Reproductive medicine and family planning

xix. 449 hlm.19 c

MRI Image Analysis for Abdominal and Pelvic Endometriosis

Endometriosis is an oestrogen-dependent gynaecological condition defined as the presence of endometrial tissue outside the uterus cavity. The condition is predominantly found in women in their reproductive years, and associated with significant pelvic and abdominal chronic pain and infertility. The disease is believed to affect approximately 33% of women by a recent study. Currently, surgical intervention, often laparoscopic surgery, is the gold standard for diagnosing the disease and it remains an effective and common treatment method for all stages of endometriosis. Magnetic resonance imaging (MRI) of the patient is performed before surgery in order to locate any endometriosis lesions and to determine whether a multidisciplinary surgical team meeting is required. In this dissertation, our goal is to use image processing techniques to aid surgical planning. Specifically, we aim to improve quality of the existing images, and to automatically detect bladder endometriosis lesion in MR images as a form of bladder wall thickening. One of the main problems posed by abdominal MRI is the sparse anisotropic frequency sampling process. As a consequence, the resulting images consist of thick slices and have gaps between those slices. We have devised a method to fuse multi-view MRI consisting of axial/transverse, sagittal and coronal scans, in an attempt to restore an isotropic densely sampled frequency plane of the fused image. In addition, the proposed fusion method is steerable and is able to fuse component images in any orientation. To achieve this, we apply the Riesz transform for image decomposition and reconstruction in the frequency domain, and we propose an adaptive fusion rule to fuse multiple Riesz-components of images in different orientations. The adaptive fusion is parameterised and switches between combining frequency components via the mean and maximum rule, which is effectively a trade-off between smoothing the intrinsically noisy images while retaining the sharp delineation of features. We first validate the method using simulated images, and compare it with another fusion scheme using the discrete wavelet transform. The results show that the proposed method is better in both accuracy and computational time. Improvements of fused clinical images against unfused raw images are also illustrated. For the segmentation of the bladder wall, we investigate the level set approach. While the traditional gradient based feature detection is prone to intensity non-uniformity, we present a novel way to compute phase congruency as a reliable feature representation. In order to avoid the phase wrapping problem with inverse trigonometric functions, we devise a mathematically elegant and efficient way to combine multi-scale image features via geometric algebra. As opposed to the original phase congruency, the proposed method is more robust against noise and hence more suitable for clinical data. To address the practical issues in segmenting the bladder wall, we suggest two coupled level set frameworks to utilise information in two different MRI sequences of the same patients - the T2- and T1-weighted image. The results demonstrate a dramatic decrease in the number of failed segmentations done using a single kind of image. The resulting automated segmentations are finally validated by comparing to manual segmentations done in 2D.This item is notcurrently available on ORA

The correlation between raised body mass index and assisted reproductive treatment outcomes: a systematic review and meta-analysis of the evidence

Abstract Background Public funding for fertility services within the United Kingdom is limited, and therefore, strict guidance exists regarding who can be offered treatment under the National Health Service (NHS). Body mass index (BMI) is a universal criteria adopted by both the public and private sector. This study addresses an important aspect of the impact of a raised BMI on fertility treatment outcomes. We standardise the analysis of the data by only including studies incorporating the WHO BMI criteria; the current reference point for clinicians and clinical commissioning groups in ascertaining which group of patients should receive treatment. This study is an update of the previous systematic review performed in 2010, with the inclusion of a larger number of cycles from central databases such as the Society for Assisted Reproductive Technology (SART). Methods An electronic literature search was conducted through the Cochrane, Medline and Embase libraries. Data extraction for each outcome measure was pooled and expressed as an odds ratio with 95% confidence intervals. Where clinical heterogeneity was evident, the random effects model was used to calculate the risk ratio and a fixed effects model was used for the remaining studies. A p value < 0.05 was considered statistically significant. Results A total of 49 studies have been identified and included in this systematic review. Overweight and obese (BMI ≥ 25 kg/m2) women have a statistically significant lower live birth rate (OR 0.81, 95% CI 0.74–0.89, p < 0.00001) following Assisted Reproductive Technology (ART) when comparisons are drawn to women with a normal BMI. An increase is also demonstrated in the number of miscarriages experienced by women with a BMI ≥ 30 kg/m2 (OR 1.52, 95% CI 1.28–1.81, p < 0.00001). Conclusion Although this review concludes that a clear impact of BMI on ART outcomes is demonstrated, there remains questions as to the pathophysiology underlying these differences. This review supports the government’s stringent criteria regarding BMI categories under which NHS funding is made available for ART, through a clear description of poor reproductive outcomes in women with a BMI ≥ 30 kg/m2

Evaluation of the use and handling of three different pen systems considered for in vitro fertilization treatment

OBJECTIVE The objective of this study was to assess and compare the features of the Bemfola, Gonal-f and Puregon injection pens. METHODS Females who intended to undergo hormonal treatment received the three different pens in a randomized, consecutive sequence. For each of the pens, the potential patients completed an Injection Pen Assessment Questionnaire, as well as a questionnaire comparing the handling, convenience and preference among the three pens. RESULTS The mean score on the visual analogue scale (VAS) for the Bemfola pen (BP) was 77.8 ± 14.0; for the Puregon pen (PP), 72.1 ± 12.4; and for the Gonal-f pen (GP), 68.6 ± 16.4. The BP was superior to both competitor devices in pen size, inconspicuousness, ease of use and dose changing; no significant differences to both competitor pens were observed in the way the pen looks, the way the pen feels and the ease of injection of the volume. The 'overall' assessment was significantly better for the BP when compared to the GP (p = 0.0019), while no significant difference was observed between the BP and the PP. CONCLUSIONS This study demonstrated significantly higher ratings for pen size, inconspicuousness, ease of use and dose adjustment for the BP compared to other marketed pens

Total levels, localization patterns, and proportions of sperm exhibiting phospholipase C zeta are significantly correlated with fertilization rates after intracytoplasmic sperm injection

To study the relationship of total levels, localization patterns, and proportions of sperm exhibiting phospholipase C zeta, with fertilization rates after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).Laboratory study; controls vs. patients after IVF (n = 27) or ICSI (n = 17) treatment.Fertility center.A total of 44 semen samples, subjected to either IVF or ICSI treatment. Oocyte collection, ICSI or IVF, determination of sperm concentration and motility, and immunocytochemical analyses of phospholipase C zeta (PLCζ).None.Percentages of sperm exhibiting PLCζ.Significant positive correlation between ICSI fertilization rates and total levels, localization patterns, and the proportion (percentage) of sperm exhibiting PLCζ. Total levels, localization patterns, and the proportion of sperm exhibiting PLCζ are correlated with fertilization rates for ICSI, but not for IVF.Evaluating total levels, localization patterns, and proportions of PLCζ may represent a useful diagnostic tool for clinical purposes in men for whom IVF is not advised or has previously failed. This clinical study further supports the fundamental role of PLCζ in the oocyte activation process