A new study shows that subfertile women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) to conceive can eliminate the required daily shots of follicle-stimulating hormone (FSH) to induce multiple follicles and instead use long-acting FSH, which offers the benefits of daily FSH without the uncomfortable daily needle sticks.1
Corifollitropin alfa, a long-acting FSH developed through recombinant DNA technologies, is not yet available in the United States, but it has been available in Europe for several years. A single dose of long-acting FSH is equivalent to 7 days of daily FSH injections.
To compare pregnancy and safety outcomes of long-acting FSH and daily FSH injections, researchers analyzed 4 previous randomized controlled trials that included a total of 2335 women undergoing IVF or ICSI. Of those, 987 women received daily injections of FSH for 1 week and 1348 women had 1 injection of long-acting FSH, which was given at various doses.
The group of women who received the lowest dose of long-acting FSH, 60 to 120 micrograms, had fewer live births than women who received daily FSH. However, live birth rates in women who received slightly higher doses of long-acting FSH, 150 to 180 micrograms, were similar to those in women who received daily injections (343 per 1000 women vs 336 per 1000 women, respectively). In addition, the risks of miscarriage, multiple gestation, ectopic pregnancy, and ovarian hyperstimulation syndrome were similar between FSH treatment types (long-acting vs daily).
The main advantage of the weekly shot of long-acting FSH is convenience. However, many women who use long-acting FSH will still require several daily injections of FSH before their eggs are ready to be harvested. In addition, long-acting FSH should not be used in women who are unlikely to respond to the hormone or in those who may overrespond.
Research on corifollitropin alfa has been submitted to the FDA for review, but its availability in the United States is at least a year or two away, according to Samuel Pang, MD, who was involved in the research that is being reviewed by the FDA.2
Pertinent Point:
- Use of long-acting FSH at medium doses (150 to 180 micrograms) is just as effective as daily FSH and, upon availability in the United States, should be considered a safe treatment option for subfertile women.
B mode and 3D Ultrasound images of a fetal abdomen (35wks) revealing gallbladder calculi
This case study shows a 26 week gestation with a cystic mass close to the sacrum.
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.
Single umbilical artery color doppler, transverse scan of urinary bladder shows single umbilical artery (left), transverse section of umbilical cord showing only two vessels: one vein and one artery (right).
Normal 35 week pregnancy
An approx. 12 week fetus, first ultrasound of this pregnancy.
4D image of 29 weeks pregnancy, multiple anomalies: Clinch hand, omphalocoele, single atrium
Is this lesion a fibroid or adenomyosis? Patient is a young (38n yr. old) married female with a history of dysmenorrhea and polymenorrhoea.
The patient was a 38 year old G4 P3, 20w4d. I was doing an anatomic survey today. While I was looking at a long axis view of the fetal heart with color Doppler, the baby developed hiccups, and with each contraction of the fetal thorax (which was quite obvious) I could see an explosion of blue color representing blood going through the foramen ovale from right to left.
This is a confirmed case of scar ectopic pregnancy. Yesterday, I carried out this exam in an emergency room, without much time to perform an adequate sonogram, the patient did not feel good with “cramps” but no signs of bleeding.
Normal aspect of the ossification centers of the fetal sternum at 33 weeks. Size of the ossification centers decreases in a cranio-caudal sense.
Leiomyoma that has undergone fatty degeneration.
Sagittal image from a transvaginal sonogram in a patient with bleeding after a spontaneous abortion. The endometrium (between cursors) was thick and heterogeneous, measuring 8.5 mm in thickness (Fig1). Color doppler image in same patient shows focal flow (Fig. 2 - arrow) within the heterogeneous endometrium.
Images of "Bulky Uterus"
Cystic spaces in the sub-endometrial myometrium of the fundus.
Complete Invasive Mole
A 29-year-old gravida 10, para 3 (1 term gestation, 1 preterm gestation of twins, 1 stillbirth at 5 months, 2 spontaneous abortions, and 4 elective abortions) presented to the clinic at about 5 weeks’ gestation with abdominal pain and vaginal bleeding. She described the pain as sporadic, mostly on the left side, exacerbated by movement, and resolving with rest, and the bleeding as initially intermittent but then heavier “like a period.”
Implantation in the scar of a previous Cesarean is thought to be the rarest of ectopic pregnancies. With the increasing numbers of Cesareans performed, scar implantation may become more frequent as well. We present an illustrative case.
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome affects at least 1 in 4500 female births.1 The syndrome consists of vaginal aplasia with other müllerian duct abnormalities. The characteristic feature of MRKH syndrome is congenital absence or underdevelopment of the upper vagina and uterus; it is rarely associated with unilateral renal agenesis, ectopia, or horseshoe kidney.
Endometrial stromal sarcoma (ESS) is a rare malignant tumor of the endometrium, occurring in the age group of 40-50 years.
