Increased Pregnancy Loss Research Articles

Assessment of the ovarian volume, number and volume of follicles and ovarian vascularity by three-dimensional ultrasonography and power Doppler angiography on the HCG day to predict the outcome in IVF/ICSI cycles

The aim of this prospective study was to investigate whether ovarian blood flow is related to embryological parameters and whether it could be a predictor of outcomes of IVF/ICSI. Eighty infertile women underwent ovarian stimulation with gonadotrophins after a long protocol with GnRH agonists. The ovarian volume (OV), number of follicles (NF) and follicular volume (FV) of all follicles >10 mm and vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were obtained by three-dimensional (3D) ultrasonography and power Doppler angiography (PDA) on the day of HCG administration. These parameters were tested for their relation with IVF laboratory parameters. The OV, FV, VI, FI and VFI were significantly greater in the pregnant group. The NF and FV were the only independent predictors of the number of oocytes retrieved, mature and fertilized, and the number of embryos developed and their cumulative embryo score. Nevertheless, the number of grade 1 embryos depends on the NF and the VI. The ovarian FI and the number of transferred grade 1 embryos can predict gestation in 76% of IVF patients. A low FI and non-grade 1 embryo transferred are also associated with an increased pregnancy loss. 3D ultrasonography and PDA allow for an easier ovarian assessment in IVF cycles. The predictive value of IVF outcome suggests a high clinical usefulness of this new technique.

145 THE METHYLATION PATTERNS OF POTENTIAL DIFFERENTIALLY METHYLATED REGIONS IN BOVINE Xist, Impact, NDN, AND H19 GENES

Clinical and laboratory-assisted reproductive techniques such as ICSI have recently been associated with an increased incidence of several syndromes associated with defects in genomic imprinting. Genomically imprinted genes are expressed from only one parental allele and act to regulate growth of the fetus and placenta and brain development/ function. Imprinted genes are controlled by differentially methylated regions (DMRs), whereby one parental allelle (i.e. either maternal or paternal) is epigenetically silenced via methylation. Studies conducted in vitro suggest that culture of embryos and embryo manipulations may perturb the imprinting process. In the current study, the genomic DNA methylation patterns of CpG islands within bovine H19 (27 CpGs analyzed), Impact (36 CpGs), NDN (22 CpGs), and Xist (21 CpGs) were analyzed by bisulfite sequencing. Genomic DNA from a female fibroblast cell line and sperm were chosen for analysis. Potential DMRs for the 4 genes were identified, and semi-nested PCR primers were designed surrounding those regions. Second-round PCR products (2 separate reactions) were mixed, subcloned, and sequenced (n ≥ 10). The fibroblast methylation pattern of the Xist DMR showed consistent methylation in 50% of sequenced clones, with no methylation observed in sperm. The H19 DMR in fibroblast DNA also showed consistent methylation in 25% of sequenced clones, with sperm DNA fully methylated. These results confirm previous studies showing that Xist and H19 are imprinted in cattle. Sequencing of the putative Impact DMR clones indicated no methylation in either cell type, suggesting no imprinting in cattle, tissue-specific imprinting, or that this CpG island (15 bp post ATG) is not the DMR that controls imprinted expression of the Impact gene. The NDN DMR (500 bp post ATG) in sperm was not methylated, whereas the fibroblast cells had a variable methylation pattern. This may be for the same reasons suggested for Impact, but the variability within the CpG island may also be due to in vitro culture conditions resulting in aberrant methylation. This possible culture effect is currently being confirmed through bisulfite sequencing of the gene in an adult tissue. The investigation of methylation patterns in oocytes is also underway. Together, the information gathered will be used to determine the imprinting status of several bovine genes and, in the future, whether any of these imprinted genes are responsible for the increased pregnancy loss and calf abnormalities associated with advanced reproductive technologies.

