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Background: Transvaginal Hydro Laparoscopy (THL) is known as a minimal invasive procedure allowing endoscopic exploration of the female pelvis. Objective: To evaluate the possibilities of the THL as a tool for early diagnosis and treatment of minimal endometriosis. Materials and Methods: A retrospective study of a consecutive series of 2288 patients referred for fertility problems to a tertiary centre for reproductive medicine was undertaken. Mean duration of infertility was 23.6 months (SD ±11-48), mean age of patients was 31.25 (SD± 3.8y). With normal findings at clinical and ultrasound examination patients underwent, as part of their fertility exploration, a THL. Main outcome measures: Evaluation of feasibility, identified pathology and pregnancy rate. Results: Endometriosis was diagnosed in 365 patients (16%); the localisation was higher on the left side (n=237) than on the right side (n=169). Small endometriomas, with diameters between 0.5 and 2 cm, were present in 24.3% (right side in 31, left side 48 and bilateral 10). These early lesions were characterised by the presence of active endometrial like cells and a pronounced neo-angiogenesis. Destruction of the endometriotic lesions with bipolar energy resulted in an in vivo pregnancy rate (spontaneous/IUI) of 43.8% (CPR after 8 months: spontaneous 57.7%; IUI/AID 29.7%). Conclusion: THL allowed in a minimally invasive way an accurate diagnosis of the early stages of peritoneal and ovarian endometriosis with the possibility of offering treatment with minimal damage. What is new?: This is the largest series reporting the usefulness of THL for the diagnosis and treatment of peritoneal and ovarian endometriosis in patients without obviously visible preoperative pelvic pathology.
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BACKGROUND: The aim of this study was to evaluate the added value of transvaginal hydrolaparoscopy (THL) in the investigation of the infertile patient. METHODS: A retrospective cohort study, based on records from 01/09/2006 to 30/12/2019 was undertaken in a tertiary care infertility centre. THL was performed in 2288 patients. These were patients who were referred for endoscopic exploration of the female pelvis as part of their infertility investigation. In 374 patients with clomiphene-resistant polycystic ovary syndrome (PCOS), ovarian capsule drilling was also performed. The outcome objectives of this study included the evaluation of the added diagnostic value of THL as well as the feasibility and safety of the visual inspection of the female pelvis using this technique. RESULTS: Of the 2288 procedures failed access to the pouch of Douglas occurred in in 23 patients (1%). The complication rate was 0.74%, due to bowel perforations (n= 13) and bleeding (n= 4) requiring laparoscopy. All bowel perforations were treated conservatively, with 6 days of antibiotics, and no further complications occurred. Findings were normal in 49.8% of patients. Endometriosis was diagnosed in 366 patients (15.9%); adhesions were present in 144 patients. CONCLUSIONS: THL is a minimally invasive procedure, with a low complication and failure rate, providing an accurate visual exploration of the female pelvis in a one-day hospital setting. When indicated, minimally invasive surgery is possible in the early stages of endometriosis and for ovarian capsule drilling in patients with clomiphene-resistant PCOS.
ABSTRACT
The incidence of endometriosis in the infertile female is estimated to be between 20 and 50 %. Although the causal relationship between endometriosis and infertility has not been proven, it is generally accepted that the disease impairs reproductive outcome. Indirect imaging techniques and transvaginal laparoscopy now offer the possibility of an early stage diagnosis. Although it remains debated whether the disease is progressive, treatment in an early stage is recommendable as it carries less risk for ovarian damage, hence premature ovarian failure. Under water, inspection with the technique of transvaginal hydrolaparoscopy (THL) accurately shows the invagination of the ovarian cortex as minimal superficial lesions but with the presence of well-differentiated endometrial like tissue at the base, the lateral walls and especially the inner edges of the small endometrioma. An inflammatory environment is responsible for the formation of connecting adhesions with the broad ligament and lateral wall with invasion of endometrial-like tissue and formation of adenomyotic lesions. In around 50 % of the small endometriomas, adhesiolysis is necessary at the site of invagination with opening of the cyst, to free the chocolate content and hereby recognize the underlying endometrioma. The detailed inspection of these early-stage endometriotic lesions at THL reunites the hypothesis of Sampson with the observation of Hughesdon.
