A more realistic approach to the cumulative pregnancy rate after in-vitro fertilization

As most studies overestimate the cumulative pregnancy rate,a method is proposed to estimate a more realistic cumulativepregnancy rate by taking into account the reasons for an earlycessation of treatment with in-vitro fertilization (IVF). Threemethods for calculating cumulative pregnancy rates were compared.The first method assumed that those who stopped treatment hadno chance at all of pregnancy. The second method, the one usedmost often, assumed the same probability of pregnancy for thosewho stopped as for those who continued. The third method assumedthat only those who stopped treatment, because of a medicalindication, had no chance at all of pregnancy and that the otherswho stopped had the same probability of pregnancy as those whocontinued treatment Data were used from 616 women treated atthe University Hospital Nijmegen, Nijmegen, The Netherlands.The cumulative pregnancy rates after five initiated IVF cyclesfor the three calculation methods were in the ranges 37–51%for the positive pregnancy test result, 33–55% for a clinicalpregnancy and 30–56% for an ongoing pregnancy. As expected,the first method underestimated the cumulative pregnancy rateand the second overestimated it The third method produced themost realistic cumulative pregnancy rates.     

Factor V Leiden and recurrent miscarriage-prospective outcome of untreated pregnancies

BACKGROUND: Some cases of recurrent miscarriage and later pregnancy complications have a thrombotic basis. Factor V Leiden is a common thrombophilic mutation. METHODS: The prospective outcome of untreated pregnancies amongst 25 women heterozygous for the Factor V Leiden allele who had a history of either recurrent early miscarriages only (three or more miscarriages at <12 weeks gestation; n = 19) or of late miscarriage (>12 weeks gestation; n = 9) was studied. Control groups of women with a similar pregnancy history but who had a normal Factor V genotype were also studied. RESULTS: The live birth rate was significantly lower amongst women with a history of recurrent early miscarriage who carried the Factor V Leiden allele (6/16; 37.5%) compared with that amongst those with a normal Factor V genotype (106/153; 69.3%; odds ratio 3.75, 95% confidence intervals 1.3-10.9). The live birth rate was 11.1% (1/9) amongst those with a history of late miscarriage carrying the Factor V Leiden allele and 48.9% (22/45) amongst those with a normal Factor V genotype. CONCLUSIONS: Attention should be directed at screening women with recurrent miscarriage associated with placental thrombosis for Factor V Leiden and a policy of targeted thromboprophylaxis during future pregnancies should be assessed in the form of a randomized controlled trial.     

Characterization of one alpha 2-macroglobulin with anticomplementary activity from pregnant women.

In 15 pregnant women during the third term of pregnancy, the immunomodulatory property of alpha 2-macroglobulin (alpha 2M) was initially detected by measuring the inhibitory effect on immune complement-dependent haemolysis of serum alpha 2M fractions obtained by gel filtration. By a two-step chromatography procedure consisting of gel filtration followed by anion-exchange chromatography, different sub-forms of alpha 2M in serum were separated. Amongst them, it was shown that the inhibition of complement activity was almost exclusively linked to one particular subform. Additional studies revealed that the observed effect was not due to proteases bound to alpha 2M during clotting since, by using protease-specific inhibitors, no change was observed in complement inhibition. This subform, though present at very low levels in control sera, appeared in strikingly increased amounts during the third trimester of pregnancy (35 mg/l) and comprised between 3 and 5% of the total alpha 2M. Results show that the increase of alpha 2M anticomplementary activity is linked to the increase in alpha 2M levels in serum.     

Drug use in pregnancy: an overview of epidemiological (drug utilization) studies

Summary The need for further information on drug utilization patterns during pregnancy in different countries was assessed by reviewing literature obtained by hand and computer searches for the years 1960–1988.The 13 identified studies showed that pregnant women used an average of 4.7 drugs. The most commonly ingested medications were vitamins and iron preparations (almost all women), analgesics, antiemetics and antacids.However, the important variables taken into account differently in each study, such as date of surveillance, country, size of population, personal habits, and physiopathological and demographic characteristics, may it impossible to construct a comprehensive, detailed, up-to-date picture of drug utilization during pregnancy.The evaluation confirmed the need for systematic permanent surveillance of drug utilization in pregnancy, so as to avoid the use of data based on widely differing contexts, times and methods, in a field where knowledge is often derived from scanty information.This study was supported in part by the National Research Council (CNR, Rome, Italy), Convenzione Farmacologia Clinica     

