RESUMEN
OBJECTIVE: To compare cycle outcomes among normal-responding patients Asunto(s)
Fármacos para la Fertilidad Femenina/uso terapéutico
, Fertilización In Vitro/métodos
, Leuprolida/uso terapéutico
, Adulto
, Gonadotropina Coriónica/uso terapéutico
, Estudios de Cohortes
, Cuerpo Lúteo/efectos de los fármacos
, Cuerpo Lúteo/fisiología
, Relación Dosis-Respuesta a Droga
, Implantación del Embrión/efectos de los fármacos
, Implantación del Embrión/fisiología
, Estradiol/sangre
, Femenino
, Humanos
, Recién Nacido
, Análisis Multivariante
, Recuperación del Oocito/métodos
, Selección de Paciente
, Embarazo
, Resultado del Embarazo
, Estudios Retrospectivos
RESUMEN
A randomized comparison trial was performed to evaluate whether follicular reaspiration with use of a double-lumen retrieval needle improves oocyte recovery when compared with direct follicular aspiration among low-responding patients undergoing ART. There were no differences observed in the number of oocytes retrieved (single lumen: 6.5 +/- 2.2 oocytes, double lumen: 7.2 +/- 2.3 oocytes) whereas follicular reaspiration with the double-lumen retrieval needle resulted in a twofold increase in procedure time.
Asunto(s)
Recuperación del Oocito/métodos , Folículo Ovárico , Técnicas Reproductivas Asistidas , Adulto , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Infertilidad Femenina/sangre , Infertilidad Femenina/terapia , Recuperación del Oocito/instrumentación , Proyectos Piloto , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
OBJECTIVE: To report a unique fluoroscopically guided approach to treat severe intrauterine adhesions and cervical stenosis using balloon hysteroplasty. DESIGN: Case report. SETTING: Military-based fertility center. PATIENT(S): A 33-year-old woman undergoing assisted reproductive technology whose uterus could not be cannulated because of the development of intrauterine synechiae and cervical stenosis after a post-IUI infection that was further complicated by a prominent lower uterine segment-filling defect in the location of a prior cesarean delivery scar. INTERVENTION(S): Fluoroscopic cannulation and balloon uterine dilation. MAIN OUTCOME MEASURE(S): Resolution of synechiae by hysterosalpingogram and successful uterine cannulation. RESULT(S): A postprocedure hysterosalpingogram demonstrated a normalized uterine cavity with the exception of a persistent prominent lower uterine segment-filling defect from a prior cesarean delivery. A frozen ET cycle was performed successfully. CONCLUSION(S): Hysteroplasty, using standard interventional radiographic techniques, may provide an alternative treatment modality for patients with intrauterine adhesions and lower uterine defects from prior cesarean deliveries in select cases. While treating intrauterine adhesions improves pregnancy outcome, the effect of lower uterine segment-filling defects from cesarean deliveries on pregnancy outcome in assisted reproductive technology cycles warrants further investigation.
