Postoperative Pregnancy Rate Research Articles

Application of DDI in prediction of fertility outcome after laparoscopic myomectomy

Objective: To analyze the application of difficulty degree index (DDI) in predicting patients's fertility outcome after laparoscopic myomectomy. Methods: A retrospective study was carried out on 118 patients with subserous myoma or intramural myoma undergoing laparoscopic myomectomy from January 2005 to December 2014. The rate of post-operative pregnancy, delivery outcome and disease recurrence were investigated. Logistic regression analysis was used to analyze the impact of DDI, the age of patients undergoing surgery, presence of infertility history etc, on the patients' reproductive outcome following the surgery. Results: Follow-up for 1 to 10 years,118 cases were included in the study, the rate of post-operative pregnancy, live birth, vaginal delivery were 72.9% (86/118) , 52.5% (62/118) and 24.2% (15/62) respectively. No cases of uterine rupture and obstetric complications occurred. Univariate analysis showed that the independent variables of post-operative pregnancy rate were DDI, patient's age at the time of surgery, presence of infertility history and myoma recurrence (all P<0.05) . In multivariate analysis, the factors of post-operative pregnancy rate were DDI (OR=3.131, 95%CI:1.012-8.894) , patient's age at the time of surgery (OR=2.722, 95%CI:1.048-7.067) and presence of infertility history (OR=8.509, 95%CI: 2.102-34.445) . Conclusions: DDI could be applied to predict post-operative pregnancy rate, with the increasing of DDI the post-operative pregnancy rate decreasing. The patients with high DDI scores, age>35 years old or presence of infertility history should get ready for pregnancy positively.

High postoperative fertility rate following surgical management of colorectal endometriosis.

STUDY QUESTIONWhat are fertility outcomes in patients surgically managed for large deep endometriosis infiltrating the rectum who intend to get pregnant postoperatively?SUMMARY ANSWERSurgical management for rectal endometriosis is followed by high pregnancy rates, with a majority of natural conceptions.WHAT IS KNOWN ALREADYOptimal management such as surgery versus first-line ART for patients with severe deep endometriosis who desire pregnancy is not defined.STUDY DESIGN, SIZE, DURATIONThe study included the patients enrolled in ENDORE randomized trial who attempted pregnancy after the surgery. From March 2011 to August 2013, we performed a two-arm randomized trial, enrolling 60 patients with deep endometriosis infiltrating the rectum up to 15 cm from the anus, measuring more than 20 mm in length, involving at least the muscular layer in depth, and up to 50% of rectal circumference. Postoperative follow-up was prolonged in 55 patients recruited at Rouen University Hospital, and varied from 50 to 79 months. No women were lost to follow-up.PARTICIPANTS/MATERIALS, SETTING, METHODSPatients had either conservative surgery by shaving or disc excision, or radical rectal surgery by segmental resection. One gynecologist experienced in deep endometriosis surgery performed all the procedures, assisted when required by three general surgeons experienced in colorectal surgery. Institutional review board approval was obtained to extend postoperative follow-up to 10 years after the surgery. Among patients enrolled at Rouen University Hospital, women who intended to get pregnant after surgery were selected and followed up postoperatively every 6 months for 2 years, then every year. Pregnancy intention, fertility outcomes, conception mode, endometriosis recurrences and digestive and urinary outcomes were rigorously recorded. The primary outcome was postoperative pregnancy rate. Secondary outcomes were conception mode, the delay to conception from the day of surgery and the day when hormonal treatment was stopped, and delivery rate. Kaplan Meier curves were used to estimate the probability of conception after surgery.MAIN RESULTS AND THE ROLE OF CHANCEAmong the 55 patients enrolled at Rouen University Hospital, 25 had conservative and 30 had radical surgery, and their postoperative follow-up varied from 50 to 79 months. No patient was lost to follow-up. Among the 55 patients, 36 intended to get pregnant after surgery, 23 of whom had unsuccessfully attempted to conceive for more than 12 months before surgery (63%). At the end of follow-up, 29 patients achieved pregnancy (81%), and natural conception was recorded in 17 of them (59% of conceptions). As several women had more than 1 pregnancy (range: 0–3), we recorded 37 pregnancies, 24 natural conceptions (65%) and 29 deliveries (78%). The probabilities of achieving pregnancy at 12, 24, 36 and 48 months postoperatively were 33.4% (95% CI: 20.6–51.3%), 60.6% (44.8–76.8%), 77% (61.5–89.6%) and 86.8% (72.8–95.8%), respectively. Women who had been advised to attempt natural conception achieved pregnancy significantly earlier than patients referred for ART (P = 0.008). In infertile patients, the postoperative pregnancy rate was 74%, and 53% of conceptions were natural.LIMITATIONS, REASONS FOR CAUTIONThe main outcomes of the original trial were related to digestive function and not to fertility. Several factors impacting fertility could not be revealed due to small sample size. The study included a high percentage of young women with an overall satisfactory prognosis for fertility, as patients’ median age was 28 years. The inclusion of only large infiltrations of the rectum does not allow the extrapolation of conclusions to small nodules of <2 cm in length. Only one skilled gynecologic surgeon performed all the procedures.WIDER IMPLICATIONS OF THE FINDINGSFirst-line surgery can be considered in patients with deep endometriosis infiltrating the rectum and pregnancy intention. Patients receiving advice from experienced surgeons on conception modes were more likely to conceive faster after surgery.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by a grant from the clinical research program for hospitals (PHRC) in France. The authors declare no competing interests related to this study.TRIAL REGISTRATION NUMBERThe original randomized trial is registered with ClinicalTrials.gov (number NCT 01291576).

