Basal and metoclopramide induced prolactin secretion in lean PCOS women

Polycystic ovary syndrome (PCOS) as well as hyperprolactinemia can cause infertility. In retrospective study the prolactin levels during the oral metoclopramide test among lean PCOS woman according to four phenotypes and free androgen index (FAI) were compared. The study population consisted of 314 lean PCOS women. The population was divided into four groups according to the FAI and menstrual cycle regularity. The group A consisted 126 women with FAI≥5 and irregular menstruation, the group B- 53 patients with FAI≥5 and regular menstruation. Group C- 70 patients with FAI<5 and irregular menstruation, group D - 65 patients with FAI<5 and regular menstruation. The ratio of prolactin value in 120th minute in the metoclopramide test to the basal prolactin value was higher in group D than in groups A and B. The prolactin basal concentration was higher in patients with FAI≥5 than in patients with FAI<5, (262.9 vs 228.9 µIU/ml; p<0.001). The ratio of prolactin in 60th minute (12.3 vs 16.7; p=0.006) and in the 120th minute (10.9 versus 13.3; p<0.001) of the metoclopramide test to the basal prolactin were lower in patients with FAI≥5. The prolactin secretion in lean PCOS women may be associated with their FAI.

Perinatal outcome of in vitro fertilization singletons - 10 years' experience of one center

INTRODUCTION

In vitro fertilization (IVF) singletons have a worse perinatal outcome than spontaneously conceived singletons, especially in terms of preterm birth and its complications.

MATERIAL AND METHODS

An observational retrospective case control study was carried out. The study population consisted of 644 women in singleton pregnancies (336 IVF/intracytoplasmic sperm injection (ICSI); 308 controls) who delivered > 22 weeks of gestation at the 1^st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland, between 2004 and 2014. Controls were initially matched by age and parity and drawn from the group of deliveries following each IVF delivery. Collected data included maternal characteristics, incidence of pregnancy complications, time and mode of delivery, and neonatal outcome at delivery.

RESULTS

The two study groups were initially matched for age and parity and were also similar with regard to BMI and gestational weight gain. The IVF treatment increased the odds of having vaginal bleeding in the first trimester (OR = 1.68; 95% CI: 1.0-2.86), placenta previa (OR = 5.15; 95% CI: 1.1-33.9), preterm delivery (OR = 2.06; 95% CI: 1.16-3.68), newborn's low birth weight (OR = 2.27; 95% CI: 1.19-4.36) and elective cesarean section (OR = 2.39; 95% CI: 1.7-3.4).

CONCLUSIONS

The IVF singleton pregnancies have an increased risk of adverse perinatal outcome, among which prematurity remains the greatest problem. Therefore, they should be managed as high risk not only due to psychological reasons.

Endometrial injury for women with previous in vitro fertilization failure - does it improve pregnancy rate?

Implantation failure is one of the major factors limiting success of in vitro fertilization (IVF) treatment. According to ESHRE 2009 data only 32% of fresh embryo transfers resulted in clinical pregnancies. There are many ideas to improve the treatment outcomes, endometrial injury being one of them. It has been suggested that local endometrial injury, performed either by pipelle biopsy or hysteroscopy, may increase clinical pregnancy rate. However, up to date literature is widely disparate on that subject. There is no conclusion with regard to optimal timing, the number and technique of the procedure. The following paper is the review of the evidence from clinical studies dealing with the effect of endometrial injury on the IVF outcome to guide clinical practice for this challenging problem. PubMed, Embase, the Cochrane Library using Medical Subject Headings and free text terms were searched up to June 2016 without year restriction. Though the majority of trials showed positive impact of endometrial injury on IVF outcome, there is still a lack of strong evidence to support routine local endometrial injury in women prior to IVF treatment.

Poor responders in IVF--is there any evidence-based treatment for them?

