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ABSTRACT: A retrospective matched-control study to evaluate the effect of uterine anomalies on pregnancy rates after 2481 embryo transfers in conventionally stimulated IVF/intracytoplasmic sperm injection (ICSI) cycles. The study group of 289 embryo transfers before and 538 embryo transfers following hysteroscopic resection of a uterine septum was compared with two consecutive embryo transfers in the control group. Groups were matched for age, body mass index, ovarian stimulation, embryo quality, IVF or ICSI and infertility aetiologies. Number of embryos transferred, embryo quality and absence of uterine anomalies significantly predicted the pregnancy rates in the study group: odds ratios (OR) 1.7, 2.6 and 2.5, respectively (P<0.001). Pregnancy rates after embryo transfer before hysteroscopic metroplasty were significantly lower, both in women with subseptate and septate uterus and in women with arcuate uterus compared with controls. If two or three embryos with at least one best-quality embryo were transferred, the differences were 9.6% versus 43.6%, OR 7.3 (P<0.001) and 20.9% versus 35.5%, OR 2.1 (P<0.03), respectively. Differences in terms of live birth rates were even more evident: 1.9% versus 38.6%, OR 32 (P<0.001) and 3.0% versus 30.4%, OR 14 (P<0.001). After surgery, the differences disappeared. This retrospective matched control study evaluated the influence of septate, subseptate and arcuate uterus on pregnancy and live birth rates after 2481 in conventionally stimulated IVF/intracytoplasmic sperm injection (ICSI) cycles. The study group included 827 embryo transfers (289 embryo transfers before and 538 embryo transfers following hysteroscopic resection of uterine septum ans was compared with two consecutive mebryo transfers in the control group. Both groups were matched by age, body mass index, stimulation protocol, quality of embryos, use of IVF or ICSI, and infertility aetiologies. Multivariate logistic regression analysis of the study group showed that the number of embryos, embryo quality and the absence of uterine anomalies significantly predicted the pregnancy rates: odds ratios (OR) 1.7, 2.6, and 2.5, respectively (P<0.001). The pregnancy and live birth rates before surgery were lower compared with controls, both in women with subseptate or septate uterus and in women with arcuate uterus. If two or three embryos with at least one best quality embryo were transferred, the differences in terms of pregnancy rates were 9.6% versus 43.6%, OR=7.3 (P<0.001) and 20.9% versus 35.5%, OR=2.1 (P<0.03), respectively. The differences in terms of live birth rates were even more evident: 1.9% versus 38.6%, OR=32 (P<0.001) and 3.0% versus 30.4%, OR=14 (P<0.001). After surgery, the differences disappeared. Negative impact of uterine anomalies on pregnancy and on live birth rates are two important arguments for treating uterine anomalies in infertile women.
Reproductive biomedicine online 11/2010; 21(5):700-5. · 2.04 Impact Factor
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ABSTRACT: To evaluate the effect of hysteroscopic resection of a large uterine septum (Class V according to the American Fertility Society (AFS) classification) and of a small partial uterine septum (Class VI according to AFS classification or arcuate uterus) on the abortion rate in pregnancies after IVF and ICSI.
The retrospective matched control study included 31 women who conceived following IVF or ICSI before hysteroscopic resection of a large (12 women) or small partial (19 women) uterine septum and 106 women who conceived following IVF or ICSI after hysteroscopic resection of a large (49 women) or small partial (57 women) uterine septum. For each pregnancy in the study group, we found two consecutive pregnant control women from the IVF/ICSI registry who had a normal uterus and were matched for age, BMI, stimulation protocol and the use of IVF or ICSI and for various infertility causes. The abortion/pregnancy rate was the main outcome measure. Data on the septum length were obtained during hysteroscopic resection by comparing the length of the 1.4 cm long yellow tip of the electric knife to the length of the resected septum.
The abortion rate before hysteroscopic metroplasty was significantly higher, both in women with a small partial septum (78.9% before resection vs. 23.7% in the normal controls, OR 12.08) and a large septum (83.3% before resection vs. 16.7% in normal controls, OR 25.00) compared to women with a normal uterus. After the surgery, the abortion rate was comparable to the abortion rate in women with normal uterus: in both women with a small partial and women with a larger septum.
