Air bubble migration is a random event post embryo transfer.

INTRODUCTION: Air bubble location following embryo transfer (ET) is the presumable placement spot of embryos. The purpose of this study was to document endometrial air bubble position and migration following embryo transfer. DESIGN: Multicenter prospective case study. MATERIALS AND METHODS: Eighty-eight embryo transfers were performed under abdominal ultrasound guidance in two countries by two authors. A single or double air bubble was loaded with the embryos using a soft, coaxial, end opened catheters. The embryos were slowly injected 10-20 mm from the fundus. Air bubble position was recorded immediately, 30 minutes later and when the patient stood up. RESULTS: Bubble marker location analysis revealed a random distribution without visible gravity effect when the patients stood up. The bubble markers demonstrated splitting, moving in all directions and dispersion. CONCLUSION: Air bubbles move and split frequently post ET with the patient in the horizontal position, suggestive of active uterine contractions. Bubble migration analysis supports a rather random movement of the bubbles and possibly the embryos. Standing up changed somewhat bubble configuration and distribution in the uterine cavity. Gravity related bubble motion was uncommon, suggesting that horizontal rest post ET may not be necessary. This report challenges the common belief that a very accurate ultrasound guided embryo placement is mandatory. The very random bubble movement observed in this two-center study suggests that a large "window" of embryo placement maybe present.

Comparison of microlaparoscopy and conventional laparoscopy for tubal sterilization under local anesthesia with mild sedation.

STUDY OBJECTIVE: To compare tubal sterilization performed by microlaparoscopy and conventional laparoscopy. DESIGN: Prospective, randomized trial (Canadian Task Force classification I). SETTING: Gazi University School of Medicine. PATIENTS: Twenty women undergoing surgical sterilization. INTERVENTION: Ten sterilizations by conventional laparoscopy and 10 by microlaparoscopy. MEASUREMENTS AND MAIN RESULTS: The techniques were comparable in quality of visualization, operating time, amount of drugs used for sedation and local anesthesia, and intraoperative pain scores. However, the postoperative analgesic requirement was significantly less in women treated by by microlaparoscopy. CONCLUSION: Tubal sterilization by microlaparoscopy does not differ greatly from conventional laparoscopic sterilization.

Diagnostic and operative microlaparoscopy: a preliminary multicentre report.

Microlaparoscopes have been evaluated for minimally invasive laparoscopy using minimal anaesthesia or analgesia since our preliminary report on microlaparoscopy in 1993. This international multicentre report of safety and efficacy of diagnostic and operative microlaparoscopy was completed to evaluate the role of microlaparoscopy in a wide spectrum of gynaecological indications, diagnoses of pelvic and tubal disease, tubal occlusion and assisted reproduction. A total of 408 patients from seven centres around the world were included in this report. Of the 164 patients who underwent microlaparoscopy under local analgesia only three patients (1.8%) converted to i.v. sedation because of pain intolerance. All 71 patients who underwent microlaparoscopy under i.v. sedation as planned tolerated the procedure with acceptable pain level perception. Only one abdominal wall minor bleeding and one uterine wall minor bleeding were recorded in the remaining 173 patients who underwent microlaparoscopy under general anaesthesia. Visualization of the pelvic organs was sufficient in all 408 cases for diagnosis and treatment of selected pelvic pathology. We concluded, based on this sizeable microlaparoscopy series, that this outpatient procedure can replace large diameter laparoscopy for diagnosis and treatment of various pelvic conditions. Microlaparoscopy can safely replace large diameter laparoscopy in motivated patients who require minor operative procedures such as tubal occlusion, minor adhesiolysis, tubal gamete or embryo transfers and fulguration of endometriotic implants. This series demonstrated that operative microlaparoscopy can be carried out under general anaesthesia, reducing to nil the potential damage of a large diameter tracer. Future improvements in i.v. sedation in combination with i.p. local anaesthesia will potentially eliminate the need for general anaesthesia in some of the patients undergoing minor operative microlaparoscopy.

