Simon Meagher

Effect of intramural, subserosal, and submucosal uterine fibroids on the outcome of assisted reproductive technology treatment

OBJECTIVE To investigate the effect of subserosal, intramural, and submucosal fibroids on the outcome of assisted reproductive technology (ART) treatment. DESIGN A retrospective comparative study. SETTING A tertiary referral center for infertility. PATIENT(S) Treatment outcome of 106 ART cycles in 88 patients with uterine fibroids (33 subserosal, 46 intramural without cavity distortion, and 9 submucosal) was compared with that of 318 ART cycles in age-matched patients without fibroids. INTERVENTION(S) Controlled ovarian hyperstimulation and ART. MAIN OUTCOME MEASURE(S) Findings on transvaginal uterine ultrasonography performed before the initiation of treatment and pregnancy and implantation rates. RESULT(S) The pregnancy rates per transfer were 34.1%, 16.4%, 10%, and 30.1% in the patients with subserosal fibroids, intramural fibroids, submucosal fibroids and no fibroids, respectively. The implantation rates were 15.1%, 6.4%, 4.3%, and 15.7%, respectively. Both rates were significantly lower in patients with intramural fibroids than in those with subserosal fibroids or no fibroids. CONCLUSION(S) Pregnancy and implantation rates were significantly lower in the groups of patients with intramural and submucosal fibroids, even when there was no deformation of the uterine cavity. Pregnancy and implantation rates were not influenced by the presence of subserosal fibroids. Surgical or medical treatment should be considered in infertile patients who have intramural and/or submucosal fibroids before resorting to ART treatment.

Ultrasound detection of the Essure permanent birth control device: A case series

Background:  The current recommendation to check the position of the Essure permanent birth control (PBC) micro‐insert device after its insertion is by abdominal X‐ray 3 months after insertion. We propose that ultrasound imaging is more suited for this purpose and gives reassurance much earlier. The sonographic appearance of the micro‐inserts and the reliability of this modality in localising the devices is described in the present study.

Ultrasound prediction of risk of spontaneous miscarriage in live embryos from assisted conceptions

An accurate method to predict subsequent miscarriage in live embryos has not yet been established. This pilot study aimed to determine the most discriminatory ultrasound‐based model for predicting spontaneous miscarriage after embryonic life was first detected in assisted conceptions. A method for estimating individual risk of miscarriage was developed.

Noninvasive prenatal testing in routine clinical practice – An audit of NIPT and combined first‐trimester screening in an unselected Australian population

There are limited data regarding noninvasive prenatal testing (NIPT) in low‐risk populations, and the ideal aneuploidy screening model for a pregnant population has yet to be established.

Determining zygosity in early pregnancy by ultrasound

First‐trimester ultrasound can reliably determine chorionicity but not zygosity. We set out to investigate whether it may be possible to determine zygosity using ultrasound by noting the number of corpora lutea (CLs), structures which reflect ovulation. In the presence of a dichorionic twin pregnancy, the identification of one CL would suggest that twins are monozygotic whereas two CLs implies dizygosity.

First-trimester diagnosis of conjoined twins aided by spatiotemporal image correlation

A case of conjoined twins after frozen embryo transfer at early blastocyst stage is described. The diagnosis was made early at 7 weeks by vaginal sonography and later confirmed by spatiotemporal image correlation with power Doppler. The value of spatiotemporal image correlation with Doppler in facilitating an early diagnosis of conjoined twinning is discussed.

Sonographic features of anorectal atresia at 12 weeks

We present the sonographic features of a fetus with anal atresia at 12 weeks of gestation. Follow-up ultrasound examination at 17 week revealed apparently normal bowel. Spontaneous miscarriage occurred at 18 weeks and postmortem examination showed anorectal atresia and arthrogryposis multiplex. It seems that dilatation of the bowel in the early pregnancy is a possible marker for anorectal atresia, and the abnormality may be overlooked if a mid-trimester scan alone is performed.

Colour and pulsed Doppler examination in the diagnosis of uterine arteriovenous malformation.

EDITORIAL COMMENT: We accepted this case report because it makes the point that transvaginal colour and pulsed Doppler examination facilitates the diagnosis of arteriovenous malformation in the uterus, which would allow more conservative curative therapy of heavy uterine haemorrhage, when indicated by the patients requirements, than was adopted in this case.

Three-dimensional imaging of the uterus: The value of the coronal plane

Advent in three-dimensional (3D) imaging technology has seen 3D ultrasound establish itself as a useful adjunct complementary to traditional two-dimensional imaging of the female pelvis. This advantage largely arises from its ability to reconstruct the coronal plane of the uterus, which allows further delineation of many gynecological disorders. 3D imaging of the uterus is now the preferred imaging modality for assessing congenital uterine anomalies and intrauterine device localization. Newer indications include the diagnosis of adenomyosis. It can also add invaluable information to delineate other endometrial and myometrial pathology such as fibroids and endometrial polyps.

Management of Choroid Plexus Cysts in the Mid-Trimester Fetus

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