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Study question Are patients aware of their fertiltiy risk factors (i.e. capable of understanding and making decision regarding their reproductive health)? Summary answer There are fertiltiy risk factors (e.g., hormonal levels and sperm parameters) that patients do not know are necessary to test or simply do not know. What is known already The fertility rate of both women and men has been declining in both developed (1/6 couples' infertile) and developing countries (1/4 couples' infertile). To these couples, it takes them 3.2 years to be diagnosed and a further 1.6 years before being assessed by a fertility specialist. On average it can take up to 7 years to have a baby for these couples and most quit due to emotional ando financial distress. The knowledge people have about their fertility health (quality and relevance) impacts their decision to seek a medical diagnosis and eventual treatment. Study design, size, duration Questionnaire development and validation Participants/materials, setting, methods Participants & Methods: Reproductive health professionals (N = 5) - questionnaire Pre-screen, patients TTC (N = 16) - interview Patients TTC (target population): N = 943 ( Females N = 497, Males N = 446) - website questionnaire (https://www.efp.clinic/frdt/) Main results and the role of chance The final FRDT is composed of 90 questions, related to female and male health (contextual questions, cycle and ovarian reserve, gynaecological history and health, sperm and male health, genetic predisposition, intake of supplements, lifestyle choices and behaviours, environment). We collected 497 answers from female patients. The most common factors that influenced infertility included abdominal/pelvic surgery, hormonal problems, sexually transmitted infections, endometriosis and uterine fibroids, and 341 (68,6%) had been trying for more than 12 months, being considered infertility (WHO). The most represented demographic was women under 35 years of age. We were also able to collect 446 answers from male participants. The most common factors that influenced infertility included autoimmune disease, poor sperm parameters like concentration, count, motility and morphology, surgery to correct a deformity (penis or inguinal hernia), sexual dysfunction, and sexually transmitted disease, and 312 (70,0%) had been trying for more than 12 months, being considered infertility (WHO). The most represented demographic was under 40 years of age. Limitations, reasons for caution A new version of the FRDT has been uploaded with further screening of previous treatments tried and consequent results. Female patients tend to answer for their male partners. Wider implications of the findings Younger people (women under 38 yo and men under 40 yo) are struggling to conceive for long periods of time (>12 months) and aren't aware of key fertility factors, which may be a reason for their inability to conceive and/or look for medical help effeciently. Trial registration number not applicable

In this paper I analyse Francisco Sánchez's role in the Quaestio de certitudine mathematicarum debate. Despite some studies on the philosophical and medical scepticism of Sánchez and, his extant letter with Christopher Clavius, a participant in the debate, we have few analyses about Sánchez's position regarding the certainty of mathematics. Sánchez discussed some problems that Clavius analysed in his Prolegomena to propose an empirical basis for mathematics through a questioning of its certainty. I will trace the conceptual connections between Sánchez's 1589 letter to Clavius and the Quaestio debate, to introduce Sánchez's sceptical approach to analysing the certainty of mathematics.

This short paper aims to present some philosophical considerations about the relationship between credibility and the uses of evidence. The point of view regarding evidence and scientific and political decisions in this paper focuses on the current world situation of the COVID-19.

