 65 years or older). Overall, the mean time to writing an order to ambulate a patient after a hip fracture surgery was 2 +/- 1.5 days. Time to ambulation after hip fracture surgery was significantly less in patients cared for on orthopedic surgery service compared to general surgery service (1.8 +/- 1 vs 2.5 +/- 2, p <.05) or general internal medicine service (2.5 +/- 1.5, p <.05). It did not relate, however, to patient's age, sex, or race, or to patient's functional status prior to admission, fracture site (femoral neck, intertrochanteric, or subtrochanteric), whether a femoral neck fracture is displaced or not, type of anesthesia (spinal/epidural vs general), type of surgery (open reduction and internal fixation vs hemiarthroplasty), degree of preoperative risk, number of medical conditions, or to obtaining physical therapy and/or medical consultation. Time to ambulation after surgery was an independent predictor for the development of pneumonia (1.5 OR [odds ratio]/day, p <.001), new onset delirium (1.7 OR/day, p <.001), and to prolonged length of hospital stay (B [slope coefficient] = 1.36, p <.0001) but not to the development of pressure ulcers, deep venous thrombosis, or urinary tract infection. CONCLUSIONS: Delayed ambulation after hip fracture surgery is related to the development of new onset delirium and pneumonia postoperatively as well as to increased length of hospital stay. Early ambulation after hip fracture surgery should be encouraged.