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BACKGROUND: Many theories regarding the pathophysiology leading to ovarian hyperstimulation syndrome (OHSS) have been proposed and tested. Increased erythrocyte aggregation is associated with capillary slow flow and tissue hypoxaemia. We performed this study in order to assess the degree of erythrocyte aggregation in the peripheral blood of individuals with OHSS and undergoing controlled ovarian stimulation (COH). METHODS: Twenty women with severe OHSS, 20 women undergoing COH under IVF protocol, and 20 healthy matched controls were recruited for this prospective study. Blood samples were drawn for determination of erythrocyte aggregation as well as haematological indices. The percentage of slide covered by the cells (‘erythrocyte percentage’: EP) was determined using a simple slide test and image analysis. Lower EP values correspond to higher degrees of aggregation. RESULTS: The respective measures of EP were 59.2 ± 3.0, 42.0 ± 3.0 and 35.0 ± 2.4% µm for the controls, women with COH and OHSS (P < 0.01 between controls and the two stimulation groups). CONCLUSIONS: The degree of erythrocyte aggregation is enhanced in the peripheral venous blood of patients with both COH and OHSS. This finding, known to cause capillary leak, may contribute to the pathophysiology of the OHSS. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the clinical and economic implications of integrating human papilloma virus (HPV) load testing into the follow-up and management protocol of women postconisation for high-grade cervical intraepithelial neoplasia (CIN2-3). We evaluated 130 suitable women: 63 were screened biannually by Pap smears ('conventional approach') and 67 also had HPV-load testing ('HPV approach'). More stringent criteria for undergoing colposcopy or reconisation were observed by the former group compared to the latter. Both approaches were analysed for cost effectiveness. There were 33 out of 67 (49.2%) colposcopic referrals and 24 out of 67 (35.8%) reconisation/hysterectomies with the 'conventional approach' compared to 9 out of 63 (14.2%) and 7 out of 63 (11.1%) with the 'HPV approach'. Cervical intraepithelial neoplasia 2-3 residual disease was detected in 7 out of 67 (10.5%) and 7 out of 63 (11.1%) women. The 'conventional approach' had more negative colposcopic biopsies and more negative reconisation/hysterectomy histologies than the 'HPV approach'. The respective cost per detection of one case of residual disease was US$3573 and US$3485. The 'HPV approach' required fewer colposcopic and reconisation procedures to detect one case of residual CIN2-3. Its higher positive predictive value than that of cytology provided a significant decrease in false positive rates and a reduction of US$88 per detected case. [ABSTRACT FROM AUTHOR]

The objective of the study was to evaluate, clinically and sonographically, the time required for the progestative effect of the levonorgestrel-releasing intrauterine system (IUS, Mirena) to be manifested. Doppler flow of the cervical branch and spiral artery of the uterine artery, as well as the endometrial width (up to day 10 of the cycle), were evaluated in 36 women carrying levonorgestrel-releasing IUS 1–2 months after insertion of the device compared to 4–6 months after insertion. The rate of intermenstrual bleeding was reduced from 44% during the first 2 months, to only 8% of women after 4–6 months of use. Complete cessation of menstrual bleeding occurred in 5% after 2 months and in 66% after 4–6 months following insertion. While there was no change in the Doppler flow in the cervical branch of the uterine artery between both groups, there was a significant reduction in the subendometrial flow in the spiral artery. This observation was reinforced by the demonstration of significant reduction in endometrial thickness in the following 4 months of use. The present study has demonstrated that the local progestative effect of the levonorgestrel-releasing IUS on the endometrium is already manifested within a period of 3 months and over after insertion. [Copyright &y& Elsevier]

