Search

Tests to identify chromosomal abnormalities in embryos and in early pregnancies are frequently used to make important decisions, including terminations, but many rely on outdated science. Regulation of these genetic tests is urgently needed to ensure transparency and validation.

Indicators of male fertility are in decline globally, but the underlying causes, including the role of environmental exposures, are unclear. This study aimed to examine organic chemical pollutants in seminal plasma, including both known priority environmental chemicals and less studied chemicals, to identify uncharacterized male reproductive environmental toxicants. Semen samples were collected from 100 individuals and assessed for sperm concentration, percent motility, and total motile sperm. Targeted and nontargeted organic pollutant exposures were measured from seminal plasma using gas chromatography, which showed widespread detection of organic pollutants in seminal plasma across all exposure classes. We used principal component pursuit (PCP) on our targeted panel and derived one component (driven by etriadizole) associated with total motile sperm (p< 0.001) and concentration (p= 0.03). This was confirmed by the exposome-wide association models using individual chemicals, where etriadizole was negatively associated with total motile sperm (FDR q= 0.01) and concentration (q= 0.07). Using PCP on 814 nontargeted spectral peaks identified a component that was associated with total motile sperm (p= 0.001). Bayesian kernel machine regression identified one principal driver of this association, which was analytically confirmed to be N-nitrosodiethylamine. These findings are promising and consistent with experimental evidence showing that etridiazole and N-nitrosodiethylamine may be reproductive toxicants.

Objective: The objectives if this study were: (1) to determine anti-Mullerian hormone (AMH) levels in menopausal women, and (2) to confirm the source if AMH in cycling women and its disappearance after the removal if the source. Methods: An observational and prospective study was conducted. Results: A total of 47 women were recruited for the study. The study population consisted of the following groups of patients: (A) women of late reproductive age(h = 24; mean age± SD, 44± 2.8 years); (B) menopausal women (n =14; mean age, 56± 4 years); and (C) regularly cycling women undergoing surgical menopause (n = 9; mean age, 43± 4 years). Blood samples were obtained from all patients. In patients undergoing surgery, blood samples were obtained before and after surgery. AMH was undetectable in 13 of 14 postmenopausal women, whereas it was undetectable in only two of 24 women of late reproductive age. A significant negative correlation has been found between AMH and age or follicle-stimulating hormone (FSH) in women of late reproductive age. In women who were candidates for oophorectomy, samples were obtained 3—5 days after surgery. AMH was undetectable after the surgery in all women. Conclusions: We found that AMH levels decreased in women in the late reproductive period and that menopause and ovariectomy in regularly cycling women are associated to undetectable AMH in serum. These observations confirm that the ovary could be the only source of AMH in women and that it is a novel marker for ovarian aging.

Objective:The objectives of this study were: (1) to determine anti-Mullerian hormone (AMH) levels in menopausal women, and (2) to confirm the source of AMH in cycling women and its disapperance after the removal of the source.Methods:An observational and prospective study was conducted.Results:A total of 47 women were recruited for the study. The study population consisted of the following groups of patients: (A) women of late reproductive age (n= 24; mean age ± SD, 44 ± 2.8 years); (B) menopausal women (n= 14; mean age, 56 ± 4 years); (C) regularly cycling women undergoing surgical menopause (n= 9; mean age, 43 ± 4 years). Blood samples were obtained from all patients. In patients undergoing surgery, blood samples were obtained before and after surgery. AMH was undetectable in 13 of 14 postmenopausal women, whereas it was undetectacle in only two of 24 women of late reproductive age. A significant negative correlation has been found between AMH and age or follicle-stimulating hormone (FSH) in women of late reproductive age. In women who were candidates for oophorectomy, samples were obtained 3-5 days after surgery. AMH was undetectable after the surgery in all women.Conclusions:We found that AMH levels decreased in women in the late reproductive period and that menopause and ovariectomy in regularly cycling women are associated to undetectable AMH in serum. These observations confirm that the ovary could be the only source of AMH in women and that it is a novel marker for ovarian aging.

