Fehlbildungen nach assistierter Reproduktionsmedizin

Zusammenfassung: Insgesamt deuten die Daten auf ein leicht erhöhtes Malformationsrisiko nach assistierter Reproduktionsmedizin (ART) hin. Wenn auch die Studien in ihren Ergebnissen stark schwanken und das absolute Risiko für ein Kind mit Fehlbildungen klein ist, müssen die Paare darüber aufgeklärt sein. Gesichert ist, dass Eltern nach In-vitro-Fertilisation und intrazytoplasmatischer Spermieninjektion (ICSI) durch soziodemographische und anamnestische Hintergrundsrisiken per se ein erhöhtes Risiko haben, ein Kind mit einer Fehlbildung zu zeugen. In der Kinderwunschsprechstunde müssen die Paare außerdem darüber aufgeklärt werden, dass durch ICSI gezeugte Kinder im Vergleich zum Normalkollektiv ein höheres Risiko für chromosomale Anomalien haben. Dies leitet sich aus den vererbten chromosomalen Anomalien (1-4%) ab, welche schon bei den Eltern (vornehmlich bei den Vätern) vorhanden sind, oder durch chromosomale De-novo-Anomalien, welche vorwiegend durch die schlechte Spermienqualität (2,1% bei einer Spermienzahl <20Mio./ml) zustande kommen. Die Gesundheit von Kindern nach assistierter Reproduktionsmedizin muss unbedingt in weiteren Studien ausgewertet werden, um klare Schlüsse über die Sicherheit dieser Techniken zu erlangen. Immer noch unklar sind vor allem die Relevanz des Risikofaktors "Sterilität" an und für sich sowie die Bedeutung epigenetischer Veränderungen nach Einsatz der assistierten Reproduktionsmedizi

Nitrate Poisoning in Swine

On July 23, 1959, a call was received from a client Wll0 reported that his hogs were sick. Upon arrival at the client\u27s farm, two dead pigs were found. Three other pigs were weak and when forced to move, did so at a staggering gait. These pigs were examined. The temperatures ranged from 101.5° to 102.7,° well within the normal range. Olle pig was noted to be breathing rather rapidly and evidence of a watery diarrhea was noted on all of the affected pigs. One of the pigs was unable to rise. A slight dilation of the pupils was noted

Origin and outcome of multiple pregnancies in Bern, Switzerland, 1995-2006 and the current proposal of the Swiss parliament to revise the Swiss law of reproductive medicine: Switzerland quo vadis?

INTRODUCTION: Infertility treatments are a major source of the increase in multiple pregnancies (MPs). AIMS: The aims of the present study were (1.) to investigate the origin and maternal/neonatal outcomes of MP and (2.) to review the different measures that can be adopted to reduce these serious complications. METHODS: The study included all women with multiple births between 1 January 1995 and 31 December 2006 at the University Hospital of Bern, Switzerland. The outcomes associated with the various origins of MP (natural conception, ovarian stimulation [OS] ‒ in-vitro fertilisation [IVF-ICSI]) were analysed using a multinomial logistic regression model. An analysis of the Swiss law on reproductive medicine and its current proposed revision, as well as a literature review using Pubmed, was carried out. RESULTS: A total of 592 MP were registered, 91% (n = 537) resulted in live births. There was significantly more neonatal/maternal morbidity in MP after OS compared with natural conception and even with the IVF-ICSI group. With a policy of elective single embryo transfer (eSET), twin rates after IVF-ICSI can be reduced to &lt;5% and triplets to &lt;1%. CONCLUSIONS: After OS, more triplets are found and the outcome of MP is worse. MP is known to be associated with morbidity, mortality, and economic and social risks. To counteract these complications (1.) better training for physicians performing OS should be encouraged and (2.) the Swiss law on reproductive medicine needs to be changed, with the introduction of eSET policies. This would lead to a dramatic decrease in neonatal and maternal morbidity/mortality as well as significant cost reductions for the Swiss healthcare system

Hope for Bohemian ecologists &ndash; comments on “A possible role of social activity to explain differences in publication output among ecologists?” by Tomáš Grim, Oikos 2008

No abstract available

Anxiety, depression, and attachment before and after the first-trimester screening for Down syndrome: comparing couples who undergo ART with those who conceive spontaneously.

