To determine the extent to which embryo selection by blastulation and elective single blastocyst transfer, supported by efficient cryostorage of spare embryos, can reduce multiple pregnancies and maintain or improve o...To determine the extent to which embryo selection by blastulation and elective single blastocyst transfer, supported by efficient cryostorage of spare embryos, can reduce multiple pregnancies and maintain or improve on the live birth rate from IVF. Design: Prospective, nonrandomized cohort study. Setting: Sydney IVF, a private clinic in Australia. Patient(s): In vitro fertilization patients aged < 38 years with three or more usable blastocyst, recruited from April 2000 through December 2001, with pregnancies followed up until August 2004. Intervention(s): Blastocysts were cultured and cryostored with stage-specific culture medium and low oxygen conditions. Main Outcome Measure(s): Fetal heart-positive twin pregnancy rate and accumulating “ take-home baby” rate per retrieval leading to blastocyst transfer. Result(s): Among 121 women who elected single fresh blastocyst transfer (but who could elect to have two frozen blastocysts transferred at once), 79 (65.3% ) took home a baby, with a twin pregnancy rate of 7% . Among 285 women who chose two blastocysts for fresh transfer, 184 (64.2% ) took home at least one baby, with a twin pregnancy rate of 34% and five perinatal deaths. Conclusion(s): With technically appropriate blastocyst culture and freezing, and elective single blastocyst transfer in the fresh cycle, the overall multiple pregnancy rate can be reduced by > 75% , permitting in this series a slight increase in the chance of taking home a baby.展开更多
To assess adhesion reformation and subsequent fertility after a transient ovariopexy performed during severe pelvic endometriosis surgery. Retrospective study. University hospital. Twenty young women who underwent sev...To assess adhesion reformation and subsequent fertility after a transient ovariopexy performed during severe pelvic endometriosis surgery. Retrospective study. University hospital. Twenty young women who underwent severe pelvic endometriosis surgery. Unilateral or bilateral transient ovariopexy to the anterior abdominal wall was performed as the last step in the surgical procedure. Median duration of ovariopexy was 4 days. Adhesion reformation and subsequent fertility. This welltolerated procedure induced neither specific complication nor prolonged hospital stay. A secondlook laparoscopy, performed in eight patients (40%), has shown a reduction of the occurrence, the extent, and the severity of ovarian adhesions. Two thirds of the suspended ovaries had no or smooth adhesions at secondlook laparoscopy, even though all ovaries were initially adherent. Fifteen infertile women without male infertility factors tried actively to conceive after surgery. In this group of patients, four conceived spontaneously, and four conceived after IVF (total pregnancy rate = 53.3%). Seven patients delivered, and one pregnancy is ongoing. Median pregnancy delay was 11.5 months (range, 4-24 months). Transient ovariopexy appears to be a simple, safe, and effective technique in preventing postoperative adhesion reformation in severe pelvic endometriosis.展开更多
文摘To determine the extent to which embryo selection by blastulation and elective single blastocyst transfer, supported by efficient cryostorage of spare embryos, can reduce multiple pregnancies and maintain or improve on the live birth rate from IVF. Design: Prospective, nonrandomized cohort study. Setting: Sydney IVF, a private clinic in Australia. Patient(s): In vitro fertilization patients aged < 38 years with three or more usable blastocyst, recruited from April 2000 through December 2001, with pregnancies followed up until August 2004. Intervention(s): Blastocysts were cultured and cryostored with stage-specific culture medium and low oxygen conditions. Main Outcome Measure(s): Fetal heart-positive twin pregnancy rate and accumulating “ take-home baby” rate per retrieval leading to blastocyst transfer. Result(s): Among 121 women who elected single fresh blastocyst transfer (but who could elect to have two frozen blastocysts transferred at once), 79 (65.3% ) took home a baby, with a twin pregnancy rate of 7% . Among 285 women who chose two blastocysts for fresh transfer, 184 (64.2% ) took home at least one baby, with a twin pregnancy rate of 34% and five perinatal deaths. Conclusion(s): With technically appropriate blastocyst culture and freezing, and elective single blastocyst transfer in the fresh cycle, the overall multiple pregnancy rate can be reduced by > 75% , permitting in this series a slight increase in the chance of taking home a baby.
文摘To assess adhesion reformation and subsequent fertility after a transient ovariopexy performed during severe pelvic endometriosis surgery. Retrospective study. University hospital. Twenty young women who underwent severe pelvic endometriosis surgery. Unilateral or bilateral transient ovariopexy to the anterior abdominal wall was performed as the last step in the surgical procedure. Median duration of ovariopexy was 4 days. Adhesion reformation and subsequent fertility. This welltolerated procedure induced neither specific complication nor prolonged hospital stay. A secondlook laparoscopy, performed in eight patients (40%), has shown a reduction of the occurrence, the extent, and the severity of ovarian adhesions. Two thirds of the suspended ovaries had no or smooth adhesions at secondlook laparoscopy, even though all ovaries were initially adherent. Fifteen infertile women without male infertility factors tried actively to conceive after surgery. In this group of patients, four conceived spontaneously, and four conceived after IVF (total pregnancy rate = 53.3%). Seven patients delivered, and one pregnancy is ongoing. Median pregnancy delay was 11.5 months (range, 4-24 months). Transient ovariopexy appears to be a simple, safe, and effective technique in preventing postoperative adhesion reformation in severe pelvic endometriosis.