Asunto(s)
Cateterismo , Ginatresia/terapia , Histerosalpingografía , Radiografía Intervencional , Enfermedades Uterinas/terapia , Adulto , Cesárea/efectos adversos , Transferencia de Embrión , Femenino , Fertilización In Vitro , Fluoroscopía , Ginatresia/diagnóstico por imagen , Ginatresia/etiología , Humanos , Adherencias Tisulares , Resultado del Tratamiento , Enfermedades Uterinas/diagnóstico por imagen , Enfermedades Uterinas/etiologíaRESUMEN
OBJECTIVE: To assess cycle outcome among day 5 and day 6 cryopreserved frozen-thawed blastocyst embryo transfers (FBET). DESIGN: Retrospective cohort study. SETTING: Military-based assisted reproduction technology (ART) center. PATIENT(S): One hundred seventy-two nondonor, programmed cryopreserved embryo cycles. INTERVENTION(S): Fully expanded blastocysts on day 5 were cryopreserved on day 5, and those achieving this state on day 6 were cryopreserved on day 6. Leuprolide acetate was given for ovulation inhibition, and endometrial supplementation was by oral and vaginal estradiol. Progesterone in oil was administered, and blastocyst transfer occurred in the morning of the sixth day of progesterone. MAIN OUTCOME MEASURE(S): Implantation, pregnancy, and live-birth rates. RESULT(S): Fresh and frozen cycle characteristics were similar between groups. Day-5 FBET had statistically significantly higher implantation rates (32.2% vs. 19.2%), which remained significant even when adjusting for covariates (odds ratio: 1.91; 95% confidence interval, 1.00, 3.67). Live-birth rates trended toward improvement after adjusting for covariates (odds ratio: 1.18; 95% confidence interval, 0.61, 2.30). CONCLUSION(S): Cryopreserved day-5 blastocysts have higher implantation rates and trend toward improved pregnancy outcomes compared with cryopreserved day-6 blastocysts. This suggests that embryo development rate may, in part, predict implantation and subsequent FBET outcomes, although embryos not achieving the blastocyst stage until day 6 still demonstrate acceptable outcomes.
Asunto(s)
Blastocisto/fisiología , Criopreservación , Implantación del Embrión , Transferencia de Embrión , Fertilización In Vitro , Infertilidad/terapia , Adulto , Técnicas de Cultivo de Embriones , Desarrollo Embrionario , Femenino , Humanos , Nacimiento Vivo , Embarazo , Índice de Embarazo , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
A retrospective cohort study examining all completed nondonor first ART cycles was performed to evaluate the ultrasonographic appearance of the endometrial pattern and thickness at time of hCG administration among precycle screened patients with uterine fibroids compared with patients without fibroids. There was no difference in the endometrial thickness (10.3 +/- 2.0 mm vs. 10.0 +/- 2.6 mm) between those with fibroids and controls; however, the rate of nonproliferative endometrial pattern (3.1% vs. 1.0%) and live birth rates (34.4% vs. 43.0%) were significantly different, most notably among those patients with intramural fibroids.
Asunto(s)
Endometrio/diagnóstico por imagen , Infertilidad Femenina/terapia , Leiomioma/complicaciones , Técnicas Reproductivas Asistidas , Neoplasias Uterinas/complicaciones , Proliferación Celular , Gonadotropina Coriónica/administración & dosificación , Esquema de Medicación , Endometrio/patología , Femenino , Fármacos para la Fertilidad Femenina/administración & dosificación , Humanos , Infertilidad Femenina/diagnóstico por imagen , Infertilidad Femenina/etiología , Infertilidad Femenina/patología , Leiomioma/diagnóstico por imagen , Leiomioma/patología , Leiomioma/terapia , Nacimiento Vivo , Inducción de la Ovulación , Estudios Retrospectivos , Resultado del Tratamiento , Ultrasonografía , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/patología , Neoplasias Uterinas/terapiaRESUMEN
Pre-ART cycle screening with saline infusion sonohysterography is effective at limiting cycle cancellation caused by endometrial polyps to 0.5%. Although a thickened lining at the time of baseline ultrasound can be indicative of a uterine polyp, a normal endometrial lining does not eliminate the possibility that a polyp will be discovered during the cycle.
Asunto(s)
Pólipos/diagnóstico por imagen , Técnicas Reproductivas Asistidas , Cloruro de Sodio , Enfermedades Uterinas/diagnóstico por imagen , Adulto , Medios de Contraste , Femenino , Humanos , Infusiones Parenterales , Selección de Paciente , UltrasonografíaRESUMEN
In a lower cost, equal-access-to-care setting, Hispanic use of assisted reproductive technology was less than half of what would have been expected based on patient demographics. Despite this use disparity, there were no significant differences between Hispanic and Caucasian women with regard to infertility diagnoses, assisted reproductive technology cycle parameters, clinical pregnancy rates, live birth rates, spontaneous abortion rates, and implantation rates.
