[Human embryo cryopreservation].

Widespread incorporation of human embryo cryopreservation into in-vitro fertilization (IVF) programs may reduce the risk of multiple gestation and severe ovarian hyperstimulation syndrome while contributing to an overall increase in pregnancy rates. The main known complication arising from ovarian stimulation is ovarian hyperstimulation syndrome (OHSS). The development of severe OHSS is contingent on either exogenous administration of hCG or endogenous pregnancy-derived hCG stimulation. The rationale behind the strategy of electively cryopreserving all embryos from woman at risk of developing OHSS is therefore to avoid these additional influences of the exogenous and trophoblastic HCG upon the ovary. Successful implantation depends on embryo quality and uterine receptivity. If a good embryo was present, among those in the cleavage stage, the pregnancy rate was significantly higher (41.5%) after the transfer of embryos at the 3 approximately 4 cell stage in the cases of pronuclear-stage freezing. A significantly higher pregnancy rate of multilayered echogenic patterns was observed when pregnancy and nonpregnancy cycles were compared. No differences in mean endometrial thickness were observed when pregnancy and non pregnancy cycles were compared. No pregnancies occurred when endometrial thickness was less than 5 millimeters. A statistically significant decrease in pregnancy rate was seen when thawed embryo transfer is performed in a natural cycle in patients who were 35 to 39 years old. No age-related decline was seen in patients in which transfer was performed in the hormone replacement cycle.

Peritoneal washing cytology at second-look laparotomy in cisplatin-treated ovarian cancer patients.

The use of peritoneal washing cytology during second-look laparotomy in 58 cisplatin-treated ovarian cancer patients was evaluated. Washing was performed for the 41 patients who showed no gross evidence of persistent disease. Peritoneal washing cytology was positive in 8 of 18 cases with histologically identified residual disease and in 4 of 23 cases without residual disease. However, three of the four cytologically positive patients without other evidence of disease later died of recurrences. The five-year survival rate of the 23 patients who showed no residual carcinomas macroscopically was 60.9%; when their washing cytologies were negative, there was a 73.7% five-year survival rate. These findings indicate that, despite its limitations, a peritoneal washing cytology at the time of second-look laparotomy is important to assess the response to treatment and to evaluate the prognosis of patients with ovarian cancer.