Despite the vast experience in controlled ovarian hyperstimulation, there are still women who respond poorly to gonadotropins, which results in few oocytes at retrieval, reduced number of embryos for transfer and consequently unsatisfactory pregnancy rates. Although such patients are quite common in IVF practice, the exact prevalence of so-called "poor responders" is difficult to estimate due to the variety of applied definitions. The urgent need for an internationally accepted definition of poor ovarian response (POR) was addressed by an ESHRE Workshop held in Bologna in 2010, where the consensus was reached and criteria were finally established. The application of this uniform definition may allow a correct estimate of POR prevalence and, what is more important, designing proper trials to assess and finally compare the interventions used in POR patients. The article describes the possible physiology of POR and patient characteristics, mentions risk factors and laboratory tests of decreased ovarian reserve. Finally it reviews the possible management of POR with different stimulation protocols in the light of EBM. Basing on published meta-analyses, various additional alternatives (such as estradiol priming, the addition of rLH, growth hormone, androgens and androgen-modulating agents, aspirin) are also summarized. Despite the two decades of trying, there is still no consensus on what is best for POR. No single treatment can be recommended over another, as the evidence for all of them is insufficient. It is obvious that interventions used in POR require properly designed large randomized studies, because until now there is no evidence-based treatment for that particular group of patients.

[Proteomics in endometriosis]

Despite significant scientific progress, etiology of endometriosis remains enigmatic. New advances in molecular biology have allowed the use of proteomics in demystifying this puzzling disease. Proteomics is a technology that permits the visualization of thousands of proteins inside a cell, tissue, or organism, and simultaneous observation of any alterations in protein expression and post-translational modification that may have important, clinical implications. Owing to its capacity to reveal the structural and functional properties of proteins, proteomics might illuminate the biology of the disease much better than genomics can. This state-of-the-art technology allows us to globally compare the expression and regulation profiles of proteins found in endometriosis with normal eutopic tissues (endometrium and peritoneum), as well as to compare those found in the different forms of endometriosis (i.e., peritoneal endometriosis, endometrioma, and adenomyoma). Proteomic analysis has been employed in endometriosis research in hope of discovering endometriosis-specific proteins, pathways, and potential biomarkers for precise, early detection. In recent years, several published studies have compared serum and peritoneal fluid protein content in women with and without endometriosis, as well as protein composition in endometrial implants, eutopic endometrium, endometriomas, menstrual blood and urine. It appears that use of proteomics could revolutionize our understanding of etiopathogenesis of the disease. Some of the identified proteins could indeed be responsible for the onset and progression of endometriotic implants. Because early stages of endometriosis may be difficult to diagnose, it would be of the utmost importance to identify specific biological markers of the disease. Additionally specific implant proteins could become targets for molecular treatment of endometriosis. It is very challenging, however to draw clear conclusions from the analysis of the obtained samples. First of all, the samples are usually pathologically confirmed to be endometriotic, but from a molecular stand point, the particular portion of the sample that is analyzed may matter greatly; none of the methods allow us to gain information about the molecular and pathological pattern of the same sample. Secondly it is very difficult to define an 'unaffected peritoneum' as a control for the endometriotic lesions. Thirdly the variety of options in each individual makes it difficult to see the molecular picture of the diseased area (such as the ovary or peritoneum) clearly ideally the samples would be of greater value if obtained at an early age, that is, before puberty in each individual and then again when endometriosis occurs later in reproductive age. Such a project cannot be performed prospectively although it may be considered as retrospective analysis of obtained material in some patients after successful chemotherapy due to oncological conditions.

Proteomic analysis of eutopic and ectopic endometriotic tissues based on isobaric peptide tags for relative and absolute quantification (iTRAQ) method

OBJECTIVE

The present study aimed at performing proteomic analysis of matched eutopic endometrium and ovarian endometrioid cysts from women with endometriosis in order to discover any abnormal protein expression related to the disease.

DESIGN AND SETTING

The study included 8 women with stage III/IV endometriosis according to revised American Fertility Society (rAFS) classification and one woman with no signs of the disease as a reference. Proteomic analysis was performed using a novel isobaric tag-based methodology for relative and absolute peptide quantification (iTRAQ) coupled with multidimensional liquid chromatography and tandem mass spectrometry.

RESULTS

The selection of 419 proteins was found in all endometriosis specimens. Using normal eutopic endometrium from woman without endometriosis as a reference, some proteins expressions were significantly increased in all endometriosis samples. They included collagen α1(XIV), calmodulin, collagen α(VI), plexin, integrin αVβ3, transgelin, desmin, and vimentin. The comparison of these proteins' expression in paired eutopic and ovarian endometriosis samples has revealed that only vimentin was significantly increased in ovarian endometrioma.

CONCLUSIONS

It was confirmed that endometriosis is associated with different expression of proteins in endometriotic samples. Nevertheless, further studies seem to be necessary as they may reveal possible markers that would be useful in clinical diagnosis of the disease.