Similar to a large uterine septum, a small partial uterine septum is an important and hysteroscopically preventable risk factor for spontaneous abortion in pregnancies after IVF and ICSI.
European journal of obstetrics, gynecology, and reproductive biology 10/2009; 146(2):184-7. · 1.97 Impact Factor
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ABSTRACT: To evaluate whether a uterus with a small septum (arcuate uterus or class VI according to the American Fertility Society (AFS) classification) behaves similarly to a uterus with a larger septum (septate or subseptate uterus or AFS class V).
Observational study included 826 singleton deliveries to 730 women with a history of hysteroscopic resection of the uterine septum. Data on deliveries were obtained from the National Perinatal Registry of Slovenia (NPIS). Multiple gestations were excluded. We analysed and compared perinatal outcomes before and after hysteroscopic resection in two groups of women: in women with a small uterine septum (Group A) and in those with a larger uterine septum (Group B). Data on the septum length were obtained during hysteroscopic resection by comparing the length of the 1.4-cm long yellow tip of the electric knife to the length of the resected septum. A small uterine septum was defined as having a length of 1.3-1.5 cm.
The preterm birth rate in Group A (n=420) was 33.9% before and 7.2% after hysteroscopic resection (P<0.001); the preterm birth rate in Group B (n=406) was 36.5% before and 8.0% after hysteroscopic resection (P<0.001). The very preterm birth rate in Group A was 12.5% before and 3.1% after hysteroscopic resection (P<0.001); the very preterm birth rate in Group B was 15.0% before and 2.9% after hysteroscopic resection (P<0.001). After surgery, we registered a decreased need for neonatal intensive care, as well as a significant decrease in stillbirth and neonatal death rates in both groups of patients.
Similarly to a large uterine septum, a small uterine septum or arcuate uterus is an important hysteroscopically preventable risk variable for preterm birth.
European Journal of Obstetrics & Gynecology and Reproductive Biology 12/2007; 135(2):154-7. · 1.97 Impact Factor
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Ultrasound in Obstetrics and Gynecology 09/2007; 30(4):569 - 570. · 3.01 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the influence of maternal age and oestradiol concentrations on blastocyst development and live birth rates in natural cycle IVF-embryo transfer. This observational study included 397 natural cycles with IVF embryo transfer for female infertility with embryo transfer on day 5. The cycles were divided into two groups according to the woman's age (<39 and > or = 39 years of age), and into two groups according to oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration (0.4-0.49 nmol/l and 0.5-1.2 nmol/l). Comparison between the cycles in younger versus older age groups showed significant differences in blastocyst development rate, live birth rate per embryo transfer and live birth rate per cycle (55 versus 29%, 23 versus 3% and 13 versus 2% respectively) (P < 0.001). Comparison between cycles with lower versus higher oestradiol concentrations showed no significant differences in blastocyst development rate, live birth rate per embryo transfer and live birth rate per cycle (47 versus 49%, 18 versus 18%, and 11 versus 10% respectively). Advanced maternal age negatively predicts the success of natural cycle IVF, while low oestradiol concentrations on the day of HCG administration (ultrasound criteria fulfilled) do not negatively predict blastocyst development and success of natural cycle IVF.
