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Text of the page (random words):
guish between a polycystic and a normal ovary has been ongoing for some time and will surely continue for a while yet although the results are somewhat predictable since this report is a reassessment of partial data from a previous study 2 the timing of this publication is important because it reinforces a recently published task force report 3 change is long overdue but we believe the recommendation of using 25 follicles per ovary 3 should be adopted promptly as it is clear that the former threshold of 12 follicles is obsolete due to the improvement in the resolution of ultrasound however physicians should be aware that a much lower threshold should be used when trying to identify women at high risk of having an excessive response to exogenous gonadotropins used in in vitro fertilization intracytoplasmic sperm injection cycles women with a total antral follicle count afc 20 considering both ovaries are already at a higher risk of ovarian hyperstimulation syndrome 4 another important point to consider when choosing the best threshold are the differences observed in afc during reproductive age 5 the question of using the same threshold or different thresholds depending on a woman s age should be balanced between diagnostic test accuracy and ease of implementation read the rest of this entry comments leave a comment tags anovulation hyperandrogenism ovarian follicle polycystic ovary syndrome ultrasonography categories uncategorized the lack of clinical congruence in diagnosis and research in relation to subclinical hypothyroidism 8 01 2014 to the editor we have just read a publication by bernardi et al on the topic of subclinical hypothyroidism and recurrent early pregnancy loss 1 going through the paper we found that the opposite situation was being described that is no impact of subclinical hypothyroidism on recurrent early pregnancy loss this puzzling situation motivated us to dissect the concepts presented by the authors one central point of misconception on thyroid function can be tracked down to a 2007 publication cited by bernardi which recommended a desirable tsh level of 2 5 miu ml for pregnant women in that original publication the authors had admitted that this recommendation was done on the basis of a poor level of evidence although this recommendation does not fulfill the principles of evidence based medicine it has very unfortunately found its way into clinical practice choosing a low cut off value for the upper range of tsh as bernardi et al have done will result in a misclassification of normal subjects by which the apparent subgroups euthyroids and women with subclinical hypothyroidism are not truly subgroups but belong to a same group of subjects having tsh values within the normal range therefore it is logical that one cannot expect to find any difference between these artificial subgroups in relation to recurrent early pregnancy loss read the rest of this entry comments leave a comment tags abortion hypothyroidism thyroid tsh categories uncategorized the effect of methotrexate injection for treatment of an ectopic pregnancy on ovarian reserve 7 01 2014 to the editor we read with great interest the paper does methotrexate administration for ectopic pregnancy after in vitro fertilization ivf impact ovarian reserve or ovarian responsiveness by boots et al 1 in the article the authors evaluated the effects of methotrexate mtx on the future fertility of women undergoing ivf by comparing markers of ovarian reserve day 3 fsh antral follicle count measures of ovarian responsiveness duration of stimulation peak e2 level total dose of gonadotropins number of oocytes retrieved fertilization rate and time from mtx administration to subsequent ivf cycle in the ivf cycle before and after an ectopic pregnancy ep treated with mtx they concluded that mtx treatment of an ep does not compromise ovarian reserve or ovarian responsiveness in subsequent cycles however other studies have demonstrated that when gonadotropin stimulation dose remains unchanged fewer oocytes may be collected after mtx is taken as management of an ectopic pregnancy suggesting a decrease in ovarian reserve 2 read the rest of this entry comments leave a comment tags ectopic pregnancy in vitro fertilization methotrexate ovarian reserve ovarian responsiveness categories uncategorized the playing field is changing 7 01 2014 to the editor the clinical practice of assisted reproductive technology art has continued to evolve rapidly the practice committee of the american society for reproductive medicine asrm in collaboration with the society for assisted reproductive technology sart in october 2012 e published a guideline indicating that the cryopreservation of oocytes should no longer be experimental 1 as a direct result the current system of data collection for sart and the center for disease control and prevention cdc requires revision additional data collection is required to comply