Patient: Male, 62 Final Diagnosis: Condyloma acuminatum Symptoms: Urinary retention Medication: — Clinical Procedure: Cystoscopy Specialty: Urology Objective: Unusual clinical course Background: A condyloma acuminatum is a sexually transmitted, human papillomavirus (HPV) associated, neoplasm. In men, it is predominantly found on external genitalia and rarely progresses more proximally than the distal penile urethra. Condyloma acuminata of the prostatic urethra are rare and are usually seen as an extension of, or in association with external lesions. Therefore, it is not typically considered in the differential diagnosis of isolated papillary lesions limited to the prostatic urethra. Case Report: A 62-year-old male with rheumatoid arthritis treated with abatacept presented to urology due to a history of intermittent bladder self-catheterization for urinary obstruction. He underwent a transurethral resection of the prostate and had incidental findings of papillary lesions restricted to the prostatic urethra that were presumed to be urothelial carcinoma. Microscopic examination established the diagnosis of condyloma acuminata, and low-risk HPV 6 and 11 were detected by in-situ hybridization. Subsequent cystoscopy showed marked growth and extension of condyloma acuminata to near the external meatus. After multiple treatments with intraurethral 5-fluorouracil, several small lesions remained in the bulbous urethra. With follow up for 2 years since diagnosis, the patient has not developed external condylomata. Conclusions: A condyloma acuminatum might present as an isolated papillary growth in the prostatic urethra without clinical or historical evidence of a visible lesion on external genitalia. Immunosuppression and/or urethral instrumentation might be a risk factor for such a presentation. Urologists and pathologists should be aware of this rare possibility in order to avoid misdiagnosis, and ensure that the patient receives appropriate therapy.

Patient: Male, 61 Final Diagnosis: Urothelial carcinoma • lipid-rich variant • metastatic Symptoms: Hematuria Medication: — Clinical Procedure: Transurethral resection of bladder tumour (TURBT) Specialty: Urology Objective: Rare co-existance of disease or pathology Background: The lipid-rich variant is a rare and aggressive type of urothelial carcinoma (UCa), with less than 40 cases reported in the literature. This variant usually presents as an advanced-stage primary tumor. Case Report: We report the case of a 61-year-old man with previous history of T1 high-grade conventional urothelial carcinoma treated with local therapy. The patient later presented with a new 6.5-cm exophytic bladder mass. Histopathological examination revealed a T2 urothelial carcinoma of the lipid-rich variant. Retrospective review of the previous biopsies confirmed conventional high-grade urothelial carcinoma, but scattered rare individual or small clusters of cells that resemble the lipid-rich variant urothelial carcinoma were also noted. Conclusions: The findings in this case suggest that the differential sensitivity of conventional urothelial carcinoma to local therapy may have allowed the lipid-rich variant to predominate in the recurrence. Pathologists should be aware of the lipid-rich variant of urothelial carcinoma. The prognostic significance of rare lipoblast-like cells among predominantly conventional urothelial carcinoma may requires further study.

An introduced species’ invasion success may be facilitated by the release of natural enemies, like parasites, which may provide an invader with a competitive advantage over native species (enemy release hypothesis). Lower parasite infection levels in introduced versus native populations have been well documented. However, any potential competitive advantage will depend on whether native competitors exhibit higher parasite loads than introduced hosts and whether native hosts suffer more (e.g., reduced reproduction or growth) from parasite infections than introduced hosts. In this study, we compared macroparasite richness, prevalence, and intensity in sympatric populations of one native and two introduced brachyuran crab hosts in the centre of their European range. While the native green crab Carcinus maenas (Linnaeus, 1758) hosted three parasite groups (acanthocephalans, microphallid trematodes, rhizocephalans), the two invasive crab species Hemigrapsus sanguineus (De Haan, 1835) and H. takanoi Asakura and Watanabe, 2005 were only infected with acanthocephalans. All acanthocephalans were molecularly identified (COI) as the native Profilicollis botulus (Van Cleave, 1916). Prevalence and intensities of P. botulus were generally lower in the introduced than in the native crabs. Metacercariae of microphallid trematodes were only found in the native C. maenas, with mean infection levels of 100–300 metacercariae per host, depending on geographical location. Likewise, the castrating rhizocephalan barnacle Sacculina carcini Thompson, 1836 was only found in C. maenas at a few locations with low prevalences (< 3%). This first study on infection levels in invasive Hemigrapsus species in Europe indicates that these invasive crabs indeed experience lower infection levels than their native competitor C. maenas. Future experiments are needed to investigate whether this difference in infection levels leads to a competitive advantage for the invasive crab species.

