DOCSLIB.ORG

Is Endometrial Scratching Beneficial for Patients Undergoing a Donor

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Is Endometrial Scratching Beneficial for Patients Undergoing a Donor diagnostics Article Is Endometrial Scratching Beneficial for Patients Undergoing a Donor-Egg Cycle with or without Previous Implantation Failures? Results of a Post-Hoc Analysis of an RCT Alexandra Izquierdo 1,*, Laura de la Fuente 2, Katharina Spies 3, David Lora 4,5 and Alberto Galindo 6 1 Gynaecology Unit, Médipôle Hôpital Mutualiste Lyon-Villeurbanne, 69100 Villeurbanne, France 2 Human Reproduction Unit, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, Avda, Andalucia s/n, 28041 Madrid, Spain; [email protected] 3 ProcreaTec–IVF Spain, Manuel de Falla 6, 28036 Madrid, Spain; [email protected] 4 Clinical Research Unit (imas12-CIBERESP), University Hospital 12 de Octubre, Avda, Andalucia s/n, 28041 Madrid, Spain; [email protected] 5 Facultad de Estudios Estadísticos, Complutense University of Madrid, 28040 Madrid, Spain 6 Fetal Medicine Unit—Maternal and Child Health and Development Network (Red SAMIDRD12/0026/0016), Department of Obstetrics and Gynaecology, 12 de Octubre Research Institute (imas12), University Hospital 12 de Octubre, Complutense University of Madrid, Avda, Andalucia s/n, 28041 Madrid, Spain; [email protected] * Correspondence: [email protected] Abstract: Endometrial scratching (ES) has been proposed as a useful technique to improve outcomes in in vitro fertilization (IVF) cycles, particularly in patients with previous implantation failures. Our objective was to determine if patients undergoing egg-donor IVF cycles had better live birth rates Citation: Izquierdo, A.; de la Fuente, after ES, according to their previous implantation failures. Secondary outcomes were pregnancy L.; Spies, K.; Lora, D.; Galindo, A. Is rate, clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, and multiple pregnancy rate. Endometrial Scratching Beneficial for We analysed the results of 352 patients included in the Endoscratch Trial (NCT03108157). A total of Patients Undergoing a Donor-Egg 209 were patients with one or no previous implantation failures (105 with an ES done in the previous Cycle with or without Previous cycle, group A1, and 104 without ES, group B1), and 143 were patients with at least two previous Implantation Failures? Results of a failed implantations (71 patients with ES, group A2, and 72 without ES, group B2). We found an Post-Hoc Analysis of an RCT. improvement in pregnancy rates (62.9% in group A1 vs. 55.8% in group B1 vs. 70.4% in group A2 vs. Diagnostics 2021, 11, 1167. https:// doi.org/10.3390/diagnostics11071167 76.4% in group B2, p = 0.028) in patients with at least two previous implantation failures, but this difference was not statistically different when we compared clinical pregnancy rates (59.1% vs. 51.0% Academic Editor: Antonio Maccio vs. 64.8% vs. 68.1% in groups A1, B1, A2 and B2, respectively, p = 0.104) and live birth rates (52.4% vs. 43.3% vs. 57.8% vs. 55.6% in groups A1, B1, A2 and B2, respectively, p = 0.218). According to these Received: 19 March 2021 results, we conclude that there is no evidence to recommend ES in egg-donor IVF cycles, regardless Accepted: 24 June 2021 of the number of previous failed cycles. Published: 26 June 2021 Keywords: endometrial scratching; in vitro fertilization; recurrent implantation failure; egg donor Publisher’s Note: MDPI stays neutral IVF cycle; endometrial receptivity with regard to jurisdictional claims in published maps and institutional affil- iations. 1. Introduction In 2003, Barash et al. published for the first time their results on patients undergoing endometrial scratching (ES) before an in vitro fertilization (IVF) cycle. They aimed to Copyright: © 2021 by the authors. enhance endometrial receptivity, as this had been seen in guinea pigs when an intentional Licensee MDPI, Basel, Switzerland. injury was caused before embryo implantation [1]. They performed four endometrial This article is an open access article injuries during the cycle prior to the embryo transfer and found an improvement in implan- distributed under the terms and tation rate (IR), pregnancy rate (PR), and live birth rate (LBR) in the study group [2]. Several conditions of the Creative Commons studies were conducted after that and some authors reached the same conclusions [3,4], Attribution (CC BY) license (https:// but others did not [5]. When only patients with recurrent implantation failure (RIF) were creativecommons.org/licenses/by/ 4.0/). Diagnostics 2021, 11, 1167. https://doi.org/10.3390/diagnostics11071167 https://www.mdpi.com/journal/diagnostics Diagnostics 2021, 11, 1167 2 of 11 considered, ES seemed to have a better impact on the outcomes [6], as the review by Potdar et al. [7] and the Cochrane review by Nastri et al. showed in their results [8]. In 2019, Vitagliano et al. published a meta-analysis on the impact of ES in infertile women undergoing a first embryo transfer, and they could not find a difference between groups in terms of clinical pregnancy rates (CPR), miscarriage