First Weeks Of Pregnancy Research Articles

Structural-tridimensional study of yolk sac in pregnancies complicated by diabetes

To assess by two- and three-dimensional ultrasound the diameter and volume of the yolk sac in pregnant women affected by type 1 diabetes during the first trimester of pregnancy. 18 women affected by insulin-dependent diabetes mellitus (IDDM) and 52 normoglycemic pregnant women (controls) were enrolled in this study. The women were evaluated once a week (5-12 weeks of pregnancy). Ultrasound examination in all pregnant women was initially performed in a bidimensional fashion with a transvaginal 6.5-MHz probe and subsequently using a three-dimensional technique. In the pregnant diabetic women the diameter of the yolk sac was significantly higher than that of controls in the first weeks of pregnancy, reaching a maximum diameter at 9 weeks, and decreasing thereafter, earlier than controls. The volume of the yolk sac increased in both groups from 5 weeks of pregnancy and reached maximum values at 10 weeks in both groups. The volumetric increase and decrease after reaching highest values were greater in IDDM patients. The clinical and diagnostic implications of the results of this study are still to be defined. Such a diagnostic technique may prove to be an additional element in monitoring diabetic women during early pregnancy.

Maternal Exposures and Risk of Infant Acute Leukemia in Brazil.

Associations between some environmental exposures and IAL with MLL rearrangements have been pointed out in the literature. We performed an investigative analysis to determine the frequency of MLL gene rearrangement in IAL in order to explore the risk factors for maternal exposure to DNA-damaging substances. Three different methods to detect the possible abnormalities involving this gene were used during a Brazilian epidemiological study: conventional karyotyping, RT-PCR assay, and FISH. The distribution of ALL and AML cases was very similar with respect to gender, age and region of residence at the time of diagnosis, and it was possible to study the MLL status in 198 of these cases. A statistically significant association was observed between pro-B ALL and MLL+ve cases and also, the age group 0–2 months was associated with MLL+ve cases, as expected. The FISH technique was clearly the most efficient one to detect the rearrangements, followed by RT-PCR assay. The maternal exposure data were obtained from cases and controls by interview, using a structured questionnaire. Up to now, 171 incident IAL cases were eligible for the study and 379 aged-frequency matched controls showing severe no-neoplasic diseases in the same regions were retrieved and their respective mothers interviewed. Intrauterine and childhood exposure to medicines, pesticides and other chemicals, smoking, alcohol intake, pets and reproductive antecedents were ascertained for both groups. A high frequency of molecular MLL+ve (84,4%) and other chromosomal abnormalities were found. A statistically significant association with MLL+ve was observed for pesticides exposure at home (OR 2.38, 95% CI, 1.27–3.96), and intake of hormones during the first weeks of pregnancy (OR 5,93 CI, 2,05–17,11) p=0,001. Statistically no significant increased risks were seen for urban families (OR 1.33, 95% CI, 0.70–2.52), metronidazol (OR 1.31, 95% CI 0.58–2.95) and dipirona (OR 1.51, 95% CI 0.85–2.68). It is therefore important that the associations observed in this study regarding hormone in taking should be re-evaluated in an extended case-control study. In view of the association recently reported between MLL+ve infant leukaemia and lack of function NQ01 alleles, screening for metabolic polymorphisms involved in carcinogen metabolism should also be included in subsequent studies.

DIABETIC MANAGEMENT IN HIGH RISK PATIENTS (PREGNANCY, INSULIN PUMPS)

During the past decades our understanding about the clinical impact of diabetes has changed. We now know for certain that a good (read : near normal) glycemic control is necessary to prevent chronic complications of this disease in women regardless of the type of diabetes. Pregnancy is a specific situation whereby a “near normal” control is wanted not only for the patient but also for the fetus. Several studies have shown a correlation beween glycemic control and complications of pregnancy. Reaching optimal glycemic control is mandatory even before the pregnancy starts, considering the time window of occurance of the severe foetal congenital malformations (first weeks of pregnancy). The role of pre-conception care is emphasized. Reaching optimal control in type 1 and type 2 diabetic patients can best be reached through intensive insulin therapy, but reaching normoglycemia is mainly limited by the occurence of hypoglycemia. The introduction of the new insulin analogues is an important step in our arsenal to achieve control using multiple daily insulin injections, but Novorapid® and Lantus® have not yet been approved for use in pregnancy. Insulin pumps are often used in pregnant patients, allowing an even better glycemic control with less hypoglycemia. An absolute requirement for CSII therapy to be successful is patienteducation and motivation by an experienced team.

