Vaginal sildenafil may be a therapeutic option for improving the chances of successful pregnancy in women with a history of recurrent miscarriage, study findings show. Malgorzata Jerzak (Military Institute of Health Sciences, Warsaw, Poland) and colleagues found that sildenafil citrate improved the quality of the endometrium and the immunologic environment in these patients.
For the study, 38 nonpregnant women with a history of recurrent miscarriage and 37 healthy women with previous successful pregnancies self-administered sildenafil suppositories 25 mg intravaginally, four times a day for 36 days. Peripheral blood natural killer (NK)-cell activity was significantly increased in the miscarriage patients compared with controls before treatment, at 15.67 versus 8.29 percent. But after vaginal sildenafil therapy, NK-cell activity was significantly reduced in the miscarriage patients by an average of 5.45 percent.
Endometrial thickness, which was significantly reduced in the miscarriage group compared with the control group, increased significantly after sildenafil therapy, from 8.06 mm to 9.25 mm.
"The mechanism of sildenafil's influence on NK cells is unknown; however, it can not be excluded that improvement in uterine artery flow has efficient influence on the local endometrial NK-cell population, and the diminished NK cell activity may promote successful pregnancy outcome," say Jerzak et al.
"Additionally, sildenafil significantly improves endometrial thickness, which is especially important in successful implantation."
Thursday, June 26, 2008
Wednesday, June 25, 2008
AFC predicts ovarian response in egg donors
Antral follicle count (AFC) is a noninvasive and simple tool that can predict ovarian response among women who donate their eggs, a study indicates. In an effort to find a prognostic predictor that can improve the selection process of oocyte donors with normal baseline endocrine determinations, Spanish researchers assessed the value of AFC in predicting ovarian response and IVF outcome.
AFC was determined on the first day of controlled ovarian hyperstimulation in 1,074 donors, after pituitary down-regulation had been confirmed. Donors with an AFC of less than 10 had lower estradiol levels and fewer mature retrieved oocytes than others. These donors also had significantly higher cancellation and no-donation rates; almost 50 percent of cycles were cancelled in this group, with poor or insufficient response the cause in 82 percent of cases.
However, there were no differences between donors regarding embryo development parameters and IVF outcomes in 975 oocyte recipient cycles.
Marco Antonio Barreto Melo and colleagues conclude: "This study suggests that the AFC is a good predictor of controlled ovarian hyperstimulation in oocyte donors but that it cannot predict oocyte/embryo quality or, consequently, IVF outcome."
AFC was determined on the first day of controlled ovarian hyperstimulation in 1,074 donors, after pituitary down-regulation had been confirmed. Donors with an AFC of less than 10 had lower estradiol levels and fewer mature retrieved oocytes than others. These donors also had significantly higher cancellation and no-donation rates; almost 50 percent of cycles were cancelled in this group, with poor or insufficient response the cause in 82 percent of cases.
However, there were no differences between donors regarding embryo development parameters and IVF outcomes in 975 oocyte recipient cycles.
Marco Antonio Barreto Melo and colleagues conclude: "This study suggests that the AFC is a good predictor of controlled ovarian hyperstimulation in oocyte donors but that it cannot predict oocyte/embryo quality or, consequently, IVF outcome."
Tuesday, June 24, 2008
Limiting IVF cycles may deny women the chance to conceive
Researchers from Israel believe that limiting the number of IVF cycles can deny women the right to the possibility of having a baby.Raoul Orvieto (Barzilai Medical Center, Ashkelon, Israel) and colleagues found that, although the number of pregnancies achieved in cycles 1 to 3 is significantly greater than that in subsequent cycles, the number remains constant through cycles 4 to 20.
The researchers note that in most countries couples are limited as to how many cycles they can undergo, mainly due to financial constraints.To see if the chances of pregnancy decline with increasing number of cycles, they surveyed women in Israel, where IVF is completely covered by medical insurance allowing couples to perform as many cycles as they want.
