The effect of endometriosis on pregnancy outcome following in vitro fertilization-embryo transfer (IVF-ET) in women with decreased egg reserve.

PURPOSE: To determine the effect of the presence of endometriosis on the delivered pregnancy rate following in vitro fertilization-embryo transfer. METHODS: A retrospective cohort analysis of fresh or frozen embryo transfer in women with diminished egg reserve having IVF-ET and who also had had a laparoscopy. The data was analyzed as to whether endometriosis was present or not. RESULTS: The data demonstrated that women with diminished egg reserve can achieve pregnancies following IVF-ET. The presence of endometriosis did not have any negative effects on pregnancy rates. CONCLUSIONS: At least in women with diminished egg reserve the presence of endometriosis did not impair outcome following IVF-ET.

Ectopic pregnancy is not more likely following fresh vs frozen embryo transfer.

PURPOSE: To determine if the risk of ectopic pregnancy is greater following frozen vs fresh embryo transfer (ET). METHODS: Retrospective review of pregnancy outcome from January 1, 1997 to November 30, 2003. Cryopreservation was used as a simple freezing method and one-step removal of cryoprotectant. The cycles consisted mostly of graduated estradiol and progesterone supplementation. RESULTS: The ectopic pregnancy rate in 1,445 clinical pregnancies from fresh ET was 2.6% vs 2.0% of 975 clinical pregnancies resulting from frozen ET. CONCLUSION: In contrast to the conclusions of two previous studies, the present study evaluating twice as many clinical pregnancies than the two aforementioned studies combined failed to show any greater risk of ectopic pregnancy when transfers were performed on day 3.

Effect of an abnormal sperm chromatin structural assay (SCSA) on pregnancy outcome following (IVF) with ICSI in previous IVF failures.

A high DNA fragmentation index (DFI) when performing the sperm chromatin structural (SCSA) assay was claimed to be so specific for male subfertility that even IVF and ICSI did not result in live pregnancies. The present study was designed to corroborate or refute these findings. The SCSA test was performed on the male partner from couples failing to have a successful pregnancy despite at least 2 previous IVF attempts. In contrast to the aforementioned studies, ongoing pregnancies were found despite working with a group of recalcitrant patients. Nevertheless, a high DFI score was associated with a trend for lower ongoing pregnancy rates especially related to a high miscarriage rate. Other more recent studies seem to support our conclusions. A high DFI score should influence a patient to choose IVF as a therapeutic modality sooner, especially with ICSI.

Outcome of in vitro fertilization-embryo transfer according to age in poor responders with elevated baseline serum follicle stimulation hormone using minimal or no gonadotropin stimulation.

PURPOSE: To determine whether decreased ovarian reserve or advancing age are more associated with decreased oocyte quality. METHODS: Women with baseline serum follicle stimulating hormone (FSH) > 12 mIU/ml who demonstrated previous poor response to controlled ovarian hyperstimulation (COH) had oocyte retrieval without gonadotropin stimulation in natural cycles or with minimal stimulation (maximum 75 IU gonadotropins) without agonists or antagonists were evaluated following in vitro fertilization-embryo transfer. RESULTS: The ongoing/delivered pregnancy rates were 27.3%, 30.8%, 21.7%, and 0.0%, respectively, with a mean of 1.06 embryos per transfer. The implantation rates were 33.3%, 28.6%, 14.7%, and 6.0%. Approximately half of the retrievals resulted in failed fertilization. CONCLUSION: Using these minimal or no drug COH regimens in a difficult group of women, age was found to be a more adverse infertility factor than elevated serum FSH.

Shared donor oocyte system to determine if top embryos can be derived from oocyte factors or more likely from an oocyte/sperm interaction.

