RESUMO
RESEARCH QUESTION: Does music therapy help in reducing pain and anxiety in women undergoing transvaginal ultrasound-guided oocyte retrieval (TUGOR)? DESIGN: In this randomized controlled open label study, 209 participants were recruited and randomized into three groups (music group, n = 70; headphone group, n = 70; control group, n = 69). Patients' psychological status was assessed using the visual analogue scale of pain (VAS-P), satisfaction of pain control, state-trait anxiety inventory (STAI), Beck depression inventory (BDI), and general health questionnaire (GHQ). Stress biomarkers, including salivary alpha amylase (sAA) and salivary cortisol (sCort), were measured before and after TUGOR. RESULTS: No significant differences were found in psychological scoring of STAI, BDI, GHQ and the stress biomarkers. Although neither the anxiety scores nor the analgesic requirements differed among the three groups, the visual measure of vaginal pain (median, range) showed music group (20,0-70) was significantly (P = 0.005) lower than headphone group (30,0-90) and control group (30,0-100). The degree of satisfaction with pain control (median, range) in the music group (80,30-100), was significantly (P = 0.001) higher than the headphone group (80,10-100) and control group (70,0-100). CONCLUSION: Music is a simple, inexpensive and effective way to reduce pain score and increase satisfaction with pain control during TUGOR procedure, which may justify its routine use.
Assuntos
Musicoterapia , Recuperação de Oócitos/efeitos adversos , Manejo da Dor/métodos , Dor/psicologia , Satisfação do Paciente , Estresse Psicológico/terapia , Adulto , Feminino , Humanos , Recuperação de Oócitos/métodos , Recuperação de Oócitos/psicologia , Dor/etiologia , Medição da Dor , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/psicologiaRESUMO
The benefit of endometrial scratch (ES) prior to embryo transfer is controversial. Systemic analysis has confirmed its potential benefit, especially in women with repeated IVF failures, yet most studies have focused on fresh embryo transfer, and its effect on vitrified-warmed embryo transfer (FET) cycles is yet to be explored. We hereby present our prospective, double-blind, randomized controlled study on the evaluation of the implantation and pregnancy rate after ES prior to natural-cycle FET. A total of 299 patients underwent natural-cycle FET and were randomized to receive ES (n = 115) or endocervical manipulation as control (n = 114) prior to FET cycle, and a total of 196 patients had embryo transfer (93 patients in each group). Our study showed no significant difference in the implantation and pregnancy rate, as well as the clinical and ongoing pregnancy or live birth rates between the two groups. It appears that ES does not have any beneficial effect on an unselected group of women undergoing FET in natural cycles. Further studies on its effect in women with recurrent implantation failure after IVF are warranted.
Assuntos
Implantação do Embrião , Transferência Embrionária/métodos , Adulto , Criopreservação , Método Duplo-Cego , Endométrio/cirurgia , Feminino , Humanos , Gravidez , Taxa de GravidezRESUMO
In this prospective cohort study of 286 women undergoing fresh embryo transfer after IVF, uterine contraction frequency and direction were measured before (-5 min), 5 min after (+5 min) and 60 min after (+60 min) embryo transfer. Mean ± SD uterine contraction frequency at -5 min was 1.8 ± 1.1 contractions per min, increasing significantly (P < 0.05) to 2.0 ± 1.1 at +5 min, and returning back to baseline 1.8 ± 1.1 at +60 min. At -5 min, the proportion of women the with retrograde, antegrade, indeterminate direction and absent contractions were 33%, 44%, 17% and 6%; at +5 min, 40%, 42%, 13% and 5%, and at +60 min, 42%, 38%, 14% and 6%. No significant change was observed in the proportion of direction at these three time points. Logistic regression analysis showed live birth rate was significantly reduced in older women (P = 0.035) and in those with higher uterine contraction frequency at +5 min (P = 0.006). Frequency of uterine contraction immediately after embryo transfer (+5 min) seemed to be a significant predictor of IVF outcome and may help to identify women who could benefit from the use of muscle relaxant therapy to improve outcome.
