Increased incidence of preeclampsia in mothers of advanced age conceiving by oocyte donation.

PURPOSE: The aim of this study was to evaluate the risk of preeclampsia in women of advanced age who conceived through donated oocytes as compared with natural conceptions. METHODS: A historical prospective study of singleton live births of parturients ≥ 45 years of age at four university hospitals was conducted. For the purpose of the study, the population was divided by the mode of conception into two groups: oocyte donation and natural conception. The main outcome variable in this study was preeclampsia. Secondary outcomes included pregnancy-induced hypertension and Small for Gestational Age. RESULTS: Two hundred and seventy pregnancies were achieved naturally and 135 women conceived by oocyte donation. Mean age at delivery for the natural conception and oocyte donation groups was 45.7 and 47.8, respectively. Preeclampsia complicated 3 out of 270 (1.1%) natural conception pregnancies and 17 out of 135 (12.6%) oocyte donation conceptions. After adjusting for confounders, oocyte donation pregnancies were found to be associated with a 12-fold increased risk for preeclampsia (P = 0.001). Among oocyte donation pregnancies, the risk of preeclampsia was not affected by parity or age. CONCLUSIONS: A substantially increased risk for preeclampsia was found in oocyte donation pregnancies, suggesting that the foreign oocyte may play a specific biologic role in the development of preeclampsia after the age of 45.

Safety of trial of labor after cesarean delivery in grandmultiparous women.

OBJECTIVE: To evaluate the risk of uterine rupture and other major labor complications in a trial of labor after cesarean delivery (TOLAC) in grandmultiparous women. METHODS: A retrospective descriptive study of 64,345 births in three hospitals between the years 1999 and 2009. The study group included 1,922 deliveries of women in their sixth or higher birth with one previous cesarean delivery. RESULTS: The risk for uterine rupture was 0.3% (six cases) (95% confidence interval [CI] 0.11-0.68); of these, two cases ended in hysterectomy. There were another four hysterectomies not attributable to uterine rupture (a total risk of 0.3%). Neither induction nor augmentation of labor increased the risk for uterine rupture. Trial of labor after cesarean delivery in the first labor after prior cesarean delivery conferred a higher risk for hysterectomy (1% compared with 0.1%; P=.019). In the presence of shoulder dystocia (n=20), the risk of uterine rupture was 10% (two cases) compared with 0.2% when shoulder dystocia did not occur (P=.002; odds ratio 52.7, 95% CI 9-306). CONCLUSION: Grandmultiparous women with one previous cesarean delivery can be offered TOLAC. Labor induction is not contraindicated in such women. LEVEL OF EVIDENCE: III.

Periodontal status of males attending an in vitro fertilization clinic.

AIMS: An association has been demonstrated previously between periodontal diseases and various systemic conditions, including endometriosis. A possible role of dental infection in male infertility was also suggested. The aim of the present study was to examine the association between fertility parameters and the periodontal status of men attending a fertility and in vitro fertilization (IVF) clinic. METHODS: The study population consisted of 75 men attending the clinic for sperm analysis before homologue semen insemination or IVF. The quality of sperm was assessed according to WHO criteria. On the same day, patients received a clinical periodontal examination. RESULTS: The patients were diagnosed with either gingivitis (40%) or periodontitis (48%), whereas the remaining 12% were classified as "periodontally healthy". Normospermia was attributed to 37%, oligozoospermia to 48% and azoospermia to 15% of these patients. Familial infertility was significantly associated with having at least one WHO parameter contributing to infertility. A higher number of sites with deep periodontal pockets tended to associate positively with sperm sub-motility. Clinical attachment levels were significantly associated with sperm sub-motility. CONCLUSIONS: These findings may point to a possible association between male infertility, diminished semen quality and periodontal infections in men attending fertility and IVF clinics.

[Umbilical cord cyst--should it concern us?].

