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Research question Ovarian stimulation during IVF cycles involves close monitoring of oestradiol, progesterone and ultrasound measurements of follicle growth. In contrast to blood draws, sampling saliva is less invasive. Here, a blind validation is presented of a novel saliva-based oestradiol and progesterone assay carried out in samples collected in independent IVF clinics. Design Concurrent serum and saliva samples were collected from 324 patients at six large independent IVF laboratories. Saliva samples were frozen and run blinded. A further 18 patients had samples collected more frequently around the time of HCG trigger. Saliva samples were analysed using an immunoassay developed with Salimetrics LLC. Results In total, 652 pairs of saliva and serum oestradiol were evaluated, with correlation coefficients ranging from 0.68 to 0.91. In the European clinics, a further 237 of saliva and serum progesterone samples were evaluated; however, the correlations were generally poorer, ranging from –0.02 to 0.22. In the patients collected more frequently, five out of 18 patients (27.8%) showed an immediate decrease in oestradiol after trigger. When progesterone samples were assessed after trigger, eight out of 18 (44.4%) showed a continued rise. Conclusions Salivary oestradiol hormone testing correlates well to serum-based assessment, whereas progesterone values, around the time of trigger, are not consistent from patient to patient.

Inactivating variants in the centrosomal CEP78 gene have been found in cone-rod dystrophy with hearing loss (CRDHL), a particular phenotype distinct from Usher syndrome. Here, we identified and functionally characterized the first CEP78 missense variant c.449T>C, p.(Leu150Ser) in three CRDHL families. The variant was found in a biallelic state in two Belgian families and in a compound heterozygous state-in trans with c.1462-1G>T-in a third German family. Haplotype reconstruction showed a founder effect. Homology modeling revealed a detrimental effect of p.(Leu150Ser) on protein stability, which was corroborated in patients' fibroblasts. Elongated primary cilia without clear ultrastructural abnormalities in sperm or nasal brushes suggest impaired cilia assembly. Two affected males from different families displayed sperm abnormalities causing infertility. One of these is a heterozygous carrier of a complex allele in SPAG17, a ciliary gene previously associated with autosomal recessive male infertility. Taken together, our data indicate that a missense founder allele in CEP78 underlies the same sensorineural CRDHL phenotype previously associated with inactivating variants. Interestingly, the CEP78 phenotype has been possibly expanded with male infertility. Finally, CEP78 loss-of-function variants may have an underestimated role in misdiagnosed Usher syndrome, with or without sperm abnormalities. ispartof: Human Mutation vol:41 issue:5 pages:998-1011 ispartof: location:United States status: published

Background: Gonadotropin therapy and laparoscopic ovarian drilling (LOD) are treatment options for ovulation induction (OI) in clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients. The current evidence of the cost-effectiveness of both treatments is scarce, conflicting and performed from different health-economic perspectives. Methods: A retrospective health-economic evaluation was performed from a societal perspective in which human menopausal gonadotropin (hMG) therapy (n = 43) was compared with LOD (n = 35), followed by OI with CC and/or hMG if spontaneous ovulation did not occur within 2 months. Data were collected until the patients were pregnant, with a time limit of 6 months after the onset of treatment. Outcomes were expressed as ongoing pregnancy rate and number of live-born children. Results: The ongoing pregnancy rate was 21/35 (60%) after LOD and 30/43 (69.8%) after hMG treatment (relative risk 0.85, 95% CI 0.61-1.19). The societal cost per patient, up to an ongoing pregnancy, was significantly higher after LOD versus hMG treatment (adjusted mean difference EUR 1,073, 95% CI 180-1,967). Conclusion: This economic evaluation based on real-life data shows that the societal cost up to an ongoing pregnancy is less after hMG treatment when compared with LOD surgery in CC-resistant PCOS patients.

PURPOSE OF REVIEW Traditionally, ovarian stimulation for IVF/intracytoplasmic sperm injection is performed by healthcare professionals, requiring the patient to make frequent visits to these centres. We describe the rationale, research findings and early clinical experience with home-based sonography for IVF patients. RECENT FINDINGS Published experience indicates that selected patients are able to procure video sequences themselves; they value the empowerment, discretion and decreased stress involved in these visits; partner involvement increases as well. SUMMARY Experience is still limited but consistently indicate patients' willingness and competence to procure sonograms; home sonography is positive from the patients' perspective but may be disruptive form the healthcare provider's point of view.

