Rachel K. Ashby

The medical management of ectopic pregnancy: a meta-analysis comparing 'single dose' and 'multidose' regimens

OBJECTIVE Medical management of an unruptured ectopic pregnancy with intramuscular methotrexate is common and cost-effective. Two treatment protocols, the “single dose” and the “multidose,” have been advocated and independently reported in the medical literature. This analysis systematically compares the success and prevalence of side effects of these two regimens. DATA SOURCES Published data on women with an ectopic pregnancy medically managed were identified using a MEDLINE search from 1966 to 2001 using key words and review of the references of each manuscript. METHODS OF STUDY SELECTION Studies were selected based on dosing regimen, number of subjects, and study quality. Data regarding outcome, number of doses administered, side effects, and baseline characteristics were extracted. Data were summarized, and the associations of failed management and the presence of side effects with treatment protocol were calculated. Baseline serum chorionic gonadotropin values and the presence of embryonic fetal actively were controlled for with multivariable logistic regression. TABULATION, INTEGRATION, AND RESULTS The overall success rate for women treated with methotrexate for an ectopic pregnancy was 89% (1181 of 1327). The single dose was much more commonly used. The use of single dose was associated with a significantly greater chance of failed medical management than the use of the multidose in both crude (odds ratio [OR] 1.71; 1.04, 2.82) and adjusted analyses (OR 4.74; 1.77, 12.62). The single-dose regimen was associated with fewer side effects (OR 0.44; 0.31, 0.63). Women who experienced side effects were more likely to have successful treatment regardless of regimen. CONCLUSION The multidose regimen is more effective than the single-dose regimen.

Physical activity and semen quality among men attending an infertility clinic

OBJECTIVE To examine the association between regular physical activity and semen quality. DESIGN Prospective cohort study. SETTING Couples attending one of three IVF clinics in the greater Boston area during 1993-2003. At study entry, male participants completed a questionnaire about their general health, medical history, and physical activity. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived using generalized estimating equations models, accounting for potential confounders and multiple samples per man. PATIENT(S) A total of 2,261 men contributing 4,565 fresh semen samples were enrolled before undergoing their first IVF cycles. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Semen volume, sperm concentration, sperm motility, sperm morphology, and total motile sperm (TMS). RESULT(S) Overall, none of the semen parameters were materially associated with regular exercise. Compared with no regular exercise, bicycling ≥ 5 h/wk was associated with low sperm concentration (OR 1.92, 95% CI 1.03-3.56) and low TMS (OR 2.05, 95% CI 1.19-3.56). These associations did not vary appreciably by age, body mass index, or history of male factor infertility. CONCLUSION(S) Although the present study suggests no overall association between regular physical activity and semen quality, bicycling ≥ 5 h/wk was associated with lower sperm concentration and TMS.

Embryo banking between induction and consolidation chemotherapy in women with leukemia

OBJECTIVE To report the results of controlled ovarian hyperstimulation (COH) after long-acting GnRH agonist (GnRH-a) and chemotherapy for the purposes of embryo cryopreservation. DESIGN Case report. SETTING University medical center. PATIENT(S) Two premenopausal women with acute myelogenous leukemia with recent treatment with GnRH-a and induction chemotherapy for hematopoietic cell transplantation (HCT). INTERVENTION(S) COH with embryo cryopreservation. MAIN OUTCOME MEASURE(S) Numbers of oocytes and embryos cryopreserved. RESULT(S) Both patients responded to gonadotropin stimulation and cryopreserved embryos. CONCLUSION(S) Women who have received recent long-acting GnRH-a and chemotherapy may respond to gonadotropin stimulation. The option of embryo banking can be offered to leukemia patients who are preparing for HCT.

Does emotional support during the luteal phase decrease the stress of in vitro fertilization

OBJECTIVE To determine if phone calls between ET and pregnancy test, decrease stress levels as determined by the Perceived Stress Scale (PSS). DESIGN Randomized controlled trial. SETTING Academic medical center. PATIENT(S) Women undergoing a first fresh cycle of assisted reproductive technology using autologous oocytes with a day 2 or 3 ET. INTERVENTION(S) Phone calls from specialized social workers or standard of care. MAIN OUTCOME MEASURE(S) Primary outcome was the change in PSS score from day of ET compared with 10 days after ET; secondary outcome was perceived patient benefit. RESULT(S) A total of 131 patients were randomized to the intervention (n = 66) or control (n = 65) group. No differences were seen in the final PSS score or the change in PSS score between groups. At the completion of the study, the intervention group was more likely to report that participating in this study was helpful (65.9% vs. 21.4%), as well as to recommend emotional support during an IVF cycle (95.4% vs. 78.6%). CONCLUSION(S) Although we observed no significant change in PSS score, first-cycle IVF patients felt that increased emotional support was needed during the waiting period between ET and pregnancy test. Additional research should be conducted to determine the best interventions for this time period.