INVAZIVNI DIJAGNOSTIČKI POSTUPCI U VIŠEPLODNOJ TRUDNOĆI

Over the past few years, the rising rate of multiple pregnancies, attributed to both increasing reliance on infertility treatment modalities and delayed childbearing, has expanded the need for prenatal invasive genetic testing. In multiples, first-trimester chorionic villus sampling and second-trimester amniocentesis are relatively safe and efficient alternative procedures, whereas fetal blood sampling is reserved for cases where an indefinite result of fetal karyotyping needs elucidation. The choice of invasive technique should be based on gestational age at referral date, procedure related risks and technical demands, but experience of the center performing the modality should be emphasized in decision making. Technological advances in modern high resolution ultrasound equipment along with increasing operator experience available today result in more accurate and efficacious invasive prenatal diagnosis in twin or higher-order pregnancies, minimizing potential post-procedural fetal loss rate.Monozigotni blizanci čine oko 30% blizanačkih trudnoća, njihova je učestalost stalna, a dvozigotni blizanci čine oko 70% blizanačkih trudnoća, njihova je učestalost u porastu, zbog učestale primjene tehnike pomognute oplodnje i zbog odgađanja prvih trudnoća te posljedične veće životne dobi trudnica. Rizik strukturalnih anomalija u blizanaca je veća nego u jednoplodnih trudnoća, rizik je do tri puta veći u monozigotnih, a u dizigotnih blizanaca je od prilike kao u jednoplodnih trudnoća. Zbog ukupno veće učestalosti višeplodnih trudnoća povećana je potreba za invazivnom prenatalnom dijagnostikom. U višeplodnim trudnoćama su biopsija korionskih resica u prvom i amniocenteza u drugom tromjesečju relativno sigurni i uspješni alternativni postupci, a uzimanje fetalne krvi kordocentezom je rezervirano za slučajeve kada je učinjena kariotipizacija fetusa nesigurna i nejasna. Izbor invazivne tehnike se temelji na dobi trudnoće kad se trudnica javlja, na postojeći rizik postupka i na tehničke zahtjeve, a od velikog je značaja iskustvo prenatalnog centra. Tehnološki napredak suvremene ultrazvučne aparature te rastuće iskustvo prenatalnog operatera doprinose točnoj i učinkovitijoj invazivnoj prenatalnoj dijagnostici u dvojaka i blizanaca višeg stupnja te na najmanju moguću mjeru smanjuju fetalni gubitak nakon invazivnog postupka

"hCG priming" effect in controlled ovarian stimulation through a long protocol

<p>Abstract</p> <p>Background</p> <p>Recently, it has been demonstrated that, in patients down-regulated by GnRH analogues (GnRHa), a short-term pre-treatment with recombinant LH (rLH), prior to recombinant FSH (rFSH) administration, increases the number of small antral follicle prior to FSH stimulation and the yield of normally fertilized embryos. However, no data exist in the literature regarding the potential beneficial effect of "hCG priming" in controlled ovarian hyperstimulation (COH) through a long GnRH-a protocol, which binds the same receptor (LH/hCGR), though it is a much more potent compared to LH. The primary aims of this study were to assess the effect of short-term pre-rFSH administration of hCG in women entering an ICSI treatment cycle on follicular development, quality of oocytes and early embryo development. The secondary endpoints were to record the effects on endometrial quality and pregnancy rate.</p> <p>Methods</p> <p>Patients with a history of at least one previous unsuccessful ICSI cycle were randomly assigned into two groups to receive treatment with either a long protocol with rFSH (control group) or a long protocol with rFSH and pre-treatment with hCG (hCG group). In particular, in the latter group, a fixed 7 days course of 200 IU/day hCG was administered as soon as pituitary desensitization was confirmed.</p> <p>Results</p> <p>The mean number of oocytes retrieved was not significantly different between the two treatment groups, although the percentage of mature oocytes tended to be higher but not significantly different in hCG-treated patients. The percentage of patients with more than one grade 3 embryos was higher in the pre-treatment group, which also showed a higher pregnancy rate.</p> <p>Conclusion</p> <p>All the above clinical observations, in conjunction with previous data, suggest a point towards a beneficial "hCG priming" effect in controlled ovarian hyperstimulation through a long GnRH-a down-regulation protocol, particularly in patients with previous ART failures.</p

Effect of male mating history and age on remating by female European corn borer.

