Safety and efficacy of infertility treatment after conservative management of borderline ovarian tumors: a preliminary report

OBJECTIVE: To evaluate the safety and efficacy of infertility treatment in a group of patients after conservative management of borderline ovarian tumors. DESIGN: Retrospective study. SETTING: University IVF unit. PATIENT(S): Five patients with previous conservative treatment of borderline ovarian tumor. INTERVENTION(S): Seventeen IVF cycles. MAIN OUTCOME MEASURE(S): Recurrence, IVF outcome. RESULT(S): At the time of diagnosis, the mean age of the patients was 32.2 +/- 6.9 years. The mean time elapsed between the initial diagnosis of a borderline tumor and the performance of IVF was 42.2 months. After IVF, the mean number of oocytes retrieved was 7.9 +/- 4.0 with a mean fertilization rate of 57.1% and a mean number of 3.1 +/- 1.4 day 3 embryos transferred. Six pregnancies were achieved in three of the five patients with a pregnancy rate per retrieval of 37.5% and per transfer of 42.9%. The mean follow-up time that elapsed since the first IVF cycle was 39.2 months (range 9-78 months). One patient had three recurrences 13, 27, and 43 months after her first IVF cycle, all of which remained histologically serous borderline tumor. All patients were without evidence of disease at the time of last follow-up. CONCLUSION(S): At a mean follow-up time of 39.2 months, our results suggest that IVF may be considered for patients with conservatively treated borderline tumors. Furthermore, overall IVF success rates were very satisfactory, suggesting no perceptible negative impact of prior borderline ovarian neoplasia on pregnancy rates after IVF.     

Autologous endometrial coculture in patients with IVF failure: outcome of the first 1,030 cases

OBJECTIVE: To analyze the effectiveness of autologous endometrial coculture (AECC) in improving embryo quality and pregnancy rates in 1,030 consecutive cycles of in vitro fertilization-embryo transfer (IVF-ET) utilizing AECC from January 1996 to December 2001. STUDY DESIGN: Embryos from each of 1,030 patients allocated to growth on AECC were analyzed for outcome. All patients had previously undergone failed IVF cycles. During a luteal phase biopsy (5-12 days after the luteinizing hormone surge) performed prior to the treatment cycle, glandular (G) and stromal (S) endometrial cells were isolated by enzymatic digestion and separated based on differential sedimentation rates. These cells were cryopreserved, then plated as a 50%/50% combination of G and S cells prior to embryo exposure. The conditioned medium was changed every 2 days. Embryos were randomly grown on endometrial coculture (ECC) or conventional media if > 6 oocytes were normally fertilized. Otherwise, all embryos were grown on AECC. RESULTS: The patients' mean age was 36.9 (+/-3.1) years. The patients had on average a history of 3.1 (+/- 1.7) failed prior attempts. When comparing a previous cycle (same institution only), the cleaved embryos on day 3 were of an improved quality (6.8+/-1.2 vs. 5.5+/-1.0 blastomeres and 14.6% +/- 9.3 vs. 27.2% +/- 9.8 fragmentation, P <.05). Twenty-two (2.13%) patients did not undergo ET secondary to poor embryonic development. Overall positive and clinical pregnancy rates of 49.8% and 41.5% were noted, respectively. Age remained the most important predictor of outcome. CONCLUSION: We demonstrated a significant improvement in embryo quality with ECC. We also demonstrated that patients with a poor prognosis secondary to prior IVF failures can have a good outcome when utilizing AECC.     

Involvement of Interleukin-1 and the Interleukin-1 Receptor Antagonist in In Vitro Embryo Development Among Women Undergoing In Vitro Fertilization–Embryo Transfer

PURPOSE: To examine the roles of Interleukin-1 (IL-1) and IL-1 receptor antagonist (IL-1ra), in in vitro embryo development and subsequent pregnancy outcome. METHODS: Maternal serum utilized to supplement embryo growth in IVF cycles was analyzed for the presence of IL-1 cytokines. RESULTS: The maternal serum that was utilized to supplement the embryo media was found to have measurable amounts of IL-1beta and IL-1ra. CONCLUSIONS: Relative antagonism of the IL-1 system was positively associated with embryo development and pregnancy outcome.     

