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STUDY QUESTION Does intrauterine application of diluted seminal plasma (SP) at the time of ovum pick-up improve the pregnancy rate by ≥14% in IVF treatment? SUMMARY ANSWER Intrauterine instillation of diluted SP at the time of ovum pick-up is unlikely to increase the pregnancy rate by ≥14% in IVF. WHAT IS KNOWN ALREADY SP modulates endometrial function, and sexual intercourse around the time of embryo transfer has been suggested to increase the likelihood of pregnancy. A previous randomized double-blind pilot study demonstrated a strong trend towards increased pregnancy rates following the intracervical application of undiluted SP. As this study was not conclusive and as the finding could have been confounded by sexual intercourse, the intrauterine application of diluted SP was investigated in the present trial. STUDY DESIGN, SIZE, DURATION A single-centre, prospective, double-blind, placebo-controlled, randomized, superiority trial on women undergoing IVF was conducted from April 2007 until February 2012 at the University Department of Gynaecological Endocrinology and Reproductive Medicine, Heidelberg, Germany. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was powered to detect an 14% increase in the clinical pregnancy rate and two sequential tests were planned using the Pocock spending function. At the first interim analysis, 279 women had been randomly assigned to intrauterine diluted SP (20% SP in saline from the patients' partner) (n = 138) or placebo (n = 141) at the time of ovum pick-up. MAIN RESULTS AND THE ROLE OF CHANCE The clinical pregnancy rate per randomized patient was 37/138 (26.8%) in the SP group and 41/141 (29.1%) in the placebo group (difference: −2.3%, 95% confidence interval of the difference: −12.7 to +8.2%; P = 0.69). The live birth rate per randomized patient was 28/138 (20.3%) in the SP group and 33/141 (23.4%) in the placebo group (difference: −3.1%, 95% confidence interval of the difference: −12.7 to +6.6%; P = 0.56). It was decided

Various hormones have been studied as regards prediction of pregnancy outcome after infertility treatment, but no ideal candidate has been found. Folate and genetic variations in folate metabolism have also been associated with infertility, but it remains unclear how these factors affect IVF pregnancy outcome. It is known that infertility is associated with active folic acid supplement use, but the effect of socioeconomic and lifestyle factors on folic acid supplement use in infertile women has not been well investigated. The overall aim of this work was to obtain information on the prediction of live birth, and to study factors affecting the role of folate and folic acid intake in relation to IVF pregnancy outcome. Infertile women with various infertility diagnoses were studied. Healthy, fertile non-pregnant women were used as controls in three of the studies. Blood samples were taken for assay of eight different hormones, folate and homocysteine, and for genomic DNA extraction. A questionnaire was used to assess background data and use of folic acid supplements. Twenty-four-hour recall interviews were performed for validation of the questionnaire. The studied hormones were not good predictors of live birth. The best predictor was age of the women, together with ovulatory menstrual cycles, and thyroid-stimulating hormone and anti-Müllerian hormone (AMH) status. Well-educated women, high-status employed women, and married and infertile women used the most folic acid supplements. Infertile women had better folate status than fertile women. However, pregnancy outcome after infertility treatment was not dependent on folic acid intake, folate status, genetic variation of 5,10-methylenetetrahydrofolate reductase or socioeconomic status. In conclusion, AMH levels vary less than those of other hormones during the menstrual cycle, and AMH could be used as a predictive marker of live birth together with age and ovulation. Folate might play a minor role in IVF pregnancy outco

Folic acid supplements are commonly used by infertile women which leads to a positive folate status. However, the effect of folic acid supplements on pregnancy outcome in women with unexplained infertility has not been well investigated. This study evaluated folic acid supplement use and folate status in women with unexplained infertility in relation to IVF pregnancy outcome. In addition, use of folic acid supplements and folate status were compared between women with unexplained infertility and fertile, nonpregnant control women. Women with unexplained infertility used significantly more folic acid supplements and had higher median total folic acid intake from supplements compared with fertile control women (both P < 0.001). Women with unexplained infertility also had significantly higher median plasma folate and lower median plasma homocysteine concentrations than fertile women (both P < 0.001), but folic acid supplementation or folate status were not related to pregnancy outcome in women with unexplained infertility. In conclusion, folic acid supplementation or good folate status did not have a positive effect on pregnancy outcome following infertility treatment in women with unexplained infertility.

Objective: To study folic acid intake, folate status and pregnancy outcome afterinfertility treatment in women with different infertility diagnoses in relation tomethylenetetrahydrofolate reductase (MTHFR) 677C>T, 1298A>C and 1793G>A genevariations. Also the use of folic acid supplements, folate status and the frequency ofdifferent gene variations were studied in women undergoing infertility treatment andfertile women. Design: Observational study. Setting: University hospital. Population:Women undergoing infertility treatment and healthy, fertile, non-pregnant women. Methods: A questionnaire was used to assess general background data and use ofdietary supplements. Blood samples were taken to determine plasma folate andhomocysteine levels, and for genomic DNA extraction. A meta-analysis of four studieswas performed to assess pregnancy outcome in relation to MTHFR 677 TT vs. CC, and1298 CC vs. AA polymorphisms. Main outcome measures: Folic acid supplementintake, and plasma folate, homocysteine and genomic assays. Results: Women in theinfertility group used significantly more folic acid supplements and had better folatestatus than fertile women, but pregnancy outcome after fertility treatment was notdependent on folic acid intake, folate status or MTHFR gene variations. However, ameta-analysis demonstrated that MTHFR 1298AA polymorphism was related topregnancy outcome. Conclusion: Folic acid supplementation seems to play only a minorrole in the context of pregnancy outcome after in vitro fertilisation, and other variablesin folate metabolism are of more importance. In particular, MTHFR 1298AA genevariation appears to have a positive association with the success of fertility treatment

