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.

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.