Asunto(s)
Accesibilidad a los Servicios de Salud/economía , Hispánicos o Latinos , Técnicas Reproductivas Asistidas/economía , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Embarazo , Índice de Embarazo , Estudios RetrospectivosRESUMEN
BACKGROUND: Elevated estradiol (E(2)) levels predispose to development of ovarian hyperstimulation syndrome (OHSS). Since GnRH antagonist is associated with a reduction in E(2) levels, we hypothesized that GnRH-antagonist treatment of women down-regulated with GnRH agonist who are at risk of OHSS might reduce E(2) levels and avoid cycle cancellation. METHODS: Retrospective study in a university-based assisted reproduction technology (ART) programme in 87 patients treated with long luteal (LL) or microdose flare (MDF) with ovarian hyperresponse and 87 control patients without ovarian hyperresponse. GnRH-antagonist (ganirelix acetate) treatment was started and leuprolide acetate discontinued in women who failed to respond to a reduction in gonadotrophin dosage. RESULTS: In the treatment group, there was a significant, reproducible reduction in serum E(2) levels. Mean E(2) at the start of ganirelix treatment was 4219.8 pg/ml and decreased in 24 h to 2613.7 pg/ml (36.7%; P < 0.001). An average of 24.9 +/- 8.8 oocytes were obtained at retrieval and an average of 19.1 +/- 8.0 were metaphase II (79.2%). Fertilization occurred in 13.9 +/- 8.1 embryos (72.8%). In this high risk group, two cases of severe OHSS (2.3%) occurred. The ongoing pregnancy rate was 51.8%. Compared with the control group, there were no statistically significant differences in the rate of oocyte recovery, oocyte maturity, 2PN rate, fertilization, cancellation, OHSS or pregnancy. CONCLUSIONS: GnRH-antagonist treatment of women pretreated with GnRH agonist rapidly reduced circulating serum E(2) without adversely affecting oocyte maturation, fertilization rates or embryo quality and resulted in a high pregnancy rate in this subgroup of patients at risk of OHSS.
Asunto(s)
Estradiol/sangre , Hormona Liberadora de Gonadotropina/análogos & derivados , Antagonistas de Hormonas/farmacología , Leuprolida/uso terapéutico , Oocitos/fisiología , Síndrome de Hiperestimulación Ovárica/prevención & control , Adulto , Femenino , Fármacos para la Fertilidad Femenina/uso terapéutico , Fertilización , Hormona Liberadora de Gonadotropina/farmacología , Humanos , Oocitos/efectos de los fármacos , Embarazo , Resultado del Embarazo , Valores de Referencia , Estudios RetrospectivosRESUMEN
OBJECTIVE: Racial disparity in assisted reproductive technology (ART) outcomes has been reported but remains controversial. Reasons for the disparity are unclear, and access to care has been suggested as a causative factor. In this study, we sought to examine minority utilization of ART in the Department of Defense (DoD) compared with minority utilization in the U.S. ART population. Outcomes from ART were compared between Caucasian (Cau) and African American (AA) patients, and etiologies of disparity were examined. DESIGN: Retrospective cohort study. SETTING: University-based ART program. PATIENT(S): A total of 1,457 patients undergoing first-cycle fresh, nondonor ART. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate, live birth rate, implantation rate, spontaneous abortion rate. RESULT(S): Within the DoD population, AA women had a fourfold increase in utilization of ART services relative to the U.S. ART population. In this equal-access-to-care setting, AA women experienced a clinically significant decrease in live birth rate that did not reach statistical significance (29.6% vs. 35.8%, risk ratio [RR] 0.83, 95% confidence interval [CI] 0.67-1.02) and a statistically significant increase in spontaneous abortions compared with Cau women (25% vs. 15.9%, RR 1.57, 95% CI 1.05-2.36). This might be explained, in part, by a higher prevalence of uterine leiomyomas in AA women (30.8% AA vs. 10.7% Cau, RR 2.85, 95% CI 2.06-3.95). For both AA and Cau women, the presence of fibroids at baseline ultrasound was associated with reductions in clinical pregnancy rates (35% with leiomyomas vs. 43.2% without leiomyomas, RR 0.74, 95% CI 0.51-0.98), live birth rates (26.2% vs. 36.0%, RR 0.63, 95% CI 0.44-0.90), and implantation rates (25.6% vs. 31.1% RR 0.82, 95% CI 0.69-0.98). CONCLUSION(S): Utilization of ART services among AA women increased when access to care was improved. A clinically significant reduction in live birth rate and statistically significant increase in spontaneous abortion rate was observed in AA women compared with Cau women. Leiomyomas were three times more prevalent in AA women and reduced ART success, regardless of race. The persistence of racial differences in an equal-access-to-care environment might be explained, in part, by the increased prevalence of leiomyomas in AA women.
