Cumulative Probability Of Conception Research Articles

The randomised uterine septum transsection trial (TRUST): design and protocol

BackgroundA septate uterus is a uterine anomaly that may affect reproductive outcome, and is associated with an increased risk for miscarriage, subfertility and preterm birth. Resection of the septum is subject of debate. There is no convincing evidence concerning its effectiveness and safety. This study aims to assess whether hysteroscopic septum resection improves reproductive outcome in women with a septate uterus.Methods/designA multi-centre randomised controlled trial comparing hysteroscopic septum resection and expectant management in women with recurrent miscarriage or subfertility and diagnosed with a septate uterus. The primary outcome is live birth, defined as the birth of a living foetus beyond 24 weeks of gestational age. Secondary outcomes are ongoing pregnancy, clinical pregnancy, miscarriage and complications following hysteroscopic septum resection. The analysis will be performed according to the intention to treat principle. Kaplan-Meier curves will be constructed, estimating the cumulative probability of conception leading to live birth rate over time. Based on retrospective studies, we anticipate an improvement of the live birth rate from 35% without surgery to 70% with surgery. To demonstrate this difference, 68 women need to be randomised.DiscussionHysteroscopic septum resection is worldwide considered as a standard procedure in women with a septate uterus. Solid evidence for this recommendation is lacking and data from randomised trials is urgently needed.Trial registrationDutch trial registry (NTR1676, 18th of February 2009).

A prospective cohort study of a woman's own gestational age and her fecundability.

What is the magnitude of the association between a woman's gestational age at her own birth and her fecundability (cycle-specific probability of conception)? We found a 62% decrease in fecundability among women born <34 weeks of gestation relative to women born at 37-41 weeks of gestation, whereas there were few differences in fecundability among women born at later gestational ages. One study, using retrospectively collected data on time-to-pregnancy (TTP), and self-reported data on gestational age, found a prolonged TTP among women born <37 gestational weeks (preterm) and with a birthweight ≤1500 g. Other studies of women's gestational age at birth and subsequent fertility, based on data from national birth registries, have reported a reduced probability of giving birth among women born <32 weeks of gestation. We used data from a prospective cohort study of Danish pregnancy planners ('Snart-Gravid'), enrolled during 2007-2011 and followed until 2012. In all, 2814 women were enrolled in our study, of which 2569 had complete follow-up. Women eligible to participate were 18-40 years old at study entry, in a relationship with a male partner, and attempting to conceive. Participants completed a baseline questionnaire and up to six follow-up questionnaires until the report of pregnancy, discontinuation of pregnancy attempts, beginning of fertility treatment, loss to follow-up or end of study observation after 12 months. Among women born <34 gestational weeks, the cumulative probability of conception was 12, 28 and 48% within 3, 6 and 12 cycles, respectively. Among women born at 37-41 weeks of gestation, cumulative probability of conception was 47, 67 and 84% within 3, 6 and 12 cycles, respectively. Relative to women born at 37-41 weeks' gestation, women born <34 weeks had decreased fecundability (fecundability ratio (FR) 0.38, 95% confidence interval (CI): 0.17-0.82). Our data did not suggest reduced fecundability among women born at 34-36 weeks of gestation or at ≥42 weeks of gestation (FR 1.03, 95% CI: 0.80-1.34, and FR 1.13, 95% CI: 0.96-1.33, respectively). Data on gestational age, obtained from the Danish Medical Birth Registry, were more likely to be based on date of last menstrual period than early ultrasound examination, possibly leading to an overestimation of gestational age at birth. Such overestimation, however, would not explain the decrease in fecundability observed among women born <34 gestational weeks. Another limitation is that the proportion of women born before 34 weeks of gestation was low in our study population, which reduced the precision of the estimates. By using prospective data on TTP, our study elaborates on previous reports of impaired fertility among women born preterm, suggesting that women born <34 weeks of gestation have reduced fecundability. The study was supported by the National Institute of Child Health and Human Development (R21-050264), the Danish Medical Research Council (271-07-0338), and the Health Research Fund of Central Denmark Region (1-01-72-84-10). The authors have no competing interests to declare.

