Groups presented similar pregnancy (36.2% x 31.2%; p¼0.385) and multiple pregnancy rates (31.1% x... more Groups presented similar pregnancy (36.2% x 31.2%; p¼0.385) and multiple pregnancy rates (31.1% x 25.0%; p¼0.541). CONCLUSIONS: Limiting the number of embryos transferred can benefit the bottom line by decreasing the incidence of multiple pregnancy. We hypothesized that patients who failed in fresh eSET could present worst prognosis and hence had lower multiple pregnancy rates in a second attempt with two embryos transferred. However, in this sample, the second transfer with two elective embryos, after a failed elective transfer of one embryo, was not effective to protect this population of multiple gestation, suggesting that for this purpose the appointment of new elective transfer of an embryo would be the most appropriate for good prognosis patients, even after a failure Supported by: Not applicable.
balloon introducer to be inserted in the pouch of Douglas in order to evaluate the status of ovar... more balloon introducer to be inserted in the pouch of Douglas in order to evaluate the status of ovaries, tubes and peritoneum with the help of a 2.9 mm scope Results: In total, 300 fertiloscopies were performed. Results are summarized in the following Table: PID = pelvic inflammatory disease. Conclusion: This technique has proved to be safe and reliable. Of course the aim is not to replace laparoscopy, which remains the 'gold standard' in the treatment of tubo-ovarian disease. Nevertheless, the quality of imaging provided by fertiloscopy, the recent development given by the micro-salpingoscopy, allowing an 'in-vivo tubal histology' and the realization of the first operative fertiloscopies, are going to give a brilliant future for this new mini-invasive approach.
Reproductive biology and endocrinology : RB&E, Jan 5, 2016
To preclude transfer of aneuploid embryos, current preimplantation genetic screening (PGS) usuall... more To preclude transfer of aneuploid embryos, current preimplantation genetic screening (PGS) usually involves one trophectoderm biopsy at blastocyst stage, assumed to represent embryo ploidy. Whether one such biopsy can correctly assess embryo ploidy has recently, however, been questioned. This descriptive study investigated accuracy of PGS in two ways. Part I: Two infertile couples donated 11 embryos, previously diagnosed as aneuploid and, therefore, destined to be discarded. They were dissected into 37 anonymized specimens, and sent to another national laboratory for repeat analyses to assess (i) inter-laboratory congruity and (ii) intra-embryo congruity of multiple embryo biopsies in a single laboratory. Part II: Reports on human IVF cycle outcomes after transfer of allegedly aneuploid embryos into 8 infertile patients. Only 2/11 (18.2 %) embryos were identically assessed at two PGS laboratories; 4/11 (36.4 %), on repeat analysis were chromosomally normal, 2 mosaic normal/abnormal,...
To assess the clinical utility of prescribing a sliding scale regimen for methotrexate administer... more To assess the clinical utility of prescribing a sliding scale regimen for methotrexate administered in cases of persistent ectopic pregnancy, a prospectively designed clinical trial was performed. Patients (« = 37) previously operated on for ectopic pregnancy by laparoscopic salpingostomy and found to have persistent disease were enrolled into the study. Methotrexate was given intramuscularly at a dose of 1 mg/kg body weight, with the number of doses administered depending on the presenting level of serum beta-human chorionic gonadotropin (/J-hCG). Group 1 (n = 27), levels of 10-1500 mIU/ml, received a single dose; group 2 (n = 5), levels of 1500-2500 mIU/ml, received two doses 3 days apart; group 3 (n = 5), levels >2500 mIU/ml, received three doses 3 days apart. Patients were followed with weekly transvaginal ultrasound examinations, and serum /3-hCG and progesterone measurements. Results noted resolution in all three treatment groups without the requirement of surgery or further treatment: group 1, 19.9 ± 1.7 days; group 2, 35.2 ± 4.5 days; group 3, 49.0 ± 1.0 days. All patients remained asymptomatic, and no adverse side effects from the drug were experienced. We conclude, although preliminary, that a sliding scale approach to prescribing methotrexate based on the initial serum titer of ß-hCG to treat persistent ectopic pregnancy is easy to use, efficacious, and likely results in complete resolution of the condition. In most cases, even with presenting levels of /3-hCG > 2500 mIU/ml, persistent disease will resolve within 50 days of initiating care.
