Shahar Kol

Preoperative diagnosis of fallopian tube carcinoma by transvaginal sonography and CA-125

Primary carcinoma of the fallopian tube is rarely diagnosed preoperatively. We report the case of a 42-year-old woman with primary tubal carcinoma, which was diagnosed preoperatively on the basis of an elevated CA-125 and characteristic features on transvaginal sonography.

The natural history of multiple pregnancies after assisted reproduction: is spontaneous fetal demise a clinically significant phenomenon?

OBJECTIVEnTo determine the rate of spontaneous fetal demise after heartbeats are demonstrated in multiple pregnancies conceived after IVF-ET.nnnDESIGNnRetrospective case series.nnnSETTINGnUniversity-based IVF-ET program.nnnPATIENTSnEighty-one patients in whom initial transvaginal ultrasound (US) study, performed at 5 to 6 weeks of gestation, identified more than one gestational sac. Total number of sacs was 191.nnnINTERVENTIONnPatients were followed by serial US examinations.nnnMAIN OUTCOME MEASUREnOutcome of pregnancies.nnnRESULTSnTwenty-four empty gestational sacs were identified in 21 patients, of whom 15 delivered, 2 miscarried, and 4 are currently ongoing beyond first trimester. Of the 167 initially viable embryos, 9 (5%) underwent spontaneous fetal demise. In 5 of these 9 pregnancies, initial US identified significant interfetal size variation.nnnCONCLUSIONSnThe rate of spontaneous fetal demise for a specific embryo in multiple gestation, after fetal heartbeats have been identified in early pregnancy, is 5%. This rate is similar to that seen in spontaneous conceptions. The chance of future fetal demise increases if first trimester interfetal size variation is significant.

Does intravenous administration of human albumin prevent severe ovarian hyperstimulation syndrome

OBJECTIVEnTo report our experience with i.v. albumin as a means to prevent ovarian hyperstimulation syndrome (OHSS) in high-risk patients.nnnDESIGNnRetrospective case-series.nnnSETTINGnUniversity hospital-based IVF program.nnnPATIENTSnFive women undergoing controlled ovarian stimulation for IVF-Based on previous history and/or E2 measurements and number of ovarian follicles, these patients were considered to be at high risk for developing OHSS.nnnINTERVENTIONSnIntravenous albumin was given at the time of oocyte retrieval. Additional doses were given 12 and 24 hours later.nnnMAIN OUTCOME MEASUREnDevelopment of OHSS.nnnRESULTSnFour patients developed OHSS; two of them had the severe form of the syndrome.nnnCONCLUSIONSnSevere OHSS may develop in high-risk patients despite the prophylactic administration of i.v. albumin.

The use of GnRH analogs for induction of the preovulatory gonadotropin surge in assisted reproduction and prevention of the ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) remains a potential severe complication of the use of gonadotropin therapy in ovulation induction and assisted reproduction technologies. In 1988, we reported preliminary results which demonstrated the ability of gonadotropin-releasing hormone analogs (GnRH-a) to trigger ovulation, and to prevent subsequent OHSS. In this report, we summarize our experience of 73 treatment cycles involving 44 high responders (i.e. patients with a previous history of severe OHSS, or with high estradiol levels (> 13 200 pmol/l) on the day of triggering the luteinizing hormone (LH) surge).In spite of the high estradiol levels (mean 24 202 pmol/l) and the large number of oocytes (mean 32.4), none of our patients developed severe OHSS. Luteal support with progesterone and estradiol valerate was necessary to maintain adequate serum levels of these hormones. Without such support, a precipitous decline in levels of estradiol and progesterone was observed. We believe that the use of GnRH-a i...

Ovarian stimulation in in vitro fertilization with or without the “long” gonadotropin-releasing hormone agonist protocol: effect on cycle duration and outcome

OBJECTIVEnTo study the correlation between stimulation duration of IVF cycles, with and without GnRH agonist (GnRH-a), and cycle outcome.nnnDESIGNnRetrospective analysis of data.nnnSETTINGnUniversity-affiliated IVF clinic.nnnPATIENT(S)n998 IVF cycles in which long GnRH-a protocol was used, and 155 cycles with hMG only.nnnINTERVENTION(S)nIVF cycles.nnnMAIN OUTCOME MEASURE(S)nCycle outcome in number of oocytes and embryos, and pregnancy rate.nnnRESULT(S)nThe mean stimulation duration (+/-SD) was 9.6+/-1.7 and 6.7+/-1.0 for the GnRH-a and the hMG-only cycles, respectively (P<0.01). In the GnRH-a group, no statistically significant correlation between cycle duration and pregnancy rate was found. Interestingly, the patients treated for 9 days had the highest number of oocytes retrieved and the highest pregnancy rate. Stimulation duration was not affected by age in either protocol. GnRH-a cycles yielded a significantly higher number of oocytes and embryos compared to cycles without GnRH-a. The pregnancy rate was similar in both groups.nnnCONCLUSION(S)nStimulation duration in the long GnRH-a protocol group was significantly longer than in the hMG-only group. Stimulation duration was not affected by age. No statistically significant correlation was found between stimulation duration and cycle outcome in the long protocol group.