infertility Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(2):69-73
DOI 10.1590/S0100-72032001000200002
Purpose: to analyze the follow-up of regretful sterilized women who sought sterilization reversal at a public service. Method: a retrospective study was carried out with a population of sterilized women who attended the infertility clinic during the period from June 1983 to July 1998. The analysis of the data was descriptive. Results: among the 147 women who sought the infertility clinic, most were 20 to 30 years old and 60% were sterilized at the age of 25 years. During follow-up, 54.4% of the initial patients gave up treatment, 15% were discouraged to continue the investigation and only 31 (21%) underwent tubal anastomosis. Fourteen women became pregnant and nine (6.1%) of them had term gestation. Conclusion: women who request sterilization should be counseled and instructed about the definitive feature of this method in order to reduce regret after sterilization.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(2):69-73
DOI 10.1590/S0100-72032001000200002
Purpose: to analyze the follow-up of regretful sterilized women who sought sterilization reversal at a public service. Method: a retrospective study was carried out with a population of sterilized women who attended the infertility clinic during the period from June 1983 to July 1998. The analysis of the data was descriptive. Results: among the 147 women who sought the infertility clinic, most were 20 to 30 years old and 60% were sterilized at the age of 25 years. During follow-up, 54.4% of the initial patients gave up treatment, 15% were discouraged to continue the investigation and only 31 (21%) underwent tubal anastomosis. Fourteen women became pregnant and nine (6.1%) of them had term gestation. Conclusion: women who request sterilization should be counseled and instructed about the definitive feature of this method in order to reduce regret after sterilization.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(9):589-595
DOI 10.1590/S0100-72032001000900007
Purpose: to compare the embryonic development obtained with two different culture methods (sequential medium or coculture in Vero cells). Methods: oocytes were recovered from 110 patients and submitted toin vitro fertilization. The embryos of half of the patients were co-cultured with Vero cells and the embryos of the other half were cultured in sequential G1:2/G2:2 medium for five days. The embryos were transferred on the 5th day after fertilization after morphological evaluation for the determination of blastula formation rate. Pregnancy was defined by ultrasonography and a fetal heartbeat was determined 13 weeks after transfer. Results: the expanded blastocyst rate found in our study was 15.9 and 14% with Vero cells and G1:2/G2:2, respectively. With Vero cells 36.0% of patients became pregnant and the implantation rate was 18.9%. When G1:2/G2:2 was used, the pregnancy and implantation rates were 28.9 and 14.9%, respectively. Only 17 patients had blastocysts after coculture in Vero cells, with a 76.5% pregnancy rate and a 63.5% implantation rate. When embryos were cultured in G1/G2, 21 patients presented blastocysts and the pregnancy and implantation rates were 57.1 and 76.0%, respectively. Conclusion: there was no significant difference in pregnancy or implantation rates between the 2 types of culture. When expanded blastocysts were transferred, the implantation and pregnancy rats increased with both culture types. In these patients, regardless of the type of culture used, a larger number of oocytes was obtained, suggesting that the implantation and pregnancy rates are affected not only by the culture conditions but also by the quality of the eggs, since "good responders" had better results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(9):589-595
DOI 10.1590/S0100-72032001000900007
Purpose: to compare the embryonic development obtained with two different culture methods (sequential medium or coculture in Vero cells). Methods: oocytes were recovered from 110 patients and submitted toin vitro fertilization. The embryos of half of the patients were co-cultured with Vero cells and the embryos of the other half were cultured in sequential G1:2/G2:2 medium for five days. The embryos were transferred on the 5th day after fertilization after morphological evaluation for the determination of blastula formation rate. Pregnancy was defined by ultrasonography and a fetal heartbeat was determined 13 weeks after transfer. Results: the expanded blastocyst rate found in our study was 15.9 and 14% with Vero cells and G1:2/G2:2, respectively. With Vero cells 36.0% of patients became pregnant and the implantation rate was 18.9%. When G1:2/G2:2 was used, the pregnancy and implantation rates were 28.9 and 14.9%, respectively. Only 17 patients had blastocysts after coculture in Vero cells, with a 76.5% pregnancy rate and a 63.5% implantation rate. When embryos were cultured in G1/G2, 21 patients presented blastocysts and the pregnancy and implantation rates were 57.1 and 76.0%, respectively. Conclusion: there was no significant difference in pregnancy or implantation rates between the 2 types of culture. When expanded blastocysts were transferred, the implantation and pregnancy rats increased with both culture types. In these patients, regardless of the type of culture used, a larger number of oocytes was obtained, suggesting that the implantation and pregnancy rates are affected not only by the culture conditions but also by the quality of the eggs, since "good responders" had better results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(8):491-495
DOI 10.1590/S0100-72032001000800003
