The Births of Five Spanish Babies From Cryopreserved Donated Oocytes

Abstract

This randomized, prospective study was performed to compare 2 techniques used to reduce the size of an enlarged uterus before vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH). Thirty patients scheduled to undergo vaginal hysterectomy or LAVH were randomized to have uterine reduction performed using either bisection/morcellation (group I, n ϭ 14) or myometrial coring (group II, n ϭ 16). The 2 groups were comparable in clinical and demographic characteristics, including preoperative uterine size, operating times, surgical outcomes, and use of laparoscopic assistance. There were no conversions to laparotomy and no major perioperative complications. The uterus was successfully removed in all cases. The uterus weighed more than 280 g in 81% of the patients in group I (bisection/morcellation) and in 73% of the patients in group II (myometrial coring). There were no significant differences between the 2 groups in operative details except for the rate of extraction failure. In 4 patients (25%) in group II, myometrial coring failed to reduce the size of the uterus, necessitating the use of the bisection/morcellation technique to complete the operation. All reduction attempts were successful in group I (P ϭ 0.06 for difference). Blood loss and transfusion rate were similar in both groups (3 transfusions required in group I and 2 in group II). Postoperative data were similar in both groups with the exception of a greater number of patients with postoperative fever (28%) among those who had myometrial coring compared with bisection/morcellation (P ϭ 0.03). Most uterine characteristics were similar in women in whom uterine reduction with myometrial coring was or was not successful. However, myometrial coring failure occurred more often when the uterus was narrow (68.3 Ϯ 2.3 mm) compared with wide (83.9 Ϯ 9.6 mm; P ϭ 0.01) and less often in uteri heavier than 280 g. EDITORIAL COMMENT(There are many advantages to vaginal hysterectomy, and the skilled gynecologic surgeon will find the vaginal approach in the patient with an enlarged uterus both challenging and, hopefully, satisfying. However, there are several ad-vanced surgical techniques that are required to facilitate the removal of an enlarged uterus. In this article, Nazah and his colleagues from Paris compared bisection and morcellation with myometrial coring in a prospective, randomized, GYNECOLOGY Volume 59, Number 2 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT At the Mayo Clinic, vulvar vestibulitis is treated with vestibulectomy consisting of simple excision of the vulvar vestibule as described by Bornstein and Kaufman. The authors conducted a review of the medical records of their patients who underwent vestibulectomy between 1986 and 2002, and identified 45 who met the definition of vestibulitis described by Friedrich: 1) focal, reproducible points in the vestibule exquisitely tender to light touch; 2) coincident focal area of erythema; and 3) a history of superficial dyspareunia or severe pain on attempted vaginal entry. In addition, a ...

Report of four donor-recipient oocyte cryopreservation cycles resulting in high pregnancy and implantation rates

“…Yang et al required 17 frozen oocytes to achieve one pregnancy (seven pregnancies from 120 frozen and thawed oocytes) (19). In 2003, Fosas et al reported on the need for 22 frozen donor oocytes to achieve one pregnancy (four pregnancies using 88 frozen and thawed oocytes) (20). In our study, 3 out of 4 patients became pregnant, with a total of six embryos implanting and resulting in ongoing pregnancies, representing the need of only 13 frozen and thawed oocytes to achieve an implantation (six fetal heartbeats from 79 frozen and thawed oocytes).…”

Oocyte cryopreservation

“…Higher survival rates were obtained when oocytes were cryopreserved in 0.3 mol/L vs. 0.2 mol/L sucrose (60% vs. 82%) and when longer exposure to the cryoprotectant (10.5 to 15 min) was used. Other investigators using comparable slow-freeze methods reported similar survival and fertilization rates but higher pregnancy rates, ranging from 33% per embryo transfer with autologous oocytes (36), up to 57.1% when cryopreserved donor oocytes were used (37,38).…”

Vitrification of oocytes produces high pregnancy rates when carried out in fertile women

“…Porcu et al (2)(3)(4) described the freezing of metaphase II (MII) oocytes by the slow-freezing method. Other groups using the slow-freezing protocol reported 43% to 90% survival rates (6,8,9,12,27) with PRs of 19% to 33%.…”

“…Since the first successful pregnancy from frozen human oocytes was reported 20 years ago (1), many researchers around the world have exerted great effort attempting to make this part of the infertility treatment armamentarium. For the most part, efforts have been focused on the conventional slow-freezing method (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). More recently, vitrification methods have been adopted and studied by many researchers (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”