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.     

Infertility: Spontaneous ovulatory cycle donor insemination programme: prognostic indicators of a successful pregnancy

The effects of female and male infertility factors as well asthe insemination regime on the outcome of donor insemination(DI) during 1001 spontaneous ovulatory cycles were assessed.Overall, the average monthly fecundability was 4.4% and thecumulative conception rate after nine cycles was 45%. FemaleDI recipients’ age, nulligravidity or the presence ofother infertility factors were associated with a significantlylower pregnancy rate. DI recipients of azoospermic partnershad a significantly higher pregnancy rate. The likelihood ofa successful pregnancy was higher when more frequent (1) inseminationswere used or in association with higher cervical score and largerfollicle diameter at the time of insemination. We suggest thatfemale recipients of DI should be fully investigated beforecommencing DI treatment. Early resort to other methods of assistedreproduction should be considered in DI recipients aged 35 years,or in younger women if they fail to conceive after nine cyclesof DI. More frequent and better timing of inseminations is expectedto improve the fecundability rate during spontaneous ovulatoryDI cycles.     

Laser acupuncture versus reflexology therapy in elderly with rheumatoid arthritis

The purposes of this study are to determine and compare efficacy of laser acupuncture versus reflexology in elderly with rheumatoid arthritis. Thirty elderly patients with rheumatoid arthritis aged between 60 and 70 years were classified into two groups, 15 patients each. Group A received laser acupuncture therapy (904 nm, beam area of 1cm², power 100 mW, power density 100 mW/cm², energy dosage 4 J, energy density 4 J/cm², irradiation time 40 s, and frequency 100,000 Hz). The acupuncture points that were exposed to laser radiation are LR3, ST25, ST36, SI3, SI4, LI4, LI11, SP6, SP9, GB25, GB34, and HT7. While group B received reflexology therapy, both offered 12 sessions over 4 weeks. The changes in RAQoL, HAQ, IL-6, MDA, ATP, and ROM at wrist and ankle joints were measured at the beginning and end of treatment. There was significant decrease in RAQoL, HAQ, IL-6, and MDA pre/posttreatment for both groups (p < 0.05); significant increase in ATP pre/posttreatment for both groups (p < 0.05); significant increase in ankle dorsi-flexion, plantar-flexion, wrist flexion, extension, and ulnar deviation ROM pre/posttreatment in group A (p < 0.05); and significant increase in ankle dorsi-flexion and ankle plantar-flexion ROM pre/posttreatment in group B (p < 0.05). Comparison between both groups showed a statistical significant decrease in MDA and a statistical significant increase in ATP in group A than group B. Percent of changes in MDA was 41.82%↓ in group A versus 21.68%↓ in group B; changes in ATP was 226.97%↑ in group A versus 67.02%↑ in group B. Moreover, there was a statistical significant increase in ankle dorsi-flexion, ankle plantar-flexion, wrist flexion, wrist extension, and radial deviation in group A than group B. Laser therapy is associated with significant improvement in MDA and ATP greater than reflexology. In addition, it is associated with significant improvement in ankle dorsi-flexion, ankle plantar-flexion, wrist flexion, wrist extension, and radial deviation greater than reflexology in elderly patients with rheumatoid arthritis.     

Do patients need to remain in bed following embryo transfer? The Birmingham experience of 103 in-vitro fertilization cycles with no bed rest following embryo transfer

Since the early days of human in-vitro fertilization and embryotransfer, rest in bed for hours immediately following the transferhas been advocated and widely practised. However, there is noscientific validation for this practice which is both time-consumingfor the patient and increases space occupancy in the hospitalor clinic. We report here on a study of 103 in-vitro fertilizationcycles with no bed rest in hospital following the embryo transfer.The mean number of embryos transferred was 2.7 (range 1–3)and the clinical pregnancy rate per embryo transfer procedurewas 40%. These results suggest that bed rest is not necessaryfollowing embryo transfer.     

Assessment of early cleaving in vitro fertilized human embryos at the 2-cell stage before transfer improves embryo selection

Objective: To determine the most viable embryos for transfer.

