The Association Between Follicular Fluid Sialic Acid Levels, Oocyte Quality, and Pregnancy Rates

Sialic acid residues perform important roles in both physiological and pathologic processes. Our aim was to measure the levels of sialic acid in the follicular fluid of women undergoing in vitro fertilization (IVF) and to assess correlations between IVF parameters and sialic acid levels. All women meeting the inclusion criteria underwent gonadotropin-releasing hormone agonist treatment and during oocyte retrieval, follicular fluids of mature follicles were collected and pooled for each patient. Correlation analysis was made between sialic acid levels and oocyte quality. Eighty-seven patients meeting the inclusion criteria were enrolled. In terms of oocyte quality and sialic acid, follicular fluid total sialic acid (FF-TSA) levels positively correlated with germinal vesicle oocytes and metaphase I oocytes. In terms of clinical parameters, no correlation between sialic acid levels and body mass index, serum levels of hormones, duration of infertility, and the total dose of gonadotropins was observed. The mean FF-TSA was 86.1±35.19 mg/dl in the clinical pregnancy positive group and was 73.64±22.15 mg/dl in the clinical pregnancy negative group. FF-TSA levels positively correlated with immature oocytes. This can be either as part of the normal oocyte maturation or as a compensatory mechanism against reactive oxygen species during the oocyte maturation process.

Comparison of antagonist mild and long agonist protocols in terms of follicular fluid total antioxidant capacity

OBJECTIVE

A high dose of prolonged gonadotropins can yield higher numbers of oocytes and embryos. The high dose or prolonged regimens can be associated with ovarian hyperstimulation syndrome (OHSS), multiple gestations, emotional stress, economical burden and treatment dropout. In mild stimulation lower doses and shorter duration times of gonadotropin are used in contrast to the conventional long stimulation protocol in IVF. It has been proposed that supraphysiologic levels of hormones may adversely affect endometrium and oocyte/embryo. Also it has been proposed that oxidative stress (OS) may alter ovarian hormone dynamics and could be further affected by additional exogenous hormonal stimulation. Therefore our aim was to compare follicular fluid total antioxidant capacity (TAC) in antagonist mild and long agonist stimulations.

MATERIALS AND METHODS

Forty patients received antagonist mild stimulation, starting on the 5th day of their cycle and forty patients received long agonist treatment. Seventy-five patients undergoing their first IVF cycle were included in the final analysis. Follicular fluid (FF) samples were analyzed for estradiol (E2), antimullerian hormone (AMH) and TAC.

RESULTS

FF-Total antioxidant capacity (TAC) levels were higher in the long agonist group as opposed to the antagonist group [1.07 ± 0.04 mmol Trolox equivalent/L vs 1 ± 0.13 mmol Trolox equivalent/L] (Fig. 1). Pregnancy rates were not significantly different between the two treatments. The FF-TAC levels were not different among infertility etiologies (Fig. 3). FF-TAC levels did not have a direct correlation with pregnancy but a positive correlation with the total gonadotropin dose was observed.

CONCLUSION

Patients with good ovarian reserves and under the age of 35 effectively responded to mild stimulation treatment. Using lower amounts of gonadotropin, yielded less FF-TAC levels in patients who underwent antagonist mild protocol. In patients under the age of 35, antagonist mild stimulation is a patient friendly and effective procedure when undergoing their first IVF cycle.

