Does the experience of the provider affect pregnancy rates after embryo transfer?

OBJECTIVE: To study the influence of provider experience in a university hospital where resident physicians need to learn how to perform embryo transfer (ET). STUDY DESIGN: A cohort prospective study was conducted in a tertiary care university medical center between March 2008 and August 2009. A total of 443 women undergoing fresh ET after in vitro fertilization were studied. ET with Frydman catheter or tight difficult transfer (TDT), conducted by three groups of providers of varying experience were studied: attending physicians with > 20 years of experience, assistant physicians with 2-5 years of experience and resident physicians with < 6 months of experience. The main outcomes were clinical pregnancy and implantation rates. RESULTS: The provider's experience had an impact on the pregnancy rate: 29.9% for attending physicians, 28.2% for assistant physicians and 19.1% for resident physicians (p < 0.05). Resident physicians used TDT catheter more often than attending physicians: 42% vs. 21.3% (p < 0.05). CONCLUSION: Resident physicians must be better monitored to avoid the lower pregnancy rates. ET should be further standardized. In this study, the ET protocol was modified in our assisted reproductive technology unit.

Obstetric outcome of women with in vitro fertilization pregnancies hospitalized for ovarian hyperstimulation syndrome: a case-control study.

OBJECTIVE: To evaluate the obstetric outcome of women with IVF pregnancies hospitalized for ovarian hyperstimulation syndrome (OHSS). DESIGN: A case-control study. SETTING: Department of Obstetrics-Gynecology and Reproductive Medicine. PATIENT(S): All IVF patients hospitalized for OHSS with a positive pregnancy test matched to an IVF pregnancy control group who did not develop OHSS. INTERVENTION(S): Retrospective study of all clinical and laboratory data. MAIN OUTCOME MEASURE(S): OHSS morbidity, early pregnancy outcome, and obstetric complications. RESULT(S): The incidence of OHSS requiring hospitalization was 1.14% among 3,504 IVF cycles. Forty patients (31 singletons, 8 twins, and 1 triplet) hospitalized for severe OHSS with a mean duration of hospitalization of 10.2 ± 7.2 days were compared with a control group of 80 IVF pregnancies (48 singletons, 15 twins, and 2 triplets). Early OHSS occurred in 22.5% of patients, and late OHSS in the remaining 77.5% patients. In the OHSS group, 10% had thromboembolic complications. The miscarriage rate was similar for the OHSS group and the control IVF group (17.5% vs. 16%). Concerning ongoing clinical pregnancies, pregnancy-induced hypertension (PIH) and preterm labor were significantly higher in the OHSS group (respectively, 21.2% vs. 9.2% and 36% vs. 10.7%). In the subgroup of singletons, PIH was significantly higher for OHSS pregnancies than for controls. CONCLUSION(S): Pregnancies after IVF and OHSS are associated with a greater risk of adverse obstetric outcome.

[Breast cancer and pregnancy: decision making and the point of view of the mother]. / Cancer du sein et grossesse: modalités de décision et point de vue de la mère.

For the treatment of breast cancer, modifications of decision making related to pregnancy could be assessed through three questions. Why a decision had been chosen? In that case, the hypothesis is that decisions are based on the expected utility. The theory assumes weighting and computation of complete possibilities with their associated probabilities and values. However values exhibits a wide inter-individual variation range. Therefore the predictability of choice based on this model is indeed very low. Furthermore it is likely that the willingness of pregnancy after breast cancer contains besides classic constituents of appeals of motherhood, a specific meaning of recovery both of health and femininity. The second question: who is in charge of the decision? And under the paradigm of autonomy, women' decision is, merely by itself, the right decision. The last question is how? For some situations for which foreseeing is quiet complex, the value of the process in itself is increased and could help the end-oriented or self-determined decision. Casuistic analysis could therefore improve women' decisions. The issue is not only about decision but also related to patient-physician relationship, about an issue that is not only a biomedical problem.