rate (MR), ongoing preg- nancy rate (OPR), LBR, multiple pregnancy rate (MulPR), and ectopic pregnancy rate (EPR) in fresh or frozen embryo transfers [9]. They found a negative impact in one study that eval- uated ES performed on the day of the oocyte retrieval [10]. The same authors published a meta-analysis of studies including patients with at least one previous failure, and found an increased LBR and CPR in patients who had two or more previous unsuccessful cycles [11]. In addition, a review conducted of studies that included patients who had at least one previous failed cycle found a significative increase in CPR and LBR after ES, but differences were not significative if studies with a high risk of bias were excluded [12]. Nevertheless, neither of these reviews included the last randomised controlled trial (RCT) published, the largest to date, that could not find, in their subgroup analysis of IVF patients, any difference in the LBR of patients undergoing a first cycle or after previous failed attempts [13]. The underlying mechanism that would lead to benefits of ES remains uncertain. Some authors have suggested that ES would lead to a better synchronization between embryo and endometrium through the endometrial maturation retardation [14], while others have advocated that ES would enhance decidualization through the induction of cytokine and growth factor secretion as well as immune cell invasion [15], or that ES would modify endometrial gene expression of specific factors involved in embryo implantation [16]. It is known that ovarian stimulation may induce an asynchrony between the embryo and the endometrium [17], due to the high oestrogen levels achieved during controlled ovarian stimulation, and this endometrial development is also different from one patient to another as it is determined by each woman’s ovarian reserve and stimulation protocols. In addition, embryo implantation potential may also be very different among patients undergoing IVF cycles as embryo quality and euploidy depend on maternal age [18]. With this background, we designed an RCT in egg donor recipients in order to assess the real effect of ES under similar endometrial conditions and with the highest embryo quality [19], including patients with and without previous implantation failures. Our results showed no differences in PR (65.9% vs. 64.2%, p = 0.823), CPR (61.4 vs. 58.0, p = 0.587) and LBR (54.5% vs. 48.3%, p = 0.286) between intervention and control groups in intention-to-treat (ITT) analysis. The definition of RIF has been subject of debate during the last years as it is difficult to determine if a negative result is due to implantation deficient phenomena or to impaired embryo quality. This has led to many different definitions among authors, who may consider recurrent implantation failure from two to six previous failed embryo transfers, with fresh or frozen embryos [20]. In 2014, a thorough review of implantation failure definition and therapies defined RIF as the implantation failure of four or more good quality embryos, including fresh and frozen embryos, in at least three embryo transfers [21]. Nevertheless, recent meta-analyses and reviews consider RIF patients those who have undergone at least two previous embryo transfers, as they have found that, according to this definition, RIF patients had improved outcomes when an ES was performed [8,9,11]. The reduction in the total number of transferred embryos considered in the RIF definition is related to an increase in embryo selection due to laboratory culture conditions and pre-implantation genetic testing, reducing the impact of implantation failure associated with impaired embryo quality or embryo genetic conditions. Thus, we performed a subgroup analysis of the outcomes of patients included in the Endoscratch Trial (NCT03108157), dividing our patients into RIF patients (with two or more previous failed implantations) and non-RIF patients (with a maximum of one previous failed embryo transfer) to determine the efficacy of ES in improving live birth rates in egg-donor IVF cycles according to previous implantation failures. Diagnostics 2021, 11, 1167 3 of 11 2. Materials and Methods The overall number of patients included in the Endoscratch Trial (NCT03108157) was 352, of whom 176 were allocated to receive an ES in the luteal phase of the cycle preceding the embryo transfer cycle (group A), and another 176 to receive no intervention (group B). Sample size was calculated upon egg-donor IVF average pregnancy rates (60%) in order to detect a difference of 15% between the two groups. We performed an analysis according to the number of previous failed embryo transfers, including own egg and donor egg, and fresh and frozen embryo transfers. This secondary analysis of our RCT was not included in the original design of the trial and thus sample size according to the number of implantation failure patients to be included in each arm was not calculated. Out of the 352 patients, 209 had a maximum of 1 previous failed embryo transfer (non-RIF patients), and 143 had at least two previous failed transfers (RIF patients).