The objective of the present study was to evaluate the association between the expression of sperm mannose-ligand receptors and sperm morphology. Sperm samples were obtained from 45 men, 30 fertile sperm donors and 15 infertile men. Sperm concentration, motility and morphology were evaluated and then incubated with control medium (Ham's F-10 + 1% HSA) for 4 h. Expression of mannose-ligand receptors was evaluated by mannosylated-BSA-FITC (subdivided into 3 patterns: I, for uncapacitated sperm; II, for capacitated; and III, for acrosome-reacted sperm). The mean (± SE) frequencies of sperm cells of the total sperm population that expressed patterns I, II, and III were 88 ± 2.1%, 7 ± 1.6%, and 5 ± 0.8%, respectively, for fertile men, and 90 ± 2.1%, 7 ± 1.3%, and 3 ± 0.5%, respectively, for infertile men. The rate of pattern III expression of mannose-ligand receptors was significantly higher in the fertile group compared to the infertile patients (p < .01). A poor but significant correlation was observed between the rate of pattern III and the percentage of normal-forms sperm cell in the ejaculate (r = .35, p = .018). Fertile sperm samples express more advanced patterns of mannose-ligand receptors compared to infertile men. This phenomenon is related to the morphology of human sperm cell in the ejaculate more than to any other basic sperm characteristics. [ABSTRACT FROM AUTHOR]

The objective of the present experiments was to establish an acceptable standard for the cervical mucus penetration test (CMPT) by determining the minimal progressive motile spermatozoa concentration (PMSC) that will yield the highest score for proven fertile donor sperm specimens. For this purpose, fresh and frozen-thawed samples were used. Semen was obtained from 29 fertile donors and different PMSC (8, 10, and 14 10[sup 6]/mL) were prepared for each sample. The same mucus specimen was used for testing each sperm sample in the three different dilutions. No difference in the scoring of the CMPT between the fresh vs. frozen-thawed groups was found. When PMSC of 14 10[sup 6]/mL was used, almost all specimens scored the highest rank. The present study revealed that only semen samples with a minimal PMSC of 14 10[sup 6]/mL cells can be used in the CMPT. The information that the freeze-thaw process does not affect the CMPT results supports the concept of cryopreservation of pooled fertile donor specimens in aliquots with adequate concentration of progressive motile spermatozoa for later use as a CMPT control. [ABSTRACT FROM AUTHOR]

Objective To assess the role of peak systolic velocity in the middle cerebral artery (MCA-PSV) in the management of pregnancies complicated by Kell isoimmunization. Methods Sixteen fetuses were monitored by conventional protocol (Group 1) and eight fetuses by an MCA-PSV-guided protocol (Group 2). The conventional protocol included a weekly ultrasound evaluation and measurement of maternal anti-Kell titers every 4—6 weeks. In Group 2 Doppler assessment of the MCA-PSV was performed at intervals of 4 to 7 days and MCA-PSV >1.5 multiples of the median (MoM) was considered as an indication for fetal blood sampling (FBS). Results No parameter emerged as a reliable predictor of isoimmunization severity in Group 1. In Group 2, no FBS was necessary in one case since the MCA-PS V values obtained during the follow-up were < 1 .29 MoM. In two cases the first FBS was already indicated after 1 week of follow-up, but five other fetuses were followed for 3–9 weeks before FBS was indicated. All fetuses with MCA-PSV > 1.5 MoM prior to intrauterine transfusion (IUT) had severe fetal anemia on FBS. In fetuses with severe anemia on the first PBS, the MCA-PSV values 7 days before the first FBS were < 1.29 MoM (four cases), between 1.29 and 1.5 MoM (two cases) and > 1.55 MoM (one case). Conclusions In the management of Kell isoimmunization invasive procedures may be avoided by implementing MCA-PSV measurements. Delineation of appropriate intervals between reassessments, the reliability of MCA-PSV following repeated IUTs, and cut-off values for FBS await further study. [ABSTRACT FROM AUTHOR]

Objective To construct a normal range for the internal diameter of the fetal descending colon and rectum during gestation. Subjects and Methods This was a prospective, crosssectional study including 379 healthy pregnant women with normal singleton pregnancies at 19-40 weeks of gestation. Measurements of the fetal descending colon (maximum internal diameter) and the fetal rectum (at the level of the bladder, measuring the anteroposterior diameter), were performed by highresolution transabdominal sonography. Results Adequate bowel measurements were obtained in all 379 fetuses. The diameter of the descending colon and rectum plotted as a function of gestational age had a sigmoid curve; the curve estimation was expressed by a cubic regression equation with R² of 0.848 and 0.831, respectively (P < 0.0001). The normal mean and the 95% prediction limits were defined. Conclusion The present data provide a normal range of fetal bowel (descending colon and rectum) diameters from the early second trimester of pregnancy onwards. They may allow intrauterine assessment of the development of the fetal colon and may serve as reference values in the detection of anomalies of the fetal bowel. [ABSTRACT FROM AUTHOR]