Is Mutated Serine Hydroxymethyltransferase (SHMT) Involved in the Etiology of Neural Tube Defects?

Neural tube defects (NTD) arise in the first weeks of pregnancy due to a combination of environmental and genetic factors. In mothers of children with NTD elevated homocysteine (Hcy) levels and decreased plasma folate levels were observed, which suggests a defect in the folate-dependent Hcy metabolism. Therefore, mutations in genes coding for enzymes of this metabolism could be involved in NTD. Serine hydroxymethyltransferase (SHMT) catalyzes the reversible reaction of serine and tetrahydrofolate (THF) to glycine and 5,10-methylene THF. Two different isoforms of SHMT are known, one is present in the cytosol (cSHMT) and the other in the mitochondrion (mSHMT). Theoretically, mutated SHMT could lead to elevated Hcy levels and to an altered distribution of the different folate derivatives and might therefore become a risk factor for NTD. This study concerns the molecular genetic analysis of genes coding for both isoforms of the SHMT enzyme by single-stranded conformation polymorphism analysis. Several mutations as well as polymorphisms were found in both genes. The relevance of two variations, the 1420 C>T mutation of the cytosolic isoform and the 4-bp deletion of the mitochondrial isoform (delTCTT 1721–1724), to NTD risk was tested in a study group, which consisted of 109 NTD patients, 120 mothers of children with NTD, and 420 controls. Neither of the two polymorphisms led to an increased risk of NTD. In mothers with the 1420 CC genotype, significant increased Hcy levels are present. Also, significantly decreased red blood cell folate and plasma folate levels were present in individuals with the 1420 CC genotype. Probably, the 1420 C>T polymorphism causes a shift in distribution of the different folate derivatives. The 4-bp deletion of the mSHMT gene did not lead to altered Hcy or folate levels. So far, the results of this study provide no direct evidence for a role of defective SHMT functioning in NTD. Still, the influence of the 1420 C>T polymorphism of the cSHMT gene on the folate-related risk of NTD needs further investigation.

Factors predicting peri- and neonatal outcome in diabetic pregnancy

A population-based birth cohort including 296 consecutive type 1 diabetic births in a geographically defined catchment area was used to evaluate factors predicting poor perinatal and neonatal outcome. Though perinatal mortality has decreased (17.1/1000 births at 28 or more weeks of gestation), the neonatal morbidity rate still remains high despite improved maternal metabolic control and developed antepartum surveillance. Poor glycemic control during the first weeks of pregnancy was the most important risk factor (relative risk (RR) 2.91; 95% confidence interval (CI) 1.29-6.55) predicting adverse neonatal events such as long (>10 days) stay in the neonatal unit, malformation or perinatal death. The risk was further increased in cases of severe diabetes (White class F-R; RR 2.75; 95% CI 1.59-4.76) and primiparity (RR 1.64; 95% CI 1.02-2.65). By evaluating these risk factors at the first antenatal visit, a subgroup with a particular need of counselling and intensive feto-maternal monitoring can be identified.

Growth, development and differentiation: a functional food science approach.

Few other aspects of food supply and metabolism are of greater biological importance than the feeding of mothers during pregnancy and lactation, and of their infants and young children. Nutritional factors during early development not only have short-term effects on growth, body composition and body functions but also exert long-term effects on health, disease and mortality risks in adulthood, as well as development of neural functions and behaviour, a phenomenon called 'metabolic programming'. The interaction of nutrients and gene expression may form the basis of many of these programming effects and needs to be investigated in more detail. The relation between availability of food ingredients and cell and tissue differentiation and its possible uses for promoting health and development requires further exploration. The course of pregnancy, childbirth and lactation as well as human milk composition and the short- and long-term outcome of the child are influenced by the intake of foods and particularly micronutrients, e.g. polyunsaturated fatty acids, Fe, Zn and I. Folic acid supplementation from before conception through the first weeks of pregnancy can markedly reduce the occurrence of severe embryonic malformations; other potential benefits of modulating nutrient supply on maternal and child health should be further evaluated. The evaluation of dietary effects on child growth requires epidemiological and field studies as well as evaluation of specific cell and tissue growth. Novel substrates, growth factors and conditionally essential nutrients (e.g. growth factors, amino acids, polyunsaturated fatty acids) may be potentially useful as ingredients in functional foods and need to be assessed carefully. Intestinal growth, maturation, and adaptation as well as long-term function may be influenced by food ingredients such as oligosaccharides, gangliosides, high-molecular-mass glycoproteins, bile salt-activated lipase, pre- and probiotics. There are indications for some beneficial effects of functional foods on the developing immune response, for example induced by antioxidant vitamins, trace elements, fatty acids, arginine, nucleotides, and altered antigen contents in infant foods. Peak bone mass at the end of adolescence can be increased by dietary means, which is expected to be of long-term importance for the prevention of osteoporosis at older ages. Future studies should be directed to the combined effects of Ca and other constituents of growing bone, such as P, Mg and Zn, as well as vitamins D and K, and the trace elements F and B. Pregnancy and the first postnatal months are critical time periods for the growth and development of the human nervous system, processes for which adequate substrate supplies are essential. Early diet seems to have long-term effects on sensory and cognitive abilities as well as behaviour. The potential beneficial effects of a balanced supply of nutrients such as I, Fe, Zn and polyunsaturated fatty acids should be further evaluated. Possible long-term effects of early exposure to tastes and flavours on later food choice preferences may have a major impact on public health and need to be further elucidated. The use of biotechnology and recombinant techniques may offer the opportunity to include various bioactive substances in special dietary products, such as human milk proteins, peptides, growth factors, which may have beneficial physiological effects, particularly in infancy and early childhood.

