Persistent swelling after ankle arthroscopy: pseudoaneurysm of the anterior tibial artery as a rare complication A patient was admitted to a geriatric rehabilitation ward following a septic arthritis for which she received an antibiotic treatment and arthroscopic irrigation. She had a normal kidney function and received a prophylactic dose of enoxaparin for the prevention of a deep venous thrombosis (DVT). During the hospitalization, a progressive, painless swelling of the ankle was seen. The ultrasonography showed a pseudoaneurysm of the anterior tibial artery measuring 4.2 cm by 4 cm by 1.7 cm. Following the surgical consultation, compression therapy was started. The follow-up ultrasonography after 4 weeks showed absence of flow in the pseudoaneurysm. A pseudoaneurysm is a rare complication (0.008%) of foot and ankle surgery. Risk factors are malnutrition, immunosuppression, diabetes mellitus and trauma or infection. Abnormal coagulation may contribute to the development of a pseudoaneurysm. The diagnosis is mostly based on clinical clues, confirmed by means of color-flow Doppler imaging. The treatment options include non-surgical methods (external compression, ultrasound-guided compression and ultrasound-guided thrombin injections), percutaneous endovascular therapy (coil, stenting) or surgical ligation with an aneurysmectomy and an arterial reconstruction. Although pseudoaneurysms are a rare complication, their possibility should be considered in the period following the commencement of mobilization and weight-bearing after ankle surgery, especially if risk factors are present.

Study question: To quantify the meaning and effort involved in an extensive search for spermatozoa in ejaculated and surgically retrieved samples in relation to ICSI clinical outcome.Summary answer: A strenuous search for spermatozoa to be injected, independent of the origin, is rewarded by the achievement of a successful pregnancy.An extensive sperm quest yields morphologically and kinetically impaired spermatozoa with a reduced oocyte activation capacity without affecting embryo developmental competence.TESE provides more consistent fertilization and pregnancy outcomes.What is known already: ICSI is the established insemination method to alleviate male infertility.Spermatogenic dysfunction ranges from virtual azoospermia to non-obstructive azoospermia in the ejaculate and at times requiring testicular sampling.These conditions often imply an extraneous pursuit to identify the spermatozoa required to inseminate all oocytes.Study design, size, duration: During a six year period, 598 couples who had a total of 993 ICSI/TESE cycles and 1,109 couples that had 2,196 ICSI/EJAC cycles were included in the study.We ranked ICSI cycles according to the increasing sperm search time in ejaculated or testicular samples and in relation to clinical outcome.Participants/materials, setting, methods: Extended sperm quest was performed with an inverted microscope in droplets under oil.Searches, often carried out by several embryologists, were grouped by 30min-1hr, 1-2 hrs, 2-3hrs, and .3hrs,and compared to a control requiring less than 30mins.Embryo development and implantation were recorded for the different sperm quest times.Main results and the role of chance: In a female age-matched comparison, fertilization rate was clearly inferior in the TESE (T) in comparison to the ejaculated (E) control groups (58.9% T vs. 75.6%E,P,0.0001; respectively), but were comparable in the groups of (30min-1hr) 55.6% T vs. 56.2%E,(1-2hrs) 50.5% T vs. 52.5%E,(2-3hs) 32.7% T vs. 33.9%E,and .3hrs(27.8% T vs. 33.3%E).However, over time fertilization progressively decreased (P,0.0001).Although not significantly, the T group granted higher clinical pregnancy rates in all the study gourps (30min-1hr) 51.6% T vs. 35.4%E,(1-2hrs) 44.6% T vs. 57.1%E,(2-3hrs) 34.4% T vs. 0%E, and (.3hrs) 26.7 T vs. 100%E.Limitations, reason for caution: Although the reason for spermatogenetic dysfunction often remains unclear, this analysis hints to a retained embryo developmental competence of the suboptimal spermatozoa located during extreme ICSI.Wider implications of the findings: The power of ICSI to achieve a pregnancy remains unaffected by the semen origin and the characteristic of the scarce spermatozoon.Therefore, the pursuit for a spermatozoon independently from the time invested in searching for it represents the sole method to treat extreme forms of male infertility.In virtual azoospermic men if spermatozoa are identified in the ejaculate, their competence is comparable to those retrieved from the seminiferous tubules.

BACKGROUNDThis study was done to test the hypothesis that intrauterine insemination (IUI) using a soft-tip catheter results in a higher live birth rate than IUI using a hard-tip catheter.METHODSFive hundred and forty patients were randomized into those inseminated with a soft-tip catheter (group 1, n = 267) and those inseminated with a hard-tip catheter (group 2, n = 269). Four patients were excluded. Main outcome measures included pregnancy rate and live birth rate per cycle.RESULTSBoth groups were similar with regard to female age, duration of infertility, ovarian stimulation and sperm quality. No significant differences were observed between group 1 and group 2 regarding clinical pregnancy rate per cycle (20 versus 19%), live birth rate per cycle (15 versus 14%), multiple live birth rate per cycle (4 versus 6%) and multiple live birth per total of live births (5 versus 8%, overall 6%), respectively.CONCLUSIONOur hypothesis that IUI using a soft tip catheter results in a higher live birth rate per cycle than IUI using a hard-tip catheter was not confirmed in this study. Multiple live birth rate after treatment with low-dose gonadotrophins and IUI can be kept low (6%).

