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1.
Manuel Fernández-Sánchez Hana Visnova Albert Yuzpe Bjarke Mirner Klein Bernadette Mannaerts Joan-Carles Arce 《Reproductive biomedicine online》2019,38(4):528-537
Research question
Is individualization of dosing with follitropin delta in sequential ovarian stimulation cycles an effective preventive strategy for ovarian hyperstimulation syndrome risk? If so, for which patients does an individualized strategy provide the greatest OHSS risk reduction and/or the need for additional preventive interventions?Design
A secondary analysis of three ovarian stimulation cycles in IVF/intracytoplasmic sperm injection patients included in one randomized, assessor-blinded trial comparing two recombinant FSH preparations (ESTHER-1, NCT01956110), and a second trial in women undergoing up to two additional cycles (ESTHER-2, NCT01956123). Of 1326 women (aged 18–40 years) randomized and treated with follitropin delta or alfa in cycle 1, 513 continued to cycle 2 and 188 to cycle 3. Follitropin delta and alfa doses were maintained/adjusted according to ovarian response in the previous cycle.Results
Individualized dosing with follitropin delta significantly reduced moderate/severe OHSS and/or preventive interventions (P=0.018) versus conventional dosing with follitropin alfa in patients undergoing up to three ovarian stimulation cycles. The greatest benefit was observed in patients in the highest anti-Müllerian hormone (AMH) quartile (P=0.012). On evaluating separately, individualized dosing with follitropin delta significantly lowered the incidences of moderate/severe OHSS (P=0.036) and preventive interventions (P=0.044) versus follitropin alfa.Conclusion
An individualized follitropin delta dosing regimen decreased the risk of moderate/severe OHSS as well as the incidence of preventive interventions versus a conventional follitropin alfa regimen. An analysis per AMH quartile indicated that these statistically significant differences are driven mainly by patients with the highest pretreatment AMH levels. 相似文献2.
Birgit Alsbjerg Thor Haahr Helle O Elbaek Rita Laursen Betina B Povlsen Peter Humaidan 《Reproductive biomedicine online》2019,38(5):677-682
Research question
What are the reproductive outcomes of Bologna criteria poor responders undergoing dual stimulation (DuoStim) and subsequent cryopreserved embryo transfer?Design
Case series of patients treated during the period August 2015 to March 2018 in a public fertility clinic. The study included 54 Bologna criteria poor responder IVF patients younger than 42 years receiving a follicular stimulation (DuoStim 1) followed by a luteal phase stimulation (DuoStim 2) within the same cycle, both stimulations being performed with corifollitropin alfa followed by a subsequent cryopreserved embryo transfer cycle. The primary endpoint was the number of oocytes retrieved in DuoStim 1 compared with DuoStim 2. The secondary endpoint was ongoing pregnancy rate (OPR) at 12 weeks of gestation.Results
The mean number of oocytes retrieved in DuoStim 1 and DuoStim 2 was 2.4 ± 2.1 versus 3.7 ± 2.6, respectively; thus, a total of 1.2 (95% CI, 0.46–1.96) more oocytes was retrieved in DuoStim 2 compared with DuoStim 1 (P = 0.002). The OPR at 12 weeks was 20% (11/54) in this poor ovarian response population with a mean age of 36.7 years.Conclusions
Luteal phase stimulation results in more oocytes in poor responders compared with follicular phase stimulation. DuoStim, using corifollitropin alfa followed by individualized FSH dosing, appears to be an alternative to conventional follicular phase stimulation, decreasing the risk of cycle cancellation. 相似文献3.