Murine peritoneal macrophages in syngeneic and allogeneic pregnancies

We have previously observed that some functional characteristics of peritoneal macrophages (MOp) are altered during syngeneic murine pregnancy. To determine if these alterations are related to the immunological stimulation that the embryo produces on the mother, we evaluated MOp activity in allogeneic pregnancy. We also compared expression of the la antigen, ability to phagocyte and reduce nitro blue tetrazolium (NBT) and to produce interleukin-1 (IL-1) in allogeneic and syngeneic pregnancies. We observed that at Day 7 of pregnancy the increment in MOpIa + percentages was more evident in allogeneic (P < 0.05) than syngeneic pregnancies, and that these values remained high during the second week of gestation. We also observed a significant decrease in the macrophages that reduced NAT during the first week both in allogeneic and syngeneic pregnancies. Yet, in the former, the percentages of MOpNBT + were still low in the last week of pregnancy (P < 0.05). No differences were found in IL-1 production or in estradiol and progesterone levels between the 2 types of pregnancies. Thus, it is possible to postulate that during the first week of pregnancy the strong antigenic challenge that the embryo represents may activate MOp and that this activation could be augmented when major antigenic differences between mother and embryo are present.

Influence of antimicrobial agents on replication and stage conversion of Toxoplasma gondii.

As yet, only a few drugs are available that are frequently used for the treatment of human toxoplasmosis. Pyrimethamine and sulfadiazine are regularly used in combination and are the first choice for most clinical conditions. However, due to severe side effects that are observed especially with sulfadiazine, other drugs, such as clindamycin, have successfully been used as alternative treatment. Since pyrimethamine might be teratogenic when used in the first weeks of pregnancy, spiramycin has been introduced as first-choice treatment during the first 16–20 weeks of pregnancy. In addition to these four well-established drugs, others such as tetracycline or cotrimoxazole have been studied as therapeutics against toxoplasmosis. Although their effectiveness has been demonstrated to some extent, they have not been accepted as general treatment (Joss 1992). None of these drugs has been shown to completely eliminate the parasite in the human host. Since persistent infection with cysts is the source of reactivated toxoplasmosis, new drugs have been developed that might even be more effective against the cyst stage. The hydroxynaphthoquinone atovaquone and macrolides such as azithromycin, clarithromycin, and roxithromycin are thought to inhibit the tachyzoite and the cyst stage as well, as has been shown in vitro or/and in vivo (Araujo et al. 1991,1992a,1992b; Blais et al. 1993a, Huskinson-Mark et al. 1991).

Severely impaired fetal growth is preceded by maternal hemodynamic maladaptation in very early pregnancy.

To test the hypothesis that in pregnancies complicated by intrauterine growth retardation (IUGR) maternal cardiovascular adaptation is already abnormal in the first weeks of pregnancy. University Hospital Maastricht, Maastricht, The Netherlands. Fourteen healthy pregnant women, recruited from the subfertility clinic. Ten pregnancies were uneventful and four pregnancies resulted in the birth of growth retarded infants. Maternal cardiovascular status was followed longitudinally by combined M-mode and Doppler echocardiography. Studies were performed weekly between the fifth and 10th week, at 14, 25 and 35 weeks and postpartum. Differences between the two groups were analyzed by nonparametric tests. In early pregnancy, the IUGR group differed from the normal group by a consistently smaller left atrial diameter and a cardiac output that failed to increase. Postpartum the subjects in the IUGR group had a significantly smaller left atrial diameter and faster mean circumferential fiber shortening. Maternal hemodynamic adaptation in the first weeks of pregnancy is defective in IUGR pregnancies, presumably associated with a concomitant inadequacy of the vascular filling state.

