Endometriosis is an inflammatory disease that commonly occurs in women of reproductive age and is associated with pain and infertility. This disease can be challenging to manage given its propensity to progress and recur despite treatment. Although medical therapy is beneficial for controlling pain due to endometriosis, medical management has not proven to be effective in treating infertility resulting from endometriosis. Surgery has historically been performed to both improve pain and treat infertility in women with endometriosis. However, the optimal management of endometriosis in asymptomatic women who desire fertility is unclear. Intrauterine insemination with superovulation and IVF are other treatments that have proven to be effective in assisting women with endometriosis to conceive. As the underlying molecular mechanisms of this disease become better understood, promising new therapies for the treatment of endometriosis continue to be investigated.
Transvaginal ultrasound-guided oocyte retrieval is a safe and well-tolerated procedure. Complications are uncommon and usually limited to vaginal bleeding and pelvic infection. Ureteral injury following oocyte retrieval is exceedingly rare, with only 8 previously reported cases.A 34-year-old woman developed gross hematuria 4 hours after transvaginal ultrasound-guided oocyte aspiration. Cystoscopy, laparoscopy, and retrograde pyelography revealed bleeding from the left ureter, no intra-abdominal bleeding, and a patent left urinary collecting system. The ureteral bleeding was successfully managed with placement of a ureteral stent.Ureteral trauma during transvaginal-guided oocyte retrieval is a rare complication with a variable clinical presentation. If ureteral injuries are not promptly recognized, significant morbidity may occur. This case demonstrates that early identification of injury and timely intervention result in favorable outcomes.
Abstract Background: While natural cycle frozen embryo transfer (NC-FET) is becoming increasingly common, significant practice variation exists in the use of ovulation induction medications, administration of ovulation trigger, and timing of embryo transfer without consensus as to the optimal protocol. Aims: The objective of this study is to evaluate the association of key aspects of the NC-FET protocol with implantation, pregnancy and live birth. Settings and Design: This was a retrospective cohort study of blastocyst stage NC-FET cycles from October 2019 to July 2021 at a single academic fertility centre. Materials and Methods: Protocols varied between cycles across three key parameters which were evaluated as primary predictors of cycle outcomes: (1) use of letrozole for mild ovarian stimulation/ovulation induction, (2) administration of exogenous ovulation trigger versus spontaneous luteinising hormone surge and (3) transfer timing based on ovulation trigger versus sequential progesterone monitoring. Primary outcomes included implantation rate, clinical pregnancy and ongoing pregnancy. Statistical Analysis Used: Generalised estimating equations were fitted to obtain adjusted odds ratios or rate ratios as appropriate with 95% confidence intervals for each outcome across the three primary predictors. Results: A total of 183 cycles from 170 unique patients were eligible for inclusion. The average implantation rate was 0.58, resulting in an overall clinical pregnancy and ongoing pregnancy rate of 59.0% and 51.4%, respectively. After adjusting for age at embryo freeze and history of a failed embryo transfer, there were no significant associations between any predictor and implantation rate, clinical pregnancy, ongoing pregnancy, or live birth. Conclusion: In NC-FET, a variety of preparation and timing protocols may lead to comparable cycle outcomes, potentially allowing for flexibility on the basis of patient and physician preference. These findings warrant validation in a larger, randomised trial.
