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Biomedical subjects

S Gordts

Publications and source records attributed to S Gordts.

At least 19 recordsLinked to original sources
PubMed2005

Transvaginal laparoscopy.

Transvaginal laparoscopy (TvL) offers an alternative to standard diagnostic laparoscopy in subfertile patients without obvious pelvic pathology. With a specially developed needle-trocar system, access to the pouch of Douglas is gained through a needle puncture of the posterior fornix. Performed under local anaesthesia or sedation with the patient in a dorsal decubitus position and using prewarmed Ringer lactate as a distension medium, TvL allows complete exploration of the tubo-ovarian structures without supplementary manipulation. The combination of transvaginal sonography and transvaginal endoscopy, including minihysteroscopy, TvL, salpingoscopy and chromopertubation test, permits the most complete exploration of the reproductive tract and can be used as a first-line investigation of female fertility in a one-stop infertility clinic. As the transvaginal route offers easy access to the tubes, ovaries and fossa ovarica, some operative procedures are possible. However, in the absence of a panoramic view, these will be limited to minor interventions.

Ambulatory Surgical Procedures↗
PubMed2005

Belgian legislation and the effect of elective single embryo transfer on IVF outcome.

In order to reduce the number of multiple pregnancies following IVF, the Belgian government agreed to reimburse laboratory expenses for six IVF cycles up to the age of 42 years, in exchange for restriction of the number of embryos replaced. Data on assisted reproduction outcome before and after the introduction of this new legislation were analysed retrospectively in terms of implantation, pregnancy and multiple pregnancy rates. After the introduction of the new law, the percentage of single embryo transfer increased from 14 to 49%. Implantation rates were 25.9 and 23% respectively. There was no difference in the overall pregnancy rate before and after the introduction (36 versus 37%). Twin pregnancies, however, decreased from 19 to 3%. These findings indicate that elective single embryo transfer significantly decreases the twin pregnancy rate without a reduction in the overall pregnancy rate.

Belgium↗
PubMed2003

Endometriosis: modern surgical management to improve fertility.

Endometriosis is a pleiotropic reproductive condition and the lesions visualized at laparoscopy are only one aspect of this disease process. At present, there is no evidence that surgery for endometriosis can cure infertility. The most important surgery in infertility is ovarian surgery. It is generally accepted that, in most cases, the invagination of the cortex results in the formation of an endometriotic pseudocyst. As a consequence, primordial follicles are present at the base of the cyst. Since surgery is of limited value, the utmost care has to be given to conservation of the patient's fertility. Ablative surgery offers advantages over excision of the cyst in terms of less adhesion formation and better preservation of the ovarian reserve. The ablative eversion technique differs from fenestration and drainage by its access through the site of inversion and resection of the fibrotic ring. Using the new technique of transvaginal hydrolaparoscopy, access to the site of pathology in the fossa ovarica is facilitated. Furthermore, the aqueous distension medium keeps the organs afloat and provides a clear delineation between the organs and adhesions allowing atraumatic reconstructive surgery.

Endometriosis↗
PubMed2001

Transvaginal hydrolaparoscopy but not standard laparoscopy reveals subtle endometriotic adhesions of the ovary.

OBJECTIVE: To determine whether transvaginal hydrolaparoscopy is superior to standard laparoscopy for detection of subtle endometriotic adhesions of the ovary. DESIGN: Videotapes of standard laparoscopy and transvaginal hydrolaparoscopy were viewed by an independent observer in random order and in a blinded manner. SETTING: Tertiary referral centers for infertility. PATIENT(S): Patients with minimal or mild endometriosis (n = 11) and unexplained infertility (n = 10) on standard laparoscopy from a group of 43 patients with infertility who were undergoing both studies. INTERVENTION(S): Transvaginal hydrolaparoscopy followed by standard laparoscopy. MAIN OUTCOME MEASURE(S): Detection of unexplained ovarian adhesions. RESULT(S): Patients with minimal and mild endometriosis and unexplained infertility had significantly more ovarian adhesions on transvaginal hydrolaparoscopy than on standard laparoscopy. The subtle adhesions seen on transvaginal hydrolaparoscopy but not on standard laparoscopy were filmy, microvascularized, and nonconnecting. CONCLUSION(S): Unexplained ovarian adhesions are frequently detected on transvaginal hydrolaparoscopy but not on standard laparoscopy in infertile patients with minimal and mild endometriosis and unexplained infertility.

