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Biomedical subjects

M Wikland

Publications and source records attributed to M Wikland.

At least 55 records · Page 3Linked to original sources
PubMed1995

Couples' willingness to pay for IVF/ET.

BACKGROUND: Many politicians and decision-makers in health care consider assisted reproduction an expensive and exclusive treatment despite the results of in vitro fertilization/embryo transfer (IVF/ET) treatments having improved considerably during the last few years. With the improved results the costs in relation to successful outcome are decreasing. AIM AND METHODS: The aim of this study was to evaluate the cost-benefit of IVF/ET treatments in a group of infertile couples. The benefit was measured as willingness to pay (WTP) for IVF/ET treatment and was related to the cost of IVF/ET: For the calculation of costs, data from one private and one public IVF clinic in Sweden during the period from January 1992 to March 1993 were used. RESULTS AND CONCLUSIONS: The cost analysis showed a direct cost for IVF/ET of 3,170 pounds per started treatment and 9,410 pounds per delivery. Including the indirect cost, the total cost was 3,880 pounds per started IVF/ET treatment and 11,490 pounds per delivery. The survey of the WTP showed that the infertile couples gave high economic priority to infertility treatment. A majority of the couples were willing to pay more for a child than the calculated direct cost.

Attitude to Health↗
PubMed1994

Endometrial thickness as measured by transvaginal sonography: interobserver variation.

Transvaginal sonography of the uterus has become an important tool for diagnosing endometrial pathology in women with postmenopausal bleeding. One parameter that has been claimed to be important for curly detection of endometrial pathology in this group of women is the endometrial thickness. The purpose of this study was to evaluate the reproducibility of measurements of endometrial thickness as performed by five inexperienced doctors and one doctor experienced in the transvaginal sonography technique. The endometrial thickness as measured by the experienced doctor was regarded as the 'true measurement', and the mean discrepancy from this true measurement was 1.5 mm for the inexperienced doctors. No endometrial pathology was found at the histopathological examination after dilatation and curettage (D & C) when the endometrial thickness was measured as <or= 4 mm by both the inexperienced and the experienced doctors. However, there were considerable differences between the results obtained by the five inexperienced doctors. If this method is to be used for identifying those women who will not have a D & C performed, based on the findings of a thin endometrium (<or= 4 mm), training is needed in order to minimize the error. We believe that this will make measurement more accurate and it may then be used to exclude endometrial abnormality in women with postmenopausal bleeding.

Journal Article↗
PubMed1994

Transvaginal ultrasound-guided ovarian endoscopy: a novel approach to the assessment of ovarian tumors.

The investigation of ovulatory dysfunction and the characterization of ovarian cystic tumors remain two major problems in gynecology. One of our limitations is the resolution of imaging techniques currently available. We describe the use of a fiberoptic endoscope to inspect the internal appearance of five different ovarian cystic lesions under the guidance of transvaginal ultrasound. The images obtained allow the operator to visualize structures of less than 1.0 mm in diameter, and so introduce the possibility of identifying both the cumulus oophorus in younger women, and very small papillary projections within potentially malignant ovarian cysts.

Journal Article↗
PubMed1994

Subzonal insemination (SUZI) or in vitro fertilization (IVF) in microdroplets for the treatment of male-factor infertility.

PURPOSE: The results of subzonal insemination (SUZI) and in vitro fertilization with microdroplet insemination used in couples with male-factor infertility are presented. RESULTS: The total fertilization rate was 17.4% for SUZI (n = 89) and 49.3% for microdroplet IVF (n = 100). The fertilization rate for standard IVF (n = 510), not including any male-factor infertility and performed during the same period, was 73.2%. The "take-home baby rate" per started cycle and per embryo transfer (ET), respectively, was 10 and 17.6% for SUZI and 20 and 24.7% for microdrop IVF. For standard IVF these figures were 27 and 31.7%. CONCLUSION: It was concluded that microdroplet IVF can be used with good results in cases of moderate male-factor infertility. The normal (2PN) fertilization rate with the SUZI technique was only 15.1%. However, despite the low fertilization rate, SUZI should be considered when dealing with severe male-factor infertility.

Fertilization in Vitro↗
PubMed1994

Simplification of IVF: minimal monitoring and the use of subcutaneous highly purified FSH administration for ovulation induction.

During the past few years much effort has been put into simplifying the clinical management of in-vitro fertilization/embryo transfer cycles. One important step was the introduction of transvaginal ultrasound-guided oocyte collection, as previously described. This study describes further simplifications of the clinical management of ovarian stimulation. During the period 1st January 1991 to 31st August 1993, three major simplification steps were introduced. All cycles were down-regulated with a gonadotrophin-releasing hormone (GnRH) agonist according to a long protocol permitting fairly precise programming of the oocyte collection. During period I (n = 329 cycles), closer monitoring by several pelvic ultrasound scans and serum oestradiol was used for monitoring the ovarian stimulation. During period II (n = 230 cycles), only one ultrasound scan was used for monitoring the ovarian cycle; oocyte collections during weekends were avoided. During period III (n = 386 cycles), further simplification of the clinical management was introduced by using a highly purified follicle stimulating hormone (FSH) (Fertinorm/Metrodin HP), which was self-administered s.c. for ovarian stimulation. The take-home baby rates per started cycle for periods I, II and III were 16.4, 32.6 and 31.3% respectively. These figures indicate that when using long down-regulation with a GnRH agonist, simplification of the monitoring of the ovarian stimulation is possible without decreasing the pregnancy rate. Furthermore, the use of a highly purified FSH, self-administered s.c., greatly simplified treatment without compromising cycle outcome or increasing the risk of developing an ovarian hyperstimulation syndrome.

