Does ICSI improve outcomes in ART cycles without male factor, specifically in couples with a history of tubal ligation as their infertility diagnosis?The use of ICSI showed no significant improvement in fertilization rate and resulted in lower pregnancy and live birth (LB) rates for women with the diagnosis of tubal ligation and no male factor.Prior studies have suggested that ICSI use does not improve fertilization, pregnancy or LB rates in couples with non-male factor infertility. However, it is unknown whether couples with tubal ligation only diagnosis and therefore iatrogenic infertility could benefit from the use of ICSI during their ART cycles.Longitudinal cohort of nationally reported cycles in the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System (SART CORS) of ART cycles performed in the USA between 2004 and 2012.There was a total of 8102 first autologous fresh ART cycles from women with the diagnosis of tubal ligation only and no reported male factor in the SART database. Of these, 957 were canceled cycles and were excluded from the final analysis. The remaining cycles were categorized by the use of conventional IVF (IVF, n = 3956 cycles) or ICSI (n = 3189 cycles). The odds of fertilization, clinical intrauterine gestation (CIG) and LB were calculated by logistic regression modeling, and the adjusted odds ratios (AORs) with 95% confidence intervals were calculated by adjusting for the confounders of year of treatment, maternal age, race and ethnicity, gravidity, number of oocytes retrieved, day of embryo transfer and number of embryos transferred.The main outcome measures of the study were odds of fertilization (2PN/total oocytes), clinical intrauterine gestation (CIG/cycle) and live birth (LB/cycle). The fertilization rate was higher in the ICSI versus IVF group (57.5% vs 49.1%); however, after adjustment this trend was no longer significant (AOR 1.14, 0.97-1.35). Interestingly, both odds of CIG (AOR 0.78, 0.70-0.86), and odds of LB were lower (AOR 0.77, 0.69-0.85) in the ICSI group. Plurality at birth, mean length of gestation and birth weight did not differ between the two groups.This was a retrospective study, therefore only the available parameters could be included, with parameters of interest such as smoking status not available for inclusion. Smoking status may have led practitioners to use ICSI to improve pregnancy and LB outcomes.Studies have shown that in the USA there is an increasing usage of ICSI for non-male factor infertility despite a lack of evidence-based benefit. Our study corroborates this increasing use over the last 8 years, specifically in the tubal ligation only patient population. Even after adjusting for multiple confounders, the patients who underwent ICSI had no statistically significant improvement in fertilization rate and actually had a lower likelihood of achieving a clinical pregnancy and LB. Therefore, our data suggest that the use of ICSI in tubal ligation patients has no overall benefit. This study contributes to the body of evidence that the use of ICSI for non-male factor diagnosis does not improve ART outcomes over conventional IVF.None.
Puberty is a defining time of many adolescents’ lives. It is a series of events that includes thelarche, pubarche, and menarche. Primary amenorrhea is the absence of menarche. There are numerous etiologies including outflow tract obstructions, gonadal dysgenesis, and anomalies of the hypothalamic axis. This review’s aims are to define primary amenorrhea and describe the various causes, their workups, associated comorbidities, and treatment options. At the end, a generalist should be able to perform an assessment of an adolescent who presents with primary amenorrhea and, if warranted, begin initial treatment. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completing this CME activity, physicians should be better able to perform and assess the findings of an initial workup on a patient with primary amenorrhea, identify the appropriate referral providers, and provide appropriate basic treatment for patients with primary amenorrhea.
Purpose: The purpose of this study was to provide a preliminary characterization of new-onset abdominopelvic pain reported by trans-masculine persons after initiation of testosterone gender-affirming hormone therapy (GAHT). Methods: From December 2015 to February 2017, an anonymous survey was distributed through social media, listservs, and community centers to trans-masculine persons, 18 years or older, on testosterone GAHT, who experienced new-onset abdominopelvic pain after initiating GAHT. Results: Of the 183 persons who completed the survey, 127 (69.4%) endorsed new-onset abdominopelvic pain since the initiation of testosterone GAHT. Median interval from testosterone initiation to pain onset was 1 year (range: 1 month to 20 years). The majority of respondents reported pain that was intermittent (79.5%), cramping in nature (75.6%), and localized to the suprapubic region (78.7%). Those with a uterus and ovaries were 9.50 times (95% confidence interval 2.85–31.66) more likely to endorse suprapubic localization (as opposed to other abdominopelvic regions). All 28 respondents who reported pain resolution with treatment, identified this treatment as a hysterectomy. Conclusion: In this preliminary evaluation of new-onset abdominopelvic pain experienced by trans-masculine persons after the initiation of testosterone GAHT, the combination of suprapubic localization of pain with self-reported effectiveness of hysterectomy as treatment suggests a reproductive organ etiology. Based on our data, clinicians should be aware of the possibility that trans-masculine persons may present for this concern. This study offers a starting point for research. Further prospective studies are necessary to evaluate the incidence, cause(s), and the most appropriate interventions.