The Relationship of the Factor V Leiden Mutation and Pregnancy Outcomes for Mother and Fetus

We sought to estimate the frequency of pregnancy-related thromboembolic events among carriers of the factor V Leiden (FVL) mutation without a personal history of thromboembolism, and to evaluate the impact of maternal and fetal FVL mutation carriage or other thrombophilias on the risk of adverse outcomes. Women with a singleton pregnancy and no history of thromboembolism were recruited at 13 clinical centers before 14 weeks of gestation from April 2000 to August 2001. Each was tested for the FVL mutation, as was the resultant conceptus after delivery or after miscarriage, when available. The incidence of thromboembolism (primary outcome), and of other adverse outcomes, was compared between FVL mutation carriers and noncarriers. We also compared adverse outcomes in a secondary nested carrier-control analysis of FVL mutation and other coagulation abnormalities. In this secondary analysis, we defined carriers as women having one or more of the following traits: carrier for FVL mutation, protein C deficiency, protein S deficiency, antithrombin III deficiency, activated protein C resistance, or lupus anticoagulant-positive, heterozygous for prothrombin G20210A or homozygous for the 5,10 methylenetetrahydrofolate reductase mutations. Carriers of the FVL mutation alone (with or without activated protein C resistance) were compared with those having one or more other coagulation abnormalities and with controls with no coagulation abnormality. One hundred thirty-four FVL mutation carriers were identified among 4,885 gravidas (2.7%), with both FVL mutation status and pregnancy outcomes available. No thromboembolic events occurred among the FVL mutation carriers (0%, 95% confidence interval 0-2.7%). Three pulmonary emboli and one deep venous thrombosis occurred (0.08%, 95% confidence interval 0.02-0.21%), all occurring in FVL mutation noncarriers. In the nested carrier-control analysis (n = 339), no differences in adverse pregnancy outcomes were observed between FVL mutation carriers, carriers of other coagulation disorders, and controls. Maternal FVL mutation carriage was not associated with increased pregnancy loss, preeclampsia, placental abruption, or small for gestational age births. However, fetal FVL mutation carriage was associated with more frequent preeclampsia among African-American (15.0%) and Hispanic (12.5%) women than white women (2.6%, P = .04), adjusted odds ratio 2.4 (95% confidence interval 1.0-5.2, P = .05). Among women with no history of thromboembolism, maternal heterozygous carriage of the FVL mutation is associated with a low risk of venous thromboembolism in pregnancy. Neither universal screening for the FVL mutation, nor treatment of low-risk carriers during pregnancy is indicated. II-2.

The impact of increased lupus activity on obstetric outcomes

Systemic lupus erythematosus is associated with multiple adverse pregnancy outcomes. We examined the impact of disease activity on spontaneous abortions, perinatal mortality, preterm delivery, and birth weight. The study was designed to assess all pregnancies in a cohort of lupus patients who were observed prospectively from 1987 to 2002. At each visit, the physician's estimate of lupus activity was determined on a visual analog scale (high-activity lupus defined as a score of >or=2). Disease activity in each trimester was compared. We assessed the impact of high-activity lupus during pregnancy on gestational age, live birth rate, and small for gestational age babies. Potential confounders, including demographics of the women as well as maternal history of lupus, renal lupus, and antiphosphoplipid antibody syndrome, were analyzed through multivariate analysis. Two hundred sixty-seven pregnancies were observed. Of these, 229 (85.8%) resulted in a live birth. High-activity lupus occurred in 57 pregnancies (21%). Fewer pregnancies among women with high-activity lupus ended with live births (77% versus 88% of those with low-activity lupus; P = 0.063). Full-term delivery was achieved in 15 pregnancies (26%) among women with high-activity lupus, compared with 127 pregnancies (61%) achieving full-term in those with no or mild lupus activity (P < 0.001). High-activity lupus in the first and second trimesters led to a 3-fold increase in pregnancy loss (miscarriages and perinatal mortality). High-activity lupus during pregnancy leads to increased premature birth and a decrease in live births, with almost one-quarter of these pregnancies resulting in fetal loss. Pregnancies in lupus patients must be closely watched and treated during all trimesters to improve pregnancy outcomes.

