Guillermo Marconi

Laparoscopic ovarian cystectomy of endometriomas does not affect the ovarian response to gonadotropin stimulation

OBJECTIVE To evaluate the ovarian response cycles of IVF-ET in patients who previously underwent laparoscopic cystectomy for endometriomas. DESIGN Retrospective study with prospective selection of participants and controls. SETTING Instituto de Ginecología y Fertilidad Buenos Aires, Argentina. PATIENT(S) Thirty-nine patients underwent an operation for ovarian endometriomas by atraumatic removal of the pseudocapsule with minimal bipolar cauterization of small bleeders and an IVF-ET cycle (group A) and 39 control patients of similar age underwent an IVF-ET cycle for tubal factor infertility (group B). INTERVENTION(S) Laparoscopic endometrioma cystectomy, IVF-ET cycle. MAIN OUTCOME MEASURE(S) E(2) levels, number of gonadotropin ampoules, follicles, oocytes retrieved, number and quality of embryos transferred, and clinical pregnancy rate. RESULT(S) There were no differences in all the parameters studied (E(2) levels, number of follicles, oocytes retrieved, number and quality of embryos transferred, and clinical pregnancy rate) except for the number of gonadotropin ampoules needed for ovarian hyperstimulation, which was significantly higher in group A than in group B. CONCLUSION(S) Our results indicate that laparoscopic cystectomy for endometriomas is an appropriate treatment since it did not negatively affect the ovarian response for IVF-ET.

Inhibition of cyclooxygenase-2 (COX-2) by meloxicam decreases the incidence of ovarian hyperstimulation syndrome in a rat model

OBJECTIVE To investigate the effects of selective cyclooxygenase-2 (COX-2) inhibition on the ovarian hyperstimulation syndrome (OHSS) in an experimental model. DESIGN Controlled laboratory study. SETTING University-affiliated fertility center. ANIMAL(S) Female Wistar rats. INTERVENTION(S) Female Wistar rats (22 days old) were divided into four groups: group 1 (control group; n = 10) received 0.1 mL of intraperitoneal (IP) saline from days 22-26; group 2 (mild-stimulated group; n = 10) received 10 IU of pregnant mare serum gonadotropin (PMSG) on day 24 and 10 IU of hCG 48 hours later (day 26); group 3 (OHSS group; n = 10) was given 10 IU of PMSG for 4 consecutive days from day 22 and 30 IU hCG on the fifth day to induce OHSS; group 4 was treated the same as group 3, but received 2 muL (15 mg/mL) of meloxicam 2 hours before the PMSG injection for 4 consecutive days, and 2 hours before the hCG injection on the fifth day. All groups were killed on day 26. MAIN OUTCOME MEASURE(S) Number of antral and luteinized follicles, ovarian weight, semiquantitative vascular endothelial growth factor (VEGF) and COX-2 immunohistochemistry. RESULT(S) There were no differences in the ovarian weight between groups 1 and 2. Group 3 showed significantly increased ovarian weight that was suppressed, in group 4, by meloxicam. There was no difference in the number of antral follicles among the four groups. In the mild-stimulated and OHSS groups, the granulosa cells (GC) of preovulatory follicles and the stromal cells showed intense VEGF immunoreactivity. The ovaries from the meloxicam-treated group showed less immunoreactivity than the OHSS group, indicating diminished VEGF expression associated with meloxicam treatment. Group 3 (OHSS group) showed increased COX-2 immunoreactivity that was diminished in the meloxicam-treated group. Meloxicam treatment did not affect the hormone-induced increase in serum E(2) levels seen in OHSS rats. CONCLUSION(S) Our results in a rat model suggest that meloxicam has a beneficial effect on OHSS by reducing the increases in ovarian weight and VEGF expression associated with OHSS. These effects may be mediated by the COX-2 inhibitory capacity of meloxicam.

