The use of heparin for preventing miscarriage.

Recommendations for the use of heparin for preventing miscarriage are recently rapidly changing based on evidenced based prospective studies. At present either heparin or low molecular weight heparin (LMWH) is recommended for the antiphospholipid syndrome (APS). However criteria for diagnosing APS have become much stricter.

Sympathetic neural hyperalgesia edema syndrome, a frequent cause of pelvic pain in women, mistaken for Lyme disease with chronic fatigue.

Purpose: To show that chronic fatigue syndrome can be mistakenly attributed to Lyme disease rather than considering sympathetic neural hyperalgesia edema syndrome. This common disorder of women, frequently, but not always causing pelvic pain, can present simply as chronic fatigue.

Methods: A water load test was performed in a woman reactive for B-Burgdorferi with chronic fatigue whose symptoms did not improve despite three months of treatment with doxycycline.

Successful pregnancy following a single fresh embryo transfer in a 45-year-old woman whose early follicular phase serum follicle stimulating hormone was 29 mIU/ml.

Purpose: To determine if a successful pregnancy is possible following in vitro fertilization embryo transfer (IVF-ET) in a woman of advanced reproductive age with diminished egg reserve.

Methods: In vitro fertilization-embryo transfer with intracytoplasmic sperm injection (ICSI) was performed for a 45-year-old woman with a peak serum follicle stimulating hormone (FSH) level of 29 mIU/ml and a history of failing to conceive in five previous IVF-ET cycles at a younger age. A minimal FSH stimulation protocol was used.

Speculum retention during embryo transfer does not improve pregnancy rates following embryo transfer--a randomized study.

Purpose: To corroborate or refute two previous studies that suggested that a technique using prolonged speculum retention may improve pregnancy rates per embryo transfer.

Methods: Women undergoing day 3 embryo transfer were randomly assigned to the conventional transfer technique vs the speculum retention technique. The speculum retention technique involves following the embryo transfer not to withdraw the speculum but to loosen the screw in order to exert gentle pressure on the portiovaginalis of the cervix and leave it in for seven minutes.

Live fetus following embryo transfer in a woman with diminished egg reserve whose maximal endometrial thickness was less than 4 mm.

Purpose: To report the thinnest peak endometrial thickness to date resulting in a viable fetus following embryo transfer.

Methods: Mild ovarian hyperstimulation was given to a 35-year-old woman with not only a family history of premature ovarian failure but she also had diminished egg reserve.

Results: She consistently could not attain more than a 4 mm endometrial thickness in graduated estrogen replacement cycles or IVF-ET cycles.

Successful twin pregnancy in a donor oocyte recipient despite a maximum endometrial thickness in the late proliferative phase of 4 mm.

Purpose: To show that even a twin pregnancy is possible following embryo transfer despite a very thin endometrium.

Methods: Two embryos derived from donor oocytes were transferred into a 47-year-old woman despite a peak endometrial thickness of 4 mm.

Results: She delivered viable dichorionic twins at 30 weeks in a pregnancy complicated by HELLP syndrome.

Evidence that the main adverse effect of ganirelix on pregnancy and implantation rates is on the embryo rather than the endometrium.

Purpose: To compare pregnancy rates following the transfer of thawed frozen embryos according to the type of GnRH antagonist or agonist used during controlled ovarian hyperstimulation (COH).

Methods: Retrospective review of frozen embryo transfers according to whether a GnRH agonist or antagonist was used. Furthermore to determine if a specific antagonist/agonist resulted in higher pregnancy rates than the other.

Effect of multiple source vs single source of donor embryos on pregnancy and implantation rates per transfer.

Purpose: To evaluate whether using donated embryos from more than one source has a negative impact on pregnancy rates compared to a single source.

Methods: Retrospective review of all donor embryo transfers that occurred in our IVF center over a 10-year period. Embryos were all from our own patient pool.

Effect of serum progesterone level on the day of human chorionic gonadotropin injection on outcome following in vitro fertilization-embryo transfer in women using gonadotropin releasing hormone antagonists.