Safety of tumour necrosis factor-alpha antagonists.

Tumour necrosis factor-alpha (TNFalpha) is a proinflammatory cytokine that is synthesised by a variety of cell types in response to infectious or inflammatory stimuli. Although TNFalpha plays an adaptive role in immune protection and wound healing at 'physiological' levels, excess TNFalpha production can lead to adverse consequences. TNFalpha is a pivotal cytokine involved in the pathogenesis and progression of rheumatoid arthritis (RA). TNFalpha antagonists have been shown to be effective in the treatment of signs and symptoms of RA and the US FDA has approved three TNFalpha antagonists, etanercept, infliximab, and most recently, adalimumab, for the treatment of RA. However, differences have emerged, with respect to their demonstrated efficacy in other diseases (e.g. Crohn's disease). Worldwide, over half a million patients have been treated with TNFalpha antagonists and concerns regarding their safety have been raised. There is a risk of reactivation of granulomatous diseases, especially tuberculosis, with all three agents and appropriate measures should be taken for detection and treatment of latent infections. An association between non-Hodgkin's lymphoma and treatment with TNFalpha antagonists has been reported, although patients with active, long-standing RA are already known to have an increased incidence of non-Hodgkin's lymphoma. No associations with solid tumours have been found to date. The biological plausibility of lymphomas associated with immunomodulatory agents raises concern and vigilance is appropriate until the relationship is fully characterised. Large phase II and III trials have shown a detrimental effect of TNFalpha antagonists in advanced heart failure and these agents should be avoided in this population. Rare case reports of drug-induced lupus, seizure disorder, pancytopenia and demyelinating diseases have been noted after TNFalpha antagonists and continued vigilance is warranted in patients on TNFalpha antagonists for the development of these diseases. At present there is no evidence implicating TNFalpha antagonists with embryotoxicity, teratogenicity or increased pregnancy loss.

GLUT9 is differentially expressed and targeted in the preimplantation embryo.

During preimplantation development in the mouse, it is crucial that glucose metabolism not be compromised. Any decrease in glucose uptake at this stage in development can compromise the developing embryo. We have cloned another member of the glucose transporter family, GLUT9, which is expressed embryonically. Three different isoforms were identified. We have shown that two of the mouse GLUT9 isoforms transport glucose at a rate significantly greater than controls. Expression analysis of the preimplantation blastocyst identifies only the presence of the shorter GLUT9 isoform, RT-PCR and Western immunoblot confirmed this finding. A differential pattern of expression was seen with GLUT9 present at the plasma membrane in one- and two-cell zygotes and in an intracellular compartment in trophectoderm cells at a blastocyst stage. Although blocking GLUT9 expression during preimplantation development had no effect on glucose transport or apoptosis, transfer of these embryos into pseudopregnant mice resulted in increased pregnancy loss, suggesting that GLUT9 is critical for early preimplantation development.

September 11th in New York City (NYC): the effect of a catastrophe on IVF outcome in a New York City based program

