Success Rate In Women Research Articles

Degree of TNF-α/IL-10 Cytokine Elevation Correlates With IVF Success Rates in Women Undergoing Treatment With Adalimumab (Humira) and IVIG

In this retrospective observational study, we investigate whether the degree of preconception cytokine elevation predicts the risk of IVF failure. Seventy-six women undergoing fresh IVF/ICSI cycles (≤41 years, good responders with ≥5 embryos on day 3, each with ≥5 cells with a normal endometrium) and preconception tumor necrosis factor (TNF)-α/IL-10 cytokine elevation [PMA/ionomycin stimulated CD3(+) CD8(-) ; TNF-α/IL-10 ratio above 30.6 (normal range 13.2-30.6)] were retrospectively evaluated. This high cytokine population was divided into two subgroups. Group I included 39 women with severe preconception and pre-treatment TNF-α/IL-10 cytokine elevation >39.0 (mean 47.5 ± 7.5 pre-treatment, mean 31.5 ± 9.4 post-treatment) treated with preconception Adalimumab (Humira(®) ) and intravenous immunoglobulin (IVIG). Group II included 37 women with a moderate TNF-α/IL-10 ratio >30.6 and ≤39.0 (mean 35.2 ± 2.2 pre-treatment, mean 28.8 ± 8.5 post-treatment) treated with preconception Adalimumab and IVIG. Groups I and II were comparable in relation to baseline IVF characteristics and patient history. The implantation rate (number of gestational sacs per embryo transfer, with an average of two embryos transferred per cycle) was 43% (36/83) for Group I and 56% (44/78) for Group II. The clinical pregnancy rate (fetal heart activity per IVF cycle started) was 67% (26/39) for Group I and 73% (27/37) for Group II. The delivery rate was 56% (22/39) for Group I and 68% (25/37) for Group II. The live birthrate per embryo transferred was 36% (30/83) for Group I and 45% (35/78) for Group II. Comparing Groups I and II, there was non-significant increase in implantation rate, clinical pregnancy rate, delivery rate, and live birthrate per embryo transferred (P = 0.1, 0.6, 0.4, and 0.3, respectively). However, when the subgroup with the least optimal cytokine conditions (Group I with inadequate cytokine suppression) was compared to the subgroup with the most optimal cytokine conditions (Group II with adequate cytokine suppression), the increase in implantation rate reached statistical significance [41% (19/46) to 64% (29/45); P = 0.04]. The reduction in TNF-α/IL-10 ratio following immunotherapy was highly significant (P < 0.0001). The degree of preconception TNF/IL-10 elevation may correlate with an increased risk of IVF failure. Elevated TNF-α/IL-10 ratios can be corrected with therapy. It may be possible to improve IVF success rates by modulating high cytokine levels. Although our pilot database is small, the trends in the data are consistent and compelling. Larger studies are needed for confirmation.

Audit of management of women with one previous caesarean section at the Royal Infirmary of Edinburgh

IntroductionThis audit assesses the management of women with one previous Caesarean section (CS) at the Royal Infirmary Edinburgh (RIE) compared to the Royal College of Obstetricians and Gynaecologists (RCOG) guideline...

Recurrent Miscarriage in Women with and without Antiphospholipid Syndrome: Prognosis and Predictors of a Subsequent Successful Delivery.

