L. Hamberger

Risk factors for ectopic pregnancy in assisted reproduction

OBJECTIVEnTo identify risk factors for ectopic pregnancy (EP) after IVF-ET.nnnDESIGNnRetrospective cohort study.nnnSETTINGnIn vitro fertilization clinic at a university hospital.nnnPATIENT(S)nA total of 725 women who conceived after IVF were studied with regard to background factors, indications for IVF, and factors related to the IVF procedure through review of their medical charts. The rate of EP was 4%, corresponding with 29 EPs, of which 2 were heterotopic.nnnINTERVENTION(S)nNone.nnnMAIN OUTCOME MEASURE(S)nPregnancy outcome, defined as intrauterine pregnancy or EP. Background factors, indications for IVF, and factors related to the IVF procedure were analyzed for possible correlation with the outcome of EP. Risk factors for EP were identified by logistic regression analysis.nnnRESULT(S)nTubal factor infertility, various previous abdominal surgeries, previous EP or pelvic infection, presence of a hydrosalpinx or fibroid, and type of transfer catheter used showed a positive correlation with EP as outcome. Logistic regression analysis identified two factors with predictive power: tubal factor infertility and previous myomectomy.nnnCONCLUSION(S)nTubal factor infertility was the most prominent risk factor for EP after IVF. Previous myomectomy appeared to be another important risk factor, but this is a new finding that needs to be confirmed by further study.

Postnatal growth and health in children born after cryopreservation as embryos

BACKGROUNDnThere is uncertainty about the health of children born from in-vitro fertilisation (IVF) with cryopreserved embryos. We investigated the postnatal growth and health (up to 18 months) of these children compared with those born after standard IVF with fresh embryos and those from spontaneous pregnancies.nnnMETHODSn255 children from cryopreserved embryos were matched by maternal age, parity, single or twin pregnancy, and date of delivery with 255 children born after IVF with fresh embryos, and 252 children from spontaneous pregnancies. The main endpoint was growth; secondary endpoints were the prevalence of chronic illness, major malformations, cumulative incidence of common diseases, and development during the first 18 months. Growth was assessed by comparison with standard Swedish growth charts and by standard deviation scores.nnnFINDINGSnGrowth features were similar for both singletons and twins in the three groups. There were 6 (2.4%) of 255, 9 (3.5%) of 255, and 8 (3.2%) of 252 major malformations in the cryopreserved group, standard IVF, and spontaneous groups, respectively (p=0.6 between the cryopreserved and standard IVF group). The prevalence of chronic diseases did not differ between the three groups, with 18.0%, 15.3%, and 16.7% of children with a chronic illness in the cryopreserved group, standard IVF, and spontaneous groups, respectively.nnnINTERPRETATIONnThe cryopreservation process does not adversely affect the growth and health of children during infancy and early childhood. Minor handicaps, behavioural disturbances, learning difficulties, and dysfunction of attention and perception cannot be ruled out at this age.

Molecular and Pharmacological Properties of Human Embryonic Stem Cell–Derived Cardiomyocytes

Human embryonic stem cells (hESCs) can be coaxed to differentiate Into specific cell types, including cardiomyocyte-like cells. These cells express cardiac-specific markers and display functional similarities to their adult counterparts. Based on these properties, hESC-derived cardiomyocytes have the potential to be extremely useful in various in vitro applications and to provide the opportunity for cardiac cell replacement therapies. However, before this can become a reality, the molecular and functional characteristics of these cells need to be Investigated in more detail. In the present study we differentiate hESCs into cardiomyocyte-like cells via embryoid bodies (EBs). The fraction of spontaneously beating clusters obtained from the EBs averaged approximately 30% of the total number of EBs used. These cell clusters were isolated, dissociated into single-cell suspensions, and frozen for long-term storage. The cryopreserved cells could be successfully thawed and subcultured. Using electron microscopy, we observed Z discs and tight Junctions in the hESC-derived cardiomyocytes, and by Immunohistochemical analysis we detected expression of cardiac-specific markers (cTnl and cMHC). Notably, using BrdU labeling we also could demonstrate that some of the hESC-derived cardiomyocytes retain a proliferative capacity. Furthermore, pharmacological stimulation of the cells resulted in responses Indicative of functional adrenergic and muscarinic receptor coupling systems. Taken together, these results lend support to the notion that hESCs can be used as a source for the procurement of cardiomyocytes for in vitro and in vivo applications.

Is misoprostol the drug of choice for induced cervical ripening in early pregnancy termination

Background. To study the effectiveness of three different cervical ripening agents in terms of dilatation ability and patient discomfort in connection with legal first trimester abortion.

Towards single embryo transfer in IVF

Assisted reproductive technologies have, during the last two decades, managed to overcome a majority of the reasons for infertility in both women and men. Also, infertility associated to a specific couple can generally be successfully treated. The techniques have been proven both safe and cost effective. There is, however, one major shortcoming: an adverse effect in terms of multiple pregnancy, sometimes in the high order. The present communication gives suggestions on how to avoid multiple pregnancy by correct application and improvement of techniques already utilized today. Controlled ovarian hyperstimulation, fertilization and culture procedures, preimplantation genetic diagnosis, freezing procedures and prolonged embryo culture are all techniques and applications which need improvement if the goal of a predominance for singletons with only occasional twins should be reached within a predictable future.

