BackgroundVitamin D concentrations during pregnancy are measured to diagnose states of insufficiency or deficiency. The aim of this study is to apply accurate assays of vitamin D forms [single- hydroxylated [25(OH)D2, 25(OH)D3], double-hydroxylated [1α,25(OH)2D2, 1α,25(OH)2D3], epimers [3-epi-25(OH)D2, 3-epi-25(OH)D3] in mothers (serum) and neonates (umbilical cord) to i) explore maternal and neonatal vitamin D biodynamics and ii) to identify maternal predictors of neonatal vitamin D concentrations.MethodsAll vitamin D forms were quantified in 60 mother- neonate paired samples by a novel liquid chromatography -mass spectrometry (LC-MS/MS) assay. Maternal characteristics [age, ultraviolet B exposure, dietary vitamin D intake, calcium, phosphorus and parathyroid hormone] were recorded. Hierarchical linear regression was used to predict neonatal 25(OH)D concentrations.ResultsMothers had similar concentrations of 25(OH)D2 and 25(OH)D3 forms compared to neonates (17.9 ± 13.2 vs. 15.9 ± 13.6 ng/mL, p = 0.289) with a ratio of 1:3. The epimer concentrations, which contribute approximately 25% to the total vitamin D levels, were similar in mothers and neonates (4.8 ± 7.8 vs. 4.5 ± 4.7 ng/mL, p = 0.556). No correlation was observed in mothers between the levels of the circulating form (25OHD3) and its active form. Neonatal 25(OH)D2 was best predicted by maternal characteristics, whereas 25(OH)D3 was strongly associated to maternal vitamin D forms (R2 = 0.253 vs. 0.076 and R2 = 0.109 vs. 0.478, respectively). Maternal characteristics explained 12.2% of the neonatal 25(OH)D, maternal 25(OH)D concentrations explained 32.1%, while epimers contributed an additional 11.9%.ConclusionsBy applying a novel highly specific vitamin D assay, the present study is the first to quantify 3-epi-25(OH)D concentrations in mother - newborn pairs. This accurate assay highlights a considerable proportion of vitamin D exists as epimers and a lack of correlation between the circulating and active forms. These results highlight the need for accurate measurements to appraise vitamin D status. Maternal characteristics and circulating forms of vitamin D, along with their epimers explain 56% of neonate vitamin D concentrations. The roles of active and epimer forms in the maternal - neonatal vitamin D relationship warrant further investigation.

Objective: To assess the effect of age on clinical, endocrine and sonographic features associated with polycystic ovary syndrome (PCOS) in normogonadotrophic anovulatory infertile women of reproductive years. Design: Cross-sectional study. Methods: Four hundred and seventy-two oligo-amenorrhoeic infertile patients, presenting with normal FSH and oestradiol concentrations, aged 17±42 years underwent a standardised initial evaluation including: cycle history, body mass index, waist-to-hip ratio and transvaginal ultrasound scanning of ovaries. Fasting blood samples were obtained for extensive endocrine evaluation. Cycle duration, serum levels of gonadotrophins, androgens, oestradiol, insulin, glucose, inhibin B as well as mean number of follicles, ovarian volume and ovarian stroma echogenicity were assessed. Results: Older women had signi®cantly lower LH and androgen and inhibin B serum levels. Similarly, older women presented with a reduced number of ovarian follicles. Age was inversely correlated with cycle duration r 20X112Y P 0X02Y LH r 20X154Y P 0X001Y testosterone r 20X194Y P 0X001Y androstenedione r 20X170Y P 0X001Y dehydroepiandrosterone r 20X157Y P 0X001Y insulin r 20X126Y P 0X02Y inhibin B r 20X118Y P 0X03 serum levels and mean follicle number r 20X100Y P 0X03X A positive correlation was observed between age and glucose to insulin ratio r 0X138Y P 0X009X Conclusions: Advanced age in normogonadotrophic anovulatory infertile women is associated with lower LH and androgen levels and with a decreased number of ovarian follicles. Although during reproductive years observed differences are relatively small, these age-related changes may affect the observed incidence of PCOS. European Journal of Endocrinology 145 749±755

Ovarian pregnancy is a rare variant of ectopic implantation. A case of an intrafollicular ovarian pregnancy after ovulation induction/intrauterine insemination is presented. The woman had primary infertility of 4 years. Diagnostic laparoscopy revealed endometriosis and adhesions. After adhesiolysis and laser vaporization of endometriotic implants, the patient underwent ovulation induction with artificial insemination by husband/intrauterine insemination; she conceived at her second attempt. The pregnancy proved to be an ovarian intrafollicular one. She was treated by right partial ovariectomy. Three months later she conceived spontaneously with an intrauterine pregnancy which is still ongoing. The diagnostic problems resulting from the coexistence of ovarian hyperstimulation and the intrafollicular development of pregnancy are discussed. A re-evaluation of the criteria for the diagnosis of ovarian pregnancy based on the currently available diagnostic methods is proposed. Moreover, the pathophysiology of ovarian and especially intrafollicular implantation is reviewed.

Intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of male infertility, since normal fertilization and ongoing pregnancies can be achieved with severely affected spermatozoa. Hence, the application of ICSI is rapidly expanding around the world, necessitating an accurate assessment of the efficacy and safety of this novel technique. The European Society of Human Reproduction and Embryology (ESHRE) Task Force is gathering data annually on the clinical results, the pregnancy outcome and the follow-up of children born after ICSI using ejaculated, epididymal and testicular spermatozoa, in order to be able to provide reliable information on these important issues. During the 3 years 1993-1995, the number of centres performing ICSI increased from 35 to 101, and the total number of ICSI cycles performed per year rose from 3157 to 23932. The incidence of oocytes damaged by the procedure remained low (<10%) and the fertilization rates obtained with ejaculated, epididymal and testicular spermatozoa in 1995 were 64, 62.5 and 52% respectively. Thus, approximately 90% of the couples had an embryo transfer and the viable pregnancy rate was 21% for ejaculated, 22% for epididymal and 19% for testicular spermatozoa (with 25-30% multiple pregnancies). Furthermore, 3149 transfers of frozen-thawed embryos were performed and 7-11% of them resulted in a viable pregnancy. The ICSI results were similar during this 3 year period, irrespective of the origin of the spermatozoa. The perinatal outcome of children born after ICSI was not different from those born after in-vitro fertilization (IVF) or natural conception, and was only affected by multiplicity. Moreover, the incidence of major or minor malformations was not increased, but the chromosomal, especially the sex-chromosomal, aberration rate was slightly elevated. To summarize, a very high success rate is obtained by ICSI independently of the source of the spermatozoa, verifying the superiority of ICSI over conventional IVF. The procedure seems to be safe, but further follow-up of the children is necessary in order to be able to assess its safety more accurately.