Effect of contaminated preprocessed semen on fertilization rate and embryo quality in assisted reproductive techniques.

We aimed to identify the sources and prevalence of semen contamination from mastrubation and determine the effect of bacterospermia on fertilization rate and embryo quality in standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This was a prospective controlled study, in an IVF unit of a university teaching hospital, of 93 consecutive couples undergoing IVF-embryo transfer cycles. We evaluated handwashing; semen collection and processing; and assisted reproductive technology using semen provided by masturbation. The main outcome measures were presence and type of micro-organisms in the semen samples and embryo culture medium; the effect of hand washing on rate of contamination; and the effect of semen contamination on fertilization rate and embryo quality. The first consecutive 52 men of the 93 couples were not instructed to wash their hands before masturbation, and the remainder were so instructed. Forty-nine semen cultures (94.2%) in the first group were contaminated compared to only 16 (39%) in the second (p < 0.016); 27 of the 65 positive cultures (41.5%) were contaminated by more than one organism. The most common contaminators were bacteria usually found on the skin. All but four embryo medium cultures were negative. There was no significant difference in fertilization rate and embryo quality by culture findings in either the IVF or the ICSI procedures. We found that a high percentage of manually obtained semen for standard IVF or ICSI procedures was contaminated, but this had no effect on fertilization rate and embryo quality.     

Perineal stapled prolapse resection (PSPR) in elderly patients for external rectal prolapse: early experience

Background

Full-thickness rectal prolapse in frail elderly patients is often treated by a perineal approach with considerable attendant morbidity. We report our preliminary results of the perineal stapled prolapse resection (PSPR) technique for resection of full-thickness external rectal prolapse using a new reloadable Contour^® Transtar? stapler (Ethicon Endo-Surgery) device.

Methods

Fourteen elderly high-risk patients with an external prolapse up to 10 cm in length were treated between April 2010 and October 2011, and operative factors, outcome and recurrence rates were assessed.

Results

There were no intraoperative difficulties and no perioperative morbidity. The median operating time was 35 min (range 25–45 min) with a median hospital stay of 3 days (range 3–5 days). Four patients developed early recurrence over a median follow-up of 32 months (range 25–41 months).

Conclusions

PSPR is safer, faster and easier to perform than other conventional perineal prolapse procedures and is suitable for elderly, high-risk patients for whom an abdominal approach under general anesthesia is not advisable.     

Risk factors and maternal outcomes following preterm premature rupture of membrane in the second trimester of gestation

Archives of Gynecology and Obstetrics - To characterize the population of women who underwent mid-trimester preterm premature rupture of membrane (PPROM) in a country where mid-trimester abortions...     

Laparoscopic management of suspicious ovarian cysts in elderly, postmenopausal women

OBJECTIVES: To present our experience with laparoscopic treatment of ovarian cysts in elderly, postmenopausal women. STUDY DESIGN: During the period January 1996 to August 1997, 21 elderly, postmenopausal women were admitted to the Rabin Medical Center for laparoscopy. The indications for the operation were an ovarian cyst that did not meet the criteria of a simple cyst, was larger than 4 cm, had pathological Doppler flow or elevated CA-125 level. RESULTS: The median age of the patients was 67.19 (range 60-74). Despite the fact that 15 (71.4%) of the patients suffered from chronic disease, all laparoscopies were successfully accomplished. No case of malignancy was found. CONCLUSIONS: Laparoscopic management of carefully selected ovarian cysts is an appropriate alternative for exploratory laparotomy even in elderly patients with or without underlying diseases.     

Modified hysterosalpingography during infertility work-up: use of contrast medium and saline to investigate mechanical factors

OBJECTIVE: To evaluate the effectiveness of modified hysterosalpingography using <3 mL amount of contrast medium followed by injection of saline to minimize the adverse effects associated with the procedure. DESIGN: For modified hysterosalpingography, 1-2 mL of water-soluble contrast medium were injected to visualize the uterine cavity, followed by injection of 10 mL of saline to check tubal patency and spillage. A control group of patients underwent hysterosalpingography with undiluted contrast medium. SETTING: Teaching hospital. PATIENT(S): Seventy-eight infertile women [study (n = 40)/control (n = 38) groups]. INTERVENTION(S): Modified and standard hysterosalpingography. MAIN OUTCOME MEASURE(S): Assessment of uterine cavity, tubal patency, and sensation of pain during modified hysterosalpingography was compared with that during standard hysterosalpingography. RESULT(S): Uterine cavity and tubal patency were properly visualized during modified hysterosalpingography. Saline pushed the contrast medium successfully from the uterine cavity through the open fallopian tubes and into the pelvic cavity. The study group reported significantly less pain than did the control group. Between-group differences were statistically significant when pain perception (no pain vs. minimal pain vs. severe pain; no pain vs. any kind of pain) was analyzed by type of adnexal pathology (bilateral passage or unilateral passage). CONCLUSION(S): Modified hysterosalpingography was sufficient to diagnose tubal and pelvic mechanical factors. The procedure was associated with a significant reduction in self-reported pain and no medical complications.     