Purpose: to evaluate hysterosalpingo-contrast sonography as an alternative method in the study of tubal patency in a group of infertile women. Methods: this is a transversal clinic study, which analyzed hysterosalpingo-contrast sonography and compared it with hysterosalpingography, as a method for the study of tubal patency, in a group of 31 infertile patients. Hysterosalpingo-contrast sonography had a sensitivity of 93.6%, specificity of 75%, positive predictive value of 95.6%, negative predictive value of 66.7% and accuracy of 90%. The tubes were not accessible in 8.9%. The mean time to perform the examination was 12 minutes. Fourty-six percent of the patients did not report pain during the examination and 23% reported light, 19.2% moderate, and only 11.5% reported severe pain. Conclusion: hysterosalpingo-contrast sonography proved to be a safe, and tolerable method, of quick performance, with good sensitivity and specificity in the study of tubal patency in infertile women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(8):491-495
DOI 10.1590/S0100-72032001000800003
Purpose: to evaluate hysterosalpingo-contrast sonography as an alternative method in the study of tubal patency in a group of infertile women. Methods: this is a transversal clinic study, which analyzed hysterosalpingo-contrast sonography and compared it with hysterosalpingography, as a method for the study of tubal patency, in a group of 31 infertile patients. Hysterosalpingo-contrast sonography had a sensitivity of 93.6%, specificity of 75%, positive predictive value of 95.6%, negative predictive value of 66.7% and accuracy of 90%. The tubes were not accessible in 8.9%. The mean time to perform the examination was 12 minutes. Fourty-six percent of the patients did not report pain during the examination and 23% reported light, 19.2% moderate, and only 11.5% reported severe pain. Conclusion: hysterosalpingo-contrast sonography proved to be a safe, and tolerable method, of quick performance, with good sensitivity and specificity in the study of tubal patency in infertile women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):371-376
DOI 10.1590/S0100-72032002000600003
Purpose: to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. Methods: a total of 61 women, with primary infertility and previous ovarian surgery for endometriosis, submitted to 74 in vitro fertilization/intracytoplasmic spermatozoid injection (IVF/ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as control group. Patients were matched for age and performed treatment. The groups were compared regarding number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, number of oocytes, fertilization and pregnancy rate. IVF started with long protocol GnRHa for pituitary suppression followed by superovulation. After oocyte collection, in vitro insemination or sperm injection was performed and embryos were transferred from day 2 to day 5. Results: patients <35 years with previous ovarian surgery had less oocytes retrieved than the patients of the control group (p=0.049). Number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, and fertilization rate were similar in both groups. The same was observed for pregnancy rates, as 24 patients (53.3%) with previous ovarian surgery and 27 (56.2%) of the control group became pregnant. Patients >35 years with previous ovarian surgery needed more ampoules for superovulation (p=0.017) and had less follicles and oocytes than women of the control group (p=0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Conclusion: ovarian surgery for endometriosis reduced the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, we believe that for infertile patients, a conservative treatment might be a better option to avoid the reduction of ovarian response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(6):371-376
DOI 10.1590/S0100-72032002000600003
Purpose: to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. Methods: a total of 61 women, with primary infertility and previous ovarian surgery for endometriosis, submitted to 74 in vitro fertilization/intracytoplasmic spermatozoid injection (IVF/ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as control group. Patients were matched for age and performed treatment. The groups were compared regarding number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, number of oocytes, fertilization and pregnancy rate. IVF started with long protocol GnRHa for pituitary suppression followed by superovulation. After oocyte collection, in vitro insemination or sperm injection was performed and embryos were transferred from day 2 to day 5. Results: patients <35 years with previous ovarian surgery had less oocytes retrieved than the patients of the control group (p=0.049). Number of ampoules used for superovulation, duration of folliculogenesis, number of follicles, and fertilization rate were similar in both groups. The same was observed for pregnancy rates, as 24 patients (53.3%) with previous ovarian surgery and 27 (56.2%) of the control group became pregnant. Patients >35 years with previous ovarian surgery needed more ampoules for superovulation (p=0.017) and had less follicles and oocytes than women of the control group (p=0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Conclusion: ovarian surgery for endometriosis reduced the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, we believe that for infertile patients, a conservative treatment might be a better option to avoid the reduction of ovarian response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):337-341
DOI 10.1590/S0100-72032002000500008
