The perurethral technique for ultrasound directed follicle aspiration in an in-vitro fertilization and embryo transfer programme: a report of 636 patient cycles

Article Abstract:

In vitro fertilization is a method in which the ovaries are stimulated to produce eggs, which are then retrieved from the ovaries, fertilized outside of the body and reintroduced into the uterus to achieve pregnancy. Originally, eggs were retrieved by inserting a small tube called a laparoscope into the abdomen while the patient was under anesthesia. Ultrasound directed follicle aspiration (UDFA), a method of retrieving eggs using the guidance supplied by high frequency sound to visualize the ovarian egg follicles, is now widely used since it does not require anesthesia and can be performed without an overnight hospital stay. This ultrasound method can image the ovaries via the bladder (transabdominal) or the vagina (transvaginal). A variation of the abdominal approach, which entails inserting a needle to aspirate the eggs from the ovaries by entering the bladder through the abdominal wall, approaches the bladder via the urethra, the tube leading from the bladder. Follicles are emptied, the needle withdrawn and the guiding catheter is removed. The women can leave the hospital within two hours. The experience with the perurethral technique of UDFA performed between 1984 and 1988 on 545 women having 636 in vitro fertilization cycles is reported. The average follicle aspiration rate was 93 percent and the average number of eggs retrieved was around six. Small follicles and difficult access were the main reasons for failure to retrieve an egg. Minor complications were experienced by 34 women (six percent), and included blood in the urine (hematuria), escape of urine and puncture of nearby blood vessels. In 91 patients (14 percent) another route was needed to retrieve the eggs because it was difficult to reach all the follicles. The transvaginal route and the perurethral route have similar rates of retrieval success. The transvaginal route for egg retrieval is more advantageous because it uses transvaginal ultrasound, an improved ultrasound technique in which sound transduced through a probe inserted into the vagina produces a clearer image of the ovarian follicles. However, the perurethral route will be useful where practitioners do not yet have transvaginal ultrasound equipment or is cases where ovaries are not accessible using the vaginal route or in women with current vaginal infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Innovations, Fertilization in vitro, Human, Human fertilization in vitro, Fertilization in vitro

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Cerebral doppler ultrasound of the human fetus

Article Abstract:

Doppler ultrasonography is a diagnostic tool that uses high frequency sound to study the flow of blood through vessels. Waveform patterns produced by Doppler studies can reveal the character of blood flow through the vessels in the brain of fetuses. It has been suggested that fetuses with abnormal growth during pregnancy, intrauterine growth retardation (IUGR), have compromised blood flow in the blood vessels supplying the brain. However, studies suggesting an abnormal Doppler pattern in fetuses with IUGR have had poor test sensitivity. To confirm the presence of an abnormal waveform pattern in the brain blood vessels of growth retarded fetuses, a combination of high-resolution real-time and pulse-directed Doppler ultrasonography (duplex sonography) was used. The blood vessel velocity was measured in the internal carotid artery (ICA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and anterior cerebral artery (ACA) in 55 normal and 14 growth retarded fetuses. In the normal pregnancies, blood flow patterns were acceptable in 89 percent of the ICA, 91 percent of the MCA, 58 percent of the PCA, and 64 percent of the ACA. The blood flow patterns were significantly lower in all the brain blood vessels examined in the fetuses with IUGR. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cerebral circulation, Fetus, Fetal growth retardation, Regional blood flow, Duplex ultrasonography

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Embryonic heart activity: appearance and development in early human pregnancy

Article Abstract:

Detection of the fetal heartbeat is one of the first signs of a viable pregnancy. In the past, this was detected at 45 to 47 days of amenorrhea (no menstruation) using abdominal ultrasound. However, vaginal ultrasound is more sensitive, as the probe is much nearer to the uterus. The appearance of the fetal heartbeat was evaluated by vaginal ultrasound in 47 women who became pregnant by in-vitro fertilization. Cardiac activity was detectable as early as 25 days after egg fertilization, but this varied by as much as 5 days. This variability existed even in multiple pregnancies (twins or triplets), suggesting that fetal rather than maternal factors were significant. A later appearance of the heartbeat was associated with a higher chance of miscarriage. The initial heart rate was 90 beats per minute (bpm) on day 26 and increased gradually to 165 bpm. Heart rate correlated with the size of the embryo, measured as crown-rump length. Heart rates in pregnancies which miscarried tended to be normal initially, but then declined from the average values observed in normal pregnancies. Further research is needed to explore the significance of these observations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical examination, Physiological aspects, Human embryo, Fetal heart rate, Fetal heart

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