T.C. Vaughn

Vaginal (Crinone 8%) gel vs. intramuscular progesterone in oil for luteal phase support in in vitro fertilization: a large prospective trial

OBJECTIVE To compare the efficacy of intravaginal and IMP for luteal phase support in IVF cycles. DESIGN Prospective trial. SETTING Tertiary care private practice. PATIENT(S) Women 25-44 years old with infertility necessitating treatment with IVF. From April 1, 2008-April 1, 2009, 511 consecutive patients were enrolled; 474 completed participation, and 37 were excluded for no autologous ET (freeze all, donor recipients, failed fertilization/cleavage). There were no demographic differences between the two treatment groups. INTERVENTION(S) Luteal phase support using either Crinone or P in oil starting 2 days following oocyte retrieval. MAIN OUTCOME MEASURE(S) Pregnancy and delivery rates stratified by patient age. RESULT(S) Overall, patients who received vaginal P had higher pregnancy (70.9% vs. 64.2%) and delivery (51.7% vs. 45.4%) rates than did patients who received IMP. Patients <35 who received vaginal P had significantly higher delivery rates (65.7% vs. 51.1%) than did patients who received IMP. There were no differences, regardless of age, in the rates of biochemical pregnancy, miscarriage, or ectopics. CONCLUSION(S) In younger patients undergoing IVF, support of the luteal phase with Crinone produces significantly higher pregnancy rates than does IMP. Crinone and IMP appear to be equally efficacious in the older patient.

Laparoscopic repair of bilateral inguinal hernias in a patient with müllerian agenesis

OBJECTIVE To report a case of laparoscopic repair of bilateral inguinal hernias in a patient with müllerian agenesis. DESIGN Case report. SETTING Hospital. PATIENT(S) An 18-year-old woman with müllerian agenesis who presented with symptomatic inguinal hernias containing ovaries. INTERVENTION(S) Laparoscopic repair of bilateral inguinal hernias. MAIN OUTCOME MEASURE(S) Hernia repair was accomplished laparoscopically. RESULT(S) Outpatient laparoscopic repair of bilateral inguinal hernias with reduction of ovaries was performed using an extraperitoneal approach without complication. CONCLUSION(S) Laparoscopic approach of inguinal hernias can be an option for surgical repair in patients with müllerian agenesis even when the hernias contain ovaries.

The Intercycle Variability in Patients Treated With Repeated Cycles of Gonadotropins Is Due to Intrinsic Factors and Is Not Eliminated by Recombinant Gonadotropins

2.4 6 1.9 2.1 6 2.7 2.7 6 2.6 1.6 6 1.3 ,0.05 1.6 6 1.0 1.3 6 0.5 1.9 6 1.1 1.6 6 0.7 ,0.05 25 6 83 0 610 31 6 84 2 615 ,0.05 23 6 32 17 6 29 29 6 51 8 6 12 N.S.