Purpose: to evaluate pregnancy outcome after laparoscopic tubal anastomosis. Method: from December 1998 to December 2001, 26 patients with bilateral tubal ligation who underwent laparoscopic tubal anastomosis were prospectively evaluated. Patients' age ranged from 28 to 37 years. The follow-up period ranged from 150 to 425 days and tubal patency (evaluated by hysterosalpingography) and pregnancy outcome were evaluated. Results: laparoscopic tubal reversal was performed in 23 patients. Bilateral reversal was attempted in all except two patients. The operation time ranged from 95 to 155 minutes and all patients were discharged on the following morning. Tubal patency was confirmed in 15 patients (15/23). Pregnancy rate was 56.5% (13/23), without ectopic pregnancies. Nine patients got pregnant in up to four months and four in up to nine months after discontinuing the use of condom. Conclusion: in selected cases, laparoscopic tubal reversal can be performed in patients who had been submitted to tubal sterilization and desire new pregnancies. Patient selection as well as meticulous surgical technique are key factors in achieving satisfactory pregnancy rates.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):337-341
DOI 10.1590/S0100-72032002000500008
Purpose: to evaluate pregnancy outcome after laparoscopic tubal anastomosis. Method: from December 1998 to December 2001, 26 patients with bilateral tubal ligation who underwent laparoscopic tubal anastomosis were prospectively evaluated. Patients' age ranged from 28 to 37 years. The follow-up period ranged from 150 to 425 days and tubal patency (evaluated by hysterosalpingography) and pregnancy outcome were evaluated. Results: laparoscopic tubal reversal was performed in 23 patients. Bilateral reversal was attempted in all except two patients. The operation time ranged from 95 to 155 minutes and all patients were discharged on the following morning. Tubal patency was confirmed in 15 patients (15/23). Pregnancy rate was 56.5% (13/23), without ectopic pregnancies. Nine patients got pregnant in up to four months and four in up to nine months after discontinuing the use of condom. Conclusion: in selected cases, laparoscopic tubal reversal can be performed in patients who had been submitted to tubal sterilization and desire new pregnancies. Patient selection as well as meticulous surgical technique are key factors in achieving satisfactory pregnancy rates.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):323-327
DOI 10.1590/S0100-72032002000500006
Purpose: to assess ovarian reserve by FSH determination on the 3rd day of the menstrual cycle compared to the clomiphene test and to correlate the results with the ovarian response to controlled hyperstimulation with gonadotrophins for in vitro fertilization. Methods: a total of 49 patients older than 30 years who had been presenting a clinical picture of infertility for at least 1 year were selected. All patients were evaluated for ovarian reserve by the clomiphene citrate test and 26 of them were later submitted to controlled ovarian hyperstimulation with gonadotrophins. Of these 26 patients, 18 showed a good response to ovarian hyperstimulation and 8 showed a poor response. Mean (+ SD) FSH values were calculated for the determinations on the 3rd and on the 10th day and for their sum in the group of patients who responded favorably to ovarian stimulation, and were later correlated with the ovarian response after gonadotrophin stimulation. Results: employing a FSH value > 16.1 IU/mL on the 10th day (mean plus 2 SD) for the prediction of a poor ovarian response in the clomiphene test, the sensitivity, specificity, and positive and negative predictive values of this parameter were 50, 100, 100 and 81.8%, respectively. Considering the clomiphene test to be positive when the sum of the FSH values determined on the 3rd and 10th day plus 2 SD was > 22.6 IU/mL, we obtained 62.5% sensitivity 100% specificity, 100% positive predictive value, and 85.7% negative predictive value. A single FSH determination of 10 IU/mL on the 3rd day of the cycle for the prediction of a poor ovarian response showed 87% sensitivity, 100% specificity, 100% positive predictive value and 94.7% negative predictive value. Conclusion: in the present study, a single FSH determination on the 3rd day of the cycle showed to be more sensitive than the clomiphene test for the evaluation of ovarian reserve.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(5):323-327
DOI 10.1590/S0100-72032002000500006
Purpose: to assess ovarian reserve by FSH determination on the 3rd day of the menstrual cycle compared to the clomiphene test and to correlate the results with the ovarian response to controlled hyperstimulation with gonadotrophins for in vitro fertilization. Methods: a total of 49 patients older than 30 years who had been presenting a clinical picture of infertility for at least 1 year were selected. All patients were evaluated for ovarian reserve by the clomiphene citrate test and 26 of them were later submitted to controlled ovarian hyperstimulation with gonadotrophins. Of these 26 patients, 18 showed a good response to ovarian hyperstimulation and 8 showed a poor response. Mean (+ SD) FSH values were calculated for the determinations on the 3rd and on the 10th day and for their sum in the group of patients who responded favorably to ovarian stimulation, and were later correlated with the ovarian response after gonadotrophin stimulation. Results: employing a FSH value > 16.1 IU/mL on the 10th day (mean plus 2 SD) for the prediction of a poor ovarian response in the clomiphene test, the sensitivity, specificity, and positive and negative predictive values of this parameter were 50, 100, 100 and 81.8%, respectively. Considering the clomiphene test to be positive when the sum of the FSH values determined on the 3rd and 10th day plus 2 SD was > 22.6 IU/mL, we obtained 62.5% sensitivity 100% specificity, 100% positive predictive value, and 85.7% negative predictive value. A single FSH determination of 10 IU/mL on the 3rd day of the cycle for the prediction of a poor ovarian response showed 87% sensitivity, 100% specificity, 100% positive predictive value and 94.7% negative predictive value. Conclusion: in the present study, a single FSH determination on the 3rd day of the cycle showed to be more sensitive than the clomiphene test for the evaluation of ovarian reserve.