OBJECTIVE: To study folic acid intake, folate status and pregnancy outcome after infertility treatment in women with different infertility diagnoses in relation to methylenetetrahydrofolate reductase (MTHFR) 677C>T, 1298A>C and 1793G>A polymorphisms. Also the use of folic acid supplements, folate status and the frequency of different gene variations were studied in women undergoing infertility treatment and fertile women. DESIGN: Observational study. SETTING: University hospital. POPULATION: Women undergoing infertility treatment and healthy, fertile, non-pregnant women. METHODS: A questionnaire was used to assess general background data and use of dietary supplements. Blood samples were taken to determine plasma folate and homocysteine levels, and for genomic DNA extraction. A comparison of four studies was performed to assess pregnancy outcome in relation to MTHFR 677 TT vs. CC, and 1298 CC vs. AA polymorphisms. MAIN OUTCOME MEASURES: Folic acid supplement intake, and plasma folate, homocysteine and genomic assays. RESULTS: Women in the infertility group used significantly more folic acid supplements and had better folate status than fertile women, but pregnancy outcome after fertility treatment was not dependent on folic acid intake, folate status or MTHFR gene variations. CONCLUSION: High folic acid intakes and MTHFR gene variations seem not associated with helping women to achieve pregnancy during or after fertility treatment., Funding Agencies:Family Planning Foundation and Fodelsefonden, Uppsala, SwedenRegional Research Foundation, Örebro, SwedenPampers Scholarship, SwedenR&D grants from Praktikertjanst AB, Stockholm, Sweden

In order to analyse the relationship between the ovarian response to stimulation in in-vitro fertilization (IVF) treatment cycles and relaxin concentrations during subsequent pregnancies, 31 healthy women pregnant after IVF treat ment were studied prospectively. The maximum number of follicles observed from day −4 to day −2 in relation to ovum retrieval and the number of oocytes recovered were recorded. In addition, blood samples were drawn in the follicular phase, the luteal phase, early pregnancy and at gestational weeks 12, 16, 20, 27 and 35 to assess oestradiol, progesterone, human choriomc gonadotrophin and relaxin. The maximum numbers (mean±SEM) of follicles observed and oocytes recovered were 9.0±0.6 and 6.1±0.5 respectively. The supraphyslological mean relaxin values were strongly correlated to the maximum number of follicles observed (r=0.72, P <0.0001) and the number of oocytes recovered (r=0.64, P <0.0001), indicating that the source of increased relaxin production during IVF pregnancy might be the ovary. These results are supported by experimental data. In the present study, the occurrence of multiple pregnancy was not associated with higher relaxin concentrations, which is further support for the hypothesis that the ovary is the main source of serum relaxin.

The aetiology of Oculo-Auriculo-Vertebral Spectrum (OAVS) is unkown. We report a case following a prenatal diagnosis of 45,X/46,XY mosaicism in a pregnancy achieved by In-Vitro Fertilization (IVF) and describe evidence for the interrelationships of these phenomena and multiple births. This report extends the phenotypes associated with prenatally diagnosed 45,X/46,XY mosaicism and supports the association of OAVS and IVF.

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info:eu-repo/semantics/nonPublished

STUDY QUESTION Does intrauterine application of diluted seminal plasma (SP) at the time of ovum pick-up improve the pregnancy rate by ≥14% in IVF treatment? SUMMARY ANSWER Intrauterine instillation of diluted SP at the time of ovum pick-up is unlikely to increase the pregnancy rate by ≥14% in IVF. WHAT IS KNOWN ALREADY SP modulates endometrial function, and sexual intercourse around the time of embryo transfer has been suggested to increase the likelihood of pregnancy. A previous randomized double-blind pilot study demonstrated a strong trend towards increased pregnancy rates following the intracervical application of undiluted SP. As this study was not conclusive and as the finding could have been confounded by sexual intercourse, the intrauterine application of diluted SP was investigated in the present trial. STUDY DESIGN, SIZE, DURATION A single-centre, prospective, double-blind, placebo-controlled, randomized, superiority trial on women undergoing IVF was conducted from April 2007 until February 2012 at the University Department of Gynaecological Endocrinology and Reproductive Medicine, Heidelberg, Germany. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was powered to detect an 14% increase in the clinical pregnancy rate and two sequential tests were planned using the Pocock spending function. At the first interim analysis, 279 women had been randomly assigned to intrauterine diluted SP (20% SP in saline from the patients' partner) (n = 138) or placebo (n = 141) at the time of ovum pick-up. MAIN RESULTS AND THE ROLE OF CHANCE The clinical pregnancy rate per randomized patient was 37/138 (26.8%) in the SP group and 41/141 (29.1%) in the placebo group (difference: −2.3%, 95% confidence interval of the difference: −12.7 to +8.2%; P = 0.69). The live birth rate per randomized patient was 28/138 (20.3%) in the SP group and 33/141 (23.4%) in the placebo group (difference: −3.1%, 95% confidence interval of the difference: −12.7 to +6.6%; P = 0.56). It was decided

