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Biomedical subjects

S Gordts

Publications and source records attributed to S Gordts.

At least 19 recordsLinked to original sources
PubMed2000

Office transvaginal hydrolaparoscopy for early diagnosis of pelvic endometriosis and adhesions.

UNLABELLED: STUDY OBJECTIVE. To evaluate the feasibility of a new endoscopic technique, transvaginal hydrolaparoscopy, for early office screening of subfertile women. DESIGN. Retrospective, descriptive feasibility study (Canadian Task Force classification II-2). SETTING: Office in an infertility center. PATIENTS: One hundred fifty-seven continuous women with primary or secondary subfertility. INTERVENTION: Under local anesthesia, a Veress needle-cannula system was inserted into the posterior fornix with peritoneal distention by saline. MEASUREMENTS AND MAIN RESULTS: Access was achieved in 95% of patients. In 58.5% the findings were normal and in 28% an explorative or operative laparoscopy was indicated. No major complication occurred. Patients' pain scores were similar to those for office hysteroscopy. CONCLUSION: Transvaginal hydrolaparoscopy was successfully performed in the office. The technique allows early and complete endoscopic screening of subfertile women.

Ambulatory Care↗
PubMed2000

Hydrosalpinx and ART: hydrosalpinx--functional surgery or salpingectomy?

The debate on the effect of the hydrosalpinx on medically-assisted reproduction has demonstrated the importance of understanding the complex pathophysiology of the hydrosalpinx in outlining the principles of its clinical management, whether it is by functional surgery or IVF, preceded or not by salpingectomy. New endoscopic techniques are available to accurately assess, both in the operating room and the office, the quality of the tubal mucosa. The direct endoscopic evaluation of the tubal mucosa in hydrosalpinges is at present the most reliable technique to select between functional surgery and preventive salpingectomy. In future, prospective randomized studies on salpingectomy will benefit greatly from accurate clinicopathological data.

Fallopian Tube Diseases↗
PubMed1999

Diagnostic accuracy of transvaginal hydrolaparoscopy in infertility.

OBJECTIVE: To determine whether the accuracy of transvaginal hydrolaparoscopy is comparable to that of standard laparoscopy for the diagnosis of infertility. DESIGN: Prospective, comparative study. SETTING: General hospital in Belgium. PATIENT(S): Ten infertile patients without obvious pelvic pathology. INTERVENTION(S): Two gynecologists independently performed transvaginal hydrolaparoscopy and standard laparoscopy and reported the observations in a confidential manner to a third person. MAIN OUTCOME MEASURE(S): Endometriosis, adhesions, and other pelvic pathology related to infertility. RESULT(S): Minimal or mild endometriosis was diagnosed in seven patients and sequelae of pelvic inflammatory disease in one patient at both procedures. The interobserver agreement for tuboovarian adhesions was 95% at transvaginal hydrolaparoscopy and 74% at standard laparoscopy. Ovarian adhesions were detected in 63% at transvaginal hydrolaparoscopy and in 37% at standard laparoscopy. CONCLUSION(S): Transvaginal hydrolaparoscopy is comparable in accuracy to standard laparoscopy for the diagnosis of adhesions and endometriosis in infertile patients without obvious pathology.

Endometriosis↗
PubMed1999

Office hydrolaparoscopy for the diagnosis of endometriosis and tubal infertility.

Transvaginal hydrolaparoscopy has been described as an office procedure that is particularly suitable for the diagnosis of endometriosis and adhesions. It is recommended as a first line procedure in patients with infertility. The procedure is performed under local anaesthesia or sedation in an office setting. The abdominal distension is achieved by transvaginal instillation of warm saline using a combined Veress needle-trocar system. The exploration under fluid allows the inspection of the tubo-ovarian structures in their natural position and the easy identification of endometriotic lesions and adhesions in the posterior pelvis. The limitation of the inspection to the posterior pelvis is not a major problem for the diagnosis of endometriosis because exclusively anterior pelvis endometriosis is rare and of doubtful significance in infertility. Transvaginal hydrolaparoscopy can be performed in the office setting in combination with minihysteroscopy, tubal patency test and salpingoscopy, offering major advantages for the diagnosis of pelvic disease in patients with infertility.