Our aim was to investigate whether decreased levels of vitamin E can be measured during the early stages of pregnancy in women at risk of developing preeclampsia or other associated complications before the onset of the clinical syndrome. We prospectively measured the plasma concentrations of vitamin E in 62 pregnant women at 7–32 weeks of gestation who were at risk of developing preeclampsia and other complications, before the appearance of clinical signs. The results were compared with those of 16 healthy controls. Of the 62 study patients, 8 (13%) developed preeclampsia, and 18 (29%) had other complications, such as intrauterine growth restriction (n = 8), fetal or neonatal loss (n = 9), and preterm delivery (≤30 weeks of gestation; n = 7). Both gestational age at delivery and birth weight were significantly lower in the patients with complications than in the healthy controls. However, there were no significant differences in vitamin E levels between women who developed preeclampsia or other complications and those who did not. There was no significant correlation between plasma vitamin E and creatinine concentrations. A significant positive correlation was found in both the complicated and normal pregnancies between plasma vitamin E concentration and gestational week of blood collection (R = 0.485, p < 0.001, and R = 0.718, p = 0.004, respectively). We conclude that the vitamin E concentrations are not decreased prior to the development of preeclampsia or other complications in women at risk.

PROBLEM: To aim of the study was to investigate whether controlled ovarian hyperstimulation (COH) causes endothelial activation and whether there is a correlation between endothelial activation and serum sex‐steroid levels.
 METHOD OF STUDY: The study population consisted of 14 consecutive patients undergoing our routine IVF long gonadotropin‐releasing hormone‐analog protocol. Blood was drawn three times during the COH cycle: (1) day when adequate suppression was obtained (Day‐S); (2) on the day of or the day prior to hCG administration (Day‐hCG); and (3) on the day of ovum pick‐up (Day‐OPU). The levels of sex steroids and plasma soluble endothelial (E)‐selectin were compared among the time points. Soluble E‐selectin was measured with a commercial sandwich enzyme‐linked immunosorbent assay.
 RESULTS: Soluble E‐selectin levels were significantly higher on Day‐OPU than Day‐S and Day‐hCG, whereas no difference was observed between Day‐hCG and Day‐S. No significant correlations were found between soluble E‐selectin level and patient age, number of gonadotropin ampoules used, number of oocytes retrieved, or serum estradiol, progesterone and human chorionic gonadotropin levels.
 CONCLUSIONS: Human chorionic gonadotropin administration leads to endothelial activation regardless of the degree of ovarian response. Further studies are required to elucidate the relationship between COH and endothelial activation. These findings may lead to new strategies for predicting and preventing complications of COH, such as severe ovarian hyperstimulation syndrome.

Polycystic ovary syndrome is one of the most common endocrinopathies among women. Nevertheless, there is no one single acceptable definition for this syndrome, its pathophysiology is not completely understood and its etiology remains an enigma. Several studies have examined the genetic basis of polycystic ovary syndrome with varying results, probably caused by the different criteria used to define the syndrome. These studies, together with studies that deal with reclassification of polycystic ovary syndrome, are described in the following review. Furthermore, a simplified alternative approach to this symptom complex is proposed.

Orvieto R, Ben‐Rafael Z, Abir R, Bar‐Hava I, Fisch B, Molad Y. Controlled ovarian hyperstimulation: a state of neutrophil activation. AJRI 1999; 42:288–291© Munksgaard, Copenhagen

Recent advances in high-resolution ultrasonography combined with color-coded Doppler analysis have enabled a new insight to be gained into fetal physiology and allowed the investigation of small, previously inaccessible fetal vessels under normal and abnormal conditions. In addition, the findings in some cases contradict the accepted fetal pathophysiology derived from animal studies. The aim of the present study is to describe new reports assessing the major compartments of the fetal cardiovascular system (heart, lung, splanchnic and fetal venous circulations) and to discuss the developments in these fields.

Objective:To relay the current knowledge on the interaction between cytokines, growth factors, and ovarian hyperstimulation syndrome (OHSS) and to propose a new insight into the pathogenesis of OHSS.Methods:Major studies that have reported on the association between cytokines, growth factors, and OHSS were identified through MEDLINE searches and through the published literature.Results:Several cytokines, as well as vascular endothelial growth factor, were found to have a role, either in the prediction or pathogenesis of OHSS. Moreover, intravenous immunoglobulin, which has an anticytokine nature and inhibits the secretion of various cytokines, was shown to prevent the development of OHSS.Conclusions:Current knowledge indicates a close interaction between cytokines, growth factors, and OHSS. Further understanding of these interactions may lead to different understanding of ovarian hyperstimulation syndrome.