Laparoscopic adnexal transposition: novel surgical technique

Treatment of some cancers diagnosed at an early stage with expectation of prolonged survival has permitted the consideration of salvaging the reproductive and hormonal function of premenopausal female patients. When radiation to the pelvic area is part of treatment, this will almost always result in ovarian failure. To protect the ovaries, an oophoropexy may be performed, which involves moving the ovaries away from the radiation field. This procedure may be performed via laparoscopy. Some women undergoing laparoscopic radical hysterectomy may also be candidates for laparoscopic transposition. Because failure rates are still reported to be high, we developed a novel technique to mobilize the adnexa, which we present in this paper and attached movie.After separating the adnexa from the uterus and developing the infundibulopelvic (IP) ligament, a retroperitoneal tunnel is developed from the pelvis to the transposition opening laterally. The adnexa are moved through this tunnel, avoiding torsion of the vessels, and are brought through the opening back into the peritoneum. The adnexa are now fixed securely to the posterolateral abdominal wall with nonabsorbable sutures.Several issues permit better results using this technique. The IP ligament remains retroperitoneal and itself is outside the field of radiation. There is no kinking of the ovarian blood supply on the peritoneal fold. The location of the transposition is way above the field of radiation, preventing scatter injury. Even if one or both of the sutures fail, placement of the ovary will not change because of the peritoneum it has been brought through. This and the final location of the IP ligament retroperitoneally may enforce the ovary to it outside of the radiation field and prevent possible migration of the ovary back to the pelvis. This technique has advantages, which may offer the ovaries a better chance to resume hormonal function.     

Acute Bartholin’s abscess: microbial spectrum,patient characteristics,clinical manifestation,and surgical outcomes

The purpose of this investigation was to evaluate the patient characteristics, clinical manifestations, microbiology, and modes of treatment of a large cohort of women with acute Bartholin’s abscess, from a single medical center. A retrospective study was undertaken of all women diagnosed with acute Bartholin’s gland abscess who were admitted to the gynecology department in a university-affiliated tertiary hospital in central Israel from January 2004 to December 2013. A total of 267 women were included in the study. The mean age at diagnosis was 33.5?±?12.1 years and the mean hospitalization period was 1.4?±?0.9 days. Pain presented in 152 (56.9 %), swelling in 81 (30.3 %), and fever in 34 (12.7 %). Leukocytosis was detected in 149 (55.8 %). The three main treatment modalities were: antibiotics (75.7 %), abscess drainage (19.1 %), and marsupialization (80.9 %). Bacterial infections were detected in 154 (57.7 %) cultures, Escherichia coli presented in 59 (22.1 %), and Streptococcus species in 27 (10.1 %). The clinical and patient characteristics were similar between women with bacterial and sterile Bartholin’s abscesses, though leukocytosis was more prevalent among women with bacterial infections. E. coli was the single most frequent pathogen in cultures of acute Bartholin’s abscess. Respiratory tract-associated organisms were also common. This study indicates the polymicrobial spectrum of acute Bartholin’s abscess.     

PREGNANCY: Triple-Test Screening in In Vitro Fertilization Pregnancies

Purpose: To determine whether the results of triple-test analysis differ between spontaneous and IVF pregnancies.Methods: The study population consisted of 140 women with singleton pregnancies, 70 by IVF, and 70 by spontaneous conception. The groups were matched for maternal age, gestational week, and laboratory batch. The levels of all triple-test markers—alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and unconjugated estriol (u-E₃)—were compared between the groups.Results: Significantly higher HCG levels were detected in the patients with IVF pregnancies than in the control group (1.31 ± 0.8 vs. 0.95 ± 0.5 multiple of the medians, respectively, (p < 0.006), but there were no significant differences in AFP or u-E₃ levels. Overall, 18.5% of the IVF group were found to be screen-positive as compared with 11.4% of the control group (difference not statistically significant). Only 8 IVF pregnancies (11.4%) reached the lowest calculated risk possible (1:9999) compared with 17 (24.2%) in the control group (p < 0.05).Conclusions: Our findings support previous data demonstrating elevated maternal serum HCG in IVF patients in comparison with spontaneous ones.