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1 Fertility and Birth Rates After Hydrotubation with Corticosteroid at Fertility and Birth Rates After Hydrotubation with Corticosteroid at Hysterosalpingogram in Patients Experiencing Unexplained InfertilityJeremy A. Kalamarides, D.O., Anthony.R. Pivarunas, D.O. Ralph Sperrazza, M.D., Michael Sullivan, M.D.,and Katherine Bernecki, M.S.Sisters of Charity Hospital, Buffalo, NYObjectiveBackgroundResultsResultsTable 1.All patients recruited =81Age, average30.5Smoker statusyes5yes, in the past7no62Ethnic originBlackWhite65AsianHispanic2Marital statusMarriedSingle8Of those becoming pregnant 2 did so on the first cycle sometimes prior to sperm analysis being complete.Additional follow up since completion of this portion of the study revealed 3 more patients having become pregnant in the ovulatory cycle of the HSG.To determine if steroid hydrotubaion at time of hysterosalpingogram (HSG) would decrease time to conception and increase birthrates in unexplained infertility.in addition to clearing mucus plugs. However, oil based HSG has, in the past, been found to have risks of acute air oil embolism and chronic granulation formation in the fallopian tubes (Johnson, 2004Therefore, a new technique of enhancing fertility is needed that is less invasive and less costly than intrauterine insemination or in vitro fertilization or enhance the chances of these procedures working. It is also necessary to continue searching for morally sufficient ways of helping infertile couples with strong religious beliefs attain pregnancy.BackgroundDiscussionFor couples experiencing difficulty achieving pregnancy 15 percent will be classified as having unexplained infertility (Moghissi, 1983). This category of infertility is recognized as absence of a definable cause of a couple’s failure to achieve after 12 months of attempting conception despite normal ovulation studies, normal semen analysis, normal uterine cavity, tubal patency, and adequate oocyte reserve(Moghissi, 1983). Rather than a single pathological factor causing a couple’s failure to achieve pregnancy the etiology of this condition is likely a result of multiple factors.Unexplained infertility is managed either conservatively or treated aggressively depending on the age of the patient starting with interventions consuming the fewest resources including cost and invasiveness [emotional spiritual as well at physical (hormonal and surgical) demands]. Couples not choosing any intervention to help achieve and instead waiting expectantly may have become pregnant 0-3 percent per cycle. Patients where the woman is less than 32 years of age can use fertility focused intercourse or intrauterine insemination plus hormonal treatments to attain better results at achieving pregnancy. A couple in which the infertile woman is older than 37 is typically treated with In-Vitro Fertilization as means of achieving pregnancy (Hull, 1994).However for many couples with recognized religious and/or ethical objections to parts of or entire IUI and IVF procedures there remain limited treatment options (Fryday, 1995). There remains a need for more effective means to achieve and maintain pregnancy with out the associated cost or invasiveness of artificial insemination or In-Vitro Fertilization.Previous attempts to increase fecundity in cases of unexplained infertility by chromotubation at the time of hysterosalpingogram have been met with varied success (Olive, 1985; Goodman, 1993), with oil contrast producing more promising results. The mechanism for the advantage of oil over water is postulated to be immunomodulative effects on the cell-mediated inflammatory milieu of the salpinges especially in cases of undiagnosed endometriosis (Johnson, 2004)).Early conception in time to follow-up may be the observed benefit of HSG in patients with unexplained infertility.Subgroup analysis may be evaluated of UI patients going through induction with oral induction agents versus injectable agents.MethodsDesign: Double blind randomized controlled trialIRB approved studyTreatment group and control, intention to treatMaterialsHydrocortisone 100mg in water based contrast mediaNormal water based contrast media: Hexabrix I oxaglate Meglume 39.3%,ioxaglate sodium 19.6%, (Bracco Diagnostics Princeton, NJ 08543)Informed consent and agreement prior to participationInclusion Criteria:Women years with unexplained infertility (or undetected endometriosis associated infertility)Infertility for greater than 12 months or 6 months of fertility focused intercourse with the Creighton Model FertilityCare System1Normal semen by Kruger Strict Criteria with modification of > 5% normal morphologyExclusion Criteria:Any women treated in the last 3 months with an assisted reproductive techniqueAbnormal HSG finding occlusive tubal disease or abnormal uterine shape and sizeAbnormal sperm analysisOther infertilityPregnancy was defined as +HCG Urine or serum quantitative HCG >5 µIU/ml at follow up.Follow-up at 3 months and 6monthsConclusionComputer randomizedenvelopesn= 104No show at HSG or declined participation N=23Exclusions n=35Abnormal HSG: 2Other infertility: 4Injectable ovulation agents: 9Male infertilityfactor: 16Sperm analysis never completed: 4Women recruitedN=81In follow period n=38Non-pregnant= 3Pregnant =8Met criterian=11This ongoing study continues to produce blinded data. Currently 81 patients participants have been recruited. So far11 patients met criteria for inclusion. Participants and examiners will be un-blinded when adequate sample size has been attained. Final tabulations are to be complete in 12/2010. Our goal is to publish this research in a leading journal. To date one known birth occurredMReferencesAboulghar M, Mansour R, Serour G, Abdrazek A, Amin Y, Rhodes C. Controlled ovarian Hyperstimulation an dintrauterine insemination for treatmetn of unexplained infertility should be limited to a maxiumum of three trials. Fertility and Sterility :75;1, 88-91Acien P, Quereda F, Campos A, Gomez-Torres MJ, Velasco I, Gutierrez M. Use of intraperitoneal interferon -2b therapy for endometriosi and postoperative medical treatment with depot gonadotropin releasing hormone analog: a randomized clinical trial. Fertility and Sterility 2002:78; 4:Agarwal S, Haney AF. Does Recommending Timed Intercourse Really Help the Infertile Couple? 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Peritoneal macrophages and infertility: the association between cell number and pelvic pathology. Fertility and Sterility. 1985;44:772-7Of UI patients meeting criteria (n=11), 8 became pregnant within 3 months.In patients assisted by clomid (n=4), 2 became pregnant.In patients assisted by femara (n=6 ), 5 became pregnant.One patient meeting criteria used a spontaneous cycle and conceived.
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