Systemic Methotrexate Treatment Under the Spotlight in Cervical Ectopic Pregnancies

Verma and colleague recently described a safe and viable noninvasive method of managing cervical ectopic pregnancies.(1) This report takes the management of this potentially life-threatening disease a significant step forward by administering systemic methotrexate alone or in a combination with ultrasound-guided potassium chloride (KCl) into the fetal heart.

Parity and Subfertility Effects of Continuous Oral Contraceptives on Fertility Are Important

To the Editor:

In recent articles, Barnhart and colleagues present data on time to conception following discontinuation of continuous oral contraception (OC) (1). They compare these and other data and conclude that “the return of fertility in former OC users … is comparable to … other contraceptive methods” (2). While we are pleased to see the addition of empirical evidence to this debate, we have some concerns about the role of parity in the time to conception, and are concerned that an uncritical acceptance of this conclusion may cause harm.

Measures of ovarian function in galactosemia — a response to Gubbels et al.

To the Editor:

We are writing in response to a recent case report by Gubbels and colleagues (1) describing a woman with classic galactosemia who became pregnant shortly after a low anti-mullerian hormone (AMH) blood measurement. The authors contrast their case with results published by our group from a study of 35 galactosemic girls and women (2).

Study Raises Further Questions on the Effectiveness of GnRH Analogs as a Method of Gonadal Protection in Cancer Patients

To the Editor:

While we read the recent manuscript from Badawy et al. (1) with great interest, we have concerns about their interpretation that GnRH analogs (GnRHa) preserve fertility.

Leveling the playing field for grandfather’s sperm

To the Editor:

A recent publication by Frattarelli et al., found that sperm from males age 50 or over resulted in a lower percentage of live deliveries, even when using a donor oocyte model to negate the adverse effect of maternal oocyte age (1). These data reached a different conclusion compared to an earlier publication by another group using the donor oocyte model

Low AMH and GnRH-antagonist strategies

To the Editor:

We read with interest the case report by Tocci reporting a live birth in a woman with a negligible anti-Mullerian hormone (AMH) as defined by an AMH of <3.5 pmol/L (1).  We have previously reported a prospective cohort of 61 women with a median AMH of 3.0 (IQR 2.0 -3.8) pmol/L, where use of antagonist cycles without preprogramming achieved a clinical pregnancy rate of 14.7% per cycle started and a trend towards higher pregnancy rates as compared to agonist cycles [adjusted OR 2.89 (95% CI 0.88 -9.50); p=0.08](2). 

Laparoscopically Assisted Myomectomy

To the Editor:

We read with interest the article entitled “Surgical management of uterine fibroids in Hesse, Germany, between 1998 and 2004″ by Hesse et al (1). In doing so, we wonder how the authors identified the specific surgical route used for myomectomy and hysterectomy.

A call to provide multiple options for women in developing countries

To the Editor:

I was encouraged to read the article by Vayena et al, which justly addressed the needs of women experiencing infertility in developing countries (1). What is not clear is whether the authors are truly concerned with fairly evaluating “innovative approaches in treatment” (1) or whether they are simply one-sided advocates for assisted reproductive technology (ART).

Woman’s age and morphologic pattern should be taken into consideration while talking about “thin” endometrium

To the Editor:

We have read with great interest the excellent study by Miwa et al. (1) and would like to comment on the potential relationship between endometrial thickness, a woman’s age and endometrial morphologic pattern.

Acupuncture and IVF trial

I have some real concerns about the implications and conclusions drawn from the study of Domar et al. (1).

This study explores the effects of one protocol on IVF treatment. The study was indeed attempting to make sure that this was as close to the same protocol as used in the 2002 study.

Mathematical models used to determine sperm donor limits for infertility treatment

 

To the Editor:

In the August 2008 issue of Fertility and Sterility, Sawyer and McDonald provide a useful and insightful review of mathematical models used to determine sperm donor birth limits (1).  The review is timely, given recent policy deliberations around gamete-donation. 

Evidence of absence or absence of evidence? A reanalysis of the effects of low-dose aspirin in in-vitro fertilization

To the Editor:

We read with respect the article by Ruopp et al. (1) that has questioned the methodological approach of our previously published review (2) on the use of aspirin in in vitro fertilization cycles. We disagree with the authors in that random-effects models should only be used in the absence of inter-study heterogeneity. With fixed-effects models, it is assumed that there is a sole common effect estimates for all studies, i.e., the true effect of treatment, in both magnitude and direction, is the same value in every study.

