David R. Meldrum, MD
Coronado aspects not covered
Each year I try to be sure that all critical aspects of IVF were covered during the course. Below are some aspects that were not covered. Some were brought up in the Q&A but would not be in the syllabus and could be missed by participants.
Women taking cabergoline for OHSS can occasionally have severe constipation. I know of two who presented like a bowel obstruction. We have found that a small dose of Miralax prevents this problem.
Practitioners need to know that patients with Turners syndrome can die during pregnancy due to aortic rupture. If pregnancy is to be considered in such a patient, evaluation by a cardiologist close to the time of the procedure is mandatory. Unfortunately, there has been at least one death where the studies were negative prior to pregnancy. Consequently many people consider Turners to be an absolute contraindication for performing oocyte donation. Obviously single embryo transfer should be done if the practitioner is to treat such a patient and full informed consent is mandatory.
In evaluating the male with non-obstructive azospermia (NOA), assessment of Y chromosome deletions is advisable. If there is a complete AZFa or AZFb deletion, published reports have reported an absence of sperm with TESE. When asked during the Q&A, Dr. Niederberger stated that he did not know of any such cases with sperm being retrieved. This was confirmed the following year by Dr. Schlegel.
In my discussion of oocyte retrieval I did not mention that flank pain in the absence of clear signs of urinary tract infection should indicate ureteral injury until proven otherwise. Ureteral injury is more common with endometriosis, which fixes the ureter in place. It is always best to bring the ovary up laterally away from the ureter and placing a tenaculum on the cervix makes that an easy maneuver. Logically, a slow, rather than sudden entry of the needle allows the ureter to move away from the needle.
See you next year at “The Del”.