Utility of Laparoscopic Uterine Myomectomy as a Treatment for Infertility with No Obvious Cause Except for Uterine Fibroids.

Objectives:Uterine fibroids are capable of causing infertility, but there are no definite criteria for which laparoscopic uterine myomectomy (LM) is known to be beneficial. To investigate the usefulness of LM, we examined pregnancy rates in patients with infertility with no obvious cause except for the presence of uterine fibroids.Materials and Methods:We retrospectively reviewed the clinical records at Suzuki Memorial Hospital between June 2010 and August 2014. We found 60 eligible patients (LM group, 46; non-LM group, 14). The criteria for performing LM were a maximal fibroid diameter of 40 mm or more or the presence of >4 fibroids.Results:The duration of infertility before the first visit was significantly longer in the LM group; although there was no significant difference in the mean patient age and body mass index. Pregnancy was achieved in 45.7% of patients (21/46) in the LM group and 28.6% (4/14) in the non-LM group. There were no pregnancies in patients with >10 fibroids. The postoperative pregnancy rate in the LM group was comparable to previously reported pregnancy rates.Conclusions:Our criteria for performing LM in patients with no obvious cause for infertility except for uterine fibroids seem appropriate, especially when the fibroids are large and the number of fibroids is between 4 and 9. However, our results suggest that the effectiveness of LM is low in patients with 10 or more uterine fibroids.

Clinical effect of laparoscopic surgery combined with gonadotropin-releasing hormone agonist in the treatment of endometriosis

Objective To investigate the clinical efficacy of laparoscopic surgery combined with gonadotropin-releasing hormone agonist (GnRH-a) in the treatment of endometriosis (EMs). Methods 86 patients with EMs were selected as study subjects.The patients were divided into two groups by random number table.43 patients in the control group underwent laparoscopic surgery, while 43 patients in the observation grouop received GnRH-a treatment based on laparoscopic surgery, and the clinical effect was analyzed. Results The total effective rate was 93.02% in the observation group, which was significantly higher than 72.09% in the control group.The recurrence rate in the observation group was 11.63%, which was significantly lower than 32.56% in the control group, the difference was statistically significant (χ2=7.55, 8.41, all P<0.05). After treatment, the levels of FSH, LH, and E2 of the observation group were (1.71±0.64)U/L, (2.66±0.75)U/L, (96.72±14.51)pmol/L, respectively, which were significantly lower than before treatment (t=8.80, 7.80, 7.55, all P<0.05), and the differences were statistically significant compared with the control group (t=8.55, 7.48, 7.19, all P<0.05). The total pregnancy rate of the observation group was 70.59%, which was significantly higher than 38.71% of the control group, the difference was statistically significant (χ2=7.77, P<0.05). The pain relief rate, dysmenorrhea rate, remission rate of chronic pelvic pain in the observation group were 90.70%, 86.05%, 93.02%, which were significantly higher than those in the control group (χ2=6.55, 7.01, 7.88, all P<0.05). The incidence rate of adverse reactions in the observation group was 11.63%, which was significantly lower than 27.91% in the control group, the difference was statistically significant (χ2=7.06, P<0.05). The main adverse reactions were hot flashes sweating, vaginal dryness, insomnia, fatigue and other low estrogen symptoms, which could tolerate, after treatment to relieve or disappear, liver and kidney function tests had no abnormalities. Conclusion Laparoscopic surgery combined with GnRH-a in the treatment of endometriosis can improve the treatment effect, improve the symptoms and reproductive hormone levels, improve the postoperative pregnancy rate, reduce the recurrence rate, and with high safety, it is worthy of clinical promotion and application. Key words: Endometriosis; Laparoscopic surgery; Gonadotropin-releasing hormone agonists

