OBJECTIVE: To evaluate the efficacy of acupuncture on pregnancy rate in patients undergoing IVF. DESIGN: Prospective randomised controlled trial. MATERIALS AND METHODS: 168 patients undergoing embryo transfer, consecutively enrolled in our IVF clinic, were randomised between between acupuncture and observation in the period may-december 2009. The informed patients who accepted and were randomly assigned to acupuncture group have been treated with needles inserted 25 minutes before and after embryo transfer. The selection of points was performed, in an effort to positively influence blood flow and energy to the uterus and to provide sedative effect, according to different sequences: before transfer Yintang, Hegu, Zusanli, Sanyinjiao, Taichong, after transfer along points Shenmen, uterus, kidney and heart. RESULTS: The patients were evenly distributed according to age (35.8 ± 4.3 vs 35.6 ± 3.8), transferred embryos (2.1 ± 1.4 vs 2.0 ± 2.1), and IVF clinical indication. No losses at follow up were observed. No adverse effects of acupuncture were reported. The pregnancy rate per transfer (as documented by positive beta-HCG) was 50% in the acupuncture group vs 34.6% in the no-treatment arm. The clinical pregnancy rate, as documented by positive US scan 6 weeks after IVF procedure, was 45% and 28% respectively. CONCLUSION: Acupuncture performed on the day of embryo transfer appears to increase pregnancy rates in women undergoing in vistro fertilization.

OBJECTIVE: The aim of this study was to prospectively evaluate the predictive value of serum progesterone levels as measured on the day of oocyte retrieval on pregnancy rate and stimulation response. DESIGN: Retrospective study. MATERIALS AND METHODS: We prospectively evaluated 79 consecutive patients treated by FIVET/ICSI. Serum progesterone was measured the day of oocyte retrieval. The mean age of patients was 38,1 and mean BMI was 22,3. All patients underwent gonadotropins ovarian stimulation and pituitary suppression with either GnRh agonist or antagonist. Pregnancy was defined as beta HCG levels greater than 5 UI two weeks after the oocyte retrieval and vital embryo visible on trans vaginal ultrasound at 6 weeks gestation. The date were than analyzed with respect to serum progesterone levels on the day of oocyte retrieval with the chi-squared test. RESULTS: Among 79 patients, 12 had a viable intrauterine pregnancy at 6 weeks of gestation. Age, BMI and FSH on third day of cycle between pregnant and not pregnant patients were statistically similar. In cycles with high serum progesterone levels, there were more follicle > 15 mm (p=0,0001); more oocyte were retrieved (p=0,0001) and more embryos were available for transfer (p=0,046). There were no significant differences in the progesterone levels on the day of oocyte retrieval in pregnant or not pregnant patients. CONCLUSIONS: Serum progesterone levels on the day of oocyte retrieval appear not to be correlated significantly with pregnancy rate. However high progesterone levels were significantly correlated with higher number of follicles >15mm, with oocytes retrieved and embryos transferred.

OBJECTIVE: To evaluate the role of sonohysterography in the diagnosis of intrauterine pathology in comparison to hysteroscopy. DESIGN: Prospective study using sonohysterography as a first step examination of uterine cavity in a group of infertile women during 18 months. MATERIALS AND METHODS: 444 sonohysterography were performed from January 2005 to april 2007. The mean age of patients was 35 (range 23-42). In 23 patients the exam was not possible due to cervical stenosis (5,2%). The sonohysterography was performed between 10-15 day of the menstrual cycle. If a diagnosis of possible intrauterine anomaly was made at sonohysterography, hysteroscopy was scheduled. Comparative results of sonohysterography and hysteroscopy has been analyzed. Positive predictive value (PPV) and specificity of sonohysterography have been calculated. RESULTS: In 58 of 421 patients (15,4%), sonohysterography showed an abnormal uterine cavity: 36 polyps (8,5%), 3 submucous myomas (0,7%), 18 uterine malformation (4,3%), 1 synechiae (0,2%), 7 non accessible cavity (1,7%). Among these patients, 51 underwent diagnostic hysteroscopy. Hysteroscopy revealed 34 polyps, 2 myomas, 1 synechiae, 9 uterine malformation and 3 normal cavity. PPV of sonohysterography was 94% for polyps detection, 100% for myomas, 100% for synechiae, 90% for uterine malformation. Overall PPV has been 94%. CONCLUSIONS: Sonohysterography is a simple, low cost and well tolerated procedure. Diagnostic accuracy and the low false positive rate suggest sonohysterography as a routine test in the evaluation of the uterine cavity of infertile women.

