Amir Lass

The Effect of Endometrial Polyps on Outcomes of In Vitro Fertilization (IVF) Cycles

Purpose:Our purpose was to investigate the effect of endometrial polyps on pregnancy outcome in an in vitro fertilization (IVF) program.Methods:Endometrial polyps less than 2 cm in diameter were suspected by transvaginal ultrasound before oocyte recovery in 83 patients. Forty-nine women (Group I) had standard IVF–embryo transfer, while in 34 women (Group II) hysteroscopy and polypectomy were performed immediately following oocyte retrieval, the suitable embryos were all frozen, and the replacement cycle took place a few months later.Results:Of the 32 hysteroscopies, a polyp was diagnosed in 24 cases (75%) and polypoid endometrium in another 5 patients (15.6%). An endometrial polyp was confirmed by histopathological examination in 14 women (58.3%). The pregnancy rate in group I was similar to the general pregnancy rate of our unit over the same period (22.4 vs 23.4%) but the miscarriage rate was higher (27.3 vs 10.7%, P = 0.08). In Group II, the pregnancy and miscarriage rates were similar to those of the frozen embryo cycles at Bourn Hall (30.4 and 14.3 vs 22.3 and 12.1%, respectively).Conclusions:Small endometrial polyps, less than 2 cm, do not decrease the pregnancy rate, but there is a trend toward increased pregnancy loss. A policy of oocyte retrieval, polypectomy, freezing the embryos, and replacing them in the future might increase the “take-home baby” rate.

How useful is cervical dilatation in patients with cervical stenosis who are participating in an in vitro fertilization- embryo transfer program? The Bourn Hall experience

OBJECTIVEnTo evaluate the place of cervical dilatation performed at the initial visit in an IVF-ET cycle in patients with known cervical stenosis.nnnDESIGNnRetrospective study.nnnSETTINGnA tertiary care assisted conception unit.nnnPATIENT(S)nFifty-seven patients who failed to conceive after a previous ET attempt and in whom the ET was classified as difficult.nnnINTERVENTION(S)nCervical dilatation under general anesthesia after pituitary suppression and before gonadotropin stimulation.nnnMAIN OUTCOME MEASURE(S)nEase of the ET procedure and clinical pregnancy rate.nnnRESULT(S)nEighteen (31.6%) of 57 women who failed to conceive after a previous attempt at IVF-ET achieved a clinical pregnancy after cervical dilatation. In 40 patients (70.2%), the subsequent ET was classified as easy, whereas in the other 17 (29.8%), it remained difficult. The pregnancy rate was significantly higher when the ET was easy than when it was difficult (40% versus 11.8%, P<.05).nnnCONCLUSION(S)nIn patients with cervical stenosis and a previous difficult ET, cervical dilatation during the initial visit leads to an easier subsequent ET and improves the pregnancy rate.

Monitoring of in vitro fertilization–embryo transfer cycles by ultrasound versus by ultrasound and hormonal levels: a prospective, multicenter, randomized study ☆

OBJECTIVEnTo determine whether cycle monitoring using both serum E(2) and ultrasound findings yields superior clinical pregnancy rates during IVF-embryo transfer (ET) compared to monitoring with ultrasound alone.nnnDESIGNnProspective, randomized, multicenter, patient-blinded study.nnnSETTINGnFour assisted conception units in the United Kingdom.nnnPATIENT(S)nTwo hundred ninety-seven women believed to be normal responders undergoing IVF treatment.nnnINTERVENTION(S)nPatients were randomly allocated on day 7 of stimulation to one of the two hCG administration criteria: [1] the E(2)-to-follicle > or =11 mm ratio was between 250 and 500 pmol/L/follicle and at least 2 follicles reached a mean diameter of 18 mm or [2] at least 2 follicles reached a mean diameter of 18 mm and the endometrium thickness was > or =8 mm.nnnMAIN OUTCOME MEASURE(S)nDuration and cumulative dose of recombinant human FSH, total number of growing follicles, oocytes retrieved, number and quality of embryos, pregnancy rates, and ovarian hyperstimulation syndrome (OHSS) rates.nnnRESULT(S)nTwo hundred ninety-seven patients were randomized to one of the two criteria groups. Of these, 288 (97%) received urinary (u)-hCG (143 in group A and 145 in group B). One hundred three women in group A (72%) met both criteria for hCG administration. Pregnancy and OHSS rates were similar (34.3% vs. 31.4% and 4.9% vs. 4.1%, respectively).nnnCONCLUSION(S)nThe addition of E(2)/follicle criteria to ultrasound monitoring of IVF cycles in normal responders seldom changes the timing of hCG, and does not increase pregnancy rates or the risk of OHSS.

