Where does the embryo implant after embryo transfer in humans?

OBJECTIVE: To investigate where human embryos implant after ET. DESIGN: Prospective analysis. SETTING: University hospital. PATIENT(S): Sixty infertile women without uterine fibroids, a major uterine anomaly, or a history of cesarean section. INTERVENTION(S): Transabdominal and transvaginal three-dimensional ultrasound examinations. MAIN OUTCOME MEASURE(S): The location of ET-associated air bubbles in the uterine cavity and the location of the resultant gestational sac. RESULT(S): Sixty ETs resulted in 22 pregnancies, and 32 gestational sacs were located. Twenty-six of the 32 embryos were within or between the area in which the catheter tip was situated and the area over which air bubbles had spread immediately after ET. CONCLUSION(S): In cases of pregnancy achieved through ET, approximately 80% of embryos implant in areas to which they initially are transferred and approximately 20% implant in other areas.

Prescription drug monitoring program inquiry in psychiatric assessment: detection of high rates of opioid prescribing to a dual diagnosis population.

OBJECTIVE: An epidemic of prescription drug abuse is disproportionately impacting the mentally ill. We examined the utility of a state prescription drug monitoring database for assessing recent controlled substance prescribing to patients presenting for dual diagnosis treatment. METHOD: In a community mental health center that provides integrated dual diagnosis care, we queried the Indiana Scheduled Prescription Electronic Collection and Tracking (INSPECT) system for all cases that were open as of August 2, 2011, and had been practitioner-diagnosed (per DSM-IV criteria) by January 2, 2012. INSPECT provided a record of controlled substance dispensations to each patient; diagnostic evaluation was conducted blind from prescription data compilation covering the prior 12 months. Demographic data, insurance status, and DSM-IV diagnoses were compiled from the clinic's electronic medical record. RESULTS: The sample (N = 201) was 51% female, 56% white, and two-thirds uninsured. Over 80% were dually diagnosed with substance use disorders and psychotic, mood, or anxiety disorders. Nicotine and alcohol disorders were identified in most, with about a third diagnosed with cannabis, cocaine, or opioid disorders. A majority of patients (n = 115) had been prescribed opioids in the prior year, with nearly 1 in 5 prescribed an opioid and benzodiazepine simultaneously. Patients were dispensed a mean of 4 opioid prescriptions and 213 opioid pills. More opioid prescriptions correlated with opioid dependence (OR = 1.08; 95% CI, 1.016-1.145), and more prescribers correlated with personality disorder diagnoses (OR = 1.112; 95% CI, 1.001-1.235). Higher rates and riskier patterns of controlled substance prescribing were identified in patients with Medicaid/Medicare insurance compared to uninsured patients. CONCLUSIONS: Prescription drug monitoring is a powerful tool for assessing addictions and high frequencies of patient exposures to prescribed opioids in a dual diagnosis clinic. Improved prevention and treatment strategies for addictions as facilitated by more research and clinical use of prescription drug monitoring in psychiatric care are warranted.

Three-dimensional ultrasound in embryo transfer.

OBJECTIVE: To examine the feasibility of using three-dimensional (3D) ultrasound (US) guidance in routine embryo transfer (ET) procedures. METHODS: Seventy-five ETs were performed using a 3D US scanner to locate the catheter tip in the uterine cavity. RESULTS AND CONCLUSION: Three-dimensional ultrasound could show the exact position of the tip of the catheter in the uterine cavity quickly enough in most cases. It should be used in ET for seeking an optimal transfer area in the uterine cavity to assist in achieving high success rates and less complications.