Is the Use of a GnRH Antagonist Effective in Patients with Polycystic Ovarian Syndrome? A South African Perspective

Introduction. Polycystic ovarian disease (PCOS) can account for up to 35 - 40 of the female factor causes of infertility. These patients present as medically complex cases and are challenging to manage and treat successfully. They are resistant to treatment and are often offered controlled ovarian stimulation (COS) and in vitro fertilisation (IVF) technology. Aim. The aim of this study was to assess whether there was a difference in the pregnancy outcomes of women with PCOS when a standard gonadotrophin-releasing hormone (GnRH) antagonist (cetrorelix) protocol was used for ovarian stimulation; compared with non-PCOS patients undergoing IVF. Methods. A retrospective patient record audit was performed on 142 patients with PCOS and 501 non-PCOS patients undergoing a similar cetrorelix-based COS treatment protocol during a specified time period. Results. The main primary outcome was an ongoing pregnancy at 12 weeks; achieved in 34 of patients in the PCOS group and 27 in the non-PCOS group. This was not significantly different (p=0.07). No patient in the PCOS group experienced severe hyperstimulation syndrome. Conclusion. There was no significant difference in pregnancy rates in patients with PCOS undergoing GnRH-antagonist ovarian stimulation compared with non-PCOS patients. The fact that no hyperstimulation syndrome occurred makes this an attractive option for women with PCOS

Laparoscopic Myomectomy for Infertile Patients with Intramural Fibroids: a Retrospective Study at a Tertiary Endoscopic Centre

Background: The safety of laparoscopic myomectomy has been questioned especially in the case of intramural fibroids. Objectives: To assess the safety of a laparoscopic myomectomy for intramural fibroids and study the subsequent effect on fertility Methods and Settings: A retrospective study of a tertiary endoscopic centre specialising in laparoscopic myomectomy. Results: 87 Patients were studied and there were no major complications. The conversion rate from laparoscopy to laparotomy was 3/87 (3.4) due to multiple fibroids. There was one case of uterine perforation during hysteroscopy. The overall pregnancy rate was 29/64 (45) with a spontaneous pregnancy rate of 18/29 (62). Conclusions: Laparoscopic myomectomy can be regarded as a safe alternative to abdominal myomectomy in the hands of the experienced surgeon resulting in good subsequent pregnancy rates