Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment

Obesity affects ovulation, response to fertility treatment, pregnancy rates and outcome. In this prospective study, a weight loss programme was assessed to determine whether it could help obese infertile women, irrespective of their infertility diagnosis, to achieve a viable pregnancy, ideally without further medical intervention. The subjects underwent a weekly programme aimed at lifestyle changes in relation to exercise and diet for 6 months; those that did not complete the 6 months were treated as a comparison group. Women in the study lost an average of 10.2 kg/m2, with 60 of the 67 anovulatory subjects resuming spontaneous ovulation, 52 achieving a pregnancy (18 spontaneously) and 45 a live birth. The miscarriage rate was 18%, compared to 75% for the same women prior to the programme. Psychometric measurements also improved. None of these changes occurred in the comparison group. The cost savings of the programme were considerable. Prior to the programme, the 67 women had had treatment costing a total of A$550,000 for two live births, a cost of A$275,000 per baby. After the programme, the same women had treatment costing a total of A$210,000 for 45 babies, a cost of A$4600 per baby. Thus weight loss should be considered as a first option for women who are infertile and overweight.     

Contracting, prompting, and reinforcing substance use disorder continuing care: A randomized clinical trial.

Although continuing care is strongly related to positive treatment outcomes for substance use disorder (SUD), participation rates are low and few effective interventions are available. In a randomized clinical trial with 150 participants (97% men), 75 graduates of a residential Veterans Affairs Medical Center SUD program who received an aftercare contract, attendance prompts, and reinforcers (CPR) were compared to 75 graduates who received standard treatment (STX). Among CPR participants, 55% completed at least 3 months of aftercare, compared to 36% in STX. Similarly, CPR participants remained in treatment longer than those in STX (5.5 vs. 4.4 months). Additionally, CPR participants were more likely to be abstinent compared to STX (57% vs. 37%) after 1 year. The CPR intervention offers a practical means to improve adherence among individuals in SUD treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cardiovascular prevention, primary or secondary, in high risk patients

Two groups of patients admitted to hospital consecutively for coronary artery disease in 36 university hospital departments were interrogated about the advice received and followed concerning cardiovascular prevention both before the clinical onset of the disease (Group I), those with disease of less than one month duration (primary prevention), or after this period (Group II), those with disease for over six months (secondary prevention). The follow-up of risk factors or medical advice concerning prevention (dietary and/or treatment) was more common, and compliance to the advice was better, in secondary prevention. However, in both groups, with the exception of hypertension, the diagnosis and follow-up of the risk factors were incomplete with 19% vs 41% (p < or = 0.001) of serum cholesterol levels unmeasured before the onset of clinical disease; during the last 5 years, 41% vs 12% (cholesterol, p < or = 0.001) and 27% vs 9% (serum glucose, p < or = 0.001) were not checked. At least one measure of prevention had been advised to 66% vs 80% (p < or = 0.001) of patients and the measures taken concern 53 vs 75% (p < or = 0.001) of patients: serum cholesterol 27% vs 51% (p < or = 0.001), hypertension 32% vs 36% (NS) and serum glucose 14% vs 21% (p < or = 0.05). Compliance with advice was mediocre with regards to diet and cholesterol lowering drugs. A large proportion of patients in both groups had higher than recommended levels, including those on diet or treatment. These observations, confirmed in France and abroad, suggest that cardiovascular prevention should be better organised.     

Cytotoxicity versus antibacterial activity of some antiseptics in vitro

The relationship between endometriosis and infertility is observed frequently. Patients with both conditions require a conservative approach to their management. Since hormonal therapy is one of those approaches, we sought to compare the efficacy of Danazol and Gestrinone in 80 infertile patients (48 and 32, respectively). Therapy lasted 6 months in both treatment groups, and all patients studied had laboratory tests performed and were clinically evaluated and classified through laparoscopy before and after therapy. The improvement of symptoms and favorable follow-up were similar with both treatments. The reestablishment of menstrual patterns and fertility were also nearly alike in both groups. However, Gestrinone was associated with fewer secondary effects and is easier to administer than Danazol. We conclude that Gestrinone is a useful medication in the management of the infertile patient with endometriosis.     