Conjoined twins are estimated to occur in 1:50 000 pregnancies. Eighteen cases of pregnancies achieved by ART have been published of which three were achieved after single embryo transfer, allowing discussion of embryo characteristics. We report, to the best of our knowledge, the first case of parapagus conjoined twins after ART. Furthermore, this is the first report of conjoined twins with detailed morphokinetics of the earliest embryogenesis from zygote to expanded and hatched blastocyst stage. The case zygote had three refractile bodies, which were all allocated to one blastomere at first cleavage following an asynchronous pronuclei fading. Within 2 h, this blastomere cleaved to four and fragmented. The remaining blastomere cleaved symmetrically and regularly and a blastocyst (score: 4AB) was vitrified 120 h after IVF. Pregnancy was achieved following a frozen-thawed single blastocyst transfer. The etiopathogenetic mechanism of the origin of conjoined twins is unknown and several hypotheses exist. The morphokinetics in the present case and morphology of other reported cases will be discussed in this context.

This article conducted a correlation analysis to search for factors from the obstetric history of a woman that affect the outcome of IVF pregnancy. Initial data include terms and methods of childbirth, diagnoses of children at the stage of the maternity hospital., В данной статье был проведен корреляционный анализ для поиска факторов из акушерского анамнеза женщины, влияющих на исход беременности, полученной с помощью ЭКО. Исходные данные включают сроки и способы родоразрешения, диагнозы детей на этапе роддома.

‘Uterine receptivity’ refers to the status of the uterus when the endometrium is available to accept the embryo for implantation. Optimal endometrial receptivity leads to normal embryo implantation processes that serve as a foundation for a healthy pregnancy. Over the last three decades, there have been many advances in embryology that have resulted in significant improvements in embryo viability and overall in vitro fertilization (IVF) success rates. It is believed that implantation failure due to reduced endometrial receptivity is one of the major remaining impediments to higher IVF pregnancy rates. In a normal ovulatory cycle, the receptive endometrium develops following sequential exposure to sex steroids – estrogen and progesterone, secreted by the ovaries during follicular development, ovulation and formation of a corpus luteum. Successful implantation will occur when the development of endometrium is in synchrony with the growing embryo. Both asynchronous and pathological endometrium can lead to reduced receptivity and implantation failure. With the rapid development of transcriptomic technologies in the recent years, gene expression studies of endometrium have advanced our understandings of endometrial physiology. Clinical tests based on gene expression profiles of endometrium have also been developed. Unfortunately, there are still significant knowledge gaps in endometrial receptivity research. Expression quantitative trait loci (eQTL) analysis seeks to identify genetic variants – single nucleotide polymorphisms (SNPs) that affect the expression of genes. Identification of eQTLs has proven to be a powerful tool in the study and understanding of various diseases. We hypothesized that an eQTL approach to identify DNA variants (SNPs) which influence the expression level of genes in the peri-implantation human endometrium would have significantly more power to identify genes and gene pathways that influence uterine receptivity than simple endometrial gene (or p

Purpose of the article. To explore the strength of association between different maternal and pregnancy characteristics and the occurrence of abnormally invasive placenta (AIP). Materials and methods: Pubmed, Embase, CINAHL databases were searched. The risk factors for AIP explored were: obesity, age >35 years, smoking before or during pregnancy, placenta previa, prior cesarean section (CS), placenta previa and prior CS, prior uterine surgery, abortion and uterine curettage, in vitro fertilization (IVF) pregnancy and interval between a previous CS, and a subsequent pregnancy. Random-effect head-to-head meta-analyses were used to analyze the data. Results: Forty-six were included in the systematic review. Maternal obesity (Odd ratio, OR: 1.4, 95% CI 1.0–1.8), advanced maternal age (OR: 3.1, 95% CI 1.4–7.0) and parity (OR: 2.5, 95% CI 1.7–3.6), but not smoking were associated with a higher risk of AIP. The presence of placenta previa in women with at least a prior CS was associated with a higher risk of AIP compared to controls, with an OR of 12.0, 95% CI 1.6–88.0. Furthermore, the risk of AIP increased with the number of prior CS (OR of 2.6, 95% CI 1.6–4.4 and 5.4, 95% CI 1.7–17.4 for two and three prior CS respectively). Finally, IVF pregnancies were associated with a high risk of AIP, with an OR of 2.8 (95% CI 1.2–6.8). Conclusion: A prior CS and placenta previa are among the strongest risk factors for the occurrence of AIP.

