Stephen J. Steigrad

Epidemiology of gestational trophoblastic diseases

The epidemiology of gestational trophoblastic diseases is unclear. Problems with collection and interpretation of differing data abound. Hydatidiform mole (HM) is associated with abnormal gametogenesis and/or fertilization. This is further influenced by age, ethnicity and a prior history of an HM suggesting a genetic basis for its aetiology. Whilst a prior HM is significant in the development of trophoblastic neoplasia there is no clear explanation for the development of gestational trophoblastic neoplasia in association with a normal gestation. The development and improvements in suction curettage, termination of pregnancy, contraceptive techniques, diagnostic imaging and biochemical testing have been associated not only with a fall in the birth rate, but also with a reduction in the incidence of trophoblastic diseases. Future study should examine the mechanism of malignant change in normal and abnormal trophoblast.

Transcervical intrauterine topical local anesthetic at hysterosalpingography: a prospective, randomized, double-blind, placebo-controlled trial

OBJECTIVE To assess whether transcervical intrauterine topical instillation of a local anesthetic agent reduces pain at hysterosalpingography. DESIGN Prospective, randomized, double-blind, placebo-controlled study. SETTING Department of reproductive medicine at a university teaching hospital. PATIENT(S) One hundred ten women undergoing hysterosalpingography (HSG). INTERVENTION(S) Subjects were randomized to receive either 2 mL of 2% plain lignocaine or 2 mL of 0.9% sodium chloride solution (placebo) topically into the uterine cavity before the HSG was performed. MAIN OUTCOME MEASURE(S) The degree of lower abdominal pain experienced both during the injection of contrast media at HSG and 10 minutes after the procedure using a 20-cm visual analogue scale (VAS) and a four-point verbal descriptor scale (VDS). RESULT(S) There was no difference in pain scores between lignocaine and placebo during the HSG. However, at 10 minutes after the HSG, subjects receiving lignocaine experienced more pain than those on placebo. CONCLUSION(S) Transcervical intrauterine topical instillation of 2 mL of 2% plain lignocaine does not reduce pain during HSG and may lead to increased pain immediately after the procedure.

The Influence of Advanced Age on the Outcome of Assisted Reproduction

Purpose:Our purpose was to determine the influence of age on the outcome of assisted reproduction, with particular interest in women aged 40 years or older.Methods:A retrospective review of the 779 patients enrolled in the Royal Hospital for Women Fertility Group fertility program between 1987 and 1994 was performed. The results for women aged 40 years or older were compared with those for women between 36 and 39 years and those younger than 36 years. The main outcome measures were pregnancy rate, pregnancy outcome, fertilization rate, and ovarian response.Results:Compared with those in younger women, pregnancy rate, pregnancy outcome, fertilization rate, and ovarian response to controlled ovarian stimulation were significantly worse in women aged 40 years or older.Conclusions:The outcome of assisted reproduction in women of 40 years of age or older was extremely poor. Compared with those in younger women, pregnancy outcome and ovarian response to controlled ovarian stimulation were significantly worse in women of 40 years or more.

No Decline in Semen Quality Among Potential Sperm Donors in Sydney, Australia, Between 1983 and 2001

AbstractPurpose: To determine whether the quality of semen has changed over time in men screened for semen donation. Methods: All 448 men volunteering for semen donation between 1983 and 2001 at a donor insemination clinic in Sydney, Australia, were included in this longitudinal single centre observational analysis of semen parameters. There was no selection for fertility or marital status but all volunteers had to be aged between 18 and 40 years. Results: There was no change in the total sperm count during the study period (r = 0.065, P = 0.17) using a linear regression model. The ejaculate volume did not change (r = 0.002, P = 0.97), while an increase in sperm motility was seen (Spearman R = 0.194, P < 0.001). Conclusion: The semen quality of volunteers for sperm donation presenting to our donor insemination clinic in Sydney between 1983 and 2001 has not declined.

Power doppler ultrasound assessment of the relationship between age and ovarian perifollicular blood flow in women undergoing in vitro fertilization treatment

Purpose: To examine the relationship between age and ovarian perifollicular blood flow (PFBF) in women undergoing IVF.Methods: Serial transvaginal power Doppler ultrasound (PDU) scans to assess ovarian PFBF were performed prospectively throughout the follicular phase of ovarian stimulation in women undergoing IVF. The ultrasound assessment days were categorized according to day of hCG trigger.Results: A total of 1050 ovarian follicles from 34 women undergoing one IVF treatment cycle were used for data analysis. The median age of the women was 38.5 years, ranging from 28 years to 44 years. There was a significant negative correlation between age and ovarian PFBF on the day of hCG trigger or trigger day minus 1, but not beforehand during the follicular phase.Conclusions: There was a significant negative correlation between age and ovarian PFBF in women undergoing IVF which was only observed very late in the follicular phase of ovarian stimulation.

Are preoperative antibiotics helpful in abdominal hysterectomy

An open, randomized study to compare the effectiveness of triple-dose cefoxitin with the effectiveness of cephradine-tinidazole and with the result of nontreatment in patients undergoing abdominal hysterectomy was conducted from July 1983 to July 1984. One hundred ninety-nine patients were enrolled: 66 untreated control patients, 69 patients in the cephradine-tinidazole--treated group, and 64 patients in the cefoxitin-treated group. No significant differences were present in relation to age, pathologic condition, length of operation, blood loss, or length of hospital stay. That patients in both treatment groups had a lower incidence of postoperative febrile morbidity was not statistically significant.

Choriocarcinoma Co-Existent with an Intact Pregnancy : Case Report and Review of the Literature

A patient presenting with antepartum haemorrhage due to a vaginal metastasis of choriocarcinoma is reported. Following delivery she was successfully treated with chemotherapy and surgery. This report details this unusual presentation and reviews the literature on this rare condition.

Longitudinal assessment of ovarian perifollicular and endometrial vascularity by power Doppler ultrasound in pregnant and non-pregnant cycles in the IVF setting.

Purpose: This longitudinal study aimed to compare ovarian perifollicular and endometrial blood flow (PFBF and EBF, respectively) during the follicular phase in pregnant and non-pregnant IVF cycles.Methods: Serial transvaginal scans were performed in 15 subjects undergoing IVF treatment. Both PFBF and EBF were subjectively graded (grades 0–4 for PFBF and grades 1–3 for EBF). After confirmation of clinical pregnancy, the treatment cycles were grouped into ‘Pregnant’ and ‘Non-pregnant’ cycles. Ovarian PFBF and EBF were retrospectively compared between the two groups.Results: In pregnant cycles, the proportion of large (⩾15 mm) follicles with high (2–4) grade PFBF increased with time throughout the follicular phase, and the proportion of large follicles with poor (0–1) grade PFBF decreased. In non-pregnant cycles these trends were reversed. There was no difference in EBF between the two groups.Conclusion: The pattern of ovarian PFBF but not EBF may be predictive of treatment outcome.

Predictive value of mid luteal progesterone concentration before luteal support in controlled ovarian hyperstimulation with intrauterine insemination.

Background:  There is no published data assessing whether higher mid luteal serum progesterone (P4) levels are associated with a higher cycle pregnancy rate (CPR) in controlled ovarian hyperstimulation (COH) with intrauterine insemination (IUI).

The Incidence of Neoplastic Trophoblastic Disease in Australia

The incidence of hydatidiform mole and choriocarcinoma over a 16‐year‐period (1950–1966) is presented for 3 major hospitals in Sydney.