Endometriosis↗
PubMed2001

Risk and outcome of bowel injury during transvaginal pelvic endoscopy.

OBJECTIVE: To determine the risk and outcome of bowel injury associated with new techniques of transvaginal pelvic endoscopy. DESIGN: A multinational retrospective survey based on confidential, self-reported cases. SETTING: Tertiary referral centers for infertility. PATIENT(S): Infertile patients without obvious pelvic pathology. INTERVENTION(S): Transvaginal hydrolaparoscopy and fertiloscopy. MAIN OUTCOME MEASURE(S): Full-thickness bowel injury. RESULT(S): Thirty-nine responders reported a total of 24 bowel injuries (0.65%) in 3667 procedures. After initial experience, the prevalence of bowel injury was 0.25%. All of the injuries were diagnosed during the procedure. Twenty-two (92%) of the cases were managed without consequences. CONCLUSION(S): The bowel lesion caused by the new techniques of transvaginal pelvic endoscopy tends to be minor and under strict conditions can be treated expectantly.

Female↗
PubMed2001

The management of eating disorders in a fertility clinic: clinical guidelines.

Although the wish for a child may be ambivalent in women with anorexia or bulimia nervosa, the prevalence of eating disorders in fertility clinics is probably underestimated. Motivated by the wish for a child, these couples may be reluctant to reveal a history of an eating disorder and/or show resistance to some therapy for this disorder. Nevertheless, in our opinion, the eating disorder must be in full remission before any fertility treatment can start, if treatment is still necessary at that moment. Illustrated with some case examples, we will discuss the major problems and clinical strategies in the management of these complex cases, based upon the experience in our own fertility clinic.

Counseling↗
PubMed2001

An appraisal of the role of laparoscopy: past, present, and future.

OBJECTIVE: To review the role of laparoscopy in the management of chronic pelvic pain (CPP). METHOD: A literature search was conducted to obtain a clear perspective on the role of laparoscopy for CPP. RESULTS: Laparoscopy has been widely used as a diagnostic tool in CPP, but often falls short in defining the type and activity of ectopic endometrial-like tissue. Because pelvic endometriosis includes a wide range of lesions, histological confirmation varies greatly. The evaluation of peritoneal endometriosis at laparoscopy can be misleading. In one study 43% of the patients with minimal or mild endometriosis were found at second-look laparoscopy to be free of lesions. Finally, laparoscopy is not without major complications and the risk of undiagnosed bowel injury is likely to be underestimated. CONCLUSION: The diagnosis of endometriosis can no longer be limited to the visual inspection of the pelvis but requires a wider range of investigations to assess the reproductive system and the role of endometriotic lesions and adhesions in CPP.

Chronic Disease↗
PubMed2000

Office transvaginal hydrolaparoscopy for early diagnosis of pelvic endometriosis and adhesions.

UNLABELLED: STUDY OBJECTIVE. To evaluate the feasibility of a new endoscopic technique, transvaginal hydrolaparoscopy, for early office screening of subfertile women. DESIGN. Retrospective, descriptive feasibility study (Canadian Task Force classification II-2). SETTING: Office in an infertility center. PATIENTS: One hundred fifty-seven continuous women with primary or secondary subfertility. INTERVENTION: Under local anesthesia, a Veress needle-cannula system was inserted into the posterior fornix with peritoneal distention by saline. MEASUREMENTS AND MAIN RESULTS: Access was achieved in 95% of patients. In 58.5% the findings were normal and in 28% an explorative or operative laparoscopy was indicated. No major complication occurred. Patients' pain scores were similar to those for office hysteroscopy. CONCLUSION: Transvaginal hydrolaparoscopy was successfully performed in the office. The technique allows early and complete endoscopic screening of subfertile women.

Ambulatory Care↗
PubMed2000

Hydrosalpinx and ART: hydrosalpinx--functional surgery or salpingectomy?

The debate on the effect of the hydrosalpinx on medically-assisted reproduction has demonstrated the importance of understanding the complex pathophysiology of the hydrosalpinx in outlining the principles of its clinical management, whether it is by functional surgery or IVF, preceded or not by salpingectomy. New endoscopic techniques are available to accurately assess, both in the operating room and the office, the quality of the tubal mucosa. The direct endoscopic evaluation of the tubal mucosa in hydrosalpinges is at present the most reliable technique to select between functional surgery and preventive salpingectomy. In future, prospective randomized studies on salpingectomy will benefit greatly from accurate clinicopathological data.