OBJECTIVES: This study's aim was to describe the emotional status of parents to be before and after the first-trimester combined prenatal screening test. METHODS: One hundred three couples participated, of which 52 had undergone an in vitro fertilization/intracytoplasmic sperm injection treatment [assisted reproductive technology (ART)] and 51 had conceived spontaneously. Participants completed the state scale of the State-trait Anxiety Inventory, the Edinburgh Depression Scale, and the Maternal and Paternal Antenatal Attachment Questionnaire before the first-trimester combined prenatal screening test at around 12 weeks of gestational age (T1) and just after receiving the results at approximately 14 weeks of gestational age (T2). RESULTS: We observed a significant decrease in anxiety and depression symptoms and a significant increase in attachment from T1 to T2. Results showed no differences between groups at either time point, which suggests that ART parents are more similar to than different from parents conceiving spontaneously. Furthermore, given the importance of anxiety during pregnancy, a subsample of women with clinical anxiety was identified. They had significantly higher rates of clinical depression and lower attachment. CONCLUSIONS: These results indicate that, regardless of whether conception was through ART or spontaneous, clinical anxiety in women over the prenatal testing period is associated with more vulnerability during pregnancy (i.e. clinical depression and less attachment to fetus). © 2015 John Wiley &amp; Sons, Ltd

The hysteroscopic view of infertility: the mid-secretory endometrium and treatment success towards pregnancy

The purpose of this study was the analysis of a correlation, in infertile patients, between the quality of the endometrium based on its vascularisation and the chances of conception. Hysteroscopy was carried out to determine the quality of the endometrial surface using the Sakumoto-Masamoto classification ("good” vs. "poor” endometrium) in the secretory phase of the menstrual cycle. The results were set in relation to the outcome of the subsequent infertility treatment, i.e. the establishment of a pregnancy within the study period (4years). In 108 (67%) of the 162 followed-up patients, the endometrium was endoscopically classified as "good”, while in 54 (33%) the result was "poor”. The overall pregnancy rate was 37% (60 patients); 47 of all pregnancies (78%) occurred in women with a "good” endometrium while 13 (22%) had a "poor” classification. This positive association between the establishment of a pregnancy in the follow-up and a "good" classification of the endometrial vasculature in the group with a "good" endometrium was significant (P = 0.0165, Fisher's exact test). This study confirms the usefulness of endometrial evaluation by hysteroscopy as a diagnostic instrument for providing a prognosis of the chance for the patients to become pregnan

Gene expression in cultured endometrium from women with different outcomes following IVF

Estradiol and progesterone are crucial for the acquisition of receptivity and the change in transcriptional activity of target genes in the implantation window. The aim of this study was to differentiate the regulation of genes in the endometrium of patients with recurrent implantation failure (IF) versus those who became pregnant after in vitro fertilization (IVF) treatment. Moreover, the effect of embryo-derived factors on endometrial transcriptional activity was studied. Nine women with known IVF outcome (IF, M, miscarriage, OP, ongoing pregnancy) and undergoing hysteroscopy with endometrial biopsy were enrolled. Biopsies were taken during the midluteal phase. After culture in the presence of embryo-conditioned IVF media, total RNA was extracted and submitted to reverse transcription, target cDNA synthesis, biotin labelling, fragmentation and hybridization using the Affymetrix Human Genome U133A 2.0 Chip. Differential expression of selected genes was re-analysed by quantitative PCR, in which the results were calculated as threshold cycle differences between the groups and normalized to Glyceraldehyde phosphate dehydrogenase and β-actin. Differences were seen for several genes from endometrial tissue between the IF and the pregnancy groups, and when comparing OP with M, 1875 up- and 1807 down-regulated genes were returned. Real-time PCR analysis confirmed up-regulation for somatostatin, PLAP-2, mucin 4 and CD163, and down-regulation of glycodelin, IL-24, CD69, leukaemia inhibitory factor and prolactin receptor between Op and M. When the different embryo-conditioned media were compared, no significant differential regulation could be demonstrated. Although microarray profiling may currently not be sensitive enough for studying the effects of embryo-derived factors on the endometrium, the observed differences in gene expression between M and OP suggest that it will become an interesting tool for the identification of fertility-relevant markers produced by the endometriu

