Objective: To describe the clinical outcomes for all HIV-serodiscordant couples attending an assisted reproduction program.Design, setting and participants: Retrospective review of demographic, clinical and outcome data for all HIV-serodiscordant couples who attended an assisted reproduction program at a tertiary hospital in Melbourne, between its commencement in 2003 and June 2010.Main outcome measures: Pregnancies, miscarriages, births, HIV transmission to the HIV-negative partner, semen quality and detection of HIV (HIV RNA and HIV DNA) in semen.Results: As of June 2010,39 HIV-positive clients had proceeded to assisted reproduction after the initial consultation in the program. There were 162 completed cycles, with 26 pregnancies (clinical pregnancy rate per cycle, 16.2% for HIV-positive men with an HIV-negative partner, and 15.4% for HIV-positive women). Of all 222 tested semen samples, 18 (8%) had HIV RNA detected despite these men receiving antiretroviral therapy and having an undetectable HIV viral load in plasma. Sperm velocity was significantly lower in HIV-positive clients receiving combination antiretroviral therapy than in a control group of recipient-recruited sperm donors (P = 0.01); there were no other significant differences in sperm quality between the two groups. No HIV transmission to babies or HIV-negative partners occurred.Conclusion: Our findings show detectable HIV in 8% of semen samples from men with an undetectable HIV viral load in plasma, but confirm the safety of assisted reproduction for HIV-serodiscordant couples within a program with, strict protocols for HIV treatment and testing of all semen before use.

Objective: To report preterm birth and small for gestational age (SGA) rates from assisted reproduction technologies (ART) patients with ovarian endometriomata compared with control groups.Design: Retrospective cohort study.Setting: Tertiary university affiliated ART center and Perinatal Data Collection Unit (PDCU).Patient(s): Every woman who had an ART singleton baby born between 1991 and 2004 had her database record assessed (N = 4382). Control groups included 1201 singleton babies from ART patients without endometriosis and 2400 randomly selected women from the PDCU database of 850,000 births.Intervention(s): There were 95 singleton ART babies from patients with ovarian endometriomata and 535 ART singleton babies from patients who had endometriosis but no ovarian endometriomata.Main Outcome Measure(s): Preterm birth rates and SGA birth rates.Result(s): Preterm birth rate increased only in the ovarian endometriomata group when compared with community birth records (n = 850,000). Furthermore, ART patients with ovarian endometriomata had a statistically significantly increased likelihood of having a SGA baby when compared with other forms of endometriosis.Conclusion(s): Rates of preterm birth and SGA babies doubled in infertility patients with ovarian endometriomata who required ART. (Fertil Steril (R) 2009;91:325-30. (C)2009 by American Society for Reproductive Medicine.)

OBJECTIVE:To describe the experience of changing from the use of the 10-mm standard laparoscope to the use of the 2-mm microlaparoscope (MicroLap, Imagyn Medical Inc., Laguna Niguel, CA) and to compare the amount of postoperative pain and requirement for analgesics after each technique.DESIGN:Prospective study.SETTING:Day surgery unit in an academic reproductive medicine unit.PATIENT(S):One hundred thirty-five women undergoing diagnostic microlaparoscopy.INTERVENTION(S):Diagnostic laparoscopy with a 2-mm instrument. Recording of postoperative pain on an analog scale.MAIN OUTCOME MEASURE(S):Ability to complete the procedure satisfactorily with the microlaparoscope, pain scores, and use of analgesics.RESULT(S):All diagnostic procedures were performed satisfactorily with the use of the MicroLap. Patients who underwent MicroLap procedures had significantly less abdominal pain postoperatively, but there was no difference in shoulder tip (gas-related) pain. Less analgesia was required after the microlaparoscopy.CONCLUSION(S):In most situations, the microlaparoscope is the instrument of choice for initial diagnostic laparoscopy. The 10-mm laparoscope should be used only as a secondary instrument after microlaparoscopy, if indicated.