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Until now there has been no evidence-based consensus amongst fertility specialists as to whether or not men should refrain from sex for a few days before attempting to conceive with their partner, either spontaneously or via assisted reproduction.

Comments from Specialists I heard from a reliable newspaper or television station that he implanted 6 and two of the embryos split into twins. Allen Worrall, RDMS Intra - endometrial implantation is evolving to be a superior method and Dr Kamrava deserves recognition for this contribution but......if hysteroscopic embryo implantation is supposed to be 70% more effective than the "blind technique", why then would Dr Kamrava aim to obtain 8 pregnancies??????George Haber, MD Regardless of the media hype and not knowing the inside story of why so many embryos were implanted, we have apparently a high success rate technique with zero ectopics, this is worth considering. Let's separate science from entertainment.Mario E. Domenzain, M.D., F.A.C.O.G. What we so far know about implantation is that it is a very complex process, where a sequence of events happens with a very delicate synchronization (selection of the site of implantation by Selectin molecules which help the blastocyst "roll" to the right spot, MUC-1 repelling it from the "bad" ones, chemokines and cytokines -LIF, IL-1. Integrins- attracting it, adhesion molecules attaching it to pinopodes, to cite a few). I doubt that forcibly "implanting" an embryo into a self-selected spot in the endometrium could really improve pregnancy rates; it is bypassing the natural selection process (for example: embryos do not "take" on endometrium without pinopodes either because of poor timing or because of endometrium defect).  Hysteroscopic embryo implantation might reduce the rate for ectopic pregnancies. But unless the hysteroscopic process in itself stimulates the release of these molecules on the spot (like the repeated Pipelle might be doing???), it should not improve the overall pregnancy rate. I of course -and all my IVF team in Jerusalem, where we do see several very religious women "pushing" for many children!!!, cannot agree with replacing 8 embryos by ANY type of woman (especially if she is young and proven fertile !!!!) Dr Hava-Yael Schreiber, M.DOB/GYN and Fertility specialist Zir Chemed Medical Center and Bikur Holim Hospital, Jerusalem Roberta and friends, There has been such a media frenzy about this, and for good reason. While any licensed practitioner is theoretically entitled to their own opinion about procedures, standard of care dictates the concept of evidence-based medicine, i.e. do no harm and do what is reasonable based on the best interpretation of peer-reviewed medical literature. When Dr. Kavarna gave this interview awhile ago, perhaps he had a hypothesis that hysteroscopic assistance of embryo transfers would aid the success of implantation. To my knowledge, he hasn't proven the value of this technique, nor has anyone else. And in fact, the standard of care has become ultrasound-assisted embryo transfer, which is hardly a blind technique. In fact, many centers (such as ours) utilize echo-tip catheters which allow for excellent visualization of transfer catheter placement via abdominal ultrasound, especially when the patient has a moderately full bladder. Now as far as results, prospective patients who are looking into IVF, along with their physicians, should be strongly urged to evaluate data published annually online by the Society for Assisted Reproductive Technology (SART) at www.sart.org Although there is a lag in SART's ability to compile and post data, both patients and physicians can get an idea of who is doing what, practice-by-practice, and both nationally and regionally. Currently, the latest data listed on the SART website is from 2006, but I believe 2007 will be available soon. Most SART clinics have already compiled preliminary 2008 data but have not yet submitted, mainly because final results are not in yet for live births generated from 2008 cycles. Now, you asked about our data. And here is what I can share, which is available already publicly (2006) and will soon be available publicly (2007): For women under 35 using fresh non-donor eggs, the live birth rate per transfer in 2006 was 51.4 percent, and we transferred an average of 1.8 embryos for those patients. For that group, 22.2 percent had elective single embryo transfer. The overall implantation rate was 43.1% (see https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=2442 for the full summary) In 2007 for the same group, the live birth rate per transfer was 55.1%, and we transferred an average of 1.4 embryos. Approximately 60% of our patients < 35 had a single embryo transfer. SART calculates the implantation rate after the data is submitted, but I would estimate it to be around 45-50%. This trend towards "fewer is better" is again seen in our preliminary 2008 results. We had an abstract at ASRM in 2007 which also concluded this, based on the results we had at that time. There is so much focus these days on clinics that are doing a substandard job, I think it's time for the media to infuse some hope into those who could benefit from great fertility care, and by letting people know there are some centers that are exceeding national averages and have the data to prove it. There are many important factors that go into generating high success rates, and I'm happy to discuss this further with anyone in the media who might be interested. Regards to all,Ronald F. Feinberg MD, PhDIVF Medical Director Reproductive Associates of Delaware Suite 3217, Medical Arts Pavilion 2 4735 Ogletown-Stanton Road Newark, DE 19713 302-623-4242 FAX 302-623-4241www.ivf-de.org "The ethical, personal care that helps families grow." Dear Editor of Ob-Gyn Net: I was appalled and saddened when I heard that a physician had intentionally transferred multiple embryos into a woman who had already had a multiples birth. This showed very poor judgment, in my opinion. It is also contrary to the guidelines of SART for infertility clinics. Because of all of the potential problems for these ultra-light babies, now and in the future, it is against the ethical principle of justice or “community good”. I am sure the California Board of Medical Examiners will be looking into this and well they should. The public is rightly infuriated over this situation and should demand an investigation by the Board if it is not forthcoming. Even the old caution that doctors have tried to follow for centuries, “primum non-nocere”, first, do no harm, has been breached. This whole situation likely will result in new laws or requirements for REIs and clinics that specialize in infertility. Thomas F. Purdon, MD FACOG No need to apologize. Many of us were curious about this individual, and you gave us what you had. I didn't see it as flashy or trashy--it was a legitimate interview about a relevant topic. Remember, curious people want to know.Steven Nelson MDPhoenix, AZ Dear Madam: Greetings! The interview was done as if we are condoning this procedure. Maybe this is becoming a moral issue like doctors playing God. Yes the interview was done in poor taste the interviewer allowing himself to be manipulated. Thank you and more power.Dr. Ferry AnolinManila, Phillipines I think it sounds like a very innovative procedure that may improve outcomes. (Obviously using only 1 or 2 embryos) Ginger H. Riley

Stillbirth rate is an important indicator of access to and quality of antenatal and delivery care. Obtaining overall estimates across various regions of the world is not straightforward due to variation in definitions, data collection methods and reporting.

