Outpatient Infertility Clinic Research Articles

METFORMIN TREATMENT IN INSULIN RESISTANT POLYCYSTIC OVARIES PATIENTS

Objectives: To know the incidence and characters of insulin resistance (lR) in polycystic ovaries (PCO) patients, andthe efficacy of metformin treatment for induction of ovulation compared to clomiphene citrate (CC); also the effect of.metformin on the clinical, biochemical and hormonal features of the patient would be evaluated.Design: A prospective, blind, controlled study.Setting: Outpatient infertility clinic, Benha University Hospital.Subjects: Sixty infertile PCO patients.Methods: The body mass index (BMI), the hirsutism and the acne scores, the fasting blood glucose, the fasting seruminsulin and serum testosterone levels were measured for every patient. A ratio of fasting blood glucose to fasting seruminsulin (G/I) of less than 4.5 mgllO-4 untis was considered IR. Insulin resistant patients were randomly divided intothree groups and treated for three cycles. The first group was treated with CC + mctforrnin, the second with placebo +metformin and the third with CC + placebo.Main outcome measures: The ovulation and pregnancy rates with metformin treatment compared to CC.Results: IR is present in about 86.6% of PCO patients. They are characterized by having higher BML fasting seruminsulin and serum testosterone levIes, than non IR patients. Treatment with CC + mctformin results in higher ovulationand pregnancy rates compared to that obtained with CC alone.Conclusions: IR must be diagnosed in PCO patients. Induction of ovulation with CC + mctforrnin results in higherovulation and pregnancy rates. In contrast to ce, the longer the duration of metformin treatment, the better arc theresults.

Serum leptin concentrations in patients with severe ovarian hyperstimulation syndrome during in vitro fertilization–embryo transfer treatment

To investigate the changes in serum leptin concentration in the conception cycle of severe ovarian hyperstimulation syndrome (OHSS). Prospective longitudinal study of 66 IVF-ET cycles between May 2000 and June 2002. Infertility outpatient clinic at a Japanese medical school. Infertile patients undergoing IVF-ET cycles at the infertility outpatient clinic were divided into three groups consisting of group 1 (conception-cycle patients with severe OHSS, n = 9), and group 2 (conception cycle, non-OHSS, n = 28), and group 3 (nonconception cycle, non-OHSS, n = 29). Blood samples were collected at five different periods. Period I, on the first day of ovarian stimulation with FSH; period II, at hCG administration before oocyte retrieval; period III, 7 days after oocyte retrieval; period IV, 14 days after oocyte retrieval; and period V, 21 days after oocyte retrieval. Serum leptin concentration. The serum leptin concentration was low in the OHSS group compared with that of the non-OHSS groups in all serum samples, with significant levels at periods III (vs. groups 2 and 3; P<.05) and IV (vs. group 3; P<.01). A twofold increase of leptin concentration from period I to period II (P<.05) was observed in all groups. The change pattern in serum leptin concentration might provide a great contribution to the pathophysiology development of OHSS patients during assisted reproductive treatment.

Prevalence of Chlamydia trachomatis in subfertile couples

Prevalence of Chlamydia trachomatis in subfertile couples

Detection of herpes simplex virus, cytomegalovirus, and Epstein-Barr virus in the semen of men attending an infertility clinic

Objective To investigate the prevalence of herpes simplex virus (HSV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) in the semen of men with fertility problems. Design A descriptive clinical study. Setting Outpatient infertility clinic of a private hospital. Patient(s) One hundred thirteen men attending an infertility clinic in Athens. Intervention(s) Semen samples were collected by masturbation. Main outcome measure(s) Detection of HSV, CMV, and EBV in semen by a nested polymerase chain reaction technique. Complete spermogram including sperm count, motility, pH, viscosity, and morphology. Result(s) Viral DNA was detected by the nested polymerase chain reaction technique in 64 (56.6%) of 113 semen samples. Specifically, HSV DNA was detected in 56 (49.5%) semen samples, EBV DNA in 19 (16.8%) semen samples, and CMV DNA in 8 (7.1%) semen samples. HSV was significantly related to low sperm count and poor motility. In contrast, CMV and EBV did not show any association with sperm concentration and motility. Conclusion(s) Herpes simplex virus seems to play a significant role in male infertility, and its early detection by the nested polymerase chain reaction technique will permit successful antiviral therapy to increase the possibility for fertility restoration and long-term protection of the sperm quality. Finally, the detection of herpes viruses within semen will allow better control of the transmission of these viruses.

