Yoav Paltieli

High Progesterone Levels and Ciliary Dysfunction—A Possible Cause of Ectopic Pregnancy

AbstractObjectives: To investigate the effects of different levels ofhormones on the ciliary activity of human oviducts and,consequently, to assess their possible role in tubalimplantation of the fertilized egg. Design: Fallopian tube epithelial samples were incubatedin media with the addition of Estradiol (E2), progesterone(P), human menopausal gonadotropin (hMG), LH, or pureFSH (Metrodin) in different concentrations. The ciliary beatfrequency (CBF) was measured after 24 h of incubation.Then the media were exchanged to media without theaddition of hormones and the CBF was measured again 24 hlater by using the photoelectric technique. Setting: University teaching hospital, IVF unit. Results: Twenty-four hr after the addition of P to the culturemedium in concentrations of 0.5 or 1 ng/ml a significantdecline of the CBF down to 63% of the control level wasobserved (P < 0.001) and with P in concentration of 2 ng/ml or greater, 50–70% of the cilia were paralyzed. Theseeffects of P were found to be reversible. Incubation with E2induced a slight increase of 4% in the mean CBF (P =0.002). Twenty-four hr incubation with Metrodin, Pergonal,or LH did not affect ciliary motility. Conclusions: Higher levels of progesterone cause ciliarydysfunction and subsequently may be a possible cause ofectopic pregnancy.

Determination of fetal head station and position during labor : a new technique that combines ultrasound and a position-tracking system

OBJECTIVE The purpose of this study was to compare the ultrasound-based LaborPro (Trig Medical Ltd, Yokneam, Israel) system determination of fetal head station and position with routine vaginal examination. STUDY DESIGN This prospective study, which was conducted in 3 centers included 311 measurements that were performed in 166 singleton term pregnancies during the active phase of vertex, uncomplicated labor. Ultrasound-based position-tracking system calculations of fetal head station and position were compared with routine vaginal examination measurements. RESULTS Comparison of vaginal examination with the system head station results revealed a mean absolute difference of 5.5 +/- 6.1 mm (n = 311). Vaginal examination head-position evaluation, within a 45 degrees interval, complied with the system in 35 of 87 cases (40.2%). CONCLUSION Our data show that an ultrasound-based system can determine fetal head station and position during labor, when compared with vaginal examination, and requires minimal ultrasound skills. The limits of vaginal examination assessment of the head position are in agreement with published data.

Ovarian response to gonadotropin stimulation in repeated IVF cycles after unilateral salpingectomy.

AbstractPurpose: This study aimed to examine ovarian response to gonadotrpoin stimulation after repeated IVF treatment cycles in patients who underwent previous unilateral salpingectomy for tubal pregnancy. Methods: The study group included 26 patients who underwent unilateral salpingectomy for tubal pregnancy 1–9 years prior to starting IVF treatment. A control group of 52 patients with anatomically intact pelvis was treated during the same time period by ICSI. The two groups were matched for age, number of gonadotropin ampules, and length of stimulation. End point measurements included number of follicles, oocytes, and cleaved embryos in consecutive treatment cycles of each group. Results: There were 98 cycles in the study group and 154 cycles in the control group. The mean number of follicles, retrieved oocytes, and cleaved embryos were not different in the two groups, and no reductions in these parameters were noted up to 10 cycles of treatment. The mean number of follicles ipsilateral to the operated side was similar to the number of follicles of the contralateral ovary and was not different whether salpingectomy was by laparoscopy or laparotomy. Conclusions: Unilateral salpingectomy does not affect ipsilateral ovarian response to gonadotropin stimulation even after repeated IVF treatment cycles.

How reliable is the determination of cervical dilation? Comparison of vaginal examination with spatial position-tracking ruler

OBJECTIVE The purpose of this study was to evaluate the accuracy of clinical measurement of cervical dilation with a position-tracking system during vaginal examination. STUDY DESIGN This prospective study that was conducted in Poissy, France, Brooklyn, NY, and Haifa, Israel, included 333 measurements that were performed in 188 women with term singleton vertex uncomplicated pregnancies during the active stage of labor. Ninety measurements with clinical diagnosis of full dilation were excluded from analysis. Measurements were performed with a sensor attached to the midwifes index fingertip and a position-tracking system that was based on a low magnetic field. Evaluations were done when cervical examinations were clinically indicated. RESULTS Results were similar in all centers. Mean error was 10.2 +/- 8.4 mm and ranged from 7.5 +/- 7.3 mm, when cervical dilation was > 8 cm, to 12.5 +/- 8.7 mm when cervical dilation was between 6.1 and 8 cm. CONCLUSION This first evaluation of cervical assessment accuracy during vaginal examination with a position-tracking system shows limited precision.