The aim of the study is to investigate the meiotic segregation in fresh eggs from anonymous egg donors and to analyze the baseline levels of aneuploidy in this population.The study includes the largest series of donor eggs so far studied: 203 eggs from donors aged between 20 and 31 years. No diagnosis was obtained in 10.8 % of cases (22/ 203). The biopsy of the first and second polar bodies was completed in a sequential manner on day 0 and day 1 of embryo development. Chromosomes 13, 16, 18, 21 and 22 are analyzed by means of the FISH test. The diagnosable fertilized eggs gave an aneuploidy rate of 19.1 % (31/162), with 83.8 % (26/31) of the errors produced during meiosis I, 12.9 % (4/31) produced during meiosis II, and 3.2 % (1/31) produced during both meiosis I and II. The premature division of sister chromatids is the main source of meiotic error during Meiosis I, resulting in the creation of oocyte aneuploidy.FISH analysis of the first and second polar body in donor oocytes gave an aneuploidy rate of 19.1 %. This study shows the majority of errors occur during Meiosis I.

BACKGROUND: Sister chromatid cohesion is essential for ordered chromosome segregation at mitosis and meiosis. This is carried out by cohesin complexes, comprising four proteins, which seem to form a ring-like complex. Data from animal models suggest that loss of sister chromatid cohesion may be involved in age-related non-disjunction in human oocytes. Here, we describe the distribution of cohesins throughout meiosis in human oocytes. METHODS: We used immunofluorescence in human oocytes at different meiotic stages to detect cohesin subunits REC8, STAG3, SMC1 beta and SMC3, [also synaptonemal complex (SC) protein 3 and shugoshin 1]. Samples from euploid fetuses and adult women were collected, and 51 metaphase I (MI) and 113 metaphase II (MII) oocytes analyzed. SMC1 beta transcript levels were quantified in 85 maturing germinal vesicle (GV) oocytes from 34 women aged 19-43 years by real-time PCR. RESULTS: At prophase I, cohesin subunits REC8, STAG3, SMC1 beta and SMC3 overlapped with the lateral element of the SC. Short cohesin fibers are observed in the oocyte nucleus during dictyate arrest. All four subunits are observed at centromeres and along chromosomal arms, except at chiasmata, at MI and are present at centromeric domains from anaphase I to MII. SMC1 beta transcripts were detected (with high inter-sample variability) in GV oocytes but no correlation between SMC1 beta mRNA levels and age was found. CONCLUSIONS: The dynamics of cohesins REC8, STAG3, SMC1 beta and SMC3 suggest their participation in sister chromatid cohesion throughout the whole meiotic process in human oocytes. Our data do not support the view that decreased levels of SMC1 beta gene expression in older women are involved in age-related non-disjunction.

BACKGROUND: Comparative genomic hybridization (CGH) is a valuable alternative to fluorescence in situ hybridization (FISH) for preimplantation genetic screening (PGS) because it allows full karyotype analysis. However, this approach requires the cryopreservation of biopsied embryos until results are available. The aim of this study is to reduce the hybridization period of CGH, in order to make this short-CGH technique suitable for PGS of Day-3 embryos, avoiding the cryopreservation step. METHODS: Thirty-two fibroblasts from six aneuploid cell lines (Coriell) and 48 blastomeres from 10 Day-4 embryos, discarded after PGS by FISH with 9 probes (9-chr-FISH), were analysed by short-CGH. A reanalysis by the standard 72 h-CGH and FISH using telomeric probes was performed when no concordant results between short-CGH and FISH diagnosis were observed. The short-CGH was subsequently applied in a clinical case of advanced maternal age. RESULTS: In 100% of the fibroblasts analysed, the characteristic aneuploidies of each cell line were detected by short-CGH. The results of the 48 blastomeres screened by short-CGH were supported by both 72 h-CGH results and FISH reanalysis. The chromosomes most frequently involved in aneuploidy were 22 and I 6, but aneuploidies for the other chromosomes, excepting I , 10 and 13, were also detected. Forty-one of the 94 aneuploid events observed (43.6%) corresponded to chromosomes which are not analysed by 9-chr-FISH. CONCLUSIONS: We have performed a preliminary validation of the short-CGH technique, including one clinical case, suggesting this approach may be applied to Day-3 aneuploidy analysis, thereby avoiding embryo cryopreservation and perhaps helping to improve implantation rate after PGS.

