Maria Nuova Research Articles

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Ultrasound evaluation is widely accepted as an accurate tool in the assessment of the fetal head during labor. Several classification systems have been proposed to aid in the assignment of different fetal head positions. In 1998 Gardberg et al.1 classified fetal head position as occipitoanterior and occipitoposterior. In 2002, Sherer et al.2 classified it as occiput anterior (OA), occiput posterior (OP), left or right occiput transverse (LOT and ROT) and left or right occiput anterior or posterior (LOA, ROA, LOP and ROP). In the same year, Akmal et al.3 proposed recording the fetal head position according to a clock-like diagram with 24 divisions. Similar clocks, with 24, 12 and eight divisions were used by Rane et al.4, Zahalka et al.5 and Dupuis et al.6, respectively. Using one of these classification methods should enable the clinician to discern promptly the position of the fetal head in most cases, although any clinician would find it very difficult to analyze the fetal head when it lies in a position of transition (e.g. between OP and OT). Attempts have been made to address these borderline situations by modifying the number of clock subdivisions or, in cases when the fetal head position did not match one of the defined grid lines, the nearest location was given, but we and others3, 6 have been unable to solve the issue as the object of analysis is not punctiform. In our opinion, Drs Eggebo and Salvesen, in their Correspondence, do not help solve, improve or modify the current definition of fetal head position. Their main concern is the division of the Akmal clock and the fact that, in our study, the borderline limits were 02 : 29, 03 : 29, 08 : 29 and 09 : 29 hours instead of the 02 : 30, 03 : 30, 08 : 30 and 09 : 30 hours used by Akmal et al.3. Because the fetal head is not punctiform it appears that the difference in the two models is actually irrelevant in the overall assessment. For the purposes of our study7, the position of the fetal head was allocated within the portion of the clock in which the largest part of the fetal occiput was visualized and, in the Methods section, we clearly state that the clock was divided into 12 sections and not into 720 sections as implied by Drs Eggebo and Salvesen. We acknowledge that it would not be useful to try to differentiate the position of the occiput between, for example, a 02.29 and 02.30-hours position and are aware that it would be equally unhelpful to have the same position of 02.30 hours identifying two different positions. The modifications of the Akmal clock made in our paper were not an attempt to solve the issue of borderline cases, merely representing an interpretation that we believe had no effect on the overall analysis. Regarding the relevance of assessment of fetal head position before and in the first stage of labor, considering the findings of Peregrine et al.8, Akmal et al.9 and Souka et al.10, that the position before and in the first stage of labor is not predictive of fetal head at delivery, the data on which our discussion was focused were position at the second stage of labor. In closing, we recognize the importance of keeping alive the discussion on fetal occiput position in borderline cases, but are not convinced that the criticisms of our study contribute helpfully to the debate. I. Blasi*, V. Vinci*, W. Henrich*, V. Mazza*, * Arcispedale Santa Maria Nuova, Modena and Reggio Emilia University, Reggio Emilia, Italy

Population Baseline of Meconium Ethyl Glucuronide and Ethyl Sulfate Concentrations in Newborns of Nondrinking Women in 2 Mediterranean Cohorts

The detection of ethyl glucuronide (EtG) and ethyl sulfate (EtS) in meconium has been investigated recently as an alternative to meconium fatty acid ethyl esters (FAEEs) measurement as an objective estimate of prenatal alcohol exposure, independent of maternal self-reporting. We report the results of the first study conducted to investigate the concentrations of EtG and EtS in meconium from newborns with and without intrauterine exposure to ethanol, defined by questionnaire and meconium FAEEs concentration. FAEEs, EtG, and EtS were quantified by liquid chromatography tandem mass spectrometry in meconium samples obtained from the Arcispedale Santa Maria Nuova, Reggio Emilia, Italy (n = 80) and from the Hospital del Mar in Barcelona, Spain (n = 105). Median EtG and EtS values in meconium from newborns without intrauterine exposure to ethanol varied between 0.100 and 0.140 nmol/g and 0.010 and 0.020 nmol/g in Reggio Emilia and Barcelona samples, respectively. In meconium from newborns with uncertain prenatal ethanol exposure, the EtG median value was 0.160 nmol/g in the Italian cohort and 0.250 nmol/g in the Spanish one. The median EtS concentration was 0.020 in both cohorts. EtG and EtS median values in 5 meconium samples from newborns of heavily drinking mothers were 7.240 nmol/g and 0.033 nmol/g, respectively. A positive cutoff of 2.0 nmol/g for EtG yielded the best sensitivity and specificity (100%) to discriminate for true prenatal exposure to ethanol. It was not possible to establish a proper cutoff for EtS because of the low number of positive samples. Based on our results, meconium EtG can be proposed as an alternate biomarker for intrauterine alcohol exposure. In contrast to the 7 FAEEs, EtG is just one molecule that could be screened in meconium samples from all newborns by a simple, low-cost, easy-to-perform immunoassay, which can be routinely applied in neonatology wards for the early diagnosis of prenatal exposure to ethanol.