Identification and treatment of leukocytospermia in couples with unexplained infertility

OBJECTIVE: To evaluate whether identifying men with leukocytospermia in couples with unexplained infertility and treating them with antibiotics improves pregnancy rates. STUDY DESIGN: A prospective, cohort study of men with and without leukocytospermia was identified on a smear of semen using Bryan-Leishman stain. Cumulative six-month pregnancy rates were determined for members of the leukocytospermic group who responded to treatment with resolution of their leukocytospermia on a semen smear, those who failed to respond to treatment, those not treated and those without leukocytospermia. RESULTS: Thirty-six of 53 men with leukocytospermia responded to antibiotic treatment, and 19 women in these 36 couples (53%) became pregnant within the six-month follow-up period. Only 7 of 17 (6%) of those who failed to respond to treatment had their partner become pregnant (P < .001). Partners of men with leukocytospermia and no treatment had a 6% pregnancy rate, and the women in 13% (5/42) of couples without leukocytospermia became pregnant (P < .001). CONCLUSION: Leukocytospermia exists in a significant number of males with unexplained infertility and normal semen analyses. Identifying and successfully treating such men results in a significant improvement in pregnancy rates. These men may be a subgroup with male infertility that can be identified and treated.     

Antiovarian antibodies and their effect on the outcome of assisted reproduction

PURPOSE: To compare the presence in levels of antiovarian antibodies (AOAb) in the pre- and postovulatory stage from serum of infertile patients undergoing intrauterine insemination (IUI) or in vitro fertilization (IVF) with outcome of the procedures. RESULTS: Serum from 36 women undergoing IUI, 36 women undergoing IVF and 25 fertile, healthy controls were assayed for the presence of AOAb by a commercially available ELISA kit. AOAb was positive in 59.7% of infertile women, while none of the fertile controls were positive for AOAb. The levels of these antibodies increased as the patient age and the number of treatment attempts increased. Though the presence of AOAb did not affect oocyte recovery rate, it resulted in decreased fertilization rate, cleavage rate, and pregnancy rate in infertile women. CONCLUSIONS: Our studies suggest that AOAb may be a cause of infertility and presence of these antibodies could have adverse effects on the outcome of assisted reproductive techniques.     

Crib death in the eastern regions of Norway 1984-1992. A survey of risk factors

Cot death is the most important cause of death during the first year of life after the newborn period in Norway. A case control study was performed by sending questionnaires to 188 cot death parents and 475 control parents with infants matched for age, sex and time of birth. 76% of the cot death parents and 79% of the control parents completed the questionnaires. The male/female ratio of the babies in both groups was 64/36. The age distribution showed a peak between two and four months. 65% succumbed during the winter months. During the winter 32% died outdoors. This was true for only 16% of those who died during summer. A higher proportion of the cot death cases than the controls were premature (more than eight weeks). 78% of the cot death victims usually slept prone, whereas this was true for only 50% of the controls (p < 0.01). 91% of the cot death victims were found dead in a prone position. When comparing live babies during the first three months of life, significantly more cot death mothers than control mothers had stopped breastfeeding. A larger proportion of the cot death victims than the controls had had apparent life threatening events (p < 0.01). Foam mattresses were equally frequent in both groups.     

Score prognosis for the infertile couple based on historical factors and sperm analysis

OBJECTIVE: To identify variables, obtained from historical factors and sperm analysis, associated with greater chances of pregnancy in infertile couples. METHODS: The study was carried out in Córdoba, Argentina. The characteristics of 247 couples consulting for infertility who achieved pregnancy within 3 years of their first visit were compared with those of 312 couples who did not become pregnant. We evaluated the relationship between the age of the woman and her partner, the type and duration of infertility, length of the last three menstrual cycles, history of pelvic surgery in the woman, and testicular volume, sperm density, motility and morphology in her partner, and the achievement of pregnancy. For the analysis, logistic regression was used. RESULTS: Six variables had a predictive value: sperm morphology, the woman's age, type and duration of infertility, her history of pelvic surgery, and duration of menstrual cycles. CONCLUSIONS: The best prognosis for future fertility in infertile couples is correlated with a higher percentage of normal sperm morphology, younger woman's age, secondary infertility, fewer years of infertility, negative history of pelvic surgery, and abnormal menstrual cycles.     