A total of 2,760 cycles were studied, which resulted in 602 clinical pregnancies.In cycles 1 to 3, 25.2 percent of clinical pregnancies were achieved per cycle. This was significantly greater than the 17.8 percent rate per cycle for cycles 4 to 6. However, there was no further decline for cycles 7 to 9, 10 to 12, and 12 or more, at 17.5, 13.0, and 11.2 percent per cycle, respectively.
Orvieto et al conclude: "The number of attempted cycles available in the vast majority of countries severely and unjustly denies women the right to the possibility of having a baby."
The researchers note that in most countries couples are limited as to how many cycles they can undergo, mainly due to financial constraints.To see if the chances of pregnancy decline with increasing number of cycles, they surveyed women in Israel, where IVF is completely covered by medical insurance allowing couples to perform as many cycles as they want.
A total of 2,760 cycles were studied, which resulted in 602 clinical pregnancies.In cycles 1 to 3, 25.2 percent of clinical pregnancies were achieved per cycle. This was significantly greater than the 17.8 percent rate per cycle for cycles 4 to 6. However, there was no further decline for cycles 7 to 9, 10 to 12, and 12 or more, at 17.5, 13.0, and 11.2 percent per cycle, respectively.
Orvieto et al conclude: "The number of attempted cycles available in the vast majority of countries severely and unjustly denies women the right to the possibility of having a baby."
Monday, June 23, 2008
IVF success unaffected by ovarian stimulation after natural cycle technique
The overall success rate of IVF does not appear to be reduced by sequential treatment with modified natural cycle IVF (MNC-IVF) and controlled ovarian stimulation IVF (COS-IVF), and the twin pregnancy rate is low, conclude Dutch researchers.
M. Pelinck, from University Medical Center Groningen, and colleagues followed-up 268 patients from an earlier study who had been offered nine cycles of MNC-IVF, assessing ongoing pregnancy and live birth rates, along with time-to-pregnancy after COS-IVF following MNC-IVF.
By the start of COS-IVF, 109 patients, aged an average of 34.2 years, remained in the study.
For COS-IVF following MNC-IVF, the actual observed cumulative ongoing pregnancy, live birth, and term live birth rates were 51.5 percent, 50.0 percent, and 43.3 percent, respectively, of which 8.0 percent, 6.7 percent, and 2.6 percent, respectively, were twins.
In addition, the cumulative ongoing pregnancy rate, including treatment-independent pregnancies, was 56.7 percent. The median time to ongoing pregnancy was 28.8 weeks.
The team says: "In conclusion, sequential treatment with MNC-IVF followed by COS-IVF does not appear to compromise overall success rates, while twin pregnancy rate is very low. Because of the patient-friendly and low-risk profile of MNC-IVF, this seems an appropriate strategy."
M. Pelinck, from University Medical Center Groningen, and colleagues followed-up 268 patients from an earlier study who had been offered nine cycles of MNC-IVF, assessing ongoing pregnancy and live birth rates, along with time-to-pregnancy after COS-IVF following MNC-IVF.
By the start of COS-IVF, 109 patients, aged an average of 34.2 years, remained in the study.
For COS-IVF following MNC-IVF, the actual observed cumulative ongoing pregnancy, live birth, and term live birth rates were 51.5 percent, 50.0 percent, and 43.3 percent, respectively, of which 8.0 percent, 6.7 percent, and 2.6 percent, respectively, were twins.
In addition, the cumulative ongoing pregnancy rate, including treatment-independent pregnancies, was 56.7 percent. The median time to ongoing pregnancy was 28.8 weeks.
The team says: "In conclusion, sequential treatment with MNC-IVF followed by COS-IVF does not appear to compromise overall success rates, while twin pregnancy rate is very low. Because of the patient-friendly and low-risk profile of MNC-IVF, this seems an appropriate strategy."
Sunday, June 22, 2008
Saturday, June 21, 2008
Indian Traffic From A Dutch Point-of-view
A rather well researched article......you'll like it!
