Reduced Pregnancy Rates Research Articles

Effect of Ovulatory Follicle Size on Steroidogenic Capacity and Molecular Markers of Oocyte Competence prior to GnRH-Induced Ovulation in Nonlactating Beef Cows.

Gonadotropin releasing hormone (GnRH)-induced ovulation of small dominant follicles decreased pregnancy rates and increased late embryonic/fetal mortality in beef cows. Inadequate oocyte competence, as affected by the physiological status of the dominant follicle, is a potential explanation for the reduction in pregnancy rates and late embryonic/fetal survival. Molecular markers of oocyte competence in both the oocyte (i.e. inhibin beta A [INHBA], inhibin beta B [INHBB] and their binding protein follistatin [FST]) and the surrounding cumulus cells (cathepsins B [CTSB], S [CTSS], and Z [CTSZ]) have been reported. The objective was to examine the relationship between preovulatory follicle diameter, steroidogenic capacity of the preovulatory follicle, and the following measures of oocyte competence: relative abundance of FST, INHBA, and INHBB mRNA in the oocyte, relative abundance of cathepsin (CTSB, CTSS, CTSK, and CTSZ) mRNA in cumulus cells, and the fatty acid profile (total monounsaturated fatty acids, polyunsaturated fatty acids, and saturated fatty acids) in follicular fluid. Non-lactating beef cows (n = 40) were administered GnRH on d −9, prostaglandin F2a (PG) on d −2, and ovaries harvested 48 hr after PG administration (d 0). Blood samples were collected every 8 hr from PG until ovary collection to characterize serum concentrations of estradiol, progesterone, insulin like growth factor 1 (IGF1), and luteinizing hormone (LH). None of the animals had a spontaneous LH surge by the time of ovary collection. The dominant follicle was dissected from the stroma and the cumulus-oocyte complex retrieved along with the corresponding follicular fluid. Only data from cows (n = 16) that did not express estrus and that had an estrogenic follicle at harvest (estradiol to progesterone ratio = 1 in follicular fluid) were included in the simple linear regression analysis. Dominant follicle diameter ranged from 9 to 14 mm at 48 hr after PG and the correlation between dominant follicle size and serum estradiol and follicular fluid estradiol was 0.54 (P < 0.05) and 0.50 (P < 0.04), respectively. As dominant follicle diameter increased, oocyte mRNA abundance (n = 16) of FST (P < 0.02), INHBA (P < 0.01) and INHBB (P < 0.03) decreased. However, as dominant follicle diameter increased cumulus cells (n = 12) had lower mRNA abundance of CTSB (P < 0.04), and tended to have lower abundance of CTSZ (P < 0.07). Furthermore, as follicular fluid concentrations of estradiol increased, CTSS abundance increased (P < 0.04) and CTSZ abundance tended to decrease (P < 0.06). Fatty acid profiles of total monounsaturated fatty acids, polyunsaturated fatty acids, and saturated fatty acids were not affected by dominant follicle size. In summary, relative abundance of INHBA, INHBB and FST mRNA in the oocyte were all negatively correlated with follicle diameter 48 hr after PG. Furthermore, relative abundance of CTSB mRNA in the cumulus cells from the ooctyes collected was also negatively associated with follicle diameter. As follicular diameter increased there was a correlated increase in serum and intrafollicular estradiol at ovary collection, but no effect on total fatty acids. In conclusion, there was no compelling data from the study to indicate that larger dominant follicles contained more competent oocytes. Supported by USDA NRI grant 2006-35203-17284 from USDA-CSREES.