[Robotic surgery in gynecology]

Introduction of robotic surgery in the first decade of the 21 century was one of the biggest breakthroughs in surgery since the introduction of anesthesia. For the first time in history the surgeon was placed remotely from the patient and was able to operate with the device that has more degrees of freedom than human hand. Initially developed for the US Military in order to allow surgeons to be removed from the battlefield, surgical robots quickly made a leap to the mainstream medicine. One of the first surgical uses for the robot was cardiac surgery but it is urology and prostate surgery that gave it a widespread popularity Gynecologic surgeons caught on very quickly and it is estimated that 31% of hysterectomies done in the United States in 2012 will be done robotically. With over half a million hysterectomies done each year in the US alone, gynecologic surgery is one of the main driving forces behind the growth of robotic surgery Other applications in gynecology include myomectomy oophorectomy and ovarian cystectomy resection of endometriosis and lymphadenectomy Advantages of the surgical robot are clearly seen in myomectomy The wrist motion allows for better more precise suturing than conventional "straight stick" laparoscopy The strength of the arms allow for better pulling of the suture and the third arm for holding the suture on tension. Other advantage of the robot is scaling of the movements when big movement on the outside translates to very fine movement on the inside. This enables much more precise surgery and may be important in the procedures like tubal anastomosis and implantation of the ureter Three-dimensional vision provides excellent depth of field perception. It is important for surgeons who are switching from open surgeries and preliminary evidence shows that it may allow for better identification of lesions like endometriosis. Another big advantage of robotics is that the surgeon sits comfortably with his/her arms and head supported. This results in much less fatigue and therefore increases precision and potentially may decrease the number of medical errors. The eyes of the surgeon are directed at where the hands should be, which is more natural, allows for a more natural body position and mimics open surgery Robot also enables better teaching, especially when two consoles are used. The surgeon and the student may be either sharing the instruments with two consoles or switching between one another. In a situation where the student operates, the surgeon can use the telestation to teach. Robotic simulator attached to one of the consoles allows students to practice after hours. In summary surgical robot is a great tool, especially in gynecology but also in urology cardiac surgery general surgery and laryngology The device will evolve and most likely with time will eliminate laparoscopy

Is mid-gestational cervical length measurement as sensitive prediction factor of preterm delivery in IVF as in spontaneous singleton pregnancies?

OBJECTIVES

To verify the relation between pregnancy duration and cervical length (CL) at 22-24 wks of spontaneous and IVF singleton gestations and to assess its predictive value for preterm delivery (< 37 wks).

MATERIAL & METHODS

CL at 22-24 wks was performed according to FMF recommendations in 344 women who conceived spontaneously and in 107 IVF singleton pregnancies. The results of CL in both groups were divided into subgroups: ≤ 29 mm, 30-34 mm; 35-39 mm; 40-44 mm; 45-49 mm and ≥ 50 mm. They were subsequently correlated with mean durations of gestation within subgroups and parameters of accuracy were calculated. Correlation and regression analysis was performed.

RESULTS

The average age of women in both groups was 28.1 y.o. (SD=4.2 years) and 33.4 y.o. (SD=4.1 years), respectively. The mean gestation age at delivery was 38.9 wks (SD=2.1 wks) vs. 37.9 wks (SD=2.3 wks) and the rate of prematurity equaled 7% vs. 15%, respectively. Regardless the method of conception there is a positive correlation between the CL and the duration of gestation. The regression analysis showed that the significant increase in pregnancy duration was correlated with CL ≥ 35 mm (correlation coefficient greater for spontaneous vs. IVF: rxy=0.418 vs rxy=0.341; p<0.001). All CL parameters of accuracy were better for spontaneous in comparison to IVF pregnancies.

CONCLUSIONS

IVF singleton pregnancy carries additional risk factors for preterm delivery. Therefore mid-gestational cervical length is less sensitive predictor than in spontaneous singleton gestations.

Are patient characteristics associated with the accuracy of hysterosalpingography in diagnosing tubal pathology? An individual patient data meta-analysis

BACKGROUND

Conventional meta-analysis has estimated the sensitivity and specificity of hysterosalpingography (HSG) to be 65% and 83%. The impact of patient characteristics on the accuracy of HSG is unknown. The aim of this study was to assess by individual patient data meta-analysis whether the accuracy of HSG is associated with different patient characteristics.