Objective: The events of September 11, 2001, provoked extraordinary levels of stress at both the regional and national levels. Severe stress affects many aspects of human physiology and may impact human fertility. Several studies indicate that anxiety and especially depression may lower pregnancy rates in women undergoing ART. We therefore sought to evaluate IVF outcomes comparing pre- and post- September 11, 2001 cycles in a New York City center. Design: Retrospective analysis evaluating IVF outcome of 397 consecutive patients who underwent IVF at a single institution in NYC during a 13 week series encompassing the events of September 11, 2001. Materials and Methods: We analyzed 397 consecutive fresh IVF cycles during the series that included September 11, 2001. Only patients that underwent an embryo transfer were included in the study. The patient groups were divided into those that had a pregnancy test before September 11, 2001, and those that had a pregnancy test after September 11, 2001. Statistics included Chi-square and Student’s t-test where appropriate. P value < 0.05 was considered significant. Results: Two hundred and thirty-four patients (58.94%) had a pregnancy test before September 11. One hundred and sixty-three patients (41.06%) had a pregnancy test after September 11. There were no differences in the age, mean number of oocytes harvested or number of embryos transferred when comparing the two groups (Table 1). Clinical pregnancy rates were similar between the two groups (Table 1). There was, however, a significant increase in pregnancy loss in patients with a pregnancy test date after September 11 (Table 1). Consequently, the delivery rate was significantly reduced in the group of patients whose pregnancy tests were performed after September 11 as compared to those patients with pregnancy tests prior to September 11 (Table 1). Tabled 1 Conclusion: A significant increase in pregnancy losses was noted surrounding the events of September 11. This resulted in nearly a 25% lower delivery rate for patients with a pregnancy test date after September 11, 2001. There are many possible explanations for these findings, most significantly including psychological stresses. A further study will hopefully clarify these issues.

Amniocentesis and chorionic villus sampling for prenatal diagnosis.

A major disadvantage of second trimester amniocentesis is that the result is usually available only after 18 weeks' gestation. Chorionic villus sampling (CVS) and early amniocentesis can be done between 9 and 14 weeks and offer an earlier alternative. The objective was to assess comparative safety and accuracy of second trimester amniocentesis, early amniocentesis, transcervical and transabdominal CVS. We searched the Cochrane Pregnancy and Childbirth Group trials register (March 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2002). All randomised trials comparing amniocentesis and CVS. Two reviewers assessed eligibility and trial quality and performed data extraction. We analysed the data using RevMan software. A total of 14 randomised studies have been included. In a low risk population with a background pregnancy loss of around 2%, a second trimester amniocentesis will increase this risk by another 1%. This difference did not reach statistical significance, but the increase in spontaneous miscarriages following second trimester amniocentesis compared with controls (no amniocentesis) did (2.1% versus 1.3%; relative risk (RR) 1.02 to 2.52). Early amniocentesis is not a safe early alternative to second trimester amniocentesis because of increased pregnancy loss (7.6% versus 5.9%; RR 1.29, 95% CI 1.03 to 1.61) and higher incidence of talipes compared to CVS (1.8% versus 0.2%; RR 6.43, 95% CI 1.68 to 24.64).Compared with second trimester amniocentesis, transcervical CVS carries a significantly higher risk of pregnancy loss (14.5% versus 11%; RR 1.40, 95% CI 1.09 to 1.81) and spontaneous miscarriage (12.9% versus 9.4%; RR 1.50, 95% CI 1.07 to 2.11). One study compared transabdominal CVS with second trimester amniocentesis and found no significant difference in the total pregnancy loss between the two procedures (6.3% versus 7%). Transcervical CVS is more technically demanding than transabdominal CVS with more failures to obtain sample and more multiple insertions. Second trimester amniocentesis is safer than transcervical CVS and early amniocentesis. If earlier diagnosis is required, transabdominal CVS is preferable to early amniocentesis or transcervical CVS. In circumstances where transabdominal CVS may be technically difficult the preferred options are transcervical CVS in the first trimester or second trimester amniocentesis.

Thyroid autoimmunity and hypothyroidism before and during pregnancy.