with the fertility clinic success rate and certification act fcsrca of 1992 wyden law moreover other trends in art practice have been identified the freezing of embryos following blastocyst biopsy is often necessary to allow adequate time to obtain results of genetic testing prior to embryo transfer 2 some clinics also freeze eggs or embryos from multiple stimulations retrievals prior to transfer as a strategy to manage low responder patients 3 critiques of our current reporting system together with suggested changes have recently been published by sart members 4 5 sart has been well aware of these practice trends and the inability of our current reporting system to handle them read the rest of this entry comments leave a comment tags art crs ivf sart clinic database sart cors categories uncategorized first trimester down syndrome screening following assisted conception 19 12 2013 to the editor we would like to comment on the article written by dr bellver and colleagues 1 regarding the need for adjustments of first trimester down syndrome screening parameters following assisted conception although we greatly appreciate their work which confirms earlier data in the field we would like to issue some additional remarks the bellver et al study suggests a reduced maternal serum pregnancy associated plasma protein a papp a and increased false positive rates fpr in singleton pregnancies achieved by in vitro fertilization ivf and intracytoplasmic sperm injection icsi compared with naturally conceived pregnancies however the latter showed to be significant when including only icsi cycles using non donor oocytes the authors discuss several other groups according mode of conception iui with partner or donor sperm ivf non donor versus donor oocytes fresh versus frozen embryo transfer which veils the main message of the article namely that at least in their cohort only in icsi non donor cycles serum papp a level at first trimester down screening is significantly different from that seen in natural pregnancies in their manuscript the authors describe a diminished papp a level even in cases where these levels are not significantly different which is confusing read the rest of this entry comments leave a comment tags assisted conception down syndrome screening first trimester serum papp a concentrations categories uncategorized the postreproductive salpingectomy 13 12 2013 to the editor findley et al report 1 that simultaneous salpingectomy performed at the time of hysterectomy has no short term negative effects on ovarian reserve to add plausibility to this finding we would like to point to the vascular connections in the ovaries blood supply is mainly secured via the arteria ovarica from the aorta and via the ramus ovaricus from the arteria uterina these two arteries naturally anastomose with each other a further branch of the arteria uterina the ramus tubarius connects the fallopian tube during hysterectomy the arteria uterina is ligated nevertheless the central branch of the arteria ovarica in the infundibulopelvic ligament still guarantees sufficient blood flow from the aorta to the ovaries a collateral connection of the remaining branch of the ramus tubarius from the anastomosis with the arteria ovarica also secures the vascular supply of the fallopian tube however when salpingectomy is performed concomitant to hysterectomy the ramus tubarius will be removed accordingly all the blood passing through the ligamentum infundibulo pelvicum will now become available to the ovaries blood circulation through the ovaries should thus remain unaffected or even increase when hysterectomy is combined with salpingectomy the few available studies support the hypothesis that removal of both uterus and fallopian tubes causes a redistribution of the blood flow in favor of the ovaries moreover hormone production by the ovaries was also found to be unaffected even months after the intervention 2 3 read the rest of this entry comments leave a comment tags hysterectomy prevention salpingectomy sterilization categories uncategorized microdissection testicular sperm extraction in older men 10 12 2013 to the editor women experience a notable decrease in oocyte production in their late thirties however the effect of age on spermatogenesis is less well described indeed while there are no known limits to the age at which men can father children the effects of advanced paternal age are incompletely understood reproductive concerns related to advanced paternal age are less well defined 1 with a recent whole genome sequencing study suggesting an increased risk for rare de novo mutations for older fathers 2 whether the risk for major birth defects from de novo mutations is greater than the risk from assisted reproduction remains unknown 3 our retrospective study showed that sperm retrieval rates in men undergoing microdissection testicular sperm extraction tese was not negatively affected by age 4 despite the limited number of men in this study as pointed out by kim 5 it remains