Análisis retrospectivo de los factores determinantes de gestación múltiple en fecundación in vitro / No disponible

La aplicación creciente de técnicas de reproducción asistida para el tratamiento de la esterilidad ha generado diversos problemas y efectos adversos. Entre ellos, las gestaciones múltiples han, emergido como el más frecuente y uno de los más graves desde el punto de vista médico. Con el fin de evaluar su importancia en nuestro medio, y con el objetivo de diseñar estrategias correctivas, se revisaron los registros correspondientes a las 324 gestaciones producidas en el programa de fecundación in vitro de la Fundació Puigvert-Hospital de la Santa Creu i Sant Pau durante los años 2000 a 2003. La proporción de gestaciones múltiples fue de 41,4% (31,2% gemelares, 9,6% trillizos y 0,6% cuatrillzos) aunque en los años 2002 y 2003 se observó una tendencia a la reducción, como resultado de la aplicación de criterios más estrictos en el número de embriones transferidos. La indicación masculina mostró mayor frecuencia de gestaciones múltiples que otras indicaciones. Las variables clinicas y embriológicas más influyentes en la producción de gestaciones múltiples fueron la edad de la muer; el número de folículos y la dosis (menor) de gonadotropinas usada durante la estimulación, el grosor endometrial, el número de embriones totales obtenidos y transferidos, y la suma de puntuación de la calidad embrionaria. Un modelo de función discriminante seleccionó tres variables (calidad global de los embriones transferidos, edad y grosor endometrial) como mejores predictores de gestación múltiple (sensibilidad 59%, especificidad 76%). En conclusión, sigue siendo necesario reducir el número de embriones transferidos en ciclos de FIV, aunque la inclusión de ciertas variables clínicas y embriológicas mediante algoritmos predictivos, puede facilitar la elección en cada caso individual, con el fin de reducir la prevalencia de gestaciones múltiples sin disminuir la tasa global de embarazos

The increasing application of techniques of assisted reproduction for the treatment of sterility has generated a number of adverse effects. Among them, multiple pregnancies have emerged as the most frequent and serious problem from the medical point of view. With the purpose of evaluating their importance in OUT environment, and with the objective to design corrective strategies, we reviewed the registries corresponding to the 324 gestations produced in the program of fertilization in vitro of the Fundació Puigvert-Hospital de la Santa Creu i Sant Pau during years 2000 to 2003. The proportion of multiple gestations was of 41.4% (31.2% twins, 9.6% triplets and 0.6% quadruplets) althougth in 2002 and 2003 there was a tendency towards a reduction, as a result of the application of stricter criteria in the number of transferred embryos. Male infertility indication showed greater frequency of multiple gestations that other indications. The clinical and embryologic variables that significantly influenced the production of multiple pregnancies were age of the woman, the number of follicles and the (smaller) dose of gonadotrophins used during the stimulation, the endometrial thickness, the number of embryos obtained and transferred and the sum of the scores showing embryonic quality. A discriminant function model selected three variables (global quality of the transferred embryos, age and endometrial thickness) as the best predictors of multiple pregnancy (sensitivity 59% speciftcity 76%). In conclusion, it is necessary to further reduce the number of embryos transferred in cycles of FIV, although the inclusion of certain clinical and embryologic variables by means of predictive algorithms, can facilitate the election in each individual case, with the purpose of reducing the prevalence of multiple gestations without diminishing the global rate of pregnancies

Critical evaluation of the present experience on microsurgical sperm aspiration.

Microsurgical epididymal sperm aspiration (MESA) and IVF techniques are indicated in those cases of bilateral congenital absence of the vas deferens (BCAVD) and in cases of epididymal obstruction (EO) of other aetiologies were vasoepididymostomy is not possible or has failed. Microsurgical deferential sperm aspiration (MDSA) is indicated in those cases where spermatogenesis and epididymal permeability are conserved but spermatozoa, for different causes, cannot reach the ejaculate and other therapies have failed. We have performed this procedure in 70 patients by two different human reproduction teams. Both teams achieved very similar results regarding fertilization rate: 5.5 and 7.2% in cases of BCAVD, 6.5 and 8.8% in cases of EO and 33.3 and 26.7% in cases of non-epididymal pathology (NEP). However, the fertilization rate per patient presents differences between both teams: 27 and 44.4% in BCAVD, 31 and 11% in EO and 80 and 100% in NEP. In spite of a better fertilization rate per patient in team two, it was in the other where pregnancies were achieved (7% in BCAVD, 15% in EO and 20% in NEP). One pregnancy in EO group was achieved by intracytoplasmatic sperm injection. The pregnancy rates per transfer were 25% in BCAVD, 50% in EO and 25% in NEP.