Fallopian Tube Diseases↗
PubMed1999

Diagnostic accuracy of transvaginal hydrolaparoscopy in infertility.

OBJECTIVE: To determine whether the accuracy of transvaginal hydrolaparoscopy is comparable to that of standard laparoscopy for the diagnosis of infertility. DESIGN: Prospective, comparative study. SETTING: General hospital in Belgium. PATIENT(S): Ten infertile patients without obvious pelvic pathology. INTERVENTION(S): Two gynecologists independently performed transvaginal hydrolaparoscopy and standard laparoscopy and reported the observations in a confidential manner to a third person. MAIN OUTCOME MEASURE(S): Endometriosis, adhesions, and other pelvic pathology related to infertility. RESULT(S): Minimal or mild endometriosis was diagnosed in seven patients and sequelae of pelvic inflammatory disease in one patient at both procedures. The interobserver agreement for tuboovarian adhesions was 95% at transvaginal hydrolaparoscopy and 74% at standard laparoscopy. Ovarian adhesions were detected in 63% at transvaginal hydrolaparoscopy and in 37% at standard laparoscopy. CONCLUSION(S): Transvaginal hydrolaparoscopy is comparable in accuracy to standard laparoscopy for the diagnosis of adhesions and endometriosis in infertile patients without obvious pathology.

Endometriosis↗
PubMed1999

Office hydrolaparoscopy for the diagnosis of endometriosis and tubal infertility.

Transvaginal hydrolaparoscopy has been described as an office procedure that is particularly suitable for the diagnosis of endometriosis and adhesions. It is recommended as a first line procedure in patients with infertility. The procedure is performed under local anaesthesia or sedation in an office setting. The abdominal distension is achieved by transvaginal instillation of warm saline using a combined Veress needle-trocar system. The exploration under fluid allows the inspection of the tubo-ovarian structures in their natural position and the easy identification of endometriotic lesions and adhesions in the posterior pelvis. The limitation of the inspection to the posterior pelvis is not a major problem for the diagnosis of endometriosis because exclusively anterior pelvis endometriosis is rare and of doubtful significance in infertility. Transvaginal hydrolaparoscopy can be performed in the office setting in combination with minihysteroscopy, tubal patency test and salpingoscopy, offering major advantages for the diagnosis of pelvic disease in patients with infertility.

Ambulatory Surgical Procedures↗
PubMed1998

Transvaginal salpingoscopy: an office procedure for infertility investigation.

OBJECTIVE: To evaluate the feasibility of salpingoscopy as an office procedure using transvaginal access to the pelvic cavity. DESIGN: Descriptive study. SETTING: Gynecology office. PATIENT(S): Infertile women with no obvious pelvic pathology. INTERVENTION(S): Transvaginal Veress needle puncture and peritoneal distension by saline. MAIN OUTCOME MEASUREMENT(S): Visualization of distal tubal segment. cannulation, and salpingoscopy. RESULT(S): The fimbriae were visualized in all patients. Cannulation of the distal tubal segment was achieved without manipulation of the tube in 20% before ovulation and 55% in the early luteal phase. CONCLUSION(S): Transvaginal fimbrioscopy and salpingoscopy can be performed as an office procedure in patients without obvious pelvic pathology. In combination with hydrolaparoscopy and dye hydrotubation, the technique provides comprehensive screening of the tuboovarian structures in the early stage of infertility investigation.

Ambulatory Surgical Procedures↗
PubMed1998

Intracytoplasmic sperm injection in the treatment of male subfertility.

OBJECTIVE: To evaluate the results obtained after intracytoplasmic sperm injection (ICSI) in couples with male factor subfertility. DESIGN: Retrospective analysis of results obtained after ICSI in the unit of in vitro fertilisation in a private centre for infertility. RESULTS: Application of ICSI in treatment cycles for male subfertility resulted in a fertilisation rate of 62%. An embryo transfer was done in 98% of the cycles, resulting in a 24% pregnancy rate/ET or 22% per cycle. CONCLUSION: ICSI is the first microfertilisation technique with reproducible high fertilisation rates in different centres and the method of choice in the treatment of severely impaired sperm quality. Although, up to now, no higher incidence of congenital malformations has been reported, except for sex chromosomal anomalies, careful genetic counselling is mandatory because of the risk of transmitting genetically defined male subfertility to the next generation.

Adult↗
PubMed1998

Performance of the sperm quality analyser in predicting the outcome of assisted reproduction.