Objectives. To evaluate whether there may be an association between postmenopausal ovarian cysts and hormone replacement therapy.Methods. The study comprised 564 consecutive, asymptomatic, postmenopausal women who were referred for routine, transvaginal ultrasound examinations between January 1 and December 31, 1995. Various demographic and ultrasonographic parameters were recorded on a prospectively-created, computerized data base.Results. There was no difference in the prevalence of ovarian cysts with or without hormone replacement therapy (10.5% vs. 12.5%, respectively). However, in the subgroup of early postmenopausal women (40-55 years), the use of hormone replacement therapy was associated with a significantly reduced prevalence of ovarian cysts (10.4% vs. 28.6%; p<0.05). Conclusions. Hormone replacement therapy is associated with a reduced prevalence of ovarian cysts in early postmenopause.

Objective: To relay the current knowledge on the interaction between cytokines, growth factors, and ovarian hyperstimulation syndrome (OHSS) and to propose a new insight into the pathogenesis of OHSS. Methods: Major studies that have reported on the association between cytokines, growth factors, and OHSS were identified through MEDLINE searches and through the published literature. Results: Several cytokines, as well as vascular endothelial growth factor, were found to have a role, either in the prediction or pathogenesis of OHSS. Moreover, intravenous immunoglobulin, which has an anticytokine nature and inhibits the secretion of various cytokines, was shown to prevent the development of OHSS. Conclusions: Current knowledge indicates a close interaction between cytokines, growth factors, and OHSS. Further understanding of these interactions may lead to different understanding of ovarian hyperstimulation syndrome.

To evaluate the outcome of oocytes donated by women with polycystic ovarian syndrome (PCOS) compared with oocytes donated by women with mechanical infertility.

To relay the current knowledge on the interaction between the immune and reproductive systems that results from sharing certain lymphohematopoietic cytokines and their receptors.

Clubfoot (talipes equinovarus) is a common orthopaedic malformation that can be accurately diagnosed prenatally. The study was conducted to investigate possible in utero visualization of transient and late-onset clubfoot. Early (13–16 weeks' gestation) prenatal transvaginal sonographic diagnosis of clubfoot deformity was made in 36 cases during the study period. Only those cases where follow-up examination revealed different sonographic findings were considered. The results showed that seven cases of transient (as well as relapsing) clubfoot were identified. In 4 of 7 cases, the clubfoot resolved (all after more than 10 min of observation) during the same examination. In the fifth and sixth cases, it initially resolved, later reappearing in follow-up examinations (20 and 22 weeks' gestation). In the seventh case, the clubfoot persisted for two consecutive examinations (2 weeks apart each) and later disappeared. In addition, six late-onset (22–24 weeks' gestation) clubfoot cases were identified during the study period. Although infrequent, in utero clubfoot can be both a transient and a late-onset phenomenon. Over- and under-diagnosis are potential hazards in these situations. © 1997 John Wiley & Sons, Ltd.

Background. Low-back pain (LBP) is a commonly observed symptom during pregnancy. Despite its high frequency the extent of the problem is less well documented and detailed studies concerning related risk factors are scarce. Furthermore, efforts to address the problem are hampered by the inability to predict accurately which pregnancies are at risk. This study was conducted in order to assess the frequency, manifestations and the contribution of various factors to the development of LBP during pregnancy.Methods. The study included 449 pregnant women who were consecutively referred for an antenatal ultrasonographic examination for various reasons. A simple questionnaire which consisted of several items along with ultrasonographic measurements was devised to evaluate the incidence of and risk factors for LBP during pregnancy.Results. 246 (54.8%) women reported LBP in the present pregnancy. Factors which were found to be significantly associated with an increased risk to develop LBP during pregnancy included low socioeconomic class, existence of LBP before the first pregnancy, during previous pregnancy, and interim pregnancies. Moreover, in nulliparous women, body mass index (BMI) was found to be significantly higher in women suffering from LBP. A tendency was observed between posterior/fundal location of the placenta to the presence of LBP during pregnancy. This tendency was also observed among parous but not among nulliparous women. Among pregnant women with LBP, pain radiation correlated significantly to fetal weight. Moreover, this correlation was also of statistical significance in nulliparous women with anterior placental location. Back care advice given to women suffering from LBP was found to significantly reduce LBP. The age, number of prior pregnancies, gestational age, average maternal height, weight and BMI were not found to be risk factors in LBP. Furthermore, we found no influence of previous abortion/s, instrumental delivery, previous cesarean section, or a history of epidural anesthesia during a previous labor were risks to develop LBP in the subsequent pregnancy.Conclusions. In the present pregnancy, LBP during pregnancy was associated with a history of LBP various socioanthropometric measures, as well as several ultrasonographic and obstetrical data. Back care advice offered to pregnant women who are prone to develop LBP during pregnancy, as early in their pregnancy as possible, may prevent or result in less 'troublesome' and 'severe' LBP during pregnancy.