the largest study to evaluate the effect of male age on sperm retrieval in nonobstructive azoospermia noa the sperm retrieval rates were similar in men 30 years of age 30 to 50 years of age and older than 50 years of age 50 60 we identified that most men over 50 years of age who had successful sperm retrieval had hypospermatogenesis histology on previous diagnostic biopsy it is possible that some older men with noa may have secondary azoospermia with sperm detectable in the ejaculate at an earlier age therefore it is likely that older men may be more likely to have acquired noa i e secondary infertility whereas younger men may be more likely to have congenital noa read the rest of this entry comments leave a comment tags age azoospermia elderly sperm retrieval categories uncategorized response to commentary on manuscript the impact of fresh versus cryopreserved testicular sperm on intracytoplasmic sperm injection icsi pregnancy outcomes in men with azoospermia due to spermatogenic dysfunction a meta analysis 9 12 2013 to the editor we appreciate the insightful comments of dr kim 1 as he correctly states the use of fresh versus cryopreserved sperm has been controversial while the use of frozen sperm from men with obstructive azoospermia appears to yield equivalent outcomes to fresh sperm the application to men with nonobstructive azoospermia noa is less certain 2 however if proven equivalent dr kim correctly emphasizes the significant logistical and economic burdens that could be improved for couples additionally we agree with his assessment on the importance of methodology we as male reproductive specialists do not have a standardized evidence based protocol for the cryopreservation of sperm as such we believe that there should be some caution in mentioning an established detrimental effect of cryopreservation the analyses that produced such findings suffer the same methodological dependence that is inherent within essentially any cryopreservation data to date 3 moreover as data from men with obstructive azoospermia suggest equivalent outcomes it appears that cryopreservation does not irreparably impact sperm function 2 read the rest of this entry comments leave a comment tags cryopreservation fresh frozen nonobstructive azoospermia pregnancy categories uncategorized regarding medical treatment of ectopic pregnancy a committee opinion 6 12 2013 to the editor we welcome the recently published article by the practice committee of the american society for reproductive medicine on the medical treatment of ectopic pregnancy ep 1 in selected patients methotrexate mtx is an effective treatment for unruptured ep and helps to avoid surgical intervention we are however concerned about some aspects of the committee s opinion the document advocates the use of single measurements of serum human chorionic gonadotropin hcg as a discriminatory zone to separate abnormal from normal gestations at the first presentation if a transvaginal ultrasound scan tvs fails to identify the location of a pregnancy this approach is not without risk for example it does not take into account the possibility of a multiple pregnancy where for a given gestational age serum hcg levels are higher than in a singleton consequently hcg levels in multiple pregnancies are usually much higher before the pregnancy reaches a size that may be visualized on tvs 2 this could result in the administration of mtx to a woman with a pregnancy of unknown location pul who has a developing twin pregnancy rather than an underlying ep such an outcome would in all likelihood lead to major congenital abnormalities in the developing fetuses we recommend that the diagnosis of ep be based on the positive identification of an ep mass if inappropriate use of mtx is to be avoided in the event of a pul waiting 48 hours to determine the hcg ratio has been shown to be a safe management approach which offers further reassurance if the ratio is incompatible with a viable iup 3 read the rest of this entry comments leave a comment tags ectopic pregnancy medical management methotrexate categories uncategorized reply to commentary methotrexate treatment of ectopic pregnancies does not affect ovarian reserve in ivf patients 26 11 2013 to the editor we read with interest the editorial commentary by dr moragianni 1 on our recent publication evaluating the effect of methotrexate on ovarian reserve and subsequent assisted reproductive technology art treatment outcomes 2 the potential adverse effects of methotrexate specifically when used in infertile patients following ovarian hyperstimulation for art remain an important issue as dr moragianni summarizes the majority of the literature does not demonstrate an adverse effect of methotrexate however these data are limited by the fact that all of the current studies are retrospective an adequately powered randomized controlled trial would be the most appropriate way to answer this question definitively however the low rate of ectopic pregnancy occurring after art ...