Abstract 2971Poster Board II-947 Introduction:Women with antiphospholipid syndrome (APS) are at increased risk of recurrent miscarriage. Remarkably, the outcome of a successive pregnancy in women with APS and recurrent miscarriage is merely unknown. Patients and methods:We performed a cohort study including all women with 2 or more consecutive miscarriages who attended the recurrent miscarriage clinic of Liverpool Women's Hospital, Liverpool, UK between 1988 and 2006. All women underwent a systematic diagnostic work up including testing for APS. Women with proven APS (according to the SAPPORO criteria) were studied, and outcomes were compared to women with unexplained recurrent miscarriage. We excluded all women from couples with other reasons for recurrent miscarriage. Results:737 women were included, of whom 220 (30%) had APS. Mean age (32 years) and obstetric history (mean number of prior losses: 3) did not differ between women with and without APS. Of women with APS, 148 (67%) had a successful pregnancy outcome as compared to 324 women without APS (63%), OR=1.2 (95%CI 0.9 to 1.7). No differences were found for birth weight, gestational age, and intra-uterine growth retardation. Women with APS who received aspirin and heparin more often had a successful pregnancy 53/67 (79%) as compared to women without treatment 26/44 (59%); OR=2.6 (95%CI 1.0 to 6.6). Combined use of aspirin and heparin was not associated with an increased success rate in women without APS: 25/43 (58%) vs 204/305 (67%); OR=0.7 (95%CI 0.3-1.4). Conclusions:The prognosis of a successive pregnancy in women with recurrent miscarriage and APS was comparable to women with unexplained recurrent miscarriage. However, the combined use of heparin and aspirin was associated with a significantly increased chance of a successful pregnancy in women with APS. Disclosures:No relevant conflicts of interest to declare.

Pregestational Diabetes: A Risk Factor for Vaginal Birth after Cesarean Section Failure?

Vaginal birth after cesarean delivery (VBAC) failure is associated with perinatal morbidity. The ability to predict VBAC failure in subgroups of high-risk women is important. Our objectives were: (1) to estimate if women with pregestational diabetes (PDM) who attempt VBAC are at increased risk of failure, and (2) to identify clinical characteristics of PDM women associated with failure. We performed a retrospective cohort study of women eligible for VBAC, delivered between 1995 and 1999 at 17 hospitals to study maternal history/outcomes and neonatal outcomes ascertained through chart abstraction. Women with gestational diabetes were excluded. Student T test was used to compare continuous characteristics. Chi-square/Fisher exact tests were used to compare categorical variables. Multivariable logistic regression analysis was used to control for confounders. Of all eligible women (23,601), 37% of diabetics ( N = 127) and 56% of nondiabetics ( N = 12968) attempted VBAC. The VBAC failure rate for PDM was 38% versus 24% for nondiabetic women ( P < 0.001). The risk of failure for PDM patients was increased after controlling for confounders (adjusted odds ratio 1.61, 95% confidence interval 1.06 to 2.51; P = 0.038). PDM is independently associated with VBAC failure. The success rate for women with PDM who attempted VBAC (62%) is at the lower end of the general published VBAC success rate range.

Pretreatments before the Induction of Ovulation in Assisted Reproduction Technologies: Evidence‐based Medicine in 2007

Many pretreatment modalities used prior to ovulation induction have been proposed to increase the success rate in women undergoing assisted reproductive technologies. However, no clear evidence from well-designed clinical trials has shown a benefit of these treatments. We conducted a systematic review to explore the effect of different pretreatment therapies on outcomes of in vitro fertilization (IVF) cycles. Studies were limited to women treated prior to undergoing controlled ovarian hyperstimulation in IVF cycles with low-dose aspirin, metformin, growth hormone, oral contraceptives, or corticosteroid supplementation versus placebo or no supplementation. Searches were conducted in the Cochrane Library, MEDLINE, EMBASE, and ISI Proceedings, and all randomized controlled trials that evaluated the effectiveness of those therapies compared with placebo or no treatment in women before IVF were included. The main outcome measures considered were clinical pregnancy and live birth rates, miscarriage rate, number of oocytes retrieved, cycle cancellations, and the incidence of ovarian hyperstimulation syndrome. We conclude that, currently, no clear evidence indicates that using any of these pretreatment modalities is superior to no treatment in IVF cycles. Even when the studies are pooled, small sample size and low power preclude a complete assessment of adjuvant treatment modalities before ovulation stimulation in IVF cycles.

