Abstracts


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Single blastocyst transfer: Contemporary experience
Baw C.-K., Ly K.D., Kader A., Ahmady A., Agarwal A

Recent studies demonstrated an overwhelming success in single blastocyst transfer (SBT): implantation rates (IR) were 60.9%-70.5% and pregnancy rates (PR) were 60.9%-76% while the multiple pregnancy rates (MPR) were 0%-3.2%. Most of these studies involved good prognosis patients not more than 37 years of age. The results indicated that SBT decreased the number of multiple pregnancies while maintaining desirable pregnancy outcomes. However, SBT and cryopreserved single blastocyst transfer (cSBT) in the field of in vitro fertilization (IVF) are still in their infancy. Guidelines for the number of blastocysts being transferred and the techniques have not yet been standardized. The method to estimate the most viable blastocyst has not yet been proposed. The success of SBT also was found to be highly associated with the technique and patients’ and clinicians’ perceptions toward it.


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The role of oxidative stress and antioxidants in assisted reproduction
Gupta S., Sekhon L., Kim Y., Agarwal A.

Aim: Oxidative stress contributes to the high rate of failure seen in assisted reproductive techniques in achieving fertilization and pregnancy. Many studies have been done to elucidate the sources of oxidative stress in the setting of assisted reproductive technology (ART) and interventions to overcome its negative influence on the outcome of IVF and ICSI. This article explores the utility of metabolomics as a novel, non-invasive method of accurately and efficiently quantifying oxidative stress. The aim of this study was to review the current literature on the effects of various interventions, including the use of antioxidants supplementation of IVF culture media and patients to improve fertilization and pregnancy rates in subfertile patients undergoing ART.

Methods: Review of recent publications through Pubmed and the Cochrane data base. Results: Oxidative stress is correlated with negatives ART outcomes. Both exogenous and endogenous sources of reactive oxygen species during IVF/ICSI are well established in the literature. Compared to IVF, ICSI is known to minimize the exposure of gametes to endogenous sources of oxidative stress. Strategies to control exogenous sources of oxidative stress within the ART setting include reducing visible/near UV light exposure, the addition of metal chelators to culture media, maintenance of low oxygen tension in the environment and the use of antioxidant therapy. Antioxidant supplementation of culture media with vitamin C, vitamin E, and melatonin has been investigated and yielded conflicting results. Whereas oral antioxidant supplementation of male patients has been accepted and is currently practiced, there is a lack of consensus regarding the effectiveness of supplementation of vitamin C, vitamin E and melatonin in females undergoing ART.

Conclusion: There is a need for further investigation with randomized controlled studies to confirm the efficacy and safety of antioxidant supplementation of culture media and patients as well as the need to determine the dosage required to improve fertilization rates and pregnancy outcome with IVF/ICSI.


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Ovarian tissue vitrification: Modalities, challenges and potentials
Posillico S., Kader A., Falcone T., Agarwal A.

Ovarian tissue cryopreservation is the key step towards the establishment of an ovarian tissue bank or the preservation of ovarian tissue for patients scheduled for gonadotoxic cancer therapies, aiming for fertility restoration later on. Conventional cryopreservation, or slow freezing, has been the mainstay of ovarian tissue cryopreservation. Vitrification has recently emerged as a new trend for biological specimen preservation. It has shown increasing success over slow freezing, especially with oocytes, which is mainly attributed to avoiding ice formation. Much research is underway to investigate the application of vitrification to ovarian tissue. Ovarian tissue vitrification may have specific challenges and requirements that differ from single cell or oocyte vitrification. The medical literature was searched for studies on ovarian tissue vitrification using the keywords: ovary, ovarian tissue, transplantation, vitrification, cryopreservation, and freezing. After authors’ agreement, relevant citations were analyzed. Thirty studies reported the ovarian tissue vitrification of 11 species, using different vitrification methods and different outcome measures. The vitrification of ovarian tissue is a promising alternative to slow freezing. However, proper ovarian tissue preparation and the specific method of vitrification are both key factors that determine the viability and functionality of preserved tissue in other applications, notably transplantation.