Load more

Recommended publications
  • Role of Ultrasound in the Evaluation of First-Trimester Pregnancies in the Acute Setting
    University of Massachusetts Medical School eScholarship@UMMS Radiology Publications Radiology 2020-04-01 Role of ultrasound in the evaluation of first-trimester pregnancies in the acute setting Venkatesh A. Murugan University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/radiology_pubs Part of the Female Urogenital Diseases and Pregnancy Complications Commons, Obstetrics and Gynecology Commons, Radiology Commons, and the Women's Health Commons Repository Citation Murugan VA, Murphy BO, Dupuis CS, Goldstein AJ, Kim YH. (2020). Role of ultrasound in the evaluation of first-trimester pregnancies in the acute setting. Radiology Publications. https://doi.org/10.14366/ usg.19043. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/526 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Radiology Publications by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Role of ultrasound in the evaluation of first-trimester pregnancies in the acute setting Venkatesh A. Murugan, Bryan O’Sullivan Murphy, Carolyn Dupuis, Alan Goldstein, Young H. Kim PICTORIAL ESSAY Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA https://doi.org/10.14366/usg.19043 pISSN: 2288-5919 • eISSN: 2288-5943 Ultrasonography 2020;39:178-189 In patients presenting for an evaluation of pregnancy in the first trimester, transvaginal ultrasound is the modality of choice for establishing the presence of an intrauterine pregnancy; evaluating pregnancy viability, gestational age, and multiplicity; detecting pregnancy-related Received: July 25, 2019 complications; and diagnosing ectopic pregnancy.
    [Show full text]
  • Transvaginal Sonography in Early Human Pregnancy
    TRANSVAGINAL SONOGRAPHY IN EARLY HUMAN PREGNANCY (Transvaginale echoscopie in de vroege humane graviditeit) PROEFSCHRIFT TER VERKRIJGING VAN DE GRAAD VAN DOCTOR AAN DE ERASMUS UNIVERSITEIT ROTTERDAM OP GEZAG VAN DE RECTOR MAGNIFICUS PROF. DR. C.J. RIJNVOS EN VOLGENS BESLUIT VAN HET COLLEGE VAN DEKANEN. DE OPENBARE VERDEDIGING ZAL PLAATSVINDEN OP WOENSDAG 30 JANUARI 1991 OM 15.45 UUR DOOR ROELOF SCHATS GEBOREN TE LEIDEN PROMOTIECOMMISSIE PROMOTOR: Prof. Jhr. Dr. J.W. Wladimiroff CO-PROMOTOR: Dr. C.A.M. Jansen OVERIGE LEDEN: Prof. Dr. Ir. N. Born Prof. Dr. H.P. van Geijn Prof. Dr. J. Voogd Voor Wilma, Rachel & Tamar PASMANS OFFSETDRUKKERJJ B.V., 's-GRAVENHAGE CONTENTS Page CHAPTER 1 GENERAL INTRODUCTION AND DEFINITION OF THE STUDY OBJECTIVES................................. 7 1.1. Introduction............................................. 7 1.2. Definition of the study objectives............................ 8 1.3. References.............................................. 9 CHAPTER 2 TRANSVAGINAL SONOGRAPHY: technical and methodological aspects........................................ 11 2.1. Introduction............................................. 11 2.2. Technical aspects......................................... 11 2.3. Acceptability ............................................13 2.4. The examination......................................... 14 2.5. Transvaginal ultrasound equipment used in the present study ........20 2.6. References............................................. 21 CHAPTER 3 THE SAFETY OF DIAGNOSTIC ULTRASOUND WITH PARTICULAR
    [Show full text]
  • Ultrasound in the First Trimester