Reproductive biomedicine online 08/2007; 15(2):220-6. · 2.04 Impact Factor
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ABSTRACT: Malocclusion assessment methods are based on measurements of study casts, which requires that impressions be taken. In addition to being costly and time consuming, this process can be unpleasant for children. Therefore, the aim of this study was to evaluate intra- and inter-examiner reliability of intraoral score measurements to determine malocclusion severity in the permanent dentition. The research was a part of a longitudinal study from which a cohort of 92 children (39 boys, 53 girls), with a mean age of 14.8 years (standard deviation = 0.18), were randomly selected and classified into severity grades based on total malocclusion score. Subsequently, 12 children were randomly selected for a reliability study to assess intra-examiner reliability of malocclusion trait measurements. Nine subjects gave informed consent to participate in the study. Quantitative registrations of space and occlusal anomalies were performed intraorally by five examiners, on two occasions with a 1-month interval between the two measurements. Intra- and inter-examiner reliability was determined using intraclass correlation coefficients (ICCs). Overall classification into severity grades, based on total malocclusion score, showed almost perfect intra-examiner reliability for all examiners (ICC = 0.97-0.99); inter-examiner ICC was almost perfect (0.97). Near perfect intra-examiner reliability was determined for eight occlusal trait measurements (ICC = 0.89-1.0); substantial reliability for midline deviation (ICC = 0.68), overbite (ICC = 0.78), but large variability for space condition assessment (ICC = 0.42-0.52). Inter-examiner reliability was almost perfect for the eight traits (ICC = 0.81-1.0); substantial reliability for midline deviation (ICC = 0.65), and axial tooth inclination (ICC = 0.75), but large variability for space condition assessment (ICC = 0.13-0.26). Intra- and inter-examiner malocclusion assessment, recorded and measured intraorally to determine malocclusion severity scores in 14-year old children, is reliable. It is therefore proposed as the method of choice to be used not only in epidemiological studies and screening but also in clinical orthodontic assessment.
The European Journal of Orthodontics 03/2007; 29(1):88-94. · 0.89 Impact Factor
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ABSTRACT: To establish whether LPA determination improves the differentiation of benign from malignant ovarian tumors.
Total LPA and LPA species in the serum were determined using a novel method in 142 patients with ultrasound (US) suspecious ovarian tumors and in 78 healthy women. All women underwent determination of CA125 in the serum, a vaginal US examination and morphology scoring of the tumor.
The levels of total LPA and its species in women with ovarian tumors were significantly higher from those in healthy women (p < 0.001). No significant difference was found in the levels of total LPA or any of its species between the women with benign and those with malignant ovarian tumors.
Determination of serum LPA would be an appropriate test for ovarian tumor presence, especially in women of reproductive age. The method however does not differentiate benign from malignant ovarian tumors.
European journal of gynaecological oncology 02/2007; 28(5):394-9. · 0.47 Impact Factor
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ABSTRACT: This is the first study evaluating whether oocyte development and fertilization competence are related to intrafollicular concentration of cholesterol, meiosis-activating sterols and progesterone, after human chorionic gonadotrophin (HCG) administration of women with polycystic ovarian syndrome (PCOS). The concentration of follicular fluid meiosis-activating sterol (FF-MAS) significantly increased in the periovulatory period from 10-14 to 34-38 h after HCG administration, while the concentration of testis meiosis-activating sterol (T-MAS) decreased, suggesting a HCG-dependent inhibition of sterol Delta14-reductase. There was no correlation between follicular lanosterol, FF-MAS, T-MAS, and progesterone concentrations and the presence or absence of MII oocytes. Interestingly, free cholesterol level was significantly lower and FF-MAS/cholesterol and progesterone/cholesterol ratios significantly higher in follicles containing MII oocytes compared to follicles from which oocytes were not retrieved. Yet, fertilization and embryo quality did not correlate with follicular sterols. This knowledge should be beneficial for the implementation of protocols for in vitro maturation process, usually used in PCOS patients.
Molecular and Cellular Endocrinology 05/2006; 249(1-2):92-8. · 4.19 Impact Factor
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ABSTRACT: The aim of this study was to determine whether, in polycystic ovarian syndrome (PCOS) patients, HCG action prolonged for 4 h improves the action of angiogenic substances [ovarian renin angiotensin system and vascular endothelial growth factor (VEGF)], and consequently follicular maturation, oocyte quality and oocyte fertilization competence.
In this prospective study 20 patients with PCOS undergoing IVF were included. Oocyte retrieval was carried out either 34 or 38 h after HCG administration. Each follicle was analysed for prorenin, active renin, VEGF and estradiol. Oocytes were evaluated for quality (mature, immature, degenerated oocytes), as were the embryos (low or high).