Pharmacokinetics of the protease inhibitor KNI-272 in plasma and cerebrospinal fluid in nonhuman primates after intravenous dosing and in human immunodeficiency virus-infected children after intravenous and oral dosing

The aim of this study was to evaluate the feasibility of routine falloposcopy in infertile patients undergoing basic infertility investigations, and to determine its usefulness in comparison with other tubal investigation methods. Seventy-five infertile women were selected based on the following criteria: 2 years of infertility, age between 18 and 40 years, normal ovulation, and partner with normal spermatozoa. Based on the results of the classical means of tubal evaluation (hysterosalpingography and laparoscopy), these patients were classified in one of two groups: tubal or unexplained infertility. All patients underwent a falloposcopy under general anaesthesia. The procedures were performed by the same surgeon with the linear everting catheter. Based on the falloposcopic findings, these patients were then reclassified in one of two other groups: falloposcopic tubal or falloposcopic unexplained infertility. The mean outcome measures were catheterization rate, duration of the procedure, pregnancy rates, complication rate and predictive value of Falloposcopy. The tubal catheterization rate was 94.5%. The mean duration of falloposcopy was 19 min per tube. Based on a standard scoring system, the spontaneous pregnancy rates were 27.6% for a score <20; 11.5% for a score between 21 and 30; and 0% if the score was >30. Complication rate was 5.1% of pinpoint perforations of the tube. With Cox's statistical model, none of the parameters analysed was statistically predictive of intrauterine pregnancy. We conclude that the greater accuracy of diagnosis by falloposcopy may indicate that it should be incorporated into the initial screening of infertile patients.     

Nursing home resuscitation policies and practices for residents without DNR orders

The purpose of this study was to explore the policies and practices of nursing homes with respect to the resuscitation of residents who do not have a do-not-resuscitate (DNR) order. Responses from a survey of 36 facilities revealed that most residents had DNR orders and most facilities were capable of providing basic cardiopulmonary resuscitation (CPR). Less than 30% had performed CPR in the past 6 months, and 22.8% had no written CPR policies. More facilities required CPR in witnessed arrests of non-DNR residents (79.3%) than in unwitnessed arrests (24%). Methods for identifying CPR status need improvement to enable accurate identification and prompt resuscitation of residents who want CPR.     

Sex and electroencephalographic synchronization after photic stimulation predict signal changes in the visual cortex on functional MR images

OBJECTIVES: To determine whether the gonadotropin-releasing hormone (GnRH) test can serve as an indicator for the need and timing of surgery in infertile men with varicocele. METHODS: The GnRH test was performed in 121 infertile men with varicocele before surgical correction and 4 to 6, 9 to 12, and 16 to 18 months after. Levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were evaluated immediately before the test and 45 minutes after intravenous injection of 100 jig Relisorm L (a synthetic GnRH analogue). Eighteen fertile men with normal semen parameters served as control patients for defining the preoperative hormone levels. A more than twofold increase in FSH and a more than fivefold increase in LH was considered a positive result. Findings were correlated with semen parameters and rate of pregnancy in the patients' wives at 18 months postoperatively. RESULTS: Of the 121 patients, 89 (73.5%) had a positive GnRH test result, and 32 had a negative result. Semen parameters were improved postoperatively in 72 of the GnRH-positive patients (80.9%) and in only 6 of the GnRH-negative patients (1 8.7%). Corresponding pregnancy rates at 18 months in the two subgroups were 60 (67.4%) and 3 (9.3%), respectively. CONCLUSIONS: A positive preoperative GnRH test is a good predictor of improvement in semen parameters and pregnancy after varicocele surgery. We suggest that the GnRH test can serve as an additional indicator for varicocelectomy.     

Fertility after laparoscopic myomectomy of large intramural myomas: preliminary results

Fertility outcome following laparoscopic myomectomy was evaluated. A prospective clinical study was carried out between October 1990 and October 1993 in 21 infertile patients who underwent laparoscopic myomectomy for a myoma measuring > or = 5 cm in diameter. The overall rate of intrauterine pregnancy was 33.3% (seven patients). Out of 12 patients with infertility factors associated with uterine myomas, three (25.0%) became pregnant, whereas four (44.4%) out of nine patients with no other associated infertility factor became pregnant. No uterine rupture was observed. Out of the seven pregnancies, four were spontaneous and began within 1 year of the operation. The other three were achieved after in-vitro fertilization in patients with associated infertility factors. In the four patients who gave birth by Caesarean section, no adhesions were found on the myomectomy scar. From these preliminary results, laparoscopic surgery for myomas seems to offer comparable results with those obtained by laparotomy.     