ObjectiveA 2004 Italian regulation, indicates that during assisted reproductive technologies (ART) all fresh fertilized embryos should be transferred. The same regulation states that transferred embryos should not exceed the number of three and that embryos freezing is not permitted. Due to this reason it is allowed to fertilize not more than three oocytes per patient and per cycle. In this study, we investigated the impact of this law regulation on the ART results, comparing two consecutive series of patients, recruited before and after its onset.DesignRetrospective clinical studyMaterials and methodsA total of 108 and 114 different patients undergoing ART between June and December 2003 and between June and December 2004 were included. Inclusion criteria: woman’s age ≤ 41 years, integrity of both ovaries, informed consent. Three different patient categories (poor, normal and high responder) have been identified using clinical, biochemical and sonographic parameters. “Poor” responder patients were 17 in 2003 and 24 in 2004, “normal” were 66 in 2003 and 68 in 2004, “high” were 25 in 2003 and 22 in 2004; all patients were therefore included in 3 different ovulation induction regimens. The ovarian stimulation has been monitored by transvaginal sonography and estradiol measurements until ovulation induction. A total of 56 (51.9%) patients underwent ICSI in 2003 and 52 (45.6%) in 2004; 52 (48.9%) in 2003 and 62(54.4%) in 2004 underwent FIVET procedure. The selection of the treatment was performed using FSH, LH and estradiol level, sonographically visible antral follicle count, ovarian volume size, body mass index (BMI) and age of patients. The number of retrieved and inseminated oocytes, cleavaged and transferred embryos, cancelled cycles, the incidence of multiple gestations and miscarriages have been evaluated. The results have been expressed as mean and standard deviation; the X2 test was used in the comparison of the groups. A P value < .05 was considered statistically significant.ResultsA significantly lower number of inseminated oocytes and cleavaged embryos has been observed in the group of normal and high responders in 2004 versus 2003. In poor responders group and in the total number of patients a significantly lower number of retrieved, inseminated oocytes, cleavaged and transferred embryos in 2004 versus 2003. No-oocyte recovery occurrence, failure of fertilization, twin pregnancies and miscarriages were similar in all groups. The pregnancy rate (PR) per transfer in the “normal” responders was 37% in 2004 vs 46,2% in 2003, in the “high” responders was 29.4% in 2004 vs 45.0% in 2003, in the “poor” responders was 37.5% in 2004 vs 18.2% in 2003, and finally among the whole series was 35.4% in 2004 vs 42.2% in 2003. The 2003 vs 2004 data analysis showed significant differences between standard FIVET and ICSI: FIVET patients had a lower number of inseminated oocytes and cleavaged embryos, ICSI patients and the whole series had a lower number of retrieved and inseminated oocytes, cleavaged and transferred embryos. Cancelled cycles, multiple pregnancy and miscarriages incidence were not different in the three groups. The PR per transfer in the standard FIVET group was 43.7% in 2004 vs 52.4% in 2003, in the ICSI group was 22.5% in 2004 vs 31.7% in 2003.ConclusionOur results show that this present new Italian regulation caused a detrimental effect on the pregnancy rates for all the patients undergoing ART. ObjectiveA 2004 Italian regulation, indicates that during assisted reproductive technologies (ART) all fresh fertilized embryos should be transferred. The same regulation states that transferred embryos should not exceed the number of three and that embryos freezing is not permitted. Due to this reason it is allowed to fertilize not more than three oocytes per patient and per cycle. In this study, we investigated the impact of this law regulation on the ART results, comparing two consecutive series of patients, recruited before and after its onset. A 2004 Italian regulation, indicates that during assisted reproductive technologies (ART) all fresh fertilized embryos should be transferred. The same regulation states that transferred embryos should not exceed the number of three and that embryos freezing is not permitted. Due to this reason it is allowed to fertilize not more than three oocytes per patient and per cycle. In this study, we investigated the impact of this law regulation on the ART results, comparing two consecutive series of patients, recruited before and after its onset. DesignRetrospective clinical study Retrospective clinical study Materials and methodsA total of 108 and 114 different patients undergoing ART between June and December 2003 and between June and December 2004 were included. Inclusion criteria: woman’s age ≤ 41 years, integrity of both ovaries, informed consent. Three different patient categories (poor, normal and high responder) have been identified using clinical, biochemical and sonographic parameters. “Poor” responder patients were 17 in 2003 and 24 in 2004, “normal” were 66 in 2003 and 68 in 2004, “high” were 25 in 2003 and 22 in 2004; all patients