Ambulatory Surgical Procedures↗
PubMed1998

Transvaginal salpingoscopy: an office procedure for infertility investigation.

OBJECTIVE: To evaluate the feasibility of salpingoscopy as an office procedure using transvaginal access to the pelvic cavity. DESIGN: Descriptive study. SETTING: Gynecology office. PATIENT(S): Infertile women with no obvious pelvic pathology. INTERVENTION(S): Transvaginal Veress needle puncture and peritoneal distension by saline. MAIN OUTCOME MEASUREMENT(S): Visualization of distal tubal segment. cannulation, and salpingoscopy. RESULT(S): The fimbriae were visualized in all patients. Cannulation of the distal tubal segment was achieved without manipulation of the tube in 20% before ovulation and 55% in the early luteal phase. CONCLUSION(S): Transvaginal fimbrioscopy and salpingoscopy can be performed as an office procedure in patients without obvious pelvic pathology. In combination with hydrolaparoscopy and dye hydrotubation, the technique provides comprehensive screening of the tuboovarian structures in the early stage of infertility investigation.

Ambulatory Surgical Procedures↗
PubMed1998

Intracytoplasmic sperm injection in the treatment of male subfertility.

OBJECTIVE: To evaluate the results obtained after intracytoplasmic sperm injection (ICSI) in couples with male factor subfertility. DESIGN: Retrospective analysis of results obtained after ICSI in the unit of in vitro fertilisation in a private centre for infertility. RESULTS: Application of ICSI in treatment cycles for male subfertility resulted in a fertilisation rate of 62%. An embryo transfer was done in 98% of the cycles, resulting in a 24% pregnancy rate/ET or 22% per cycle. CONCLUSION: ICSI is the first microfertilisation technique with reproducible high fertilisation rates in different centres and the method of choice in the treatment of severely impaired sperm quality. Although, up to now, no higher incidence of congenital malformations has been reported, except for sex chromosomal anomalies, careful genetic counselling is mandatory because of the risk of transmitting genetically defined male subfertility to the next generation.

Adult↗
PubMed1998

Performance of the sperm quality analyser in predicting the outcome of assisted reproduction.

The present study was undertaken to assess the relationship between the results of conventional semen analysis and the sperm motility index (SMI) as measured by the sperm quality analyser (SQA), and to evaluate these in relation to the fertilization and/or pregnancy outcome of assisted reproduction. SMI determinations and conventional semen analyses were performed on 223 samples from subfertile men in two laboratories in Leuven (n = 136) and Antwerp (n = 87), and on spermatozoa prepared on a Percoll gradient (n = 136) used for treatment of male factor infertility in 57 cycles of intrauterine insemination (IUI), 44 attempts at in vitro fertilization (IVF) and 31 attempts at intracytoplasmic sperm injection (ICSI). SMI values for native semen correlated significantly with sperm concentration, motility and morphology. Multiple regression analysis revealed sperm concentration after preparation, and the concentration of motile spermatozoa with normal morphology and SMI (before preparation) to be the independent determinants for SMI after preparation. SMI values were significantly higher after, than before, preparation (p < 0.0001). In regular IVF (n = 44) the percentage of fertilized oocytes correlated significantly (p < 0.05) with sperm motility (A + B%, r = 0.33), with the percentage of spermatozoa with normal morphology (r = 0.46) before preparation, with the values of SMI both before and after preparation (r = 0.54, r = 0.48), with sperm concentration (r = 0.34) and with the motile sperm concentration (r = 0.29) after preparation. For the occurrence of pregnancy (all treatment methods), comparison of areas under ROC curves (AURC) indicated motile sperm concentration after preparation, as well as SMI both before and after preparation, to have the highest AURC, with no significant difference between these values as far as predictive power was concerned. These results indicate that the SQA allows for rapid evaluation of sperm characteristics and of the effectiveness of sperm preparation techniques. However, it is not superior to conventional semen analysis in predicting the outcome of assisted reproduction.

