Avoidance of the vaginal incision site for mesh placement in vaginal wall prolapse surgery: A prospective study.

OBJECTIVE: To evaluate efficacy of a minimal surface area, vaginally-installed polypropylene tape (VPT), avoiding insertion on the incision line to treat an anterior, posterior or anteroposterior vaginal wall prolapse. STUDY DESIGN: Patients with an anterior, posterior or anteroposterior vaginal wall prolapse waiting for surgical treatment were included in the study. Primary outcome was the incidence of prolapse recurrence reported with combined outcome measures and was reported with Kaplan-Meier cumulative incidence. Secondary outcomes were operative complications, adverse events, urinary, colorectal and sexual functions as well as quality of life. Participation in the study involved up to 8 visits over 5 years. At each visit, patients used a self-reported questionnaire to report symptoms related to pain, urinary, colorectal, sexual functions, and quality of life. A physical examination was also performed. Paired t-tests were used to investigate change in POP-Q and quality of life measurements since baseline. RESULTS: 71 patients underwent the procedure and were followed-up for an average (standard deviation) of 32.5 (18.7) months. Only 2 (2.8%) women experienced a recurrence of their pelvic organ prolapse. Only one case of erosion and no case of persistent pain have been recorded up to 5 years post-surgery. Quality of life was improved and then sustained throughout the follow-up period (p<0.01). CONCLUSION: This VPT surgical procedure is safe and has a high level of efficacy to treat anterior, posterior or anteroposterior vaginal wall prolapse. It is also associated with improvements in quality of life of patients which are sustained for many years.

Influence of group embryo culture strategies on the blastocyst development and pregnancy outcome.

PURPOSE: To compare two different embryo culture methods and to determine whether grouping embryos based on quality following Day 3 improved outcomes. METHODS: Two group embryo culture methods were compared in this study. All zygotes were individually cultured from Day 1 to Day 3. On Day 3, embryos were then cultured in group of 2-5 embryos per droplet until Day 5 or 6. The two group culture methods are: A, embryos were randomly grouped regardless of embryo quality; B, good and poor quality embryos were separately grouped. Blastocyst development rate, blastocyst utilization rate, implantation rate and pregnancy rate were detected. RESULTS: The group culture of Day 3 embryos, in which good or poor quality embryos were separately grouped, significantly promoted blastocyst development (61.2 %, 289/472) and blastocyst utilization rate (55.9 %, 264/472) in comparison with those embryos that were randomly grouped for culture regardless of embryo quality (44 %, 177/402 and 41.5 %, 167/402). There was no significant difference in the implantation rate and pregnancy rate between two group culture methods. CONCLUSIONS: Grouping of embryos after Day 3 based on embryo quality may benefit blastocyst formation. This may be due to secretion of beneficial factors by good embryos, or removal of detrimental factors from poor embryos. No impacts on pregnancy or implantation outcomes were observed.

Optimized hormonal stimulation is critical for production of viable embryos and establishment of subsequent implantation.

PURPOSE: To investigate the effects of follicle number and size at the time of hCG administration, and ovarian stimulation length on the outcome of in vitro fertilization and pregnancy rate. METHODS: During the ovarian stimulation regimen, the follicular number and size were determined by transvaginal ultrasonographic examination. Ovulation was induced as early as three or more follicles were at least 16 mm in their greatest diameter. RESULTS: The fertilization rates were significantly increased with the longer length of stimulation (10-12 days: 75.4% and 13-16 days: 83.2%). However, no significant differences in the chemical pregnancy, clinical pregnancy, and implantation rates were found between 10-12 days (53.7%, 43.9%, and 21.8%) and 13-16 days (50.0%, 43.8%, and 23.4%) of stimulation. There were no significant differences in fertilization and chemical pregnancy rates between two groups with > or = and <18 follicles in the ovaries on the day of hCG (human chorionic gonadotrophin) administration. However, the clinical pregnancy and implantation rates (47.2% and 26.0%) in the group with <18 follicles were significantly higher than those (33.3% and 15.5%) in the group with > or =18 follicles, respectively. CONCLUSIONS: Excessive and rapid ovarian stimulation appears to decrease the survival of embryos at later stages after transfer. The advantage of prolonged stimulation may outweigh the potential adverse effects in some patients.