Here's an article written by a Dutch gentleman about Indian traffic.
Driving in Bangalore / India
For the benefit of every Tom, Dick and Harry visiting India and daring to drive on Indian roads, I am offering a few hints for survival. They are applicable to every place in India except Bihar ,where life outside a vehicle is only marginally safer...........
Indian road rules broadly operate within the domain of karma where you do your best, and leave the results to your insurance company. The hints are as follows: Do we drive on the left or right of the road? The answer is 'both'. Basically you start on the left of the road, unless it is occupied. In that case, go to the right, unless that is also occupied. Then proceed by occupying the next available gap, as in chess. Just trust your instincts, ascertain the direction, and proceed. Adherence to road rules leads to much misery and occasional fatality. Most drivers don't drive, but just aim their vehicles in the generally intended direction.
Don't you get discouraged or underestimate yourself except for a belief in reincarnation; the other drivers are not in any better position. Don't stop at pedestrian crossings just because some fool wants to cross the road. You may do so only if you enjoy being bumped in the back.
Pedestrians have been strictly instructed to cross only when traffic is moving slowly or has come to a dead stop because some minister is in town. Still some idiot may try to wade across, but then, let us not talk ill of the dead.
Blowing your horn is not a sign of protest as in some countries. We horn to express joy, resentment, frustration, romance and bare lust (two brisk blasts),or just mobilize a dozing cow in the middle of the bazaar. Keep informative books in the glove compartment. You may read them during traffic jams, while awaiting the chief minister's motorcade, or waiting for the rainwater to recede when over ground traffic meets underground drainage.
Occasionally you might see what looks like a UFO with blinking colored lights and weird sounds emanating from within. This is an illuminated bus, full of happy pilgrims singing bhajans. These pilgrims go at breakneck speed, seeking contact with the Almighty, often meeting with success.
Auto Rickshaw (Baby Taxi): The result of a collision between a rickshaw and an automobile, this three-wheeled vehicle works on an external combustion engine that runs on a mixture of kerosene oil and creosote. This triangular vehicle carries iron rods, gas cylinders or passengers three times its weight and dimension, at an unspecified fare. After careful geometric calculations, children are folded and packed into these auto rickshaws until some children in the periphery are not in contact with the vehicle at all. Then their school bags are pushed into the microscopic gaps all round so those minor collisions with other vehicles on the road cause no permanent damage.
Of course, the peripheral children are charged half the fare and also learn Newton 's laws of motion enroute to school. Auto-rickshaw drivers follow the road rules depicted in the film Ben Hur, and are licensed to irritate.
Mopeds: The moped looks like an oil tin on wheels and makes noise like an electric shaver. It runs 30 miles on a teaspoon of petrol and travels at break-bottom speed. As the sides of the road are too rough for a ride, the moped drivers tend to drive in the middle of the road; they would rather drive under heavier vehicles instead of around them and are often 'mopped' off the tarmac.
Leaning Tower of Passes: Most bus passengers are given free passes and during rush hours, there is absolute mayhem. There are passengers hanging off other passengers, who in turn hang off the railings and the overloaded bus leans dangerously, defying laws of gravity but obeying laws of surface tension. As drivers get paid for overload (so many Rupees per kg of passenger), no questions are ever asked. Steer clear of these buses by a width of three passengers.
One-way Street: These boards are put up by traffic people to add jest in their otherwise drab lives. Don't stick to the literal meaning and proceed in one direction. In metaphysical terms, it means that you cannot proceed in two directions at once. So drive as you like, in reverse throughout, if you are the fussy type. Least I sound hypercritical, I must add a positive point also. Rash and fast driving in residential areas has been prevented by providing a 'speed breaker'; two for each house. This mound, incidentally, covers the water and drainage pipes for that residence and is left untarred for easy identification by the corporation authorities, should they want to recover the pipe for year-end accounting.