Evaluation of a nonhomogeneous endometrial echo pattern in the midluteal phase as a potential factor associated with unexplained infertility

Objective To determine whether the failure to develop a homogeneous hyperechogenic pattern in the midluteal phase is associated with decreased fecundity in infertile women who are not receiving follicle-maturing drugs. Design Observational study. Setting Outpatient infertility clinic of a University Medical Center. Patient(s) Two hundred ninety-six infertile women (≥6 months) with regular menses, normal fallopian tubes and uterine cavity, and absence of severe male factor on their initial investigation cycle for follicular dynamic studies. Intervention(s) Midluteal phase sonographic endometrial evaluation. Main outcome measure(s) Viable pregnancy rates (live fetus at end of first trimester) according to endometrial echo pattern in the midluteal phase. Other variables considered were age of patient, endometrial thickness and serum E 2 levels at midcycle and midluteal phase, midcycle echo pattern, and P levels in the midluteal phase. Result(s) The viable pregnancy rate was significantly higher in those women who exhibited a homogeneous hyperechogenic pattern (8.5%) compared to those women whose endometrium was found to be nonhomogenous (2.2%). No other confounding variables were found that could explain this outcome. Conclusion(s) A nonhomogeneous hyperechogenic sonographic endometrial echo pattern predicts lower fertility potential in women who are not receiving follicle-maturing drugs.

Decline in sex ratio at birth after 10-day war in Slovenia: brief communication.

We investigated whether the psychological stress related to a short war (26 June-7 July, 1991) in Slovenia induced changes in fertility, sex ratio at birth and semen quality characteristics. Sex ratios [i.e. males/(males + females)] for 4966 births in the general population of Slovenia and separately for 1565 births in the Slovenian capital, Ljubljana, from January-March 1992 were compared with the sex ratio calculated for the same time period in 1991 and 1993. Semen analyses for 38 normozoospermic men attending an outpatient infertility clinic from May to September 1991 were also evaluated. In the general population in Slovenia there was a significant fall in the sex ratio at birth in 1992, compared with 1991 (0.504 versus 0.518; P = 0.03). In Ljubljana, the decline in sex ratio in 1992 was even more pronounced: 0.483 versus 0.537 in 1991 (P = 0.0001) and 0.483 versus 0.516 in 1993 (P = 0.005). A decrease in the proportion of sperm that were progressively motile from 56% before the war to 52% after it (P = 0.01) and of those that were rapidly motile from 40 to 36% (P = 0.01) was observed. Acute psychological stress in relation to a short war in Slovenia resulted 6 to 9 months later in a decrease in the observed sex ratio at birth. Negative changes in sperm motility may be involved in the sex ratio modifications.

