Use of glucocorticoids around the time of implantation has no effect on live birth rates and mimimal effect on pregnancy rates, confirms a new meta-analysis.1 Despite a lack of evidence supporting the practice,2,3 glucocorticoids are sometimes used to help make the lining of the uterus more responsive to embryo implantation during in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
In a review of available randomized controlled trials investigating the use of glucocorticoids in IVF or ICSI, researchers analyzed data from 14 studies involving 1879 couples in which some women used glucocorticoids and some women did not. There was no evidence that use of glucocorticoids improved pregnancy rates. In a subgroup analysis, however, researchers found that among women undergoing IVF, those who used glucocorticoids had a borderline significantly higher pregnancy rate than those who did not use glucocorticoids. Adverse events were inconsistently or poorly reported in the studies that were reviewed, but available data on adverse events showed that there were no significant differences between study groups.
When looking at success in terms of delivery of a healthy baby, the success rate of IVF and ICSI is between 20% and 30%.3 According to Randall Hines, MD, director of the division of reproductive endocrinology and infertility at the University of Mississippi Medical Center, “That tantalizing hint of benefit may nevertheless encourage some practitioners to continue routine use of glucocorticoids for their IVF patients. When you have a therapy that doesn’t have significant risk and doesn’t impose significant burden on the patient in terms of cost or convenience, it’s hard for people to let go of it.”3
These findings are consistent with other studies that have shown that use of glucocorticoids have little to no effect on improving pregnancy and live birth rates in ICSI in subfertile couples.
Pertinent Points:
- Glucocorticoids do not improve live birth rates and should not be used routinely in assisted reproductive techniques.
- A minimal improvement in pregnancy rates was associated with use of glucocorticoids, but this finding should be interpreted cautiously, say the study authors.
- Use of glucocorticoids may have some benefit in terms of uterine receptivity for certain subsets of patients, such as those with unexplained infertility, endometriosis, recurrent implantation failure, or certain immunological conditions, but additional studies are needed to determine the specific role of this treatment in well-defined patient groups.
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.
