A randomized controlled trial of fallopian tube sperm perfusion compared with standard intrauterine insemination for women with non-tubal infertility.

STUDY QUESTION: Does fallopian tube sperm perfusion (FSP) result in better pregnancy and live birth rates than standard intrauterine insemination (SIUI) for couples with non-tubal infertility with or without gonadotrophin or clomiphene stimulation? SUMMARY ANSWER: There was no evidence of an improvement in live birth rates with FSP compared with SIUI. WHAT IS KNOWN ALREADY: Previous randomized controlled trials have suggested improved live birth rates with FSP but these trials were small. A systematic review published in 2004 suggested heterogeneity in results. STUDY DESIGN, SIZE, AND DURATION: This pragmatic, multicentre, randomized controlled trial compared SIUI and FSP in 417 women with non-tubal infertility. PARTICIPANTS/MATERIALS, SETTING, METHODS: The patients were treated at fertility clinics in New Zealand, Australia and the United Arab Emirates. MAIN RESULTS AND THE ROLE OF CHANCE: Four hundred and seventeen women were randomized to SIUI (n = 210) or FSP (n = 207). Data were available for analysis from 198 women in the SIUI group and 198 women in the FSP group. There were 19 women with incomplete data because of cycle cancellation or withdrawals and 2 women who conceived prior to commencing treatment. There were no significant differences in live birth rates between the two groups with 27 (12.9%) in the SIUI group and 21 in the FSP group (10.1%) [Odds Ratio (OR) 1.31 (0.71, 2.39), P = 0.48]. Two ectopic pregnancies were reported in the SIUI group and one was reported in the FSP group. LIMITATIONS, REASONS FOR CAUTION: Different ovulation protocols were used in the different clinics. Approximately 10% of the cycles involved donor sperm and ∼5% of the cycles did not complete the assigned intervention. WIDER IMPLICATIONS OF THE FINDINGS: There was no evidence of an improvement in live birth rates with FSP compared with SIUI. STUDY FUNDING/COMPETING INTEREST(S): The study was funded in part by the A+ trust of the Auckland District Health Board. No commercial funding was received. TRIAL REGISTRATION NUMBER: ANZCTR Number ACTRN12612001303831.

Ovarian salvage in bilaterally complicated severe ovarian hyperstimulation syndrome.

OBJECTIVE: To report the management of 2 cases of severe ovarian hyperstimulation syndrome (OHSS) bilaterally complicated by rupture and late subsequent torsion. DESIGN: Two case reports. SETTING: Obstetrics and Gynecology department of a hospital. PATIENT(S): Case 1: Severe OHSS complicated by massive intraperitoneal hemorrhage and bilateral extensive ovarian rents and rupture at multiple sites. Case 2: Twin IVF pregnancy and late severe OHSS complicated further by subsequent bilateral torsion. INTERVENTION(S): Case 1: Diagnosed by clinical, hematologic, and ultrasound findings. Resuscitation, laparotomy, and meticulous ovarian repair with suture, glue, and hemostat affected bilateral ovarian conservation. Case 2: Diagnosed clinically and confirmed by color Doppler. Left salpingoopherectomy was performed because of a devitalized left ovary; 3 days later laparoscopic right ovarian detorsion and aspiration was possible as early Doppler diagnosis was made. MAIN OUTCOME MEASURE(S): Case 1: ovarian conservation. Case 2: ovarian conservation and continuation of pregnancy. RESULT(S): Case 1: Recovery and normal serum FSH and E(2) 2 months postsurgery. Case 2: Continuation of pregnancy and the remaining ovary was healthy at abdominal delivery. CONCLUSION(S): Two cases of bilaterally complicated severe OHSS in which the patients' safety and bilateral ovarian integrity were at jeopardy. The cases are presented to define the importance of awareness, early diagnosis, and intervention, as well as the use of various methods and techniques to affect preservation of ovarian integrity and reserve.

Inguinal uterus, fallopian tube, and ovary associated with adult Mayer-Rokitansky-Küster-Hauser syndrome.

OBJECTIVE: To report a case of Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) with a utero-ovarian inguinal hernia, and to present a review of the pertinent literature. DESIGN: Case report and literature review. SETTING: Hospital clinic. PATIENT(S): A 31-year-old married woman. INTERVENTION(S): Ultrasound, magnetic resonance imaging, intravenous pyelography, hormone analysis, peripheral karyotyping, ovarian biopsy, repositioning of the uterus, fallopian tube, and ovary, herniorrhaphy, and Williams vulvovaginoplasty. MAIN OUTCOME MEASURE(S): Accuracy of diagnosis, preservation of ovarian function, hernia repair and creation of neovagina. RESULT(S): Our patient represented an adult case of MRKH syndrome associated with renal abnormality and utero-ovarian inguinal hernia. Our English-language literature search for similar well-documented cases revealed only two. Our management consisted of thorough counseling, and successful one-step ovarian biopsy, repositioning of the uterus, fallopian tube, and ovary, herniorrhaphy, and Williams vulvovaginoplasty. CONCLUSION(S): This is the third case of adult 46,XX MRKH with utero-ovarian inguinal hernia in the English literature. Genital repositioning is mandatory to avoid torsion and preserve ovarian function. The choice of the type of hernia repair and vaginoplasty or any other procedure should be individualized to the patient's medical status.

The significance of fetal renal pelvic dilatation as a predictor of postnatal outcome.

OBJECTIVES: To define the clinical outcome of fetal renal pelvic dilatation (FRPD) in cohort of infants in United Arab Emirates. STUDY DESIGN: Data were collected from all fetuses having FRPD from January 2005 to February 2008. FRPD was graded as normal (<5 mm), mild (5-9 mm), moderate (10-15 mm), and severe (>15 mm). RESULTS: Data from 80 fetuses with 120 kidneys were studied. Nine resolved antenatally and seven were lost to follow up. Of the remaining 89 FPRD (64 patients), 36% had normal postnatal ultrasound, 22.5% significant uropathy, and 41.5% had isolated hydronephrosis. Pelvi-ureteric junction obstruction was the commonest identified underlying abnormality. Severe FRPD predicted significant postnatal uropathy with a sensitivity of 65% and a specificity of 98.6%. Moderate FRPD increased the sensitivity to 95% but decreased the specificity to 60.9%, mild FPRD was seldom (4%) associated with significant postnatal pathology. Postnatal resolution was significantly (p = 0.01) higher in mild RPD than in the moderate or severe group. CONCLUSION: Severe FRPD need comprehensive postnatal assessment. Although moderate FRPD had a high prevalence of uropathy, they rarely needed surgical intervention. Parents could be reassured that RPD of less than 10 mm in the third trimester is unlikely to be associated with significant uropathology.