Homocysteine in embryo culture media as a predictor of pregnancy outcome in assisted reproductive technology

The aim of this study was to determine whether homocysteine (hcy) concentrations in embryo culture media correlate with pregnancy outcome in assisted reproductive technology (ART) cycles. Forty patients who underwent single embryo transfer at the infertility clinic of a tertiary care center were recruited for this case-control study. Spent embryo culture media from all patients were collected after single embryo transfer on day 3 (n = 40). Hcy concentrations in embryo culture media were analyzed by enzyme cycling method. Patients were grouped according to the diagnosis of a clinical pregnancy. Sixteen patients were pregnant while 24 patients failed to achieve conception. Mean Hcy levels in the culture media were significantly different between the groups (p < 0.003), as 4.58 ± 1.31 μmol/l in the non-pregnant group and 3.37 ± 0.92 μmol/l in the pregnant group. Receiver operator curve analysis for determining the diagnostic potential of Hcy for pregnancy revealed an area under the curve of 0.792 (confidence interval: 0.65-0.94; p < 0.05). A cut-off value of 3.53 μmol/l was determined with a sensitivity of 83.3%, and a specificity of 68.8%. Lower hcy levels were associated with a better chance of pregnancy and better embryo grades. Hcy may be introduced as an individual metabolomic profiling marker for embryos.

Comparison of follitropin alfa and urinary gonadotropins in IVF cycles

AIM

The aim of this study was to compare human menopausal gonadotropins with recombinant follicle stimulating hormone-follitropin alpha following a long down-regulation protocol in intra cytoplasmic sperm injection cycles in our clinic, and to review the outcomes in the light of preceding studies.

METHODS

This was a retrospective study. Among a total number of 2798 patients who had undergone IVF/ICSI applications, 579 eligible patients were included, and their data were evaluated retrospectively. Three hundred eighteen patients were treated with follitropin alpha and 255 patients were treated with hMG. Total units of follitropin alpha preparations used in ovulation induction, total number of meiois-2 phase oocytes, total number of used oocytes in ICSI cycle, fertilization rate and clinical pregnancy rates of both groups were analyzed.

RESULTS

Mean duration of stimulation was longer in the group of patients treated with rFSH-α compared to the second group of patients treated with hMG (8.88 days and 8.55 days, respectively; P<0.05). The number of transferred embryos were 3.08 and 2.68 for patients treated with follitropin alpha and hMG, respectively (P<0.05). Clinical pregnancy rates were %28 and %33 in the groups of patients treated with follitropin alpha and hMG, respectively. Even though a greater clinical pregnancy rate was noted in the hMG group, there was no statistically significant difference between the two groups (P>0.05).

CONCLUSION

Our results indicate that there is no statistically significant difference between follitropin alpha and human menopausal gonadotropin in terms of the clinical pregnancy rates.

Investigation of the association between the outcomes of sperm chromatin condensation and decondensation tests, and assisted reproduction techniques

The main purpose of this prospective study is to examine possible influences of abnormalities of sperm nuclear condensation and chromatin decondensation with sodium dodecyl sulphate (SDS)-EDTA on outcomes of intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI) cycles. Semen samples from 122 IUI and 236 ICSI cycles were evaluated. Before semen preparation for IUI or ICSI, basic semen analysis was performed and a small portion from each sample was spared for fixation. The condensation of sperm nuclear chromatin was evaluated with acidic aniline blue, followed by sperm chromatin decondensation by SDS-EDTA and evaluation under light microscope. Ongoing pregnancy rate was 24% and 26.2% in the IUI and ICSI groups respectively. The chromatin condensation rate was significantly higher in the ongoing pregnancy-positive group compared to the negative group, both in IUI (P = 0.042) and ICSI groups (P = 0.027), and it was positively correlated with ongoing pregnancy rate in both IUI and ICSI groups (P = 0.015, r = 0.214 and P = 0.014, r = 0.312 respectively). Chromatin decondensation rates were not significantly different in neither of the groups. These results indicate that IUI and ICSI outcome is influenced by the rate of spermatozoa with abnormal chromatin condensation. Sperm chromatin condensation with aniline blue is useful for selecting assisted reproduction techniques (ART) patients.

The association between homocysteine in the follicular fluid with embryo quality and pregnancy rate in assisted reproductive techniques

PURPOSE

To investigate the association between follicular fluid homocysteine levels and embryo quality and pregnancy rates in patients undergoing assisted reproduction.

