Tubal function tests generally provide evidence of patency only. We wish to know if there are blocked fallopian tubes. The earliest work on the subject was published in 1920 by Rubin - The Rubin Test, when it was demonstrated that if the tubes are patent, oxygen introduced through the cervix would pass into the peritoneal cavity. Initially, passage of the gas was checked by listening over the lower abdomen with a stethoscope. The concept that investigation of tubal patency may be therapeutic (increase the likelihood of pregnancy) also dates from about that time. More reliable tests are: In the 1940s hysterosalpingography (HSG) was introduced. A radio-opaque dye was introduced through the cervix and an x-ray picture was taken to track the dye through the uterus and Fallopian tubes (Figure 9.3). The mechanism of this anovulation is uncertain, but there is evidence of arrested antral follicle development, which, in turn, may be caused by abnormal interaction of insulin and luteinizing hormone (LH) on granulosa cells. A reason that insulin sensitizers work in increasing fertility is that they lower total insulin levels in body as metabolic tissues regain sensitivity to the hormone. This reduces the overstimulation of gonadotroph cells in pituitary. PCOS usually causes infertility associated with anovulation, and therefore, the presence of ovulation indicates absence of infertility, though it does not rule out infertility by other causes. Ovulation may be predicted by the use of urine tests that detect the preovulatory LH surge, called ovulation predictor kits (OPKs). However, OPKs are not always accurate when testing on women with PCOS. Charting of cervical mucus may also be used to predict ovulation, or certain fertility monitors (those that track urinary hormones or changes in saliva) may be used.
Metformin reduces risk of OHSS in patients with PCO during gonadotropin-stimulated IVF cycles – a randomized controlled trial. (Article in-press at Fertility and Sterility Journal)[box type=”info”]Take Home Message[unordered_list style=”green-dot”][/unordered_list][/box]OHSS is a potentially serious complication of COH (controlled ovarian hyperstimulation) but it most commonly presents after IVF stimulation because we try to stimulate more for IVF and for ovulation induction. Less than 10% of all IVF patients get OHSS and 30 eggs). Severe OHSS primarily presents as a large accumulation of fluid in the abdominal cavity. OHSS always resolves by itself but it can take several weeks. Over 90% of severe OHSS patients are pregnant because the HCG hormone from the pregnancy stimulates the ovary, which is its purpose. We can usually treat the fluid accumulation in the office by removing the fluid (paracentesis) every 2-3 days until the OHSS resolves. Polycystic ovary syndrome (PCOS) is a relatively common hormonal disorder that is one of the leading causes of infertility. Some women who have PCOS develop insulin resistance. This occurs when the cells of the body don’t respond well to a hormone known as insulin. Insulin allows the cells to take sugar (glucose) from the blood. If the cells don’t take in this sugar it leads to higher levels of glucose and insulin circulating through the body in the bloodstream. This, in turn, leads to increased levels of androgens (male hormones) which cause the classic symptoms of PCOS such as excess hair growth and more importantly in terms of fertility – lack of ovulation. Getting pregnant with PCOS can be possible with the right diagnosis and treatment plan.
The aim of study was to investigate whether pre-treatment with metformin before and during IVF increases the live birth rate compared to placebo in women with sonographic evidence of polycystic. Peter Kovacs comments on a new guideline from the American Society for Reproductive Medicine on the use of metformin for ovulation induction in women with polycystic ovary syndrome.