Renaissance of Surgical Recanalization for Proximal Fallopian Tubal Occlusion: Falloposcopic Tuboplasty as a Promising Therapeutic Option in Tubal Infertility

Study Objective To assess the clinical effectiveness of falloposcopic tuboplasty in tubal infertility. Design Retrospective cohort study (Canadian Task Force classification II-3). Setting Infertility clinic. Patients Three hundred forty-five infertile patients (≥2y) with a diagnosis of proximal tubal occlusion, either bilateral or unilateral, between January 2005 and January 2011. Intervention Falloposcopic tuboplasty. Measurements and Main Results Medical records for 345 patients with a diagnosis of proximal tubal occlusion were reviewed. Of the 345 patients, 304 underwent falloposcopic tuboplasty, with successful recanalization achieved in 248 patients (81.6%). Ninety-one of the 304 patients (29.9%) became pregnant. Of these, 18 patients (19.8%) miscarried, and 4 (4.4%) had ectopic pregnancies in the recanalized tube. At 1-, 3-, 6-, and 9-month follow-up, the cumulative probability of conception was 23.1%, 50.6%, 73.6%, and 82.4%, respectively. Related complications included postsurgical infection (0.3%), perforation of the fallopian tube (1.3%), and accidental breakage of the catheter (4.9%) or the falloposcope (1.3%). Conclusions Falloposcopic tuboplasty is safe and effective for treatment of tubal infertility. The pregnancy rate after falloposcopic tuboplasty is comparable to that after in vitro fertilization, which suggests that it can be an alternative to in vitro fertilization in women with tubal infertility.

A randomized study of laparoscopic chromopertubation with lipiodol versus saline in infertile women

Eighty-eight infertile patients undergoing laparoscopy were randomized to undergo chromopertubation with lipiodol or with normal saline. The cumulative probability of conception at 1, 3, and 6 months following laparoscopy was not statistically different between the lipiodol group (21%, 31% , and 43%, respectively) and the saline group (18%, 21%, and 33%, respectively).

Reproductive performance after selective tubal catheterization

To evaluate the reproductive performance of women after selective tubal catheterization. Retrospective study (Canadian Task Force classification II-3). University teaching hospital. Ninety-eight infertile women with hysterosalpingographic findings of proximal tubal occlusion. Hysterosalpingography and selective tubal catheterization. Repeat hysterosalpingography examination before selective tubal catheterization in 98 patients revealed bilateral tubal patency in 14 patients and patency of one of the tubes in 12 others (12.2%). True proximal tubal occlusion was encountered in 72 patients (139 tubes). Successful recanalization of both tubes was achieved in 25 patients (34.7%), and successful recanalization of at least one tube was achieved in 44 patients (61.1%). Of the 72 patients who underwent selective tubal catheterization, 23 patients conceived. The cumulative probability of conception was 28%, 59%, and 73% at 12, 18, and 24 months of follow-up, respectively. The median procedure-conception interval was 16.2 months. One-quarter of patients diagnosed with bilateral proximal tubal occlusion on hysterosalpingography do not have tubal obstruction. Among those with true occlusion, selective tubal catheterization leads to an overall pregnancy rate of 31.9%.

Prognostic factors of reproductive outcome after myomectomy in infertile patients.

The objective of this study was to identify the prognostic factors for conception after myomectomy carried out in cases of infertility. A total of 91 infertile patients presenting at least one subserous or intramural myoma measuring >2 cm underwent myomectomy. The characteristics of the patients, myomata and associated infertility factors were collected in a uniform and systematic way. A postal questionnaire was sent to patients. For each of the various factors studied, the specific cumulative probability of spontaneous intrauterine conception was estimated using the Kaplan-Meier method. Multiple regression analysis was then carried out using Cox's proportional hazards model. The cumulative probability of spontaneous intrauterine conception at 2 years follow-up was 44% (95% confidence interval: 32-56%). The cumulative probability of conception was less after removal of a posterior or intramural myoma, after a sutured hysterotomy, and when accompanied by a male factor, associated tubal or ovulation pathology. The cumulative probability of conception was greater after ablation of myomata responsible for menometrorrhagia. The size, deforming effect on the cavity and age played no role in our sample. Our results indirectly suggest that post myomectomy adhesions could have an adverse effect on fertility. Myomata responsible for menometrorrhagia are also the cause of infertility. In the presence of an associated male, tubal or ovulatory factor, the results were poor and it was not possible to determine if a myomectomy should be performed in these cases in order to enhance fertility.

