Patient acceptability of manual versus electric vacuum aspiration for early pregnancy loss.

Objective: To compare the safety, efficacy, postprocedure quality of life, and acceptability of manual vacuum aspiration (MVA) performed as an outpatient with electric vacuum aspiration (EVA) performed in a hospital in women experiencing a first-trimester miscarriage.

Methods: From a randomized multicenter trial comparing misoprostol with vacuum aspiration for first-trimester loss, data were extracted comparing the safety, efficacy, and acceptability of MVA in an office setting with local anesthesia with EVA in an operating room environment with spinal or general anesthesia or monitored anesthesia care (MAC).

Results: One hundred fifty-seven women underwent EVA or MVA.

Endometrial stripe thickness and pregnancy outcome in first-trimester pregnancies with bleeding, pain or both.

Objective: To determine the association between endometrial stripe (ES) thickness and pregnancy outcome in women with a symptomatic first-trimester pregnancy and to determine how vaginal bleeding, pelvic pain and 1 human chorionic gonadotropin (hCG) level affect ES thickness.

Study Design: Data on ES thickness, serum hCG, presence of pain, characterization of vaginal bleeding and ultimate clinical outcome were collected for 576 women presenting to the emergency room.

Results: ES was thinner with increased vaginal bleeding and associated with hCG level and pregnancy outcome.

The clinical rationale for menses-free contraception.

The impact of monthly menstruation may range from a minor inconvenience for some women to a major health concern for those who suffer from menstrual disorders and health conditions that are aggravated during their menstrual cycle. Oral contraceptives (OCs) have been used safely in continuous regimens for the treatment of menstrual disorders in some women and for others who choose to extend their 28-day menstrual cycle to accommodate major life events. There is no physiological requirement for the monthly hormone withdrawal bleed that is experienced by women taking cyclic OCs or for a menstrual period in women who do not desire to (or cannot) become pregnant.

Contraceptive efficacy of a novel spermicidal microbicide used with a diaphragm: a randomized controlled trial.

Objective: Women need products that protect against both pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). The acid buffering gel is a nondetergent spermicide that may provide this dual protection by reinforcing normal vaginal acidity to inactivate both sperm and acid-sensitive sexually transmitted pathogens. The objective of this study was to assess the gel's contraceptive effects, safety, and acceptability.

Panel of markers can accurately predict endometriosis in a subset of patients.

Objective: To evaluate whether a combination of putative markers of inflammation and CA-125 could serve as a multiple-marker screening test for endometriosis in a heterogeneous population of patients.

Design: Case-control evaluation of a diagnostic test.

Setting: University medical center.

Sheep stromal-epithelial cell interactions and ovarian tumor progression.

Previous studies suggest that underlying ovarian stromal cues may regulate the ovarian surface epithelium. However, little is known about the interaction between ovarian stromal cells (OSC) and ovarian surface epithelial cells (OSE) under normal physiologic and pathologic conditions, largely because of the lack of a suitable model. In the current study, the OSC obtained from a sheep were immortalized with SV-40 T/t antigen (designated IOSC) and telomerase reverse transcriptase (designated IOSCH), followed by transfection with the oncogenic allele of the human H-Ras oncogene (designated IOSChR).

Do sperm DNA integrity tests predict pregnancy with in vitro fertilization?

Objective: To evaluate the predictive value of sperm DNA integrity tests for pregnancy from in vitro fertilization treatment.

Design: Systematic review and meta-analysis.

Setting: Studies from infertility centers.

The effect of ambulation on vaginal distribution of miconazole nitrate (1200 mg).

Objective: To evaluate the effect activity has on the vaginal distribution of a 1200 mg miconazole nitrate gelatin encapsulated insert, an antifungal agent commonly used to treat vaginal vulvocandidiasis.

Method: Nine subjects underwent two sessions of serial magnetic resonance imaging after insertion of the insert. One session required that the subjects ambulate between images; the other session required the subjects remain supine between images.

Clinical indicators for success of misoprostol treatment after early pregnancy failure.

Objective: To identify clinical indicators for success of misoprostol treatment after early pregnancy failure.

Methods: A total of 473 women with early pregnancy failure received 800 microg of vaginal misoprostol on treatment day 1. At the follow-up visit on day 3, a second dose was given if expulsion was incomplete.

A simulation using data from a primary care practice database closely replicated the women's health initiative trial.

Objective: In contrast to prior observational studies, hormone replacement therapy (HRT) did not prevent coronary heart disease in the Women's Health Initiative Randomized Controlled Trial (WHI RCT). To assess the validity of a novel observational study design, we compared the WHI RCT with a simulation using data from the United Kingdom General Practice Research Database (GPRD).

