Life-table analysis falls short of the mark!
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Adult↗
Biomedical subjects
Peter G A Hompes
Publications and source records attributed to Peter G A Hompes.
Investigation of the infertile couple: should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination?
Diagnostic laparoscopy is normally the standard procedure performed as the final test in the infertility work up before progressing to infertility treatment. Recently, there has been a growing tendency to bypass diagnostic laparoscopy after a normal hysterosalpingogram and instead to start direct infertility treatment [intrauterine insemination (IUI) or IVF] for indications such as unexplained infertility, male subfertility and cervical hostility. In our clinic, laparoscopy revealed abnormalities that resulted in changed treatment decisions in 25% of the patients who would normally have been scheduled for IUI if laparoscopy had not been performed. The changed treatments mainly concerned surgery for minimal/mild endometriosis and periadnexal adhesions, both performed during the diagnostic laparoscopy. Because the effect of such interventions on the success rate of IUI has never been described, it still remains unclear whether laparoscopy is usefully performed in these cases. Therefore, further prospective studies should be performed to assess whether delaying, or bypassing entirely, diagnostic laparoscopy is more cost effective and if laparoscopic interventions for intra-abdominal abnormalities are effective in terms of higher pregnancy rates after treatment with IUI.
Endometriosis↗
GnRH agonists, antagonists, and assisted conception.
Pituitary stimulation with pulsatile gonadotropin-releasing hormone (GnRH) induces both follicle-stimulating hormone and luteinizing hormone (LH). Blockade of pituitary gonadotropin secretion occurs upon desensitization when a continuous GnRH stimulus is provided by means an agonist or when the pituitary receptors are occupied with a competitive antagonist. The most common indication for blockade of pituitary gonadotropin secretion is with assisted reproduction treatment (ART) where it prevents premature luteinization. Originally by lack of clinically available GnRH antagonist, prolonged daily injection of agonist with its desensitizing effect was introduced for this purpose. Today, single- and multiple-dose injectable antagonists are also available to block the LH surge. This review provides an overview of the use of GnRH agonists and antagonists in assisted reproduction.
Fertilization↗
The impact of the embryo transfer catheter on the pregnancy rate in IVF.
BACKGROUND: The aim was to assess whether the type of embryo transfer set used for embryo transfer affects the ongoing pregnancy rate in IVF. METHODS: The TDT set was compared with the K-soft 5000 in a large, prospective, randomized study. Patients were randomized moments before transfer by drawing a consecutively numbered, sealed, opaque envelope indicating the catheter to be used. RESULTS: 2059 embryo transfers in 1296 patients were analysed. The ongoing pregnancy rate was significantly higher in the K-soft group. If the first transfer of a patient (n = 1296) within this study period was analysed, the ongoing pregnancy rates were 27.1 versus 20.5% (P = 0.006). If the analysis is limited to patients that underwent their very first transfer ever (n = 607), the ongoing pregnancy rates were 30.3 versus 20.0% (P = 0.003) in favour of the K-soft. CONCLUSION: We conclude from these data that the type of embryo transfer set used for embryo transfer does affect the ongoing pregnancy rate and that the impact of the variable transfer catheter on the ongoing pregnancy rate increases when the a priori chance of pregnancy increases.
Adult↗