Emergency nurses'' perceptions of critical incidents and stress debriefing

The efficacy of examining antinuclear antibody (ANA) was investigated as a screening test detecting subclinical immune disorders in infertility and sterility. ANA was measured in 116 unexplained infertile or sterile patients. The ANA positive rate was 43.5% in group A (habitual abortion, n = 23), 38.1% in group B (consecutive miscarriages, n = 21), 30.0% in group C (one miscarriage, n = 10), 16.7% in group D (one or more deliveries n = 12) 22.0% in group E (primary sterility, n = 50), and 22.4% in the control group (n = 54). The positive rate for all the infertile patients (group A+B) was 40.9% and significantly higher than that in for the control group (p < 0.05). Ten patients with positive ANA had 12 deliveries and 20 patients with negative ANA had 23 deliveries. The frequency of preeclampsia in the patients with positive ANA was higher than in those with negative ANA (41.7% versus 4.3%, p < 0.05). A higher incidence of premature deliveries was recognized in the patients with positive ANA than in those with negative ANA (41.7% versus 8.7%, p < 0.1). Average birth weight (> 35 week) for patients with and without positive ANA was 2,976g (n = 8) and 3,122g (n = 19) respectively. The former tends to be smaller than the latter (p < 0.1).     

Immediate management of the airway during cardiopulmonary resuscitation in a hospital without a resident anaesthesiologist

The effect of withdrawing the resident anaesthesiologist from the cardiopulmonary resuscitation (CPR) team was audited over a 1-year period in a 407-bed hospital in which nurses had been trained in the use of the laryngeal mask airway (LMA) as a first response airway in CPR. The data were compared to those of the previous year, which are shown in parentheses. During the audit period, there were 115 (79) calls to 115 (79) patients; the immediate airway was secured using a mask bag valve assembly in 75 (49) episodes, the Laerdal pocket mask in 2 (2) episodes, the LMA in 64 (2) and the endotracheal tube in 20 (57). Return of spontaneous circulation occurred in 61% (36%). There were no instances of failure to maintain the immediate airway during the audit period. Initial results suggest that an anaesthesiologist may not be essential for the provision of an immediate airway in patients requiring CPR.     

The efficacy of hysteroscopy: a comparison of women presenting with infertility versus other gynaecological symptoms

The aim of this study was to compare the relative efficacy of hysteroscopy as a management tool in the routine initial assessment of women presenting for investigation of infertility with women presenting for investigation of other general gynaecological symptoms for which it is routinely performed. The results of 400 consecutive completed hysteroscopies performed during the primary investigation of infertility are compared with 400 consecutive completed hysteroscopies undertaken in the investigation of women with other gynaecological symptoms. Abnormalities were detected in 12.3% of the 800 hysteroscopies. Significantly less of the infertility group demonstrated abnormality (8.8%) compared to the general gynaecological group (15.8%) (p = 0.0034). There was no difference in the detection rate between primary and secondary infertility. In patients undergoing the procedure for infertility, the results of the hysteroscopy led to an alteration in management in 5.8% of the entire group and in 65.7% of those in whom an abnormality was detected. In patients undergoing the procedure for general gynaecological symptoms, the results of the hysteroscopy led to an alteration in management in 14.5% of the total group and in 97.2% of those in whom an abnormality was detected (p < 0.0001). Structural abnormality correlated with the presence of histological abnormality in 97.2% of cases. In infertile women, the use of hysteroscopy is supported as part of a comprehensive assessment of female reproductive anatomy.     

Scar formation and ligament healing

OBJECTIVE: To compare the efficacy of IUI husband in natural versus FSH stimulated cycles. DESIGN: Prospective, controlled study. MATERIALS AND METHODS: IUI were performed in 57 infertile couples with natural cycles, and in 16 under FSH and GnRH stimulation (Short protocol). In stimulated patients also hCG and hydrogesteron were given. Indication in both groups was idiopathic infertility. Duration of infertility and the age were comparable. Semen preparation and ovarian monitoring were the same in 2 groups. RESULTS: Three pregnancies in 57 natural IUI cycles (5.3%) and 5 out of 16 cycles in stimulated women (31.2% per cycle-with one triple pregnancy). CONCLUSION: In couples with idiopathic infertility FSH stimulation significantly increases rate of pregnancy and multiple gestation.     

FIVNAT. Influence of attempt rank in in vitro fertilization

The French national register on in vitro fertilization (IVF) FIVNAT, which has collected most of the oocyte pick-ups realised in France since 1986 has allowed us to build a cohort of 35,714 couples, of which the first recovery took place between 1990 and 1994 and followed up to a pregnancy or to the 31st of december, 1996. The per recovery clinical pregnancy rate decreased from 20.2% on the first attempt to 17.4% on the second, and to less than 13% after the sixth. This evolution existed whatever the women's age class or the infertility diagnosis. The women's age remained the most important factor, since the cumulative pregnancy rate decreased from 60% for women aged less than 35 years to 17% for those aged more than 41 years. Among the indications, male infertility using spouse's semen had the poorest prognosis, especially for women aged more than 41 years (9.6%) whereas male infertility using donor's semen among women aged less than 35 years was associated to the best results (68%). It must be noticed than a high percentage of unpregnant women did not come again for a further recovery (40% to 50%). Then, the crude cumulative birth rate (24.4%) was far below the theoretical cumulative one(54.2%).     

