Medicine and Health Sciences Commons^™

Ultrasound Is The Optimal Choice For Guidance In Difficult Hysteroscopy., J. Kresowik, Craig Syrop, Bradley Van Voorhis, Ginny Ryan

Ginny L. Ryan

OBJECTIVES: To compare costs and complications associated with ultrasound-guided hysteroscopy vs laparoscopy-guided hysteroscopy vs hysteroscopy alone for the surgical repair of intrauterine septa and synechiae. METHODS: This was a retrospective cohort study. Charts of all patients undergoing reparative surgery for intrauterine synechiae or uterine septa at our academic institution between 2000 and 2008 were reviewed. A total of 159 procedures were included in the study, categorized into concurrent laparoscopic guidance (n = 69), ultrasound guidance (n = 52) or no guidance (n = 38). Data regarding billing, surgical case logs and complications were collected for these procedures. Using these data, …

Progression Of Atypical Endometrial Hyperplasia To Adenocarcinoma Despite Intrauterine Progesterone Treatment With The Levonorgestrel-Releasing Intrauterine System., J. Kresowik, Ginny Ryan, Bradley Van Voorhis

Ginny L. Ryan

BACKGROUND: Intrauterine progesterone therapy has been proposed as a potential uterine-sparing treatment for atypical endometrial hyperplasia and adenocarcinoma.

CASE: We present a case of an infertility patient with atypical endometrial hyperplasia who was treated with the levonorgestrel-releasing intrauterine system for 6 months. At follow-up, she was noted to have an increasing endometrial thickness on ultrasonography, and biopsy revealed progression of her lesion to adenocarcinoma.

CONCLUSION: Although there is a need for uterine-sparing treatment for atypical endometrial hyperplasia and early adenocarcinoma, especially in the setting of desired fertility, caution should be exercised. We do not recommend using the levonorgestrel-releasing intrauterine system …

The Desire Of Infertile Patients For Multiple Births, Ginny Ryan, S. Zhang, A. Dokras, Craig Syrop, Bradley Van Voorhis

Ginny L. Ryan

OBJECTIVE: To determine the proportion of infertile women who prefer a multiple birth over a singleton, patient characteristics associated with this desire, and patient knowledge about the risks of multiple births. DESIGN: Prospective analysis. SETTING: Academic university hospital-based infertility center and private general gynecology clinic. PATIENT(S): Four hundred sixty-four female patients with infertility who presented for their initial visit. MAIN OUTCOME MEASURE(S): Demographic characteristics, infertility history, desire regarding multiple births, knowledge of the risks of multiple births, and goals of infertility evaluation and treatment were determined by using a 41-question survey. Univariate analysis was performed to assess patient characteristics associated …

Eating Disorders In The Obstetric And Gynecologic Patient Population, A. Andersen, Ginny Ryan

Ginny L. Ryan

The eating disorders anorexia nervosa and bulimia nervosa and eating disorders not otherwise specified disproportionately affect women, have profound effects on the overall well-being of women and their children, and can have mortality rates as high as those found with major depression. These disorders may present to obstetrician-gynecologists (ob-gyns) clinically as menstrual dysfunction, low bone density, sexual dysfunction, miscarriage, preterm delivery, or low birth weight in offspring. Ninety percent of eating disorders develop before the age of 25 in otherwise healthy young women, a group that characteristically seeks the majority of their health care from ob-gyns. For all of these …

In Vitro Fertilization Is Associated With An Increase In Major Birth Defects, C. Olson, K. Keppler-Noreuil, P. Romitti, W. Budelier, Ginny Ryan, Amy Sparks, Bradley Van Voorhis

Ginny L. Ryan

OBJECTIVE: To determine the risk of major birth defects in cohorts of children conceived through IVF or through IUI as compared with naturally conceived children. DESIGN: Retrospective cohort study. SETTING: Academic medical center. PATIENT(S): Children conceived by IVF or IUI at the University of Iowa from 1989 through 2002, compared with a matched cohort of naturally conceived children. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Outcome data were obtained from Iowa state birth and fetal death certificates and from the Iowa Birth Defects Registry. RESULT(S): Ninety of 1,462 IVF-conceived children (6.2%) and 17 of 343 IUI-conceived children (5.0%) had a major birth …

Sextuplets: An Unusual Complication Of Single Embryo Transfer, L. Mains, Ginny Ryan, Amy Sparks, Bradley Van Voorhis

