Supreeya Wongtrangan

ABSTRACT Ultrasound guided transvaginal aspiration of oocytes has replaced other methods of oocyte retrieval for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). However, there is controversy over whether flushing yields a larger number of oocytes and a higher potential for pregnancy than aspiration only. To determine whether follicular aspiration and flushing increases live birth or ongoing pregnancy rates and the number of oocytes over aspiration alone in women undergoing IVF and ICSI. We searched the Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO and the citation lists of relevant publications (to April 2010). Randomised controlled trials that compared follicular aspiration and flushing with aspiration alone were included. Trials were excluded if the flushing method comparison was confounded by comparisons of other methods. Eligible studies were assessed for methodological quality. For dichotomous data, odds ratios (OR) and 95% confidence intervals (CI) were calculated. For continuous data, mean differences were reported. The heterogeneity of the studies was examined by using statistical tests of homogeneity and the I(2) statistic. No studies reported on the primary outcome of live birth. There was no evidence (3 studies, 164 patients) to suggest an association between follicular aspiration and flushing and ongoing or clinical pregnancy per woman randomised (OR 1.17, 95% CI 0.57 to 2.38). There was no evidence of a difference in adverse events reported between follicular aspiration and flushing and aspiration only. There was no evidence of significant differences in increased oocyte yield per woman randomised (1 study, 44 patients). Without flushing the operative time was significantly shorter, by 3 to 15 minutes (3 studies, P < 0.001) and the dose of pethidine required was significantly less (50 mg versus 100 mg, P < 0.00001). There is no evidence that follicular aspiration and flushing is associated with improved clinical or ongoing pregnancy rates, nor an increase in oocyte yield. The operative time is significantly longer and more opiate analgesia is required for pain relief during oocyte retrieval. There is a lack of evidence regarding the effect of follicular aspiration and flushing on live birth rates in the identified data.

This report presents a sonographic diagnosis of exencephaly combined with omphalocele at 11 weeks of gestation. The transvaginal ultrasound showed frog-eye appearance face with no skull, abnormal shape of disorganized brain with covering membrane separated from brain mass by anechoic fluid in some area, and omphalocele of 8 mm diameter. Therapeutic abortion was successfully done with misoprostol. Postabortal macroscopic findings confirmed the prenatal diagnosis. The combination of exencephaly and omphalocele is rare, and this is one of the earliest diagnosis of not only exencephaly but also omphalocele. To our best knowledge, this represents the earliest diagnosis of the combination. In conclusion, transvaginal ultrasound proved highly informative for both exencephaly and omphalocele as early as in first trimester.

To compare the outcomes of slow freezing with ultra-rapid freezing (URF) of cleavage-stage human embryos on aluminum foil. Two-cell mouse embryos were used to test our method of ultra-rapid freezing. The embryos were randomly allocated to a non-frozen control (208 embryos), and slow (204 embryos) or ultra-rapid freezing groups (204 embryos). Immediate survival rate, further cleavage and blastocyst formation were compared. After validating our ultra-rapid freezing method on mouse embryos, we applied a similar ultra-rapid freezing protocol to human embryos. Consecutive human frozen/thawed embryo transfer (FET) cycles from October 1998 to June 2005 were reviewed. The survival rate, further cleavage rate and the pregnancy outcomes were compared between the URF and slow programmable freezing. Mouse embryos in the URF group survived the freezing/thawing process better than those in the slow freezing group (93.1% vs 82.8%, P = 0.001). Blastocyst and hatching blastocyst formation of the surviving embryos were comparable in the URF and slow freezing group (59% vs 58.6%, P = 0.944 and 32.6% vs 42%, P = 0.066, respectively). There were 146 human FET cycles in the URF group and 28 cycles in the slow freezing group. The immediate survival of embryos was higher in the URF group than in the slow freezing group (87.9% and 64.3%, P < 0.001). There was no significant difference in the mean number of embryos per transfer (3.7 +/- 1.3 and 3.3 +/- 1.2, P = 0.178), clinical pregnancy rate per transfer (28.5% and 21.4%, P = 0.444) and implantation rate per embryo (10.98% and 10.9%, P = 0.974) in the URF or slow freezing groups. Our in-house URF method gave comparable results to slow programmable freezing. Although the risk of potential contamination is a major drawback of the present ultra-rapid freezing technique, future refinement will minimize or entirely eliminate this concern.

To study the prevalence, reproductive hormone profiles and ovarian sonographic appearance of Thai women with polycystic ovary syndrome (PCOS). One thousand and ninety-five women were screened for oligomenorrhea/amenorrhea, and the clinical symptoms of hyperandrogenism. Ovarian morphology and volume were assessed by ultrasonography in diagnosed cases. Blood was taken for the measurement of the follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, androstenedione, dehydroepiandrosterone and 17-hydroxyprogesterone. The prevalence of PCOS was 5.7%. The mean age of women with PCOS was less than that of non-PCOS cases (27.4 +/- 6.5 and 31.1 +/- 6.4 years, respectively; P < 0.0001). Abnormal uterine bleeding and infertility were the leading presenting symptoms. The mean ovarian volume in women with PCO appearance was 9.22 +/- 4.36 mL compared to 6.53 +/- 3.31 mL in those without this appearance (P = 0.04). Hyperandrogenemia was confirmed in 23 of the 62 cases (37.1%). The prevalence and clinical presentations of Thai women with PCOS were similar to those in other reports. However, hirsutism, elevated testosterone level and acanthosis nigricans were uncommon in our population. Serum androstenedione was a more sensitive indicator of hyperandrogenemia than total testosterone. Further research is needed to clarify whether there is an ethnic difference in endocrine profiles and risks of metabolic syndrome.

Address requests for reprints: Wattanavadee Sriwattanapongse, MS, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand: E-mail:watdee@chiangmai.ac.th Received 29 December, 2008, and in revised form 12 ...