What are the European trends and developments in ART and IUI in 2014 as compared to previous years?
The 18th ESHRE report on ART shows a continuing expansion of both treatment numbers in Europe and ...more variability in treatment modalities resulting in a rising contribution to the birth rates in most participating countries.
Since 1997, ART data generated by national registries have been collected, analysed by the European IVF-monitoring (EIM) Consortium and reported in 17 manuscripts published in Human Reproduction.
Continuous collection of European data by the EIM for ESHRE. The data for treatments performed in 2014 between 1 January and 31 December in 39 European countries were provided by national registries or on a voluntary basis by clinics or professional societies.
From 39 countries and 1279 institutions offering ART services, a total of 776 556 treatment cycles, involving 146 148 with IVF, 362 285 with ICSI, 192 027 with frozen embryo replacement (FER), 15 894 with PGT, 56 516 with egg donation (ED), 292 with IVM and 3404 with frozen oocyte replacement (FOR) were reported. European data on IUI using husband/partner's semen (IUI-H) and donor semen (IUI-D) were reported from 1364 institutions offering IUI in 26 countries and 21 countries, respectively. A total of 120 789 treatments with IUI-H and 49 163 treatments with IUI-D were included.
In 14 countries (17 in 2013), where all institutions contributed to their respective national registers, a total of 291 235 treatment cycles were performed in a population of ~208 million inhabitants, corresponding to 1925 cycles per million inhabitants (range: 423-2978 per million inhabitants). After treatment with IVF the clinical pregnancy rates (PR) per aspiration and per transfer were marginally higher in 2014 than in 2013, at 29.9 and 35.8% versus 29.6 and 34.5%, respectively. After treatment with ICSI the PR per aspiration and per transfer were also higher than those achieved in 2013 (28.4 and 35.0% versus 27.8 and 32.9%, respectively). After FER with own embryos the PR continued to rise, from 27.0% in 2013 to 27.6% in 2014. After ED a similar trend was observed with PR reaching 50.3% per fresh transfer (49.8% in 2013) and 48.7% for FOR (46.4% in 2013). The delivery rates (DR) after IUI remained stable at 8.5% after IUI-H (8.6% in 2013) and at 11.6% after IUI-D (11.1% in 2013). In IVF and ICSI together, 1, 2, 3 and ≥4 embryos were transferred in 34.9, 54.5, 9.9 and in 0.7% of all treatments, respectively (corresponding to 31.4%, 56.3, 11.5% and 1% in 2013). This evolution in embryo transfer strategy in both IVF and ICSI resulted in a singleton, twin and triplet DR of 82.5, 17.0 and 0.5%, respectively (compared to 82.0, 17.5 and 0.5%, respectively, in 2013). Treatments with FER in 2014 resulted in a twin and triplet DR of 12.4 and 0.3%, respectively (versus 12.5 and 0.3% in 2013). Twin and triplet DR after IUI were 9.5 and 0.3%, respectively, after IUI-H (in 2013:9.5 and 0.6%) and 7.7 and 0.3% after IUI-D (in 2013: 7.5 and 0.3%).
The method of data collection and reporting varies among European countries. The EIM receives aggregated data from various countries with variable levels of completeness. Registries from a number of countries have failed to provide adequate data about the number of initiated cycles and deliveries. As long as incomplete data are provided, the results should be interpreted with caution.
The 18th ESHRE report on ART shows a continuing expansion of treatment numbers in Europe. The number of treatments reported, the variability in treatment modalities and the rising contribution to the birth rates in most participating countries point towards the increasing impact of ART on reproduction in Europe. Being the largest data collection on ART, the report gives detailed information about ongoing developments in the field.
The study has no external funding and all costs are covered by ESHRE. There are no competing interests.
The {sup 1}H(e,e{sup '}{pi}{sup +})n cross section was measured at four-momentum transfers of Q{sup 2}=1.60 and 2.45 GeV{sup 2} at an invariant mass of the photon nucleon system of W=2.22 GeV. The ...charged pion form factor (F{sub {pi}}) was extracted from the data by comparing the separated longitudinal pion electroproduction cross section to a Regge model prediction in which F{sub {pi}} is a free parameter. The results indicate that the pion form factor deviates from the charge-radius constrained monopole form at these values of Q{sup 2} by one sigma, but is still far from its perturbative quantum chromodynamics prediction.
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CMK, CTK, FMFMET, IJS, NUK, PNG, UM
The aim of the study was to analyze the effectiveness of the application of DDAVP (desmopressin) and Hemate P with cryoprecipitate pre- and postpartum in patients with von Willebrand disease.
We ...monitored 32 patients with von Willebrand disease during the study period 1993-2003. DDAVP was applied in the 36th/37th week of gestation and cryoprecipitate and fresh frozen plasma were applied 1 day before and 3 days after delivery. DDAVP treatment continued for 4 weeks. Factor VIII (Hemate P) at the day of delivery
No complications occurred in the studied population.
