Heterotopic Triplet Pregnancy in Gonadotropin Stimulation Cycle: A Case Report.

Background: Heterotopic pregnancy is defined as the simultaneous presence of 2 or more pregnancies at different implantation sites, most commonly one intrauterine and one ectopic. Triplet heterotopic pregnancy refers to the presence of specifically 3 concurrent gestations with at least 1 being abnormally implanted. Heterotopic pregnancy is a potentially life-threatening condition that requires thorough diagnostic workup and prompt intervention. Case: We report the fourth case of triplet heterotopic pregnancy after ovarian stimulation with gonadotropins. A 24-year-old woman, G0, presented at 6 weeks of gestation with bilateral tubal ectopic pregnancies and a nonviable intrauterine pregnancy (IUP) after gonadotropin stimulation cycle. Bilateral tubal pregnancies were removed laparoscopically and the nonviable IUP via dilation and curettage. Conclusion: Although rare, heterotopic pregnancy of 2 or more gestations must be kept in mind when managing patients undergoing treatment with ART. Careful examination of bilateral adnexa and consideration of uterine sampling at the time of surgery for ectopic pregnancy is advisable, even for patients with few or no risk factors.

SGI 2012: what's new in obstetrics/gynecology and reproductive medicine: an update from the Society for Gynecologic Investigation.

The Society for Gynecologic Investigation (SGI) hosted its 59th Annual Meeting in San Diego (CA, USA) on 21-24 March 2012. The program attracted 1313 attendees, 918 from the USA and Canada and 395 from the rest of the world. The event was hosted by the SGI president Stephen J Lye and the program director Stephen Matthews. The mission of the SGI is to discover, review, report and transfer new knowledge through creative research and training, community integration and partnerships that improve the reproductive health of women everywhere. More than 1100 abstracts were presented at the meeting, 172 of which were oral presentations. A selection of notable presentations are highlighted here.

Physicians' perspectives and practices regarding the fertility management of obese patients.

To assess the practice patterns and personal beliefs of fertility physicians who care for obese patients seeking assisted reproduction, we conducted a national survey of fertility program directors from both private and academic practices and discovered that although few practices have firm guidelines regarding the management of obese patients, the overwhelming majority of providers believe that body mass index guidelines or cutoffs should exist.

Fertility and the aging male.

In the United States since 1980, the birth rate in women aged > 35 years has increased by nearly 60%, whereas the birth rate for women aged 20 to 34 years has increased by only 10%. The trend in parenthood at an older age has also been seen in men. Since 1980, the fertility rate for men in their 30s has increased by 21% and for men aged 40 years and older, the rate has increased nearly 30%. In contrast, the fertility rate in men younger than age 30 years has decreased by 15%. Age-related infertility will continue to be a problem. A basic understanding of the issues is critical for health care professionals so that they can effectively counsel patients who are considering a delay in childbearing for social reasons or for those seeking fertility treatments. This review details the changes in fertility seen in the aging male.

Poor success of gonadotropin-induced controlled ovarian hyperstimulation and intrauterine insemination for older women.

OBJECTIVE: To determine the success rates and utility of controlled ovarian hyperstimulation in conjunction with intrauterine insemination (COH/IUI) cycles in women aged 38-39 years versus women >or=40 years old. DESIGN: Retrospective cohort study. SETTING: Tertiary-care academic medical center. PATIENT(S): There were 130 women, 57 aged 38-39 years (42.6%) and 73 aged >or=40 years (57.4%), who underwent 262 IUI cycles (range 1-3 cycles per woman). INTERVENTION(S): Infertility treatments with gonadotropins and IUI. MAIN OUTCOME MEASURE(S): Clinical pregnancy rates and live birth rates stratified by age. RESULT(S): The most common infertility diagnosis was diminished ovarian reserve, which was found more frequently among women aged >or=40 years than among the slightly younger group. The age-specific groups were similar in their baseline characteristics and cycle parameters. Women who were 38-39 years old had an overall live birth rate of 6.1% per cycle, with no live births occurring after the second cycle, and women >or=40 years old had an overall live birth rate of 2.0% per cycle, with all births occurring in the first cycle. CONCLUSION(S): The efficacy of COH/IUI cycles significantly decreases with age, but women aged 38-39 years had reasonable success during the first two cycles. However, for women aged >or=40 years, no benefit after a single cycle of COH/IUI was observed. Women aged >or=40 years should be considered for in vitro fertilization after one failed COH/IUI cycle.

Ultrasonographer experience does not impact outcomes following ultrasound-guided embryo transfer.

OBJECTIVE: To determine the effect of sonographer experience during ultrasound guided embryo transfer on pregnancy outcomes. DESIGN: Retrospective chart review. SETTING: A university-based academic practice. PATIENT(S): A total of 319 women who underwent in vitro fertilization and embryo transfer (IVF-ET) from the site-specific clinic. A total of 118 women (37%) underwent embryo transfers with a medical assistant (inexperienced ultrasonographer) performing ultrasound guidance, and 201 women (63%) underwent embryo transfers by an REI fellow (experienced ultrasonagrapher) performing the US guidance. INTERVENTION(S): Real-time transabdominal ultrasound guidance during IVF-ET. MAIN OUTCOME MEASURE(S): Respective biochemical, clinical, and live birth rates following ultrasound-guided IVF-ET performed by either experienced or nonexperienced sonographers. RESULT(S): The two groups were similar in baseline characteristics or treatment response. Pregnancy outcomes were similar in both groups, with the MA cohort demonstrating clinical pregnancy rate of 43.2% and a live birth rate of 35.6%, and the REI fellow group yielding a clinical pregnancy rate of 44.8% and a live birth rate 35.8%, respectively. CONCLUSION(S): The clinical experience of the person performing ultrasound guidance during IVF-ET does not have an effect on clinical outcome. Thus, the use of an assistant without formal ultrasound training during IVF-ET is a reasonable option.