Female↗
PubMed1998

Transvaginal hydrolaparoscopy as an outpatient procedure for infertility investigation.

A new technique called transvaginal hydrolaparoscopy is described for the exploration of the tubo-ovarian structures in infertile patients without obvious pelvic pathology. It aims to be an acceptable alternative to diagnostic laparoscopy, a standard but not innocuous procedure which infrequently reveals pathology in the asymptomatic patient. Transvaginal hydrolaparoscopy copy is performed under local anaesthesia using a small diameter optic with the patient in the dorsal position. Cavity distension is achieved with normal saline. Transvaginal hydrolaparoscopy does not provide the familiar and panoramic view of the pelvis given by laparoscopy, but it does have several advantages. These include accurate and atraumatic inspection of adnexal structures without manipulation, with the opportunity to perform dye hydrotubation and salpingoscopy. The risks of a general anaesthetic are avoided, and there is less risk of trauma to major vessels. The high patient acceptability makes transvaginal hydrolaparoscopy suitable as an early stage procedure in the investigation of infertility and as a repeat or second look procedure. Minor operative procedures such as biopsy and adhesiolysis can also be performed. In patients with obvious pelvic pathology, diagnostic laparoscopy will obviously remain the procedure of choice. Transvaginal hydrolaparoscopy deserves full evaluation of its accuracy, risks and benefits before it can be accepted as a new first line technique in gynaecological practice.

Ambulatory Care↗
PubMed1998

Endoscopic visualization of the process of fimbrial ovum retrieval in the human.

The process of ovum retrieval by the fimbriae in the human still remains elusive. Animal studies have suggested that ova can be 'sucked' into the oviduct by negative pressure caused by muscular contractions of the tube, while laparoscopic observations in women have indicated a close relationship between fimbriae and the ovulating ovary. Here, a case is described in which the process of ovum retrieval was observed directly using a new endoscopic technique, called transvaginal hydrolaparoscopy. The access is through the posterior fornix of the vagina and saline is used for distension. The tubo-ovarian structures during the process of ovum retrieval were visualized under fluid. The fimbriae on the ovulatory side appeared congested and tumescent and showed pulsatile movements synchronous with the heartbeat. The cumulus mass was adherent to the fimbriae and released from the site of rupture by the sweeping movements of the fimbriae until it disappeared between the rigid fimbrial folds. To the best of our knowledge this is the first direct observation of the process of ovum retrieval in the human. Vascular congestion causing erection and pulsatile movements of the fimbriae play a role in the retrieval of the ovum. The retrieval process from the site of rupture is slow and transport is achieved by ciliary activity only. The fimbrial changes are apparently controlled by the ovulatory ovary.

Adult↗
PubMed1997

The relationship between ovarian vascularity and the duration of stimulation in in-vitro fertilization.

The role of transvaginal pulsed colour Doppler ultrasound in the assessment of ovarian vascularity was studied in 196 in-vitro fertilization (IVF) cycles. The changes in ovarian blood flow after gonadotrophin-releasing hormone agonist (GnRHa) down-regulation and human menopausal gonadotrophin (HMG) stimulation were determined. The data obtained showed that the ovarian blood flow was significantly improved by oestradiol secretion (P = 0.05) and human chorionic gonadotrophin (HCG) administration (P = 0.003). Folliculogenesis was affected by blood flow supply. The resistance index (RI) value was significantly different (P = 0.05) according to the duration of ovarian stimulation. Patients with a mean RI value >0.56 had a longer stimulation with a significantly lower mean number of oocytes retrieved (P = 0.01) despite the administration of a standard dose of HMG. The RI value is a good indicator of modifications in ovarian vascularization during stimulation. Doppler blood flow measurement could be used to determine the optimal timing for the beginning of HMG administration in patients undergoing ovarian stimulation after down-regulation for IVF treatment.

Adult↗
PubMed1996

A unilateral hydrothorax as the only manifestation of ovarian hyperstimulation syndrome: a case report.

