- Determinants of Infertility in Couples. [Journal Article]
- JNJ Nepal Health Res Counc 2019 Apr 28; 17(1):85-89
- CONCLUSIONS: Primary infertility cases are three times more common in Dhulikhel hospital.Ovulatory cause was the most common contributory factors among female infertile cases while abnormality in semen parameter was the commonest problem among male infertile cases. Thorough evaluation and repeated visits were required to find out the apparent determinants of infertility problem.
- Asherman's syndrome: current perspectives on diagnosis and management. [Review]
- IJInt J Womens Health 2019; 11:191-198
- Intrauterine adhesions with symptoms like hypomenorrhea or infertility are known under the term Asherman's syndrome. Although the syndrome has been widely investigated, evidence of both prevention of…
Intrauterine adhesions with symptoms like hypomenorrhea or infertility are known under the term Asherman's syndrome. Although the syndrome has been widely investigated, evidence of both prevention of the syndrome and the ideal treatment are missing. Understanding the pathogenesis of intrauterine adherences is necessary for the prevention of the formation of intrauterine scarring. Intrauterine adhesions can develop from lesion of the basal layer of the endometrium caused by curettage of the newly pregnant uterus. The syndrome may also occur after hysteroscopic surgery, uterine artery embolization or uterine tuberculosis. For initial diagnosis the less invasive contrast sonohysterography or hysterosalpingography is useful. The final diagnosis is based on hysteroscopy. Magnetic resonance imaging is required in cases with totally obliterated uterine cavity. Intrauterine adherences are classified in accordance with different classification systems based on the hysteroscopic diagnosis of severity and localization of adherences. Classification is necessary for the planning of surgery, information on prognosis and scientific purposes. Surgery is performed in symptomatic patients with either infertility or with painful periods. Intrauterine adherences are divided with a hysteroscope using scissors or a power instrument working from the central part of the uterus to the periphery. Peroperative ultrasonography is useful in an outpatient setting for the prevention of complications. Hysteroscopy with fluoroscopy is a solution in difficult cases. Use of intrauterine devices like balloon catheters or intrauterine contraceptive devices seems to be the preferred methods for the prevention of re-occurrence of adhesions after treatment. Both primary prevention after hysteroscopic surgery or curettage and secondary prevention of new adhesions after adhesiolysis have been investigated. The aim of this review was to summarize the literature on diagnosis, classification, treatment and prevention, based on a literature search with a wide range of search terms.
- Laparoscopic surgery: Any role in patients with unexplained infertility and failed in vitro fertilization cycles? [Journal Article]
- MMedicine (Baltimore) 2019; 98(13):e14957
- Patients who undergo several in-vitro fertilization (IVF) treatment cycles and fail to conceive present a frustrating problem to the clinician. When 1 cycle of IVF treatment fails, should we offer th…
Patients who undergo several in-vitro fertilization (IVF) treatment cycles and fail to conceive present a frustrating problem to the clinician. When 1 cycle of IVF treatment fails, should we offer the couples to choose additional cycle of IVF instead of evaluation of the potential peritoneal factor? In cases of otherwise unexplained infertility, the investigation cannot be considered to be complete until laparoscopy has been performed. The aim of the study is to investigate the fertility outcome of laparoscopic treatment in infertile women with repeated IVF failures.This is a retrospective case-control study conducted in a tertiary care, academic teaching hospital from January 2012 to December 2015. Patients recruited in this study were classified into 2 groups. Study group (n = 45) were offered laparoscopy for evaluation of infertility, control group (n = 45) elected to proceed to IVF without laparoscopy. Diagnostic laparoscopy and subsequent excision of suspected endometriotic lesions, lysis of adhesion and treatment of tubal pathology were performed when indicated.Forty-four (97.8%) patients in study had pelvic pathologies and the treatment was performed at the same time. Twenty-four patients in study group conceived including 16 patients conceived spontaneously and 14 patients conceived with additional IVF following laparoscopy management. There was a significant difference in the ongoing pregnancy rates between patients conceived through IVF in study group and control group (41.9% vs 19.6%, P < .05).Laparoscopy in women with normal hysterosalpingography but recurrent IVF failures can detect unrecognized pelvic pathologies. Laparoscopy evaluation prior to additional cycle of IVF seems to improve the subsequent pregnancy rate.
- The capacity of transvaginal hydrolaparoscopy versus hysterosalpingography to diagnose tubal pathology in the work-up of subfertile women, a randomised clinical trial. [Journal Article]
- EJEur J Obstet Gynecol Reprod Biol 2019; 236:127-132
- CONCLUSIONS: THL and HSG have a comparable capacity in diagnosing tubal pathology with comparable performance in safety, pain and acceptability.