Precipitation of DDAVP, Hemate P, and cryoprecipitate may help in the treatment of pregnant women with von Willebrand disease.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The heterologous expression and spectroscopic characterization of the 2Fe-2S ferredoxin from the sexually transmitted human
parasite Trichomonas vaginalis is described. Using oligonucleotide primers ...based on the deduced DNA sequence, the gene encoding the ferredoxin was amplified
by polymerase chain reaction and cloned into a T7 RNA polymerase expression vector. Expression of the gene in Escherichia coli host HMS174(DE3) resulted in the high level production of the protein with the correctly assembled iron-sulfur cluster. The
absorption, circular dichroism, resonance Raman, and EPR spectra of the recombinant protein revealed many differences from
those of other 2Fe-2S ferredoxins. The redox potential of the protein (â347 mV versus normal hydrogen electrode) was also determined. Whereas the amino acid sequence of T. vaginalis ferredoxin showed greatest homology to the 2Fe-2S ferredoxins found in bacteria and vertebrate mitochondria which function
in cytochrome P450 oxidation pathways, the spectroscopic properties showed substantial dissimilarity. Differences in the biophysical
properties and function of T. vaginalis ferredoxin are proposed to result from the characteristic amino acid sequence of the parasite protein near the cysteine residues
that ligate the valence-localized Fe(III) site of the reduced cluster.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A large set of cross sections for semi-inclusive electroproduction of charged pions (π±) from both proton and deuteron targets was measured. The data are in the deep-inelastic scattering region with ...invariant mass squared W2 > 4 GeV2 and range in four-momentum transfer squared 2 < Q2 < 4 (GeV/c)2, and cover a range in the Bjorken scaling variable 0.2 < x < 0.6. The fractional energy of the pions spans a range 0.3 < z < 1, with small transverse momenta with respect to the virtual-photon direction, Pt2 < 0.2 (GeV/c)2. The invariant mass that goes undetected, Mx or W', is in the nucleon resonance region, W' < 2 GeV. The new data conclusively show the onset of quark-hadron duality in this process, and the relation of this phenomenon to the high-energy factorization ansatz of electron-quark scattering and subsequent quark → pion production mechanisms. The x, z and Pt2 dependences of several ratios (the ratios of favored-unfavored fragmentation functions, charged pion ratios, deuteron-hydrogen and aluminum-deuteron ratios for π+ and π-) have been studied. The ratios are found to be in good agreement with expectations based upon a high-energy quark-parton model description. We find the azimuthal dependences to be small, as compared to exclusive pion electroproduction, and consistent with theoretical expectations based on tree-level factorization in terms of transverse-momentum-dependent parton distribution and fragmentation functions. In the context of a simple model, the initial transverse momenta of d quarks are found to be slightly smaller than for u quarks, while the transverse momentum width of the favored fragmentation function is about the same as for the unfavored one, and both fragmentation widths are larger than the quark widths.
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CMK, CTK, FMFMET, IJS, NUK, PNG, UM
STUDY QUESTION: What are the data on ART and IUI cycles, and fertility preservation (FP) interventions reported in 2017 as compared to previous years, as well as the main trends over the years? ...SUMMARY ANSWER: The 21st ESHRE report on ART and IUI shows the continual increase in reported treatment cycle numbers in Europe, with a decrease in the proportion of transfers with more than one embryo causing an additional slight reduction of multiple delivery rates (DR) as well as higher pregnancy rates (PR) and DR after frozen embryo replacement (FER) compared to fresh IVF and ICSI cycles, while the number of IUI cycles increased and their outcomes remained stable. WHAT IS KNOWN ALREADY: Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been gathered and analyzed by the European IVF-monitoring Consortium (EIM) and communicated in a total of 20 manuscripts published in Human Reproduction and Human Reproduction Open. STUDY DESIGN, SIZE, DURATION: Data on European medically assisted reproduction (MAR) are collected by EIM for ESHRE on a yearly basis. The data on treatments performed between 1 January and 31 December 2017 in 39 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. PARTICIPANTS/MATERIALS, SETTING, METHODS: Overall, 1382 clinics offering ART services in 39 countries reported a total of 940 503 treatment cycles, including 165 379 with IVF, 391 379 with ICSI, 271 476 with FER, 37 303 with preimplantation genetic testing (PGT), 69 378 with egg donation (ED), 378 with IVM of oocytes, and 5210 cycles with frozen oocyte replacement (FOR). A total of 1273 institutions reported data on 207 196 IUI cycles using either husband/partner's semen (IUI-H; n= 155 794) or donor semen (IUI-D; n = 51 402) in 30 countries and 25 countries, respectively. Thirteen countries reported 18 888 interventions for FP, including oocyte, ovarian tissue, semen and testicular tissue banking in pre- and postpubertal patients. MAIN RESULTS AND THE ROLE OF CHANCE: In 21 countries (20 in 2016) in which all ART clinics reported to the registry, 473 733 treatment cycles were registered for a total population of approximately 330 million inhabitants, allowing a best-estimate of a mean of 1435 cycles performed per million inhabitants (range: 723-3286). Amongst the 39 reporting countries, the clinical PR per aspiration and per transfer in 2017 were similar to those observed in 2016 (26.8% and 34.6% vs 28.0% and 34.8%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2016 (24% and 33.5% vs 25% and 33.2% in 2016). When freeze all cycles were removed, the clinical PRs per aspiration were 30.8% and 27.5% for IVF and ICSI, respectively. After FER with embryos originating from own eggs the PR per thawing was 30.2%, which is comparable to 30.9% in 2016, and with embryos originating from donated eggs it was 41.1% (41% in 2016). After ED the PR per fresh embryo transfer was 49.2% (49.4% in 2016) and per FOR 43.3% (43.6% in 2016). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and greater than or equal to4 embryos in 46.0%, 49.2%, 4.5% and in 0.3% of all treatments, respectively (corresponding to 41.5%, 51.9%. 6.2% and 0.4% in 2016). This resulted in a reduced proportion of twin DRs of 14.2% (14.9% in 2016) and stable triplet DR of 0.3%. Treatments with FER in 2017 resulted in a twin and triplet DR of 11.2% and 0.2%, respectively (vs 11.9% and 0.2% in 2016). After IUI, the DRs remained similar at 8.7% after IUI-H (8.9% in 2016) and at 12.4% after IUI-D (12.4.0% in 2016). Twin and triplet DRs after IUI-H were 8.1% and 0.3%, respectively (in 2016: 8.8% and 0.3%) and 6.9% and 0.2% after IUI-D (in 2016: 7.7% and 0.4%). Amongst 18 888 FP interventions in 13 countries, cryopreservation of ejaculated sperm (n = 11 112 vs 7877 from 11 countries in 2016) and of oocytes (n = 6588 vs 4907 from eight countries in 2016) were the most frequently reported. LIMITATIONS, REASONS FOR CAUTION: As the methods of data collection and levels of reporting vary amongst European countries, interpretation of results should remain cautious. Some countries were unable to deliver data about the number of initiated cycles and deliveries. WIDER IMPLICATIONS OF THE FINDINGS: The 21st ESHRE report on ART, IUI and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, efforts should continue to optimize data collection and reporting with the perspective of improved quality control, transparency and vigilance in the field of reproductive medicine. STUDY FUNDING/COMPETING INTEREST(S): The study has received no external funding and all costs are covered by ESHRE. There are no competing interests. Key words: IVF / ICSI / IUI/ / egg donation / frozen embryo replacement / surveillance / vigilance / registry / data collection/ fertility preservation
In the population of pregnant women in Serbia and Montenegro, hemorrhoids are present in 85% of the cases during the second and third pregnancy. Urged by the complications of non-treated hemorrhoids, ...we carried out a routine diagnostic procedure to examine hemorrhoids during pregnancy, i.e. a differential diagnosis with other possible complications was performed. Fifty patients, aged between 36 and 38, were examined by anoscope and rectoscope during the second trimester. Rectal carcinoma was found in three cases, which is a disturbing number. The patient with the most serious clinical picture was subjected to urgent artificial fetal lung maturation and surgical delivery. One of the patients had clinical cachexia, and in view of the fact that the magnetic resonance imaging during pregnancy showed infiltration and that the patient was 38 years old, with the patient's consent, surgery was performed together with hysterectomy and salpingo-oophorectomy and immediate removal of the rectum and anus. In the other two cases, the delivery ended vaginally between the 35th and 38th week of gestation, after which the patients were moved to the surgery ward. Besides a positive family history for digestive tract carcinoma (95%), smoking and increased body mass index, there were no significant parameters distinguishing these three patients from others with hemorrhoids. Interesting data were obtained from the fact that there was no increase in body mass during pregnancy which patients correlated with their already present obesity. Moreover, pain was correlated with the fact that the patients did not follow a healthy dietary regime. In all 50 patients, the following procedures were performed: anoscope, rectoscope and digestive tract tumor markers. Observing the results of the biopsies, we found rectal carcinoma Stage C according to Dukes staging (tumor included serosa) in one case. In the other two cases, Stage B1 carcinomas were found (which included all layers except serosa). Magnetic resonance imaging was performed and confirmed progression of the disease. The delivery ended per vias naturalis in two cases in view of the fact that it was the third pregnancy for both patients. Surgery was performed 40 days after delivery. Postoperative recovery was unremarkable in all described cases.
Cervical carcinoma is the fourth most common malignant disease in women, after breast, lung and colon cancer. It is present in two-thirds of all malignant diseases of the genital tract. Although in ...most of Europe patients are subjected to regular health screening, diagnoses of severe life-threatening alterations are often made when they are already in late stages.
We have analyzed a case of pancreatic carcinoma in a pregnant woman, 37 years old, in the second trimester of the pregnancy. She had a positive family history of digestive tract carcinoma. The ...delivery ended surgically and hysterectomy was performed at the same time.
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