Laparoscopic hysterectomy and pelvic floor reconstruction have recently undergone some degree of ... more Laparoscopic hysterectomy and pelvic floor reconstruction have recently undergone some degree of evolution. New instrumentation has appeared, such as the vaginal delineator, but overall most of the instruments used have remained basically unchanged. This is related mostly to the need of keeping costs down by limiting the use of disposable instrumentation. For pelvic reconstruction, the laparoscopic approach is now usually considered the optimal approach, as it allows the surgeon to visualize structures that the vaginal surgeon could in the past only palpate.
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
The majority of laparoscopic complications occur at the time of Veress needle and trocar insertio... more The majority of laparoscopic complications occur at the time of Veress needle and trocar insertion. Although not very frequent, they increase the morbidity and mortality of both diagnostic and operative laparoscopic procedures. Alternative techniques of trocar insertion have been described but have not completely eliminated the risk of injury. After Veress needle insertion and establishment of pneumoperitoneum to 25 to 30 mm Hg, insertion of a short trocar is performed in the deepest part of the umbilicus without elevation of the anterior abdominal wall. The result is a parietal peritoneal puncture directly beneath the umbilicus. The high-pressure setting used during initial insertion of the trocar is lowered as soon as safe abdominal entry is documented. The trocar insertion technique described above was performed in 3041 procedures. No vascular injury occurred. There were two bowel perforations. No complications related to the increased intra-abdominal pressure were observed. The ...
Our purpose was to assess the value of monitoring serum P and inhibin A to determine how values m... more Our purpose was to assess the value of monitoring serum P and inhibin A to determine how values might improve the clinical monitoring of natural cycle in vitro fertilization (IVF)-embryo transfer (ET) patients. All patients (n = 26) who underwent natural-cycle IVF-ET (n = 35) were analyzed. Groups were evaluated according to patients who had a spontaneous luteinizing hormone (LH) surge (group I) and women receiving human chorionic gonadotropin (hCG) who underwent subsequent oocyte aspiration (group II). Group II was further evaluated according to women who did (n = 10) and did not (n = 7) have an ET. All cycles were evaluated with serial transvaginal ultrasonography and serum estradiol, progesterone, and inhibin A. When follicle maturity was achieved, hCG, 10,000 IU, was administered intramuscularly if a LH surge was not detected. Transvaginal ultrasound-guided aspiration was performed 34-36 hr after hCG administration followed by a 48-hr transcervical ET. No differences were seen i...
Best Practice & Research Clinical Obstetrics & Gynaecology, 1999
The surgical treatment of patients with dysfunctional uterine bleeding (DUB) is discussed in this... more The surgical treatment of patients with dysfunctional uterine bleeding (DUB) is discussed in this chapter, including indications, techniques and complications. Hysterectomy is the definitive treatment for DUB; in most studies it has a higher rate of patient satisfaction than does hysteroscopic endometrial ablation. The vaginal or laparoscopic approach should be selected in this group of patients with small uteri, while laparotomy is seldom indicated. In general, the indications for vaginal hysterectomy and endometrial ablation differ from those of laparoscopic hysterectomy. Ablation and vaginal hysterectomy are done for hypermenorrhoea, while laparoscopic hysterectomy is best when pathology is present, usually adhesions, endometriosis or fibroids.
