Joseph Tal

Heterotopic pregnancy after ovulation induction and assisted reproductive technologies : a literature review from 1971 to 1993

OBJECTIVE To review and analyze records on heterotopic pregnancy occurring after ovulation induction and assisted reproductive technologies. DATA IDENTIFICATION Case reports in the English literature related to the topic were identified through a computerized bibliography search up to December 1993. CONCLUSIONS The incidence of heterotopic pregnancies increased in recent years because of the escalating use of new reproductive technologies in infertile patients and has stabilized at approximately 1:100 pregnancies with these procedures. The main reasons for development of such a condition in these patients are past tubal or pelvic disease and multiple ovulations or multiple ET. Progress has been made in diagnosis of heterotopic pregnancy during the last two decades, mainly because of development of ultrasonographic techniques, especially transvaginal ultrasonography. Treatment of heterotopic pregnancy should be prompt to avoid maternal morbidity and mortality from extensive intraperitoneal bleeding. No increased intrauterine fetal mortality due to hemoperitoneum has been proven in the present review, except in advanced cornual pregnancies. More experience is needed for application of new treatment modalities such as salpingocentesis, which are used successfully for ectopic pregnancy, in treatment of heterotopic pregnancy. With early diagnosis and skillful treatment, the outcome of the intrauterine pregnancy is favorable and its survival rate should increase in the future.

Alternative Models for Antecedents and Outcomes of Work Centrality and Job Satisfaction of High-Tech Personnel

Alternative causal models were developed, relating Work Centrality and Job Satisfaction to antecedents and outcomes. The antecedents examined were demographics and need for achievement, and the outcomes included performance, wages, organizational commitment, and career planning. The models were tested using data of Israeli high-tech personnel. Results indicated that organizational commitment, career planning, and wages were significantly affected by work centrality, while performance was positively but nonsignificantly related to it. While all models proved to be acceptable, the best model posited Job Satisfaction as an antecedent rather than an outcome of Work Centrality. It also revealed the importance of demographics for outcomes. Implications are discussed.

Activated Protein C Resistance and Factor V Leiden Mutation can be Associated with First‐ as well as Second‐Trimester Recurrent Pregnancy Loss

PROBLEM: To examine whether the occurrence of activated protein C resistance (APCR) and factor V Leiden mutation differs in women with first‐ compared to women with second‐trimester unexplained recurrent pregnancy loss. METHOD OF STUDY: Seventy eight consecutive women with two or more unexplained post‐embryonic recurrent pregnancy losses and 139 fertile women with at least one successful pregnancy and no abortions were prospectively investigated for APCR and the factor V Leiden mutation. No women were pregnant at the time of investigation. APCR was defined as APC–sensitivity ratio (APC–SR) of ≤2.0. All patients with an APC–SR ≤2.4 were investigated for the factor V Leiden mutation. Women in this study were divided into three groups. Group A included only women with a history of recurrent first‐trimester embryonic loss (37 women) and Group B included women with second‐trimester abortions with or without additional first‐trimester abortions (41 women). Group C included the controls (139 women). RESULTS: APCR and factor V Leiden mutations were significantly more prevalent in all recurrent pregnancy loss patients in this study as compared to controls, 38% (30/78) and 19% (15/78) in contrast to 8% (11/139) and 6% (8/139), respectively. All three groups in the study were comparable regarding age, parity, and number of living children, whereas Groups A and B were also comparable regarding gravidity. Mean APC–SRs were significantly higher in Group C as compared to Groups A and B. The incidence of APCR was significantly higher in Groups A and B, as compared to controls, 27 and 49% in contrast to 8%, respectively. Moreover, the incidence of the factor V Leiden mutation was significantly higher in Groups A and B as compared to Group C, 16 and 22% as distinct from 6%, respectively. The incidence of APCR was higher in Group B as compared to Group A, 49% in contrast to 27%, with borderline significance; however, the factor V Leiden mutation did not significantly differ between the two groups. CONCLUSIONS: APCR and factor V Leiden are associated with unexplained recurrent pregnancy loss. The occurrence of APCR and factor V Leiden seems to be linked to post‐embryonic first‐trimester as well as second‐trimester recurrent pregnancy loss. The significance of acquired, non‐heritable APCR in recurrent fetal loss patients, especially in the second‐trimester aborters, is still to be determined.

Decidualization of Ovarian Endometriosis During Pregnancy Mimicking Malignancy

The purpose of this series is to present deciduosis (the formation of extrauterine decidua) as one of the differential diagnoses of a malignant tumor during pregnancy.