Objective To ascertain whether embryos classified by preimplantation genetic diagnosis (PGD) for infertility as abnormal and then plated to obtain stem cells would self-correct partially or totally in culture, producing disomic stem cells. Design Prospective study to determine the chromosome status of embryos on day 3 and 6, as well as cultured cells derived from inner cell masses from the same embryos when cultured up to day 12. Setting Research laboratory. Patient(s) Patients undergoing PGD of aneuploidy. Intervention(s) Of 142 embryos classified by PGD for aneuploidy as abnormal, 50 were cultured to the blastocyst stage. At that stage a fraction of the embryos underwent trophectoderm biopsy to reconfirm the PGD diagnosis. After further co-culture with feeders up to day 12, 34 embryos attached to the feeder cells. Of those, 24 were analyzed by fluorescence in situ hybridization (FISH) and the rest for the expression of Oct-4, SSEA-3, SSEA-4, TRA1-60, and TRA1-80. Main Outcome Measure(s) Disomic cells obtained from trisomic embryos. Result(s) Analysis by FISH of day-12 cultures showed that 7 were totally normal, 6 were mostly abnormal, and 11 had experienced some chromosome normalization, having between 21% and 88% normal cells. Day-12 culture was positive for Oct-4 expression by reverse transcriptase polymerase chain reaction analysis and for SSEA-3, SSEA-4, TRA1-60, and TRA1-80 by immunocytochemistry. Conclusion(s) Chromosome self-normalization occurs in a significant proportion of chromosomally abnormal embryos, possibly because of the loss of a chromosome in trisomic cells after blastocyst stage. Thus chromosomally abnormal embryos are a potential source of disomic stem cells. Not all chromosomally abnormal embryos self-corrected. Abnormal stem cells that might be derived could be used as models to study the effect of chromosomal abnormalities on human development.

The purpose of this study was to find specific rates of aneuploidy in cleavage-stage embryos compared with first trimester data and to evaluate post-zygotic selection against aneuploidy. A total of 2058 embryos were analysed by flurorescence in-situ hybridization (FISH), and specific aneuploidy rates were obtained for 14 chromosomes. Data from morphologically abnormal embryos could be pooled with data from preimplantation genetic diagnosis (PGD) cycles because it was observed that they had similar rates of aneuploidy; thus, for the purpose of studying aneuploidy they could be, and were, pooled. Specific chromosome aneuploidy rates were not related to morphology or development of the embryos. The average maternal age of patients with aneuploid embryos was significantly higher than the overall analysed population. Monosomy appeared more commonly than trisomy. The chromosomes most frequently involved in aneuploidy were (in order) 22, 16, 21 and 15. When compared with first trimester pregnancy data, aneuploidies detected at cleavage stage seem to die in excess of 90% before reaching first trimester, with the exception of chromosome 16 and gonosomes (76% and 14% respectively). Differences in chromosome-specific aneuploidy rates at first trimester conceptions are probably produced by different chromosome-specific aneuploidy rates at cleavage stage and different survival rates to first trimester.

