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 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to compare pregnancy characteristics and perinatal outcome of intracytoplasmic sperm injection (ICSI) pregnancies with pregnancies obtained after in-vitro fertilization (IVF). Retrospectively, 145 ICSI pregnancies were matched with 145 IVF pregnancies using the last menstruation data. The main outcome measures were preclinical and clinical abortions, ectopic pregnancies, multiple gestations, prenatal morbidity, prematurity, Caesarean section, birthweight, perinatal mortality and malformations for singletons, twins and triplets. Although patients were significantly younger (P < 0.001) in ICSI (31 years) than in IVF (33 years), their infertility duration (5 years) was similar. The mean number of transferred embryos (2.7 embryos per transfer) was similar in IVF and ICSI. The rates of preclinical (15%) and clinical abortions (11% in ICSI versus 15% in IVF) were not different. Four ectopic pregnancies were observed in the IVF group and none in the ICSI group. In ICSI, two minor malformations were detected and two therapeutic abortions were performed respectively for polymalformations and suspicion of cystic fibrosis. The rate of congenital malformation was 2.8% in ICSI and 2.2% in IVF. In this last group, one therapeutic abortion for malformation of neural tube was performed and two minor malformations were detected. The rate of aborted embryonic sacs before 16 weeks of gestation was not significantly lower in ICSI compared with IVF (13.7% versus 20%). The rate of multiple gestations was similar in both groups (31% in IVF and 35% in ICSI). The number of Caesarean sections was similar in IVF and in ICSI and was twice as frequent for twins versus singletons. The number of singletons born by Caesarean section was 21% after ICSI and 17% after IVF. Mean birthweights and gestational ages at birth for twins were significantly higher (P < 0.05) in ICSI than in IVF (2488 versus 2281 g and 36.5 versus 35.5 weeks). This difference was not observed for singletons. In conclusion, pregnancy characteristics and perinatal outcome after ICSI showed no increase in the number of pathologies in comparison with IVF.
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PMID:Comparison of pregnancy outcome after intracytoplasmic sperm injection and in-vitro fertilization. 968 84

This article takes an evolutionary approach to the study of reproductive failure, drawing attention to the importance of reproductive failure among mammals as a means of timing reproduction in response to a variable environment. These concepts also apply to the diagnosis and treatment of prematurity, because before the advent of modern medicine most premature births probably constituted failed reproduction. Problems in the diagnosis and treatment of reproductive failure are described, with specific parallels drawn between the diagnoses and treatments of infertility and prematurity.
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PMID:Stress and reproductive failure: an evolutionary approach with applications to premature labor. 991 33

In order to evaluate the reproductive risks of low-frequency electromagnetic fields (EMF), it is important to include epidemiological and animal studies in the evaluation, as well as the appropriate basic science information in developmental biology and teratology. This review presents a critical review of in vivo animal studies and in vitro tests, as well as the biological plausibility of the allegations of reproductive risks. In vitro or in vivo studies in nonhuman species can be used to study mechanisms and the effects that have been suggested by human investigations. Only well designed whole-animal teratology studies are appropriate when the epidemiologists and clinical teratologists are uncertain about the environmental risks. Even the inference of teratogenesis cannot be drawn from culture experiments, because the investigator is not in a position to know whether any of his observations will be manifested in living organisms at term. Other aspects of reproductive failure such as abortion, infertility, stillbirth, and prematurity, cannot be addressed by in vitro or culture experiments. In fact, they are very difficult to design and interpret in nonprimate in vivo models. The biological plausibility some of the basic mechanisms involved in reproductive pathology were evaluated, concentrating primarily on the mechanisms involved in the production of birth defects. The studies dealing with mutagenesis, cell death and cell proliferation using in vitro systems do not indicate that EMFs have the potential for deleteriously affecting proliferating and differentiating embryonic cells at the exposures to which populations are usually exposed. Of course, there is no environmental agent that has no effect, deleterious or not, at very high exposures. The animal and in vitro studies dealing with the reproductive effects of EMF exposure are extensive. There are >70 EMF research projects that deal with some aspect of reproduction and growth. Unfortunately, a large proportion of the embryology studies used the chick embryo and evaluated the presence or absence of teratogenesis after 48-52 h of development. This is not a stage of development at which an investigator could determine whether teratogenesis occurred. The presence of clinically relevant teratogenesis can only be determined at the end of the gestational period. The chick embryo studies are also of little assistance to the epidemiologist or clinician in determining whether EMF represents a hazard to the human embryo, and the results are, in any event, inconsistent. On the other hand, the studies involving nonhuman mammalian organisms dealing with fetal growth, congenital malformations, embryonic loss, and neurobehavioral development were predominantly negative and are therefore not supportive of the hypothesis that low-frequency EMF exposures result in reproductive toxicity.
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PMID:Reproductive and teratologic effects of low-frequency electromagnetic fields: a review of in vivo and in vitro studies using animal models. 1033 29

