Valter Feyles

Future in vitro fertilization pregnancy potential of women with variably elevated day 3 follicle-stimulating hormone levels

OBJECTIVE To determine the IVF-ET pregnancy potential of women with variably elevated day 3 FSH. DESIGN Cohort evaluation of 1,868 consecutive IVF-ET cycles January 1991 to December 1994. SETTING University hospital infertility unit. PATIENTS Four cohorts of couples were defined based on day 3 FSH determinations with an arbitrary threshold of 20 mIU/mL, only > or = 20 mIU/mL, always < 20 mIU/mL, current < 20 mIU/mL but one previous > or = 20 mIU/mL, and current < 20 mIU/mL but two or more previous > or = 20 mIU/mL (conversion factor to SI unit, 1.00). INTERVENTION In vitro fertilization-embryo transfer. MAIN OUTCOME MEASURE Fetal heart activity on luteal day 40 transvaginal ultrasound. RESULTS No pregnancies occurred in 53 cycles with day 3 FSH only > or = 20 mIU/mL. In 1,750 women whose day 3 FSH levels were always < 20 mIU/mL, the pregnancy rate (PR) per cycle was 16.5%. In 54 cycles in which day 3 FSH was > or = 20 one time only, but < 20 mIU/mL during the treatment cycle, the PR was 5.6%. In 11 cycles where two or more previous FSH determinations were > or = 20 mIU/mL but with a current day 3 FSH < 20 mIU/mL, no pregnancies occurred. CONCLUSION Our data leads us to the conclusion that day 3 FSH determination precede every IVF cycle and that cycles with FSH > or = 20 mIU/mL be canceled. It also suggests that women with two previous elevations of day 3 FSH be discouraged from future IVF cycles. The 5.6% pregnancy per cycle with one previously elevated FSH warrants extreme pessimism in discussion of further cycles.

High Frequency of Imprinted Methylation Errors in Human Preimplantation Embryos.

Assisted reproductive technologies (ARTs) represent the best chance for infertile couples to conceive, although increased risks for morbidities exist, including imprinting disorders. This increased risk could arise from ARTs disrupting genomic imprints during gametogenesis or preimplantation. The few studies examining ART effects on genomic imprinting primarily assessed poor quality human embryos. Here, we examined day 3 and blastocyst stage, good to high quality, donated human embryos for imprinted SNRPN, KCNQ1OT1 and H19 methylation. Seventy-six percent day 3 embryos and 50% blastocysts exhibited perturbed imprinted methylation, demonstrating that extended culture did not pose greater risk for imprinting errors than short culture. Comparison of embryos with normal and abnormal methylation didn’t reveal any confounding factors. Notably, two embryos from male factor infertility patients using donor sperm harboured aberrant methylation, suggesting errors in these embryos cannot be explained by infertility alone. Overall, these results indicate that ART human preimplantation embryos possess a high frequency of imprinted methylation errors.

Effects of American Ginseng on Preimplantation Development and Pregnancy in Mice

In North America, a high proportion of pregnant women use herbal medications including North American ginseng. This medicinal plant contains high amounts of triterpene saponins (ginsenosides), which are the main bioactive compounds. It is important to assess ginsengs impact on all reproductive functions to ensure the safety of pregnant women and fetuses. In this study, we defined the concentration-responsive effects of North American alcoholic and aqueous ginseng extracts on preimplantation development in vitro and on pregnancy and post-partum development in the mouse. Two-cell mouse embryos were cultured with 5 different concentrations of whole ginseng root extracts, or ginsenosides Rb1, Rg1 and Re alone, a combinatorial ginsenoside solution and a crude polysaccharide fraction solution. Embryonic development and recovery from each treatment was assessed. To investigate the in vivo effects of ginseng extracts, female mice were gavaged with 50[Formula: see text]mg/kg/day, 500[Formula: see text]mg/kg/day or 2000[Formula: see text]mg/kg/day of either extract (treatment) or water (sham) for 2 weeks prior to mating and throughout gestation. Gestation period, litter size, pup growth and pup sex ratio were evaluated. Oral ginseng consumption did not significantly affect fertility or pregnancy in the mouse. High doses of ginseng (2000[Formula: see text]mg/kg/day) decreased maternal weight gain. Direct treatment of preimplantation embryos in vitro demonstrated that ALC and AQ extract treatment reduced development in a concentration responsive manner, while only ALC extract effects were largely reversible. Treatments with individual or combinatorial ginsenosides, or the polysaccharide fraction solution alone did not impair preimplantation development, in vitro. In conclusion, maternal oral consumption of ginseng has little negative impact on pregnancy in the mouse, however, direct exposure to ginseng extract during mouse preimplantation development in vitro is detrimental.

