International Journal of Fertility and Womens Medicine最新文献

Objective: to assess whether fetal oxymetry reduces the intervention rate in a "theoretical setting".

Study design: Data bank including 93 cases where a fetal oxymetry had been used for suspicion of fetal distress. Subjects-Two sets of labor charts were constructed for each case. One included relevant data with the saturometry, the other included relevant data without the saturometry.

Intervention: Theoretical setting: 3 obstetricians, unaware of study aim of the obstetrical outcomes. Each case was presented first without the saturometry; in a second reading, its result was available.

Outcomes: Number of extractions. Consensus between experts.

Statistics: descriptive and paired non parametric tests.

Results: The global intervention rate was lower (47% versus 52%; p<0.05) and the consensus higher, using monitoring and saturometry than using monitoring only.

Conclusion: In a theoretical setting, the use of saturometry in suspicious cardiotocography (CTG) may help reduce the risk of invasive procedures.

Objective: To evaluate the efficiency of testicular sperm recovery by testicular sperm aspiration (TESA) in an IVF program.

Design: Retrospective Data Analysis.

Setting: The Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.

Patient(s): Couples undergoing TESA/ICSI for obstructive or nonobstructive azoospermia.

Intervention(s): ESA/ICSI.

Main outcome measure(s): Efficiency of testicular sperm recovery, fertilization rate, implantation rate and clinical pregnancy rate.

Result(s): Between March 1, 1997 and March 31, 2005, 327 cycles of TESA/ICSI were performed in couples in which the male had obstructive or nonobstructive azoospermia. The efficiency of testicular sperm recovery was 99.4% and 99.3%, fertilization rate 57.1% and 49.1%, implantation rate 5.7% and 6.2%, and the clinical pregnancy rate 12.9% and 15.4% in men with obstructive and nonobstructive infertility, respectively.

Conclusion(s): The efficiency of TESA is very high in both obstructive and nonobstructive azoospermia. Because TESA is less invasive than TESE, it should be considered a valuable alternative to TESE in IVF programs, especially in setting where resources are limited.

Considerable controversy surrounds the use of hormone replacement therapy (HRT) for treatment of peri-menopausal symptoms. Recent publications from three large, prospective randomized studies call the safety of HRT into question, and leave patients searching for answers. Nutrient therapy may provide symptomatic relief without increasing risk of chronic disease. In this study, results of a series of uncontrolled prospective studies of peri-menopausal symptom relief using Menopace nutrient therapy were combined to provide a broad perspective on the safety and effectiveness of this alternative treatment modality. Data from seven studies with a total of 766 subjects were analyzed. Subjects with specific menopausal symptoms reported improvement after three months of daily use of the therapy, ranging from 87.8% of subjects with hot flashes to 67.5% of subjects with poor concentration reporting improvement. Overall improvement in menopausal symptoms was reported in 93.2% of all subjects. These results provide consistent evidence of the effectiveness of comprehensive, nutritionally balanced nutrient therapy for treatment of menopausal symptoms. While most evidence-based practitioners focus primarily on research results from randomized, controlled clinical trials, other forms of research evidence can also guide clinicians searching for safe and effective treatment options for their patients.

Objective: To assess the rate of blastocyst development (BDR) from embryos remaining in culture after day-3 embryo transfer (ET), and its relationship to cause of infertility.

Study design: Retrospective cohort study in tertiary-care IVF Center. Blastocyst development rate (BDR) after day-3 ET was assessed in 126 women who underwent either conventional IVF or ICSI.

Results: Mean age, early follicular FSH levels, number of 2PN zygotes, number of excess embryos, and number of ET were similar between patients that underwent IVF and ICSI. Overall, 20% of extra embryos from conventional IVF patients developed into blastocysts compared to 14% of embryos obtained from ICSI. Cause of infertility did not affect BDR, even in patients who required ICSI due to male factors.

Conclusions: Low rates of blastocyst development from excess embryos are similar between IVF and ICSI patients. Only 15 to 25% of excess embryos left in culture develop into blastocysts, regardless of cause of infertility. Physicians and patients can use this information to adjust both AR treatment protocols and patient expectations.