Objective: To determine whether severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is present in the vaginal secretions of both reproductive‐aged and postmenopausal women during acute SARS‐CoV‐2 infection. Design: Prospective study. Setting: A single tertiary, university‐affiliated medical centre in Israel. Time period, 1 June 2020 through to 31 July 2020. Population: Women who were hospitalised in a single tertiary medical centre, who were diagnosed with acute SARS‐CoV‐2 infection by a nasopharyngeal RT‐PCR test. Methods: Women were diagnosed with acute SARS‐CoV‐2 infection by a nasopharyngeal RT‐PCR test. Vaginal RT‐PCR swabs were obtained from all study participants after a proper cleansing of the perineum. Main outcome measures: Detection of SARS‐CoV‐2 in vaginal RT‐PCR swabs. Results: Vaginal and nasopharyngeal swabs were obtained from 35 women, aged 21–93 years. Twenty‐one women (60%) were in their reproductive years, of whom, five were in their third trimester of pregnancy. Most of the participants (57%) were healthy without any underlying medical conditions. Of the 35 patients sampled, 2 (5.7%) had a positive vaginal RT‐PCR for SARS‐CoV‐2, one was premenopausal and the other was a postmenopausal woman. Both women had mild disease. Conclusion: Our findings contradict most previous reports, which did not detect the presence of viral colonisation in the vagina. Although passage through the birth canal exposes neonates to the vaginal polymicrobial flora, an acquisition of pathogens does not necessarily mandate neonatal infection or clinical disease. Nevertheless, when delivering the infant of a woman with acute SARS‐CoV‐2 infection, a clinician should consider the possibility of vaginal colonisation, even if it is uncommon. When delivering the infant of a woman with acute SARS‐CoV‐2 infection, a clinician should consider the possibility of vaginal colonisation. When delivering the infant of a woman with acute SARS‐CoV‐2 infection, a clinician should consider the possibility of vaginal colonisation. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Shehata F, Levin I, Shrim A, Ata B, Weisz B, Gamzu R, Almog B. Placenta/birthweight ratio and perinatal outcome: a retrospective cohort analysis. BJOG 2011;118:741-747. The placenta weight/birthweight (PW/BW) ratio has been shown to be associated with certain long-term fetal outcomes; however, its association with short-term outcomes has not received much attention. Our aim was to assess the correlation between the PW/BW ratio and short-term adverse obstetrics outcomes in full-term, appropriate-for-gestational-age (AGA) newborns. Retrospective cohort study analysis using data from the McGill Obstetrical and Neonatal Database. McGill University Health Centre in Montreal Canada. AGA neonates. Three groups of full-term AGA neonates were created, according to their PW/BW ratio (high, normal and low), to be compared. Our primary outcome was the admission rate to the neonatal intensive care unit (NICU), and secondary outcomes included an Apgar score < 7 at 5 minutes, cord PH < 7.0, cord base excess (BE) ≤ 12, respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), occurrence of apnoea episodes, breech presentation at delivery, caesarean section rate and status in discharge home. A logistic regression model was instituted to investigate the predictors for adverse obstetrics outcomes. Admission to the NICU. Compared with the group with normal PW/BW ratios, the high PW/BW ratio group was associated with increased rates of admission to the NICU, of Apgar scores < 7 at 5 minutes, of breech presentation and caesarean section. On the contrary, the low PW/BW ratio group showed decreased rates of NICU admission, breech presentation and caesarean section. A high PW/BW ratio is significantly correlated with short-term adverse perinatal outcomes. This ratio may be used as a new and simple warning sign to predict the possibility of short-term health risks for newborns. [ABSTRACT FROM AUTHOR]

