[Show abstract][Hide abstract] ABSTRACT: Introduction In vitro fertilisation (IVF) is the treatment of choice for unexplained infertility. Preovulatory uterine flushing could reduce intrauterine debris and inflammatory factors preventing pregnancy and constitute an alternative to IVF. Our objective is to assess the efficacy of preovulatory uterine flushing with physiological saline for the treatment of unexplained infertility.
Methods and analysis We will perform a randomised controlled trial based on consecutive women aged between 18 and 37 years consulting for unexplained infertility for at least 1 year. On the day of their luteinising hormone surge, 192 participants will be randomised in two equal groups to either receive 20 mL of physiological saline by an intrauterine catheter or 10 mL of saline intravaginally. We will assess relative risk of live birth (primary outcome), as well as pregnancy (secondary outcome) over one cycle of treatment. We will report the side effects, complications and acceptability of the intervention.
Ethics and dissemination This project was approved by the Ethics committee of the Centre Hospitatlier Universitaire de Quebec (no 2015–1146). Uterine flushing is usually well tolerated by women and would constitute a simple, affordable and minimally invasive treatment for unexplained infertility. We plan to communicate the results of the review by presenting research abstracts at conferences and by publishing the results in a peer-reviewed journal.
Trial registration number NCT02539290; Pre-results.
[Show abstract][Hide abstract] ABSTRACT: Ehlers-Danlos syndrome (EDS) is an autosomal dominant connective tissue disorder with one of the highest maternal mortality rates of any condition. Patients with the vascular type of EDS are prone to spontaneous arterial and visceral ruptures. The occurrence of these severe and life-threatening complications is increased in pregnancy. Moreover, these patients carry a 50% risk of having an affected child. However, little is known about the risks of assisted conception treatments on these patients. We present the case of a 33-year-old woman suffering from EDS with a history of repeated ruptures of arterial aneurysms and a recently ruptured aneurysm of the splenic artery during her first intracytoplasmic sperm injection (ICSI) cycle who was then advised to undergo only unstimulated cycles. After a few natural ICSI cycles, the patient safely underwent two in vitro maturation cycles with pre-implantation genetic diagnosis in our unit. An unaffected blastocyst was transferred into a surrogate host. To our knowledge, this is the first case of EDS in assisted reproduction technologies including pre-implantation genetic diagnosis to be reported in the medical literature. This case has shown that unstimulated in vitro maturation and pre-implantation genetic diagnosis can safely be offered for vascular-type Ehlers-Danlos patients.
[Show abstract][Hide abstract] ABSTRACT: STUDY QUESTION Is hysterosalpingosonography (sono-HSG) an accurate test for diagnosing tubal occlusion in subfertile women and how does
it perform compared with hysterosalpingography (HSG)?
Full-text · Article · Feb 2014 · Human Reproduction
[Show abstract][Hide abstract] ABSTRACT: Hysterosalpingosonography has been suggested as a less invasive alternative to hysterosalpingography for detecting tubal occlusion among subfertile women. We aim to determine the diagnostic accuracy of hysterosalpingosonography and to compare it to hysterosalpingography.Methods/design: We will conduct a systematic review of diagnostic test accuracy. We will search Medline, Embase, Cochrane Library, Web of Science and Biosis, as well as reference lists of included studies and previous related review articles. Diagnostic studies that compared hysterosalpingosonography +/- hysterosalpingography to laparoscopy with chromotubation in women suffering from subfertility will be eligible. Two authors will independently screen for inclusion, data extraction, and quality assessment. Methodological quality will be assessed using the Quality Assessment of Diagnostic Accuracy Study 2 tool (QUADAS-2). We will use SAS 9.3 (SAS Institute Inc., Cary, NC, USA, 2011) to program bivariate random-effects models, estimate pooled sensitivity and specificity with 95% confidence intervals and to generate summary receiver operating characteristics curves. We will perform sensitivity analyses to examine the effect of differences in techniques used for hysterosalpingosonography and in methodological quality of studies.
