The overall success rate of IVF does not appear to be reduced by sequential treatment with modified natural cycle IVF (MNC-IVF) and controlled ovarian stimulation IVF (COS-IVF), and the twin pregnancy rate is low, conclude Dutch researchers.
M. Pelinck, from University Medical Center Groningen, and colleagues followed-up 268 patients from an earlier study who had been offered nine cycles of MNC-IVF, assessing ongoing pregnancy and live birth rates, along with time-to-pregnancy after COS-IVF following MNC-IVF.
By the start of COS-IVF, 109 patients, aged an average of 34.2 years, remained in the study.
For COS-IVF following MNC-IVF, the actual observed cumulative ongoing pregnancy, live birth, and term live birth rates were 51.5 percent, 50.0 percent, and 43.3 percent, respectively, of which 8.0 percent, 6.7 percent, and 2.6 percent, respectively, were twins.
In addition, the cumulative ongoing pregnancy rate, including treatment-independent pregnancies, was 56.7 percent. The median time to ongoing pregnancy was 28.8 weeks.
The team says: "In conclusion, sequential treatment with MNC-IVF followed by COS-IVF does not appear to compromise overall success rates, while twin pregnancy rate is very low. Because of the patient-friendly and low-risk profile of MNC-IVF, this seems an appropriate strategy."
Monday, June 23, 2008
Sunday, June 22, 2008
Saturday, June 21, 2008
Indian Traffic From A Dutch Point-of-view
A rather well researched article......you'll like it!
Here's an article written by a Dutch gentleman about Indian traffic.
Driving in Bangalore / India
For the benefit of every Tom, Dick and Harry visiting India and daring to drive on Indian roads, I am offering a few hints for survival. They are applicable to every place in India except Bihar ,where life outside a vehicle is only marginally safer...........
Indian road rules broadly operate within the domain of karma where you do your best, and leave the results to your insurance company. The hints are as follows: Do we drive on the left or right of the road? The answer is 'both'. Basically you start on the left of the road, unless it is occupied. In that case, go to the right, unless that is also occupied. Then proceed by occupying the next available gap, as in chess. Just trust your instincts, ascertain the direction, and proceed. Adherence to road rules leads to much misery and occasional fatality. Most drivers don't drive, but just aim their vehicles in the generally intended direction.
Don't you get discouraged or underestimate yourself except for a belief in reincarnation; the other drivers are not in any better position. Don't stop at pedestrian crossings just because some fool wants to cross the road. You may do so only if you enjoy being bumped in the back.
Pedestrians have been strictly instructed to cross only when traffic is moving slowly or has come to a dead stop because some minister is in town. Still some idiot may try to wade across, but then, let us not talk ill of the dead.
Blowing your horn is not a sign of protest as in some countries. We horn to express joy, resentment, frustration, romance and bare lust (two brisk blasts),or just mobilize a dozing cow in the middle of the bazaar. Keep informative books in the glove compartment. You may read them during traffic jams, while awaiting the chief minister's motorcade, or waiting for the rainwater to recede when over ground traffic meets underground drainage.
Occasionally you might see what looks like a UFO with blinking colored lights and weird sounds emanating from within. This is an illuminated bus, full of happy pilgrims singing bhajans. These pilgrims go at breakneck speed, seeking contact with the Almighty, often meeting with success.
Auto Rickshaw (Baby Taxi): The result of a collision between a rickshaw and an automobile, this three-wheeled vehicle works on an external combustion engine that runs on a mixture of kerosene oil and creosote. This triangular vehicle carries iron rods, gas cylinders or passengers three times its weight and dimension, at an unspecified fare. After careful geometric calculations, children are folded and packed into these auto rickshaws until some children in the periphery are not in contact with the vehicle at all. Then their school bags are pushed into the microscopic gaps all round so those minor collisions with other vehicles on the road cause no permanent damage.
Of course, the peripheral children are charged half the fare and also learn Newton 's laws of motion enroute to school. Auto-rickshaw drivers follow the road rules depicted in the film Ben Hur, and are licensed to irritate.