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OBJECTIVE: To compare two short protocols for ovarian stimulation in IVF cycles using an antagonist and an agonist short protocol. The outcomes studied were dosis rec FSH needed, days of stimulation, number of oocytes retrieved and pregnancy outcome. METHODS: A prospective randomised study design. INCLUSION CRITERIA: first or second IVF attempt in women younger than 40 years. In the agonist protocol (Suprefact®) nasal spray was used. In the antagonist protocol (Orgalutran)® was started as soon as at least 1 follicle of 12 mm was visualized on ultrasound. RESULTS: 160 cycles were included in the study: 80 in the antagonist group and 80 in the agonist group. A higher dosis of recombinant FSH (rec FSH) was used for stimulation in the antagonist group (1897 IU versus 1655 IU). Pregnancy rate per ET in the antagonist group was 37% with an ongoing pregnancy rate of 21%/ET and an -implantation rate of 22%; versus respectively 39%, 20% and 22% in the agonist treated group. Live birth rate per started cylce was 19% in the antagonist group versus 20% in the agonist group. CONCLUSION: This study shows that implantation rates, ongoing pregnancy rates and live birth rates are equal in both groups. An identical number of oocytes was retrieved, with no difference in duration of the stimulation although a higher dosis of rec FSH was needed in the antagonist group.
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The air-Q Intubating Laryngeal Airway (ILA) is a newly introduced extraglottic airway device. In this pilot study, we evaluated its use as a routine airway device during positive pressure ventilation. Ease of endotracheal intubation through the device was also assessed. Fifty-nine ASA I and II patients undergoing elective surgery received an air-Q ILA and an endotracheal tube where indicated. Insertion, ventilation and intubation characteristics were noted, as well as throat morbidity and occurrence of adverse events. An air-Q ILA was successfully inserted in 100% of patients. Mean leak pressure was 19 +/- 5 cmH2O. Endotracheal intubation was indicated in 19 patients and successful in 58% on the first attempt and 74% in total. Ten percent of the study patients were noted to have dysphagia. One patient was diagnosed with bilateral lingual nerve injury but made a complete recovery in four weeks. The air-Q ILA is an adequate extraglottic airway device in terms of insertion and ventilation. However the proposed advantage of ease of endotracheal intubation requires further investigation.
Subject(s)
Intubation, Intratracheal/instrumentation , Adult , Humans , Laryngeal Masks , Lingual Nerve Injuries , Middle Aged , Pilot ProjectsABSTRACT
In order to reduce the number of multiple pregnancies following IVF, the Belgian government agreed to reimburse laboratory expenses for six IVF cycles up to the age of 42 years, in exchange for restriction of the number of embryos replaced. Data on assisted reproduction outcome before and after the introduction of this new legislation were analysed retrospectively in terms of implantation, pregnancy and multiple pregnancy rates. After the introduction of the new law, the percentage of single embryo transfer increased from 14 to 49%. Implantation rates were 25.9 and 23% respectively. There was no difference in the overall pregnancy rate before and after the introduction (36 versus 37%). Twin pregnancies, however, decreased from 19 to 3%. These findings indicate that elective single embryo transfer significantly decreases the twin pregnancy rate without a reduction in the overall pregnancy rate.
Subject(s)
Embryo Transfer , Fertilization in Vitro , Reproductive Techniques, Assisted/legislation & jurisprudence , Belgium , Embryo Implantation , Female , Humans , Pregnancy , Pregnancy Rate , Pregnancy, Multiple/statistics & numerical data , Retrospective Studies , Treatment Outcome , TwinsABSTRACT
BACKGROUND: The aim of this study was to evaluate the impact of transferring a single top quality embryo in the first IVF/ICSI cycle of patients <38 years old who chose to have one or two embryos transferred. METHODS: A total of 262 patients participated in the study, and 243 transfers were performed: 156 (64%) patients chose the transfer of a single top quality embryo, if available, and two non-top quality embryos if not available; 87 (36%) patients chose to have a double embryo transfer regardless of embryo quality. RESULTS: In the first group an ongoing pregnancy rate of 40% (63/156) with a twin pregnancy rate of 2% (1/63) was achieved. In the second group the ongoing pregnancy rate was 44% (38/87) with 26% (10/38) twin pregnancies. In the patient group with only one embryo transferred, irrespective of the patient's choice, the ongoing pregnancy rate was 43% (54/127) with no twin pregnancies. For the study population as a whole, the ongoing pregnancy rate was 42% (101/243) with 11% (11/101) twins. CONCLUSION: We conclude that the introduction of single embryo transfer in the first IVF/ICSI cycle is highly acceptable in women <38 years old.
Subject(s)
Embryo Transfer , Embryo, Mammalian/physiology , Fertilization in Vitro , Patient Satisfaction , Adult , Embryo Implantation , Female , Humans , Pregnancy , Pregnancy Outcome , Pregnancy Rate , Pregnancy, Multiple , TwinsABSTRACT
One of the negative aspects of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) is the increased risk of multiple pregnancies. Multiples of high order (triplets and pregnancies of higher order) are obsolete to both doctors and patients and need to be avoided. However, there is an epidemic of twin pregnancies with a higher risk of obstetric, perinatal and neonatal complications than singleton pregnancies and with an important psychosocial, economic and financial impact for the parents to be. A reduction in the number of twins can only be obtained by transfer of one embryo. If this guideline would be applied to all cycles, a dramatic fall in pregnancy rate would occur. In a selected patient group one selected embryo with an excellent implantation potential can be transferred.
