Gamete intrafallopian transfer. Comparison of epidural vs. general anesthesia.

OBJECTIVE: To investigate the reproductive outcome of laparoscopic gamete intrafallopian transfer (GIFT) performed under epidural vs. general anesthesia. STUDY DESIGN: Retrospective analysis of 110 consecutive laparoscopic GIFT procedures performed under general or epidural anesthesia. All patients underwent controlled ovarian hyperstimulation employing human menopausal gonadotropin and gonadotropin releasing hormone agonist, given either in the midluteal or early follicular phase. Data were retrieved concerning age, diagnosis, estradiol levels and maximum follicular diameter at the time of human chorionic gonadotropin injection, percentage of mature oocytes retrieved and number of oocytes transferred. These variables were compared using the independent means t test. Pregnancy rates and outcome between the general and epidural anesthesia groups were compared with the chi 2 test. RESULTS: Of the 110 procedures, 84 were performed under general anesthesia, whereas 22 were done using epidural anesthesia. Four procedures started with epidural anesthesia and were converted to general anesthesia because of upper abdominal discomfort. The success rate of epidural anesthesia, therefore, was 85% (22/26). There were no significant differences in the confounding variables between the general and epidural anesthesia groups. However, patients receiving epidural anesthesia had a significantly higher pregnancy rate, 59.1%, and a live birth rate of 40.9% as compared to 31.0% and 21.4%, respectively, for the general anesthesia group. CONCLUSION: Laparoscopic GIFT can be performed safely under epidural anesthesia. Because of the higher pregnancy and live birth rates, epidural is the anesthetic of choice for GIFT. However, a prospective, randomized study is needed to confirm the above observation.

Gamete intrafallopian transfer. Does smoking play a role?

OBJECTIVE: To investigate the effects of active and passive cigarette smoking on the outcome of gamete intrafallopian transfer (GIFT). STUDY DESIGN: A retrospective analysis of 98 patients who had laparoscopic GIFT was performed. Data were retrieved concerning age, diagnosis, amount of human menopausal gonadotropins (hMG) used for controlled ovarian hyperstimulation (COH), and number of oocytes retrieved and transferred. A detailed smoking history, if any, of patients and household members was obtained from chart review and an additional telephone survey. Pregnancy rates and outcome in active and passive smokers were compared to those of non-smokers. RESULTS: No difference was observed among active smokers (n = 19), passive smokers (n = 13) or nonsmokers (n = 66) regarding diagnosis, age percentage of mature oocytes retrieved or number of oocytes transferred during GIFT. However, active, but nor passive, smokers consumed a higher amount of hMG for COH as compared to nonsmokers. More important, pregnancy and live birth rates for active smokers (15.8% and 10.5%, respectively) were significantly lower than those for passive smokers (46.2% and 23.1%) and nonsmokers (45.5% and 33.3%). No difference, however, was noted between the latter two groups. CONCLUSION: Our results show that active, but not passive, smoking has a negative impact on GIFT pregnancy rates and outcomes. It is important to counsel patients against cigarette smoking prior to GIFT, but whether smoking cessation will improve the outcome needs further study.

Intraperitoneal rupture of benign cystic teratoma after midtrimester pregnancy termination. A case report.

Spontaneous intraperitoneal rupture of a benign cystic teratoma is an unusual occurrence. This is the first reported case associated with midtrimester abortion accomplished by dilatation and evacuation.