Tamar Margalit Avi Ben-Haroush Roni Garor Naomi Kotler Dania Shefer Natalia Krasilnikov Moran Tzabari Galia Oron Yoel Shufaro Onit Sapir 《Reproductive biomedicine online》2019,38(1):7-11
Research question
Does delayed maturation of aspirated metaphase I (MI) oocytes, completed in vitro, adversely affect early embryo development?Design
Time-lapse microscopy was used to compare morphokinetic variables between embryos derived from oocytes with delayed maturation after ovarian stimulation and from in-vivo-matured metaphase II (MII) sibling oocytes from the same IVF and intracytoplasmic sperm injection cycle.Results
A total of 1545 injected oocytes in 169 cycles from 149 patients were included. The in-vitro-matured oocytes had lower normal fertilization rates than the MII aspirated oocytes (50.2% versus 68.0%; P < 0.001). Early key developmental events were significantly delayed in the normally fertilized in-vitro-matured compared with in-vivo-matured oocytes (polar body extrusion: 5.4 ± 3 versus 3.9 ± 1.8 h; P < 0.001; pronuclear fading: 27.2 ± 4.7 versus 25.1 ± 4.2 h; P < 0.001, respectively) and synchrony of the second cell cycle was adversely affected. The proportions of embryos with optimal second cell cycle length and second cell cycle were similar but with fewer top-quality embryos, based on an algorithm, for the delayed in-vitro-matured oocytes compared with their in-vivo-matured sibling oocytes (14% versus 29.1%; P < 0.001).Conclusions
Embryos derived from oocytes that failed to mature in-vivo in standard treatment after ovarian stimulation may show a different morphokinetic profile from their sibling oocytes aspirated at the MII stage after completing maturation in-vivo. 相似文献4.
Yunni Cai Min Ding Fei Lin Zhenyu Diao Ningyuan Zhang Haixiang Sun Jianjun Zhou 《Reproductive biomedicine online》2019,38(5):669-675
Research question
Can next-generation sequencing (NGS) based on copy number variation sequencing (CNV-Seq) identify normal/balanced embryos in balanced reciprocal translocation carriers and what are their reproductive outcomes?Design
One hundred couples with balanced reciprocal translocation who underwent a total of 134 preimplantation genetic testing (PGT) cycles between January 2015 and October 2017 were evaluated. Trophectoderm cells of blastocysts were biopsied for CNV-Seq-based NGS. All the balanced/normal blastocysts were vitrified and cryopreserved. Single balanced/normal blastocysts were warmed and transferred in the subsequent frozen embryo transfer (FET) cycle.Results
During the study period, 400 blastocysts were analysed by NGS-PGT, of which 109 (27.25%) were balanced and euploid. A total of 52 blastocysts were transferred in the FET cycle. Clinical pregnancy was confirmed in 34 women (65.38%), with a miscarriage rate of 2.94%; 26 healthy term babies were born, including 24 singletons and one set of twins, while eight couples had ongoing pregnancies. Amniocentesis revealed a fetal chromosome status that was consistent with the NGS-PGT results. Female carriers had a significantly higher blastocyst rate than did the male carriers (37.01% versus 31.27%, P?=?0.04). The transferable blastocyst rate was higher in couples treated with gonadotrophin-releasing hormone (GnRH) antagonist than in those treated with GnRH agonist (38.20% versus 24.37%, P = 0.01). However, neither carrier sex nor ovarian stimulation protocol influenced the clinical pregnancy rate.Conclusions
CNV-Seq-based NGS is an efficient and reliable PGT method for balanced reciprocal translocation. 相似文献5.