    ULTRASOUND IN THE 4 FIRST TRIMESTER INTRODUCTION First trimester ultrasound is often done to assess pregnancy location and thus it overlaps between an obstetric and gynecologic ultrasound examination. Accurate performance of an ultrasound examination in the first trimester is important given its ability to confirm an intrauterine gestation, assess viability and number of embryo(s) and accurately date a pregnancy, all of which are critical for the course of pregnancy. Main objectives of the first trimester ultrasound examination are listed in Table 4.1. These objectives may differ somewhat based upon the gestational age within the first trimester window, be it 6 weeks, 9 weeks, or 12 weeks, but the main goals are identical. In this chapter, the approach to the first trimester ultrasound examination will be first discussed followed by the indications to the ultrasound examination in early gestation. Chronologic sequence of the landmarks of the first trimester ultrasound in the normal pregnancy will be described and ultrasound findings of pregnancy failure will be presented. The chapter will also display some of the major fetal anomalies that can be recognized by ultrasound in the first trimester. Furthermore, given the importance of first trimester assignment of chorionicity in multiple pregnancies, this topic will also be addressed in this chapter. TABLE 4.1 Main Objectives of Ultrasound Examination in the First Trimester - Confirmation of pregnancy - Intrauterine localization of gestational sac - Confirmation of viability (cardiac activity in embryo/fetus) - Detection of signs of early pregnancy failure - Single vs. Multiple pregnancy (define chorionicity in multiples) - Assessment of gestational age (pregnancy dating) - Assessment of normal embryo and gestational sac before 10 weeks - Assessment of basic anatomy after 11 week TRANSVAGINAL ULTRASOUND EXAMINATION IN THE FIRST TRIMESTER There is general consensus that, with rare exceptions, ultrasound examination in the first trimester of pregnancy should be performed transvaginally.
    [Show full text]
  • First, Do No Harm . . . to Early Pregnancies
    295jum_online.qxp:Layout 1 4/25/10 3:04 PM Page 685 Editorial First, Do No Harm . to Early Pregnancies Peter M. Doubilet, MD, PhD Carol B. Benson, MD Department of Radiology Brigham and Women’s Hospital Harvard Medical School Boston, Massachusetts USA hen a woman of childbearing age presents to a physician or other care- giver complaining of vaginal bleeding and/or pelvic pain, a pelvic ultra- sound examination is often performed to assess the etiology of her symptoms.1,2 If she has a positive pregnancy test, the major role of ultra- Wsound is to assess whether she has a normal intrauterine pregnancy (IUP), an abnor- mal IUP, or an ectopic pregnancy. The information provided by ultrasound can be of great value in guiding management decisions and improving outcome. Errors in ultrasound interpretation, however, can lead to mismanagement and, there- by, to bad pregnancy outcome. Potential interpretation errors include: (1) failure to conclude that there is a definite or probable IUP despite ultrasound images depicting such a finding; and (2) failure to conclude that there is a definite or probable ectopic pregnancy despite ultrasound images depicting such a finding. This editorial focuses on the former error. Definition and Scope of the Problem The issue addressed here involves the situation in which a woman with a positive preg- nancy test and symptoms of bleeding and/or pain undergoes a pelvic ultrasound examination, and the scan demonstrates a nonspecific intrauterine fluid collection (Figure 1). By “nonspecific,” we mean a fluid collection with curved edges in the central echogenic portion of the uterus (ie, in the decidua) with no visible embryo or yolk sac, that does not demonstrate one of the published signs of early IUP (double sac sign3 or intradecidual sign4).