Asunto(s)
Negro o Afroamericano/etnología , Accesibilidad a los Servicios de Salud , Infertilidad Femenina/terapia , Aceptación de la Atención de Salud/etnología , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Población Blanca/etnología , Adulto , Estudios de Cohortes , Femenino , Humanos , Infertilidad Femenina/economía , Infertilidad Femenina/etnología , Masculino , Embarazo , Índice de Embarazo/etnología , Técnicas Reproductivas Asistidas/economía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Forty-seven patients at high risk for ovarian hyperstimulation syndrome because of markedly elevated serum E2 levels on either long-luteal or microdose flare leuprolide acetate regimens were treated with ganirelix acetate. Despite being pretreated with GnRH agonist and without withholding gonadotropins, serum E2 decreased by 49.5% and 41.0% of pretreatment values (long luteal and microdose flare, respectively) after initiation of ganirelix, and 68.1% of the patients became pregnant.
Asunto(s)
Hormona Liberadora de Gonadotropina/agonistas , Hormona Liberadora de Gonadotropina/antagonistas & inhibidores , Infertilidad Femenina/tratamiento farmacológico , Síndrome de Hiperestimulación Ovárica/prevención & control , Inducción de la Ovulación/métodos , Adulto , Estudios de Cohortes , Estrógenos/metabolismo , Femenino , Fármacos para la Fertilidad Femenina/administración & dosificación , Fertilización In Vitro , Hormona Liberadora de Gonadotropina/administración & dosificación , Hormona Liberadora de Gonadotropina/análogos & derivados , Antagonistas de Hormonas/administración & dosificación , Humanos , Infertilidad Femenina/epidemiología , Leuprolida/administración & dosificación , Síndrome de Hiperestimulación Ovárica/epidemiología , Embarazo , Índice de Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: The B-Lynch uterine suture brace has been used for the surgical treatment of postpartum hemorrhage. To date, no complications of this procedure have been reported. We describe B-Lynch suture erosion through the uterine wall identified at a 6-week postpartum visit. CASE: A 19-year-old primigravida underwent a primary low transverse cesarean section at term for arrest of descent. The surgery was complicated by postpartum hemorrhage secondary to uterine atony unresponsive to medical management. The patient underwent successful placement of a B-Lynch suture using delayed, absorbable suture for control of the hemorrhage and had an uneventful postoperative course. At her 6-week postpartum examination, she was found to have the suture protruding from the uterine cervical os. The suture was removed in its entirety without difficulty. Follow-up sonohysterography at 6 months identified a small defect in the anterior wall of the lower uterine segment, corresponding to the probable site of suture erosion. CONCLUSION: Erosion of suture through the uterine wall can be a complication of the B-Lynch uterine suture brace. Delayed, absorbable suture is less desirable than absorbable suture for this procedure due to the risk of erosion through the uterine wall.