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Utility of in vitro fertilization at diagnostic laparoscopy
Ciiations from the literature/International
Journal of Gynecology & Obstetrics 49 (1995) 87-97
parison with normal cycling women, PcoS showed normal frequency and increased amplitude LH pulses, elevated mean LH levels, and increased LH responseto GnRH. In PcoS, placebo administration was not associated with any LH modification, whereas naltrexone enhanced the frequency and decreasedthe amplitude of LH pulses, without modifying mean LH levels and the LH responseto GnRH. Conclusions: The naltrexoneinduced increment of LH frequency revealed a conserved central opioid tone in PcoS. Reduced LH pulse amplitude, induced by naltrexone, was not associated with a reduced LH responseto GnRH or with a reduction in mean LH levels. Present data do not support a role for endogenousopioid peptides in the pathogenesis of increased LH levels in PCOS.
Utility of in vitro fertilization
at diagnostic laparoscopy
Gindoff P.R.; Hall J.L.; Stillman R.J. USA
FERTIL STERIL 199462/2 (237-241) Objective: To compare stimulation and outcome variables for IVF in stimulated cycles when ova are retrieved during diagnostic infertility laparoscopy versus transvaginal ultrasound (US) directed retrieval and to investigate the presenceof unexpected failed fertilization in the diagnostic laparoscopy group, which allows an opportunity to diagnosis an etiology of infertility based on gamete interaction. Design: Consecutive patients who needed infertility diagnostic laparoscopy and agreed to combination with IVF were compared with concurrent patients undergoing transvaginal US IVF. Male factor screeningparameters (semenanalysis, sperm penetrating assay) and resultant fertilization were analyzed for these patients. Setting: The George Washington University Hospital, a tertiary referral center offering assisted reproductive technologies. Patients for diagnostic laparoscopy combined with IVF were enrolled in the Program of Oocyte Retrieval at Diagnostic Laparoscopy (PORDL). Participants: One hundred twenty-four women enrolled for diagnostic laparoscopy combined with IVF; 237 women were concurrently enrolled for transvaginal US IVF. Results: Responsevariables (number of follicles, days of monitoring, ampules of hMG, maximum E2) between the two groups were similar. Outcome variables (ova retrieved, ova fertilized, ova cleaved, clinical pregnancy rate per embryo transferred) were similar despite a significantly higher number of embryos transferred for the transvaginal US group. The clinical pregnancy rate per cycle was similar, 26% versus 28”/u for the women in the transvaginal US versus those women in the PORDL group, as was the clinical pregnancy rate per ET, 31% versus 34%. respectively. The number of fertilized ova for each group was not significantly different: 5.5 0.3 for the transvaginal group versus 4.8 0.4 for the PORDL group. Patients in the PORDL group with a known male factor (group B) had a lower fertilization rate than those with no male factor (group A). Within the group A with no detectable male factor prospectively, 17.2% had unexpectedly poor fertilization (group Al), whereasthe rest of the group A patients had higher fertilization rates as was expected (group A2). The clinical pregnancy rate per ET for group Al was O?/compared with 43.4% for the group A2 patients. Conclusions: In vitro fertilization
89
can be successfully performed during diagnostic laparoscopy yielding comparable results to transvaginal ultrasound IVF while gaining diagnostic information concerning sperm-ova interaction (i.e., fertilization).
The cast of a successful delivery with in vitro fertilization
Neumann P.J.; Gharib SD.; Weinstein M.C. USA
NEW ENGL J MED 1994 331/4 (239-243) Background. The use of in vitro fertilization has engendered considerable debate about who should have the procedure, whether health insurance should cover the cost, and if so. to what extent. We investigated the cost of a successfuldelivery with in vitro fertilization. Methods. We calculated the cost per successfuldelivery with in vitro fertilization (defined as at least one live birth) for a general population of couples undergoing in vitro fertilization and for two subgroups: couples with a diagnosis of tubal disease(who have a better chanceof success), and couples in which the woman is over the age of 40 years and the man has a low sperm count (who have a lower chance of success).Information on charges per cycle of in vitro fertilization was obtained from six facilities acrossthe country; delivery rates with this procedure were estimated from the literature. Results. On average, the cost incurred per successfuldelivery with in vitro fertilization increases from $66,667 for the first cycle of in vitro fertilization to $114,286by the sixth cycle. The cost increases because with each cycle in which fertilization fails, the probability that a subsequenteffort will be successful declines.Sensitivity analysesindicated that the cost per delivery range from $44,000 to $211,940. For couples with a better chanceof successfulin vitro fertilization (i.e., those with a diagnosis of tubal disease),it costs $50,000per delivery for the first cycle and $72,727 for the sixth. For couples in which the woman is older and there is a diagnosis of male-factor infertility, the cost rises from $160,000for the first cycle to $800,000 for the sixth. Conclusions. The debate about insurance coveragefor in vitro fertilization must take into account ethical judgments and social values. But analyses of costs and cost effectivenesshelp elucidate the economic implications of using in vitro fertilization and thus inform the policy discussion.
