Summary. A novel protocol is described which has been developed for immunotherapy in unexplained recurrent miscarriage. This is based on a single intravenous infusion with isolated placental trophoblast plasma membrane vesicle preparations. Clinical experience gained with this approach is described. A total of 16/21 (76%) patients who subsequently had pregnancies have now achieved a live birth or are currently pregnant at greater than 28 weeks gestation.

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There is a relative paucity of data on perinatal outcomes following Intracytoplasmic Sperm Injection using surgically retrieved sperm. In this retrospective cohort study, data were collected on couples who conceived following Intracytoplasmic Sperm Injection using surgically retrieved sperm from 1996 to 2014. Outcome measures included live birth, miscarriage, congenital abnormality, birthweight, gestation at delivery, stillbirth and neonatal death. Outcome measures were compared according to male diagnosis and sperm source. Live birth rates were similar between groups (obstructive azoospermia 90%, non-obstructive azoospermia 83%, p = 0.55). There was a trend towards higher miscarriage rates in the non-obstructive azoospermia group (17% versus 9%, p = 0.45). Other perinatal outcomes were similar between groups. In those with obstructive azoospermia, live birth rates were similar regardless of source of sperm (epididymal 89%, testicular 91%, p = 0.79). Median gestation at delivery was earlier in the epididymal sperm group (39 weeks versus 40 weeks, p = 0.02). Other perinatal outcomes were unaffected by sperm source. Overall these results are reassuring, suggesting high live birth rates regardless of diagnosis or sperm source, although there may be higher miscarriage rates in cases of non-obstructive azoospermia. Other perinatal outcomes were not affected by diagnosis or sperm source.

ObjectiveCoasting is a well-known strategy to decrease severity of Ovarian Hyperstimulation Syndrome (OHSS). The purpose of this study is to assess the effect of Coasting on blastocyst development and subsequent clinical outcome following exclusive blastocyst transfer.MethodsWe conducted an observational cohort study of patients having blastocyst transfer following IVF/ICSI treatment. Patients undergoing IVF/ICSI cycles were included in the study. Patients at risk of OHSS were coasted. Outcome following exclusive blastocyst transfer was compared between coasted and non-coasted groups. The main outcome measures were the rate of blastocyst development and live birth rates in coasted and non-coasted cycles. Within coasted cycles, outcome was further analysed based on coasting duration and serum estradiol (E2) drop (difference between peak E2 and E2 on day of HCG).ResultsA total of 166 coasted cycles and 656 non-coasted cycles had blastocyst transfer. Blastocyst development (45.97% vs. 48.6%) and live birth rates (45.18% vs. 43.44%) were not significantly different between coasted and non-coasted cycles. The overall clinical pregnancy (54.21% vs. 49.08%) and implantation rates (43.95% vs. 39.54%) following blastocyst transfer in coasted cycles were not significantly different from those of non-coasted cycles.ConclusionCoasting duration up to 6 days and drop in serum E2 levels did not compromise blastocyst development, implantation, clinical pregnancy or live birth rates. We conclude that coasting with subsequent blastocyst transfer can be used as an effective strategy in patients at risk of OHSS with no detrimental effects on blastocyst development or live birth outcome.

A case of monoammotic twins with double survival in the presence of cord entanglement is described. This is foIlowed by a discussion of the aetiology, embryology, clinical significance, pathology, diagnosis and management.