Effect of archer density on elk pregnancy rates and conception dates

AbstractArchery hunting in Oregon has increased dramatically over the past 2 decades. At the same time, spring juvenile to adult female ratios of Rocky Mountain elk (Cervus elaphus) have been declining. This has raised concern that archery seasons may be disrupting elk breeding and contributing to the decline in recruitment. Two mechanisms could contribute to reduced juvenile:female ratios: 1) reduced pregnancy rates, and 2) delayed conception dates because of human disturbance during the rut. We varied the number of archery hunters at the Starkey Experimental Forest and Range over 13 years to evaluate effects of archer density on reproduction of elk. Archer densities were maintained at high densities during 4 years $({\bar {x}} = 1.09\,{\rm tags}\;{\rm sold}/{\rm km}^{_{2} } )$, low densities during 3 years $({\bar {x}} = 0.53\,{\rm tags}\,{\rm sold}/{\rm km}^{_{2} } )$, and no archers during 6 years. We determined pregnancy status, age, kidney fat index (KFI), lactation status, and fetus conception dates for 622 female elk harvested in December. We found pregnancy rate differences of 0.105, 0.080, and 0.021 between high and no archer density years (P = 0.004), high and low archer density years (P = 0.054), and low and no archer density years (P = 0.616), respectively. Conception dates were 4 days later for high archer density compared to low archer density (P = 0.006), but did not differ between high and no archer years (2 days; P = 0.136) or between low and no archer years (2 days; P = 0.108). We compared generalized linear model estimates of pregnancy rates and determined pregnancy rates for 28% of the lactating female elk to be affected by high archer density, whereas archer densities had no significant affect on pregnancy rate estimates for non‐lactating females. We found no difference in conception dates among archer densities when comparing model estimates. Our results suggest that archer density and its interaction with nutritional condition of elk influence pregnancy rates of lactating females with low KFI levels; however, the effect of archer density alone does not explain the magnitude of decline in juvenile to female ratios observed in Oregon. © 2012 The Wildlife Society.

The impact of endometriosis on in vitro fertilization outcome

Introduction: Nowadays, endometriosis represents the most frequent cause of female infertility.The treatment of choice is by all means laparoscopic surgery, which results in more than a 60 % pregnancy rate, regardless of the stage of the disease. For the rest of patients in vitro fertilization (IVF) is the most appropriate treatment of choice. Views of the impact of endometriosis on IVF outcome remain controversial and subject to debate. Whereas some studies have documented that endometriosis is associated with reduced pregnancy rates, others failed to prove this association. The present study was designed to elucidate whether or not endometriosis affects IVF outcome at our institution. The study was retrospective, statistical significance was considered at p ≤ 0.05. Methods: In 96 patients (group A) that underwent IVF program the only cause of infertility was endometriosis which had been previously treated surgically. Sixty-two (64.6 %) patients had minimal or mild endometriosis (group C) and 34 (35.4 %) had moderate or severe stage of the disease (group D). The control group (group B) consisted of 305 patients who underwent IVF procedure for tubal or idiopathic infertility. Among other variables, pregnancy rate per cycle and per embryo transfer (ET), take-home-baby rate (THBR) per cycle and per ET were compared between the study and control groups of patients as well as between both groups with endometriosis. The study was retrospective. Statistical significance was defined as p ≤ 0.05. Results: No statistically significant differences were found in any of the compared parameters. In Group “A” pregnancy rate per cycle and per ET was 41.7 % and 46.8 % respectively, compared to Group “B” where it was 36.4 % and 40.5 % respectively. THBR per cycle and per ET in Group “A” was 35.4 % and 43.0 %, whereas in the control group it was 30.5 % and 33.9 % respectively. Pregnancy rate per cycle and per ET in Group “C” was 40.3 % and 48.1 % whereas in Group “D” it was 44.1 % and 55.6 % respectively. THBR per cycle and per ET in Group “C” was 33.9 % and 40.4 % whereas in Group “D” it was 38.2 % and 48.1 % respectively. Conclusions: Endometriosis does not affect the outcome of IVF procedures. We believe that appropriate surgical technique is of paramount importance in patients with endometriosis, leading to favourable IVF outcomes.

