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Kapaya H.,Academic Unit of Reproductive and Developmental Medicine | Mercer E.,Academic Unit of Reproductive and Developmental Medicine | Boffey F.,Academic Unit of Reproductive and Developmental Medicine | Jones G.,University of Sheffield | And 2 more authors.
BMC Pregnancy and Childbirth | Year: 2015

Background: Published guidelines emphasise the need for early antenatal care to promote maternal and neonatal health. Inadequate engagement with antenatal care is associated with adverse pregnancy outcomes including maternal death. The factors that influence the uptake and utilisation of maternity care services are poorly understood. We retrospectively explore a large maternity database of births in a large referral UK hospital to capture the socio-demographic factors that influence late pregnancy booking, and then prospectively compare the stress and social support status of consenting early and late-booking women. Methods: Retrospective socio-demographic and clinical outcome data on 59,487 women were collected from the maternity database record of births between 2002 and 2010 at the Jessop Wing Hospital, Sheffield UK. In a follow-on prospective survey between October 2012 and May 2013 a convenience cohort of early and late bookers for antenatal care were then studied using validated scales for fetomaternal attachment, stress and anxiety, and social support. Results: In our retrospective study, pregnancy during the teenage years, higher parity, non-white ethnic background, unemployment and smoking were significantly associated with late access to antenatal services and poor fetal outcomes (P < 0.001). However, late booking per se did not predict adverse fetal outcomes, when socio-demographic factors were accounted for. A high index of multiple deprivation (IMD) score remained independently associated with late booking when confounding factors such as ethnicity and employment status were controlled for in the model (P = 0.03). Our prospective data demonstrated that women who book late were more likely to be unmarried (OR: 3.571, 95 % CI: 1.464-8.196, p = 0.005), of high parity (OR: 1.759, 95 % CI: 1.154-2.684, P = 0.009), and have lower social support than early bookers (P = 0.047). Conclusions: Of the many complex sociocultural factors that influence the timing of maternal engagement with antenatal care, multiple deprivation and poor social support remain key factors. Improving access to prenatal care requires in-depth exploration of the relationship between maternal psychosocial health indices, social support mechanisms and engagement with antenatal care. Findings from these studies should inform interventions aimed at improving access to care. © 2015 Kapaya et al.


Holt W.V.,Academic Unit of Reproductive and Developmental Medicine | Del Valle I.,Academic Unit of Reproductive and Developmental Medicine | Fazeli A.,Academic Unit of Reproductive and Developmental Medicine
Theriogenology | Year: 2015

Heat shock protein A8 (HSPA8) is a highly conserved member of the Hsp70 family, which is expressed in oviductal cells, translocated into oviductal fluid, and becomes attached to the sperm surface during sperm transport. Previous research has shown that HSPA8 supports mammalian sperm viability during in vitro incubation at both 5 °C and body temperature. The present series of experiments was designed to explore the possibility that bovine recombinant HSPA8 might therefore protect bull spermatozoa during cryopreservation through its beneficial effects on the sperm plasma membrane. Soy-based cryopreservation media were used in these experiments. The effects of HSPA8 addition before freezing were examined at concentrations ranging from 0.2 to 6.4 μg/mL, whereas the effects of postthaw HSPA8 addition were tested between 0.2 and 12.8 μg/mL. When bull spermatozoa (from beef and dairy breeds) were frozen in the presence of HSPA8, beneficial but complex effects on postthaw viability were observed. Low HSPA8 concentrations (0.2 and 0.4 μg/mL) resulted in significantly reduced postthaw sperm viability, but concentrations above 0.8 μg/mL improved plasma membrane integrity. If HSPA8 was added to spermatozoa after thawing, outcomes were also biphasic and beneficial effects on viability were only seen if the HSPA8 concentration exceeded 3.2 μg/mL. Beneficial effects were significantly more apparent with beef rather than dairy breeds. When HSPA8 was used in combination with cholesterol-loaded cyclodextrin, spermatozoa from the beef breeds showed significantly lower apoptotic effects. This was not observed with the dairy breeds. © 2015 Elsevier Inc..