Does preoperative antimüllerian hormone level influence postoperative pregnancy rate in women undergoing surgery for severe endometriosis?

To compare postoperative pregnancy rates as they relate to presurgery antimüllerian hormone (AMH) level in patients with stage 3 and 4 endometriosis. Retrospective comparative study using data prospectively recorded in the North-West Inter-Regional Female Cohort for Patients with Endometriosis (CIRENDO) database. University tertiary referral center. One hundred eighty patients with stage 3 and 4 endometriosis and pregnancy intention, managed from June 2010 to March 2015, were divided into two groups according to their preoperative AMH levels: group A (AMH ≥2ng/mL) and group B (AMH <2ng/mL). Surgical procedure involved ovarian endometrioma ablation by plasma energy along with resection of various localizations of the disease. Postoperative conception was either spontaneous or used assisted reproductive technology, depending on patient characteristics. Patient characteristics, preoperative symptoms, infertility history, intraoperative findings, and probability of pregnancy were recorded and compared between the two groups. Among 180 women enrolled in the study, 134 (74.4%) were assigned to group A and 46 (25.6%) to group B. The women's ages were, respectively, 30 ± 3.8 and 32 ± 4.6years. Pregnancy was achieved by 134 (74.4%) patients, and conception was spontaneous in 74 of them (55.2%). Pregnancy rates in groups A and B were, respectively, 74.6% (100 women) and 73.9% (34 women), while spontaneous conception represented 54% (54 women) and 58.8% (20 women). The probability of pregnancy at 12, 24, and 36months after surgery in groups A and B was comparable, respectively, 65% (95% confidence interval [CI], 55%-75%), 77% (95% CI, 86%-68%), and 83% (95% CI, 90%-75%) versus 50% (95% CI, 69%-34%), 77% (95% CI, 90%-61%), and 83% (95% CI, 94%-68%). Supplementary analysis in women with normal (≥2ng/mL), low (1-1.99ng/mL), and very low (<1ng/mL) AMH level showed an inverse relationship between AMH level, age, and antecedents of miscarriage; however, postoperative pregnancy rates were comparable among the three groups at 12 and 24months, respectively, 59.5% (95% CI, 49.3%-70%) and 77.4% (95% CI, 68%-85.4%); 57.1% (95% CI, 34%-83%) and 78.6% (95% CI, 55.2%-94.8%); and 46.7% (95% CI, 25.6%-73.7%) and 73.3% (95% CI, 50.4%-91.7%). The probability of postoperative pregnancy was comparable between women with low and normal AMH level who were managed for stage 3 and 4 endometriosis and who were a mean age of 30years. However, the small sample size might have been unable to detect differences in pregnancy and live-birth rates between the two groups. As the majority of pregnancies were spontaneous, our results suggest that surgical management may be offered to young patients with severe endometriosis and reduced ovarian reserve with good fertility outcomes.

Clinical observation of fallopian tube obstruction recanalization by ozone.