G/R 241 Polymorphism of Intercellular Adhesion Molecule 1 (ICAM-1) Is Associated with Fuchs Uveitis

To investigate potential associations of the ICAM-1 gene polymorphisms and Fuchs uveitis in a cohort of Italian patients. Seventy-one consecutive Italian patients affected by Fuchs uveitis were observed at the Ocular Immunology Unit, Arcispedale S. Maria Nuova (Reggio Emilia, Italy) from 2002 to 2008. Two hundred twenty-six healthy Italian blood donors from the same geographic area were selected as the control group. All Fuchs uveitis patients and control subjects were genotyped by polymerase chain reaction (PCR) and allele-specific oligonucleotide techniques for ICAM-1 polymorphisms at codon 241 (exon 4). The frequency of the ICAM-1 G/R 241 polymorphism was significantly higher in Fuchs uveitis than in the control subjects (16.9% vs. 5.8%; P=0.006, Pcorr=0.012; odds ratio, 3.3; 95% confidence interval, 1.4-7.7). No significant association between clinical features and ICAM-1 polymorphisms was found. This study demonstrates for the first time that the ICAM-1 G/R 241 polymorphism may represent a candidate gene for Fuchs uveitis susceptibility.

Hip fracture management and outcomes in Italy

Hip fractures are a major health care problem in Italy since more than 90,000 such fractures per year occur among elderly people. Nowadays, in several boroughs, orthopaedic wards are being restructured, overcoming the traditional model of care towards heterogeneous liaison models between the orthopaedic staff and medical-geriatric staff. However, the care pathway changes considerably from one area to another of the country. Wide differences in the choice of treatment, surgical delays, length of in-hospital stay and the availability of rehabilitation services and intermediate care in the sub-acute period have been reported over the country. The authors described the orthogeriatric model of Arcispedale Santa Maria Nuova (ASMN) Hospital, the main hospital of the province of Reggio Emilia (Emilia-Romagna region), implemented in 2007 for all patients aged 75 years and older admitted with a hip fracture. During hospital stay each patient is comanaged by an orthopedic surgeon and a geriatrician with different responsibility and using a number of evidence-based protocols and standardized procedures. Even without dedicated trauma theatre, comparing data before and after the implementation of the Ortho-Geriatric model, a 50% reduction of waiting time to surgery was observed and the mean hospital stay decreased about 5 days. The Ortho-Geriatric approach should include all those strategies and interventions that have been shown to improve outcomes in well-designed and strictly evidence-based studies and the ASMN model need to be improved in several critical aspects such as standardized approaches in the management of the patients with very high level of comorbidity in the preoperative phase and the coordination of all the medical staff in the presurgical period.

PET systems: the value of added length

The past decade has brought unbelievable advances in CT technology. These have been reflected in a progressive widening of the radiation beam in the axial direction (from “fan beam” to “cone beam” geometry) and in a corresponding increase in the number of detector rings. From the four detectors and 2 cm axial field of view (AFOV), acquired in half a second, that characterised the systems of a decade ago, we now have, with the present technology, 256/312 multi-row detectors that allow the acquisition of an 8/16 cm axial field in less than a third of a second. In addition, dual-source CT is offering a wealth of new possibilities. These new systems, whose realisation demanded the solution of complex mechanics, electronics and information technology problems, have opened up a completely new field of medical investigation: the four-dimensional study of the heart and the vascular system. The past few years have also seen evolutions in the field of PET/CT. Indeed, this combined modality has benefitted not only from improved CT technology, but also from gradual advances in the PET sphere—advances prompted by the introduction of new crystal detectors (such as LSO, GSO, LYSO), new iterative reconstruction algorithms, faster electronics, the “gating” technique (synchronisation of data acquisition with respiratory motion) and, especially, “time of flight” PET technology (TOF) [1–4]. Yet despite these significant improvements, the length of the detector cylinder, or length of the system’s sensitive volume (“field of view”), has remained essentially the same (15–18 cm). With this acquisition geometry, only a very small fraction of the radiation emitted at any given instant is acquired (geometric efficiency ≤0.2). Therefore, to obtain, for example, a “whole-body” study of about 80 cm in length (from the temples to the bladder of the patient), a series of six to eight static scans (“views”) need to be acquired. The adjacent single views, obtained with the movement of the bed, must, of course, also provide an appropriate region of overlap. Obviously, the acquisition time increases in proportion to the number of views. A “standard study” with the injection of 10 mCi of F-FDG takes about 3 min per view and, therefore, approximately 25 min per entire study. To this about a minute should be added for the CT scan. However, when used for wholebody studies in diagnostic oncology—this use accounts for approximately 90% of all PET scans—this procedure presents major limitations. The limited length of the sensitive volume not only imposes the need for multiple views, and thus prolongs the overall duration of the examination, it also (and this is particularly important) limits the maximum “line of response” (LOR) angle (with G. Borasi (*) : F. Fioroni Medical Physics Department, Santa Maria Nuova Hospital, V. le Risorgimento 80, 42100 Reggio Emilia, Italy e-mail: giovanni_borasi@libero.it

