Matthew G. Retzloff

Is intracytoplasmic sperm injection safe

OBJECTIVEnTo review the pregnancy and birth outcomes of patients undergoing intracytoplasmic sperm injection (ICSI).nnnDESIGNnSelective review of the literature.nnnSETTINGnCouples undergoing either conventional IVF or ICSI and their resulting offspring.nnnPATIENT(S)nNone.nnnMAIN OUTCOME MEASURE(S)nNone.nnnINTERVENTION(S)nNone.nnnRESULTSnThese observational studies are unfortunately inherently biased. Regardless, the information and experiences from these large centers cannot be ignored. These experiences reveal that birth weight may be decreased by an amount that is generally not clinically relevant. Chromosomal and genetic abnormalities are increased probably only as a direct corollary to the underlying parental risk. Congenital malformations reveal no clustering of any single specific abnormality. Developmental assessment is available for up to 2 years, and no major delays have been identified in either motor or mental function.nnnCONCLUSION(S)nIntracytoplasmic sperm injection appears to be a safe alternative for couples who otherwise would be unable to achieve pregnancy. The inherent risks associated with these genetically at risk couples mandate thorough evaluation and counseling before undertaking ICSI.

Impact of day 3 or day 5 embryo transfer on pregnancy rates and multiple gestations

OBJECTIVEnTo test the hypothesis that day 5 ET (D5ET) is superior to day 3 ET (D3ET) in pregnancy outcome and that it also reduces multiple gestations.nnnDESIGNnRetrospective cohort study.nnnSETTINGnAssisted reproductive technologies program at Wilford Hall Medical Center.nnnPATIENT(S)nPatients electing for either D3ET or D5ET.nnnINTERVENTION(S)nParticipants meeting inclusion criteria for D5ET elected either D3ET or D5ET.nnnMAIN OUTCOME MEASURE(S)nCycles were compared by day of transfer and further stratified by patient age (<35 years and 35-40 years). The number of oocytes retrieved, embryos on day 3, embryos transferred, pregnancy rate, implantation rate, and twin and high order multiples (>or=triplets) rates were compared.nnnRESULT(S)nOf the 274 patients who met our inclusion criteria, 153 underwent a D3ET and 121 underwent a D5ET. The D5ET group had a significantly lower mean age and number of embryos transferred and a higher implantation rate (56% vs. 42%) than the D3ET group. Patients who were 35-40 years old had a significantly higher live-birth rate (68% vs. 40%). Although not statistically significant, the D5ET groups had higher clinical pregnancy (73% vs. 65%) and twin pregnancy (33% vs. 25%) rates.nnnCONCLUSION(S)nBlastocyst transfer resulted in fewer embryos transferred, with a trend toward improved clinical pregnancy and higher twin pregnancy rates. Live-birth rates were improved in patients 35-40 years of age. Younger patients opting for D5ET should do so with a commitment toward single ET.

Optic neuritis with transient total blindness during lactation1

BACKGROUND Lactation-induced blindness is a rare but devastating puerperal complication. There are few reported cases and no consistent associated disease processes historically identified. This case illustrates lactation-associated optic neuritis as an early identifier of multiple sclerosis. CASE A nulliparous woman underwent a term vaginal delivery complicated only by chorioamnionitis. She was treated with intravenous antibiotics, which included spontaneous bacterial endocarditis prophylaxis. Her postpartum course was uncomplicated, and she was discharged on postpartum day 2 with her infant. She was readmitted on postpartum day 16 completely blind. Evaluation revealed bilateral optic neuritis. Symptoms were initiated and exacerbated during nursing. Transitory waxing and waning of her visual deficits were noted after aggressive steroid therapy and discontinuing nursing. The patient was subsequently diagnosed with multiple sclerosis of relapsing-remitting type. CONCLUSION Multiple sclerosis must be considered as an etiology for acute puerperal lactation-associated blindness when there is no clear anatomic or infectious cause.