Boaz Sheizaf

Effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization

OBJECTIVE To evaluate the effects of ovarian endometrioma on the number of oocytes retrieved for IVF. DESIGN Retrospective case control study. SETTING University-based tertiary medical center. PATIENT(S) We studied 81 women with unilateral endometrioma who underwent their first IVF cycle. INTERVENTION(S) Oocyte collection. MAIN OUTCOME MEASURE(S) The numbers of antral follicles and the retrieved oocytes in the ovary that contained endometrioma were compared with those from the contralateral ovary. Antral follicle count and the total number of oocytes retrieved from these women then were compared with those in 162 age-matched women with no endometrioma or endometriosis, who also underwent the first IVF treatment cycle. RESULT(S) There was no significant difference in the number of antral follicles and oocytes retrieved in the endometrioma-containing ovary (6.0 ± 0.4 and 7.7 ± 1.0, respectively) and in the opposite ovary (6.1 ± 0.5 and 8.5 ± 0.9, respectively). There was no correlation between the size and the number of endometriomas with the number of retrieved oocytes. Antral follicle count and the number of retrieved oocytes in these women (15.0 ± 1.6 and 11.9 ± 0.8) were similar to those in women with no endometrioma (14.2 ± 1.4 and 11.4 ± 0.5, respectively). CONCLUSION(S) The presence of ovarian endometrioma in a controlled ovarian hyperstimulation cycle for IVF treatment is not associated with a reduced number of oocytes retrieved from the affected ovary.

Effects of excision of ovarian endometrioma on the antral follicle count and collected oocytes for in vitro fertilization

We compared the response of operated and nonoperated ovaries to gonadotropin stimulation in 38 women who had had excision of ovarian endometrioma. The antral follicle count, numbers of dominant follicles, and number of oocytes collected in the operated ovaries were significantly lower than in the nonoperated ovaries suggesting reduced ovarian reserve after excision of ovarian endometrioma.

Effect of different types of ovarian cyst on antral follicle count

We compared antral follicle count in ovaries harboring different types of cysts to the contralateral normal ovaries. Besides endometrioma, the presence of other types of ovarian cysts does not influence the antral follicle count.

Difference between serum beta-human chorionic gonadotropin levels in pregnancies after in vitro maturation and in vitro fertilization treatments

OBJECTIVE To compare β-hCG levels measured as the first pregnancy test in women who conceived after in vitro maturation (IVM) or IVF. DESIGN Retrospective matched cohort analysis. SETTING University-based medical center. PATIENT(S) Women treated with IVM or IVF. INTERVENTION(S) We studied the first serum β-hCG levels in 104 pregnant women who were successfully treated with IVM and in another 104 women with IVF treatment. Blood samplings for β-hCG were drawn on day 12-15 after ET. The two groups were matched by age, order of pregnancy, and day of blood sampling. MAIN OUTCOME MEASURE(S) First β-hCG levels. RESULT(S) Serum β-hCG levels on days 12 to 13 after ET of IVM viable singleton pregnancies were significantly higher than those of IVF pregnancies (343.2±48.4 vs. 264.0±29.2 IU/L, 95% confidence interval [CI] 22-229). Similarly, β-hCG levels on days 14 to 15 after ET of IVM viable singleton pregnancies were higher than those of IVF pregnancies (350.1±126.4 vs. 284.4±30.2 IU/L). Similar trends were found in β-hCG levels on days 12 to 13 after ET of twin viable pregnancies (IVM, 682.1±97.7 vs. IVF, 434.5±41.8 IU/L; 95% CI 44-662). Grouped linear regression with covariance analysis showed a significant difference between IVM and IVF regression lines. CONCLUSION(S) The first serum β-hCG levels in pregnancies after IVM are consistently higher than those after IVF treatment. More studies are needed to elucidate these findings.

Unabsorbed Intraabdominal Polylactide Adhesion Barrier

Fig. 1. Unabsorbed polylactide adhesion barrier on the uterine surface and proximal right fallopian tube. Adhesion formation even after laparoscopic procedures remains one of the most common complications of abdominal surgery. Intra abdominal adhesions can cause infertility, chronic pelvic pain, and small-bowel obstruction [1,2]. The presence of intra abdominal adhesions increases operating time [3]. In addition, the risk of bowel injury at subsequent surgery [4] has a role in the increase in malpractice lawsuits and health care costs [5]. Among gynecologic operations, myomectomy is often associated with postsurgical adhesions. Accordingly, most gynecologic surgeons use an adhesion barrier at completion of a myomectomy. One of the newest adhesion barriers is polylactide, copolymer of 70:30 poly (L-lactide-co-D, L-lactide) film (SurgiWrap; Mast BioSurgery USA, San Diego, CA). This material is not widely used in gynecology. A few reports have revealed that polylactide could be easily applied in laparoscopy, and no adverse events were noted up to 5 months after application [6,7]. In a publication sponsored by Mast BioSurgery USA [8], the authors stated that this material is degraded by hydrolysis within 24 weeks. Our patient was a 27-year-old healthy woman who underwent laparoscopic removal of a myoma 8 ! 3 cm in diameter followed by application of a sheet of polylactide film on the myomectomy incision. Because of inability to conceive and abdominal pain, she underwent a laparoscopic examination 13 months later. There was no adhesion between the uterus and the surrounding tissue. However, on the uterine surface, we observed a yellow irregular structure approximately 3 ! 2 ! 1.5 cm with rich vascularization (Fig. 1). A smaller similar structure was observed on the proximal right fallopian tube. Both structures were removed. Histopathologic analysis

Morbidity with total laparoscopic and laparoscopically assisted vaginal hysterectomy

We evaluated the operative and postoperative morbidity among 103 women who underwent total laparoscopic hysterectomy and 107 others who underwent laparoscopically assisted vaginal hysterectomy. Blood loss was significantly greater in the assisted vaginal hysterectomy group (178.0 ± 12.1 ml) than in the total hysterectomy group (130.2 ± 10.7 ml) (p < 0.001). Despite higher uterine weight in the total hysterectomy group, the operative time of both techniques was similar. The complications of both hysterectomies were also comparable. The results from our study suggest that the complication rates of laparoscopically assisted vaginal hysterectomy and total hysterectomy are similar. However, laparoscopically assisted vaginal hysterectomy is associated with increased blood loss.