Objective:To investigate the clinical effect of fallopian tube obstruction recanalization by ozone.Methods:Total 116 cases of patients undergoing the fallopian tube obstruction were randomly divided into the experimental group and control group, with 58 cases in each group. All patients underwent the interventional fallopian tube recanalization. The patients in the experimental group underwent the fallopian tube perfusion by the ozone water. Meanwhile, the patients in the control group were treated with the conventional anti-inflammatory and anti-adhesion drugs. After the follow-up visit for 6 months, the pregnancy rate and fallopian tube re-occlusion rate were counted and compared between the two groups. Meanwhile, the symptoms were evaluated and compared between the two groups after the operation for two weeks.Results:The success rate of fallopian tube recanalization was 93.1% (54/58), the pregnancy rate was 79.3% (46/58) and the recurrence rate was 5.2% (3/58) in the experimental group. While the success rate of fallopian tube recanalization was 91.4% (53/58), the pregnancy rate was 60.3% (35/58) and the recurrence rate was 17.2% (10/58) in the control group. Analysis showed that there was no significant difference in the recanalization success rate between the two groups (P>0.05). However, the pregnancy rate and re-occlusion rate in the experimental group were significantly lower than those of the control group (P<0.05), and the difference was statistically significant. There was no significant difference in the discomfort symptoms between the experimental group and control group (P>0.05).Conclusion:Fallopian tube recanalization by ozone perfusion can effectively increase the postoperative pregnancy rate and reduce the fallopian tube re-occlusion.

Postvasectomy reversal semen analysis: a predictor of pregnancy

Vasectomy reversal (VR) is commonly performed on men who wish to regain fertility after elective sterilization. Despite a thorough understanding of predictors of vasal patency after surgery, little is known about the predictors of pregnancy post vasectomy reversal. The aim of this study is to investigate the postoperative pregnancy rate and explore semen analysis reference values associated with it. A retrospective study. The records of 171 patients who underwent VR at the Glickman Urological and Kidney Institute from 2011-2014 were reviewed. Data regarding patient/spouse age, obstructive interval, intraoperative findings, procedure performed, postoperative semen results and spontaneous pregnancy outcome was collected. Pearson’s test was used to analyze categorical data, while appropriate T-tests were used to examine numerical data. A p-value of <0.05 was considered significant. Analysis was performed using the SPSS software, version 21. The mean obstructive interval was 9.5 ± 1.2 years. Spontaneous pregnancy was achieved by 49.6% (69/139) of patients and was directly related to better intraoperative sperm quality and postoperative sperm concentration, total motility and normal morphology (p<0.001). The reference ranges of postoperative semen parameters of patients with spontaneous pregnancy were presented in table 1. Spontaneous pregnancy was reported by 15% of patients with a sperm concentration <5million/ml; 21.3% patients with total sperm motility <10% and 14.8% of patients with normal morphology <1% (p<0.001). Semen parameters associated with pregnancy after vasectomy reversal are significantly lower than reference ranges reported in the WHO 2010 normal ranges. Consideration of these ranges allows better post reversal counseling of patients.Tabled 1Reference values of semen parameters from patients with documented pregnancy post VRCentiles5th95% CI10th25th50th75th95thVolume0.740.4-1.41.281.622.53.45.9Sperm Concentration3.560.1-5.895.1713.123.745.5119.6Total Motility4.453-7.35.91325.537.763.2TMC0.580.1-1.60.824.714.742.7152.2Normal Forms00-11135.7514.1 Open table in a new tab

Reproductive performance after hysteroscopic metroplasty in infertile women: complete versus partial uterine septum

Objective: To investigate the impact of hysteroscopic metroplasty on pregnancy outcome in women with complete or incomplete uterine septum (US) accompanying infertility. Materials and Methods: Seventy-three patients who had hysteroscopic metroplasty for complete and incomplete US with primary and secondary infertility were reviewed. Obstetric outcomes (number of pregnancies, live births, and miscarriages) up to 36 months follow up period were investigated. Results: Twenty-five patients in complete US and 28 patients in incomplete US became pregnant in 36 months follow up. Postoperative miscarriage rate was significantly lower in patients with complete US (p = 0.0001, p = 0.0001, respectively). The mean gestational week at the time of birth and mean birth weight of the infants were significantly lower in patients with complete US compared to the incomplete US cases (p = 0.026, p = 0.049, respectively). Postoperative pregnancy rate was significantly lower in incomplete US patients with primary infertility compared with secondary infertility (p = 0.037). Conclusion: Hysteroscopic metroplasty improves fertility and pregnancy performance. This improvement is more prominent in patients with complete US, and incomplete US patients with secondary infertility.

