C.E. Alford

Ovarian reserve and subsequent assisted reproduction outcomes after methotrexate therapy for ectopic pregnancy or pregnancy of unknown location

OBJECTIVE To assess ovarian reserve after methotrexate treatment for ectopic pregnancy or pregnancy of unknown location after assisted reproductive technology (ART). DESIGN Retrospective cohort study. SETTING Large ART practice. PATIENT(S) Women receiving methotrexate or surgery after ART. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Follicle-stimulating hormone (FSH), antral follicle count (AFC), and oocyte yield compared between women treated with methotrexate or surgery, with secondary outcomes of clinical pregnancy and live birth. RESULT(S) There were 153 patients in the methotrexate group and 36 patients in the surgery group. Neither group demonstrated differences in ovarian reserve or oocyte yield in a comparison of the before and after treatment values. The change in ovarian reserve and oocyte yield after treatment were similar between the two groups. The number of doses of methotrexate was not correlated with changes in ovarian reserve, indicating no dose-dependent effect. Time between treatment and repeat ART was not correlated with outcomes. Live birth in subsequent cycles was similar in the two groups. CONCLUSION(S) Ovarian reserve and subsequent ART cycle outcomes were reassuring after methotrexate or surgical management of ectopic pregnancy. No adverse impact of methotrexate was detected in this large fertility cohort as has been previously described elsewhere.

Favorable Response to Antigonadal Therapy for a Benign Metastasizing Leiomyoma

BACKGROUND: Benign metastasizing leiomyoma and lymphangioleiomyomatosis (LAM) both are characterized by abnormal proliferation of smooth muscle-like cells in the lung. CASE: A 32-year-old African woman with a diagnosis of LAM underwent myomectomy for uterine leiomyomas. An alternative diagnosis of benign metastasizing leiomyoma was made on repeat lung biopsy. Treatment with leuprolide acetate decreased pulmonary infiltrates and improved lung function and exercise tolerance. CONCLUSION: Accurately diagnosing benign metastasizing leiomyoma has important implications for clinical outcome. Because its clinical presentation may be misleading, immunohistochemical techniques may assist in differentiating benign metastasizing leiomyoma from LAM. This is important because, in benign metastasizing leiomyoma, reduced tumor burden and improved pulmonary function may be achieved by suppressing gonadal steroids.

Cost and efficacy comparison of in vitro fertilization and tubal anastomosis for women after tubal ligation

OBJECTIVE To compare cost and efficacy of tubal anastomosis to in vitro fertilization (IVF) in women who desired fertility after a tubal ligation. DESIGN Cost-effectiveness analysis. SETTING Not applicable. PATIENT(S) Not applicable. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Cost per ongoing pregnancy. RESULT(S) Cost per ongoing pregnancy for women after tubal anastomosis ranged from

2009 H1N1 influenza prevention and treatment: counseling infertility patients.

16,446 to

Influences on endometrial development during intrauterine insemination: clinical experience of 2,929 patients with unexplained infertility

223,482 (2014 USD), whereas IVF ranged from

Cost analysis of in vitro fertilization (IVF) versus bilateral tubal reanastomosis (BTA) to achieve a live birth

32,902 to

Use of the levonorgestrel containing intrauterine device (LNG-IUS) as a strategy to decrease maternal mortality in Uganda: estimating impact with a prediction model

111,679 (2014 USD). Across maternal age groups <35 and 35-40, years tubal anastomosis was more cost effective than IVF for ongoing pregnancy. Sensitivity analyses validated these findings across a wide range of ongoing pregnancy probabilities as well as costs per procedure. CONCLUSION(S) Tubal anastomosis was the most cost-effective approach for most women less than 41 years of age, whereas IVF was the most cost-effective approach for women aged ≥41 years who desired fertility after tubal ligation. A model was created that can be modified based on cost and success rates in individual clinics for improved patient counseling.

Estimated reduction of vertical transmission of human immunodeficiency virus (HIV) with the levonorgestrel intrauterine device (LNG-IUS): use of a prediction model to estimate the impact of LNG-IUS

It is known that pregnant women are at high risk for complications from the 2009 H1N1 influenza virus. Reproductive endocrinologists often have the opportunity to evaluate patients before conception and are able to counsel them before they become part of this high-risk obstetrics group. The 2009 H1N1 vaccine data and the current recommendations by the Centers for Disease Control and Prevention, American College of Obstetrics and Gynecology, and American Society of Reproductive Medicine are discussed. There is universal agreement in recommending vaccination for all pregnant women and all women attempting conception. Patients should be counseled regarding the vaccine and consider delaying conception until the immunization has been received.