Subject(s)
Embryo Transfer , Fertilization in Vitro , Pregnancy, Multiple , Sperm Injections, Intracytoplasmic , Female , Humans , Pregnancy , Risk FactorsABSTRACT
A prospective randomized study comparing single embryo transfer with double embryo transfer after in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) was carried out. First, top quality embryo characteristics were delineated by retrospectively analysing embryos resulting in ongoing twins after double embryo transfer. A top quality embryo was characterized by the presence of 4 or 5 blastomeres at day 2 and at least 7 blastomeres on day 3 after insemination, the absence of multinucleated blastomeres and <20% cellular fragments on day 2 and day 3 after fertilization. Using these criteria, a prospective study was conducted in women <34 years of age, who started their first IVF/ICSI cycle. Of 194 eligible patients, 110 agreed to participate of whom 53 produced at least two top quality embryos and were prospectively randomized. In all, 26 single embryo transfers resulted in 17 conceptions, 14 clinical and 10 ongoing pregnancies [implantation rate (IR) = 42.3%; ongoing pregnancy rate (OPR) = 38.5%] with one monozygotic twin; 27 double embryo transfers resulted in 20 ongoing conceptions with six (30%) twins (IR = 48.1%; OPR = 74%). We conclude that by using single embryo transfer and strict embryo criteria, an OPR similar to that in normal fertile couples can be achieved after IVF/ICSI, while limiting the dizygotic twin pregnancy rate to its natural incidence of <1% of all ongoing pregnancies.
Subject(s)
Fertilization in Vitro , Pregnancy, Multiple , Sperm Injections, Intracytoplasmic , Adult , Embryo Implantation , Embryo Transfer , Female , Humans , Pregnancy , Pregnancy Rate , Prospective Studies , Retrospective Studies , Risk Factors , Twins, MonozygoticABSTRACT
In most in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) programmes approximately one ongoing pregnancy in three is multiple. The need to characterize embryos with optimal implantation potential is obvious. We retrospectively examined all of 23 double transfers resulting in ongoing twins, occurring between January 1, 1996 and May 19, 1997. Characteristics of these top quality embryos were absence of multinucleated blastomeres, four or five blastomeres on day 2, seven or more cells on day 3, and =20% anucleated fragments. In a subsequent series of 400 IVF/ICSI cycles (out of which 372 were selected for embryo transfer) from May 20, 1997 to July 31, 1998, only women <38 years of age had multiple pregnancies: after 221 transfers of two embryos, 45/116 (39%) were multiple, and after 77 transfers of >2 embryos, 11/31 (35%) were multiple. We applied our top quality criteria to the 221 double transfers: 106 transfers with two top embryos resulted in 65 (63%) ongoing pregnancies with 37 (57%) twins, 65 transfers with one top embryo in 38 (58%) ongoing pregnancies with eight (21%) twins. In the group without top embryos, 12/52 (23%) ongoing singletons occurred, with no twins. The corresponding ongoing implantation rates were 49, 35 and 12%. This analysis suggests that single embryo transfer with an acceptable pregnancy rate might be considered if a top quality embryo is available.
Subject(s)
Embryo Transfer , Embryo, Mammalian/physiology , Fertilization in Vitro/methods , Blastomeres/cytology , Embryo Implantation , Embryo, Mammalian/cytology , Embryonic and Fetal Development , Female , Humans , Microinjections , Pregnancy , Pregnancy, Multiple , Retrospective Studies , TwinsABSTRACT
OBJECTIVE: To compare zygote intrafallopian transfer (ZIFT) and in vitro fertilization and embryo transfer (IVF-ET) as treatments of male-factor infertility. DESIGN: Patients were prospectively randomized to ZIFT or IVF-ET. SETTING: In vitro fertilization program of the Centre for Reproductive Medicine of the Dutch-speaking Brussels Free University, Belgium, which is a tertiary referral institution. PATIENTS: One hundred fifty-seven couples were enrolled in the study. Inclusion criteria allowed only first trials of couples with long-standing infertility caused by a male factor. Female factors were excluded. INTERVENTIONS: In ZIFT, up to three fertilized oocytes were transferred into one single patient fallopian tube by means of laparoscopy 18 hours after insemination. In IVF-ET, cleaving embryos were replaced into the uterine cavity about 48 hours after insemination. MAIN OUTCOME MEASURES: Fertilization and transfer rates, implantation and pregnancy rates, pregnancy outcome, and cost per procedure were evaluated. RESULTS: Implantation rates of 12.3% and 10% per replaced conceptus were achieved for ZIFT and IVF-ET, respectively. CONCLUSIONS: This study demonstrates no therapeutic advantage of ZIFT over IVF-ET in male-factor infertility in terms of reproductive outcome or economic benefit.