Mopeds: The moped looks like an oil tin on wheels and makes noise like an electric shaver. It runs 30 miles on a teaspoon of petrol and travels at break-bottom speed. As the sides of the road are too rough for a ride, the moped drivers tend to drive in the middle of the road; they would rather drive under heavier vehicles instead of around them and are often 'mopped' off the tarmac.
Leaning Tower of Passes: Most bus passengers are given free passes and during rush hours, there is absolute mayhem. There are passengers hanging off other passengers, who in turn hang off the railings and the overloaded bus leans dangerously, defying laws of gravity but obeying laws of surface tension. As drivers get paid for overload (so many Rupees per kg of passenger), no questions are ever asked. Steer clear of these buses by a width of three passengers.
One-way Street: These boards are put up by traffic people to add jest in their otherwise drab lives. Don't stick to the literal meaning and proceed in one direction. In metaphysical terms, it means that you cannot proceed in two directions at once. So drive as you like, in reverse throughout, if you are the fussy type. Least I sound hypercritical, I must add a positive point also. Rash and fast driving in residential areas has been prevented by providing a 'speed breaker'; two for each house. This mound, incidentally, covers the water and drainage pipes for that residence and is left untarred for easy identification by the corporation authorities, should they want to recover the pipe for year-end accounting.
Night driving on Indian roads can be an exhilarating experience for those with the mental make up of Genghis Khan. In a way, it is like playing Russian roulette, because you do not know who amongst the drivers is loaded. What looks like premature dawn on the horizon turns out to be a truck attempting a speed record. On encountering it, just pull partly into the field adjoining the road until the phenomenon passes.
Our roads do not have shoulders, but occasional boulders. Do not blink your lights expecting reciprocation. The only dim thing in the truck is the driver, and with the peg of illicit arrack (alcohol) he has had at the last stop, his total cerebral functions add up to little more than a naught. Truck drivers are the James Bonds of India, and are licensed to kill. Often you may encounter a single powerful beam of light about six feet above the ground. This is not a super motorbike, but a truck approaching you with a single light on, usually the left one. It could be the right one, but never get too close to investigate. You may prove your point posthumously.
Here's an article written by a Dutch gentleman about Indian traffic.
Driving in Bangalore / India
For the benefit of every Tom, Dick and Harry visiting India and daring to drive on Indian roads, I am offering a few hints for survival. They are applicable to every place in India except Bihar ,where life outside a vehicle is only marginally safer...........
Indian road rules broadly operate within the domain of karma where you do your best, and leave the results to your insurance company. The hints are as follows: Do we drive on the left or right of the road? The answer is 'both'. Basically you start on the left of the road, unless it is occupied. In that case, go to the right, unless that is also occupied. Then proceed by occupying the next available gap, as in chess. Just trust your instincts, ascertain the direction, and proceed. Adherence to road rules leads to much misery and occasional fatality. Most drivers don't drive, but just aim their vehicles in the generally intended direction.
Don't you get discouraged or underestimate yourself except for a belief in reincarnation; the other drivers are not in any better position. Don't stop at pedestrian crossings just because some fool wants to cross the road. You may do so only if you enjoy being bumped in the back.
Pedestrians have been strictly instructed to cross only when traffic is moving slowly or has come to a dead stop because some minister is in town. Still some idiot may try to wade across, but then, let us not talk ill of the dead.
Blowing your horn is not a sign of protest as in some countries. We horn to express joy, resentment, frustration, romance and bare lust (two brisk blasts),or just mobilize a dozing cow in the middle of the bazaar. Keep informative books in the glove compartment. You may read them during traffic jams, while awaiting the chief minister's motorcade, or waiting for the rainwater to recede when over ground traffic meets underground drainage.
Occasionally you might see what looks like a UFO with blinking colored lights and weird sounds emanating from within. This is an illuminated bus, full of happy pilgrims singing bhajans. These pilgrims go at breakneck speed, seeking contact with the Almighty, often meeting with success.
