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- Volume 13, Issue 2, 2007
South African Journal of Obstetrics and Gynaecology - Volume 13, Issue 2, 2007
Volume 13, Issue 2, 2007
Author Paul DalmeyerSource: South African Journal of Obstetrics and Gynaecology 13, pp 34 –35 (2007)More Less
Author Zephne Van der SpuySource: South African Journal of Obstetrics and Gynaecology 13, pp 36 –37 (2007)More Less
Source: South African Journal of Obstetrics and Gynaecology 13, pp 42 –44 (2007)More Less
Objective. To determine whether active pelvic endometriosis impairs the efficacy of GIFT (gamete intrafallopian transfer) and whether prior surgical treatment of endometriosis improves the efficacy of GIFT.
Design. Matched controlled retrospective study.
Setting. University-based assisted reproduction programme.
Patients. Patients who had GIFT between 1990 and 1997 were included in the study. Female patients were laparoscopically diagnosed as having endometriosis. Patients who did not have surgical treatment for endometriosis before GIFT were staged for endometriosis during the GIFT laparoscopy. Two patients, with no signs of endometriosis, were matched for every endometriosis case, and served as controls. Patients were matched for age, number of eggs transferred and percentage of normal sperm morphology.
Intervention. Patients in 80 cycles had surgical treatment for endometriosis and 128 patients had GIFT procedures as treatment for endometriosis-related infertility.
Main outcome measures. Ongoing pregnancies and deliveries.
Statistical analysis. A Mantel-Haenszel approach was used to estimate relative risk of pregnancy outcome in the endometriosis groups versus controls.
Results. There was a 22.9% pregnancy rate (11/48) among patients with active endometriosis who had GIFT procedures, versus a 37.0% pregnancy rate (37/100) for the controls, giving a relative risk of 0.62 (95% confidence interval (CI): 0.35 - 1.10, p = 0.082). There was a 36.3% pregnancy rate (29/80) among patients who had surgical treatment for endometriosis before GIFT, versus a 33.3% pregnancy rate (53/159) for the controls, giving a relative risk of 1.07 (95% CI: 0.75 - 1.54, p = 0.647).
Conclusion. There is an indication that GIFT pregnancy rates are impared in patients suffering from active endometriosis, while prior surgery may alleviate the impairment.
Source: South African Journal of Obstetrics and Gynaecology 13, pp 46 –50 (2007)More Less
Objective. To determine the correlation between sperm morphology groups (strict criteria) and testicular spermatozoa, and day 2 and 3 embryo quality in intracytoplasmic sperm injection (ICSI) and in vitro fertilisation (IVF) cases.
Methods. A retrospective study was done of 2 402 IVF and ICSI-fertilised embryos classified as goodquality embryos (GQEs) or poor-quality embryos (PQEs). Sperm morphology (strict criteria) was classified as teratozoospermia (P-pattern (< 5% normal); G-pattern (5 - 14% normal)), normozoospermia (N-pattern (> 14% normal)), and testicular spermatozoa (immature, only ICSI group).
Results. Sperm morphology (P, G, and N-patterns) and immature esticular sperm had no effect on day 2 or 3 embryo quality for ICSI (p = 0.82) and IVF-fertilised (p = 0.64) embryos. A significant increase in GQEs from day 2 to 3 in the P-pattern group (33 - 39%, p = 0.002) and testicular spermatozoa group (30 - 35%, p = 0.014) was found in ICSI cases.
Conclusion. Morphology of human spermatozoa according to Tygerberg's strict criteria and testicular spermatozoa had no predictive value for the outcome of day 2 and 3 embryo quality.
A study of two sequential culture media - impact on embryo quality and pregnancy rates : research articleSource: South African Journal of Obstetrics and Gynaecology 13, pp 52 –58 (2007)More Less
Objective. A comparative study of embryo quality and pregnancy outcome between Sydney IVF medium and Quinn's Advantage sequential culture media.
Design. A prospective randomised controlled trial and a retrospective study.
Setting. In vitro fertilisation clinic in an academic research environment.
Patients. All women < 38 years undergoing fresh embryo transfers.
Interventions. Use of clinic specific age, randomisation of patients and embryo score.
Main outcome measures. Fertilisation and cleavage rate, embryo quality (day 2 and day 3), blastulation rate and pregnancy rate.
Results. Prospective randomised trial: In this study the only significant difference was in day 3 embryo quality (33/79 (42%) v. 40/67 (60%) for Sydney IVF and Quinn's Advantage respectively, p < 0.05).
