生殖医学杂志最新文献

OBJECTIVE: To determine whether twice daily dosing of progesterone vaginal gel (PVG) is better for luteal phase support (LPS) than once daily dosing.STUDY DESIGN: Retrospective study including 456 women aged ≤42 years who underwent assisted reproductive technology with long GnRH agonist protocol. Blastocyst transfers and difficult embryo transfers were excluded. LPS was started with 90 mg PVG once daily on the evening of oocyte retrieval and continued until negative pregnancy test or 10th week of pregnancy in both groups. PVG dosage was doubled on the day of embryo transfer in the twice-daily group.RESULTS: Age, duration of infertility, and number of oocytes collected were similar. Numbers of embryos transferred were 2.9 and 2.8 in the once-daily and twice-daily groups, respectively (p=0.04). Embryo implantation (23.96% vs. 27.95%) and clinical pregnancy (50.9% vs. 56.5%) rates favored twice-daily dosage; however, differences were statistically nonsignificant, and the study had 20% power to demonstrate significance. When our results were pooled with a prior trial comparing once and twice daily dosing, twice daily dosing seemed to significantly increase clinical pregnancy rate (rate ratio: 1.18, 95% CI 1.01-1.38).CONCLUSION: Trends favoring twice daily dosing are encouraging findingsand require further investigation.

BACKGROUND: Office endometrial biopsy with a Pipelle cannula is the main method for sampling the endometrial lining. The Pipelle biopsy is safe, efficient, and cost effective. This office endometrial sampling method is also an accurate and safe procedure for endometrial sampling of patients with endometrial carcinoma. It is associated with minimal pain and does not require anesthesia.CASE: Pipelle is the most common method used for sampling the endometrial lining. No data are available of infectious complications related to endometrial biopsy. The incidence is presumed to be negligible. We present an unusual case of a 52-year-old woman who experienced septic shock and multiple organ failure following Pipelle endometrial sampling.CONCLUSION: Lower abdominal pain is the cardinal presenting symptom in woman with pelvic infection. Our case emphasizes that an atypical symptom such as abdominal pain after endometrial biopsy could be a sign of infectious complications.

BACKGROUND: Paraurethral vaginal leiomyoma is a rare and solid tumor of unknown etiology. We present a case of successfully treated paraurethral leiomyoma.CASE: A 49-year old woman, G4P2A2, was admitted to our clinic with complaints of vaginal mass and dyspareunia. During pelvic examination a 4x4-cm-sized, solid mass with hard consistency was detected at the paraurethral area in the front wall of the vagina. In the histopathological examination the mass was found to be compatible with leiomyoma.CONCLUSION: Paraurethral leiomyoma is a rare, hormone-dependent, benign tumor of mesenchymal origin. Surgical excision is necessary for discrimination from sarcoma. One should be cautious of urethral injury during the excision.

OBJECTIVE: To investigate which attributes of reproductive endocrinology and infertility (REI) fellowship applicants are most valued by fellowship program directors during the match process.STUDY DESIGN: An electronic survey was administered to determine characteristics most favored by program directors in the selection of REI fellows. A 5-point Likert scale was utilized to rank characteristics, with 1 being "most important" and 5 being" least important." The main outcome measures were factors desired by REI fellowship directors.RESULTS: The overall response rate was 61%. Objective factors that ranked highly were training at a competitive obstetrics and gynecology (OB/GYN) residency program, and clinical or basic science research experience. First authorship research ranked favorably regardless of whether it was in the form of a peer-reviewed paper, oral presentation, or poster abstract. Personal interview and perceived ability to work well with others were subjective factors considered favorably by REI fellowship directors.CONCLUSION: When selecting REI fellows for interviews, fellowship directors value candidates who have trained at competitive OB/GYN residency programs, who have clinical or basic science research experience, and who have contributed to scientific literature as first author. When subsequently ranking fellowship applicants, however, the most important factors are those found in the interview process, such as identification as a "team player".

Objective: To examine women�s perceptions of their obstetrician/gynecologist (ob-gyn) as primary care provider (PCP) and comfort in receiving primary care services in an ob-gyn setting.

Study design: Survey regarding women�s use of their ob-gyn provider as a PCP, their desire and comfort in receiving primary care services from them, and their perceptions of their ob-gyn�s delivery of primary care. Associations were assessed between use of an ob-gyn as PCP and various demographic and attitudinal factors, as well as patients� perceptions of primary care performance

Results: The response rate was 48% (1,404/2,916). Overall, the majority of participants responded that routine primary care services are available at their ob-gyn office and that they were comfortable receiving those services from their ob-gyn. Twenty percent of respondents considered their ob-gyn as their PCP, 52% considered another provider their PCP, and 28% of women did not identify a PCP. Women who were pregnant, mothers of newborns, and patients without a chronic health condition were more likely to identify their ob-gyn as their PCP.