Approximately five million children have been born worldwide as a result of assisted reproductive technology (ART). These techniques are now practised independently in most of the world's nations. Although the vast majority of ART parents and children are healthy following the procedures involved, there is an imperative to maintain a high standard of practice and monitor outcomes carefully. Interpretation of outcome data is difficult for a variety of reasons. As ART technologies evolve and new variants are established, the need for robust assessment of outcomes increases. This book gives a thorough review of potential complications of ART, with detailed analysis of outcome data for the various conditions described. A worldwide perspective is given throughout, with an international team of chapter authors.

STUDY QUESTION: Do overweight women with polycystic ovary syndrome (PCOS) have a higher risk of perinatal complications than normal weight women with PCOS? SUMMARY ANSWER: Overweight women with PCOS with an ongoing singleton pregnancy have an increased risk of preterm birth as well as an increased risk of giving birth to a baby with a higher birthweight than normal weight women with PCOS. WHAT IS KNOWN ALREADY: There is evidence that overweight (BMI > 25 kg/m²) has a negative influence on the prevalence of gestational diabetes mellitus and fetal macrosomia in women with PCOS. STUDY DESIGN, SIZE, DURATION: We set up a retrospective comparative cohort study of 93 overweight (BMI ≥ 25 kg/m²) and 107 normal weight (BMI < 25 kg/m²) women with PCOS who were scheduled for fertility treatment between January 2000 and December 2009 and achieved a pregnancy as a result of a treatment cycle, or spontaneously before or between treatment cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS: All data (patient characteristics, medical information, pregnancy, delivery and neonatal outcome) were retrieved from patient medical files. All pregnancy, delivery and neonatal outcome parameters were adjusted for age and pre-pregnancy smoking behaviour. The neonatal outcome parameters were additionally adjusted for gestational age. MAIN RESULTS AND THE ROLE OF CHANCE: The median BMI in the overweight and normal weight women was, respectively, 30.8 kg/m² [interquartile quartile range (IQR) 5.8] and 20.9 kg/m² (IQR 2.3) (P < 0.001). Baseline characteristics did not differ between groups, except for free testosterone and fasting insulin levels, which were higher, and sex hormone-binding globulin, which was lower, in overweight versus normal weight women (all P < 0.001). The time-to-pregnancy was significantly higher in the overweight group (P = 0.01). Multivariate analyses of the ongoing singleton pregnancies showed significantly more preterm births in overweight (10/61) versus normal weight (2/71) women [adjusted odds ratio 0.1, 95% confidence interval (CI) 0-0.6, P = 0.01]. The mean birthweight of newborns was significantly higher in overweight (3386 ± 663 g) than in normal weight (3251 ± 528 g) women (adjusted mean difference 259.4, 95% CI 83.4-435.4, P = 0.004). LIMITATIONS, REASON FOR CAUTION: Our results only represent the pregnancy, delivery and neonatal outcome of ongoing singleton pregnancies. The rather small sample size and observational nature of the study are further limitations. WIDER IMPLICATIONS OF THE FINDINGS: Our results suggest the importance of pre-pregnancy weight loss in overweight women with PCOS in order to reduce the risk of adverse perinatal outcomes. STUDY FUNDING/COMPETING INTERESTS: Veerle De Frene is holder of a Special PhD Fellowship by the Flemish Foundation for Scientific Research (FWO-Vlaanderen). Petra De Sutter is holder of a fundamental clinical research mandate by the Flemish Foundation for Scientific Research (FWO-Vlaanderen). There are no competing interests.

Aims: We define criteria to predict the number of mature oocytes using automated three-dimensional (3D) ultrasound follicle measurements. Methods: Fifty in vitro fertilization/intracytoplasmic sperm injection patients underwent automated 3D echographic monitoring by a single researcher following the stimulation procedure. Classic criteria for triggering oocyte maturation as defined in the literature were utilized. 3D parameters, including the follicular volume and follicle diameter calculated from the volume measurement, were related to the oocyte count, mature oocyte count and the number of observed fertilized oocytes. Results: We found that when oocyte maturation was induced, 55% of the total follicles with a diameter of at least 10 mm had a volume of at least 1.5 cm3. The number of mature eggs that were retrieved was correlated with the number of follicles observed with a volume of at least 1 cm3 or a calculated follicle diameter of at least 12 mm. Conclusion: Sonography-based automated volume count measurements of follicle volume and reconstructed follicle diameter can be used to reliably predict the number of mature oocytes.