were therefore included in 3 different ovulation induction regimens. The ovarian stimulation has been monitored by transvaginal sonography and estradiol measurements until ovulation induction. A total of 56 (51.9%) patients underwent ICSI in 2003 and 52 (45.6%) in 2004; 52 (48.9%) in 2003 and 62(54.4%) in 2004 underwent FIVET procedure. The selection of the treatment was performed using FSH, LH and estradiol level, sonographically visible antral follicle count, ovarian volume size, body mass index (BMI) and age of patients. The number of retrieved and inseminated oocytes, cleavaged and transferred embryos, cancelled cycles, the incidence of multiple gestations and miscarriages have been evaluated. The results have been expressed as mean and standard deviation; the X2 test was used in the comparison of the groups. A P value < .05 was considered statistically significant. A total of 108 and 114 different patients undergoing ART between June and December 2003 and between June and December 2004 were included. Inclusion criteria: woman’s age ≤ 41 years, integrity of both ovaries, informed consent. Three different patient categories (poor, normal and high responder) have been identified using clinical, biochemical and sonographic parameters. “Poor” responder patients were 17 in 2003 and 24 in 2004, “normal” were 66 in 2003 and 68 in 2004, “high” were 25 in 2003 and 22 in 2004; all patients were therefore included in 3 different ovulation induction regimens. The ovarian stimulation has been monitored by transvaginal sonography and estradiol measurements until ovulation induction. A total of 56 (51.9%) patients underwent ICSI in 2003 and 52 (45.6%) in 2004; 52 (48.9%) in 2003 and 62(54.4%) in 2004 underwent FIVET procedure. The selection of the treatment was performed using FSH, LH and estradiol level, sonographically visible antral follicle count, ovarian volume size, body mass index (BMI) and age of patients. The number of retrieved and inseminated oocytes, cleavaged and transferred embryos, cancelled cycles, the incidence of multiple gestations and miscarriages have been evaluated. The results have been expressed as mean and standard deviation; the X2 test was used in the comparison of the groups. A P value < .05 was considered statistically significant. ResultsA significantly lower number of inseminated oocytes and cleavaged embryos has been observed in the group of normal and high responders in 2004 versus 2003. In poor responders group and in the total number of patients a significantly lower number of retrieved, inseminated oocytes, cleavaged and transferred embryos in 2004 versus 2003. No-oocyte recovery occurrence, failure of fertilization, twin pregnancies and miscarriages were similar in all groups. The pregnancy rate (PR) per transfer in the “normal” responders was 37% in 2004 vs 46,2% in 2003, in the “high” responders was 29.4% in 2004 vs 45.0% in 2003, in the “poor” responders was 37.5% in 2004 vs 18.2% in 2003, and finally among the whole series was 35.4% in 2004 vs 42.2% in 2003. The 2003 vs 2004 data analysis showed significant differences between standard FIVET and ICSI: FIVET patients had a lower number of inseminated oocytes and cleavaged embryos, ICSI patients and the whole series had a lower number of retrieved and inseminated oocytes, cleavaged and transferred embryos. Cancelled cycles, multiple pregnancy and miscarriages incidence were not different in the three groups. The PR per transfer in the standard FIVET group was 43.7% in 2004 vs 52.4% in 2003, in the ICSI group was 22.5% in 2004 vs 31.7% in 2003. A significantly lower number of inseminated oocytes and cleavaged embryos has been observed in the group of normal and high responders in 2004 versus 2003. In poor responders group and in the total number of patients a significantly lower number of retrieved, inseminated oocytes, cleavaged and transferred embryos in 2004 versus 2003. No-oocyte recovery occurrence, failure of fertilization, twin pregnancies and miscarriages were similar in all groups. The pregnancy rate (PR) per transfer in the “normal” responders was 37% in 2004 vs 46,2% in 2003, in the “high” responders was 29.4% in 2004 vs 45.0% in 2003, in the “poor” responders was 37.5% in 2004 vs 18.2% in 2003, and finally among the whole series was 35.4% in 2004 vs 42.2% in 2003. The 2003 vs 2004 data analysis showed significant differences between standard FIVET and ICSI: FIVET patients had a lower number of inseminated oocytes and cleavaged embryos, ICSI patients and the whole series had a lower number of retrieved and inseminated oocytes, cleavaged and transferred embryos. Cancelled cycles, multiple pregnancy and miscarriages incidence were not different in the three groups. The PR per transfer in the standard FIVET group was 43.7% in 2004 vs 52.4% in 2003, in the ICSI group was 22.5% in 2004 vs 31.7% in 2003. ConclusionOur results show that this present new Italian regulation caused a detrimental effect on the pregnancy rates for all the patients undergoing ART. Our results show that this present new Italian regulation caused a detrimental effect on the pregnancy rates for all the patients undergoing ART.

