Methotrexate treatment of ectopic pregnancy: 100 cases treated by primary transvaginal injection under sonographic control.

OBJECTIVE: To evaluate safety and efficacy of intrasaccular methotrexate (MTX) for treatment of ectopic pregnancy (EP). DESIGN: Longitudinal nonrandomized trial of MTX treatment of EP. SETTING: Department of Obstetrics and Gynecology (A. Béclère Public Hospital, Clamart, France Paris-Sud University). PATIENTS: One hundred patients with an EP visualized by sonography. Patients were 31.4 +/- 4.8 years old, para 0 to 4, and gravida 0 to 7. Twelve patients had a past history of EP, and 18 had previously undergone tubal surgery. Inclusion score for proposed medical treatment used six criteria graded from 1 to 3: gestational age, initial hCG level, P level, existence of abdominal pain, size of hemoperitoneum, and diameter of hematosalpinx. Eleven patients had an EP with cardiac activity. Treatment consisted of MTX, 1 mg/kg, given locally under transvaginal sonographic control. RESULTS: Eighty-three of 100 patients were considered to be completely cured (return of hCG to < 10 mIU/mL). The success rate was 92.8% with an initial hCG level < 5,000 mIU/mL and 87% when the score was < or = 12. Seven of the 11 patients with an EP with cardiac activity were treated successfully, including 5 of 7 when the initial score was < or = 12, and all failures concerned cases with an initial score > 12. Twenty-eight of 83 patients treated successfully required more than one injection of MTX (additional doses being given intramuscularly) because of nonresolution of hCG levels. Follow-up hysterosalpingography was performed in 80 patients showing 90% tubal patency on the side of the treated EP. Of 58 patients wishing pregnancy, 34 pregnancies occurred, including 25 ongoing or delivered. We observed a low recurrence rate of EP (3 with 1 on the same side). CONCLUSION: Treatment by initial transvaginal injection of MTX under sonographic control appears to be simple and effective, with no demonstrable untoward effects. The tubal patency and subsequent fertility obtained appear satisfactory. The highest success rate is observed when hCG level is under 5,000 mIU/mL and/or a pretherapeutic score < or = 12 when EP is visualized by sonography.

[Simulation of ovulation using two types of LH-RH agonists]. / Stimulation de l'ovulation associée a deux modes d'utilisation des agonistes du LH-RH.

Luteinizing hormone-releasing hormone (LH-RH) agonists are being increasingly used in ovulation stimulation protocols in IVF programs. The results of two methods of utilization of LH-RH agonists are compared. There was difference in the ovarian response on the day of human chorionic gonadotropin (hCG) higher in the short protocol (69% vs 56%, P less than 0.001). The ongoing pregnancy rate per treatment cycle was similar in both groups (18% in the long protocol and 16% in the short protocol).

[Celioscopy under local anesthesia for collecting oocytes for in vitro fertilization]. / Coelioscopie sous anesthésie locale pour recueil d'ovocyte en vue d'une fécondation in vitro.

Since 1960, laparoscopy under local anaesthesia has been gradually abandoned in France and until now oocytes for in vitro fertilization were collected under general anaesthesia, thus increasing the risk of allergic reactions to anaesthesia in these patients who usually undergo several operations. From February to May, 1983, at the Antoine Béclère Maternity, Paris, 50 laparoscopies were performed under local anaesthesia with lidocaine combined with neuroleptanalgesia with diazepam and fentanyl. The procedure was uneventful in 94% of the cases and only 3 women required general anaesthesia. At least one mature oocyte was collected in 46 of these 50 women and 4 pregnancies have already been recorded. Local anaesthesia enables the woman to participate fully in this first stage of in vitro fertilization, increases the out-patient activities of the hospital unit and reduces the cost of in vitro fertilization.