The inaugural in vitro fertilisation cycle in Jamaica: an overview

INTRODUCTION: At the Fertility Management Unit, an assisted reproduction technology service was established in June 2000. Twenty-eight couples were enrolled for treatment, which was carried out in collaboration with staff of the Midland Fertility Service, United Kingdom, and a local team of doctors, nurses and embryologist. The main Pre-treatment diagnoses were tubal factors in eight (28.5 percent) women and oligospermia in eight males (28.5 percent). The mean age of the women was 34.1 years (range 27 to 41 years). METHODS: All patients under the "long protacol" with down regulations of the hypothalamo-pituitary-ovarian axis, using subcutaneous injections of the gonadotrophin releasing hormone agonist (Buserelin), followed by stimulation with the human menopausal gonadotrophin (Pergonal), for ovulation induction. Monitoring of the response was by use of transvaginal ultrasound at the end of down regulation, day 5 of stimulation and from day 9 until the follicles were determined to be ready for retrieval. Oestradiol levels were measured and human chorionic gonadotrophin (Profasi) was given to mature the oocytes. Oocyte recovery was by transvaginal ultrasound-guided needle aspiration of the follicles 35 hours later. Two days after egg recovery and fertilisation, embryos were transferred back to the patient. There were 24 transfers of 1, 2 or 3 embryos. Fertilised embryos not transferred were cryopreserved at -70 degree celcius. Ten women received human chorionic gonadotrophin (HCG) on the day of transfer and 2, 4 and 6 days later, for luteal phase support, and 24 women received progesterone pessaries. RESULTS: All women responded and came to oocyte recovery. There were 3 cases of ovarian hyperstimulation syndrome (OHSS), one severe and 2 mild. Ten couples had intracytoplasmic sperm injection (ICSI) as planned. Two percutaneous epididymal sperm aspirations were necessary due to aspermia, so these had ICSI as well. Standard in vitro firtilzation procedures were used in 16 cases. Twenty-five patients (89.3 percent) had fertilised oocytes. Three couples had no fertilisations. The patient with severe OHSS had numerous fertilisations but no embryos were transferred to the patient. Five patients (20.8 percent) had "chemical" pregnancies. Three pregnancies have continued, 2 twins and one singleton. The pregnancy rate for viable pregnancies is therefore 12.5 percent. CONCLUSION: In vitro fertilization had been successfully achieved (Au)

Trans abnormal versus trans vaginal ultrasound imaging of the pelvis

Imaging of the female pelvis by ultrasound may be carried out either by the use of trans-abdominal probes or, more recently with trans-vaginal probes also. The relative merits of the two are discussed in this paper with special referencwe to the diagnosis of abnormalities in the first six to eight weeks of pregnancy. The advantages of the trans-vaginal probe in the investigation of infertility and the process of ovum retrieval for in-vitro fertilization are outlined. (AU)

Endovaginal sonography in obstetrics and gynaecology - abstract

The recent advent of endovaginal ultrasound transducers has facilitated a comprehensive view of the female pelvis. These high frequency transducers sacrifice depth of penetration and a panoramic view but allow for "sonomicroscopy" of various pelvic organs to be performed. This presentation will focus on the clinical utility and versatility of endovaginal sonography as it pertains to ovarian and endometrial changes in the normal and abnormal menstrual cycle; its role in infertility studies, early normal and abnormal gestation, early foetal embryology including yolk sac growth and in the clarification of the diagnosis of placenta previa. Finally, the role of colour doppler studies in the pelvis will be explored (AU)

Combined vaginal-abdominal delivery of twins

Seven cases of combined vaginal-abdominal delivery of twins were encountered. The indication for operative intervention for the second twin were obstructed labour and umbilical cord prolapse. Good maternal and foetal results were achieved (AU)

Injury to the posterior vaginal fornix during intercourse

Four cases of injury to the posterior fornix during intercourse have been presented. Aetiology, incidence, diagnosis and treatment have been discussed. Cases which were presented all bled heavily and were largely misdiagnosed when first seen. It would seem that there is a place for a greater awareness of this condition, especially in countries with large Negro populations. (Summary)

Een primaire vagina-steen / A primary vaginal concretion

A primary vaginal concretion was found and removed in a 2-year-old child with severe hydrocephalus. The causative factors were probably the child's neurogenic incontinence and paresis of the legs......(AU)