Does obesity really matter? The impact of BMI on embryo quality and pregnancy outcomes after IVF in women aged ≤38 years

The increasing prevalence of obesity in women of child-bearing age is of growing concern in the health community. Obesity is associated with sub-optimal reproductive performance; therefore, it is understandable that the number of young women with elevated body mass index (BMI) accessing assisted reproductive treatment (ART) is on the rise. Consequently, this study not only assessed the impact of BMI on fertilisation rates, embryo development and freezing during ART in women aged ≤38years but also determined their subsequent pregnancy and delivery rates. Data were retrospectively analysed from all cycles initiated in 2006/2007 for women aged ≤38years. The BMI categorisations were as follows: normal - 18.5-24.9kg/m(2) ; overweight - 25-29.9kg/m(2) ; obese - 30-34.9kg/m(2) ; morbidly obese class I - 35-39.9kg/m(2) ; morbidly obese class П -≥40kg/m(2) . Obese and morbidly obese women required a significantly higher follicle stimulating hormone start dose than normal BMI women; however, they obtained significantly fewer oocytes (P<0.05). Although BMI did not affect embryo development, morbidly obese class Π women had significantly reduced pregnancy rates compared to normal BMI women (30.5 vs 41.7%, respectively; P<0.05). Furthermore, increasing BMI was positively correlated to increasing rates of preterm delivery (P<0.05). Increasing BMI was also positively correlated to increasing delivery rates of singleton term macrosomic offspring (≥4000g). Obesity in women aged≤38years does not affect embryo development; however, it does reduce clinical pregnancy rates in women with a BMI≥40 and increases rates of preterm labour and delivery of macrosomic offspring.

Adenomyosis reduces pregnancy rates in infertile women undergoing IVF

High-resolution transvaginal ultrasound has facilitated the diagnosis of adenomyosis. This study determined the prevalence of this finding in infertile women and its effect on the outcome of IVF/intracytoplasmic sperm injection (ICSI). This prospective study evaluated 275 consecutive women, commencing IVF/ICSI for the first time. Inclusion criteria were adequate ovarian reserve. Women with fibroids or a previous myomectomy were excluded. All women were screened for adenomyosis by transvaginal ultrasound on three separate occasions. The control group included 256 women and the adenomyosis group included 19 women. There was no significant difference in the ages of women, FSH, cause of infertility, body mass index, total dose of gonadotrophin used and number of oocytes collected between the two groups. However, women with adenomyosis had a higher mean antral follicle count (P=0.006). The clinical pregnancy rate (22.2% versus 47.2%) and ongoing pregnancy rate (11.1% versus 45.9%) were significantly lower in women with adenomyosis and the miscarriage rate (50.0% versus 2.8%) was significantly higher in women with adenomyosis (all P<0.001). Ultrasound evidence of adenomyosis is found in a significant number of women presenting with infertility and has a negative impact on the outcome of IVF/ICSI.This paper suggests that a common condition known as adenomyosis is associated with a reduced success following fertility treatment such as IVF. The diagnosis of adenomyosis has been greatly facilitated by the advent of high-resolution transvaginal ultrasound. This was a study including 275 consecutive women who were commencing IVF for the first time. Comparing women who did not have adenomyosis and those that did, the clinical and ongoing pregnancy rates were both lower in women with adenomyosis (22.2% versus 47.2% and 11.1% versus 45.9%, respectively). So, fewer women with adenomyosis became pregnant and had an ongoing pregnancy. The miscarriage rate was higher in women with adenomyosis compared with those without (50.0% versus 2.8%). We conclude that ultrasound evidence of adenomyosis is found in a significant number of women presenting with infertility and has a negative impact on the outcome of IVF.

Pregnancy and contraceptive use among women participating in an HIV prevention trial in Tanzania

ObjectivesInformation on pregnancy rates and factors associated with pregnancy and contraceptive use is important for clinical trials in women in sub-Saharan Africa where withdrawal of investigational products may be required...