Background The incidence of multiple gestation after therapy for infertility is especially high a... more Background The incidence of multiple gestation after therapy for infertility is especially high among women in whom ovulation is induced with gonadotropins. Whether the number of high-order multiple pregnancies (those with three or more fetuses) can be reduced is not known. Methods We analyzed data on 3347 consecutive treatment cycles in 1494 infertile women, 441 of which resulted in pregnancy. The data collected included the peak serum estradiol concentration, the number of follicles 16 mm or larger in diameter, and the total number of follicles on the day of induction of ovulation with human chorionic gonadotropin. Receiveroperating-characteristic curves and ordinal logisticregression analyses were used to identify values that predicted multiple conceptions. Results Among the 441 pregnancies, 314 resulted from the conception of singletons, 88 of twins, 22 of triplets, 10 of quadruplets, 5 of quintuplets, and 2 of sextuplets. Neither the number of follicles 16 mm or larger nor peak serum estradiol concentrations greater than 2000 or 2500 pg per milliliter (7342 or 9178 pmol per liter) (the cutoff values currently in wide use) were significantly associated with the incidence of high-order multiple pregnancy. However, increasing total numbers of follicles and increasing peak serum estradiol concentrations correlated significantly with an increasing risk of high-order multiple pregnancy (P<0.001), as did younger age (P=0.008). The risk of high-order multiple pregnancy was significantly increased in women with a peak serum estradiol concentration of 1385 pg per milliliter (5084 pmol per liter) or higher (multivariate odds ratio, 1.9; 95 percent confidence interval, 1.3 to 2.8) or with seven or more follicles (multivariate odds ratio, 2.1; 95 percent confidence interval, 1.2 to 3.9) on the day of induction of ovulation. Conclusions Gonadotropin stimulation that is less intensive than is currently customary may reduce the incidence of high-order multiple pregnancy in infertile women, though only to a limited extent and at the expense of overall pregnancy rates.
The relevance of abnormal autoimmune function to reproductive function in the female has over rec... more The relevance of abnormal autoimmune function to reproductive function in the female has over recent years become an increasingly controversial and contentious issue. Opposing views have led to a polarization of opinions which, at times, resulted in publications of rather vocal opinions by individuals as well as societal committees. This communication is an attempt to reconcile these, at times diametrically opposing opinions, in a concept of (auto)immune-driven reproduction failure, which could explain and unify these opposing opinions and, thus, hopefully end the ongoing 'immunological wars of the roses'.
The aim of this study was to determine the usefulness of routine intra-operative cystoscopy in do... more The aim of this study was to determine the usefulness of routine intra-operative cystoscopy in documenting ureteral injury during total laparoscopic hysterectomy with vault suspension and to document the incidence of this complication in a large series. The charts of 118 patients who underwent laparoscopic hysterectomy with vault suspension from January 1992 to January 1998 were retrospectively reviewed. The patients underwent intra-operative cystoscopic evaluation to verify ureteral permeability and bladder integrity. Intra-operative ureteral obstruction occurred in four patients (3.4%). All complications were immediately fixed and there were no postoperative ureteral problems. No late ureteral complications were observed. Intra-operative cystoscopy allows for early recognition and treatment of obstructive ureteral injuries and may reduce the rate of late postoperative complications during advanced laparoscopic procedures.
Adrenal hyperandrogenism is prevalent in many women with polycystic ovary syndrome (PCOS), althou... more Adrenal hyperandrogenism is prevalent in many women with polycystic ovary syndrome (PCOS), although the expression of this enhanced secretion may be heterogeneous. Since no single factor acts in isolation, this study was performed to assess the influence of oestradiol (total and unbound), insulin, insulin-like growth factor (IGF)-I, IGF-II and the binding proteins IGFBP-I, and IGFBP-3, on basal and adrenocorticotrophic hormone (ACTH) stimulated adrenal androgen secretion in 25 women with PCOS and 10 matched ovulatory controls. Women with PCOS exhibited elevations of all androgens as well as unbound oestradiol, insulin and non-IGFBP-1 bound IGF-I. Positive correlations were noted between oestrogen and basal and ACTH stimulated ∆ 5 adrenal androgens. Serum IGF-I was only correlated with basal dehydroepiandrosterone sulphate (DHEA-S), while insulin exhibited a strong correlation with the ∆ 4 pathway and androstenedione formation in particular. This correlation was also confirmed by dividing the PCOS group into those women with and without hyperinsulinaemia. The activity of 17,20 lyase favouring androstenedione was increased in the hyperinsulinaemic women. By multivariate analyses, body mass index did not influence these findings. Although there are inherent difficulties in making major conclusions based on correlative analyses, it is suggested that oestrogen may have a greater influence on enhancing ∆ 5 adrenal androgen secretion, and insulin a greater effect on the ∆ 4 pathway. In turn, the relative importance of these influences may contribute to the heterogeneous nature of adrenal hyperandrogenism in PCOS.