If mating with an inferior male has high fitness costs, females may try to avoid mating with these males. Alternatively, females may accept an inferior male to ensure they have obtained at least one mate, and/or to avoid the costs of resisting these males. We hypothesized that females compensate for mating with an inferior male by remating. We tested this hypothesis by measuring remating propensity in females that had mated with an old, multiply-mated male, a 9-day-old virgin male, or a young, virgin male. Females were more likely to remate when they had mated with multiply-mated males than when they had mated with a 9-day-old or young virgin male. We discuss the observed mating behavior by females in terms of sexual selection for multiple mating

Myomas and Adenomyosis: Impact on Reproductive Outcome

Among uterine structural abnormalities, myomas and adenomyosis represent two distinct, though frequently coexistent entities, with a remarkable prevalence in women of reproductive age. Various mechanisms have been proposed to explain the impact of each of them on reproductive outcome. In respect to myomas, current evidence implies that submucosal ones have an adverse effect on conception and early pregnancy. A similar effect yet is not quite clear and has been suggested for intramural myomas. Still, it seems reasonable that intramural myomas greater than 4 cm in diameter may negatively impair reproductive outcome. On the contrary, subserosal myomas do not seem to have a significant impact, if any, on reproduction. The presence of submucosal and/or large intramural myomas has also been linked to adverse pregnancy outcomes. In particular increased risk for miscarriage, fetal malpresentation, placenta previa, preterm birth, placenta abruption, postpartum hemorrhage, and cesarean section has been reported. With regard to adenomyosis, besides the tentative coexistence of adenomyosis and infertility, to date a causal relationship among these conditions has not been fully confirmed. Preterm birth and preterm premature rupture of membranes, uterine rupture, postpartum hemorrhage due to uterine atony, and ectopic pregnancy have all been reported in association with adenomyosis. Further research on the impact of adenomyosis on reproductive outcome is welcome

Fitted parameters for Weibull hazard function for the time to remating for <i>Ostrinia nubilalis</i> females that mated first with a young virgin male (YVM), an old (9 days old) virgin male (OVM) or a multiple mated male (MMM).

<p>The lines enclose 95% confidence regions for the joint parameter estimates.</p

Average fecundity for <i>Ostrinia nubilalis</i> females that mated first with a multiple mated male (MMM), an old (9 days old) virgin male (OVM) or a young virgin male (YVM), and then remated (R) or not (NR).

<p>Means with different letters are significantly different (Sidak Test a = 0.05)</p

Fitted parameters for Weibull mortality function for <i>Ostrinia nubilalis</i> females that mated first 1) with a young virgin male and didn’t remate (YVM-NR) or did remate (YVM-R), 2) with an old (9 days old) virgin male and didn’t remate (OVM-NR) or did remate (OVM-R) and 3) with a multiple mated male and didn’t remate (MMM-NR) or did remate (MMM-R).

<p>The lines enclose 95% confidence regions for the joint parameter estimates.</p

LH receptor gene expression in cumulus cells in women entering an ART program

Luteinizing hormone (LH) exerts its actions through its receptor (LHR), which is mainly expressed in theca cells and to a lesser extent in oocytes, granulosa and cumulus cells. The aim of the present study was the investigation of a possible correlation between LHR gene and LHR splice variants expression in cumulus cells and ovarian response as well as ART outcome. Forty patients undergoing ICSI treatment for male factor infertility underwent a long luteal GnRH-agonist downregulation protocol with a fixed 5-day rLH pre-treatment prior to rFSH stimulation and samples of cumulus cells were collected on the day of egg collection. RNA extraction and cDNA preparation was followed by LHR gene expression investigation through real-time PCR. Furthermore, cumulus cells were investigated for the detection of LHR splice variants using reverse transcription PCR. Concerning LHR expression in cumulus cells, a statistically significant negative association was observed with the duration of ovarian stimulation (odds ratio = 0.23, = 0.012). Interestingly, 6 over 7 women who fell pregnant expressed at least two specific types of LHR splice variants (735 bp, 621 bp), while only 1 out of 19 women that did not express any splice variant achieved a pregnancy. Consequently, the present study provide a step towards a new role of LHR gene expression profiling as a biomarker in the prediction of ovarian response at least in terms of duration of stimulation and also a tentative role of LHR splice variants expression in the prediction of pregnancy success