Assuntos
Transferência Embrionária , Contração Uterina , Adulto , Fatores Etários , Estudos de Coortes , Feminino , Fertilização in vitro , Humanos , Modelos Logísticos , Gravidez , Resultado da GravidezRESUMO
STUDY QUESTION: Does three-dimensional (3D) versus two-dimensional (2D) ultrasound (US) guidance during embryo transfer (ET) increase the ongoing pregnancy rate in women undergoing ART treatment. SUMMARY ANSWER: There is no significant difference in the ongoing pregnancy rate of women undergoing 3D versus 2D US-guided ET. WHAT IS KNOWN ALREADY: Studies have suggested that 3D US may confer additional benefits compared with 2D US during ET, although this has not been tested within the context of an RCT. STUDY DESIGN, SIZE, DURATION: This was a single-blind, single centre prospective RCT performed between April 2015 and April 2016. A total of 481 recruited women were randomised into either a 3D or 2D US-guided ET group. PARTICIPANTS/MATERIALS, SETTING, METHOD: Women younger than 42 years in whom the endometrial cavity could be adequately visualised by US underwent ET in a university ART unit following a standard treatment protocol. All US examinations were performed by a single operator. In both 3D and 2D US groups, the inner catheter tip was aimed at the centre of the uterine cavity. The primary outcome measure was ongoing pregnancy rate, defined as the presence of at least one foetus with heart pulsation at 8 weeks of gestation. MAIN RESULTS AND THE ROLE OF CHANCE: There was no significant difference in the ongoing pregnancy rate between the 3D and 2D US groups (35.4% versus 37.1%, P = 0.70; rate ratio 0.96, 95% confidence interval 0.75-1.21). There were also no significant differences in terms of positive hCG rate, biochemical pregnancy rate, implantation rate, clinical pregnancy rate, miscarriage rate, ectopic pregnancy rate and multiple pregnancy rate. LIMITATIONS, REASONS FOR CAUTION: This study recruited unselected women undergoing routine ET and was therefore not sufficiently powered to assess differences in subsets of women. WIDER IMPLICATIONS OF THE FINDINGS: Although 3D US may be a modern method for demonstrating the ET procedure, it should not be currently recommended as a strategy to improve clinical outcomes in women undergoing ART treatment. STUDY FUNDING/COMPETING INTERESTS: This study was funded by the Health and Medical Research Fund of Hong Kong. The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT02413697. TRIAL REGISTRATION DATE: 4 April 2015. DATE OF FIRST PATIENT'S ENROLMENT: 20 April 2015.
Assuntos
Transferência Embrionária/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Implantação do Embrião , Feminino , Humanos , Gravidez , Taxa de Gravidez , Estudos Prospectivos , Método Simples-Cego , Resultado do TratamentoRESUMO
STUDY QUESTION: Does the air bubble (embryo flash) position and migration as visualized with 3D ultrasound (US) within 60 min of embryo transfer correlate with clinical outcome following fresh ART transfer cycles? SUMMARY ANSWER: The location of the embryo flash and the direction of its movement at 60 min, but not at 1 or 5 min after transfer, are associated with clinical pregnancy. WHAT IS KNOWN ALREADY: Studies assessing the relation between the pregnancy rate and the position of the catheter tip and/or the position of the air bubbles following embryo transfer show conflicting results to date. STUDY DESIGN, SIZE AND DURATION: This was a prospective cohort study including 277 infertile women undergoing ART between July 2011 and August 2013. PARTICIPANTS/MATERIALS, SETTING AND METHODS: Good prognosis patients undergoing fresh ART cycles within a single tertiary University unit were assessed by 3D US at 1, 5 and 60 min after embryo transfer. The distance of the embryo flash from the fundus was measured at these time points, along with the direction of the embryo flash movement within 60 min of transfer. MAIN RESULTS AND THE ROLE OF CHANCE: Within 60 min of embryo transfer, 76.4% (198/259) of the embryo flashes migrated towards the fundus, 12.4% (32/259) migrated towards the cervix and 11.2% (29/259) remained static. There was no significant association between the embryo position or movement and the pregnancy rate at 1 and 5 min. At 60 min, however, the pregnancy and implantation rates among subjects with embryo flashes located <15 mm from the fundus was significantly higher than those with embryo flashes located >15 mm from the fundus (46.5 and 32.8% versus 25.8 and 18.2%, respectively; P < 0.05). The pregnancy and implantation rates when the embryo flash was seen moving towards the cervix (25.0 and 15.0%) was significantly lower (P < 0.05 and P < 0.01, respectively) compared with those remaining static (55.2 and 37.7%) or moving towards the fundus (45.5 and 32.8%). LIMITATIONS AND REASONS FOR CAUTION: Although the air bubbles seen at the time of embryo transfer are thought to represent the position of the embryo, they are in fact a surrogate marker of the embryo itself, as this cannot be directly visualized by US. WIDER IMPLICATIONS OF THE FINDINGS: Following embryo transfer the majority, but not all, embryo flashes undergo significant migration towards the fundus. The location of the embryo flash and the direction of its movement at 60 min, but not at 1 or 5 min after transfer, is associated with clinical outcome. These findings may challenge the traditional notion that the exact position of the embryo flash immediately following embryo transfer is related to clinical outcome. STUDY FUNDING/COMPETING INTERESTS: The authors have no relevant funding or conflicts of interest to disclose.