reproduction tissues. In summary, effects of ROS on female reproduction are not still clear and n... more reproduction tissues. In summary, effects of ROS on female reproduction are not still clear and needs further investigation.
Objective: To assess the efficacy of human embryo twinning by blastomere biopsy at different earl... more Objective: To assess the efficacy of human embryo twinning by blastomere biopsy at different early embryonic stages (splitting efficiency) and to determine the in vitro developmental capacity of twinned human embryos (developmental efficiency). Design: Randomized comparative study. Setting: Private IVF centers. Patient(s): Couples undergoing IVF donating triploid embryos. Intervention(s): Embryos at the 2-to 5-and 6-to 8-cell stage were split into twin embryos. Half the number of blastomeres from donor embryos were removed and inserted into recipient empty zonae pellucidae. After embryo splitting, donor and recipient embryos were cultured in vitro. Main Outcome Measure(s): Development of twinned embryos to the blastocyst stage. Result(s): The number of developing embryos obtained after splitting could be increased in comparison with the number of embryos available before splitting at the 6-to 8-cell stage but not at the 2-to 5-cell stage (splitting efficiency). Splitting of 6-to 8-cell embryos yielded superior rates of twin embryos developing to blastocysts (developmental efficiency). Twinning success was related to the superior morphological quality of embryos used for splitting. Conclusion(s): This is the first report on twinned human embryos developing to blastocysts. This study exhibits the potential for novel applications in human assisted reproduction. (Fertil Steril Ò 2010;93:423-7. Ó2010 by American Society for Reproductive Medicine.
Groups presented similar pregnancy (36.2% x 31.2%; p¼0.385) and multiple pregnancy rates (31.1% x... more Groups presented similar pregnancy (36.2% x 31.2%; p¼0.385) and multiple pregnancy rates (31.1% x 25.0%; p¼0.541). CONCLUSIONS: Limiting the number of embryos transferred can benefit the bottom line by decreasing the incidence of multiple pregnancy. We hypothesized that patients who failed in fresh eSET could present worst prognosis and hence had lower multiple pregnancy rates in a second attempt with two embryos transferred. However, in this sample, the second transfer with two elective embryos, after a failed elective transfer of one embryo, was not effective to protect this population of multiple gestation, suggesting that for this purpose the appointment of new elective transfer of an embryo would be the most appropriate for good prognosis patients, even after a failure Supported by: Not applicable.
balloon introducer to be inserted in the pouch of Douglas in order to evaluate the status of ovar... more balloon introducer to be inserted in the pouch of Douglas in order to evaluate the status of ovaries, tubes and peritoneum with the help of a 2.9 mm scope Results: In total, 300 fertiloscopies were performed. Results are summarized in the following Table: PID = pelvic inflammatory disease. Conclusion: This technique has proved to be safe and reliable. Of course the aim is not to replace laparoscopy, which remains the 'gold standard' in the treatment of tubo-ovarian disease. Nevertheless, the quality of imaging provided by fertiloscopy, the recent development given by the micro-salpingoscopy, allowing an 'in-vivo tubal histology' and the realization of the first operative fertiloscopies, are going to give a brilliant future for this new mini-invasive approach.
