A retrospective study of preimplantation embryos diagnosed with monosomy by fluorescence in situ hybridization (FISH).

This report is a retrospective study of preimplantation embryos diagnosed with monosomy for chromosomes 13, 15, 16, 18, 21, 22, X and Y on day 3 to determine the rate of true positives, false positives and/or mosaicism and to assess if these embryos are suitable for in vitro fertilization (IVF) transfer. In a one year period, 80 patients went through preimplantation genetic diagnosis for aneuploidy screening (PGD-AS). Monosomy was diagnosed in 51 embryos. Fluorescence in situ hybridization (FISH) was then performed on the blastomeres at day 5-7 with commercially available probes using the same probe set that initially identified monosomy for chromosomes 13, 16, 21 and 22 or chromosomes 15, 18, X and Y. Based on FISH analysis, the monosomy diagnosed during routine PGD-AS analysis was confirmed in 17 of the 51 embryos. A euploid result for the specific chromosomes tested was observed in 16 of the 51 embryos while mosaicism was found in the remaining 18 embryos. This results in an estimated false positive rate of 3.8% for a diagnosis of monosomy. Reanalysis of these embryos demonstrates that the majority of monosomy diagnoses represents true monosomy or mosaicism and should be excluded for transfer in IVF. Furthermore, improved understanding from recent emerging data regarding the fate of oocytes in women with advanced maternal age undergoing IVF to the development of early embryos may provide a valuable insight into the mechanism of chromosome mosaicism.

Low blastocyst formation rates in day-2 fertilized oocytes.

PURPOSE: To examine the blastocyst formation rates of day-2 fertilized oocytes. METHODS: A retrospective study of the outcomes/blastocyst formation of day-2 fertilized oocytes was undertaken. RESULTS: Fertilization rates of day-1 and -2 oocytes by intra-cytoplasmic sperm injection were similar. The development frequencies to four cells were similar. However, the blastulation rates were significantly lower from the day-2 fertilized eggs. The fertilization rates from day-2 conventional in vitro fertilization reinsemination were lower than the fertilization rates of day-1 oocytes. The blastulation rates from day-2 fertilized eggs were also lower than the rates from day-1 fertilized eggs in the in vitro fertilization group. CONCLUSIONS: Fertilization is not a good indicator to predict the viability of fertilized oocytes. Day-2 fertilized oocytes had significantly lower blastocyst formation rates than the rates from day-1 fertilized oocytes.

Optimal insemination concentration for human in vitro fertilization (IVF).

This study is looking for optimal insemination concentration to achieve optimal IVF pregnancy. Sperm lateral head displacement, total abnormal form, Kruger morphology and index, hypo-osmotic swelling test were significantly correlated with fertilization in vitro. Based on those parameters, logistic regression models were formulated. These models predict either fertilization probability provided with an insemination concentration or insemination concentration assigned with a definite fertilization percentage. These models showed that increased insemination concentration can increase fertilization percentage. The increase of fertilization didn't compensate for the significant loss of implantation by increasing insemination concentration.

Blastocyst formation is a good indicator for attainment of assisted reproduction.

Blastocyst formation is a late stage of embryogenesis before implantation. The examination for the percentage of blastocyst formation (PBF) can predict the viability/pregnancy of the assisted reproduction trials. The PBF significantly correlates with age and pregnancy. The PBF is significantly lower in the intracytoplasmic sperm injection (ICSI) treatment than the conventional IVF treatment. The zygotes from immature oocytes give less blastocyst formation than the zygotes from mature oocytes. One pronucleus "zygotes" have significantly less chance to blastocyst than the normal 2 pronuclei zygotes. A mathematical model is proposed, verified, and predicts the hatching/hatched is the rate limiting step for the outcome of pregnancy.

Minimum essential medium alpha (MEM) enhances assisted reproductive technology results. I. Mouse embryo study.

PURPOSE: Our purpose was to find a medium to enhance mouse zygote development and, hopefully, to apply the results to a coculture system and to enhance the ART pregnancy rate. DESIGN: The study was designed to compare different media's support of mouse zygote development with/without serum supplement. The outcome measure was the percentage of mouse zygotes/embryos that developed to the expanded blastocyst and hatchout stage. RESULTS: (1) Using human tubal fluid (HTF), one-cell zygotes had a 34.6 +/- 5.2% (mean +/- standard deviation) development rate, and two-cell embryos a 86.5 +/- 3.2% development rate. (2) Minimum essential medium alpha (MEM) showed the best results (52.2 +/- 14.5%) among Ham's F-10 (19.1 +/- 6.3%), HTF (26.8 +/- 8.2%), NCTC-135 (38.8 +/- 12.6%), MEM with nuclei acid (24.6 +/- 10.0%), and Dulbecco's modified Eagle medium (28.0 +/- 20.2%). (3) With the serum supplement, there was no significant difference among Ham's F-10 (21.5 +/- 23.7), HTF (29.3 +/- 10.4%), NCTC-135 (36.5 +/- 6.2%), and MEM (38.8 +/- 17.9%). CONCLUSION: MEM is the best medium among the six media examined. Preliminary study showed that MEM gave a good clinical pregnancy rate (29%).

Relationship between the results of sperm analysis and GIFT.