Background/Aims: A large proportion of men with normal sperm results as analyzed using conventional techniques have fragmented DNA in their spermatozoa. We performed a prospective study to examine the incidence of DNA fragmentation in sperm in cases of couples with previously unexplained infertility and treated with intra-uterine insemination. We evaluated whether there was any predictive value of DNA fragmentation for pregnancy outcome in such couples. Methods: The percentage of DNA fragmentation and all classical variables to evaluate sperm before and after sperm treatment were determined. We studied the probable association between these results and pregnancy outcome in terms of clinical and ongoing pregnancy rate per started first cycle. We also assessed the optimal threshold level to diagnose DNA fragmentation in our center. Results: When using threshold levels of 20%, 25%, and 30%, the occurrence of DNA fragmentation was 42.9%, 33.3%, and 28.6%, respectively. Receiver operating characteristic (ROC) analysis of all cases revealed an area under the curve (AUC) of 80% to predict the clinical pregnancy rate per cycle from testing the sperm motility (a+b) before treatment. We failed to generate an ROC curve to estimate pregnancy outcome from the amount of DNA fragmentation before treatment. However, when selecting only those men with a pre-treatment DNA fragmentation of at least 20%, the pre-treatment result was statistically different between couples who achieved a clinical pregnancy and those who did not. Conclusion: DNA fragmentation is often diagnosed in couples with unexplained infertility. Each center should evaluate the type of test it uses to detect DNA fragmentation in sperm and determine its own threshold values.

BACKGROUND: In mammals, oocyte activation at fertilization is thought to be induced by the sperm-specific phospholipase C zeta (PLCzeta). However, it still remains to be conclusively shown that PLCzeta is the endogenous agent of oocyte activation. Some types of human infertility appear to be caused by failure of the sperm to activate and this may be due to specific defects in PLCzeta. METHODS AND RESULTS: Immunofluorescence studies showed PLCzeta to be localized in the equatorial region of sperm from fertile men, but sperm deficient in oocyte activation exhibited no specific signal in this same region. Immunoblot analysis revealed reduced amounts of PLCzeta in sperm from infertile men, and in some cases, the presence of an abnormally low molecular weight form of PLCzeta. In one non-globozoospermic case, DNA analysis identified a point mutation in the PLCzeta gene that leads to a significant amino acid change in the catalytic region of the protein. Structural modelling suggested that this defect may have important effects upon the structure and function of the PLCzeta protein. cRNA corresponding to mutant PLCzeta failed to induce calcium oscillations when microinjected into mouse oocytes. Injection of infertile human sperm into mouse oocytes failed to activate the oocyte or trigger calcium oscillations. Injection of such infertile sperm followed by two calcium pulses, induced by assisted oocyte activation, activated the oocytes without inducing the typical pattern of calcium oscillations. CONCLUSIONS: Our findings illustrate the importance of PLCzeta during fertilization and suggest that mutant forms of PLCzeta may underlie certain types of human male infertility.

Introduction Controlled ovarian hyper-stimulation for in vitro fertilization or intra cytoplasmatic sperm injection necessitates close monitoring using ultrasound and estradiol measurements. Monitoring is also important to prevent or limit the severity of ovarian hyper stimulation syndrome, an iatrogenic and potentially life-threatening complication. Self-operated endovaginal telemonitoring has been shown to offer an attractive and less costly alternative to classic consultation and saliva estradiol measurements could be a stress-free and practical alternative to serial blood determinations. Objectives were to evaluate whether saliva can be a surrogate marker for serum estradiol and its potential applicability in assisted reproduction treatment monitoring. Material and methods Serial blood and saliva samples were collected from 31 patients undergoing ovarian hyper-stimulation. All patients were followed-up using in-house serial vaginal sonograms and immunoassay serum estradiol measurements. Afterwards estradiol was determined in saliva and serum by LC-MS/MS. For a subset equilibrium dialysis and measurement of free serum estradiol was performed. Results About 1% of estradiol is present in serum in its free, unbound, form. Salivary estradiol correlates well to both serum free estradiol and serum total estradiol (r = 0.80). The concentration of salivary estradiol corresponds to the unbound concentration in serum. The dynamics observed in serum monitoring during treatment are closely mimicked in saliva. ROC analysis on the current limited dataset suggested a saliva cut-off of 22 pg/mL (81 pmol/L) could help predict risk for OHSS. Conclusions Salivary E2 can be considered a surrogate marker for free serum estradiol and total serum estradiol in assisted reproduction treatment. Additionally there might be a role as a prediction marker for OHSS although this finding has to be validated in larger datasets.