INTRODUCTION: Advancements in sonographic technology have led to improved prenatal detection of fetal umbilical cord and placental anomalies. The prevalence of umbilical cord cystic masses detected in the first trimester is 0.4% to 3.4%. The second- and third-trimester umbilical cord cysts are a rare sonographic finding and its prevalence is unknown. There is a strong association between umbilical cord cysts and fetal anomalies but not in all cases. The main questions are: what are the implications of these findings and what is the prenatal follow-up that should be offered. CASE REPORT: In this study the authors present a case in which an umbilical cord cyst was diagnosed at 29 weeks of gestation following normal integrated test and anatomical sonographic survey. At 32 weeks of gestation, fetal karyotype was found to be normal. The outcome of the pregnancy was normal and so was the developmental follow-up during the first three years. DISCUSSION AND CONCLUSIONS: From the literature survey it appears that transient first-trimester cysts are not associated with chromosomal anomaLies, yet they might be associated with congenital maLformations, especially those of the abdominal wall and the urinary tract, and should lead to further detailed sonographic evaluation. Routine karyotype may not be necessary. Second and third trimester umbilical cord cystic masses accompanied by additional malformations are strongly associated with chromosomal anomalies, especially with trisomy 18. Second- and third-trimester umbilical cord cystic masses without additional abnormal findings were also found to be associated with chromosomal anomalies in some works. Therefore, these findings should be an indication for fetal karyotype. In the case of an isolated umbilical cord cyst with normal karyotype, serial sonographic evaluation is needed. If all these are normal, it may be presumed that the cyst is an isolated umbilical cord anomaly and that the fetal prognosis is good.

Comparison between the first and the second electroejaculate qualities obtained from neurologically intact men suffering from anejaculation.

BACKGROUND: Electroejaculation is an artificial method used to procure semen from neurologically intact men suffering from anejaculation that have failed other treatments. In order to establish the consistency of semen parameters in repeated electroejaculations, we compared retrospectively the quality of the first and the second electroejaculates of anejaculatory men who were not suffering from any known neurological problems. METHODS: Between 1995 and 2004, 59 neurologically intact men suffering from anejaculation underwent multiple electroejaculations. Sperm quality of the first and the second ejaculates was compared. RESULTS: A significant difference of 0.33 +/- 0.16 ml in the volume of the antegrade portion was found (P = 0.023). The results showed no significant difference in the concentration, motility, count and total motile count of the antegrade ejaculates. In retrograde ejaculates there were no significant differences in the count, motility and total motile count. Neither was there any difference in the total count and the total motile count of both fractions. CONCLUSIONS: Electroejaculation is a reliable method for semen procurement in men suffering from anejaculation. Since semen parameters are consistent, repeated procedures are not justified for improving the sperm quality in anejaculatory, neurologically intact men.

Electroejaculation with a foley catheter in the bladder.

Electroejaculation has been successfully used for sperm procurement in anejaculatory men desiring fertility. The electroejaculation procedure begins with complete catheterization of the bladder and instillation of an insemination medium into the bladder as a buffer. This step can minimize possible detrimental effects of urine on any retrograde ejaculate. The catheter is then removed. After the collection of the antegrade ejaculate, the bladder is catheterized again. Our objective was to evaluate the possibility of performing electroejaculation while the Foley catheter is instilled in the bladder. Eleven men with anejaculation underwent 22 procedures of rectal probe electroejaculation. Each patient underwent electroejaculation twice, once without the catheter instilled in the bladder (standard method) and once with it. The 2 methods, with and without the catheter, showed no significant differences in volume, concentration, motility, count, and total motility of the antegrade ejaculate. In retrograde ejaculate, there were no significant differences in the count, motility, and total motility. In addition, there was no difference in the total count and the total motility of both fractions in the 2 methods. In this study, we show that ejaculation can be achieved while the Foley catheter is instilled in the urethra without any detrimental effect on the sperm. Therefore, we recommend not removing the Foley catheter while performing electroejaculation.

Successful spontaneous pregnancies in women older than 45 years.

OBJECTIVE: To characterize the reproductive history of women who delivered an infant after a spontaneous pregnancy after the age of 45 years. DESIGN: Observational study. SETTING: University departments. PATIENT(S): Two hundred nine women who conceived spontaneously and had their most recent delivery after the age of 45 years. INTERVENTION(S): Review of all individual medical charts for a complete history of all pregnancies. MAIN OUTCOME MEASURE(S): Gravidity, parity, and spontaneous abortion (SAB) rate. RESULT(S): The mean (+/-SD) age at last delivery was 45.7 +/- 0.9 years (range: 45-49). The mean parity was 9.6 +/- 4 children (range: 2-20): 81% of the women were grandmultiparas (> or =6 deliveries) and 46% were grand-grandmultiparas (> or =11 deliveries). The mean number of SAB was 1.9 +/- 1.9 (range: 0-9). Increased parity did not have a protective effect on abortion rate: 12.9% for parity 2-5, 15.6% for parity 6-10, and 21.3% for parity 11-20. Women in the study group differed significantly in their SAB rate from a general population: 11.3% vs. 17.7% at age 39, 13.2% vs. 33.8% at age 44, and 9.1% vs. 33.8% at age 45. CONCLUSION(S): Women who conceived at or after 45 years of age were mostly grandmultiparas. Although multiparity in itself did not affect SAB rates, this measure was remarkably low in our exceptionally fertile group as compared with the rates published for a general population. This unique group of grandmultiparous women might possess a genetic propensity that delays the normal rate of ovarian and oocyte senescence.