The present study was undertaken to assess the relationship between the results of conventional semen analysis and the sperm motility index (SMI) as measured by the sperm quality analyser (SQA), and to evaluate these in relation to the fertilization and/or pregnancy outcome of assisted reproduction. SMI determinations and conventional semen analyses were performed on 223 samples from subfertile men in two laboratories in Leuven (n = 136) and Antwerp (n = 87), and on spermatozoa prepared on a Percoll gradient (n = 136) used for treatment of male factor infertility in 57 cycles of intrauterine insemination (IUI), 44 attempts at in vitro fertilization (IVF) and 31 attempts at intracytoplasmic sperm injection (ICSI). SMI values for native semen correlated significantly with sperm concentration, motility and morphology. Multiple regression analysis revealed sperm concentration after preparation, and the concentration of motile spermatozoa with normal morphology and SMI (before preparation) to be the independent determinants for SMI after preparation. SMI values were significantly higher after, than before, preparation (p < 0.0001). In regular IVF (n = 44) the percentage of fertilized oocytes correlated significantly (p < 0.05) with sperm motility (A + B%, r = 0.33), with the percentage of spermatozoa with normal morphology (r = 0.46) before preparation, with the values of SMI both before and after preparation (r = 0.54, r = 0.48), with sperm concentration (r = 0.34) and with the motile sperm concentration (r = 0.29) after preparation. For the occurrence of pregnancy (all treatment methods), comparison of areas under ROC curves (AURC) indicated motile sperm concentration after preparation, as well as SMI both before and after preparation, to have the highest AURC, with no significant difference between these values as far as predictive power was concerned. These results indicate that the SQA allows for rapid evaluation of sperm characteristics and of the effectiveness of sperm preparation techniques. However, it is not superior to conventional semen analysis in predicting the outcome of assisted reproduction.

Female↗
PubMed1998

Transvaginal hydrolaparoscopy as an outpatient procedure for infertility investigation.

A new technique called transvaginal hydrolaparoscopy is described for the exploration of the tubo-ovarian structures in infertile patients without obvious pelvic pathology. It aims to be an acceptable alternative to diagnostic laparoscopy, a standard but not innocuous procedure which infrequently reveals pathology in the asymptomatic patient. Transvaginal hydrolaparoscopy copy is performed under local anaesthesia using a small diameter optic with the patient in the dorsal position. Cavity distension is achieved with normal saline. Transvaginal hydrolaparoscopy does not provide the familiar and panoramic view of the pelvis given by laparoscopy, but it does have several advantages. These include accurate and atraumatic inspection of adnexal structures without manipulation, with the opportunity to perform dye hydrotubation and salpingoscopy. The risks of a general anaesthetic are avoided, and there is less risk of trauma to major vessels. The high patient acceptability makes transvaginal hydrolaparoscopy suitable as an early stage procedure in the investigation of infertility and as a repeat or second look procedure. Minor operative procedures such as biopsy and adhesiolysis can also be performed. In patients with obvious pelvic pathology, diagnostic laparoscopy will obviously remain the procedure of choice. Transvaginal hydrolaparoscopy deserves full evaluation of its accuracy, risks and benefits before it can be accepted as a new first line technique in gynaecological practice.

Ambulatory Care↗
PubMed1998

Endoscopic visualization of the process of fimbrial ovum retrieval in the human.

The process of ovum retrieval by the fimbriae in the human still remains elusive. Animal studies have suggested that ova can be 'sucked' into the oviduct by negative pressure caused by muscular contractions of the tube, while laparoscopic observations in women have indicated a close relationship between fimbriae and the ovulating ovary. Here, a case is described in which the process of ovum retrieval was observed directly using a new endoscopic technique, called transvaginal hydrolaparoscopy. The access is through the posterior fornix of the vagina and saline is used for distension. The tubo-ovarian structures during the process of ovum retrieval were visualized under fluid. The fimbriae on the ovulatory side appeared congested and tumescent and showed pulsatile movements synchronous with the heartbeat. The cumulus mass was adherent to the fimbriae and released from the site of rupture by the sweeping movements of the fimbriae until it disappeared between the rigid fimbrial folds. To the best of our knowledge this is the first direct observation of the process of ovum retrieval in the human. Vascular congestion causing erection and pulsatile movements of the fimbriae play a role in the retrieval of the ovum. The retrieval process from the site of rupture is slow and transport is achieved by ciliary activity only. The fimbrial changes are apparently controlled by the ovulatory ovary.

Adult↗