    [Show full text]
  • Ectopic Pregnancy: Ramakrishnan, MD, and Dewey C
    New research APPLIED EVIDENCE findings that are changing clinical practice Kalyanakrishnan Ectopic pregnancy: Ramakrishnan, MD, and Dewey C. Scheid, MD, MPH Forget the “classic presentation” Department of Family and Preventive Medicine, University if you want to catch it sooner of Oklahoma Health Sciences Center, Oklahoma City A new algorithm to improve detection Practice recommendations Management strategies for patients T Less than half of the patients with ectopic with ectopic pregnancy have evolved pregnancy present® withDowden the classic triad Health of rapidly, Media with ambulatory medical therapy a history of amenorrhea, abdominal pain, becoming an option for more patients.6 and irregular vaginal bleeding (C). Using a practical decision protocol, we Copyright discuss the physical findings that most reli- T Definite cervicalFor motion personal tenderness and use only ably suggest ectopic pregnancy, describe peritoneal signs are the most sensitive and sensible use of laboratory and imaging stud- specific examination findings for ectopic ies, and explain what to do when results are pregnancy—91% and 95%, respectively (A). equivocal. In part 2 of this article (coming i T Beta-human chorionic gonadotropin n the June 2006 JOURNAL OF FAMILY (β-hCG) levels can be used in combination PRACTICE), we provide a decision protocol with ultrasound findings to improve the for managment of ectopic pregnancy. accuracy of the diagnosis of ectopic pregnancy (A). T T Women with initial nondiagnostic Evaluation transvaginal ultrasound should be followed
    [Show full text]
  • Characterization of Yolk Sac Proteins of Bos Indicus Cattle Embryos
    Characterization of yolk sac proteins of Bos indicus cattle embryos F.S. Matsumoto1, V.C. Oliveira1, C.A.F. Mançanares2, C.E. Ambrosio2 and M.A. Miglino1 1Laboratório de Anatomia de Animais Domésticos e Silvestres, Departamento de Cirurgia, Faculdade de Medicina Veterinária e Saúde Animal, Universidade de São Paulo, São Paulo, SP, Brasil 2Laboratório de Morfofisiologia Molecular e Desenvolvimento, Departamento de Ciências Básicas, Faculdade de Zootecnia e Engenharia de Alimentos, Universidade de São Paulo, Pirassununga, SP, Brasil Corresponding author: C.E. Ambrósio E-mail: [email protected] Genet. Mol. Res. 11 (4): 3942-3954 (2012) Received June 11, 2012 Accepted July 26, 2012 Published November 14, 2012 DOI http://dx.doi.org/10.4238/2012.November.14.1 ABSTRACT. The yolk sac is an embryonic membrane that is essential for the embryo’s initial survival in many mammals. It also plays an important role in the production of proteins necessary for development. We studied proteins of the yolk sac in bovine embryos at up to 40 days of gestation. We examined the yolk sac of 17 bovine embryos at different gestational periods, measuring α-fetoprotein, α-1-antitrypsin, and transferrin. This experiment was carried out by Western blot technique, associated with electrophoresis on a 6% sodium dodecyl sulfate polyacrylamide gel. Mouse monoclonal antibody anti-human- α-fetoprotein, mouse antibody anti-human-transferrin and rabbit polyclonal anti-human-α-1-antitrypsin were used as primary antibodies, and conjugated peroxidase as a secondary antibody. We detected the three proteins in some of the yolk sac samples; however, the bands in some specimens (samples) were weak, maybe a result of poor antigen- antibody reaction, since the antibodies used in this study were not Genetics and Molecular Research 11 (4): 3942-3954 (2012) ©FUNPEC-RP www.funpecrp.com.br Bovine yolk sac proteins 3943 specific to bovine proteins.
    [Show full text]
  • RNA-Seq Reveals Conservation of Function Among the Yolk Sacs Of
    RNA-seq reveals conservation of function among the PNAS PLUS yolk sacs of human, mouse, and chicken Tereza Cindrova-Daviesa, Eric Jauniauxb, Michael G. Elliota,c, Sungsam Gongd,e, Graham J. Burtona,1, and D. Stephen Charnock-Jonesa,d,e,1,2 aCentre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, United Kingdom; bElizabeth Garret Anderson Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, WC1E 6BT, United Kingdom; cSt. John’s College, University of Cambridge, Cambridge, CB2 1TP, United Kingdom; dDepartment of Obstetrics and Gynaecology, University of Cambridge, Cambridge, CB2 0SW, United Kingdom; and eNational Institute for Health Research, Cambridge Comprehensive Biomedical Research Centre, Cambridge, CB2 0QQ, United Kingdom Edited by R. Michael Roberts, University of Missouri-Columbia, Columbia, MO, and approved May 5, 2017 (received for review February 14, 2017) The yolk sac is phylogenetically the oldest of the extraembryonic yolk sac plays a critical role during organogenesis (3–5, 8–10), membranes. The human embryo retains a yolk sac, which goes there are limited data to support this claim. Obtaining experi- through primary and secondary phases of development, but its mental data for the human is impossible for ethical reasons, and importance is controversial. Although it is known to synthesize thus we adopted an alternative strategy. Here, we report RNA proteins, its transport functions are widely considered vestigial. sequencing (RNA-seq) data derived from human and murine yolk Here, we report RNA-sequencing (RNA-seq) data for the human sacs and compare them with published data from the yolk sac of and murine yolk sacs and compare those data with data for the the chicken.
