Vicente Mario Izzo

Inhibin B response to EFORT is associated with the outcome of oocyte retrieval in the subsequent in vitro fertilization cycle.

OBJECTIVE To examine whether the magnitude of the rise in inhibin B levels after gonadotropin challenge is associated with subsequent response to ovarian stimulation during IVF. DESIGN Inhibin B serum levels after EFORT (exogenous follicle-stimulating hormone ovarian reserve test). SETTING Academic clinical practice. PATIENT(S) Serum samples from women who had undergone ovarian reserve screening with FSH in preparation for IVF. Thirteen of these women had a poor response in IVF (canceled cycle for low estradiol and/or no oocytes retrieved), and 19 had a good response (> or =10 oocytes retrieved). INTERVENTION(S) EFORT test. MAIN OUTCOME MEASURE(S) Baseline (day 3) serum E(2) (bE(2)), FSH (bFSH), and inhibin B (bInhB) levels and inhibin B and E(2) levels 24 hours after EFORT (DeltaInhB and DeltaE(2)). RESULT(S) The mean bInhB and DeltaInhB levels were significantly higher in good vs. poor responders. The odds ratio of having a good response for women with a DeltaInhB of 202 pg/mL was 51.8 times (95% CI = 6.1-1,244) the corresponding odds for women with a DeltaInhB of 49 pg/mL. As expected, DeltaE(2) was also significantly higher in good vs. poor responders; however, combination of DeltaE(2) plus DeltaInhB did not improve the odds for predicting IVF response. CONCLUSION(S) Our data suggest that DeltaInhB after EFORT may provide a method for predicting ovarian response to hyperstimulation in a subsequent IVF cycle.

Pattern of prolactin secretion after administration of gonadotropin-releasing hormone agonist at the preovulatory phase of intrauterine insemination cycles

CONTEXT AND OBJECTIVE Administration of a gonadotropin-releasing hormone (GnRH) agonist at the preovulatory phase is an option for triggering ovulation in assisted reproductive technology cycles. The aim of this work was to investigate the pattern of prolactin secretion after the administration of a single dose of GnRH-agonist at the preovulatory phase. DESIGN AND SETTING Descriptive study at a tertiary referral center. PARTICIPANTS Fifteen normally ovulating patients undergoing ovarian stimulation for intrauterine insemination were studied. METHODS Ovarian stimulation was carried out using human menopausal gonadotropin (intramuscular 75 IU daily). When at least one follicle reached 17 mm (observed echographically), 0.5 mg of buserelin acetate was administered. Blood samples were taken to determine prolactin concentrations, at the time of agonist injection and 4, 8, 12, 24 and 48 hours later. RESULTS A statistically significant increase in serum levels of prolactin was observed 4, 8 and 12 hours after GnRH-agonist administration, with a peak at 8 hours. CONCLUSION The administration of a single dose of GnRH-agonist at the preovulatory phase in patients undergoing ovarian stimulation performed with human menopausal gonadotropin causes a significant increase in serum prolactin levels.

Tratamento Cirúrgico Conservador da Hidrossalpinge: Laparoscopia ou Microcirurgia?

Purpose: to analyze the pregnancy rates after laparoscopic and microsurgical treatment of hydrosalpinx. Methods: from July 1996 to May 1999 thirty-nine infertile patients with hydrosalpinx were treated according to a previously approved research protocol. They were randomly divided into two groups, according to the previously proposed surgical approach: laparoscopic or open microsurgical salpingostomy. To analyze the results, patients were stratified according to tubal damage, and pregnancy rates in both groups were determined for 24 months. Results: pregnancy rates in our series were 35.3 and 33.3% after laparoscopic and microsurgical salpingostomy, respectively. According to the severity of tubal damage, patients with mildly and moderately damaged tubes got pregnant in 66.7 and 21.7% of the cases, respectively. Cumulative pregnancy rates in one and two years were 25.0 and 34.4%, respectively. There was a single case of ectopic pregnancy, corresponding to 9.1% of all pregnancies. Conclusion: patients with mild and moderate lesions may be initially treated with surgery, and conception success is inversely proportional to the degree of tubal damage.