Pemphigus vulgaris (PV) is an uncommon, immune-mediated bullous dermatosis, which, during its active phase, has been associated with infertility. Pemphigus vulgaris during pregnancy is exceedingly rare-only 26 cases with immunopathological confirmation have been reported. The disease may be associated with adverse neonatal outcome, including prematurity and fetal death. Transient skin lesions may occasionally appear in the neonate. We report a patient who conceived during the active phase of PV, required high doses of corticosteroids to control the disease, and was delivered of a pre-term, appropriate-for-gestational age newborn.
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PMID:Pemphigus vulgaris in pregnancy: a case report and review of literature. 1078 77

The aim of this study was to compare the outcome of triplets managed expectantly or by multifetal reduction to twins to assess the potential benefit of fetal reduction. The study design was prospective, comparative and monocentric and the study was conducted in a teaching hospital. Out of 148 women with triplets mostly obtained after infertility treatment, 83 were expectantly managed while 65 chose reduction to obtain twins. Main outcome measures were fetal loss before 24 weeks, premature deliveries before 28, 32 and 34 weeks, rate of low birthweight infants and neonatal and perinatal mortality rates. The fetal loss rate before 24 weeks did not differ between the ongoing group and the reduced group (6 versus 5.4%). Reducing triplets was associated with a significantly lower incidence of the following: prematurity before 28, 32 and 34 weeks (P < 0.001), low birthweight infants whose weights were under the third centile (P < 0.002) and infants whose weights were less than 1000, 1500 and 2000 g (P < 0.001). Neonatal (although apparently lower in the reduced group) and perinatal mortality did not significantly differ. Our results indicate that reduction of triplets to twins is effective to improve preterm birth and fetal growth.
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PMID:Multifetal reduction of triplets to twins: a prospective comparison of pregnancy outcome. 1087 77

Multiple gestation pregnancy rates are high in assisted reproductive treatment cycles because of the perceived need to stimulate excess follicles and transfer excess embryos in order to achieve reasonable pregnancy rates. Perinatal mortality rates are, however, 4-fold higher for twins and 6-fold higher for triplets than for singletons. Since the goal of infertility therapy is a healthy child, and multiple gestation puts that goal at risk, multiple pregnancy must be regarded as a serious complication of assisted reproductive treatment cycles. The 1999 ESHRE Capri Workshop addressed the psychological, medical, social and financial implications of multiple pregnancy and discussed how it might be prevented. Multiple gestations are high risk pregnancies which may be complicated by prematurity, low birthweight, pre-eclampsia, anaemia, postpartum haemorrhage, intrauterine growth restriction, neonatal morbidity and high neonatal and infant mortality. Multiple gestation children may suffer long-term consequences of perinatal complications, including cerebral palsy and learning disabilities. Even when the babies are healthy they must share their parents' attention and may experience slow language development and behavioural problems. Current data indicate that the average hospital cost per multiple gestation delivery is greater than the average cost of in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles. Prevention is the most important means of decreasing multiple gestation rates. Multiple gestation rates in ovulation induction and superovulation cycles can be reduced by using lower dosage gonadotrophin regimens. If there are more than three mature follicles, the cycle should be converted to an IVF cycle, or it should be cancelled and intercourse should be avoided. In IVF cycles two embryos can be transferred without reducing birth rates in most circumstances. Embryo reduction involves extremely difficult decisions for infertile couples and should be used only as a last resort. Assisted reproductive treatment centres and registries should express cycle results as the proportion of singleton live births; twin and triplet rates should be reported separately as complications of the procedures. Reducing the multiple gestation pregnancy rate should be a high priority for assisted reproductive treatment programmes, despite the pressure from some patients to transfer more embryos in order to improve success. If nothing is done, public concern may lead to legislation in many countries, a step that would be unnecessary if assisted reproductive treatment programmes and registries took suitable steps to reduce multiple pregnancy rates.
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PMID:Multiple gestation pregnancy. The ESHRE Capri Workshop Group. 1092 Jan 17