In the present review, an attempt was made to describe current knowledge and concepts concerning the complex relationships that link thyroid autoimmunity (TAI) and hypothyroidism with female and male infertility, as well as abnormalities occurring during pregnancy, such as pregnancy loss and maternal and fetal repercussions associated with hypothyroidism. In the case of infertility, although the clinical relevance of TAI is somewhat controversial, when all available information is considered the results strongly suggest that when infertility is due to well-defined female causes, autoimmunity is involved and TAI constitutes a useful marker of the underlying immune abnormality, independently of thyroid function disorders. In the case of pregnancy loss, the vast majority of available studies clearly establish that TAI (even with no overt thyroid dysfunction) is associated with a significant increase in miscarriage risk. To find an association, however, does not imply a causal relationship, and the aetiology of increased pregnancy loss associated with TAI remains presently not completely understood. With regard to maternal repercussions during gestation, the main risk associated with TAI is the occurrence of hypothyroidism and obstetric complications (premature birth, pre-eclampsia, etc.). Thus, systematic screening of TAI and hypothyroidism during early pregnancy, monitoring of thyroid function with/without L-thyroxine treatment and follow-up during post-partum have proved helpful and important in order to manage these patients adequately. Finally, with regard to potential repercussions affecting the offspring, recent evidence suggests that thyroid maternal underfunction, even when considered mild (or subclinical), may be associated with an impairment of fetal brain development. When present only during the first half of gestation, maternal hypothyroxinaemia is a risk factor for impaired fetal brain development, due to insufficient transfer of maternal thyroid hormones to the feto-placental unit. When hypothyroidism is not restricted to the first trimester and worsens as gestation progresses (as in untreated hypothyroidism), the fetus may also be deprived of adequate amounts of thyroid hormones during later neurological maturation and development, leading to poorer school performance and lower IQ.

Increased pregnancy loss in young women with aortoiliac disease

Background: During clinical evaluation of young women with peripheral arterial occlusive disease, we were surprised by the high prevalence of pregnancy loss in women with segmental stenosis confined to the aortoiliac segment. We wondered if increased occurrence of miscarriage is the result of high expression of vascular and obstetrical risk factors in these patients, or if it is related to localization of disease. In a case-control study designed to investigate risk factors for peripheral arterial occlusive disease in young women, we assessed the risk of miscarriage in these patients according to level of obstruction. Methods: A total of 202 female patients, aged 18–49 years and 466 healthy control women from a population based case-control study, donated venous blood samples and filled out a structured questionnaire concerning classical cardiovascular risk factors and obstetrical history. In all patients, diagnosis of peripheral arterial occlusive disease was confirmed by intra-arterial angiography. Patients were classified into two groups: those with and those without stenosis of the aortoiliac segment (aortoiliac disease). Results: In 77 of the 202 patients (38%) with peripheral arterial occlusive disease, the obstruction was confined to the aortoiliac segment. The occurrence of miscarriage was high (42%) in young women with aortoiliac disease. Compared to healthy controls, the risk of miscarriage increased 3-fold (OR 3.1; 95% CI 1.8–5.6) in these patients. Adjustment for obstetrical and vascular risk factors did not affect the risk estimate. Conclusion: This is the first study that identifies aortoiliac disease as a risk factor for pregnancy loss in young women. The risk of miscarriage is increased 3-fold in women with aortoiliac disease. The presence of vascular and obstetrical risk factors did not affect the strength of the association. Pregnancy loss could be the first sign of insufficient aortic circulation in these patients.

Factors affecting pregnancy loss from gestation Day 38 to 90 in lactating dairy cows from a single herd