Embryo screening for aneuploidy (AS) is part of preimplantation genetic diagnostics (PGD) and is aimed at improving the efficiency of assisted reproduction. Currently, several technologies, including the well-established fluorescence in situ hybridization (FISH) technique, cover the screening of all chromosomes in a single cell. This study evaluates a novel 24-chromosome FISH technique protocol (FISH-24). A total of 337 embryos were analyzed using the traditional 9-chromosome FISH technique (FISH-9) while 251 embryos were evaluated using the new FISH-24 technique. Embryos deemed nontransferable on Day 3 were cultured in vitro to Day 5 of development, then fixed and reanalyzed according to the technique allocated to each treatment cycle (107 embryos analyzed by FISH-9 and 111 by FISH-24). The global error rate (discrepancy between Day 3 and Day 5 results for a single embryo) was 2.8% after FISH-9 and 3.6% after FISH-24, with a p value of 0.95. Thus, we have established and validated a 24-chromosome FISH-based single cell aneuploidy screening technique, showing that the error rate obtained for FISH-24 is independent of the number of chromosomes analyzed and equivalent to the error rate observed for FISH-9, as a useful tool for chromosome segregation studies and clinical use.

Exposure of in vitro cultured human embryos to microvibrations can improve embryo development, but music as a source of mechanical vibrations has not yet been explored. To determine the effect of the exposure to music during in vitro culture, 967 oocytes (114 patients) were analyzed. Before insemination, oocytes from each patient were randomly assigned to two groups: embryo culture exposed to music (479 oocytes), and embryo culture without music (488 oocytes). Three different types of music were also tested: pop, heavy metal and classical. Fertilization rates and embryo quality (score, cleavage stage and multinucleation) were compared using a generalized linear mixed model (two levels were considered) and analyzed by means of Bayesian inferences using Integrated Nested Laplace (INLA). Results showed that fertilization rates were 4.82% higher when oocytes were exposed to music but no statistically significant differences were found regarding embryo quality on Day 2. Moreover, no statistically significant difference was observed between the different types of music played (pop, heavy metal and classical). As a conclusion, the routine use of music inside incubators during in vitro culture could be a useful tool to improve fertilization rates. The effect of music on embryo development up to Day 5 should be evaluated.

This paper presents a methodology based on a genetic algorithm guided by a multiobjective index to evaluate the optimal siting and sizing of Distributed Generation in an electrical system. The objective function consists in improving the voltage profile, minimizing active power losses, emissions and reducing the investment costs. The proposed methodology was tested on a 34bus system showing satisfactory results.

We assess the coverage of a Prevention of Mother-to-child Transmission (PMTCT) programme in Busia (Kenya) from 1 January 2006 to 31 December 2008 and estimate the risk of transmission of HIV. We also estimate the odds of HIV transmission according to pharmacological intervention received. Programme coverage was estimated as the proportion of mother-baby pairs receiving any antiretroviral (ARV) regimen among all HIV-positive women attending services. We estimated the mother-to-child transmission (MTCT) rate and their 95% confidence interval (95%CI) using the direct method of calculation (intermediate estimate). A case-control study was established among all children born to HIV-positive mothers with information on outcome (HIV status of the babies) and exposure (data on pharmacological intervention). Cases were all HIV-positive children and controls were the HIV-negative ones. Exposure was defined as: (1) complete protocol: ARV prescribed according World Health Organisation recommendations; (2) partial protocol: does not meet criteria for complete protocol; and (3) no intervention: ARVs were not prescribed to both mother and child. Babies were tested using DNA Polymerase Chain Reaction at six weeks of life and six weeks after breastfeeding ceased. In the study period, 22,566 women accepted testing, 1668 were HIV positive (7.4%; 95%CI 7.05-7.73); 1036 (62%) registered in the programme and 632 were lost. Programme coverage was 40.4% (95%CI 37.9-42.7). Out of the 767 newborns, 28 (3.6%) died, 148 (19.3%) defaulted, 282 (36.7%) were administratively censored and 309 (40.2%) babies completed the follow-up as per protocol; 49 were HIV positive and MTCT risk was 15.86% (95%CI 11.6-20.1). The odds of having an HIV-positive baby was 4.6 times higher among pairs receiving a partial protocol compared to those receiving a complete protocol and 43 times higher among those receiving no intervention. Our data show a good level of enrolment but low global coverage rate. It demonstrates that ARV regimens can be implemented in low resource rural settings with marked decreases of MTCT. Increasing the coverage of PMTCT programmes remains the main challenge.

