High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners

To the Editor:

We read the article by Meuleman et al. (1) with interest. The high incidence of endometriosis (47%) and other pelvic pathology (29%) in this cohort makes a strong case for offering laparoscopy and hysteroscopy to couples with “unexplained infertility” (a diagnosis of exclusion). This diagnosis however requires confirmation of tubal integrity, and the issue is whether laparoscopy should be the first-line investigation to establish tubal patency. The authors did not say how many women in their cohort had a completely normal pelvis following laparoscopy and hysteroscopy.

Patient’s fertility desire should be taken into consideration in the surgical treatment algorithm of infiltrating endometriosis

To the Editor:

We read with great interest the manuscript by Fanfani et al., which reports their experience with laparoscopic treatment of bowel-infiltrating endometriosis (1). The authors analyzed their patients in regards to operative long-term complications, pain relief and recurrence rate, and suggest a surgical management algorithm. However, women with bowel endometriosis, besides having gastrointestinal symptoms and pain, frequently suffer from infertility.

The unresolved origin of uniparental diploid cell lines

To the Editor:

I should like to comment on the interesting report of Morales et al. (1) describing prenatally detected cases of androgenetic/biparental mosaicism.

Cross-over design trials in infertility: How much multiplicity is too much?

To the Editor:

We read with interest the article by Francavilla et al. published in the recent issue of the Journal (1). The authors set out to “analyze the effectiveness of intrauterine insemination with or without mild ovarian stimulation in male subfertility using a prospective cross-over design.”

Endometrial preparation for in vitro maturation treatment

To the Editor:

We read with great interest the paper published recently by Elizur et al. in the September 2009 edition of Fertility and Sterility (1). The authors compared retrospective data of two different protocols used to perform in vitro maturation treatment (IVM) based on physician preference: only micronized 17β-estradiol (6-12 mg/day) for endometrial preparation or human menopausal gonadotropins (HMG) 150 IU/day to induce both endometrial preparation and mild follicle stimulation.

Questions regarding the progesterone pharmacokinetic study.

To the Editor:

We disagree with the results of the trial by Blake et al. (1) with regard to the pharmacokinetics of Crinone and Endometrin.

Serum antimüllerian hormone (AMH), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in women with polycystic ovary syndrome (PCOS).

To the Editor:

We have read with great interest the study by Singer et al. (1) and we would like to comment on the relationship between anti-müllerian hormone (AMH), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in polycystic ovary syndrome (PCOS).

It ain’t necessarily so…

To the Editor:

I have read with interest the case report by Azem et al. (1), and congratulate them. However, several points need clarification:

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

To the Editor:

We read the article by Tsoumpou et al. (1) with interest and commend the authors’ attempt to address this topical issue. The decision on what to do with regard to endometriomas in women having IVF remains an everyday challenge. The authors have done well to summarize the available data addressing this issue.

Creatsas modification of Williams vaginoplasty: more than 20 years of experience

To the Editor:

In a recent article in Fertility and Sterility, Fedele et al. discuss the efficacy of the Williams vaginoplasty as a method of treatment for the colpopoiesis in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome patients with a pelvic kidney, and compare the safety and efficacy of this method with those of the Vecchietti’s laparoscopic modification. (1)

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.

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.

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.

Protocol for luteal-phase clomiphene citrate in women with PCOS

To the Editor:

It was an interesting article by Badawy et al. on luteal-phase clomiphene citrate (1). There were two points on which I would like to request clarification.

45,X infertile males: not so rare

To the Editor:

That so-called 45,X infertile or sterile males are seldom ascertained is well illustrated by a recent case report in Fertility and Sterility (1) in which the authors only refer to three other infertile males (2-4). Yet, it seems pertinent to point out that at least six further 45,X infertile males have been described in full (5-10); moreover, another patient was found among 84 infertile men (11).

Follicle-stimulating hormone receptor (FSHR) polymorphisms and polycystic ovary syndrome (PCOS)

To the Editor:

We were very pleased to read the recent report by Achrekar et al., in which the authors studied the association between the FSHR gene and occurrence of ovarian hyperstimulation syndrome (OHSS) in Indian patients (1). We would like to make some comments.

Embryonic Heart Rates

To the Editor:

It continues to bewilder me why articles such as the one by Rauch et al. (1) continue to stratify the embryonic heart rate (EHR) rather than performing a simple regression analysis of the EHR on the embryonic age when it has been shown that there is a linear relationship (2-6). It seems researchers continue to look for a lower threshold for the EHR, when it is obviously age and embryonic size relationship (Figure).

Terry J. DuBose, M.S., R.D.M.S., F.S.D.M.S., F.A.I.U.M.
Associate Professor & Diagnostic Medical Sonography Program Director
University of Arkansas for Medical Sciences, CHRP
Little Rock, Arkansas

Re: Laproscopic metroplasty in bicornuate and didelphic uteri

To the Editor:

Alborzi et al. (1) described the technique of laparoscopic metroplasty for didelphic uteri and bicornuate uteri. The indication for the metroplasty is history of recurrent spontaneous abortions in less than 5 months of pregnancy. Three months after metroplasty, they did laparoscopic and hysterscopic examination. The laproscopic examination of the pelvic cavity revealed filmy adhesions of the uterus to the omentum; the hysteroscopy revealed spacious uniform cavity. They also found a sub-septum at the fundus of the unified uteri.

Re: Serologic markers of autoimmunity in women with the polycystic ovary syndromeTo the Editor:

To the Editor:

I would like to thank Dr. Hefler-Frischmuth et al. for their fine article (1). In this study, they found that women with polycystic ovary syndrome (PCOS) had significantly elevated serum levels of antihistone and anti-double-stranded DNA (anti-dsDNA) antibodies, whereas serum levels of anti-nuclear antibodies (ANAs) and antinucleosome antibodies were similar between PCOS and healthy controls. When autoimmune markers were correlated with clinical and biochemical parameters, a significant correlation between serum levels of ANAs and serum thyroid stimulating hormone (TSH) were established.

The Obstructed Hemivagina, Ipsilateral Renal Anomaly, Uterus Didelphys Triad

To the Editor:

We read with interest the paper by Asha and Manila published in September 2008. (1) Here the authors described a case of the triad of obstructed hemivagina, uterus didelphys and ipsilateral renal anomaly.