Auto Rickshaw (Baby Taxi): The result of a collision between a rickshaw and an automobile, this three-wheeled vehicle works on an external combustion engine that runs on a mixture of kerosene oil and creosote. This triangular vehicle carries iron rods, gas cylinders or passengers three times its weight and dimension, at an unspecified fare. After careful geometric calculations, children are folded and packed into these auto rickshaws until some children in the periphery are not in contact with the vehicle at all. Then their school bags are pushed into the microscopic gaps all round so those minor collisions with other vehicles on the road cause no permanent damage.
Of course, the peripheral children are charged half the fare and also learn Newton 's laws of motion enroute to school. Auto-rickshaw drivers follow the road rules depicted in the film Ben Hur, and are licensed to irritate.
Mopeds: The moped looks like an oil tin on wheels and makes noise like an electric shaver. It runs 30 miles on a teaspoon of petrol and travels at break-bottom speed. As the sides of the road are too rough for a ride, the moped drivers tend to drive in the middle of the road; they would rather drive under heavier vehicles instead of around them and are often 'mopped' off the tarmac.
Leaning Tower of Passes: Most bus passengers are given free passes and during rush hours, there is absolute mayhem. There are passengers hanging off other passengers, who in turn hang off the railings and the overloaded bus leans dangerously, defying laws of gravity but obeying laws of surface tension. As drivers get paid for overload (so many Rupees per kg of passenger), no questions are ever asked. Steer clear of these buses by a width of three passengers.
One-way Street: These boards are put up by traffic people to add jest in their otherwise drab lives. Don't stick to the literal meaning and proceed in one direction. In metaphysical terms, it means that you cannot proceed in two directions at once. So drive as you like, in reverse throughout, if you are the fussy type. Least I sound hypercritical, I must add a positive point also. Rash and fast driving in residential areas has been prevented by providing a 'speed breaker'; two for each house. This mound, incidentally, covers the water and drainage pipes for that residence and is left untarred for easy identification by the corporation authorities, should they want to recover the pipe for year-end accounting.
Night driving on Indian roads can be an exhilarating experience for those with the mental make up of Genghis Khan. In a way, it is like playing Russian roulette, because you do not know who amongst the drivers is loaded. What looks like premature dawn on the horizon turns out to be a truck attempting a speed record. On encountering it, just pull partly into the field adjoining the road until the phenomenon passes.
Our roads do not have shoulders, but occasional boulders. Do not blink your lights expecting reciprocation. The only dim thing in the truck is the driver, and with the peg of illicit arrack (alcohol) he has had at the last stop, his total cerebral functions add up to little more than a naught. Truck drivers are the James Bonds of India, and are licensed to kill. Often you may encounter a single powerful beam of light about six feet above the ground. This is not a super motorbike, but a truck approaching you with a single light on, usually the left one. It could be the right one, but never get too close to investigate. You may prove your point posthumously.
Friday, June 20, 2008
Infertility & Psychiatric Disorders
Infertile couples are at increased risk of psychiatric disorders, with many already having developed such disorders at the time of their first contact with specialized fertility services, research indicates.
Arianna Goracci (University of Siena School of Medicine, Italy) and colleagues assessed the presence of Axis I psychiatric disorders in 81 infertile couples before fertility treatment and 70 fertile couples.
Current psychiatric disorders were significantly more likely among infertile than fertile couples, in particular adjustment disorder with mixed anxiety and depressed mood (16 vs 2 percent) and binge eating disorder (8 vs 0 percent).
Each of these disorders occurred more frequently in infertile women than in infertile men.
The researchers also note that adjustment disorders with mixed anxiety and depressed mood tended to be more common in women with "functional," anatomic, and endocrine infertility than among women with infertile male partners. Binge eating disorder was more common among women with "functional" infertility and endocrine infertility than among women with anatomic infertility or infertile partners.
Infertility in men was associated with subclinical obsessive-compulsive disorder and subclinical social phobia.
Psychiatric comorbidity was positively associated with length of infertility, with patients who had experienced reproductive problems for 2 or more years more likely to be diagnosed with adjustment disorder and depression than other patients.