Night driving on Indian roads can be an exhilarating experience for those with the mental make up of Genghis Khan. In a way, it is like playing Russian roulette, because you do not know who amongst the drivers is loaded. What looks like premature dawn on the horizon turns out to be a truck attempting a speed record. On encountering it, just pull partly into the field adjoining the road until the phenomenon passes.
Our roads do not have shoulders, but occasional boulders. Do not blink your lights expecting reciprocation. The only dim thing in the truck is the driver, and with the peg of illicit arrack (alcohol) he has had at the last stop, his total cerebral functions add up to little more than a naught. Truck drivers are the James Bonds of India, and are licensed to kill. Often you may encounter a single powerful beam of light about six feet above the ground. This is not a super motorbike, but a truck approaching you with a single light on, usually the left one. It could be the right one, but never get too close to investigate. You may prove your point posthumously.
Here's an article written by a Dutch gentleman about Indian traffic.
Driving in Bangalore / India
For the benefit of every Tom, Dick and Harry visiting India and daring to drive on Indian roads, I am offering a few hints for survival. They are applicable to every place in India except Bihar ,where life outside a vehicle is only marginally safer...........
Indian road rules broadly operate within the domain of karma where you do your best, and leave the results to your insurance company. The hints are as follows: Do we drive on the left or right of the road? The answer is 'both'. Basically you start on the left of the road, unless it is occupied. In that case, go to the right, unless that is also occupied. Then proceed by occupying the next available gap, as in chess. Just trust your instincts, ascertain the direction, and proceed. Adherence to road rules leads to much misery and occasional fatality. Most drivers don't drive, but just aim their vehicles in the generally intended direction.
Don't you get discouraged or underestimate yourself except for a belief in reincarnation; the other drivers are not in any better position. Don't stop at pedestrian crossings just because some fool wants to cross the road. You may do so only if you enjoy being bumped in the back.
Pedestrians have been strictly instructed to cross only when traffic is moving slowly or has come to a dead stop because some minister is in town. Still some idiot may try to wade across, but then, let us not talk ill of the dead.
Blowing your horn is not a sign of protest as in some countries. We horn to express joy, resentment, frustration, romance and bare lust (two brisk blasts),or just mobilize a dozing cow in the middle of the bazaar. Keep informative books in the glove compartment. You may read them during traffic jams, while awaiting the chief minister's motorcade, or waiting for the rainwater to recede when over ground traffic meets underground drainage.
Occasionally you might see what looks like a UFO with blinking colored lights and weird sounds emanating from within. This is an illuminated bus, full of happy pilgrims singing bhajans. These pilgrims go at breakneck speed, seeking contact with the Almighty, often meeting with success.
Auto Rickshaw (Baby Taxi): The result of a collision between a rickshaw and an automobile, this three-wheeled vehicle works on an external combustion engine that runs on a mixture of kerosene oil and creosote. This triangular vehicle carries iron rods, gas cylinders or passengers three times its weight and dimension, at an unspecified fare. After careful geometric calculations, children are folded and packed into these auto rickshaws until some children in the periphery are not in contact with the vehicle at all. Then their school bags are pushed into the microscopic gaps all round so those minor collisions with other vehicles on the road cause no permanent damage.
Of course, the peripheral children are charged half the fare and also learn Newton 's laws of motion enroute to school. Auto-rickshaw drivers follow the road rules depicted in the film Ben Hur, and are licensed to irritate.
Mopeds: The moped looks like an oil tin on wheels and makes noise like an electric shaver. It runs 30 miles on a teaspoon of petrol and travels at break-bottom speed. As the sides of the road are too rough for a ride, the moped drivers tend to drive in the middle of the road; they would rather drive under heavier vehicles instead of around them and are often 'mopped' off the tarmac.
Leaning Tower of Passes: Most bus passengers are given free passes and during rush hours, there is absolute mayhem. There are passengers hanging off other passengers, who in turn hang off the railings and the overloaded bus leans dangerously, defying laws of gravity but obeying laws of surface tension. As drivers get paid for overload (so many Rupees per kg of passenger), no questions are ever asked. Steer clear of these buses by a width of three passengers.
