It’s time to pay attention to the endometrium, including the nucleolar channel system

29 09 2011

To the Editor:

In the context of the excellent Views and Reviews devoted to the endometrium (1), Dr. Bruce A. Lessey offers a thorough analysis of 186 publications that are of significance to the window of implantation (WOI) (2). We feel this already exhaustive effort needs to be expanded further. Although one histological hallmark of midluteal endometrium – pinopodes (whose significance as markers of endometrial receptivity has been questioned) – is reviewed in detail, another, the nucleolar channel system (NCS), went unmentioned. The presence of NCSs distinctly marks the midluteal phase of human endometrium overlapping with the WOI. Read the rest of this entry »

Gestational Sac Aspiration and Instillation for Treatment of Early Ectopic Pregnancy

14 09 2011

To the Editor:

We thank Cepni et al. for sharing their recent case series, “An alternative treatment option in tubal ectopic pregnancies with fetal heartbeat: aspiration of the embryo followed by single-dose methotrexate administration” (1). This was of great interest to us, as we have used a similar aspiration and instillation technique using hyperosmolar glucose to treat a heterotopic pregnancy created after in vitro fertilization (IVF). Read the rest of this entry »

Should there be a/ny limit to IVF cycles? A rejoinder to Stewart et al.

6 09 2011

In a recent paper, Stewart et al. (1) report the probability of a live delivery over real time in a population-based cohort of women undergoing in vitro fertilization (IVF) treatment at clinics in Western Australia. They suggested that women should persevere in IVF treatment. However, they did not mention any limit on IVF cycles. Moreover, in the report by Stewart et al., the success rate of live deliveries reaches a plateau (meaning zero new deliveries) long before the 180 months and the number of cycles for which they had data. This means that women may continue with IVF treatment even when the probability of a successful outcome is “zero,” which begs the question of whether there should be any limit on IVF cycles. Undoubtedly, IVF has been a milestone in reproductive medicine, as millions of babies (five million up to 2006) have already been born with the aid of IVF. However, many questions about IVF still remain (2). One of these questions is the effect/s of long-term IVF treatment on women (3). Read the rest of this entry »