Kabuki syndrome and sex chromosomal anomalies: Is it really an association?

 

To the Editor:

Kabuki syndrome (KS), described by Niikawa (1) and Kuroki (2), occurs in about 1 in 32,000 newborns (3) and is characterized by specific facial dysmorphism, mild to moderate mental retardation, short stature, skeletal abnormalities, prominent fingertip pads and a probably autosomal dominant inheritance. The patients that partially overlap these manifestations are included in the KS-like phenotype group. Up to now, no genetic basis was established, even if several cytogenetic abnormalities detected by karyotype, CGH and FISH have been reported. In particular, an association with different sex chromosomal anomalies (SCA) was reported.

Endometrin for luteal phase support in a randomized, controlled, open-label, prospective in-vitro fertilization trial using a combination of Menopur and Bravelle for controlled ovarian hyperstimulation

To the Editor:

I read with interest the article by Doody, et al (1). The literature support for the need for luteal support in IVF was presented by Daya and Gunby.(2) A recent reanalysis (3) of this meta-analysis suggests the use of vaginal progesterone to be as effective as IM Progesterone. In order to better understand this publication I seek a few points of clarification.

Premature ovarian failure and dehydroepiandrosterone

To the Editor:

We were very pleased to read the report by Mamas & Mamas (1), which reported success with  dehydroepiandrosterone (DHEA) treatment in women with premature ovarian senescence. Considering some of the questions such treatment has generated in the profession when we previously reported a series of controlled studies on DHEA supplementation (2-5), it is, however, of crucial importance that appropriate terminology be used when DHEA results are reported.

Association of sperm apoptosis and DNA ploidy with sperm chromatin quality in human spermatozoa

To the Editor:

We read with interest the recent article by Mahfouz et al. (1), and we have some observations.

First, the authors concluded that after semen processing, “the incidence of late apoptotic sperm remains unchanged.” This finding is not consistent with previous studies (2,3) and our recent report (4). The authors found the percentage of non-necrotic sperm (PI negative sperm) to be 63.1% in neat semen and 66.9% after density-gradient separation. In other words, the semen processing provided a sample with one third of PI positive (necrotic) sperm. Thus, assuming that necrotic sperm are immotile, the mean motility after semen processing was less than 67%. This is a surprising result, since the efficiency of density-gradient separation is usually much higher. In fact, the authors report that the sperm motility was significantly improved in all the samples after density-gradient separation. In our recent study, we found a significantly lower percentage of necrotic sperm in the capacitated fraction (8.4%) compared with neat semen (13.1%).

The evaluation of endothelial function with flow mediated dilatation and carotid intima media thickness in young nonobese polycystic ovary syndrome patients: existence of insulin resistance alone may not represent an adequate condition for deterioration of endothelial function

To the Editor:

A recent publication entitled “The evaluation of endothelial function with flow mediated dilatation and carotid intima media thickness in young nonobese polycystic ovary  syndrome patients: existence of insulin resistance alone may not represent an adequate condition for deterioration of endothelial function” (1) has shown that flow mediated dilatation (FMD) was not different between polycystic ovary syndrome (PCOS) and ovulatory women. The FMD in PCOS women was 24.88±9.63% and 22.35±9.40% in the control group. Comparing the values for basal brachial arterial diameter (3.54±0.37 mm and 3.81±0.66 mm; PCOS and control group, respectively) and stimulated brachial arterial diameter (4.41±0.39 mm and 4.65±0.77 mm) the observed dilation was really larger than 20% for both groups. However, the expected FMD in healthy people is 7% to 10%, while the expected FMD in patients with cardiovascular disease is 0 to 5% (2). Furthermore, the great majority of studies evaluating healthy people reported mean FMD between 3% and 15% (3).

Association of the protein Z intron F G79A gene polymorphism with recurrent pregnancy loss

To the Editor:

We have read with great interest the study by Dossenbach-Glaninger et al demonstrating a significant association between the protein-Z (PZ) intron 79G allele and recurrent pregnancy loss (1). In a recent study of 51 women with recurrent early pregnancy loss vs. 47 control women with at least one successful pregnancy and no spontaneous abortions, this finding was not confirmed (2); however, a significant association between low PZ levels and recurrent pregnancy loss was observed, in agreement with a previous larger-scale study (3).