    [Show full text]
  • Ectopic Pregnancy Management: Tubal and Interstitial SIGNS
    4/21/194/21/19njm Ectopic Pregnancy Management: Tubal and interstitial SIGNS / SYMPTOMS Pain and vaginal bleeding are the hallmark symptoms of ectopic pregnancy. Pain is almost universal; it is generally lower abdominal and unilateral. Bleeding is also very common following a short period of amenorrhea. Physical exam may reveal a tender adnexal mass, often mentioned in texts, but noted clinically only 20 percent of the time. Furthermore, it may easily be confused with a tender corpus luteum of a normal intrauterine pregnancy. Finally signs and symptoms of hemoperitoneum and shock can occur, including a distended, silent, “doughy” abdomen, shoulder pain, bulging cul de sac into the posterior fornix of the vagina, and hypotension. DIAGNOSIS Initially, serum hCG rises, but then usually plateaus or falls. Transvaginal ultrasound scanning is a key diagnostic tool and can rapidly make these diagnoses: 1. Ectopic is ruled out by the presence of an intrauterine pregnancy with the exception of rare heterotopic pregnancy 2. Ectopic is proven when a gestational sac and an embryo with a heartbeat is seen outside of the uterus 3. Ectopic is highly likely if ANY adnexal mass distinct from the corpus luteum or a significant amount of free pelvic fluid is seen. When ultrasound is not definitive, correlation of serum hCG levels is important. If the hCG is above the “discriminatory zone” of 3000 mIU/ml IRP, a gestational sac should be visible on transvaginal ultrasound. The discriminatory zone varies by ultrasound machine and sonographer. If an intrauterine gestational sac is not visible by the time the hCG is at, or above, this threshold, the pregnancy has a high likelihood of being ectopic.
    [Show full text]
  • Study of Yolk Sac Abnormalities in the First Trimester Using Ultrasonography دراسه تشوهات كيس الصفار في الثلث االول من الحمل بإستخدام الموجات فوق الصوتية
    Sudan University Of Science And Technology College Of Graduate Studies Study of Yolk Sac Abnormalities in the First Trimester Using Ultrasonography دراسه تشوهات كيس الصفار في الثلث اﻻول من الحمل بإستخدام الموجات فوق الصوتية (A Thesis Submitted For Partial Fulfillment Of The Requirements Of M.Sc Degree In Medical Diagnostic Ultrasound) Presented by: Dalia Hashim Ahmed Mahjoub Supervisor: Dr. Muna Ahmed Mohamed 2019 Dedication I dedicate this work to: My parents whom support me and sought to blessed comfort and happiness, they gave everything to push me in a way of success and pray for me. My brother and sister whom we love. My colleagues and everyone who help me at any time in my life. With my love and appreciation I Acknowledgement I wish to thank my committee members who were more than generous with their expertise and precious time. A special thanks to Dr. MUNA, my committee chairman for his countless hours of reflecting, reading, encouraging, and most of all patience throughout the entire process. I would like to acknowledge and thank my university division for allowing me to conduct my research and providing any assistance requested. II Abstract This study was conducted in Khartoum state Sudan, in the ultrasound departments of khartoum north teaching hospital, Alskeikh Mohammed Ali Fadol and new omdurman hospital. The problem of the study was difficulty of sonographic detection of yolk sac abnormalities, and lack of interest for evaluation by sonographer and sonologist. The aim of the study was to estimate the role of ultrasound in the diagnosis of yolk sac abnormalities, the complication associated with it, and the usefulness in prediction of pregnancy outcome.
    [Show full text]
  • Further Evidence Against the Reliability of the Human Chorionic Gonadotropin Discriminatory Level
    3012online.qxp:Layout 1 11/18/11 3:19 PM Page 1637 ORIGINAL RESEARCH Further Evidence Against the Reliability of the Human Chorionic Gonadotropin Discriminatory Level Peter M. Doubilet, MD, PhD, Carol B. Benson, MD Objectives—The human chorionic gonadotropin (hCG) discriminatory level—the maternal serum β-hCG level above which a gestational sac should be consistently visi- ble on sonography in a normal pregnancy—has been reported to be 1000 to 2000 mIU/mL for transvaginal sonography. We assessed whether a woman with a β-hCG above 2000 mIU/mL and no intrauterine fluid collection on transvaginal sonography can subsequently be found to have a live intrauterine gestation and, if so, what the prog- nosis is for the pregnancy. Methods—We identified all women scanned between January 1, 2000, and December 31, 2010, who met the following criteria: serum β-hCG testing and transvaginal sonog- raphy were performed on the same day; β-hCG was positive and sonography showed no intrauterine fluid collection; and a live intrauterine pregnancy was subsequently doc- umented. We tabulated the β-hCG levels in these cases and assessed pregnancy out- come. Results—A total of 202 patients met the inclusion criteria, including 162 (80.2%) who had β-hCG levels below 1000 mIU/mL on the day of the initial scan showing no in- trauterine fluid collection, 19 (9.4%) with levels of 1000 to 1499, 12 (5.9%) 1500 to 1999, and 9 (4.5%) above 2000 mIU/mL. There was no significant relationship be- tween initial β-hCG level and either first-trimester outcome or final pregnancy outcome (P> .05, logistic regression analysis and Fisher exact test).