Intracytoplasmic sperm injection (ICSI) must be proved safe as well as efficacious. In this communication we first review available data following ICSI pregnancies concerning frequency of spontaneous abortion, malformations, and chromosomal abnormalities. In ICSI the spontaneous abortion rate is slightly increased, just as it is in in vitro fertilization (IVF) without ICSI. Among 6077 ICSI cycles begun in 1997 in the United States, there were 17.5% pregnancy losses. The same cohort showed a malformation rate of 1.7% in live-born infants. Malformations in live-born infants are not increased: 1.7% in the United States and 2.3% in Brussels. However, the Swedish IVF Registry encompassing 1139 ICSI infants found hypospadias to be increased (relative risk 2.9, 95% C.I. 1.4 to 5.4). Birth weight and prematurity rate in ICSI pregnancies seem similar to that following conventional IVF without ICSI. The category of genetic defects for which concerns have most often been raised is chromosomal abnormalities. A cohort of 1987 pregnancies in Brussels yielded a frequency of de novo autosomal rearrangements of 0.36% and a de novo sex chromosomal abnormalities of 0.83%. Both rates are higher than expected in the general population. Various explanations for these increased cytogenetic autosomal abnormalities are explored in this communication. In addition to arising from the procedure per se, a genetic or cytogenetic abnormality in offspring of an ICSI pregnancy could arise as result of offspring inheriting the mutant gene or chromosomal abnormality conferring paternal infertility: Y deletions (DAZ) in oligospermia males, cystic fibrosis in offspring of males with congenital bilateral absence vas deferens (CBAVD), and sex chromosomal abnormalities in offspring of Klinefelter syndrome (47,XXY) males.
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PMID:Genetic effects of intracytoplasmic sperm injection. 1167 5

This article describes the nature and extent of sexually transmitted diseases (STDs) in South Africa, the spread of STDs, and recommended STD prevention and control approaches. Gonorrhea, chlamydia, syphilis, and chancroid are in the top 25 causes of healthy days of life lost in sub-Saharan Africa. In South Africa, an estimated 40% of women attending family planning clinics were diagnosed with an STD. 15% of women attending prenatal clinics in urban areas had latent syphilis. The World Bank estimates that over 3 million in South Africa, are infected with at least 1 STD/year. 1 in 10 sexually active persons in South Africa, may be infected with an STD every year. STDs cause morbidity, infertility, abortions, ectopic pregnancies, stillbirths, prematurity, and cervical cancer. The presence of a genital ulcer increases the risk of AIDS up to tenfold. The presence of a urethral or vaginal discharge increases the AIDS risk fivefold. An estimated 1200 HIV infections could be prevented over the next 10 years by curing or preventing 100 cases of syphilis. In 1995, 1 in 10 women who attended prenatal clinics was infected with HIV. The incidence of STDs among women are underestimates due to the greater chance that women are without STD symptoms or may be embarrassed to report symptoms. High rates of urbanization are linked to 9 factors that contribute to the spread of AIDS. STD prevention programs should create awareness, provide accessible and user-friendly services integrated within primary health care, provide simple and effective STD management, and detect/manage STD carriers.
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PMID:Urbanisation and the epidemic of sexually transmitted diseases in South Africa. 1217 2

Since the late 1980s a distinct form of focally-extensive mucoid to mucopurulent uterine body chronic placentitis,caused by nocardioform organisms, hasbeen recognised in horses in the USA state of Kentucky and possibly in other areas. This disease has led to increasing numbers of foal losses from late abortions, still-births, prematurity, or early neonatal deaths. The foals are usually not infected, but may be small or emaciated. Modes of infection and transmission are as yet unknown. Nocardia spp. and related nocardioform bacteria as causes of equine infertility, endometritis and foal death are briefly reviewed. A case of near full-term abortion involving a Friesian mare in the Pretoria district of Gauteng Province in South Africa during February 2000, with the same placental lesion as described in the Kentucky cases, is presented. Nocardioform organisms were visualised on impression smears and histological sections of affected foetal membranes, and were also cultured. The organism has been identified at the Livestock Disease Diagnostic Center of the University of Kentucky as an Amycolatopsis sp. of the less-commonly diagnosed group of nocardioforms causing placentitis in the USA. The organism was cultured from the uterus of the mare 18 days post-foaling, but after a 2-week course of oral trimethoprim and sulphamethoxazole, based on antibiogram sensitivity testing, a uterine flush yielded no growth. A semen sample from the sire of the aborted foal did not yield any Gram-positive filamentous branching bacteria. The mare subsequently conceived to a single insemination.
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PMID:The first reported case of equine nocardioform placentitis in South Africa. 1221 21

Although considerable global attention and effort have been devoted to preventing and controlling the spread of HIV/AIDS, comparatively little focus has been given to controlling other sexually transmitted diseases (STD). However, since HIV, like other STDs, may be transmitted through unprotected sexual intercourse, measures implemented to check the spread of HIV through sexual contact also help to limit the transmission of other STDs. Gonorrhea, chlamydia, trichomoniasis, genital herpes, syphilis, and human papillomavirus infections cause infertility, cervical cancer, and adverse outcomes of pregnancy such as spontaneous abortion, prematurity, and stillbirth. Many people, however, remain unconvinced that STD infection has important adverse effects upon the health of women and their infants. There are enormous morbidity, mortality, and health care costs associated with these STDs. The author discusses how women are at increased risk relative to men, as well as primary, secondary, and tertiary prevention.
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PMID:Women, children and STDs: addressing the other STD epidemic. Opinion. 1229 53


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