[REMENEN. Mental representation of natural whole numbers]. / REMENEN. La representación mental de los números enteros naturales.

Study was carried out to find the existence, form of presentation and commonalities and individual differences in the mental representation of natural whole numbers (REMENEN). The design used was an ex-post-factor exploratory and descriptive field study. A questionnaire was developed and administered to a sample of 153 senior students at the Universidad Católica Andres Bello (UCAB). The hypotheses were: a) that REMENEN exists in all individuals, b) that REMENEN are individual, c) that there are intergroup differences and intragroup similarities in REMENEN according to major field of study and sex. The existence of REMENEN in the great majority of individuals was demonstrated as well as their individuality in all subjects. There were no significant differences according to major or sex, and no significant intragroup similarities. The present study opens the field for a new line of research and allows a relationship between isolated statements regarding numbers made by Galton, Jung and some cognitive psychologists.

Microlaparoscopy: a preliminary report.

A series of 30 microlaparoscopies performed under local anaesthesia and sedation are presented. The visualization of the pelvic organs was acceptable and the patients reported mild discomfort only. Microlaparoscopy may potentially replace macrolaparoscopy in selected cases.

Transcervical tubal cannulation, past, present, and future.

OBJECTIVE: To evaluate publications that introduced novel diagnostic and therapeutic transcervical procedures on the fallopian tubes. DESIGN: Major studies that conceptually changed the therapeutic approach to the fallopian tubes were reviewed. Minor publications were also included if they introduced a new concept or contributed to the topic. Clinical publications were selected if they involved transcervical diagnosis and treatment of fallopian tubes. RESULTS: Transcervical tubal catheterization procedures for diagnosis of tubal disease, tubal obliteration, tubal recanalization, and tubal medication are minimally invasive procedures that can improve our understanding and diagnostic accuracy of tubal disease. These procedures allow transcervical treatment of proximal tubal occlusion. Further improvements in equipment and methodology are promising. Transcervical tubal occlusion, gamete and embryo deposition, and treatment of ectopic pregnancy may all be performed using the transcervical approach. CONCLUSION: Transcervical tubal catheterization can replace microsurgery and IVF in selected patients with proximal tubal occlusion, improve the diagnostic accuracy of tubal disease, and deliver medications to the fallopian tubes. Cumulative knowledge suggests that transcervical tubal catheterization should become a universally accepted, taught, and practiced approach in the diagnosis and treatment of the fallopian tubes.

Transcervical falloposcopy: preliminary experience.

The new technique of endoluminal tubal exploration was evaluated by performing transcervical falloposcopy instead of chromoperturbation under control of concurrent laparoscopy. In this feasibility study, catheterization was performed with the use of either a transhysteroscopic or a free-hand tubal cannulation technique. A total of 66 patients were investigated for primary or secondary infertility with proximal and/or distal suspected tubal defects on the basis of prior hysterosalpingography; three patients were investigated for unruptured tubal pregnancy; two patients were investigated to localize the tip of the tubal embryo transfer catheter. Transcervical catheterization was successful in 110 of the 130 tubes (84.6%). Successful and informative falloposcopy was achieved in 30% of the 110 cannulated tubes. The transcervical free-hand cannulation technique was as effective as the transhysteroscopic approach. Recanalization of at least one tube was achieved in 83% of women with proximal obstruction. Tubal cannulation by the tubal embryo transfer catheter was confirmed by falloposcopy in the two cases where free-hand catheterization was used. This study confirms that it is possible to visualize the tubal lumen and demonstrates that the free-hand cannulation technique is a simple and effective alternative to the transhysteroscopic approach. However, further progress in catheter technology has to be achieved in order to perform regularly successful transcervical falloposcopy in damaged tubes.

Transcervical cannulation of the fallopian tube for the management of ectopic pregnancy: prospective multicenter study.