Laparoscopic treatment of polycystic ovaries with insulated needle cautery: a reappraisal

Objective: To evaluate the reproductive outcome and adhesion formation after a standardized laparoscopic treatment of polycystic ovary syndrome (PCOS) in clomiphene-resistant infertile women. Design: Retrospective study. Setting: University teaching hospital. Patient(s): One hundred twelve clomiphene-resistant anovulatory women with PCOS. Intervention(s): Laparoscopic ovarian drilling using an insulated needle cautery. Main Outcome Measure(s): Ovulatory rate, pregnancy rate, and adhesion formation. Result(s): After surgery, ovulation occurred spontaneously in 73.2% of patients. The cumulative probability of conception at 12, 18, and 24 months after surgery was 54%, 68%, and 72%, respectively. With use of Cox’s proportional hazards model, the effects of age, body mass index, and duration of infertility were evaluated. These factors were not associated with the pregnancy rate. Of 15 women who underwent a second-look laparoscopy, 11 women were found to be free of adhesions. Four women had periadnexal adhesions that were filmy, minimal, and found on the ovarian surface only. Conclusion(s): Laparoscopic ovarian drilling is an effective alternative treatment in clomiphene-resistant anovulatory women with PCOS. The use of an insulated needle cautery is associated with a minimal amount of adhesion formation.

Reproductive performance and three-dimension-ultrasound volume determination of polycystic ovaries after laparoscopic ovarian drilling

Laparoscopic treatment of polycystic ovaries is a less invasive technique than ovarian wedge resection by laparotomy and is associated with less adhesion formation. Furthermore, the results appear to be superior. The purpose of the current study was to determine the changes in the ovarian volume and the reproductive outcome after laparoscopic treatment of polycystic ovaries. We studied 34 women with polycystic ovary syndrome (PCOS) who failed to ovulate with clomiphene and who subsequently underwent laparoscopic ovarian drilling. A standard procedure was done by a single surgeon using an insulated needle electrode. In six patients, ultrasound examination was performed to determine three-dimensional volume before surgery, and 1 week and 3 weeks postoperatively. Preoperative volume was 12.2 &plusmn; 1.8 cm3 and 1 week after surgery it was 13.6 &plusmn; 1.5 cm3. The ovarian volume 3 weeks after surgery (6.9 &plusmn; 1.3 cm3) was significantly smaller than that before surgery (p <0.05). Ovulation after the procedure occurred in 30 women (88.2%). Using life table analysis, the cumulative probability of conception at 12-month follow-up was 70% (median 8.1 mo). Two patients (6%) who did not ovulate with gonadotropin previously refused further expectant treatment after surgery and conceived in the first cycle of gonadotropin treatment. Aside from these women, the majority of pregnancies (76%) occurred spontaneously, and 18% conceived with clomiphene. We observed for the first time that there is a temporary swelling of the ovary after laparoscopic ovarian drilling. Subsequently, the volume decreases to the size smaller than the preoperative volume. Laparoscopic treatment of polycystic ovaries in women with PCOS who fail clomiphene therapy is associated with an ovulation rate of 88.2% and a pregnancy rate of 70% at 12-month follow-up.