In the HCG +38 h group there were 245 follicles, and in the HCG +34 h group 240 follicles. In the HCG +38 h group, log active renin was lower (2.78 +/- 0.20 versus 2.91 +/- 0.25; P < 0.001) and VEGF higher (2276.0 +/- 790.1 versus 1946.6 +/- 954.5 pg/ml; P < 0.001). The odds ratio for obtaining oocytes from follicles was 1.6 [95% confidence interval (CI) 1.1-2.6; P = 0.02], and for developing high quality embryos 7.6 (95% CI 2.8-20.9; P < 0.001) in favour of the HCG +38 h group.
Follicular maturation and oocyte quality are related to the intrafollicular influences of active renin and VEGF in a time-dependent manner after HCG administration, whereas fertilization competence is related to VEGF only.
Human Reproduction 06/2005; 20(6):1562-8. · 4.47 Impact Factor
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ABSTRACT: To identify the effect of cervical muscle activity as an additional factor influencing the duration of the latent and active phase of labour.
Prospective observational study.
The Ljubljana Maternity Hospital.
Fifty healthy nulliparous women requiring induction of labour having relatively unripe cervices.
At the onset of labour an open-ended catheter was inserted to measure intrauterine pressure during the latent and active phase of labour. Electromyographic activity of the cervix was registered by two bipolar spiral needle electrodes placed in the transverse direction on the proximal part of the cervix in the vagina. The mean intensity of distinctive peaks in an electromyographic spectrogram were calculated in the time/frequency domain. Multiple linear regression was used to find factors affecting the duration of the latent and active phase of labour.
Duration of the latent and active phase of labour.
Eleven independent variables explained 64% of the variance of the latent phase duration, the most important being the effacement and consistency of the cervix, and intensity of electromyographic signals. For the duration of the active phase the same variables explained 36% of the variance; the most important variables were mean duration of uterine contractions, mean maximum intensity of uterine contractions and the newborn's head circumference.
The cervical smooth muscle activity, expressed as an electromyographic signal, contributes to the duration of the latent phase but not to the duration of the active phase. However, frequent cervical contractions are not associated with a longer latent phase.
BJOG An International Journal of Obstetrics & Gynaecology 06/2001; 108(5):533-8. · 3.41 Impact Factor
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ABSTRACT: To estimate the risk of preterm birth in women admitted to the tertiary maternity hospital for preterm contractions by measuring electrical uterine activity.
The study included 47 patients with contractions between the 25th and 35th week of gestation and additional risk factors for preterm delivery. Uterine electrical activity was recorded using bipolar electrodes placed on the abdominal surface. A logistic model with the electromyographic and obstetric data was built, preterm delivery before 37th week of gestation being the outcome measure.
Seventeen patients (36%) delivered before term. Logistic regression model suggested only the intensity of electrical uterine activity and woman's body weight to be significant predictors of preterm delivery, with high values related to preterm birth. They predict preterm delivery with the sensitivity of 47% and specificity of 90%.
We propose uterine EMG as a simple, non-invasive means to estimate the risk of preterm birth in a high-risk population with multiple risk factors present.
European Journal of Obstetrics & Gynecology and Reproductive Biology 05/2001; 95(2):149-53. · 1.97 Impact Factor
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ABSTRACT: To estimate the clinical effectiveness of in vitro fertilization treatment in patients with minimal or mild endometriosis (stages I and II) in comparison to the patients with tubal infertility in terms of fertilization, pregnancy and livebirth rates.
Retrospective analysis of the outcome of IVF-ET in 612 cycles of the patients with endometriosis (389 stimulated with HMG/HCG and 223 co-treated with GnRH-a) and in 7,339 cycles of the patients with tubal infertility (5,520 stimulated with HMG/HCG and 1,819 co-treated with GnRH-a). RESULLTS: Regardless of the type of ovarian stimulation, the fertilization rate per treated cycle was practically the same in both groups (endometriosis 81.4% vs tubal infertility 84.2%; p = 0.07). However, in the endometriosis group the pregnancy rate was higher (25.3% vs 18.9%; p = 0.000), and so was the livebirth rate (19.0% vs 14.2%; p = 0.003). Considering the type of ovarian stimulation, the fertilization rate in the endometriosis group was almost the same in the HMG/HCG (81.2%) and in the GnRH-a co-treated cycles (81.6%), and did not differ from that in the tubal infertility group (83.6% in the HMG/HCG vs 85.9% in the GnRH-a cycles). In the GnRH-a co-treated cycles the pregnancy rate and the livebirth rate were not significantly higher in the endometriosis group than in the tubal infertility group (27% and 20.2% vs 22.2% and 17.5%). In the HMG/HCG stimulated cycles the pregnancy rate was significantly higher in the endometriosis than in the tubal infertility group (24.3% vs 17.7%; p = 0.004), and so was the livebirth rate (18.4% vs 13.0%; p = 0.008).