Ginny L. Ryan

OBJECTIVE: To describe an unusual case of a sextuplet gestation after IVF and transfer of a single blastocyst. DESIGN: Case report. SETTING: University-based IVF clinic. PATIENT(S): A 32-year-old female with secondary infertility undergoing IVF-ET. INTERVENTION(S): Transvaginal oocyte retrieval, transfer of a single blastocyst, and multifetal pregnancy reduction. MAIN OUTCOME MEASURE(S): Ultrasound determination of pregnancy viability. RESULT(S): Six intrauterine gestational sacs, each with a fetus having cardiac activity, reduced to a triplet gestation. CONCLUSION(S): Physicians should consider advising patients undergoing IVF-ET to abstain from unprotected intercourse at least 4 days before the anticipated oocyte retrieval. Incomplete aspiration of ovarian follicles is …

Oral Ovulation Induction Agents Combined With Low-Dose Gonadotropin Injections And Intrauterine Insemination: Cost- And Clinical Effectiveness, Ginny Ryan, V. Moss, W. Davis, Amy Sparks, A. Dokras, Bradley Van Voorhis

Ginny L. Ryan

OBJECTIVE: To compare the efficacy and cost-effectiveness of different induction protocols involving gonadotropins with intrauterine insemination (IUI). STUDY DESIGN: We performed a retrospective chart review of 648 IUI cycles. Some patients had gonadotropin injections alone before human chorionic gonadotropin (hCG) and IUI (human menopausal gonadotropin protocol); others were given oral medications, then gonadotropins before hCG and IUI (combination protocol). Outcomes included pregnancy rates, multiple birth rates, endometrial thickness, number of ovarian follicles, injection days, ampules of gonadotropins and cost. RESULTS: The combination protocol was more cost-effective. In first cycles, pregnancy rates, multiple birth rates, number of large follicles produced and …

A Mandatory Single Blastocyst Transfer Policy With Educational Campaign In A United States Ivf Program Reduces Multiple Gestation Rates Without Sacrificing Pregnancy Rates, Ginny Ryan, Amy Sparks, C. Sipe, Craig Syrop, A. Dokras, Bradley Van Voorhis

Ginny L. Ryan

OBJECTIVE: To reduce the twin rate in our IVF program. DESIGN: A prospective educational study of infertile couples; a retrospective review of IVF outcomes before vs. after mandatory single embryo transfer (mSBT) policy change. SETTING: University-based infertility center. PATIENT(S): One hundred ten of 120 consecutive new infertile couples completed the educational study. Outcomes of all embryo transfers (n = 693) performed 17 months before and 17 months after mSBT were evaluated. INTERVENTION(S): A 1-page educational summary of comparative risks of twins vs. singletons to maternal and child health. MAIN OUTCOME MEASURE(S): Knowledge of twin risks and desired number of embryos …

Placenta Accreta Postpartum, Ginny Ryan, T. Quinn, Craig Syrop, W. Hansen

Ginny L. Ryan

BACKGROUND: Placenta accreta is the abnormal attachment of the placenta to the uterus. It occurs when the decidua basalis is either absent or incomplete. It is uncommon and most often presents with a retained placenta and hemorrhage. CASE: A 29-year-old gravida 1 had an uncomplicated antenatal course and delivery. The third stage of labor was complicated by a retained placenta necessitating manual removal. Her postpartum course was complicated by a persistent endometritis. The diagnosis of placenta accreta was made with the help of sonohysterography. CONCLUSION: Sonohysterography is a useful tool in discriminating a solid intracavitary mass from a placenta accreta …

Embryo Transfer Practices In The United States: A Survey Of Clinics Registered With The Society For Assisted Reproductive Technology, E. Jungheim, Ginny Ryan, E. Levens, A. Cunningham, G. Macones, K. Carson, A. Beltsos, R. Odem

Ginny L. Ryan

OBJECTIVE: To gain a better understanding of factors influencing clinicians' embryo transfer practices. DESIGN: Cross-sectional survey. SETTING: Web-based survey conducted in December 2008 of individuals practicing IVF in centers registered with the Society for Assisted Reproductive Technology (SART). PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Prevalence of clinicians reporting following embryo transfer guidelines recommended by the American Society for Reproductive Medicine (ASRM), prevalence among these clinicians to deviate from ASRM guidelines in commonly encountered clinical scenarios, and practice patterns related to single embryo transfer. RESULT(S): Six percent of respondents reported following their own, independent guidelines for the number of embryos …