Holt W.V.,Academic Unit of Reproductive and Developmental Medicine | Fazeli A.,Academic Unit of Reproductive and Developmental Medicine
Theriogenology | Year: 2016

Research over the past 3 decades has caused a major shift in the way that the oviduct, or fallopian tube, is perceived. Previously, it was regarded as little more than the anatomic site for fertilization, where spermatozoa and oocytes meet as they travel in opposite directions. However, this view has been radically altered by the realization that both spermatozoa and oocytes elicit changes in the biochemical composition of oviductal fluid through the induction of novel gene expression. Moreover, it has also been shown that only a privileged sperm population, selected on the basis of multiple criteria, is permitted to enter the oviduct, where they are subjected to even more selection processes that control their motility and capacitation status, thus either inhibiting or facilitating their progress toward the oocyte. Even more recently, it has become apparent that the oviduct has some ability to differentiate the genetic signatures of X- and Y-bearing spermatozoa. Although how exactly this is achieved is unknown, it prompts us to speculate that the oviduct may also be capable of distinguishing other genetically encoded properties of individual spermatozoa and that there must ultimately be a huge payoff in terms of selective animal breeding. © 2016 Elsevier Inc.


Kapaya H.,Academic Unit of Reproductive and Developmental Medicine | Broughton-Pipkin F.,University of Nottingham | Hayes-Gill B.,University of Nottingham | Loughna P.V.,University of Nottingham
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2015

Objectives: To investigate effects of maternal smoking on the fetal heart rate (FHR) in ambulatory patients using a portable fetal electrocardiogram recording device. Methods: A prospective cohort study of 43 pregnant smokers and 43 non-smoking gestation-matched controls with uncomplicated singleton pregnancies. Smokers were divided into light (1-10) and moderate (11-20 cigarettes/d). The FHR was recorded for 16 h with smokers smoking at will, using an event button to record when they lit a cigarette. Fifty recordings were made in the patients' homes with 36 in ambulatory inpatients. Three consecutive 30-min epochs (before, during and after smoking) were compared with the controls. Results: Basal FHR was significantly lower before smoking in the foetuses of smokers compared with non-smokers (p = 0.048). During smoking, there was a significant dose-dependent fall in short-, long-term and true beat-to-beat variabilities (p = 0.004, p < 0.0001 and p = 0.024, respectively). Conclusion: Maternal smoking leads to reversible changes in FHR variability that mimic those associated with an increased incidence of adverse cardiovascular events in adults. As heart rate and variability reflect the autonomic control of the heart, our findings suggest that maternal smoking interferes with the autonomic control of the FHR. © 2014 Informa UK Ltd. All rights reserved.


Whitby E.,Academic Unit of Reproductive and Developmental Medicine | Wright P.,Royal Hallamshire Hospital
Seminars in Fetal and Neonatal Medicine | Year: 2015

Fetal magnetic resonance imaging (MRI) is currently offered in a limited number of centers but is predominantly used for suspected fetal central nervous system abnormalities. This article concentrates on the role of the different imaging sequences and their value to clinical practice. It also discusses the future of fetal MRI. © 2015.


Pacey A.A.,Academic Unit of Reproductive and Developmental Medicine
Best Practice and Research: Clinical Obstetrics and Gynaecology | Year: 2012

The assessment of male infertility is largely based around the examination of a freshly produced ejaculate by a trained technician according to laboratory methods agreed by the World Health Organization. Although many suggestions have been made to improve this approach, the basic techniques of semen analysis established in the 1950s are still being used. Although several putative tests of sperm function have been developed (e.g. the measurement of sperm hyperactivation, sperm acrosomal status, or sperm penetration through mucus or binding to zona pellucida), none have made it into routine clinical practice. Recently, several 'new' tests of sperm function and sperm selection have been developed. These include the use of microfluidic chambers, electrophoresis, the binding of sperm to hyaluronic acid, and high magnification sperm selection. Randomised-controlled trials are needed to evaluate these as a replacement or addition to routine semen analysis or current sperm preparation methods. © 2012 Elsevier Ltd. All rights reserved.