Contraceptive Failure in Matlab, Bangladesh

Data from the Matlab Surveillance System in Bangladesh are used to examine the determinants of contraceptive failure among a random multistage sample of 2856 women during 1984-89. Data from a 1987 evaluation are used to determine the effects of 56 community health workers on contraceptive behavior. Contraceptive failure is measured by theoretical failure use failure and extended-use failure as a calculation of cohort failure. The cumulative probability of failure among users of different contraceptives was 1% for injectables 3% for the IUD and 15% for the pill and other methods. The cumulative probability of conception among nonusers was 38% within 12 months after the survey. The conditional probability of failure and conception among nonusers at 6-month intervals was 11% for the pill at the beginning of use and 2-4% after 24 months of use or longer. 8% of IUD users had failures at 24 months of use. The low injectable failure rates did not change over the period of use. The probability of conception declined over time from 25% at 6 months to under 10% at the longest durations of nonuse. The probability of failure among poorly performing health workers was 24-25% compared to 9-18% among moderate or high performance workers. Multivariate analysis of the determinants of contraceptive failure are considered to show no clear pattern. Findings reveal that the likelihood of pregnancy was reduced by 50% among IUD users when health workers performance was of high quality rather than poor. When workers performed moderately well the pill and other method failures were reduced by about 75%. An increasing number of children increased by 3 times the injectable failure rate. Four limitations are identified that would underestimate the failure rate. Unfortunately the data did not allow for analysis of failure due to incorrect or irregular use.

Second-look operative laparoscopy 1 year following reproductive surgery

To evaluate the efficacy of a second-look operative laparoscopy following a reproductive surgery, a randomized study was conducted on women who failed to conceive 1 year following terminal salpingostomy or following salpingo-ovariolysis by laparotomy. There is no significant difference in the cumulative probability of pregnancy at 12, 24, and 36 months follow-up between women who underwent second-look operative laparoscopy 1 year after salpingo-ovariolysis (27%, 67%, and 67%) and women who were continued to be observed expectantly (27%, 45%, and 52%, respectively). The cumulative probability of conception at 12, 24, and 36 months follow-up in women who underwent second-look laparoscopy 1 year after salpingostomy was 6%, 18%, and 18% and in women who were observed expectantly was 5%, 21%, and 27%, respectively (P = no significant). The incidence of ectopic pregnancy which was high (about one-half of patients who conceived) was also not affected by this procedure. This study suggests that second-look operative laparoscopy 1 year after terminal salpingostomy or salpingo-ovariolysis does not increase the pregnancy rate or decrease the incidence of ectopic pregnancy. Women who fail to conceive 1 year after a reproductive surgery still maintain some of their reproductive potential, but the risk of having an ectopic pregnancy is high.

Recovery of fertility and outcome of planned pregnancies after the removal of NORPLANT R subdermal implants or Copper-T IUDs

The recovery of fertility after discontinuation of NORPLANT R implant use was assessed in ninety women who stated a desire for a new child at the time of removal. Three subjects were lost to follow-up after removal. The cumulative probability of conception in the remaining 87 women was 25, 49, 73 and 86 percent at one, three, six and twelve months after removal, respectively. Nine observations were censored either because of the use of a contraceptive method soon after removal of the implants (n = 7) or separation (n = 2). All other cases were pregnant at the end of two years with exception of three subjects where a male factor for infertility was present. There was no significant correlation between the length of NORPLANT R use and the length of the interval from removal to conception. A significantly higher frequency of intervals longer than 6 months was observed among women older than 30 years as compared to younger women. Pathology during pregnancy was cholestasia (n = 5), hypertension (n = 1) and gestational diabetes (n = 1). The outcome was term delivery in 59 cases, premature delivery in 4 cases, and spontaneous abortion in 7 cases. One woman is still pregnant and the outcome is unknown in 4 cases. One premature infant died. A contemporary control group of Copper Tusers enrolled under the same criteria as NORPLANT R implant users provided 44 women who had the device removed to become pregnant. The cumulative probability of pregnancy was 27, 69, 84 and 89 at one, three, six and twelve months and all were pregnant by the end of the second year. Six censored observations occurred because of the use of another contraceptive method after removal (n = 3) or loss to follow-up (n = 3). The outcome of pregnancy was term delivery in 23 cases and abortion in 7 cases. Recovery of fertility occurred at a normal rate after NORPLANT R implant removal and the incidence of problems detected in the ensuing pregnancy were within the expected range for Chilean women.