Assuntos
Transferência Embrionária , Ultrassonografia Pré-Natal , Adulto , Implantação do Embrião , Embrião de Mamíferos/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional , Modelos Logísticos , Gravidez , Taxa de Gravidez , Prognóstico , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
STUDY QUESTION: What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system? SUMMARY ANSWER: The ESHRE/ESGE consensus for the diagnosis of female genital anomalies is presented. WHAT IS KNOWN ALREADY: Accurate diagnosis of congenital anomalies still remains a clinical challenge because of the drawbacks of the previous classification systems and the non-systematic use of diagnostic methods with varying accuracy, some of them quite inaccurate. Currently, a wide range of non-invasive diagnostic procedures are available enriching the opportunity to accurately detect the anatomical status of the female genital tract, as well as a new objective and comprehensive classification system with well-described classes and sub-classes. STUDY DESIGN, SIZE, DURATION: The ESHRE/ESGE CONgenital UTerine Anomalies (CONUTA) Working Group established an initiative with the goal of developing a consensus for the diagnosis of female genital anomalies. The CONUTA working group and imaging experts in the field have been appointed to run the project. PARTICIPANTS/MATERIALS, SETTING, METHODS: The consensus is developed based on: (i) evaluation of the currently available diagnostic methods and, more specifically, of their characteristics with the use of the experts panel consensus method and of their diagnostic accuracy by performing a systematic review of evidence and (ii) consensus for the definition of where and how to measure uterine wall thickness and the recommendations for the diagnostic work-up of female genital anomalies, based on the results of the previous evaluation procedure, with the use of the experts panel consensus method. MAIN RESULTS AND THE ROLE OF CHANCE: Uterine wall thickness is defined as the distance between the interostial line and external uterine profile at the midcoronal plane of the uterus; alternatively, if a coronal plane is not available, the mean anterior and posterior uterine wall thickness at the longitudinal plane could be used. Gynecological examination and two-dimensional ultrasound (2D US) are recommended for the evaluation of asymptomatic women. Three-dimensional (3D) US is recommended for the diagnosis of female genital anomalies in 'symptomatic' patients belonging to high risk groups for the presence of a female genital anomaly and in any asymptomatic woman suspected to have an anomaly from routine evaluation. Magnetic resonance imaging (MRI) and endoscopic evaluation are recommended for the subgroup of patients with suspected complex anomalies or in diagnostic dilemmas. Adolescents with symptoms suggestive for the presence of a female genital anomaly should be thoroughly evaluated with 2D US, 3D US, MRI and endoscopically. LIMITATIONS, REASONS FOR CAUTION: The various diagnostic methods should always be used in the proper way and evaluated by experts to avoid mis-, over- and underdiagnosis. WIDER IMPLICATIONS OF THE FINDINGS: The role of a combined US examination and outpatient hysteroscopy should be prospectively evaluated. It is a challenge for further research, based on diagnosis, to objectively evaluate the clinical consequences related to various degrees of uterine deformity. STUDY FUNDING/COMPETING INTERESTS: None.
Assuntos
Consenso , Genitália Feminina/anormalidades , Sociedades Médicas/normas , Anormalidades Urogenitais/diagnóstico , Útero/anormalidades , Feminino , Genitália Feminina/diagnóstico por imagem , Humanos , Ultrassonografia , Anormalidades Urogenitais/diagnóstico por imagem , Útero/diagnóstico por imagemRESUMO
The recent ESHRE-ESGE classification for female genital anomalies attempts to promote objectivity in diagnosis of normal and septate uteri. The aim of this study was to ascertain whether the uterine cavity indentation - the characteristic feature of septate uteri - varies significantly throughout the cycle. Seventy consecutive women underwent three-dimensional ultrasound twice: 35 during the proliferative and luteal phase of a natural cycle, and 35 during the first and final day of a stimulated cycle. Endometrial thickness, interostial distance, cavity indentation and percentage of cavity indentation were all assessed in accordance with the ESHRE-ESGE consensus on diagnosis of female genital anomalies. Overall, throughout both cycles, there was a significant increase in endometrial thickness (from 4.6 mm to 10.2 mm; P < 0.001) and interostial distance (from 30.1 mm to 35.1 mm; P < 0.001), which was associated with a significant reduction in the percentage of cavity indentation (from 30.3% to 15.0%; P < 0.001). Between the first and second assessment, 3/70 (4.3%) patients had a change in diagnosis from septate to normal uterus, although this did not reach statistical significance. This observation of a significant intra-cycle variation of the uterine cavity indentation has important implications for both clinical practice and research.