OBJECTIVE: To determine the efficacy of transcervical tubal cannulation and intraluminal methotrexate injection for the management of tubal ectopic pregnancy (EP). DESIGN: Prospective multicenter study of 33 patients with tubal pregnancies. SETTING: Four university-based gynecology and radiology departments in three different countries: France, England, and Germany. PATIENTS: Thirty-three patients who presented with a clinical diagnosis of EP. INTERVENTIONS: Patients underwent transcervical tubal cannulation under fluoroscopic or ultrasound control and local injection of methotrexate (up to 50 mg). MAIN OUTCOME MEASURES: We evaluate the feasibility of transcervical tubal cannulation for the management of tubal pregnancy. RESULTS: Two patients elected to withdraw from the protocol. In the remaining 31 patients there was complete resolution of the EP in 27 (87%). Surgery was performed in 4 patients. Seventeen patients, 14 of whom desired pregnancies, were available for follow-up to assess the return of reproductive potential. Seven of 7 patients who subsequently underwent hysterosalpingography had patency of the affected tube. Five patients later had an intrauterine pregnancy. One patient had an early miscarriage, two have given birth, and two singleton pregnancies are still ongoing. The remaining patients are symptom free. CONCLUSIONS: This study demonstrates that transcervical tubal catheterization in patients with tubal pregnancies is feasible and can be performed without anesthesia or analgesia in most cases. Intraluminal methotrexate per se is capable of causing regression of the EP. This approach offers a new alternative for the treatment of selected patients with tubal EP.

Ectopic pregnancy.

During the last two decades, the incidence of ectopic pregnancy was shown to be rising. At the same time, ectopic pregnancy became less lethal due to improvements in diagnostic procedures, which are now able to confirm the ectopic implantation before the occurrence of life-threatening hemorrhagic complications. Earlier diagnosis has also offered the possibility of conservative surgical and medical treatments.

Transcervical tubal cannulation and falloposcopy for the management of tubal pregnancy.

This is the first report of transcervical salpingoscopic visualization of tubal pregnancy in two patients. The falloposcope was introduced through a catheter used routinely for transcervical tubal cannulation, guided by tactile impression. We have previously demonstrated that it is possible to diagnose and treat tubal pregnancies via a transcervical intra-Fallopian cannula. Falloposcopy could help select appropriate patients for transcervical intra-Fallopian therapy by verifying the site of implantation and the characteristics of the ectopic pregnancy.

[Effect of the father-daughter relationship on the morphological development of the mammary glands]. / Influencia de la relación Padre-Hija sobre el desarrollo morfológico de las glándulas mamarias.

The puberal development of the mammary glands is the result of a final increase of serum estradiol. Having observed that the relationship with the father can affect the concentration of estradiol in the serum, the authors studied the relationship between the intensity of that interaction and the morphological development of the breasts, a standing witness in a woman's body of the concentration of estradiol in the serum during the pubertal stage. The study had two parts: 1) The review of the clinical histories of 145 nulliparous women between 18 and 25 years of age. 57.3% lived with their fathers, while 42.6% had no father, either because of death or separation. The difference between both groups in breast size as well as in the width of the areola was significant. There was also a significant difference depending on whether the separation occurred before or after the girl was 9 years old. 2) The administration of a questionnaire to 90 nulliparous women between the ages of 18 and 25, to establish the intensity of the father/daughter relationship. The results showed significant differences between the intensity of the father/daughter relationship, breast size and width of the areola. There was no significant correlation between the intensity of the relationship and the pigmentation of the areola in either of the two phases.

Twin pregnancy after diagnosis and treatment of ectopic implantation by retrograde selective salpingography and intraluminal methotrexate injection.

In this case report, a patient with a right tubal pregnancy was managed by a new procedure combining retrograde salpingography and local MTX injection. A twin pregnancy occurred shortly after treatment. We conclude that retrograde tubal cannulation may provide an alternative method for the diagnosis and treatment of selected EPs.

Diagnosis and treatment of ectopic pregnancy by retrograde selective salpingography and intraluminal methotrexate injection: work in progress.