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Parenting issues in mothers with schizophrenia
Seeman M.V.

Background: Schizophrenia has been seen as a severe and persistent illness that disqualifies mothers from adequately parenting their children.

Aim: To understand the scope of the issue, to learn about the subjective experiences of mothers and children, to appreciate the impact of psychotic illness on children at various ages, and to review the necessary components of intervention programs.

Results: Approximately half of all women with a diagnosis of schizophrenia are mothers. The rate of custody loss in this group is high. Most women with schizophrenia value their roles as mothers, and their adult children remain attached to them. There can be serious harms, however, associated with being the child of a mother with psychotic illness. Most of these appear to be mediated not by the illness itself but by associated risks: poverty, substance abuse, domestic violence, social isolation, and/or substandard housing. Intervention programs have begun to cut across agency divisions to provide wraparound care in multiple domains for families in distress.

Conclusion: Schizophrenia in mothers poses problems for offspring but does not preclude effective parenting.


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Sexuality in women with schizophrenia
Romans S.

This article reviews the published English literature to learn what is empirically known about the sexuality of women with schizophrenia. Although this aspect of patients’ lives is an important determinant of their quality of life, too little is known. It is clear that women with schizophrenia have high rates of sexual dysfunction which may or may not be side effects of medications used to treat their disorder. They also show higher rates of high risk sexual behaviors, those likely to result in HIV/AIDS, and unwanted pregnancies which may be related to the higher rates of sexual and physical abuse than that seen in non-affected women. Qualitative studies which are few in number and literary accounts by women with the illness hint that women with schizophrenia wish for rewarding sexually intimate relationships but infrequently attain them. Clinicians who are handicapped by great gaps in available research do a poor job at discussing and advising women about their options and rights. The author identifies a number of key clinical questions requiring answers.


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Psychotic denial of pregnancy
Solari H.

Denial is a defense that can help reduce anxiety when coping with a stressful event, but can be detrimental to an individual if it prevents adaptation. Three types of denial of pregnancy have been described: affective, pervasive and psychotic denial. The pregnancies of women with schizophrenia can be complicated by psychotic denial of pregnancy. Misinterpretations of the symptoms of pregnancy, grief from prior loss of custody of a child, and active psychiatric symptoms may increase the risk for denial of pregnancy. The consequences of failing to accept a pregnancy can be severe, including lack of prenatal care, limited time to prepare for parenting (with subsequent risk of custody loss), and neonaticide. These risks can be alleviated by early identification of women with psychotic denial of pregnancy and implementation of medication, psychotherapy and social support. At the individual level, education about family planning may be helpful in preventing further episodes. At the public policy level, Safe Haven laws may prove to be beneficial in preventing neonaticide.


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Antipsychotic medication (safety/risk) during pregnancy and breastfeeding
Einarson A.

It is important to evaluate the safety of antipsychotic drugs in pregnancy and the postpartum, especially as most women with schizophrenia need to continue their treatment during pregnancy and breastfeeding. With the increasing use of second generation antipsychotics, which cause less hyperprolactinemia-induced infertility than was the case with older drugs, the number of women with schizophrenia becoming pregnant will likely increase. In this review, I discuss the current available, evidenced-based information regarding the safety of antipsychotic drugs used in pregnancy. These include the first generation (chlorpromazine, fluphenazine, haloperidol, loxapine, perphenazine, prochlorperazine, promethazine, thioridazine, trifluoperazine) and second generation (aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone). To date, there has been no definitive association between use of these agents and an increased risk of birth defects or other adverse outcomes. Women who are pregnant or breastfeeding and require treatment should always discuss the risks/benefits of pharmacotherapy with their own physician. The evidenced-based information contained in this paper will be of use in their joint decision.