How do patients choose private in vitro fertilization treatment? A customer survey in a tertiary fertility center in the United Kingdom

OBJECTIVEnTo assess the relevant factors affecting patients decision when choosing a clinic for private, self-funded IVF treatment.nnnDESIGNnProspective anonymous closed questionnaires.nnnSETTINGnSingle tertiary-care private IVF center.nnnPATIENT(S)nNew patients attending primary consultation in a period of 7 months from September 1999 to March 2000.nnnINTERVENTION(S)nNone.nnnMAIN OUTCOME MEASURE(S)nPrimary knowledge about the clinic, source of referral, knowledge of, availability of information pack, and familiarity with the clinics success rates and treatments price. The last question assessed the relative importance of each factor in the decision-making process according to the SERVQUAL model, modified version. All items were measured as perceptions on a 5-point Likert scale. 1 = not important, 3 = neutral, and 5 = very important.nnnRESULTS(S)nOne hundred seventy-five patients completed the questionnaire. They were well informed and investigated the market before making their final choice. Patients collect information from many sources, including new channels such as the Internet. Up to one third of patients do not consult their doctor before treatment. By far the most relevant factor in decision making is the success rate (i.e., delivery rates) of the clinic, followed by recommendation by general practitioner (GP) or consultant (respectively, Likert scale score, 4.6; 95% confidence interval [CI], 4.5-4.7; and Likert scale score, 4.0; 95% CI, 3.9-4.2; P<.01). Other factors, such as cost of the treatment, friends and relatives opinions, and distance from home were not relevant.nnnCONCLUSION(S)nUnits that wish to thrive and increase their market share should deliver high-quality service and concentrate their efforts on excelling in performance.

IVF Performance of Women Who Have Fluctuating Early Follicular FSH Levels

AbstractObjectives: The aim was to evaluate whether women who have early follicular follicle-stimulating hormone (FSH) levels >12 mIU/ml have reduced response to follicular stimulation for in vitro fertilization (IVF) in a following month, in spite of normal FSH levels.nMaterials and methods: In a 3-year period from January 1996 to December 1998, 303 women aged 38 years and above and/or who had previously responded poorly to superovulation for IVF gave blood samples for FSH, luteinizing hormone (LH), and estradiol (E2) on day 2 of menstruation before commencing treatment.nResults: In 117 (38.6%) of these women, FSH levels were >12 mIU/ml (range 12–114 mIU/ml). Sixty-six of these women gave a further 130 blood samples for FSH measurement in the following months. Seventy-eight (60.0%) of the tests showed raised FSH value >12 mIU/ml. Thirty women whose repeat FSH levels were <12 mIU/ml underwent 41 IVF cycles (group 1). Sixty-three other women, older than 38 and/or who had a poor response to superovulation previously and whose FSH levels were <12 mIU/ml, served as the control group (group II). There were no differences in the responses to superovulation and delivery rates between the two groups (14.6% vs. 12.7%).nConclusions: Women whose early follicular phase FSH levels were raised >12 mIU/ml had an increased risk (>50%) that in subsequent cycles levels would remain raised, and it was not possible to predict which individuals would have favorable FSH levels. If the cycle day 2 FSH level returns to a “normal” level of <12 mIU/ml, women aged 40 and above had substantial cycle cancellation rates (43%), but patients who achieved the stage of embryo transfer had a good chance of conceiving, regardless of their age.