Clinical analysis of efficacy and quality of life of segmental bowel resection for bowel endometriosis

To evaluate the efficacy and quality of life of segmental bowel resection for bowel endometriosis. Totally 62 symptomatic patients with bowel endometriosis undergoing segmental bowel resection were recruited. A visual analogue scale(VAS)and the 36-item short form health survey(SF-36)questionnaire were administered before and at least 1 year after surgery, respectively. Pregnancy rates were also recorded. Sixty-two patients in total underwent follow-up ranging from 12 to 74 months. All patients complained of obvious pain symptoms, including dysmenorrhea, dyspareunia, pain on defecation and chronic pelvic pain. The relief of dysmenorrhea(2.9 ± 2.2 versus 7.5 ± 2.9), dyspareunia(0.7 ± 0.5 versus 4.3 ± 2.2)and pain on defecation(1.6 ± 0.7 versus 7.3 ± 1.9)after surgery was statistically significant(all P<0.01). The scores for all 8 domains of the SF-36 questionnaire were significant improved after segmental bowel resection(all P<0.01). The complication rate was 45%(28/62), including 18 cases of urinary retention, 4 rectovaginal fistulas, 2 cases of vaginal dehiscence, and 1 case each of thrombogenesis, pelvic abscess and general peritonitis. All of the patients with complications recovered well throughout follow-up. The postoperative pregnancy rate of the previous infertile patients was 6/10. Among the 6 gestational cases, 2 had labour, 2 underwent caesarean sections, one had a spontaneous natural abortion, and one underwent uterine curettage. Segmental bowel resection could significantly relieve pain and improve quality of life for patients with bowel endometriosis.

The role of testicular artery in laparoscopic varicocelectomy: a systematic review and meta-analysis.

We performed this meta-analysis to evaluate the efficacy and safety of artery preserving versus artery non-preserving in laparoscopic varicocelectomy. All publications up until October 2015 were searched in PubMed, EMBASE, Ovid, Web of Science, and Cochrane library. Randomized controlled trials (RCTs) and cohort studies (CSs) that compared the difference in two operative approaches in laparoscopic varicocelectomy were included. Statistical analysis was performed using Stata version 12.0. A total of four RCTs and ten CSs involving 503 cases with artery preserving and 911 cases with artery non-preserving met our inclusion criteria. Meta-analysis showed that artery preserving had higher recurrence rate [risk ratio (RR)=2.91, 95% confidence interval (CI) 1.83-4.61; P=0.000], lower incidence of hydrocele formation (RR=0.18; 95% CI 0.08-0.42; P=0.000), and prolonged operating time [standard mean difference (SMD)=1.27; 95% CI 0.17-2.37; P=0.023], compared with artery non-preserving in laparoscopic varicocelectomy. The results were similar in postoperative catch-up growth (RR=1.00; 95% CI 0.86-1.17; P=0.985) and testicular atrophy (RR=0.36; 95% CI 0.09-1.54; P=0.169). Besides, no significant difference was found in sperm concentration, motility, and normal morphology between two groups, as well as on postoperative pregnancy rate (RR=0.95; 95% CI 0.65-1.40; P=0.809). With the advantages of less recurrence, easier operating and less time spending, and comparable results in other respects, artery non-preserving is preferable to artery preserving in laparoscopic varicocelectomy, although there is a relatively high incidence of hydrocele formation. Considering the limitation of included studies, more large-scaled RCTs are required to confirm the present findings.

Curative effect analysis of hysteroscopy combined with laparoscopy in the diagnosis and treatment of refractory polycystic ovarian syndrome complicated with infertility

