David Sable

Improved implantation after preimplantation genetic diagnosis of aneuploidy

The objective of this study was to assess the improvement in implantation rates after preimplantation genetic diagnosis (PGD) of numerical abnormalities for the sole indication of advanced maternal age when compared with a control group. Each PGD patient was matched to a control patient according to several parameters prior to obtaining pregnancy results. The diagnosis was based on the analysis of chromosomes X, Y, 13, 15, 16, 18, 21 and 22 plus a ninth probe (1, 7, 14 or 17) on a single cell per embryo. The results were also analysed in relation to the previous number of IVF cycles and the number of dipronucleated zygotes obtained, when replacing presumptively chromosomally normal embryos on day 4 of development. It was found that women of advanced reproductive age (average age 40 years) had a higher implantation rate (18%) than their matched controls treated with standard IVF (11%) (P < 0.05). This increase was not observed in patients with two or more previous IVF cycles or patients with fewer than eight zygotes. Patients with eight or more 2PN zygotes and one or no previous cycles showed the greatest improvement in implantation rate, from 8.8% in controls to 19.2% in the PGD group (average age 40 years) (P < 0.025).

Dexamethasone during ovulation induction for in-vitro fertilization: a pilot study

The purpose of the present study was to determine whether adrenal androgen suppression with dexamethasone (DEX) during ovulation induction improves the outcome of in-vitro fertilization (IVF) cycles. A total of 25 patients with serum dehydroepiandrosterone sulphate (DHEAS) concentrations > 2.5 micrograms/ml were randomized to receive either 0.5 mg DEX daily or placebo during ovulation induction with leuprolide acetate down-regulation plus human menopausal gonadotrophins (HMG). Nine patients undergoing a subsequent IVF cycle were crossed over to the other treatment group. Ovarian responsiveness and IVF outcome variables analysed included number of follicles > 12 mm in diameter, serum oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration, number of ampoules of HMG administered, number of oocytes retrieved, percentage of oocytes fertilized, number of embryos transferred, implantation rate and numbers of clinical pregnancies and live birth pregnancies. The 31 randomized IVF cycles revealed a trend towards a higher implantation rate for the placebo-treated group compared to the DEX-treated group (24 versus 10%; P = 0.07). The remainder of the IVF cycle variables revealed no statistically significant differences. In conclusion, the suppression of adrenal androgens with DEX in women with DHEAS concentrations > 2.5 micrograms/ml appears to have no beneficial effects on ovarian responsiveness or clinical or live birth pregnancy rates.

Ruptured pelvic abscess after intrauterine insemination: a case report.

This case reports a serious but previously unreported complication of IUI. Further reports of serious infection would warrant consideration of antibiotic prophylaxis in some cases.

Growth factor receptor messenger rna expression in human fetal brain regions

Objective To analyze growth factor receptor expression in the human fetal brain. Methods Messenger RNA was prepared from six regions of the fetal brain from three 21–22-week abortuses and used as templates for reverse transcription. Polymerase chain reaction (PCR) was used to amplify the complementary DNA for each of the six brain regions. Amplified PCR DNA fragments were analyzed by agarose gel electrophoresis. Restriction endonuclease digestion was used to confirm the identity of the amplified PCR fragments. Results Polymerase chain reaction amplified DNA fragments consistent with expression of the insulin, insulin-like growth factors I and II, fibroblast growth factor (FGF), transforming growth factor-β, and epidermal growth factor receptors were detected in each area of the human fetal brain studied. Of the two known insulin receptor subtype sequences, only the smaller (exon 11–) form was detected. We detected both the intact and the 267 base-deleted alternatively spliced forms of the FGF receptor. Conclusion All six of the receptor messenger RNAs studied were detected in the second-trimester human fetal brain. In addition, alternative splicing of the messenger RNA was noted for the FGF and insulin receptors. This report demonstrates growth factor receptor expression and alternate splicing in specific regions of the human fetal brain. These data suggest that growth factor influence on fetal brain development may be mediated through specific growth factor receptors.

Misleading press reports: another rebuttal

This short communication robustly defends embryologists and scientists against allegations in the lay press.