Immune activation in the early puerperium is related to postpartum anxiety and depressive symptoms

The pathophysiology of the postpartum blues, common transient mood disorders in the first week postpartum, has remained elusive. Recently, however, it has been shown that depression and anxiety disorders are accompanied by activation of the inflammatory response system (IRS). This study was developed to determine whether the postnatal blues is associated with IRS activation. Serum concentrations of interleukin-6 (IL-6), IL-6 receptor (IL-6R), gp130 (the IL-6 signaling protein), IL-1R antagonist (IL-1RA) and leukemia inhibitory factor receptor (LIFR) were assayed in 22 nonpregnant women and in 91 pregnant women before delivery and 1 and 3 days after delivery. On each occasion the parturient women completed the State version of the Spielberger State-Trait-Anxiety-Inventory (STAI) and the Zung Depression Rating Scale (ZDS). Serum IL-6, IL-1RA and LIFR were significantly higher in pregnant women at the end of term than in nonpregnant women.     

Advanced extrauterine pregnancy: description of 38 cases with literature survey

An analysis is presented of 38 patients with advanced extrauterine pregnancy. First three typical cases are described that emphasize the marked differentiation of clinical symptoms which these patients present to the doctor. The first patient was referred for induction because of a suspected intrauterine death. The second patient presented an intraligamentous pregnancy with a living fetus. In the third case, the patient was admitted to hospital after 32 weeks of pregnancy because of a persistent oblique lie. At 34 weeks, a normal living fetus was born. In all three cases, ultrasound examination was able to visualize the separate uterus. A literature survey is given with special attention to the specific "clinic" and the problems concerning diagnosis and treatment. It is obvious that sonography is the most important diagnostic technique at present. The decision to remove the placenta by means of a laparotomy is brought up for discussion.     

Single-step maternal serum screening for trisomy 21 in the era of combined or integrated screening

Single-step maternal serum screening (MSS) in the first (1MSS) or second (2MSS) trimester at maternal age > or =35 years was evaluated in the North Belgian region Flanders, where difficulties are encountered in the general introduction of combined or integrated screening algorithms. The fetal aneuploidy screening database of General Medical Laboratory AML in Antwerp was searched for 2MSS tests between 1992 and 1999 (alpha-fetoprotein, beta-human chorionic gonadotropin (beta-HCG) and unconjugated estriol, cut-off 1:300) and for 1MSS tests between 1999 and 2003 (free beta-HCG and pregnancy-associated plasma protein A, cut-off 1:85). At > or =35 years, the detection rate for trisomy 21 (DR) was 93.8% (15/16) for 2MSS and the screen-positive rate (SPR) was 24.5% (504/2061). For 1MSS, these figures were 85.7% (6/7) and 17.7% (109/615) respectively. To detect one trisomy 21, missed by MSS at > or =35 years of age, an additional number of 1,557 and 506 primary invasive procedures would be needed for 2MMS and 1MSS respectively. We conclude that the performance of both single-step 1MSS and 2MSS at maternal age > or =35 years in Flanders is excellent, even without the combination with ultrasound parameters or integration of first and second trimester parameters. The simplicity of both methods allows to consider them valuable options for fetal aneuploidy screening at advanced maternal age, until high quality combined or integrated screening is accessible to all pregnant women in Belgium.     

Rupture of the uterus: a changing picture

Eighty nine cases of rupture of the gravid uterus occurring over a period of 15 years with 77,133 deliveries, were analysed. The overall incidence of ruptured uteri was 1 per 866 deliveries. The patients were divided into two groups, those with a scarred uterus (47) and those with an unscarred uterus (42). Distinct differences in terms of parity, age, aetiology and pathogenesis, the clinical picture, pathology, type of surgery and outcome were seen between the two groups. Most pronounced was the difference in symptoms and signs. Lower abdominal tenderness (38.2%), and vaginal exploration after delivery (44.6%) were the clinical hallmarks in the scarred uterus group, compared to shock (33.3%), uterine bleeding (30.9%) and severe abdominal pain (23.8%) in the unscarred group. Moreover, conservative surgery was possible in 72.3% of the scarred group against 14.3% in the other group. A maternal mortality of 5.6% and fetal mortality of 52.8% was seen. All maternal deaths and 71.4% of fetal losses occurred in the unscarred group. Fortunately, the number of ruptures clearly decreased over the study period, and furthermore the ratio between spontaneous and traumatic ruptures of an unscarred uterus and ruptures of a scarred uterus increased.     