In patients with minimal or mild endometriosis the IVF-ET procedure is at least as effective as in patients with tubal infertility.
Clinical and experimental obstetrics & gynecology 02/2000; 27(3-4):191-3. · 0.43 Impact Factor
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ABSTRACT: To determine whether semen quality in Slovenians has changed over 14 years (1983-96), we analysed retrospectively the semen of 2343 healthy men with a normal spermiogram, who were partners of women with tubal infertility included in the IVF-ET programme. Age at semen collection, duration of sexual abstinence, semen volume, sperm concentration, total sperm count, percentage of spermatozoa with progressive motility, and normal morphology were determined. Multiple regression analysis was used to assess the changes in sperm characteristics according to the year of semen collection, year of the man's birth and the duration of sexual abstinence. Semen volume, sperm concentration, sperm count and total sperm motility did not change between 1983 and 1996, whereas between 1988 and 1996 rapid progressive sperm motility decreased by 0.95% per year (p < 0.0001). Semen volume, sperm concentration, and sperm count increased with duration of sexual abstinence. After adjustment for the year of semen collection and duration of sexual abstinence, multiple regression analysis showed that sperm concentration decreased by 0.67% per each successive year of birth (p = 0.03). Thus the sperm concentration decreased from 87.6 x 10(6)/mL in men born in the 1940s to 77.3 x 10(6)/mL in those born between 1956 and 1960. After 1960, sperm concentration was found to increase. In 2343 healthy men, no decline in semen quality, except in rapid progressive motility, was observed in the study period. Lower sperm concentration was found among men born between 1950 and 1960. This could be related to worse socio-economic status, stress or negative environmental factors in this time period.
International Journal of Andrology 06/1999; 22(3):178-83. · 3.59 Impact Factor
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ABSTRACT: To find the similarities and dissimilarities between the activity of the human smooth muscles in the cervix and in the uterine corpus at the onset of induced labour.
Electromyographic activity was measured in 14 primiparous women after amniotomy. The data were sampled and stored digitally in real time. For statistical analysis, the first 20 min of recordings following amniotomy were analyzed. The ratio between the mean activity at a given time and the mean activity over the whole 20 min was used for the comparison between the cervical and uterine activity.
The analysis of correlation showed that the electromyographic activity in the cervix differed from that in the uterine corpus in the majority of the enrolled cases.
The muscular activity in the cervix is independent of that in the uterine corpus at the onset of induced labour.
European Journal of Obstetrics & Gynecology and Reproductive Biology 09/1998; 79(2):199-204. · 1.97 Impact Factor
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ABSTRACT: To evaluate neonatal and maternal outcomes of PROM deliveries with regard to the time elapsed since preterm rupture of membranes (PROM) to delivery.
According to the time elapsed since PROM to delivery we divided all singleton deliveries with PROM after the completed 34th week of gestation (N = 35,419), which occurred in Slovenia between 1988 and 1994, into four groups: within 12 h, within 13-24 h, within 25-48 h, and over 48 h after PROM. The analysis was focused on the management of labor, neonatal and maternal infections and perinatal hypoxia with regard to the elapsed time. The Kruskal-Wallis analysis of variance, the Pearson chi-square test, Spearman rank correlation test, and the logistic regression test were used.
With increasing time elapsed since PROM to delivery we found significantly increased incidences of induced labor, operative delivery, fetal distress, poorer fetal condition at birth, neonatal infections, and minor maternal infections.
We may conclude that the best neonatal and maternal outcomes are obtained if delivery occurs within 12 h after PROM.