Maternal-neonatal 8-hydroxy-deoxyguanosine serum concentrations as an index of DNA oxidation in association with the mode of labour and delivery

Aim. To investigate the effect of the mode of labour and delivery on the total antioxidant status (TAS), and the biomarker of DNA oxidation, 8-hydroxy-deoxyguanosine (8-OHdG) serum levels, in mothers and their newborns. Subjects and methods. Some 106 women with normal pregnancy and normal blood biochemical parameters were divided into 4 groups: Group A ( n = 28) with normal labour and vaginal delivery ( VG), Group B ( n = 25) with scheduled cesarean section ( CS), Group C ( n = 26) with ‘emergency’ CS, and Group D ( n = 27) with prolonged labour + VG. Blood was obtained fr? m the mothers at the beginning of labour, and immediately after delivery ( pre- and post-delivery), as well as from the umbilical cord ( CB). TAS, 8-OHdG and creatine kinase (CK) were measured in the sera with appropriate methodology. Results. TAS levels were almost similar in all the groups pre- delivery, and in CB irrespective of the mode of labour and delivery, and remarkably decreased in Groups C and D post-delivery. 8-OHdG levels in Group C ( 0.94 +/- 0.08 ng/ml) and Group D (0.98 +/- 0.08 ng/ml) were significantly higher than those in Group A (0.26 +/- 0.01 ng/ml, p &lt; 0.001) and Group B (0.28 +/- 0.07 ng/ml, p &lt; 0.001) post-delivery. 8-OHdG levels were low in CB, independent of the mode of labour. CK positively correlated with 8-OHdG ( r = 0.48, p &lt; 0.001), the latter negatively correlated with TAS ( r = - 0.53, p &lt; 0.01). Conclusions. The lowest TAS and the highest 8-OHdG levels were found in Groups C and D post-delivery, probably due to the long-term participation of the mothers’ skeletal and uterus muscles, whereas 8-OHdG levels were low in CB irrespective of the mode of delivery, possibly as a consequence of the antioxidant action of the placenta and/or the low lipid levels in the serum of the umbilical cord

Single nucleotide polymorphisms in the Anti-Mullerian hormone (AMH Ile(49)Ser) and Anti-Mullerian hormone type II receptor (AMHRII-482 A &gt; G) as genetic markers in assisted reproduction technology

The aim of the study was to evaluate whether the presence Antimullerian hormone (AMH) and Antimullerian hormone type II receptor (AMHRII) single nucleotide polymorphisms (SNPs) Ile(49)Ser and -482A &gt; G respectively are related to the assisted reproduction outcome. A prospective cross-sectional observational study was conducted in order to assess the distribution of AMH and AMHRII SNPs in two cohorts, one of healthy women (N = 100) and the control group and the IVF/ICSI group (N = 151) consisted of women undergoing IVF/ICSI treatment for infertility. Furthermore, a prospective longitudinal observational study was performed on the latter group to assess possible associations of these SNPs with patients’ characteristics and controlled ovarian stimulation (COS) and pregnancy outcome. Among non-carriers of the AMH (Ile(49)Ser) polymorphism, basal FSH levels were lower in those with more than two of previous IVF attempts and fertilization rate was statistically higher in those with peak serum E2 levels below 1500 pg/ml, whereas among non-carriers of the AMHRII (-482 A &gt; G) polymorphism, number of follicles was higher in those with more than two previous IVF attempts and total dose of gonadotropins was lower in those with peak serum E2 levels above 1500 pg/ml. There was evidence that in specific subgroups of women undergoing IVF/ICSI, AMH and AMHRII SNPs may be related to patients’ characteristics and controlled ovarian stimulation and pregnancy outcome and thus may provide a means for the prediction of ovarian response in specific subgroups of women entering an IVF/ICSI program