Assuntos
Útero/anormalidades , Adulto , Feminino , Humanos , Estudos ProspectivosRESUMO
This retrospective study assessed the predictive value of endometrial thickness (EMT) on HCG administration day for the clinical outcome of fresh IVF and intracytoplasmic sperm injection (ICSI) cycles. A total of 8690 consecutive women undergoing 10,787 cycles over a 5-year period were included. The 5th, 50th and 95th centiles for EMT were determined as 8, 11 and 15 mm, respectively. Group analysis according to these centiles (Group 1: < 8 mm; Group 2: ≥ 8 and ≤11 mm; Group 3: > 11 and ≤15 mm; Group 4: > 15 mm) demonstrated significant differences (P < 0.001) in clinical pregnancy rates (23.0%, 37.2%, 46.2% and 53.3%, respectively), live birth rates per clinical pregnancy (63.3%, 72.0%, 78.1% and 80.3%, respectively), spontaneous abortion rates (26.7%, 23.8%, 19.9% and 17.5%, respectively), and ectopic pregnancy rates (10.0%, 4.3%, 2.1% and 2.2%, respectively). Logistic regression analyses showed EMT as one of the independent variables predictive of clinical pregnancy (OR = 1.097; P < 0.001), live birth (OR = 1.078; P < 0.001), spontaneous abortion (OR = 0.948; P < 0.001), and ectopic pregnancy (OR = 0.851; P < 0.001). Future research should aim to understand the underlying mechanisms relating EMT to conception, ectopic implantation and spontaneous abortion.
Assuntos
Endométrio/fisiologia , Fertilização in vitro/métodos , Resultado da Gravidez , Injeções de Esperma Intracitoplásmicas/métodos , Aborto Espontâneo/diagnóstico , Adulto , Gonadotropina Coriônica/metabolismo , Feminino , Humanos , Nascido Vivo , Masculino , Idade Materna , Valor Preditivo dos Testes , Gravidez , Taxa de Gravidez , Análise de Regressão , Estudos Retrospectivos , Transferência de Embrião ÚnicoRESUMO
AIM: To assess whether pain experienced during embryo transfer (ET) is associated with the chance of clinical pregnancy in assisted reproductive technology cycles. METHODS: This was a prospective observational study of 284 women conducted between July 2011 and January 2014. Women under 40 years undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles followed by fresh/frozen ET were recruited. Pain was measured using a 100-mm visual analogue scale. Several factors relating to both pain and also the nature of the ET procedure were recorded: use of vulsellum, uterine contractility, depth of ET, duration of ET catheter insertion, urgency of micturition, psychological profile tests, salivary α-amylase and salivary cortisol. Primary outcome was the achievement of clinical pregnancy. RESULTS: Women who experienced pain during ET had a significantly lower clinical pregnancy rate compared with women who did not (42.2% vs 53.8%; P = 0.03). Non-pregnant women also had significantly higher pain scores compared with pregnant women (10.3 vs 6.4; P = 0.01). Pain was independent of >20 variables relating to (i) the nature of the ET procedure; (ii) psychological testing; and (iii) potential confounding factors inherent to IVF/ICSI. On binary logistic regression analysis, pain was an independent predictor for the chance of clinical pregnancy (OR, 0.59; 95%CI: 0.37-0.94; P = 0.03). CONCLUSIONS: Pain during ET is independently associated with the chance of clinical pregnancy. The underlying mechanism could involve factors other than nature of the ET and the psychological state of the patient, and warrants further investigation.
