M Rubinstein

Low-dose aspirin treatment improves ovarian responsiveness, uterine and ovarian blood flow velocity, implantation, and pregnancy rates in patients undergoing in vitro fertilization: a prospective, randomized, double-blind placebo-controlled assay

OBJECTIVE To determine the effects of low-dose aspirin on ovarian response, uterine and ovarian blood flow velocity, and implantation and pregnancy rates in patients undergoing IVF. DESIGN Prospective, randomized, double-blind placebo-controlled assay. SETTING Department of Reproductive Medicine, CER Medical Institute, Buenos Aires, Argentina. PATIENT(S) Two hundred ninety-eight infertile patients (mean [+/- SDI age, 35.6+/-4.09 years) undergoing IVF cycles. INTERVENTION(S) In the treatment group, 149 patients underwent controlled ovarian hyperstimulation and received a daily dose of 100 mg of aspirin. In the control group, 149 patients underwent controlled ovarian hyperstimulation in association with placebo. MAIN OUTCOME MEASURE(S) Number of follicles, number of oocytes retrieved, serum E2 levels, uterine and ovarian pulsatility index, cancellation rate, number of embryos transferred, and implantation and pregnancy rates. RESULT(S) There were statistically significant differences between the treatment group and the control group, respectively, in the number of follicles (19.8+/-7.2 versus 10.2+/-5.3), number of oocytes retrieved (16.2+/-6.7 versus 8.6+/-4.6), serum E2 levels (2,923.8+/-1,023.4 versus 1,614.3+/-791.7 pg/mL), uterine pulsatility index (1.22+/-0.34 versus 1.96+/-0.58), ovarian pulsatility index (1.18+/-0.31 versus 1.99+/-0.56), pregnancy rate (45% versus 28%), and implantation rate (17.8% versus 9.2%). CONCLUSION(S) Low-dose aspirin treatment significantly improves ovarian responsiveness, uterine and ovarian blood flow velocity, and implantation and pregnancy rates in IVF patients.

Pregnancy After Human Donor Oocyte Cryopreservation and Thawing in Association with Intracytoplasmic Sperm Injection in a Patient with Ovarian Failure

OBJECTIVE To describe a pregnancy after human donor oocyte cryopreservation in association with intracytoplasmic sperm injection in a patient with ovarian failure. SETTING Department of Reproductive Medicine, CER Medical Institute, Buenos Aires, Argentina. PATIENT A 48-year-old patient with ovarian failure. RESULTS Ten donated oocytes were cryopreserved. Survival after thawing was 30%. Three oocytes were microinjected, and two embryos were obtained. The fertilization rate was 66%, and embryo development was 100%. Both embryos were transferred to a patient who had received hormonal replacement therapy. The attempt was successful, and a pregnancy was achieved after the transfer. CONCLUSION In association with intracytoplasmic sperm injection, an adequate technique of freezing and thawing of human oocytes might achieve encouraging results in ART programs.

Reply from authors

2) investigated the time of appearance of auto-antibodies with respect to CMV antigenemia in liver transplant recipients. In this study, AECAs were detected in coincidence with or immediately after the CMV antigenemia peak in most cases and were observed for at least 15 days. It is speculated that the CMVinduced endothelial damage and the presence of circulating cytomegalic endothelial cells may be a potent antigenic stimulus that leads to the production of AECAs. CMV antigenemia is considered as a possible indirect marker of endothelial cell infection and can reflect the state of the endothelial barrier. We reported the differences in the clinical outcomes between the recipients with mismatched and matched combinations of CMV glycoprotein H (gH) antibodies 3) . In our study, most acute rejection was diagnosed within one month after transplantation (mean 25±32 days of rejection after transplantation), and initial positive antigenemia was detected thereafter. On the other hand, the mean weeks of the initial antigenemia detection was 7 weeks after transplantation and its range was varied from 1 to 20 weeks after transplantation. Although this might indicate that most acute rejection was diagnosed prior to AECAs production, association between auto-antibodies and acute rejection could not be ruled out. In addition to measurement of the AECAs titers and their comparison between gH match and mismatch recipients, longer follow up data would be interesting to evaluate the AECAs as a predictor of acute renal allograft vascular rejection.