Objective To investigate the effect and necessity of hysteroscopy combined with laparoscopy in the diagnosis and treatment of refractory polycystic ovarian syndrome complicated with infertility. Methods 80 cases of patients with polycystic ovary syndrome(PCOS)combined with infertility were randomly divided into two groups with 40 cases in each group. The testing group used hysteroscopy combined with laparoscopy in diagnosis and treatment while the laparoscopy was only used in the control group. The changes of ovary, ovarian follicles and serum hormone level of the two groups which before and after operation were compared, and the data of postoperative normal ovulation rate, pregnancy rate and abortion rate of the two groups were recorded. Results The follicle number and ovarian volume of the testing group were significantly decreased than that before treatment, and were significantly lower than that of the control group, with statistical difference(t=3.82,3.80,3.74,3.75,all P<0.05). The serum T, LH and LH/FSH of the testing group were significantly decreased than the data before surgery, and were significantly lower compared to the control group with statistical difference(t=9.32,4.06,3.80,all P<0.05). The normal ovulation rate, pregnancy rate and abortion rate of the testing group were significantly higher compared to the control group(90.0%,62.5%and 7.5%vs.72.5%,50%and 15%)χ2=4.02,4.10,3.90,all P<0.05). Conclusion Hysteroscopy combined with laparoscopy has an obvious curative effect in the diagnosis and treatment of polycystic ovary syndrome combined with infertility, which can effectively improve ovulation rate and pregnancy rate and reduce the abortion rate, is worthy of clinical application. Key words: Polycystic ovary syndrome; Sterilec(female); Hysteroscopy; Laparoscopy

Comparison of curative effect of three kinds of operation method for varicocele

Objective To evaluate clinical application value and curative effect of laparoscopic,retroperitoneal open operation and microscopical treatment of varicocele.Method 85 cases of varicocele who were treated with three kinds of operation method in our hospital from 2005 to 2013 were randomly selected.Results All patients selected had fast recovery after surgery,without recurrence and atrophy of testis.Sperm quality in 77 patients improved in varying degrees after surgery.Sperm count and activity rate after operation were significantly higher than those before operation,with statistically significant difference (P ＜ 0.01).Postoperative pregnancy rate was 25％.Spermiogenesis function in 8 patients did not improve obviously after surgery,whose preoperative sperm count was ＜ 10 × 106/ml.Conclusions Regardless of the degree of varicocele,once bad semen quality is found,and other causes ruled out,operation should be taken as soon as possible.There is no difference between three kinds of operation method for side varicocele,laparoscopic surgery is more appropriate for recurrent and bilateral varicocele. Key words: Varicocele; Three kinds of operation method; Male infertility

Effects of laparoscopic ovarian endometriosis cystectomy combined with postoperative GnRH-a therapy on ovarian reserve, pregnancy, and outcome recurrence

Objective: The aim of this study was to investigate the impacts of laparoscopic ovarian endometriosis cystectomy combined with postoperative GnRH-a therapy on ovarian reserve, pregnancy outcome and recurrence. Materials and Methods: This was a prospective control study. The experimental group: 63 patients with combinations of laparoscopic bilateral ovarian endometrial cystectomies and gonadotropin-releasing hormone agonist (GnRH-a) treatment for three months. Control group: 62 patients with laparoscopic bilateral ovarian endometrial cystectomies. Benchmarks: the changes of follicle stimulating hormone (FSH) and FSH / luteinizing hormone (LH), etradiol (E2) in preoperative and postoperative three months or menstrual two to three days, menstrual two to three days after surgery, natural pregnancy, and cyst recurrence in 18th month during postoperative follow-up. Results: In experimental group after six months, the percentage of returned FSH accounted for 95.3% of normal range, in the control group it was 82.2%, and the difference was significant (p 0.05). The natural pregnancy rate of preoperative infertility patients (57.1%) was higher than the control (36.8%) (p 0.05). The recurrence rate of preoperative infertility patients (12.7%) was lower than the control (27.4%) (p 0.05). Conclusion: After bilateral laparoscopic ovarian endometrial cystectomy, an implement of GnRH-a therapy can improve the postoperative pregnancy rate, which changes with clinical stage and patient age, reduces ovarian recurrence, and its influence on ovarian reserve is lesser.