METHODS

Fifty infertile women who were admitted to our clinic were enrolled in the study. Ovulation induction was performed by using GnRH agonist and gonadotropins. For each patient, homocysteine level in the follicular fluid was measured by using nephelometric method after the oocyte pick-up. The association between the homocysteine concentration in the follicular fluid and the oocyte-embryo quality, pregnancy rates and hormone levels were investigated.

RESULTS

Mean ± SD Hcy was 9.6 ± 2.02 μmol/L and 14.9 ± 2.93 μmol/L in pregnant and non-pregnant women, respectively (p < 0.0001). There were no statistically significant differences between pregnant and non-pregnant women in mean age, duration of infertility, body mass index, the oocyte-embryo quality parameters, and hormone levels. Homocystein did not have any correlation with M2, late M2, and total number of oocytes, number of fertilized oocytes and transferred embryos, and embryo quality grade. Area under curve (AUC) of hcy for prediction of pregnancy failure was 0.922 (p = 0.0001, 95% Confidence interval 0.85-0.99). A threshold of 11.9 μmol/L of hcy had a sensitivity of 82%, specificity of 100%, positive predictive value of 100% and negative predictive value of 91.6% for prediction of pregnancy failure. The subgroup analysis in male factor infertility group (n = 28), showed that mean homocystein was 9.9 ± 2.44 μmol/L and 14.1 ± 2.72 μmol/L in pregnant and non-pregnant women, respectively (p = 0.002).

CONCLUSION

Low follicular fluid homocysteine level is associated with a better chance of clinical pregnancy.

Recurrent implantation failure is more frequently seen in female patients with poor prognosis

BACKGROUND

This study evaluated the characteristics and results of patients who suffer from recurrent implantation failure (RIF).

MATERIALS AND METHODS

In this cross sectional study, a total of 2183 cases who were evaluated retrospectively at the Istanbul University Cerrahpasa Medical Faculty, Department of Obstetrics and Gyneacology, IVF unit between 2000-2007. According to the data gathered, we included 1822 cases in this study. We compared 185 patients with RIF to 1637 women without RIF.

RESULTS

Pregnancy was achieved by 589 couples out of 1822 (32%). The implantation rate was 10%, which declined to 5.8% after the fourth attempt. In the RIF group, patients' mean age was higher and there were more overweight women, the duration of fertility was longer, day 3 follicle stimulation hormone (FSH) levels and the total gonadotropin dose administered were higher, mean level of Estradiol (E2) on the human chorionic gonadotropin (hCG) day was lower, and the mean level of progesterone on the hCG day was elevated compared to the non-RIF group. Although the comparison of MII oocyte number was not significant, the mean number of fertilized oocytes was found to be significant in favor of the non-RIF group. The endometrial thicknesses were found to be similar for both groups. Comparison of sperm motility and morphology were statistically significant in favor of the RIF group.

CONCLUSION

In our study, we have found that the group with RIF were comprised of patients with poor prognosis who were older, overweight, had a longer infertility duration, a higher FSH level, and needed more gonadotropin doses in controlled ovarian hyperstimulation (COH). Sperm motility and morphology were better in the RIF group compared to the non-RIF group, and multiple pregnancy rates were lower in RIF patients.

Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles

OBJECTIVE

To evaluate predictive role of day-3 serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) in ovarian hyperstimulation syndrome (OHSS) in patients undergoing IVF/ICSI cycles.

MATERIALS AND METHODS

Forty-one women with moderate/severe OHSS and 41 age matched women without OHSS were compared to evaluate the predictive value of certain risk factors for OHSS. AFC, and E(2), FSH, LH, AMH, inhibin-B levels measured on day 3 of the menstrual cycle before controlled ovarian hyperstimulation.