Clubfoot (talipes equinovarus) is a common orthopaedic malformation that can be accurately diagnosed prenatally. The study was conducted to investigate possible in uterovisualization of transient and late‐onset clubfoot. Early (13–16 weeks' gestation) prenatal transvaginal sonographic diagnosis of clubfoot deformity was made in 36 cases during the study period. Only those cases where follow‐up examination revealed different sonographic findings were considered. The results showed that seven cases of transient (as well as relapsing) clubfoot were identified. In 4 of 7 cases, the clubfoot resolved (all after more than 10 min of observation) during the same examination. In the fifth and sixth cases, it initially resolved, later reappearing in follow‐up examinations (20 and 22 weeks' gestation). In the seventh case, the clubfoot persisted for two consecutive examinations (2 weeks apart each) and later disappeared. In addition, six late‐onset (22–24 weeks' gestation) clubfoot cases were identified during the study period. Although infrequent, in uteroclubfoot can be both a transient and a late‐onset phenomenon. Over‐ and under‐diagnosis are potential hazards in these situations. © 1997 John Wiley & Sons, Ltd.

Objective:Controlled ovarian hyperstimulation (COH) is apparently a key factor in the success of in vitro fertilization-embryo transfer. One of the major complications of COH is severe ovarian hyperstimulation syndrome (OHSS), which may be attributable to a massive increase in systemic inflammatory cytokines or to neutrophil activation. The aim of the present review was to investigate the role of COH in the induction of an inflammatory response.Methods:Major studies that have reported on the association between COH and inflammation were identified through MEDLINE searches and the published literature.Results:Several inflammatory mediators, namely, C-reactive protein and leukocyte and endothelial selectins, showed a significant increase after human chorionic gonadotropin (hCG) administration in vivo, reflecting an inflammatory state, and neutrophil and endothelial activation, respectively. On the other hand, hCG showed a direct depressive effect on mononuclear cells in vitro. Because the development of OHSS almost always follows hCG administration, the negative effect of hCG on peripheral mononuclear cells indicates that it probably causes OHSS by an indirect mechanism.Conclusion:We suspect that hCG stimulates the ovaries to produce and secrete a still unknown intermediate factor, which in turn activates inflammatory processes that may lead to an increase in capillary permeability.

Objective: Controlled ovarian hyperstimulation (COH) is apparently a key factor in the success of in vitro fertilization-embryo transfer. One of the major complications of COH is severe ovarian hyperstimulation syndrome (OHSS), which may be attributable to a massive increase in systemic inflammatory cytokines or to neutrophil activation. The aim of the present review was to investigate the role of COH in the induction of an inflammatory response. Methods: Major studies that have reported on the association between COH and inflammation were identified through MEDLINE searches and the published literature. Results: Several inflammatory mediators, namely, C-reactive protein and leukocyte and endothelial selectins, showed a significant increase after human chorionic gonadotropin (hCG) administration in vivo, reflecting an inflammatory state, and neutrophil and endothelial activation, respectively. On the other hand, hCG showed a direct depressive effect on mononuclear cells in vitro. Because the development of OHSS almost always follows hCG administration, the negative effect of hCG on peripheral mononuclear cells indicates that it probably causes OHSS by an indirect mechanism. Conclusion: We suspect that hCG stimulates the ovaries to produce and secrete a still unknown intermediate factor, which in turn activates inflammatory processes that may lead to an increase in capillary permeability.

To evaluate the role of the recently suggested IV administration of human albumin solution as an effective preventive measure of severe ovarian hyperstimulation in high-risk patients.

Summary In an attempt to explain the increased frequency of pathological fractures found in thalassemia major patients, we examined noninvasively several properties of bones in 17 patients. We found a significant decrease in the bone mineral content (BMC) and the bone density (BD) of both trabecular (34% and 4% diminution, respectively) and cortical bone (24% and 3% diminution, respectively), as compared with normal controls. We also found that metacarpal cortical indices (CI) were significantly lower in thalassemic patients as compared with normal controls (36% diminution). As expected, upper limb fractures were more frequent in those patients with greater bone diminution. Furthermore, the degree of bone diminution was greater in patients receiving fewer blood transfusions and shorter courses of desferrioxamine. Bone densitometry should probably be included in the comprehensive evaluation of thalassemia patients in order to help guide overall treatment.

The prostaglandin transporter is a mediator of ovulation, and inhibiting it blocks ovulation in mice.

No Abstract