Tired old dog

An older, tired looking dog wandered into my yard. I could tell from his collar and well fed belly, that he had a home and was well taken care of. He calmly came over to me and I gave him a few pats on the head, whereupon he followed me into my house, slowly walked down the hall, curled up in a corner and went fast asleep.

An hour later he went to the door and I let him out. The next day he was back, greeted me in my yard, walked inside and resumed his spot in the hall and slept for about an hour.

This continued off and on for several weeks. Curious, I pinned a note to his collar: 'I would like to find out who the owner of this wonderful sweet dog is, and ask if you are aware that almost every afternoon your dog comes to my house to take a nap'.

The next day he arrived for his nap, with a different note attached to his collar: 'He lives in a home with 6 children, two under the age of three - he's just trying to catch up on his sleep.'

HDL linked to oocyte health and embryo development

High-density lipoprotein (HDL) in follicular fluid (FF) and its component proteins appear to have protective roles in the health of oocytes and early embryo development, US study findings indicate.

R. Browne, from University at Buffalo, State University of New York, and colleagues determined HDL lipids, apolipoprotein (Apo)AI, paraoxonase (PON)1, and PON3 activity in serum and FF samples obtained from 60 women undergoing IVF.

Embryo cell number (ECN) and embryo fragmentation score (EFS) were used as embryo morphology parameters and surrogate markers of oocyte health.

In FF, all biochemical parameters were significantly lower than in serum, aside from PON3 levels, which were significantly higher in FF than in serum.

EFS was negatively predicted by HDL and ApoAI levels in FF, at respective odds ratios of 0.66 and 0.13. However, their effects were not independent, with levels of one moderating the effects of the other.

In addition, when the analysis was restricted to day 3 embryo transfers, PON1-arylesterase activity in FF was a significant predictor of ECN, at an odds ratio of 1.09.

"Our pilot study establishes the possibility that HDL and/or its component proteins have the potential to predict embryo fragmentation and cell number in women undergoing IVF," the team concludes.

Sildenafil shows pregnancy benefits in women with recurrent miscarriage

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."

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."

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."

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."

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