Antinuclear Antibodies Predicts a Poor IVF-ET Outcome: Impaired Egg and Embryo Development and Reduced Pregnancy Rate

To investigate the impact of anti-nuclear antibodies (ANAs) on the outcome of in vitro fertilization-embryo transfer (IVF-ET), 66 (96 cycles) infertile women positive for anti-nuclear antibodies (ANA+ group), and 233(285 cycles) infertile women negative for ANAs (ANA− group) were enrolled. The clinical characteristics and IVF outcome were compared between the two groups. In the ANA+ group, the proportion of MII oocytes and two-pronuclear zygotes (2PN), cleavage rate, number of available embryos and proportion of available embryos, number of high-quality embryos and proportion of high-quality embryos were significantly lower than those in the ANA− group. In addition, the pregnancy rate and implantation rate in patients positive for ANA was markedly lower than the ANA− patients (28.1% vs 46.4%, 15% vs 25.7%, respectively). Thus, our findings suggest that the presence of ANAs significantly interfere with the oocyte and embryo development, as well as reduce implantation and pregnancy rate in patients undergoing IVF treatment.

Follicular determinants of pregnancy establishment and maintenance

Synchronization of dominant follicle development and control of ovulation/oocyte retrieval are commonly used assisted reproductive technologies in both cattle and humans. The final maturation of the dominant follicle is intimately tied to the final maturation of the oocyte, preovulatory secretion of estradiol, preparation of follicular cells for luteinization, postovulatory secretion of progesterone and endocrine control of the oviductal and uterine environment for gamete and embryo development. The physiological maturity of a dominant/ovulatory follicle can affect the establishment and maintenance of pregnancy. Premature induction of the ovulatory process can reduce pregnancy rates and increase late embryonic/fetal mortality in cattle, which is likely mediated through inadequate oocyte competence and a compromised maternal environment. Oocyte competence increases with follicular maturity and is dependent upon acquisition of a complete complement of mRNA transcripts and establishment of the appropriate epigenetic marking of the oocyte genome before the preovulatory gonadotropin surge. Preovulatory secretion of estradiol is a reflection of follicular maturity and affects the oocyte, follicular cells, oviduct and uterus. The corpus luteum is a continuation of follicular maturation and rate of progesterone secretion following ovulation is linked to fertility. Advancements in our understanding of how the follicular microenvironment affects pregnancy establishment and maintenance will improve the efficiency of assisted reproductive technologies in all species. The purpose of this review is to discuss how follicular microenvironment, oocyte competence, preovulatory secretion of estradiol and postovulatory secretion of progesterone can affect pregnancy establishment and embryo/fetal survival, with an emphasis on cattle.

Progestagen Supplementation During Early Pregnancy does not Improve Embryo Survival in Pigs

Progesterone supplementation during early pregnancy may increase embryo survival in pigs. The current study evaluated whether oral supplementation with an analogue of progesterone, altrenogest (ALT), affects embryo survival. A first experiment evaluated the effect of a daily 20-mg dosage of ALT during days 1-4 or 2-4 after onset of oestrus on embryo survival at day 42 of pregnancy. A control group (CTR1) was not treated. The time of ovulation was estimated by transrectal ultrasound at 12-h intervals. Altrenogest treatment significantly reduced pregnancy rate when start of treatment was before or at ovulation: 25% (5/20) compared to later start of treatment [85% (28/33)] and non-treated CTR1 [100% (23/23)]. Altrenogest treatment also reduced (p < 0.05) number of foetuses, from 14.6 ± 2.6 in CTR1 to 12.5 ± 2.5 when ALT started 1-1.5 days from ovulation and 10.7 ± 2.9 when ALT started 0-0.5 days from ovulation. In a second experiment, sows with a weaning-to-oestrous interval (WOI) of 6, 7 or 8-14 days were given ALT [either 20 mg (ALT20; n = 49) or 10 mg (ALT10; n = 48)] at day 4 and day 6 after onset of oestrus or were not treated (CTR2; n = 49), and farrowing rate and litter size were evaluated. Weaning-to-oestrous interval did not affect farrowing rate or litter size. ALT did not affect farrowing rate (86% vs 90% in CTR2), but ALT20 tended to have a lower litter size compared with CTR2 (11.7 ± 4.1 vs 13.3 ± 3.1; p = 0.07) and ALT10 was intermediate (12.3 ± 2.9). In conclusion, altrenogest supplementation too soon after ovulation reduces fertilization rate and embryo survival rate and altrenogest supplementation at 4-6 days of pregnancy reduces litter size. As a consequence, altrenogest supplementation during early pregnancy may reduce both farrowing rate and litter size and cannot be applied at this stage in practice as a remedy against low litter size.