METHODS

We approached authors of primary studies reporting on the accuracy of HSG using findings at laparoscopy as the reference. We assessed whether patient characteristics such as female age, duration of subfertility and a clinical history without risk factors for tubal pathology were associated with the accuracy of HSG, using a random intercept logistic regression model.

RESULTS

We acquired data of seven primary studies containing data of 4521 women. Pooled sensitivity and specificity of HSG were 53% and 87% for any tubal pathology and 46% and 95% for bilateral tubal pathology. In women without risk factors, the sensitivity of HSG was 38% for any tubal pathology, compared with 61% in women with risk factors (P = 0.005). For bilateral tubal pathology, these rates were 13% versus 47% (P = 0.01). For bilateral tubal pathology, the sensitivity of HSG decreased with age [factor 0.93 per year (P = 0.05)]. The specificity of HSG was very stable across all subgroups.

CONCLUSIONS

The accuracy of HSG in detecting tubal pathology was similar in all subgroups, except for women without risk factors in whom sensitivity was lower, possibly due to false-positive results at laparoscopy. HSG is a useful tubal patency screening test for all infertile couples.

Differences in the soluble HLA-G blood serum concentration levels in patients with ovarian cancer and ovarian and deep endometriosis

PROBLEM

The relationship between endometriosis and cancer has been widely discussed in the literature but is still not well clarified. Perhaps significantly, soluble human leukocyte antigen-G (sHLA-G) has been identified in the microenvironment of both ovarian cancer and endometrioma. The aim of this study has been to evaluate the sHLA-G levels in the blood sera of women with deep endometriosis and ovarian endometrioma over the course of the menstrual cycle and to compare to the levels of sHLA-G in the blood sera of women with ovarian cancer.

METHOD OF STUDY

In our study, we examined the blood sera obtained from 123 patients operated on because of ovarian cancer (65 cases), ovarian endometrioma (30 cases), and deep endometriosis (28 cases). We decided to compare the levels of sHLA-G in patients with endometriosis to those found in patients with ovarian cancer with respect to the menstrual cycle phases. The sHLA-G concentration level was measured by enzyme-linked immunosorbent assay kit.

RESULTS

The level of sHLA-G concentration in the blood serum of patients with deep endometriosis fluctuates over the course of the menstrual cycle, and during the proliferative and secretory phases, it remains at a high level comparable to that found in patients with ovarian cancer. By contrast, the level of sHLA-G concentration in the blood serum of patients with ovarian endometrioma fluctuates minimally over the course of the different menstrual cycle phases and, as in patients with ovarian cancer, it remains at high level during the proliferative phase.

CONCLUSION

sHLA-G blood serum concentration levels would seem to provide important information regarding the degree of immune system regulation disturbance in both ectopic endometrial cells and the cancer cell suppressive microenvironment.

Laparoscopic treatment of uterine myomas in women of reproductive age

OBJECTIVES

To analyze the indications, safety and feasibility of laparoscopic myomectomies performed during the last 10 years.

MATERIAL AND METHODS

The studied material consisted of 187 typically performed laparoscopies, mostly due to uterine myomas. All the patients underwent an ultrasound examination at the time of admission and those with the maximum of 3 tumors, where the largest tumors were less than 10cm in diameter, were qualified for endoscopic surgery.

RESULTS

Out of 187 women, 39 patients had laparoscopy performed twice, with a 3-4 months interval for GnRH analogues treatment. Among 164 operative laparoscopies myomas were enucleated in 132 of the women (80.5%). In the case of 18 patients (9.6%) there was a need for laparoconversion resulting from the difficulties with enucleation, adhesions, and the size or localization of the tumor. There were also 62 cases of diagnostic laparoscopy, where myomas were either too large or too small to be enucleated. On analyzing the number and size of the tumors it occurred that a single myoma was the most frequent finding, while more than half of all the enucleated uterine tumors found during diagnostic and operative endoscopies were up to 2cm in diameter.

CONCLUSIONS

Laparoscopic myomectomy is a safe and reliable surgical alternative for women suffering from symptomatic myomas and is a method of choice in young patients of reproductive age. Beside skillful surgical techniques, a proper qualification for the operation is essential for the desired outcome.

The comparison of microlaparoscopy and laparoscopy in pelvic region assessment in infertile women

OBJECTIVES

To compare the efficacy of microlaparoscopy and laparoscopy in the assessment of pelvic region in infertile women.