Endometrial lesions caused by catheters used for embryo transfers: a preliminary report

OBJECTIVE To visualize by microhysteroscopy any possible lesions on the endocervix and endometrium made by the catheters commonly used for embryo transfer (ET). DESIGN Prospective descriptive study. Tertiary fertility center (IFER). PATIENT(S) Twenty-three infertile patients underwent a mock transfer before a microhysteroscopy during the postovulatory phase (days 2-5 after ovulation) of the cycle with a Tomcat catheter (n = 5), Frydmans catheter (n = 5), Frydmans set (n = 3), or Wallaces catheter (n = 10). INTERVENTION(S) Mock ETs and subsequent mycrohysteroscopies.Visualization, description, and documentation of endocervical and endometrial lesions. RESULT(S) The lesions in all 23 patients were described and documented (tunnel-like, groove-like, punch-out, crater-like). The Wallace catheter appears to be less traumatic to the endometrium (but it seems that it is important to take care to not pass the internal os with the outer sheath). The Tomcat catheter and the Frydmans set caused the more significant lesions that were observed. CONCLUSION(S) In this preliminary study, for the first time endometrial lesions caused by the ET catheters were directly visualized and documented. Some of these observed lesions appear to be capable of compromising the success of ET.

Salpingoscopy: systematic use in diagnostic laparoscopy.

OBJECTIVE To evaluate the importance of salpingoscopy together with laparoscopy in the diagnosis of tubal pathology. DESIGN Salpingoscopy was performed as a complementary method in patients who were subjected to diagnostic laparoscopy. The relationship between the salpingoscopy and (1) the patients previous history of tubal disease and (2) laparoscopic diagnoses was evaluated. SETTING Private patients referred to the Instituto de Fertilidad, Buenos Aires. PATIENTS, PARTICIPANTS Forty-two patients undergoing a diagnostic laparoscopy during the evaluation of their fertility or as a follow-up of previous therapy. MAIN OUTCOME MEASURE(S) Salpingoscopy was performed, using a colpomicrohysteroscope. We evaluated alterations in major and minor folds and their vascularization, the presence of microadhesions, and cellular nuclei dyed with methylene blue in the tubal lumen. RESULTS Fifty percent of the patients who had no previous history of tubal disease presented with endosalpingeal alterations, and in 37% of the normal laparoscopies the salpinx had unilateral or bilateral salpingoscopic abnormalities. CONCLUSIONS Salpingoscopy is a useful method to evaluate oviducts, before assuming their normality, and consideration of these women for assisted reproductive technology.

Significance of ovarian macrophages in the follicular aspirates from ART patients

AbstractPurpose: To evaluate the percentages of macrophages present in granulosa cells (GC) cultures from patients with different responses to the hyperstimulation, in relation to the percentages of apoptotic cells (ApC), as well as to the release of cytokines. Methods: We studied 42 patients: 12 Hyporesponders, (with ≤4 follicles), 15 Normoresponders, (5–14 follicles), and 15 Hyperresponders, (≥15 follicles). In GC cultures percentages of macrophages and ApC were counted and, in the conditioned media, cytokines were measured Results: Percentages of macrophages were significantly higher in GC cultures from Hyporesponders compared with Hyperresponders patients. Also, the percentages of ApC cells were the highest in Hyporesponders. On the contrary, cytokines concentrations were the lowest in this group. Conclusions: The low ovarian response is probably due to the decreased angiogenesis, which in turn produces increased apoptosis and decreased production of cytokines. The increased percentage of macrophages could be related to increased frequency of apoptotic cells.

In vitro fertilization and embryo transfer program at the Instituto de Fertilidad, Buenos Aires, Argentina.

No. of patients 84 No. of cycles 158 Cancellation (cycle) 50 Ovum pickups Laparoscopies 56 Ultrasound 52 No. of retrieved oocytes 602 No. of oocytes/patient 7.2 Fertilization rate 64% No. of cleaved oocytes 273 Embryo/transfer 2.9 No. of clinical pregnancies 15 Abortions 3 Ectopic pregnancy 1 Intrauterine + ectopic 1 Ongoing (over 20 weeks) 7 Deliveries 4 No. of live babies 5 Pregnancy/pickup 13.8% Pregnancy/tran sfer 15.9% Pregnancy/patie nt 17.8%