RESULTS

Mean FSH was significantly lower (p < 0.0001); and mean LH, AFC and AMH were significantly higher in women with OHSS compared to women without OHSS (p = 0.049, p < 0.0001 and p < 0.0001, respectively). There was no significant difference in inhibin B (p = 0.112) and estradiol (p = 0.706) between the groups. The ROC area under curve (AUC) for AMH presented the largest AUC among the listed risk factors. AMH (AUC = 0.87) and AFC (AUC = 0.74) had moderate accuracy for predicting OHSS while Inhibin B (AUC = 0.58) and LH (AUC = 0.61) had low accuracy. The cut-off value for AMH 3.3 ng/mL provided the highest sensitivity (90%) and specificity (71%) for predicting OHSS. It's positive (PPV) and negative predictive values (NPV) were 61% and 94%, respectively. The cut-off value for AFC was 8 with 78% sensitivity, 65% specificity, 52% PPV and 86% NPV.

CONCLUSION

Measurement of basal serum AMH and AFC can be used to determine the women with high risk for OHSS.

Expression and comparison of gap junction protein connexin 37 in granulosa cells aspirates from follicles of poor responder and nonpoor responder patients

OBJECTIVE

To localize gap junction protein connexin 37 (Cx37) in granulosa cells obtained from aspiration of follicles, and to compare differences between poor responder and nonpoor responder patients in assisted reproductive technology.

DESIGN

Prospective clinical study.

SETTING

IVF unit of a university hospital.

PATIENT(S)

Seventy patients with various causes of infertility, undergoing an IVF treatment.

INTERVENTION(S)

Controlled ovarian hyperstimulation, serum hormone level measurements, ultrasonography scanning of ovarian follicles, oocyte retrieval after hCG administration and embryo transfer.

MAIN OUTCOME MEASURE(S)

Outcome of the IVF treatment and expression rate of Cx37 in granulosa cells.

RESULT(S)

Connexin 37 was expressed in the granulosa cells of all the patients. Connexin 37 rate in granulosa cells in the poor responder group was 81.32 +/- 35.86% (distribution: 2.95%-99.9%), while it was 88.98 +/- 23.73% (distribution: 6.30%-100.00%) in the nonpoor responder group. Connexin 37 rates between the two groups were not significantly different.

CONCLUSION(S)

Connexin 37 is expressed in the granulosa layer of follicles in the human ovary, and expression of Cx37 in granulosa cells was not different between poor responder and nonpoor responder patients.

Regional clinical practice patterns in reproductive endocrinology: A collaborative transnational pilot survey of in vitro fertilization programs in the Middle East

Background

This research describes current clinical and demographic features sampled from reproductive endocrinology programs currently offering in vitro fertilization (IVF) in the Middle East.

Methods

Clinic leadership provided data via questionnaire on patient demographics, demand for IVF services, annual cycle volume, indications for IVF, number of embryos transferred, twinning frequency, local regulations governing range of available adjunct therapies, time interval between initial enrollment and beginning IVF as well as information about other aspects of IVF at each center.

Results

Data were received from representative IVF clinics (n = 13) in Cyprus, Egypt, Iran, Israel, Jordan, Lebanon, Qatar, Saudi Arabia and Turkey. Mean (± SD) age of respondents was 47.8 ± 8 yrs, with average tenure at their facility of 11.2 ± 6 yrs. Estimated total number of IVF programs in each nation responding ranged from 1 to 91. All respondents reported individual participation in accredited CME activity within 24 months. 76.9% performed embryo transfers personally; blastocyst transfer was available at 84.6% of centers. PGD was offered at all sites. In this population, male factor infertility accounted for most IVF consultations and the majority (59.1%) of female IVF patients were < 35 yrs of age. Prevalence of smoking among female IVF patients was 7.2%. Average number of embryos transferred was 2.4 (± 0.4) for patients at age < 35 yrs, and 2.9 (± 0.8) at age > 41 yrs. For these age categories, twinning (any type) was observed in 22.6 (± 10.8)% and 13.7 (± 10.4)%, respectively. In 2005, the average number of IVF cycles completed at study sites was 1194 (range 363–3500) and 1266 (range 263–4000) in 2006. Frozen embryo transfers accounted for 17.2% of cycles at these centers in 2005. Average interval between initial enrollment and IVF cycle start was 8 weeks (range 0.3–3.5 months).