VIRAL INFECTIONS ImmunohistochemicaI characterization of endometrial Iymphoii cell populations in women infected with human immmmdeficiency VhlS
Johnstone F.D.; Williams A.R.W.; Bird G.A.; Bjornsson S. GBR
OBSTET GYNECOL 1994 8314(586-593) Objective: To determine whether lymphocytic infiltration of the endometrium accompanieshuman immunodeficiency virus (HIV) infection. Methods: Endometrial samples from I2 HIVinfected women and from rigorously matched controls were examined. The following markers were used: common leukocyte antigen (CD45), T lymphocytes (CD3), monocytesmacrophages (CD68), and CD4 and CD8 lymphocytes. Cell
Journal of Gynecology & Obstetrics 49 (1995) 87-97
parison with normal cycling women, PcoS showed normal frequency and increased amplitude LH pulses, elevated mean LH levels, and increased LH responseto GnRH. In PcoS, placebo administration was not associated with any LH modification, whereas naltrexone enhanced the frequency and decreasedthe amplitude of LH pulses, without modifying mean LH levels and the LH responseto GnRH. Conclusions: The naltrexoneinduced increment of LH frequency revealed a conserved central opioid tone in PcoS. Reduced LH pulse amplitude, induced by naltrexone, was not associated with a reduced LH responseto GnRH or with a reduction in mean LH levels. Present data do not support a role for endogenousopioid peptides in the pathogenesis of increased LH levels in PCOS.
Utility of in vitro fertilization
at diagnostic laparoscopy
Gindoff P.R.; Hall J.L.; Stillman R.J. USA
FERTIL STERIL 199462/2 (237-241) Objective: To compare stimulation and outcome variables for IVF in stimulated cycles when ova are retrieved during diagnostic infertility laparoscopy versus transvaginal ultrasound (US) directed retrieval and to investigate the presenceof unexpected failed fertilization in the diagnostic laparoscopy group, which allows an opportunity to diagnosis an etiology of infertility based on gamete interaction. Design: Consecutive patients who needed infertility diagnostic laparoscopy and agreed to combination with IVF were compared with concurrent patients undergoing transvaginal US IVF. Male factor screeningparameters (semenanalysis, sperm penetrating assay) and resultant fertilization were analyzed for these patients. Setting: The George Washington University Hospital, a tertiary referral center offering assisted reproductive technologies. Patients for diagnostic laparoscopy combined with IVF were enrolled in the Program of Oocyte Retrieval at Diagnostic Laparoscopy (PORDL). Participants: One hundred twenty-four women enrolled for diagnostic laparoscopy combined with IVF; 237 women were concurrently enrolled for transvaginal US IVF. Results: Responsevariables (number of follicles, days of monitoring, ampules of hMG, maximum E2) between the two groups were similar. Outcome variables (ova retrieved, ova fertilized, ova cleaved, clinical pregnancy rate per embryo transferred) were similar despite a significantly higher number of embryos transferred for the transvaginal US group. The clinical pregnancy rate per cycle was similar, 26% versus 28”/u for the women in the transvaginal US versus those women in the PORDL group, as was the clinical pregnancy rate per ET, 31% versus 34%. respectively. The number of fertilized ova for each group was not significantly different: 5.5 0.3 for the transvaginal group versus 4.8 0.4 for the PORDL group. Patients in the PORDL group with a known male factor (group B) had a lower fertilization rate than those with no male factor (group A). Within the group A with no detectable male factor prospectively, 17.2% had unexpectedly poor fertilization (group Al), whereasthe rest of the group A patients had higher fertilization rates as was expected (group A2). The clinical pregnancy rate per ET for group Al was O?/compared with 43.4% for the group A2 patients. Conclusions: In vitro fertilization
89
can be successfully performed during diagnostic laparoscopy yielding comparable results to transvaginal ultrasound IVF while gaining diagnostic information concerning sperm-ova interaction (i.e., fertilization).
The cast of a successful delivery with in vitro fertilization
Neumann P.J.; Gharib SD.; Weinstein M.C. USA
NEW ENGL J MED 1994 331/4 (239-243) Background. The use of in vitro fertilization has engendered considerable debate about who should have the procedure, whether health insurance should cover the cost, and if so. to what extent. We investigated the cost of a successfuldelivery with in vitro fertilization. Methods. We calculated the cost per successfuldelivery with in vitro fertilization (defined as at least one live birth) for a general population of couples undergoing in vitro fertilization and for two subgroups: couples with a diagnosis of tubal disease(who have a better chanceof success), and couples in which the woman is over the age of 40 years and the man has a low sperm count (who have a lower chance of success).Information on charges per cycle of in vitro fertilization was obtained from six facilities acrossthe country; delivery rates with this procedure were estimated from the literature. Results. On average, the cost incurred per successfuldelivery with in vitro fertilization increases from $66,667 for the first cycle of in vitro fertilization to $114,286by the sixth cycle. The cost increases because with each cycle in which fertilization fails, the probability that a subsequenteffort will be successful declines.Sensitivity analysesindicated that the cost per delivery range from $44,000 to $211,940. For couples with a better chanceof successfulin vitro fertilization (i.e., those with a diagnosis of tubal disease),it costs $50,000per delivery for the first cycle and $72,727 for the sixth. For couples in which the woman is older and there is a diagnosis of male-factor infertility, the cost rises from $160,000for the first cycle to $800,000 for the sixth. Conclusions. The debate about insurance coveragefor in vitro fertilization must take into account ethical judgments and social values. But analyses of costs and cost effectivenesshelp elucidate the economic implications of using in vitro fertilization and thus inform the policy discussion.
VIRAL INFECTIONS ImmunohistochemicaI characterization of endometrial Iymphoii cell populations in women infected with human immmmdeficiency VhlS
Johnstone F.D.; Williams A.R.W.; Bird G.A.; Bjornsson S. GBR
OBSTET GYNECOL 1994 8314(586-593) Objective: To determine whether lymphocytic infiltration of the endometrium accompanieshuman immunodeficiency virus (HIV) infection. Methods: Endometrial samples from I2 HIVinfected women and from rigorously matched controls were examined. The following markers were used: common leukocyte antigen (CD45), T lymphocytes (CD3), monocytesmacrophages (CD68), and CD4 and CD8 lymphocytes. Cell