Study Design And Setting: A cohort from GPRD was used to simulate the WHI RCT by replicating, to the extent possible, all aspects of the RCT except randomization.

Risk factors for ectopic pregnancy: a comparison between adults and adolescent women.

Purpose: To compare the prevalence of classical risk factors and presenting signs and symptoms between adolescents and adults with ectopic pregnancy (EP).

Procedure: A database containing information regarding presentation symptoms, past medical history, and ultimate pregnancy outcomes of patients presenting to the Emergency Department during early pregnancy is maintained in our institution. Data were extracted and analyzed for all patients ultimately diagnosed with EP.

Hormone therapy and coronary heart disease in young women.

Objective: Because the Women's Health Initiative randomized controlled trial (WHI RCT) primarily studied older women, it is unresolved whether hormone therapy might prevent coronary heart disease in younger women. Given the similarity between our UK General Practice Research Database (GPRD) study of older women and the WHI RCT, the GPRD methodology was used to study a cohort of younger women.

Design: Women ages 50 to 55 years were investigated using data from the GPRD to simulate the WHI RCT in a manner similar to our initial study of older women.

Ectopic pregnancies in unusual locations.

The majority of ectopic pregnancies are located within the fallopian tube. Nevertheless, pregnancies have been reported to implant in the cervix, ovary, interstitial tubal segment, and at various intra-abdominal sites. The diagnosis and treatment of these unusual implantation sites presents both diagnostic and therapeutic dilemmas.

Estrogen affects post-menopausal women differently than estrogen plus progestin replacement therapy.

Background: In the Women's Health Initiative Randomized Controlled Trial (WHI RCT), estrogen-only treatment compared with combined estrogen-progestin treatment resulted in less coronary artery disease, no increase in breast cancer and no reduction in colorectal cancer. Since we previously reasonably replicated the combined estrogen-progestin WHI RCT using the UK General Practice Research Database (GPRD), estrogen-only treatment was investigated using a similar methodology.

Methods: This GPRD study simulated the estrogen-only WHI RCT of women who had undergone a hysterectomy except for randomization.

Bleeding patterns after misoprostol vs surgical treatment of early pregnancy failure: results from a randomized trial.

Objective: The purpose of this study was to describe bleeding patterns after misoprostol or curettage for early pregnancy failure (EPF).

Study Design: This was a randomized trial that included women (n = 652) with EPF. Participants were assigned to vaginal misoprostol (800 microg) or curettage in a 3:1 ratio.

Establishing a human chorionic gonadotropin cutoff to guide methotrexate treatment of ectopic pregnancy: a systematic review.

Objective: Successful medical management of an ectopic pregnancy is inversely associated with initial hCG level. The purpose of this publication is to assess whether there is a level of hCG above which failure rate substantially increases.

Design: A systematic review and summary analysis was performed, including studies reporting methotrexate treatment outcomes as stratified by various hCG ranges.

Use of "2-dose" regimen of methotrexate to treat ectopic pregnancy.

Objective: To evaluate the safety and acceptability of a novel dosing regimen of methotrexate to treat ectopic pregnancy.

Design: Prospective study.

Setting: Three academic medical centers.

Factors influencing adverse perinatal outcomes in pregnancies achieved through use of in vitro fertilization.

Objective: To determine the associations of specific components of IVF treatment with abnormal perinatal outcomes.

Design: Case-control study.

Setting: University-based and community-based infertility centers.

Karyomegaly and intranuclear inclusions in the renal tubules of sentinel ICR mice (mus musculus).

Among 585 sentinel ICR mice (Mus musculus), 8 (7 female, 1 male) had unusual microscopic lesions in the kidney. Light microscopy revealed occasional tubular epithelial cells with large, karyomegalic nuclei that contained intranuclear inclusions and marginated chromatin. These cells were randomly present in the cortex and medulla but were more prominent near the corticomedullary junc tion.

Expression of multiple human endogenous retrovirus surface envelope proteins in ovarian cancer.

Individual classes of human endogenous retrovirus (HERV) genes and proteins are expressed in cancer, but expression of more than one type of HERV is rare. We report here the expression of multiple HERV genes and proteins in ovarian cell lines and tissues. Expression of HERV-K env mRNA was greater in ovarian epithelial tumors than in normal ovarian tissues (N = 254).

The challenge and enjoyment of the interpretation of epidemiologic data.

The trend toward a decline in the percentage of women with infertility in the United States appears real. While the factors associated with this trend are likely many, complex, and interrelated, we cannot overlook the positive impact of those individuals who practice in the field of reproductive medicine.