    [Show full text]
  • Recurrent Implantation Failure: Definition and Management
    Reproductive BioMedicine Online (2014) 28,14– 38 www.sciencedirect.com www.rbmonline.com REVIEW Recurrent implantation failure: definition and management C Coughlan a, W Ledger b, Q Wang c, Fenghua Liu d, Aygul Demirol e, Timur Gurgan e, R Cutting a, K Ong f, H Sallam g,TCLia,* a Department of Reproductive and Developmental Medicine, Jessop Wing, Royal Hallamshire Hospital, Sheffield, United Kingdom; b Department of Obstetrics and Gynaecology, Royal Hospital for Women, Sydney, Australia; c Reproductive Centre, First Affiliated Hospital of Sun Yat Sen University, Guangzhou, China; d The Women and Children Hospital of Guangdong Province, No. 13, Guangyuan Road West, Guangzhou 510010, China; e Women’s Health, Infertility and IVF Centre, Cankaya Caddesi, 20/3, Ankara, Turkey; f Monash IVF, Gold Coast, Australia; g Department of Obstetrics and Gynaecology, University of Alexandria and Suzanne Mubarak Regional Centre for Womens Health and Development, Alexandria, Egypt * Corresponding author. E-mail address: [email protected] (TC Li). Dr Carol Coughlan received her medical training in Ireland and obtained her MRCOG in 2003 and MRCPI in 2004. She completed subspecialist training in reproductive medicine and surgery at the Jessop Wing, Royal Hallamshire Hospital, Sheffield, UK. She is pursuing her research interests in recurrent implantation failure and recurrent miscarriage. Abstract Recurrent implantation failure refers to failure to achieve a clinical pregnancy after transfer of at least four good-quality embryos in a minimum of three fresh or frozen cycles in a woman under the age of 40 years. The failure to implant may be a con- sequence of embryo or uterine factors.
    [Show full text]
  • EARLY PREGNANCY PITFALLS Guys and St
    Dr Catherine Magee Clinical Fellow EARLY PREGNANCY PITFALLS Guys and St. Thomas’ NHS Foundation Trust CONTENTS Why / who / when should we scan? Role of biochemical markers Scan findings: Pregnancy of Unknown Location Ectopic pregnancies Miscarriage Difficulties in diagnosis SCANNING IN THE EARLY PREGNANCY UNIT Why Determine the location and viability of a pregnancy Who Symptomatic Reassurance scan Dating scan Post miscarriage / termination When At presentation Positive urinary pregnancy test No need for blood HCG / progesterone prior to scan BIOCHEMICAL MARKERS BHCG Hormone produced by the placental trophoblast Detected in plasma or urine 8 days post ovulation Peaks at 8-10 weeks gestation Trend gives indication of pregnancy viability Typically doubles over 48 hours in viable intrauterine pregnancies Not used to establish gestational age Not used to diagnose location of pregnancy Used to plan management of ectopic pregnancy BIOCHEMICAL MARKERS Progesterone Hormone produced by ovaries Causes endometrial lining to thicken after ovulation Continued production by corpus luteum after fertilisation / implantation Usually high in viable intrauterine pregnancies, low in failing pregnancies Not useful in predicting ectopic pregnancies No need for serial progesterone levels WHEN SHOULD WE SCAN? Discriminatory zone for intrauterine pregnancies Not the case for ectopic pregnancies Therefore don’t need bloods prior to first scan PREGNANCY OF UNKNOWN LOCATION Positive pregnancy test but unable to visualise pregnancy on ultrasound
    [Show full text]