Amanika Kumar Sumer A. Wallace William A. Cliby Gretchen E. Glaser Andrea Mariani Mario M. Leitao Michael Frumovitz Carrie L. Langstraat 《Journal of minimally invasive gynecology》2019,26(4):727-732
Study Objective
We sought to estimate the impact of sentinel nodes in gynecologic oncology on fellowship training and discuss potential solutions.Design
Retrospective multi-institution cohort (Canadian Task Force classification II-2).Setting
Three tertiary cancer referral cancer centers.Patients
Patients with endometrial and vulvar cancer undergoing lymph node evaluation.Interventions
Patient history and fellow case volumes were evaluated retrospectively for type of lymph node assessment.Measurements and Main Results
Minimally invasive endometrial cancer and vulvar cancer fellow case volumes in 3 large institutions were reviewed and average annual volumes calculated for each clinical gynecologic oncology fellow. For vulvar cancer, probabilities of sentinel lymph node mapping and laterality of lesions were estimated from the literature. For endometrial cancer, estimates of lymphadenectomy rates were determined using probabilities calculated from our historic database and from review of the literature. Modeling the approaches to lymphadenectomy in endometrial cancer (full, selective, and sentinel), 100% versus 68% versus 24%, respectively, of patients would require complete pelvic lymphadenectomy and 100% versus 34% versus 12% would require para-aortic lymphadenectomy. In vulvar cancer, rates of inguinal femoral lymphadenectomy are expected to drop from 81% of unilateral groins to only 12% of groins.Conclusions
Sentinel lymph node biopsy for endometrial and vulvar cancer will play an increasing role in practice, and coincident with this will be a dramatic decrease in pelvic, para-aortic, and inguinal femoral lymphadenectomies. The declining numbers will require new strategies to maintain competency in our specialty. New approaches to surgical training and continued medical education will be necessary to ensure adequate training for fellows and young faculty across gynecologic surgery. 相似文献6.
Shailesh Puntambekar Seema Puntambekar Milind Telang Pankaj Kulkarni Shardul Date Mangesh Panse Ravindra Sathe Nikhil Agarkhedkar Neeta Warty Sandesh Kade Manoj Manchekar Mihir Chitale Hirav Parekh Kajal Parikh Mehul Mehta Bhushan Kinholkar Joy Shankar Jana Avinash Pare Raviraj Tiruke 《Journal of minimally invasive gynecology》2019,26(4):628-635
Study Objective
To evaluate 2 cases of uterine transplant surgery that used utero-ovarian veins as outflow channels, internal iliac arteries for perfusion, and the organ harvest surgery performed laparoscopically.Design
Case study (Canadian Task Force Classification III).Setting
An urban, private, tertiary care hospital.Patients
Two patients, ages 30 and 24years, diagnosed with absolute uterine factor infertility secondary to Mayer-Rokitansky-Küster-Hauser syndrome underwent related living donor uterine transplants; donors were their mothers with normal menses.Interventions
Retrieval of organs through minilaparotomy and laparoscopic harvest of donor internal iliac arteries and ovarian veins.Measurements and Main Results
Anastomosis was completed with bilateral donor internal iliac arteries to recipient internal iliac arteries in an end-to-end manner and with bilateral donor ovarian veins to recipient external iliac veins in an end-to-side manner. The lengths of utero-ovarian veins of both donors were 11 and 11cm on both sides; the lengths of the internal iliac arteries of both donors were 10 and 7.5cm on the left side and 10 and 6cm on the right side. The operative times for harvest surgery, bench surgery and transplant surgery were 2:40 and 3:20 hours, 34:32 and 33:30 min and 4:00 and 4:30 hours respectively for recipients 1 and 2. Daily postoperative uterine Doppler was completed through day 8 and then every other day and showed good intrauterine blood flow (i.e., low resistance arcuate vessel flow; resistance index < .5). Cervical biopsies on postoperative days 7 and 14 showed no evidence of rejection in either recipient. Both recipients started menstruating within 2 months of surgery.Conclusion
By using ovarian veins as outflow channels, the challenges involved in dissection along the internal iliac vein are avoided, and harvesting the donor internal iliac artery reduces the tension on vascular anastomosis. The selection of vessels to be harvested could make the technique reproducible, although larger studies are warranted to confirm results. 相似文献7.
