Feasibility of transabdominal electrohysterography for analysis of uterine activity in nonpregnant women

Purpose: Uterine activity plays a key role in reproduction, and altered patterns of uterine contractility have been associated with important physiopathological conditions, such as subfertility, dysmenorrhea, and endometriosis. However, there is currently no method to objectively quantify uterine contractility outside pregnancy without interfering with the spontaneous contraction pattern. Transabdominal electrohysterography has great potential as a clinical tool to characterize noninvasively uterine activity, but results of this technique in nonpregnant women are poorly documented. The purpose of this study is to investigate the feasibility of transabdominal electrohysterography in nonpregnant women. Methods: Longitudinal measurements were performed on 22 healthy women in 4 representative phases of the menstrual cycle. Twelve electrohysterogram-based indicators previously validated in pregnancy have been estimated and compared in the 4 phases of the cycle. Using the Tukey honest significance test, significant differences were defined for P values below .05. Results: Half of the selected electrohysterogram-based indicators showed significant differences between menses and at least 1 of the other 3 phases, that is the luteal phase. Conclusion: Our results suggest transabdominal electrohysterography to be feasible for analysis of uterine activity in nonpregnant women. Due to the lack of a golden standard, this feasibility study is indirectly validated based on physiological observations. However, these promising results motivate further research aiming at evaluating electrohysterography as a method to improve understanding and management of dysfunctions (possibly) related to altered uterine contractility, such as infertility, endometriosis, and dysmenorrhea

Individualized versus standard FSH dosing in women starting IVF/ICSI:An RCT. Part 1: The predicted poor responder

STUDY QUESTION: Does an increased FSH dose result in higher cumulative live birth rates in women with a predicted poor ovarian response, apparent from a low antral follicle count (AFC), scheduled for IVF or ICSI? SUMMARY ANSWER: In women with a predicted poor ovarian response (AFC <11) undergoing IVF/ICSI, an increased FSH dose (225/450 IU/day) does not improve cumulative live birth rates as compared to a standard dose (150 IU/day). WHAT IS KNOWN ALREADY: In women scheduled for IVF/ICSI, an ovarian reserve test (ORT) can predict ovarian response to stimulation. The FSH starting dose is often adjusted based on the ORT from the belief that it will improve live birth rates. However, the existing RCTs on this topic, most of which show no benefit, are underpowered. STUDY DESIGN, SIZE, DURATION: Between May 2011 and May 2014, we performed an open-label multicentre RCT in women with an AFC <11 (Dutch Trial Register NTR2657). The primary outcome was ongoing pregnancy achieved within 18 months after randomization and resulting in a live birth. We needed 300 women to assess whether an increased dose strategy would increase the cumulative live birth rate from 25 to 40% (two-sided alpha-error 0.05, power 80%). PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with an AFC ≤ 7 were randomized to an FSH dose of 450 IU/day or 150 IU/day, and women with an AFC 8–10 were randomized to 225 IU or 150 IU/day. In the standard group, dose adjustment was allowed in subsequent cycles based on pre-specified criteria. Both effectiveness and cost-effectiveness of the strategies were evaluated from an intention-to-treat perspective. MAIN RESULTS AND THE ROLE OF CHANCE: In total, 511 women were randomized, 234 with an AFC ≤ 7 and 277 with an AFC 8–10. The cumulative live birth rate for increased versus standard dosing was 42.4% (106/250) versus 44.8% (117/261), respectively [relative risk (RR): 0.95 (95%CI, 0.78–1.15), P = 0.58]. As an increased dose strategy was more expensive [delta costs/woman: €1099 (95%CI, 562–1591)], standard FSH dosing was the dominant strategy in our economic analysis. LIMITATIONS, REASONS FOR CAUTION: Despite our training programme, the AFC might have suffered from inter-observer variation. As this open study permitted small dose adjustments between cycles, potential selective cancelling of cycles in women treated with 150 IU could have influenced the cumulative results. However, since first cycle live birth rates point in the same direction we consider it unlikely that the open design masked a potential benefit for the individualized strategy. WIDER IMPLICATIONS OF THE FINDINGS: Since an increased dose in women scheduled for IVF/ICSI with a predicted poor response (AFC <11) does not improve live birth rates and is more expensive, we recommend using a standard dose of 150 IU/day in these women

Gynaecological procedures and surgery under Procedural Sedation and Analgesia (Psa) in a Dutch out-patient clinic

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Quantitative ultrasound imaging of the uterus for improved embryo implantation : preliminary study

Enhanced by the modern trend in postponing conception, infertility problems touch nowadays an increasing number of women. Many couples are therefore referred for in vitro fertilization procedures. Despite representing the most advanced option, in vitro fertilization still counts for a low success rate of about 30%. There is evidence that uterine movement may play an important role influencing the procedure outcome. Until now, no objective means of measuring uterine movement is available. Therefore, in this work we present the first method for quantitative analysis of the uterine movement. Given its widespread availability and relatively low cost, ultrasound imaging is employed for the analysis. In particular, a speckle-tracking algorithm has been implemented that is based on block matching by normalized cross correlation. Wiener deconvolution is used to regularize the image resolution prior to speckle tracking. The method feasibility was tested for its ability to distinguish between active and non-active phase of a natural menstrual cycle in eight women. Two pairs of sites were manually defined on the uterine muscle and automatically tracked over time. Variance and mean frequency of the strain and distance between these sites were the features extracted and evaluated for classification. The results are promising, showing significant class separation by Student t-test (p < 0.05), and sensitivity and specificity both equal to 75% for the strain variance and distance mean frequency. Extensive validation is however required to confirm this result, also involving the evaluation of additional features. Once fully validated, this method will be tested for quantitative evaluation of uterine movement in the context of in vitro fertilization

Hysteroscopic morcellator system can be used for removal of a uterine septum

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