Subject(s)
Embryo Transfer , Fallopian Tubes , Fertilization in Vitro , Infertility, Male/therapy , Zygote , Adult , Female , Humans , Male , Pregnancy , Prospective StudiesABSTRACT
Results of intrauterine insemination (IUI) in 39 couples are presented. Indications were male subfertility, cervical factor, unexplained infertility and immunological factor. The patients received a total of 119 treatment cycles. Nine pregnancies were achieved (23.1%) during IUI treatment. The monthly fecundity rate (MFR) during treatment was 7.6%. After stopping IUI, within a follow-up of 1 year 13 pregnancies occurred. Seven pregnancies occurred spontaneously without invasive treatment methods. The MFR was calculated to be 4.8% for this group. We conclude that couples with IUI treatment do achieve pregnancies more quickly, but IUI does not influence a patient's eventual chance to become pregnant.
Subject(s)
Fertility , Insemination, Artificial, Homologous , Insemination, Artificial , Adult , Female , Follow-Up Studies , Humans , Male , Pregnancy , Superovulation , Time FactorsABSTRACT
Between April 1, 1985, and April 1, 1986, four cases of perinatal listeriosis were reported at the Maastricht Academic Hospital. All cases were of the early-onset type. All mothers were admitted for pre-term labour between 28 and 33 weeks of gestation. Pre-natal symptoms included maternal fever, non-characteristic influenza-like manifestations, leucocytosis and (pre-term) meconium-stained amniotic fluid. Two neonates died, one in utero and one due to listeriosis sepsis. Another neonate developed a hydrocephalus. Only one neonate has survived without damage up to now. Such a high incidence of listeriosis and the high perinatal morbidity and mortality rates are remarkable. Epidemiological, bacteriological and placental sequelae of Listeria monocytogenes are discussed.
Subject(s)
Listeriosis/diagnosis , Obstetric Labor, Premature/etiology , Pregnancy Complications, Infectious/diagnosis , Prenatal Diagnosis , Adult , Female , Fetal Diseases/diagnosis , Humans , PregnancyABSTRACT
Two groups of 10 chronically heroin addicted patients who were admitted to the Emergency Ward because of hypoventilation and coma, were treated random- aselectively with naloxone, 3 micrograms kg-1 BW iv, or with physostigmine salicylate 0,04 mg kg-1 BW iv. Patients in both groups completely regained consciousness and breathed spontaneously, regularly and adequately within 10 minutes. One essential difference in the treatment was that physostigmine caused no signs of acute opiate withdrawal, the patients felt fine and stayed for further control, in contrast with naloxone where the patients felt bad and occasionally escaped prematurely from the ward. Another difference is that the beneficial effect of one dose of physostigmine is shorter lived than that of naloxone. Authors emphasise the fact that treatment of heroin overdose in an addict need not jeopardize the patient's well-being by a withdrawal syndrome.
Subject(s)
Heroin/poisoning , Naloxone/therapeutic use , Physostigmine/therapeutic use , Respiration Disorders/drug therapy , Heroin Dependence/complications , Humans , Naloxone/adverse effects , Random Allocation , Respiration Disorders/chemically induced , Substance Withdrawal Syndrome/chemically inducedABSTRACT
Two patients were admitted to us from the city of Rotterdam suffering from central and peripheral symptomatology which indicated anticholinergic poisoning. Physostigmine salicylate was administered and the symptomatology promptly cleared up. These two cases demonstrate the potential differential-diagnostic and curative value of physostigmine.
Subject(s)
Parasympatholytics/poisoning , Physostigmine/therapeutic use , Adult , Amnesia/drug therapy , Electrocardiography , Female , Hallucinations/drug therapy , Humans , Pupil/drug effectsSubject(s)
Parasympatholytics/poisoning , Physostigmine/therapeutic use , Adult , Female , Humans , Scopolamine/urineABSTRACT
(Ethylenedinitrilo)tetraacetic acid soluble phosphoproteins were isolated from rat incisor and bovine unerupted teeth. This material was examined for its effect on the stability of amorphous calcium phosphate in vitro. When the precipitation of amorphous calcium phosphate was attempted in the presence of small amounts of these phospho-proteins, an apatite-like mineral was observed to form, which was approximately 60% crystalline, as determined by infrared measurements. This apatite phase could not be induced by addition of phosphoprotein after the precipitation reaction. The organic phosphate bound to these phosphoproteins was shown to be directly responsible for the formation of the apatite phase, since removal of 60% of the covalently bound phosphate with alkaline phosphatase destroyed the protein's ability to induce hydroxylapatite formation. The properties of the dental phosphoproteins appear to be consistent with their possible involvement in the development of the mineral phase of dentine.