Semen parameters in a fertile versus subfertile population: a need for change in the interpretation of semen testing

This prospectively designed study was conducted to compare a fertile and a subfertile population so as to define normal values for different semen parameters. Semen analyses were performed according to the World Health Organization (WHO) guidelines, except for sperm morphology (strict criteria). In the fertile population (n = 144), all patients had recently achieved pregnancy, within 12 months of unprotected coitus. As subfertile controls we examined semen samples from 143 consecutive men attending our infertility clinic during the same study period. Couples with tubal factor infertility and/or ovulatory disorders were excluded from our study. Using receiver operating characteristic (ROC) curve analysis we determined the diagnostic potential and cut-off values for single and combined sperm parameters. Sperm morphology scored best, with a value of 78% (area under the ROC curve). Summary statistics showed a shift towards abnormality for most semen parameters in the subfertile population. Using the 10th percentile of the fertile population as the cut-off value, the following results were obtained: 14.3 x 10(6)/ml for sperm concentration, 28% for progressive motility and 5% for sperm morphology. Using ROC analysis, cut-off values were 34 x 10(6)/ml, 45% and 10% respectively. Cut-off values for normality were different from those described in the WHO guidelines. Routine bacterial and non- bacterial cultures turned out to be of little prognostic value.      

Obstetric and perinatal outcome of 1655 ICSI and 3974 IVF singleton and 1102 ICSI and 2901 IVF twin births: a comparative analysis

A total of 3974 IVF and 1655 ICSI singleton births and 2901 IVF and 1102 ICSI twin births were evaluated. Pregnancies after both fresh and frozen transfers were included. IVF and ICSI singleton pregnancies were very similar for most obstetric and perinatal variables. The only significant difference was a higher risk for prematurity (< 37 weeks of amenorrhoea) in IVF pregnancies compared with ICSI pregnancies (12.4 versus 9.2%, OR = 1.39, 95% CI = 1.15-1.70). For twin pregnancies, differences were not statistically different except for a higher incidence of stillbirths in the ICSI group (2.08 versus 1.03%, OR = 2.04, 95% CI = 1.14-3.64). Intrauterine growth retardation with or without pregnancy-induced hypertension was observed more often in the ICSI group. Regression analysis of the data with correction for parity and female age showed similar results for twins. For singletons, this analysis showed similar results with the exception of low birth weight babies (< 2500 g), which were also observed more often in IVF pregnancies (9.6 versus 7.9%, OR = 0.79, CI = 0.65-0.98, P = 0.03). This large case-comparative retrospective analysis showed that the obstetric outcome and perinatal health of IVF and ICSI pregnancies is comparable.     

Teratozoospermia and in-vitro fertilization: a randomized prospective study

A prospective randomized study was conducted to assess the prognosticvalue of sperm morphology in an in-vitro fertilization (IVF)programme, using strict criteria. The first group (T, teratozoospermic)included 32 couples with an isolated teratozoospermia in themale partner (morphology <9% normal). The second group (C,control) contained 36 couples with normal semen parameters,including morphology (>9% normal, strict criteria). In bothgroups, 50 IVF cycles were performed. Patients were matchedfor indication for IVF. There was no difference between thetwo groups regarding age, duration of infertility, stimulationprotocol, catheter used for embryo transfer and different spermparameters. A statistically significant difference between theT and C groups respectively was observed regarding the fertilizationrate (69.2 and 79.4%P < 0.05), pregnancy rate per cycle (12.0and 42%, P < 0.001), the pregnancy rate per transfer (13.9and 42.0%, P< 0.01) and per embryo transferred (6.1 and 14.8%,P< 0.05). No pregnancy occurred in the poor prognosis group(morphology <5% normal). In cases of moderate teratozoospermia,the fertilization rate appeared normal (78.6%) but the conceptionrate remained low. We concluded that the use of strict criteriain the assessment of sperm morphology is useful in predictingfertilization and pregnancy rate in the human in-vitro model.     

Cryopreservation of human sperm

Freezing of human sperm is considered a routine procedure in assisted reproductive technology (ART) laboratories. This article considers various aspects of cryopreservation of human sperm. Human sperm show a specific cryophysical behaviour and different sperm freezing protocols have been developed to avoid damage to the sperm cells. The damage can range from impaired motility and reduced viability to damage to the cellular organelles and effects at the molecular level, resulting in an impaired fertilizing potential. As testicular sperm are immature and only a small number can be retrieved, special techniques are required for successful freezing and thawing of these samples. Banking of human sperm has to be performed in a safe and controlled way and different guidelines are necessary to ensure that this is achieved.