Includes bibliographical references (leaves 60-65). / Polycystic ovary syndrome (PCOS) is the commonest endocrinopathy in women of reproductive age, affecting 5-10% of women in the general population. Patients present with menstrual disturbances, infertility and clinical hyperandrogenism. While the pathophysiology is not completely delineated, a strong familial association has been demonstrated, suggesting a genetic component. From January 2007 until February 2009, a total of 83 probands were recruited from the Gynaecological Endocrinology Clinic (GEC) at GSH. These were all women with PCOS according to the Rotterdam criteria who presented for management at the GEC. With their consent, first degree female family members were contacted and 57 mothers, 108 sisters and 8 daughters agreed to participate in the study.

Background: Poor response of the ovaries to gonadotropin stimulation is associated with poor outcome following in vitro fertilization. The historical lack of a standard definition for poor ovarian response has resulted in a wide variation in prevalence and outcome measures. More recently, the Bologna criteria has emerged as the standard for identification of poor ovarian responders. There is paucity of literature on poor ovarian response in the African setting. This study was conducted to document the prevalence and the outcome of in vitro fertilization among poor ovarian responders in women undergoing assisted reproduction technology in the public sector of Western Cape Province of South Africa. Method: Retrospective review of data of women who underwent assisted reproduction technology between January 2011 and December 2015 was conducted. The Bologna criteria was used to identify women for inclusion into the study. For the analysis of prevalence and treatment outcomes, only a woman's first cycle at the Groote Schuur Hospital was included, however the occurrence of further cycles was recorded. Main results: A total of 40 women met the criteria for poor ovarian response in this study. The prevalence of poor ovarian response was 3.6%. The mean age among the study population was 37.8years (25 – 42yrs). Cycle cancellation rate due to poor ovarian response was 15.0% and the average number of eggs retrieved was 1.8. Twenty-four (60%) women had at least one embryo transferred. The clinical pregnancy and live birth rates were 10.0% and 5.0% respectively, per cycle initiated. Half of those with failed IVF due to poor ovarian response withdrew from the program. Conclusion: The prevalence of poor ovarian response among women who underwent assisted reproduction at Groote Schuur Hospital was 3.6% which is low compared to 9-24% reported in other studies. The clinical pregnancy and live birth rates were low. Half of the women did not continue with treatment after their first failed IVF cycle.

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The incidence of allergic diseases is increasing, possibly due to a reduced intensity and diversity of microbial stimulation. More knowledge is needed on the immunological mechanisms underlying the eczema preventive effect of pre- and postnatal probiotic supplementation. The pregnancy period seems to be of essential importance, since both epidemiological and experimental animal studies show the importance of microbial exposure during gestation on allergy prevention. We have performed a study where the probiotic lactic acid producing bacteria Lactobacillus reuteri was supplemented to pregnant women, at risk of having an allergic infant. The pregnant mothers received the study product from gestational week 36 until delivery, and the infants then continued with the same product until one year of age. The probiotic, as compared with placebo, supplemented infants had less IgE-associated eczema at two years of age. In order to investigate how the supplementation affected the immune system peripheral blood was collected and immune cells were stimulated with common allergens and TLR ligands. The probiotic treated group responded with a more regulated response to allergens and TLR2 ligands in comparison to the placebo supplemented group. We also investigated how the probiotic supplementation affected the epigenetic methylation pattern in circulating T helper cells during infancy, observing the most pronounced effects at birth. In a follow up study, supplementation was started earlier to possibly gain a stronger allergy preventive effect via changes in maternal immune regulation. Supplementation with Lactobacillus reuteri and ω-3 fatty acids started at gestational week 20 and throughout pregnancy. After 20 weeks of supplementation, some immunomodulatory effects among circulating activated regulatory T cells and a subpopulation of monocytes were noted. Several systemic immune modifying effects of pregnancy were observed. In summary, probiotics show several immunomodulatory effects in infants and pregnant women. However, more research is needed to better understand the effects of the probiotic supplementation to aid future identification of more efficacious allergy preventive strategies.

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Abstract Aim: To map first-time mothers experiences of breastfeeding support provided by maternal health care, birth center and BB. Method: A quantitative survey with a cross-sectional design. The criterias to be included was first-time mothers who breastfed or wished to breastfeed and gave birth to a full-term child in the last two years. Data were collected through a web survey published on Facebook. A comfort selection was chosen and data were analyzed with descriptive statistics. Comparisons were made between two age groups Results: A total of 197 first time mothers were answered in the survey. Group 1 consisted of first-time mothers aged 21-30 years and Group 2 consisted of first-time mothers aged 31-42 years. The breastfeeding support included written, verbal and practical guidance. Positive and negative factors in breastfeeding support were identified. Both differences but mainly similarities were identified among first-time mothers’ experiences of breastfeeding support. It was 70,3% of the entire population who wanted more information about breastfeeding. A difference was that Group 2 generally estimated lower breastfeeding support compared with Group 1. Conclusion: The breastfeeding support was estimated quite low by both age groups. Almost half of the first-time mothers considered themselves to receive the best breastfeeding support from sources other than maternal health care, childbirth and BB. This indicates that the breastfeeding support that first-time mothers received was insufficient. First-time mothers requested more information about breastfeeding. High attendance of the midwife and individual guidance were positive factors.   Keywords: breastfeeding, experiences, midwives, mothers, support.

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