One-way Street: These boards are put up by traffic people to add jest in their otherwise drab lives. Don't stick to the literal meaning and proceed in one direction. In metaphysical terms, it means that you cannot proceed in two directions at once. So drive as you like, in reverse throughout, if you are the fussy type. Least I sound hypercritical, I must add a positive point also. Rash and fast driving in residential areas has been prevented by providing a 'speed breaker'; two for each house. This mound, incidentally, covers the water and drainage pipes for that residence and is left untarred for easy identification by the corporation authorities, should they want to recover the pipe for year-end accounting.
Night driving on Indian roads can be an exhilarating experience for those with the mental make up of Genghis Khan. In a way, it is like playing Russian roulette, because you do not know who amongst the drivers is loaded. What looks like premature dawn on the horizon turns out to be a truck attempting a speed record. On encountering it, just pull partly into the field adjoining the road until the phenomenon passes.
Our roads do not have shoulders, but occasional boulders. Do not blink your lights expecting reciprocation. The only dim thing in the truck is the driver, and with the peg of illicit arrack (alcohol) he has had at the last stop, his total cerebral functions add up to little more than a naught. Truck drivers are the James Bonds of India, and are licensed to kill. Often you may encounter a single powerful beam of light about six feet above the ground. This is not a super motorbike, but a truck approaching you with a single light on, usually the left one. It could be the right one, but never get too close to investigate. You may prove your point posthumously.
Friday, June 20, 2008
Infertility & Psychiatric Disorders
Infertile couples are at increased risk of psychiatric disorders, with many already having developed such disorders at the time of their first contact with specialized fertility services, research indicates.
Arianna Goracci (University of Siena School of Medicine, Italy) and colleagues assessed the presence of Axis I psychiatric disorders in 81 infertile couples before fertility treatment and 70 fertile couples.
Current psychiatric disorders were significantly more likely among infertile than fertile couples, in particular adjustment disorder with mixed anxiety and depressed mood (16 vs 2 percent) and binge eating disorder (8 vs 0 percent).
Each of these disorders occurred more frequently in infertile women than in infertile men.
The researchers also note that adjustment disorders with mixed anxiety and depressed mood tended to be more common in women with "functional," anatomic, and endocrine infertility than among women with infertile male partners. Binge eating disorder was more common among women with "functional" infertility and endocrine infertility than among women with anatomic infertility or infertile partners.
Infertility in men was associated with subclinical obsessive-compulsive disorder and subclinical social phobia.
Psychiatric comorbidity was positively associated with length of infertility, with patients who had experienced reproductive problems for 2 or more years more likely to be diagnosed with adjustment disorder and depression than other patients.
The researchers recommend that "gynecologists screen for clinical or subclinical psychiatric disorders in infertility patients and offer treatment accordingly."
Arianna Goracci (University of Siena School of Medicine, Italy) and colleagues assessed the presence of Axis I psychiatric disorders in 81 infertile couples before fertility treatment and 70 fertile couples.
Current psychiatric disorders were significantly more likely among infertile than fertile couples, in particular adjustment disorder with mixed anxiety and depressed mood (16 vs 2 percent) and binge eating disorder (8 vs 0 percent).
Each of these disorders occurred more frequently in infertile women than in infertile men.
The researchers also note that adjustment disorders with mixed anxiety and depressed mood tended to be more common in women with "functional," anatomic, and endocrine infertility than among women with infertile male partners. Binge eating disorder was more common among women with "functional" infertility and endocrine infertility than among women with anatomic infertility or infertile partners.
Infertility in men was associated with subclinical obsessive-compulsive disorder and subclinical social phobia.
Psychiatric comorbidity was positively associated with length of infertility, with patients who had experienced reproductive problems for 2 or more years more likely to be diagnosed with adjustment disorder and depression than other patients.
The researchers recommend that "gynecologists screen for clinical or subclinical psychiatric disorders in infertility patients and offer treatment accordingly."
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