Failed treatment of abdominal pregnancy with methotrexate. A case report

BACKGROUND

Methotrexate is an effective, safe, low-cost alternative to surgery for treating tubal pregnancies. To our knowledge, there have only been two other reported attempts at treating abdominal pregnancy with methotrexate.

CASE

Despite two courses of treatment with methotrexate, the pregnancy persisted, and laparoscopy permitted a tissue diagnosis of abdominal pregnancy.

CONCLUSION

Although treatment with methotrexate was not successful in this case, its potential use in abdominal pregnancies merits further investigation.

Is chemiluminescent immunoassay an appropriate substitution for radioimmunoassay in monitoring estradiol levels?

OBJECTIVE

To determine the correlation between serum estradiol measurements by chemiluminescent immunoassay (CIA) vs. radioimmunoassay (RIA) in two groups: patients treated with gonadotropins and patients treated with oral estrogen.

DESIGN

Prospective study.

SETTING

Assisted Reproductive Technology (ART) program based in a university-affiliated hospital in Manhasset, New York.

PATIENT(S)

Three hundred forty-eight patients undergoing gonadotropin stimulation and 63 patients receiving oral estrogen between July and December, 1997.

INTERVENTION(S)

Estradiol levels were measured concomitantly on all patients undergoing gonadotropin stimulation for IVF and all patients receiving oral estrogen for a frozen-thaw cycle.

MAIN OUTCOME MEASURE(S)

RIA:CIA ratio.

RESULT(S)

In the group undergoing gonadotropin stimulation, the median RIA:CIA ratio was 0.92, RIA = 1.26 x CIA(0.96), r = 0.98. In the group receiving oral estrogen, the median ratio was 3.93, RIA = 2.9 x CIA(1.05), r = 0.89.

CONCLUSION(S)

Estradiol levels determined by CIA correlate closely with RIA results for patients being treated with gonadotropins. Conversely, for patients receiving oral estrogen, CIA levels are one-third or less of the RIA level.

Abnormal sperm morphology is highly predictive of pregnancy outcome during controlled ovarian hyperstimulation and intrauterine insemination

PURPOSE

The purpose of this study was to assess the predictive value of a modified form of Kruger's strict criteria for sperm morphology for pregnancy outcomes after intrauterine insemination (IUI) and controlled ovarian hyperstimulation (COH) in the presence of normal sperm concentration and motility.

MATERIALS AND METHODS

A retrospective review of 42 couples undergoing COH/IUI was stratified by favorable or unfavorable sperm morphology. End points were pregnancy or failure of treatment as defined by four or more cycles of COH/ IUI without pregnancy.

RESULTS

An unfavorable morphology (< 4%) was highly predictive of failure during COH-IUI (94.45%; 17/18). A normal PIF was a sensitive indicator of those patients who became pregnant (93.8%; 15/16) and had a fair specificity for failure to achieve pregnancy after four cycles of treatment (65.4%; 17/26). Couples with a favorable sperm morphology were 28.3 times as likely to achieve a pregnancy within four cycles of treatment as those with unfavorable sperm morphology [95% confidence limits, 3.2 to 250.5; P < 0.001].

CONCLUSIONS

Abnormal strict morphologic assessment is both sensitive and specific for pregnancy outcomes in couples undergoing COH/IUI. Couples with persistently unfavorable sperm morphology should be counseled appropriately and would be better served by more aggressive treatment with in vitro fertilization and embryo transfer.