Long-term follow-up after quinacrine sterilization in Vietnam. Part I: interim efficacy analysis

Objective: To determine the long-term efficacy of nonsurgical sterilization with quinacrine.

Design: Observational cohort study.

Setting: Rural provinces in northern Vietnam.

Patient(s): Two thousand seven hundred and nine women who had quinacrine insertions between 1989 and 1993.

Intervention(s): Interviews in 1994, 1995, and 1996 and review of available medical records. Pregnancy rates were corrected for problems in detecting and confirming pregnancies.

Main Outcome Measure(s): Pregnancy rates.

Result(s): Over 90% of women were interviewed at least once. Uncorrected cumulative pregnancy rates were 12.9% at 5 y after two insertions and 27.3% after one insertion. Effectiveness varied by age group: the partially corrected pregnancy rates after two insertions were 6.8% in women 35 or older at the time of insertion and 13.0% in women under 35. A subgroup of women who received oral papaverine at the time of quinacrine insertion had lower pregnancy rates, with a cumulative uncorrected rate of 5.3% at 4 years among women of all ages.

Conclusion(s): Efficacy of quinacrine appears reasonable for two insertions of quinacrine in women 35 and older. It may be possible to improve efficacy by the use of papaverine or the Hieu insertion technique.     

体外受精-胚胎移植后宫内妊娠并发输卵管残端出血——2例临床分析

目的:探讨因输卵管积液等行腹腔镜下绝育术后助孕、宫内成功妊娠而并发输卵管残端出血的病因及预治。方法:回顾性分析2例宫内妊娠并发输卵管残端出血患者的临床资料。结果:2例患者经腹腔镜手术止血成功,并保住了宫内胎儿,获得满意的治疗效果。结论:宫内妊娠并发输卵管残端出血原因可能与前次腹腔镜绝育术中不恰当的电凝导致残端组织愈合不良、宫角受损未予成形缝合以及手术器械使用不当等有关,应采用恰当的手术方式加以防范。     

Long-term follow-up of cryopreserved hemi-ovary autografts in ewes: pregnancies,births, and histologic assessment

OBJECTIVE: To evaluate a 2-year follow-up of cryopreserved hemi-ovary autografts in ewes. DESIGN: Animal study. SERTTING: University fertility center, Hospices Civils de Lyon; Ecole Nationale Vétérinaire de Lyon, INSERM U 418 Hocaron;pital Debrousse, Lyon; and H?pital Edouard Herriot, Lyon, France. PATIENT(S): Grivette ewes. INTERVENTION(S): Recently we reported four pregnancies and six live births after transplantation of frozen-thawed hemi-ovary in six different ewes. The four remaining ewes were monitored for 2 years. After the last birth, the autografted ovary was removed in each ewe during a final laparotomy. The entire grafted ovary was sliced to estimate the remaining primordial follicle population 2 years after grafting. MAIN OUTCOME MEASURE(S): Uterine ultrasound scanning was performed to diagnose pregnancy. Histological assessment of the grafted ovary was performed after delivery. RESULT(S): The four remaining ewes began new gestations. For two of them, this was a second gestation obtained more than 2 years after the autograft. These two ewes delivered male lambs, which died immediately after delivery because of distocia. The lambs were both oversized for gestational age; autopsy found no malformation. A twin pregnancy of a healthy male and a healthy female occurred in May 2002, and a singleton male was born in February 2002. All grafted ovaries showed drastic reduction in follicle population. CONCLUSION(S): Frozen-thawed ovary autograft allowed recovery of fertility a very long time after the procedure despite a drastic reduction in the total number of follicles.     

Prediction of the individual follicle-stimulating hormone threshold for gonadotropin induction of ovulation in normogonadotropic anovulatory infertility: an approach to increase safety and efficiency.

OBJECTIVE: To predict the FSH response (threshold) dose in normogonadotropic, anovulatory infertile women undergoing gonadotropin induction of ovulation. DESIGN: Prospective longitudinal clinical study. SETTING: Specialist academic fertility unit. PATIENT(S): Normogonadotropic, oligoamenorrheic, infertile women who were resistant to clomiphene citrate or in whom clomiphene citrate therapy had failed. INTERVENTION(S): Daily exogenous FSH administration in a low-dose, step-up regimen. MAIN OUTCOME MEASURE(S): The FSH dose on the day of ovarian response (follicle growth > 10 mm in diameter). RESULT(S): Multivariate analysis was used to devise the following equation to predict the individual FSH response dose (75 to >187 IU/d) before initiation of therapy: [4 body mass index (in kg/m(2))] + [32 clomiphene citrate resistance (yes = 1 or no = 0)] + [7 initial free insulin-like growth factor-I (in ng/mL)] + [6 initial serum FSH level (in IU/L)] - 51. The SE of the predicted dose is 35 IU. CONCLUSION(S): The individual FSH response dose for gonadotropin induction of ovulation in anovulatory infertile women can be predicted on the basis of initial screening characteristics. The prediction model developed in this study may increase the safety and efficiency of low-dose gonadotropin protocols (step-up and step-down) by correctly determining the appropriate starting dose for a given patient.