Difference in post-surgical reproductive prognosis between transcervical resection and transcervical incision of the septum

Objective: This study aims to determine the difference between transcervical resection of septum (TCRS) and transcervical incision of septum (TCIS) in the improvement of reproductive prognosis. Study Design: Women with uterine septum in the Affiliated Hospital of Ningxia Medical University were retrospectively analyzed. A statistical method was used according to operative time, postoperative menstruation, postoperative pregnancy rate, postoperative term delivery rate, and so on. Results: Compared with TCRS, the TCIS method decreased operative time, blood loss, and consumption of uterus distension medium. No statistical difference was observed in operative complications between the two methods. After TCIS, the incidence of uterine adhesion was low and the degree of endometrial epithelialisation was high by hysteroscopy review. No statistical difference was observed in residual septum after the operation. The total pregnancy rate after TCIS was higher than that of TCRS. However, no statistical difference was observed in early and late pregnancy loss rates, preterm birth rate, and term birth rate. Conclusion: TCIS exhibits advantages of decreasing operative time, blood loss, and consumption of uterus distension medium. TCIS can reduce the incidence of uterine adhesion and can promote endometrial epithelialisation, which are the key factors to increase pregnancy rate after operation.

Efficacy of spermatic vein ligation in patients affected by high grade left varicocele

To study the effect of high grade varicocele treatment in infertile patients. Seventy-five patients were selected by the following criteria: infertility persisting for more than 1 year; abnormal semen parameters; no other infertility-related disease; no obvious causes of infertility in the subject's partner; basal eco-color Doppler ultrasound demonstrating continuous reflux in the spermatic vein. All patients considered for the study had at least a six months period from the diagnosis to the surgery due to waiting list, choice of the patient or time needed to complete diagnostic evaluation of the couple. The surgical procedure was performed through an inguinal approach. All enrolled patients were counseled to have unprotected intercourse during the ovulation period in order to maximize the probability of pregnancy within the 6-month preoperative period. The achievement of pregnancy and semen parameters were recorded during the preoperative and postoperative period. Two of the seventy-five patients were excluded because of persistent varicocele after surgery. The preoperative pregnancy rate was 1.3% (1 couple). The postoperative pregnancy rate was 42.5%. The stratification of pregnancies by semester showed a significantly higher rate in the first postoperative period (p = 0.0012). Mean time to conception was 13.5 months. Mean preoperative sperm count was 17.6x10(6)/mL compared to 19.7x10(6)/mL in the postoperative period (p < 0.0001). Mean percentage of progressive sperm motility was 13.7%, compared to 17.6% in the postoperative period (p < 0.0001). Mean percentage of normal sperm morphology was 7.6%, compared to 15.2% postoperatively (p < 0.0001). Surgical treatment of high grade varicocele proved to effectively treat associa¬ted infertility by improving seminal parameters and pregnancy rate in our patient cohort.

Long-term reproductive performance after surgery for ovarian endometrioma

ObjectiveTo determine the long-term impact of different types of endometrioma surgery on reproductive performance and on age of menopause. Study designThis was a longitudinal observational cohort study of 68 women with previous endometrioma surgery and 68 age- and weight-matched healthy controls. All participants’ hospital records were reviewed and each woman completed a questionnaire and attended an interview. Pregnancy rates were compared between the study and control groups. In the study group, pregnancy rates were compared before and after surgery. ResultsAmongst the 38 women desiring pregnancy after endometrioma surgery, 19 (50%) achieved a spontaneous pregnancy during the follow-up period. This was not significantly different from a pre-operative pregnancy rate of 48% (22/46). Of these 19 patients, four achieved another pregnancy with fertility treatment. An additional eight patients conceived only with the help of fertility treatment, giving an overall long-term post-operative pregnancy rate of 71% (27/38). These results were significantly lower (p=0.0001) than the 98% (57/58) long-term natural pregnancy rate in the control group. Pregnancy rates in patients receiving fertility treatment significantly (p=0.001) increased from 7% (1/15) before surgery to 63% (12/19) post-operatively. In post-menopausal women, the median (quartile) age at menopause was similar in the study (n=9) and control groups (n=6) [48 (45–52) versus 49 (44–52) years, respectively]. ConclusionEndometriomas per se appear to be the main cause of the reduced long-term reproductive performance of the affected patients, with little or no contribution from surgery. Furthermore, endometrioma surgery seems to improve the success rates of fertility treatment.

