Serum hCG Levels following the Ovulatory Injection: Associations with Patient Weight and Implantation Time.

Objective. To test if serum hCG levels the morning after the ovulatory hCG injection correlate with (1) retrieval efficiency, (2) oocyte maturity, (3) embryo quality, (4) pregnancy, and/or (5) time to implantation in patients undergoing in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). Design. Retrospective cohort analysis. Setting. University-based IVF clinic. Patient(s). All IVF/ICSI cycles from April 2005 to February 2008 whose hCG administration was confirmed (n = 472 patients). Intervention(s). Serum hCG was measured the morning following the ovulatory injection, on the 16th day following retrieval, and repeated on day 18 for those with positive results. Main Outcome Measure(s). Number of follicles on the day of hCG injection, number of oocytes retrieved, maturity of oocytes, embryo quality, pregnancy outcome, and time to implantation. Result(s). hCG levels did not correlate with retrieval efficiency, oocyte maturity, embryo quality, or pregnancy. Postinjection hCG levels were inversely associated with patient weight and time to implantation. Conclusion(s). No correlation was found between hCG level and any parameter of embryo quality. Patient weight affected hCG levels following hCG injection and during the early period of pregnancy following implantation. No association between postinjection hCG level and time of implantation (adjusted for patient weight) was apparent.

Racial differences in women who have a hysterectomy for benign conditions.

OBJECTIVE: To evaluate if there are racial differences between African-American and Caucasian women who have hysterectomy for benign conditions in terms of (1) presenting symptoms (prolapse, vaginal bleeding, pain, and known history of leiomyomas), (2) serum estradiol and testosterone levels at the visit before hysterectomy, and (3) uterine weight. METHODS: A multi-ethnic, multisite, community-based longitudinal cohort study of 3,302 women ages 42-52 at enrollment was conducted. During 9 years of follow-up, 203 African-American and Caucasian women reported a hysterectomy, 90 with evidence of uterine leiomyomas. Women were surveyed regarding their overall perceived health before and after hysterectomy, presenting symptoms, and their motivations for surgery. Serum estradiol and testosterone levels were measured. Uterine weight at time of hysterectomy and clinical pathology were determined via medical record abstraction. RESULTS: Previously diagnosed leiomyomas were presenting symptoms more frequently in African-American women than Caucasian women (85% vs. 63%; p = .02). African-American women had less prolapse than Caucasian women (0% vs. 10%; p = 0.04). Chronic pain was a more frequent reason for hysterectomy in African-American women than in Caucasian women (49% vs. 29%; p = .05). There were no differences between the groups in levels of estradiol or testosterone. African-American women had almost twice the uterine weight as that of Caucasian women (448 vs. 240 g; p = .0005). CONCLUSION: Racial differences in frequency of hysterectomy for benign conditions are consistent with differences in presenting symptoms, where African-American women seemingly have larger, more symptomatic fibroids.

Follicle-stimulating hormone levels and medication compliance during in vitro fertilization.

OBJECTIVE: To report the use of serum FSH levels during gonadotropin therapy for IVF to ensure medication compliance. DESIGN: Case report. SETTING: University-based reproductive endocrinology clinic. PATIENT(S): Two women with normal ovarian reserve undergoing IVF cycles with unexpected clinical responses. INTERVENTION(S): FSH laboratory values. MAIN OUTCOME MEASURE(S): Ovarian follicular development. RESULT(S): Adequate follicular response leading to oocyte retrieval. CONCLUSION(S): Determination of serum FSH levels may help detect noncompliance with recommended gonadotropin regimens during IVF.

Gadolinium radiologic contrast is a useful alternative for hysterosalpingography in patients with iodine allergy.

OBJECTIVE: To report the successful use of gadolinium radiologic contrast for hysterosalpingography. DESIGN: Case report. SETTING: Outpatient care in a private practice setting. PATIENT(S): One female patient entering and finishing study. INTERVENTION(S): Hysterosalpingogram. MAIN OUTCOME MEASURE(S): Interpretability of radiological imaging. RESULT(S): Visualization of a normal uterine cavity and fallopian tubes with bilateral patency was confirmed during the procedure. Radiologic films were created that document the results. The best visualization of the internal pelvic anatomy was noted during the actual procedure. There was a lighter image noted on the films taken from the use of gadolinium rather than the traditional iodinated contrast. CONCLUSION(S): Gadolinium is a safe and useful alternative to iodinated contrast for hysterosalpingography in patients with iodine allergy.