The causes of uveitis in a referral centre of Northern Italy

Uveitis is a complex intraocular inflammatory disease resulting from several aetiological entities that are linked to geographical, genetic and socioeconomic variables. The purpose of this study was to provide an overview of the distribution patterns of uveitis as seen in a nationwide referral centre at a community hospital in Reggio Emilia, northern Italy, and to compare our data with those reported in previously published international series. The records of 1064 patients of Italian origin with uveitis referred to the Immunology Ocular Unit of the Arcispedale S. Maria Nuova Hospital in Reggio Emilia from 2002 to 2008 were classified and analysed. Data regarding sex, race, residence, age at presentation and at onset of uveitis, ocular involvement, clinical characteristics, ocular condition, and systemic disease associations were collected. The mean age at onset of uveitis was 41 years (range: 1-94), and the male-to-female ratio was 1:1.2. Anterior uveitis was the most common location (51.2%), followed by posterior uveitis (23.4%), panuveitis (19.6%), and intermediate uveitis (5.8%). The most frequent entities included Fuchs uveitis (22.7%), herpetic anterior uveitis (9.9%), toxoplasmosis (6.9%), HLA-B27-associated anterior uveitis (5.3%), and Behçet's disease (5.3%). The distribution we observed of the most common disease entities conformed to previous international series. In our series, Fuchs uveitis represented the most common diagnosis (22.7%, 45% of anterior uveitis). The high percentage of specific diagnosis (74%) can be explained by the establishment of new disease categories over time as well as by a systematic multi-disciplinary diagnostic approach.

Papillary Poroid Hidradenoma

To the Editor: Poroid hidradenoma (PH) is a rare eccrine neoplasm, described by Abenoza and Ackerman,1 and so-called because of its morphology intermediate between a poroma and a hidradenoma. As they are often cystic and superficially located, fine needle aspiration cytology has been useful in establishing a suspect of PH,2,3 but the diagnosis still relies on the histological examination and the findings of the typical cell population. We describe a case of PH with prominent papillary features, arising in the thigh of a 70-year-old white man who presented with a 2-cm reddish lesion. Clinically, the lesion was tender, localized in the deep dermis, and covered by normal-looking epidermis; it was surgically removed in fragments, with sparing of the epidermis, and sent for histological examination. On light microscopy, it presented as a cystic lesion refilled by multiple papillae (Fig. 1), sometimes with large stalks, bordered by monomorphous, cytologically bland, poroid cells (Fig. 2), and larger eosinophilic cuticular cells showing evident ductular differentiation (Fig. 2, inset). At immunohistochemistry, the former were positive with cytokeratin AE1/AE3, whereas the latter reacted with cytokeratin 7, EMA (Fig. 3A), and, focally, CEA (Fig. 3B). Neither necrosis en masse nor atypia or increased mitotic activity was noted.FIGURE 1: At low power, the papillary pattern of growth of the lesion is apparent.FIGURE 2: The lesion is composed of small, dark, poroid cells admixed with larger eosinophilic cuticular cells (inset).FIGURE 3: At immunohistochemistry, ductular differentiation is highlighted by epithelial membrane antigen (A) and CEA (B). CEA, carcinoembryonic antigen.Our case fulfills morphological criteria for PH, as already described,4-9 namely, it is confined to the dermis, it has a prominent cystic component, and it is composed of a monomorphous population of either basaloid cells or large cuticular cells. Its immunohistochemical profile suggests that it is closely related to poroma,8,9 and it is in keeping with an eccrine derivation. A quite unusual finding is the prominent papillary architecture, which expands the spectrum of growth patterns8; in the presence of papillary epithelial fronds, when dealing with an adnexal skin tumor, a diagnosis of PH should therefore be considered. Simonetta Piana, MD Elena Tagliavini, MD Department of Pathology Arcispedale Santa Maria Nuova Reggio Emilia, Italy