The present study was designed to establish whether factors such as previous estrus synchronization, corpus luteum and embryo number at the time of pregnancy diagnosis, changes in body condition score, milk production, clinical disease (mastitis or lameness) and the inseminating bull affect pregnancy loss from 38 to 90 days of gestation. We derived data from 601 pregnant lactating dairy cows from a single herd. Pregnancy diagnosis was performed by ultrasonography between Day 38 and 44 following insemination. We also recorded corpus luteum and embryo number at this time. Pregnancy loss was defined as a negative pregnancy diagnosis on the second palpation per rectum undertaken between 90 and 96 days after insemination. Data were analyzed using multiple logistic regression methods. Cows that had an additional corpus luteum were eight times less likely to miscarry. The risk of pregnancy loss was 3.1 times higher in cows bearing twins. A one unit reduction in body condition score from previous partum to 30 days postpartum resulted in a 2.4-fold increase in pregnancy loss. We noted a higher incidence of pregnancy loss in cows inseminated using semen from one of the six bulls used. This particular bull led to a 3.4-fold increase in the rate of pregnancy loss. Logistic regression analysis showed no significant effects of previous estrus synchronization, milk production, clinical disease, body condition at previous partum or at pregnancy diagnosis, or body condition change between previous partum and pregnancy diagnosis. Our findings indicate a positive relationship between the presence of an additional corpus luteum and the maintenance of gestation. Risk factors for pregnancy loss were twin pregnancy, reduced body condition after previous parturition and the inseminating bull.

The evidence that lead increases the risk for spontaneous abortion

Background Reports from a period spanning more than a century, and covering occupationally exposed women in several countries, support an increase in pregnancy loss from high maternal lead exposures. Nevertheless, most studies conducted among populations with low/moderate exposures have provided little evidence of an association with pregnancy loss, or in particular, spontaneous abortions. Methods A critique of these low/moderate level studies reveals small sample sizes, problems in definition or ascertainment of outcome, lack of control for confounding, and/or deficiencies in the exposure assessment. For estimating exposure, either an ecologic measure was used, or individual biologic specimens were taken but attention was not paid to the timing of measurement of lead levels in these samples. A prospective study that overcame most of the deficiencies of previous studies enrolled pregnant women in Mexico City with low-to-moderate-level lead exposures, collected blood specimens during their first trimester, and ascertained spontaneous abortions by week 20. A key design element of this study was the use of incidence-density-matched controls in order to achieve comparable opportunity for the outcome and comparable timing of exposure measurements. The latter is especially important because blood lead levels are altered by pregnancy. Results In the prospective Mexico City Study, a striking dose–response relation between blood lead and risk of spontaneous abortion was found: the odds ratio for spontaneous abortion was 1.8 (95% confidence interval = 1.1–3.1) for every 5 μg/dL increase in blood lead. Conclusions Low-to-moderate lead exposures may increase the risk for spontaneous abortion at exposures comparable to U.S. general population levels during the 1970s and to many populations worldwide today; these are far lower than exposures encountered in some occupations. Further research is needed to confirm the association, to delineate the role of maternal vs. paternal exposures, and to assess increases in menstrual variability as an explanation for this finding. Am. J. Ind. Med. 38:300–309, 2000. © 2000 Wiley-Liss, Inc.

Symptoms and findings related to HIV in women in rural Gutu District, Zimbabwe, 1992 to 1993.

To relate self-reported morbidity and clinical findings to HIV-status in rural women in Zimbabwe. A cross sectional study. 12 randomly selected villages in rural Gutu District, Zimbabwe. In 1992 to 1993 all women of fertile age (15 to 44 years) in the selected villages were interviewed and examined (n = 1,213). Retrospectively, HIV status was assessed anonymously from frozen blood samples. Self-reported morbidity, body mass index (BMI), arm circumference, palpable lymphnodes, prevalence of syphilis, haemoglobin, HIV status. Overall HIV prevalence was 22%. Mean haemoglobin (Hb) was significantly lower (p < 0.005) and anaemia was significantly more common (p < 0.001) among HIV positive women. Syphilis prevalence was 2.2%, a positive syphilis test increased the risk of being HIV positive three-fold. Persistent cough was significantly more common in HIV positives (OR = 3.0, 95% CI 1.4-6.2). Palpable lymphnodes was the most common clinical finding and generalised lymph adenopathy had a positive predictive value of 67% for HIV. Self-reported morbidity was low and no increased pregnancy loss was reported related to HIV. The low morbidity found in 1992 to 1993, in spite of the high prevalence, indicates a fairly short duration of the HIV infection and would also have contributed to the late awareness of the problem.

