Blastocyst transfer for patients with multiple assisted reproduction treatment failures: preliminary experience

This preliminary study reports the results obtained from a patient group in which blastocyst culture and transfer were performed, and discusses the advantages and disadvantages of introducing blastocyst transfer in a clinic. Twenty-six patients who had failed to achieve a pregnancy in previous in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments were offered the choice of a fresh cycle with culture to the blastocyst stage. Of the 26 patients who elected to attempt blastocyst culture, 11 opted to have transfer on day 2 or day 3 due to low numbers of embryos. Of the 15 patients who proceeded to blastocyst culture, 46.2% of the embryos cultured reached the blastocyst stage or later and eight of the patients achieved a clinical pregnancy. More oocytes were collected in this patient group, hence the chances of obtaining blastocysts were higher. Offering blastocyst culture to patients with a reasonable chance of success who have had previous multiple assisted reproduction failures is an acceptable way of introducing blastocyst culture into practice.     

The learning curve of selective salpingography and tubal catheterization

OBJECTIVE: To determine the effect of increasing experience in fluoroscopically guided selective salpingography and tubal catheterization on radiation doses and screening times, thus establishing a learning curve for the procedure. DESIGN: Retrospective case note analysis. SETTING: IVF center of an academic teaching hospital. PATIENTS: Three hundred sixty-six patients with infertility seen over 3.5 years. INTERVENTION(S): Fluoroscopically guided selective salpingography and tubal catheterization. MAIN OUTCOME MEASURE(S): Reductions in radiation doses and screening times for different categories of selective salpingography and tubal catheterization, expressed as percentage reductions during the study period and reductions per 10 procedures. RESULT(S): During the study period, The median dose of radiation decreased by 62.6%-71.9%, and the median screening time declined by 61.5%-78.5%. Reductions per 10 procedures were 2.5%-4.2% and 2.7%-5%, respectively. CONCLUSION(S): Significant reductions in radiation doses and screening times start early in a clinical team's practice of selective salpingography and tubal catheterization and continue even as trainees are added to the pool of operators.     

Interrelationships between seminal parameters and sperm nuclear DNA damage before and after density gradient centrifugation: implications for assisted conception

BACKGROUND: With an increase in the use of assisted reproduction technologies the requirements of the diagnostic semen analysis are constantly changing. METHODS: Spermatozoa from patients undergoing IVF were analysed by examining the conventional semen parameters and DNA/chromatin integrity, using in-situ nick translation (NT) and the Chromomycin A(3) fluorochrome, which indirectly demonstrates a decreased presence of protamine. Samples were examined before and after preparation using discontinuous density gradient centrifugation. RESULTS: Density gradient centrifugation enriched samples by improving the percentage of morphologically normal forms by 138% and sperm nuclear integrity by 450%. Sperm nuclear integrity as assessed by in-situ nick translation (NT) demonstrated a very clear relationship with sperm concentration, motility and morphology. Morphology correlated with fertilization rates of patients undergoing IVF, while NT values of the spermatozoa post-preparation were significantly lower in pregnant patients. CONCLUSIONS: We have demonstrated that along with the classical semen parameters, the assessment of nuclear integrity improves the characterization of the semen sample and may be used as a tool for allocating patients to specific assisted reproduction treatments.     

Prevalence of Symptoms of Gastroesopahgeal Reflux in a Cohort of Saudi Arabians: A Study of 1265 Subjects

Background/Aims:

In this study, we aimed to determine the prevalence of gastroesophageal reflux disease (GERD) in the general population of the capital city of Riyadh and to assess its association with other factors including age, smoking, body mass index (BMI), asthma, as well as the presence of other co-morbid diseases.

Materials and Methods:

We used the Gastroesophageal Reflux Disease Questionnaire (GerdQ) for diagnosing GERD, based on a GerdQ score of 8 or more. Riyadh was divided into four quadrants, and from each area, a single shopping mall was chosen randomly to conduct our surveys. Data collected included age, sex, history of smoking, history of asthma or any other medical condition, dietary habits, monthly household income, history and frequency of heartburn, epigastric pain, regurgitation of food, nausea, sleep disturbance from heartburn, the use of common over-the-counter antacids for the control of their symptoms, and their height and weight.

Results:

Over a 4-week period from the 19 December 2012 to 17 January 2013, a total of 1265 individuals were included in the survey. The mean age was 29.97 ± 11.58 years. Females formed 67.81% of the respondents and 62.73% had one or more episodes of heartburn per week. Based on a cutoff GERDQ score of 8, the prevalence of GERD in the surveyed population was 45.4%. GERD was more prevalent in older individuals (mean age 31.9 vs. 30.0 years, P < 0.001) and in those with a higher BMI (27.29 vs. 26.31 kg/m², P = 0.02). There was no difference between males (45.43%) and females (45.13%) (P = 0.92); there was a trend of a higher prevalence in smokers (51.63% vs. 44.41%), but it did not reach statistical significance (P = 0.09).

Conclusion:

Symptoms suggestive of GERD as determined by the translated GerdQ are prevalent among this study population.     

