Annick Delvigne

Continuation rates with a levonorgestrel-releasing contraceptive implant (Norplant®): A prospective study in belgium

Contraceptive protection offered by a method depends on its duration of use, which reflects costs, side effects, and relatives opinions. This study investigated in Norplant implants users the continuation rates, some of their determinants, and the motives for removals. Since 1988, 612 Norplant implants sets, designed to protect for 5 years, have been inserted. Observing 13,907 months of use, we determined over time the continuation rates and how age, parity, circumstances at insertion (postpartum, postabortum, others), and patronymic origins (surrogate for sociocultural factors) influenced them. Statistics included Kaplan-Meiers method and log rank tests, and uni- and multivariate Cox models. Continuation increased with age and depended on sociocultural factors. Parity exerted influence only in younger women. Median duration of use was 3 years 11 months. Removals before 5 years related almost equally to irregular bleeding, other side effects, and pregnancy wish. The cumulative 5-year failure rate was 1.5%. Unsatisfied users returned earlier, distorting the first results. A literature search showed that implants yield, in the mean, slightly better continuation figures than do intrauterine devices, and clearly higher than those obtained with pills and injectables. To optimize costs and counseling, warnings about the risk of short duration of use in young nullipara, especially if negative sociocultural influences prevail, are recommended. In no category are the implants absolutely to be avoided. Individual and programmatic contraceptive choice should take into account the expected continuation of use.

Is fresh or frozen semen to be used in in vitro fertilization with donor sperm

Sixty-six partners of either severely oligoasthenospermic or azoospermic men were treated by in vitro fertilization with donor sperm (IVF-D), usually (86%) after failure of artificial insemination with donor sperm. One hundred twenty-nine IVF trials were performed with either fresh (59%) or frozen-thawed (41%) donor sperm. Characteristics of sperm preparations were significantly lower in the frozen-thawed group (P less than 0.001). In the latter group, fertilization rates had slightly decreased (but without statistical significance); embryonic vitality scores and cryopreservable spare embryos had significantly decreased (P less than 0.05). However, cumulative ongoing pregnancy rates were strictly equivalent in both groups (40% after three trials). Frozen-thawed sperm thus can be substituted for fresh donor sperm without entailing impairment of the outcome of IVF, and this method must be preferred for its greater safety regarding transmission of human immunodeficiency virus.

Presence of HIV-1 in follicular fluids, flushes and cumulus oophorus cells of HIV-1-seropositive women during assisted-reproduction technology.

HIV-1 RNA and DNA were measured in follicular fluids, flushes and cumulus cells during eight cycles of in-vitro fertilization/intracytoplasmic sperm injection in four infected patients. No production of HIV-1 RNA or DNA was evidenced in the follicular fluids or cumulus cells of patients with undetectable plasma viral loads. In the one patient with a detectable plasma viral load, HIV-1 RNA was detected in a sixth of the samples tested. Her baby remained HIV-1 negative.

Self-operated endovaginal telemonitoring versus traditional monitoring of ovarian stimulation in assisted reproduction: an RCT

STUDY QUESTIONnDoes self-operated endovaginal telemonitoring (SOET) of the ovarian stimulation phase in IVF/ICSI produce similar laboratory, clinical, patient reported and health-economic results as traditional monitoring (non-SOET)?nnnSUMMARY ANSWERnSOET is not inferior to traditional monitoring (non-SOET).nnnWHAT IS KNOWN ALREADYnMonitoring the follicular phase is needed to adapt gonadotrophin dose, detect threatening hyperstimulation and plan HCG administration. Currently, patients pay visits to care providers, entailing transportation costs and productivity loss. It stresses patients, partners, care providers and the environment. Patients living at great distance from centres have more difficult access to treatment. The logistics and stress during the follicular phase of assisted reproduction treatment (ART) is often an impediment for treatment.nnnSTUDY DESIGNS, SIZE, DURATIONnThe study was a non-inferiority RCT between SOET and non-SOET performed between February 2012 and October 2013. Sample size calculations of number of metaphase II (MII) oocytes (the primary outcome): 81 patients were needed in each study arm for sufficient statistical power. Block randomization was used with allocation concealment through electronic files. The first sonogram was requested after 5 days of stimulation, after that mostly every 2 days and with a daily sonograms at the end.nnnPARTICIPANTS/MATERIALS, SETTINGS, METHODSnInclusion criteria were age <41 years, undergoing ICSI, no poor response and having two ovaries. We used a small laptop with USB connected vaginal probe and developed a specific web site application. Sonographic training was given to all women at the initiation of a treatment attempt at the centre. The website contained demonstration material consisting of still images and video sequences, as well as written instructions regarding the use of the instrument and probe handling. In total, 185 eligible patients were recruited in four centres: 123 were randomized; 121 completed SOET (n = 59) or non-SOET (n = 62), and 62/185 (33%) eligible patients declined participation for various reasons.nnnMAIN RESULTS AND THE ROLE OF CHANCEnPatient characteristics were comparable. The clinical results showed similar conception rates (P = 0.47) and ongoing pregnancy rates (SOET: 15/59 = 25%; non-SOET: 16/62 = 26%) (P = 1.00) were obtained. Similar numbers of follicles >15 mm diameter at oocyte retrieval (OR), ova at OR, MII oocytes, log2 MII oocytes, embryos available at transfer, top quality embryos and embryos frozen were obtained in the two groups, indicating non-inferiority of SOET monitoring. Regarding patient-reported outcomes, a significantly higher contentedness of patient and partner (P < 0.01), a higher feeling of empowerment, discretion and more active partner participation (P < 0.001) as well as a trend towards less stress (P = 0.06) were observed in the S versus the NS group. In the economic analysis, the use of SOET led to reduced productivity loss, lower transportation costs, and lower sonogram and consultation costs (all P < 0.001 but higher personnel cost than NS).nnnLIMITATIONS, REASONS FOR CAUTIONnThe study was stopped (no further funding) before full sample size was reached. There were also a few cases of unexpected poor response, leading to a wider SD than anticipated in the power calculation. However, although the study was underpowered for these reasons, non-inferiority of SOET versus non-SOET was demonstrated.nnnWIDER IMPLICATIONS OF THE FINDINGSnHome monitoring using SOET may provide a patient-centred alternative to the standard methods. ART sonograms can be made, and then sent to the care provider for analysis at any appropriate time and from anywhere if an internet connection is available. This approach offers several advantages for patients as well as care providers, including similar results to the traditional methods with less logistical stress and potentially bringing care to patients in poor resource settings.nnnSTUDY FUNDING/COMPETING INTERESTSnSupported by an IOF (industrial research fund) of Ghent University (full protocol available at iBiTech) and as a demonstration project of Flanders Care (Flemish Government). There are no conflicts of interest to declare.nnnTRIAL REGISTRATION NUMBERnEC/2011/669 (Ghent University Hospital), B670201112232 (Belgian registration) and NCT01781143 (clinical trials number).