Administration of a gonadotropin-releasing hormone agonist during pregnancy: follow-up of 28 pregnancies exposed to triptoreline

To evaluate the teratogenic or fetal risk of a long-acting GnRH agonist (GnRH-a) triptoreline acetate (Decapeptyl; Ipsen-Biotech, Inc., Paris, France), inadvertently administrated in the first weeks of pregnancy. Prospective follow-up of exposed pregnancies and case reports. Teratology information service of a public hospital and pharmacovigilance department of the firm. Inadvertent pregnant women receiving a treatment, mainly for endometriosis or IVF. Case by case, individual estimations of the risks have been provided. Each pregnancy issue has been analyzed. No teratogenic or fetal toxic effect has been noted. No specific hazard has been observed among newborns after inadvertent exposures to a GnRH-a during the first 20 weeks of pregnancy.

Ovarian hormone secretion and embryo development during early pregnancy in mink and ferrets

These experiments were designed to investigate the effects of early ovariectomy and exogenous hormone treatment on early embryo development and survival in mink and ferrets. Ovariectomy on Day 2 of pregnancy in mink or Day 3 of pregnancy in ferrets (day of mating designated Day 0) was associated with marked increases in the proportions of degenerate or cleavage stage embryos on Day 8 in mink or Day 6 in ferrets. Exogenous progesterone administered as Silastic implants at ovariectomy or to intact animals on Day 2 significantly decreased the proportion of degenerate/cleavage embryos on Day 8. These results suggest that maternal progesterone during early pregnancy promotes embryo survival both after ovariectomy and in the undisturbed reproductive tract. The effect of exogenous oestrogen during early pregnancy was also examined. Treatment of mink beginning on Day 2 with subcutaneous Silastic implants containing oestradiol resulted in significant loss of embryos from the reproductive tract and an increase in the proportion of degenerate and cleavage embryos among those remaining in the tract. Thus, excessive embryo mortality in ranch mink might result in part from insufficient progesterone secretion or excessive oestrogen secretion during the first week of pregnancy.

Vitamin and mineral status of women of childbearing potential.

Increasing data suggest a role for micronutrients in pregnancy outcome, and in some cases nutritional status must be adequate in the first weeks of pregnancy. We examined nationally representative survey data on women of childbearing age: the NHANES II data for serum measures of iron status and the CSFII four-day data for dietary measures of intake of protein, iron, zinc, folic acid, and vitamins A, C, and B6. For those nutrients, women below or near poverty had consistently lower levels, with median intakes below the RDA for all but protein (e.g., folic acid, 150 micrograms in contrast with the RDA of 180 for nonpregnant and 400 for pregnant women; for B6, 0.96 mg instead of 1.6 or 2.2). Even among women with incomes as high as three times the poverty level or more, large segments of the population had very low intakes. For example, the 25th percentile in that group was only 142 micrograms/day of folic acid, 4.6 alpha-tocopherol equivalents of vitamin E, 6.7 mg zinc, and 433 mg of calcium. Approximately 15% of women had low transferrin saturation.

Influence du rapport calcium/phosphore de la ration sur la calcémie, la phosphatémie et la magnésémie de la lapine en gestation

Sixteen Thiès strain rabbits were used to study the effect of the calcium/phosphorus ratio on plasma calcium, inorganic phosphorus and magnesium levels during pregnancy. Animals were allocated in 2 groups of 8: one receiving a diet with a Ca/P ratio of 1:0 and the other a diet with Ca/P ratio of 2:1. Water was given ad libitum for all rabbits. Results obtained showed that Ca blood level was significantly higher in rabbits receiving the diet with Ca/P ratio of 2:1 before covering and during the first week of pregnancy. During the last 15 d of pregnancy, Ca blood level decreased significantly in the 2 groups of animals. Plasma inorganic phosphorus and magnesium levels were not significantly different in the 2 groups of rabbits until the 2nd wk of pregnancy. But at the end of pregnancy, while phosphatemia and magnesemia decreased in rabbits fed a high Ca/P ratio, in the other group these parameters remained unchanged.

