Donald I. Galen

Low-dose aspirin for oocyte donation recipients with a thin endometrium: prospective, randomized study

OBJECTIVE To evaluate the effect of low-dose aspirin use in oocyte donation recipients with an endometrial thickness of < 8 mm. DESIGN A prospective, randomized study. SETTING An oocyte donation program in a private infertility practice. PATIENT(S) Twenty-eight recipients undergoing oocyte donation who failed to develop an endometrial thickness of at least 8 mm in a previous evaluation cycle. INTERVENTION(S) Fifteen recipients received low-dose aspirin (81 mg/d) in addition to standard hormone replacement for an oocyte donation cycle. The remaining 13 recipients did not receive aspirin. MAIN OUTCOME MEASURE(S) Clinical pregnancy rates, delivery rates, implantation rates, and change in endometrial thickness were compared in the aspirin and nonaspirin groups. RESULT(S) There was no demonstrable increase in endometrial thickness in the aspirin-treated group. However, there was a statistically significant increase in implantation rates in the aspirin-treated group (24% versus 9%) and in implantation rates and clinical pregnancy rates in the aspirin-treated group when the final endometrial thickness was < 8 mm. CONCLUSION(S) Low-dose aspirin therapy improves implantation rates in oocyte donation recipients with a thin endometrium.

Outpatient laparoscopic-assisted vaginal hysterectomy

STUDY OBJECTIVE To compare laparoscopic-assisted hysterectomy (LAVH) with conventional abdominal hysterectomy. DESIGN First 50 consecutive LAVH procedures. SETTING An outpatient facility at a major medical center (35 procedures) and a nonhospital free-standing surgicenter (15). PATIENTS Sequential sample of 50 women requiring hysterectomy. INTERVENTIONS LAVH in 46 women, converted to open laparotomy in 4. MEASUREMENTS AND MAIN RESULTS Outpatient LAVH was performed successfully in the majority of women. Most patients had significant uterine enlargement, pelvic adhesions, or endometriosis. Only six required replacement of autologous blood postoperatively. Other complications were cystotomy and postoperative pelvic hematoma in one patient each. CONCLUSIONS LAVH can be performed safely in free-standing surgicenters. It offers several advantages to patients, and is considered cost effective by third-party payers.

Improvement of pregnancy rates with oocyte donation in older recipients with the addition of progesterone vaginal suppositories

Pregnancy rates and implantation rates with oocyte donation in recipients 40 years of age and older were significantly lower than those obtained in recipients under the age of 40. This difference was eliminated when P vaginal suppositories were added to the luteal regimen in older recipients. Our experience suggests that uterine aging may play a role in the successful initiation of a pregnancy, but this may be overcome with the preparation of the uterus with P vaginal suppositories.

Argon beam coagulation rescue to correct bleeding during pelviscopy

A new technique of unipolar laparoscopic coagulation is particularly useful for the treatment of pelvic or abdominal bleeding during laparoscopic procedures. Blood present at the coagulation site is blown clear with a stream of argon gas prior to tissue coagulation. Of particular importance is the virtual absence of smoke, and because the procedure involves a nontouch technique, eschar is not removed inadvertently. The speed of tissue coagulation is faster than that of conventional bipolar and unipolar techniques.