Low-dose FSH stimulation in polycystic ovary syndrome: comparison of 3 FSH-preparations.

In patients with PCOS low dose administration of follicle stimulating hormone is accepted as a safe treatment modality with low risk for an ovarian hyperstimulation syndrome or a multiple pregnancy. In this study we have retrospectively compared the efficacy of 3 different FSH preparations in low dose protocols-urinary FSH (FSH), highly purified urinary FSH (FSHHP) and recombinant FSH (rec. FSH). A total of 68 PCOS-patients, 36 lean and 32 moderately obese patients, were treated in 116 stimulation cycles. The mean age did not differ between the groups. A mean number of 1.7 cycles per patient was performed. PCOS was diagnosed in all patients by hormonal and sonographic means. Treatment was performed with daily injections of one ampoule FSH from day 3 onwards. Ovulation was induced with 10,000 IU HCG, when the leading follicle exceeded 16 mm in diameter and no more than 3 follicles were seen. The rate of monofollicular cycles was lowest in obese patients after FSHHP stimulation (30%) and after rec. FSH (66.6% in lean and 58.3% in obese patients, respectively). The number of FSH ampoules did not differ significantly between the groups. No severe hyperstimulation syndrome was registered. 21 pregnancies were achieved without significant differences between the different FSH preparations. Besides two abortions and one ectopic implantation, 12 pregnancies were ongoing singleton pregnancies, 3 twin pregnancies and 3 sets of triplets were noted. In conclusion, low-dose stimulation with FSH offers a safe and successful treatment option in patients with PCOS with an acceptable risk for multiple gestations.

Low-dose follicle stimulating hormone for ovulation induction in polycystic ovary syndrome.

In 20 patients with clinically, sonographically and endocrinologically proven polycystic ovary syndrome, ovulation induction with low doses of follicle stimulating hormone (FSH) was attempted by administration for 27 menstrual cycles. One ampule FSH was administered from day 3 onwards. If the ovarian response was inadequate after days 10-12, the daily FSH dose was increased by half an ampule until ovulation induction. Of the cycles, 55.5% were monofollicular, whereas 4 cycles had to be cancelled due to a multifollicular response or failure of ovarian stimulation. On average, 14.4 ampules was used, and human chorionic gonadotropin was given on day 16. Seven pregnancies were established, with all of them ongoing at this writing. One twin pregnancy and one triplet pregnancy occurred. Even in polycystic ovary syndrome patients, low-dose administration of FSH allows safe stimulation, with a low incidence of ovarian hyperstimulation, a high pregnancy rate and an acceptably low risk of multiple pregnancies.

[Hormonal replacement therapy and oral contraception. Risk of induction or reactivation of gynecologic malignancies]. / Hormonelle Substitution und orale Kontrazeption. Risiko der Induktion oder Reaktivierung gynäkologischer Malignome.

The administration of oral contraceptives does not enhance the incidence of gynecologic malignancies. Only few subgroups of patients seem to have a slightly elevated relative risk of breast cancer. On the other hand, the incidence of endometrial and ovarian cancer is markedly reduced. This is also true for correct hormonal replacement therapy. In addition, no elevation of breast cancer risk has been evidenced for low-estrogen administration. In most cases, hormonal replacement therapy may also be performed safely following successful treatment of gynecologic cancers.

[Radiologic versus ultrasound fallopian tube imaging. Painfulness of the examination and diagnostic reliability of hysterosalpingography and hysterosalpingo-contrast-ultrasonography with echovist 200]. / Radiologische versus sonographische Tubendarstellung. Schmerzhaftigkeit der Untersuchung und diagnostische Sicherheit von HSG bzw. HKSG mit Echovist 200.

UNLABELLED: Evaluation of tubal patency is usually assessed with hysterosalpingography (HSG) or laparoscopy including chromopertubation. Sonographical visualisation with Echovist 200 (hysterosalpingo-contrast sonography-HyCoSy) provides a new noninvasive tool. Therefore we conducted a prospective controlled study to compare sonographic and radiological evaluation of the fallopian tube. Main test parameters were accuracy of both methods and patient discomfort. PATIENTS AND METHODS: 50 patients were enrolled in this study. All patients were examined by both techniques; the sequence was randomly chosen. The results of HSG and HyCoSy were compared. Patient discomfort was assessed with a standardised questionnaire using a visual analog scale (0-10). RESULTS: Diagnosis of tubal patency identifying proximal or distal blockage was the primary end point using HSG as standard technique. Proximal and distal patency by HSG was sonographically confirmed in 82.9% (63/76) and 82.1% (46/56) tubes respectively. If HSG revealed proximal or distal occlusion, identical results were obtained in 91.7% (22/24) or 60% (12/20) by HyCoSy. No significant differences were found in patient discomfort. However a significant correlation was demonstrated between tubal patency and discomfort. The lowest score was obtained in patients with open tubes (4.6) increased in patients with distal occlusion (6.0) and reached a maximum with proximal pathology (8.7). CONCLUSION: Compared to conventional HSG, HyCoSy provides a highly efficient evaluation of tubal pathology and can be successfully used as a noninvasive screening method.

Combined intra-uterine and extra-uterine pregnancy in the contralateral tube after gamete intra-fallopian transfer.

A case of combined intra-uterine and contralateral tubal pregnancy after gamete intra-Fallopian transfer (GIFT) is presented. Laparotomy with partial tubal resection was performed after tubal rupture. The intra-uterine pregnancy is still ongoing without complications. Heterotopic pregnancies are dangerous conditions for the patient and should be taken into account after transfer of multiple oocytes. To our knowledge this is the first report of a heterotopic pregnancy in the contralateral tube after GIFT.

'Blind' transvaginal gamete intra-fallopian transfer in distal tubal and peritubal pathology: an evaluation in respect to the laparoscopic approach.

Transvaginal gamete intra-Fallopian transfer (GIFT) is a new treatment modality for patients with proven tubal patency, avoiding invasive laparoscopy. In this study 79 cycles of standard laparoscopic GIFT (group 1) were analysed in comparison to 40 cycles of transvaginal intratubal gamete transfer guided by tactile sensation (group 2). GIFT in group 1 was performed for standard indications; patients with severe intra-abdominal adhesions, distal tubal pathology, peritubal adhesions or extreme obesity were included in group 2. No difference in mean age, duration of infertility, oestradiol level and number of oocytes was found. In group 1 a clinical pregnancy rate of 33% per GIFT cycle (n = 79) was achieved. The clinical pregnancy rate in group 2 was 17.5% per gamete transfer cycle. In conclusion, transvaginal GIFT offers an acceptable chance for in-vivo fertilization to patients who cannot be treated laparoscopically despite having patent tubes and who refuse in-vitro fertilization.