Diagnostic imaging modalities for Müllerian anomalies: the case for a new gold standard.

Female reproductive tract anomalies are difficult to number in the general population but are often discovered in evaluations of menstrual complications or fertility disorders. Traditionally, assessment of the reproductive tract entailed hysterosalpingography to image the uterine cavity with the final diagnosis provided by combined hysteroscopy/laparoscopy. These approaches, while providing important information, were uncomfortable and invasive and for HSG, involved radiation exposure.

Uterine cavity-myoma fistula after hysteroscopic myomectomy mimicking uterine perforation at hysterosalpingography: case report.

Fistula formation between the uterine cavity and the cavity of a subserosal myoma was diagnosed at laparoscopy/hysteroscopy in a 39-year-old woman with primary infertility. The patient had undergone 2 previous hysteroscopic resection procedures for removal of a submucosal myoma as part of infertility treatment. Hysterosalpingography demonstrated leakage of contrast medium from the uterine cavity, a characteristic feature of uterine perforation.

Is a placebo-controlled surgical trial an oxymoron?

Within the context of the new medical methodology of evidence-based medicine, the ethical issues of making the randomized, placebo-controlled, clinical trial part of the matrix of surgical procedure evaluation are discussed. Surgical trials with alternative research design less rigorous than the double-blind, placebo-controlled, randomized trial leave the alternative: implementing surgical procedures based on anecdotal evidence and weaker scientific research. The conundrum of these clinical trials, as it relates to the evaluation of surgical procedures, is that it appears to confound some of the fundamental ethical principles of beneficence and nonbeneficence.

Abnormal uterine bleeding: imaging techniques for evaluation of the uterine cavity and endometrium before minimally invasive surgery--the case for transvaginal ultrasonography.

Transvaginal ultrasound has been utilized for first line evaluation of abnormal uterine bleeding since its development in the early 1980's. The benefits and diagnostic effectiveness of transvaginal ultrasound in assessing the uterus, unlike hysteroscopy, extends to the complete pelvis. The ease of application, patient acceptance, and immediacy of results are rapidly apparent.

GnRH analogs: options for endometriosis-associated pain treatment.

While none of the currently available treatment options for endometriosis pain resolved the underlying disease process, there are growing numbers of medical alternatives available. Medical options include the GnRH agonists and antagonists. Review of these treatments in the management of endometriosis pain and the insight often to the etiology of endometriosis are presented for discussion.

Postmortem parenthood and the need for a protocol with posthumous sperm procurement.

Objective: Posthumous sperm procurement involves harvesting gametes from a recently deceased man for cryopreservation and future use in ART. This paper discusses the practical and ethical role of posthumous sperm procurement in medical practice and society and submits possible solutions, including the establishment of formal policies and protocols.

Design: English-language literature review and bioethical discussion.

Ultrasound-guided soft catheter embryo transfers will improve pregnancy rates in in-vitro fertilization.

Attempts to improve clinical pregnancy rates after in-vitro fertilization (IVF) and embryo transfer are constantly being made. Two changes in technique of embryo transfer of potential clinical importance were evaluated over two contiguous time periods in order to observe any corresponding change in clinical pregnancy (CP) rate per transfer: (i) embryo transfer catheter; (ii) ultrasound guidance. Catheter choices were hard: Tefcat, Tom Cat, or Norfolk; or soft: Frydman or Wallace.

Inhibin-B as a test of ovarian reserve for infertile women.

The objective of the study was to compare a standard clomiphene citrate challenge test with inhibin-B serum concentrations also obtained on cycle days 3 and 10 as a negative predictor of pregnancy in a group of 106 women at risk for compromised ovarian function. Mean duration of follow-up was 8.25 months in 95 patients with 30 pregnancies recorded (plus one biochemical).

Ovarian response to gonadotrophins, optimal method for oocyte retrieval and pregnancy outcome in patients with vaginal agenesis.

The aim of this study is to characterize the ovarian response to stimulation and the optimal method of oocyte retrieval in patients with vaginal agenesis (Mayer- Rokitansky-Küster-Hauser syndrome) in a gestational carrier programme. Twelve patients underwent gonadotrophin stimulation and hormonal monitoring. Forty-nine treatment cycles were initiated; seven cycles were cancelled secondary to poor stimulation.

Live birth from a zygote cryopreserved for 8 years.

After a cryopreservation period of 8 years, four zygotes were thawed and transferred to the patient's uterine cavity. A singleton pregnancy resulted in the delivery of a normal male. This case report offers evidence that long terms of cryopreservation are consistent with full developmental potential post-thaw, and encourages further examination of imposing limits on length of storage of frozen concepti.

Discontinuous Percoll gradient preparation for donor insemination: determinants for success.

The use of cryopreserved donor spermatozoa for insemination has become necessary to decrease the risk from sexually transmitted infectious diseases. Lower fecundity rates have been reported with this practice. Efforts have been applied to increase success, including identification of those sperm characteristics which correlate with increased fecundity.

Association of positive Chlamydia trachomatis and Chlamydia pneumoniae immunoglobulin-gamma titers with increasing age.

Study Objectives: To use Chlamydia trachomatis immunoglobulin-gamma (IgG) titers to investigate the possibility of their association with ovarian cancer, and to evaluate the effectiveness of this titer in algorithmic protocols in infertility.

Design: Prospective, age-matched, pilot study (Canadian Task Force classification II-2).

Setting: University and university-affiliated office practice.

Obesity and GnRH action. Report of a case with contribution by peripherally derived estrogens.

Background: Gonadotropin-releasing hormone agonists (GnRH-a) are effective in reducing the pituitary release of gonadotropins, which, in turn, decrease ovarian steroidogenesis. The resulting menopausal state decreases the volume and vascular supply to uterine leiomyomas. Peripheral adipose tissue also contributes significantly to the circulatory estrogen pool, which is formed independent of pituitary function.

A double-blind comparison of nafarelin and leuprolide acetate for down-regulation in IVF cycles.

Objective: To compare nafarelin (NAF) with leuprolide acetate (LA) for pituitary down-regulation in IVF cycles.

Materials And Methods: Patients in a private IVF program who received both nasal spray and subcutaneous injections starting in the luteal phase prior to intended stimulation with any one route containing active drug in a randomized, prospective, double-blind study. Variables measured included the usual hormonal values as well as oocyte data, but not pregnancy rates, because of sample size and the heterogeneity of the study group.

Association of Positive Chlamydia trachomatis and Chlamydia pneumoniae Immunoglobulin G Titers with Increasing Age.

Due to previously reported associations of ovarian cancer with pelvic inflammatory disease, tubal infertility, and positive Chlamydia trachomatis titers, women undergoing follow-up for ovarian cancer were screened with a C. trachomatis IgG titer. Positive titers were seen in 15 (79%) of 19 women with ovarian cancer, 9 (90%) of 10 age-matched controls, and 14 (67%) of 21 patients with infertility and pain.