John S. Hesla

Expanded polytetrafluoroethylene (Gore-Tex Surgical Membrane) is superior to oxidized regenerated cellulose (Interceed TC7 ) in preventing adhesions

OBJECTIVEnTo compare the impact of expanded polytetrafluoroethylene (PTFE; Gore-Tex Surgical Membrane; W. L. Gore & Associates, Inc., Flagstaff, AZ) and oxidized regenerated cellulose (Interceed TC7, Johnson & Johnson Medical, Inc., Arlington, TX) on the development of postsurgical adhesions.nnnDESIGNnA multicenter, nonblinded, randomized clinical trial.nnnSETTINGnUniversity medical centers.nnnINTERVENTIONSnEach barrier was allocated randomly to the left or right sidewall of every patient.nnnPATIENTSnThirty-two women with bilateral pelvic sidewall adhesions undergoing reconstructive surgery and second-look laparoscopy.nnnMAIN OUTCOME MEASURESnAdhesion score (on a 0- to 11-point scale), the area of adhesion (cm2), and the likelihood of no adhesions.nnnRESULTSnThe use of both barriers was associated with a lower adhesion score and area of adhesion postoperatively. However, those sidewalls covered with PTFE had a significantly lower adhesion score (0.97 +/- 0.30 versus 4.76 +/- 0.61 points, mean +/- SEM) and area of adhesion (0.95 +/- 0.35 versus 3.25 +/- 0.62 cm2). Overall, more sidewalls covered with PTFE had no adhesions (21 versus 7) and, when adhesions were present on the contralateral sidewall, the number of sidewalls covered with PTFE without adhesions was greater than those covered with oxidized regenerated cellulose (16 versus 2).nnnCONCLUSIONnExpanded polytetrafluoroethylene was associated with fewer postsurgical adhesions to the pelvic sidewall than oxidized regenerated cellulose.

Optimal euploid embryo transfer strategy, fresh versus frozen, after preimplantation genetic screening with next generation sequencing: a randomized controlled trial

OBJECTIVEnTo compare two commonly used protocols (fresh vs. vitrified) used to transfer euploid blastocysts after IVF with preimplantation genetic screening.nnnDESIGNnRandomized controlled trial.nnnSETTINGnPrivate assisted reproduction center.nnnPATIENT(S)nA total of 179 patients undergoing IVF treatment using preimplantation genetic screening.nnnINTERVENTION(S)nPatients were randomized at the time of hCG administration to either a freeze-all cycle or a fresh day 6 ET during the stimulated cycle.nnnMAIN OUTCOME MEASURE(S)nImplantation rates (sac/embryo transferred), ongoing pregnancy rates (PRs) (beyond 8xa0weeks), and live birth rate per ET in the primary transfer cycle.nnnRESULT(S)nImplantation rate per embryo transferred showed an improvement in the frozen group compared with the fresh group, but not significantly (75% vs. 67%). The ongoing PR (80% vs. 61%) and live birth rates (77% vs. 59%) were significantly higher in the frozen group compared with the fresh group.nnnCONCLUSION(S)nEither treatment protocol investigated in the present study can be a reasonable option for patients. Freezing all embryos allows for inclusion of all blastocysts in the cohort of embryos available for transfer, which also results in a higher proportion of patients reaching ET. These findings suggest a trend toward favoring the freeze-all option as a preferred transfer strategy when using known euploid embryos.nnnCLINICAL TRIAL REGISTRATION NUMBERnNCT02000349.

Use of suboptimal sperm increases the risk of aneuploidy of the sex chromosomes in preimplantation blastocyst embryos

OBJECTIVEnTo compare autosomal and sex chromosome aneuploidy rates of embryos derived from sperm with abnormal and normal parameters.nnnDESIGNnRetrospective cohort study.nnnSETTINGnAssisted reproduction center.nnnPATIENT(S)nThree thousand eight hundred thirty-five embryos generated from 629 couples undergoing IVF.nnnINTERVENTION(S)nNone.nnnMAIN OUTCOME MEASURE(S)nIncidence of aneuploidy in the trophectoderm of blastocyst embryos derived from standard IVF embryos and intracytoplasmic (ICSI) males with normal and oligozoospermic semen samples, in couples with donor eggs (mean maternal age, 25.0 years) and their own eggs (mean maternal age, 35.4 years).nnnRESULT(S)nThe rate of sex chromosome aneuploidy was significantly (around threefold) higher in the oligozoospermic group compared with in both control groups (standard vs. ICSI insemination). This applied whether donor (young) or own (older) eggs were used. Significant differences were seen in the oligozoospermic samples for autosomes 1, 2, 11 (own eggs), and 18 (donor eggs) compared with both control groups; however, no significant difference was seen between each of the treatment groups for the overall rate of autosomal aneuploidy. No significant differences were seen between the two control groups (normozoospermic males, standard vs. ICSI insemination) in either of the egg group types for any chromosome pairs.nnnCONCLUSION(S)nSevere male factor infertility is associated with a significant increase in the occurrence of sex chromosome abnormalities in blastocyst embryos compared with in embryos derived from normal semen samples. Aneuploidy rates in embryos derived from sperm with normal parameters were not significantly different whether ICSI or standard insemination was used to achieve fertilization. These results highlight severe male factor infertility as a possible referral category for preimplantation comprehensive chromosomal screening.

Laparoscopic Tubal Surgery and Adhesiolysis

Major advances in instrument design during the past two decades have allowed the development of endoscopie techniques for correction of pelvic pathology. These reconstructive procedures are in many circumstances supplanting traditional open abdominal microsurgery because of equivalence in outcomes and lower patient morbidity and expense. Operative laparoscopy provides excellent visualization and, when performed properly, fulfills the major tenets of microsurgery. These principles include the precise dissection and approxima-tion of planes with minimal damage to adjacent tissue, use of atraumatic instruments, frequent irrigation to maintain serosal surface moisture, meticulous hemostasis, and minimal introduction of foreign bodies such as glove powder and lint into the peritoneal cavity.

The effect of the ergoline derivative, CU 32-085, on prolactin secretion in hyperprolactinemic women**Supported in part by a grant-in-aid from Sandoz, Inc., National Institute of Health grant ST33AM07039 (Dr. Rodman), and United States Public Health Service grant RR 054 to the Clinical Research Center of Tufts-New England Medical Center.

Twelve hyperprolactinemic women were administered the alpha aminoergoline derivative, CU 32-085 (Sandoz, Inc., East Hanover, NJ), in order to determine its effect on prolactin (PRL) secretion. The mean pretreatment serum PRL level was 145.0 +/- 11.5 ng/ml. Significant declines of serum PRL occurred with total daily doses of CU 32-085 of 0.1 to 0.5 mg (P less than 0.001). The magnitude of response to therapy was dose-related. In six patients, PRL levels were reduced to less than 25 ng/ml; this effect lasted at least 24 hours after intake of a single dose. In the other six patients, the response was less dramatic. No subjects developed adverse cardiovascular side effects. The results of this study demonstrate that CU 32-085 exhibits a clinically significant dopaminomimetic action on PRL secretion in hyperprolactinemic women.