SpainFertility

Reporting the efficacy of fluoroscopically guided balloon stenosis for the treatment of severe intrauterine adhesions and cervical stenosis.

Researchers have reported success with a novel fluoroscopically guided approach to treating severe intrauterine adhesions and cervical stenosis using balloon hysteroplasty.

“Hysteroscopy has become the mainstay for the evaluation of suspected intrauterine adhesions as it allows for direct visualization of the uterine cavity and provides the opportunity to treat these adhesions,” say Rebecca Chason (National Naval Medical Center, Bethesda, Maryland, USA) and fellow researchers.

“However, hysteroscopy may not always be possible to perform, and when it can be successfully accomplished, it is not without its risks, including anesthesia, uterine perforation, and hemorrhage,” the authors note.

In the present report, Chason and team report the treatment of a 33-year-old woman undergoing assisted reproductive interventions whose uterus could not be cannulated because of intrauterine synechiae, cervical stenosis, and a lower uterine segment-filling defect, all secondary to infection and scarring related to previous cesarean delivery.

The physicians used fluoroscopic cannulation and balloon uterine dilation to treat this patient, which they say resulted in a normalized uterine cavity and allowed an embryonic transfer procedure to take place.

“We present a case of significant lower uterine adhesions that were successfully lysed using fluoroscopy-guided balloon dilation,” the authors conclude.

“Further study exploring the outcomes of this procedure in a larger study population is warranted,” they add.
Orgyn.com

Assessing the suitability of laparoscopic ovarian diathermy versus clomiphene citrate therapy for inducing ovulation in women with polycystic ovary syndrome.
Laparoscopic ovarian diathermy (LOD) should remain a second-line method for inducing ovulation in women with polycystic ovary syndrome (PCOS), except in certain cases, findings from a randomized, controlled trial indicate.

For their study, Saad Amer (University of Nottingham, UK) and co-workers randomly assigned 65 anovulatory women with PCOS to undergo treatment with LOD or the current gold-standard, first-line therapy for ovulation induction in women with PCOS, clomiphene citrate.

Overall, 44 percent of women who received clomiphene citrate therapy became pregnant compared with 27 percent of those treated with LOD; a difference that was large but not statistically significant.

The women who remained anovulatory after first-line therapy with either LOD or clomiphene citrate were subsequently switched to the opposite therapy and, again, pregnancy rate was nonsignificantly higher in those who received first-line clomiphene citrate, at 63 percent and 52 percent, respectively.

The authors recommend that clomiphene citrate remain the standard first-line method for ovulation induction.

They add, however: “LOD could be recommended as a first line if laparoscopy is indicated for other reasons in these women, and as an adjunct to clomiphene citrate treatment should monotherapy fail to produce a pregnancy after a limited duration of exposure.”
Orgyn.com

Comparing the cost-effectiveness, for treatment of post-vasectomy obstructive azoospermia, of vasectomy reversal, microsurgical epididymal sperm aspiration and percutaneous testicular sperm extraction.

Vasectomy reversal appears to be more cost-effective for the treatment of post-vasectomy obstructive azoospermia than either percutaneous testicular sperm extraction (TESE) or microsurgical epididymal sperm aspiration (MESA), US study findings suggest.

Researchers from Cornell University in New York studied the cost-effectiveness of vasectomy reversal versus MESA or percutaneous TESE plus IVF or intracytoplasmic sperm injection for men with post-vasectomy obstructive azoospermia in a decision analytic model that simulated treatment.

Using information collected from high-volume IVF centers, peer-reviewed literature, and registry data, they found that vasectomy reversal was the most cost-effective treatment under all probability conditions.

In 1999, the cost per live delivery with vasectomy reversal was US$19,633 (€13,663) versus $45,637 (€31,761) with TESE and $48,055 (€33,445) with MESA. In 2005 dollars, this was equivalent to $25,321 (€17,623), $58,858 (€40,964)and $61,977 (€43,135), respectively, the researchers say.

Vasectomy reversal remained most cost-effective in 2005, with a cost per delivery of $20,903 (€14,543) versus $54,797 (€38,124) with TESE and $56,861 (€39,560) with MESA.

Indirect costs accounted for most of the differences, such as lost productivity and complications due to male-related intervention, maternal risks from IVF, and multiple pregnancies.

P. Schlegel and colleagues conclude: “Our decision analysis suggests that vasectomy reversal is more cost-effective than either MESA or TESE for the treatment of obstructive azoospermia.”

Orgyn.ccom

A new study has added to the evidence suggesting that an elevated day 3 ratio of FSH to LH is associated with poorer outcomes of IVF and higher rates of cycle cancellation.

For their study, published in the current issue of the journal Fertility and Sterility, researchers from the Mount Sinai Hospital and the University of Toronto, Canada, conducted a retrospective review of the records of 297 women in order to evaluate the day 3 ratio of follicle-stimulating hormone (FSH) to luteinizing hormone (LH) as a predictor of the prognosis of IVF cycles. The women in the study were all less than 40 years of age, undergoing their first cycle of IVF, and had a normal day 3 basal FSH level, of 10 IU/L or less.

About one-third of the patients had an elevated day 3 FSH/LH ratio: 97 women had a ratio of 2.0 or more, while 200 had a ratio of less than 2.0.

Both groups of women were similar in age, gravidity, parity and diagnosis. However, the patients with an elevated ratio were significantly more likely to have been placed on an aggressive (microdose flare) protocol. They were also significantly more likely to have been started on a slightly higher starting dose of FSH (mean 257 IU versus 232 IU, respectively), and to have been given a higher total dose of FSH (mean 2484 IU versus 2136 IU, respectively).

Overall, the women with an elevated FSH/LH ratio had poorer cycle outcomes, including significantly fewer follicles (7.6 follicles 1.7cm or larger, compared with 8.9 in the non-elevated ratio group), significantly fewer oocytes (10 versus 13.2) and significantly fewer day 3 embryos of 6 cells or more (4.2 versus 5.6).

The researchers also found that the women with an elevated FSH/LH ratio were significantly more likely to have their cycles cancelled before retrieval: 19.6 percent of cycles were cancelled compared with only 8.5 percent of cycles in women with an FSH/LH ratio below 2.0.

There was a trend towards a lower rate of clinical pregnancy per cycle start in women with an elevated FSH/LH ratio (18.6 percent versus 25.5 percent) but this difference was not statistically significant.

In the discussion of their findings, the researchers note that the FSH/LH ratio showed the highest correlation with clinical pregnancy over the other measures of ovarian reserve that were investigated, including day 3 estradiol levels, ovarian volume, and antral follicle count.

The researchers conclude: “The day 3 FSH/LH ratio is a relatively easy test to obtain and adds more predictive power over the day 3 FSH level alone, especially in younger patients with a normal FSH level [less than or equal to 10 IU/L]. In particular, the unexpectedly high rate of cycle cancellation in this group as found in this study may aid in cycle planning and counseling.”

Your views? Please use the Comment button below to give us your feedback on any aspect of this article.

To be notified of the contents of new ORGYN.com Reviews as they are published, and to receive direct links to the articles, you can subscribe to the email update via the “Edit profile” page (click on the link, above right).

Orgyn.com