Role of Surgery in Endometriosis-Associated Subfertility

Analysis of published series reveals that no more than a fourth of subfertile patients undergoing surgery for peritoneal endometriotic implants, rectovaginal endometriotic lesions, or recurrent endometriomas achieved conception spontaneously. First-line surgery for ovarian endometriotic cysts appears associated with a better reproductive performance, that is, a mean postoperative pregnancy rate of ∼50%. At the same time, excision of endometriomas paradoxically seems to induce gonadal damage. With the exception of peritoneal disease, no randomized trials are available to assess the effect of surgery in subfertile women with endometriosis. Therefore, it is not possible to define the absolute benefit increase of the treatment of ovarian and rectovaginal lesions. The decision to undergo surgery for endometriosis-associated subfertility must be shared with the woman after detailed information and taking into account several additional conditions, such as presence of pain, large or complex adnexal masses, bowel or ureteral stenosis, and coexisting infertility factors. When considering surgery, a therapeutic equipoise should be reached that includes demonstrated benefits, potential morbidity, and costs of treatment alternatives. Particularly in case of recurrent endometriosis, in vitro fertilization should generally be preferred to surgery. The role of surgery in endometriosis-associated subfertility includes temporary pain relief in symptomatic women desiring a spontaneous conception.

Hysteroscopic Transcervical Resection of Uterine Septum

To explore the method of diagnosis for uterine septum and the clinical effect of hysteroscopic transcervical resection of the septum. One-hundred ninety cases of patients with uterine septum who were diagnosed and treated at our hospital during 2007-2011 were selected, and their general information, perioperative status, postoperative recovery treatment, and postoperative pregnancy rates were statistically analyzed. All 190 patients were cured with one surgery, with an average hysteroscopic operating time of 22.60 ± 10.67 minutes and intraoperative blood loss of 15.74 ± 9.64 mL. There were no complications such as uterine perforation, water intoxication, infection, or heavy bleeding. Among the 115 patients that we followed up, 86 became pregnant and delivered infants, 81 of which were born at term and 5 that were born premature. The combination of hysteroscopy and laparoscopy is still the most reliable method for the diagnosis of uterine septum. With a shorter operative time, less blood loss, a significantly increased postoperative pregnancy rate and live birth rate, and a significantly lower spontaneous abortion rate, transcervical resection of the septum was the preferred method for the treatment of uterine septum, and surgical instruments and skills were critical to the prognosis of uterine septum.

Application of treatment of laparoscopy combined with Zoladex to prevent endometriosis and nursing

Objective To study the effect of Zoladex therapy after endometriosis.Methods Totals of 174 cases with Ⅲ-Ⅳ endometriosis after laparoscopic surgery were randomly divided into experimental group (n =82),which received Nored therapy after endometriosis surgery and lasting 6 months,and control group (n =92)without any drug treatment.All patients were monthly followed up by telephone for two years,and postoperative recurrence rate and pregnancy rate in patients with infertility were observed and compared.Results After two years,the recurrence rate of experimental group was 23.17％,and that of control group was 51.09％,and the difference was statistically significant (P ＜ 0.05).The pregnancy rate of experimental group was 80.00％ significantly higher than 46.67％ of control group (x2 =6.419,P ＜ 0.05).Conclusions The endometriosis treated with Nored therapy is important for the patients which can effectively reduce the relapse rate,increase the rate of pregnancy,so as to the careful and effective nursing care to patient outcomes. Key words: Endometriosis; Laparoscopy; Recurrence; nursing; Nored

Clinical observation on the effect of hysteroscopy combined with laparoscopy in treatment of 102 patients with infertility

Objective To investigate the role of hysteroscopy combined with laparoscopy in treatment of infertility.Methods 102 patients with infertility treated by hysteroscopy combined with laparoscopy were retrospectively analyzed.Results Of 102 cases of infertility,there were 57 cases with Pelvic adhesions and tubal obstruction,24 cases with endometriosis,12 cases with polycystic ovary syndrome,4 cases with endometrial polyp,3 cases with hysteromyoma and 2 cases with uterus septum.The first three cases were chronic pelvic inflammatory with salpingemphraxis ( 55.88% ), endometriosis Ⅰ -Ⅱ (23.53% ) and polycystic ovary syndrome (11.76% ).The postoperative pregnancy rate was 41.18%, 3 patients with ectopic pregnancy (7.14%) and 4 spontaneous abortion (9.52%).Conclusion Laparoscopy with hysteroscopy played an important role in treatment of infertility.It was an effective method and worthy to be widely used. Key words: Hysteroscopy; Laparoscopy infertility; Pregnancy