Assessment of vascular endothelial growth factor, basic fibroblast growth factor, and transforming growth factor levels in amniotic fluid.

OBJECTIVE: To measure amniotic fluid levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor (TGF)-beta2 and to characterize their levels with respect to advancing gestational age and pregnancy-related complications. STUDY DESIGN: Amniotic fluid was collected from a total of 37 patients, 2 of whom had twin pregnancies. Twenty-seven specimens were collected in the second trimester and 10 specimens were collected in the third trimester. VEGF, bFGF and TGF-beta2 were isolated from centrifuged amniotic fluid and quantified using commercially available ELISA kits. Concentrations of growth factors were expressed in pg/mL. RESULTS: The growth factors under investigation were present in most but not all amniotic fluid specimens throughout pregnancy. The levels of VEGF, bFGF and TGF-beta2 were inconsistent and did not show a statistically significant association with gestational age, number of fetuses, or the presence of hypertension and/or diabetes. One significant finding emerged from the data: smokers had significantly higher amniotic fluid levels of VEGF compared to nonsmokers (p = 0.03). CONCLUSION: VEGF, bFGF and TGF-beta2 are detectable in second and third trimester amniotic fluid. Smoking appears to correlate with increased amniotic fluid VEGF during pregnancy. VEGF may represent a molecular marker of hypoxia and is an interesting focus for future investigation.

Association between time from endometriosis surgery and outcome of in vitro fertilization cycles.

OBJECTIVE: To evaluate the effect of time from surgery on the outcome of subsequent in vitro fertilization (IVF) cycles in endometriosis patients. STUDY DESIGN: One hundred five women treated surgically for endometriosis and who underwent 252 IVF cycles were included. Approximately 1/2, 1/4 and 1/5 of the study group underwent 1, 2 and 3 cycles, respectively. We used the cycle as the basic unit of analysis with the time since surgery as the independent variable and the clinical pregnancy as the dependant variable. We used nonparametric approach for estimating the probabilities. To convey the uncertainty of the probability estimates, we produced bootstrap 95% CI. RESULTS: The overall pregnancy rate was 31%. There does not appear to be any relationship between the length of time from surgery and clinical outcome. The point estimates suggest that there may be a slight negative relationship, since the estimated probability decreases steadily from 0.34 to 0.21 as the time since surgery goes from 0.5 to 5 years. CONCLUSION: The data do not provide evidence for a strong relationship between the time since surgery and the probability of a clinical pregnancy with IVF.