Experience in office mini-hysteroscopy

Objective To evaluate the usefulness of and necessity for diagnostic office mini-hysteroscopy, and to review its indications and results with regard to patients who were admitted to the gynaecology and infertility outpatient clinics of the SSK Aegean Maternity and Women's Health Teaching Hospital. Study design A retrospective review was carried out of 344 women admitted with various gynaecological and reproductive complaints, who underwent office mini-hysteroscopy. Results A mini-hysteroscope with an operating channel of outer diameter (OD) 4 mm was used successfully in 344 patients, to evaluate abnormal and postmenopausal bleeding, endometrial thickness, intrauterine device dislocation, secondary amenorrhoea, severe dysmenorrhoea, infertility, tubal integrity and endometrial biopsy. In 219 patients (63.7%), the procedure was carried out without local anaesthesia and in 131 patients (38%) without cervical dilation. Local anaesthesia was used in 124 patients (36%) and only one patient (0.2%) had general anaesthesia. When indicated, endometrial biopsies were performed without any complication or difficulty. In 62.5% of patients intrauterine pathology was identified and 28% required further operative procedures. Conclusion Mini-hysteroscopy can be used in office conditions for more than 60% of women without the requirement for general or local anaesthesia. The experience of the operator is the most important factor in correct evaluation of the endometrium and for thus reducing the failure rate of endometrial biopsy. Office mini-hysteroscopy is a safe, fast and effective method of intrauterine evaluation, allowing the operator to take direct biopsies from suspected focal lesions and thus giving the opportunity of curing some intrauterine pathologies during the same session. It is very effective in clarification of indefinite results obtained from ultrasonography, magnetic resonance imaging, blind biopsy and hysterosalpingography.

Comparison of stimulation with clomiphene citrate in combination with recombinant follicle-stimulating hormone and recombinant luteinizing hormone to stimulation with a gonadotropin-releasing hormone agonist protocol: a prospective, randomized study

Objective: To compare IVF-ET outcome with a new stimulation protocol using clomiphene citrate (CC) with recombinant FSH and LH to stimulation with the standard long GnRH-a protocol. Design: Prospective randomized study. Setting: Outpatient infertility clinic in Vienna, Austria. Patient(s): Two hundred ninety-four infertile women undergoing IVF-ET; 154 IVF cycles stimulated with CC + recombinant FSH + recombinant LH (group A) and 140 cycles with long GnRH-a suppression + recombinant FSH (group B). Intervention(s): Controlled ovarian hyperstimulation, egg retrieval, and ET. Main Outcome Measure(s): Cycle parameters (number of oocytes, fertilization, number of embryos) and outcome (pregnancy rate, cancellation rate, ovarian hyperstimulation syndrome [OHSS]). Result(s): Pregnancy rate per ET was 42.9% (implantation rate, 21.3%) in group A and 36.6% (17.4%) in group B. Cancellation rates were similar. The OHSS occurred in four cases (3%) in group A and 12 cases (10%) in group B. Conclusion(s): Stimulation with CC + recombinant FSH + recombinant LH leads to comparable pregnancy rates vs. the long protocol. With this new stimulation, less gonadotropins are used and there is less need for monitoring (lower cost for patient and clinic). The risk of OHSS is reduced as well. Therefore, this protocol should be regarded as the first-line treatment.

Differential diagnosis of septate and bicornuate uterus by sonohysterography eliminates the need for laparoscopy

Objective: To determine whether sonohysterography can differentiate septate from bicornuate uterus. Design: Prospective study. Setting: Outpatient infertility clinic of a university hospital. Patient(s): Twenty patients with history of recurrent pregnancy loss and hysterosalpingographic diagnosis of septate or bicornuate uterus. Intervention(s): Sonohysterography was done in all patients. Laparoscopy was performed to confirm diagnosis in 10 patients and was not done in 10 patients. All patients with septate uterus underwent hysteroscopic metroplasty; simultaneous laparoscopy was done in women who had diagnostic laparoscopy. Abdominal metroplasty was performed in patients with bicornuate uterus. Main Outcome Measure(s): Shape of the uterine cavity after surgery and pregnancy outcome. Result(s): The shape of the uterine cavity was normal in seven cases in each group and almost normal in six other patients after surgery. There were two pregnancy losses after metroplasty, one in a woman who had laparoscopy and one in a woman who did not have laparoscopy. One case of bicornuate uterus occurred in each group. Conclusion(s): Sonohysterography can differentiate septate and bicornuate uterus and may eliminate the need for laparoscopy to diagnose these uterine anomalies.