Two-Year Clinical, Angiographic, and Intravascular Ultrasound Follow-Up of the XIENCE V Everolimus-Eluting Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions: The SPIRIT II Trial

Two-Year Clinical, Angiographic, and Intravascular Ultrasound Follow-Up of the XIENCE V Everolimus-Eluting Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions: The SPIRIT II Trial

Impact of insemination technique, semen quality and oocyte cryopreservation on pronuclear morphology of zygotes derived from sibling oocytes

Pronuclear morphology seems to be an important predictive value of zygote development and integrity. In this study we want to evaluate the effect of insemination technique, male factor and oocyte cryopreservation on pronuclear morphology of zygotes derived from sibling oocytes in our Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy. Subjects (n = 190) were submitted to IVF cycles with non-frozen and frozen sibling oocytes. Morphological evaluations were assessed using zygote pronuclear morphology (pronuclei, nucleoli and axis) in four groups: Group 1: 144 zygotes from 85 conventional IVF cycles with non-frozen oocytes; Group 2: 164 zygotes from 85 intracytoplasmic sperm injection (ICSI) cycles with Group 1 patients' sibling frozen oocytes; Group 3: 221 zygotes from 123 ICSI cycles with non-frozen oocytes; Group 4: 197 zygotes from 123 ICSI cycles with Group 3 patients' sibling frozen oocytes. No differences between Group 1 and Group 2 were seen. Group 3 was statistically different from Group 4 in relation to the nucleolar morphology. Oocyte cryopreservation procedure modified the nucleolar morphology of zygotes only in the presence of poor semen quality.

Nitric oxide as an early marker of human embryo metabolic cleavage in ART using fresh or thawed oocytes

Objective To study a possible role of nitric oxide (NO) as a marker of development in the early phases of human embryo cleavage during assisted reproduction. Study design 179 women having ART were included. 123 women used fresh oocytes and 56 oocyte thawing cycles in the Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova, between July 2005 and June 2006; 57 patients had IVF and 122 patients had ICSI. NO concentrations in IVF or ICSI embryo culture media were assessed by monitoring levels of NO stable oxidation products (nitrites/nitrates). Analysis of embryo quality was performed. Student’s t-test or Mann–Whitney and logistic regression model tests were applied to the data. Results In patients using fresh oocytes, there were greater NO production in embryos derived from ICSI than from IVF after 52 h of culture (38.64 μmol/L vs 11.2 μmol/L, p < 0.05). No correlation with embryo quality was observed. Embryos derived from fresh oocytes produce more NO than embryos from thawed oocytes both after 48 and 52 h of culture (16.12 μmol/L vs 6.83 μmol/L and 25.93 μmol/L vs 2.98 μmol/L respectively, p < 0.05). Conclusion(s) NO in embryo culture media is not a metabolic cleavage marker or a marker of embryo quality in ART. However, it could be an important parameter in the investigation of metabolism in frozen/thawed oocytes.

Pericarditis Heralding Erdheim-Chester Disease

A 47-year-old man with a history of gynecomastia due to prolactin-releasing pituitary microadenoma was admitted to the hospital because of persistent chest pain and fatigue. Chest x-ray showed pronounced enlargement of the cardiac profile (Figure 1), and echocardiography demonstrated a marked pericardial effusion (Figure 2). Pericardiocentesis allowed the drainage of 1800 mL of pericardial fluid whose biochemical analysis was consistent with an exudate (total protein and lactate dehydrogenase fluid-to-serum ratios of 0.9 and 2.6, respectively); cytological examination showed the presence of mesothelial cells, histiocytes, and lymphocytes. Figure 1. Chest x-ray performed at the time of admission to hospital showing marked enlargement of the cardiac profile. Figure 2. Transthoracic echocardiographic image, obtained on admission to hospital, …

Chronic Periaortitis

Chronic Periaortitis

Depressive symptoms during late pregnancy and early parenthood following assisted reproductive technology