Correlation of technical difficulty during embryo transfer with rate of clinical pregnancy.

AIM:To correlate the ease or difficulty of embryo transfer and blood at catheter tip with pregnancy rate when embryo transfer (ET) was performed by the same operator using soft catheter.MATERIALS AND METHODS:A retrospective analysis of 342 patients who underwent in vitro fertilization or ICSI cycle from January 2008 to December 2010 in a single centre was done. The type of transfer was divided into two groups: ‘easy’ or ‘difficult’. Transfer was considered difficult when additional instrumentation was required or firmer catheter was used or required changing of catheter. Patients undergoing cryo-preserved ET were excluded from the study.RESULTS:On the day of transfer in 284 (83%) patients, ET was easy and difficulty was encountered in 58 (17%) patients. Blood at catheter was seen in 101 (29.53%) patients. In the group of 58 difficult transfers, 10 pregnancies resulted with a clinical pregnancy rate of 17.2%, while 67 pregnancies resulted in 284 cycles of easy transfer with clinical pregnancy rate of 23.6% (P value = 0.045). While no significant difference was seen in pregnancies with blood on outer catheter and blood less transfer, there was significant reduction in pregnancy rate when blood was present on catheter tip compared to bloodless transfer (13.3% v/s 24.1; P value = 0.032).CONCLUSION:Reduction in clinical pregnancy rate is seen with difficult ETs, more when blood is present at the catheter tip.

Black Teenage Pregnancy

This article examines the relative importance of race and socioeconomic status (SES) in determining whether Black and White teenagers report having ever been pregnant. Data gathered from 1999 to 2006 by the National Center for Health Statistics of the Center for Disease Control and Prevention included 1,580 Black and White females aged 15 to 19 years. Results supported the effects of race and SES, with SES having the stronger effect. However, the effects of race and SES differ when controlling for the state of the economy. No difference between Blacks and Whites was found during better economic times. During 2003-2004, the period of greatest economic stress, race was determined to be the only predictor of teenage pregnancy. In particular, during 2005-2006, the reduction in pregnancy rates for Black minors (15-17) fell below those for White minors within their respective SES categories. Policy implications are discussed in light of these findings.

Reduced Pregnancy Rates in Lactating Cows Inseminated Following Short or Prolonged Luteal Phases

Reduced Pregnancy Rates in Lactating Cows Inseminated Following Short or Prolonged Luteal Phases

The poor responder in IVF: is the prognosis always poor? A systematic review

BACKGROUND In IVF treatment a considerable proportion of women are faced with a low number of oocytes retrieved. These poor responders have reduced pregnancy rates compared with normal responders. However, this may not be applicable to all poor responders. This review aims at identifying patient characteristics and ovarian reserve tests (ORT) that will determine prognosis for pregnancy in poor responders. METHODS A systematic search was conducted in PubMed, Embase, Cochrane and SCOPUS databases in April 2010. Studies regarding patient characteristics or ORT in poor responders and their pregnancy prospects were included. All included papers were summarized in descriptive tables. RESULTS Nineteen studies were included. Pooled data of six studies comparing poor and normal responders demonstrated clearly lower pregnancy rates in poor responders (14.8 versus 34.5%). Ten studies indicated that older poor responders have a lower range of pregnancy rates compared with younger (1.5-12.7 versus 13.0-35%, respectively). Four studies showed that pregnancy prospects become reduced when fewer oocytes are retrieved (0-7% with 1 oocyte versus 11.5-18.6% with 4 oocytes). Five studies concerning pregnancy rates in subsequent cycles suggested a more favourable outcome in unexpected poor responders, and if ≥2 oocytes were retrieved. CONCLUSIONS Poor responders are not a homogeneous group of women with regards to pregnancy prospects. Female age and number of oocytes retrieved in particular will modulate the chances for pregnancy in current and subsequent cycles. Applying these criteria will allow the identification of couples with a reasonable prognosis and balanced decision-making on the management of poor responders.