Proper nutritional status of women before, during, and after pregnancy is an important element of reproductive health. It maintains maternal health and reduces the risk of adverse pregnancy outcome, birth defects and chronic disease in children later in postnatal life. Pregnancy creates a special metabolic demand for high-quality nutrients. With careful food selection, it is possible to obtain most of the recommended levels of nutrients. Apart from the dietary intake, nutrition is highly dependant on economic status, social and cultural environment, and personal habits of the mother. Nutritional imbalance could cause detrimental effects to the pregnant woman, influence pregnancy outcome, and impair breast milk composition. Despite the extensive research, we still do not have a complete understanding how nutritional status of the mother influences her health as well as fetal growth and development. It is well known that fetal growth and development is strongly linked with maternal supply of essential nutrients, e.g. vitamins. The exact role of the variety of micronutrients in fetal growth and development has yet to be explored in detail. It is estimated that up to 30% of pregnant women suffer from a vitamin deficiency. Without supplementation, about 75% would show a deficit of at least one vitamin. Moreover, multivitamin deficit combinations often co-exist, and subclinical depletations are probably common; consequences could be severe. Studies carried on in developing countries have shown that improving micronutrient intake in deficient women can reduce maternal morbidity and mortality. Also, proper maternal intake of important micronutrients directly enhances the quality of breast milk. To meet the increasing demands during pregnancy and the breastfeeding period women should not be dependent only upon the dietary intake: adequate reserve is essential for the successful pregnancy outcome.

It is widely accepted that micronutrients have a major function in many periods of women's life, particularly during pregnancy and lactation. Inadequate stores or intake of micronutrients might have adverse effects both to the mother (hypertension, anemia, complications of labor) and the fetus (congenital malformations, pre-term delivery, intrauterine growth retardation). The effect of improper nutrition is influenced by gestational age, severity of deficiency, or both. Generally, the daily requirements in minerals and trace elements are easily met in women having a balanced diet. Such diet during pregnancy should provide the recommended daily allowance of all nutrients except elemental iron. Consequently, deficiency states are supposed to be rare in developed countries, and supplementation should be made on an individual basis. On the other hand, nutritional deficiencies during pregnancy might be difficult to detect. Studies from developing countries where micronutrient malnutrition is common during pregnancy gave us strong evidence that supplementation of certain trace elements and minerals could prevent some of the most severe adverse pregnancy outcomes. While some micronutrients have been studied extensively (e.g. calcium, iron, zinc, iodine), much less is known about others. It has been shown that multiple micronutrient deficiencies, rather than single deficiencies, are common. Our knowledge about the significance of interactions between micronutrients in relation to pregnancy outcome is limited. The role of these interactions in improving pregnancy outcome need to be investigated more precisely. According to the summarized data, the potential benefits of routine supplementation seem to outweigh any potential adverse reaction that can be attributed to their consumption.

The increased rates of twinning and the increased consumption of folic acid are two parallel processes described in recent years. However, the possible association between an increased incidence of twin pregnancies and periconceptional folic acid supplementation remains controversial. Whereas the data indicating that when folic acid levels are increased to the range required for reducing the incidence of neural tube defects, the data pertaining to the increase in twinning rate are significantly incoherent and are flawed by serious confounders, such as fertility treatments and maternal age. The only plausible theory connecting methyltetrahydrofolate reductase mutation, folic acid, and twinning has not been confirmed. In addition, temporal and dose-effect relationships have not been established. Because of the lack of coherence, questionable plausibility, and no clear dose-effect and temporal relationships, a cause (folic acid supplementation) and effect (increased twinning rate) association cannot be, at present, accepted. Thus, the established policy of peri-conceptional folic acid supplementation to reduce the incidence of neural tube defects should be continued.

Objective: To evaluate a new climacteric symptom scale (SUMEVA) and to assess its correlation with follicle stimulating hormone (FSH) and estradiol (E2) levels.

