Carole Dietterich

Ipsilateral versus contralateral ovary selection of dominant follicle in succeeding cycle.

There is still confusion as to whether ovulation in a succeeding cycle is a random event or is more likely to occur at the ipsilateral or contralateral ovary. Both histologic and sonographic data support alternating ovulation. Some ultrasound studies have suggested that ipsilateral ovulation is more likely in succeeding cycles, and another found rightsided ovulation to be more common. Because many of the studies are based upon small numbers, we initiated a large study to determine the more likely side of ovulation. Furthermore, the present investigation attempted to confirm biochemically the true existence of the dominant follicle by demonstrating appropriate serum estradiol levels. Evaluation of natural cycles (286 pairs) demonstrated 52.4% ipsilateral ovulation and 47.6% contralateral ovulation. Rightsided ovulation occurred in 54.5% of cycles. Our data suggest that the side of ovulation in successive cycles is not influenced by the side of ovulation in the preceding cycle.

The effects of multiple gestation and selective reduction on fetal outcome.

A group of 32 women with at least 3 or more viable fetuses by sonography at approximately 8 weeks gestation were given the option of selective reduction. They were advised that this was a relatively new procedure but heretofore in a small series was not associated with a significant increase in fetal demise. Only 7 of 32 women chose this option. six of these 7 had triplets reduced to twins, 1 woman had quadruplets reduced to twins. Thirteen of 14 viable babies were successfully delivered at a mean of 36.8 weeks gestation; 2 of 7 (28.6%) delivered before 37 weeks. In contrast, 7 of 25 (24%) not having reduction lost all babies (6 triplets, 1 quadruplet). Four other women lost at least 1 of their gestations (total of 5 babies). Pre-term deliveries (< 37 weeks) occurred in 16 of 18 (88.8%) patients delivering at least 1 live baby, with a mean of 33.7 weeks gestation. Thus the high rate of total fetal loss and prematurity for multiple gestation and the low pregnancy wastage and pre-term delivery rate following selective reduction might make the latter a reasonable therapeutic option to patients interested in having the best chance of delivering healthy viable babies.

Evaluation of a nonhomogeneous endometrial echo pattern in the midluteal phase as a potential factor associated with unexplained infertility

OBJECTIVE To determine whether the failure to develop a homogeneous hyperechogenic pattern in the midluteal phase is associated with decreased fecundity in infertile women who are not receiving follicle-maturing drugs. DESIGN Observational study. SETTING Outpatient infertility clinic of a University Medical Center. PATIENT(S) Two hundred ninety-six infertile women (> or =6 months) with regular menses, normal fallopian tubes and uterine cavity, and absence of severe male factor on their initial investigation cycle for follicular dynamic studies. INTERVENTION(S) Midluteal phase sonographic endometrial evaluation. MAIN OUTCOME MEASURE(S) Viable pregnancy rates (live fetus at end of first trimester) according to endometrial echo pattern in the midluteal phase. Other variables considered were age of patient, endometrial thickness and serum E(2) levels at midcycle and midluteal phase, midcycle echo pattern, and P levels in the midluteal phase. RESULT(S) The viable pregnancy rate was significantly higher in those women who exhibited a homogeneous hyperechogenic pattern (8.5%) compared to those women whose endometrium was found to be nonhomogenous (2.2%). No other confounding variables were found that could explain this outcome. CONCLUSION(S) A nonhomogeneous hyperechogenic sonographic endometrial echo pattern predicts lower fertility potential in women who are not receiving follicle-maturing drugs.

Effect of fibroids on cumulative probability of pregnancy in women taking follicle-maturing drugs without assisted reproductive technology

PURPOSE To determine if the presence of uterine fibroids adversely affect in vivo conception rates. METHODS Pelvic ultrasound evaluation of the presence or absence of fibroids in consecutive infertility patients not treated with assisted reproductive technology in a two-year period. Conception outcome noted. Data analyzed according to the presence or absence of fibroids. RESULTS No difference in cumulative probability of pregnancy after five months was seen in patients with or without the presence of fibroids. There were no confounding variables found that could have skewed the pregnancy rates in one direction or the other. CONCLUSION In general the presence of fibroids do not adversely affect conception outcome for in vivo pregnancies. However, since the majority of the fibroids were small (< 6 cm) and were not submucosal and did not compress the endometrial cavity, larger studies are needed to address specific subtypes and circumstances on pregnancy outcome.

The effect of endometrial thickness and echo pattern on in vitro fertilization outcome in donor oocyte-embryo transfer cycle**Presented at the 40th Annual Meeting of the Pacific Coast Fertility Society, Indian Wells, California, April 8 to 12, 1992.

There have been some conflicting data concerning the importance of endometrial thickness and echo patterns before transfer in different IVF-ET situations under different COH regimens. We previously found in women undergoing IVF-ET after luteal phase LA-hMG a significantly higher PR in those patients attaining at least a 10-mm endometrial thickness and a lower rate in those women with an entirely homogeneous hyperechogenic endometrium (pattern C). The present study evaluated the relationship of endometrial thickness and echo pattern to PRs in donor oocyte recipient immediately before transfer. There were 16 pregnancies in 58 cycles (27.5%). Conclusions similar to the previous COH study were reached concerning the > or = 10-mm thickness levels correlating with improved PRs (9% versus 38.7%, P < 0.01). In contrast, no correlation with echo pattern was found.