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05.02.2009
 
Newsletter Nr. 1/2009
 
Text
  1. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis.
  2. Physical health at 5.5 years of age after ICSI
  3. Neuromotor development and mental health at 5.5 years after ICSI
  4. Systemic methotrexate to treat ectopic pregnancy does not affect ovarian reserve

1. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis.

OBJECTIVE: To determine whether first physician seen and symptoms beginning in adolescence have an impact on the diagnostic experience of endometriosis. DESIGN: Cross-sectional study of self-reported survey data. SETTING: Academic research. PATIENT(S): Four thousand three hundred thirty-four Endometriosis Association Survey respondents reporting surgical diagnosis of endometriosis. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Specialty of first physician seen, timing of onset of symptoms, time to seeking medical care and to diagnosis, number of physicians seen, and satisfaction with care. RESULT(S): Almost all respondents reported pelvic pain. Fifty percent first saw a gynecologist and 45% saw a generalist for symptoms related to endometriosis. Two thirds reported symptoms beginning during adolescence; they waited longer to seek medical care than adults did. Those seeing a generalist first took longest to get diagnosed; those seeing a gynecologist first saw fewer physicians. Sometime before diagnosis, 63% were told nothing was wrong with them. CONCLUSION(S): Women and girls who reported seeing a gynecologist first for symptoms related to endometriosis were more likely to have a shorter time to diagnosis, to see fewer physicians, and to report a better experience overall with their physicians. The majority reported symptoms beginning during adolescence, also reporting a longer time and worse experience while obtaining a diagnosis.

Reference

Greene R, Stratton P, Cleary SD, Ballweg ML, Sinaii N. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril. 2009 Jan;91(1):32-9. Epub 2008 Mar 25.

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2. Physical health at 5.5 years of age of term-born singletons after intracytoplasmic sperm injection: results of a prospective, controlled, single-blinded study

OBJECTIVE: To study the health of children born after ICSI and of spontaneously conceived control children at the age of 4-6 years. DESIGN: Prospective, controlled, blinded study. SETTING: Tertiary-care center. PATIENT(S): Two hundred seventy-six term-born singletons conceived by ICSI and 273 matched spontaneously conceived singletons at the age of 5.5 years. INTERVENTION(S): Detailed physical examination, interview of the parents, and collection of data from each child’s examination booklet. MAIN OUTCOME MEASURE(S): Biometrical data; current health status; acute, chronic and childhood illnesses; hospitalizations; and surgeries. RESULT(S): Detailed physical examination did not reveal any relevant differences between ICSI and spontaneously conceived children. There were no relevant differences regarding the incidence of childhood illnesses, acute or chronic illnesses, accidents, and surgeries up to the age of 5.5 years. However, a history of undescended testicles was found significantly more often in boys born after ICSI (5.4% vs. 0.7%), with the consequence that they had significantly more urogenital surgery (19.2% vs. 8.9%). Significantly more ICSI children had been hospitalized (37.6% vs. 27.2%), although we did not find any specific reason for the increased hospitalization rate. CONCLUSION(S): Other than an increased risk of undescended testicles and therefore an increase in urogenital surgeries in ICSI boys, the physical health of ICSI children was comparable to that of spontaneously conceived children at the age of 5.5 years.

Reference

Ludwig AK, Katalinic A, Thyen U, Sutcliffe AG, Diedrich K, Ludwig M. Physical health at 5.5 years of age of term-born singletons after intracytoplasmic sperm injection: results of a prospective, controlled, single-blinded study Fertil Steril. 2009 Jan;91(1):115-24. Epub 2008 Jan 18.

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3. Neuromotor development and mental health at 5.5 years of age of singletons born at term after intracytoplasmatic sperm injection ICSI: results of a prospective controlled single-blinded study in Germany

OBJECTIVE: To assess the neurodevelopmental health of children born after intracytoplasmatic sperm injection (ICSI). DESIGN: Prospective controlled blinded study. SETTING: Tertiary care center. PATIENT(S): A total of 276 term-born singletons conceived by ICSI and 273 matched spontaneously conceived (SC) singletons at the age of 5.5 years. MAIN OUTCOME MEASURE(S): Neuromotor development assessed by a detailed neurologic examination, including the standardized motor test MOT 4-6, and emotional/behavioral development and intelligence assessed with the Kaufman-Assessment Battery for Children. RESULT(S): There were no significant differences between ICSI children and control children regarding the neurologic examination, motor skills, emotional/behavioral development, and intelligence. CONCLUSION(S): The ICSI children born at term develop normally, similar to SC children.

Reference

Ludwig A, Katalinic A, Thyen U, Sutcliffe AG, Diedrich K, Ludwig M. Neuromotor development and mental health at 5.5 years of age of singletons born at term after intracytoplasmatic sperm injection ICSI: results of a prospective controlled single-blinded study in Germany Fertil Steril. 2009 Jan;91(1):125-32. Epub 2008 Feb 20.

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4. Systemic methotrexate to treat ectopic pregnancy does not affect ovarian reserve

OBJECTIVE: To evaluate whether methotrexate (MTX) compromises ovarian reserve and future reproductive outcome in women undergoing assisted reproductive technology (ART), when it is used as first-line treatment for ectopic pregnancy (EP). DESIGN: Prospective, observational study. SETTING: University-affiliated private IVF unit. PATIENT(S): Twenty-five women undergoing IVF-ICSI who were treated with MTX (1 mg/kg IM) for an EP after ART. INTERVENTION(S): Evaluation of reproductive outcome and serum anti-Müllerian hormone (AMH) levels. Serum AMH was evaluated before administering MTX and >or=1 week after the resolution of the EP. Reproductive outcome was evaluated by comparing subsequent IVF-ICSI cycles after EP resolution. MAIN OUTCOME MEASURE(S): Serum AMH levels, cycle length, gonadotropin dose required, peak serum E(2) level, oocytes collected, and embryos obtained. RESULT(S): Serum AMH levels before MTX were not statistically significantly different from those after treatment (3.7 +/- 0.3 ng/mL vs. 3.9 +/- 0.3 ng/mL). Patients undergoing a subsequent cycle after systemic treatment for EP had similar cycle durations (10.3 vs. 10.8 d), gonadotropin requirements (2,775 vs. 2,630.3 IU), peak E(2) levels (1,884.3 vs. 1,523.6 pg/mL), number of oocytes retrieved (12.1 vs. 10.5), and total number of embryos obtained (7.1 vs. 6.5). CONCLUSION(S): Single-dose MTX is a safe first-treatment choice that does not compromise future reproductive outcomes in women who are diagnosed with EP after ART.

Reference

Oriol B, Barrio A, Pacheco A, Serna J, Zuzuarregui JL, Garcia-Velasco JA. Systemic methotrexate to treat ectopic pregnancy does not affect ovarian reserve Fertil Steril. 2008 Nov;90(5):1579-82. Epub 2007 Dec 11.

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Gerhard Leyendecker