The researchers recommend that "gynecologists screen for clinical or subclinical psychiatric disorders in infertility patients and offer treatment accordingly."
Arianna Goracci (University of Siena School of Medicine, Italy) and colleagues assessed the presence of Axis I psychiatric disorders in 81 infertile couples before fertility treatment and 70 fertile couples.
Current psychiatric disorders were significantly more likely among infertile than fertile couples, in particular adjustment disorder with mixed anxiety and depressed mood (16 vs 2 percent) and binge eating disorder (8 vs 0 percent).
Each of these disorders occurred more frequently in infertile women than in infertile men.
The researchers also note that adjustment disorders with mixed anxiety and depressed mood tended to be more common in women with "functional," anatomic, and endocrine infertility than among women with infertile male partners. Binge eating disorder was more common among women with "functional" infertility and endocrine infertility than among women with anatomic infertility or infertile partners.
Infertility in men was associated with subclinical obsessive-compulsive disorder and subclinical social phobia.
Psychiatric comorbidity was positively associated with length of infertility, with patients who had experienced reproductive problems for 2 or more years more likely to be diagnosed with adjustment disorder and depression than other patients.
The researchers recommend that "gynecologists screen for clinical or subclinical psychiatric disorders in infertility patients and offer treatment accordingly."
Thursday, June 19, 2008
PCOS & Gestational Diabetes
A history of polycystic ovarian syndrome (PCOS) is a significant risk factor for the development of gestational diabetes, researchers have reported.
Previous studies have produced conflicting results about the link between PCOS and gestational diabetes, with some finding a significant association and others not.
For the new study, researchers from the departments of obstetrics and gynecology, and midwifery, at the Iran University of Medical Sciences, in Tehran, conducted a case-control investigation of cases of gestational diabetes occurring at the center between April 1996 and March 2004.
They identified a total of 732 cases of gestational diabetes (the diagnosis made based on the results of an impaired glucose tolerance test). After exclusions based on criteria such as maternal age greater than 36 years, a history of diabetes mellitus in a first-degree relative, a history of gestational diabetes, and a history of preterm labor or delivery, the final population consisted of 94 women, who were compared with an age-matched control group of 94 pregnant women without gestational diabetes.
In their new paper published in the journal Diabetes Research and Clinical Practice, the researchers say the prevalence of a history of PCOS was significantly higher in the gestational diabetes group than in the women without gestational diabetes (16 percent versus 6.4 percent, respectively).
The women in the gestational diabetes group also had a significantly higher body mass index and neonatal weight, a significantly lower gestational age, a significantly higher rate of cesarean delivery, and were significantly more likely to have a history of oligomenorrhea, compared with the women without gestational diabetes.
The researchers found that among overweight women (with a body mass index between 25 and 30 kg/m2), 12.5 percent of those with a history of PCOS had gestational diabetes, compared with only 1.9 percent in the control group. This difference was also statistically significant.
They conclude their analyses by stating: “In the present study, the risk of gestational diabetes increased in patients with a history of PCOS” (odds ratio 2.78).
After reviewing the conflicting findings from previous studies investigating PCOS and gestational diabetes, the researchers advise: “Regarding the above mentioned studies and in spite of the conflicting results, the screening of women with PCOS for gestational diabetes is suggested, especially if these women are obese.”
Previous studies have produced conflicting results about the link between PCOS and gestational diabetes, with some finding a significant association and others not.
For the new study, researchers from the departments of obstetrics and gynecology, and midwifery, at the Iran University of Medical Sciences, in Tehran, conducted a case-control investigation of cases of gestational diabetes occurring at the center between April 1996 and March 2004.
They identified a total of 732 cases of gestational diabetes (the diagnosis made based on the results of an impaired glucose tolerance test). After exclusions based on criteria such as maternal age greater than 36 years, a history of diabetes mellitus in a first-degree relative, a history of gestational diabetes, and a history of preterm labor or delivery, the final population consisted of 94 women, who were compared with an age-matched control group of 94 pregnant women without gestational diabetes.
