Intravaginal administration of misoprostol is a safe and effective alternative for cervical ripening and labor induction. Maternal and neonatal complications did not increase significantly.

Our data suggest that hormone profile during menstrual cycle is different at high altitude than at sea level, probably as an effect of low barometric pressure.

Objectives Chlamydia trachomatis, which is asymptomatic in most women, causes significant adverse effects for pregnant women and neonates. No programmes conduct antenatal screening in Latin America. We determined chlamydia prevalence, the feasibility and acceptability of chlamydia screening, and adherence to treatment in pregnant women in two urban public hospitals in Lima, Peru. Methods We offered chlamydia screening using self-collected vaginal swabs to pregnant women ≥ 16 years during their first antenatal visit. Chlamydia-infected women were contacted within 14 days and asked to bring partners for counselling and directly observed therapy with oral azithromycin. Unaccompanied women received counselling, directly observed therapy, and azithromycin to take to partners. Test of cure was performed ≥ 3 weeks after treatment. Results We approached 640 women for the study and enrolled 600 (93.7%). Median age was 27.3 years (range 16–47), median lifetime partners 2.3 (range 1–50), and median gestational age 26.1 weeks (range 4–41). Chlamydia prevalence was 10% (95% CI: 7.7% – 12.7%). Of 60 infected patients, 59 (98%) were treated with one dose of azithromycin. Fifty-two of 59 (88%) returned for test of cure, all of whom were treated successfully, with 46 (86%) achieving negative test of cure with one dose of azithromycin and 6 (12%) after retreatment with a second dose. Conclusions C. trachomatis screening and treatment in pregnancy was feasible and highly acceptable in two urban hospitals in Peru. Chlamydia prevalence was high. Clinical trials to evaluate efficacy and cost-effectiveness of chlamydia screening and treatment of pregnant women to prevent adverse pregnancy outcomes in low-resource settings are warranted.

Objective To assess the efficacy and safety in clinical practice of a low dose regimen of 50 IU of recombinant follicle stimulating hormone in induction of ovulation. Design Prospective, observational, non‐comparative, open, multicentre study. Setting Eighty‐eight infertility clinics and teaching hospital fertility units throughout Spain. Population Women with normogonadotrophic chronic anovulation (WHO group II) with or without echographic diagnosis of polycystic ovary syndrome. Methods Low dose step‐up protocol of recombinant follicle stimulating hormone administration (follitropin beta, Puregon) with a starting dose of 50 IU and weekly increments according to follicular response monitored prospectively by transvaginal ultrasonography. Patients were followed for a minimum of one cycle and a maximum of six. Main outcome measures Rate and size of follicular growth, cumulative ovulation rate, follicle stimulating hormone doses and duration of treatment, pregnancy and cycle cancellation rate, ovarian hyperstimulation syndrome and multiple pregnancy. Results A total of 945 treatment cycles were evaluated. In 817 cycles, ovulation was induced with human chorionic gonadotrophin (hCG) and in 501 (61.3%) unifollicular development (a follicle of ≥18 mm) was achieved. A total of 128 cycles (13.5%) were cancelled because of ovarian hyper‐responsiveness or spontaneous ovulation. The cumulative ovulation rate (confirmed by mid‐luteal serum progesterone concentrations) after six treatment cycles was 84%. There were 136 clinical pregnancies (14.4% pregnancies per cycle). The cumulative pregnancy rate after six treatment cycles was 53.1%. Eight twin pregnancies occurred. Thirteen women miscarried and there were two cases of ectopic pregnancies. The median of average daily doses of follitropin beta in all cycles was 50 IU. Between 68% and 86% of patients received treatment with follitropin beta for a maximum of 14 days. Ovarian hyperstimulation syndrome occurred in 64 (6.8%) cases but no case of severe ovarian hyperstimulation developed. Conclusions Low dose regimen of 50 IU of recombinant follicle stimulating hormone (Puregon) is efficient, safe and well tolerated for inducing follicular development in WHO group II anovulatory women.

Objective: To evaluate the impact of patient follicular environment with oxidative stress on oocyte quality. Methods: Patients on fertility treatment with either advanced maternal age or endometriosis were asked to donate follicular fluid collected during ovum pick-up. Follicular fluid (FF) was added (20%, 10% and 5%; %V/V) to in vitro maturation (IVM) medium with mouse oocytes. Following maturation culture, the oocytes were assessed for meiosis reinitiation. In a second setup, coenzyme Q10 was added to culture medium with FF. In addition to assessing meiotic maturation, a subset of oocytes was assessed for spindle structure and chromosome alignment. Results: Supplementation of IVM medium with FF of patients of advanced maternal age (with or without antioxidants) did not have an effect on the maturation capacity of mouse oocytes. However, the addition of FF of individuals with endometriosis (without antioxidants) in the two highest concentrations affected oocyte maturation (61.5% & 57.0% maturation) compared with the lowest concentration (89.2% maturation) ( p <0.05). Supplementation of medium with coenzyme Q10 did not improve the maturation rate of oocytes exposed to the FF of individuals with endometriosis (28.5±13.7%) ( p <0.05). Nevertheless, preliminary analysis of spindle abnormality and chromosome alignment revealed that oocytes resuming meiosis in the presence of FF of patients with endometriosis displayed aberrant spindle morphology and chromosomal misalignment. Conclusion: The follicular environment of patients with endometriosis severely affected oocyte (nuclear) maturation. In vitro maturation in the presence of coenzyme Q10 appears to be a tool for rescuing oocytes exposed to such follicular environment.