Marco Sbracia

Natural-cycle in vitro fertilization in poor responder patients: a survey of 500 consecutive cycles.

OBJECTIVE To determine the role of the natural cycle for in vitro fertilization (IVF) in poor responder patients. DESIGN Retrospective survey. SETTING Private center for assisted reproduction. PATIENT(S) 294 women who were poor responders in a previous IVF cycle. INTERVENTION(S) Analysis of 500 consecutive natural cycles IVF. MAIN OUTCOME MEASURE(S) Number of cycles with oocytes, pregnancy rate per cycle, per transfer, and implantation rate. RESULT(S) Oocytes were found in 391 cases (78.1%), and cleaving embryos suitable for transfer were obtained in 285 cycles (57.0%). Pregnancy was observed in 49 cases, with a pregnancy rate of 9.8% per cycle, 17.1% per transfer, and 16.7% per patient. The patients were subdivided arbitrarily by the womens age into three groups. Patients 35 years old or younger showed a pregnancy rate of 18.1% per cycle, 29.2% per transfer, and 31.7% per patient. Women aged between 36 and 39 years showed a pregnancy rate of 11.7% per cycle, 20.6% per transfer, and 20.3% per patient. Women 40 years old or older showed a pregnancy rate of 5.8% per cycle, 10.5% per transfer, and 9.7% per patient. No differences were found for any of the evaluated parameters, independent of which cycle was the first, the second, third, fourth, or fifth, or further consecutive cycle. CONCLUSION(S) In poor responder patients, natural-cycle IVF is an effective treatment, especially in younger women.

Cetrorelix protocol versus gonadotropin-releasing hormone analog suppression long protocol for superovulation in intracytoplasmic sperm injection patients older than 40

OBJECTIVE To determine which protocols work better between cetrorelix and long protocols in older patients in a randomized controlled study. DESIGN A controlled randomized study in a single private IVF center. SETTING Infertile women referred to a private IVF center. PATIENT(S) Five hundred sixty-four women 40 years or older undergoing IVF. INTERVENTION(S) At their first IVF cycle, the women were randomized into two study groups using a computer-generated number sequence: 281 cases were treated with the cetrorelix protocol, and 283 patients were treated with a long protocol for controlled ovarian hyperstimulation. MAIN OUTCOME MEASURE(S) Days of stimulation, E(2) on the day of hCG administration, amount of FSH administered, number of oocytes yielded, number of embryos obtained, pregnancy rate, and implantation rate. RESULT(S) Patients treated with the long protocol showed a significantly higher number of oocytes retrieved and a higher pregnancy rate for both the cycle and transfer with respect to the cetrorelix protocol patients. The other parameter evaluated did not show any statistically significant differences. CONCLUSION(S) Our study showed that the long protocol performed better in older women than the cetrorelix protocol and that the GnRH antagonist may be detrimental in older women.

Clinical complications after transvaginal oocyte retrieval in 7,098 IVF cycles.

We report the complications observed after transvaginal oocyte retrieval guided by ultrasound in 7,098 IVF cycles. The frequency of severe complications in our patients was 0.08%, of which four cases were intraperitoneal bleeding (0.06%) and two were cases of ovarian abscess (0.003%).

Differential Expression of IGF-I and IGF-II in Eutopic and Ectopic Endometria of Women With Endometriosis and in Women Without Endometriosis

PROBLEM: Factors regulating the development, growth, and differentiation of endometrial cells of endometriotic lesions are poorly understood. To investigate the paracrine‐autocrine regulation of ectopic endometrial cell growth, the expression of IGF‐I and IGF‐II were studied.

Psychological stress and lipoperoxidation in miscarriage.

It is a common belief that emotional distress, like anxiety and frustrating experiences, can negatively influence reproductive life and pregnancy outcome. Basic research during the last few years has led to increased awareness of the role of psychological stress on the physiology and pathophysiology of pregnancy. Although a reliable system to measure stress and its biological effects is not available, a number of papers have been published; therefore, the real role played by emotional distress in reproductive life remains a debated issue. It has been suggested that serum lipoperoxide levels in pregnant women are directly influenced by psychological stress. Furthermore, increased serum lipoperoxide levels have been shown to be associated with pregnancy diseases like preeclampsia.* We have attempted to develop a model to study stress and its biological effects on early pregnancy, using lipoperoxidation activity as a biochemical marker. We reports the results of a preliminary study on normal healthy pregnant women and women with threatened abortion tested concurrently for lipoperoxidation activity and psychological distress.