Role of previous ectopic pregnancy in altering the presentation of suspected ectopic pregnancy

OBJECTIVE: To evaluate the differences in the presentations of women with and without a prior history of an ectopic pregnancy and a suspicion of a current ectopic. STUDY DESIGN: Evaluation of a cohort of patients presenting to an emergency department to exclude an ectopic pregnancy. Over a 58-month study period (January 1992-October 1996), 1,510 consecutive, pregnant women presenting to an emergency department with pelvic pain and/or vaginal bleeding to exclude an ectopic pregnancy were evaluated. A comparison was made of the presenting signs and symptoms between patients with and without a previous history of an ectopic pregnancy. RESULTS: Of patients presenting to exclude an ectopic pregnancy, 105 had a history of an ectopic pregnancy, and 1,355 had no such history. Fifty patients were excluded because they were lost to follow-up or transferred their care to another hospital. Those with a history of an ectopic pregnancy were more likely to be diagnosed again with an ectopic pregnancy, were older and were more likely to have a history of pelvic inflammatory disease and abdominal surgery. Patients with a history of an ectopic pregnancy presented earlier with a lower hCG level. CONCLUSION: Women with a previous history of an ectopic present in a clinically different manner than do those without such a history.     

Evaluation of tricyclic antidepressant false positivity in a pediatric case of cyproheptadine (periactin) overdose

CASE REPORT: The authors report a case of pediatric cyproheptadine toxicity, initially misdiagnosed as tricyclic toxicity based on the results of a preliminary rapid toxicological serum screen. Although such cross-reactivity has been reported, the chemical basis of this observation has not yet been evaluated. By GC/MS methods and HPLC assays adapted for the detection of tricyclic compounds, the authors confirmed that cyproheptadine was indeed responsible for this patient's toxicity. In addition, the authors identified the presence of a cyproheptadine metabolite in the patient's serum. Further testing in an immunoassay-based toxicologic screen demonstrated some cross-reactivity exhibited by the patient's serum, but not the parent compound. These findings showed that the cross-reactivity correlated with the presence of the cyproheptadine metabolite, highlighting the value of confirmatory toxicologic testing of routine rapid toxicologic screens.     

Epidemiology of venous thromboembolic disease.

From the information presented in this article, it can be concluded that clinical suspicion of VTE should be increased in patients with a history of VTE, recent surgery, spinal cord injury, trauma, or malignancy. A variety of medical illnesses also increase the risk of venous thrombosis, including congestive heart failure, myocardial infarction, stroke with paresis, nephrotic syndrome, cigarette smoking, and obesity. Hypercoagulable states, such as antithrombin III deficiency, protein C deficiency, protein S deficiency, or factor V Leiden mutation should be considered in those patients who develop VTE in the absence of known risk factors. Additionally, the presence of vena caval filters does not exclude the possibility of PE or recurrent DVT. With a careful assessment of risk, physicians can hope to increase the diagnostic yield of VTE and decrease the significant morbidity and mortality of caused by this disease.     

Live birth outcomes in infertile patients with class III and class IV obesity following fresh embryo transfer

ObjectiveAssess the effect of class III (body mass index [BMI, kg/m²] 40–49.9) and class IV obesity (≥ 50) on clinical pregnancy and live birth outcomes after first oocyte retrieval and fresh embryo transfer cycle.DesignCohort studySettingAcademic centerPatientsPatients undergoing their first oocyte retrieval with planned fresh embryo transfer in our clinic between 01/01/2012 and 12/31/2018. Patients were stratified by BMI: 18.5–24.9 (n = 4913), 25–29.9 (n = 1566) 30–34.9 (n = 559), 35–39.9 (n = 218), and ≥ 40 (n = 114).InterventionNoneMain outcome measureLive birth rateResultsFollowing embryo transfer, there were no differences in pregnancy rates across all BMI groups (p value, linear trend = 0.86). However among pregnant patients, as BMI increased, a significant trend of a decreased live birth rate was observed (p value, test for linear trend = 0.004). Additionally, as BMI increased, a significant trend of an increased miscarriage rate was observed (p value, linear trend = < 0.001). Compared to the normal-weight cohort, women with a BMI ≥ 40 had a significantly higher rate of cancelled fresh transfers after retrieval (18.4% vs. 8.2%, OR 2.51; 95%CI 1.55–4.08). Among singleton deliveries, a significant trend of an increased c-section rate was identified as the BMI increased (p value, linear trend = <0.001).ConclusionOverall, patients with a BMI > 40 have worse IVF treatment outcomes compared to normal-weight patients. After embryo transfer, their pregnancy rate is comparable to normal-weight women; however, their miscarriage rate is higher, leading to a lower live birth rate for pregnant women in this population. Patients with a BMI > 40 have a c-section rate that is 50% higher than normal-weight patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-020-02011-1.