Use of the levonorgestrel-releasing intrauterine system in breast cancer patients

To the Editor:

The observational study by Trinh et al.(1) concludes that there is a higher recurrence rate when breast cancers are detected during the use of a LNG-IUS and when it is not removed after diagnosis. Although the authors mainly generate several hypotheses around their observations, we would like to warn about  inappropriate interpretation of their data and premature conclusions, as such a message was released in a couple of Belgian newspapers recently.(2)

The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis

To the Editor:

We read with interest the review by Tsoumpou et al (1) that continues the debate on the surgical treatment of endometrioma and the effect of such surgery on the outcome of assisted reproductive techniques (ART).

Careful cardiovascular screening and follow-up of women with Turner syndrome before and during pregnancy is necessary to prevent maternal mortality

To the Editor:

The recent paper from Boissonnas et al. (1) reporting the tragic death from aortic dissection and rupture of  a women with Turner syndrome in the third trimester of an oocyte donation pregnancy raises important issues concerning the current guidelines for attempting pregnancy in women with this disorder (2). The current ASRM guidelines require preliminary cardiovascular screening using echocardiography to identify women with known risk factors for aortic complications such as abnormal aortic valve, aortic dilation (diameter >4 cm) or coarctation. However, recent studies show that routine transthoracic echocardiography fails to reveal significant pathology in many women with Turner syndrome (3, 4) and that 4 cm may signify  aortic dilation in small women (5).

Generational Amnesia

To the Editor:

I read with interest the study by Deb and colleagues who have surveyed UK gynecologists to determine their preferred method for performing endometrial ablation (EA) (1). Certainly there is value in determining the relative use of various EA techniques on a national level, remembering that the outcome will likely vary considerably among various countries and provider systems.

Modified ultrasound scanning is a cost-effective method for the detection of deep infiltrating endometriosis

To the Editor:

We were very pleased to read the well-written study of Bazot et al (1), which compares the value of physical examination, transvaginal sonography (TVS), rectal endoscopic sonography, and magnetic resonance imaging (MRI) for the assessment of different locations of deep infiltrating endometriosis (DIE).

Good news for women who suffer from endometriosis

To the Editor:

I read with great interest the study of Seracchioli et al (1), and I would like to start by warmly congratulating the authors. In fact, as gynecologist involved in the management of endometriosis, I have always been aware that postoperative long-term suppression of menses ought to follow the surgical procedure in order to reduce the recurrences. Now we have LE-1 data supporting the usefulness of postoperative long term medical treatment, and this is very good news for our patients!

Is perifollicular vascularity assessment always feasible and clinically effective?

To the Editor:

We read with great interest the recent paper by Robson et al. (1). The authors described their experience on power Doppler assessment of perifollicular vascularity (PV) at the time of ultrasound-guided transvaginal oocyte retrieval in infertile patients who underwent in vitro fertilization (IVF) showing that this procedure is practical and reproducible, and concluding that it should be tested in larger studies in order to define its clinical value.

Dehydroepiandrosterone sulfate and insulin resistance in patients with polycystic ovary syndrome

To the Editor:

We would like to thank Dr. Brennan et al for their fine article (1). In this study, they found that dehydroepiandrosterone (DHEAS) was negatively correlated to insulin resistance in patients with polycystic ovary syndrome (PCOS) and the independent variables that affect the insulin resistance, in decreasing importance, were body mass index (BMI), waist-to-hip ratio (WHR), age, DHEAS, free testosterone (T), sex hormone binding globulin (SHBG) and 17-hydroxyprogesterone (17-OHP).

Unexplained Infertility and Inherited Thrombophilia

To the Editor:

Approximately 15% to 30% of couples (1) will be diagnosed with unexplained infertility (UI) after their diagnostic workup as suggested in guidelines (2) fails to reveal any abnormality. The treatment for unexplained infertility is therefore, by definition, empiric because it does not address a specific defect or functional impairment (1).

The endometriosis-ovarian cancer connection: the case against preventive surgery/CA-125 as a biomarker for malignant transformation of endometriosis

To the Editor:

In their informative review on the relationship between endometriosis and ovarian malignancy (1), Nezhat and co-workers conclude that, given “the strong relationship between endometriosis and ovarian cancer […], appropriate and timely resection and elimination of disease should be practiced.”