background: Despite the success of ICSI, total fertilization failure (TFF) still occurs in 1–3% of all ICSI cycles. ICSI followed by assisted oocyte activation (ICSI-AOA) can restore fertilization, most efficiently in cases of sperm-related fertilization deficiency. The indication for ICSI-AOA is less obvious when the capacity of the sperm to activate oocytes is considered normal, as proved by a heterologous ICSI model, such as the mouse oocyte activation test (MOAT). In this study, we verified whether ICSI-AOA is beneficial for patients in whom an oocyte-related activation deficiency is suspected. methods: A prospective study was conducted including patients presenting with a history of TFF or low fertilization (LF) following conventional ICSI in our centre (in-house cases, n ¼ 2) or elsewhere (out-house cases, n ¼ 12). In all cases a sperm deficiency was refuted by the MOAT. In a next treatment cycle, ICSI-AOA was performed on half of the sibling metaphase II oocytes and conventional ICSI on the rest (‘split ICSI-AOA cycle’). The main outcome parameters were fertilization, pregnancy and live birth rates. results: Overall, ICSI-AOA was able to improve fertilization rates in couples with a suspected oocyte-related fertilization problem, with a mean fertilization rate of 74.2% following ICSI-AOA compared with 43.5% following conventional ICSI (P , 0.001). Cumulative pregnancy rate and live birth rate per cycle were 35.7 and 14.3%, respectively. Considering the out-house patients only, fertilization rates with ICSI-AOA were higher in couples with previous TFF than with conventional ICSI (P , 0.001). Interestingly, for out-house patients who had experienced low, but not zero, fertilization elsewhere, ICSI-AOA could not enhance the fertilization rate. For the two in-house patients, both suffering from previous LF following conventional ICSI, the ICSI-AOA procedure enhanced the mean fertilization rate (25 versus 75%, respectively). conclusions: For patients with a suspected oocyte-related activation deficiency, as diagnosed by a heterologuous ICSI model, the indication for ICSI-AOA still remains debatable. Our data show that ICSI-AOA is very efficient in patients with a suspected oocyterelated activation deficiency and previous TFF after conventional ICSI. In contrast, when there was a history of LF in another centre, one should be careful and test the efficiency of ICSI-AOA on half of the sibling oocytes, because ICSI-AOA is not always beneficial for patients with previous LF and a suspected oocyte-related activation deficiency. For these patients, a split ICSI-AOA cycle using sibling oocytes can help to distinguish between a molecular oocyte-related activation deficiency and a previous technical or other biological failure. Moreover, this split ICSI-AOA strategy enables us to set the appropriate strategy for future treatment cycles. Further research with larger groups of patients is now required.

Since very little research in this field is available, this study aims to assess the role of psychosexual, relationship, hormonal and genetic measures in the sexual desire of users of three hormonal contraceptive products [low-dose combined oral contraceptive (20 mcg ethinylestradiol/150 mcg desogestrel), progestin-only pill (75 mcg desogestrel) and vaginal ring (daily dose of 15 mcg ethinylestradiol/120 mcg etonogestrel)].Fifty-five couples were randomized over three groups in which the women consecutively used each product during 3 months. Both partners repeatedly filled out questionnaires on solitary and dyadic sexual desire (desire to behave sexually by oneself or towards a partner). Total and free testosterone, sex hormone binding globulin and a genetic marker of androgen receptor sensitivity [cytosine-adenine-guanine (CAG) repeat length] were assessed on blood samples of the female partners.Sexual desire was higher in women with either short or long CAG repeats (solitary, p=.004; dyadic, p=.008). Desire levels were higher during vaginal ring use (solitary, p=.018; dyadic, p=.007). The woman's mood was found to impact her dyadic sexual desire (p.001); this scale was also strongly associated with the male partner's dyadic sexual desire (p.001).The current study found evidence for a role of androgen receptor sensitivity and mood in the sexual desire of hormonal contraceptive users.

Parental influence on children's values is usually examined by direct value transmission. In addition to the direct transmission, this study investigates two alternative routes of parental influences: (1) an indirect link between parents’ and children's value orientations via parenting behaviors (based on the identification perspective) and (2) a direct link between parenting behaviors and children's value orientations, independent of parents’ value orientations (based on the need (dis)satisfaction perspective). Regression and dominance analyses were conducted on a three-wave longitudinal dataset of 295 Dutch intact families spanning 10 years. We found direct mother-to-emerging adult transmissions on self-determination; direct father-to-mid adolescent and emerging adult transmissions on work ethic and political traditionalism; indirect parent-to-adolescent transmissions on work ethic and political traditionalism via parental conformity demands; and an independent negative influence of parental autonomy gr...