Reproductive biology and endocrinology : RB&E, Jan 5, 2016
To preclude transfer of aneuploid embryos, current preimplantation genetic screening (PGS) usuall... more To preclude transfer of aneuploid embryos, current preimplantation genetic screening (PGS) usually involves one trophectoderm biopsy at blastocyst stage, assumed to represent embryo ploidy. Whether one such biopsy can correctly assess embryo ploidy has recently, however, been questioned. This descriptive study investigated accuracy of PGS in two ways. Part I: Two infertile couples donated 11 embryos, previously diagnosed as aneuploid and, therefore, destined to be discarded. They were dissected into 37 anonymized specimens, and sent to another national laboratory for repeat analyses to assess (i) inter-laboratory congruity and (ii) intra-embryo congruity of multiple embryo biopsies in a single laboratory. Part II: Reports on human IVF cycle outcomes after transfer of allegedly aneuploid embryos into 8 infertile patients. Only 2/11 (18.2 %) embryos were identically assessed at two PGS laboratories; 4/11 (36.4 %), on repeat analysis were chromosomally normal, 2 mosaic normal/abnormal,...
To assess the clinical utility of prescribing a sliding scale regimen for methotrexate administer... more To assess the clinical utility of prescribing a sliding scale regimen for methotrexate administered in cases of persistent ectopic pregnancy, a prospectively designed clinical trial was performed. Patients (« = 37) previously operated on for ectopic pregnancy by laparoscopic salpingostomy and found to have persistent disease were enrolled into the study. Methotrexate was given intramuscularly at a dose of 1 mg/kg body weight, with the number of doses administered depending on the presenting level of serum beta-human chorionic gonadotropin (/J-hCG). Group 1 (n = 27), levels of 10-1500 mIU/ml, received a single dose; group 2 (n = 5), levels of 1500-2500 mIU/ml, received two doses 3 days apart; group 3 (n = 5), levels >2500 mIU/ml, received three doses 3 days apart. Patients were followed with weekly transvaginal ultrasound examinations, and serum /3-hCG and progesterone measurements. Results noted resolution in all three treatment groups without the requirement of surgery or further treatment: group 1, 19.9 ± 1.7 days; group 2, 35.2 ± 4.5 days; group 3, 49.0 ± 1.0 days. All patients remained asymptomatic, and no adverse side effects from the drug were experienced. We conclude, although preliminary, that a sliding scale approach to prescribing methotrexate based on the initial serum titer of ß-hCG to treat persistent ectopic pregnancy is easy to use, efficacious, and likely results in complete resolution of the condition. In most cases, even with presenting levels of /3-hCG > 2500 mIU/ml, persistent disease will resolve within 50 days of initiating care.
Laparoscopic hysterectomy and pelvic floor reconstruction have recently undergone some degree of ... more Laparoscopic hysterectomy and pelvic floor reconstruction have recently undergone some degree of evolution. New instrumentation has appeared, such as the vaginal delineator, but overall most of the instruments used have remained basically unchanged. This is related mostly to the need of keeping costs down by limiting the use of disposable instrumentation. For pelvic reconstruction, the laparoscopic approach is now usually considered the optimal approach, as it allows the surgeon to visualize structures that the vaginal surgeon could in the past only palpate.
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
The majority of laparoscopic complications occur at the time of Veress needle and trocar insertio... more The majority of laparoscopic complications occur at the time of Veress needle and trocar insertion. Although not very frequent, they increase the morbidity and mortality of both diagnostic and operative laparoscopic procedures. Alternative techniques of trocar insertion have been described but have not completely eliminated the risk of injury. After Veress needle insertion and establishment of pneumoperitoneum to 25 to 30 mm Hg, insertion of a short trocar is performed in the deepest part of the umbilicus without elevation of the anterior abdominal wall. The result is a parietal peritoneal puncture directly beneath the umbilicus. The high-pressure setting used during initial insertion of the trocar is lowered as soon as safe abdominal entry is documented. The trocar insertion technique described above was performed in 3041 procedures. No vascular injury occurred. There were two bowel perforations. No complications related to the increased intra-abdominal pressure were observed. The ...