Modern Trends in Reproductive Organ Transplantation Advances and Controversies

To the Editor:

The highly erudite and learned review by Bedaiwy, Shahin and Falcone (1) has excellently addressed most of the issues regarding ovarian transplantation and oocyte preservation, but has omitted a few of the classic presentations related to tubal and/or tubo-ovarian transplantation.

Risk of birth defects increased in pregnancies conceived by AHR

To the Editor:

In a recent publication, using the Niday Perinatal Database from 82 primary and tertiary centers in Ontario for 2005, El-Chaar et al found that assisted human reproduction (AHR) procedures increase the risk of birth defects in a retrospective cohort design (1).  

Is there any difference among the most frequently used laparoscopic ovarian drilling techniques?

To the Editor:

I read with interest the article by Hendriks et al. (1) and I would like to express certain considerations. Since polycystic ovary syndrome (PCOS) ovaries in humans have different endocrinologic and morphologic properties, the normal bovine ovary model for the evaluation of the amount of damage at different energy modalities seems inadequate. The PCOS ovaries in human are mostly bigger (volume difference), contain several subcortical antral follicles (morphologic difference), are usually anovulatory (functional difference) and secrete more androgen than the non-PCOS counterparts (endocrinologic difference).

Comment on “Body mass index is an independent risk factor for the development of endometrial polyps in patients undergoing in vitro fertilization.”

To the Editor:

We would like to make some comments on the paper by Onalan et al (1). In this paper, the authors found that obesity could be a factor in initiating the growth of an endometrial polyp because they identified obesity as the only independent risk factor using logistic regression analysis.

Evidence-based medicine or just a theory?

To the Editor:

Recent correspondence in this journal (1,2) renewed interest in GnRH agonist therapy as an “ovarian protectant” in female patients undergoing chemotherapy. Do we have evidence-based data to recommend this treatment? Twenty-eight years ago the concept was first introduced. One would expect an “evidence-based” answer to the question, by now. After all, this is a classic question that can only be answered by a multi-center, randomized prospective study.

Do we have the answer?

Reassurance of safety of letrozole and suggested approaches in controlled ovarian hyperstimulation

To the Editor:

We read the article by Dr. Dickey with interest (1). Although it covers many aspects of ovulation induction and related multiple pregnancies, we believe some points require further comment.

Criteria for the polycystic ovary syndrome

To the Editor:

I have read with interest the extensive revision and establishment of criteria for the polycystic ovary syndrome (PCOS) by The Androgen Excess and PCOS Society (1). Certainly I agree with most of the concepts stated, but I would like to point out some with which I disagree:

The outcomes of pregnancy following laparoscopic cornuotomy for interstitial pregnancy

To the Editor:

I have read the recent article in press by Eun et al (1) with great interest. The authors described their clinical experiences in laparoscopic cornuotomy in interstitial pregnancy using a temporary tourniquet suture and diluted vasopressin injection.

Re: Asymmetric dimethylarginine levels and carotid intima-media thickness in obese patients with polycystic ovary syndrome and their relationship with metabolic parameters

To the Editor:

We would like to thank Dr. Pamuk et al. for their fine article (1). In this study, they found that there were no significant differences in asymmetric dimethylarginine (ADMA) levels and intima media thickness (IMT) in polycystic ovary syndrome (PCOS) group compared with controls. In addition, there was no relationship between ADMA and IMT in the study.

IVM of immature oocytes in stimulated cycles

Johnson et al’s (1) efforts to rescue and utilize immature oocytes generated during ovarian stimulation cycles which would otherwise be wasted are commendable. This author’s experience in a similar endeavor (2) suggests that ovarian stimulation regimes may generate approximately 20% immature oocytes (1, 2), which is a significant loss if efforts are not made to rescue and utilize them.

Comments to article Sildenafil citrate (Viagra) impairs fertilization and early embryo development in mice by Glenn et al.

To the Editor:

The article entitled Sildenafil citrate (Viagra) impairs fertilization and early embryo development in mice by Glenn et al. (1) was of great interest. However, the presented data should be clarified from a teratological point of view, as it is insufficient for any further toxicological evaluation, in particular the human risk assessment.