High live birth rate in the subsequent IVF cycle after first-cycle poor response among women with mean age 35 and normal FSH.

Poor ovarian response in IVF cycles is associated with diminished ovarian reserve and poor pregnancy outcome. Little is known about pregnancy outcome after a poor response in women with a normal ovarian reserve. This retrospective study studied women undergoing IVF/intracytoplasmic sperm injection between January 2003 to December 2008 in the FertilityPLUS Clinic in Auckland, New Zealand. All women with a poor response in the first cycle were selected. Primary outcome was live birth after the second cycle. Secondary outcomes were poor response in the second cycle and the predictive values of female age and basal FSH at first cycle and IVF outcome at second cycle. Of the 2487 women starting IVF, 142 women (5.7%) with a poor response in the first cycle were selected, of which 66 (46.5%) women had a repeated poor response in the second cycle. There were 31 live births in the second cycle (21.8%). Female age was the only significant predictor for repeated poor response (AUC 0.69, 95% CI 0.61-0.78) and clinical pregnancy (AUC 0.66, 95% CI 0.57-0.75), but the predictive value was low. Therefore poor response in women with a normal ovarian reserve should not be a reason to discontinue further IVF treatment. Poor ovarian response in IVF cycles is associated with diminished ovarian reserve and poor pregnancy outcome. Little is known about pregnancy outcome after a poor response in women with a normal ovarian reserve. In this retrospective study, we studied women undergoing IVF/intracytoplasmic sperm injection (ICSI) between January 2003 to December 2008 in the FertilityPLUS Clinic in Auckland, New Zealand. All women with a poor response in the first cycle were selected. Primary outcome was live birth after the second cycle. Secondary outcomes were poor response in the second cycle and the predictive value of female age and basal FSH at first cycle and IVF outcome at the second cycle. Of the 2487 women starting wit IVF, a total of 142 women (5.7%) with a poor response in the first cycle were selected, of which 66 (46.5%) women had a repeated poor response in the second cycle. There were 31 live births in the second cycle (22%). Female age was the only significant predictor for repeated poor response and clinical pregnancy, but the predictive value was low. Therefore poor response in women with a normal ovarian reserve should not be a reason to discontinue further IVF treatment.

What is endosalpingiosis?

OBJECTIVE: To describe the demographics and clinical presentation of endosalpingiosis. To compare endosalpingiosis with endometriosis, particularly in regards to infertility and chronic pelvic pain. DESIGN: Retrospective analysis. SETTING: Hospital. PATIENT(S): We included women with a histologic diagnosis of endosalpingiosis, a second group with a histologic diagnosis of endometriosis, and a final group who had neither endosalpingiosis nor endometriosis, with histology reports after undergoing gynecologic surgery. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Infertility and chronic pelvic pain. RESULT(S): We found that 34.5% of endosalpingiosis cases had concurrent endometriosis; 40% of the endosalpingiosis group were postmenopausal. Endometriosis was significantly associated with infertility (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.4-8.5) and chronic pelvic pain (OR 3.0, 95% CI 1.7-5.5). In contrast, there was no significant link between endosalpingiosis and infertility (OR 1.6, 95% CI 0.7-3.7) nor chronic pelvic pain (OR 0.8, 95% CI 0.5-1.5). Gynecologic malignancy occurred significantly more in premenopausal women with endosalpingiosis than in those without (OR 10.3, 95% CI 3.6-29.8). CONCLUSION(S): Endosalpingiosis appears to affect postmenopausal women at a rate much higher than previously reported. Endosalpingiosis and endometriosis occur concurrently in 34% of endosalpingiosis cases; however, the two diseases have different clinical presentations. This demonstrates that endosalpingiosis is not a variant of endometriosis.

Long-term follow up of women with laparoscopic ovarian diathermy for women with clomiphene-resistant polycystic ovarian syndrome.

BACKGROUND: Laparoscopic ovarian diathermy (LOD) is one of the options for managing women with anovulation secondary to polycystic ovarian syndrome. The long-term benefits and harms of LOD are unknown. AIMS: The aim of this report was to establish the long-term benefits and harms of LOD in the group of women who took part in a randomised controlled trial (RCT) six to ten years earlier. METHODS: Women who took part in the fertility PLUS RCT comparing laparoscopic ovarian diathermy and gonadotrophins were contacted six to ten years following the end of the study. A postal questionnaire of clinical symptoms and pregnancy outcomes was collected, and follicle-stimulating hormone (FSH) levels were measured. RESULTS: Of the 33 women who completed the postal questionnaire, 29 had subsequently undergone LOD. The mean FSH level of these women was 5.7 IU/L (SD 3.7) ranging from <0.1 to 18.4 IU/L. The number of periods per year increased from 3.5 at study entry to 7.8 in the follow-up period in women not on the oral contraceptive. At the follow up, 15 of 29 women undergoing LOD (52%) reported symptoms of hirsutism and 14.0% reported acne. After undergoing laparoscopic ovarian diathermy, 79.0% (23 of 29) of the women delivered live infants, and over the follow-up period, 35 babies were delivered. Further fertility treatment was needed by 14 of 29 women who underwent LOD. CONCLUSIONS: There are the benefits of ongoing fertility and regular menstrual cycles in more than half of the women who underwent LOD.