Comment on “Does cold loop hysteroscopic myomectomy reduce intrauterine adhesions? A retrospective study”

6 03 2014

To the Editor:

Ivan Mazzon et al. recently published an interesting paper focusing on “the prevalence and the characteristics of intrauterine adhesions after cold loop resectoscopic myomectomy” for G1 and G2 submucous myomas (1).

Although retrospective, the large number of operated patients (688) and removed myomas (806) make this study robust and relevant. The authors interestingly concluded that “cold loop resectoscopic myomectomy of G1-G2 myomas is effective and safe, with a prevalence of postsurgical intrauterine adhesions that appears to be lower than those reported in the literature. The technique we have described could thus contribute to improving fertility, making it especially noteworthy for patients who desire pregnancy.” Read the rest of this entry »

Toward adhesion-free endoscopy?

3 03 2014

To the Editor:

Although the influence of CO2 insufflation on adhesion formation remains controversial, its non-physiological effects include tissue acidosis combined with metabolic hypoxemia and other respiratory and cardiovascular alterations. Therefore, the suggested hypothesis in a recent article by Corona et al. (1) that CO2-pneumoperitoneum should be supplemented by N2O seems to be promising. Read the rest of this entry »

Should early cleavage (EC) be assessed in routine practice?

28 02 2014

To the Editor:

In a recent study (1), an important question has been mooted, namely, “Should we assess early cleavage between 25 to 27 hours after insemination, with the aim of yielding any benefit in the clinical outcomes?” The message I have been delivered by the results has been, “There was not any benefit of early cleavage assessment, unless all transfer embryos were of sub-optimal quality.” Promoted by ASEBIR with a clear aim to conclude with a scientifically based recommendation to embryologists, I think the results need to be evaluated under scrutiny. Read the rest of this entry »

Male infertility biomarkers and genomic aberrations in azoospermia

17 02 2014

To the Editor:

Estimates indicate that 15-30% (or more) of male infertility is due to whole-organism genetic abnormalities with large numbers of genes already discovered to play important roles (1, 2). Numerous methods have yielded new genetic discoveries with the karyotype, fluorescent in situ hybridization, comparative genomic hybridization and microarrays all contributing (1). All identified genetic aberrations are further complicated by epigenetic modifications (i.e., methylation and protamination), as well as individual differences and environmental influences that make diagnosis and treatment frustrating (1). Unfortunately, in many men, the result of multiple investigations often yields inconclusive, or slightly abnormal results, with a subsequent diagnosis of idiopathic infertility. Read the rest of this entry »

Microbiota of the seminal fluid

22 01 2014

To the Editor:

I read with great interest the article by Hou et al. (1) regarding the microbiota of the seminal fluid from sperm donors and infertile subjects. This study aimed to explore potential causes of male infertility and showed that increased number of bacteria were present in semen samples from infertile subjects as well as sperm donors. The topic of infections and infertility is extremely interesting, and there are still a lot of aspects to be covered.

The significance of bacteriospermia in subfertile men is controversial. When dealing with a sperm sample the possibility of contamination is always probable since the presence of normal flora cannot be overlooked. Moreover, it is quite challenging to evaluate which microorganisms significantly affect male fertility potential. However, bacteriospermia and leukocytospermia have a negative effect on male fertility through multiple proposed mechanisms (2). In the largest study to evaluate bacteriospermia, Domes et al. (2) commonly diagnosed in subfertile men bacteriospermia and leukocytospermia, which were associated with a significantly increased DNA fragmentation index. Read the rest of this entry »

Examining the ovaries by ultrasound for diagnosing hyperandrogenic anovulation: updating the threshold for newer machines

9 01 2014

To the Editor:

We enjoyed reading the article by Christ et al. (1). The discussion about ultrasound criteria, specifically where to put the threshold to distinguish between a polycystic and a normal ovary, has been ongoing for some time and will surely continue for a while yet. Although the results are somewhat predictable since this report is a reassessment of partial data from a previous study (2), the timing of this publication is important because it reinforces a recently published task force report (3). Change is long overdue, but we believe the recommendation of using ≥ 25 follicles per ovary (3) should be adopted promptly as it is clear that the former threshold of 12 follicles is obsolete due to the improvement in the resolution of ultrasound. However, physicians should be aware that a much lower threshold should be used when trying to identify women at high risk of having an excessive response to exogenous gonadotropins used in in vitro fertilization/intracytoplasmic sperm injection cycles. Women with a total antral follicle count (AFC) > 20, considering both ovaries, are already at a higher risk of ovarian hyperstimulation syndrome (4). Another important point to consider when choosing the best threshold are the differences observed in AFC during reproductive age (5). The question of using the same threshold or different thresholds depending on a woman’s age should be balanced between diagnostic test accuracy and ease of implementation. Read the rest of this entry »

The lack of clinical congruence in diagnosis and research in relation to subclinical hypothyroidism

8 01 2014

To the Editor:

We have just read a publication by Bernardi et al. on the topic of subclinical hypothyroidism and recurrent early pregnancy loss (1). Going through the paper we found that the opposite situation was being described, that is, no impact of subclinical hypothyroidism on recurrent early pregnancy loss. This puzzling situation motivated us to dissect the concepts presented by the authors.

One central point of misconception on thyroid function can be tracked down to a 2007 publication cited by Bernardi which recommended a “desirable TSH level” of 2.5 mIU/ml for pregnant women. In that original publication the authors had admitted that this recommendation was done on the basis of a poor level of evidence. Although this recommendation does not fulfill the principles of evidence-based medicine, it has very unfortunately found its way into clinical practice. Choosing a low cut-off value for the upper range of TSH, as Bernardi et al. have done, will result in a misclassification of normal subjects by which the apparent subgroups, euthyroids and women with subclinical hypothyroidism, are not truly subgroups but belong to a same group of subjects having TSH values within the normal range. Therefore it is logical that one cannot expect to find any difference between these artificial subgroups in relation to recurrent early pregnancy loss. Read the rest of this entry »