The evidence that lead increases the risk for spontaneous abortion.

Reports from a period spanning more than a century, and covering occupationally exposed women in several countries, support an increase in pregnancy loss from high maternal lead exposures. Nevertheless, most studies conducted among populations with low/moderate exposures have provided little evidence of an association with pregnancy loss, or in particular, spontaneous abortions. A critique of these low/moderate level studies reveals small sample sizes, problems in definition or ascertainment of outcome, lack of control for confounding, and/or deficiencies in the exposure assessment. For estimating exposure, either an ecologic measure was used, or individual biologic specimens were taken but attention was not paid to the timing of measurement of lead levels in these samples. A prospective study that overcame most of the deficiencies of previous studies enrolled pregnant women in Mexico City with low-to-moderate-level lead exposures, collected blood specimens during their first trimester, and ascertained spontaneous abortions by week 20. A key design element of this study was the use of incidence-density-matched controls in order to achieve comparable opportunity for the outcome and comparable timing of exposure measurements. The latter is especially important because blood lead levels are altered by pregnancy. In the prospective Mexico City Study, a striking dose-response relation between blood lead and risk of spontaneous abortion was found: the odds ratio for spontaneous abortion was 1.8 (95% confidence interval = 1.1-3.1) for every 5 microg/dL increase in blood lead. Low-to-moderate lead exposures may increase the risk for spontaneous abortion at exposures comparable to U.S. general population levels during the 1970s and to many populations worldwide today; these are far lower than exposures encountered in some occupations. Further research is needed to confirm the association, to delineate the role of maternal vs. paternal exposures, and to assess increases in menstrual variability as an explanation for this finding.

The effect of endometrial polyps on outcomes of in vitro fertilization (IVF) cycles.

Our purpose was to investigate the effect of endometrial polyps on pregnancy outcome in an in vitro fertilization (IVF) program. Endometrial polyps less than 2 cm in diameter were suspected by transvaginal ultrasound before oocyte recovery in 83 patients. Forty-nine women (Group I) had standard IVF-embryo transfer, while in 34 women (Group II) hysteroscopy and polypectomy were performed immediately following oocyte retrieval, the suitable embryos were all frozen, and the replacement cycle took place a few months later. Of the 32 hysteroscopies, a polyp was diagnosed in 24 cases (75%) and polypoid endometrium in another 5 patients (15.6%). An endometrial polyp was confirmed by histopathological examination in 14 women (58.3%). The pregnancy rate in group I was similar to the general pregnancy rate of our unit over the same period (22.4 vs 23.4%) but the miscarriage rate was higher (27.3 vs 10.7%, P = 0.08). In Group II, the pregnancy and miscarriage rates were similar to those of the frozen embryo cycles at Bourn Hall (30.4 and 14.3 vs 22.3 and 12.1%, respectively). Small endometrial polyps, less than 2 cm, do not decrease the pregnancy rate, but there is a trend toward increased pregnancy loss. A policy of oocyte retrieval, polypectomy, freezing the embryos, and replacing them in the future might increase the "take-home baby" rate.

Selective termination and elective reduction in twin pregnancies: 10 years experience at a single centre