- [Pelvic Inflammatory Diseases: Updated Guidelines for Clinical Practice - Short version]. [Journal Article]
- GOGynecol Obstet Fertil Senol 2019 Mar 14
- CONCLUSIONS: Current management of PID requires easily reproducible investigations and antibiotics adapted to STI and vaginal microbiota.
- [Prevention of postoperative or associated of care pelvic inflammatory diseases: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. [Journal Article]
- GOGynecol Obstet Fertil Senol 2019 Mar 08
- Numerous prophylactic antibiotic regimens (PBR) have been evaluated particularly in surgical abortion, hysterosalpingography or caesarean section, but few randomized comparative trials are available.…
Numerous prophylactic antibiotic regimens (PBR) have been evaluated particularly in surgical abortion, hysterosalpingography or caesarean section, but few randomized comparative trials are available. Recommendations for PBR should take into account, expected and demonstrated benefits that reduce the risk of surgical site infection, but also the impact on the microbiota, the risk of bacterial resistance selection, and the overall cost to the community. In addition, antibiotic prophylaxis is not the only one factor to reduce the risk of surgical site infection, such as preventive measures and good hygiene practices.
- Venous intravasation during hysterosalpingography. [Letter]
- KJKaohsiung J Med Sci 2019; 35(1):65-66
- Rupture of an unsuspected ectopic pregnancy following a hysterosalpingography-A case report. [Journal Article]
- IJInt J Surg Case Rep 2019; 55:179-182
- CONCLUSIONS: Based on available guidelines and the rare occurrence of such complication, we find insufficient evidence to perform universal pre-procedural pregnancy testing. However, we strongly recommend doing it for abnormal menstrual cycles (cycles shorter than 21 or longer than 35 days, unreliable menstrual history or unusual menstrual flow pattern). Furthermore, HSG should be scheduled during the follicular phase after practicing safe sex within the two weeks preceding the test.While pre-procedural pregnancy test should not be performed for all, a high index of suspicion for early pregnancy should be maintained as undetected ectopic and heterotopic pregnancies could lead to serious complications once the HSG is done.
- The effectiveness of tubal flushing with different contrast media on fertility outcomes: a systematic review and network meta-analysis. [Review]
- UOUltrasound Obstet Gynecol 2019 Feb 10
- CONCLUSIONS: In women with infertility undergoing fertility work-up, tubal flushing with oil-based contrast probably increases clinical pregnancy rates within 6 months and may increase subsequent live birth rates, compared to tubal flushing with water-based contrast and compared to no intervention. Evidence on fertility outcomes beyond 6 months is insufficient. This article is protected by copyright. All rights reserved.
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- Laparoscopic Reversal of Tubal Sterilization; A Retrospective Study Over 135 Cases. [Journal Article]
- FSFront Surg 2018; 5:79
- Objectives: To evaluate the pregnancy and delivery rates of laparoscopic tubal reanastomosis. Study Design: From 2003 to 2013, 135 laparoscopic tubal reversals were performed according to the four …
Objectives: To evaluate the pregnancy and delivery rates of laparoscopic tubal reanastomosis. Study Design: From 2003 to 2013, 135 laparoscopic tubal reversals were performed according to the four stitch technique. The parameters studied, included positive pregnancy test, miscarriage, ectopic pregnancy, termination of pregnancy, term delivery, post-operative time to conception, post-operative hysterosalpingography, and spermogram. Results: From the 135 patients operated, 93 fulfilled the inclusion criteria. The age of patients varied from 27 to 47 years old. All ages combined, positive β-HCG blood sample rate was 75.3% (95% CI: 65.0-83.4%) and term delivery 52.7% (95%CI: 42.1-3.0%). The age-adjusted pregnancy and delivery rates were as follows: 27-35 y.o. (n = 23) 95.7% (95%CI: 76.0-99.8%) and 73.9% (95%CI: 51.3-88.9%),36-39 y.o. (n = 40) 77.5% (95%CI: 61.1-88.6%) and 47.5% (95%CI: 31.8-63.7%),40-42 y.o. (n = 19) 68.4% (95%CI: 43.5-86.4%) and 52.6% (95%CI: 29.5-74.8%),43-47 y.o. (n = 11) 36.4% (95%CI: 12.4-68.4%) and 27.3% (95%CI: 7.3-60.7%). Conclusions: In our series the pregnancy and delivery rates after laparoscopic reversal of tubal sterilization is estimated at 75.3 and 52.7%, respectively. For women with tubal sterilization and no other infertility factors, reanastomosis can restore anterior natural fertility related to age. Laparoscopic reversal should be proposed systematically to patients and performed by well-trained laparoscopists, avoiding potentially the inconvenient and adverse outcomes of an IVF treatment. Although, it may seem a more cost-effective technique compared to robotically assisted reversal, a prospective randomized trial could answer this question.