Ultrasound Assessment of the Bladder Volume after Anterior Colporrhaphy

In 40 gynecological patients 44 different determinations of the bladder volume were made using ultrasonic methods. The product of bladder depth, height, and width, as determined from transverse and sagittal scans, showed the best correlation with the bladder volume measured by urethral catheter (r = 0.981). For 73% of the measurements the error was under 20% when the true bladder volume was greater than 100 cm3. This method gives a reasonable assessment of the bladder residual volume. It is quick, safe, and repeatable and, therefore, useful in postoperative clinical practice.

Association between ultrasound-based assessment of fetal head station and clinically assessed cervical dilatation

To describe the association between ultrasound‐based determination of fetal head station and clinical assessment of cervical dilatation during active labor.

Improved development of very-poor-quality human preembryos by coculture with human fallopian ampullary cells.

AbstractPurpose: To determine whether a confluent culture of fallopian ampullary epithelial cells, taken from women at the end of their reproductive life, is capable of rescuing very-poor-quality preembryos from cleavage arrest and/or degeneration. Methods: Human preembryos, rejected for transfer or freezing because of very poor quality, and arrested within 24 h of cleavage, were cultured for 5 days in medium alone or over a confluent culture of fallopian ampullary epithelial cells. Morphological criteria were utilized to assess preembryo degeneration and stage of development. Results: The described coculture rescued preembryos from degeneration, enhancing development to the blastocyst stage 2.2-fold, compared with cultures in medium alone. Furthermore, fully expanded and hatching blastocysts were observed only under coculture conditions. Conclusions: Very-poor-quality human preembryos may be rescued from degeneration, and their growth and development dramatically improved, when cocultured with a confluent culture of fallopian ampullary epithelial cells.

Endometrium-to-Myometrium Relative Echogenicity Coefficient

A computer program was developed to assess the endometrial echogenicity relative to the myometrial one, based on the gray-level processing of the midsagittal uterine image. The endometrial region of interest was specified within the upper part of the uterine cavity. The adjacent area of the myometrium was used to determine the reference brightness. The endometrial region of interest was analyzed along the anteroposterior uterine axis, as a set of thin strips directed parallelly to the midcavitary line. The endometrial/myometrial relative echogenicity coefficient (E/M REC) was computed for each strip and displayed graphically as a function of the distance from the midcavitary line. The area under the E/M REC curve within the limits of the total endometrial width was defined as total area (TA) and was used as a measure of the endometrial echogenicity. This parameter was assessed in 9 patients during their normal ovulatory cycles and in 29 IVF-treated patients with mechanical infertility. TA has a significant linear increase during the days of the ovulatory cycles. TA was found in high correlation with log(estradiol). TA can be used reliably for sonographic endometrial dating in ovulatory cycles.

Prospective multicenter study of ultrasound-based measurements of fetal head station and position throughout labor.

To assess the relationship between fetal head position and head station during labor, as measured using an ultrasound‐based system, and the occurrence of occiput posterior (OP) position at delivery.

Andrology: The Effect of Human Fallopian Tube Epithelium on Human Sperm Velocity Motility and Binding

AbstractPurpose: A prospective, controlled in vitro study was conducted to evaluate the effects of human fallopian tube epithelium on the motility, velocity, and binding of humanspermatozoa. Methods: Eleven fallopian tubes from six women undergoinghysterectomy and semen samples from 14 male partnersof women undergoing in vitro fertilization were collected.Human spermatozoa were cultured with monolayer of humanfallopian tube epithelial cells. The motility and velocity wereanalyzed subsequently at 0, 2, 6, 24, and 48 hr of incubation.The sperm binding capacity was analyzed after 48 hr in thehemizona assay (HZA). Results: The presence of the human fallopian tube epithelialcells did not have any beneficial effects on sperm motilityand velocity. On the other hand, significant promoting effectwas observed in the ability of the sperm to bind to thezona pellucida. Conclusions: The interaction of human spermatozoa withfallopian tube epithelial cells significantly increases spermbinding in the HZA.