PURPOSE: To determine if top embryos require an unusual, and possibly fortuitous, combination of excellent oocyte quality and sperm, or whether some oocyte property alone leads to the formation of superior quality embryos on day 3. METHODS: The embryo quality of donor oocyte recipient cycles was evaluated to find a woman who made 100% top embryos. After finding such an individual, the quality of the recipient's embryos was also evaluated. The shared donor oocyte recipient cycles were also evaluated for pregnancy outcome. RESULTS: All 15 embryos were graded top. The six embryos transferred to the donor and recipient resulted in two sets of triplets. One of the fetuses of the recipient aborted related to trisomy 21. CONCLUSION: The data indicates that the formation of an extremely high percentage (100%) of top embryos can be related to an oocyte factor. It is extremely unlikely to find two male partners who produce sperm with a unique property that makes superior morphologic embryos implant.

Efficacy of sharing oocytes from compensated donors between two recipients.

PURPOSE: To see if sharing of donated oocytes from a compensated donor lowers outcome following embryo transfer compared to recipients keeping all oocytes. METHOD: Retrospective review. Recipients have the option of keeping all oocytes or sharing to reduce costs. RESULTS: There were equal clinical, and ongoing/delivered pregnancy rates and implantation rates in the two groups. There were almost twice as many frozen embryos available to recipients who did not share for potential future use. CONCLUSIONS: Sharing of oocytes between two recipients reduces the financial burden for the recipient without affecting efficacy. Such a policy would make more oocytes available to recipients and thus shorten the long waiting times.

Hysteroscopic endometrial ablation using free heated saline for the treatment of menorrhagia.

STUDY OBJECTIVE: To assess the safety and efficacy of hysteroscopic endometrial ablation using controlled intrauterine instillation and circulation of heated (90 degrees C) saline. DESIGN: Phase II clinical study (Canadian Task Force classification II-2). SETTING: Preliminary study performed in an outpatient ambulatory surgery center of a university hospital. PATIENTS: Twenty women with menorrhagia of benign causes. INTERVENTION: Hysteroscopic endometrial ablation. MEASUREMENTS AND MAIN RESULTS: There were no complications. At no time did fluid leak from the fallopian tubes or cervix during treatment. Six patients had concurrent laparoscopy to measure serosal temperatures and to observe fimbriae directly during the 10-minute treatment. Serosal and endocervical temperatures were not elevated. Eighteen women kept evaluable menstrual diaries for 2 months before and 12 months after surgery. Ten women (55.6%) became amenorrheic, four (22.1%) hypomenorrheic, and three (16.7%) returned to normal periods after 12 months of follow-up. One woman (5.6%) reported a 75% decrease in menstrual flow but continued to be menorrhagic by definition. One patient subsequently underwent hysterectomy for simple endometrial hyperplasia. CONCLUSION: This procedure appears to be a safe method of globally ablating the endometrium, resulting in effective treatment of menorrhagia.

Results of a randomized, multicenter, comparative trial of a single dose of cefotetan versus multiple doses of cefoxitin as prophylaxis in cesarean section.

In a multicenter, open, randomized, comparative trial, 308 women undergoing cesarean section were given a single 1 gm dose of cefotetan or three 2 gm doses of cefoxitin after cord clamping to reduce the incidence of postoperative infectious morbidity. Of the 286 evaluable patients, 195 received cefotetan and 91 received cefoxitin. Most patients were in active labor and one third had ruptured membranes. Microorganisms cultured from the endocervix or intraoperatively from the endometrium or abdominal wall operative sites were comparable for the two groups. In this multicenter study, the difference between the percentage of patients receiving cefotetan who did not develop clinical signs and symptoms of infection (93%) and the percentage of patients receiving cefoxitin (85%) considered clinical successes was statistically significant (p = 0.02, chi 2). The bacteriologic response rate for patients taking cefotetan was also significantly higher than that for patients taking cefoxitin (93% versus 85%, p = 0.03). Isolates recovered from the endocervix, endometrium, or operative site were comparable for the two groups. Both drugs were well tolerated. In this evaluation, cefotetan administered in a single dose of 1 gm was more effective as a prophylactic agent than multiple 2 gm doses of cefoxitin in the reduction of infectious morbidity in this large series of patients undergoing cesarean section.