Endometrial preparation for frozen-thawed embryo transfer with or without pretreatment with gonadotropin-releasing hormone agonist

Objective: To test the efficacy of endometrial preparation with exogenous steroids, without pretreatment with gonadotropin-releasing hormone (GnRH) agonist, in women with normal ovarian function. Design: Prospective randomized study. Setting: Private outpatient infertility clinic. Patient(s): Two hundred ninety-six women undergoing frozen-thawed embryo transfer. Intervention(s): In group 1 (146 patients), depot GnRH agonist was administered in the luteal phase; treatment with 17β-estradiol transdermal patches at steadily increasing dosage from 100 to 300 μg was then given for at least 12 days. In group 2 (150 patients), endometrial preparation began on day 1 of menstrual cycle. The starting dose was 200 μg; this was increased to 300 μg after 7 days. Main Outcome Measure(s): Pregnancy, abortion, implantation and cancellation rates. Result(s): In group 2, six cycles (4%) were cancelled due to evidence of ovulation. Groups were similar in the percentage of embryos that survived freezing-thawing (77.1% in group 1 and 76.6% in group 2) and in the number of embryos transferred per patient (2.1 ± 0.6 and 2.1 ± 0.7, respectively). Groups 1 and 2 did not differ significantly in rates of pregnancy (19.7% and 24.1%), abortion (17.8% and 11.7%), and implantation (10.4% and 11.9%). Conclusion(s): Endometrial preparation for frozen-thawed embryo transfer based exclusively on steroid administration appears to be as effective as the more conventional protocol involving preliminary desensitization with a GnRH agonist. This simplified protocol reduces costs, minimizes pharmacologic treatment, and increases patient compliance.

Are zinc levels in seminal plasma associated with seminal leukocytes and other determinants of semen quality?

Objective: To evaluate a potential association of zinc levels with seminal leukocytes, the outcome of semen cultures; and semen quality and sperm fertilizing capacity. Design: Prospective study. Setting: Outpatient infertility clinic of a university hospital. Patient(s): Two hundred fifty-six randomly chosen asymptomatic males from subfertile couples. Intervention(s): None. Main Outcome Measure(s): Determination of zinc in seminal plasma by flame atomic absorption spectroscopy. In aliquots of the same ejaculates the following tests were performed: immunocytochemical round cell differentiation to determine leukocyte counts and ratios, microbial screening, and comprehensive evaluation of semen quality (sperm analysis, biochemical parameters, antisperm antibody testing, and in vitro examination of sperm ability to penetrate cervical mucus). The patients underwent medical history, clinical examination, and postcoital testing. Subsequent fertility was determined (controlled for female infertility factors). Result(s): The concentration of zinc in seminal plasma did not correlate in a statistically significant way with leukocytes in semen, nor was it associated with bacterial colonization. There was no statistically significant relationship of zinc in seminal plasma or serum with semen quality parameters nor with local antisperm antibody testing of the IgG or IgA class. Zinc levels did not influence sperm capacity to penetrate cervical mucus in vitro or in vivo, and did not affect subsequent fertility. Conclusion(s): The zinc level in seminal fluid and serum is not associated with silent male genital tract infection (indicated by seminal leukocytes); nor is it related to semen cultures in asymptomatic individuals. The lack of association with other semen quality parameters indicates that the routine determination of zinc levels during infertility investigation is not recommended.

Bacteria in the transfer catheter tip influence the live-birth rate after in vitro fertilization

Objective: To assess the impact of individual bacteria isolated from the vagina and tip of the embryo transfer catheter on live-birth rates. Design: Prospective clinical study. Setting: Infertility outpatient clinic of a university hospital. Patient(s): Ninety-one women undergoing IVF-ET. Intervention(s): Cultures were obtained from the vagina for aerobic and anaerobic bacteria at the time of both sonographic egg retrieval and embryo transfer and from the tip of the embryo transfer catheter. Doxycycline treatment was started after egg retrieval. Main Outcome Measure(s): The live birth of one or more neonates. Result(s): Doxycycline had no substantial impact on the recovery of individual vaginal bacteria or on bacterial vaginosis. An increase in live-birth rate was associated with the recovery of hydrogen peroxide–producing Lactobacillus from the vagina ( P=0.01) and from the embryo transfer catheter ( P=0.01). In contrast, a reduction in live-birth rate was associated with recovery of Streptococcus viridans ( S. viridans) from the embryo transfer catheter tip ( P=0.04). Conclusion(s): In the setting of IVF-ET, prophylactic doxycycline had little effect on vaginal bacteria. Specific bacteria recovered from the embryo transfer catheter appear associated with a detrimental or beneficial effect or with no effect on live-birth rates.

