PubMed · 12095521
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Kamal Jaroudi, Serdar Coskun. 2002. Appropriate credit.. https://doi.org/10.1016/s0015-0282(02)03195-3
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Second trimester maternal serum biochemical markers, introduced between 1990 and 1995, were supplemented with new ultrasound methods at 14-16 weeks and first trimester biochemical markers between 1995 and 2000. This study evaluated the effectiveness of a Down syndrome (DS) prevention program among the Israeli Jewish population between 1990 and 2000. We collected data on the total number of prenatal tests performed on Israeli Jewish women, DS cases detected prenatally and DS livebirths in Israel during these years. We also studied the use of the newer screening tests in 1990, 1992, and 2000. Between 1990 and 1995, use of chromosomal studies for DS in this population increased from 11.3% to 21.6% and the percentage of cases detected prenatally from 53% to 70%. However, between 1996 and 2000, even with the new screening methods, the utilization rate remained similar (20.7% and 19.8%, respectively) and the percentage detected prenatally decreased to 61% in 2000. The total cost per case detected increased from $47,971 US dollars in 1990 to $75,229 US dollars in 1992, and to $190,171 US dollars in 2000. Between 1990 and 1995, improvement in the percentage of cases detected prenatally was associated with a significant increase in the amniocentesis rate-both are attributed to the introduction of second trimester maternal serum biochemical marker tests. Unexpectedly, the introduction between 1995 and 2000 of new genetic methods to assess the DS risk did not improve the percentage detected or reduce the amniocentesis rate, and was accompanied by an increased cost per case detected.
Leptin is a metabolic signal to the reproductive axis, where it increases the plasma levels of luteinising hormone (LH) and follicle stimulating hormone (FSH). Since the placental regulation of human chorionic gonadotrophin (hCG) mimics that of the pituitary LH, we undertook this study to see if leptin could be involved in the secretion and synthesis of hCG in first-trimester trophoblast. We incubated cytotrophoblastic cells (CTB) with GnRH-I or GnRH-II, for 4 or 48 h and collected the media at different times thereafter. GnRH-II was more potent than GnRH-I when incubated for 4 h with CTB. Leptin secretion, as measured at 4 h, was significantly stimulated by GnRH-II. When measured at 24 h leptin values were also increased as compared to controls. Neither GnRH-I, nor GnRH-II had any effect on leptin secretion when incubated for 48 h with CTB. Leptin was also added to perifused placental explants, and samples (in which hCG was measured) were collected every 3 min. Leptin significantly stimulated hCG secretion by explants and induced a pulse of hCG immediately (within 6 min) after its injection, increasing significantly the area under the curve (P=0.04) and the amplitude (P=0.02) of hCG pulses. We conclude that GnRH-II is more effective than GnRH-I in stimulating leptin secretion. This difference could be explained by the existence of two different types of placental GnRH receptors or two different pathways of GnRH degradation. Furthermore, we observe that leptin has a significant stimulatory effect on hCG pulsatility.
BACKGROUND: Five women undergoing intracytoplasmatic sperm injection (ICSI) considered to be at high risk of developing an ovarian hyperstimulation syndrome (OHSS) from March to July 2002 underwent unilateral follicular aspiration. METHODS: When >/=15 follicles of 12-15 mm diameter in each ovary and a serum estrodial level >/=2500 pg/ml was present, follicular aspiration was performed unilaterally without hCG administration. Ovarian stimulation was continued for 1-3 days in four women before human chorionic gonadotrophin (hCG) was given. In one woman hCG injection was administered at the evening after unilateral follicular aspiration. The oocyte retrieval from the contralateral ovary was performed 36 h after hCG injection. By unilateral follicular aspiration two to six germinal vesicle (GV) oocytes could be retrieved. After in-vitro maturation of those oocytes ICSI was performed. RESULTS: In four women one to two oocytes were fertilized and cryopreserved. In one case only one triploid pronucleus (3PN) was observed. At the contralateral ovum-pick up after hCG injection a median of 10 could be retrieved. After transfer of a median of 3 embryos, no pregnancy was achieved. Four of five patients developed a severe OHSS and were hospitalized for a median of 3 days. CONCLUSION: Unilateral follicular aspiration and continuation of stimulation therefore can not be recommended for the prevention of OHSS.