Assuntos
Transferência Embrionária/efeitos adversos , Percepção da Dor , Dor/complicações , Taxa de Gravidez , Adulto , Transferência Embrionária/estatística & dados numéricos , Feminino , Humanos , Medição da Dor , Gravidez , Estudos Prospectivos , Curva ROC , Injeções de Esperma IntracitoplásmicasRESUMO
PURPOSE: The purpose of this study is to report two cases of monozygotic quadruplet and triplet pregnancies following single embryo transfer (ET). METHODS: A 29-year-old woman and a 34-year-old woman underwent ART treatment in two affiliated University based ART units. The first woman underwent ICSI with day 3 embryo biopsy for pre-implantation genetic diagnosis (PGD) followed by day 4 transfer, which resulted in a monochorionic quadramniotic (MCQA) quadruplet pregnancy. The second woman underwent conventional IVF with transfer of a single blastocyst, which resulted in a monochorionic triamniotic (MCTA) triplet pregnancy. RESULTS: The first patient underwent successful selective foetal reduction at 16 + 3 and 17 + 4 weeks of gestation. Two healthy twin girls were delivered by elective caesarean section at 35 + 6 weeks of gestation. The second patient underwent successful selective foetal reduction at 14 + 1 weeks of gestation. The remaining monochorionic diamniotic (MCDA) twins are well at the time of writing this article. CONCLUSIONS: To our knowledge, these cases represent the first case of viable MCQA pregnancy following single ET in the world and the third case of a viable MCTA pregnancy following conventional IVF with single ET. Several factors including blastocyst stage transfer and zona pellucida manipulation have been thought to contribute to monozygotic twinning in the context of ART. These two cases add to the growing literature of monozygotic multiple pregnancies following ART.
Assuntos
Gravidez de Quadrigêmeos , Gravidez de Trigêmeos , Técnicas de Reprodução Assistida , Transferência de Embrião Único/métodos , Adulto , Feminino , Humanos , Gravidez , Diagnóstico Pré-Implantação , Transferência de Embrião Único/efeitos adversos , Injeções de Esperma Intracitoplásmicas/métodos , Gemelaridade Monozigótica/fisiologia , Gêmeos Monozigóticos , Ultrassonografia Pré-NatalRESUMO
Despite the emergence of new classifications, the best way to measure and differentiate between the most common congenital uterine anomalies remains debatable. The aim of this study was to test the intra- and inter-observer variability of the different three-dimensional ultrasound (3DUS) uterine measurements described to date. Twenty consecutive women underwent 3DUS in a standardized manner. Two observers analysed each volume three times to assess the interostial distance, indentation distance, indentation angle, percentage of indentation, fundal wall thickness, and lateral wall thickness. Intra- and inter-class correlation coefficients (intra- and inter-CC), limits of agreement (LOA) and repeatability coefficients were estimated. For observers 1 and 2, the intra-observer reproducibility was the lowest for the left lateral wall thickness (intra-CC 0.91 [LOA -6.54 to 7.10] and 0.58 [LOA -6.58 to 6.94], respectively) and right lateral wall thickness (intra-CC 0.92 [LOA -5.68 to 4.74] and 0.56 [LOA -6.79 to 5.59], respectively). The inter-observer reproducibility was also the lowest for both these measurements (inter-CC 0.74 [LOA -4.01 to 6.09] and 0.72 [LOA -3.33 to 5.83], respectively). The remaining measurements showed high levels of intra- and inter-observer reproducibility (intra- and inter-CC ≥0.95). It is evident that not all uterine measurements are equally reproducible on 3DUS.
Assuntos
Imageamento Tridimensional/métodos , Útero/anormalidades , Útero/diagnóstico por imagem , Adulto , Feminino , Humanos , Imageamento Tridimensional/estatística & dados numéricos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricosRESUMO
AIM: Chromosomal abnormalities are an important cause of repeated miscarriage. Several studies have discussed the association between chromosomal abnormalities and repeated miscarriage. This study attempts to describe the pattern of miscarriage in this group of women and the eventual pregnancy outcome of couples with chromosomal abnormalities compared with couples with unexplained repeated pregnancy loss. MATERIAL AND METHODS: This was a retrospective study involving 795 couples with repeated miscarriages. RESULTS: Out of 795 couples, 28 (3.52%) were found to have a chromosomal abnormality (carrier group). Over half (65.5%) of the chromosomal abnormalities were balanced reciprocal translocations. After referral, this carrier group had a total of 159 pregnancies, leading to 36 live births (22.6%) among 18 couples. The after referral miscarriage rate in the chromosomal anomaly group (55.6%) was significantly (P < 0.01) higher than that in the unexplained recurrent miscarriage group (28.1%). In couples with chromosomal anomaly, the miscarriages were more likely to occur between 6 and 12 weeks' gestation. CONCLUSIONS: The encouraging cumulative live birth rate of 64.3% for couples with chromosomal anomaly and repeated miscarriage suggests that further attempts at natural conception are a viable option.
