Colour Doppler indices of follicular blood flow as predictors of pregnancy after in-vitro fertilization and embryo transfer.

Peak systolic velocity (PSV) of individual follicles has been correlated with oocyte recovery, fertilization rate and embryo quality [in women undergoing in-vitro fertilization (IVF) and embryo transfer]. The present study assessed the role of quantitative and qualitative indices of follicular vascularity in predicting pregnancy after IVF and embryo transfer. A total of 106 women undergoing IVF treatment for infertility who were considered to be at risk of failure (>37 years of age, history of low response to gonadotrophin stimulation, or multiple failed IVF cycles) constituted the study group. PSV was measured from the three largest follicles on both the right and left ovaries on the day of human chorionic gonadotrophin (HCG) administration using an Acuson Sequoia with a 4-8 MHz transvaginal probe. The quality of follicular flow was graded from 1 to 4 according to the amount of visible colour flow around the follicle (grade 1 when one-quarter of the follicle, grade 2 when one-half, grade 3 when three-quarters, and grade 4 when the entire follicle was surrounded by colour). Clinical pregnancies resulted in 11 (10%) of the 106 high-risk women. Women who had PSV >/= 10 cm/s in at least one follicle on the day of HCG administration more often became pregnant than those with PSV <10 cm/s (P = 0.05). All pregnancies occurred in women with grade 3 or 4 follicular blood flow. Qualitative as well as quantitative measurements of follicular flow predict pregnancy after IVF and embryo transfer.

What is a preclinical pregnancy loss?

PURPOSE: To evaluate the contribution of embryo quality to preclinical loss rates after in vitro fertilization (IVF)/embryo transfer (ET) pregnancy, multiple gestation, and clinical loss rates were compared to preclinical pregnancy loss rates over a 3-year period. METHODS: The pregnancy outcomes after 1675 fresh ETs from 1994 to 1997 were studied. While establishment of a clinical pregnancy confirms uterine receptivity, multiple gestation rates reflect embryo quality. Because the majority of clinical losses are chromosomally abnormal, clinical loss rates serve as another indicator of embryo quality. RESULTS: The overall preclinical pregnancy loss rate was 5% (78/1675) of ETs and 17% (78/472) of pregnancies. During the 3-year period the pregnancy rates per ET increased from 19 to 36% (P < 0.0001), multiple gestation rates increased from 21 to 48% (P < 0.008), clinical loss rates decreased from 20 to 6% (P < 0.0001), and preclinical pregnancy loss rates remained unchanged from 13 to 19% (P = 0.1). CONCLUSIONS: Preclinical pregnancy loss more likely reflects abnormalities in uterine receptivity rather than embryo quality. If recurrent preclinical pregnancy loss occurs after IVF/ET, evaluation for abnormalities of uterine receptivity should be performed.

Infertility and subsequent pregnancy.

Although the incidence of fertility has not increased over the last several decades, the number of patients seeking treatment has increased, especially among older women who have delayed childbearing for various social reasons. During this postponement they are more likely to develop pelvic pathology including endometriosis and uterine myomas and to have been exposed to more encounters with sexually transmitted diseases, all of which contribute to infertility. In addition, it is now well recognized that natural fecundity declines rather dramatically after age 35 years, as a function of the natural depletion of oocytes and decreased ovarian follicular function. Modern endoscopic surgical procedures may be performed to remove myomas, uterine septa, and intrauterine adhesions, but obstetric complications following these operations can occur. Treatment of ovulatory dysfunction can result in multiple pregnancies despite careful monitoring. Patients who fail conventional infertility treatment may now successfully conceive using artificial reproductive techniques, including the use of donor oocytes. This may also result in multifetal gestations and their attendant clinical risks. These aggressive methods of treatment have also led to a marked increase in the occurrence of heterotopic pregnancies, which can be a diagnostic challenge. Infertility patients who conceive should be considered at higher risk for pregnancy complications. A careful history of their fertility treatment and the underlying factors should be reviewed by the obstetric team. Anticipation of known complications will usually result in timely intervention and the successful conclusion of the pregnancy.