The levels of C-reactive protein in women treated by IVF.

BACKGROUND: The complex regulation of endometrial receptivity and embryo implantation involves cytokines, several of which are stimulators of the acute-phase reactant C-reactive protein (CRP). The purpose of this study was to evaluate the concentrations of serum CRP in women treated by IVF. METHODS: Seventy-two women who underwent IVF treatment were prospectively studied. The levels of serum CRP were evaluated on the following days: oocyte retrieval, embryo transfer, 5, 6 or 7 days afterwards and 12 days after embryo transfer. RESULTS: CRP levels increased from 6.8 +/- 9.5 mg/l on oocyte retrieval day to 14.6 +/- 12.5 mg/l on days 5-7 post-transfer (P<0.0001). The ratios of CRP levels for transfer day/pick-up day were 1.2 in women who conceived versus 2.5 in the non-pregnant group (P=0.01). CONCLUSION: In women treated by IVF the concentrations of CRP in blood increase significantly during the first week following oocyte retrieval. Successful outcome is associated with a relative small increment in CRP on the day of embryo transfer.

Decreased levels of fibrinogen in very high parity women.

OBJECTIVES: To evaluate coagulation parameters in healthy pregnant grand grand multiparous women. STUDY DESIGN: Prothrombin time (PT), activated partial thromboplastin time (PTT), fibrinogen, D-dimer, albumin and blood lipids were prospectively determined in 50 pregnant grand grand multiparas (> or =9 deliveries) and 50 age-matched pregnant women with low parity (< or =3 deliveries). RESULTS: The average concentrations of fibrinogen in the grand grand multiparas were 4.0+/-0.6 as compared to 4.7+/-0.7 g/l in the control group (P<0.001). In both groups D-dimer levels were >1000 ng/ml and the concentrations of albumin, triglycerides, cholesterol, high-density lipoprotein (HDL) were not significantly different. CONCLUSIONS: In healthy pregnant grand grand multiparous women fibrinogen levels are lower than in age-matched women with low parity. These changes are not directly associated with lipids metabolism during pregnancy.

Comparison of semen quality obtained by electroejaculation and spontaneous ejaculation in men suffering from ejaculation disorder.

BACKGROUND: Electroejaculation has become an accepted form of semen procurement in men suffering from anejaculation. However, sperm in these ejaculates often exhibit low motility. The aetiology of asthenozoospermia remains uncertain. It may be related to primary low-grade motility of sperm from anejaculatory men or to detrimental effects of the electroejaculation process itself. The aim of this study was to determine whether the procedure of electroejaculation alters the quality of the semen by comparing the characteristics of the electroejaculates with those of the normal ejaculates of the same patients. METHODS: Nine men suffering from ejaculation disorders underwent 14 procedures of electroejaculation. The sperm concentration and motility of the 14 samples from electroejaculation were compared with 20 collected at a later date after successful ejaculation by the same patients. RESULTS: The mean +/- SD concentration of the electroejaculates was (52.3 +/- 42.1)x10(6)/ml and of the natural samples (67.4 +/- 38.1)x10(6)/ml. No statistical difference was found between the two groups. The mean percentage of sperm showing progressive motility following electroejaculation was 23.1 +/- 18.8% and 36.3 +/- 16.7% after spontaneous ejaculation. No statistical difference was found between the groups (P = 0.082). Likewise, the quality of sperm motility was similar after both methods of procurement. CONCLUSIONS: In our small-sized study group (nine men with ejaculation disorders), the concentration and the motility of sperm obtained by electroejaculation were not significantly different from sperm obtained naturally.