Preimplantation genetic diagnosis increases the implantation rate in human in vitro fertilization by avoiding the transfer of chromosomally abnormal embryos

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Citations from the literature /International

Journal of Gynecology & Obstetrics 61 (1998) 93-104

despite vertebral defects at high localisation. These leg movements were of normal quality (normal in appearance) and endogenously generated, since no external stimulus was exerted to elicit them. This implies that in fetuses with spina bifida aperta active leg movements can be generated at spinal segments which are located at (n = 11, or under (n = 12) the meningo-myelelocele. Postnatally, for a short period of time (mostly during the first few hours), leg movements related to myelum function at (n = 1) or lower than (n = 7) the spinal defect were detected. However, only in two infants these early leg movements were of normal quality and corresponded with the final motor outcome. In contrast to these early neonatal leg movements, early sensory function was strongly related to the spinal defect (r = 0.76; P = 0.005) and to the final motor outcome (sensory function predicted outcome in all infants of whom follow-up was performed). CONCLUSION: These data on fetuses/infants with spina bifida aperta strongly indicate that a discrepancy exists between the occurrence of prenatal leg movements and the spinal localisation of the meningomyelocele on the one hand, and between the occurrence of pre- and postnatal leg movements on the other hand (quantity and quality). Better maternal outcomes are achieved with dexamethasone therapy for postpartum DELLP (hemolysis, elevated liver enzymes, and thrombocytopenia) syndrome

Martin J.N. Jr.; Perry K.G. Jr.; Blake P.G.; May W.A.; Moore A.; Robinette L. USA

AM J OBSTET GYNECOL 1997 177/5 (1011-1017) OBJECTIVE: Our purpose was to determine whether the routine initiation of dexamethasone therapy in patients with postpartum HELLP (hemolysis, elevated liver enzymes, and thrombocytopenia) syndrome produces specific and general therapeutic benefits. STUDY DESIGN: In this retrospective, analytic study the puerperal courses of 43 women with postpartum HELLP syndrome who were treated with dexamethasone were compared with those of 237 similar patients who did not receive corticosteroids. Dexamethasone 10 mg intravenously at 12-hour intervals was given until disease remission was noted in treated patients, at which time up to two additional 5 mg intravenous doses were given at 12-hour intervals RESULTS: The two patient groups were similar in regard to mode of delivery, gestational age, parity, and frequency of eclampsia. Compared with control subjects, dexamethasonetreated postpartum patients were more ill with significantly higher (p < 0.05) admission mean arterial blood pressure, higher serum uric acid level, and severe. Dexamethasone administration was associated with a more rapid normalization of platelet counts and lactic dehydrogenase values. Most impressive was a clinically significant reduction of indicated transfusion and respiratory therapy, invasive hemodynamic monitoring, infectious or bleeding-related morbidity, and length of postpartum hospital course. CONCLUSIONS: Patients who received dexamethasone for postpartum-onset HELLP syndrome experienced a shorter disease course, faster recovery, less morbidity, and less need for other intervention-

ist therapy compared with patients with HELLP syndrome who did not receive dexamethasone.

FERTILITY

AND STERILITY

Preimplantation genetic diagnosis increases the implantation rate in human in vitro fertilization by avoiding the transfer of chromosomally abnormal embryos

Gianaroli L.; Magli M.C.; Ferraretti A.P.; Fiorentino A.; Garrisi J.; Munne S. ITALY

FERTIL STERIL 1997 68/6 (1128-1131) OBJECTIVE: To verify the percentage of chromosomally abnormal preimplantation embryos in patients with a poor prognosis and possibly to increase the chance of implantation by selecting chromosomally normal embryos. DESIGN A prospective, randomized, controlled study. SETTING: In vitro fertilization program at the Reproductive Medicine Unit of the Societa Italiana Studi Medicina della Riproduzione, Bologna, Italy. PATIENT@): In a total of 28 stimulated cycles, the maternal age was 2 38 years and/or the patient had I 3 previous IVF failures, factors that indicated a poor prognosis. After consent, 11 patients underwent preimplantation genetic diagnosis for aneuploidy, whereas 17 controls underwent assisted zona hatching. INTERVENTION(S): Simultaneous analysis of chromosomes X, Y, 13,18, and 21 in a blastomere biopsied from day-3 embryos. Chromosomal analysis was performed with fluorescence in situ hybridization. Assisted zona hatching was performed on day-3 embryos from the control-group patients. MAIN OUTCOME MEASURE(S): Embryo morphology, results of fluorescence in situ hybridization, clinical pregnancies, and implantation. RESULT(S): In the study group, a total of 61 embryos were analyzed by fluorescence in situ hybridization, and 55% were chromosomally abnormal. Embryo transfer with at least one normal embryo was performed in 10 cycles. Four clinical pregnancies resulted, with a 28.0% implantation rate. In the control group, 41 embryos were transferred in 17 cycles after the assisted zona hatching procedure, yielding four clinical pregnancies and an 11.9% implantation rate. CONCLUSION(S): Infertile patients classified as having a poor prognosis have a high percentage of chromosomally abnormal embryos. The advantage of selecting and transferring embryos with normal fluorescence in situ hybridization results has an immediate impact on implantation. Delay of gonadotropin stimulation in patients receiving gonadotropin-releasing hormone agonist (GnRH-a) therapy permits increased clinic efficiency and may enhance in vitro fertilization @VP) pregnancy rates

Damario M.A.; Moomjy M.; Tortoriello D.; Moy F.; Davis O.K.; Rosenwaks Z. USA FERTIL STERIL 1997 68/6 (1004-1010) OBJECTIVE: To promote an even temporal distribution of patients starting IVF cycles at our center, patients undergoing