Single embryo transfer : Why and how to identify the embryo with the best developmental potential

Multiple pregnancies with higher risk of preterm birth and the associated higher morbidity have been a major obstacle from the early days of in vitro fertilization. A good strategy to avoid multiple pregnancies is elective single embryo transfer and cryopreservation of spare embryos. Important factors in adopting this strategy are good counselling of the patients and the selection of embryos with high implantation potential. Technical advances in embryo selection have been described during recent years, time lapse monitoring and genetic assessment of the embryos being the most important achievements. With these studies we have gained new information on early embryos. However, at present, there is insufficient evidence to recommend the routine use of these new techniques. The ultimate goal of infertility treatment is a healthy baby. (C) 2019 Elsevier Ltd. All rights reserved.Peer reviewe

B-hepatiitin kantajan raskaus

Teema : hepatologia. English summaryPeer reviewe

Systeemiset sidekudossairaudet, hedelmällisyys ja raskaus

Systeemisissä sidekudossairauksissa hedelmällisyyteen, sikiöön ja raskauteen vaikuttavat sairauden ­aiheuttamat elinmuutokset, taudin aktiivisuus sekä hoitoon käytetyt lääkitykset. Systeemiset sidekudossairaudet voivat lisätä keskenmenon, sikiön pienipainoisuuden ja ennenaikaisen ­synnytyksen riskiä. Tyypillisesti Sjögrenin oireyhtymään liittyviä sikiön sydämen johtumishäiriöitä aiheuttavia vasta-aineita voi esiintyä myös muissa sidekudossairauksissa. Systeemisiin sidekudossairauksiin voi liittyä myös tukoksille altistavia fosfolipidivasta-aineita. Systeemistä sidekudossairautta sairastavan naisen raskauden suunnittelu ja seuranta tulee keskittää keskus- tai yliopistosairaaloihin.Peer reviewe

Paikallisestrogeenit ja rintasyöpä

VertaisarvioituEmättimen paikallisten estrogeenihoitojen ei ole todettu lisäävän rintasyöpäriskiä. Limakalvojen kuivuminen on yleinen oire vaihdevuosien jälkeen, ja rintasyöpähoidot voivat pahentaa oireita. Hoitona voidaan aina käyttää hormonittomia kosteuttavia geelejä tai tabletteja. Liukuvoiteen käyttö yhdynnöissä on suositeltavaa. Rintasyövän hoidon jälkeen voidaan käyttää paikallisia estrogeenejä. Paikallishoitoa voidaan nykytiedon mukaan harkita myös aromataasinestäjää käyttävillä. Ensisijaisia ovat estriolia sisältävät valmisteet.Peer reviewe

Paikallisestrogeenit ja rintasyöpä

Emättimen paikallisten estrogeenihoitojen ei ole todettu lisäävän rintasyöpäriskiä.Limakalvojen kuivuminen on yleinen oire vaihdevuosien jälkeen, ja rintasyöpähoidot voivat pahentaa oireita.Hoitona voidaan aina käyttää hormonittomia kosteuttavia geelejä tai tabletteja. Liukuvoiteen käyttö yhdynnöissä on suositeltavaa.Rintasyövän hoidon jälkeen voidaan käyttää paikallisia estrogeenejä.Paikallishoitoa voidaan nykytiedon mukaan harkita myös aromataasinestäjää käyttävillä. Ensisijaisia ovat estriolia sisältävät valmisteet

Lapsettomuushoitojen komplikaatiot

•Lapsettomuushoidot ovat nykyisin tavallisia ja yleensä varsin turvallisia. •Hoitoja tehdään Suomessa sekä julkisella sektorilla että yksityisillä klinikoilla. •Vakavat komplikaatiot ovat harvinaisia, mutta uhkaavat pahimmillaan henkeä. •Mikäli päivystävä lääkäri epäilee lapsettomuushoitoon liittyvää komplikaatiota, hänen tulee lähettää potilas tarkempiin tutkimuksiin naistentautien päivystykseen.Peer reviewe

Endocrine Disorders and Genital Infections Impair Gynecological Health in APECED (APS-1)

ObjectiveIn autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) defects in the autoimmune regulator gene lead to impaired immunotolerance. We explored the effects of immunodeficiency and endocrinopathies on gynecologic health in patients with APECED. DesignCross-sectional cohort study combined with longitudinal follow-up data. MethodsWe carried out a gynecologic evaluation, pelvic ultrasound, and laboratory and microbiologic assessment in 19 women with APECED. Retrospective data were collected from previous study visits and hospital records. ResultsThe study subjects' median age was 42.6 years (range, 16.7-65.5). Sixteen patients (84%) had premature ovarian insufficiency, diagnosed at the median age of 16.5 years; 75% of them used currently either combined contraception or hormonal replacement therapy. In 76% of women, the morphology and size of the uterus were determined normal for age, menopausal status, and current hormonal therapy. Fifteen patients (79%) had primary adrenal insufficiency; three of them used dehydroepiandrosterone substitution. All androgen concentrations were under the detection limit in 11 patients (58%). Genital infections were detected in nine patients (47%); most of them were asymptomatic. Gynecologic C. albicans infection was detected in four patients (21%); one of the strains was resistant to azoles. Five patients (26%) had human papillomavirus infection, three of which were high-risk subtypes. Cervical cell atypia was detected in one patient. No correlation between genital infections and anti-cytokine autoantibodies was found. ConclusionsOvarian and adrenal insufficiencies manifested with very low androgen levels in over half of the patients. Asymptomatic genital infections, but not cervical cell atypia, were common in female patients with APECED.Peer reviewe

The effect of paternal and maternal factors on the prognosis of live birth in couples with recurrent pregnancy loss

Introduction Currently, recurrent pregnancy loss (RPL) examinations focus on the woman, although paternal factors are also involved. Men in couples with RPL have higher sperm DNA fragmentation levels than fertile men, but the effect of sperm DNA damage on couple's later prognosis is unknown. Advanced maternal age and obesity are associated with RPL, but paternal lifestyle factors are less studied. Therefore, we aimed to study the associations of couples' lifestyle factors, causes of RPL, and sperm DNA fragmentation with their prognosis of future live birth. Material and methods This descriptive cohort study comprised 506 couples investigated for RPL at Helsinki University Hospital, Finland, between 2007 and 2016, linked with national health and population registers. The primary outcome was couple's live birth after RPL investigations. Data on couple's background factors, including age, body mass index, smoking, and alcohol use, were collected from medical records. Sperm DNA fragmentation index was analyzed from 211 men using the sperm chromatin dispersion test. The associations between background factors, sperm DNA fragmentation, and cumulative probability of live birth over time were analyzed using cross-tabulations and age-adjusted Cox regression. Results In all, 352 of 506 couples (69.6%) achieved live birth. Maternal age, unexplained RPL, prolonged pregnancy attempts before investigations, paternal obesity, and maternal smoking were associated with prognosis: unadjusted hazard ratio for couple's live birth for women aged 35-39 versus younger than 30 years was 0.63 (95% confidence interval [CI] 0.47-0.84), and for 40 years or older was 0.36 (95% CI 0.22-0.58). Age-adjusted hazard ratio for unexplained versus explained RPL was 1.39 (95% CI 1.12-1.72), for couple's pregnancy attempt at least 4 years versus less than 2 years was 0.50 (95% CI 0.33-0.76), for paternal body mass index at least 30 kg/m(2) versus less than 25 kg/m(2) was 0.67 (95% CI 0.46-0.98), and for maternal smoking was 0.71 (95% CI 0.51-0.99). Altogether, 96/135 (71.1%) couples with normal (Peer reviewe