Ultrasound in gynecology: endometrium

With the development and clinical application of transvaginal transducers/probes (TVS) the sonographic imaging of the endometrium was greatly enhanced compared with abdominal ultrasound. Also, the discomfort of a full bladder associated with abdominal ultrasound could be avoided. A shorter distance between probe and target allowed the use of higher frequency transducers, thereby achieving improved imaging. This review will only discuss the use of TVS, but it does not mean that abdominal ultrasound should not or cannot be used when dealing with the postmenopausal uterus. Transvaginal sonography (TVS) provides a valuable tool for the diagnosis of a wide range of gynecological disorders including those of the uterus and endometrium. The ability of TVS to depict the thickness and morphology of the endometrium has been established in both office and hospital settings. This article will discuss and illustrate the clinical and research applications of transvaginal sonography in relation to the endometrium in both symptomatic and asymptomatic postmenopausal women. The article is of particular relevance today given the number of women who are undergoing transvaginal ultrasonography in the absence of symptoms as a part of their routine check ups. There is a paucity of data relating to the management of apparent ultrasound abnormalities in such women. In symptomatic women or for women at risk of developing endometrial pathology, a technique that could reduce the number of biopsy procedures would be of value. Hysteroscopy, dilatation and curettage (D & C) as well as other endometrial sampling methods are all invasive, thus it would be of benefit if a way could be found to assess the endometrium using a relatively non‐invasive approach. Such a technique would need to be relatively easy to learn and perform, as well as being well accepted by the patients. We believe that transvaginal sonography fulfills many of these requirements, the following review will attempt to put forward some of the evidence to support this view.

Culture of human spare preembryos association between blastocyst formation and pregnancy

The rate of blastocyst development was studied in cultures of human fertilized eggs. A total of 195 spare embryos from 86 cycles in 73 in vitro fertilization (IVF) patients resulted in a total of 77 expanded blastocysts, corresponding to an overall blastocyst development of 39%. In the group of patients where pregnancy occurred, at least one of the spare embryos developed into the blastocyst stage in 100% of the patients, while the corresponding figure for nonpregnant patients was 53%. Superficially these results seem to indicate that blastocyst development could be of decisive importance for the success rate in IVF. A detailed analysis revealed, however, that this is not the case as long as in vitro culture before replacement is limited to 2–3 days.

A Simplified Ultrasound Based Infertility Investigation Protocol and Its Implications for Patient Management

AbstractPurpose: To evaluate whether a simplified infertilityinvestigation protocol, focusing on the use of hysterocontrastsonography (HyCoSy), one blood test, and a semen analysis,would be sufficient as an initial screening test to selectcouples for specific treatment.nMethods: The infertile couples underwent gynaecologicalexamination, cervical sampling for cytology and Chlamydiatrachomatis culture, B-mode transvaginal ultrasonographyand basic hormonal analyses followed by a HyCoSy, and asemen analysis. A preliminary diagnosis was made for allpatients. A management plan for treatment was suggestedwhen possible; otherwise further examinations wererecommended. The data were stored for later analysis and theroutine investigation protocol was then adhered to and afinal diagnosis and treatment were decided upon.nResults: Agreement between the diagnosis based on HyCoSyand our routine protocol was present in 74% of cases(N = 73). In 13% (N = 13) there was partial agreement. In36% the HyCoSy based protocol was considered sufficientto suggest treatment.nConclusions: A simplified approach may lead to asignificant reduction in both the time and cost of investigating aninfertile couple.

Is any form of gender selection ethical

In later years, sex selection has become of importance for prevention of X-linked diseases in families at risk. There is today a potential to perform sperm selection before fertilization by taking advantage of the chromosomal heterogamy of spermatozoa, and before implantation by preimplantation genetic diagnosis (PGD). The methods of sex determination by separating spermatozoa are, in our opinion, still not safe enough for routine clinical use. Apart from the technical problems and possible associated risks, which first must be better evaluated, the most critical questions are ethical or legal. We support the use of sex selection by PGD in X-linked severe disease, but due to the potential risks of misuse, we are not prepared to support a more liberal attitude as long as the discriminated sex in nearly all parts of the world are women.

Are the new microfertilization techniques associated with an increased genetic risk to the offspring

Since the introduction of in vitro fertilization (IVF) in the human two decades ago, the techniques have advanced rapidly and are now (especially with the successful development of intracytoplasmic sperm injection (ICSI)) used for a wide range of indications. However, with the development of novel techniques, new evaluations have to be made of the risks which may be involved, particularly concerning both short-term and long-term health of the offspring. Since the main indications so far for applying ICSI have been male infertility factors, potential risks might be different (particularly when sperm aspiration from the epididymis and/or the testis is performed) from those when conventional IVF techniques are used. The rapidly increasing knowledge about the human genome allows us to explain many infertility factors that could only be guessed at a few years ago and as a result socalled unexplained infertility will gradually be-