Purpose Patients often undergo repeat surgery for endometriosis, due to recurrent or residual disease. Previous surgery is often considered a risk factor for worse surgical outcome. However, data... Show morePurpose Patients often undergo repeat surgery for endometriosis, due to recurrent or residual disease. Previous surgery is often considered a risk factor for worse surgical outcome. However, data are scarce concerning the influence of subsequent endometriosis surgery. Methods A retrospective study in a centre of expertise for endometriosis was conducted. All endometriosis subtypes and intra-operative steps were included. Detailed information regarding surgical history of patients was collected. Surgical time, intra-operative steps and major post-operative complications were obtained as outcome measures. Results 595 patients were included, of which 45.9% had previous endometriosis surgery. 7.9% had major post-operative complications and 4.4% intra-operative complications. The patient journey showed a median of 3 years between previous endometriosis surgeries. Each previous therapeutic laparotomic surgery resulted on average in 13 additional minutes (p = 0.013) of surgical time. Additionally, it resulted in more frequent performance of adhesiolysis (OR 2.96, p < 0.001) and in a higher risk for intra-operative complications (OR 1.81, p = 0.045), however no higher risk for major post-operative complications (OR 1.29, p = 0.418). Previous therapeutic laparoscopic endometriosis surgery, laparotomic and laparoscopic non-endometriosis surgery showed no association with surgical outcomes. Regardless of previous surgery, disc and segmental bowel resection showed a higher risk for major post-operative complications (OR 3.64, p = 0.017 respectively OR 3.50, p < 0.001). Conclusion Previous therapeutic laparotomic endometriosis surgery shows an association with longer surgical time, the need to perform adhesiolysis, and more intra-operative complications in the subsequent surgery for endometriosis. However, in a centre of expertise with experienced surgeons, no increased risk of major post- operative complications was observed. Show less
Tweel, M.M. van den; Struijs, S. van der; Munckhof, E.H.A. van den; Boers, K.E. 2022
Purpose Bacterial vaginosis (BV) is a dysbiosis of the vaginal microbiome and a condition found in 20-30% of all women. Literature describing the possible link between BV and subfertility is... Show morePurpose Bacterial vaginosis (BV) is a dysbiosis of the vaginal microbiome and a condition found in 20-30% of all women. Literature describing the possible link between BV and subfertility is increasing. Newer techniques such as quantitative polymerase chain reactions (qPCR) detect BV more accurately than traditional methods but come with high costs. The association between pH and BV as diagnosed using traditional methods is well-established in a symptomatic population. This study is the first to investigate the association between pH and BV diagnosed by qPCR in an asymptomatic subfertile population and to examine the usefulness of pH as a means of cost reduction.Methods Data of 170 pH-qPCR combinations were used from a prospective cohort study examining bacterial vaginosis in a subfertile population. 102 women received a vaginal swab and pH measurement at baseline and subsequent advanced reproductive technology (ART) treatments. The swabs are analysed using the -AmpliSens (R) Florocenosis/Bacterial vaginosisFRT qPCR kit.Results pH is strongly associated with BV as diagnosed by qPCR (OR 3.06, p = 0.000, CI 1.65-5.68). The cut-off point for pH >= 4.7 maximised diagnostic performance [AUC 0.74 (CI 0.66-0.83), sensitivity 76%] and reduced costs by 60%.Conclusion This study shows that the vaginal pH for a multi-ethnic, asymptomatic population of women attending fertility clinics is strongly associated with BV qPCR outcome. Using the cut-off of pH of 4.7 has a high sensitivity for diagnosis of BV by qPCR and can be achieved at a cost reduction of 60%. Show less
Purpose Ovulation induction (OI) using letrozole or human menopausal hormone (hMG) is recently developed for endometrium preparation in frozen embryo transfer (FET) cycles. The purpose of this... Show morePurpose Ovulation induction (OI) using letrozole or human menopausal hormone (hMG) is recently developed for endometrium preparation in frozen embryo transfer (FET) cycles. The purpose of this study is to compare the live birth rate of twin pregnancies between modified natural and OI regimens for endometrium preparation in FET cycles. Study design This study included all consecutive twin pregnancies following FET with modified natural cycle (mNC-FET) or OI (OI-FET) regimen for endometrium preparation between January 2015 to June 2019. Primary outcome was the live birth of at least one twin per pregnancy. Multivariable logistic regression analysis was used to evaluate the potential association of endometrium preparation regimen and live birth. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Results During the study period, 269 twin pregnancies after mNC-FET and 177 twin pregnancies after OI-FET were included. The live birth rate of at least one twin per pregnancy was not significantly different between mNC-FET and OI-FET groups, 92.2% vs 90.4%; aOR 0.65; 95%CI 0.32-1.34. The multivariable regression analysis showed that twin pregnancies after OI-FET had decreased odds for gestational diabetes mellitus (aOR 0.37; 95% CI 0.16-0.87) in comparison to twin pregnancies after mNC-FET. In subgroup analysis, we found that the rate of live birth of at least one twin per pregnancy was significantly higher in OI-FET cycles using letrozole compared to those using hMG (94% vs 83.3%; aOR 3.45; 95%CI 1.24-9.57). Conclusion The live birth rate in twin pregnancies after FET is comparable between mNC or OI regimens for endometrium preparation. Show less
Haak, L. van den; Kroon, C.D. de; Warmerdam, M.I.; Siebers, A.G.; Rhemrev, J.P.; Nieboer, T.E.; Jansen, F.W. 2019