Predictors of the outcome of nasal surgery in terms of olfactory function

Nasal surgery is frequently performed. Predictors of surgical outcome in terms of chemosensory function are not clear. A total of 64 patients were included in this prospective study (41 men, 23 women; age range 22-67 years). Prior to surgery, patients received a detailed otorhinolaryngological examination including nasal endoscopy, and CT scans used to establish the Lund-Mackay score. Olfactory function was analyzed using a custom-built odor identification test which allowed separation of chemosensory function into "olfactory" and "trigeminal" portions. Retest was performed 6 months after surgery. In terms of the sense of smell, nasal surgery produced the highest success rates in women, high degree of polyposis, and aspirin-intolerance. Neither age, presence of asthma, nor the number of preoperative surgical interventions had a significant impact on the outcome of surgery in terms of chemosensory function. Although "trigeminal scores" changed to a lesser degree than "olfactory scores", the present results indicated that nasal surgery may also improve trigeminal function, although this needs further corroboration. Improvement of olfactory function following nasal surgery appears to last, on average, for at least 6 months. While the present results may be seen as an encouraging step towards the description of more detailed prognostic factors related to nasal surgery, results from the present investigation also point towards the idea that nasal polyposis is due to a multifactorial process that, so far, is not adequately addressed by current research. Future work is needed to identify further predictors of postoperative outcome in terms of olfactory function.

Academic women's promotions in Australian universities

PurposeThe purpose of this research is to examine the hypothesis that under‐representation of women in Australian universities reflects barriers in the academic promotion process.Design/methodology/approachThis study uses three complementary approaches. Promotion policies and guidelines are examined using content analysis of documents from all Australian universities. A sample of 17 universities was selected for interviews with key gatekeepers to examine promotions practice. Data on promotions by level and gender were analysed for 16 of these universities 2000‐2002.FindingsThe analysis of promotions policies and guidelines established a range of practice. Policies supporting women's participation and success in promotions included explicit consideration of part‐time and non‐traditional careers, clear equity statements, and gender representation on promotions committees. Interviews emphasised the importance of support for and identification of female candidates, and the need for the establishment of institution‐wide and performance targets for senior managers. Implicitly, most interviewees accepted the premise that women experienced barriers in the promotion process, including reticence in applying and stereotypically gendered notions of merit. However, the analysis of promotions data showed a more encouraging picture. Application rates and success rates for women are similar to men's and, at professorial level, slightly higher. Nonetheless women remain under‐represented at senior levels, comprising only 16 per cent of the professoriate.Practical implicationsThe study provided a report to the Australian Vice‐Chancellors' Committee (AVCC) with a number of recommendations for improving University promotions policies. These recommendations are available on the AVCC website and have applicability beyond the Australian university sector.Originality/valueThis study is an original study across all Australian universities which has international applicability and policy relevance.

Carbon Dioxide Laser Vaporization of Condyloma Acuminata

Carbon dioxide laser vaporization of condyloma acuminata continues to be the treatment with a greater rate of success and with excellent cosmetic results. To evaluate the clinical outcome of carbon dioxide laser vaporization of condyloma acuminata at a referral center in Mexico. Carbon dioxide laser vaporization was performed for condyloma acuminata in 46 women and 35 men, measured from 3 to 60 months with colposcopy or peneoscopy every 6 months. It was a clinical prospective study. The average length of follow-up in women was 21 months, and the average length of follow-up in men was 16 months. The women's study follow-up showed an initial success rate of 93%, and the recurrence rate after 6 months of treatment was 7%. The follow-up of men showed an initial success rate of 69%, and the recurrence rate after 6 months was 25%. The success rate in women after the second treatment was 100% without recurrence. In men, the second treatment success rate was 88%, and the recurrence rate after 6 months was 33%. Carbon dioxide laser vaporization condyloma acuminata provides an excellent rate of success and patient satisfaction.