Background: Although studies in animals demonstrated a better wound healing after abdominal incision with cold scalpel than with electrocautery, clinical experiences did not confirm these findings. The purpose of this study was to compare early and late wound complications between diathermy and scalpel in gynecologic oncologic patients undergoing midline abdominal incision. Methods: Patients undergoing midline abdominal incision for uterine malignancies were divided into two groups according to the method used to perform the abdominal midline incision: cold scalpel and diathermy in coagulation mode. Early and late complications were compared. Logistic regressions were used for statistical analysis. Results: Nine hundred sixty-four patients were included, of whom 531 were in the scalpel group and 433 in the electrocautery group. Both groups were similar with respect to demographic, operative, and postoperative characteristics. Univariate analysis revealed a higher incidence of severe wound complications in the scalpel group than in the electrocautery group (8 of 531 versus 1 of 433, P <0.05). After adjustment for confounding variables (eg, age, body mass index) no differences were found between groups. Conclusions: Scalpel and diathermy are similar in terms of early and late wound complications when used to perform midline abdominal incisions. Therefore the choice of which method to use remains only a matter of surgeon preference.

Objectives The aim of this study was to assess if endometrial thickness could be used to select postmenopausal women on hormonal replacement therapy (HRT) at increased risk for endometrial abnormalities. The secondary aim was to assess if endometrial abnormalities were more likely to occur in patients with increased endometrial thickness or in patients with unexpected bleeding.Methods Bi-endometrial thickness was measured by transvaginal ultrasound (TVS) in postmenopausal patients on sequential or combined HRT regimens. Women following a sequential regimen underwent TVS examination immediately after their withdrawal,al bleed, always between 5 and 10 days after the last progesterone tablet. A hysteroscopy with Endometrial biopsy was performed within 5 days after the TVS Examination, when endometrial thickness was greater than or equal to 4 nlm, ol when unscheduled bleeding was observed.Results A total of 190 women were recruited. In 138 women on sequential regimens, the mean value of endometrial thickness was 3.6 mot +/- 1.5, and in 52 women on combined regimens it was 3.2 mm +/- 1.8 (P = n.s.) Twenty-eight patients (15%) had an endometrial thickness >4 mm, 35 patients (18.4%) reported unexpected bleeding. The percentage of abnormal endometrial findings (9%; three of 35) in patients selected for unscheduled bleeding was significantly lower? than the percentage of abnormal findings in patients selected for hysteroscopy for endometrial thickness >4 mm (36%; 10 of 28) (P < 0.01). All patients with unexpected bleeding and endometrial thickness less than or equal to 4 mm (24 cases) were found to have an atrophic endometrium.Conclusions Endometrial thickness in patients on sequential HRT, measured soon after withdrawal bleeding, is not significantly different from thickness measured in patients on combined HRT. Patients on HRT with art endometrial thickness of > 4 mm could be considered for histological sampling. The prevalence of abnormal endometrial findings in patients with a thick endometrium is significantly higher than the prevalence observed in patients with unexpected bleeding.

Menopause is the time of life when menstrual cycles cease, and is caused by reduced secretion of the ovarian hormones oestrogen and progesterone. Although menopause is a normal event for women, individual experiences vary, and some women seek medical advice for the management of symptoms. Many symptoms have been attributed to menopause, but only vasomotor dysfunction and vaginal dryness are consistently associated with this time of life in epidemiological studies. Other common symptoms such as mood changes, sleep disturbances, urinary incontinence, cognitive changes, somatic complaints, sexual dysfunction, and reduced quality of life may be secondary to other symptoms, or related to other causes. Trials of therapies for vasomotor dysfunction have shown improvements with oestrogen, gabapentin, paroxetine, and clonidine, but little or no benefit with other agents; adverse effects of these treatments must also be considered. Many questions about menopausal transition and its effects on health have not been adequately addressed.

Fallo, L; Dordoni, D; Ruggeri, C; Palai, N; Omodei, U; Boccuti, A M; Daldoss, C Author Information

The question of whether surgical treatment in early-stage cervical cancer should be aggressive or restricted to less radical techniques is still controversial. To answer this question it was thought useful to investigate the correlation of parametrial lymph node metastases with extension and stage of disease. Two-hundred and sixty-three consecutive primary radical surgical procedures were performed in our institute in clinical stage IB or stage IIA cervical cancer. Positive parametrial nodes were found in 6.9% of cases: 5% in stage IB (3% in the proximal part of the parametrium and 2% in the distal part, near the pelvic wall) and 16.3% in stage IIA (7% proximal and 9.3% distal) (P = 0.0193). During a median follow-up period of 92 months, disease recurred in 17.1% and 17.6% of cases, in negative and positive parametria, respectively. The 5-year overall and disease-free survival rates were 80.4% and 81.6% for patients with negative and positive parametria, respectively. From this experience it is concluded that the extent of radical hysterectomy should be related to the extent of the disease on the basis of modern knowledge of the pattern of spread. The principal key to prognosis remains pelvic and paracavoaortic nodal status.