Response to commentary on manuscript: “The impact of fresh versus cryopreserved testicular sperm on intracytoplasmic sperm injection (ICSI) pregnancy outcomes in men with azoospermia due to spermatogenic dysfunction: a meta-analysis”

9 12 2013

To the Editor:

We appreciate the insightful comments of Dr. Kim (1). As he correctly states, the use of fresh versus cryopreserved sperm has been controversial. While the use of frozen sperm from men with obstructive azoospermia appears to yield equivalent outcomes to fresh sperm, the application to men with nonobstructive azoospermia (NOA) is less certain (2). However, if proven equivalent, Dr. Kim correctly emphasizes the significant logistical and economic burdens that could be improved for couples. Additionally, we agree with his assessment on the importance of methodology. We as male reproductive specialists do not have a standardized, evidence-based protocol for the cryopreservation of sperm. As such, we believe that there should be some caution in mentioning an established detrimental effect of cryopreservation. The analyses that produced such findings suffer the same methodological dependence that is inherent within essentially any cryopreservation data to date (3). Moreover, as data from men with obstructive azoospermia suggest equivalent outcomes, it appears that cryopreservation does not irreparably impact sperm function (2). Read the rest of this entry »

Uterus transplantation research at the cutting edge?

13 09 2013

To the Editor:

We appreciate Dr. Donnez’s interest in our recent manuscript and his insightful remarks on uterus transplantation (1).

Uterine factor infertility affects 3% to 5% of the population (2). Uterus transplantation aims to increase the quality of life in uterine factor infertility patients facing psychological and social problems related to the loss of female identity. Gestational surrogacy offers the only current option for being a genetic parent, with limited availability and potential ethical and psychological problems (3).

Research experience in animals is essential prior to the introduction and attainment of the clinical application of a new surgical innovation. This is especially important when the indication is not life-threatening. Dr. Brannstrom’s group remains the leading team in uterus transplantation research (4). His group has described the basic techniques for uterus transplantation and reported the first pregnancy following uterus transplantation in an experimental animal model.

Due to limitations in postoperative care, assisted reproductive technology (ART), poor control of serum immunosuppressive levels, and financial issues, animal models have not been able to give sufficient information regarding its feasibility and role in acquirement of fertility potential. Read the rest of this entry »

Regarding the effects of fibroids on obstetrical outcomes

4 05 2012

To the Editor:

We read the recent article by Shavell et al. (1) regarding the effects of fibroids on obstetrical outcomes and have the following comments:

First, the number of women in each group was very small (n=95) and the number of women with fibroids >5cm was much smaller (n=42). Compare this with the study by Stout et al. (2) where 2,058 women with fibroids were compared with 61,989 without fibroids, all of whom had routine second trimester ultrasounds. Stout reported significant differences in OR for placenta previa, abruption, PROM, preterm birth 5 cm. It would be helpful for the authors to describe criteria for transfusion. Read the rest of this entry »

Is it really the impact of controlled ovarian hyperstimulation on thyroid function?

1 06 2011

To the Editor:

I read with great interest the article by Poppe et al.(1) in which they found that serum TSH and fT4 levels increased 2 weeks after embryo transfer (ET) in both the ovarian hyperstimulation syndrome (OHSS) and no-OHSS groups compared with prestimulation levels and they addressed that controlled ovarian hyperstimulation (COH) had an important impact on thyroid function. They have done a good work. However, we have a question according to their data: is it really the impact of COH on thyroid function? Read the rest of this entry »

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 »

Defining Case Control Studies

6 04 2011

We read with great interest the article “Obstetric outcome of women with in vitro fertilization pregnancies hospitalized for ovarian hyperstimulation syndrome: a case-control study” by Courbiere et al. (1). It is our belief that, despite the title, the study did not adhere to the principles of a case-control study. Read the rest of this entry »

Pregnancy in women with PCOS

17 01 2011

To the Editor:

I read the article of Palomba et al (1) with great interest. This is the first study that investigates the pregnancy outcomes according to different phenotypes of polycystic ovary syndrome. They conclude that “The increased risk for adverse obstetric or neonatal outcomes, which are observed in women with PCOS, varies widely according to their different PCOS phenotypes and features.” Although it is clear that the results are attractive, some of the data in this paper need further clarification. Read the rest of this entry »