Contraceptive Choices, Pregnancy Rates, and Outcomes in a Microbicide Trial

Women who become pregnant during the conduct of biomedical human immunodeficiency virus prevention trials are taken off the study product for safety reasons. High pregnancy rates can compromise statistical integrity in these trials. The comprehensive contraceptive curriculum developed for the Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004 trial was evaluated for its ability to enhance contraceptive uptake, reduce pregnancy rates, and preserve statistical integrity. Contraceptive- and pregnancy-related eligibility criteria were specified in the protocol. We enrolled women who opted for a nonbarrier method of contraceptive and provided hormonal contraceptives onsite at no cost. At each monthly study visit, we provided pregnancy prevention counseling and performed pregnancy testing. Study product was withheld on pregnancy diagnosis, but women continued with monthly follow-up. Contraceptive use was high throughout the study with 100% uptake at baseline and 94.71% use after a mean of 18 months follow-up at exit. Injectable progestins, particularly medroxyprogesterone acetate, remained the preferred choice of contraceptive. After 30 months of follow-up, 54 pregnancies were reported out of 889 participants, giving a pregnancy incidence rate of 3.95 per 100 woman-years (95% confidence interval 2.96-5.17). Of all pregnancies, two thirds (64.81%) resulted in a full-term live birth, whereas 18.52% and 11.11% pregnancies culminated as miscarriage and terminated pregnancies, respectively. There were no congenital anomalies in the early neonatal period. Pregnancies resulted in 1.56% of woman-years of study follow-up lost as a result of temporary product withdrawal. The CAPRISA 004 contraceptive curriculum was an effective strategy for maintaining low pregnancy rates, thereby minimizing product withdrawal and loss of follow-up time. III.

Fertility Responses to Prevention of Mother-to-Child Transmission of HIV

Prevention of mother-to-child transmission (PMTCT) interventions reduce the cumulative probability of transmission from a HIV positive woman to her child by as much as 40 percentage points. This paper is the rst economic analysis of the behavioral e ects of PMTCT. I examine fertility responses to the scale-up of PMTCT in Zambia, a country where approximately 15 percent of adults age 15-49 are HIV positive. My results suggest that the local introduction of PMTCT reduced pregnancy rates by up to 20 percent, that the fertility response was greater among women who were more likely to be HIV positive, and that PMTCT substantially increased breastfeeding rates.

Relationships between human sperm protamines, DNA damage and assisted reproduction outcomes