Jordina Munrós Maria-Angeles Martínez-Zamora Dolors Tàssies Juan Carlos Reverter Mariona Rius Meritxell Gracia Cristina Ros Francisco Carmona 《Journal of minimally invasive gynecology》2019,26(3):450-455
Study Objective
To evaluate serial generation of microparticles (MPs) after laparoscopic stripping or CO2 laser vaporization in the surgical treatment of patients with ovarian endometrioma (OE).Design
A prospective, randomized, blinded, pilot study (Canadian Task Force classification I).Setting
Tertiary care university hospital from December 2014 to July 2016.Patients
Thirty women with unilateral OE undergoing laparoscopic surgery.Intervention
Patients were randomly selected to undergo either CO2 laser vaporization (L group) or laparoscopic stripping (S group) of OE.Measurements and Main Results
Blood samples were collected before surgery and at 2 hours, 24 hours, 1 month, and 3 months after surgery. An MP generation curve after OE surgery was created. MP generation was greater in the S group than in the L group at all time points evaluated. The MP generation curve showed a significantly higher area under the curve after excisional surgery (p <.05).Conclusion
The higher MP levels in the S group suggest an increased inflammation and procoagulant response after this procedure. 相似文献8.
M Blake Evans Toral Parikh Alan H DeCherney John M Csokmay Mae W Healy Micah J Hill 《Reproductive biomedicine online》2019,38(5):691-698
Research question
Is ovulation suppression with progestins, requiring a freeze-all approach and subsequent frozen embryo transfer resulting from progestenic endometrial changes, cost-effective compared with gonadotropin releasing hormone analogues (GnRH) during assisted reproduction cycles.Design
Cost-effectiveness analysis derived from a PubMed literature search of average US costs of GnRH agonist and antagonist IVF cycles.Results
In all fresh IVF cycle models, progestin cycles were more expensive owing to the additional costs of increased gonadotropin use, embryo freezing and subsequent frozen embryo transfer (FET). The average cost per live birth with progestins ($32,466–$56,194) was higher than fresh IVF cycles with short (flare) GnRH agonist ($4,447–$12,797 higher) and GnRH antagonist ($1,542–$9,893 higher). When analyzing an initial embryo transfer plus additional FET in patients not initially pregnant, progestin cycles were still more expensive per live birth compared with conventional protocols. When planned freeze only cycles were analyzed, progestins became more cost-effective per live birth compared with antagonist cycles ($2,079 lower) but remained more expensive than short agonist cycles ($823 more expensive).Conclusions
Ovulation inhibition in IVF using progestins requires a freeze-only approach of embryos, and thus progestin use was not cost-effective compared with fresh embryo transfer cycles. Progestins, however, may be cost-effective compared with GnRH antagonist in planned freeze only cycles such as in preimplantation genetic testing or fertility preservation. 相似文献9.
Ernesto Bosch Carlo Bulletti Alan B Copperman Renato Fanchin Hakan Yarali Carlos A Petta Nikolaos P Polyzos Daniel Shapiro Filippo Maria Ubaldi Juan A Garcia Velasco Salvatore Longobardi Thomas D&#x;Hooghe Peter Humaidan 《Reproductive biomedicine online》2019,38(1):118-130
Research question
How might time to healthy singleton delivery affect decision-making during infertility treatment?Design
This was a Delphi consensus investigating expert opinion that comprised three steps. In Step 1, 12 experts developed statements. In Step 2, 27 experts (including 12 from Step 1) voted (online survey) on their agreement/disagreement with each statement (providing reasons). Consensus was reached if ≥66% of participants agreed/disagreed. Statements not reaching consensus were revised and the process repeated until consensus was achieved. In Step 3 details of the final agreed statements were communicated.Results
Twelve statements were developed, and consensus (agreement) was reached on all after one round of voting.Conclusions
Time to healthy singleton delivery should be taken into consideration when making decisions related to infertility treatment, and it is important that fertility treatment is provided in a timely manner, avoiding over- or under-treatment. In all subfertile women <40 years old, IVF outcomes could be optimized by performing up to six single-embryo transfers and certain procedures might reduce time to healthy singleton delivery. These procedures include preimplantation genetic testing for aneuploidies, frozen replacement cycles immediately after failed fresh cycles and use of gonadotrophin-releasing hormone antagonists. Finally, the number of oocytes retrieved should be maximized to increase cumulative live birth rate. 相似文献10.