OBJECTIVE: To describe a rare case of unilateral hydrothorax occurrence after ovarian stimulation for IVF. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 39-year-old female suffering from primary infertility due to a severe male factor. INTERVENTION(S): Thoracocentesis with IV albumin administration for correction of a concomitant hypoalbuminemia. MAIN OUTCOME MEASURE(S): Laboratory values of hematologic measures and electrolytes, screening of the thoracic fluid aspirated for viral and bacterial infections, resolution of pleural effusion after the second thoracocentesis as determined by chest roentgenogram. RESULT(S): Treatment of this manifestation of the ovarian hyperstimulation syndrome (OHSS) by thoracocentesis with albumin perfusion. CONCLUSION(S): This report describes a very rare case of thoracic complication after ovarian stimulation. It demonstrates that pleural effusion may be the only manifestation of the OHSS and implies a careful management of patients with pulmonary complaints after treatment with exogenous gonadotropins.

Adult↗
PubMed1995

A magnetic resonance imaging approach for the diagnosis of a triplet cornual pregnancy.

OBJECTIVES: To describe a rare case of triplet cornual pregnancy after IVF-ET and to assess the role of magnetic resonance imaging (MRI) for early diagnosis. DESIGN: Case report. SETTING: Infertility and IVF Unit, in an university medical center. PATIENT: A 31-year-old healthy patient with a 3-year history of primary male infertility. INTERVENTION: Standard IVF-ET treatment cycle, using a GnRH-agonist (long protocol) and hMG for ovarian stimulation. RESULTS: A cornual triplet pregnancy is described with the approach for the diagnosis. Magnetic resonance imaging was complementary to endovaginal sonography for early diagnosis and permitted a timed conservative management. CONCLUSIONS: When transvaginal ultrasound findings did not provide an accurate location of the pregnancy, MRI was indicated to confirm the diagnosis.

Adult↗
PubMed1995

Uterine vascularity during stimulation and its correlation with implantation in in-vitro fertilization.

The changes in uterine artery blood flow in women undergoing in-vitro fertilization cycles were studied throughout stimulation after gonadotrophin-releasing hormone (GnRH) desensitization. The data obtained showed that the uterine vascularity was related to hormonal changes. The GnRH agonist effect was seen only after the third week of administration, and the uterine perfusion was significantly (P = 0.002) improved by the oestradiol secretion. Human chorionic gonadotrophins increased the resistance index (RI) significantly (P = 0.0001) for a period of 48 h. Then the progesterone secretion modified the curve with a significant improvement in the uterine blood flow (P = 0.03). Comparison of the RI value 2 days before human menopausal gonadotrophin (HMG) commencement, in patients with and without pregnancy, showed a higher RI in patients who did not conceive but no difference was observed on the day of embryo transfer. The pregnancy rates were similar whatever the range of the RI observed. The data available so far suggest that haemodynamic parameters alone, detected by Doppler sonography, do not provide full information on endometrial receptivity on the day of embryo transfer. A resistance index > 0.79 before HMG commencement seems to indicate poor uterine vascularity and may necessitate an increase in the HMG doses to prevent endometrial immaturity.

Adult↗
PubMed1995

Does treatment with testosterone undecanoate improve the in-vitro fertilizing capacity of spermatozoa in patients with idiopathic testicular failure? (results of a double blind study).

Seventy-seven couples in whom conventional in-vitro fertilization (IVF) had remained unsuccessful because of low fertilization rate and abnormal sperm characteristics were given either testosterone undecanoate 120 mg/day, or placebo during 3 months, after which a new IVF treatment was applied under identical technical conditions. There were no significant changes in sperm characteristics among the treated and placebo couples and the fertilization rate showed a similar increase after treatment in both groups. No significant difference in pregnancies occurred, with 32% pregnancies in the placebo controls and 17% among couples treated with testosterone undecanoate. It is concluded that testosterone undecanoate intake does not improve sperm characteristics, or the in-vitro fertilizing potential, or pregnancy rate over those observed in the placebo controls in cases with primary idiopathic testicular failure.

Adult↗