The exchange of histones with protamines in sperm DNA results in sperm chromatin compaction and protection. Variations in sperm protamine expression are associated with male infertility. The aim of this study was to investigate relationships between DNA fragmentation, sperm protamines and assisted reproduction treatment. Semen and spermatozoa prepared by density-gradient centrifugation (DGC) from 73 men undergoing IVF and 24 men undergoing intracytoplasmic sperm injection (ICSI) were included in the study. Nuclear DNA fragmentation was assessed using the alkaline Comet assay and protamines were separated by acid-urea polyacrylamide gels. Sperm DNA fragmentation and protamine content (P1–DNA, P2–DNA, P1 + P2–DNA) decreased in spermatozoa after DGC. Abnormally high and low P1/P2 ratios were associated with increased sperm DNA fragmentation. Couples with idiopathic infertility had abnormally high P1/P2 ratios. Fertilization rates and embryo quality decreased as sperm DNA fragmentation or protamines increased. Sperm DNA fragmentation was lower in couples achieving pregnancies after IVF, but not after ICSI. There was no correlation between protamine content (P1–DNA, P2–DNA, P1 + P2–DNA) or P1/P2 ratios and IVF or ICSI pregnancies. Increased sperm DNA fragmentation was associated with abnormal protamination and resulted in lower fertilization rates, poorer embryo quality and reduced pregnancy rates. During late spermatogenesis, around 85% of the histones in the sperm nucleus are replaced with protamines. This process results in sperm chromatin compaction and also transcription silencing. In the human, protamines are comprised of two types: protamine-1 (P1) and protamine-2 (P2). Variations in sperm protamine expression are associated with male infertility. Similarly, sperm DNA integrity is important for male fertility. The aim of this study was to investigate relationships between DNA fragmentation, sperm protamines and assisted reproduction treatment. Semen and spermatozoa prepared by density-gradient centrifugation (DGC) from 73 men undergoing IVF and 24 men undergoing intracytoplasmic sperm injection (ICSI) were included in the study. Nuclear DNA fragmentation was assessed using the alkaline Comet assay and protamines were separated by acid-urea polyacrylamide gels. Sperm DNA fragmentation and protamine content decreased in spermatozoa after DGC. Abnormally high and low P1/P2 ratios were associated with increased sperm DNA fragmentation. Couples with idiopathic infertility had abnormally high P1/P2 ratios. Fertilization rates and embryo quality decreased as sperm DNA fragmentation or protamines increased. Sperm DNA fragmentation was lower in couples achieving pregnancies after IVF, but not after ICSI. There was no correlation between protamine content or P1/P2 ratios and IVF or ICSI pregnancies. Increased sperm DNA fragmentation was associated with abnormal protamination and resulted in lower fertilization rates, poorer embryo quality and reduced pregnancy rates.

Development and survival of Ostertagia gruehneri under natural and artificially warmed conditions on the Canadian tundra

Abstract: Climate change in the Arctic is occurring at an unprecedented rate and is anticipated to alter the ecology of northern ecosystems, including the patterns, diversity, and transmission of infectious diseases. Ostertagia gruehneri is the most common gastrointestinal nematode in caribou and can cause decreased food intake, weight loss, and reduced pregnancy rates in Rangifer species. Because O. gruehneri has a direct life-cycle that includes a free-living stage, the develop¬ ment and survival rates of this parasite are influenced by climate and climate change. To investigate the response of the free-living stages of O. gruehneri to climate change field experiments were done from May to September 2007-08 at the Tundra Ecosystem Research Station (TERS), Daring Lake, Northwest Territories. Fecal plots containing 0. gruehneri were established on the tundra under natural and artificially warmed conditions. Plots were sampled throughout the summer to determine development and survival rates of O. gruehneri and to compare between the two climate regimes (natural vs. warmed). Effects of both temperature and relative humidity on development and survival were investigated. Results from these field seasons will be used, together with laboratory experiments, to develop and validate a predictive model for the impacts of climate change on the epidemiology of O. gruehneri.

Renewed evidence for a negative impact of autoimmunity on reproductive success with IVF

Impacts of autoimmunity on reproduction have remained controversial. We investigated if, in genetically predisposed women, autoimmunity, indeed, negatively affects reproductive success. Cross-sectional analysis This study expands on 399 previously reported women, 75 with PCO-like phenotypes [PLoS ONE 2010; 5(12):e15303], with similar distribution of ovarian FMR1 genotypes and sub-genotypes and autoimmune prevalence but significantly different autoimmune prevalence (P=0.003) [especially with PCO-like phenotype (P<0.0001)] and IVF pregnancy rates with different genotypes and sub-genotypes. Here, analyses were expanded, adjusting for ovarian function-associated factors (age, medication dosage for stimulation, race), attempting to statistically isolate a possible autoimmune effect. Het-norm/low sub-genotypes demonstrated significantly reduced pregnancy rates in comparison to norm genotype [OR 0.84 (95% CI 0.74 to 0.96l Wald 6.9; df = 1; P=0.009)], a difference maintained after age adjustment (OR 0.43; 0.22 to 0.86, P=0.017). Adjustments for ovarian function-specific patient factors completely eliminated pregnancy advantages of the norm FMR1 genotype, resulting in almost significant predictive value for pregnancy (P=0.06) of autoimmunity alone. This confirms FMR1 (mapping to Xq27.3) as mediator of ovarian function and autoimmunity. Elimination of pregnancy differences by adjustment for ovarian factors, and almost significance for autoimmunity alone, suggest endometrial (i.e., implantation), and not ovarian autoimmune effects as cause. Findings are also consistent with Xq evolving as an “autoimmune chromosome.” Variations in autoimmune prevalence with different FMR1 genotypes and sub-genotypes explain reported contradictory results of autoimmune effects, and mandates that relevant studies be performed with patients stratified for FMR1.

