A reassessment of comparative pregnancy and implantation rates following embryo transfer in recipients vs their infertile donors also trying to conceive in the background of performing salpingectomy for hydrosalpinx

PURPOSE

To compare pregnancy and implantation rates in egg donors trying to conceive vs their recipients in the background of salpingectomy for hydrosalpinx prior to IVF-ET.

METHODS

A retrospective six-year review of all donor egg cycles where the eggs are supplied by an infertile donor trying to conceive herself was carried out. Salpingectomy for hydrosalpinx was performed prior to IVF-ET.

RESULTS

Clinical and delivered pregnancy rates (PRs) following fresh ET were not significantly different in donors vs recipients (60.0%, 45.8% vs 56.8%, 50.8%). Implantation rates were 27.3% vs 32.6%. The respective implantation rates following frozen ET were 13.8% and 14.4%.

CONCLUSIONS

In the background of salpingectomy for hydrosalpinges the much higher PRs in recipients vs donors is no longer seen. The trend for higher implantation rates in recipients (about 20%) following fresh but not frozen transfer could still reflect some adverse effect of the controlled ovarian hyperstimulation regimen in a minority of women.

An evaluation of the efficacy of using oocyte donors aged 36-39

PURPOSE

To determine if oocyte donors aged 36-39 can provide adequate pregnancy rates for recipients.

METHODS

Retrospective analysis of clinical, ongoing/delivered pregnancy and implantation rates for a group of recipients receiving oocytes from a pilot group of older donors.

RESULTS

Comparable pregnancy and implantation rates were found in recipients transferring embryos derived from donors aged 36-39 as recipients using oocytes from donors < or = 35.

CONCLUSIONS

The demonstration of adequate outcome following embryo transfer from embryos derived from fertilization of oocytes from donors aged 36-39 should expand the pool of donor oocytes and reduce the long waiting times for recipients.

Efficacy of sharing oocytes from compensated donors between two recipients

PURPOSE

To see if sharing of donated oocytes from a compensated donor lowers outcome following embryo transfer compared to recipients keeping all oocytes.

METHOD

Retrospective review. Recipients have the option of keeping all oocytes or sharing to reduce costs.

RESULTS

There were equal clinical, and ongoing/delivered pregnancy rates and implantation rates in the two groups. There were almost twice as many frozen embryos available to recipients who did not share for potential future use.

CONCLUSIONS

Sharing of oocytes between two recipients reduces the financial burden for the recipient without affecting efficacy. Such a policy would make more oocytes available to recipients and thus shorten the long waiting times.

New humanitarianism: does it provide a moral banner for the 21st century?

There is a 'new humanitarianism' for the new millennium. It is 'principled', 'human-rights based' and politically sensitive. Above all it is new. It marks a break from the past and a rejection of the traditional principles that guided humanitarianism through the last century. New humanitarians reject the political naivety of the past, assess the long-term political impact of relief and are prepared to see humanitarian aid used as a tool to achieve human rights and political goals. New Humanitarianism is compelling, in tune with our times and offers a new moral banner for humanitarians to cling to as we enter the new millennium. Or does it? After outlining the key elements of new humanitarianism, including the human rights approach and developmental relief, the paper spells out some of the dangers. The author claims that new humanitarianism results in an overt politicisation of aid in which agencies themselves use relief as a tool to achieve wider political goals. The paper shows how this approach has spawned a new conditionality which allowsfor aid to be withheld and has produced a moral hierarchy of victims in which some are more deserving than others. The paper concludes with a plea for a revival of the principle of universalism as the first step to a new set of principles.

Fresh embryo transfer is more effective than frozen for donor oocyte recipients but not for donors

BACKGROUND

Recipients of donor oocytes need to be synchronized to the donor's cycle if fresh embryos are to be transferred on the cycle of oocyte retrieval. It would be much easier to merely retrieve the oocytes from the donor, fertilize the oocytes with the recipient's male partner's spermatozoa, cryopreserve the embryos, then transfer on an oestrogen/progesterone treatment programme.

METHODS

The IVF outcomes of all patients enrolled in a shared oocyte programme from January 1997 to June 1999 were reviewed. Pregnancy and implantation rates were computed and statistically analysed.

RESULTS

There was a significantly higher clinical pregnancy rate for recipients who had a fresh embryo transfer compared with recipients whose first embryo transfer consisted of frozen/thawed embryos (63.4 versus 43.6%).