Retrospective study: Significant difference (p < 0.05) for embryo development (early-dividing embryos 156/786 (20%) v. 263/919 (29%)), day 3 good quality (234/639 (37%) v. 378/795 (48%)) and pregnancy rate (ongoing pregnancy rate 31/179 (17%) v. 59/195 (30%)) between Sydney IVF v. Quinn's Advantage sequential culture media.
Conclusion. We conclude from these two studies that the range of Quinn's Advantage sequential culture media is more beneficial for in vitro embryo culture as each of the media in the range contribute collectively to more embryos with a better quality. The reason for the significant increase in embryo developmental parameters and pregnancy rate can possibly be attributed to the differences in composition between the two media.
Maternal levels of free fetal DNA are elevated in pregnancies with growth restriction due to placental dysfunction : a preliminary study : research articleSource: South African Journal of Obstetrics and Gynaecology 13, pp 60 –63 (2007)More Less
Objective. Fetal growth restriction (FGR) is associated with an increased risk of perinatal mortality and morbidity but can have many different causes. Non-cellular fetal DNA in maternal blood offers many opportunities for noninvasive prenatal diagnosis. It is likely that the source of the DNA is apoptosis or cell death in the placenta and that free fetal DNA (ffDNA) levels could theoretically be increased in placental dysfunction or infarction. We hypothesised that non-cellular fetal DNA levels would be increased only in the subset of FGR cases with placental dysfunction, which could explain previous contradictory reports.
Methods. We used plasma samples obtained during a previous study from pregnant women with singleton male pregnancies as controls and from women with small-for-gestational-age (SGA) infants that had been classified as having FGR due to placental dysfunction. A third group was defined as normal but small fetuses with placental function within the normal ranges indicated by Doppler studies. Twenty-two cases were identified in the third trimester of pregnancy (8 from the control group and 7 from each of the FGR and the normal small groups). DNA was extracted and the DYS14 gene of the Y chromosome was quantified by real-time quantitative polymerase chain reaction (PCR).
Results. ffDNA levels were higher in pregnancies with FGR due to placental dysfunction than in either normal pregnancies or those with SGA fetuses from causes other than placental dysfunction. There was no significant difference in the ffDNA levels between the fetuses of normal growth and those with FGR from other causes.
Conclusion. The level of ffDNA in maternal plasma is increased in pregnancies complicated by FGR secondary to placental dysfunction but not in those with small fetuses with normal placental function.
Suburethral sling procedures after previous surgery for urinary incontinence or pelvic organ prolapse : research articleSource: South African Journal of Obstetrics and Gynaecology 13, pp 64 –66 (2007)More Less
Objective. To compare the outcome of suburethral sling procedures (tension-free vaginal tape (TVT), obturator tape (Ob-tape)) for stress urinary incontinence (SUI) in women with previous surgery for SUI or pelvic organ prolapse (POP).
Methods. A comparative, descriptive, retrospective study was done using information drawn from a urogynaecological database of 195 women with urinary incontinence. We divided 195 women into a group with previous surgery for urinary incontinence or POP (study group, N = 106) and a group without previous incontinence surgery (control group, N = 89). All women underwent a TVT (86%) or Ob-tape procedure (14%). The mean follow-up in the study group was 25 months (range 2 - 61 months) and in the control group 24 months (range 1 - 49 months). Since a urodynamic evaluation facility was not available for most women, the diagnosis of SIU and other types of incontinence was made clinically.
Results. On admission 43 women in the study group presented with SUI (40.6%), compared with 34 in the control group (38.2%) (95% confidence interval (CI) -11.3%; 15.7%). Urge incontinence was present in 10 women in the study group (9.4%) and 6 in the control group (6.7%) (95% CI -5.7%; 10.6%). Mixed incontinence was present in 47 (44.3%) of the study group and 39 (43.8%) of the control group (CI -13.3%; 14.2%). The diagnosis was unknown in 6 women in the study group and 10 in the control group.
Following surgery, SUI recurred in 25 (23.6%) women in the study group and 12 (13.5%) in the control group (95% CI -1.0%; 20.6%). Overactive bladder symptoms were present postoperatively in 43 women in the study group women (40.6%) and 39 controls (43.8%) (95% CI -16.9%; 10.4%).
Follow-up surgery was performed in 14 women in the study group (13.2%) and 6 controls (6.7%) (95% CI -2.4%; 15.0%). Included were mesh removals (4 study group, 1 control), Burch colposuspension (1 and 2, respectively), and TVT or Ob-tape (2 and 1, respectively).
Conclusion. Statistically, previous surgery was not a risk factor for recurrent SUI, but a tendency was observed towards more SUI in these women.