Conclusion

This sampling of diverse IVF clinics in the Middle East, believed to be the first of its kind, identified several common factors. Government registry or oversight of clinical IVF practice was limited or nonexistent in most countries, yet number of embryos transferred was nevertheless fairly uniform. Sophisticated reproductive health services in this region are associated with minimal delay (often < 8 weeks) from initial presentation to IVF cycle start. Most Middle East nations do not maintain a comprehensive IVF database, and there is no independent agency to collect transnational data on IVF clinics. Our pilot study demonstrates that IVF programs in the Middle East could contribute voluntarily to collaborative network efforts to share clinical data, improve quality of care, and increase patient access to reproductive services in the region.

Transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose for treatment of unruptured tubal heterotopic pregnancy

OBJECTIVES

To report a case of tubal heterotopic pregnancy (HP) treated conservatively with transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose.

METHODS

Aspiration of the tubal ectopic pregnancy and hyperosmolar glucose instillation was performed with a 16-gauge needle under transvaginal ultrasound guidance.

RESULTS

Unruptured tubal HP with positive cardiac activity was treated successfully without any further interventions, and intrauterine pregnancy has reached full-term without any complications.

CONCLUSIONS

Early diagnosis of this life-threatening condition is the key to its successful treatment. Transvaginal ultrasound-guided aspiration and hyperosmolar glucose injection can be safely performed for the treatment of unruptured tubal HP.

Detection of an inguinal ovary at controlled ovarian stimulation that was successfully treated by repositioning

OBJECTIVE

To report a rare case of an ectopic ovary placed in the inguinal canal that was detected while performing a controlled ovarian hyperstimulation (COH).

DESIGN

Case report.

SETTING

A university hospital.

PATIENT(S)

A couple with primary infertility for 4 years was referred to our infertility clinic. The woman's medical history revealed a left inguinal operation at age 7. On vaginal ultrasound, only the right ovary could be seen. An infertility workup conducted for the man revealed teratospermia. The couple was subsequently admitted to the in vitro fertilization (IVF) program. While having a COH, the woman experienced a painful swelling in the inguinal area, and an ovarian image with follicular growth on the left inguinal region was observed with ultrasound. Afterward, surgery was performed, and the ectopic ovary in the left inguinal region was detected.

INTERVENTION(S)

Detection of an inguinal ovary with a controlled ovarian hyperstimulation procedure and surgical repositioning of the ectopic ovary.

MAIN OUTCOME MEASURE(S)

Controlled ovarian hyperstimulation, transabdominal ultrasound, transvaginal ultrasound.

RESULT(S)

The ectopic ovary was successfully repositioned with surgery.

CONCLUSION(S)

Patients must be closely monitored while performing COH. In patients who do not have a unilateral ovary, a painful inguinal mass should alert the physician to the possible presence of an ectopic ovary in the inguinal canal.

Comparison of transvaginal sonography, saline infusion sonography and hysteroscopy in the evaluation of uterine cavity pathologies

AIMS

To determine whether performing transvaginal sonography (TVS) and saline infusion sonography (SIS) before hysteroscopy could reduce the number of diagnostic hysteroscopies performed for the evaluation of uterine cavity abnormalities.

METHODS

Two hundred and twenty three women with suspected uterine cavity abnormalities were prospectively evaluated by TVS, SIS and hysteroscopy, and had histological evaluation of the endometrium with hysteroscopic biopsy or dilatation and curettage (D&C). One hundred and sixty five patients (74%) were premenopausal and 58 patients (26%) were postmenopausal.

