ABSTRACT
We report a 15-year-old woman who presented with an allegation of having been raped, with subsequent pregnancy due to the failure of postcoital emergency contraception. This case demonstrates a medicolegal perspective of how to approach the raped case and how to be safe for both the patient and the doctor to participate in an abortion legally. The management of sexually transmitted disease and termination of unwanted pregnancy is documented as well as the patient's psychological reactions in coping with the incidents.
ABSTRACT
The study was carried out to compare the effectiveness of human menopausal gonadotrophin (HMG) and recombinant follicle-stimulating hormone (recombinant FSH) in term of in vitro fertilisation (IVF) and pregnancy outcome. A total of 238 patients who underwent IVF for infertility treatment were included in the study. The first attempt of controlled ovarian stimulation was recorded and evaluated. A long protocol of ovarian stimulation was performed with gonadotrophin releasing hormone analogue (GnRH-a) administration. Gonadotrophin, which was either HMG (group A) or recombinant FSH (group B), was administrated to each patient for ovarian stimulation. The results of this study showed no difference in the number of stimulation days, fertilised oocytes, transferred embryos and cycles with embryos available for freezing between the two groups. Although the starting doses of both gonadotrophins were similar, the total dosage of HMG was higher than that of recombinant FSH (48.8ฑ20.8 versus 42.9ฑ20.0, p = 0.03). The number of retrieved oocytes in group A was higher than that in group B (9.5ฑ4.4 versus 8.3ฑ4.3, p = 0.04). The differences in cancellation rate, fertilisation rate, pregnancy rate per cycle and per transfer, as well as implantation rate between the two groups was not statistically significant. In conclusion, patients who underwent ovarian stimulation with GnRH-a long down-regulation still benefit for HMG for their treatment. We did not find any difference in fertilisation rate or pregnancy rate as well as implantation rate between HMG and recombinant FSH. A greater number of oocytes were retrieved in patients treated with HMG. However, more ampoules of HMG were administrated to achieve ovarian stimulation, compared with recombinant FSH.
ABSTRACT
A prospective clinical study was performed to determine an appropriate cut-off point value of endometrial thickness for the detection of endometrial abnormalities among women with abnormal uterine bleeding. Two hundred and forty nine women with abnormal uterine bleeding who had indication for fractional uterine curettage were enrolled. Endometrial thickness was measured by transvaginal ultrasonographic examination in each patient before performing fractional uterine curettage on the same day. The results were compared with the final histological diagnosis from fractional uterine curettages. Endometrial abnormalities were identified in 69 out of 249 cases (27.7%) as hyperplasia in 57 cases(22.9%) and endometrial cancer in 12 cases (5.0%). The appropriate cut off point value of endometrial thickness was 4 mm below which no abnormal endometrial was found. This cut-off point yielded a sensitivity of 100%, a specificity of 18.3%, a positive predictive value of 31.9%, a negative predictive value of 100%, a false positive rate of 68.2%, a false negative rate of 0% and an accuracy of 40.5%. In conclusion, endometrial thickness measurement by transvaginal ultrasonography is a simple diagnostic method for identifying endometrial abnormalities in women with abnormal uterine bleeding. The cut-off point value of below 4 mm can identify endometrial abnormalities, thus unnecessary fractional uterine curettage can be avoided.
ABSTRACT
To evaluate the efficacy of a new technique, micro-injected oocytes intrafallopian transfer (MIFT), involving a same day procedure. 9 patients with at least one patient fallopian tube were offered this procedure. Ovarian induction consisted of down regulation with GnRHa followed by ovarian stimulation with hMG except for one patient who received only hMG due to a poor response. HCG 10,000 IU was administered when at least 2 leading follicles exceeded 18 mm. in diameter and transvaginal oocyte retrieval was performed 34-36 hours thereafter. Intracytoplasmic sperm injection (ICSI) was performed on the oocytes of all patients with male factor infertility. MIFT was performed on the same day after ICSI by transferring 2-5 micro-injected oocytes into the fallopian tube by laparoscopy under general anesthesia. The implantation rate and pregnancy rate were 16.1% (5/31) and 55.6% (5/9) respectively. This study suggests that MIFT is effective, easy and should be considered as a new option which yields a high pregnancy rate.
ABSTRACT
assessment of uterine cavity and tubal patency compare with hysterosalpingography ( HSG ). Thirty four of infertile women undergoing investigation for infertility were enrolled from July 1997 until November 1998 for the current study. HyCoSy using Echovistฎ and HSG were successful carried out during the first half of each patient’s menstrual cycle. The flow of contrast medium through the uterine cavity and each fallopian tube was visualised in real time by transvaginal ultrasonography for HyCoSy. Meanwhile, HSG was performed and reported by consultant radiologists. Regarding the uterine cavity evaluation, 32 of 34 cases ( 94.1 % ) was reported to be normal by both procedures. Only 2 cases were noted with different results. From the 68 fallopian tubes studied, though 47 of 68 tubes were showed patent by the two procedures, HyCoSy could detect occlusion in only 5 of 10 left fallopian tubes and in 5 of 9 right fallopian tubes which were reported to be occluded by HSG. Mean length of time for HyCoSy was 8.7 minutes (range 2-30 minutes, Std. Dev. 5.4) and mild pelvic pain was the only complication incurred. In conclusion, HyCoSy using Echovistฎ is a reliable and safe procedure for outpatient uterine cavity evaluation. However, it does not substitute to HSG for tubal patency assessment in basic infertility investigation.
ABSTRACT
Twenty nine fallopian tubes from 15 patients were examined for tubal patency using HyCoSy followed by chromolaparoscopy. The mean volume of contrast medium used was 14.3 ml and the duration of HyCoSy was 8.5 minutes. Concordance, sensitivity, specificity, positive predictive value and negative predictive value were 75.9, 44.4, 90.0, 66.7 and 78.3% respectively. The only adverse effect was mild pelvic pain and this was found in 60%. These results suggest that HyCoSy may become an established method for assessing fallopian tubal patency in the future.
ABSTRACT
An experimental study was carried out in order to evaluate the effect to of pentoxifylline on the membrane function of washing and swim-up sperm in the process of sperm preparation for assisted reproductive techniques. Normal semen samples were taken according to World Health Organization criterias, from 30 male partners who attended the infertility clinic from November 1996 to January 1997, and divided into two aliquots. In the process of sperm preparation by the washing and swim-up method, pentoxifylline was added in only one aliquot. The hypo-osmotic swelling test was used to evaluate the outcome of both aliquots. From the study, the percentage of sperm that showed swollen tails in the hypo-osmotic solution prepared by the washing and swim-up method and treated by pentoxifylline was higher than that in the group which did not have pentoxifylline added in the process of sperm preparation. However, the difference was not atatistically significant (54.9 and 49.2 percent; P>0.01). It was therefore concluded that pentoxifylline added to washing and swim-up sperm in the process of sperm preparation dose not improve membrane function of spermatozoa. Thus, it may not be necessary to use pentoxifylline in the treatment of male infertility.