MATERIALS AND METHODS

47 patients (aged 24-35) had microlaparoscopy and subsequent laparoscopy performed in order to diagnose the cause of infertility. Pelvic region assessment was performed in both procedures and the results were afterwards compared in regard to duration of the operations and findings reported by independent surgeons. The data was statistically analyzed using Statistica for Windows 5.1.

RESULTS

There were no major differences in the assessment of the pelvic region and found abnormalities in the analyzed postoperative protocols. All the diagnosed abnormalities were described similarly by both surgeons; the differences referred only to subjectively evaluated sizes of findings. The assessment of the pelvic region during microlaparoscopy was fully satisfactory in all cases, none required earlier than scheduled conversion to laparoscopy. The duration of endoscopic procedures was calculated from the moment of trocars insertion into the peritoneal cavity. The average duration time of microlaparoscopic evaluation was 6'20"+/-45", while in laparoscopy - 3'40"+/-32" (p<0.0001).

CONCLUSIONS

Microlaparoscopy and laparoscopy are of similar efficacy in the assessment of small pelvis organs and in detecting pathological changes. Both procedures differ significantly only in regard to the duration.

Comparison of tubal patency assessment during microlaparoscopy and laparoscopy, and its compatibility with previous histerosalpingography results

OBJECTIVES

The aim of the study was to compare tubal patency assessment during microlaparoscopy and laparoscopy and its compatibility with previously performed histerosalpingography (HSG).

MATERIAL & METHODS

Endoscopic evaluation of tubal patency was performed on 135 women, aged 30-39 (microlaparoscopy in 65 cases, laparoscopy in 70). In the group of 42 patients qualified for endoscopy, histerosalpingography was carried out in the past. The duration of tubal patency assessment was counted from the moment of the salpingograph placement, with trocars already introduced into the peritoneal cavity.

RESULTS

The mean duration of tubal patency evaluation during laparoscopy was 5'45"+/-39 and during microlaparoscopy - 7'30"+/-49". The results of the examination were afterwards compared with the results of previously performed HSG. Their sensitivity, specificity, compatibility and positive and negative predictive values were calculated. The sensitivity and specificity of microlaparoscopy in tubal patency assessment were 81% and 100%, respectively; its positive predictive value -100% and negative -96%. As to laparoscopy, the values were established at 90%, 100%, 100% and 98.4%, respectively.

CONCLUSIONS

Tubal patency assessment during microlaparoscopy and laparoscopy is characterized by similar sensitivity and specificity. Although the mean duration of microlaparoscopy is significantly longer, the difference in time is of no practical implication.

The comparison of two different embryo culture methods in the course of in vitro fertilization program

The objective of the study was to compare two different embryo culture methods in the course of in vitro fertilization program by means of fertilization rate, embryo development, total time and cost. 98 patients undergoing assisted reproduction procedures due to infertility were analyzed. The inclusion criteria for the study: first IVF-ET program, at least 10 MII oocytes, no indications for ICSI. Oocytes were divided into two study groups: group A- open culture (oocytes placed in four-well dishes together, then inseminated and cultured in successive wells) and group B - a closed culture (oocytes placed in microdroplets, each embryo cultured separately). The fertilization rate was assessed around 18 hours from insemination. The embryos were classified into four classes. The best embryos were chosen for transfer. In the group A the fertilization rate obtained was lower than in group B (68% vs. 78%, respectively). The microdroplet culture required more time on the insemination day and on the second day of culture, while the four-well dish method required more time on the first day of culture and on the day of transfer. On analyzing the total cost of the above procedures (MI medium and oil costs) it occurred that the microdroplet culture was more expensive than the four-well dish method (due to the intake of paraffin oil). However, the difference was of no practical importance. In the conclusion, microdroplet culture gives a higher fertilization rate than four-well dish culture, probably due to a homogenous sperm distribution. Despite the differences in time outside the incubator and laboratory expenses (which are after all insignificant) microdroplet culture allows a better control over the embryo development. The embryos of best developmental potential can therefore be chosen for ET.

The occurrence of genital types of human papillomavirus in normal pregnancy and in pregnant renal transplant recipients

OBJECTIVE

The aim of this study was to evaluate: 1) The prevalence of human papillomavirus (types 6 and 11 carrying a low risk of neoplasia, and type 16 implicated as cause of cervical neoplasia and cancer) in normal pregnant women and pregnant renal transplant recipients. 2) The correlation between maternal HPV infection and HPV presence in the cord blood and the oral cavity of the neonate. Evaluation of a likely, additional route of HPV transmission to the fetus, apart from the infected birth canal during vaginal delivery. The correlation between the mode of delivery in HPV-infected patients and the presence of HPV in their offspring.