Detection of endometrial pinopodes by light microscopy

Objective: To study the value of light microscopy (LM) in the assessment of endometrial pinopodes. Design: Comparative histologic study. Setting: Outpatient infertility clinic in an academic teaching institution. Patient(s): Eighteen oocyte donors undergoing controlled ovarian hyperstimulation. Intervention(s): Endometrial biopsies on days 14–24 of the cycle. Main Outcome Measure(s): Assessment of pinopodes by scanning electron microscopy (SEM) and of endometrial surface projections by LM. Result(s): The luminal surface was identified by LM in 36 of 38 endometrial specimens obtained. Although apical projections could be recognized in all, they were few, moderate, and abundant in 20, 12, and 4 cases, respectively. Pinopodes were detected by SEM in all 4 samples with abundant projections, but in only 14 of 32 samples with lesser quantities of these surface features. No predictive value could be ascribed to apical projections viewed by LM for the developmental stage of pinopodes as defined by SEM. Conclusion(s): The LM of routine endometrial specimens can serve as a preliminary tool in the evaluation of surface morphology. Although abundant apical projections by LM are compatible with the presence of pinopodes by SEM, the latter modality remains as the definitive method in cases with few or moderate projections and for the evaluation of the stage of pinopode development.

Semen granulocyte elastase: its relevance for the diagnosis and prognosis of silent genital tract inflammation.

Elastase-inhibitor complex was assessed by immunoassay in the seminal plasma of 312 men attending the outpatient infertility clinic. Using receiver operating characteristic (ROC) curve analysis, elastase at the cut-off value of > or =290 ng/ml was shown to be efficient (sensitivity 79.5%, specificity 74.4%) in the detection of genital tract inflammation as defined by leukocytospermia (>1x10(6) leukocytes/ml). The prevalence of increased elastase in 292 infertile men was significantly higher (34%) as compared with that (5%) observed in 20 fertile men (P: = 0.02). Moreover, high elastase concentration (> or =290 ng/ml) was observed in 66 of the 264 men (25%) without leukocytospermia. A significant positive correlation was found between elastase concentration and patient age (r = 0.202, P: < 0.0001) and the number of leukocytes (r = 0.330, P: < 0.0001). A negative correlation was found between elastase concentration and semen volume (r = -0.146, P: = 0.01) and the percentage of spermatozoa with single-stranded DNA (r = -0.194, P: = 0.024), but there was no correlation between elastase and sperm reactive oxygen species production. A higher seminal elastase concentration was significantly associated with tubal damage in female partners (P: < 0.001). After norfloxacine antibiotic therapy, decrease in elastase concentration was observed in 15 (25%) of the 60 treated patients. Tubal damage in the partner negatively affected the response to antibiotic therapy. In conclusion, granulocyte elastase is a reliable screening test for silent genital tract inflammation of the couple. The elastase-inhibitor complex may have a protective effect in reducing sperm DNA denaturation.

Herpes simplex virus infection of the uterine cervix—relationship with a cervical factor?

