[Painfulness of transvaginal follicle aspiration for oocyte retrieval in in-vitro-fertilization]. / Schmerzhaftigkeit vaginaler Punktionen im Rahmen der In-vitro-Fertilisation.

OBJECTIVE: The aim of this study was to analyze the painfulness of a transvaginal ultrasound-guided follicle punction. MATERIAL AND METHODS: Patients could choose to have either a neuroleptanalgesia or to be supported by the partner or a psychotherapist during the oocyte pick up. Based on a questionnaire, 277 patients tried to describe their level of pain in a horizontal alphanumeric scale divided in 15 categories, while other painful physical interacts could be quantified, too. Furthermore, patients were asked for the cause of sterility, former IVF-ET treatments and whether the partner or the psychotherapist looked after them during the oocyte retrieval. Statistical analysis was performed using a standardized computer program (Stat View, Abacus Concepts, USA). RESULTS: The neuroleptanalgesia reduced the intensity of pain (average value of pain: 1.21 vs 9.26 without analgesia) in a significant way (p = 0.0001). Some patients compared the pain at oocyte retrieval with a bone fracture (8.08) or surgeries (10.12). More painful was a colic (13.67), infections (13.5), some diagnostic surgeries (12.09) or a delivery (11.91). Younger woman and patients with dysmenorrhea felt significantly more pain than others. Neither the presence of the partner or psychotherapist during punction nor the indication, number of previous IVF-ET treatments or a following pregnancy had any influence on the statistics. CONCLUSION: Age as well as the rate of problems with menstruation should help the patient to decide on whether to have the follicle punction with or without anesthesia.

Prospective randomized study of an ultrashort gonadotrophin-releasing hormone agonist versus a modified suppression protocol for ovarian stimulation in intracytoplasmic sperm injection cycles.

To compare oocyte quality and clinical outcome after an ultrashort or a modified suppression gonadotrophin-releasing hormone agonist (GnRHa) protocol for ovarian stimulation in intracytoplasmic sperm injection (ICSI) cycles, we conducted a prospective randomized study of 60 consecutive couples with severe male infertility admitted for their first in-vitro fertilization (IVF) and ICSI attempt. More cycles were cancelled after the ultrashort protocol (8/30) than after the modified suppression protocol (3/30), although the difference was not significant. There were no cases of severe ovarian hyperstimulation syndrome (OHSS) in the ultrashort group compared to three cases in the suppression group. The percentage of mature metaphase II oocytes recovered in both groups was similar (88 versus 86%), as were the fertilization or cleavage rates after ICSI. In the ultrashort group, a total of 64 embryos was replaced in 22 transfers (mean 2.9 embryos per transfer), resulting in three first trimester abortions and seven deliveries. In the suppression group, 11 deliveries were achieved after transfer of a total of 75 embryos in 27 patients (mean 2.8 embryos per transfer). In conclusion, there was no apparent difference between the two GnRHa protocols in terms of oocyte quality and clinical outcome. However, because of the lower rate of severe OHSS, in our study the ultrashort protocol was more appropriate for ovarian stimulation in ICSI cycles than the modified suppression protocol.

Prediction of ovarian hyperstimulation syndrome by ultrasound volumetric assessment [corrected] of baseline ovarian volume prior to stimulation.

The aim of the study was to find out whether the estimation of the baseline ovarian volume prior to stimulation would be a suitable predictor for the risk of ovarian hyperstimulation syndrome (OHSS). A total of 101 patients underwent in-vitro fertilization (IVF) and embryo transfer. They had a 3-D volumetric assessment of the ovaries and body weight estimations on the first day of hormonal stimulation. A second measurement was performed on the day of ovulation induction with human chorionic gonadotrophin (HCG) together with an oestradiol 17 beta estimation in serum. During the IVF programme 15 women developed OHSS and 86 did not. There was a significant correlation between the baseline ovarian volume and subsequent occurrence of OHSS (P = 0.03). Other significant relationships were found between the occurrence of OHSS and the number of follicles (P = 0.002), the number of oocytes retrieved (P = 0.0001) and the length of the cycle (P = 0.0001). The body weight before and after the stimulation was significantly lower in the group of women who did develop the syndrome (P = 0.011 resp. 0.03). The oestradiol 17 beta concentration on the day of HCG administration in the serum of the patients who had OHSS was significantly higher (P = 0.0001). In conclusion, volumetry of the ovaries could help to detect patients at risk and prevent the occurrence of OHSS by early adjustment of the hormonal dosage. Recent advances in ultrasound technology (3-D ultrasound) enable quick and highly accurate volumetric assessments. Furthermore, our study confirms previous observations that low body weight and long cycles seem to be additional risk factors for the development of OHSS.

Video rating analysis of effect of maprotiline in patients with dementia and depression.

In patients with dementia and mild depression (DSM-III-R 290.21), the effect of low doses of the antidepressant maprotiline (up to 75 mg/d) was examined. The main parameter was a video rating of global impression. The Mini-Mental State Examination (MMS) and the Geriatric Depression Scale (GDS) were applied to evaluate the effect of maprotiline on cognitive and depressive symptoms. The double-blind, placebo-controlled trial was of eight weeks' duration and included 127 patients, randomized in two groups. The antidepressant effect of maprotiline was reflected in the GDS. There was, however, no indication of an effect of maprotiline on cognitive performance. The global impression, evaluated by video rating, gave no indication as to a beneficial effect of the treatment. - The video analysis showed a significant interrater reliability. The discrepancy between the results of the video rating and the GDS is discussed. - The results confirm similar findings of other authors; i.e., that a sedating antidepressant with some anticholinergic effects cannot be expected to improve cognitive functions despite its antidepressant effect. The main interest of this study, however, lies in its methodology (video analysis).

Regression of heart muscle hypertrophy after nifedipine therapy: changes in cardiac gene expression.

Changes in cardiac gene expression were studied during development and regression of cardiac hypertrophy in spontaneously hypertensive rats (SHR) in an attempt to determine some of the biochemical factors responsible for alterations in cardiac mass. Chronic nifedipine treatment of SHR (30 mg/kg per day for 20 weeks) led to a marked reduction in arterial blood pressure and to a subsequent regression of cardiac hypertrophy. Cardiac mRNA concentration decreased, whereas cardiac protein concentration remained unchanged. Changes in cardiac gene expression, as reflected by the decrease in cardiac mRNA concentration, were thus identified as a major factor responsible for the regression of cardiac hypertrophy after nifedipine therapy of SHR.