Success Strategies for Women in Science: a Portable Mentor

Studies have shown that the most significant method for increasing the success rate of women in scientific fields is mentoring. Many institutions have initiated formal mentoring programs, usually for all beginning scientists regardless of gender. However, this book recognizes that not all women in science have access to such programs. Therefore, it provides a framework for women, as well as men, to take an active role in their career development through self-education. This book guides the reader through the steps of identifying values, setting goals, and determining the best course of action to achieve those goals. I think most scientists at early stages in their careers would find this book extraordinarily useful, and many scientists at later stages would benefit enormously from the advice as well.

Cervical Cerclage for Prevention of Preterm Delivery in Women With a Short Cervix: A Randomized, Controlled Trial

Although observational studies have often claimed high success rates in women undergoing cervical cerclage for an incompetent cervix, randomized trials have not consistently favored this procedure. This multicenter, randomized, controlled trial sought to determine whether patient selection for cerclage could be improved by transvaginal sonographic measurements of cervical length. More than 47,000 women were offered scanning at 11 to 14 and 22 to 24 weeks gestation. Of 470 women whose cervix measured 15 mm or less in length, 253 entered the trial and were randomly assigned to either cervical cerclage using a Shirodkar suture or expectant management. The major outcome was the frequency of delivery before 33 completed weeks gestation. Cervical cerclage did not significantly lower the rates of early preterm delivery, neonatal mortality, or neonatal morbidity compared with expectant management. The 2 groups had similar proportions of spontaneous delivery or delivery after preterm prelabor rupture of membranes. Mean birth weight was 204 g more in the cerclage group, but this arose from a 1-week difference in gestational age at delivery. More than twice as many women in the cerclage group received antibiotics, most often because of prolonged prophylaxis and symptomatic vaginal discharge. More women in the cerclage group received tocolytic agents immediately after the procedure or because of threatened preterm labor. Approximately one third of women required emergency removal of the suture, most often because of preterm labor or premature labor or rupture of membranes. In this trial, placing a cervical suture in women with a short cervix did not lower the risk of early preterm delivery in a substantial proportion of cases. Routinely measuring cervical length at 22 to 24 weeks gestation by transvaginal sonography does identify women who are at high risk of early preterm delivery.

The effects of endometrioma resection on subsequent ovarian stimulation and in vitro fertilization/embryo transfer (IVF/ET) success rates

1) To compare ovarian response to stimulation and IVF/ET success rates in women who previously underwent laparoscopic resection of ovarian endometrioma(s) or ablation of endometriosis. 2) To compare the response of resected and non-resected ovaries and to determine whether repeated ovarian surgery has an additional negative effect on the ovarian response. A retrospective analysis of 76 consecutive IVF/ET cycles performed in women who previously underwent laparoscopic surgery for endometriosis. Thirty one of 76 IVF/ET cycles were performed in women who had endometrioma(s) resected and 45 in women who had ablation of endometriosis only. The effect of bilateral endometriomas was evaluated in eight women matched by age and time of IVF/ET with eight control subjects without endometriomas. To compare the response of resected and non-resected ovaries in the same subset, follicular development during 17 cycles was also evaluated. Lastly the group was subdivided according to primary and repeated surgical procedures. During laparoscopic surgery the endometriomas were resected in their entirety with stripping of the pseudo-capsule followed by ovarian reconstruction using atraumatic sutures and tissue-sparring techniques. Ovarian stimulation for IVF/ET was performed by the same team, according to the standard hMG/FSH/hCG long-stimulation protocol with Lupron down-regulation. Student's t-test and Chi-square tests were used for statistical comparisons. After resection of endometrioma(s) the response to ovarian stimulation was decreased as indicated by lower estradiol levels at hCG, and lower numbers of mature follicles and oocytes aspirated. However, with the same number of embryos transferred in the endometrioma and no endometrioma groups respectively, the pregnancy (48% vs. 49%) and implantation rates (23% vs. 34%) were comparable. A similar decrease in the ovarian response was noted after bilateral endometrioma resection, but there was also a significantly higher requirement for hMG/FSH. With a similar number of embryos transferred again, there were no significant differences in implantation or pregnancy rates. The resected as compared to non-resected ovaries yielded lower numbers of follicles but only for endometriomas between 3 and 5 cm in diameter. There were no significant differences when primary and repeated laparoscopic interventions were compared. Ovarian response to stimulation following laparoscopic resection of endometriomas may be decreased as indicated by lower estradiol levels and fewer oocytes aspirated, but with a similar number of embryos transferred the implantation and pregnancy rates do not seem to be affected.