Aila Coello Eva Sanchez Begoña Vallejo Marcos Meseguer José Remohí Ana Cobo 《Reproductive biomedicine online》2019,38(3):313-320
Research question
Does the presence of dysmorphisms affect post-warming survival and embryo development in vitrified autologous oocytes?Design
A retrospective study comparing post-warming survival, fertilization and embryo development between morphologically normal (n?=?269) and dysmorphic oocytes (n?=?147).Results
The survival rate was 81.4% in the morphologically normal oocytes and 87.1% in the dysmorphic oocyte group (OR 1.53; 95% CI 0.86 to 2.72). The fertilization rate was 69.9 versus 66.4% (OR 0.85; 95% CI 0.53 to 1.36), the proportion of good-quality embryos on day 3 was 30.3% versus 32.0% (OR 1.08; 95% CI 0.59 to 1.97) and the blastocyst formation rate was 54.5% versus 60.5% (OR 1.27; 95% CI 0.60 to 2.72) for the morphologically normal and the dysmorphic oocytes group, respectively. No statistical differences were found when the number and type of dysmorphism were analysed.Conclusion
Oocyte dysmorphisms did not seem to affect survival, fertilization and embryo development in vitrified autologous oocytes, and yielded comparable results to the morphologically normal oocytes. 相似文献11.
Daisuke Shigemi Shotaro Aso Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga 《Journal of minimally invasive gynecology》2019,26(3):501-506
Study Objective
To compare fetal, maternal, and operative outcomes of laparoscopic surgery versus laparotomy for major benign diseases including appendicitis, cholecystitis, adnexal masses, and uterine myoma during pregnancy.Design
Retrospective cohort study (Canadian Task Force classification II-2).Setting
The Diagnosis Procedure Combination database, a national inpatient database for acute care inpatients in Japan.Patients
Eligible patients (n?=?6018) underwent abdominal surgery (4047 laparotomy and 1971 laparoscopy patients) from July 2010 through March 2016.Interventions
The 2 groups were compared using propensity score matching analysis.Measurements and Main Results
The primary outcome was fetal adverse events, including abortion or stillbirth within 7 days after surgery and premature delivery during hospitalization. Secondary outcomes were operative time, blood transfusion, and length of hospital stay after surgery. Propensity score matching created 740 pairs. Significant difference was observed in the primary outcome between propensity score–matched patients in the laparotomy versus laparoscopy group (1.8% vs .41%, respectively; risk difference, ?1.4%; 95% confidence interval, ?2.4 to ?.30; p?=?.01). Compared with the laparotomy group, the laparoscopy group had a significantly lower incidence of blood transfusion (2.3% vs .41%, pConclusion
Our current study using propensity score matching suggests the advantages of laparoscopic surgery for benign diseases compared with laparotomy because laparoscopic surgery had advantages in short-term fetal adverse events, incidence of blood transfusion, operative time, and hospital stay. 相似文献12.
Taraneh Gharib Nazem Lucky Sekhon Joseph A Lee Jessica Overbey Stephanie Pan Marlena Duke Christine Briton-Jones Michael Whitehouse Alan B Copperman Daniel E Stein 《Reproductive biomedicine online》2019,38(2):169-176
Research question
Does the composite morphology score or a particular developmental component (expansion stage, inner cell mass [ICM] or trophectoderm [TE]) of euploid blastocysts undergoing single frozen embryo transfer (FET) impact ongoing pregnancy/live birth (OP/LB) rates?Design
Retrospective cohort study including a total of 2236 embryos from 1629 patients who underwent single euploid FET between 2012 and 2017.Results
Embryos with an ICM grade of A compared with C had a higher OP/LB rate (55.6% versus 32.3%, P < 0.001). Blastocysts with a TE grade of A or B compared with C had a higher likelihood of OP/LB (A versus C: odds ratio [OR] 1.6, 99% confidence interval [CI] 1.1–2.3, B versus C: OR 1.5, 99% CI 1.1–2.1), and blastocysts with a developmental stage of 4 or 5 compared with 6 had higher odds of OP/LB (4 versus 6: OR 1.6, 99% CI 1.2–2.2, 5 versus 6: OR 1.6, 99% CI 1.2–2.3).Conclusions
Among euploid embryos, ICM morphology is the best predictor of sustained implantation; however, a composite score may provide additional guidance. While there is a known benefit in genomic screening prior to embryo selection, morphology provides individualized, prognostic information about implantation potential. 相似文献13.