In their new paper published in the journal Diabetes Research and Clinical Practice, the researchers say the prevalence of a history of PCOS was significantly higher in the gestational diabetes group than in the women without gestational diabetes (16 percent versus 6.4 percent, respectively).
The women in the gestational diabetes group also had a significantly higher body mass index and neonatal weight, a significantly lower gestational age, a significantly higher rate of cesarean delivery, and were significantly more likely to have a history of oligomenorrhea, compared with the women without gestational diabetes.
The researchers found that among overweight women (with a body mass index between 25 and 30 kg/m2), 12.5 percent of those with a history of PCOS had gestational diabetes, compared with only 1.9 percent in the control group. This difference was also statistically significant.
They conclude their analyses by stating: “In the present study, the risk of gestational diabetes increased in patients with a history of PCOS” (odds ratio 2.78).
After reviewing the conflicting findings from previous studies investigating PCOS and gestational diabetes, the researchers advise: “Regarding the above mentioned studies and in spite of the conflicting results, the screening of women with PCOS for gestational diabetes is suggested, especially if these women are obese.”
LaVaSa = A Walk in The Clouds
I read a poster about Lavasa sometime in the past which read:"Enter a world of extraordinary scale & reach". Welcome to Lavasa, an idea so colossal, so visionary & fantabulous that I am convinced this will be a feather-in-the-cap of free India. I met Mr Nathan Andrews at an RCI dinner a month ago & upon exchanging visiting cards, we started talking about free India's largest hill-station. He invited me to visit Lavasa; it took me more than a month to take up his offer & drive down 190 Kms last weekend on a typical Mumbai Monsoon Weekend - the best time to visit the Western Ghats. I have been to almost all the "known" weekend retreats around Mumbai including Mahabaleshwar, Panchgani, Matheran, Lonavla, Khandala & almost all the beach resorts within driving distance from Mumbai. I was not prepared for what I saw & felt after driving into the Mose Valley near Pune.
Situated in the sprawling lap of nature, Lavasa is "A Walk In The Clouds"- a beautiful world of peace & calm. It offers tranquil surroundings and its only guest-house presently is called "Ekaant" (Sanskrit for Solitude). Everything about this hillstation is very contemporary, yet truly timeless.Lavasa is a dynamic swirl of opposites. One is far far away from the madding crowd, yet close to the bustling metropolis of Pune (Only 35 Kms)... side by side with nature, but right in the midst of technology - We had wireless broadband at Ekaant (I could not believe it and had not carried by notebook with my logical thought-process!). At Lavasa, one is caught up in the lively spirit of enterprise, but soothed by the gentle hand of spirituality. International in execution and bursting with possibilities!
At 3000 feet above sea level, Lavasa offers a vibrant self-contained world encircling 25,000 acres of lakes and hills with a concept design that seamlessly evolves living spaces around a central water body.Let me tell you what impressed us the most- 40 Kms of a two lane motor-way from Chandni Chowk to Ekaant - this road can put the best roads in Switzerland or North America to shame. This road was laid down by the parent company that is backing the Lavasa project - HCC or Hindustan Construction Company three years ago!!! There is not a single pot-hole or even a small 2 inch efect in the road after three Monsoons in the Western Ghats!!! Roads in Mumbai -the financial capital of India do not last one month & are likened to craters on the moon within a few days of being inaugurated. It was a pleasure to drive on this 'Made-in-India" by Indians motor-way but even this feel-good feeling was superceded by the "Drive In The Clouds" that followed when I almost reached the summit after a lush-green drive through the Maharashtra countryside. The clouds walked into our car, into our hair & into our Lungs - This was the best pollution free experience of my life in India!!!!
