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15.11.2000

Newsletter No.6

The prevalence of polycystic ovarian syndrome. Cauterization of hydrodalpinges before in vitro fertilization is an effective surgical treatment associated with improved pregnancy rates. Outcome of assisted reproductive technology in women over the age of 41 Does assisted hatching pose a risk for monozygotic twinning in pregnancies conceived through in vitro fertilization? 1.The prevalence of polycystic ovarian syndrome It is well known to endocrinologists and gynecologists that the PCO-Syndrome is frequently encountered in particular among infertile patients. However exact figures are lacking concerning the prevalence of PCOS in the normal population. Asuncion and colleagues prospectively estimated the prevalence of polycystic ovarian syndrome (PCOS) in a population of 154 Caucasian women of reproductive age reporting spontaneously for blood donation. Anthropometic data, the presence of hirsutism, acne, and androgenetic alopecia were recorded and blood test for androgen levels were performed. PCOS was defined by the presence of oligomenorrhea, clinical or/and biochemical hyperandrogenism and the exclusion of hyperprolactinemia, thyroid disorders and adrenal disorders (non-classic 21-hydroxylase deficiency). The results demonstrated a 6.5% prevalence of PCOS in a minimally biassed population of Caucasian women of Spain. The PCOS is therefore a common endocrine disorder. Reference Asuncion, M et al. (2000) A prospective study of the prevalence of the polycystic ovary syndrome in unselected caucasian women from Spain. J. Clin. Endocrinol. Metab. 85: 2434-2438 TOP 2.Cauterization of hydrodalpinges before in vitro fertilization is an effective surgical treatment associated with improved pregnancy rates The success rate of IVF treatment in tubal sterility is lower in the presence of hydrosalpinges in comparison with tubal sterility without hydrosalpinges. Several reports during the last years could show that the results of IVF treatment could be improved by prior removal of the hydrosalpinges. If the tubal mucosa looks healthy upon laparoscopy operative cure of tubal sterility should be attempted. If infertility persists or if the tubal mucosa appears to be destroyed IVF should be attempted with prior salpingectomy. There have, however, been concerns that salpingectomy might impair utero-ovarian blood circulation and could result in reduced ovarian reserve. If these concerns are justified a simple cauterization of the proximal part of the fallopian tube could be performed. In fact, with respect to the improvement of the success rates in IVF treatment proximal tubal cauterization and salpingectomy were equally effective. References Stadtmauer LA et al. (2000) Cauterization of hydrosalpinges before in vitro fertilization is an effective surgical treatment associated with improved pregnancy rates. Am. J. Obstet. Gynecol. 183: 367-371) Strandell, A and Lindhard, A (2000) Hydrosalpinx and ART: Salpingectomy prior to IVF can be recommended to a well-defined subgroup of patients. Hum. Reprod. 15: 2072-2074 Puttemans P et al. (2000) Hydrosalpinx and ART: hydrosalpinx – functional surgery or salpingectomy. Hum. Reprod. 15: 1427-1430 TOP 3. Outcome of assisted reproductive technology in women over the age of 41 Conception rates in spontaneous cycles as well as in assisted reproduction technologies decline with advancing age in women. Ron-El and colleagues reported on the results of IVF and IVF/ICSI treatment in 431 treatment cycles in women aged 41 – 45 years. Oocytes could be retrieved in 87% of the cycles. While the pregnancy rate was 12.5% only 4.5% resulted in birth. In women aged 41-43 years the birth rate was 2 – 7%. No birth was recorded in women aged 44 years and older and no pregnacy occurred in women aged 45. Ovarian reserve declines with age and a low number of stimulated follicles and retrieved oocytes in standard stimulation protocols is prognostic of bad treatment results. Frattarelli and colleagues could show that ovarian diameter and basal antral follicle number identify patients who may respond poorly in stimulation cycles for ART (assisted reproduction technology). References Ron-El, R et al. (2000) Outcome of assisted reproductive technology in women over the age of 41. Fertil. Steril. 74: 471-475 Frattelli et al. (2000) Basal antral follicle number and mean ovarian diameter predict cycle cancellation and ovarian responsiveness in assisted reproductive technology cycles. Fertil. Steril. 74: 512-517 TOP 4. Does assisted hatching pose a risk for monozygotic twinning in pregnancies conceived through in vitro fertilization? There are still controversies concerning the benefits of assisted hatching (AH). Schieve and colleagues studied the occurrence of monozygous twinning in 35,503 registered ART cycles performed 1996 in the US. AH was performed in all embryos in 10,703 cycles (30%) and in some embryos in 3,310 cycles (9%). The cycles resulted in 12,095 clinical pregnancies and information on the number of fetusses could be obtained in 11,274 of these pregnancies. 22 pregnancies could be identified with a set of monozygous twins. The analysis of the data showed that the chance of monozygous twinning was twice as high in AH cycles in comparison to cycles without assisted hatching. The pregnancy rates did not differ between cycles with and without AH. Therefore, prospective studies should demonstrate what patient might benefit from AH at all. Reference Schieve, LA et al. (2000) Does assisted hatching pose a risk for monozygotic twinning in pregnancies conceived through in vitro fertilization? Fertil. Steril. 74: 288-294 TOP

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