Does uterine artery ligation, performed because of a severe postpartum hemorrhage, alter fertility?

26 04 2011

To the Editor:

We read with interest the case series report by Blanc et al. that highlights the risk of synechia after uterine-sparing procedures (1). The authors concluded that their “results suggest that triple ligation (TUAL), with or without haemostatic multiple square suturing (HMSS), exposes patients to the risk of subsequent abnormalities of the uterine cavity.” (1).

Regarding HMSS, we could not agree more with the authors, as we have been attempting to alert physicians to the possible hidden mid-term or long-term effects of uterine compression sutures (2–6), although these procedures were adopted promptly throughout the world. Read the rest of this entry »





Androgen pre-treatment in poor responders undergoing controlled ovarian stimulation and IVF treatment

25 04 2011

To the Editor:

We updated our meta-analysis (1) following the recent publication of a randomized controlled trial (RCT) evaluating the effect of testosterone pre-treatment in poor responders undergoing IVF treatment (2).

Our updated meta-analysis of RCTs of adjuvant androgens [DHEA (dehydroepiandrosterone) and testosterone] in poor responders showed a significant improvement in the ongoing pregnancy/ live birth rates (RR 2.08; 95% CI: 1.10, 3.93; p = 0.002, Figure 1). Meta-analysis for the outcome of total dose of gonadotrophin consumption showed a significantly lower gonadotrophin consumption in the androgen supplementation group compared to the control group (WMD -464.66; 95% CI: – 612.90 to -312.42; p < 0.01, Figure 2). Read the rest of this entry »





Which surgery should be the first-line uterine-sparing procedure to control severe postpartum hemorrhage?

18 04 2011

To the Editor:

We read with great interest the case series reported by Rathat et al, which highlights the risk of synechia after uterine compression suture (1). The authors concluded that “even though ligation techniques require more surgical experience, we think that they should be the first choice for surgical management” (1).

We could not agree more with the authors, as we have been attempting to alert physicians to the possible hidden mid-term or long-term effects of uterine compression sutures (2–6), in particular in publishing our algorithm for management of postpartum hemorrhage (2, 7-8), whereas these procedures were adopted promptly throughout the world. In fact, to our knowledge, vessel ligation including uterine and/or hypogastric artery ligation seems to have no or limited impact on subsequent fertility (7). Nevertheless, we would like to highlight that surgical procedures involving uterine artery ligation (UAL), such as stepwise uterine devascularization or triple ligation (2, 4-5, 7-8), must absolutely be differentiated from hypogastric artery ligation (HAL), whereas many authors unfortunately pool these two procedures in the same entity of “vessel” (9) or “techniques” ligation (1). Read the rest of this entry »





Contamination of single-straw carrier for vitrification

11 04 2011

To the Editor:

We read with interest the recent article by Criado et al. (1) regarding the assessment of contamination of a single-straw ultravitrification closed carrier (Ultravit). They observed no contamination in any microdrops of medium contained in the closed devices, whereas the bacteria they used for forced contamination of liquid nitrogen (LN2) were present in 45% of open carriers’ strip (Cryotop). Read the rest of this entry »





Embryo Culture and pH

11 04 2011

To the Editor:

In their article “Differential pH in Embryo Culture” (1), Hentemann et al. attempt to demonstrate differential requirements of media pH during stages of mouse embryo development. Unfortunately, in its current state, it is not clear that any conclusion regarding pH can be drawn from the publication. In fact, results should be interpreted with caution. Read the rest of this entry »





Progesterone level and progesterone/estradiol ratio on the day of hCG administration: detrimental cutoff levels and new treatment strategy?

7 04 2011

To the Editor:

I read the paper by Elgindy (1) on the detrimental role of progesterone levels on the day of hCG administration in pregnancy rates.

The detrimental effect of the high steroid levels on endometrial receptivity is a matter of debate. The advances in the study of endometrial receptivity are providing us with deeper knowledge of the possible mechanisms (2). The advances in cryopreservation are helping to propose new strategies to make up for the endometrium-embryo desynchronization (3).

However, Elgindy’s article raises two points:

Firstly, the authors find through ROC analysis that the levels of P > 1.5 ng/mL and the rate of P/E > 0.55 on the day of hCG administration had a detrimental effect on the pregnancy rates in the cleave-stage embryo transfer compared with blastocyst-stage embryo transfer. However, in an earlier study (4), using the same kind of analysis and with a population of similar characteristics (normal response and long protocol) we did not identify a cut-off level that had prognostic value, for which reason we disagree with their conclusions. Read the rest of this entry »





Pitfalls in the Assessment of PON1 Status in Clinical Populations

7 04 2011

To the Editor:

We read with great interest the recent report by Soyman and colleagues (1) detailing relations between the high-density lipoprotein (HDL) associated enzyme paraoxonase (PON1), the endogenous nitric oxide synthase (NOS) inhibitor asymmetric dimethylarginine (ADMA), and flow-mediated dilatation (FMD) of the brachial artery, which is a non-invasive measure of endothelial function, in women with polycystic ovary syndrome (PCOS). Numerous other clinically relevant anthropometric, biochemical, and hormonal parameters were reported and compared with PON1 activity with the substrate paraoxon (ie, paraoxonase activity), ADMA, and FMD using Pearson correlation analyses. The finding of lower PON1 activity in the PCOS population is intriguing, but unfortunately difficult to evaluate based on the available data. Read the rest of this entry »