1
|
Bethel K, Warwar R, Thakore S, Hurley EG. The Effect of Baseline Ovarian Cyst on Pregnancy Outcomes in Ovulation Induction/Intrauterine Insemination Cycles. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:75-81. [PMID: 38404676 PMCID: PMC10890952 DOI: 10.1089/whr.2023.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/27/2024]
Abstract
Objective To determine the effects of a baseline ovarian cyst on ovulation induction/intrauterine insemination (OI/IUI) cycle outcomes. Methods A retrospective cohort analysis of 270 patients and 461 OI/IUI cycles performed between 2011 and 2021 was performed. The exposure variable was a simple appearing ovarian cyst diagnosed at baseline ultrasound measuring ≥10 mm with an estradiol level <75 ng/mL. The primary outcome analyzed was an ultrasound-confirmed intrauterine pregnancy. Secondary outcomes included positive pregnancy test and live birth. Summary data were presented with percentages, mean (standard deviation), or median (interquartile range). Comparisons of dichotomous variables were performed with the chi-square test, and continuous variables were compared using t-test. Regression analysis was performed using a general linear model. p-Values <0.05 were considered statistically significant. Results The clinical pregnancy rate was nominally higher in the group without a cyst present at baseline ultrasound compared with those cycles with a simple cyst present, but the difference was not statistically significant (45/300 [15%] vs. 15/161 [9.3%], risk ratio [RR] 0.63 [0.36, 1.1]). After adjusting for BMI ≥30 and age ≥35, there remained no significant difference in clinical pregnancy rate (adjusted RR 0.65 [0.37, 1.1]). Conclusion Given the present data, it is reasonable to proceed with IUI in the case of a baseline simple ovarian cyst. However, this finding may have an impact on clinical pregnancy outcomes in OI/IUI, and further research on the topic is warranted. Although this study was underpowered with fewer cycles than needed to demonstrate a significant difference, the point estimate suggests that the difference in clinical pregnancy rate could be ∼35%.
Collapse
Affiliation(s)
- Karen Bethel
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rachel Warwar
- Division of Reproductive Endocrinology and Infertility, University of Cincinnati, West Chester, Ohio, USA
| | - Suruchi Thakore
- Division of Reproductive Endocrinology and Infertility, University of Cincinnati, West Chester, Ohio, USA
| | - Emily G. Hurley
- Division of Reproductive Endocrinology and Infertility, University of Cincinnati, West Chester, Ohio, USA
| |
Collapse
|
2
|
O’Driscoll V, Georgescu I, Koo I, Arthur R, Chuang R, Dempsey JA, De Franco G, Jones CA. Reducing day 3 baseline monitoring bloodwork and ultrasound for patients undergoing timed intercourse and intrauterine insemination treatment cycles. FERTILITY RESEARCH AND PRACTICE 2021; 7:11. [PMID: 33931123 PMCID: PMC8085474 DOI: 10.1186/s40738-021-00102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the current context of a global pandemic it is imperative for fertility clinics to consider the necessity of individual tests and eliminate those that have limited utility and may impose unnecessary risk of exposure. The purpose of this study was to implement and evaluate a multi-modal quality improvement (QI) strategy to promote resource stewardship by reducing routine day 3 (d3) bloodwork and transvaginal ultrasound (TVUS) for patients undergoing intrauterine insemination (IUI) and timed intercourse (IC) treatment cycles. METHODS After literature review, clinic stakeholders at an academic fertility centre met to discuss d3 testing utility and factors contributing to d3 bloodwork/TVUS in IC/IUI treatment cycles. Consensus was reached that it was unnecessary in patients taking oral/no medications. The primary intervention changed the default setting on the electronic order set to exclude d3 testing for IC/IUI cycles with oral/no medications. Exceptions required active test selection. Protocols were updated and education sessions were held. The main outcome measure was the proportion of cycles receiving d3 bloodwork/TVUS during the 8-week post-intervention period compared with the 8-week pre-intervention period. Balancing measures included provider satisfaction, pregnancy rates, and incidence of cycle cancellation. RESULTS A significant reduction in the proportion of cycles receiving d3 TVUS (57.2% vs 20.8%, p < 0.001) and ≥ 1 blood test (58.6% vs 22.8%, p < 0.001) was observed post-intervention. There was no significant difference in cycle cancellation or pregnancy rates pre- and post-intervention (p = 0.86). Treatment with medications, cyst history, prescribing physician, and treatment centre were associated with receiving d3 bloodwork/TVUS. 74% of providers were satisfied with the intervention. CONCLUSION A significant reduction in IC/IUI treatment cycles that received d3 bloodwork/TVUS was achieved without measured negative treatment impacts. During a pandemic, eliminating routine d3 bloodwork/TVUS represents a safe way to reduce monitoring appointments and exposure.
Collapse
Affiliation(s)
- Victoria O’Driscoll
- University of Toronto, Undergraduate Medical Education, 1 King’s College Circle, Room 3157, Toronto, ON M5S 1A8 Canada
- University of Toronto, Institute of Health Policy, Management, and Evaluation, 155 College Street, 4th floor, Toronto, ON M5T 3M6 Canada
| | - Ilinca Georgescu
- Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON N6A 5C1 Canada
| | - Irene Koo
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward Street, Suite 1200, Toronto, ON M5G 1E2 Canada
- Mount Sinai Fertility, Sinai Health System, 250 Dundas Street West, Suite 700, Toronto, ON M5T 2Z5 Canada
| | - Rebecca Arthur
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward Street, Suite 1200, Toronto, ON M5G 1E2 Canada
- Mount Sinai Fertility, Sinai Health System, 250 Dundas Street West, Suite 700, Toronto, ON M5T 2Z5 Canada
| | - Rita Chuang
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward Street, Suite 1200, Toronto, ON M5G 1E2 Canada
| | - Jillian Ann Dempsey
- Mount Sinai Fertility, Sinai Health System, 250 Dundas Street West, Suite 700, Toronto, ON M5T 2Z5 Canada
| | - Giulia De Franco
- Mount Sinai Fertility, Sinai Health System, 250 Dundas Street West, Suite 700, Toronto, ON M5T 2Z5 Canada
| | - Claire Ann Jones
- Department of Obstetrics and Gynaecology, University of Toronto, 123 Edward Street, Suite 1200, Toronto, ON M5G 1E2 Canada
- Mount Sinai Fertility, Sinai Health System, 250 Dundas Street West, Suite 700, Toronto, ON M5T 2Z5 Canada
| |
Collapse
|
3
|
Abdrabbo MS, Khalil MH, Elsedeek MSE, Elagawany A. The use of clomiphene citrates for ovulation induction in women with functional ovarian cysts. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2011. [DOI: 10.1016/j.mefs.2011.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
4
|
Altinkaya SO, Talas BB, Gungor T, Gulerman C. Treatment of clomiphene citrate-related ovarian cysts in a prospective randomized study. A single center experience. J Obstet Gynaecol Res 2009; 35:940-5. [DOI: 10.1111/j.1447-0756.2009.01041.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sunduz Ozlem Altinkaya
- Department of Infertility, Dr Zekai Tahir Burak Women's Health Care Education and Research Hospital, Ankara, Turkey.
| | | | | | | |
Collapse
|