Assuntos
Aborto Habitual/etiologia , Aberrações Cromossômicas , Perda do Embrião/etiologia , Perda do Embrião/genética , Morte Fetal/etiologia , Morte Fetal/genética , Adulto , Implantação do Embrião , Perda do Embrião/fisiopatologia , Características da Família , Feminino , Morte Fetal/fisiopatologia , Heterozigoto , Humanos , Nascido Vivo , Masculino , Gravidez , Gravidez Ectópica/fisiopatologia , Estudos Retrospectivos , Translocação GenéticaRESUMO
This retrospective observational study was performed to determine the predictive value of midluteal serum progesterone measurement on the subsequent pregnancy outcome in women with unexplained recurrent miscarriage after referral. This study involved women with unexplained recurrent miscarriage attending the recurrent miscarriage clinic between January 1992 and March 2011. A total of 132 women with unexplained recurrent miscarriage who conceived again within 12 months of midluteal serum progesterone measurement were analysed. Midluteal serum progesterone concentrations were compared between miscarriage and live birth groups. Also live birth rates were compared between higher and lower progesterone groups. Among 132 women studied, the serum progesterone concentrations (mean ± SE) in the live birth group (n=86) and miscarriage group (n=46) were 42.3 ± 2.4 nmol/l and 42.5 ± 3.2 nmol/l, respectively. In addition, using three different progesterone cut-off values (20, 30 and 40 nmol/l), the live birth and miscarriage rates were also not significantly different. The conclusion is that midluteal serum progesterone measurement does not predict the outcome of a subsequent pregnancy in women with unexplained recurrent miscarriage. This retrospective observational study was performed to determine the predictive value of midluteal serum progesterone measurement on the subsequent pregnancy outcome in women with unexplained recurrent miscarriage after referral. This study involved women with unexplained recurrent miscarriage attending the recurrent miscarriage clinic between January 1992 and March 2011. A total of 132 women with unexplained recurrent miscarriage who conceived again within 12 months of midluteal serum progesterone measurement were analysed. Midluteal serum progesterone values were compared between miscarriage and live birth groups. Also live birth rates were compared between higher and lower progesterone groups. Among 132 women studied, the serum progesterone concentration in the live birth group (n=86) and miscarriage group (n=46) were (mean ± SE) 42.3 ± 2.4 nmol/l and 42.5 ± 3.2 nmol/l, respectively. In addition, using three different progesterone cut-off values (20, 30 and 40 nmol/l), the live birth and miscarriage rates were also not significantly different. The conclusion is that midluteal serum progesterone measurement does not predict the outcome of a subsequent pregnancy in women with unexplained recurrent miscarriage.
Assuntos
Aborto Habitual/sangue , Fase Luteal/sangue , Progesterona/sangue , Adulto , Feminino , Humanos , Recém-Nascido , Nascido Vivo , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Estudos RetrospectivosRESUMO
Unexplained recurrent miscarriage (RM) can be a challenging and frustrating condition for both patients and clinicians. For the former, there is no diagnosis available for consolation, while for the latter there is little evidence-based treatment to offer. However, the majority of these patients have an excellent prognosis without the need for any treatment. Epidemiological associations suggest that the reason for this is that the majority of women with unexplained RM are in fact healthy individuals, with no underlying pathology, who have suffered three miscarriages purely by chance. Nevertheless, a certain proportion of women with unexplained RM will continue to miscarry, and preliminary studies suggest the presence of pathology in some women of this group. As a result, two types of unexplained RM can be described: Type I unexplained RM, which occurs by chance in women who have no underlying pathology and has a good prognosis; and Type II unexplained RM, which occurs due to an underlying pathology that is currently not yet identified by routine clinical investigations and has a poorer prognosis. Distinguishing between Types I and II unexplained RM can be achieved by considering several factors: the age of the woman, the definition used for RM (i.e. whether biochemical pregnancy losses are considered as miscarriages), the number of previous miscarriages suffered and the karyotype of the products of conception, where available. A better understanding of the two types of unexplained RM could lead to more targeted referrals, investigations and treatments, which would improve cost-effectiveness and overall clinical care.