Comparison of the hamster sperm motility assay to the mouse one-cell and two-cell embryo bioassays as quality control tests for in vitro fertilization.

The hamster sperm motility assay, mouse one-cell embryo, and mouse two-cell embryo bioassays were used to test modified Tyrode's solution and modified Ham's F-10 (Gibco, Grand Island, NY) medium prepared in tap water versus ultrapure water. Factors influencing the ability of each assay to discriminate water quality were evaluated to characterize these assays for quality control use in the in vitro fertilization laboratory. The hamster sperm motility assay reproducibly detected differences in treatment without significant interanimal, interanalyst, or interassay variation. Interanalyst and interanimal variation significantly affected the ability to detect treatment differences using the mouse bioassays. Sample sizes needed to predict clinically significant treatment effects were calculated using varying assay conditions. Ham's F-10 medium can be tested with the hamster sperm motility assay.

Quality control in the in vitro fertilization laboratory: comparison of bioassay systems for water quality.

Three mouse embryo bioassays [mouse one-cell and two-cell embryos and in vitro fertilization (IVF)] were tested for their ability to discriminate between three sources of water for medium preparation: tap water, high-performance liquid chromatography (HPLC)-grade water, and Milli-Q purified water. No differences could be detected using these assays. The lack of sensitivity of the mouse bioassays could not be attributed to the protein source or medium type. The hamster sperm motility assay (HSMA) permitted quantitative discrimination between water sources (Milli-Q greater than HPLC greater than tap). Media prepared for use in human IVF using water that exceeded minimal HSMA quality standards resulted in pregnancy rates that were greater than those attained with a lot of HPLC water that did not meet these standards. The HSMA can serve as a basis for a quality-control program in the human IVF laboratory.

Treatment of premenstrual syndrome with alprazolam: results of a double-blind, placebo-controlled, randomized crossover clinical trial.

A double-blind, placebo-controlled, randomized multiple crossover study was designed to determine the effectiveness of alprazolam in the treatment of premenstrual syndrome. Patients maintained daily diaries of 22 premenstrual symptoms for one pretreatment control cycle and four treatment cycles. Alprazolam 0.25 mg or placebo was administered three times daily from cycle day 20 until the second day of menstruation, at which time the dosage was tapered by one tablet per day to minimize withdrawal effects. The results of the clinical trial indicate that alprazolam is significantly more effective than placebo in relieving the severity of premenstrual nervous tension, mood swings, irritability, anxiety, depression, fatigue, forgetfulness, crying, cravings for sweets, abdominal bloating, abdominal cramps, and headache. The low incidence of side effects makes alprazolam an acceptable treatment for premenstrual syndrome for those women unresponsive to other therapies.

Isometric fatigue induced by different levels of rhythmic exercise.

Three subjects were trained in leg extensor isometric contractions and in cycling. They then cycled for three consecutive bouts, each of 2.75 min at a constant level of VO2, from 20 to 80% VO2 max. Fifteen seconds after each bout of cycling the subjects exerted an isometric contraction of the right leg at 40% of the maximum voluntary contraction. In each experiment, the duration of the three successive isometric contractions decreased as in hand-grip contractions. There was also a linear reduction in isometric endurance as the severity of the preceding rhythmic exercise increased. In other experiments, after three bouts of rhythmic exercise at 20% VO2 max (each followed by a fatiguing contraction at 40% MVC), further bouts of cycling at increasing levels of severity up to 60% VO2 max resulted in a linear fall in isometric endurance which could be reversed by interposing a lighter level of cycling. The heart rates during these experiments showed a steady increase during the isometric exercise, to about 150 beats X min-1, as the bouts of preceding rhythmic exercise became progressively more severe. The isometric contractions had little influence on the heart rate during cycling. But the rhythmic cycling exercise markedly increased the heart rate achieved at the end of the isometric contractions while decreasing the increment in heart rate during the contraction.

Influence of posture on isometric fatigue.