Objective To evaluate fertility outcomes after laparoscopic and ART management of endometriosis in an infertile population. Patients and methods Retrospective analysis including 79 infertile patients treated by laparoscopic surgery. Fertility was studied in relation to pregnancy's mode (spontaneous or ART) and to endometriosis stages (rAFS). Results After laparoscopy, 8.9% of patients had a spontaneous pregnancy. IIU led to a cumulative rate of pregnant women of 21.5%. Then after laparoscopy, IIU and IVF, 68.4% of patients were pregnant. The average delay was 460 days between laparoscopy and spontaneous pregnancy, 271 days between surgery and IIU pregnancy and 600 days between surgery and IVF pregnancy. Among women with stages I-II endometriosis (62 cases), 11.3% patients obtained a spontaneous pregnancy, the cumulative rate of pregnant women after laparoscopy and IIU was 25,8%. After laparoscopy, IIU and IVF, 66.1% of patients were pregnant. The average post-surgical time to spontaneous pregnancy was 460 days. The average delay between surgery and IIU pregnancy was 279 days and 589 days between surgery and IVF pregnancy. In case of stages III-IV (17 patients), 76.4% of pregnancies were obtained. No spontaneous pregnancy was observed. 94.1% of patients were treated with IVF, leading to a global rate of pregnancy of 70.5%. The average delay between surgery and IVF pregnancy was 563 days. Conclusions With a combination of surgery and ART, two-third of patients were pregnant with an average time between surgery and pregnancy of less than two years. This combination (surgery and ART) increases the chances of becoming pregnant. At the moment, the delay between surgery and ART needs to be established.

1 juli 2010, Item does not contain fulltext, BACKGROUND: We assessed all deaths in the Netherlands that might have been related to IVF or to an IVF pregnancy in order to investigate this most serious complication. METHODS: All deaths related to IVF, within 1 year after IVF, from 1984 to 2008 were collected by sending a letter to all gynaecologists, and by retrieving data from a large cohort study examining the late effects of ovarian stimulation (OMEGA) and from the Dutch Maternal Mortality Committee. RESULTS: Six deaths were directly related to IVF (6/100,000), 17 deaths were directly related to the IVF pregnancy (42.5/100,000) and eight deaths were neither related to the IVF nor to the IVF-related pregnancy. The overall mortality in patients undergoing IVF procedures was lower than in the general population, whereas the overall mortality related to IVF pregnancies was higher than the maternal mortality in the general population. CONCLUSION: The decreased mortality is probably the result of a 'healthy female effect' in women undergoing IVF. The high maternal mortality in IVF pregnancies is probably related to the high number of multiple pregnancies and to the fact that (donor egg) IVF is successfully used in women who are older. The fact that only a few deaths directly related to IVF are reported in the literature whereas we observed six in the Netherlands indicates worldwide under-reporting of IVF-related mortality. We underline the importance of reporting all lethal cases to the European Society of Human Reproduction and Embryology Committee 'Safety and Quality after IVF'.

Background: We will assess to what extent in vitro fertilization (IVF) is effective in ncreasing the number of births overall and whether earlier application of IVF will increase this number. Methods: We simulate 100 000 women trying for their first and second child. Natural and IVF pregnancy rates and infertility rates are age-dependent and based on published data. The age at which women start trying for their first child is based on the Netherlands 2002 data.Three cycles of IVF are given during a 12-month period after 1 or 3 years of trying to conceive unsuccessfully. Main outcome measures are live born deliveries and children, both naturally conceived or after IVF, as well as numbers of singletons, twins and triplets, the total fertility rate (TFR) and the number of IVF cycles performed. Results: Full access to IVF after 3 years increases the TFR by 0.08 children. Applying IVF after 1 year leads to an additional TFR increase of 0.04, with double the number of IVF cycles and twin and triplet children, and a shift from naturally conceived children to IVF children. Conclusions: Full access to IVF after 3 years is important. It does increase the TFR. Early availability of IVF would further increase the TFR, but with side-effects and high costs. Key words: in vitro fertilization / assisted reproduction / total fertility rate / multiple pregnancies / IVF policy, Background: We will assess to what extent in vitro fertilization (IVF) is effective in ncreasing the number of births overall and whether earlier application of IVF will increase this number. Methods: We simulate 100 000 women trying for their first and second child. Natural and IVF pregnancy rates and infertility rates are age-dependent and based on published data. The age at which women start trying for their first child is based on the Netherlands 2002 data.Three cycles of IVF are given during a 12-month period after 1 or 3 years of trying to conceive unsuccessfully. Main outcome measures are live born deliveries and children, both naturally conceived or after IVF, as well as numbers of singletons, twins and triplets, the total fertility rate (TFR) and the number of IVF cycles performed. Results: Full access to IVF after 3 years increases the TFR by 0.08 children. Applying IVF after 1 year leads to an additional TFR increase of 0.04, with double the number of IVF cycles and twin and triplet children, and a shift from naturally conceived children to IVF children. Conclusions: Full access to IVF after 3 years is important. It does increase the TFR. Early availability of IVF would further increase the TFR, but with side-effects and high costs. Key words: in vitro fertilization / assisted reproduction / total fertility rate / multiple pregnancies / IVF policy