Ultrasonographic and clinical correlates of menotropin versus sequential clomiphene citrate: menotropin therapy for induction of ovulation

Forty-six women remaining infertile with clomiphene citrate (CC) with or without human chorionic gonadotropin (hCG) were treated by either human menopausal gonadotropin (hMG, 44 cycles) or CC + hMG (33 cycles) and monitored by serum estradiol (E2) and ultrasonography. Ovarian hyperstimulation syndrome (OHS) and pregnancy outcome were compared in both regimens. In the presence of dominant follicles (greater than or equal to 18 mm) alone or with a single secondary follicle (14 to 16 mm) at hCG administration, OHS did not develop. A significant increase in OHS was noted when three or more secondary follicles were observed. Overall pregnancy rates were similar in both regimens but significantly higher when hCG was injected before rather than after the E2 peak. The results suggest secondary follicles rather than dominant follicles are a valuable sign of possible OHS development; and CC + hMG should be considered in CC-failure patients.

Ovarian response to gonadotropin stimulation in repeated IVF cycles after unilateral salpingectomy.

AbstractPurpose: This study aimed to examine ovarian response to gonadotrpoin stimulation after repeated IVF treatment cycles in patients who underwent previous unilateral salpingectomy for tubal pregnancy. Methods: The study group included 26 patients who underwent unilateral salpingectomy for tubal pregnancy 1–9 years prior to starting IVF treatment. A control group of 52 patients with anatomically intact pelvis was treated during the same time period by ICSI. The two groups were matched for age, number of gonadotropin ampules, and length of stimulation. End point measurements included number of follicles, oocytes, and cleaved embryos in consecutive treatment cycles of each group. Results: There were 98 cycles in the study group and 154 cycles in the control group. The mean number of follicles, retrieved oocytes, and cleaved embryos were not different in the two groups, and no reductions in these parameters were noted up to 10 cycles of treatment. The mean number of follicles ipsilateral to the operated side was similar to the number of follicles of the contralateral ovary and was not different whether salpingectomy was by laparoscopy or laparotomy. Conclusions: Unilateral salpingectomy does not affect ipsilateral ovarian response to gonadotropin stimulation even after repeated IVF treatment cycles.

Stress-related reproductive failure

Life is a stressful experience, especially in modern civilization. Stress affects a large spectrum of biological systems including the reproductive system. The modern definition of stress as coined by Seyle is rather complex. It may be caused by any or all of the following: (1) the environment, (2) the response of the individual, and (3) the interaction of the individuals perception of the environment with the response. In the present review we focus on the adverse effects exerted by stressful conditions upon endocrine and reproductive processes.

Accurate Diagnosis of Postabortal Placental Remnant by Sonohysterography and Color Doppler Sonographic Studies

The decision whether to perform uterine curettage for postabortal bleeding depends on the ability to demonstrate placental remnants in the uterine cavity. However, diagnosis of postabortal trophoblastic residua by conventional ultrasonography may be inconclusive. We report our experience with the use of combined sonohysterography and color Doppler to demonstrate a placental polyp after early pregnancy termination.

Assessment of fetal lung maturity by a microviscosimeter.

A new method of rapid antenatal assessment of fetal lung maturity was evaluated in relation to the newborn outcome and two other accepted test. This method is based on fluorescence depolarization (FD) technique. The special instrumentation required for this method (the Microviscosimeter) was found to be simple and easy to handle even to nonprofessional personnel. Analysis of 47 samples of amniotic fluid received within 48 hours of delivery demonstrated that lung maturity threshold may be related to a numeric value (P value) measured by this technique. With a P value of less than 0.320 respiratory distress syndrome (RDS) is unlikely to develop. With a P value greater than 0.340, chances for RDS, usually severe, are high. With a P value of less than 0.340 but greater than 0.320, RDS may or may not develop. This method did not prove to be more reliable then the determination of L/S ratio by thin layer chromatography, but its advantage is that it supplies the results in less then an hour. The FD technique proved to be more reliable then the commonly used foam stability test.

Contexts of Collaboration in Caregiving: Infant Interactions with Israeli Kibbutz Mothers and Caregivers

This report directly compares caregiving activities of mothers and nonfamilial care‐givers in the context of the Israeli kibbutz, where responsibilities for chiidrearing are typically shared according to formalized kibbutz social norms. For comparison, the study also included full‐time homemaker mothers from typical, urban nuclear families in Israel. The frequency and sequence of common caregiving activities showed similarities and differences among mothers and caregivers, as did patterns of associations among mother and caregiver behaviors and patterns of interactions between mothers and infants as well as between caregivers and infants. Infants themselves differed in exploration and vocalization with different caregivers. Caregiving activities, interactions, and developmental processes provided by kibbutz mothers and professional nonfamilial caregivers are discussed in terms of a “division of caregiving responsibilities,” and they are compared with caregiving provided by homemaker mothers.