Adult↗
PubMed1994

Comparative study of transvaginal sonography and hysteroscopy for the detection of pathologic endometrial lesions in women with postmenopausal bleeding.

Dilatation and curettage is used as the "gold standard" for diagnosing pathologic endometrial lesions in women with postmenopausal bleeding. In this group of women, about 10% have an endometrial cancer and an additional 20% have some other endometrial abnormality. However, some abnormalities, such as endometrial polyps and submucous fibroids, are difficult to diagnose by dilatation and curettage. In such cases, combining transvaginal sonography with hysteroscopy may be of value. This study compared the use of transvaginal sonography and hysteroscopy for evaluation of the uterine cavity in women with postmenopausal bleeding. The study included 51 women, 39 of whom had an abnormally thick ( > 4 mm) endometrium as measured by transvaginal sonography, and 35 of 39 had an abnormal appearance at hysteroscopy. The sensitivity and specificity for the measurement of endometrial thickness using transvaginal sonography to diagnose an endometrial abnormality were 100% and 75%, respectively. The corresponding figures for hysteroscopy were 97% and 88%. In all women with an endometrial thickness of 8 mm as measured by transvaginal sonography, hysteroscopy is identified as an abnormality. The study indicates that transvaginal sonography reveals an endometrial thickness of > or = 8 mm and the histopathologic diagnosis after dilatation and curettage is atrophic endometrial polyp or submucous myoma.

Aged↗
PubMed1994

Adjuvant growth hormone treatment during in vitro fertilization: a randomized, placebo-controlled study.

OBJECTIVES: To explore the effect of recombinant, human GH on follicular development and oocyte retrieval after gonadotropin stimulation with the addition of GH or placebo to a standard IVF treatment regimen. Further, to investigate whether GH is a more effective adjuvant if the standard treatment regimen is preceded by GH injections. DESIGN: A randomized, double-blind, parallel, placebo-controlled study. SETTING: The IVF unit at university hospital. PATIENTS: Forty normally ovulating women, age 25 to 38 years, with infertility because of tubal factors and being classified as "poor responders" with at least two previously performed and failed IVF attempts. INTERVENTIONS: Human, recombinant GH (Genotropin, Kabi Pharmacia, Uppsala, Sweden) or placebo (0.1 IU/kg body weight per day) was given SC as pretreatment during down regulation with GnRH and during stimulation with hMG according to the randomized protocol. MAIN OUTCOME MEASURES: Number of oocytes retrieved after stimulation, total amount of gonadotropin used, time required for stimulation, number of follicles developing, rate of fertilization, and cleavage in vitro. Further, the quality of embryos, development of the endometrium, rate of clinical pregnancy, and serum and follicular fluid (FF) concentrations of insulin-like growth factor I (IGF-I), insulin-like growth factor binding protein-1 (IGFBP-1), and IGFBP-3 were estimated. RESULTS: The number of oocytes retrieved did not differ significantly between the groups, nor did the amount of hMG required for stimulation. The fertilization rate increased in patients who had received GH. Growth hormone caused a significant increase in serum and FF levels of IGF-I. An increase in serum IGFBP-3 could also be recorded in patients who had received GH. CONCLUSION: Although certain beneficial effects were noted in GH-treated patients, the overall results did not support GH as a clinically useful adjuvant treatment.

Adjuvants, Pharmaceutic↗
PubMed1993

Endovaginal scanning of the endometrium compared to cytology and histology in women with postmenopausal bleeding.

Endovaginal scanning (EVS) of the endometrium has recently been proposed as a method for the investigation of the endometrial mucosa. In this study, the specificity and sensitivity of EVS have been compared with endometrial cytology and D&C to discriminate between a normal and pathological endometrium. The study included 105 women who underwent preoperative endovaginal ultrasound investigation, endometrial cytology, and D&C because of postmenopausal bleeding. A specificity of 81% and a sensitivity of 97% in diagnosing morphological alterations by means of endovaginal ultrasound was found. The corresponding figures for cytological evaluation were 81 and 58%, respectively. We conclude that endovaginal ultrasound is a valuable diagnostic instrument for detecting pathological conditions in the uterine mucosa and as sensitive as endometrial cytology or D&C.

Aged↗
PubMed1993

Replacing diagnostic curettage by vaginal ultrasound.