Endocrinology: Ovarian response in consecutive cycles of ovarian stimulation in normally ovulating women

Ovarian stimulation combined with intra-uterine insemination(IUI) is an effective treatment of non-tubal infertility butmost women undergo several cycles of treatment to achieve apregnancy. This prospective study was designed to assess theconsistency (or variation) of ovarian responses and the effectof various ovarian stimulation protocols on this consistencyin consecutive cycles of ovarian stimulation and IUI in womenwith non-ovulatory infertility. A total of 86 regularly menstruatingovulating patients each completed three to six cycles of ovarianstimulation and IUI (n = 347 cycles). Ovarian stimulation wasachieved by sequential clomiphene citrate/human menopausal gonadotrophin(HMG), HMG-only or combined gonadotrophin-releasing hormoneanalogue—HMG protocols in 33, 29 and 24 patients respectively,and each patient used the same protocol consistently throughoutthe study. Standard methods were used to monitor ovarian responseand to perform IUI. Using each patient as her own control, repeatedmeasurements analysis of variance revealed consistency of ovarianresponse in consecutive ovarian stimulation cycles, as shownby the number and mean diameter of maturing pre-ovulatory follicles,peak plasma oestradiol, duration of stimulation and mean HMGrequirements. This consistency existed using any of the ovarianstimulation protocols. We conclude that regularly menstruatingand ovulating women are likely to have similar ovarian responsesin consecutive cycles of ovarian stimulation and IUI if thesame ovarian stimulation protocol is used consistently. Thisis expected to reduce the frequency of treatment monitoringand clinic visits and to help schedule the timing of IUI.     

Synergistic killing of gram-negative bacilli by cefotaxime, its desacetyl metabolite and human polymorphonuclear neutrophils

Using an in-vitro model the effects of sub-MIC cefotaxime and its desacetyl metabolite singly and in combination on killing of E. coli by PMNs were studied. Our purpose was to determine if the parent compound and its metabolite had a synergistic effect on killing of E. coli by PMNs. Thymidine-labelled serum resistant Escherichia coli 018:K1:H7 were incubated during log phase growth with varying sub-MICs (1/2, 1/8, 1/32) of cefotaxime, its desacetyl metabolite and both agents together, or phosphate buffered saline (PBS) as a control for 90 min at 37 degrees C. The bacteria were then washed and a series of opsonization experiments was performed using intact and sonicated PMNs. Killing of bacteria was determined at 3, 10 and 20 min. Uptake and killing of bacteria by PMNs were measured using standard techniques. Pre-treatment of E. coli with cefotaxime alone and desacetyl cefotaxime and cefotaxime together resulted in significantly enhanced bacterial killing by PMNs at all three exposure times to PMNs. Pre-treatment of the bacteria with sub-MICs of desacetyl cefotaxime alone showed enhanced killing only after exposure for three minutes. In all cases, any increased killing was independent of ingestion by the phagocytes. The opsonization experiments demonstrated that contact between bacteria and PMNs was necessary for optimal killing to occur. The enhanced killing of the sub-MIC antibiotic pre-treated bacteria was seen even when sonicated PMNs were used. The extent of bacterial killing, however, was less than that seen with intact PMNs.     

Phytoestrogen intake and cardiovascular risk markers in Bangladeshi postmenopausal women

Menopause is the transitional event of female life creating a considerable degree of clinical and psychological as well as social problem and it is known to affect the risk markers of cardiovascular diseases. Hormone replacement therapy (HRT) was though to be a cornerstone in the management of menopause, but evidences accumulated in the recent past have raised serious questions regarding its safety and usability. In this context, phytoestrogens are getting increasingly more attention for therapeutic (as an alternate of HRT) and dietary interventions. Menopause is a special problem for women in developing countries and intake of phytoestrogens can be highly useful also from the economic point of views. The nutraceuticals of specific vitamins, minerals and especially phytoestrogens supplementations are a vital component of the strategy to reduce health problem. The present study was aimed to assess the association of phytoestrogens and risk markers of cardiovascular diseases in postmenopausal women. A total of 111 postmenopausal subjects [age, (years, M±SD) 52±5.35] were studied. The dietary intake of phytoestrogens by study subjects was calculated by a specific food frequency questionnaire (FFQ). Serum fasting homocysteine was measured by AxSYM system. Serum glucose was estimated by glucose-oxidase method. Serum total cholesterol, triglyceride and HDL-C were estimated by enzymatic-colorimetric method LDL-C was estimated by the Friedewald's formula. The intake of total phytoestrogens, isoflavones and lignans (mean±SD, mg/day) were 7.65±3.33, 0.32±0.16, 7.32±3.28 respectively in postmenopausal women. The intake of diadzein, genistein, formononetin, biochanin A (mean±SD, mg/day) were 0.085±0.035, 0.168±0.101, 0.074±0.052 and 0.001±0.0008 respectively. The intake of matairesinol and secoisolaiciresinol (SILR) (mean±SD, mg/day) were 0.022±0.006 and 7.30±3.28 respectively. The total phytoestrogens (r=-0.19, p=0.03) and SILR, one specific type of lignans (r=-0.19, p=0.04) consumption in this study were inversely significantly associated with serum glucose level. The dietary formononetin, one specific type of isoflavones was negatively significantly associated with LDL-cholesterol (r=-0.18, p=0.04). There was no significant relationship found between phytoestrogen intake and serum homocysteine level (r=-0.11, p=0.23). Phytoestrogens containing food intake should be encouraged for reducing risk markers of cardiovascular disease in postmenopausal women.