CONCLUSIONS

Conception is more likely after fresh than frozen embryo transfer with recipients but is similar to donor conception rates. If a uterine defect, per se, even without the use of the controlled ovarian stimulation regimen, could explain the difference between fresh pregnancy and implantation rates in donors versus recipients, then these same differences would have been seen when comparing frozen transfers, but they were, in fact, similar.

The presence of small uterine fibroids not distorting the endometrial cavity does not adversely affect conception outcome following embryo transfer in older recipients

PURPOSE

To determine if uterine fibroids have a negative impact in older patients having embryo transfer (ET).

METHODS

Comparison of clinical and viable pregnancy rates, implantation rates, and spontaneous abortion rates in older (>35) oocyte or embryo recipients with uterine leiomyomata compared to comparable patients without fibroids.

RESULTS

The clinical pregnancy rate per transfer was 56% in the fibroid group vs 64% for the controls. Implantation rates were also very similar (33 vs 32%7). There were no spontaneous abortion or preterm deliveries <32 weeks in the fibroid group and the average term of pregnancies was also similar.

CONCLUSION

Small fibroids not distorting the uterine cavity do not seem to negatively affect conception outcome even in older women.

Time course of osteocalcin, bone-specific alkaline phosphatase, and C-terminal procollagen peptide during callus distraction

This study involved 15 patients who were undergoing extremity lengthening by callus distraction. Blood samples and radiographs of the callus distraction segment were obtained before surgery, every 2 weeks during the distraction phase, and every 4 weeks between the end of distraction and removal of the fixator. A digital radiograph analysis system was used to determine the radiographic density of the callus distraction segments. In addition, the serum parameters osteocalcin, bone-specific alkaline phosphatase, and C-terminal procollagen peptide (PICP) were evaluated. The radiographic density was constant during the distraction phase, but increased logarithmically during the consolidation period. Similar kinetics were observed for osteocalcin, with an average coefficient of correlation between these two parameters of 0.66+/-0.15. PICP levels rose rapidly after surgery and increased further during the consolidation period. Serum levels of bone-specific alkaline phosphatase were not uniform between patients, and there was no correlation to the kinetics of radiographic density or the other serum parameters. The similarity between radiographic density and osteocalcin kinetics, as well as the rapid postoperative increase in PICP, imply that further information may be obtained about osteoneogenesis from the study of these two serum parameters.

Focus on: The Methodist Hospital, Houston, Texas, Biomedical Instrumentation Department

The Methodist Hospital in Houston, Texas, is a 1,527-bed, tertiary care teaching hospital that is both a national and international referral center for medical care in many medical and surgical specialties. The Biomedical Instrumentation Department provides services throughout the hospital in all aspects of clinical equipment management and clinical engineering. With 29 employees and an annual budget of $2.1 million, the department enhances efficiency in the delivery of quality medical care.

Developing a model for technology assessment. A system helps its facilities prepare for technological change

In 1991 the Franciscan Health System (FHS), Philadelphia, created a Technology Assessment Task Force to support specific goals and strategies in the FHS strategic plan and to help prepare its members for technological change. Because FHS is a large and diverse system, with facilities in seven states both on the East Coast and in the Pacific Northwest, the task force needed to develop flexible recommendations with broad applicability. The task force recommended a time-phased approach for changing the way technology is identified, acquired, and used in FHS organizations. Key recommendations included (1) creating a standing FHS technology steering committee, (2) implementing a technology assessment model for selected technology activities, (3) sponsoring systemwide technology conferences, and (4) reviewing FHS technology actions, revising as appropriate. The system and hospital leadership adopted the task force's recommendations and are now implementing them.

Purification of human leukocyte interferon alpha by carboxymethyl controlled pore glass bead chromatography

Human leukocyte-derived alpha interferon [HuIFN-alpha(Le)] has been purified and/or concentrated on Carboxymethyl derivatized Controlled Pore Glass (CML-CPG240) beads. These glass beads adsorb HuIFN-alpha(Le) efficiently at acid pH and at physiological ionic strengths. Elution of HuIFN-alpha(Le) may be accomplished by several methods. Using buffers at relatively high ionic strengths (approximately 0.6 M) and pH values ranging from 2.6 to 6.9 for elution, preparations with specific activities of 10(5)-10(6) IU/mg were obtained with approximately 90 percent recoveries. Alternatively, using elution buffers at the same high ionic strength and at pH values ranging from 7.0 to 8.0, five-fold or better concentration and complete recovery of crude HuIFN-alpha(Le) were achieved. The resulting preparations were suitable for direct application to an antibody affinity chromatography column.