RESULTS

The positive predictive value (PPV) for endometrial polyps was 69% for TVS, 78% for SIS and 81% for hysteroscopy in premenopausal patients. In the postmenopausal group, TVS and SIS could detect only 24% of endometrial polyps, whereas 70% were diagnosed by hysteroscopy. The PPV for submucous fibroids was 47% for TVS, 81% for SIS and 77% for hysteroscopy in the premenopausal group.

CONCLUSIONS

In premenopausal patients, SIS and hysteroscopy are equally accurate in the diagnosis of endometrial polyps and submucous fibroids. Hysteroscopy is the most accurate test for polypoid lesions in the postmenopausal group. Performing TVS, SIS and D&C could reduce the number of diagnostic hysteroscopies performed for the evaluation of uterine cavity abnormalities by 71.5% in premenopausal patients. However, this rate decreases to 40% in the postmenopausal group.

Follicular fluid concentrations of vascular endothelial growth factor, inhibin A and inhibin B in IVF cycles: are they markers for ovarian response and pregnancy outcome?

OBJECTIVE(S)

The aim of this study was to measure concentrations of vascular endothelial growth factor (VEGF), inhibin A and inhibin B in follicular fluid (FF) of women undergoing to in vitro fertilization (IVF) cycles and to determine their relationship with ovarian response and pregnancy.

STUDY DESIGN

Follicular fluid was collected from 58 patients undergoing oocyte retrieval for IVF. Ovulation was induced with GnRH analogues and gonadotropins. Follicular fluids of mature follicles (>17 mm) were aspirated and pooled for each patient. Follicular fluid steroid hormone levels (E2, P) and VEGF, inhibin A, inhibin B concentrations were studied. The serum levels of E2, P and VEGF were also assessed on the day of the oocyte retrieval. These parameters and characteristics of the cycles were compared between the pregnant (group 1) and non pregnant (group 2) patients.

RESULTS

The serum and FF VEGF levels were found to be significantly lower in the group in whom the pregnancy was achieved (P < 0.001). The FF inhibin A and FF inhibin B were found to be significantly higher in pregnant group (P < 0.001). However, age, day 3 FSH, dosage of gonadotropin administered, fertilization rate, sperm count, motile and morphologically normal sperm percentage were not significantly different in the two groups. There was an negative correlation between VEGF and number of follicles, number of oocytes, FF inhibin A, FF inhibin B. The number of oocytes retrieved, the fertilization rate were positively correlated with FF inhibin B and FF inhibin A.

CONCLUSION

This study demonstrated that decreased FF VEGF, serum VEGF and elevated FF inhibin A and B are associated with better ovarian response and high pregnancy rate.

Infertility due to intrauterine residual fetal bone fragments

A case of intrauterine retention of fetal bone diagnosed 8 years after termination of a pregnancy is presented. The patient had a history of hypermenorrhea infertility, and persistent vaginal discharge beginning after the abortion. Transvaginal sonography demonstrated an intrauterine foreign body. Curettage was performed, and fetal bone fragments were found within the removed materials.

Conservative treatment of cervical ectopic pregnancy with transvaginal ultrasound-guided aspiration and single-dose methotrexate

OBJECTIVE

To present a case of cervical ectopic pregnancy successfully treated with ultrasound-guided aspiration and single-dose methotrexate administered systemically.

DESIGN

Case report.

SETTING

University hospital.

PATIENT(S)

A 27-year-old nulliparous woman with a cervical ectopic pregnancy.

INTERVENTION(S)

Transvaginal ultrasound-guided aspiration of the cervical ectopic pregnancy followed by single-dose methotrexate administered systemically.

MAIN OUTCOME MEASURE(S)

Recovery of the patient, successful conservative treatment of the cervical ectopic pregnancy, with preservation of the uterus.

RESULT(S)

The cervical ectopic pregnancy was successfully aborted, and the reproductive capability of the patient was preserved.

