Comparison of daily and alternate day recombinant follicle-stimulating hormone stimulation protocols for intrauterine insemination.

OBJECTIVE: To determine the efficacy of daily versus alternate-day stimulation for patients undergoing intrauterine insemination (IUI). DESIGN: Retrospective comparative study. SETTING: University tertiary care center for infertility. PATIENT(S): Women with anovulatory or unexplained infertility for over 12 months who had not responded to or not conceived with clomiphene citrate treatment. INTERVENTION(S): Ovarian stimulation with recombinant follicle-stimulating hormone (FSH; follitropin-beta) given either daily or on alternate days before IUI. MAIN OUTCOME MEASURE(S): Clinical pregnancy at ultrasound 4 weeks after IUI. Secondary outcome measures were duration of stimulation, total gonadotropin dose, ovarian response, and multiple pregnancy rate. RESULT(S): Of the 212 women who underwent a first cycle of gonadotropin stimulation, 28 had daily injections and 117 had alternate-day injections of follitropin-beta only for IUI. Female age, antral follicle count, and day-3 serum FSH were comparable. The median duration of stimulation (8 days vs. 8 days) and the median number of follicles over 14 mm (3.5 vs. 3.0) were similar in both groups. However, the total recominbinant FSH dose (825 vs. 625 IU) and endometrial thickness (10.1 vs. 9.3 mm) were greater in the daily injection group. The clinical pregnancy rate per cycle was 42% (12 out of 28) in the daily injection group and 19% (22 out of 117) in the alternate-day group. CONCLUSION(S): Daily recombinant FSH stimulation for IUI seems to be associated with a higher clinical pregnancy rate than alternate-day FSH stimulation. Prospective randomized trials would be needed to determine whether this is indeed the case.

Patient satisfaction after laparoscopic total or supracervical hysterectomy.

BACKGROUND/AIMS: To evaluate patient satisfaction after laparoscopic supracervical (LASH) or total hysterectomy (TLH). METHODS: Retrospective study of patient satisfaction after LASH or TLH. RESULTS: We studied 40 cases of LASH and another 40 of TLH. The age of the patients, marital status, education level and employment status between the two groups were comparable. Both LASH and TLH results in improvement of general health and symptoms. However, there was no significant difference in patient satisfaction with surgery, in general health, body and self-images, and sexual satisfaction between the LASH and TLH group. Before surgery, patients in the TLH group experienced more pain with a sexual relationship than those in the LASH group. The difference became non-significant after surgery. There was no difference in urinary or gastrointestinal symptoms after either type of hysterectomy. CONCLUSIONS: Both LASH and TLH result in improvement of general health and symptoms. Body and self-images, sexual function, gastrointestinal and urinary functions after LASH or TLH are comparable.

A randomized trial of outpatient hysteroscopy with and without intrauterine anesthesia.

STUDY OBJECTIVE: To evaluate the amount of pain during office hysteroscopy and endometrial biopsy with and without intrauterine anesthesia. DESIGN: Prospective randomized study (Canadian Task Force classification I). SETTING: Academic teaching center. PATIENTS: A total of 82 women underwent outpatient hysteroscopy for evaluation of their uterine cavity. INTERVENTIONS: Randomization to local cervical or combined cervical and intrauterine anesthesia. MEASUREMENTS AND MAIN RESULTS: Amount of pain experienced during the procedure; 10, 30, and 60 minutes after the procedure; and during endometrial biopsy. We used a visual analog scale ranging from 0 to 10 (0: no pain, 10: excruciating pain). Of 82 patients, 4 patients were excluded, 36 patients underwent hysteroscopy using local cervical anesthesia, and 42 others with combined cervical and intrauterine anesthesia. The mean age of the patients in the local group was 37.4 +/- 0.8 years and in the combined group was 38.3 +/- 0.7 years. In both groups, patients experienced significantly more pain during and 10 minutes after the procedure than 30 and 60 minutes after. No significant differences occurred in the pain scores during the hysteroscopy, and 10, 30, and 60 minutes after between the 2 anesthesia groups. The pain score in the local group during endometrial biopsy was significantly higher than during (p <.05), 10 minutes after (p <.001), 30 minutes after (p <.001), and 60 minutes after (p <.001) the procedure, respectively. In the combined group, compared with the pain score during endometrial biopsy, the scores during the hysteroscopy (p <.05), 10 minutes after (p <.01), 30 minutes after (p <.001), and 60 minutes after (p <.001) the procedure were also less, respectively. CONCLUSION: Intrauterine anesthesia with medicated saline as a distending medium is ineffective. Endometrial biopsy is associated with more pain than hysteroscopy.

Congenital malformations among 911 newborns conceived after infertility treatment with letrozole or clomiphene citrate.

OBJECTIVE: To evaluate the incidence of congenital malformations among offspring of mothers who conceived with clomiphene citrate (CC) or with letrozole treatment for infertility. DESIGN: Retrospective study. SETTING: 5 fertility centers in Canada. PATIENTS: 911 newborns from women who conceived following CC or letrozole treatment. INTERVENTIONS: Examination of medical files of both mother and newborn, and cross-checked with the parents by telephone calls. MAIN OUTCOME MEASURES: Identified major and minor congenital malformations, birth weight, age of the mother, and type of treatment that led to the conception. RESULTS: Overall, congenital malformations and chromosomal abnormalities were found in 14 of 514 newborns in the letrozole group (2.4%) and in 19 of 397 newborns in the CC group (4.8%). The major malformation rate in the letrozole group was 1.2% (6/514) and in the CC group was 3.0% (12/397). One newborn in the letrozole group was found to have a ventricular septal defect (0.2%) compared to 4 newborns in the CC group (1.0%). In addition, the rate of all congenital cardiac anomalies was significantly higher (P: 0.02) in the CC group (1.8%) compared to the letrozole group (0.2%). CONCLUSION: There was no difference in the overall rates of major and minor congenital malformations among newborns from mothers who conceived after letrozole or CC treatments. However, it appears that congenital cardiac anomaly is less frequent in the letrozole group. The concern that letrozole use for ovulation induction could be teratogenic is unfounded based on our data.