Methods for improvement of the success rate of artificial insemination with donor semen.

The cumulative probability of conception within 12 cycles of insemination with frozen-thawed donor semen increased from 59 to 70% by selecting the semen on the basis of its concentration of adenosine triphosphate (ATP) rather than on the basis of its motile sperm count. The success rate further improved to 83% by performing induction of ovulation in all recipients who did not achieve pregnancy within the initial 6 cycles.

Microsurgical tubal anastomosis: a controlled trial in four Asian centers.

An international program to determine the reversibility of female sterilization in Asia using microsurgical technique was established in 1980. One hundred eleven of 219 patients (51%) conceived following tubal anastomosis; of these, 79 delivered living children. The overall cumulative probability of conception at the end of follow-up, as determined by life-table analysis, was 63%. A decreased pregnancy rate was associated with anastomosis of tubes sterilized by electrocautery methods.

Tubal anastomosis following unipolar cautery

Twenty-five of 48 women (52%) sterilized by unipolar cautery techniques conceived following tubal anastomosis, of whom 17 (36%) had a living child. The overall cumulative probability of conception at the end of follow-up as determined by life-table analysis was 76%. Increasing age, parity, and the duration of the interval from sterilization to reversal did not influence pregnancy success. A decreased pregnancy rate was associated with ampullary-isthmic anastomosis; however, a pregnancy was least likely to occur in women with shortened oviducts of less than or equal to 4 cm (P less than 0.01). A decreased pregnancy rate in cautery-sterilized patients undergoing reversal may be related to the destruction of a larger segment of the fallopian tube. Interestingly, 71% of the cautery-sterilized patients were noted to have associated tubal disease such as endometriosis and/or proximal hydrosalpinx. The influence of these findings on subsequent pregnancy success remains to be established.

Fertility Following Bilateral Ovarian Wedge Resection: A Critical Analysis of 90 Consecutive Cases of the Polycystic Ovary Syndrome

Fertility following bilateral ovarian wedge resection (BOWR) was evaluated in a retrospective cohort study of 90 consecutive cases of the polycystic ovary syndrome. Post-BOWR follow-up was available for varying time spans of up to 10 years. BOWR resulted in the resumption of menstrual cyclicity in 91.1% (82/90) of the cases. However, within this ovulatory group, 26 patients were characterized by oligo-ovulation and a significantly reduced conception rate (29.2%), as compared with that of 56 normo-ovulatory counterparts (60.3%). Although the crude overall conception rate for this series was 47.8%, the overall cumulative probability of conception at the end of follow-up as determined by life table analysis was 73%. The likelihood of conception at any given point in time was estimated by a monthly fecundability rate of 1.34%. Our findings also indicate that the probability of post-BOWR conception was unaffected by age, race, ward status, or duration of infertility. In contrast, persistent post-BOWR oligo- or anovulation and the presence of concurrent tuboperitoneal disease were reaffirmed as the most important determinants of the likelihood of post-BOWR conception. A minimum incidence of 7.8% was documented for acquired post-BOWR pelvic disease.

Clinical Findings in Infertile Women with Circulating Antibodies Against Spermatozoa

The association between clinical findings and the occurrence of spermagglutinating antibodies was investigated in serum from women in 326 consecutive infertile couples. No relationship was found between unexplained infertility and the occurrence of sperm antibodies as detected by the tray agglutination technique. The occurrence of pregnancy at follow-up was the same in women with and without circulating sperm antibodies. However, the cumulative probability of conception per year was significantly lower in women with spermagglutinating antibodies than in women without such activity (0.005 greater than 2 P greater than 0.001), and the results showed a positive correlation between the duration of infertility and the occurrence of sperm antibodies. The latter findings may either reflect a fertility-reducing effect of the sperm antibodies or represent a time-related increasing tendency to develop sperm antibodies secondarily to the infertility.