Recurrent ectopic pregnancies with secondary infertility: a case report

Infertility is defined as 1 year of unprotected sexual intercourse without pregnancy. It is further classified as primary and secondary. Secondary infertility is one in which prior pregnancy not necessarily live birth has occurred. Pelvic infections as a cause for infertility are seen in 12% cases while genital tuberculosis contribute 10-15%. Various studies have well established a relationship between subclinical infection and infertility with the two most potential pathogens being: Chlamydia trachomatis and mycoplasma species. Authors are presenting two cases one of a 30yr female, P0+5, with class 2 obesity with previous three ectopic pregnancies with LSO done 1 year back i/v/o left ruptured ectopic now presenting with secondary infertility for 1 year and another case of a 21 years female, P0+2, with previous two ectopic with LSO done 2 years back now presenting with infertility. These cases emphasize that infections are important causes for recurrent ectopic pregnancies and infertility.

Estudio citogenético en 677 casos de aborto espontáneo / Cytogenetic study of 677 spontaneous abortions

INTRODUCCIÓN: La reproducción humana es un proceso relativamente ineficaz. Los abortos espontáneos ocurren entre el 15 a 20 por ciento de los embarazos clínicamente reconocidos. El impacto emocional se acentúa debido a la falta de diagnóstico. OBJETIVO: Describir la experiencia del Laboratorio de Citogenética de la Clínica Sanatorio Alemán de Concepción e identificarlas alteraciones más frecuentes y su relación estadística con la edad materna. MATERIAL Y MÉTODO: 677 muestras de tejido obtenidas de abortos espontáneos, ocurridos desde julio de1996 a abril de 2009. Es un trabajo de tipo transversal donde las muestras utilizadas son las vellosidades coriónicas, cultivadas en medios estandarizados. RESULTADOS: De las 677 muestras estudiadas, en 259 se obtuvo un cariotipo normal (38,3 por ciento). En 418 muestras se encontraron anomalías cromosómicas, correspondiendo estas a un 61,7 por ciento. Entre los cariogramas alterados se encontraron: 265 trisomías (63,4 por ciento), 83 poliploidías (19,9 por ciento), 48 monosomías (11,5 por ciento) y 22 alteraciones estructurales (5,3 por ciento). La trisomía más frecuente fue la 16 (34,4 por ciento), seguida de la trisomía 21 (13,6 por ciento). Se encontró una relación estadísticamente significativa entre la edad de la madre (> 37 años) y la presencia de alteraciones citogenéticas (p<0,0001). DISCUSIÓN: El 61,7 por ciento de los abortos presentó alguna alteración del cariotipo. La trisomía 16 fue la aberración más frecuente concordando con la literatura. La trisomía 21 se presentó en un 13,6 por ciento siendo más frecuente que lo encontrado en series extranjeras. En el grupo mayor de 37 años existe mayor prevalencia de anomalías cromosómicas siendo estadísticamente significativa (p<0,0001).

INTRODUCCION: The human reproduction is a relatively inefficient process. In the 15 to 20 percent of the pregnancy clinically diagnosticated finish in spontaneous abortions. The great emotional impact, that in many times is worst by the lack of diagnostic. OBJECTIVE: Describe experience of the Cytogenetic Laboratory of Clínica Sanatorio Alemán of Concepción Chile and determinate the frequency of alteration and his relationship with maternal age. MATERIAL AND METHOD: 677 samples of tissue of spontaneous abortions, taked from July, 1996 to April, 2009. It is a descriptive work; the samples are chorionic villous, cultivated in standard solutions. RESULTS: Of 677 samples in 259 was found a normal cariotype (38.3 percent). In 418 was found some type of chromosome aberrations (61.7 percent). The distribution of the abnormal result is the follow: 265 trisomies (63.4 percent), 83 polyploidy (19.8 percent), 48 monosomy (11.5 percent) and 22 abnormalities structures (5.3 percent). Of the trisomies the most recurrent is 16 trisomy with the 34.4 percent, follow by the 21 trisomy with 13.6 percent and the 22 trisomy with 12.8 percent. In the statistic analysis we found a statistically significant relation between the age of the mother (<38 years) and the development of chromosomal alterations (p<0.0001). DISCUSSION: The 61.7 percent of abortions show some cytogenetic alteration. The 16 trisomies were the most frequent, agreeing with the literature. The trisomy 21 was more common than published to date. In older women is most frequent found chromosome aberrations (p<0.0001).

