Successful embryo implantation is a complex process that involves multiple biological mechanisms and reciprocal interactions between the embryo and the proliferated endometrium. In this review, we provide an informative contribution on the pathways underlying the beneficial nature of endometrial injury toward improving implantation rates of embryos conceived and through in vitro fertilization. The evidence published to date are in favor of inducing local endometrial injury in the preceding cycle of ovarian stimulation to improve pregnancy outcomes in women with unexplained and recurrent implantation failure. Endometrial injury triggers a series of biological responses but the findings suggest that no particular pathway is solely adequate to explain the association between trauma and improved pregnancy rates rather than a cluster of events in response to trauma which benefits embryo implantation in ways both known and unknown to the scientific community.
Though promising data on the IVM technique have been published, unfortunately there is still no evidence from RCTs upon which to base any practice recommendations regarding IVM before IVF or ICSI for women with PCOS. Meanwhile, the results of the above-mentioned ongoing trials are awaited and, of course, further evidence from good quality trials in the field is eagerly anticipated.
Granulocyte macrophage colony stimulating factor (GM-CSF) is a cytokine/growth factor produced by epithelial cells that exerts embryotrophic effects during the early stages of embryo development. We performed a systematic review, and six studies that were performed in humans undergoing assisted reproduction technologies (ART) were located. We wanted to evaluate if embryo culture media supplementation with GM-CSF could improve success rates. As the type of studies and the outcome parameters investigated were heterogeneous, we decided not to perform a meta-analysis. Most of them had a trend favoring the supplementation with GM-CSF, when outcomes were measured in terms of increased percentage of good-quality embryos reaching the blastocyst stage, improved hatching initiation and number of cells in the blastocyst, and reduction of cell death. However, no statistically significant differences were found in implantation and pregnancy rates in all apart from one large multicenter trial, which reported favorable outcomes, in terms of implantation and live birth rates. We propose properly conducted and adequately powered randomized controlled trials (RCTs) to further validate and extrapolate the current findings with the live birth rate to be the primary outcome measure.
The limited predictive value of semen analysis in achieving natural conception or in IVF outcome confirms the need for sperm function tests to determine optimal management. We reviewed HZA and SPA predictive power in IVF outcome, with statistical significance of diagnostic power of the assays. HZA was readily efficient in predicting IVF outcome, while evident inconsistency among the studies analysed framed the SPA's role in male fertility evaluation. Considerable variation was noted in the diagnostic accuracy values of SPA with wide sensitivity (52–100%), specificity (0–100%), and PPV (18–100%) and NPV (0–100%) together with fluctuation and notable differentiation in methodology and cutoff values employed by each group. HZA methodology was overall consistent with minor variation in cutoff values and oocyte source, while data analysis reported strong correlation between HZA results with IVF outcome, high sensitivity (75–100%), good specificity (57–100%), and high PPV (79–100%) and NPV (68–100%). HZA correlated well with IVF outcome and demonstrated better sensitivity/specificity and positive/negative predictive power. Males with normal or slightly abnormal semen profiles could benefit by this intervention and could be evaluated prior to referral to assisted reproduction. HZA should be used in a sequential fashion with semen analysis and potentially other bioassays in an IVF setting.
The evolution of QT interval and its dispersion (QTd) were studied in 135 newly diagnosed nondiabetic patients, as well as the relationship between changes of these left ventricular (LV) repolarization parameters with blood pressure (BP) and LV mass changes, which were prospectively studied for a median period of 3.8 years. At baseline and at last follow-up visit, all patients underwent ambulatory BP monitoring, echocardiographic assessment, and 12-lead electrocardiography. At the end of follow-up, responders of antihypertensive treatment based on a reduced 24-hour systolic BP (n=122) exhibited a reduction in LV mass index (by 7.6 g/m 2 , P<.001) and corrected QT (by 4.3, P=.038), while corrected QTd was unchanged. In nonresponders (n=13), although no difference in LV mass index was observed, corrected QT increased by 12.4 ms (P=.048) and corrected QTd by 8.2 ms (P=.027). Changes in parameters of LV repolarization were related to BP changes but not to changes of myocardial size. J Clin Hypertens (Greenwich). 2014;16:219-224. ª2014 Wiley Periodicals, Inc.Parameters of left ventricular (LV) repolarization and its inhomogeneity, such as prolonged QT interval and its dispersion (QTd), are associated with an adverse prognosis in various clinical settings, including essential hypertension.1 Moreover, QT interval and QTd have been exhibited to be increased in diverse pathological conditions, such as myocardial ischemia and heart failure, as well as in diabetic and hypertensive patients and in those with the metabolic syndrome. 1-9Focusing on patients with hypertension, QT interval and QTd are increased in those with LV hypertrophy, whereas regression of LV hypertrophy decreases LV repolarization parameters. [10][11][12][13][14][15] Various types of antihypertensive treatment have been accompanied by significant changes in these parameters of LV repolarization after short periods of treatment. [15][16][17][18][19][20][21][22] The aim of the present study was to investigate the evolution of QT interval and QTd, as well as the relationship between changes of these LV repolarization parameters with blood pressure (BP) and LV mass changes in a cohort of patients with newly diagnosed hypertension after a long-term follow-up period. MATERIALS AND METHODS Study PopulationA total of 177 consecutive, white patients with untreated newly diagnosed stage I or II essential hypertension confirmed by ambulatory BP monitoring (daytime systolic/diastolic BP ≥135/85 mm Hg) were recruited between January 2004 and October 2008. We excluded patients with stage III hypertension or secondary hypertension (n=3); white-coat hypertension (n=14) (office BP >140/90 mm Hg and daytime BP <135/ 85 mm Hg); history of coronary artery disease, cerebrovascular disease, or congestive heart failure (n=2); atrial fibrillation; (n=2); diabetes mellitus (n=6); overt proteinuria (≥300 mg/g) or renal dysfunction (estimated glomerular filtration rate according to the Modification of Diet in Renal Disease formula <60 mL/min/1.73 m 2 ); and presence of neoplastic ...
Purpose To examine the association of maternal bone markers (sclerostin, sRANKL, osteocalcin, 25OHD3) with fetal intra-abdominal and subcutaneous adipose tissue deposition and birthweight during normal pregnancy. Methods One hundred pregnant women (aged 30.4±5.6 years, mean±SD) with pre-pregnancy BMI=24.1±4.6 kg/m² were seen prospectively during each trimester. At each visit they were submitted to anthropometric measurements, a fasting blood sampling, a 75gr oral glucose tolerance test (OGTT) and a fetal ultrasonogram. At birth, neonates had birth weight measurement. Results In the 2 nd trimester maternal sclerostin concentrations correlated positively with fetal abdominal circumference and birth weight; maternal sRANKL concentrations correlated positively with fetal abdominal subcutaneous fat thickness, sagittal abdominal diameter and abdominal circumference. Fetuses born to mothers with greater (>254 ng/mL) compared to fetuses born to mothers with lower (≤254 ng/mL) sRANKL concentrations had greater abdominal circumference, sagittal diameter and abdominal subcutaneous fat thickness. Maternal serum sclerostin concentrations were the best positive predictors of birth weight. In the 3 rd trimester maternal sclerostin concentrations correlated positively with fetal sagittal abdominal diameter; maternal sRANKL concentrations positively correlated with fetal abdominal circumference and fetal abdominal sagittal diameter. Conclusions Maternal bone markers sclerostin and sRANKL may relate with fetal intra-abdominal adipose tissue deposition through direct or indirect unknown as yet mechanisms contributing thus, to birthweight.
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