To determine the predictive value and to define prognostic threshold measurements for mean ovarian volume (MOV) in patients undergoing IVF. Prospective cohort analysis. Tertiary care center. Two hundred sixtyseven p...To determine the predictive value and to define prognostic threshold measurements for mean ovarian volume (MOV) in patients undergoing IVF. Prospective cohort analysis. Tertiary care center. Two hundred sixtyseven patients. Transvaginal ultrasound before starting gonadotropins. Number of oocytes retrieved, basal hormone levels, and cycle outcomes. The MOV for the population was 4.78 ±2.6 cm3 (range 0.9-21.1 cm3). The MOV significantly correlated with the majority of prestimulation and poststimulation IVF parameters. Threshold analysis demonstrated a lower pregnancy rate associated with a MOV of < 2cm3 (31.6%vs. 55.6%). Threshold analysis revealed a trend toward higher cancellation rate associated with a MOV of < 2cm3 (21.1%vs. 7.3%). Although MOV correlated with IVF stimulation parameters, its use as an adjunct in counseling patients during IVF appears to be of limited value. A MOV < 2 cm3 was associated clinically with a higher cancellation rate (21.1%) and a lower pregnancy rate (31.6%) in those cycles not cancelled. However, these values do not deviate far from the mean national IVF outcome rates. There was no absolute MOV that was predictive of pregnancy outcome or cycle cancellation.展开更多
Objective: To evaluate adhesion reformation after laparoscopic excision of endometriosis and adhesiolysis in women with chronic pelvic pain. Design: Prospective clinical trial. Setting: University hospital. Patient(s)...Objective: To evaluate adhesion reformation after laparoscopic excision of endometriosis and adhesiolysis in women with chronic pelvic pain. Design: Prospective clinical trial. Setting: University hospital. Patient(s): Thirty-eight women with endometriosis and chronic pelvic pain. Intervention(s): A primary and second-look laparoscopy with adhesiolysis and excision of endometriotic lesions with a neodymium-yttrium argon garnet surgical laser technologies (SLT) contact laser. Main Outcome Measure(s): Adhesion formation and character (thin, thin and thick, or thick). Location of adhesions at a first laparoscopy was compared with de novo or reformation of adhesions and the location of adhesions at a second surgery. Result(s): Adhesions or adhesions combined with endometriotic lesions were significantly more likely to reform at second surgery compared with sites having only an endometriosis lesion. Thick adhesions were associated with a significantly increased likelihood of an adhesion reforming, compared with thin adhesions or thin and thick adhesions. Lesions or adhesions involving the ovarywere more likely to be associated with adhesions at a subsequent surgery, compared with lesions in the adjacent ovarian fossa or fallopian tube. Conclusion(s): Most patients developed adhesions after radical surgical excision of endometriosis for pelvic pain. The high incidence of adhesion formation after surgery for endometriosis underscores the importance of optimizing surgical techniques to potentially reduce adhesion formation.展开更多
文摘To determine the predictive value and to define prognostic threshold measurements for mean ovarian volume (MOV) in patients undergoing IVF. Prospective cohort analysis. Tertiary care center. Two hundred sixtyseven patients. Transvaginal ultrasound before starting gonadotropins. Number of oocytes retrieved, basal hormone levels, and cycle outcomes. The MOV for the population was 4.78 ±2.6 cm3 (range 0.9-21.1 cm3). The MOV significantly correlated with the majority of prestimulation and poststimulation IVF parameters. Threshold analysis demonstrated a lower pregnancy rate associated with a MOV of < 2cm3 (31.6%vs. 55.6%). Threshold analysis revealed a trend toward higher cancellation rate associated with a MOV of < 2cm3 (21.1%vs. 7.3%). Although MOV correlated with IVF stimulation parameters, its use as an adjunct in counseling patients during IVF appears to be of limited value. A MOV < 2 cm3 was associated clinically with a higher cancellation rate (21.1%) and a lower pregnancy rate (31.6%) in those cycles not cancelled. However, these values do not deviate far from the mean national IVF outcome rates. There was no absolute MOV that was predictive of pregnancy outcome or cycle cancellation.
文摘Objective: To evaluate adhesion reformation after laparoscopic excision of endometriosis and adhesiolysis in women with chronic pelvic pain. Design: Prospective clinical trial. Setting: University hospital. Patient(s): Thirty-eight women with endometriosis and chronic pelvic pain. Intervention(s): A primary and second-look laparoscopy with adhesiolysis and excision of endometriotic lesions with a neodymium-yttrium argon garnet surgical laser technologies (SLT) contact laser. Main Outcome Measure(s): Adhesion formation and character (thin, thin and thick, or thick). Location of adhesions at a first laparoscopy was compared with de novo or reformation of adhesions and the location of adhesions at a second surgery. Result(s): Adhesions or adhesions combined with endometriotic lesions were significantly more likely to reform at second surgery compared with sites having only an endometriosis lesion. Thick adhesions were associated with a significantly increased likelihood of an adhesion reforming, compared with thin adhesions or thin and thick adhesions. Lesions or adhesions involving the ovarywere more likely to be associated with adhesions at a subsequent surgery, compared with lesions in the adjacent ovarian fossa or fallopian tube. Conclusion(s): Most patients developed adhesions after radical surgical excision of endometriosis for pelvic pain. The high incidence of adhesion formation after surgery for endometriosis underscores the importance of optimizing surgical techniques to potentially reduce adhesion formation.