BACKGROUND: In the Netherlands, couples with unexplained infertility and a good prognosis to conceive spontaneously (i.e. Hunault > 30%) are advised to perform timed intercourse for at least another 6 months. If couples fail to conceive within this period, they will usually start assisted reproductive technology (ART). However, treatment of unexplained infertility by ART is empirical and can involve significant burdens. Intentional endometrial injury, also called 'endometrial scratching', has been proposed to positively affect the chance of embryo implantation in patients undergoing in vitro fertilization (IVF). It might also be beneficial for couples with unexplained infertility as defective endometrial receptivity may play a role in these women. The primary aim of this study is to determine whether endometrial scratching increases live birth rates in women with unexplained infertility.METHOD: A multicentre randomized controlled trial will be conducted in Dutch academic and non-academic hospitals starting from November 2017. A total of 792 women with unexplained infertility and a good prognosis for spontaneous conception < 12 months (Hunault > 30%) will be included, of whom half will undergo endometrial scratching in the luteal phase of the natural cycle. The women in the control group will not undergo endometrial scratching. According to Dutch guidelines, both groups will subsequently perform timed intercourse for at least 6 months. The primary endpoint is cumulative live birth rate. Secondary endpoints are clinical and ongoing pregnancy rate; miscarriage rate; biochemical pregnancy loss; multiple pregnancy rate; time to pregnancy; progression to intrauterine insemination (IUI) or IVF; pregnancy complications; complications of endometrial scratching; costs and endometrial tissue parameters associated with reproductive success or failure. The follow-up duration is 12 months.DISCUSSION: Several small studies show a possible beneficial effec

Introduction The maternal age has steadily risen over the years. IVF has contributed to this trend, in particular with the introduction of donor oocyte treatment. IVF pregnancy rates are directly correlated with the age of the egg provider. However, there is less reliable data on perinatal outcomes in donor and autologous cycles. Our aim was to analyse the perinatal complication rates in women over 40 years of age who conceived with IVF using donor (DO) or autologous oocytes (AO). Methods This was a retrospective cohort study between 2000 and 2013. Women >=40 years, all pregnant after IVF using AO or DO. A total of 2824 pregnancies were identified for analysis excluding pregnancies with vitrified oocytes/embryos, GIFT, surrogacy and incomplete identifying data. Both fresh and frozen cycles were included. t test and Fisher's exact test were used where appropriate. Adjusted odds ratios (aOR) were calculated using generalised estimating equations to adjust for within-patient correlations and confounding variables. Results 2134 AO and 689 DO pregnancies were analysed. The average age (years) of the AO and DO mothers was 41.0 +/- 1.2 (mean +/- SD) and 44.5 +/-3.0 respectively and that of the oocyte donors was 32.9 +/- 4.6. There was no statistical difference between the two groups for BMI, smoking, parity and the number of embryos transferred. The DO group had a significantly higher number of treatment cycles (6.7 versus 4.8) and a lower miscarriage rate (24.4% versus 37.7%). Compared to the AO group, the aORs (95% CI) for the following obstetric complications in DO were: IUGR 1.4 (0.5-3.9); GDM 1.1 (0.6-2.0); PET 1.1 (0.5-2.6); pregnancy-induced hypertension 2.0 (0.8-4.9); placenta previa 1.8 (0.6-5.9); and surgical delivery rate 1.3 (0.8-2.1). Conclusion As expected, the miscarriage rate is lower in the DO group. However, our results suggest that the risk of obstetric complications in women >=40 years is not reduced with the use of donor oocytes from younger women.

INTRODUCTION: Recently MSC have been identified in the regenerative endometrial lining of the uterus and specific markers (W5C5/ SUSD2) for their prospective isolation identified. Postmenopausal endometrium is atrophic but regenerates with systemic estrogen treatment and has even lead to a successful IVF pregnancy in a 64 year old woman.The aim of this study was to determine whether postmenopausal endometrium contains a population of endometrial MSC (eMSC) that might be responsible for its regenerative capacity which could be exploited for future clinical applications. We hypothesized that eMSC are present in postmenopausal endometrium at similar frequency as in premenopausal endometrium. METHOD(S): Single-cell suspensions of endometrial stromal cells were obtained from hysterectomy tissues of 17 premenopausal (pre-MP), 19 postmenopausal (post-MP) and 15 postmenopausal women enrolled into a phase IV clinical trial of estrogen replacement therapy (2mg oral estradiol valerate daily) (post-MP+E2) for 8 weeks. The proliferative potential and differentiation W5C5+ cells were assessed by colony forming unit CFU assays and differentiation-induction media culture. EMSC surface markers were determined using flow cytometry. RESULT(S): In post-MP+E2 Passage 1 (P1) stromal cultures, 3.7+/-1.8% (n=7) of the cells were W5C5+ cells and 7.7+/-6.3% (n=8) in post-MP cultures (p=0.69). The cloning efficiency for post-MP+E2 W5C5+ P1 cells was 3.41+/-2.71% (n=6), and comparable to post-MP W5C5+ cells (3.73+/-1.19%; n=8) but statistically lower than P1 Pre-MP cells (p>0.05) (n=6). W5C5, CD140b, CD146, CD29, CD44, CD73, CD105 surface markers were present in both PostMP groups. PostMP W5C5+ cells differentiated into chondrocytes, adipocytes, myocytes and osteocytes, but to a lesser degree than PreMP W5C5+ cells. CONCLUSION(S): Postmenopausal endometria possess eMSC at similar frequency and potency irrespective of whether or not it is regenerated with estrogen. Human endometrium is a promis