DESIGN

Thirty-nine pregnant patients were included in the study. The study group consisted of nine pregnant renal transplant recipients. The control group consisted of 30 patients with normal pregnancy. The DNA of HPV types 6, 11 and 16 was studied in the discharge from the cervical canal, the maternal venous blood, the cord blood and the buccal smear obtained from the neonates.

SETTING

A university teaching hospital delivering approximately 2000 women annually.

RESULTS

Human papillomavirus (HPV) was found in 10 (26%) of 39 subjects. HPV types 6 and 11 was found in 7 (18%) of 39 subjects while HPV type 16 was present in 5 (13%) of the subjects. The co-occurrence of HPV types 6, 11 and 16 was detected in 2 patients from the control group. Transmission of HPV was established in 70% of study patients and their offspring.

CONCLUSIONS

1) The HPV was found with 26% pregnant women. 2) The occurrence of HPV infections with pregnant renal transplant recipients in comparison with normal pregnancy was on similar level. High percentage of HPV transmission from mother to neonate was obtained. 3) The cesarean section probably doesn't protect from HPV infection. 4) There's a suggestion, the HPV infection of fetus may occur in utero.

The changes of hormonal serum levels and ovulation/pregnancy rates after ovarian electrocautery in microlaparoscopy and laparoscopy in patients with PCOS

OBJECTIVES

To compare the efficacy of ovarian electrocautery performed during microlaparoscopy and laparoscopy, basing on ovulation and pregnancy rates obtained within one year of follow-up.

MATERIALS AND METHODS

Ovarian drillings, performed with the use of endoscopic methods, were carried out in 135 women with hormonal and ultrasound features of PCOS, aged 30-39 (average age 36 +/- 3.3). Laparoscopic ovarian electrocautery was carried out in 65 cases, whereas microlaparoscopic drilling was conducted in 70 cases. The obtained results were compared in regard to duration of the procedure and ovulation/pregnancy rates within one year of follow-up. Changes in hormonal profiles were also compared in both groups, measured in patients who did not get pregnant before, and 3 months after, the procedures.

RESULTS

The difference in durations between the two studied procedures was statistically significant (19 +/- 3 min vs. 24 +/- 4.4 min; p<0.001). However, the ovulation and pregnancy rates did not differ significantly between the two groups (72% vs. 77.7%; p<0.5 and 19.4% vs. 20%; p<0.95, respectively). There were also similar trends in hormonal changes after microlaparoscopic and laparoscopic drilling.

CONCLUSIONS

The efficacy of ovarian drilling in PCOS, estimated by ovulation and pregnancy rates within 12 months of follow-up is similar for microlaparoscopy and laparoscopy, as well as the trends in hormonal changes. Ovarian electrocautery is significantly longer in microlaparoscopy, but the difference in time is of no practical impact.

[Protocol of GNRH antagonist in poor responders in IVF-ET cycles]

INTRODUCTION

Response to stimulation is one of the factors that affect the results of infertility treatment in IVF-ET cycles. Poor responders as well as the occurrence of ovulation prior to the oocyte retrieval is a main reason of nearly 30% of cancellations of the treatment cycles. In poor responders high doses of gonadotrophins are sometimes required. However administration of gonadotrophins alone does not prevent premature LH surge. The aim of the study was to assess controlled ovarian stimulation protocols with GnRH antagonists (Cetrotide) in poor responders.

MATERIAL AND METHODS

The study group consisted of 27 infertile women, mean age 35.8 (range 28-45) undergoing the second IVF cycle. In those women the first cycle was either cancelled due to the lack of follicles' development or the small number of growing follicles (1-2). Ovarian stimulation was started on the 2 day of cycle with administration of 225 IU or rFSH or hMG. Cetrotide was administered subcutaneously in a daily dose of 0.25 mg starting when estradiol serum concentration reached 150 pg/ml with a lead follicle 14 mm diameter and continued throughout the gonadotrophin treatment until HCG administration.

RESULTS

In 31 cycles the mean number of MII oocytes retrieved was 4.71 (range 1-10). In one woman there was no mature oocytes obtained during pick-up. In one case the cycle was cancelled due to the bad response. The mean duration of cetrotide administration was 5.16 days. The mean number of rFSH and HMG ampoules was 23 and 30 respectively. The fertilisation rate was 64%. Embryo transfer was performed on the 3rd day after pick-up. The pregnancy rate in this group was 22%. There weren't any adverse effects of Cetrotide in treated women. No case of ovarian hyperstimulation syndrome occurred.