Hydration Repulsion Effects of the Formation of Supported Lipid Bylayers

When zwitterionic lipids fuse onto substrates such as silica (SiO2), the water of hydration between the two approaching surfaces must be removed, giving rise to an effective hydration repulsion. Removal of water around the polar headgroups of the lipid and the silanols (SiOH) of SiO2 allows supported lipid bilayer (SLB) formation, although an interstitial water layer remains between the lipid and surface. The importance of hydration repulsion in SLB formation is demonstrated by monitoring fusion of zwitterionic lipids onto silica (SiO2) nanoparticles heat treated to control the silanol group (SiOH) density and thus the amount of bound water. SLB formation, observed by cryo-TEM and nanodifferential scanning calorimetry, was found to be slower for the more hydrated surfaces. Although the SiOH density decreased with increasing heat treatment temperature, z-potentials were the same for all the SiO2. This arose since at the pH ¼ 8 of the experiments, only isolated silanols, with a pKa ¼ 4.9, and not hydrogen bonded silanols, with a pKa ¼ 8.5, were dissociated/charged.1 Since there were no differences in double layer forces between the SUVs and SiO2, which are the largest and most important interactions determining lipid fusion onto surfaces,2,3 the slower rate of SLB formation of DMPC onto SiO2 nanoparticles with higher silanol densities and more bound water was therefore attributed to greater hydration repulsion of the more hydrated nanoparticles. For SiO2 heated to 1000 °C, with only a few isolated silanols, little adsorbed water and many hydrophobic Si–O–Si groups, particle aggregation occurred and lipid sheaths formed around the nanoparticle aggregates

Are we architects of our own happiness? The importance of family background for well-being

Abstract This paper analyzes whether individuals have equal opportunity to achieve happiness (or wellbeing). We estimate sibling correlations and intergenerational correlations in self-reported life satisfaction, satisfaction with household income, job satisfaction, and satisfaction with health. We find high sibling correlations for all measures of well-being. The results suggest that family background explains, on average, between 30% and 60% of the inequality in permanent wellbeing. The influence is smaller when the siblings&apos; psychological and geographical distance from their parental home is larger. Results from intergenerational correlations suggest that parental characteristics are considerably less important than family and community factors

From principles to practice in paying for nature

Payments for Environmental Services (PES) constitute an innovative economic intervention to counteract the global loss of biodiversity and ecosystem functions. In theory, some appealing features should enable PES to perform well in achieving conservation and welfare goals. In practice, outcomes depend on the interplay between context, design and implementation. Inspecting a new global dataset, we find that some PES design principles pre-identified in the social-science literature as desirable, such as spatial targeting and payment differentiation, are only partially being applied in practice. More importantly, the PES-defining principle of conditionality-monitoring compliance and sanctioning detected non-compliance-is seldom being implemented. Administrative ease, multiple non-environmental side objectives and social equity concerns may jointly help explain the reluctance to adopt more sophisticated, theoretically informed practices. However, by taking simplifying shortcuts in design and implementation, PES programmes may become less environmentally effective and efficient as economic incentives, thus underperforming their conservation potential. © 2018 The Author(s).This work resulted from workshops held at Vrije Universiteit Amsterdam and the Basque Centre for Climate Change (Bilbao) in 2015. We appreciate the assistance provided by C. Caro with the maps, and funding from CGIAR’s Forest, Trees and Agroforestry programme, the European Commission (SINCERE, H2020 GA 773702), the Alexander von Humboldt-Foundation, the Basque Foundation for Science, Ikerbasque and the Agence Nationale de la Recherche. S.E. is the recipient of an Alexander von Humboldt Professorship in Environmental Economics. U.P. acknowledges research grants PI_2015_1_103 from the Education Department of the Basque Government and CSO2015-71243-R from the Spanish Ministry of Economy, Industry and Competitivenes