trelstar and Pregnancy--Ectopic

To evaluate the safety and efficiency of a new delivery system to perform transcervical GIFT.. Evaluation of pregnancy rate (PR), miscarriage rate, ectopic pregnancy rate, and delivery rate.. Institute of Obstetrics and Gynecology, Reproductive Endocrinology Unit, Infertility and IVF Center.. Twenty-five patients with patent tubes documented by laparoscopy plus falloposcopy.. Superovulation was induced with GnRH analogue and FSH. Under laparoscopic control, transcervical cannulation of the tube was done using a linear everting catheter incorporating direct falloposcopic vision of the tubal lumen. Two lengths of everting catheter (3 and 6 cm) were used providing either isthmic-ampullary or midampullary placement of the inoculum. A comparison was done in terms of ease of access and transfer, falloposcopic observations, and PRs between the groups.. Efficacy was established by evaluating the PR, miscarriage rate, ectopic pregnancy rate, and delivery rate.. The PR was 28% (with no differences between the lengths of everting catheters). No ectopic pregnancies occurred. The abortion rate was 28.6% and the delivery rate was 20%. Neither tubal perforation nor other complications occurred during the procedure.. Falloposcopic GIFT is safe and efficient and may be a less invasive alternative than laparoscopic transfer.

Topics: Abortion, Spontaneous; Cervix Uteri; Chorionic Gonadotropin; Embryo Transfer; Female; Gamete Intrafallopian Transfer; Humans; Infant, Newborn; Laparoscopy; Luteolytic Agents; Pregnancy; Pregnancy, Ectopic; Safety; Superovulation; Triptorelin Pamoate

To determine if the routine use of gonadotropin-releasing hormone agonists (GnRH-a) for all patients undergoing in vitro fertilization (IVF) produces any significant medical advantage.. Prospective randomized study.. Three hundred eight patients having their first ever IVF attempt.. Patients were randomly divided into four groups and received either human menopausal gonadotropin (hMG) alone for ovarian simulation (group A, n = 81); clomiphene citrate and hMG (group B, n = 77); a 3-day ultrashort course of GnRH-a and hMG (group C, n = 74); or pituitary desensitization with GnRH-a followed by hMG (group D, n = 76).. The indications for IVF and mean age of all four groups of patients were comparable. There was a significant difference in the number of embryos cleaved and transferred among the groups, but there were no significant differences in the cancellation rate, mean number of oocytes collected or fertilized, and number of cases of failed fertilization. There were also no significant differences in the pregnancy and live birth rates per cycle commenced or per embryo transfer.. The routine use of GnRH-a for all patients undergoing IVF has practical but no significant medical advantages.

Topics: Abortion, Spontaneous; Clomiphene; Delayed-Action Preparations; Drug Administration Schedule; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Prospective Studies; Triptorelin Pamoate

The aim of this study was to compare the incidence of ectopic pregnancy in GnRH agonist triggered IVF cycles with intensive luteal support versus hCG triggered IVF cycles.. This study was conducted as a retrospective cohort analysis of women who underwent IVF treatment employing GnRH agonist or recombinant hCG (rhCG) triggers during 2-year period. The medical charts of women who achieved pregnancies were reviewed and their demographic characteristics, infertility reasons and IVF data were recorded. A multiple logistic regression analysis was performed to estimate the association between the triggering medication used to stimulate final oocyte maturation (GnRHa or rhCG) and EP, with adjustment for important confounders: the day of embryo transfer (ETD), the etiology of infertility and estrogen level at the time of triggering.. The number of metaphase II oocytes, fertilized oocytes and good quality embryos were significantly higher in the GnRH agonist triggered group compared with the hCG triggered group (p < 0.001 for all). The clinical pregnancy and implantation rates in the hCG triggered cycles were 38.6 and 31.1 %, respectively and 24.7 and 22 %, respectively in the triptorelin triggered cycles. The ectopic pregnancy rates were 5.3 % in the triptorelin triggered group and 1.4 % in the hCG triggered group. The trigger medication and the day of embryo transfer were found to have a significant effect on the probability of developing ectopic pregnancy (p = 0.028, p = 0.046 respectively). However, the estrogen level was not found to have a significant effect on the probability of developing ectopic pregnancy (p = 0.447).. The reasons for higher ectopic pregnancy rates in GnRH agonist triggered cycles relative to hCG triggered cycles may be the decreased receptivity of the endometrium due to insufficient luteal support and higher implantation potential of embryos in correlation with a higher number of good quality embryos obtained in these cycles.

Topics: Adult; Chorionic Gonadotropin; Cohort Studies; Embryo Implantation; Embryo Transfer; Endometrium; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Gonadotropins; Hormone Antagonists; Humans; Oocytes; Oogenesis; Pregnancy; Pregnancy Rate; Pregnancy, Ectopic; Retrospective Studies; Triptorelin Pamoate

Topics: Antineoplastic Agents; Antineoplastic Agents, Hormonal; Biomarkers; Chorionic Gonadotropin; Endocrinology; Estrogens; Female; Fertility Agents, Female; Humans; Middle Aged; Obesity; Ovarian Neoplasms; Pregnancy; Pregnancy, Ectopic; Primary Ovarian Insufficiency; Reproductive Medicine; Triptorelin Pamoate; Weight Reduction Programs

A patient is described who developed neurological signs of the left leg following transvaginal ultrasound-guided puncture. A hypodense lesion of the obturator space above the lumbosacral plexus was seen on ultrasound which could explain her signs, due to compression by a hematoma. She recovered completely.

Topics: Adult; Female; Fertilization in Vitro; Humans; Leg; Menotropins; Oocyte Donation; Paresis; Pregnancy; Pregnancy, Ectopic; Triptorelin Pamoate; Ultrasonography; Vagina