Comparison of pediatric hospitalization using the pediatric appropriateness evaluation protocol at three diverse hospitals in Louisiana

The purpose of this study was to compare the number of inappropriate pediatric admissions and hospital days in three hospitals in Louisiana using Pediatric Appropriateness Evaluation Protocol (PAEP) criteria. The hospitals studied included an urban, nontertiary care, teaching hospital with 20 inpatient, pediatric beds (A); a private, tertiary care hospital with 30 beds (B); and a tertiary care, regional referral center with 133 pediatric beds (C). The study prospectively observed all nonintensive care pediatric admissions (> six months of age) between May 1 and June 30, 1993. Admissions and subsequent hospital days were labeled as appropriate or inappropriate based on PAEP criteria. A significantly shorter hospital stay (days) was demonstrated at hospital C (4.41 +/- 1.01, p < .05) compared to A (5.98 +/- 4.95) or B (5.78 +/- 1.21). Similarly, hospital B had significantly more patients admitted electively (19%, p < .05) compared to A (4%) or C (15%). The percentage of inappropriate admissions for hospitals A, B, and C were 11.0, 10.0, and 2.0 (p < .05) and hospital days 18.0, 22.0, and 12.0 (p < .05), respectively. A significant proportion of inappropriate hospital days came from trauma admissions in hospital A (18%, p < .05) and elective admissions in hospital B (36%, p < .05). Hospital A had 99% of patients with either Medicaid or uninsured payor status compared to 35% and 84% at hospital B and C, respectively. Significant differences in the rate of inappropriate admission or subsequent hospital days were demonstrated in the three hospitals studied. Finally, the rates of inappropriate hospitalization demonstrated in this study of Louisiana hospitals were similar to previous studies using the PAEP in other regions.     

Salivary lead and cadmium in a young population residing in Mexico city

Antisperm antibodies were determined in the sera of 250 infertile couples and 100 puerperal women as controls using the immunofluorescence technique. Couples with significant circulating antisperm antibodies were placed on low-dose prednisolone 5 mg daily for 3-6 months. Initial routine semen analysis and hypoosmotic swelling test were done and repeated after 3 months of therapy. The incidence of antisperm antibodies (ASA) was 18.8 and 17.6% in the men and women, respectively, compared to 4% in the women controls (p < .02). In the men, the main determinants (with incidence) of ASA included smoking (33.9%), past history of sexually transmitted disease (33.3%), surgery to genital tract (28.6%), trauma (27.3%), and unexplained infertility (18.5%). In women whose husbands had antisperm antibodies the incidence of circulating antisperm antibodies was 38.3%, while endometriosis and thyroid dysfunction had incidence of antisperm antibodies of 21.4 and 16.7%, respectively. In the 27 (10.8%) case of unexplained infertility, the incidence of antisperm antibodies was 22.2%. High follicle-stimulating hormone (FSH) in the men and low midluteal-phase progesterone in the women were associated with increased expression of antisperm antibodies. Antisperm antibodies adversely affected quality of sperm. Low-dose prednisolone significantly reduced the titer of antisperm antibodies and improved the sperm parameters and conception rate.     

Epitope mapping of cytochrome P450cam (CYP101)

OBJECTIVE: A retrospective study of women with inflammatory bowel disease, aged 16-45 years during the 20-year period 1967-1986, was carried out in North East Scotland. METHOD: Five-hundred and three women were identified: 15 patients had died from unrelated causes and 22 had emigrated, but 409 of the remaining 466 patients (88%) replied to the study questionnaire. RESULTS: Women with ulcerative colitis and Crohn's disease had normal fertility when compared with the general population of north east Scotland. However, unresolved infertility problems were more frequent in women who had undergone surgery for inflammatory bowel disease compared with those who had not (12% vs. 5% for Crohn's disease; 25% vs. 7% for ulcerative colitis). Disease relapse rates did not increase in pregnancy. CONCLUSIONS: Overall, at conception women with active disease were as likely to have a normal full-term pregnancy as those in remission. However, spontaneous abortion occurred in five (36%) pregnancies of women who had undergone previous surgery for Crohn's disease and had evidence of recurrent disease. Three of these pregnancies were associated with active disease.