This systematic review will help to determine if hysterosalpingosonography is an adequate alternative screening test for diagnosing tubal occlusion. Accuracy of specific sono-HSG techniques may also be identified.Trial registration: This review has been registered at PROSPERO. The registration number is CRD42013003829.
[Show abstract][Hide abstract] ABSTRACT: Operative hysteroscopy requires the use of a distension medium and its absorption can lead to serious consequences from intravascular volume overload and water intoxication. We compared the impact of 2 types of anesthesia (general anesthesia and local anesthesia with sedation) on the absorption of glycine solution in operative hysteroscopy.
A randomized controlled trial was conducted over a 17-month period. Eligible patients undergoing operative hysteroscopy for abnormal uterine bleeding were randomized in 2 groups: a general anesthesia group and a local anesthesia with sedation group. The primary outcome was the median absorption of the glycine solution (10th-90th percentile) measured with an automated tandem canister system. Secondary outcomes included incidence of absorption >1000 mL, discontinued surgery because of excessive absorption, median change in serum sodium, postoperative hyponatremia, and patients' postoperative quality of life at 24 hours (8-item Short Form Health Survey questionnaire). Nonparametric analyses (Mann-Whitney U test, χ(2) test, and Fisher exact test) were used.
Of 142 eligible patients, 95 agreed to participate and were randomized. Women who underwent general anesthesia had a higher median absorption of the glycine solution (10th-90th percentile) compared with women who underwent local anesthesia with sedation (480 mL [76-1300 mL] vs 253 mL [70-728 mL]; P = 0.005). General anesthesia was also associated with a higher rate of glycine solution absorption (>1000 mL [20% vs 4%; P = 0.009]) and a more rapid rate of decrease in serum sodium (≥10 mEq/L [8% vs 0%; P = 0.005]) than local anesthesia with sedation. Postoperative quality of life measures as rated by the patients were comparable between the 2 groups.
Compared with general anesthesia, local anesthesia with sedation is associated with less glycine absorption and should be considered the preferred method of anesthesia for operative hysteroscopy.
No preview · Article · Jul 2011 · Anesthesia and analgesia
[Show abstract][Hide abstract] ABSTRACT: This study aimed to evaluate the impact of anesthesia on the absorption of glycine in operative hysteroscopy.
A retrospective cohort study was performed over 2 years. The absorption of glycine was compared among general anesthesia, local anesthesia with intravenous sedation, and spinal anesthesia. Multiple logistic regression analyses were performed.
In all, 282 operative hysteroscopies were reviewed. The median absorption was 145 mL (10th-90th centile: 0-963 mL) for general anesthesia, 35 mL (10th-90th centile: 0-389 mL) for local anesthesia, and 100 mL (10th-90th centile: 0-500 mL) for spinal anesthesia (P = .002). In comparison with general anesthesia, local anesthesia was associated with lower rate of absorption of 500-1000 mL (4.2% vs 13.4%) and of 1000-1500 mL (3.6% vs 9.8; P = .002). Laparoscopic tubal ligation performed during the procedure was also associated with higher glycine absorption (odds ratio, 3.63; 95% confidence interval, 1.12-11.84).
Local anesthesia with sedation is associated with significantly decreased glycine absorption and lower rate of absorption > 500 mL when compared with general anesthesia.
No preview · Article · Apr 2009 · American journal of obstetrics and gynecology
[Show abstract][Hide abstract] ABSTRACT: Sonographic evaluation of the lower uterine segment was undertaken to study the degree of thinning and, thus, to predict uterine rupture. However, the best measuring technique and recommended cutoff values remain controversial.
Sonographic evaluation of the lower uterine segment at 36 weeks of gestation in a 31-year-old patient with prior low transverse cesarean delivery revealed a full thickness of 3.6 mm and a myometrial layer of 1.1 mm. Nevertheless, the patient experienced a large uterine rupture during a trial of labor at term.
In this case, there was a discrepancy between the full thickness and the myometrial layer, which could be representative of the lower uterine segment resistance. Such a case emphasizes the need for a consensus on sonographic measuring techniques for the prediction of uterine rupture.
No preview · Article · Mar 2009 · Obstetrics and Gynecology