The short comparative genomic hybridization (short-CGH) method was used to perform a comprehensive cytogenetic study of isolated blastomeres from advanced maternal age embryos, discarded after fluorescent in situ hybridization (FISH) preimplantation genetic screening (PGS), detecting aneuploidies (38.5% of which corresponded to chromosomes not screened by 9-chromosome FISH), structural aberrations (31.8%), and mosaicism (77.3%). The short-CGH method was subsequently applied in one PGS, achieving a twin pregnancy.

Processing of semen for assisted reproductive technologies (ART) entails a number of procedures that include semen liquefaction, removal of seminal plasma by centrifugation, incubation, and cryopreservation. The results of this study indicate that incubation of semen at room temperature and semen cryopreservation can result in increased levels of sperm DNA fragmentation.

Endometrial receptivity is a primary concern for embryo implantation success in fertility treatments. The present study was a retrospective analysis of 4070 cycles with donor oocytes and hormone-replacement therapy. Endometrial thickness was assessed once with transvaginal ultrasound. Patients were allowed to continue when endometrial thickness was ≥5 mm and had triple line morphology. Pregnancy rates, the number of gestational sacs and miscarriage rates were analysed in relation to endometrium status. Regression models were used to analyse associations, taking the day of embryo transfer into account. All patient parameters were homogeneous. Mean endometrial thickness was 7.24 ± 1.66 mm, the mean number of embryos transferred was 2.04 ± 0.43, the pregnancy rate was 48.06% and sacs were present in 42.3% of cycles. There were no significant differences in pregnancy rates, number of gestational sacs and miscarriage rates for different endometrial thickness measurements. The present study is, to our knowledge, the largest study evaluating the role of endometrial thickness in oocyte donation cycles. Endometrial thickness >5 mm is a reasonable parameter for determining treatment success, and once it is observed in a single ultrasonographic evaluation there is no need for subsequent monitoring and embryo transfer can be scheduled over the following 1–16 days, because the results are not compromised. This may lead to a significant reduction in time and cost in fertility clinics.

The aim of this study was evaluate cortical granule (CG) distribution during in vitro maturation (IVM) and fertilisation of prepubertal goat oocytes compared to CG distribution of ovulated and in vitro fertilised oocytes from adult goats. Oocytes from prepubertal goats were recovered from a slaughterhouse and were matured in M199 with hormones and serum for 27 hr. Ovulated oocytes were collected from gonadotrophin treated Murciana goats. Frozen-thawed spermatozoa were selected by centrifugation in percoll gradient and were capacitated in DMH with 20% steer serum for 1 hr. Ovulated and IVM-oocytes were inseminated in DMH medium with steer serum and calcium lactate for 20 hr. Oocytes and presumptive zygotes were stained with FITC-LCA (Lens culinaris agglutinin labelled with fluorescein isothiocyanate) and observed under a confocal laser scanning microscope. Ultrastructure morphology of oocytes and presumptive zygotes were analysed by transmission electron microscopy (TEM). Prepubertal goat oocytes at germinal vesicle stage show a homogeneous CG distribution in the cytoplasm. IVM-oocytes at Metaphase II (MII) and ovulated oocytes presented CGs located in the cortex with the formation of a monolayer beneath to the plasma membrane. At 20 hr postinsemination (hpi), zygotes from IVM-oocytes showed a complete CG exocytosis whereas zygotes from ovulated oocytes presented aggregates of CGs located at the cortical region. Images by TEM detected that CGs were more electrodense and compacts in oocytes from prepubertal than from adult goats.