Divorce, Patriarchal Authority, and Masculinity: A Case from Early National Vermont

In 1976, in a pathbreaking article on divorce in eighteenth-century Massachu? setts, Nancy Cott argued that the growing willingness of late eighteenth-century women to seek divorce implied that these wives were increasingly asserting con? trol over the direction of their lives and that wives who sought divorce in the Revolutionary era were, in part, responding to an enhanced sense of citizenship and legal rights. The fact that the success rate of women's divorce petitions also had improved suggested to Cott that wives' status within the family had risen in the eyes of authorities. Other scholars, such as Merril Smith, Glenda Riley, Steven Mintz, and Susan Kellogg, have portrayed the growing numbers of divorces and the increasingly liberal divorce laws ofthe late eighteenth and early nineteenth centuries as indicative of a gradual cultural shift away from tradi? tional notions of patriarchal authority within marriage, toward more egalitarian and companionate marital ideals. More liberal divorce laws and proceedings implicitly allowed wives to judge their husbands and to appeal to the courts to end their marriages when the women believed that their husbands had behaved inappropriately. Such laws provided married women with a way to challenge and possibly dissolve their husbands' authority over them. When viewed in this context, liberal divorce laws appear to have mounted a sustained challenge to marital patriarchy. However, not all historians have agreed with this assess? ment of late eighteenthand early nineteenth-century divorce law and practice. Michael Grossberg, in particular, has argued persuasively that increasingly lib? eral divorce laws did not truly undermine male authority within marriage, but rather substituted the authority ofa male judiciary for that of husbands. Other scholars who share this view also maintain that instead of challenging patri? archy, more liberal divorce laws merely provided a safety valve, a remedy for the worst abuses of patriarchal marriage, while upholding an ideal of benevolent patriarchal authority within marriage.1 The debate over the relationship between divorce and patriarchy has been invaluable to our understanding of the opportunities available for eighteenthand nineteenth-century husbands and wives to shape their marriages, as well as to our understanding of the larger cultural implications of individual marital conflicts. However, the debate has focused on divorce law and practice primarily from the point of view of legislators, jurists, and legal commentators. Very few scholars have attempted to assess the effects of divorce on patriarchal author? ity from the points of view of those husbands and wives who appeared before the courts to resolve their marital difficulties. To a certain degree, this lack of scholarship reflects the lack of sources detail ing the personal experiences and perceptions of couples who divorced. On occasion, however, the participants in

Possible Effect of Intravenous Immunoglobulin Therapy for Unexplained Secondary Recurrent Miscarriage

Objective. To review the role of intravenous immunoglobulin (IVIG) in the prevention of recurrent miscarriage (RM). Methods. In a prospective controlled clinical tria], 40 women with a history of unexplained. RMwere treated with IVIG, according to a specific protocol and compared to another 40 women who had the same condition and treated with tender loving care and vitamins only. The birth of a child of more than 28 weeks gestation was considered a successful outcome. Results. The overall success rate was 60% in the IVIG group compared with 52.6% in the control group (P = 0.65). The success rates for women with primary RM were 56.3% for IVIG group and 68.8% for the control group (P = 0.72). The success rates for women with secondary RM were 62.5% and 41.7% respectively (P = 0.25). None of the previous results is statistically significant. Conclusion. Women with unexplained RM in general have a good prognosis. IVIG did not improve the prognosis significantly in the total group of patients compared with controls. However; further investigations are needed to explore whether the 21 % therapeutic benefit of IVIG in patients with secondary RM indicates that the treatment is efficient in this subset of patients.

