The unicornuate uterus: clinical implications.

The unicornuate uterus is associated with a poor reproductive outcome and many gynecological problems. We collected data from 45 women with a unicornuate uterus. We found a high abortion rate of 22% in the first trimester and 16% in the second trimester. Premature labor occurred in 18%. The prevalence of infertility and endometriosis in women with a unicornuate uterus was comparable to women without the anomaly.     

Endocrinology: Luteal function following ovulation induction in polycystic ovary syndrome patients using exogenous gonadotrophins in combination with a gonadotrophin-releasing hormone agonist

The luteal phase was studied in 12 polycystic ovary syndrome(PCOS) patients following ovulation induction using exogenousgonadotrophins combined with a gonadotrophin-releasing hormoneagonist (GnRH-a). Human menopausal gonadotrophin (HMG) was precededby 3 weeks of treatment with GnRH-a (buserelin; 1200 µg/dayintra-nasally) and administered in a step-down dose regimenstarting with 225 IU/day i.m. GnRH-a was withheld the day beforeadministration of human chorionic gonadotrophin (HCG; 10 000IU i.m.). Blood sampling and ultrasound monitoring was performedevery 2–3 days until menses. The luteal phase was significantlyshorter in PCOS patients as compared to eight regularly cyclingcontrols: 8.8 (3.3–11.4) days [median(range)] versus 12.8(8.9–15.9) days (P = 0.01). Median peak values for progesteronedid not show significant differences comparing both groups:52.3 (17.1–510.3) nmol/l versus 43.0 (31.2–71.1)nmol/l, respectively (P = 0.8). The interval between the dayof the progesterone peak and return to baseline was significantlyshorter in the PCOS patients than in controls: 2.5 (0.3–4.9)days versus 4.2 (3.9–10.5) days (P < 0.005). Luteinizinghormone (LH) concentrations during the luteal phase as reflectedby area under the curve were significantly lower in PCOS ascompared to controls: 4.4 (1.6–21.0) IU/l x days and 49.0(27.8–79.6) IU/l x days, respectively (P < 0.001).In conclusion, patients with PCOS may suffer from insufficientluteal phases after ovulation induction using HMG/HCG in combinationwith a GnRH-a. The corpus luteum apparently lacks the supportof endogenous LH and may be stimulated only by the pre-ovulatoryinjection of HCG. Potential involvement of adjuvant GnRH-a medicationor HCG itself in luteal suppression of endogenous gonadotrophinsecretion, and the importance of luteal function for pregnancyrates following treatment, warrant further studies.     

Treatment of patients with long-standing unexplained subfertility with in vitro fertilization

OBJECTIVE: To evaluate whether IVF is an effective treatment for long-standing unexplained subfertility. DESIGN: Retrospective cohort study. SETTING: Tertiary care infertility center in a university hospital. PATIENT(S): Two hundred two couples with unexplained subfertility of 2 years' duration or more who attended the center for their first IVF attempt. INTERVENTION(S): Couples were placed on a waiting list for IVF. They received no treatment until IVF was started. MAIN OUTCOME MEASURE(S): Pregnancy rate (PR) while on the waiting list and PR after IVF treatment. RESULT(S): Complete data sets were available for 131 couples. Seventeen of 131 women became pregnant while waiting for IVF treatment (PR 0.9% per exposure cycle), whereas 45 of 119 receiving IVF treatment became pregnant (PR 17% per IVF attempt). CONCLUSION(S): IVF treatment has substantial added value over waiting and is an efficient treatment for long-standing unexplained subfertility.     

Endocrinology: Gonadotrophin induction of ovulation using a step-down dose regimen: single-centre clinical experience in 82 patients

A total of 82 normogonadotrophic clomiphene-resistant anovulatorypatients were treated with exogenous gonadotrophins accordingto a step-down dose regimen during 234 cycles. In 43 (18%) cyclesco-treatment with gonadotrophin-releasing hormone analogueswas applied. The initial dose was between 1.5 and 2.5 ampoules(75 IU folliclestimulating hormone each) per day (dependenton body weight), and decreasing steps of 0.5 ampoules/day werebased on sonographic findings. The overall ovulation rate was91% (213 cycles). The median treatment period was 11 days anda total of 14 ampoules of gonadotrophin were needed. In 131(62%) of the ovulatory cycles not more than one, and in 208(98%) cycles not more than two, follicles 16 mm were presenton the day human chorionic gonadotrophin was given. A totalof 37 pregnancies occurred of which two were twins and one wasa triplet (multiple pregnancy rate 8%). The pregnancy rate percycle was 17% and the cumulative pregnancy rate after 7 monthswas 47%. The abortion rate was 19%. There were four (1.7%) casesof mild ovarian hyperstimulation, of which none became pregnant.In conclusion, this study shows that the applied step-down regimenfor gonadotrophin induction of ovulation can be a safe and effectivetreatment alternative for patients with clomiphene-resistantanovulation. The duration of ovarian stimulation and the amountof exogenous gonadotrophin required is limited. Pregnancy ratesare comparable with those reported for step-up regimens, anda low incidence of complications (i.e. multiple gestation andovarian hyperstimulation) was noted. Although data obtainedfrom this non-comparative study appear favourable, a prospectivecomparative trial is mandatory to confirm and extend these observations.     

First established pregnancy and birth after induction of ovulation with recombinant human follicle-stimulating hormone in polycystic ovary syndrome

This case report describes the first established pregnancy andbirth after induction of ovulation with recombinant human follicle-stimulatinghormone (FSH) in a woman suffering from chronic clomiphene-resistantanovulation due to polycystic ovary syndrome (elevated serumluteinizing hormone and testosterone concentrations togetherwith polycystic ovaries). Starting on day 3 of a progestagenwithdrawal bleeding, 75 IU of rFSH was administered i.m.dailyuntil a single preovulatory follicle was seen upon transvaginalultrasound examination at day 13. Ovulation was induced by asingle i.m. administration of 10 000 IU of human chorionic gonadotrophin,after which aviable singleton pregnancy was revealed at a gestationalage of 6 weeks. The course of pregnancy and labour was uneventfuland no abnormalities were found upon a paediatric examination.