From the main entry-gate, it is a 6 Km drive with waterfalls all around to Ekaant, their guest-house (now open to the public) which is at one of the highest points of Lavasa! Ekaant is modern architecture at its best with two storeyed twin glass-walled buildings made of stone with balconies that overlook the Mose Valley (see pictures!). You open the sliding doors of the rooms and again - The Clouds walk in!!!! Yes, Folks... I am writing like an excited child, but Lavasa did make me feel like a child. (The Lavasa Logo has the concept of man breaking away from the bonds of earth by becoming airborne, is based on the liberating idea of transformation. Transformation that frees the soul from within, promoting self-discovery for a fuller, richer life. So one can soar, and have more time for the self and family.... see www.lavasa.com).
From our balcony, we could get a bird's eye view of the development going on by the lakeside - The ITC Fortune is almost ready and due to open this September, the Novotel & Pullman with its Convention Center will be ready by 2010.The entire hill station has been imaginatively laid out along the valley's water confluences to promote elegant lakeside living. Dasve, the first of the town centers (see photos) will offer a choice of elegant housing, from Portofino-inspired lakeside apartments (which I personally did not quite like - too tiny for my liking with tinier windows) to a multiple array of villas in Goan-Mediterranean design, providing a unique standard for living in India.
It was aound 7pm when we checked in at Ekaant - took us all of 4 hours from Mumbai. We had taken the journey non-stop & were hungry- courteous room-dining staff got us hot pakoras & Masala Chai. Close your eyes and imagine the aroma of Onion Bhajias, Masala Chai & Rain Clouds flooding your nostrils - believe me, this is Nirvana:)
Dish-TV with Sharukh Khan broke the solitude and I watched some cricket being played at Dacca. 8.30pm, we were hungry again:), and marched down with our umbrellas to the multi-cuisine restaurant on the ground level. A sumptuous multi-country buffet with chilled Fosters beer rounded off the evening & facilitated a slow release of pent-up endorphins. There was just the sound of rain on the glass windows all through the night. For someone like me who likes water, this was the most beautiful way to go to sleep with nature.
A late Sunday morning rising and a courteous call from the reception at 9.15am saying the breakfast closes at 9.30am - for all of us who usually have no breakfast in Mumbai, we were surprised at our own gastric wants. We rushed down to have a nice hot Indian breakfast with Fresh watermelon juice & mouth-watering Upma! Then came the walks & discovery that bamboo is native to the Mose valley (see photos). Sunday morning saw a whole lot of tourists who had driven up from Pune for Lunch to Ekaant. It was a pleasure to meet up with the friendly team behind LaVaSa including Mr Pillai & Mr Saxena. Our original plan of driving down before Lunch to Mumbai was shot down by the Lavasa staff who insisted we try their Sunday Lunch Buffet. Food was wonderful - I liked the amazing Cottage Cheese & Pokchoy salad(Must ask the chef where did he get the Pokchoy leaves from?). Hats off to the Executive Chef!
On our way back home, we all unanimously thought we were going back home from a fairy-tale world. I remembered the Sunday morning presentation on Lavasa by Shalini-one of the customer care executives. "Lavasa indeed is setting a new paradigm for India in urban and infrastructure planning. Central to the project are robust systems managed by professional service providers. High speed internet, comprehensive landline & mobile phone services and first-class roads will ensure that one is always connected.An artificial dam (see photo) will create a reservoir - more than sufficient to meet the demand. In addition, Lavasa provides state-of-the-art water sewage treatment plants and uninterrupted power supply to its resients. with the support of effective e-governance systems, the Hill Station is facilitating the all-round growth of the region"
Lavasa's infrastructure will also help develop the surrounding areas and provide opportunities to the locals of the region. A commitment to ensuring that everyone in Lavasa lives life on their own terms. Once again, I was proud to be an Indian, proud that I did not migrate to the USA after my MBBS, proud that our children will live in a a new India being moulded by a few visionary Indians. I am convinced that India is the future of civilization. I hope to contribute part of my being & knowledge in some form to LaVaSa...More later... Jai Hind! Jai Maharashtra!
Wednesday, June 18, 2008
Endometriosis Associated Infertility
Women who fail to conceive spontaneously within 9-12 months of surgery for endometriosis-associated infertility should be entered into an IVF program, according to specialists.