Objective To create a pool of frozen donated human oocytes and find the optimal stage for slow controlled-rate freezing of human in vitro matured oocytes. Design Oocytes at different developmental stages of maturation (germinal vesicle, metaphase I, or metaphase II) and oocytes that failed to fertilize after IVF or intracytoplasmic sperm injection (ICSI) were frozen using a slow controlled-rate freezing protocol. Frozen/thawed oocytes were artificially activated to verify activation potential and compared with oocytes that were not frozen. Setting University hospital–based fertility center. Patient(s) Stimulated patients undergoing IVF/ICSI treatment donated oocytes left over during their infertility treatment. Intervention(s) Human oocytes were frozen at different stages of maturation. Fresh and frozen/thawed oocytes were activated by electrical pulses followed by incubation in 6-dimethylaminopurine. Main Outcome Measure(s) Survival rate, maturation rate and kinetics, and activation potential. Result(s) Human oocytes at all developmental stages have high survival rates after slow controlled-rate freezing. Frozen/thawed germinal vesicle oocytes showed decreased and delayed maturation after thawing. Activation potential was not affected. Conclusion(s) A pool of donated human oocytes could be established using slow controlled-rate freezing. Immature oocytes should be frozen after in vitro maturation.

Diseases associated with point mutations in the mitochondrial DNA (mtDNA) are maternally inherited. We evaluated whether pre-implantation genetic diagnosis, based on polar body mutation load detection could be used to distinguish healthy from affected oocytes. Restriction Fragment Length Polymorphism (RFLP) analysis was used and validated, to determine A3243G tRNA(Leu(UUR)) mutation load in metaphase II oocytes and their respective first polar bodies. The results of this study show for the first time that the mutation load measured in the polar bodies correlates well with the mutation load in the respective oocytes. Therefore, human polar body analysis can be used as diagnostic tool to prevent transmission of mitochondrial disorders.

Item does not contain fulltext The effect of educational differences between partners on marital quality and stability is commonly analysed using difference, or compound measures. This article considers the theoretical foundations for these approaches and examines an alternative approach, diagonal reference models (DRMs). The three methods are then compared empirically, using data on 629 married couples from the survey Child-Rearing and Family in the Netherlands. Difference measures show no effect on marital satisfaction, whereas compound measures and DRMs do show an effect. As DRMs also allow for the quantification of this effect, while being theoretically and methodologically appropriate, they are affirmed the best method. 14 p.

BACKGROUND: Conflicting results have been reported regarding the use of polarized microscopy as a predictive tool for human oocyte quality. METHODS: Oocytes from 121 ICSI cycles were analysed with polarized microscopy. Both qualitative (spindle presence) and quantitative (retardance) data were correlated to the key assisted reproduction technology outcome parameters. Second, polarized microscopy was applied on in vitro matured (IVM) oocytes from germinal vesicle oocytes that matured after 24 or 48 h and from metaphase I oocytes matured after 3 or 24 h. These data were correlated with confocal analysis of spindle-chromosome complex. RESULTS: Spindles were detected in 82% of in vivo matured oocytes and in 64% adjacent to the first polar body (PB). Fertilization rate was higher in oocytes with a visible spindle (P = 0.0002). In patients aged over 35 years, the percentage of a visible spindle and mean spindle retardance was lower than in younger patients (P < 0.03). A higher number of spindles were located adjacent to the first PB in IVM matured oocytes (94%) versus in vivo matured oocytes (P < 0.0001). Confocal imaging revealed that spindle absent IVM metaphase II (MII) oocytes had a higher degree of aberrant spindle and chromosomal configurations versus IVM MII oocytes with a visible spindle (P = 0.002). CONCLUSIONS: Oocytes with absent spindles were associated with lower fertilization rates and advanced female age. Other important outcome parameters (embryo quality, pregnancy rates) were not correlated to spindle nor zona inner layer analysis. Interestingly, confocal imaging showed that polarized microscopy might be used as a qualitative predictive tool of human oocyte quality but no correlation could be demonstrated with quantitative polarized microscopy.

