Propofol anaesthesia for ultrasound guided oocyte retrieval: accumulation of the anaesthetic agent in follicular fluid.

Propofol (2,6-diisopropylphenol, Diprivan, ICI-Pharmaceuticals, Manchester, UK) is widely used either as an adjunct in general anaesthesia or as sole anaesthetic agent by the continuous intravenous route and intermittent bolus injections for minor surgical interventions. For several years, we have been using this kind of anaesthesia in transvaginal oocyte retrieval for in-vitro fertilization (IVF), allowing a completely painless puncture on an out-patient basis. From in-vitro studies on mouse oocytes, it appeared that propofol could be deleterious for fertilization in a dose- and time-dependent manner. We therefore investigated the concentrations of propofol in follicular fluid during oocyte retrieval in women. We measured propofol levels in serum and follicular fluid of nine patients at fixed intervals during ultrasound guided oocyte retrieval. Serum levels fluctuated randomly, due to interference from top-off doses of propofol. In follicular fluid, however, we found a steady increase of propofol levels, which was proportional to the total dose of propofol administered. These data indicate that propofol accumulates in follicular fluid. Although it seems unlikely that propofol as used in the present protocol exerts a clinically significant unfavourable effect on IVF, we suggest that the oocyte retrieval procedure should be kept as short as possible, in order to limit the accumulation of the anaesthetic in follicular fluid.

Delayed implantation. A case report.

In cycles in which conception takes place, serum human chorionic gonadotropin (hCG) becomes detectable between 8 and 12 days after ovulation. A delayed appearance of hCG has been reported in a limited number of cases, most of them ending in spontaneous abortion. We encountered a case of ectopic pregnancy characterized by a delayed appearance of hCG and accompanied by a complete, albeit temporary, halt in the steroidogenic activity of the corpus luteum. Although the patient was at risk of developing an ectopic pregnancy, the findings made an early diagnosis extremely difficult.

Contralateral tubal pregnancy after gamete intrafallopian transfer.

A case of EP after GIFT into the contralateral tube is presented. Hydrotubation with Earle's medium immediately before the GIFT cannot be excluded as a possible cause of gamete migration. The complete demise of the CL also demonstrates that trophoblast can implant and develop without steroidal support.

Predictive value of early embryonic cardiac activity for pregnancy outcome.

The biologic variation of the embryonic heart rate was investigated by transvaginal ultrasonography during the first trimester of normal (n = 141) and abnormal (n = 29) pregnancies, and the predictive value of a repeatedly diagnosed slow heart rate for pregnancy outcome was determined. The mean heart rate increased from 82 +/- 10.3 beats/min at 5 weeks' gestation to 156 +/- 9.6 beats/min at 9 weeks. A single observation of an abnormally slow heart rate did not necessarily predict subsequent embryonic death. However, a continued decline in embryonic heart activity, observed within a few days' interval, was always associated with a first-trimester abortion.

Fetal Doppler flow measurements in the early second trimester: a correlation with fetal outcome.

In 31 women with a singleton pregnancy, abdominal duplex doppler examinations were performed at W16-W17, W26 (+/- 2 weeks) and W34 (+/- 2 weeks) in order to study the flow velocity wave (FVW) indices in the early second trimester and their predictive value for fetal outcome. 24 women with a normal pregnancy outcome were considered as the reference group. In the early second trimester, end-diastolic block occurs frequently at the 150 Hz thump filter setting (15/24 in the fetal descending aorta, 19/24 in the umbilical artery). At the 50 Hz filter setting, end diastolic block appeared in 1/24 cases in the aorta and in 2/24 cases in the umbilical artery. The finding did not persist throughout pregnancy. The flow-velocity indices in the early second trimester in the small-for-dates were comparable to the normal group. We conclude that high peripheral resistance is a common finding in the fetal circulation in early pregnancy. It is not predictive of subsequent growth retardation.

Gestodene: clinical experience with an innovative progestogen used in a combination oral contraceptive preparation.

The contraceptive efficacy, tolerance, and safety of a new monophasic oral contraceptive that combines 75 mcg gestodene (delta-15- levonorgestrel) and 30 mcg ethinyl estradiol were studied in 75 women (944 cycles) currently at risk for pregnancy. 20 women were nulliparous. No woman became pregnant during the trial, nor were vital signs of body weight affected by the drug. Cycle control was excellent, with no bleeding irregularities in 92% of the cycles. Serious complications did not occur. The low incidence of side effects, e.g. headache (9%) and breast tenderness (8%), indicated that the gestodene combination was well-tolerated. In a subgroup of 10 women, no changes in routine laboratory tests could be demonstrated after 12 cycles of treatment.