Transcript Style D 36 by 48 - Catholic Health

Fertility and Birth Rates After Hydrotubation with Corticosteroid at
Hysterosalpingogram in Patients Experiencing Unexplained Infertility
Jeremy A. Kalamarides, D.O., Anthony.R. Pivarunas, D.O. Ralph Sperrazza, M.D., Michael Sullivan, M.D.,and Katherine Bernecki, M.S.
Sisters of Charity Hospital, Buffalo, NY
Objective
To determine if steroid hydrotubaion at time of
hysterosalpingogram (HSG) would decrease time to
conception and increase birthrates in unexplained
infertility.
Background
For couples experiencing difficulty achieving pregnancy
15 percent will be classified as having unexplained
infertility (Moghissi, 1983). This category of infertility is
recognized as absence of a definable cause of a
couple’s failure to achieve after 12 months of attempting
conception despite normal ovulation studies, normal
semen analysis, normal uterine cavity, tubal patency,
and adequate oocyte reserve(Moghissi, 1983). Rather
than a single pathological factor causing a couple’s
failure to achieve pregnancy the etiology of this condition
is likely a result of multiple factors.
Unexplained infertility is managed either conservatively
or treated aggressively depending on the age of the
patient starting with interventions consuming the fewest
resources including cost and invasiveness [emotional
spiritual as well at physical (hormonal and surgical)
demands]. Couples not choosing any intervention to
help achieve and instead waiting expectantly may have
become pregnant 0-3 percent per cycle. Patients where
the woman is less than 32 years of age can use fertility
focused intercourse or intrauterine insemination plus
hormonal treatments to attain better results at achieving
pregnancy. A couple in which the infertile woman is
older than 37 is typically treated with In-Vitro Fertilization
as means of achieving pregnancy (Hull, 1994).
However for many couples with recognized religious
and/or ethical objections to parts of or entire IUI and IVF
procedures there remain limited treatment options
(Fryday, 1995). There remains a need for more effective
means to achieve and maintain pregnancy with out the
associated cost or invasiveness of artificial insemination
or In-Vitro Fertilization.
Results
Results
Background
in addition to clearing mucus plugs. However, oil
based HSG has, in the past, been found to have risks
of acute air oil embolism and chronic granulation
formation in the fallopian tubes (Johnson, 2004
Therefore, a new technique of enhancing fertility is
needed that is less invasive and less costly than
intrauterine insemination or in vitro fertilization or
enhance the chances of these procedures working. It
is also necessary to continue searching for morally
sufficient ways of helping infertile couples with strong
religious beliefs attain pregnancy.
Table 1.
All patients recruited =81
Age, average
Smoker status
30.5
yes
yes, in the past
no
5
7
62
Black
White
Asian
Hispanic
5
65
0
2
Married
Single
62
8
Discussion
Ethnic origin
Marital status
Methods
Design: Double blind randomized controlled trial
IRB approved study
Treatment group and control, intention to treat
Materials
Hydrocortisone 100mg in water based contrast
media
Normal water based contrast media: Hexabrix I
oxaglate Meglume 39.3%,ioxaglate sodium 19.6%,
(Bracco Diagnostics Princeton, NJ 08543)
Informed consent and agreement prior to participation
Inclusion Criteria:
Women 21-37 years with unexplained infertility (or
undetected endometriosis associated infertility)
Infertility for greater than 12 months or 6 months of
fertility focused intercourse with the Creighton Model
FertilityCare System1
Normal semen by Kruger Strict Criteria with
modification of > 5% normal morphology
Exclusion Criteria:
Any women treated in the last 3 months with an
assisted reproductive technique
Abnormal HSG finding occlusive tubal disease or
abnormal uterine shape and size
Abnormal sperm analysis
Other infertility
Pregnancy was defined as +HCG Urine or serum
quantitative HCG >5 µIU/ml at follow up.
Follow-up at 3 months and 6months
Of those becoming pregnant 2 did so on the first cycle
sometimes prior to sperm analysis being complete.
Additional follow up since completion of this portion of the
study revealed 3 more patients having become pregnant in
the ovulatory cycle of the HSG.
Early conception in time to follow-up may be the
observed benefit of HSG in patients with unexplained
infertility.
Subgroup analysis may be evaluated of UI patients
going through induction with oral induction agents
versus injectable agents.
Conclusion
Computer
randomized
envelopes
n= 104
No show at HSG or
declined
participation N=23
Women recruited
N=81
Exclusions n=35
This ongoing study continues to produce blinded data.
Currently 81 patients participants have been recruited.
So far11 patients met criteria for inclusion. Participants
and examiners will be un-blinded when adequate
sample size has been attained. Final tabulations are to
be complete in 12/2010. Our goal is to publish this
research in a leading journal. To date one known birth
occurred
Abnormal HSG: 2
M
Other infertility: 4
Injectable ovulation
agents: 9
Male infertilityfactor: 16
Sperm analysis never
completed: 4
In follow period n=38
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