To evaluate the relationship between assisted reproduction technology (ART) and depressive symptoms during late pregnancy and early parenthood. Case-control longitudinal study. The Center of Reproductive Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Women who conceived by ART compared with men and compared with women following spontaneous conceptions. The sample of 87 subjects, 48 ART (25 mothers, 23 fathers; response rate of 30%) and 39 non-ART mothers were evaluated by the Edinburgh Postnatal Depression Scale (EPDS) at 30-32 weeks of gestation, and at 1 week and 3 months after delivery. Mean scores and prevalence of low scores. The main sociodemographic and obstetric characteristics were similar between groups. Edinburgh Postnatal Depression Scale scores were higher in ART women compared with non-ART women during all assessments and higher during the third trimester of pregnancy and at 1 week postpartum compared with ART men. The prevalence of depressed subjects was significantly higher in ART women compared with non-ART women during the antenatal assessment. Assisted reproductive technology pregnancies are more frequently associated with depressive symptoms that may persist after delivery, suggesting a greater emotional vulnerability of these women. The risk of depression during and following ART pregnancies needs monitoring to avoid adverse effects of postpartum depression on the mother-infant relationship and infant's psychologic development.

The effect of selecting oocytes for insemination and transferring all resultant embryos without selection on outcomes of assisted reproduction

To evaluate the effect of selecting three best oocytes for insemination and transfer of all resultant embryos on outcomes of assisted reproductive technologies (ART). Comparative study. The Center of Reproductive Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Women undergoing ART during the period March 10, 2004 to March 9, 2006. Comparing outcomes of ART following transfers of 3 "excellent" (n = 267) embryos and cycles in which none of the embryos was considered "excellent quality" (n = 176). Rates of fertilization, pregnancy, "take-home baby," and multiple pregnancies. The average number of retrieved oocytes and the average number of inseminated oocytes of good quality were similar in both groups. Intracytoplasmic sperm injection was performed four to five times more often in cycles without "excellent quality" irrespective of the patient's age (odds ratio 4.6, 95% confidence interval 3.0, 7.1). The two groups had similar rates of implantation, total pregnancies/ET, clinical intrauterine pregnancy, singleton and multiple births, and "take-home" baby rate. This similarity persisted irrespective of the patient's age. The selection of oocytes for insemination and transfer of all available embryos irrespective of their quality did not change outcomes of ART.

Psychological Vulnerability of Singleton Children After the ‘Vanishing’ of a Co-Twin Following Assisted Reproduction

We test the hypothesis that parents who conceived twins by assisted reproduction technology (ART), but experienced loss of one twin, have a different parental-child relationship compared with ART parents following a singleton pregnancy. We used the 1994-2005 ART database of the Centre for Infertility of the Arcispedale Santa Maria Nuova in Reggio Emilia, Italy to identify families of 53 singleton births after the 'vanishing' twin syndrome. The controls comprised 106 families who conceived and delivered singletons, matched for gestational age (>or= 28 <or= 31, >or= 32 <or= 36, >or= 37 weeks), maternal age (< 35, >or= 35 <or= 40, > 40 years), child's age (1-3, 4-6, and 7-11 years) and child's gender. We completed 3 tests: a sociodemographic questionnaire, the QUIT - Italian Questionnaires of Temperament - motor scale, and the Child Vulnerability Scale. We found that children in the study had significantly more difficulties at the beginning of nursery school (p = .002) and kindergarten (p = .0005), with more frequent anxiety of separation from the parents (nursery school, p = .009; kindergarten, p = .001). We found a lower mean QUIT motor score for the 7- to 11-year-old children when compared to the general Italian normative values, suggesting that parents perceived their children as having more motor difficulties. In contrast, analysis of the Child Vulnerability Scale showed that significantly more parents (15.1%) from the controls perceived their child as vulnerable compared to those from the study group (3.8%), p = .034. We conclude that despite the perceived motor difficulties and the difficulties in the process of individuation-separation that appear at the beginning of the different educational circumstances, parents of singletons following the 'vanishing' twin syndrome perceive their children as 'invincible', and thus less vulnerable compared to controls.

UNA COLLEZIONE DI STRUMENTARIA SCIENTIFICA ALL'AVVENTO DELL'OSPEDALE MODERNO: GLI STRUMENTI FISICO-MATEMATICI DI VINCENZO VIVIANI E L'OSPEDALE DI SANTA MARIA NUOVA DI FIRENZE (1871-1895) *

Around the second half of the nineteenth century, the collection of physics-mathematical instruments that Vincenzo Viviani (1622-1703) had bequeathed to the Santa Maria Nuova Hospital of Florence stirred new interest. The process of modernising the hospital was indeed to lead to the progressive alienation of the institution's rich historical patrimony, including the scientific collections. In tracing back the negotiations that led to the sale of the Viviani collection, archive documents have also brought to light the collection inventory, which is now proposed a new to help recount the history of how scientific instruments became museum collectibles in Florence.