The aim of the present study was (1) to examine the longitudinal effect of negative and positive affect in the parent-child, marital and sibling relationship on adolescent internalizing and externalizing problems, and (2) to compare the strengths of these effects for the different family relationships, for internalizing and externalizing problems, and for negative and positive affect. In this longitudinal study, 280 families (father, mother, and two adolescents 11–15 years old) reported on their affective relationships. Adolescents also reported on their problem behavior. Our results show significant longitudinal effects of negative and positive affect of the parent-adolescent and sibling relationship on adolescent internalizing and externalizing problem behavior. Neither positive nor negative marital affect were significant predictors of adolescent problem behavior. Model comparison showed that the effects were similar for externalizing versus internalizing problems, and for negative versus positive affe...

Contains fulltext : 90432.pdf (Publisher’s version ) (Closed access) In this study links between spousal and parent-child relationships among Finnish (n = 157 couples) and Dutch (n = 276 couples) dual earners with young children were examined using paired questionnaire data. Variable-oriented analyses (structural equation modeling with a multigroup procedure) supported the spillover hypothesis, as higher levels of satisfaction in the spousal relationship were related to higher quality in the parent-child relationship and lower parental role restrictions. These connections did not differ by gender or country. With family typological analyses (mixture modeling), 4 family types were identified: families with satisfying relationships (73.4% of the families), families with unsatisfying parent-child relationships (13.4%), and families with either dissatisfied men (6.0%) or dissatisfied women (7.2%).

The need for serial vaginal sonographies to monitor ovarian stimulation for artificial reproductive technology (ART) treatments remains a major practical and organizational drawback both for patients and health-care providers. We explore the possibility of patients and/or their partners performing their own vaginal sonographies at home. To make this a reality, a portable, easy-to-use, home-applied vaginal probe for recording relevant images would have to be developed, as well as appropriate software to transfer images using modern communication technology to the centre, to analyse the recordings and to send a swift structured response, comprising dosing advice and next-step instructions. A simplification of the uncontested need to perform these sonographies, even if applicable to just a selected proportion of IVF patients, could fit in the general tendency to make IVF more patient centred and friendly, to implement telemedicine and to increase patient empowerment by supervised active participation to their treatment. The advantages of such a technology are explored in this paper, aiming at opening up a debate on whether patients themselves would, could and should achieve a further substantial simplification of ART without loss of quality while strongly curbing costs.

Contains fulltext : 90533.pdf (Publisher’s version ) (Closed access) This study applied the gender role model of socialization theory. the developmental aging theory, and the topic salience perspective to the investigation of parent-child value transmissions Specifically, we examined whether the bi-directionality and selectivity of value transmissions differed as a function of parents' and children's gender and children's developmental phase (adolescence versus emerging adulthood) Transmissions between parents and children from 402 Dutch families on the topics of work as duty and hedonism were studied across a 5-year period using structural equation modeling As expected, we did not find convincing support for the general models of gender socialization and developmental aging Instead, parent-child value transmissions appeared to be qualified by value salience Particularly, high salience of work as duty for fathers was related with great paternal involvement in transmissions of this value orientation and high salience of hedonism for sons and adolescents was linked to transmissions from these groups to parents.

Despite the progress made in assisted reproductive technology, live birth rates remain disappointingly low. Multiple-embryo transfer has been an accepted practice with which to increase the success rate. This has led to a higher incidence of multiple-order births compared with natural conception, which not only increase the risk of mortality and morbidity to both mother and children but are also associated with social and economic consequences. Elective single-embryo transfer (eSET) was developed in an effort to increase singleton pregnancies in assisted reproduction. Studies comparing eSET with multiple-embryo transfer highlight the benefit of this approach and suggest that, with careful patient selection and the transfer of good-quality embryos, the risk of a multiple-order pregnancy can be reduced without significantly decreasing live birth rates. Although the use of eSET has gradually increased in clinical practice, its acceptance has been limited by factors such as availability of funding and awareness of the procedure. An open discussion of eSET is warranted in an effort to enable a broader understanding by physicians and patients of the merits of this approach. Ultimately, eSET may provide a more cost-effective, potentially safer approach to patients undergoing assisted reproduction technology.

Contains fulltext : 76694.pdf (Publisher’s version ) (Closed access) Previous research has not yet integrated determinants of youth delinquency at the city, neighbourhood and individual levels simultaneously. In this study we derived hypotheses from social disorganization theory at the city level as well as at the neighbourhood level. We use individual-level data from 11 cities in the Netherlands, supplemented with information about the structural characteristics of these cities and their neighbourhoods. Our results show that concentrated contextual disadvantage at both city and neighbourhood levels affects juvenile delinquency. More detailed analyses demonstrate that it is particularly the percentage of one-parent families that has a significant effect on youth delinquency. The implications for the study of the influence of ecological contexts on youth delinquency are discussed. 17 p.