The isometric strength of four trained subjects was unaltered by changes in posture. But the endurance of an isometric contraction held to fatigue at 25 and 40% of the maximum voluntary contraction (MVC) was 20% greater in the sitting than in the recumbent posture. This difference was abolished when the exercise was performed with the arm's circulation arrested. At rest, the blood flow through the forearm was greater when the subjects were in the recumbent than in the sitting position but the reverse was true during isometric contractions. In these two postures, there was no difference in the right atrial pressure during the contraction, suggesting that the low-pressure baroreceptors are not responsible for the differences in blood flow during exercise. To date no mechanism is available to explain these observations.

Anti-oestrogen action: uterine nuclear retention of the CI-628 anti-oestrogen receptor complex in vitro.

Experiments were performed in vitro which compared the nuclear retention of the anti-oestrogen receptor complex formed by CI-628 and the nuclear retention of the oestrogen receptor complex formed by oestradiol-17beta. Uterine nuclei retained the CI-628 receptor complex regardless of whether uterine incubations were carried out in the continued in fresh medium. However, for oestradiol-17beta there was a rapid decrease in the amount of receptor complex retained in the nucleus with time. When extractions using KCI were performed on nuclei after maximal accumulation of receptor complex by oestradiol-17beta or CI-628 the oestrogen receptor complex was found to have a higher relative nuclear affinity than did the CI-628 receptor complex. These studies suggest different nuclear binding sites for these complexes.

Isometric strength and endurance during the menstrual cycle.

Seven healthy young women, 3 whom had been taking oral contraceptives, were examined during the course of 2 menstrual cycles to assess their isometric strength, their endurance during a series of 5 fatiguing isometric contractions at a tension of 40% MVC, and their blood pressures and heart rates during those fatiguing contractions. Two sets of experiments were performed, one in which the subject's forearm temperature was allowed to vary as a function of T A, and one with the muscle temperature stabilized by immersion of the forearm in water at 37 degrees C. During exposure to ambient temperatures, isometric strength and both the heart rate and blood pressure responses at rest and at the end of a fatiguing, sustained isometric exercise, were not significantly different during any phase of the menstrual cycle in any subject. In contrast, the isometric endurance in the women not taking oral contraceptives varied sinusoidally in all 5 contractions with a peak endurance midway through the ovulatory phase and the lowest endurance mid-way through the luteal phase of the menstrual cycle. The isometric endurance of the women taking oral contraceptives did not vary during their menstrual cycle. After stabilization of the temperature of the muscles of the forearm in water at 37 degrees C, the isometric endurance of the normal subjects showed a hyperbolic response with the maximal endurance at the beginning and end of their cycles, and the shortest endurance at mid-cycle. Here again, however, the isometric endurance of the women taking oral contraceptives did not vary after immersion of their forearms in the 37 degree C water.

The assessment of the static component in rhythmic exercise.

A new approach has been devised to assess the "static component" of dynamic exercise. This technique involves the measurement of the isometric endurance of muscles which have just taken part in rhythmic exercise and depends on the repeatability of trained subjects in isometric effort. The premise is that isometric endurance will be inversely related to the static component of the preceeding dynamic exercise. The subjects worked on a bicycle ergometer at known fractions of their maximal aerobic capacity (max Vo2). The rate of pedalling was varied from 30 to 90 rpm, so that for a given % max Vo2, the belt tension varied inversely with the speed of cycling. At any one speed of cycling, isometric endurance decreased as the belt tension increased. Following exercise at 30 rpm, the isometric endurance was 25 to 50% lower than that found at the most advantageous speed of cycling for our subuects; at these faster rates of cycling two subjects showed least static component following exercise at 90 rpm while the remaining subject performed best after cycling at 50 rpm.

18.6-year Earth tide regulates geyser activity.

Over 40 years of records from Yellowstone National Park, Wyoming, show that the 18.6-year tidal component strongly regulates the frequencies of eruption of Grand and Steamboat geysers. The frequency of Grand Geyser increases with increasing tidal force and that of Steamboat Geyser decreases, which suggests that tidal dilatation is one factor affecting heat flow to a geyser.

Waterfall-generated Earth vibrations.

Waterfalls generate periodic earth vibrations whose frequencies are inversely proportional to the height of the waterfall. Action of turbulent eddies is a probable explanation.