Neda Smiljan Severinski

Maternal and fetal outcomes in grand multiparous women

The goal was to examine the influence of grand multiparity on the fetal and maternal outcome. The medical records of women delivered in Clinical Hospital Rijeka during seven years period were analyzed and divided into two study groups: grand multiparous women, (five or more infants), and women having given birth to three to four infants. The socio-economic parameters, frequency of pregnancy and labor complications as fetal outcome were compared between groups. The statistical analysis was done by chi square test, p<0.05. There were 22504 deliveries and 107 (0.47%) were in the grand multiparas group and 2745 (12.19%) in the control group. Cesarean section rate was significantly higher in the grand multiparas group (13.08 % vs 8.19 %). The neonatal outcome in the grand multiparas group indicated a significantly higher incidence of low Apgar score, and higher fetal mortality rate. Grand multiparity is linked with low socioeconomic status. Higher fetal mortality rate is a result of paritys interrelationship with social class factors and not parity per se.

Complications during pregnancy, labor and puerperium in women with increased BMI at pregnancy term

The aim of this study was to analyse perinatal complications in woman with increased BMI at pregnancy term. Study included 23190 women who gave singleton birth during a 10-year period in our institution. Maternal databases were reviewed for pregnancy, labor and delivery complications and early maternal postpartum morbidity. Women with increased BMI at pregnancy term had a significantly higer incidence of postterm pregnancy, gestational diabetes, pregnancy-induced hypertension and third trimester hemorrhage, compared to normal weight women (p 0.000). Women with increased BMI had significantly more labor induction with prostaglandins (p 0.001 and 0.000) and elective caesarean (p 0.025 and 0.000). Also, overweight and obese women had higher incidence of operative delivery: caesarean section (p 0.000) and vacuum extraction (p 0.000). The incidences of postpartum febrility (p 0.057, 0.000, 0.002) and trombophlebits (p 0.013) were also significantly higher. We can conclude that prepregnancy normal weight women with increased BMI during pregnancy need special follow-up and counseling in pregnancy and delivery.

Follicular fluid anti-Müllerian hormone: a predictive marker of fertilization capacity of MII oocytes

PurposeThe present study aimed to correlate anti-Müllerian hormone (AMH) levels in follicular fluid (FF) with oocyte maturity stages, morphological quality of metaphase II (MII) oocyte and fertilization capacity of MII oocytes.MethodsA total of 92 infertile women undergoing controlled ovarian stimulation and intracytoplasmic sperm injection were analyzed. Patients were divided into two groups according to age: <35xa0years (nxa0=xa043) and ≥35xa0years (nxa0=xa049). An FF sample was obtained from a single dominant follicle in each patient for a total of 92 follicular fluid samples analyzed. AMH levels in serum and follicular fluid were measured by enzyme-linked immunosorbent assay. Mature MII oocytes, zygotes, and embryos were assessed for morphological quality.ResultsSerum AMH levels were significantly higher in patients aged <35xa0years. No correlation was observed between FF AMH level and oocyte maturation stages or morphological quality of MII oocyte. Significantly lower FF AMH levels were observed in fertilized MII oocytes than in non-fertilized MII oocytes in patients aged <35xa0years (2.56xa0±xa02.0xa0ng/ml vs. 4.81xa0±xa04.14xa0ng/ml; pxa0=xa00.032).ConclusionsThe present study revealed no correlation between FF AMH and oocyte maturity stage or morphological quality of MII oocyte. However, FF AMH might be a predictive marker for fertilization capacity of MII oocytes.

Sperm Cell in ART

Infertility today represents a global problem. Male factor contributes in approximately 50% of infertile couples. In the last decade we are witnesses of the decreased quality of semen and the increased frequency of testicular cancer and cryptorchidism. Currently, the assessment of semen quality is based on the routine semen analysis including sperm count, morphology and motility. Although variation and combination among these three main factors articulate few diagnosis, nowadays developed assisted reproduction techniques (ART), especially intracytoplasmatic sperm injection (ICSI) may be used to treat most of the male infertility problems. In general we can say that traditional semen parameters provide a limited degree of diagnostic information, thus we are aware that these indexes of diagnosis should be revisited, which includes more specific test of sperm assessments, such as DNA tests and sperm proteome. Spermatogenesis is a process that includes physiological, morphological and biochemical changes. After a complex process from the round diploid spermatogonia to haploid spermatozoa, a mature sperm just has an ability to fertilize a mature oocyte. If any errors occur during spermatogenesis process, appropriate sperm will not be produced. Thus, in our ART practice, it is important to understand normal physiology of spermatogenesis and find the reason of abnormal situation.

Serum and follicular LH, pregnancy prediction and assisted reproduction

The aim of this study was to determine the mean serum and follicular fluid LH and estradiol values in patients treated by IVF/ET (ICSI) after completed ovarian stimulation and to determine the range of values for these hormones with higher chances of conceiving pregnancies. All patients underwent stimulation in long agonistic protocol. Collected samples of body fluids (serum n = 31, follicular fluid n = 93) were centrifuged and supernatant was separated, aliquoted, frozen and stored at − 20°C. LH and E2 were measured in serum and follicular fluids. Cutoff value of E2 determined using follicular LH and follicular E2 correlation was 2100 nmol/L. If the E2 value was lower than 2100 nmol/L the ratio of results related to pregnancy was 29,4% (15/51). If the follicular E2 values were higher than 2100 nmol/L the ratio of results related to pregnancy was (7,1%, 3/42). The observed differences were significant (p 0.03). Follicular LH values higher than 3.1 IU/L and follicular E2 values < than 2100 nmol/L indicate higher conceiving probability. Our results can be fit in previous findings on negative effects of low LH values in IVF treatment procedures.