Purpose: To determine if there is any association of serum progesterone (P) level at the time of human chorionic gonadotropin (hCG) injection and pregnancy outcome in in vitro fertilization (IVF) cycles using gonadotropin releasing hormone (GnRH) antagonists for controlled ovarian hyperstimulation (COH).

Methods: A retrospective analysis of IVF cycles over a six and a half-year period where either cetrorelix or ganirelix was used with COH and at least two embryos were transferred. Female partners were < or = 35.

Blastomere number and pregnancy rates in the succeeding in vitro fertilization cycle in women who formed all embryos with < or = 5 blastomeres.

Purpose: To determine the likelihood of pregnancy following the transfer of embryos all with slow cleavage to day 3. Furthermore to determine the likelihood that if slow cleavage happens once, it is likely to repeat.

Methods: A 10-year retrospective review of in vitro fertilization-embryo transfer (IVF-ET) cycles was performed to identify day 3 embryo transfers where none of the embryos had > 5 blastomeres.

Evaluation of the importance of late follicular phase endometrial echo patterns and pregnancy outcome following embryo transfer by evaluating infertile donor/recipient pairs.

Purpose: To investigate if the late follicular phase echo pattern is associated with pregnancy outcome in donors vs recipients.

Methods: Infertile donors sharing eggs with recipients were retrospectively evaluated. The endometrial echo pattern was evaluated on the day of human chorionic gonadotropin injection in donors and on the day before progesterone was given to recipients.

Serum adiponectin levels are significantly reduced during the second half of normal pregnancy.

Purpose: To demonstrate the physiologic changes in adiponectin levels during the first vs second half of pregnancy.

Methods: Sixty-six females with uncomplicated pregnancies and normal pre-gestational BMI had serum adiponectin levels obtained at various gestational ages. Thirty-one samples were obtained during the first half of their pregnancy vs 35 in the second half.

Successful pregnancy following in vitro fertilization embryo transfer in a 46-year-old woman with diminished oocyte reserve as evidenced by a high day 3 serum estradiol.

Purpose: To establish a precedent that a successful pregnancy is possible following in vitro fertilization-embryo transfer (IVF-ET) even in a 46-year-old woman with diminished egg reserve.

Methods: Mild ovarian stimulation was used to stimulate multiple follicles in a woman whose diminished oocyte reserve was manifested by elevated day 3 serum estradiol and top normal serum follicle stimulating hormone (FSH).

Results: She conceived on her third IVF-ET attempt.

Matched controlled study to evaluate the effect of endometrial polyps on pregnancy and implantation rates following in vitro fertilization-embryo transfer (IVF-ET).

Purpose: To determine if endometrial polyps negatively effect outcome following in vitro fertilization-embryo transfer (IVF-ET) and whether hysteroscopic resection improves pregnancy and implantation rates and/or decreases miscarriage rates.

Methods: Retrospective study with two matched controlled groups (polyps vs no polyps) based on age and previous number of IVF failures. The polyp group was further stratified by whether polypectomy was performed or not.

Effect of method of oocyte fertilization on fertilization, pregnancy and implantation rates in women with unexplained infertility.

Purpose: To determine if intracytoplasmic sperm injection (ICSI) offers an advantage over conventional oocyte insemination for women undergoing in vitro fertilization (IVF) and embryo transfer for unexplained infertility.

Methods: A retrospective seven-year review of outcome following IVF with conventional insemination vs ICSI for the category of unexplained infertility. The decision on which method of insemination to use was made by the couple after hearing pros and cons with the consulting physician.

A case whose outcome is consistent with the possibility that if slow embryo cleavage is related to a male factor the prognosis is far greater than if it was related to an egg factor.

Purpose: To determine if the male partner's sperm can be the cause of embryos with slow cleavage.

Methods: Retrospective evaluation of shared donor oocyte pairs where two women shared one pool of oocytes from an oocyte donor.

Results: Only one woman formed embryos that were all < 6 blastomeres in 376 paired cycles (total 752).

Hypofunction of the sympathetic nervous system is an etiologic factor for a wide variety of chronic treatment-refractory pathologic disorders which all respond to therapy with sympathomimetic amines.