Background: Infertility afflicts more than 10% of all couples worldwide. In vitro fertilization (IVF) is now performed at an ever increasing rate. There is scarce information concerning the associations between cardiovascular disease (CVD), venous thromboembolism (VTE) and infertility. Aims: To assess the incidence of pulmonary embolism (PE) and VTE in pregnancy after IVF. To investigate whether there is an association of CVD and infertility. To study effects of IVF on global and individual markers of haemostasis. Methods and Results: We studied all women who had given birth to a child after IVF (n=23,498) between 1990 and 2008 and individually matched women by age and calendar year (n=116,960). Information from the Swedish Medical Birth Register was linked to the Swedish National Patient Register in a cross-sectional study. The incidence of VTE was found to be increased during all pregnancy after IVF compared to pregnancy after natural conception. During the first trimester the risk was increased fourfold for VTE and sevenfold for PE. We also studied the two groups after delivery until occurrence of hypertension, stroke, coronary heart disease, diabetes mellitus or until end of follow-up (average follow-up time eight years). Both univariable and multivariable analyses showed a higher incidence of hypertension after IVF pregnancy compared to control. There was a tendency towards a higher incidence of stroke, whereas the incidence of coronary heart disease and diabetes did not differ. Furthermore we studied 31 women undergoing IVF at maximal downregulation (DR) and during high-level stimulation (HLS) of oestradiol synthesis. Antigen levels and activities of both von Willebrand factor (VWF) and ADAMTS13 in plasma were determined at DR and at HLS. Haemostasis was also assessed with 1) the calibrated automated thrombogram (CAT; measures thrombin generation), 2) overall haemostasis potential (OHP; measures fibrin formation and degradation) and 3) fibrin gel permeability

Although Edwards and Steptoe achieved the first IVF pregnancy and birth in 1978, the majority of pioneering developments in IVF during the eighties came from Australia. They included the world's first donor egg pregnancy, the first frozen embryo pregnancy and the first IVF multiple pregnancies. Australia also produced the first national guidelines for IVF practices, the first statute legislation protecting donor gamete pregnancies, and Victoria proclaimed the first statute legislation regarding control of IVF procedures. The reporting of the outcome of all IVF pregnancies began in 1980 as another world initiative.

OBJECTIVE: To identify risk factors associated with depression and anxiety in infertile women and men undergoing in vitro fertilization (IVF). DESIGN: Prospective study. SETTING: A university hospital in Sweden during a 2-year period. PATIENT(S): 825 participants (413 women and 412 men). INTERVENTION(S): Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), as the diagnostic tool for evaluating mood and anxiety disorders, and fertility history and outcome of IVF treatment collected from the patients' medical records. MAIN OUTCOME MEASURE(S): Risk factors associated with depression and anxiety disorders. RESULT(S): A negative pregnancy test and obesity were the independent risk factors for any mood disorders in women. Among men, the only independent risk factor for depression was unexplained infertility. No IVF-related risk factors could be identified for any anxiety disorder. CONCLUSION(S): A negative pregnancy test is associated with an increased risk for depression in women undergoing IVF, but no risk of developing anxiety disorders is associated with the pregnancy test result after IVF. Pregnancy test results were not a risk factor for depression or anxiety among men.

Udgivelsesdato: 2009-May, OBJECTIVE: The key enzyme in the biosynthesis of estradiol, aromatase, has been demonstrated within endometriosis. Combined administration of aromatase inhibitor and GnRH-agonist may efficiently suppress estrogen biosynthesis through a combined pituitary, ovarian, peripheral and "in situ" action. The aim of this study was to test the concept of combined down-regulation prior to IVF in patients with endometriomas. STUDY DESIGN: Prospective pilot study in a university-based tertiary fertility clinic including 20 infertile patients with endometriomas undergoing IVF/ICSI. The patients received goserelin 3.6mg sc on treatment Days 1, 28 and 56, and one daily tablet of anastrozole 1mg from Day 1 to Day 69. Controlled ovarian stimulation was initiated from Day 70. Outcome measures were change in endometriomal volume and serum CA125 during down-regulation, standard IVF parameters including pregnancy and delivery rate, and endocrine response. The paired T test and Wilcoxon Signed Rank test were used to analyse paired differences. RESULTS: During the combined down-regulation, the endometriomal volume and the serum CA125 level decreased by 29% (3-39%) and 61% (21-74%), respectively (median (95%CI), P=0.007 and P=0.001). In the IVF/ICSI cycle, the number of oocytes retrieved was 7.5 (6.0-10.0) and the fertilization rate was 0.78 (0.38-1.0). Nine patients (45%) conceived, five (25%) had a clinical pregnancy, and three (15%) delivered healthy children (two singletons and one twin). CONCLUSIONS: Prolonged combined anastrozole and goserelin down-regulation significantly reduces endometriomal volume and serum CA125, and is compatible with IVF pregnancy and delivery. However, a high pregnancy loss was noted.