Christina Williams Alicia J. Long Heather Noga Catherine Allaire Mohamed A. Bedaiwy Sarka Lisonkova Paul J. Yong 《Journal of minimally invasive gynecology》2019,26(3):507-515
Study Objective
To investigate ethnic differences for moderate-to-severe endometriosis.Design
Analysis of a prospective registry (Canadian Task Force classification II-2).Setting
Tertiary referral center.Patients
A total of 1594 women with pelvic pain and/or endometriosis.Interventions
NoneMeasurements and Main Results
On logistic regression, adjusting for potential confounders, East/South East Asians were 8.3 times more likely than whites to have a previous diagnosis of stage III/IV endometriosis before referral (adjusted odds ratio [aOR], 8.33; 95% confidence interval [CI], 3.74–18.57), 2.7 times more likely to have a palpable nodule (aOR, 2.66; 95% CI, 1.57–4.52), 4.1 times more likely to have an endometrioma on ultrasound (aOR, 4.10; 95% CI, 2.68–6.26), and 10.9 times more likely to have stage III/IV endometriosis at the time of surgery at our center (aOR, 10.87; 95% CI, 4.34–27.21).Conclusion
Moderate-to-severe endometriosis was more common in women with East or South East Asian ethnicity in our tertiary referral center. This could be explained by East/South East Asians with minimal to mild disease being less likely to seek care or genetic/environmental differences that increase the risk of more severe disease among East/South East Asians. (ClinicalTrials.gov, NCT02911090.) 相似文献14.
Hiroyuki Sasaki Kazuhiro Kawamura Toshihiro Kawamura Toshitaka Odamaki Noriko Katsumata Jin-Zhong Xiao Nao Suzuki Mamoru Tanaka 《Reproductive biomedicine online》2019,38(4):570-578
Research question
Do gut microbiota associate with the ovulatory cycle in women showing normogonadotrophic anovulation? In humans, the gut microbiota affects diverse physiological functions and dysbiosis (microbial imbalance) may lead to pathological syndromes. However, there is comparatively little information on the relevance of gut microbiota to reproductive functions in women. Here, a group of women with idiopathic chronic anovulation were examined, who do not exhibit any apparent endocrinological disorder, as they are suitable for investigating the relationship between intestinal bacteria and ovulatory disorders.Design
A prospective observational cohort study was performed on two groups of women who did not exhibit apparent endocrinological disorders but showed either irregular menstrual cycles (IMC group) or normal menstrual cycles (controls). The bacterial composition of faeces from rectal swabs from the women was analysed using next-generation sequencing based on bacterial 16SrRNA genes.Results
A metagenomic analysis indicated that the two groups of women had significant differences in 28 bacterial taxa in their faeces. Prevotella-enriched microbiomes were more abundant in the IMC group, whereas Clostridiales, Ruminococcus and Lachnospiraceae (butyrate-producing bacteria) were present at lower levels in the IMC group.Conclusions
Distinctive subpopulations of intestinal microbiota were identified in women with unexplained chronic anovulation. The results indicate that gut microbiota could be associated with ovarian functions. 相似文献15.
