The effect of intramural fibroids on the outcome of IVF

Objective: To evaluate the effect of fibroids on outcome of IVF and study value of myomectomy prior to IVF. Design: Prospective controlled study. Setting: Private IVF center, The Egyptian IVF ET Center, Maadi, Cairo. Materials and methods: One hundred and eighty four patients were included. Sixty three patients with intramural fibroids were counseled for either myomectomy or no treatment prior to IVF and decision left to the patient. Group A, N=19 were treated by myomectomy, Group B, N=44 had no myomectomy. Group B were subdivided into B1, N=11 with fibroid at a distance < 5 mm from the endometrial lining and B2, N=33 at a distance of > 5 mm. Group C, N= 100 were an age-matched group of infertility patients. Group D included 11 submucous fibroids and 10 fibroid polyps that were all treated by hysteroscopic resection. Main outcome Measures: Size and distance of intramural fibroid to endometrial lining were recorded. Outcome of IVF was compared between fibroids at a distance > 5 mm and < 5 mm from endometrial lining. As well as outcome between group that performed myomectomy and that which did not undergo myomectomy. Results: Pregnancy rates achieved in the three groups A, B and C were; 50%, 27.5% and 36% respectively. This was found to be non significant. In subgroup B1 there was one pregnancy (9%) as compared to 10 pregnancies in subgroup B2 (30%). The difference was non significant. Following hysteroscopic resection 2 out of 6 patients with submucous fibroids and 6 out of 10 patients with fibroid polyps became pregnant after IVF. Conclusions: The distance between the intramural myomas and the endometrial lining did not affect the IVF outcome. An insignificant tendency towards improvement of IVF outcome was found in myomas at more than 5 mm from endometrial lining

Three-dimensional ultrasound versus office hysteroscopy in assessment of pain and bleeding with intrauterine contraceptive device

Objective: To compare three-dimensional ultrasound (3D US) examination of the uterus to office hysteroscopy as a method of diagnosing cause of pain and bleeding associated with intrauterine contraceptive device (IUCD). Design: Prospective comparative study. Patients and methods: Ninety patients with a copper IUCD inserted complaining of pain, bleeding or both, underwent 3D US examination of the uterus and adnexa. The coronal view of the three orthogonal planes of the 3D volume was used to assess site and position of the IUCD. Other abnormalities such as fibroids, adenomyosis and ovarian cysts were recorded as well. This was followed by office hysteroscopy, after control of any bleeding or infection. Results: By 3D US; 15 IUCDs (16.6%) were found displaced; 2 laterally displaced, 13 displaced downward, sensitivity, specificity, NPV, PPV and accuracy of 3D US in diagnosing displaced IUCD compared to hysteroscopy were 93.3%, 84%, 63.6%, 97.7%, and 86.2%. Additional findings detected by hysteroscopy; 2 embedded IUCDS, one missed polyp one missed intrauterine synechiae, one polypoid endometrium revealed endometrial hyperplasia. Seventeen patients (18%) had abnormalities of the ovaries and adnexa confirmed by ultrasound; 13 functional cysts, one endometrioma, one dermoid cyst, one case with polycystic ovaries and one hydrosalpinx. Conclusions: Patients with abnormal bleeding and pain with IUCD have frequent abnormally positioned IUCD and associated ovarian pathology. 3D US has high diagnostic accuracy and should be the first line of investigation. Office hysteroscopy should be performed only in suspected embedded IUCD or other endometrial abnormality

The value of different ovarian reserve tests in the prediction of ovarian response in patients with unexplained infertility

Background: Ovarian reserve tests in unexplained infertility patients before management either by ovulation induction or IVF program are a worthy procedure as it saves unnecessary procedures, induction complications, canceled cycles, wasted resources and emotional stress to the couple in case of low estimate, and can as well help in adjusting the doses to obtain the most appropriate response. Aim of work: To determine the value of mean ovarian volume, AFC, maternal age, FSH and AMH in infertile patients undergoing ovulation induction or IVF cycles. Primary outcome is to predict the best parameter of ovarian reserve. Design: Prospective cross-sectional study. Patients and methods: One hundred infertile women received treatment in the form of induction of ovulation and timed intercourse/IUI or IVF. They had basal FSH, AMH, AFC and mean ovarian volume assessment. The response was then evaluated according to the number of follicles on the day of hCG or the number of oocytes retrieved in IVF cycles. Results and conclusion: The total AFC and AMH are found to correlate significantly with the ovarian response with p values < 0.001 and 0.03 respectively, indicating that they are good predictors of ovarian reserve. The basal FSH and ovarian volume do not correlate with the ovarian response indicating their poor value as predictors of ovarian reserve

Three dimensional endometrial volume versus endometrial thickness measurement in prediction of IVF/ICSI outcome

Objective: To investigate the role of estimating endometrial volume and it's correlation with endometrial thickness, on the day of hCG, in prediction of IVF outcome. Design: A prospective clinical study. Materials and methods: Endometrial volume and endometrial thickness were measured in women undergoing an IVF/ICSI cycle, on the day of HCG, using the 3 D transvaginal ultrasound probe (Sonoace 9900 Medison -Kretz , korea). Patients were divided according to endometrial volume calculated into 3 subgroups; 4 ml, as well as according to endometrial thickness into 3 groups; <8mm, 8-12mm and >12mm. Pregnancy rates were compared between all groups. Results: The study included 103 women with no significant difference in background characteristics between all subgroups. The pregnancy rates between the three groups of endometrial volume; <2ml, 2-4ml, and >4 ml was; 42%, 36% and 48% respectively. Pregnancy rates between the three groups of endometrial thickness was 25%, 40% and 50 % for 12mm respectively. There was no significant difference in pregnancy rates between all groups in relation to both endometrial volume and endometrial thickness. Conclusion: Endometrial volume on day of hCG is not a better predictor than endometrial thickness for determining outcome of IVF/ICSI cycles