BACKGROUND: Cumulative IVF pregnancy rates are compromised by the large number of couples who drop-out of treatment before achieving pregnancy. The aim of this study was to identify the role of the treatment strategy applied, and potential other factors that influence the decision of couples to discontinue treatment. METHODS: The incidence of drop-out from IVF treatment and factors related to drop-out were studied in a cohort of IVF patients aged <38 years embarking on IVF treatment either with a mild or a standard treatment strategy for a planned maximum number of treatment cycles. RESULTS: Of the 384 couples studied, 17% dropped out of IVF treatment. The physical or psychological burden of treatment was the most frequent cause of drop-out (28%). The application of a mild treatment strategy (mild ovarian stimulation along with the transfer of a single embryo) significantly reduced the chance of drop-out (hazard ratio (HR) 0.55; 95% confidence interval (CI), 0.31-0.96). When a mild IVF strategy was employed, the association between the baseline anxiety score and drop-out was reduced by >50%. The presence of severe male subfertility (HR 4.80; 95% CI, 1.63-14.13) and the failure to achieve embryo transfer (odds ratio 0.41; 95% CI, 0.24-0.72) were also related to drop-out. CONCLUSIONS: Reducing drop-out rate is crucial to further improve

OBJECTIVES: To evaluate, in pregnancies conceived by assisted reproductive technology, whether determination of gestational age (GA) by date of oocyte aspiration (DOA) or crown-rump length (CRL) at first-trimester screening influences the distribution of serum and sonographic markers or the performance of first-trimester screening for chromosomal abnormalities. METHODS: GA was calculated using either DOA or CRL at blood sampling and nuchal translucency thickness (NT) measurement in 729 singleton pregnancies conceived by in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Weight-corrected log multiples of the median (MoM) marker distributions specific for IVF pregnancy were established using multiple log regression and compared for DOA- and CRL-based GA calculation. RESULTS: GA determined by CRL was significantly larger, albeit slightly, than was GA determined by DOA, with a mean difference of 1.50 (SD, 2.4) days (P < 0.001). Log MoM distributions of free beta-human chorionic gonadotropin and NT showed that GA dating by CRL resulted in significantly higher, albeit slightly, mean log MoM values compared with DOA dating. The reverse was the case for mean log MoM pregnancy-associated plasma protein-A. The SDs were similar for CRL and DOA dating. According to Monte Carlo simulation, the use of DOA or CRL for GA dating did not appreciably influence the performance of first-trimester screening. CONCLUSIONS: DOA and CRL are practically equivalent when calculating GA for first-trimester screening. The correct method of GA dating for other purposes (e.g. estimated time of delivery) in IVF/ICSI pregnancies is still unresolved Udgivelsesdato: 2008/10

The objective of the present study was to perform comparative analysis of hair trace element content in women with natural and in vitro fertilization (IVF)-induced pregnancy. Hair trace element content in 33 women with IVF-induced pregnancy and 99 age- and body mass index-matched control pregnant women (natural pregnancy) was assessed using inductively coupled plasma mass spectrometry. The results demonstrated that IVF-pregnant women are characterized by significantly lower hair levels of Cu, Fe, Si, Zn, Ca, Mg, and Ba at p < 0.05 or lower. Comparison of the individual levels with the national reference values demonstrated higher incidence of Fe and Cu deficiency in IVF-pregnant women in comparison to that of the controls. IVF pregnancy was also associated with higher hair As levels (p < 0.05). Multiple regression analysis revealed a significant interrelation between IVF pregnancy and hair Cu, Fe, Si, and As content. Hair Cu levels were also influenced by vitamin/mineral supplementation and the number of pregnancies, whereas hair Zn content was dependent on prepregnancy anthropometric parameters. In turn, planning of pregnancy had a significant impact on Mg levels in scalp hair. Generally, the obtained data demonstrate an elevated risk of copper, iron, zinc, calcium, and magnesium deficiency and arsenic overload in women with IVF-induced pregnancy. The obtained data indicate the necessity of regular monitoring of micronutrient status in IVF-pregnant women in order to prevent potential deleterious effects of altered mineral homeostasis. © 2017, Springer Science+Business Media New York.

