Transvaginal ultrasonography combined with pelvic examination in the diagnosis of ovarian endometrioma.

The aim of this retrospective study was to evaluate the efficacy of TVS and TVS combined with pelvic examination for the diagnosis of ovarian endometrioma. Three hundred and five ovarian masses of 244 patients with either pre-operative or post-operative diagnosis of ovarian tumor and received TVS between January 1, 1996 and December 31, 1998 were included in the study. Of 305 masses, 221 endometriomas of 164 patients were diagnosed histologically. The efficacy of TVS was 84.9 per cent with a sensitivity of 92.3 per cent and specificity of 70.2 per cent. LR+ and LR- were 3.1 and 0.1 respectively. The combination of TVS and pelvic examination with either positive test had a higher sensitivity (98.8%) but lower specificity (26.6%). This combination dramatically improved NPV (97.5%) and LR- (0.05), whereas, the combination with both positive tests had a sensitivity of 78.1 per cent, and specificity of 81.5 per cent. LR+ and LR- were not different from those using TVS alone. In conclusion, the study has shown the role of TVS in the diagnosis of ovarian endometrioma. The combination of TVS and pelvic examination may be useful in ruling out the disease. However, a further prospective study should be performed to confirm the efficacy of the combination.

Propofol anesthesia for transvaginal ultrasound guided oocyte retrieval.

The purposes of this study were to determine the efficacy of propofol anesthesia for oocyte retrieval and its effect on IVF outcomes. The anesthetic records of 339 oocyte retrieval cycles were analysed. The mean of total amount of propofol, duration of anesthesia and oocyte pick up were 197.7 +/- 84.2 mg, 25.2 +/- 8.5 and 19.5 +/- 7.4 minutes, respectively. In all cases propofol induced anesthesia within seconds. Mean recovery time was 32.2 +/- 5.4 minutes. Significant nausea and vomiting occurred in one patient. Mild hypotension was observed in 55 out of 339 cycles (16.2%) which did not correlate to the amount and duration of propofol used. A total of 3,417 oocytes were obtained. Fertilization occurred in 2,431 oocytes (71.1%). Mean cleavage rate was 84.5 per cent of fertilized eggs. Mean number of transferred embryo was 4.4 +/- 2.0. Embryos were transferred in 321 cycles, resulted in 73 pregnancies (21.5% per oocyte pick up and 22.7% per transfer). Neither the dose of propofol or the duration of anesthesia has significant effect on pregnancy rate. Propofol anesthesia was found to be efficacious for oocyte retrieval with a rapid induction and recovery, and minimal side effects. The fertilization and pregnancy rates are comparable to other reports using different anesthetic or analgesic agents. However, to reliably determine if propofol affects the IVF outcome a prospective and randomized trial should be performed.

Determinants of multiple pregnancies in in vitro fertilization other than number of transferred embryos.

The aim of this study is to assess the many different parameters involved in the incidence of multiple pregnancies, such as maternal age, stimulation, endometrium, receptivity and the quality of the transferred embryos. During a 3.5 year period, 86 pregnancies were recorded in our IVF unit. A single gestational sac was identified by early ultrasonography in 67 patients, while in 19 others, multiple sacs were noted. Patient characteristics, treatment cycles and embryology results were similar in the two groups. When the number of transferred embryos was kept similar in both groups, EIR was found to be a valuable prognostic determinant for multiple pregnancies in IVF.

Two years' experience of intrauterine insemination for the treatment of infertility.

The result of a two year (1990-1991) trial of IUI is presented. Discontinuous Percoll-gradient centrifugation technic was used for motile sperm separation. In 174 couples with 610 treatment cycles, there were 49 clinical pregnancies. The pregnancy per patient was 28 per cent and the pregnancy per cycle was 8 per cent. Cycle fecundity by various factors which possibly influence the outcome were assessed. The success rate appeared to be higher in the young female age group, short duration of infertility, secondary infertility, unexplained infertility, a higher number of motile sperm inseminated and dual insemination in a cycle.

Sperm morphology after hen's egg yolk filtration.

Tyrode's washed spermatozoa were placed on top of 20 per cent hen's egg yolk column of 2 cm diameter and 10 cm in height. The spermatozoa were allowed to move downward for two and a half hours and those at the bottom of the column were removed for morphological examination under a light microscope after staining with hematoxylineosin. The study was made in 45 cases. It was found that the percentage of morphologically abnormal sperm decreased, after passing through the hen's egg yolk column, from the average of 9.98 to 0.71 per cent. It is suggested tha the hen's egg yolk method is suitable for improving sperm motility and morphology in certain infertile cases where husbands have a seminal defect.

Sperm motility after passage through the hen's egg yolk medium.

This study aimed to observe the percentage of motility of human spermatozoa after passage through 20 per cent hen's egg yolk medium. Twenty-one samples of freshly ejaculated human semen having a sperm density over 20 million per ml and a percentage of motile sperm over 50 per cent were used in the study. The percentage of sperm motility was estimated under the microscope by conventional method. The sperm motility was evaluated within 30 minutes after ejaculation and every one hour thereafter for 8 hours. After the first observation, the semen was divided into two parts, one part kept as a control and the other used for the experiment. The latter was washed in Tyrode's solution and overlaid on 20 per cent egg yolk column and allowed to migrate toward the bottom of the column for two and a half hours. The spermatozoa at the bottom of the column were brought out and washed in Tyrode's solution. The percentage of the sperm motility was observed every hour for 5 hours. After passing through the 20 per cent egg yolk medium, percentage of sperm motility was observed to increase from 66.2 to 87.2 while that of the control declined to 49.3. Five hours after passing through the egg yolk medium the percentage of motile sperm was still high, an average of 80 as compared to 17.4 for the control. Results of this study indicate that hen's egg yolk has a sperm motility stimulating property. Whether hen's egg yolk can be used as a sperm motility stimulant in the treatment of such conditions as asthenospermia and oligospermia is subjected for further study.