Urban Waldenström

Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome

Background. The present study was designed to evaluate if electro‐acupuncture (EA) could affect oligo‐/anovulation and related endocrine and neuroendocrine parameters in women with polycystic ovary syndrome (PCOS).

Low-oxygen compared with high-oxygen atmosphere in blastocyst culture, a prospective randomized study

OBJECTIVE To investigate birth rates with two oxygen (O(2)) concentrations in blastocyst culture. DESIGN Randomized trial. SETTING Private in vitro fertilization (IVF) clinic. PATIENT(S) Six hundred women undergoing IVF. INTERVENTION(S) Blastocyst culture in atmospheres with either 6% carbon dioxide (CO(2)) in air, the equivalent to 19% O(2), a two-gas system; or 5% O(2), 6% CO(2), and 90% nitrogen (N(2)), a three-gas system. MAIN OUTCOME MEASURE(S) Birth rate. RESULT(S) The inclusion criterion for blastocyst culture (at least five fertilized oocytes) was fulfilled in 396 women, randomized to 197 cultures with the three-gas system and 199 cultures with the two-gas system. The outcome with the three-gas system compared with the two-gas system showed a statistically significantly increased blastocyst rate (47.8% vs. 42.1%), mean number of blastocysts (3.8 vs. 3.3), and number of cryopreserved blastocysts (1.7 vs. 1.1). The mean number of transferred blastocysts was 1.2 versus 1.3. Culture with the three-gas system increased the relative birth rate by 10% compared with the two-gas system (42% vs. 32%, respectively), a statistically significant difference. The overall twin rate was 4.8%. CONCLUSION(S) Blastocyst culture with low-oxygen (5%) versus high-oxygen (19%) concentration yielded a better blastocyst outcome and a marked improvement in birth rate. Generation of cytotoxic reactive oxygen species with prolonged embryo culture might deteriorate blastocyst viability.

Routine ultrasound screening in pregnancy and the children's subsequent growth, vision and hearing

Objective To test a hypothesis of no association between ultrasound exposure in early fetal life and growth or impaired vision or hearing during childhood.

Comparison of ultrasonic measurement of biparietal diameter and last menstrual period as a predictor of day of delivery in women with regular 28 day-cycles

Within a randomised trial, 1713 women with regular 28‐day cycles were studied to evaluate whether the day of delivery is predicted best from the last menstrual period (LMP) or ultrasonic measurement of the fetal biparietal diameter (BPD). Among 727 women, with a spontaneous onset of labor, where the estimated day of delivery (EDD) was derived from BPD, 91.8% delivered within +14 days and 61.8% delivered within seven days of EDD. Corresponding figures for 741 women where EDD was derived from LMP were 91.6% and 61.1%, respectively. Comparison of EDDs calculated from BPD and LMP in the same woman showed that BPD postponed EDD more than seven days in 18.0% and advanced EDD more than seven days in 1.8%. When the difference in EDD between the two methods was more than seven days the BPD estimate was a better predictor of day of delivery.

Ultrasonic dating of pregnancies: effect on incidence of SGA diagnoses: a randomised controlled trial

In order to study the incidence of antenatal identification and postnatal diagnosis of small for gestational age (SGA) infants, 4997 women with optimal menstrual history were randomised. One group had the gestational age estimated from last menstrual period (LMP), the other from ultrasonographically measured biparietal diameter (BPD) in the second trimester. Both the incidence of antenatally suspected and postnatally diagnosed SGA infants were reduced by approximately 30% in the BPD-dated group. It is concluded that this was due to the shift in gestational age estimation.

Single blastocyst transfer after ICSI from ejaculate spermatozoa, percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE)

Purpose: To investigate the outcome of IVF following intracytoplasmic sperm injection (ICSI) from ejaculate, percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE), with subsequent blastocyst culture and single blastocyst transfer.Methods: Single blastocyst transfer was performed after ejaculate ICSI (oligozoospermia) in 587 patients, TESE/PESA (azoospermia) in 31 patients, and standard IVF in 680 women.Results: There were only minor differences in IVF characteristics between the standard IVF and the PESA-TESE couples. Couples where ejaculate ICSI were performed seemed to represent a slightly poorer prognostic group. A viable fetus after the 12th gestational week, i.e. ongoing pregnancy, was present in 41.4% after ICSI/ET, 51.6% after PESA-TESE/ET and in 40.4% after standard IVF/ET (no significant differences).Conclusion: Single blastocyst transfer after ejaculate ICSI or after PESA/TESE appears to give similar results as conventional IVF blastocyst culture.