Conclusion: A substantial proportion of women consider their ob-gyn their primary care provider and do not visit another provider regularly. While ob-gyns may not consider themselves as PCPs, they are often perceived as such by patients.

BACKGROUND: Mirror syndrome is defined as the development of maternal edema in association with fetal hydrops. This rare disease is called mirror syndrome due to the presence of maternal edema that "mirrors" the fetal and placental condition.CASE: We report the first case of mirror syndrome associated with 18p deletion.CONCLUSION: Cytogenetic analysis should be considered in mirror syndrome to identify the underlying cause.

OBJECTIVE: To determine whether different modes of labor induction impact the success rate and perinatal morbidity in women undergoing trial of labor after cesarean (TOLAC).STUDY DESIGN: Retrospective review of the Consortium on Safe Labor electronic database from 2002�2008; women with a prior cesarean birth, desiring TOLAC, and requiring induction of labor were included. Oxytocin and Foley bulb induction methods were compared to amniotomy alone. Prostaglandin use was also reviewed but, given the small numbers, was not the focus of this study.RESULTS: Univariate analysis showed significantly greater incidence of hemorrhage >1,000 mL (p=0.0030) and transfusion (p=0.0076) with Foley bulb use. All methods of induction for TOLAC decreased repeat cesarean sections (OR 0.34, 95% CI 0.23�0.52, p<0.01).CONCLUSION: Induction of labor does not alter the success rate for TOLAC candidates, regardless of mode of induction. When choosing induction methods, one should be mindful of the apparent additional risk of increased blood loss and transfusion with intracervical Foley bulb usage.

OBJECTIVE: To examine the effects of a levonorgestrel-releasing intrauterine device (LID) in patients with female sexual dysfunction and who were using this device for contraception.STUDY DESIGN: The results before device application and at the 6-month follow-up were compared using the female sexual function index (FSFI) test on a sample of 36 patients with female sexual dysfunction who had requested the use of the LID for contraception.RESULTS: The FSFI scores before the placement of an LID and at 6-month follow-up were determined to be 19.3±4.8 and 21.1±3.8 (p<0.001), respectively. In addition, the visual analog scale scores and menstruation duration were determined to be statistically significantly different before and after placement. When the FSFI subgroup evaluations were performed, the desire and arousal parameters before and after the application were determined to be statistically significantly different.CONCLUSION: The use of an LID for contraception resulted in positive effects in patients with female sexual dysfunction.

OBJECTIVE: To detect expression of connexin43 in cumulus cells and compare the differences between poor and non-poor ovarian responders undergoing in vitro fertilization (IVF), and to determinate whether the expression of connexin43 correlates with pregnancy outcome.STUDY DESIGN: A total of 152 infertile women undergoing IVF were included in this study. Patients were divided into 2 groups: poor ovarian responders and non-poor ovarian responders. Cumulus cells were collected from oocytes and were analyzed by Western blot for connexin43. Meanwhile, clinical data were obtained.RESULTS: The incidence of poor ovarian response was 18.42% (28/152). Connexin43 was detected in the cumulus cells of all the patients. The relative quantity of connexin43 in the poor responder group (1.11 [0.34, 2.11]) was much lower than that of the non-poor responder group (2.68 [1.41, 4.96]). There was significant difference in connexin43 between pregnant women and non-pregnant women. When adjusting for ovarian response, it yielded similar results.CONCLUSION: Expression of gap junction protein correlates with quantity of oocytes retrieved and might be related to pregnancy outcome. This study suggests that lack of connexin43 expression may contribute to poor ovarian response.

OBJECTIVE: To investigate the clinical significance of and appropriate treatments for carcinoma in situ (CIS)-positive margin after a loop electroexcisional procedure (LEEP) in the management of squamous carcinoma in situ (SCIS), adenocarcinoma in situ (ACIS), and microinvasive carcinoma (MIC).STUDY DESIGN: We analyzed 232 patients who underwent a hysterectomy for CIS-positive margin. We investigated the relationship between residual lesions after hysterectomy and clinical parameters, including age, LEEP method, histologic grade of conized cervix, location of the positive margin after LEEP, results of endocervical curettage (ECC), and size of the conized specimen.RESULTS: Age, LEEP method, proximal endocervical margin positivity, and ECC positivity differed significantly between patients with residual lesions and those with no residual lesions. In a comparison between groups with residual disease of a higher or lower grade than MIC, age, LEEP method, ECC positivity, and histologic grade of conized cervix were significantly different. Age, histologic grade of conized cervix, and ECC positivity were clinical parameters significantly contributing to invasive residual lesion in multivariate regression analysis. There were no residual invasive (MIC or advanced invasive cancer) lesions observed in women <50 years old who had SCIS conized lesions after hysterectomy.CONCLUSION: Conservative treatment with close follow-up or reconization for women <50 years old who have conized SCIS lesions without ECC positivity is acceptable. However, this study does not present sufficient evidence for the conservative treatment of conized ACIS or MIC lesions with CIS-positive margins.