A comparative study on two radioimmunoassays with cloned human interferon-alpha

We report here on the development of (a) a double-antibody radioimmunoassay and (b) a solid-phase radioimmunoassay for cloned human interferon-alpha (leukocyte) [HuIFN-alpha(Le)]. We present the results of titrations of human interferon-alpha-2 (HuIFN-alpha 2) using either method under experimental and optimized conditions. A comparative study of the two methods indicates that (a) the double-antibody procedure is 200-fold more economical of antibody when quantitations are carried out within an optimal range of 0.05--1.0 ng; (b) the double-antibody method is fivefold more sensitive than the solid-phase method, its sensitivity being within the range of the antiviral assays for interferons; and (c) the solid-phase assay is significantly faster. The data also support the presence in human serum of a factor(s) that decreases the maximal amount of HuIFN-alpha 2 bound to antibody. We conclude that these radioimmunoassays are superior to biological assays for the quantitation of interferon-alpha polypeptides from the standpoints of objectivity and reproducibility as well as time and effort required.

Mouse monoclonal antibody with specificity for human interferon gamma

We developed a monoclonal antibody (MAb) specific for human interferon gamma (HuIFN-gamma) by hybridizing cells from the NS-1 myeloma cell line with spleen lymphocytes from BALB/c mice immunized with partially purified HuIFN-gamma. Hybridoma culture supernatants were screened for neutralization of antiviral activity of HuIFN-gamma by the method determining the inhibition of nucleic acid synthesis assay (INAS), employing human fibroblasts infected with encephalomyocarditis virus (EMC). Clones exhibiting neutralization of antiviral activity of HuIFN-gamma were recloned, retested and an MAb with maximum neutralization activity was selected. This MAb was of IgM subclass and was specific for HuIFN-gamma. Antiviral activities either of human leukocyte-derived (HuIFN-alpha) or human fibroblast-derived interferon (HuIFN-beta) were not affected by this monoclonal antibody as determined by the INAS test. The specificity of the MAb for HuIFN-gamma was further confirmed by an indirect immunoprecipitation method, where monoclonal antibody-HuIFN-gamma complexes were immunoprecipitated with rabbit anti-mouse immunoglobulin and remaining IFN activity in the supernatants was determined by virus yield reduction assay. Ammonium sulfate precipitated preparations of this MAb were able to significantly increase (range of 230- to 1300-fold) the virus yield when compared with that obtained in the presence of IFN-gamma. SDS-PAGE analysis revealed that the MAb immunoprecipitates a molecule of Mr = 47 kD under nonreducing conditions. Under reducing conditions, two additional bands of Mr = 26 kD (major band) and Mr = 21 kD (minor band) were observed. A sepharose affinity column was constructed using this MAb and was able to retain approximately 60% of the partially purified HuIFN-gamma preparation applied. Significant amounts of HuIFN-gamma were eluted by increasing the ionic strength and decreasing the pH. HuIFN-alpha and HuIFN-beta were not retained by this column.

Radiation damage due to knock-on processes on carbon foils cooled to liquid helium temperature

Radiation damage on a holey carbon foil was investigated in an electron microscope with a superconducting lens system, where the temperature of the specimen and its environment initially was 4 K. Due to an electron dose of 2 X 10(4) As/cm2 the diameter of a hole increased 5 nm. Rough calculations show that this increase can be ascribed to knock-on processes. Estimates of the rise in specimen temperature during the irradiation are given.

Laboratory evaluation of pressure transducer domes containing a diaphragm

Pressure transducers are being used with increasing frequency in patient care. The recent availability of sterile transducer domes containing a diaphragm provides a means for reducing the risk of bacteremia when using these devices. The present studies measured the effect of diaphragm domes on the accuracy of pressure measurement. The sensitivity and frequency responses of 5 pressure transducers utilizing diaphragm and nondiaphragm domes were compared. The results indicate that the type of dome utilized and the method of dome application can significantly modify pressure transducer performance. The data are useful in providing optimal accuracy and reliability of pressure measurments when using a diaphragm dome, pressure transducer combination.