Introduction:
We aim to compare live birth rates, cost analysis and a survey of patient
attitudes between laparosopic tubal re-anastomosis and IVF.
Materials and Methods:
Retrospective study: A retrospective study was done in a single reproductive medicine
and IVF unit in Singapore, from January 2011 to December 2016. Previously ligated
patients underwent either laparoscopic tubal re-anastomosis or IVF. The primary
outcome was first live birth after treatment. Interval to first pregnancy, miscarriage
and ectopic pregnancies were also reported. Survey: Patients attending the subfertility
clinic completed a questionnaire on IVF and tubal re-anastomosis, on preferred choice
of treatment, before and after reading an information sheet.
Results:
Retrospective study: 12 patients underwent tubal re-anastomosis while 31 patients underwent IVF treatment. Pregnancy (75.0% vs 35.5%) and live birth (58.3% vs 25.8%) were significantly higher in the tubal surgery group (P<0.05%) after transferring all available embryos in one stimulated IVF cycle. Cost per live birth was lower in the tubal surgery group (SGD27,109 vs SGD52,438). Survey: One hundred patients participated in the survey. A majority of patients preferred tubal surgery to IVF (68.2% vs 31.8%) before given information on the procedures, but indicated a preference for IVF (54.6%) to surgery (45.4%) after receiving information on the procedures.
Conclusion:
For women less than 40 years of age, desiring fertility after tubal ligation, laparoscopic tubal re-anastomosis offers better live birth rates and cost-effectiveness. Patients in Singapore are equivocal as to their preference after education regarding the choices. Thus laparoscopic tubal re-anastomosis remains a viable alternative to IVF treatment.
Key words: Artificial reproductive technology, Laparoscopic tubal reversal, Previous
tubal ligation
Molar pregnancies are associated with extremely high levels of BhCG, out of proportion to the stage of pregnancy. However, urine and serum BhCG assays can paradoxically be negative, despite the high BhCG levels, leading to misdiagnosis and delayed treatment. This is due to saturation of the assay by the BhCG molecules. We present such a case where the initial urine pregnancy test was negative in an advanced complete molar pregnancy. Primary care and emergency department physicians should be mindful of this possibility and go on to do serum BhCG with sample dilution in cases where pregnancy is strongly suspected.
Anti-NMDAR encephalitis often causes profound neuropsychiatric symptoms in reproductive aged women. Diagnosis is based on identification of anti-NMDAR antibodies in the serum and cerebrospinal fluid (CSF), and such cases are commonly associated with ovarian teratomas. We present four cases of anti-NMDAR encephalitis with ovarian teratoma, and discuss their management, with special emphasis on the surgical approach. We propose laparotomy and systemic examination of both ovaries in such cases to avoid missing small teratomas.
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