CONCLUSION

Ovarian stimulation protocol with GnRH antagonist is effective in poor responders in IVF-ET cycles.

[Preterm deliveries after in vitro fertilization treatment of infertility]

Wide access to the assisted reproductive technics as a tool in the treatment of infertility arisen many questions regarding the outcome of the pregnancy, its possible complications and the neonatal outcome in women after IVF treatment. We completed the literature search in order to present this subject. It seems that the increased rate of spontaneous abortions and preterm deliveries in this group is caused by such factors as: maternal age, chromosomal, hormonal and uterine abnormalities and immunological factors. The incidence of preterm deliveries in the multiple gestation after IVF group is similar to the one observed in the spontaneous pregnancy group.

Localization of a proteasomal antigen in human spermatozoa: immunohistochemical electron microscopic study

The ultrastructural localization of a proteasomal antigen in human spermatozoa was studied by means of immunolabeling with the MPC21 monoclonal antibody and secondary gold labeled antibody with 1.4 nm gold particles in combination with silver enhancement reaction using pre-embedding technique. The labeling was found in the acrosomal and postacrosomal regions, in the connecting-piece (neck) and, in some cases, in the middle-piece and also in the residual bodies. There was no significant reaction in condensed chromatin. In some abnormal forms of spermatozoa, in which the chromatin was not well condensed, the labeling in nuclei was present. The nuclear vacuoles with looser chromatin were usually strongly labeled. The nuclei of cells representing different stages of spermatogenesis, that were present in semen samples, were also labeled.

[Intramuscular vs vaginal progesterone for luteal support in cycles of in vitro fertilization]

OBJECTIVE

To determine the effectiveness of two routes of progesterone supplementation by intramuscular vs. vaginal administration, for luteal phase support of patients undergoing in vitro fertilization (IVF) procedures.

SETTINGS

Rush Presbyterian St' Lukes Medical Center and Rush Northshore Medical Center in Chicago, Illinois.

MATERIALS AND METHODS

A total of 79 consecutive patients undergoing IVF procedures between August 1997 and July 1998 were assessed; 42 women received progesterone in oil intramuscularly (i.m.)--50-100 mg daily and in 37 patients progesterone was applied as intravaginal gel (80 mg daily), according to patient's preference.

STUDY DESIGN

A chart review of the patients' data was performed. There were no statistical differences between the two groups of patients with respect to age, total number of ampoules of gonadotropins used during stimulation, number of oocytes retrieved and fertilized or number of embryos transferred. We then compared pregnancy rates per cycle and pregnancy rates per embryo transferred and miscarriage rates between two groups. Statistical analysis was performed using Student's t test.

RESULTS

There were no statistically significant differences between two groups. The pregnancy rate per cycle for i.m. progesterone group was 33% and for vaginal gel group--25% (p = 0.42). Pregnancy rates per embryo transferred were also similar (8% for i.m. group and 5% for vaginal gel group (p = 0.42). Miscarriage rates were also within the same range: 0.083 for vaginal gel and 12% for i.m. group, (p = 0.48).

CONCLUSIONS

The route of post-transfer progesterone administration does not appear to affect the pregnancy rate in IVF cycles. Therefore the least expensive and the most convenient route of progesterone administration could be utilized.

Cyclodextrin enhances spermicidal effects of magainin-2-amide

Magainins are antimicrobial peptides with known spermicidal activity. Their activity is inhibited by cholesterol present in eukaryotic cell membranes. Pretreatment of spermatozoa with methyl-beta-cyclodextrin, which extracts cholesterol from cell membranes and induces capacitation, sensitizes them to magainin-2-amide as shown by a decrease in human sperm motility determined by computer-assisted sperm analysis and a concomitant decrease in sperm viability, as measured by MitoTracker(R) Red CMXRos labeling. Magainin-2-amide affects mainly the fast progressive spermatozoa inducing them directly into an immotile state, without an increase in motile non-progressive and slow progressive spermatozoa. We conclude that methyl-beta-cyclodextrin highly potentiates the deleterious effect of magainin-2-amide on human spermatozoa. Most probably, this effect can be explained by cholesterol extraction from sperm cell membranes.