Targeting a reduction in teenage pregnancy rates in Norfolk – a pilot for integrating care

PurposeThis paper aims to demonstrate the approach taken in Norfolk to improve the health and welfare of young people. Local practitioners in Thetford want to address teenage pregnancy rates as a priority issue for their community; they have volunteered to be part of a national pilot to test integrated working in a service that involves many agencies and services.Design/methodology/approachThis health promotion service was a particular challenge for integration as it involved building partnerships between children's and adults’ services, health and social care, education and care services, and voluntary and statutory services. The service also covered the counties of Norfolk and Suffolk. A local core group, chaired by a GP, planned four phases of work: design, information gathering, service redesign and evaluation. This paper sets out an analysis of progress and achievements.FindingsThe group recognised the multiple factors affecting young people and their lives and lifestyles in this area of social deprivation and the benefits of partnership working. Improvements to date include better coordination, improved access to services and an enhancement of services.Research limitations/implicationsThe impact will not be measurable within the timescale of the pilot project in respect of reducing pregnancy rates; the work is ongoing.Practical implicationsImplications of the study include how partnership working can lead to targeting resources and to improving access to contraception and services.Originality/valueThis study is a local initiative within the national programme for integrating care, demonstrating the benefits of working together to target resources and working in a more coordinated way.

Does the provision of free intrauterine contraception reduce pregnancy rates among uninsured low-income women? A cohort study a two North Carolina clinics

BackgroundLow-income women are disproportionately affected by unintended pregnancy. The Access to Resources in Contraceptive Health Foundation was established to provide free levonorgestrel intrauterine contraceptive systems to uninsured women who meet specific socioeconomic eligibility criteria. The aim of this study was to evaluate the effectiveness of this program at reducing pregnancies among uninsured women attending two North Carolina clinics. Study DesignThis was a retrospective cohort study including uninsured women (aged 15–44 years) who desired contraception, were deemed eligible for the program and attended one of two North Carolina clinics between January 1, 2003, and June 30, 2009. The primary outcome was pregnancy. Pregnancy rates were compared between those women who had a program-approved intrauterine device placed (exposed group) and those women who were eligible for the program, but did not have a device placed (the unexposed group). Questionnaires were used to determine the numbers of pregnancies (and dates of conception), the types of alternative contraception being used and basic demographic information about program participants. The data were analyzed using survival analysis of time to pregnancy. A Cox proportional hazards model was used to estimate a hazard ratio. ResultsWe attempted to reach 321 patients and obtained 104 responses. After exclusions, data from 90 participants were analyzed. Sixty-five women received a levonorgestrel device, and 25 eligible women did not. Seven pregnancies occurred in the exposed group (11%), all after the IUD was removed; three of these pregnancies were planned. Eight pregnancies occurred in the unexposed group (32%). The median follow-up time was 2.4 years (range: 0.75–4 years) and 1.8 years (0.05–4 years) in the exposed and unexposed groups, respectively. ConclusionsProvision of a levonorgestrel-releasing device was associated with significantly lower risk of pregnancy than was use of alternative or no contraception. If these data from North Carolina are representative of experience nationwide, then the public health benefit of the Foundation's philanthropy may be large.