Background It has been suggested in the literature that low-dose aspirin leads to an increased number of oocytes in IVF/ICSI as well as a higher pregnancy rate. The aim of the present study was to investigate the effect of daily administration of low-dose aspirin, compared with placebo, on pregnancy rate in IVF and ICSI. Methods This study was a prospective, randomized, double-blind placebo controlled trial, performed in the fertility centre of the University Hospital of Ghent. Concealed allocation by computerized randomization was done by the central pharmacy of the hospital. Daily oral administration of aspirin 100 mg or placebo started before stimulation and was continued until confirmation of pregnancy by detection of fetal heart activity on ultrasound. The primary outcome measure assessed in this trial was clinical pregnancy rate per cycle. Results Two hundred and one couples were included in this study, 193 women (aspirin group n = 97, placebo group n = 96) started treatment and 181 underwent an embryo transfer. There were 31 clinical pregnancies (31/97 or 32%) in the aspirin group versus 30 (30/96 or 31%; P = 0.916; OR 1.033; 95% CI 0.565-1.890) in the placebo group. Conclusions This randomized controlled trial could not show a significant difference in clinical pregnancy rate between the aspirin and the placebo group in a first or second IVF/ICSI cycle. Given the lack of evidence for a beneficial effect of low-dose aspirin, it appears that low-dose aspirin should not be prescribed routinely in IVF/ICSI treatment. ClinicalTrials.gov Identifier: NCT00644085.

Contains fulltext : 73593.pdf (Publisher’s version ) (Closed access) Using questionnaire data on 149 Dutch dual-earner couples with young children participating in the European Famwork study, we examine how adaptive strategies and gender ideology relate to parents' perceived success in balancing work and family. Path analysis indicates that some adaptive strategies may harm individuals' work-family balance, particularly when they are made in the domain where the time budget is limited. In the need to succeed in multiple roles, however, endorsement of traits traditionally linked with the opposite gender, that is masculine traits for women and feminine traits for men, seems beneficial. We speculate that two underlying mechanisms — social pressure and time constraints — jointly operate in determining perceived success in balancing work and family.

BACKGROUND: The aim of this study is to assess differences in human chorionic gonadotropin (hCG) values between singleton IVF/ICSI pregnancies after elective single (eSET) versus double embryo transfer (DET). METHODS: This is a unicentre, retrospective, non-randomized study of women with eSET or DET in years 2000-2006, giving birth to a singleton child with a birthweight of at least 500 g (N = 790). These women had between 1 and 6 hCG assessments in our centre. Log hCG values from Days 15 to 35 after oocyte pick-up were compared between eSET and DET patients in a multivariate analysis. RESULTS: We compared log hCG values in 456 eSET patients with log hCG values in 334 DET patients. Log hCG values were significantly higher after eSET than after DET from Day 15 until Day 35 after oocyte pick-up (P < 0.001). CONCLUSION: The lower hCG values in early pregnancy are possibly due to a delay in implantation when two embryos are transferred and one of them does not implant, but the exact mechanism is unknown.

In 2% of assisted reproductive techniques (ART) cycles complications occur. Some are preventable, some are not. In this paper, we will discuss risks and complications of the standard ‘Western’ approach in ART today and point to some measures to be taken when implementing ART in developing countries, where resources and access to medical care may be limited. Ovarian hyperstimulation syndrome (OHSS, and its thrombo-embolic complications) is responsible for the majority of cycle-related complications, followed by bleeding and infection at oocyte retrieval. ART pregnancies are complicated by first-trimester bleeding more often than spontaneous pregnancies, they are more often ectopic, but the major complication is the very high incidence of multiple pregnancies, when more than one embryo is transferred. OHSS can be prevented by screening patients at risk and by using mild or no stimulation. Simple measures can minimize the risks of bleeding or infection. Obviously single embryo transfer is the only way to avoid multiple pregnancies, which have a highly increased risk for severe maternal and neonatal morbidity and mortality (mainly due to prematurity). Special attention should be given to pre-existing pathologies. Risk minimization of ART in developing countries is not only mandatory from an economical but also an ethical point of view.