Intrauterine infection is considered as one of the major maternal insults during pregnancy. Intrauterine infection during pregnancy could lead to brain damage of the developmental fetus and offspring.

CC is a 31 year old primigravida who was referred for ultrasound at a community hospital due to suspected cardiac anomalies noted on a screening sonogram at her doctor's office. Due to concern about a probable cardiac abnormality an amniocentesis was performed at the local hospital.

This week, I spent over 3 hours struggling with my chief resident in a clinic case doing a robotic hysterectomy and staging. Granted, the patient was an obese, hypertensive diabetic, who benefited from avoiding a big midline incision, but it did make me think of one of my mentors from fellowship.

Test your ob/gyn knowledge in our DailyDx.

The surgical placement of mesh through the vagina to repair pelvic organ prolapse (POP) may expose patients to greater risk than other surgical interventions, said the FDA in an updated safety communication. It also stated that with the exposure to greater risk comes no evidence of greater clinical benefit, such as improved quality of life.

The 400-meter timed walk can provide insights into an older person’s cardiorespiratory fitness; the resulting data from these walks are useful in predicting total mortality, cardiovascular disease, mobility limitation, and disability. But do leisure time activities and weight/body composition changes affect walk time? Dr Kelley K. Pettee Gabriel from the division of epidemiology, human genetics, and environmental sciences at the University of Texas Health Science Center, Austin, and colleagues believe a better understanding of this relationship will help clarify the best use of the 400-meter walk in middle-aged women.

This article examines issues surrounding noncompliance, and offers advice regarding effective patient counseling. It also highlights the importance of OC packaging: Market research studies suggest that more discreet and more convenient styles of packaging may promote consistent use.

Mother is sure of LMP 17th Nov/98 ( EDD = 24/8/99). On ultrasound scan (17/7/99) the average gestational age is only 31 weeks, ie the ultrasound derived EDD=18/9/99.

The mobile foraminal flap consisted of a thin membrane ballooning into the left atrium. During ventricular filling, the flap encroached on the mitral valve annulus, but did not appear to obstruct the mitral valve flow.

Over the past 10 years controversy has surrounded the practice of ultrasound for entertainment purposes. In 1994, the ARDMS held and published a readership poll on this very subject. For our paper we decided to hold a similar poll to see if the opinion has changed over the last 5 years.

Trisomy 18 is a serious chromosomal anomaly which has a very poor (usually lethal) prognosis. T18 is usually associated with a variety of sonographically detectable abnormalities.

Research has emerged validating and confirming the recommendations of the American Congress of Obstetricians and Gynecologists, the American Cancer Society, and the American Society for Colposcopy and Cervical Pathology to screen women for cervical cancer every 3 years if they have a negative human papillomavirus (HPV) test and a normal Pap test. However, the researchers also found that Pap testing was important among women who tested positive for HPV since it helped identify women who developed cancer or precancer.

Gynecology Images: Normal Abnormal Obstetric Images: 1st Trimester: Normal Abnormal 2nd Trimester: Normal Abnormal 3rd Trimester: Normal Abnormal   Medical Professionals: Upload Your Here Obstetric Images: 3rd Trimester: Normal Normal Thymus - Albana Cerekja      Fetal urethra at 31 weeks: just before micturition - Albana Cerekja      Normal Female: 4D still image - Effendi Mansoor      Monolateral double renal artery,: Normal variant kidney artery supply - Albana Cerekja      TRV Fetal Head: BPD and HC Measurements - SIEMENS      Velamentosa insertion: 3rd trimester - Effendi Mansoor      Umbilical Cord (3D Surface Rendering): Normal Cord - MEDISON      SAG Fetal Face, Profile: Fetal Breathing on Color Doppler - SIEMENS      3D Surface Reconstruction: Face - Cayrol Guillermo      3D Surface Reconstruction: Extended Breech Presentation - Saied Mohamed Tohamy      3D Surface Reconstruction: Face - Juan Carlos Pons      3D Surface Reconstruction: Face and Foot - Cayrol Guillermo      3D Surface Reconstruction: Face - Juan Carlos Pons      3D Surface Reconstruction: Face - Juan Carlos Pons

There are many factors that go into the decision to choose a birth control method. This article is intended to be an overview to help you to think about these choices, and make a decision about what method is best for you.

Contraceptive behavior is related to changing age structure, and change in upper age limits for OCs use. However, there are unpredictable factors affecting contraceptive use such as the publicity regarding OCs and breast cancer and concern about sexually transmitted diseases (STDs) including human immunodeficiency virus infection as well as abortion legislation.

A new overview of studies of the Pill and the risk of heart attack, published today (Friday 30 August) in Europe's leading reproductive medicine journal, Human Reproduction,* provides a reassuring picture of the safety of the third generation Pill.

Questions on Contraception answered by Marta Mendez, MD,

Questions on Contraception answered by Marta Mendez, MD

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