BACKGROUND Ductal carcinoma in situ (DCIS) represents 20% of newly diagnosed breast carcinoma cases. Historically, the incidence of axillary metastasis in DCIS has been small (1–2%) and its significance has been debated. It is widely known that serial sections of lymph nodes coupled with keratin immunohistochemistry (IHC) increases identification of micrometastasis. The advent of sentinel lymph node evaluation underscores the need to reevaluate the significance of occult micrometastases in DCIS. METHODS Patients with DCIS and negative axillary lymph nodes from 1974 to 1992 were selected from the Saint Barnabas Medical Center Tumor Registry. All diagnoses were confirmed, and paraffin blocks were retrieved after acceptance into the study. Seven serial sections were obtained from each block and evaluated with two cytokeratin IHC stains. Clinical follow-up ranged from 10 to 28 years. RESULTS One hundred two patients were included in the study. Micrometastases were identified in 13 patients (13%), mostly on 1 level and composed of microscopic clusters in the subcapsular sinus. Seven of these lymph node–positive patients (58%) had high-grade comedo DCIS, 4 (33%) had intermediate grades of various types of DCIS, and one had a low-grade micropapillary DCIS. The overall disease recurrence rate was 12%, but micrometasis was not detected in any of the patients who developed disease recurrence. CONCLUSIONS Serial IHC evaluation of lymph nodes dramatically increased the identification of occult micrometastasis. However, IHC detected micrometastasis has no apparent clinical significance in DCIS, based on the current long-term clinicopathologic study. Therefore, the authors questioned the significance of occult micrometastasis, identified by IHC, in DCIS of any type and extent. Further evaluation and follow-up of lymph node micrometastases in patients with invasive tumors of various sizes are needed. The current findings would not support altering the stage of patients with DCIS and micrometastasis detected by IHC only. Cancer 2003. © 2003 American Cancer Society.

One of the most critical steps in preimplantation genetic diagnosis (PGD) studies is the fixation required to obtain good fluorescence in-situ hybridization (FISH) nuclear quality without losing any of the cells analysed. Different fixation techniques have been described. The aim of this study was to compare three fixation methods (1, acetic acid/methanol; 2, Tween 20; 3, Tween 20 and acetic acid/methanol) based on number of cells lost after fixation, average rate of informative cells, rate of signal overlaps and FISH errors. A total of 100, 106 and 114 blastomeres were fixed using techniques 1, 2 and 3 respectively. Technique 2 gave the poorest nuclear quality with higher cytoplasm, number of overlaps and FISH errors. Although technique 1 showed better nuclear quality in terms of greater nuclear diameter, fewer overlaps and FISH errors, it is difficult to perform correctly. However, technique 3 shows reasonably good nuclear quality and is both easier to learn and use for PGD studies than the others.

Introduction: Embryo transfer (ET) techniques and modifications have been extensively studied recently as one the main variables affecting in vitro fertilization (IVF) pregnancy rates; many of ET independent variables have been studied with discordant results: A better understanding of endometrial movements could help improve ET efficiency and IVF success. Objectives: The aim of this study was to record and study microdrop in utero movements after ET by ultrasound (US). Materials and Methods: 18 patients underwent pelvic US for 4 h following ET, at 15 min intervals. ET occurred on day + 3 of embryo development following IVF stimulation. The microdrop that contained the embryos consisted of 25 ΅L of culture media and was randomly placed 1-3 cm from the fundus. Results: The microdrop could be seen leaving the catheter and deposited in the final 3 cm of the uterine cavity. In the following US, endometrial wave movements flowing from the cervix to fundus and fundus to cervix could clearly be seen, and these waves started at both ends simultaneously. The microdrop moved from the fundus to about 1 cm from the isthmus, and back again. There were times when it was virtually stationary. In all cases, after 1 h the microdrop had moved from its original position. The intensity of the endometrial movements was different in every patient. Discussion: The endometrial waves that start immediately after ET probably serve to keep the embryo within the uterine cavity, and to select the most appropriate place for implantation. This study shows for the first time microdrop movements after ET. Given this endometrial activity, we should not be concerned about positioning the embryo correctly at transfer as simply ensuring the catheter is within the uterine cavity should be enough, avoiding endometrial damage.