Fertility and histology after rabbit ovarian wedge resection with CO2 laser or electrocautery using posterior reconstruction with nylon or polyglactin sutures.

In an experimental study in rabbits, the CO2 laser and electrocautery were compared in performing microsurgical ovarian wedge resection; polyglactin and nylon sutures were compared for ovarian reconstruction. Histologic reaction, adhesion formation, and functional parameters (number of corpora lutea, number of pregnancies, nidation index) were evaluated 30 and 90 days postoperatively. Thirty days after surgery, the tissue inflammatory response was very similar in the four groups; fibrosis was not detected. Significant reductions (P less than 0.01) were found for the experimental (operated right ovary) vs. the control (unoperated left ovary) groups when comparing the number of corpora lutea and the number of pregnancies. No significant differences in the nidation index were demonstrated. Adhesion formation was not different between any of the experimental procedures; adhesions were not detected in the control ovaries. At 90 days, the polyglactin suture was entirely absorbed and no inflammatory reaction persisted. Minimal giant cell infiltration was found around the nylon suture. The histologic differences between the two sutures were statistically significant (P less than 0.02). No fibrosis was observed. The functional parameters did not reveal statistically significant differences between the two sutures.

Sperm recuperation and cervical insemination in retrograde ejaculation.

Seven infertile patients with retrograde ejaculation, in which spermatozoa could be recuperated from the postejaculation urine, were admitted to a sperm recuperation and cervical insemination program. A noninvasive method for sperm recuperation based on urine alcalinization and serial controls to time masturbation has been used. Insemination has been timed according to BBT charts and cervical mucus characteristics. Pregnancy has been obtained in the seven couples after one to eight treatment cycles.

[Laparoscopic tubal sterilization: monopolar and bipolar electrocoagulation]. / Esterilizacion tubarica laparoscopica: electrocoagulacion monopolar y bipolar.

PIP: The study describes 73 interventions of female sterilization obtained laparoscopically by monopolar or bipolar electrocoagulation. Indications for sterilization were essentially medical; 86.2% of patients were above 30, and average parity was over 3. Operative procedures went very smoothly; there were 5 cases of complications: 2 emphysemas caused by pneumoperitoneum, and 3 cases of hemorrage of the mesosalpinx. Hospital stay never exceeded 4 days. No pregnancies were reported, and menstrual cycles and sexual life were quite normal after the procedure. The article also reviews the monopolar electrocoagulation.^ieng

Influence of labour on the lecithin, lecithin/sphingomyelin (L/S) ratio and palmitic acid values in the amniotic fluid.

The lecithin/sphingomyelin (L/S) ratio, lecithin concentrations and palmitic acid levels in amniotic fluid were studied during labour and compared with values found before labour. All were significantly higher in women in labour. The explanation and significance of this finding are briefly discussed.

A comparative study between the values of lecithin, sphingomyelin, lysolecithin, the L/S index, and the Clements test in amniotic fluid.

The relationship between the concentration of several phospholipids in amniotic fluid and the ocurrence of neonatal RDS was established some years ago. However the methods used for the determination of those substances are sophisticated and time consuming. They require specalized equipment and take at least 2 or 3 hours. CLEMENTS described a semiquantitative method which overcomes these disadvantages. The present study compared the concentration of lecithin, shingomyelin, lysolecithin and the L/S ratio against the results obtained when processing the same samples with the CLEMENTS Test. the results are expressed in mg/100 ml. for the different phospholipids and the test was evaluated as positive, intermediate or negative. a statistically significant correlation has been found between the values of lecithin, lysolecithin and L/S ratio and the results of the CLEMENTS Test, respectively. No correlation could be found with sphingomyelin (Figs. 1-4). It is concluded that the CLEMENTS Test can be a useful tool as a screening test available to any obstetrical centre.