妊娠期雌二醇和催乳素与瘦素的关系

目的 研究妊娠期间性激素与瘦素水平之间的关系。方法 在180例不同孕周的妇女中,按孕周分为＜20周组,20－23周组,≥28周组,采用酶联免疫吸附法测定其外周血血清雌二醇（E2）和催乳素（PRL）,放射免疫法测定血清瘦素水平,分析这些激素之间的相互关系。结果 E2和PRL均随妊娠进展而逐步升高（P＜0．0001）,组间均有显著差异（P＜0．05）。各组瘦素水平均高于非妊娠组,但组间差异无显著性。瘦素水平与孕妇体重及体重指数显著相关（P0．01）,与PRL也呈相关（P＜0．05）,而与E2无明显相关。结论 PRL水平与妊娠期瘦素水平升高有一定关系。     

米索前列醇应用于晚期妊娠引产的临床研究

目的 :研究孕激素受体拮抗剂米索前列醇对妊娠晚期引产的效果。方法 :采用双盲对照法 ,选择晚期妊娠无米索前列醇禁忌证 6 0例为研究组 ,采用阴道给药总量 1 0 0mg ;另选择有关参数相同的 6 0例 ,应用催产素 ,两组观察相关指标体系进行比较。结果 :引产效果 ,分娩时间 ,宫颈评分等指标研究组均优于对照组。结论 :米索前列醇用于晚期妊娠引产效果优 ,安全     

Pregnancy: Effects of hyperosmolar glucose, prostaglandin-F2{alpha} and 15-methyl-prostaglandin-F2{alpha} on human placental cells in vitro

The objective of this study was to assess the ability of certaindrugs, used for local injection therapy of ectopic pregnancy,to suppress the activities of cultured human placental cells.Placental cells from legal first trimester abortions were preparedby collagenase treatment and density gradient centrifugation.The cells were exposed to hyperosmolar glucose (500 mg/ml),15-methyl-prostaglandin-F₂ (15-m-PGF₂; 10–7 to 10–3mol/l) and prostaglandin-F₂ (PGF₂; 10–5 to 5X10–3mol/l) for 30 min on days 2–4 after seeding. The effectson the secretion of human chorionic gonadotrophin (HCG) andprogesterone, as well as on the protein content per culturewell, were measured. Hyperosmolar glucose was the most effectivedrug and caused a marked decrease of the protein content inthe culture wells and a reduction of progesterone secretion.Of the two prostaglandins, only 15-m-PGF₂ affected the viabilityof the cells and reduced the protein content of the wells. Theclinical effectiveness of the two groups of drugs seems to besimilar but certain in-vitro effects are different. Thus invivo they may act on different target tissues. Against thisbackground, the combination of hyperosmolar glucose and prostaglandinsmight be an interesting approach for local injection therapyfor tubal pregnancy.     

Postzygotic instability of the myotonic dystrophy p[AGC]n repeat supported by larger expansions in muscle and reduced amplifications in sperm

We have analysed the [AGC] expansion in leucocytes, muscle and sperm from 17 individuals affected by myotonic dystrophy (DM). Skeletal muscle showed a larger repeat number than leucocytes in the same patient. A similar degree of expansion was detected in differently affected muscles of a single patient. The germline mutation ( 350 repeats) was expanded in somatic cells of the progeny in all patients examined. Our results provide evidence of an early postzygotic instability of the [AGC] repeat in DM.     

Validation of the STR system FES/FPS for forensic purposes in an Austrian population sample

The short tandem repeat system FES/FPS was amplified by the polymerase chain reaction (PCR) in 211 unrelated Austrians and analysed by horizontal, non-denaturing electrophoresis. The allele distribution was in Hardy-Weinberg equilibrium. No mutations were found in 25 families (50 meioses). The mean exclusion chance was 0.49, the discriminating power 0.86 and the heterozygosity rate 74.4%. Amplification could be achieved with as little as 100 pg of high molecular weight DNA, which could be reduced to 75 pg by using 32 instead of 30 cycles. By reamplifying 1 l for another 15 cycles, the threshold could be reduced to less than 20 pg. In a degradation experiment DNA extracted from bloodstains stored for up to 24 days in a moist chamber and DNA boiled for up to 18 min could be amplified.