The researchers from the Department of Gynaecology, Perinatology and Human Reproduction at the University of Florence, Italy, conducted a study to determine whether IVF and embryo transfer (IVF-ET) can significantly increase the overall pregnancy rate in infertile patients with endometriosis who did not conceive spontaneously after laparoscopic surgery (the ‘gold standard’ treatment for endometriosis).
They analyzed their center’s medical records to identify 154 women with infertility associated with endometriosis of at least 1 year’s duration who underwent laparoscopic surgery. After excluding women with additional factors affecting fertility, the final study group comprised 107 women with endometriosis-associated infertility. These women had been followed up for periods ranging from 1 year to 11 years.
Writing in a paper in the current issue of the European Journal of Obstetrics & Gynecology and Reproductive Biology, the researchers report that 40 of the 107 women (37.4 percent) achieved a spontaneous pregnancy.
The fecundity rate for spontaneous conception was found to be significantly higher in the 6 months immediately after laparoscopy (23.2 percent) than in subsequent time periods.
The remaining 67 women who did not become pregnant after surgery subsequently underwent IVF-ET, and 20 became pregnant (producing an overall pregnancy rate of 56.1 percent for the study group as a whole).
As expected from previous research findings, the likelihood of pregnancy was significantly higher in women with stage I or II endometriosis (70.2 percent overall) than in women with stage III or IV disease (45 percent overall). In addition, the pregnancy rate was significantly higher in women aged 35 years or younger (54.1 percent) than in women who were older than 35 years of age (23.2 percent).
The researchers write: “IVF-ET after surgery increased the overall probability of pregnancy (56.1 percent as compared with 37.4 percent for spontaneous pregnancies alone, p = 0.009)”.
They suggest in their paper that if, following laparoscopic surgery for endometriosis, spontaneous pregnancy does not occur within 9-12 months in women seeking to become pregnant, the women should be entered in an IVF-ET program. The researchers conclude: “When patients fail to conceive spontaneously, after a maximum of 1 year from laparoscopic surgery, IVF should be suggested.”
The researchers from the Department of Gynaecology, Perinatology and Human Reproduction at the University of Florence, Italy, conducted a study to determine whether IVF and embryo transfer (IVF-ET) can significantly increase the overall pregnancy rate in infertile patients with endometriosis who did not conceive spontaneously after laparoscopic surgery (the ‘gold standard’ treatment for endometriosis).
They analyzed their center’s medical records to identify 154 women with infertility associated with endometriosis of at least 1 year’s duration who underwent laparoscopic surgery. After excluding women with additional factors affecting fertility, the final study group comprised 107 women with endometriosis-associated infertility. These women had been followed up for periods ranging from 1 year to 11 years.
Writing in a paper in the current issue of the European Journal of Obstetrics & Gynecology and Reproductive Biology, the researchers report that 40 of the 107 women (37.4 percent) achieved a spontaneous pregnancy.
The fecundity rate for spontaneous conception was found to be significantly higher in the 6 months immediately after laparoscopy (23.2 percent) than in subsequent time periods.
The remaining 67 women who did not become pregnant after surgery subsequently underwent IVF-ET, and 20 became pregnant (producing an overall pregnancy rate of 56.1 percent for the study group as a whole).
As expected from previous research findings, the likelihood of pregnancy was significantly higher in women with stage I or II endometriosis (70.2 percent overall) than in women with stage III or IV disease (45 percent overall). In addition, the pregnancy rate was significantly higher in women aged 35 years or younger (54.1 percent) than in women who were older than 35 years of age (23.2 percent).
The researchers write: “IVF-ET after surgery increased the overall probability of pregnancy (56.1 percent as compared with 37.4 percent for spontaneous pregnancies alone, p = 0.009)”.
They suggest in their paper that if, following laparoscopic surgery for endometriosis, spontaneous pregnancy does not occur within 9-12 months in women seeking to become pregnant, the women should be entered in an IVF-ET program. The researchers conclude: “When patients fail to conceive spontaneously, after a maximum of 1 year from laparoscopic surgery, IVF should be suggested.”
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