Objective: To determine the prevalence of genital herpes simplex virus (HSV) in women of reproductive age and to evaluate a potential relation of asymptomatic HSV shedding with a cervical factor. Design: Prospective study. Setting: Outpatient infertility clinic of a university hospital. Patient(s): Randomly chosen asymptomatic women (n = 1,262) with a median age of 30 years. Intervention(s): None. Main Outcome Measure(s): Prevalence of cervical HSV, cervical index parameters, and other variables of CM quality, including CM penetrability in vivo and in vitro. Result(s): The prevalence of HSV infection of the uterine cervix was 5.2% (identified with cell culture). There was a tendency toward increased viscosity of the CM in HSV-positive women, but no significant relation with the other variables of CM quality (amount, spinnbarkeit, ferning, cervical appearance, and cellularity of the CM), or with the summarized Insler score or the cervical index according to World Health Organization guidelines. Postcoital testing and the in vitro penetration test, using either partners’ or donors’ semen, showed that the penetrability of the CM did not differ significantly between women with and without cervical HSV shedding. Asymptomatic cervical HSV infection was not significantly associated with bacterial colonization of the lower genital tract, with leukocyte counts in cervical secretions, with the pH of the CM or the vaginal fluid, or with antisperm antibodies in the CM. Conclusion(s): The results suggest that in asymptomatic women under controlled endocrine conditions, cervical HSV infection is not a significant cause of impaired quality and penetrability of the CM.

Detection of aromatase cytochrome P-450 in endometrial biopsy specimens as a diagnostic test for endometriosis

Objective: To evaluate the clinical usefulness of examining endometrial biopsy specimens for aromatase cytochrome P-450 as a diagnostic test for endometriosis. Design: Retrospective, case-controlled study. Setting: Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Kyoto, Japan. Patient(s): One hundred five women of reproductive age with normal menstrual cycles underwent endometrial biopsy laparotomy or laparoscopy, and examination of their tissue revealed endometriosis, adenomyosis, and/or leiomyomas. Patients who had cervical carcinoma in situ but no other gynecologic disease were considered to be disease-free. Intervention(s): Endometrial biopsy specimens were collected. Main Outcome Measure(s): The expression of aromatase cytochrome P-450 was examined by reverse transcription-polymerase chain reaction and immunohistochemical analysis. The distribution and intensity of the immunostaining was assessed using a semiquantitative index designed H-score. Result(s): Immunostaining for aromatase cytochrome P-450 was detected in biopsy specimens obtained from patients with endometriosis, adenomyosis, and/or leiomyomas but not in specimens obtained from disease-free patients (H-score <20), with a sensitivity and specificity of 91% and 100%, respectively. Conclusion(s): The expression of aromatase cytochrome P-450 in biopsy specimens of eutopic endometrium distinguishes between disease-free women and women with endometriosis, adenomyosis, and/or leiomyomas. This technique can be used at outpatient infertility clinics as an initial screening procedure to rule out the presence of estrogen-dependent disease.

Effect of troglitazone on endocrine and ovulatory performance in women with insulin resistance–related polycystic ovary syndrome

Objective: To investigate the effect of troglitazone, a new antidiabetic agent that improves insulin resistance, on endocrine, metabolic, and ovulatory performance in women with insulin resistance–related polycystic ovary syndrome (PCOS). Design: Prospective clinical study. Setting: Infertility outpatient clinic, Niigata University Hospital, Niigata, Japan. Patient(s): Thirteen women with PCOS and insulin resistance. Intervention(s): Troglitazone (400 mg/d) was administered for 12 weeks. Main Outcome Measure(s): Insulin and other hormone (gonadotropins, androgens) levels; various parameters relating to glucose and lipid metabolism before, during, and after troglitazone administration; and ovulation rate. Result(s): The mean (±SD) fasting insulin concentration was significantly reduced, from 18.3 ± 8.9 to 10.5 ± 7.1 μU/mL. The LH level was reduced from 9.7 ± 3.4 to 4.8 ± 3.9 mIU/mL and the testosterone level was reduced from 0.9 ± 0.5 to 0.5 ± 0.3 ng/mL in accordance. Atherosclerotic lipid levels also were normalized. Before troglitazone administration, the ovulation rate during clomiphene citrate therapy was 34.9% per cycle (15/43). This increased significantly to 72.7% (8/11) during troglitazone coadministration. Further, an ovulation rate of 42.3% (11/26) was achieved with troglitazone alone. Conclusion(s): In women with PCOS and insulin resistance, the reduction of hyperinsulinemia that is produced by troglitazone improves the hyperandrogenism that characterizes PCOS, restoring ovulation.

