Wenjie Zhu

Repeat transvaginal ultrasound-guided aspiration of ovarian endometrioma in infertile women with endometriosis

OBJECTIVE We sought to investigate the effectiveness of repeated transvaginal ultrasound-guided aspiration of endometriomas in infertile women with endometriosis. STUDY DESIGN A retrospective study was performed in our department of reproductive health on 129 infertile women who underwent monthly repeated transvaginal aspiration of endometriomas. The recurrence and pregnancy were monitored during a follow-up period of 24 months. RESULTS Recurrences of cysts were found in 118 (91.5%) patients in the first postaspirate month and 86 (66.7%) in the second, 60 (46.5%) in the third, 28 (21.7%) in the fourth, 12 (9.3%) in the fifth, 7 (5.4%) in the sixth, and 36 (27.9%) in the 24th postaspiration month. Mean 3.1 ± 2.8 times of aspirations per patient were performed without any adverse effect. There was a linear regression relationship between the change of times of aspirations and the chance of recurrence of cysts. Overall pregnancy rate of 43.4% (56/129) was obtained. CONCLUSION The repetitive aspiration of endometriomas is an effective therapeutic option in patients with endometriosis.

Injection of day 2 embryo culture supernatant into the uterine cavity did not improve the pregnancy rate of day 3 embryo transfer in patients who underwent in vitro fertilization-embryo transfer: a randomized clinical trial

OBJECTIVE To evaluate the effectiveness of uterine cavity injection of day 2 embryo culture supernatant before day 3 embryo transfer in patients who are undergoing in vitro fertilization-embryo transfer. DESIGN Randomized controlled trial. SETTING A reproductive medical centre. PATIENT(S) A total of 90 infertile women, 45 of them in the study group and 45 in the control group. INTERVENTION(S) Uterine cavity infection of day 2 embryo culture supernatant before day 3 embryo transfer. MAIN OUTCOME MEASURE(S) Embryo implantation rate and pregnancy rate. RESULT(S) The pregnancy versus implantation rates in the study group and control group were 48.9% versus 44.4% and 27.3% versus 22.1%, respectively. Although both pregnancy and implantation rates in the study group were higher than those in the control group, no statistically significant differences were found in these two parameters. CONCLUSION(S) Injection of day 2 embryo culture supernatant into the uterine cavity cannot improve the implantation and pregnancy rates of day 3 embryo transfer.

Receptivity assessment of an ultrasonographic homogeneous endometrium in the late follicular phase of infertile women with natural cycles

OBJECTIVE The purpose of this study was to assess the receptivity of the homogeneous endometrium in the late follicular phase in infertile women with natural cycles. STUDY DESIGN Twenty-eight infertile women with ultrasonographically homogeneous (group 1) or trilaminar (group 2) endometria in the late follicular phase underwent endometrial biopsies. Some molecular markers and development of pinopodes were evaluated. RESULTS In the late follicular phase, the mean level of vascular endothelial growth factor was significantly lower in group 1 than in group 2 (0.96 ± 0.37 marks vs 1.39 ± 0.46 marks; P = .010). In the mid luteal phase, a decreased leukemia inhibitory factor and integrin alpha v beta 3 levels were found in group 1 (1.58 ± 0.99 marks vs 2.59 ± 0.61 marks; 1.85 ± 0.72 marks vs 2.60 ± 0.73 marks; 1.92 ± 0.91 marks vs 2.83 ± 0.57 marks; P = .003; P = .011; P = .004). The rate of fully developed pinopodes in the mid luteal phase was significantly decreased in group 1 (P = .018). CONCLUSION An ultrasonographically homogeneous endometrium in the late follicular phase was associated with poor receptivity in infertile women with natural cycles.

Repeat transvaginal ultrasound-guided ovarian interstitial laser treatment improved the anovulatory status in women with polycystic ovarian syndrome

OBJECTIVE To assess the effectiveness of repeated transvaginal ultrasound-guided ovarian interstitial laser treatment in the management of anovulatory patients with polycystic ovary syndrome (PCOS). STUDY DESIGN A retrospective study was performed in our department on 27 anovulatory PCOS women who failed to respond to the first ultrasound-guided transvaginal ovarian interstitial laser treatment. Each woman received a repeat procedure and postoperative rates of ovulation and pregnancy were monitored. RESULTS Of 27 patients, 18 (66.67%) ovulated spontaneously following the repeated ultrasound-guided transvaginal ovarian interstitial laser treatment Ten women became pregnant within six postoperative months and a cumulative pregnancy rate of 37.04% was achieved. There were no significant operative complications. CONCLUSION Repeated ultrasound-guided transvaginal ovarian interstitial laser treatment is an effective and safe management in anovulatory PCOS patients who fail to respond or have a transient response to the first transvaginal ovarian interstitial laser treatment.

Transvaginal ultrasound-guided ovarian interstitial laser treatment in anovulatory women with clomifene citrate-resistant polycystic ovary syndrome

OBJECTIVE To assess the effectiveness of transvaginal, ultrasound-guided, ovarian, interstitial laser coagulation treatment in anovulatory women with polycystic ovary syndrome (PCOS). DESIGN A pilot study. SETTING Assisted reproductive technology unit. SAMPLE Twenty-three anovulatory women with clomifene-citrate-resistant PCOS. METHODS Ultrasound-guided, transvaginal, ovarian, interstitial yttrium-aluminium-garnet laser treatment. MAIN OUTCOME MEASURES Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, prolactin and estradiol levels, spontaneous ovulation rate and pregnancy rate were measured over 6 months of follow up. RESULTS Regular ovulation occurred in 19 out of 22 (86.4%) women in the 6 months following ovarian treatment (one woman was lost to follow up). On the postoperative second, fourth and sixth month, the mean serum LH levels were 4.54 SD 1.21 iu/l, 4.90 SD 2.18 iu/l and 4.42 SD 1.03 iu/l, significantly (P < 0.001, P < 0.001, P < 0.001) lower than the preoperative level of 13.89 +/- 3.62 iu/l; the mean serum testosterone levels were 2.69 SD 1.83 nmol/l, 2.42 SD 1.11 nmol/l and 2.28 SD 1.96 nmol/l and significantly (P < 0.001, P < 0.001, P < 0.001) lower than the preoperative baseline value of 5.37 SD 3.09 nmol/l; the mean LH/FSH ratios of 0.93 SD 0.26, 0.88 SD 0.17 and 0.81 SD 0.14 were also significantly lower than the preoperative value of 2.78 SD 1.21 (P < 0.001). Pregnancy occurred in eight women and there was a cumulative pregnancy rate at 6 months of 36% (8/22) among the subjects. There were no significant operative complications. CONCLUSION Ultrasound-guided, transvaginal, ovarian, interstitial laser treatment appears effective in improving hormonal profiles and inducing ovulation and successful pregnancy in women with clomifene-resistant PCOS.