Gamete Intrafallopian Transfer by Hysteroscopy as an Alternative Treatment for Infertility

Objective To evaluate efficacy and safety of the hysteroscopic cannulation by flexible catheter of the fallopian tubes for gamete intrafallopian transfer (GIFT). Design We studied the pregnancy rate (PR) and the safety of this new technique. Setting All patients were enlisted for GIFT at our Reproductive Medicine Unit. Patients We treated 26 patients whose infertility causes were terminal tubal damage, male factors, unexplained factors, and endometriosis. Patients with uterine tubal ostia unsuitable for gamete transfer or cervical incontinence were not included in the group. Interventions The patients underwent ovulation induction and oocyte retrieval by transvaginal ultrasonically guided puncture. The gamete transfers were carried out by hysteroscopic procedure using a flexible catheter put through the operating channel. Main Outcome Measure The efficacy was evaluated by the PR (25.9%). Results Seven clinical pregnancies were obtained, but two patients aborted during the first weeks of pregnancy. No ectopic pregnancies were observed. Conclusions Our results indicate that hysteroscopic GIFT is an alternative, safe, effective, and not invasive technique for fertility problems.

Developmental effects of methyl benzimidazolecarbamate following exposure during early pregnancy

Methyl 2-benzimidazolecarbamate (MBC) and its parent compound benomyl are used as agricultural fungicides. Both chemicals are embryotoxic if administered during organogenesis, and benomyl is teratogenic. Based on a previous study indicating a lack of maternal effects of MBC following exposure during early pregnancy, the current experiments were designed to evaluate the effect of exposure to MBC during early pregnancy on developmental parameters of offspring. Rats were administered MBC at 0, 100, 200, 400, or 600 mg/kg/day during Days 1–8 of pregnancy and killed on Day 11 or Day 20 of gestation. On Day 11, embryos were assessed for survival rate, growth parameters, and anomalies. On Day 20, standard developmental toxicity evaluations were performed. Doses of 200 to 600 mg/kg/day MBC reduced embryonic survival by Day 11; exposure to MBC at 100 to 600 mg/kg/day reduced the number of fetuses surviving on Day 20. Evidence of developmental delay was apparent on Day 11 at all doses, and fetal weight was reduced by Day 20. MBC produced a dose-dependent increase in developmental defects seen on Day 11 and in several malformations observed on Day 20. MBC exposure during the first week of pregnancy was shown to be embryotoxic, resulting in embryonic death, growth retardation, and developmental abnormalities when evaluated on Days 11 or 20 of gestation.

Functional alterations of murine peritoneal macrophages during pregnancy.

We have studied some functional characteristics of murine peritoneal macrophages (MOp) related to hormonal changes produced during pregnancy. Maximal expression of Ia antigen and release of interleukin 1 (IL1) were observed during the first week of pregnancy (implantation), when the highest peak of estradiol was produced. Both Ia antigen expression and IL1 levels progressively decreased as gestation advanced. Inversely, MOp capability to phagocyte and reduce nitro blue tetrazolium (NBT) was diminished at the beginning of pregnancy but returned to normal values in the last week. Sexual steroid levels (estradiol and progesterone) were inversely related, and the release of prostaglandin E2 (PGE2) by MOp decreased when progesterone levels increased. Although PGE2 production had no evident relation with Ia antigen expression and IL1 activity during the first and second weeks of pregnancy, the increment in PGE2 values and percentages of NBT+ cells could indicate a different stage of macrophage activation. These results suggest a possible hormonal regulation of macrophage functionality.

Further Observations on Estrus and Ovulation in Woodchucks (Marmota Monax) in Captivity1

The woodchuck is a seasonally breeding sciurid rodent. Female woodchucks are monoestrous and, when isolated from males, remain in a prolonged period of estrus characterized by a clear predominance of cornified cells in the vaginal smear. This study was designed to characterize relationships between the degree of vaginal cornification and sexual receptivity, and to study ovulation and related phenomena of this species in captivity. Fourteen individually caged adult females, maintained under standard laboratory conditions for 9-23 mo, were used in this investigation. Females exhibiting predominantly (67-97%) cornified smears were always receptive, regardless of the time interval from the onset of estrus, and mated within 24 h of pairing. Mated females allowed to complete pregnancy gave birth to live pups 30-32 days later. Litter size ranged from 3-7 pups. Serum progesterone (P) levels increased to approximately 2 ng/ml during the first week of pregnancy and greater than 5 ng/ml during the second and third weeks of pregnancy. Serum estradiol (E2) levels were elevated during the first week of pregnancy and began to decline thereafter. Examination of ovarian serial sections revealed that ovulation took place between 20 and 32 h after copulation. Serum levels increased significantly (4-fold) after ovulation (1.2 +/- 0.3 vs. 0.3 +/- 0.01 ng/ml). However, the circulating levels of E2 remained unchanged between the periods before (53 +/- 1 pg/ml) and after ovulation (60 +/- 3 pg/ml). Ovulation was not simultaneous in all mature follicles.(ABSTRACT TRUNCATED AT 250 WORDS)