Background: The objective of this study was to explore the reasons why couples discontinue fertility treatment. Methods: A retrospective exploratory study was performed at the Leuven University Fertility Centre, a university hospital-based fertility center. Women who discontinued treatment between September 2000 and December 2001 were contacted in 2004–2005 by telephone for a standardized interview which covered 9 dropout reasons. For each reason, its importance on the decision to stop treatment was measured on an 11-point Likert scale. Results: On average, psychological burden (x = 5.96) had the highest impact on the decision to stop treatment followed by physical burden (x = 4.48) and female age (x = 3.64). Perceived lack of staff expertise (x = 1.84), negative impact on social contacts (x = 2.12) and financial burden (x = 2.16) had the lowest impact on the decision to stop treatment. Longer duration of infertility was significantly positively correlated with a higher rating of physical burden as a reason to discontinue treatment (r = 0.48; p < 0.05). Discussion: On average, psychological burden appears to be most frequently named as the number one reason to discontinue infertility treatment, whereas financial burden had the lowest impact. Longer duration of infertility is associated with more externalizing reasons to discontinue treatment.

BACKGROUND: The recognition of the distressing character of infertility diagnosis and treatment has led to the development of several psychosocial interventions for infertile couples. At the Leuven University Fertility Centre, a body-mind marital group intervention was developed to help infertile couples cope with the distress related to infertility. METHODS AND RESULTS: This treatment programme was originally adapted from a mind-body approach, but integrated concepts and techniques from body-oriented therapy, art therapy and multi-family group therapy. In this paper, the therapeutic foundations, treatment goals and practical implications of the mind-body marital group intervention are outlined. Further, the treatment procedure is explained in detail and illustrated by clinical vignettes. CONCLUSIONS: Although the first clinical impressions about the usefulness of the body-mind group programme in fertility clinics seem promising, further research is needed to assess its effectiveness.

BACKGROUND: This randomized controlled study was performed in an unselected IVF/ICSI population to test the hypothesis that blastocyst transfers result in higher clinical pregnancy rates (CPR) per oocyte retrieval when compared with day 2 transfers. METHODS: Blind randomization for transfer on day 2 (group 1) or day 5/6 (group 2) was performed before stimulation. Oocytes and embryos were cultured in sequential media in 5.5% CO2, 5% O2, 89.5% N2 and 90% humidity. A maximum of two embryos was transferred. RESULTS: The two groups were similar for age, IVF indication, number of treatment cycles, rate of ICSI/IVF, number of fertilized oocytes and number of embryos transferred. The CPR/oocyte retrieval was comparable in group 1 (32%) and in group 2 (44%), while the CPR/embryo transfer was significantly higher (P < 0.01) in group 2 (60%) than in group 1 (35%). Similarly, the implantation rate per embryo transferred was significantly higher (P < 0.03) in group 2 (46%) than in group 1 (29%). The cryo-augmented delivery rate/oocyte retrieval was comparable in group 2 (36.3%) and in group 1 (28.6%). CONCLUSION: This randomized study in an unselected population showed a significantly higher CPR/embryo transfer and a tendency toward a higher CPR/oocyte retrieval in patients receiving blastocysts when compared with day 2 transfers.

Objective: It is not known whether blastocyst transfers are really superior to day 2 transfers in all infertile patients, irrespective the ovarian response. This randomized controlled study was performed to test the hypothesis that blastocyst transfers result in higher clinical pregnancy rates per oocyte pick-up (OPU) when compared to day 2 transfers. Design: A prospective randomized study in a university center on IVF/ICSI patients, with informed consent. Materials and Methods: Patients were stimulated with a long desensitization protocol preceded by an oral contraceptive pill. Blind randomization for transfer on day 2 (group1) or day 5/6 (group2) was performed before the stimulation started. Oocytes and embryos were cultured in sequential media (Scandinavian IVF-Science AB, Göteborg, Sweden or Cook IVF, Queensland, Australia) in 5% CO2, 5% O2, 90% N2 and 90% humidity. In group 1, up to five embryos were cultured for embryo selection while the others were frozen in the pronuclear stage. In group 2, all embryos were cultured until blastocysts. Maximum two embryos were transferred with the K-Soft catheter (Cook IVF). Statistical analysis was performed with Chi-square and Students t-test. Results: An interim analysis of this study showed no differences for age (31.7 ± 2.8 and 31.2 ± 2.4), mean number of previous failed IVF cycles (1.0 and 0.8), rate of ICSI/IVF cycles (29% and 37%), number of oocytes at OPU (11.1 and 11.4), rate of mature oocytes (83.6% and 84.2%), fertilization rate (62.7% and 63.2%), and numbers of embryos transferred (1.87 and 1.85). In group 2, the clinical pregnancy rate and the implantation rate per embryo were not yet significantly higher when compared to group 1. Tabled 1Group 1Group 2Clin. pregn/ET/OPU (%/OPU)Clin. impl./ embryo (%)Clin. pregn/ET/OPU (%/OPU)Clin. impl./ embryo (%)Total13/40/4532 %NS20/7527 %19/33/4840 %25/6141 %<3 2PN0/7/900/1000/0/500/003–5 2PN6/15/1638 %NS8/2928 %5/10/1631 %7/1839 %>5 2PN8/18/2040 %NS12/3633 %14/27/2352 %18/4342 % Open table in a new tab Conclusion: In this randomized study, although the numbers are small and not yet significantly different, more clinical pregnancies per OPU could be achieved by transfers on day 5/6 than by transfers on day 2. Even a low number of 2PNs seems to be no contraindication for a transfer on day 5. This study will be continued and further cryo-augmented baby take home rate per OPU will be evaluated since we do not know how high the impact of frozen/thawed blastocysts on the final result will be in comparison with frozen/thawed pronucleate ova.