Objectives: To examine the ultrasonographic feasibility of imaging the fetal pons and to construct a reference chart for its normal development during gestation. Methods: A cross-sectional, prospective study on 293 healthy fetuses of low-risk pregnancies between 19 and 34 weeks was performed. The transfontanel approach, via the abdominal or vaginal routes, was used to evaluate the fetal metencephalon (pons and cerebellum). The anteroposterior diameter of the fetal pons was measured in a mid-sagittal plane. The longitudinal diameter of the cerebellar vermis was measured at the same plane and the vermis-pons ratio (VPR) was established. Results: One hundred and forty-four fetuses were in vertex position. In 140 (97.2%) satisfactory visualization and measurements of the pons and cerebellar vermis were obtained. One hundred and forty-nine fetuses were breech presentations and measurements were successfully performed in 147 (98.6%). The pons anteroposterior and vermis longitudinal diameters showed a linear correlation with gestational age (GA) (r = 0.95 for both measurements; P < 0.001). The mean VPR was 1.5 (+/-0.1 SD) and did not change in the gestational interval that was considered. Conclusion: By using the transfontanel approach, evaluation of the fetal pons is feasible via the mid-sagittal plane. The nomograms developed and the ratio to fetal vermis provides reference data that may be helpful when evaluating anomalies of the brainstem. [ABSTRACT FROM AUTHOR]

BACKGROUND: The present study was conducted to evaluate seasonal variability in the quality of pre‐ and post‐thaw semen parameters among sperm bank donors. METHODS: The first two consecutive ejaculates during the months March (spring, 92 males), June (summer, 97 males), September (autumn, 81 males) and December (winter, 97 males) were analysed. A comparison was made between sperm parameters from the same sperm donor at different seasons. Only males who donated semen samples during at least two seasons were enrolled in the study group (n = 103). Sperm specimens were cryopreserved in aliquots with fixed range of 8–12 × 106/ml of progressive motile sperm concentration after thawing. RESULTS: Differences between months were found in sperm concentration (P = 0.030) and normal morphology (P = 0.038); highest values were found in March and December, and the lowest in September. Mean specimen volume and percent of motile sperm cells did not vary throughout the seasons. The freezability of the donors’ sperm dropped dramatically from March to September, as determined by the number of straws (fixed aliquots of 0.5 ml) and total thawed progressive motile sperm that were cryopreserved for each male (P = 0.017 and P = 0.002, respectively). CONCLUSIONS: Cryopreservation of donor sperm is more effective during winter and spring than during the rest of the year. [ABSTRACT FROM AUTHOR]

Objective: To study the outcome of 50 pregnancies with documented vertical transmission of cytomegalovirus infection.Methods: We recruited 50 pregnant women (51 fetuses) with primary cytomegalovirus infection and confirmed in utero transmission. Prenatal evaluation included diagnostic amniocentesis and repeated ultrasound examinations. Fetal diagnosis was made after 21 weeks' gestation by amniocentesis and based on virus isolation by culture, shell vial, and polymerase chain reaction (PCR). Cytomegalovirus infection in neonates was determined by urinary viral isolation after birth or histologic examination of tissue from aborted fetuses. Cerebral ultrasound, hearing assessment, and psychomotor development were investigated for all 18 live-born neonates.Results: Thirty-three of the 50 women (66%) elected termination of pregnancy. Ultrasonographic abnormalities associated with in utero fetal infection were observed in 11 (21.5%) fetuses. Two of them continued to term; both were congenitally infected, and one had neurologic abnormalities. The positive predictive values of the PCR and virus isolation assessments performed in all 50 pregnancies (51 gestational sacs) were 92% and 93.7%, respectively. Seventeen pregnancies (18 fetuses) continued to term: four fetuses had neurologic abnormalities, of which three had normal prenatal ultrasound findings. The remaining 14 had normal neonatal assessments.Conclusion: Positive isolation of cytomegalovirus accompanied by positive PCR values in amniotic fluid provided approximately 94% certainty of in utero cytomegalovirus infection. The risk of postnatal neurologic abnormalities was 19% (three of 16) when there were no prenatal ultrasonographic abnormalities. [ABSTRACT FROM AUTHOR]

