Effect of endometriosis on implantation rates when compared to tubal factor in fresh non donor in vitro fertilization cycles.

OBJECTIVE: The objective of the following study is to compare the outcome of in vitro fertilization and embryo transfer (IVF-ET) in women with endometriosis and tubal-factor infertility. DESIGN: Retrospective study. SETTING: Tertiary referral hospital, assisted reproductive technologies unit. MATERIALS AND METHOD: The study group consisted of 78 women diagnosed with advanced stage endometriosis. The control group included 100 women with tubal-factor infertility. These groups were retrospectively analyzed regarding stimulation, fertilization, embryo development, implantation and pregnancy outcome. INTERVENTION S: Controlled ovarian hyperstimulation and IVF-ET. RESULTS: Lower oocyte yield with lower fertilization rate were found in women with endometriosis compared with tubal-factor control subjects. However, no differences were found in cleavage, implantation and clinical pregnancy rates between the endometriosis and tubal-factor groups. CONCLUSIONS: Our results showed that women with endometriosis have a lower oocyte yield and lower fertilization rate compared with women with tubal-factor infertility. However, once the oocyte is fertilized, it seems that the embryo has a normal chance of implantation, leading to similar pregnancy rates and adequately treated women with endometriosis have equal chances of conception as seen with tubal-factor infertility.

Comparison of gonadotropin-releasing hormone agonist with GnRH antagonist in polycystic ovary syndrome patients undergoing in vitro fertilization cycle: Retrospective analysis from a tertiary center and review of literature.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the most common infertility factor for which women are enrolled in in vitro fertilization (IVF) technique. In the recent years, gonadotropin releasing hormone antagonist protocol has emerged as the protocol of choice for controlled ovarian hyperstimulation in these patients. OBJECTIVES: The objective of the present study is to compare conventional long agonist protocol with fixed antagonist protocol in PCOS patients undergoing IVF cycle. MATERIALS AND METHODS: Retrospective analysis of 4 years data of a single center from northern India. Totally 81 patients who had long agonist protocol were compared with 36 patients with similar baseline characteristics who had antagonist protocol. RESULT: Total dose of gonadotropin required was significantly lower (P - 0.004) in the antagonist group. There was no significant difference in pregnancy rate or incidence of ovarian hyperstimulation syndrome between two groups. Cycle cancellation due to arrest of follicular growth was significantly higher in the antagonist group (P - 0.027). CONCLUSION: More randomized control trials and meta-analysis are required before replacing conventional long agonist protocol with antagonist protocol in patients with polycystic ovary syndrome.

Intraperitoneal bupivacaine for pain relief after minilaparoscopy in patients with infertility.

AIM: To evaluate the efficacy of intraperitoneal bupivacaine to reduce post operative pain after diagnostic minilaparoscopy in patients with infertility. DESIGN: A prospective randomized study was performed. MATERIALS AND METHODS: The study group consisted of 104 women with infertility undergoing diagnostic minilaparoscopy. At the end of the procedure, the treatment group (Group A) was given 10 mL of intraperitoneal 0.25 % bupivacaine (100 mg) and the control group (Group B) given 10 mL of intraperitoneal saline. Post operative pain was recorded with the use of a visual analog scale with scores ranging from 1 to 10 at 2, 4, 6 and 8 h intervals after the surgery. Additional analgesics given to the patients in the post operative period and any other side effects were noted. RESULTS: The treatment group had significantly lower pain scores at 2, 4, 6 and 8 h after the procedure (P < 0.05). The need for post operative analgesics also was significantly lower in the treatment group (P = 0.007). CONCLUSION: Post operative intraperitoneal bupivacaine administration is beneficial for patients undergoing diagnostic minilaparoscopy. It can significantly decrease post operative pain for up to 8 h and reduce the need for additional analgesics.

Genital tuberculosis: an important cause of ectopic pregnancy in India.

OBJECTIVE: To assess the role of genital tuberculosis as an etiological factor for ectopic pregnancy. METHOD: A total of eighteen women of ectopic pregnancy with concomitant female genital tuberculosis and a total of one hundred thirty six patients of ectopic pregnancy over a period of three years were enrolled. RESULTS: Mean age of patients with ectopic pregnancy and concomitant female genital tuberculosis was twenty-six and mean parity was 0.7. Most of these patients were in poor socio-economic group. Diagnosis of female genital tuberculosis was made by presence of granuloma in histopathological examination of endometrial aspirate or tubal specimen, positive acid fast bacilli in microscopy or culture, positive polymerase chain reaction in endometrial tissue and positive findings of genital tuberculosis during laparoscopy or laparotomy. Genital tuberculosis was responsible for 13.2% of all cases of ectopic pregnancy in the present study. CONCLUSION: Genital tuberculosis appears to be an important cause of ectopic pregnancy in India.

Vaginal misoprostol for cervical priming prior to diagnostic hysteroscopy--efficacy, safety and patient satisfaction: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness and safety of vaginal misoprostol for cervical priming prior to diagnostic hysteroscopy and to assess impact on pain scores and patient satisfaction. METHODS: One hundred women undergoing hysteroscopy were randomly allocated into two groups. The study group (n = 50) received 400 microg of misoprostol vaginally (self administered) 4-6 h prior to hysteroscopy while the control group (n = 50) did not receive any cervical priming. Primary outcome measured was need for cervical dilatation, analgesia or sedation. Secondary outcomes were pain scores, patient satisfaction and side effects. RESULTS: There was no significant difference in the need for cervical dilatation, analgesia or sedation in the two groups (P = 0.25, 0.64 and 0.5, respectively). In addition, there was no difference in subjective patient satisfaction (P = 0.70). However, those in the control group recorded a higher pain score (median +/- SD = 5 +/- 1.8) when compared to those who received misoprostol (median +/- SD = 4.5 +/- 2, P = 0.03). Only two women (4%) had bleeding per vaginum and one (2%) had a slight fever attributable to misoprostol. CONCLUSION: Vaginal misoprostol prior to diagnostic hysteroscopy did not facilitate cervical dilatation. It did effect a reduction in pain scores, but there was no difference in patient satisfaction, need for analgesia or sedation. No significant side effects were reported.