Dilatation and curettage has for many years been the method of choice for diagnosing endometrial cancer in postmenopausal women. However, less than 10% of women with postmenopausal bleeding have an endometrial cancer. Vaginal sonography for measuring endometrial thickness, has in several studies proved to be a sensitive diagnostic method for diagnosing endometrial pathology. Our studies as well as others have shown that an endometrial thickness of 4 mm or less (including both endometrial layers) indicates a very low risk for endometrial carcinoma as well as any other major endometrial pathology in women with postmenopausal bleeding. Since vaginal sonography is such a simple and a non-invasive diagnostic method, it thus seems reasonable that vaginal sonographic assessment of the endometrium should be the primary method for excluding any endometrial abnormality in a woman with postmenopausal bleeding.

Aged↗
PubMed1992

The use of endovaginal ultrasound to diagnose invasion of endometrial carcinoma.

Endovaginal ultrasound was used in 30 women to characterize endometrial carcinoma with respect to myometrial invasion according to FIGO recommendations for surgical staging of endometrial cancer. The ultrasound data were correlated to macroscopic findings of the uterine specimen and to histopathology. Using endovaginal ultrasound, the sensitivity of detecting myometrial invasion of > 50% was 15/19 or 79%. However, the positive predictive value was 100%, in all cases when ultrasound suggested myometrial invasion of > 50%. This was confirmed on histopathological examination of the tumor specimen. Cervical tumor extension was correctly diagnosed in all six women in which it was present. Endovaginal ultrasound seems to be a reliable method of assessing tumor invasion and engagement of the cervix. This non-invasive method could be included as an important tool in the establishment of individualized treatment programs in women with endometrial carcinoma.

Journal Article↗
PubMed1992

Vaginal ultrasound in assisted reproduction.

Vaginal scanning of the ovaries and the uterus is a diagnostic and monitoring tool of utmost importance in assisted conception. Although the value of ultrasound for monitoring follicular growth has been questioned, few groups working on assisted conception do not use it. Follicle aspiration under the guidance of vaginal sonography is the method of choice. With such a simple and safe technique available, using laparoscopy for retrieving oocytes for assisted conception cannot be justified. The introduction of ultrasound-guided transvaginal retrograde tubal catheterization has meant that laparoscopic GIFT and ZIFT procedures will probably soon be unnecessary. Vaginal sonography is one of the most clinically important diagnostic instruments in assisted conception.

Embryo Transfer↗
PubMed1991

Endovaginal ultrasound scanning to identify bladder tumors as the source of vaginal bleeding in postmenopausal women.

The increasing frequency of bladder tumors with increasing age is well documented, but the incidence of bladder tumors in a subgroup at potential risk, i.e. women with postmenopausal bleeding, is, however, not known. In a prospective study of 400 women with postmenopausal bleeding, endovaginal scanning (EVS) was performed the day before planned dilatation and curettage (D & C). Five bladder tumors were identified. For comparison, the medical records of 4500 women admitted for D & C due to postmenopausal bleeding, during a 15-year period, were reviewed. These women were not examined by ultrasound preoperatively. Eight bladder tumors were found in these women. The number of bladder tumors found in women with postmenopausal bleeding was high, especially in the group of women that underwent endovaginal ultrasound, compared to the known incidence (25/100,000 women) in this age group. On the basis of the present data, it appears evident that EVS contributes to an early detection of bladder tumors. We emphasize the importance of scanning all women with postmenopausal bleeding with endovaginal ultrasound.

Journal Article↗
PubMed1991

Radiological study of changes in the pelvis in women following proctocolectomy.

The vagina, uterus and adnexa of 21 women who had a proctocolectomy for ulcerative colitis or Crohn's colitis were examined with vaginography and hysterosalpinography. Six healthy women were used as controls. A characteristic post-operative deformation of the adnexa and the vagina was demonstrated. In 17 of 21 women the fallopian tube anatomy was pathological, in four cases with total obstruction. These abnormalities explain why vaginal discharge, dyspareunia and involuntary sterility are common complaints in women after this type of surgery.

Adnexa Uteri↗
PubMed1991

Endometrial thickness as measured by endovaginal ultrasonography for identifying endometrial abnormality.

Diagnostic curettage has for many years been the method of choice to diagnose endometrial cancer in women with postmenopausal bleeding. The costs for curettage performed today are huge, and approximately only 10% in this group of women will be diagnosed with endometrial cancer. Thus less expansive techniques to obtain endometrial samples have been evaluated, but all of them are invasive. The value of endovaginal ultrasonography for identifying endometrial abnormality in this group of women has not been evaluated until now. This study used endometrial thickness as measured by endovaginal ultrasonography as an indicator of endometrial abnormality. It was demonstrated in 205 women with postmenopausal bleeding that if the endometrium was less than 9 mm thick, no endometrial cancer was found at curettage. The mean endometrial thickness in those women with endometrial cancer was 18.2 +/- 6.2 mm as compared with 3.4 +/- 1.2 mm in those women with atrophic endometrium. If the cutoff limit for endometrial abnormality was 5 mm, the positive predictive value for identifying endometrial abnormality was 87.3%. If this limit had been used in this study, 70% of the curettage procedures could have been avoided.

Endometrium↗