OBJECTIVE: Cytokines are potential biomarkers of immune response in the lower female genital tract. This study compares cytokines between the vagina and endometrium, two portals of entry for infectious organisms.DESIGN: Randomized, assessor-blinded cross-over trial. MATERIALS AND METHODS: Eighteen reproductive-aged women underwent follicular phase vaginal lavage (VL) and endometrial lavage (EL) as part of a clinical trial examining the impact of vaginal gels on the vagina and endometrium. Eight pro-inflammatory cytokines (Il-1b, Il-6, Il-8, MCP-1, MIP-1a, MIP-1b, RANTES, and TNF-a and three anti-inflammatory cytokines (Il-1ra, Il-10, Slp-1) were assayed in baseline VL and EL specimens (RayBio Human Cytokines Array). Absolute cytokine levels were compared between VL and EL by signrank tests.RESULTS: Multiple cytokines differed between the vagina and endometrium. Of pro-inflammatory cytokines, Il-1b (p¼0.001) was significantly higher, while RANTES (p<0.001) was significantly lower in the vagina. Of anti-inflammatory markers, Il-1ra (p<0.001) was higher, while Il-10 (p<0.001) and Slp-1 (p<0.001) were significantly lower in the vagina than in the endometrium.CONCLUSIONS: This is the first study to compare immune response between the human vagina and endometrium using inflammatory cytokines. Our findings suggest that immune response varies by different sites of the lower reproductive tract. However, we see no common trend in regard to pro-and anti-inflammatory cytokines between these sites. It is unknown whether these differences reflect independent immune responses at the two sites, or, alternatively, vaginal immune responses are a product of mixed vaginal and endometrial immune response.

Background: Limited research suggests ambient air pollution impairs fecundity but groups most susceptible have not been identified. We studied whether long-term ambient air pollution exposure before an in vitro fertilization (IVF) cycle was associated with successful livebirth, and whether associations were modified by underlying infertility diagnosis. Methods: Data on women initiating their first autologous IVF cycle in 2012–2013 were obtained from four US clinics. Outcomes included pregnancy, pregnancy loss, and livebirth. Annual average exposure to fine particulate matter (PM2.5), PM10, and nitrogen dioxide (NO2) before IVF start were estimated at residential address using a validated national spatial model incorporating land-use regression and universal kriging. We also assessed residential distance to major roadway. We calculated risk ratios (RR) using modified Poisson regression and evaluated effect modification (EM) by infertility diagnosis on additive and multiplicative scales. Results: Among 7,463 eligible participants, 36% had a livebirth. There was a nonsignificant indication of an association between PM2.5 or NO2 and decreased livebirth and increased pregnancy loss. Near-roadway residence was associated with decreased livebirth (RR = 0.96, 95% CI = 0.82, 0.99). There was evidence for EM between high exposure to air pollutants and a diagnosis of diminished ovarian reserve (DOR) or male infertility and decreased livebirth. Conclusions: Despite suggestive but uncertain findings for the overall effect of air pollution on fecundity, we found a suggestive indication that there may be synergistic effects of air pollution and DOR or male infertility diagnosis on livebirth. This suggests two possible targets for future research and intervention.

The bladder closure mechanism works under the influence of a hydro-aerodynamic force that presses downward ("stress"). This "stress" is caused by the relative weakness of the pelvic floor. The structures running through the urogenital hiatus are compressed by the rectococcygeal and pubo-coccygeal muscles, which close the hiatus. The urogenital diaphragm bridges the slit in the levator ani muscles. It is made of the perineal membrane, the superior fascia, and the smooth and striated muscle lying between the two (M. sphincter urethrovaginalis, M. compressor urethrae). The superior fascia is an extension of the intraabdominal interior parietal fascia. The intraabdominal pressure stabilises the position of the urethrovesical region by pressing the intraabdominal contents and the subperitoneal connective tissue etc. closely together. The visceral fascia, the pubourethral ligaments, and above all, the connection to the superior fascia of the pelvis diaphragm anchor and regulate the paraurethro-vaginal region. The decompensation of this stress mechanism, usually caused by previous birth injury, leads to varied degrees of prolapse and incontinence. A rational therapy is the reconstruction of the damaged structures of the pelvis floor (diaphragma urogenitale, diaphragma pelvis, perineum etc.) in a complete individualised vaginal surgical reconstruction ("diaphragm repair"). This procedure makes a direct visualisation of the local situation and a control of the indication for surgery possible. If the suspensory apparatus is well anchored to the pelvis wall, reconstruction can be achieved. If this is not the case, a more sophisticated repair is necessary. If the indication is not correct and the limits of this method are ignored, or, if surgery is technically inadequate, this method will fall into disrepute.

The rational therapy of stress incontinence requires a knowledge of the pathologico-anatomical physiology of the urorectogenital tract of the female pelvis. The usual urethrocystography gives only very incomplete, and in the case of the chain method, misleading information. Viscerography (Wick - urethro-cysto-colpo-rectoanography), however, informs about the possibilities and requirements of appropriate anatomical procedures in a complete and objective manner. The development, practice, interpretation and indication of the viscerography are thoroughly discussed and demonstrated by means of typical examples, on the basis of more than 2000 viscerograms.

ploidy). Reports indicated the % of fragmented sperm DNA (DFI). Patients were divided into 2 groups: (<15% and >15%) and incidence of segmental aneuploidy was compared between the groups in 2 ways: 1) any segmental aneuploidy (among all embryos, including those with an additional whole chromosome aneuploidy) and 2) segmental aneuploidy only (no other whole chromosome aneuploidy).RESULTS: A total of 169 cases were included in the analysis. DFI <15% was found in 123 specimens, while DFI >15% was found in 45 specimens. The median DFI for the entire study population was 11 (interquartile range: 8 to 15). Men in the 15% DFI group were older (40.6 vs. 38.0, p<0.01), but there was no difference in the age of the female partner (37.9 vs. 37.4, p ¼ 0.71). There was no difference in the rate of conversion to blastocyst. The incidence of any segmental aneuploidy and only segmental aneuploidy was no different between the groups. The incidence of whole chromosome aneuploidy was also no different (Table 1).CONCLUSION: Specimens with elevated DNA Fragmentation used for ICSI do not result in an increased incidence of segmental aneuploidy in trophectoderm biopsy samples evaluated by NGS. These results suggest three possible rationales: 1) DNA damage in the male may be at least partially repaired by oocyte-derived mechanisms, 2) small deletions and duplications may be below the diagnostic threshold of current NGS technologies, or 3) SDF testing, which relies on average levels among pooled sperm, may be limited in its ability to prognosticate embryonic segmental aneuploidy.