Dimitrios Nasioudis Evelyn Minis Eloise Chapman-Davis Melissa K. Frey Thomas A. Caputo Steven S. Witkin Kevin Holcomb 《Journal of minimally invasive gynecology》2019,26(3):471-476
Study Objective
Evaluate the prevalence, trends, and outcomes of minimally invasive surgical (MIS) staging of malignant ovarian germ cell tumors (MOGCTs) apparently confined to the ovary.Design
Retrospective cohort study (Canadian Task Force classification II-2).Setting
Participating hospitals in the National Cancer Data Base.Patients
Women diagnosed between 2010 and 2014 with a MOGCT apparently confined to the ovary with information on the planned surgical approach.Interventions
Staging with MIS or laparotomy.Measurement and Main Results
A total of 918 patients were identified. MIS was planned for 294 patients (32%): a laparoscopic approach for 237 patients and a robotic-assisted approach for 57 patients. Rate of conversion to laparotomy was 11% (46 cases), 1.7% and 15.6% in the robotic and laparoscopy groups, respectively (p?=?.003). No difference in the use of MIS was noted based on year of diagnosis (p?=?.38). By multivariate analysis white race, higher level of education, and smaller tumor size were associated with the receipt of MIS. Patients in the MIS group were less likely to undergo lymph node dissection (39.6% vs 51.3%, p?=?.001) and omentectomy (18.7% vs 28.5%, p?=?.002). Hospital stay after surgery was shorter for patients who had MIS (median, 2 vs 3 days; p <.001). Unplanned 30-day readmission rate was also lower in the MIS group (1.4% vs 3.9%, p?=?.043). No difference in overall survival was noted between the 2 groups (p?=?.81).Conclusion
MIS for apparent early-stage MOGCTs was less comprehensive but associated with a decreased hospital stay and unplanned readmission rate. 相似文献16.
Ye Zhang Xiaochen Song Meng Mao Jia Kang Fangfang Ai Lan Zhu 《Journal of minimally invasive gynecology》2019,26(4):754-759
Study Objective
To evaluate the long-term safety and efficacy of tension-free vaginal tape (TVT).Design
Prospective observational study (Canadian Task Force classification II-2).Setting
Tertiary referral center in China.Patients
Between January 2004 and December 2005, 85 consecutive patients who underwent the TVT procedure were included. Patients with mixed incontinence or pelvic organ prolapse requiring surgery were excluded.Interventions
TVT procedure.Measurements and Main Results
The primary outcomes were long-term postoperative complications. The secondary outcomes included long-term subjective satisfaction (Patient Global Impression of Improvement), objective cure rate (stress test), quality of life, and sexual function. At the 13-year follow-up, 70 patients (82%) were available for evaluation. De novo overactive bladder was observed in 15.7% of patients, and voiding symptoms were found in 17.1% of patients. None of the patients reported voiding dysfunction that needed treatment with tape removal or catheterization. Tape exposure occurred in 2.9% of patients. The subjective satisfaction rate and objective cure rate were 78.6% and 81.4%, respectively.Conclusion
TVT is a safe and effective treatment for stress urinary incontinence, even at the 13-year follow-up. The prevalence rates of overactive bladder and voiding symptoms are increased with advancing age and should not be considered long-term postoperative complications. 相似文献17.
Sara Ilnitsky Lynda Hughes Francis Tekpetey Basim Abu Rafea George Vilos Angelos Vilos 《Journal d'obstetrique et gynecologie du Canada》2019,41(4):421-427
Objective
The objective of this study was to assess data from a fertility clinic and identify differences in patient and cycle characteristics, clinical pregnancy rates, and multiple gestation rates before and after fertility treatment funding and a policy of elective single embryo transfer were instituted by the Ontario government to reduce multiple gestations arising from fertility treatment.Methods
This study was a retrospective database review of clinic and embryology laboratory data for all patients undergoing in vitro fertilization (IVF) and intracytoplasmatic sperm injection (ICSI) cycles over a 4-year period. The investigators compared IVF and ICSI cycles before funding, from January 1, 2014 to December 31, 2015, with cycles after funding, from January 1, 2016 to December 31, 2017.Results
The number of cycles performed over a 2-year period increased from 554 to 853, of which 76.2% were funded. Patient age, body mass index, and parity were similar before and after funding. Fewer patients receiving funded IVF or ICSI had had a previous cycle. Cycle cancellation rates were similar before and after funding; however, there were fewer embryo transfers per cycle start after funding (80.3% vs. 72.2%, P?=?0.001). The clinical pregnancy rate was similar before and after funding (37.8% vs. 32.5%, P?=?0.09), whereas the multiple gestation rate was significantly lower (13.1% vs. 3.5%, P?=?0.001).Conclusion
Since the government of Ontario began funding IVF and ICSI cycles, more patients are accessing treatment, many for the first time. The clinical pregnancy rate was maintained, whereas multiple gestations were significantly reduced. These findings support the benefit of single embryo transfer in the context of funded IVF and ICSI and demonstrate the importance of government-funded assisted reproductive technology. 相似文献18.