The ADA*2 allele of the adenosine deaminase gene (20q13.11) and recurrent spontaneous abortions: an age-dependent association

OBJECTIVE: Adenosine deaminase acts on adenosine and deoxyadenosine metabolism and modulates the immune response. The adenosine deaminase G22A polymorphism (20q.11.33) influences the level of adenosine deaminase enzyme expression, which seems to play a key role in maintaining pregnancy. The adenosine deaminase 2 phenotype has been associated with a protective effect against recurrent spontaneous abortions in European Caucasian women. The aim of this study was to investigate whether the G22A polymorphism of the adenosine deaminase gene is associated with recurrent spontaneous abortions in Brazilian women. METHODS: A total of 311 women were recruited to form two groups: G1, with a history of recurrent spontaneous abortions (N = 129), and G2, without a history of abortions (N = 182). Genomic DNA was extracted from peripheral blood with a commercial kit and PCR-RFLP analysis was used to identify the G22A genetic polymorphism. Fisher's exact test and odds ratio values were used to compare the proportions of adenosine deaminase genotypes and alleles between women with and without a history of recurrent spontaneous abortion (p<0.05). The differences between mean values for categorical data were calculated using unpaired t tests. The Hardy-Weinberg equilibrium was assessed with a chi-square test. RESULTS: Statistically significant differences were identified for the frequencies of adenosine deaminase genotypes and alleles between the G1 and G2 groups when adjusted for maternal age. CONCLUSIONS:The results suggest that the adenosine deaminase *2 allele is associated with a low risk for recurrent spontaneous abortions, but this association is dependent on older age.

Incidence and Spectrum of Chromosomal Abnormalities associated with Spontaneous Abortions in Korea: 470 Products of Conception over a Period of 6 Years (2005-2010)

PURPOSE: Cytogenetic analysis of spontaneous abortions (SABs) provides valuable information to establish the causes of fetal loss, information that is essential to provide accurate reproductive and genetic counseling couples. Such analysis also provides information on the frequencies and types of chromosomal abnormalities and associated risks of recurrence. However, there have only been a few reports of chromosomal abnormalities in small samples of SABs in the Korean population. Here, we report the incidence and spectrum of chromosomal abnormalities for cases of 470 SAB in Korea. MATERIALS AND METHODS: Between 2005 and 2010, a total of 470 products of conception (POC) resulting from SABs were submitted to our laboratory for cytogenetic analysis from various medical sites in Korea. The incidences and types of specific chromosomal abnormalities were determined. The abnormalities were distinguished by gestational age at the time of SAB and by maternal age. RESULTS: The frequency of chromosomal abnormalities in POCs was 54.3% (255/470), including 228 (89.3%) numerical and 27 (10.7%: 3 balanced and 24 unbalanced) structural abnormalities. Among the numerical abnormalities, trisomy was predominant (67.0%), followed by monosomy X (12.5%), polyploidy (8.2%), triple X (0.8%), and autosomal monosomy (0.8%). The overall sex ratio (male: female) among the 470 POCs with normal and abnormal karyotypes were 0.58 and 0.65, respectively. Trisomies were identified for each autosome, with the exceptions of 1, 3, and 19. Among the 171 autosomal trisomies, trisomy 16 was the most common (19.9%), followed by trisomy 22 (13.5%), trisomy 21 (12.3%), trisomy 15 (9.9%), and trisomies 18 and 13 (5.3%). The frequency of chromosomal abnormalities decreased with gestational age and increased with maternal age, but only because of increases in trisomies and complex abnormalities. CONCLUSIONS: We have presented a large collection of cytogenetic data for SABs collected during the past 6 years and provided a database for prenatal genetic counseling of parents who have experienced SABs in Korea.

Nucleolar organising region evaluation using new NOR FISH probe.

We have carried out chromosomal analysis in a couple with repeated spontaneous abortions (RSA). The chromosomal analysis of male revealed 15ps+ and the chromosome 15 appeared as submetacentric, C- group chromosome. First time we have attempted fluorescence in situ hybridization (FISH) using NOR probe (dJ1174 A5) and FISH analysis revealed NOR duplication on chromosome 15 which was also quantitated using Q-FISH software. The identical NOR duplication also detected in chromosome preparations from products of conception. However, NOR studies in large group of patients is necessary to understand the role of NORs in RSA.

Chromosomal analysis in recurrent spontaneous aborters.

A type of endomitotic chromosome reduplication in the interphase stage of cell cycle was found in lymphocyte cultures of couples with spontaneous abortions. To find out the presence of this anomaly chromosomal analysis was performed in a series of 20 women with repeated spontaneous abortions and their husbands. Demographic data was also collected from them. Out of 40 individuals, a 27 years male whose wife has experienced three spontaneous abortions was found to have Endoreduplication. His wife was normal with 46, XX chromosomal complement.