Mannose Binding Lectin (MBL) gene polymorphism and in vitro fertilization outcome

Objective: MBL is a serum protein and a component of the innate immune system. By binding to carbohydrate residues on microorganisms, MBL activates the complement system and marks microbes for opsonization. MBL binding to Chlamydia has been demonstrated. The gene coding for MBL is polymorphic and the variant alleles result in decreased MBL serum levels. The association between C. pneumoniae and cardiovascular disease was shown to depend on the presence of variant MBL alleles. Given the relationship between Chlamydia and infertility, we examined the relationship between MBL genotype, infertility etiology and IVF outcome.Design: Prospective analysis of the association between MBL genotype, etiology of infertility and IVF outcome.Materials and Methods: MBL genotypes at codon 54 were determined in 185 consecutive IVF patients by polymerase chain reaction, endonuclease digestion and gel electrophoresis, using DNA isolated from cervical swabs. IVF outcome and the etiology of infertility were obtained at the conclusion of MBL genotype testing. Implantation was defined as the presence of a fetal heart beat. Statistics utilized included Categorical Chi-square testing and Student’s t-test where appropriate. P value < 0.05 was considered significant. Data is presented as mean ± standard deviation.Results: The wild type MBL genotype (AA) was present in 138 (74.6%) of the patients; 47 (25.4%) had variant alleles (41 were AB and 6 were BB). There were no differences in the age, oocyte yield, fertilization percentage or number of embryos transferred based on the MBL genotype result. Patients with the variant alleles had a trend towards an increased rate of tubal infertility (25.6% vs. 16.8%, p = 0.2). Among all subjects, the rates of pregnancy, clinical pregnancy and implantation were not related to the MBL genotype. However, among patients carrying the AB genotype, those with tubal infertility were less likely to achieve a clinical pregnancy than patients with non-tubal infertility (20% vs. 57.7%; P < 0.05). Patients with tubal and non-tubal infertility who had the AA genotype did not differ in pregnancy outcome.Conclusion: Possession of the MBL AB genotype is associated with a decreased IVF success rate in women with tubal infertility. Possession of this genotype, which results in reduced serum MBL levels and lowered innate immune defense against infection, may render women less effective in eliminating microorganisms from the upper genital tract. Analysis of tubal infertility patients for MBL genotypes may have predictive value for IVF outcome and for selecting patients that may need antibiotic prophylaxis. Objective: MBL is a serum protein and a component of the innate immune system. By binding to carbohydrate residues on microorganisms, MBL activates the complement system and marks microbes for opsonization. MBL binding to Chlamydia has been demonstrated. The gene coding for MBL is polymorphic and the variant alleles result in decreased MBL serum levels. The association between C. pneumoniae and cardiovascular disease was shown to depend on the presence of variant MBL alleles. Given the relationship between Chlamydia and infertility, we examined the relationship between MBL genotype, infertility etiology and IVF outcome. Design: Prospective analysis of the association between MBL genotype, etiology of infertility and IVF outcome. Materials and Methods: MBL genotypes at codon 54 were determined in 185 consecutive IVF patients by polymerase chain reaction, endonuclease digestion and gel electrophoresis, using DNA isolated from cervical swabs. IVF outcome and the etiology of infertility were obtained at the conclusion of MBL genotype testing. Implantation was defined as the presence of a fetal heart beat. Statistics utilized included Categorical Chi-square testing and Student’s t-test where appropriate. P value < 0.05 was considered significant. Data is presented as mean ± standard deviation. Results: The wild type MBL genotype (AA) was present in 138 (74.6%) of the patients; 47 (25.4%) had variant alleles (41 were AB and 6 were BB). There were no differences in the age, oocyte yield, fertilization percentage or number of embryos transferred based on the MBL genotype result. Patients with the variant alleles had a trend towards an increased rate of tubal infertility (25.6% vs. 16.8%, p = 0.2). Among all subjects, the rates of pregnancy, clinical pregnancy and implantation were not related to the MBL genotype. However, among patients carrying the AB genotype, those with tubal infertility were less likely to achieve a clinical pregnancy than patients with non-tubal infertility (20% vs. 57.7%; P < 0.05). Patients with tubal and non-tubal infertility who had the AA genotype did not differ in pregnancy outcome. Conclusion: Possession of the MBL AB genotype is associated with a decreased IVF success rate in women with tubal infertility. Possession of this genotype, which results in reduced serum MBL levels and lowered innate immune defense against infection, may render women less effective in eliminating microorganisms from the upper genital tract. Analysis of tubal infertility patients for MBL genotypes may have predictive value for IVF outcome and for selecting patients that may need antibiotic prophylaxis.