Selective retrograde trans-cervical salpingography was carried out in four patients in whom ectopic pregnancy was suspected. The Fallopian tube was catheterized using a catheter set designed in our centre. The 6F catheter was placed in the cornua and an inner coaxial catheter was easily introduced into the proximal portion of the Fallopian tube, guided by tactile impression. Contrast medium was then injected and a round haloed mass was seen. Thereafter, the Fallopian tube was catheterized using a metallic guidewire until its tip was adjacent to the ectopic pregnancy. The coaxial catheter was then advanced along the guidewire and after removal of the latter, 5-35 mg of methotrexate was injected into the Fallopian tube. This new procedure was simple, well tolerated and had no side effects. A tubal pregnancy was demonstrated and surgery was avoided in all cases.

Treatment of endometriosis with a delayed release preparation of the agonist D-Trp6-luteinizing hormone-releasing hormone: long-term follow-up in a series of 50 patients.

Fifty patients with proven endometriosis were treated for 6 to 9 months with a delayed release preparation of microcapsules of the luteinizing hormone-releasing hormone (LH-RH) agonist D-Trp6-LH-RH, injected intramuscularly at monthly intervals. After a transitory ovarian stimulation at the onset of treatment, serum estradiol was suppressed to menopausal levels (50 pg/mL). This state of hypogonadism was reversible after the discontinuation of treatment, and menses resumed within 4 months after the last injection. Pelvic pain was relieved during treatment in 87.5% of patients. After a follow-up period of up to 37 months, 24 patients are in clinical remission and 9 experienced recurrence of endometriosis 7 to 14 months after completing treatment. One patient failed to respond to therapy with the agonist and 7 patients were lost to follow-up. Among 16 previously infertile patients with no other factors contributing to infertility, 7 became pregnant; 2 of these pregnancies were the result of gamete intrafallopian transfers. An eighth patient without documented infertility also conceived spontaneously. Side effects due to hypoestrogenism were reported by nearly all patients. In conclusion, D-Trp6-LH-RH microcapsules are effective and easily-administered agents for the treatment of endometriosis.

Retrograde tubal transfer of human embryos.

This preliminary study was designed to evaluate retrograde cannulation of the Fallopian tubes up to the isthmo-interstitial junction using the new technique of tubal embryo stage transfer (TEST). Follicular aspiration was performed under the guidance of a vaginal ultrasound probe in 51 women treated with GnRH + HMG. The oocytes retrieved were inseminated in vitro with 50,000 motile spermatozoa and kept in Menezo B2 medium without serum, at 37 degrees C, in an atmosphere of air + 5% CO2. The eggs were checked 24 and 36 h after insemination. No fertilization occurred in 23 patients. Cleaved embryos were obtained in the 28 other patients. One to seven embryos at the 2-4-cell stage were transferred with the 'Baudelocque Black Catheter' (BBC) into one tube and spare embryos were frozen. Five pregnancies occurred after retrograde TEST, for a pregnancy rate of 9.8% per cycle and 17.9% per transfer. One patient has given birth to a normal full-term baby. One singleton and one twin pregnancy are ongoing (8 months in June 1989). The other two pregnancies were ectopic.

La ecografía transvaginal y los valores de B-HCG en etapas tempranas del embarazo después de procreación médicamente asistida: Estudio Prospectivo / Transvaginal echography and B-HCG values in early stages of pregnancy following fertilization in vitro. Prospective stusy

Se realiza un estudio prospectivo entre diciembre de 1988 y junio de 1989, que comprende una serie de treinta y ocho mujeres embarazadas después de una procreación médicamente asistida. Se analizan los eventos del principio de la gestación con la ayuda de la ecografía transvaginal y los valores de gonadotropina coriónica humana (HCG). En vista de los pocos resultados hasta ahora publicados, este estudio preliminar podría ser de gran interés para definir lo más precozmente posible el diagnóstico, el pronóstico y la conducta a seguir en caso de embarazo