Could 3D placental volume and perfusion indices measured at 11-14 weeks predict occurrence of preeclampsia in high-risk pregnant women?

OBJECTIVE: Preeclampsia (PE) is a known cause of maternal, fetal and neonatal morbidity and mortality. Thus, evaluation of the predicting value of combining the 3D assessment of placental volume with the assessment of placental perfusion indices through 3D power Doppler (3DPD) at 11-14 weeks in pregnant women at high risk to develop PE could be a suitable screening method. METHODS: 3D assessment of placental volume and 3DPD assessment of placental vascularization indices at 11-13 weeks and uterine artery Doppler scan (RI and PI) at 21-22 weeks were conducted in this prospective case-control study. Their predictive ability for PE was assessed. RESULTS: One-hundred pregnant women divided into two groups were enrolled in our study. High-risk group (n = 50) and control group (n = 50). Thirty-eight (76%) patients in the high-risk group and 6.0 (12%) patients in the control group developed PE, respectively. The mean values of placental volume (<0.001), vascularization index (<0.001), vascularization flow index (<0.002) were significantly lower in the high-risk group. Meanwhile, uterine artery RI (0.011) and PI (<0.001) was significantly higher in the study group. Uterine artery PI is negatively correlated with placental volume and vascularization indices (-0.36). CONCLUSION: Our findings suggest that 3D placental volume measurement and 3DPD assessment of placental vascular indices in the first trimester has the potential to detect women at risk for subsequent development of PE.

Does flushing the endometrial cavity with follicular fluid after oocyte retrieval affect pregnancy rates in subfertile women undergoing intracytoplasmic sperm injection? A randomized controlled trial.

OBJECTIVE: Follicular fluid of mature oocytes is rich in growth factors and cytokines that may exert paracrine and autocrine effects on implantation. The aim of this study was to investigate if flushing the endometrial cavity with follicular fluid after oocyte retrieval improved pregnancy rates in subfertile women undergoing intracytoplasmic sperm injection (ICSI). STUDY DESIGN: One hundred subfertile women undergoing ICSI between April 2012 and September 2012 at the centre for reproductive medicine, Cairo University, Egypt were enrolled in this open label, parallel randomized controlled study. Patients were randomized into two groups at the start of treatment using a computer-generated programme and sealed opaque envelopes: the follicular fluid group (n=50) and the control group (n=50). Inclusion criteria were: age 20-38 years; basal follicle-stimulating hormone <10mIU/ml; body mass index <35kg/m(2); and ostradiol >1000pg/ml and <4000pg/ml on the day of human chorionic gonadotrophin administration. Exclusion criteria were: evidence of endometriosis; uterine myoma; hydrosalpinges; endocrinological disorders; history of implantation failure in previous in-vitro fertilization/ICSI cycles; and severe male factor infertility. RESULTS: Clinical pregnancy and implantation rates were higher in the follicular fluid group compared with the control group [354% (17/48) vs 319% (15/47); p=0718] and (18.6% vs 11.3%; p=0.153), respectively. However, the difference was not statistically significant. CONCLUSION: Flushing the endometrial cavity with follicular fluid after oocyte retrieval neither improved nor adversely affected clinical pregnancy and implantation rates in subfertile women undergoing ICSI.

Embryo culture media and IVF/ICSI success rates: a systematic review.

BACKGROUND The media that are used to culture human preimplantation embryos are considered to be an important factor for the success rates of IVF/ICSI. Here, we present a systematic review of randomized controlled trials (RCTs) on the effect of culture media on IVF/ICSI success rates. METHODS RCTs published between January 1985 and July 2012 were eligible for inclusion. The primary outcome was live birth. Secondary outcomes were health of babies born, ongoing pregnancies, clinical pregnancies, miscarriages, multiple pregnancies, implantation rate, cryopreservation rate, embryo quality and fertilization rate. For those media that were evaluated in more than one comparison, an unconventional meta-analysis was performed by pooling the data of the media they were compared to. RESULTS Twenty-two RCTs were included that evaluated 31 different comparisons. Conventional meta-analysis was not possible for any of the outcomes as nearly all trials compared different culture media. Only four trials reported on live birth, and one of them reported a significant difference. Nine trials reported on ongoing and/or clinical pregnancy rates, of which four showed a significant difference. Pooling the data did not reveal a superior culture medium. CONCLUSIONS It is yet unknown what culture medium leads to the best success rates in IVF/ICSI. Given the potential importance of culture media for treatment outcome, rigorously designed RCTs are needed for currently available, as well as newly introduced culture media.