PubMed | Academic Unit of Reproductive and Developmental Medicine
Type: Journal Article | Journal: Theriogenology | Year: 2015

Research over the past 3 decades has caused a major shift in the way that the oviduct, or fallopian tube, is perceived. Previously, it was regarded as little more than the anatomic site for fertilization, where spermatozoa and oocytes meet as they travel in opposite directions. However, this view has been radically altered by the realization that both spermatozoa and oocytes elicit changes in the biochemical composition of oviductal fluid through the induction of novel gene expression. Moreover, it has also been shown that only a privileged sperm population, selected on the basis of multiple criteria, is permitted to enter the oviduct, where they are subjected to even more selection processes that control their motility and capacitation status, thus either inhibiting or facilitating their progress toward the oocyte. Even more recently, it has become apparent that the oviduct has some ability to differentiate the genetic signatures of X- and Y-bearing spermatozoa. Although how exactly this is achieved is unknown, it prompts us to speculate that the oviduct may also be capable of distinguishing other genetically encoded properties of individual spermatozoa and that there must ultimately be a huge payoff in terms of selective animal breeding.


PubMed | Academic Unit of Reproductive and Developmental Medicine
Type: Journal Article | Journal: Best practice & research. Clinical obstetrics & gynaecology | Year: 2012

The assessment of male infertility is largely based around the examination of a freshly produced ejaculate by a trained technician according to laboratory methods agreed by the World Health Organization. Although many suggestions have been made to improve this approach, the basic techniques of semen analysis established in the 1950s are still being used. Although several putative tests of sperm function have been developed (e.g. the measurement of sperm hyperactivation, sperm acrosomal status, or sperm penetration through mucus or binding to zona pellucida), none have made it into routine clinical practice. Recently, several new tests of sperm function and sperm selection have been developed. These include the use of microfluidic chambers, electrophoresis, the binding of sperm to hyaluronic acid, and high magnification sperm selection. Randomised-controlled trials are needed to evaluate these as a replacement or addition to routine semen analysis or current sperm preparation methods.


PubMed | Academic Unit of Reproductive and Developmental Medicine
Type: Journal Article | Journal: Theriogenology | Year: 2015

Heat shock protein A8 (HSPA8) is a highly conserved member of the Hsp70 family, which is expressed in oviductal cells, translocated into oviductal fluid, and becomes attached to the sperm surface during sperm transport. Previous research has shown that HSPA8 supports mammalian sperm viability during in vitro incubation at both 5 C and body temperature. The present series of experiments was designed to explore the possibility that bovine recombinant HSPA8 might therefore protect bull spermatozoa during cryopreservation through its beneficial effects on the sperm plasma membrane. Soy-based cryopreservation media were used in these experiments. The effects of HSPA8 addition before freezing were examined at concentrations ranging from 0.2 to 6.4 g/mL, whereas the effects of postthaw HSPA8 addition were tested between 0.2 and 12.8 g/mL. When bull spermatozoa (from beef and dairy breeds) were frozen in the presence of HSPA8, beneficial but complex effects on postthaw viability were observed. Low HSPA8 concentrations (0.2 and 0.4 g/mL) resulted in significantly reduced postthaw sperm viability, but concentrations above 0.8 g/mL improved plasma membrane integrity. If HSPA8 was added to spermatozoa after thawing, outcomes were also biphasic and beneficial effects on viability were only seen if the HSPA8 concentration exceeded 3.2 g/mL. Beneficial effects were significantly more apparent with beef rather than dairy breeds. When HSPA8 was used in combination with cholesterol-loaded cyclodextrin, spermatozoa from the beef breeds showed significantly lower apoptotic effects. This was not observed with the dairy breeds.


PubMed | Royal Hallamshire Hospital and Academic Unit of Reproductive and Developmental Medicine
Type: Journal Article | Journal: Seminars in fetal & neonatal medicine | Year: 2015

Fetal magnetic resonance imaging (MRI) is currently offered in a limited number of centers but is predominantly used for suspected fetal central nervous system abnormalities. This article concentrates on the role of the different imaging sequences and their value to clinical practice. It also discusses the future of fetal MRI.

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