Serial measurements of symphysis-fundus height in women with ultrasonically dated pregnancies

SummaryTwo symphysis-fundus (SF) curves based on ultrasonically dated pregnancies were constructed. One SF curve (A) was constructed using data from all 2255 included women and another SF curve (B) from 1226 women who were selected by almost the same maternal and neonatal criteria as Westin used. The level of both curves is higher than the SF reference curve used today.

Sonographic dating of pregnancies among women with menstrual irregularities

In order to study the benefit of sonographic dating, 277 women with irregular periods and 264 women with a scanty last bleeding had gestational age and estimated day of delivery (EDD) estimated from both last menstrual period (LMP) and measurement of fetal Biparietal Diameter (BPD) in the second trimester. For the women with irregular periods, the two estimates differed by more than 7 days for 51.6%, and more than 14 days for 25.6%. Corresponding figures for women with a scanty last bleeding were 44.3% and 21.6%, respectively. In general, the BPD estimates were better than the LMP estimates (P=<0.001) in predicting day of delivery, especially when the differences between the estimates exceeded 7 days. For women with irregular periods, post‐term pregnancies decreased, from 20.2% according to the LMP estimate to 2.5% according to the BPD estimate. Corresponding figures for women with a scanty last bleeding were 16.7% and 4.5%, respectively. According to the LMP estimate, 64.8% of the women with irregular periods and 69.3% of the women with a scanty last bleeding gave birth within ±14 days of EDD. Corresponding figures for the BPD estimate were 83.6% and 88.3%, respectively. The conclusion is that sonographic dating of pregnancies among women with irregular periods and women with a scanty last bleeding substantially improve the accuracy of term prediction.

A stop (discontinued) GnRHa regimen in in vitro fertilization.

Dear Editor: In some situations it might be necessary to have alternatives to the ‘long’ and ‘short’ regimen for downregulation of the ovaries with gonadotrophin-releasing hormone agonists (GnRHa) preceding controlled ovarian hyperstimulation (COH) in in vitro fertilization (IVF). These GnRHa regimens include GnRHa treatment during COH until ovulation induction. We assessed if a GnRHa ‘stop’ protocol induces an increased risk of premature ovulation in poor responders in IVF. We studied the GnRHa stop regimen in 126 poor responders to evaluate if there was an increased risk of premature ovulation. A poor responder was defined as having retrieval of three or less oocytes after COH. In brief, GnRHa in a standard dose was given from the midluteal phase, but was discontinued when folliclestimulating hormone (FSH) stimulation was initiated. Ovarian follicle stimulation was initiated either when serum estradiol was 18 mm. Oocyte retrieval was performed 36–39 h after ovulation induction. Embryo transfer (ET) was made 2–3 days after oocyte retrieval, followed by luteal support with micronized progesterone. Premature ovulation was diagnosed as evident on ultrasonography. Twelve (9.5%) of the cycles were cancelled with the GnRHa ‘stop’ protocol because of poor ovarian response, but none due to premature ovulation. Mean number of oocytes retrieved was 4.4, but one must bear in mind that the patients were established poor responders, as evident in the previous IVF cycle. A ‘stop’ protocol might have theoretical advantages, as ovarian hyperstimulation with FSH will be unopposed. The ‘stop’ protocol might be used when other GnRHa protocols do not succeed. One group that might have advantages with the ‘stop’ protocol is poor responders. Faber et al. [1] reported favorable outcomes when the stop protocol was used in 182 low responders, but the frequency of premature ovulations was not studied. In conclusion, the GnRHa stop regimen induces no risk of premature ovulation in COH for poor responders.