Our purpose was to assess the value of monitoring serum P and inhibin A to determine how values m... more Our purpose was to assess the value of monitoring serum P and inhibin A to determine how values might improve the clinical monitoring of natural cycle in vitro fertilization (IVF)-embryo transfer (ET) patients. All patients (n = 26) who underwent natural-cycle IVF-ET (n = 35) were analyzed. Groups were evaluated according to patients who had a spontaneous luteinizing hormone (LH) surge (group I) and women receiving human chorionic gonadotropin (hCG) who underwent subsequent oocyte aspiration (group II). Group II was further evaluated according to women who did (n = 10) and did not (n = 7) have an ET. All cycles were evaluated with serial transvaginal ultrasonography and serum estradiol, progesterone, and inhibin A. When follicle maturity was achieved, hCG, 10,000 IU, was administered intramuscularly if a LH surge was not detected. Transvaginal ultrasound-guided aspiration was performed 34-36 hr after hCG administration followed by a 48-hr transcervical ET. No differences were seen i...
Best Practice & Research Clinical Obstetrics & Gynaecology, 1999
The surgical treatment of patients with dysfunctional uterine bleeding (DUB) is discussed in this... more The surgical treatment of patients with dysfunctional uterine bleeding (DUB) is discussed in this chapter, including indications, techniques and complications. Hysterectomy is the definitive treatment for DUB; in most studies it has a higher rate of patient satisfaction than does hysteroscopic endometrial ablation. The vaginal or laparoscopic approach should be selected in this group of patients with small uteri, while laparotomy is seldom indicated. In general, the indications for vaginal hysterectomy and endometrial ablation differ from those of laparoscopic hysterectomy. Ablation and vaginal hysterectomy are done for hypermenorrhoea, while laparoscopic hysterectomy is best when pathology is present, usually adhesions, endometriosis or fibroids.
Background The incidence of multiple gestation after therapy for infertility is especially high a... more Background The incidence of multiple gestation after therapy for infertility is especially high among women in whom ovulation is induced with gonadotropins. Whether the number of high-order multiple pregnancies (those with three or more fetuses) can be reduced is not known. Methods We analyzed data on 3347 consecutive treatment cycles in 1494 infertile women, 441 of which resulted in pregnancy. The data collected included the peak serum estradiol concentration, the number of follicles 16 mm or larger in diameter, and the total number of follicles on the day of induction of ovulation with human chorionic gonadotropin. Receiveroperating-characteristic curves and ordinal logisticregression analyses were used to identify values that predicted multiple conceptions. Results Among the 441 pregnancies, 314 resulted from the conception of singletons, 88 of twins, 22 of triplets, 10 of quadruplets, 5 of quintuplets, and 2 of sextuplets. Neither the number of follicles 16 mm or larger nor peak serum estradiol concentrations greater than 2000 or 2500 pg per milliliter (7342 or 9178 pmol per liter) (the cutoff values currently in wide use) were significantly associated with the incidence of high-order multiple pregnancy. However, increasing total numbers of follicles and increasing peak serum estradiol concentrations correlated significantly with an increasing risk of high-order multiple pregnancy (P<0.001), as did younger age (P=0.008). The risk of high-order multiple pregnancy was significantly increased in women with a peak serum estradiol concentration of 1385 pg per milliliter (5084 pmol per liter) or higher (multivariate odds ratio, 1.9; 95 percent confidence interval, 1.3 to 2.8) or with seven or more follicles (multivariate odds ratio, 2.1; 95 percent confidence interval, 1.2 to 3.9) on the day of induction of ovulation. Conclusions Gonadotropin stimulation that is less intensive than is currently customary may reduce the incidence of high-order multiple pregnancy in infertile women, though only to a limited extent and at the expense of overall pregnancy rates.
The relevance of abnormal autoimmune function to reproductive function in the female has over rec... more The relevance of abnormal autoimmune function to reproductive function in the female has over recent years become an increasingly controversial and contentious issue. Opposing views have led to a polarization of opinions which, at times, resulted in publications of rather vocal opinions by individuals as well as societal committees. This communication is an attempt to reconcile these, at times diametrically opposing opinions, in a concept of (auto)immune-driven reproduction failure, which could explain and unify these opposing opinions and, thus, hopefully end the ongoing 'immunological wars of the roses'.