Assuntos
Aborto Habitual/etiologia , Aborto Espontâneo/etiologia , Complicações na Gravidez/etiologia , Aborto Habitual/epidemiologia , Aborto Espontâneo/epidemiologia , Adulto , Fatores Etários , Ensaios Clínicos como Assunto , Feminino , Humanos , Cariótipo , Cariotipagem , Gravidez , Complicações na Gravidez/epidemiologia , PrognósticoRESUMO
This is a retrospective, observational study to determine how often repeated consecutive miscarriages occur consistently in the same gestational period, including 1589 miscarriages among 543 women with recurrent miscarriage. In women who had two miscarriages only, 49.17% of both miscarriages occurred in the same gestational period, which was significantly higher than the expected probability of 34.54% (P<0.01). The proportions of all miscarriages occurring in the same gestational period in women with three, four and five or more miscarriages were 28.72%, 19.44% and 18.60%, compared with the expected probabilities of 14.36% (P<0.01), 6.57% (P<0.05) and <3.15% (P<0.05). The proportions of miscarriages occurring consistently in the same gestational period are higher than the theoretical probabilities calculated for the whole population.
Assuntos
Aborto Habitual/epidemiologia , Idade Gestacional , Modelos Estatísticos , Modelos Teóricos , Adulto , Feminino , Humanos , Incidência , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos RetrospectivosRESUMO
BACKGROUND: Although uterine fibroids have been associated with spontaneous miscarriage, to our knowledge there have been no studies in the literature assessing their role in the recurrent miscarriage (RM) population. The aims of this study are to examine the impact of different types of fibroids on the pregnancy outcome of women with RM and to investigate to what extent resection of fibroids distorting the uterine cavity affects the outcome of a future pregnancy. METHODS: The study analysed retrospective and prospective data from a large tertiary referral RM clinic. Couples were investigated as per an established protocol. Fibroids were diagnosed using combined transvaginal ultrasound and hysterosalpingography. Fibroids distorting the uterine cavity were resected via hysteroscopy. Two study groups were subsequently examined: women with cavity-distorting fibroids who underwent surgery (n =25) and women with fibroids not distorting the cavity who did not undergo any intervention (n =54). The latter was compared with a control group of women with unexplained RM (n =285). RESULTS: The prevalence of fibroids was found to be 8.2% (79/966). In total, 264 pregnancies of women with fibroids and 936 pregnancies of women with unexplained RM were analysed. Women with intracavitary distortion and undergoing myomectomy significantly reduced their mid-trimester miscarriage rates in subsequent pregnancies from 21.7 to 0% (P< 0.01). This translated to an increase in the live birth rate from 23.3 to 52.0% (P< 0.05). Women with fibroids not distorting the cavity behaved similarly to women with unexplained RM achieving a 70.4% live birth rate in their subsequent pregnancies without any intervention. CONCLUSIONS: Fibroids are associated with increased mid-trimester losses amongst women with RM. Resection of fibroids distorting the uterine cavity can eliminate the mid-trimester losses and double the live birth rate in subsequent pregnancies. Women with fibroids not distorting the uterine cavity can achieve high live birth rates without intervention.
Assuntos
Aborto Habitual/etiologia , Leiomioma/complicações , Útero/patologia , Adulto , Feminino , Humanos , Leiomioma/epidemiologia , Leiomioma/patologia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
Congenital uterine anomalies (CUA) are a known cause of recurrent miscarriage (RM), but the pattern of pregnancy loss that different CUA produce remains unknown. This study included 665 women with RM who were screened for CUA using a combined two-dimensional ultrasound (2D-US) and hysterosalpingography (HSG) approach. All suspected CUA were definitively diagnosed and classified via a combined hysteroscopy/laparoscopy procedure. Pregnancy outcomes were evaluated and compared for each type of CUA versus a control group of women with no identifiable cause of RM (unexplained RM). Fifty-six women with CUA and 107 women with unexplained RM were identified. In total, 881 pregnancies were analysed. Analysis showed that women with a septate or bicornuate uterus suffered from significantly increased second-trimester miscarriages compared with controls (13.2% and 13.8% versus 1.0%; P<0.001 and P<0.05, respectively). Women with an arcuate, septate or bicornuate uterus showed significantly reduced rates of biochemical pregnancy losses compared with controls (9.5%, 11.1% and 11.1% versus 30.4%; P<0.01, P<0.01 and P<0.05, respectively). Pregnancies of women with RM and CUA are not associated with early implantation failure and are compromised at a more advanced gestational age.
Assuntos
Aborto Habitual/etiologia , Resultado da Gravidez , Doenças Uterinas/complicações , Útero/anormalidades , Aborto Habitual/diagnóstico por imagem , Aborto Habitual/epidemiologia , Feminino , Humanos , Histerossalpingografia , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Ultrassonografia , Reino Unido/epidemiologia , Útero/diagnóstico por imagemRESUMO
Embryo transfer is the final and rate-limiting step of the assisted reproductive technique. Few advances have occurred in the last few decades with regard to this procedure. Studies conducted thus far have focused on factors and interventions taking place before, during and after this procedure. These factors are highly varied and range from methods to improve the psychological state of the patients to methods aimed at reducing uterine contractility and methods aimed at optimising the precise transfer of the embryo. The key question is which factors and interventions have thus far been proven to increase pregnancy rates and live birth rates. This paper aims to review the evidence relating to embryo transfer techniques in a systematic manner with a view to provide practical recommendations to practitioners involved in the procedure.