International Journal of Gynecology & Obstetrics 10/1997; 58(3):281-6. · 2.05 Impact Factor
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ABSTRACT: The greatest risk of preterm prelabour rupture of membranes (PPROM) is preterm delivery. According to the Perinatal Information System of Slovenia there were 5.92% preterm deliveries in 1994. We studied 809 deliveries of less than 34 weeks of gestation in the Ljubljana Maternity, from 1992 to 1994; 33.7% of these started with PPROM. Risk factors for PPROM were conization, cerclage and use of antibiotics for any reason in current pregnancy. Amnionitis and febrile illness during labour increased with longer duration of PPROM but maternal postpartum infections did not. In neonates, more cases of lower Apgar scores after 1 and 5 min and more cases of suspected sepsis were found with the increased duration of PPROM. In Slovenia, with good facilities for transport in utero and good neonatal care, after PPROM it is best to transport the pregnant women to the third level center and then wait until labour starts or to recur to prompt delivery when maternal or fetal signs so require. From 1987 to 1993 there were 159264 deliveries in gestations equal to or over 34 weeks; 20.8% started with PROM. In our observational study we found the best results when labour was induced. There are, however, many disagreements about the management of (P)PROM.
European Journal of Obstetrics & Gynecology and Reproductive Biology 03/1997; 71(2):141-6. · 1.97 Impact Factor
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ABSTRACT: To investigate the activity of the smooth muscles in the cervix at the onset of induced labor and to further elucidate this activity in relation to uterine contractions and to the duration of the latent phase of labor, taking cervical ripeness into account.
Cervical electromyographic (EMG) activity was studied at the onset of labor induced with amniotomy and oxytocin. Bipolar measurement of cervical electrical activity was performed. The root mean square of the cervical EMG activity and the intensity of intrauterine pressure in two groups of parturients with different cervical ripeness were compared.
The EMG activity was higher in the group with lower Bishop scores. We found a significant positive correlation between EMG activity and duration of the latent phase of labor.
Smooth muscles in the human cervix are active during labor and act to some extent independently of the uterine corpus.
International Journal of Gynecology & Obstetrics 07/1995; 49(3):277-81. · 2.05 Impact Factor
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ABSTRACT: To evaluate the effects of abdominal versus vaginal delivery in the groups of newborns with different birth weights.
5012 single breech deliveries with birth weight over 1000 g, lethal malformations and stillbirths excluded, were enrolled in the study. The comparison of early neonatal mortality and the incidence of 12 different symptoms and signs of fetal morbidity for abdominally/vaginally delivered newborns was made within four birth-weight groups.
In abdominal delivery we found statistically significantly lower neonatal mortality and incidence of low 5-min Apgar score in the 1000-1499-g birth-weight group; incidence of brachial plexus damage and hyperbilirubinemia due to blood resorption in the 2500-3799-g birth-weight group. In vaginal delivery we found statistically significantly lower incidence of low 1- and 5-min Apgar score, light and moderate hypoxia and RDS in the 1500-2499-g birth-weight group; low 1-min Apgar score and light hypoxia in the 2500-3799-g birth-weight group.
The effects of abdominal delivery on newborn in breech are in many aspects poorer than in vaginal delivery. In our opinion the actual incidence (36%) of cesarean section could be decreased, especially in cases with expected birth weight over 1500 g.
European Journal of Obstetrics & Gynecology and Reproductive Biology 06/1994; 54(3):181-4. · 1.97 Impact Factor
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ABSTRACT: The effect of pethidine hydrochloride (PHC) on the smooth muscles of cervix was studied in the active phase of induced labour in 27 primiparous women. The Electromyographic (EMG) root mean square (RMS) which provides information about the amplitude (intensity) of muscular cervical activity, and the median frequency (MF) which represents the EMG frequency spectrum were analyzed in connection with the intensity of intra-uterine pressure (IIUP). The RMS significantly decreases after the application of PHC, while the IIUP significantly increases. The effect of the applied drug disappears in one hour's time. The MF values increase insignificantly after the application and change in the opposite direction to the change of MSR. The change RMS, MF and IIUP values do not correlate with the duration of the active phase of labour.
Clinical and experimental obstetrics & gynecology 02/1993; 20(3):145-50. · 0.43 Impact Factor