Selective termination is employed in multifetal pregnancies, in the presence of an abnormal fetus, in order to improve the prognosis of the normal fetuses. The term elective reduction is used to describe reduction in twin pregnancies for maternal medical conditions, psychological, or socioeconomic reasons. The purpose of this study was to evaluate the factors that influence outcome in such pregnancies. Eighty-two twin pregnancies underwent selective termination (n = 59) or elective reduction (n = 23) over a 10-year period. Early procedures, performed < or = 14 weeks (n = 31), had a pregnancy loss of 9.7% and a mean procedure-to-loss interval of 4.1 +/- 2.8 weeks; mean birthweight was 3299 +/- 395 g in survivors, with a mean gestational age at delivery of 38.4 +/- 2.3 weeks. In comparison, procedures performed > 14 weeks (n = 51) had a pregnancy loss of 7.8%, with a procedure-to-loss interval of 1.2 +/- 0.6 weeks. Mean birthweight was 2577 +/- 999 g, with a mean gestational age at delivery of 35.7 +/- 5 weeks. In conclusion, outcomes were more favourable among patients who underwent a first trimester procedure. The slight increase in pregnancy loss may be attributed to a higher than expected rate of spontaneous abortions in the first trimester, as manifested by the higher procedure-to-loss interval after a first trimester procedure. These facts underscore the importance of early detection of fetal abnormalities in twin pregnancies by ultrasonography and chorionic villus sampling.

The Linear Increase in Pregnancy Loss After Clinical Pregnancy in IVF Is Related to Chromosomal Abnormalities

The Linear Increase in Pregnancy Loss After Clinical Pregnancy in IVF Is Related to Chromosomal Abnormalities

O-098 The linear increase in pregnancy loss after clinical pregnancy in IVF is related to chromosomal abnormalities

O-098 The linear increase in pregnancy loss after clinical pregnancy in IVF is related to chromosomal abnormalities

Hydrosalpinx fluid has embryotoxic effects on murine embryogenesis: a case for prophylactic salpingectomy

To ascertain if hydrosalpinges are associated with reduced pregnancy rates and increased pregnancy loss after IVF-ET. Increased volume and leakage of hydrosalpinx fluid may exert negative effects on follicular development and embryo quality and/or render the uterine environment hostile to embryogenesis. We undertook this study to examine the effect of hydrosalpinx fluid on murine embryogenesis in vitro. Descriptive study. Tertiary care facility. Premenopausal females undergoing salpingectomy or salpingostomy for hydrosalpinges. Collection of discarded hydrosalpinx fluid and development of a dose response curve for the effect of hydrosalpinx fluid on murine embryogenesis. Development of single cell mouse embryos in vitro. All samples of tubal fluid obtained from hydrosalpinges demonstrated a significant embryo toxic effect at either the 100% or 10% concentration. Hydrosalpinx fluid demonstrated pH values (8.45 to 8.65) significantly higher than the physiologic range. Correction of pH to that of media did not affect cavitation rate. There is a well-defined and significant toxic effect of hydrosalpinx fluid. Procedures such as salpingectomy or proximal tubal occlusion to circumvent the passage of hydrosalpinx fluid into the uterine cavity may have beneficial effects on the developmental environment for embryos in vivo.

Effects of grazing endophyte-infected tall fescue on eCG and progestogen concentrations from gestation days 21 to 300 in the mare

The influence of grazing endophyte-infected tall fescue on endometrial cup formation and function, progestogen production, and embryonic and fetal development were examined in pregnant mares between Day 21 and Day 300 of gestation. Total immunoreactive progestogens and equine chorionic gonadotropin (eCG) concentrations were compared between untreated controls (endophyte-free, n = 12) and treated mares (endophyte-infected, n = 12). There were no differences in endometrial cup formation or function, as determined by eCG concentrations at Days 45, 60, 75, 90 and 120 (P > 0.05) between mares grazing endophyte-infected and endophyte-free tall fescue. Mares grazing the endophyte-infected tall fescue had lower total progestogen concentrations (P < 0.01) from Days 90 to 120 than the mares grazing endophyte-free tall fescue. Embryonic development based on mean vesicle height was not affected by endophyte exposure. No pregnancies were lost by mares in either treatment group during the trial period. The results of this study indicate that grazing endophyte-infected tall fescue between Day 21 and Day 300 does not alter endometrial cup formation and function, or result in increased pregnancy losses during this period. Lower progestogen concentrations between Days 90 and 120 with exposure to endophyte-infected tall fescue could reflect decreased luteal progesterone production.