The aim of this study was to determine the usefulness of routine intra-operative cystoscopy in do... more The aim of this study was to determine the usefulness of routine intra-operative cystoscopy in documenting ureteral injury during total laparoscopic hysterectomy with vault suspension and to document the incidence of this complication in a large series. The charts of 118 patients who underwent laparoscopic hysterectomy with vault suspension from January 1992 to January 1998 were retrospectively reviewed. The patients underwent intra-operative cystoscopic evaluation to verify ureteral permeability and bladder integrity. Intra-operative ureteral obstruction occurred in four patients (3.4%). All complications were immediately fixed and there were no postoperative ureteral problems. No late ureteral complications were observed. Intra-operative cystoscopy allows for early recognition and treatment of obstructive ureteral injuries and may reduce the rate of late postoperative complications during advanced laparoscopic procedures.
Adrenal hyperandrogenism is prevalent in many women with polycystic ovary syndrome (PCOS), althou... more Adrenal hyperandrogenism is prevalent in many women with polycystic ovary syndrome (PCOS), although the expression of this enhanced secretion may be heterogeneous. Since no single factor acts in isolation, this study was performed to assess the influence of oestradiol (total and unbound), insulin, insulin-like growth factor (IGF)-I, IGF-II and the binding proteins IGFBP-I, and IGFBP-3, on basal and adrenocorticotrophic hormone (ACTH) stimulated adrenal androgen secretion in 25 women with PCOS and 10 matched ovulatory controls. Women with PCOS exhibited elevations of all androgens as well as unbound oestradiol, insulin and non-IGFBP-1 bound IGF-I. Positive correlations were noted between oestrogen and basal and ACTH stimulated ∆ 5 adrenal androgens. Serum IGF-I was only correlated with basal dehydroepiandrosterone sulphate (DHEA-S), while insulin exhibited a strong correlation with the ∆ 4 pathway and androstenedione formation in particular. This correlation was also confirmed by dividing the PCOS group into those women with and without hyperinsulinaemia. The activity of 17,20 lyase favouring androstenedione was increased in the hyperinsulinaemic women. By multivariate analyses, body mass index did not influence these findings. Although there are inherent difficulties in making major conclusions based on correlative analyses, it is suggested that oestrogen may have a greater influence on enhancing ∆ 5 adrenal androgen secretion, and insulin a greater effect on the ∆ 4 pathway. In turn, the relative importance of these influences may contribute to the heterogeneous nature of adrenal hyperandrogenism in PCOS.
reproduction tissues. In summary, effects of ROS on female reproduction are not still clear and n... more reproduction tissues. In summary, effects of ROS on female reproduction are not still clear and needs further investigation.
Objective: To assess the efficacy of human embryo twinning by blastomere biopsy at different earl... more Objective: To assess the efficacy of human embryo twinning by blastomere biopsy at different early embryonic stages (splitting efficiency) and to determine the in vitro developmental capacity of twinned human embryos (developmental efficiency). Design: Randomized comparative study. Setting: Private IVF centers. Patient(s): Couples undergoing IVF donating triploid embryos. Intervention(s): Embryos at the 2-to 5-and 6-to 8-cell stage were split into twin embryos. Half the number of blastomeres from donor embryos were removed and inserted into recipient empty zonae pellucidae. After embryo splitting, donor and recipient embryos were cultured in vitro. Main Outcome Measure(s): Development of twinned embryos to the blastocyst stage. Result(s): The number of developing embryos obtained after splitting could be increased in comparison with the number of embryos available before splitting at the 6-to 8-cell stage but not at the 2-to 5-cell stage (splitting efficiency). Splitting of 6-to 8-cell embryos yielded superior rates of twin embryos developing to blastocysts (developmental efficiency). Twinning success was related to the superior morphological quality of embryos used for splitting. Conclusion(s): This is the first report on twinned human embryos developing to blastocysts. This study exhibits the potential for novel applications in human assisted reproduction. (Fertil Steril Ò 2010;93:423-7. Ó2010 by American Society for Reproductive Medicine.
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