Assuntos
Transferência Embrionária , Técnicas de Reprodução Assistida , Coeficiente de Natalidade , Transferência Embrionária/métodos , Feminino , Humanos , Gravidez , Taxa de Gravidez , ÚteroRESUMO
BACKGROUND: A detailed assessment of the uterus forms a pivotal part of the ART treatment process. The emergence of three-dimensional ultrasound (3D US) has provided clinicians with a highly powerful tool in this respect. Assessments with 3D US range from the reconstruction of anatomical planes elusive to conventional US, to the objective measurement of anatomical volumes and vascularization parameters. However, despite the ever increasing number of publications emerging in the literature, the question of which aspects of 3D US are of most clinical value remains a topic of debate. OBJECTIVE AND RATIONALE: The objective of this review is to dissect which aspects of the 3D US assessment of the uterus are supported by a strong level of evidence to date, and should therefore be incorporated into current routine clinical practice. SEARCH METHODS: We conducted a systematic search of the PubMed database up to May 2016, using a combination of text words and Medical Subject Headings (MeSH) pertaining to the 3D US assessment of the uterus. All articles published in the English language were screened to ascertain relevance to women of reproductive age; further citations were retrieved through manual reference list searching. OUTCOMES: A multitude of predominantly observational studies were identified, which concerned a vast variety of 3D US uterine assessments. All articles unequivocally praised the non-invasive, cost-effective, highly acceptable and objective nature of 3D US. Studies regarding the value of assessing the endometrial volume and vascularization prior to embryo transfer appeared conflicting and inconsistent. Studies regarding the imaging of uterine pathology and identification of intratubal and intrauterine devices consistently reported high rates of diagnostic accuracy. A recent RCT did not show an improvement in clinical outcomes when comparing 3D versus 2D US during embryo transfer. However, preliminary studies suggested that 3D US is superior in determining the site of implantation, particularly in ambiguous cases such as interstitial and angular pregnancies. Finally, pilot studies have suggested that the further integration of 3D and possibly 4D US with surgical interventions of the uterus may be a promising prospect. WIDER IMPLICATIONS: 3D US may prove to be an invaluable tool in the assessment of the uterus within the context of ART. Currently, the aim should be to highlight the aspects of 3D US that are most evidence-based and valuable for patients, and to incorporate these into routine clinical practice.
Assuntos
Imageamento Tridimensional/métodos , Ultrassonografia/métodos , Útero/anatomia & histologia , Útero/diagnóstico por imagem , Feminino , Humanos , Técnicas de Reprodução Assistida/normasRESUMO
OBJECTIVE: To compare the expression of HOXA-10 and E-cadherin in the endometrium of women with recurrent implantation failure (RIF), women with recurrent miscarriage (RM), and women with proven fertility (normal control; NC). DESIGN: Observational cohort study. SETTING: University assisted reproductive unit. PATIENT(S): Fifty women were recruited: 18 NC, 12 unexplained RIF, and 20 RM. INTERVENTIONS(S): None. MAIN OUTCOME MEASURE(S): Endometrial biopsy was precisely timed 7 days after LH surge. The expression of HOXA-10 and E-cadherin were examined by means of immunohistochemistry. H-Scores of staining intensity in the glandular epithelium and stroma were measured. RESULT(S): HOXA-10 signal was mainly localized in the nuclei of stroma cells and the cytoplasm of glandular epithelium cells. E-Cadherin signal was found only in the cytoplasm of glandular epithelium cells. The HOXA-10 H-scores in the RIF group and the RM group were significantly lower than in the control group in both the glandular epithelium and stroma. The E-cadherin H-scores in the RM group were also significantly lower than in the control group. Interestingly, there was a positive correlation between HOXA-10 and E-cadherin H-scores in all of the women examined. CONCLUSION(S): There is a positive correlation between levels of HOXA-10 and E-cadherin expression in the endometrium, both of which are significantly reduced in women with RIF and RM compared with fertile control women. The findings suggest a potential role of HOXA-10 and E-cadherin in the implantation processes and altered expression in women with reproductive failure.