Prenatal diagnosis and successful intrauterine treatment of a female fetus with 21‐hydroxylase deficiency

To present the first reported Australian case of prenatal treatment of a female fetus with congenital adrenal hyperplasia resulting from 21-hydroxylase deficiency. A couple whose son had congenital adrenal hyperplasia resulting from 21-hydroxylase deficiency sought prenatal diagnosis and treatment in their next pregnancy. Maternal treatment with dexamethasone was commenced at seven weeks' gestation to suppress androgen production by the fetal adrenal glands and prevent virilisation of an affected female fetus. At ten weeks' gestation chorionic villus sampling demonstrated a female fetus, who was shown subsequently to be affected by means of a linkage method in which probes to HLA genes DQA and DRB were used as markers for the 21-hydroxylase genes. Increased 17-hydroxyprogesterone and androstenedione immunoactivity in amniotic fluid obtained at 14.5 weeks confirmed the fetus to be affected and demonstrated incomplete suppression of fetal adrenal androgen production. Dexamethasone was continued to term and maintained suppression of the fetal and maternal adrenal glands. The infant was born with normal female genitalia. Growth retardation was present but the relationship between this and the dexamethasone treatment remains uncertain. The mother had excessive weight gain during pregnancy. Dexamethasone treatment commenced in the first weeks of pregnancy can prevent or reduce virilisation of female fetuses with congenital adrenal hyperplasia resulting from 21-hydroxylase deficiency.

Developmental Effects of Methyl Benzimidazolecarbamate following Exposure during Early Pregnancy

Methyl 2-benzimidazolecarbamate (MBC) and its parent compound benomyl are used as agricultural fungicides. Both chemicals are embryotoxic if administered during organogenesis. and benomyl is teratogenic. Based on a previous study indicating a lack of maternal effects of MBC following exposure during early pregnancy, the current experiments were designed to evaluate the effect of exposure to MBC during early pregnancy on developmental parameters of offspring. Rats were administered MBC at 0, 100, 200, 400, or 600) mg/kg/day during Days 1–8 of pregnancy and killed on Day 11 or Day 20 of gestation. On Day 11, embryos were assessed for survival rate, growth parameters, and anomalies. On Day 20, standard developmental toxicity evaluations were performed. Doses of 200 to 600 mg/kg/day MBC reduced embryonic survival by Day 11; exposure to MBC at 100 to 600 mg/kg/day reduced the number of fetuses surviving on Day 20. Evidence of developmental delay was apparent on Day 11 at all doses, and fetal weight was reduced by Day 20. MBC produced a dose-dependent increase in developmental defects seen on Day 11 and in several malformations observed on Day 20. MBC exposure during the first week of pregnancy was shown to be embryotoxic, resulting in embryonic death, growth retardation, and developmental abnormalities when evaluated on Days 11 or 20 of gestation.

Gamete intrafallopian transfer by hysteroscopy as an alternative treatment for infertility

To evaluate efficacy and safety of the hysteroscopic cannulation by flexible catheter of the fallopian tubes for gamete intrafallopian transfer (GIFT). We studied the pregnancy rate (PR) and the safety of this new technique. All patients were enlisted for GIFT at our Reproductive Medicine Unit. We treated 26 patients whose infertility causes were terminal tubal damage, male factors, unexplained factors, and endometriosis. Patients with uterine tubal ostia unsuitable for gamete transfer or cervical incontinence were not included in the group. The patients underwent ovulation induction and oocyte retrieval by transvaginal ultrasonically guided puncture. The gamete transfers were carried out by hysteroscopic procedure using a flexible catheter put through the operating channel. The efficacy was evaluated by the PR (25.9%). Seven clinical pregnancies were obtained, but two patients aborted during the first weeks of pregnancy. No ectopic pregnancies were observed. Our results indicate that hysteroscopic GIFT is an alternative, safe, effective, and not invasive technique for fertility problems.