HLA-DR and DQ Antigens and Anticardiolipin Antibodies in Women With Recurrent Spontaneous Abortions

ABSTRACT: IgG anticardiolipin antibodies (ACL) have been shown to occur in a high proportion of women with repeated unexplained miscarriages. Forty‐nine women with unexplained recurrent spontaneous abortions (RSA), previously assayed for the presence of ACL by an enzyme‐linked immunoabsorbent assay, were typed for HLA‐DR and DQ antigens by the classical microlymphocytotoxicity test. Twenty‐five women were positive for ACL and 24 were negative. HLA‐DR7 was found in 24.5% of 49 habitually aborting women vs. 28% of healthy controls; but the DR7 frequency was 40% in ACL positive patients vs. 8.3% in ACL negative patients (P = 0.011). These results show that in the Italian population an association between HLA‐DR7 antigen and ACL is present in women with unexplained RSA, suggesting that HLA‐DR genes might control the susceptibility to specific autoantibody production.

Immunohistochemical localization of the growth hormone in human endometrium and decidua.

Problem:  Recent evidence of growth hormone (GH) receptor expression in rat endometrium and human myometrium have focused our attention on the role of the GH in endometrial development. We tested the expression of GH in the human endometrium throughout the menstrual cycle and during pregnancy.

Blood levels of lipids, lipoperoxides, vitamin E and glutathione peroxidase in women with habitual abortion

Plasma levels of triglycerides, cholesterol, cholesterol esters, phospholipids, lipoperoxides, vitamin E and erythrocyte glutathione peroxidase activity showed no significant differences between 40 women with habitual abortion and controls. However, the levels of free fatty acids (FFA), which are extremely cytotoxic compounds, were significantly higher in women with habitual abortion (HA) than in controls (16.8 +/- 6.7 vs. 8.6 +/- 3.7 mg/100 ml, p < 0.01, respectively). The high amounts of FFA in HA women during pregnancy were probably due to a continuous and/or excessive stress-dependent discharge into the blood of catecholamines from autonomic nerve endings. These catecholamines can induce a strong uterine vasoconstriction and placental ischemia-hypoxia which, in association with additional insults caused by reoxygenation, might lead to eventual miscarriage.

Serum CA 125 and first trimester abortion

Objective: The study was carried out to assess the clinical value of serum CA 125 in association with serum β‐human chorionic gonadotropin (hCG) for predicting pregnancy outcome. Methods: One hundred spontaneous pregnancies, 52 non‐threatened pregnancies and 48 with threatened abortions, observed in the Department of Obstetrics and Gynecology at the University ‘La Sapienza’, Rome, Italy, were evaluated during the first trimester using ultrasound examination, CA 125 and β‐hCG titrations. Results: Threatened pregnancies had statistically significantly higher CA 125 serum values than non‐threatened pregnancies, especially those with a negative outcome (P < 0.01). The CA 125 levels in the threatened pregnancies were positively correlated with the tropho‐decidual hematoma volume (r = 0.839, P < 0.0001). The CA 125‐β‐hCG association showed a higher prognostic value (sensitivity 78.9%, specificity 96.5%) in assessing pregnancy outcome than CA 125 or β‐hCG alone (sensitivity 78.9% and 57.9%, respectively; specificity 75.8% and 86.2%, respectively). Conclusions: Our findings are in accordance with the hypothesis of a tropho‐decidual origin of this marker, suggesting its possible usefulness in the prognostic evaluation of first trimester threatened abortion.

Influence of Histocompatibility Antigens in Recurrent Spontaneous Abortion Couples and on Their Reproductive Performances

PROBLEM: To determine if human leukocyte antigens (HLA) play any role in the aetiology of recurrent spontaneous abortion (RSA), a substantial group of RSA couples were studied, and their reproductive performances in a 3‐year follow‐up recorded.