Marion Valkenburg

Belgian legislation and the effect of elective single embryo transfer on IVF outcome

In order to reduce the number of multiple pregnancies following IVF, the Belgian government agreed to reimburse laboratory expenses for six IVF cycles up to the age of 42 years, in exchange for restriction of the number of embryos replaced. Data on assisted reproduction outcome before and after the introduction of this new legislation were analysed retrospectively in terms of implantation, pregnancy and multiple pregnancy rates. After the introduction of the new law, the percentage of single embryo transfer increased from 14 to 49%. Implantation rates were 25.9 and 23% respectively. There was no difference in the overall pregnancy rate before and after the introduction (36 versus 37%). Twin pregnancies, however, decreased from 19 to 3%. These findings indicate that elective single embryo transfer significantly decreases the twin pregnancy rate without a reduction in the overall pregnancy rate.

Impact of single embryo transfer on the overall and twin-pregnancy rates of an IVF/ICSI programme

This retrospective cohort study analyses experience with single embryo transfer (SET) in an lVF/intracytoplasmic sperm injection (ICSI) programme over a 3-year period (1998-2000): 1143 IVF/ICSI cycles were initiated, resulting in 1073 embryo transfers (93.9%). In 810 (75.4%) transfers of two (n = 580; 54%) or more than two (n = 230; 21.4%) embryos, 279 ongoing pregnancies (34.4%) were obtained. In total, there were 263 SET (24.5%): 207 of a single top quality embryo, resulting in 102 conceptions (49.3%) with 71 ongoing implantations (34.3%, one monozygotic twin); and 56 of a single non-top quality embryo, resulting in 16 conceptions (28.6%) with 11 ongoing implantations (19 .6% ). The percentage of transfers of a single top quality embryo gradually increased from 10% (1998) to 19% (1999) to 26% (2000). The total multiple pregnancy rate decreased from 34% (1998), to 32% ( 1999) and 22% (2000), without affecting the overall ongoing pregnancy rate per transfer: 38% in 1998; 29% in 1999; and 34% in 2000. The average number of transferred embryos decreased from 2.26 ( 1998) to 1.86 (2000). Transfer of a single, strictly defined top quality day 3 embryo in twin-prone IVF/ICSI patients reduced the multiple/twin-pregnancy rate but not the overall pregnancy rate.

Transvaginal hydrolaparoscopy in the treatment of polycystic ovary syndrome

OBJECTIVE To evaluate the efficacy of transvaginal endoscopic ovarian capsule drilling. DESIGN Retrospective efficacy study. SETTING Private tertiary care center. PATIENT(S) Thirty-nine PCOS patients with previously failed ovulation induction; mean duration of infertility 26.5 months (SD +/-2.6); mean age 30.38 years (SD +/-3.8); mean body mass index of 29.4 (SD +/-9.7). INTERVENTION(S) Through transvaginal hydrolaparoscopy in a 1-day clinic setting, drilling of the ovarian capsule is performed with a 5-Fr bipolar needle (Karl Storz, Tüttlingen, Germany) creating 10-15 holes of +/-0.20 mm in each ovary. MAIN OUTCOME MEASURE(S) Evaluation of feasibility, spontaneous resumption of ovulatory cycles and pregnancy rates. RESULT(S) Ovarian capsule drilling was performed in 39 patients. Six patients were lost of follow-up. In total, 25 out of 33 patients (76%) became pregnant with a mean duration between procedure and onset of pregnancy of 7.2 months (SD +/-5.4). Natural conception with or without controlled ovarian hyperstimulation and/or intrauterine insemination occurred in 13 of the 16 patients (81%). Of the 17 patients referred to our IVF program, 12 became pregnant. There were no multiple pregnancies or complications. CONCLUSION(S) The transvaginal approach for ovarian capsule drilling offers a valuable alternative to the standard laparoscopic procedure.

Perinatal listeriosis underdiagnosed as a cause of pre-term labour?

Between April 1, 1985, and April 1, 1986, four cases of perinatal listeriosis were reported at the Maastricht Academic Hospital. All cases were of the early-onset type. All mothers were admitted for pre-term labour between 28 and 33 weeks of gestation. Pre-natal symptoms included maternal fever, non-characteristic influenza-like manifestations, leucocytosis and (pre-term) meconium-stained amniotic fluid. Two neonates died, one in utero and one due to listeriosis sepsis. Another neonate developed a hydrocephalus. Only one neonate has survived without damage up to now. Such a high incidence of listeriosis and the high perinatal morbidity and mortality rates are remarkable. Epidemiological, bacteriological and placental sequelae of Listeria monocytogenes are discussed.

Transvaginal laparoscopy: A minimally invasive approach to obtain brush cytology of the Fallopian tube

OBJECTIVE To evaluate in a prospective pilot study the feasibility of cytobrushing of the fimbrial end using a transvaginal endoscopic access. STUDY DESIGN Prospective feasibility study. The procedure was performed in a consecutive series of 15 infertile women referred for a transvaginal laparoscopy as part of their fertility investigation. Tubal cells were collected using a 5Fr cytobrush. Cytology and immunocytochemistry was done. RESULTS In all patients enough cell material was obtained for analysis, without traumatizing the fimbrial end. Specimens showed the presence of a sufficient amount of cells enabling standard cytologic examinations and immunocytochemistry (Ki 67, p53). CONCLUSION Fimbrial cytobrushing using the transvaginal approach is an easy and minimally invasive procedure. The easy accessibility of the fimbrial end and the distal ampullary part at TVL allows an accurate collection of tubal epithelial cells. In view of the recent data reporting the Fallopian tube and more specifically the fimbrial end as a possible origin of ovarian carcinoma, further research is needed to evaluate the potential of this technique as a possible screening method for patients at risk for ovarian cancer.

Process of oocyte release and capture in the human

The THL was performed under local anaesthesia. The patient was conscious and could follow the entire procedure. The ovulation stigma was identified on the caudal pole of the left ovary. The fimbriae were in close contact embracing the caudal pole of the ovary. Due to vasocongestion, the fimbrial vessels were engorged and the fimbrial ends erected. In a pulsatile way, they were sweeping the surface of the ovulation ostium. At closer inspection, a mucinous structure was seen protruding from the ovulation ostium and stretched between the fimbrial ends and the ostium. The pulsatile movements of the fimbriae, synchronous with the patient’s heartbeat, slowly pulled the cumulus–oocyte complex free from the ostium of the ruptured follicle. During the observation, follicular fluid could be seen leaking from the ostium. The total duration of the observation lasted for 15 min.