Artificial oocyte activation using the calcium ionophore ionomycin is applied successfully in assisted reproduction but some concern exists on the clinical use. The aims of the present study were to optimize the oocyte activation scheme and to address embryo toxicity in a mouse model. Efficiency of oocyte activation and subsequent development was evaluated and ionomycin was found to be an efficient activator at 10 μmol/l. An improved effect of a second exposure to 5 μmol/l ionomycin on blastocyst development was observed. Toxicity of ionomycin on embryos was then investigated by evaluating pre- and post-implantation development of in-vivo fertilized oocytes following exposure to ionomycin. Blastocyst development, blastocyst cell numbers in trophectoderm and inner cell mass were not different between treated and non-treated zygotes. Also implantation rates and fetal parameters such as length, weight and morphological parameters were similar between the fetuses originating from zygotes treated with ionomycin and non-treated zygotes. Furthermore, healthy offspring originating from ionomycin-treated zygotes was born. In conclusion, no adverse effects of ionomycin on in-vitro or in-vivo mouse embryo development were noticed, giving arguments in favour of the use of ionomycin, although negative long-term effects of this compound cannot be excluded at present.

In Antwerp, single embryo transfers (SET) have increased, and this change in policy has seen the incidence of singletons rise from 70 to 90%, twins drop from 25 to 10%, and triplets drop from 1-2% to none at all. At a national and regional level, changes have been much more dramatic as a result of a change in the law in 2003 mandating SET. Data show a huge increase in the number of treatment cycles and a dramatic rise in SET. Rates of twins and triplets have dropped considerably. European data indicate wide differences in the incidence of triplets between countries, varying between 0% (e.g.Slovenia, Iceland, Lithuania) and 4.4% (Hungary), but almost nothing is known about the true incidence of fetal reduction. US data indicate some decrease in triplets during recent years, but certainly nowhere near elimination. These data suggest that in some countries, IVF triplets have almost been eliminated, but the problem is masked by significant fetal reductions. Where SET is not widely used, triplets are still frequent. A correlation appears to exist between the percentage of SET cycles and the incidence of triplets. It is suggested that the solution to almost totally eliminate triplets after IVF is single embryo transfer.

Drawing from the criminology literature and family studies, we investigated the long-term effects of established family risk factors and parenting styles on male young adult delinquency. We used data sets from two longitudinal studies, the Pittsburgh Youth Study ( N=474) and the Child-Rearing and Family in the Netherlands Study ( N=128), each with assessment periods covering at least 10 years. The lack of orderly and structured activities within the family during adolescence was a strong predictor of delinquency in young adulthood, once prior aggression and demographic variables were considered. No evidence was found for a relationship between authoritarian and authoritative parenting styles and later delinquency. Furthermore, previously identified family factors such as socioeconomic status, supervision, punishment and attachment were not related to delinquent behaviour in young adulthood.

Contains fulltext : 54563.pdf (Publisher’s version ) (Closed access) Previous research on intercity differences in crime rates neglects individual determinants of youth delinquency, whereas studies focusing on neighbourhoodand individual-level explanations of youth delinquency neglect higher-level, city characteristics. This raises the question of the extent to which city characteristics can contribute to the explanation of youth delinquency, above and beyond the influence of neighbourhood and individual characteristics. To answer this question we first discuss how previous macro-level research explains city differences in crime rates, and then we test whether there is empirical evidence that youth delinquency differs not only between individuals but also between neighbourhoods and, moreover, between cities. Using data collected among 12-17-year-old adolescents from 11 Dutch cities, multilevel analyses revealed that there is a substantial amount of variance to be explained at the city level, even after controlling for composition effects and differences between surveys. In contrast with previous research studying neighbourhood influences on youth delinquency but neglecting the city level, we found very little variance at the neighbourhood level. Possible explanations and implications for future research are given by linking explanations at the different levels 22 p.

Using panel data of Dutch first marriages with children (N Time 1=646, N Time 2=386), the relevance of economic and cultural factors in understanding marital satisfaction is examined. The sample was middle-aged and the average marital duration was 17 years (at Time 1). Besides, couples mainly represent single earner and main-earner households. Our results demonstrate that both economic and cultural factors are valid in understanding marital satisfaction. However, whereas cultural characteristics are more important explaining spousal marital satisfaction at Time 1, economic indicators are important predicting change in marital satisfaction. An interaction effect between cultural and economic factors was found as well. Husbands’ familialism moderates the effect of women’s employment on women’s marital satisfaction at Time 1.