CONCLUSION(S)

Transvaginal ultrasound-guided aspiration in combination with single-dose methotrexate administered systemically can be safely used to treat cervical ectopic pregnancies.

Does granulosa cell apoptosis have a role in the etiology of unexplained infertility?

OBJECTIVE(S)

To compare granulosa cell apoptosis in patients with unexplained infertility and tubal factor. Accelerated granulosa cell apoptosis may be the cause of unexplained infertility.

STUDY DESIGN

Setting was IVF-ET Unit of Cerrahpasa Medical Faculty, Istanbul University. GnRH analogs and gonadotropins were used for ovulation induction in patients with unexplained infertility (n=15) and tubal factor (n=15) undergoing in vitro fertilization and embryo transfer (IVF-ET) procedures. Following HCG injection and follicular aspiration, apoptosis of granulosa cells was assessed using the in situ DNA nick end labelling method and apoptosis rate was further determined by flow cytometry. Apoptosis rates were compared between two groups. Mann-Whitney's U-test and Student's t-test were used for statistics.

RESULTS

Apoptosis rate was significantly higher in the unexplained infertility group (33.20 +/- 35.62% versus 10.10 +/- 17.23%).

CONCLUSION(S)

Granulosa cell apoptosis seems to have a role in the etiology of unexplained infertility.

Assessment of antibiotic susceptibility of Ureaplasma urealyticum from prostitutes and outpatient clinic patients using the E-test and agar dilution method

In this study, a total of 647 vaginal discharge samples were examined. Ureaplasma urealyticum growth was seen in 68 samples (10.5%). The antibiotic sensitivity of 30 types of U.urealyticum was determined with the E-test and agar dilution method. With the agar dilution method, all types were sensitive to ciprofloxacin and ofloxacin (MIC 0.94 microg/ml), tetracycline (MIC 0.125 microg/ml) and doxycycline (MIC 0.125 and 0.190 microg/ml). Furthermore, with the agar dilution method, 18 types (60%) were resistant to roxithromycin and 12 (40%) were sensitive (MIC 12 microg/ml); 3 types (10%) were resistant to erythromycin and 27 (90%) were sensitive (MIC 12 microg/ml); 9 types (30%) were resistant to clarithromycin and 21 (70%) were sensitive (MIC 12 microg/ml), and all types were sensitive to azithromycin (MIC 14 microg/ml).

Significance of yolk sac measurements with vaginal sonography in the first trimester in the prediction of pregnancy outcome

BACKGROUND

The purpose of this prospective clinical study was to determine and evaluate the prognostic value of secondary yolk sac diameter of the embryo on pregnancy outcome.

METHODS

One hundred and thirty pregnant women in the first trimester were included in the study. Crown-rump length (CRL) and yolk sac diameters were measured in every patient and the outcome of the pregnancies were compared with the measurements. Intact normal pregnancy (group A), threatened abortion (group B) and missed abortion (group C) were diagnosed in 67, 43 and 20 pregnancies, respectively.

RESULTS

We detected a significant linear correlation between secondary yolk sac diameter and gestational age in group A (r = 0.5085; p < 0.0001) and a moderate correlation in group B (r = 0.4048; p = 0.007) and C patients (r = 0.3478; p = 0.1333). When the groups were evaluated irrespective of gestational age, a significant difference in secondary yolk sac diameters among the groups was noted (p = 0.037). When confidence intervals for secondary yolk sac diameters of intact normal pregnancies (group A) were calculated by linear regression, two patients in group B were below the 5% confidence interval. However, in group C patients, the yolk sac diameter of six patients were detected below the 5% confidence interval, while two of the measurements were above 95% confidence interval. Therefore, eight measurements (40%) of group C patients were outside the 5-95% confidence interval.

CONCLUSION

In the first trimester, when discrepancy is detected between secondary yolk sac diameter and gestational age, additional sonographic investigation should be performed one or two weeks later, in order to estimate the pregnancy outcome.