The hypothesis set forth is that the basis for a great many chronic debilitating conditions that involve almost all of the physiologic systems of the body may have as the underlying cause and a common link between them, i.e., hypofunction of the sympathetic nervous system.

Evidence that migraine headaches in women may be related to a common defect in the sympathetic nervous system as evidenced by marked improvement following treatment with sympathomimetic amines.

Purpose: To describe a novel therapy for women with intractable migraine headaches.

Methods: Dextroamphetamine sulfate was prescribed to a 33-year-old woman with intractable migraine headaches resistant to standard therapy. Her only abnormality noted was unexplained weight gain.

Sympathetic nervous system disorder of women that leads to pelvic pain and symptoms of interstitial cystitis may be the cause of severe backache and be very responsive to medical therapy rather than surgery despite the presence of herniated discs.

Purpose: To describe a unique pharmacologic treatment for backache that seemed to be related to herniated discs.

Methods: Dextroamphetamine sulfate was prescribed to a woman who developed acute lower backache which was attributed to herniated lumbar discs.

Results: Within hours the pain diminished and she was pain free within a week.

Impact of a teaching attending physician on medical student, resident, and faculty perceptions and satisfaction.

Objectives: To determine if a dedicated teaching attending for medical student education improves medical student, attending physician, and resident perceptions and satisfaction.

Methods: Two dedicated teaching attending physician shifts were added to the clinical schedule each week. A before-after trial compared medical student evaluations from 2000 to 2004 (preteaching attending physician) to medical student evaluations from 2005 to 2006 (teaching attending physician).

Operative Nd:YAG laser plus postoperative hyperbaric oxygen reduces surgical morbidity after radical head and neck cancer surgery and complex reconstruction.

Unlabelled: Complications after radical head and neck cancer surgery in irradiated patients are frequent and life-threatening. Hemorrhage, salivary fistulas, wound infections that expose the carotid sheath, among others, make these patients difficult management challenges in the ICU. We studied the effects of Nd:YAG laser surgery plus hyperbaric oxygen (HBO2) therapy on radical head and neck resections and complex reconstruction as a means of reducing postoperative morbidity and mortality.

Management of pediatric skin abscesses in pediatric, general academic and community emergency departments.

Objectives: To compare the evaluation and management of pediatric cutaneous abscess patients at three different emergency department (ED) settings.

Method: We conducted a retrospective cohort study at two academic pediatric hospital EDs, a general academic ED and a community ED in 2007, with random sampling of 100 patients at the three academic EDs and inclusion of 92 patients from the community ED. Eligible patients were ≤18 years who had a cutaneous abscess.

Live delivery and implantation rates of donor oocyte recipients in their late forties are similar to younger recipients.

Objective: To determine if there is a certain age when the uterus is somewhat less receptive to successful pregnancy despite the transfer of embryos from donated oocytes.

Study Design: We conducted a retrospective evaluation of donor oocyte recipient cycles according to specific ages. The recipients used an oral/vaginal graduated estradiol regimen followed by intramuscular and vaginal progesterone.

Comparison of pregnancy outcome following frozen embryo transfer (ET) in a gestational carrier program according to source of the oocytes.

Purpose: To determine any differences in pregnancy rates if frozen-thawed embryos are transferred to a gestational carrier if the source of oocytes came from infertile women trying to conceive vs a paid egg donor.

Methods: Gestational carriers were used because of uterine problems or health issues. If there was adequate ovarian egg reserve, controlled ovarian hyperstimulation followed by oocyte retrieval was performed on the infertile woman.

Comparison of the efficacy of treating sperm with low hypoosmotic swelling test scores with chymotrypsin followed by intrauterine insemination vs in vitro fertilization with intracytoplasmic sperm injection.

Purpose: To compare the efficacy of two treatments for sperm with low hypoosmotic swelling (HOS) test scores - intrauterine insemination (IUI) with sperm pretreated with the protein digestive enzyme chymotrypsin versus in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI).

Methods: The choice of patient therapy was optional. The pregnancy rates following two IUI cycles vs one IVF cycle with ICSI were then compared.