Retrospective review of the relationship between parity and pregnancy outcomes at Siriraj Hospital.

Objective: To determine the effect of parity to pregnancy outcomes. Methods: A retrospective study was conducted among 976 singleton pregnant women during July to October 2007 at Siriraj Hospital. Two groups of patients were recruited in this study, the first group was nulliparity (488 patients) and the second group was multiparity (488 patients). The adverse pregnancy outcomes including antepartum hemorrhage (APH), gestational diabetes (GDM), pre-eclampsia, preterm birth, premature rupture of membranes (PROM), mode of delivery, postpartum hemorrhage (PPH) and neonatal morbidity were studied comparatively. Results: The adverse pregnancy outcome in the aspects of pre-eclampsia, PROM, preterm birth, operative obstetrics and neonatal phototherapy in nulliparity were significantly higher than multiparity with odds ratio 2.43 (95%CI 1.05-5.61), 1.79 (95%CI 1.07-2.98), 1.91 (95%CI 1.23-2.96), 11.20 (95%CI 2.60-48.13), and 2.10 (95%CI 1.40-3.14) respectively. APH was increased in the multiparity group but not significant different by statistics, with odds ratio 5.04 (95%CI 0.59-43.31). There were no significant differences for the prevalence of GDM, PPH, low birth weight and macrosomia in these two groups. Conclusion: Increased risk of pre-eclampsia, PROM, preterm birth, operative obstetrics and neonatal phototherapy in nulliparity compared with multiparity.

Preliminary data of preimplantation genetic diagnosis for aneuploidy screening using fluorescent in situ hybridization in Siriraj Hospital.

Objective: Preimplantation genetic diagnosis (PGD) is technique for detecting genetic diseases. Preimplantation genetic diagnosis for aneuploidy screening (PGD-AS) using fluorescent in situ hybridization (FISH) has been used worldwide including at Siriraj Hospital. The objective of this study was to comparethe pregnancy rate between a PGD-AS group with standard assisted reproductive techniques (ARTs) in Siriraj Hospital. Methods: Couples who requested PGD-AS underwent a standard ARTs process followed with blastomere biopsy for FISH analysis. The pregnancy rate was compared among the PGD-AS group and the control group. The control group was divided into 2 subgroups – all patients required ARTs subgroup and age ≥ 35 yrs. subgroup. Results: 6 stimulated cycles from 4 patients were performed in the PGD-AS group. The pregnancy rate per stimulated cycle in the PGD-AS group, control group and age ≥ 35 yrs group were 33.33%, 16.20% and 12.05% respectively. Moreover, the pregnancy rate per transferred cycles in the PGD-AS group, control group and age ≥ 35 yrs group were 40.00%, 21.02% and 13.17% respectively. Conclusion: PGD is an advanced method for detecting genetic defects. PGA-AS might increase the pregnancy rate.

Preimplantation Genetic Diagnosis for alpha thalassemia: experience in Siriraj Hospital.

Objective: Detection of fetal thalassemia using preimplantation genetic diagnosis (PGD) can make a diagnosis before pregnancy so termination of pregnancy in that patient is eliminated. The objective of this study was to develop a single gene polymerase chain reaction (PCR) protocol for PGD of alpha thalassemia in Siriraj Hospital. Methods: A couple with a history of repeated Bart’s hemoglobinopathy in fetus underwent an artificial reproductive technique (ART) process using a standard ovarian stimulation protocol with intracytoplasmic sperm injection (ICSI) to reduce sperm DNA contamination. On day 3 post fertilization, laser biopsy was performed on the cleavage stage embryos to obtain a blastomere for PCR analysis of alpha thalassemia 1 SEA type. Results: 11 embryos from a total of 15 oocytes were biopsied, 2 normal, 1 alpha thal 1 trait and 3 affected embryos were detected. No contamination and allele drop out were detected, but a high PCR failure rate of 5 from 11 total biopsied embryos. Conclusion: PGD for alpha thalassemia was first established in Siriraj Hospital, but the result had a high failure rate so then optimized laboratory techniques were required.