Design: Study 1: Preselection of early-cleaving 2-cell embryos for transfer. Study 2: Alternating weeks during which preselection was performed and not performed.

Setting: ART program, Birmingham Women’s Hospital, Birmingham, United Kingdom.

Patient(s): Patients undergoing IVF or ICSI cycles with transfer on day 2.

Intervention(s): Culture of all fertilized embryos.

Main Outcome Measure(s): Number of fertilized embryos cleaving to the 2-cell stage on day 1, embryo quality, implantation rates, and pregnancy rates.

Result(s): Patients with early-cleaving 2-cell embryos had significantly higher pregnancy and implantation rates (45 of 100 [45.0%] and 58 of 219 [25.5%], respectively) than did patients without early-cleaving 2-cell embryos (31 of 130 [23.8%] and 43 of 290 [14.8%], respectively). In weeks during which preselection was used, the overall pregnancy and implantation rates of the clinic improved.

Conclusion(s): The presence of early-cleaving 2-cell embryos improves a patient’s chance of achieving pregnancy. Use of more stringent embryo selection criteria can improve overall pregnancy rates.     

Clozapine-induced blood dyscrasias in Saudi Arab patients

Background Clozapine has shown superior efficacy over other antipsychotics. However, its use is complicated by the development of life-threatening hematologic adverse effects. Objectives This paper reports the incidence of clozapine-induced hematologic toxicity in Saudi Arab patients. Setting King Khalid University Hospital, Riyadh, Saudi Arabia. Methods Medical data of Saudi Arab hospitalized patients receiving clozapine was retrospectively reviewed during the period between August 2009 and August 2012. White blood cell (WBC) counts and differentials were recorded in a specific form to watch for any hematologic toxicity. The hematologic toxicities included in this report are: eosinophilia, thrombocytopenia, lymphocytopenia, and agranulocytosis/neutropenia/leukopenia combined. Main outcome measure Complete WBC count. Results During the study period 147 charts were reviewed. The mean age of patients was 38 ± 11.42 years and 52 % were males. During the study period 61 patients (42 %) developed 82 blood dyscrasias. Sixteen patients (10.9 %) developed agranulocytosis, neutropenia and leukopenia combined, while nineteen patients (12.9 %) developed lymphocytopenia, and seven patients (4.8 %) developed thrombocytopenia. Eosinophilia developed in 40 patients (27.2 %). During the first 18 weeks of therapy with clozapine, 21 (26 %) hematologic side effects were developed. Conclusion The data collected in this study does appear to indicate there may be an increased incidence of blood dyscrasias in Saudi Arabs which warrants further, more detailed, study. It would be of concern to psychiatric clinicians if the case of a genetic predisposition to clozapine-induced blood dyscrasias were proven in the future.     

Weight reduction ameliorates inflammatory cytokines,adipocytokines and endothelial dysfunction biomarkers among Saudi patients with type 2 diabetes

BackgroundType 2 diabetes mellitus (T2DM) considered as one of the cardiovascular disorders (CVD) principle risk factor as diabetes is associated with abnormal levels of endothelial function, inflammatory and adipocytokines.ObjectiveThe aim of this study was to measure the impact of weight reducing on inflammatory cytokines, adipocytokines and endothelial function biomarkers among obese T2DM patients.MethodsOne-hundred T2DM patients enrolled in the present study; the age range was 35–55 year. Participants shared in this study were enrolled in group (A) received diet control and aerobic exercise on treadmill, while, group (B) had no intervention for 3 months.ResultsThe mean values of body mass index (BMI), tumor necrosis factor -alpha (TNF-α), interleukin-6 (IL-6), leptin, inter-cellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1), E-selectin and plasminogen activator inhibitor-1 activity (PAI-1 activity) were significantly decreased and adiponectin was increased significantly in the training group, however the results of the control group were not significant. Also, there were significant differences between both groups at the end of the study.ConclusionWeight reducing program modulates inflammatory cytokines, adipocytokines and endothelial function biomarkers among obese T2DM patients.