A Dietary Cure For Prostatitis and the Urethral Syndrome

An analysis was done to determine the effectiveness of a dietary approach for the treatment of prostatitis in men and the urethral syndrome in women. Two thousand three hundred and eighty five patients (1,710 men and 675 women) with symptoms of prostatitis or the urethral syndrome were followed. All patients in the study had at least two symptoms commonly associated with prostatitis or urethral syndrome. All patients were treated only with a strict diet, which eliminated caffeine, alcohol, and hot, spicy foods for 12 weeks. There was an 87% success rate in men and an 89% success rate in women after 12 weeks of dietary treatment only. Success is defined as the elimination of each and every symptom at reevaluation, 12 weeks after dietary restrictions were started. It is proposed that the long sought etiology for prostatitis and the urethral syndrome is an inflammatory “allergic-like” reaction to caffeine, alcohol, and hot spices.

Results of recto-vaginal fistula repair: retrospective analysis of 48 cases

Objective: To evaluate the long-term outcome of the Musset technique of recto-vaginal fistula (RVF) repair. Study design: During the years 1992–1998, 48 women underwent recto-vaginal fistula repair. A retrospective study in a university tertiary referral center was conducted. Results: The main etiologies were obstetrical trauma (25), local infection (11), inflammatory disease (7), and post surgery (3). Thirty women (63%) had a previous fistula repair failure. The mean±S.D. fistula diameter was 1.4±1.0, and in 40% of the patients the fistula diameter was >2.5 cm. In 19 cases (39.6%) there was a complete opening of the perineum and anal sphincter. Gas and stool incontinence before the operation were noted in 85 and 75% of the patients, respectively. Successful anatomic results were achieved in all patients. Five patients were re-operated due to gas and stool incontinence, and all but one had satisfactory anatomic and functional satisfactory results. The success rates in women with Crohn’s disease and with a previous RVF repair failure were 100 and 98%, respectively. No major intra or postoperative complications were noted. Conclusion: The Musset procedure provide excellent anatomic and functional results and women with Crohn’s disease or previous RVF repair have comparable long-term results.

Factors Affecting the Outcome of Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome in Women With Anovulatory Infertility

Objective To describe and analyse the factors affecting the pregnancy rate of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. Design A retrospective study. Setting A specialist infertility clinic based at a teaching hospital in England. Population One hundred and eighteen women, for whom hospital records and follow up data were available, with polycystic ovarian syndrome who underwent laparoscopic ovarian surgery for anovulatory infertility over a five year period, between January 1991 and December 1995. Main Outcome measures Ovulation and pregnancy rate. Results The cumulative conception rate 12 months after the treatment was 54%. Women who conceived following the surgery had a shorter duration of infertility, were treated with diathermy (rather than laser), had higher pre-operative luteinising hormone levels, were younger and were more likely to have ultrasonographic evidence of polycystic ovarian disease. Logistic multiple regression analysis showed that the duration of infertility, modality used in treatment (laser or diathermy) and the preoperative levels were the main determinants of the outcome. Conclusion Women with polycystic ovarian syndrome respond favourably to laparoscopic ovarian drilling. The success rate in women with infertility duration of less than three years, treated with diathermy, in whom the pre-operative level was more than 10 IU/L reached 79%.

Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility.

To describe and analyse the factors affecting the pregnancy rate of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. A retrospective study. A specialist infertility clinic based at a teaching hospital in England. One hundred and eighteen women, for whom hospital records and follow up data were available, with polycystic ovarian syndrome who underwent laparoscopic ovarian surgery for anovulatory infertility over a five year period, between January 1991 and December 1995. Ovulation and pregnancy rate. The cumulative conception rate 12 months after the treatment was 54%. Women who conceived following the surgery had a shorter duration of infertility, were treated with diathermy (rather than laser), had higher pre-operative luteinising hormone levels, were younger and were more likely to have ultrasonographic evidence of polycystic ovarian disease. Logistic multiple regression analysis showed that the duration of infertility, modality used in treatment (laser or diathermy) and the pre-operative levels were the main determinants of the outcome. Women with polycystic ovarian syndrome respond favourably to laparoscopic ovarian drilling. The success rate in women with infertility duration of less than three years, treated with diathermy, in whom the pre-operative level was more than 10 IU/L reached 79%.

In vitro fertilization in women over 40 years of age. A study on retrospective data for eight years

A retrospective (1987–1995), single-center study was conducted to evaluate the IVF success rate in women who were 40 years and over. Controls were randomly selected patients who were 35 years or younger from the same center. The main evaluation criterion was the number of pregnancies initiated in each group and especially the number of full-term deliveries (take-home baby rate). Differences were considered as statistically significant for P≤0.05. A total of 194 IVF attempts in women 40 years or over were compared to 209 attempts in the control group. The mean ages of the two groups was 40.9 vs. 29.3 years (P<0.001). The duration of follicle stimulation was 12.9 vs. 13.1 days (not significant, NS). The number of ampules was 29.6 vs. 29.2 (NS). Serum estradiol levels were 1435.8 vs. 2020.8 pg/ml (P<0.001). Oocytes: 4.6 vs. 7.3 (P<0.001). Embryos: 1.7 vs. 2.8 (P<0.0001). Full-term deliveries: 3.6 vs. 13.4% (P<0.05). Better oocyte retrieval was achieved (5.3 vs. 3.3; P=0.001) in the group that was 40 years or over, but there were no differences in the rate of embryo transfer (1.9 vs. 1.3; NS) and full-term deliveries (4.2 vs. 2.9%) in a long protocol compared to a short one. The results of the study are similar to those found in the literature. Indications for standard IVF without oocyte donation should be carefully thought out and couples should be warned of the low success rate.

Suppressed cell-mediated immunity and monocyte and natural killer cell activity following allogeneic immunization of women with spontaneous recurrent abortion.

Spontaneous recurrent abortion (SRA) has been treated by means of immunization with paternal or third-party white blood cells, yet the immunological basis for SRA and for the role of immunization protocols in pregnancy outcome remains controversial. To elucidate this question, nine women with SRA were immunized with paternal mononuclear cells and studied before and 2 weeks after immunization. Seven women who became pregnant gave birth to live newborns. Secretion of the T helper 1 cytokines IL-2 and interferon-gamma by patients, mononuclear cells decreased, while production of IL-10 increased. The levels of natural killer and lymphokine-activated killer cell-mediated cytotoxicity were markedly decreased. Monocyte functions such as secretion of IL-1 alpha, tumor necrosis factor alpha, IL-6, and cytotoxic activity decreased concurrently with elevations in IL-10 and transforming growth factor beta secretion. Production of IL-12, a pivotal regulatory cytokine, decreased. Furthermore, B7/1 expression on patients' mononuclear cells was downregulated. This resulted in a decrease in monocyte costimulatory activity of purified T cells with soluble anti-CD3, paralleled by a decline in allogeneic proliferative responses. These results suggest that the improved pregnancy success rate in women with SRA following immunization may be partly related to suppression of cell-mediated immunity and monocyte and natural killer cell activity.