Five-Years Of A Mandatory Single-Embryo Transfer (Mset) Policy Dramatically Reduces Twinning Rate Without Lowering Pregnancy Rates, J. Kresowik, B. Stegmann, Amy Sparks, Ginny Ryan, Bradley Van Voorhis

Ginny L. Ryan

OBJECTIVE: To report the outcomes of a program policy instituted in 2004 mandating single-embryo transfer (mSET) for all women aged <38 >years, with at least seven zygotes, no prior failed fresh cycle at our center, and at least one good-quality blastocyst. DESIGN: Retrospective cohort study. SETTING: Academic medical center. PATIENT(S): All women 1, 1999, to May 31, 2004 (before mSET) and from June 1, 2004, to May 31, 2009 (after mSET). INTERVENTION(S): mSET policy implementation. MAIN OUTCOME MEASURE(S): Live-birth rate, multiple pregnancy rate, clinical volume, and outcomes of all mSET fresh IVF transfers were analyzed. RESULT(S): Clinical volume was unchanged between …

In Vitro Fertilization Patients Support A Single Blastocyst Transfer Policy, S. Martini, Bradley Van Voorhis, B. Stegmann, Amy Sparks, T. Shochet, M. Zimmerman, Ginny Ryan

Ginny L. Ryan

OBJECTIVE: To determine whether patients support a mandatory single blastocyst transfer (mSBT) policy in IVF. DESIGN: Prospective survey study. SETTING: Academic hospital-based infertility center. PATIENT(S): Two hundred sixty-two female patients presenting for fresh or cryopreserved/thawed ET after IVF. INTERVENTION(S): Internet-based in-clinic survey after ET. Follow-up at-home survey after pregnancy test results. MAIN OUTCOME MEASURE(S): Patient support for an mSBT policy and attitudes regarding patient input into IVF treatment. Logistic regression analyses tested associations among main outcome measures, patient characteristics, and treatment results. RESULT(S): Ninety-four percent of patients endorsed support for our mSBT policy; 95% and 87% felt they had the …

Clinical Predictors Of Human Blastocyst Formation And Pregnancy After Extended Embryo Culture And Transfer, M. Thomas, Amy Sparks, Ginny Ryan, Bradley Van Voorhis

Ginny L. Ryan

OBJECTIVE: To determine the clinical factors associated with blastocyst development and pregnancy. DESIGN: Evaluation of a prospectively collected IVF database. SETTING: An academic IVF practice. PATIENT(S): Couples (n = 529) undergoing their first IVF cycle who qualified for extended embryo culture (more than six zygotes) over the past 5 years. INTERVENTION(S): Seven or eight zygotes were cultured for 5 days, assessed for quality, and then transferred with excess zygotes cryopreserved at the pronuclear stage. MAIN OUTCOME MEASURE(S): Clinical predictors of blastocyst development and pregnancy. RESULT(S): The mean blastocyst development rate was 49.8%, with a median number of total and good-quality …

Molecular Analysis Of The Neuropeptide Y1 Receptor Gene In Human Idiopathic Gonadotropin-Dependent Precocious Puberty And Isolated Hypogonadotropic Hypogonadism, K. C. Freitas, Ginny Ryan, V. N. Brito, Y. X. Tao, E. M. Costa, B. B. Mendonca, D. Segaloff, A. C. Latronico

Ginny L. Ryan

OBJECTIVE: To investigate the role of mutations or polymorphisms in the NPY-Y1R gene in human idiopathic central pubertal disorders. DESIGN: Molecular studies. SETTING: University hospital. PATIENT(S): Thirty-three patients with gonadotropin-dependent precocious puberty, 22 with hypogonadotropic hypogonadism, and 50 controls. INTERVENTION(S): Genomic DNA extraction, NPY-Y1R gene sequence analysis, cell-surface expression, and functional activity of an identified receptor variant. MAIN OUTCOME MEASURE(S): Results of sequencing, cell-surface receptor expression, and receptor function. RESULT(S): A heterozygous substitution of lysine (K) by threonine (T) at position 374 in the carboxyl terminal region of NPY-Y1R was identified in a girl with familial GDPP. Her mother, who …