Fertility and reproductive medicine is constantly changing and expanding as its technology rapidly advances. Freezing a woman’s eggs can be of great benefit for many conditions such as cancer and infertility.
Initially, a woman’s eggs, which are called oocytes, were frozen with moderate success. Ice crystals formed within the oocyte which caused damage and left the egg unusable.
A different freezing process was formulated which froze the oocyte at a much slower rate, which helped to prevent ice crystal formation. This method, however, had much lower rates of fertilization.
A new method, called vitrification, rapidly cools the oocyte at a rate of 20,000 degrees Celsius per minute!! The freezing occurs so quickly that it does not allow ice to form. This leads to improved oocyte survival and function, fertilization, and pregnancy rates. Chromosomal analysis of embryos of previously frozen oocytes versus normal oocytes revealed no difference in incidence of chromosomal abnormalities or congenital anomalies.
The new egg freezing technology is very exciting, and we are continuing to learn ways to apply this to both infertile and fertile women!
Preterm birth rates continue to rise in the United States and are a major cause of neonatal morbidity and mortality. Low-dose aspirin has been researched as a possible inexpensive and safe medication to help reduce the incidence of preterm birth.
Aspirin helps by reducing uterine contractility and inflammation. Many medical issues such as the fetus being too small for gestational age, preeclampsia, placental insufficiency, and spontaneous labor may be reasons to consider protocols to help prevent preterm births. In these instances, the effects of aspirin may be very helpful.
Many studies have shown a decrease in preterm births in patients taking low-dose aspirin prior to and during pregnancy. It can be especially helpful to those with a history of a previous pregnancy loss.
The possibility of decreasing the incidence of preterm labor is very exciting. Additional research is necessary to fully observe and understand all of the effects of low-dose aspirin on pregnancy. Always remember to speak to your health care provider to discuss your particular concerns and to see if low-dose aspirin can be beneficial to you!
…..Over the last 30 years, ultrasound has changed dramatically in how we evaluate early pregnancy. Transvaginal sonography has allowed us to assess early gestation with better clarity.
…..The gestational sac is the first visible sign of a normal
intrauterine pregnancy. This should be seen with the transvaginal sonogram by 5 weeks after the last menstrual period. The earliest embryonic structure is the yolk sac, and likewise, this can be seen as early as the end of the 5th week. Evaluating the yolk sac is important because it can point to problems in a pregnancy. If it is not present at this early time, or if the shape is irregular or large, this can be the first sign of a nonviable pregnancy.
…..Near the 6th week from the last menstrual period, the embryo should be seen attached to the yolk sac, and fetal heart activity should be noted between the 6th and 7th week. When the gestational sac is approximately 2 cm, an embryo should be seen, and if it is not identified at this time, a blighted ovum is confirmed.
…..There are specific sonographic signs of a problem pregnancy:
A small gestational sac around the embryo
If the embryo does not increase in size by 1 mm per day
A fetal heart beat at a rate of less than 120 beats per minute after 7 weeks of gestation.
…..Let us end this review on a positive note. If a patient has no abnormal symptoms, normal fetal heart activity, and 7 weeks of gestation has been reached, then there is a 99% chance of a successful pregnancy.
…..There are a few common causes of bleeding in the first trimester:
Gestational trophoblastic disease (less common)
…..When we speak about miscarriages (spontaneous abortions), there are a few terms which are frequently used. An ultrasound and an examination will usually confirm the diagnosis:
Threatened abortion (when vaginal bleeding occurs before 20 weeks of gestation, there is a viable pregnancy, and the woman has a closed cervix)
Inevitable abortion (if there is a dilated cervix)
Incomplete abortion (when a portion of the pregnancy has passed)
Complete abortion (when all of the pregnancy tissue (products of conception) has passed)
…..Gestational trophoblastic disease is a much less common cause of vaginal bleeding early in a pregnancy. Some signs of this condition would be a pregnancy size larger than would be expected (based on routine dates), very high levels in a blood pregnancy hormone test (hCG), and severe nausea and vomiting. Here are some common terms that are encountered:
Complete hydatidiform mole: A partial mole is formed when a sperm fertilizes an egg that has no nucleus. This is the most common type of this condition. On a sonogram, there may be many ovarian cysts seen or many cysts within the uterus.
Partial mole: This arises when two sperm fertilize an egg. On a sonogram, there may be a sac with a fetus.
…..I would like to begin a review of one of the most common complications of early pregnancy, vaginal bleeding. This is the number one reason patients will have an emergency visit in the first trimester, and it is a cause of great anxiety to patients and their families. There are a few important facts you should be aware of:
About 15% of recognized pregnancies will end in miscarriage
80% of miscarriages occur in the first trimester
Trauma, smoking, excessive alcohol use, and advanced maternal age increase the risk of first trimester bleeding
25% of pregnant women will report first trimester bleeding or spotting
8% of pregnant women report heavy vaginal bleeding
Of the patients who report bleeding, 75% will have 1 episode, 20% will have 2 episodes, and 10% will have 3 or greater episodes
The amount of bleeding is the most significant predictor of an impending miscarriage
Again, advanced maternal age is a significant risk factor for first trimester bleeding and subsequent miscarriage; 50% of pregnancies in women over 40 result in a miscarriage, with abnormal chromosomes in the fetus being a primary factor
For women under the age of 35, the rate of a spontaneous miscarriage is 2%.