Heterotopic pregnancy following tuboplasty and ovulation induction by clomiphene citrate and timed intrauterine insemination: Case report.

A Thai woman 36 year old with post tubal sterilization. She was performed for Tuboplasty to restore fertility on new marriage. Both fallopian tubes functioned post correction. She tried natural conception, but was not successful. The doctor treated her by the way of ovarian induction with Clomiphene Citrate and intrauterine insemination. She conceived in the 4th cycle, but she had an heterotopic pregnancy. Gestational sac, fetal echo and positive fetal heart beat were detected at both the intrauterine cavity and the right adnexa, and she had no abnormal symptoms. The Diagnostic Laparoscopy was performed. Following the operation an unruptured right tubal pregnancy was found. Right salpingectomy was done and the pathological report confirmed tubal pregnancy. Post operative time, she had no signs of abortion, and normal intrauterine growth was detected.

Freezing effect on post-thawed sperm characteristics especially sperm DNA integrity comparing between liquid nitrogen vapour and computerized program freezer.

The aim of the study was to evaluate the cryodamage effects on human sperm characteristics, especially on sperm DNA integrity, after 6 months of freezing comparing between liquid nitrogen vapour (LNV) and computerized program freezer (CPF). Forty normal semen samples were collected for semen analysis. Each sample was mixed with cryoprotective media and devided into 2 straws. The first straw was frozen with LNV and the second one with CPF. After 6 months of cryostorage, semen samples were thawed, and sperm chromatin integrity as well as sperm motility, morphology, vitality and cryosurvival rate were determined. Percentages of DNA damage were higher (p<0.01) following freezing with LNV than with CPF. Sperm vitality was greater (p<0.05) after CPF than after LNV, as well as cryosurvival rate (p<0.001). Post-thawed sperm motility was greater after CPF than after LNV, either in grade A (p<0.001) or in grade B (p<0.05). No significant difference was observed in the percentage of normal sperm morphology comparing the two freezing methods. The current study demonstrated post-thawed decrease in sperm DNA integrity as well as other sperm characteristics after freezing in both methods. The CPF significantly provided superior results in post-thawed sperm DNA integrity, sperm motility and vitality than LNV did. In case of 6 months of cryostorage, therefore, we recommend the computerized program freezer as a preference for sperm cryopreservation.

Comparison between sperm treated with pentoxifylline and 2-deoxyadenosine using hypo-osmotic swelling test.

OBJECTIVE: To compare the percentage of sperm tail membrane swelling under hypo-osmotic conditions between sperm treated with pentoxifylline and 2-deoxyadenosine. DESIGN: Experimental in vitro study. MATERIAL AND METHOD: Thirty normal semen samples from male partners of infertile couples were collected. After sperm preparation by two-layer Percoll gradient method, each sperm sample was divided into three specimens. Pentoxifylline and 2-deoxyadenosine were separately added into two specimens, while the third specimen was used as a control. Hypo-osmotic swelling test was performed in all specimens. Percentage of swollen spermatozoa in each specimen was evaluated. RESULTS: The mean percentage of swollen spermatozoa in the semen samples supplemented with pentoxifylline and 2-deoxyadenosine were both significantly higher than those in the control (82.8 +/- 7.7 and 83.0 +/- 9.5 vs 70.8 +/- 12.7; p < 0.001). There was no significant differences of swollen spermatozoa between pentoxifylline and 2-deoxyadenosine (p = 0.898). CONCLUSION: Addition of pentoxifylline and 2-deoxyadenosine to the sperm prepared by the two-layer Percoll gradient method can almost equally enhance the sperm membrane integrity. Therefore, it may be beneficial to add these compounds to sperm preparation for use in assisted reproduction.