Impact of luteal phase support with vaginal progesterone on the clinical pregnancy rate in intrauterine insemination cycles stimulated with gonadotropins: a randomized multicenter study.

OBJECTIVEnTo evaluate the effect of luteal phase support (LPS) in intrauterine insemination (IUI) cycles stimulated with gonadotropins.nnnDESIGNnRandomized multicenter trial.nnnSETTINGnAcademic tertiary care centers and affiliated secondary care centers.nnnPATIENT(S)nThree hundred and ninety-three normo-ovulatory patients, <43xa0years, with body mass index ≤30xa0kg/m2, in their first IUI cycle, with at least one patent tube, a normal uterine cavity, and a male partner with total motile sperm count ≥5 million after capacitation.nnnINTERVENTION(S)nGonadotropin stimulation, IUI, randomization to LPS using vaginal progesterone gel (n = 202) or no LPS (n = 191).nnnMAIN OUTCOME MEASURE(S)nClinical pregnancy rate, live-birth rate, miscarriage rate, and duration of the luteal phase.nnnRESULT(S)nThe primary outcome, the clinical pregnancy rate, was not statistically different between the treatment group (16.8%) and the control group (11%) (relative risk [RR] 1.54; 95% confidence interval [CI], 0.89-2.67). Similarly, the secondary outcome, the live-birth rate, was 14.9% in the treatment group and 9.4% in the control group (RR 1.60; 95% CI, 0.89-2.87). The mean duration of the luteal phase was about 2xa0days longer in the treatment group (16.6 ± 2.2xa0days) compared with the control group (14.6 ± 2.5xa0days) (mean difference 2.07; 95% CI, 1.58-2.56).nnnCONCLUSION(S)nAlthough a trend toward a higher clinical pregnancy rate as well as live-birth rate was observed in the treatment group, the difference with the control group was not statistically significant.nnnCLINICAL TRIAL REGISTRATION NUMBERnNCT01826747.

More women gynecologists in Belgium: assessment of changes in the workforce—a survey

Context and objectiveInternational data highlight the increasing participation of women in the workforce in the medical field and particularly among obstetricians and gynecologists (OB-GYN). Some studies reported a gender difference in work productivity and practice patterns. The aim of this study is to analyze whether disparities exist between male and female OB-GYN in their practices with potential consequences for the organization of the OB-GYN departments.MethodsA survey of all active, Belgian OB-GYNs concerning their professional activity and well-being and a survey of the heads of OG departments evaluating the impact of feminisation on their department.ResultsThe response rate was 43% (nu2009=u2009615). Women and men worked a similar number of half-days per week, respectively, 10.1u2009±u20092.4 and 10.3u2009±u20093.2 (pu2009=u20090.26) but women treated less patients per week (80 versus 90, pu2009=u20090.034). Pear year, women and men perform, respectively, 108 and 184 surgical procedures (pu2009=u20090.0001) plus 114 and 100 deliveries (pu2009=u20090.09). Female OB-GYNs have fewer children but the size of their family has no bearing on work hours. Qualitatively, most OB-GYN regardless of their gender, consider their profession to be gratifying. Dissatisfaction is related to organizational concerns for women and to pressure of competitiveness for men. Women are more concerned about their private life and men more focussed on their professional career. However, both expressed the primary importance of good health and quality of life. A majority (66%) of head of departments do not consider that the feminisation of their staff is problematic.ConclusionThere was no difference in time spent at work between male and female OB-GYN. The number of patients treated by female OB-GYN per week is smaller which means that the time spent per patient is higher. The OG profession does not appear to be jeopardized by its feminisation according to this study and the opinion of the head of departments. Nevertheless, we need to take into account when organizing the future workforce that women tend to focus more on the time spent with patients than on surgical procedures.