Ultrasound guided embryo transfer significantly improves pregnancy rates in women undergoing oocyte donation.

OBJECTIVES: Recent reports suggest ultrasound (US) guided embryo transfer (ET) improves pregnancy rates. Using the ovum donation model to eliminate confounding variables, we assessed the impact of US guided ET on pregnancy rates, implantation rates, and multiple gestation rates. METHODS: All women who underwent IVF-ET cycles using donated oocytes from November 1997 to September 1998 (n = 137) were evaluated retrospectively. ET from November 1997 to April 1998 were performed without US, while all ET from May 1998 to September 1998 were performed using transvaginal or transabdominal US. ET was further categorized as easy or difficult. Difficult ET was defined as requiring at least two attempts and/or the presence of blood on the catheter and/or > 5 min. RESULTS: Pregnant patients (n = 73) were similar with respect to the number and morphology of the embryos transferred compared to non-pregnant patients (n = 65). US guidance significantly improved implantation and pregnancy rates in cycles with easy transfers [28.8 vs. 18.4% and 63.1 vs. 36.1%, respectively (P < 0.05)] without impacting multiple pregnancy rates. CONCLUSION: US guided ET is simple and reassuring and appears to significantly improve pregnancy outcomes in ovum donation cycles by optimizing the placement of embryos.     

Optimal catheter placement during sonohysterography: a randomized controlled trial comparing cervical to uterine placement

OBJECTIVE: To estimate whether the position of the catheter placement into either the uterus or cervix during the saline infusion sonohysterography affected the magnitude of pain. METHODS: A clinical trial was conducted with women undergoing saline infusion sonohysterogram randomized to intracervical or intrauterine balloon catheter placement. The primary outcome end points were the degrees of pain experienced after initial inflation and then after deflation of the balloon catheter at the completion of the saline infusion sonohysterogram. Pain was quantified with a 10-point visual analog pain scale. Secondary end points included total time for the saline infusion sonohysterogram and the total volume of infused saline necessary for adequate visualization of the endometrial cavity. RESULTS: Thirty-five patients were randomly assigned to intracervical balloon placement and 34 to intrauterine placement. After initial inflation there was significantly less pain with intracervical than intrauterine balloon placement (1.8 compared with 3.0, P=.02), although there was no difference in pain at the end of the procedure after deflation of the balloon (P=.66). Significantly less infused saline was required with intracervical catheter placement (19 mL compared with 40 mL, P=.001). Nulliparous women had significantly more pain than did parous women, both after initial balloon inflation and at completion of the saline infusion sonohysterogram (P<.05). CONCLUSION: Intracervical catheter placement results in significantly less pain during an saline infusion sonohysterography and also requires half the saline volume to perform the saline infusion sonohysterogram. Therefore, routine intracervical balloon placement should be considered for saline infusion sonohysterogram. TRIAL REGISTRATION: ClinicalTrials.Gov, www.clinicaltrials.gov, NCT00534963 LEVEL OF EVIDENCE: I.     

Long-term adaptations differ for shortening and lengthening contractions

The purpose of this study was to determine whether practice of a sinusoidal task induces different neural adaptations for shortening and lengthening contractions performed within a task. Fourteen young adults were instructed to accurately match a sinusoidal target by lifting and lowering a light load (15% of 1 repetition maximum; 1-RM) with their index finger for 35?s. Each subject performed a total of 50 practice trials during the practice session. After 48?h, subjects performed five trials with the same sinusoidal target at each of three loading conditions: 15% (retention/savings), 7.5% (transfer to a lighter load), and 30% (transfer to a heavier load) of 1-RM. Movement error was quantified as the root mean square error of the movement trace from the target, while movement variability was quantified as the standard deviation of the acceleration of the index finger. First dorsal interosseus muscle activation was recorded using surface electromyography (EMG). The frequency structure of the acceleration and EMG signals were obtained using wavelets. Subjects were able to retain the trained task for both shortening and lengthening contractions; however, they exhibited better savings for the shortening contractions. Additionally, for the lowering segments of the task subjects exhibited better transfer to the lighter load. Short-term adaptation and transfer results may be related to changes in the agonist muscle neural activation. Finally, we found greater movement variability during lengthening contractions which was related to both the frequency structure of the acceleration and EMG signals.