UNA COLLEZIONE DI STRUMENTARIA SCIENTIFICA ALL'AVVENTO DELL'OSPEDALE MODERNO: GLI STRUMENTI FISICO-MATEMATICI DI VINCENZO VIVIANI E L'OSPEDALE DI SANTA MARIA NUOVA DI FIRENZE (1871-1895) *

Abstracttitle ABSTRACT /title A Collection of ScientificInstrumentsat theDawnof theModern Hospital: Vincenzo Viviani'sPhysical-Mathematical Instrumentsand SantaMariaHospital in Florence(1871-1895) - Around the second half of the nineteenth century, the collection of physics-mathematical instruments that Vincenzo Viviani (1622-1703) had bequeathed to the Santa Maria Nuova Hospital of Florence stirred new interest. The process of modernising the hospital was indeed to lead to the progressive alienation of the institution's rich historical patrimony, including the scientific collections. In tracing back the negotiations that led to the sale of the Viviani collection, archive documents have also brought to light the collection inventory, which is now proposed anew to help recount the history of how scientific instruments became museum collectibles in Florence.

John Henderson, The Renaissance hospital: healing the body and healing the soul, New Haven and London, Yale University Press, 2006, pp. xxxiv, 458, illus., £35.00 (hardback 0-300-10995-4).

John Henderson, The Renaissance hospital: healing the body and healing the soul, New Haven and London, Yale University Press, 2006, pp. xxxiv, 458, illus., £35.00 (hardback 0-300-10995-4).

The effect of legislation on outcomes of assisted reproduction technology: lessons from the 2004 Italian law

To evaluate the effect of the 2004 Italian regulations (insemination of <or=3 oocytes/cycle, transfer of all embryos, prohibition of embryo cryopreservation) on outcomes of assisted reproduction treatment (ART). Case-control study. The Center of Reproductive Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Women undergoing ART for the first time. Comparing outcomes of ART between 2 years before (n = 900) and after (n = 936) the law's implementation (March 10, 2004). Rates of fertilization, pregnancy, "take-home baby," and multiple pregnancies. During the pre-law period, statistically significantly more patients reached embryo transfer (odds ratio 1.9; 95% CI, 1.5, 2.5), and embryo transfer rate per cycle was statistically significantly higher (3.1 +/- 1.7 vs. 2.2 +/- 0.7), but the overall transfer of good embryos was lower (OR 0.6; 95% CI, 0.5, 0.8). The pregnancy rates per aspiration cycle were similar between the periods, but the pregnancy rate per embryo transfer and birth rate with at least one liveborn baby per embryo transfer were statistically significantly lower in the pre-law period (OR 0.7; 95% CI, 0.5, 0.9). The multiple births rate was not different between the two periods. In contrast to prior pessimistic expectations, the obligation to transfer all available embryos produced from <or=3 inseminated oocytes neither reduced success rates of ART nor increased the multiple births rate.

Limited importance of pre-embryo pronuclear morphology (zygote score) in assisted reproduction outcome in the absence of embryo cryopreservation

To investigate the hypothesis that Z-score criteria represent a reliable predictor of implantation rate and pregnancy outcome in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles, excluding the possibility of embryo selection before the embryo transfer. Retrospective clinical study. Centre of Reproductive Medicine, Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova (ASMN), Reggio Emilia, Italy. We analyzed 393 pregnancies obtained by IVF or ICSI cycles. Morphologic evaluations of Z-score in pre-embryos obtained from IVF or ICSI cycles. Evaluations of Z-scores, implantation rate, and clinical pregnancy outcome. We did not find any statistically significant correlation between the Z-score of 1032 embryos transferred in 393 embryo transfers and the implantation rate or the pregnancy outcome. In particular, the best Z-score identified (Z1, 7.2%) did not seem to correlate with embryo implantation rate or pregnancy outcomes any better than those with worse scores (Z2, 6.9% and Z3, 85.9%). Our results seem to confirm that Z-score alone cannot be considered a better tool than standard morphologic criteria for identifying, controlling, or selecting embryos with a better chance of successful ongoing pregnancy.