We studied 201 pregnancies that were established by in vitro fertilization and embryo transfer (IVF–ET) and compared the frequency of cytogenetic abnormalities with that found in a large control population matched for indication group (advanced maternal age) and time of sampling. A total of 252 IVF–ET fetuses were cytogenetically analysed by either chorionic villus sampling (CVS; n = 80) or amniocentesis (n = 172). Eleven chromosome abnormalities were found in the CVS group (13·8 per cent); among them, a 45, X/46, X, dic(q11)/46, X, del(Y)(q11) mosaic that was found in an IVF pregnancy established by intracytoplasmic sperm injection (ICSI), four cases of trisomy 21, and three cases of trisomy 7 confined to the placenta. The results indicate a statistically significant three‐to five‐fold increase in both confined placental abnormalities (P<0·008) and true fetal chromosome anomalies (P<0·04). In the amniocentesis group, identical rates (1·7 per cent) of chromosome abnormalities were found in the IVF–ET and control groups. It is concluded that late first trimester, but not early second trimester, IVF–ET pregnancies

Uterine fibroids are one of the most common diseases in reproductive-aged women, a risk factor for infertility, and reproductive failures. Patients with uterine fibroids are now managed by different strategies, including conservative treatment with high-efficacy gonadotropin-releasing hormone (GnRH) agonists. Objective. To evaluate the efficiency of conservative therapy with GnRH agonist (buserelin long) for uterine fibroids. To assess the results of IVF treatment for infertility and the course and outcome of pregnancy after using GnRH agonists for the therapy of uterine fibroids. To substantiate pathogenetic GnRH agonist therapy as part of pregravid preparation in patients with infertility and uterine fibroids. Subjects and methods. A retrospective comparative study of pregnancy outcomes was performed in 69 women with uterine fibroids and infertility. The inclusion criteria were age younger than 45 years, an anti-Mullerian hormone concentration of >1.0 pg/ml, the absence of severe extragenital pathology, the presence of types 2–6 fibroids, and good-quality embryos. Conclusion. The use of GnRH agonists (buserelin long) as part of comprehensive pregravid preparation is a highly effective conservative treatment for uterine fibroids. After GnRH agonist therapy, there was a significant increase in IVF pregnancy rates as compared to population-based rates The low rate of gestational complications in pregnant women who had received GnRH agonist therapy for uterine fibroids before entry into the IVF program indicates the validity of this management tactics for infertility concurrent with uterine fibroids. © 2017, Bionika Media Ltd. All Rights Reserved.

Three lines of research focus on the influence of positive psychological factors and processes on psychological and physical well-being. In Part I, the unique and shared predictive power of dispositional optimism on women's biological (ovarian) response to fertility treatment was examined. The results suggested that rather than dispositional optimism having direct benefits on ovarian response, this construct shared variance with a broader psychological dimension, and that this dimension compromised biological response. In Part II, a self-administered positive reappraisal coping intervention (PRCI) was developed, and then used by women waiting for an IVF pregnancy test. The effects of the PRCI on psychological well-being and pregnancy rates, compared to controls were examined. The results suggested that the PRCI helped to sustain positive reappraisal coping efforts and other coping efforts, but had no effect on mood or impact on pregnancy rates compared to routine care. In Part III, an experimental paradigm emulating an unresolved period of persistent stress in a medical context was developed (the USP). Reactions became, and remained, persistently negative in response to the USP. The USP was then employed in a test of the "goodness-of-fit" hypothesis, where the influence of dispositional and situational factors on situational coping was examined. The results showed that a manipulation of situational factors had a transient influence on escapism coping and emotional well-being whereas dispositional factors had a more pervasive influence. Overall, this thesis demonstrates that both dispositional and situational influences have important effects on emotional well-being and physical outcomes and that it is important that neither should be completely overlooked in favour of the other.

Three lines of research focus on the influence of positive psychological factors and processes on psychological and physical well-being. In Part I, the unique and shared predictive power of dispositional optimism on women's biological (ovarian) response to fertility treatment was examined. The results suggested that rather than dispositional optimism having direct benefits on ovarian response, this construct shared variance with a broader psychological dimension, and that this dimension compromised biological response. In Part II, a self-administered positive reappraisal coping intervention (PRCI) was developed, and then used by women waiting for an IVF pregnancy test. The effects of the PRCI on psychological well-being and pregnancy rates, compared to controls were examined. The results suggested that the PRCI helped to sustain positive reappraisal coping efforts and other coping efforts, but had no effect on mood or impact on pregnancy rates compared to routine care. In Part III, an experimental paradigm emulating an unresolved period of persistent stress in a medical context was developed (the USP). Reactions became, and remained, persistently negative in response to the USP. The USP was then employed in a test of the "goodness-of-fit" hypothesis, where the influence of dispositional and situational factors on situational coping was examined. The results showed that a manipulation of situational factors had a transient influence on escapism coping and emotional well-being whereas dispositional factors had a more pervasive influence. Overall, this thesis demonstrates that both dispositional and situational influences have important effects on emotional well-being and physical outcomes and that it is important that neither should be completely overlooked in favour of the other.

Infertility due to spinal cord injury (SCI) in males has been identified for decades as an area of major concern and techniques for assisted ejaculation are available. There has not been an overall consensus regarding which type of assisted procreation is the most appropriate for these couples. We describe here our experience from a programme based on assisted ejaculation combined with in vitro fertilization (IVF). Twelve couples have been treated so far and altogether 22 cycles with ovum pick-up have been completed. Fertilisation of the oocytes was obtained in 18 of these cycles. The overall oocyte fertilisation rate was 49%. Embryo transfer took place in 17 cycles, leading to seven clinical pregnancies. Four of the pregnancies are delivered or are ongoing, whereas three ended in first trimester spontaneous abortion. Thus our initial experience suggests that assisted ejaculation in combination with IVF is an effective option for these couples.