Methods: 115 healthy perimenopausal women who were not receiving, nor had received, hormone therapy were studied. They were asked to complete 3 questionnaires concerning climacteric symptoms: (1) Kupperman's index (KI), (2) Green scale (GS), and (3) SUMEVA, which is the sum of symptom evaluations done in an analog visual scale. FSH and E2 determinations were done by chemoluminiscence.

Statistical analysis: The comparison among the groups was done by Student's t test. Pearson correlation analysis was done between FSH and E2 levels and KI, the GS, and SUMEVA.

Results: There were 60 women with FSH < or = 30 mIU/mL (group I) and 55 with FSH > 30 mIU/mL (group II). The KI average in the whole group was 13.2 +/- 8.1, the GS 20.6 +/- 13.1, and the SUMEVA 65.6 +/- 44.9. The three scales had a significant correlation between them.

Conclusions: No correlation of KI, GS, or SUMEVA was found with FSH and E2 levels, but the SUMEVA was as effective as the other previously validated, scales for climacteric symptom evaluation.

Objective: To study bone mineral density and body composition in patients with early rheumatoid arthritis to determine the relationship of lean mass, fat mass and hand grip strength to bone mineral density.

Methods: Fifty-one female patients who fulfilled the American College of Rheumatology (ACR) for RA were recruited. Fifty-one (51) female RA patients, age matched female control subjects and 53 osteoporotic patients (WHO criteria) were included in the study. All subjects were at postmenopausal period. Early RA is defined as the disease duration <10 years. Whole body composition and BMD were estimated by DEXA (Norland XR-46). Hand grip strength was measured by JAMAR hand dynamometer. Body mass index (BMI) and anthropometric measures (skinfold thickness and waist-hip ratio) were also assessed.

Results: The mean age of patients and controls was 55.4 +/- 9.5, 56.9 +/- 7.4, and 55.2 +/- 7.6, respectively. There was no statistically significant difference in age, BMI, and years since menopause between RA patients, OP patients, and controls (p < 0.05). Bone mineral density of lumbar and femoral neck regions, total bone mineral density, and bone mineral content in RA patients were significantly lower than in controls but not in osteoporotic patients. Lean body mass was also significantly lower in RA patients than controls but not in osteoporotic patients. However, hand grip strength was significantly lower in RA patients than in osteoporotic patients and controls (p < 0.05). Total lean mass was correlated with body mass index, waist-hip ratio, femoral neck BMD, and total bone mineral content, total BMD in RA patients (p < 0.05). Grip strength was correlated with duration of disease (RA) and age negatively, and also correlated with total BMD in RA patients.

Conclusion: These results indicate that lean mass was associated with BMD. To preserve BMD, maintaining or increasing lean mass would appear to be an appropriate strategy for avoiding hip fracture and its complications.

Every year, about 210 million women become pregnant. Postpartum hemorrhage (PPH) is one of the major complications of pregnancy, accounting for 14 million cases annually. Of these, it is estimated that around 140,000 women die, resulting in a case fatality rate of 1%. PPH is defined by WHO as a blood loss > or = 500 mls. Most instances of PPH occur suddenly and without warning even in women without any of the known risks for this condition. If women do not receive timely medical treatment, as is often the case in many parts of the world, death can occur within two hours. The chance of receiving a safe blood transfusion as part of the therapy for PPH varies enormously from country to country, depending on whether a safe blood transfusion program has been set up as a part of the national health policy. The increasing realization of the potential deleterious effects of blood transfusion, including exposure to HIV and other viral agents, has changed the practices that were previously acceptable for the transfusion of blood, as has the recent recognition of specific patients who will benefit from a single unit of blood. In countries with limited resources, where a majority of women have anemia at the onset of their pregnancies, the slightest deviation from normality during labor and/or delivery leading to excessive hemorrhage can put a women's life at risk. In these instances, the patient needs urgent resuscitation, stabilization and transfer to a nearby center. Available blood, preferably typed cross matched and screened for infections, should be given until the patient receives specific treatment. This is especially true in bled- out obstetrics patients, where one unit may make the difference between a near death state and the possibility of slow recovery and survival.