Ozgur Oktem Kayhan Yakin Sule Yildiz Oguz Aycan Isiklar Basak Balaban Bulent Urman 《Reproductive biomedicine online》2019,38(2):206-215
Research question
Are high-responder IVF patients protected from the deleterious effect of prematurely elevated serum progesterone level on the probability of pregnancy?Design
In this retrospective cohort study, 2971 autologous fresh embryo transfer IVF cycles with gonadotrophin-releasing hormone agonist long protocol were analysed to investigate whether the detrimental effect of prematurely rising progesterone levels on clinical pregnancy rate (CPR) varies depending on the magnitude of ovarian response. Nine different evenly spaced intervals were constructed for serum progesterone level on the human chorionic gonadotrophin day (<0.5/0.5–0.9/1–1.4/1.5–1.9/2–2.4/2.5–2.9/3–3.4/3.5–3.9/>4 ng/ml). Then, IVF cycles in each of these intervals were further divided into low (≤3 oocytes), normal (4–15 oocytes) and high responders (≥16 oocytes).Results
The progressive rise of serum progesterone from the <0.5 to the >4 ng/ml interval caused a gradual and continuous decline in the CPR of all three types of ovarian response. The absolute difference in the CPR between the lowest and the highest progesterone groups was not related to the magnitude of ovarian response (–26.6%, –37.7% and –40.7% for the low, normal and high responders, respectively). On multivariate logistic regression analysis, the detrimental effect of progesterone started at 1.5–1.9 ng/ml, 3.0–3.4 ng/ml and 4.0–4.4 ng/ml intervals for the low, normal and high responders, respectively.Conclusion
High responders are not exempt from the detrimental effects of prematurely rising serum progesterone levels but the threshold interval where the detrimental effect begins is higher in the high responders compared with the low and normal responders. 相似文献19.
Tony Ma Prathima Chowdary Alex Eskander Lenore Ellett Kate McIlwaine Janine Manwaring Emma Readman Peter Maher 《Journal of minimally invasive gynecology》2019,26(3):427-433
Study Objective
To assess the usefulness of narrowband imaging (NBI) to detect additional areas of endometriosis not identified by standard white light in patients undergoing laparoscopy for the investigation of pelvic pain.Design
A prospective cohort trial (Canadian Task Force classification II). Evidence obtained from a well-designed cohort study.Setting
A tertiary laparoscopic subspecialty unit in Melbourne, Australia.Patients
Fifty-seven patients undergoing laparoscopy for the investigation of pelvic pain were recruited. Fifty-three patients were eligible for analysis.Interventions
Patients underwent standard white-light laparoscopy of the pelvis followed by NBI survey to assess for any additional areas suspicious for endometriosis.Measurements and Main Results
All identified areas of possible endometriosis were resected and sent for blinded histopathological analysis. The additional predictive value of NBI was 0% if the preceding white-light survey was negative and 86% if the preceding white-light survey was positive.Conclusion
The use of NBI at laparoscopy for the investigation of pelvic pain is beneficial in finding additional areas of endometriosis if endometriosis is already suspected after white-light survey in a tertiary laparoscopic unit. Further research in nonspecialized units may show additional benefit and requires further research. NBI may also be useful as a diagnostic aid for trainees. 相似文献20.
Anne Elizabeth Chambers Craig Fairbairn Marco Gaudoin Walter Mills Irene Woo Raj Pandian Frank Z. Stanczyk Karine Chung Subhasis Banerjee 《Reproductive biomedicine online》2019,38(2):159-168