The study was conducted to evaluate the significance of preoperative clinical parameters for detection of mature testicular sperm cells in nonobstructive azoospermic men. Sixty-five consecutive men with nonobstructive azoospermia underwent testicular sperm extraction procedures. Testicular samples were analyzed histologically with patterns classified as mature spermatogenesis (normal or partial), arrest of spermatogenesis, and Sertoli cell only. Testicular sperm cells were isolated for use in an IVF/ICSI program. Histologic patterns and detection rate of sperm cells were correlated to clinical characteristics. Mature sperm cells were found in all levels of serum FSH. The men were divided into 3 groups based on their clinical characteristics (serum FSH level and testicular size). The distribution of the different testicular histologic patterns, as well as detection rate of sperm cells, was similar in all groups. No correlation was found between serum levels of FSH, LH, prolactin, or testosterone and sperm presence. None of these parameters, nor the testicular size and consistency, can serve as predictive variables of the histological pattern or the presence of mature sperm cells in the testicular biopsies in cases of nonobstructive azoospermia. Until an effective predictive tool is available, a trial of sperm retrieval is recommended for all azoospermic men independent of their clinical characteristics. [ABSTRACT FROM AUTHOR]

Summary. The objective of this study was to determine the seminal concentrations of four different catecholamines and their association with semen quality. Seminal concentrations of adrenaline, noradrenaline, 3,4-dihydroxy-phenylalanine (DOPA), and 3,4-dihydroxy-phenyl acetic acid (DOPAC) were determined in 13 healthy volunteers, using high-performance liquid chromatography with an electrochemical detector. In addition, semen analysis was performed. Noradrenaline and DOPA were present in all specimens with a concentration of 15 181± 2951 pg ml-1 and 4023 ± 429 pg ml-1 (mean ± SE), respectively. These concentrations are respectively 19 times (range: 3–44) and twice (range: 1–3) as high as the maximal normal concentration in plasma. Adrenaline was present in 10 and DOPAC in seven of 13 specimens. No correlation was found between the concentration of any of the catecholamines evaluated and semen characteristics. In conclusion, noradrenaline and DOPA are present in human semen at concentrations that are much higher than maximal normal values in plasma. Adrenaline and DOPAC were also found in some of the samples. The concentrations of catecholamines in semen are not associated with semen quality. [ABSTRACT FROM AUTHOR]

Summary. The aim of this study was to evaluate the change in the expression of mannose-ligand receptors following a freezing–thawing procedure, in order to assess its impact on sperm capacitation and acrosome reaction. Twenty semen samples were obtained from fertile donors. Sperm samples were divided into two equal volumes. One aliquot was cryopreserved and the other aliquot was incubated at 32 °C. After 2 h the frozen sample was thawed and both samples were further incubated at 32 °C to allow capacitation. Mannose receptors were examined following 4 and 22 h of incubation using a mannosylated-BSA-FITC probe. The expression of mannose-ligand receptors on the sperm plasma membrane was determined according to the fluorescence pattern: pattern I represents pre-capacitation, pattern II represents capacitated spermatozoa and pattern III represents acrosome-reacted spermatozoa. After 4 h incubation in capacitating medium, the percentages of patterns I, II and III were 90, 7 and 3% for fresh spermatozoa and 89, 8 and 3% for frozen–thawed spermatozoa, respectively (P > 0.05). Following 22 h of incubation, the percentages of patterns I, II and III were 84, 11 and 5 for fresh spermatozoa and 83, 11 and 6% for frozen–thawed spermatozoa, respectively (not significant at P > 0.05). The percentages of patterns II and III in fresh and frozen–thawed spermatozoa were increased by the same magnitude with longer incubation in the capacitating conditions. It was concluded that the freezing–thawing procedure for human spermatozoa does not affect the expression of mannose-ligand receptors and the dynamics of sperm pre-fertilization processes. [ABSTRACT FROM AUTHOR]