Follicle aspiration with interactive three-dimensional digital imaging (Voluson): a step toward real-time puncturing under three-dimensional ultrasound control

Objective: To evaluate the possibility of performing puncturing procedures under three-dimensional ultrasound (US) control in close to real time using a new commercially available system and to describe the technique. Design: Descriptive case study. Setting: Private outpatient infertility clinic. Patient(s): A volunteer undergoing IVF-ET treatment. Intervention(s): Transvaginal needle-guided aspiration of 10 follicles using a newly developed US machine with a built-in rapid and powerful calculation software program for three-dimensional interactive volume and flow translation during operation. Interactive three-dimensional imaging was carried out during the aspiration of each follicle. Main Outcome Measure(s): The delays caused by volume acquisition and the search for the needle tip with and without “power Doppler” were estimated and compared. Result(s): Oocyte recovery was successful from all follicles. There was a mean (±SD) delay of 5.00 ± 1.22 seconds from coasting to resuming real-time US scanning during interactive volume calculation and the search for the needle tip in the three-dimensional mode. This did not delay the procedure remarkably but enabled the precise localization of both the needle and its tip after each penetration. The integration of flow signals allowed an impressive color-coded demonstration of the needle within the tissue, but the delay was significantly longer for color-coded volume acquisition (18.40 ± 4.56 seconds). Conclusion(s): Recent technology enables the performance of three-dimensional puncture procedures in close to real time; this technology is demonstrated for follicle punctures but will be of more importance in fields such as fetal medicine, oncology, and surgery.

A randomized study comparing air to Echovist(R) as a contrast medium in the assessment of tubal patency in infertile women using transvaginal salpingosonography

This study was undertaken to compare two different contrast media (air and Echovist) in the assessment of tubal patency using transvaginal salpingosonography (TSSG) in 32 infertile women referred to an infertility outpatient clinic. Altogether, 59 Fallopian tubes were examined with TSSG. Laparoscopic chromopertubation was used as a reference method. In group A (air), concordance was 90%, Cohen's kappa coefficient 0.71 [95% confidence interval (CI): 0.64-0.77], sensitivity 63%, specificity 100%, negative predictive value 88% and positive predictive value 100%. In group B (Echovist), the corresponding parameters were as follows: 93%, 0.71 (CI: 0.67-0.76), 60, 100, 93 and 100% respectively. No statistically significant differences were found between these two contrast media. Either one can reliably be used for assessing tubal patency with TSSG in infertile women as a primary phase examination modality.

In vitro platelet function in controlled ovarian hyperstimulation cycles

Objective: To determine the effects of elevated endogenous E 2 levels on in vitro platelet function in patients undergoing controlled ovarian hyperstimulation (COH). Design: Women with normal ovulatory cycles and patients undergoing COH on cycle day 3 and near ovulation (preovulatory follicles were at least 16 mm in diameter) were studied. Serum E 2, Thrombostat 4000, (V. d. Goltz, Seeon, Germany), von Willebrand factor antigen (vWF-Ag), and platelet aggregation and adenosine triphosphate (ATP) release to adenosine diphosphate (ADP), collagen (COL), and arachidonic acid (AA) were measured. Setting: University-based outpatient infertility clinic. Patient(s): Twenty-two consenting infertile women undergoing COH cycles and 14 women with documented ovulatory cycles. Main Outcome Measure(s): Whole blood platelet aggregation with ADP, COL, AA, and Thrombostat 4000. Result(s): Estradiol levels rose significantly at peak times (P = 0.011). No changes were noted in in vitro platelet function measured by the Thrombostat 4000 and by whole blood platelet aggregation with ADP and AA and in ATP release with ADP, COL, or AA. Aggregation with collagen was increased because of likely elevations in vWF-Ag levels. Conclusion(s): No significant changes in in vitro platelet function were noted in 19 women undergoing COH with E 2 levels two to three times that observed in oral contraceptive or hormone replacement therapy users, suggesting no increased risk for arterial thromboembolism.