Effect of mood states and infertility stress on patients' attitudes toward embryo transfer and multiple pregnancy

OBJECTIVE To examine whether mood state or infertility stress influences perceptions of risk, preferences for embryo transfer, or views on multiple pregnancy. DESIGN Observational cohort study. SETTING Hospital-based fertility clinic. PATIENT(S) One hundred seventy-six women participating in IVF treatment. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Mood scores, ratings of risk, preference for multiple embryo transfer, and attitudes toward multiple pregnancy. RESULT(S) Growing feelings of tension across the cycle corresponded with increases in the perceived riskiness of double-embryo transfer, but there was no change in strength of transfer preferences. Women experiencing negative moods, such as depression, viewed twin and triplet pregnancy as less likely, whereas increasing positive feelings across the cycle were associated with increasing desire for twin pregnancy. Overall, women perceived double- and triple-embryo transfer as less risky by cycle end than at cycle beginning and felt more certain about multiple-embryo transfer. CONCLUSION(S) The dyssynchrony observed among changes in mood, perceptions of risk, and transfer preferences challenges assumptions about the way medical risk information influences transfer preferences, and the findings suggest that mood states experienced during an IVF cycle might affect transfer preferences by influencing attitudes toward multiple pregnancy. Additional considerations beyond providing risk information are needed to facilitate effective patient decision making.

Ureteric Injury During Transvaginal Ultrasound Guided Oocyte Retrieval

BACKGROUND Transvaginal ultrasound guided oocyte retrieval during in vitro fertilization is performed routinely around the world and has reduced the occurrence of intra-abdominal injury considerably over laparoscopic procedures. Despite this, injuries do occur. CASE We report a case of a 37-year-old patient who underwent IVF and encountered a ureteric injury during oocyte retrieval, which was recognized early and treated with ureteral stents with full resolution. During a subsequent IVF cycle, stenting of the ureters allowed better visualization, resulting in an uneventful retrieval and subsequent pregnancy. CONCLUSION Ureteric injury can occur during transvaginal ultrasound guided egg retrieval. Prompt recognition is vital to successful treatment. Stenting of the ureters is the most common therapeutic modality and can be used in subsequent retrievals to identify the ureters.

Effects of a Herbal Formulation on Premenstrual Symptoms: A Randomized Controlled Trial

Abstract Objective: To determine the efficacy and safety of a herbal formulation, Premenefa®, containing chasteberry ( Vitex agnus castus ), cramp bark ( Viburnum opulus ), vitamin E, bioflavonoids (vitamin P complex), borage oil, and flaxseed oil, in controlling premenstrual symptoms. Background: Although many women do not satisfy strict diagnostic criteria for premenstrual syndrome (PMS), they may still experience premenstrual symptoms. Regardless of whether a woman has specific symptoms or a symptom complex such as premenstrual syndrome, persistence of premenstrual symptoms in spite of standard treatment leads many of these women to unsupervised use of non-prescription products, increasingly herbal preparations. However, few randomized studies have assessed effectiveness and safety of herbal products. Methods: This study was a randomized, double-blind, placebo-controlled, crossover trial of a herbal preparation proposed to alleviate premenstrual symptoms (Premenefa®). Participants were randomized to start either on the herbal preparation or on placebo. Crossover occurred after three menstrual cycles. Seventy-four women completed six cycles, three each on formulation and placebo. The primary outcome variable was global scores for 15 premenstrual symptoms. Individual symptom scores were also recorded and analyzed. Results: Global premenstrual symptom scores were significantly lower in the formulation cycles than in the placebo cycles (p Conclusion: Premenefa® afforded significant relief of premenstrual symptoms and was well tolerated. This formulation represents a possible choice for women presenting with premenstrual symptoms.