In vitro fertilization (IVF) and GIFT have been proposed as therapeutic approaches in infertile couples where a significant male factor is present. To date, few published data are available relating the success rate of GIFT to the severity of the male factor. In this report the results of the first 172 GIFT cases were analyzed. The overall pregnancy rate was 18.0%. The relationship between the occurrence of pregnancy and sperm count (millions/ml), total sperm count (millions/ejaculate), % motility, motile sperm count (millions/ml) and total motile sperm count (millions/ejaculate) were examined. Significant direct correlations were observed between the clinical pregnancy rate and sperm count, total sperm count, motile sperm count and total motile sperm count. Motile sperm count and total motile sperm count had the best correlations with clinical pregnancy rates, which were over 24.0% in groups with motile sperm counts exceeding 40 X 10(6) cells/ml or total motile sperm counts greater than 100 X 10(6)/ejaculate. The clinical pregnancy rates were 12.5% and 7.7%, respectively, for groups with motile sperm counts under 10 X 10(6)/ml and total motile sperm counts below 25 X 10(6)/ejaculate. No correlation was found between percent motile cells and pregnancy rate. Results of the sperm penetration assay using zona-free hamster eggs were available in a subpopulation of 27 patients. No significant correlation between this sperm penetration assay and pregnancy rate could be demonstrated. The incidence of chemical pregnancy showed a significant negative correlation with the total motile sperm count, indicating a higher incidence of early pregnancy wastage in cases of oligozoospermia.(ABSTRACT TRUNCATED AT 250 WORDS)

Refractory status epilepticus in pregnancy. A case report.

Status epilepticus is an acute, life-threatening potential complication of pregnancy in the epileptic patient. It is important that obstetricians become familiar with the initial control of such seizure activity to decrease maternal and fetal morbidity and mortality.

Endometriosis then and now. Evolution of surgical techniques and treatment.

Surgical techniques and practices for conservative endometriosis surgery began developing in the U.S. They led naturally to contemporary concepts and to the rationale for use of the techniques.

Urinary estriols: are they of value in normoglycemic diabetic pregnancy?

The purpose of the study was to assess the value of 24-h urinary estriols in the management of diabetic pregnancies. Twenty-seven pregnant diabetic patients (White's class B through R) received insulin dosages twice daily as a combination of NPH and regular insulin. Laboratory and home monitored blood glucose was maintained within the range of 70-150 mg/dl. From 32 wk onward daily 24-h urinary estriols, weekly fetal heart rate monitoring, and, when indicated, amniotic fluid lecithin/sphingomyelin ratio were used to evaluate fetal well-being. Fetal heart rate and amniotic fluid testing were of value while urinary estriols failed to be useful in management or timing of delivery. We conclude that when third-trimester normoglycemia is maintained in pregnant diabetic patients, one obviates the need for the costly and odious task of daily urine estriol measurements.

Microsurgical reanastomosis of the fallopian tubes for reversal of sterilization.

Reversal of previous tubal ligation procedures for the restoration of fertility has become an increasingly frequent request. Microsurgical techniques are believed to offer a postoperative pregnancy rate superior to that obtained with macroscopic procedures. Of 63 women who requested reversal, microsurgical reanastomosis was performed in 40. With at least 6 months' follow-up, 22 women have become pregnant (55%), and there has been 1 ectopic pregnancy (2.5%). Comparison with previous studies using standard macroscopic techniques indicates that the use of meticulous surgical methods with precise reapproximation of the fallopian tubes results in a significant (P less than .005) improvement in pregnancy rates.

Late tubal patency following tubal ligation.

Hysterosalpingography (HSG), performed in the first 3 months after tubal ligation, has demonstrated a 1% to 2% incidence of tubal patency when initial operative errors have been excluded. In a group of 54 women, HSG was performed a mean of 4.8 years following sterilization; 9 women (16.7%) demonstrated spillage which was confirmed at laparoscopy in 7 of 8 women operated upon. No cases were due to initial surgical error. Delayed acquisition of tubal patency may explain late failure of tubal ligation, and the abnormal tubal lumen formed may be responsible for the increased percentage of ectopic pregnancies observed among sterilization failures. Ectopic pregnancy must be strongly considered in any failure of tubal ligation. In investigating the proximal tubal segment prior to consideration for tubal reconstruction, the possibility of a pre-existing or an iatrogenically formed fistula must be recalled which may predispose the patient to ectopic pregnancy.

PIP: (HSG) Hysterosalpingography, performed in the first 3 months after tubal ligation, has demonstrated a 1 to 2% incidence of tubal patency when initial operative errors have been excluded. In a group of 54 women, HSG was performed a mean of 4.8 years following sterilization; 9 women (16.7%) demonstrated spillage which was confirmed at laparoscopy in 7 of 8 women operated upon. No cases were due to initial surgical error. Delayed acquisition of tubal patency may explain late failure of tubal ligation, and the abnormal tubal lumen formed may be responsible for the increased % of ectopic pregnancies observed among sterilization failures. Ectopic pregnancy must be strongly considered in any failure of tubal ligation. In investigating the proximal tubal segment prior to consideration for tubal reconstruction, the possibility of a preexisting or an iatrogenically formed fistula must be recalled which may predispose the patient to ectopic pregnancy.