Veronica Alam

Comparison of ultrasonography and hysteroscopy in the diagnosis of intrauterine lesions in infertile women

Transvaginal ultrasound is a noninvasive diagnostic technique that remains to be proved as accurate as hysteroscopy in the diagnosis of benign intrauterine lesions. We compared its efficacy with that of hysteroscopy in the diagnosis of benign intrauterine pathology in 126 infertile women in whom the diagnosis was confirmed by histologic studies. The women had a complete evaluation with preoperative transvaginal ultrasound, hysteroscopy, and histologic analysis of uterine cavity specimens. Sensivity, specificity, and predictive values were calculated for ultrasound and hysteroscopy considering the histologic study as 100%. Sensivity was 95% and 100%, and specificity 97.4% and 93.7% for transvaginal ultrasound and hysteroscopy, respectively. The positive predictive value for benign intrauterine lesions was 100% for ultrasound and 89.8% for hysteroscopy. The most frequent intrauterine lesions found were polyps and myomas. Transvaginal ultrasound is a valuable method of diagnosing benign intrauterine lesions in infertile women, and is especially important as a noninvasive technique to plan hysteroscopic surgery.

Embryo implantation rates in oocyte donation: a prospective comparison of tubal versus uterine transfers *

OBJECTIVE To compare pregnancy and implantation rates in tubal and uterine transfers during a hormonal replacement cycle in an oocyte donation program. DESIGN Prospective randomized. PATIENTS Forty-two consecutive patients who entered an oocyte donation program. INTERVENTIONS Twenty-two patients were assigned for uterine transfer and 20 for tubal embryo transfer (ET). RESULTS Twenty-three pregnancies were achieved, 12 (54.5%) after uterine transfers and 11 (57.9%) after tubal transfers. Implantation rates in both groups are not significantly different (17.4% uterine transfers versus 21.5% tubal ETs). CONCLUSIONS Our results suggest that in hormonal replacement cycles (uniform endometrial stimulation) there is no advantage in transferring embryos to the fallopian tube. Furthermore, embryo quality and endometrial receptivity appear to be significantly more important than the time of entrance of an embryo to the uterine cavity in determining its chances of implantation.

Hysteroscopic Correction of Cesarean Section Scars in Women with Abnormal Uterine Bleeding

Abnormal postmenstrual uterine bleeding may occur in women with history of cesarean section. To study the etiology of this anomaly, transvaginal ultrasound (TVU) was performed during follicular phase in 20 such patients, and hysteroscopy in 7. The TVU revealed the presence of fluid in the isthmus in relation to the cesarean section scar, where a kind of pouch or bursa was observed. Cervical introduction of a catheter showed that the fluid was blood. The TVU observation was confirmed in women in whom hysteroscopy was performed. Resection of ring-shaped fibrotic tissue on the inferior part of the scar stopped abnormal bleeding. Four women were infertile and two conceived, probably because stopping postmenstrual bleeding could interfere with the quality of cervical mucus. These findings suggest that abnormal uterine bleeding in women with an abnormal uterine scar could be resolved by minimally invasive endoscopic surgery, and TVU is a valuable diagnostic tool.

The abnormally large follicle during controlled ovarian hyperstimulation: management and outcome of the cycle *

OBJECTIVE To investigate if the presence of an abnormally large follicle during controlled ovarian hyperstimulation (COH) under pituitary suppression has any effect on the outcome of the cycle. DESIGN Prospective, observational. SETTING The reproductive endocrinology unit of a university hospital. PATIENTS One hundred fifty patients undergoing COH for assisted reproductive techniques during a 6-month period (August 1990 to January 1991). INTERVENTIONS Transvaginal follicular aspiration and IVF-uterine ET. RESULTS A total of 19 cycles had abnormally large follicles identified on day 8 of the stimulation cycle after normal baseline ultrasound. Gonadotropins were continued and hCG injection was indicated when two or more follicles of the main cohort achieved a diameter of 20 to 22 mm. Twenty preovulatory oocytes were retrieved from 22 large follicles. Two were transferred for GIFT and 18 were inseminated in vitro, resulting in a 72.0% fertilization rate. The mean number of oocytes retrieved per patient was 10.9, 71.4% of which were mature with a fertilization rate of 67.7%. All these figures were comparable with the results obtained in the 131 patients of the control group undergoing IVF. No evidence of premature luteinization was observed in the study group, based on plasma P levels (x 0.83 ng/mL [conversion factor to SI unit, 3.180], range 0.31 to 1.40 ng/mL). The clinical pregnancy rate for the group with abnormally large follicles did not differ from the control group (27.8% versus 28.2%, respectively). CONCLUSIONS The presence of an abnormally large follicle during COH under pituitary suppression does not affect the outcome of the cycle. Moreover, under these conditions, continuous gonadotropin stimulation of a follicle to diameters considerably larger than the standard ones does not have a detrimental effect on the oocyte contained in it, suggesting that oocyte aging is an independent process from follicular growth once LH surge is prevented.