FERTILITY AND STERILITY
Vol. 27, No.9, September 1976 Printed in U.S.A.
Copyright © 1976 The American Fertility Society
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ENDOMETRIAL BIOPSIES ON THE INFERTILE PATIENT
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QUESTION
Should endometrial biopsies be done on the infertile patient before menses, and, if so, what are the risks and what type of consent is obtained?
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M.D. ANSWER
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It has been our practice to perform endometrial biopsies on infertile patients during the week before an expected menses, since we believe that such timing permits better tissue samples, easier scheduling, and the performance of hysterosalpingography in sequence with endometrial biopsy. It is to be noted that, when these procedures are combined, the hysterosalpingogram is done first and the biopsy last. The only added risk is that of interruption of an early pregnancy. In the truly infertile patient this risk is minimal. In· those instances in which an early pregnancy is present the pregnancy is seldom interrupted. We have reported 1 18 pregnancies in 9100 patients in whom studies for infertility had been done premenstrually. All of the 18 had tubal patency studies and 15 of the 18 had endometrial biopsies. At the time of the report, 14 of the 18 had delivered nor-
mal children, 3 were undelivered but were apparently normal. The outcome in one patient was not known. No radiation effects were noted. Similar experiences have been reported by others. Other risks, such as infection, morbidity, and embolization, are probably the same with premenstrual and onsetof-menses biopsies. Written consent is not obtained. However, the risks, particularly those relating to the possible presence of pregnancy and the effects of radiation thereon, are carefully explained to patients and appropriate notes made regarding these matters on the patients' records. If either the patient or physician, or both, are unwilling to assume the risks, the patient is required to abstain from intercourse during the cycle in which the procedures are done. RoBERT B. WILSON, M.D. Professor Emeritus Mayo Foundation Rochester, Minnesota June 15, 1976
REFERENCE 1. Wilson RB, Lee RA, Jensen PA: Inadvertent
infertility investigations in pregnant women. Fertil Steril17:126, 1966
We solicit questions for "Quiz the Expert" dealing with current advances or concerns in the ~eld offert~lity and sterility. Each question published will be answered by an individual with special expertise. Questions should be directed to the Editor, Roger D. Kempers, M.D., 200 First Street, S.W., Rochester, Minn. 55901. Questions should not exceed 250 words.
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QUIZ THE EXPERT
September 1976
BICORNUATE UTERUS AND ECTOPIC PREGNANCY QUESTION
I have a 26-year-old patient who had a right salpingectomy in January 1975 for an ectopic pregnancy. In October 1975 she had a left ectopic pregnancy, and, to retain her fertility, a salpingostomy with insertion of a polyethylene catheter was performed. The latter was removed 3 months later. A follow-up hysterosalpingogram revealed a patent left tube and a bicornuate uterus. Is there an association between bicornuate uterus and ectopic pregnancy? Would you recommend unification of the uterus prior to another attempt at conception? A. FREn TuRNER, MAJoR, USAF, MC Chief, Obstetrics and Gynecology United States Air Force Hospital, Yokota (PACAF) APO San Francisco, California ANSWER
An extensive review of standard obstetric and gynecologic texts revealed no evidence of an association between bicornuate uteri and ectopic pregnancies. However, it is estimated that one out of four women with a double uterus will have some type of reproductive problem, such as a premature delivery or repeated early abortions. 1 Gros et aP reported two ectopic pregnancies in 57 women with bicornuate uteri. In reviewing the literature from 1974 to the present, I find that no other
authors have commented upon such an association. Repeated spontaneous abortions or premature labors are associated with congenital anomalies of the uterus. 3 Therefore, a bicornuate uterus is not an indication for a plastic unification unless there is a history of premature delivery, repeated abortion, or infertility, after all other possible endocrine and metabolic causes of fetal wastage are excluded. Rum ANsBACHER, M.D., M.S., CoL., MC USA Assistant Chief, Department of Obstetrics and Gynecology Fort Sam Houston, Texas August 3, 1976 REFERENCES 1. Jones HW, Jones GES: Double uterus as an
etiological factor in repeated abortion: indications for surgical repair. Am J Obstet Gynecol 65:325, 1953 2. Gros A, David A, Serr DM: Management of congenital malformations of the uterus: fetal salvage. Acta Eur Fertil 5:301, 1974 3. Willson JR, Beecham CT, Carrington ER: Obstetrics and Gynecology, Fourth Edition. St. Louis, CV Mosby Co, 1971, p 288 SUGGESTED READING 1. Gibbs CE: Diagnosis and treatment of uterine
conditions that may cause prematurity. Clin Obstet Gynecol 16:159, 1973
Vol. 27, No.9, September 1976 Printed in U.S.A.
Copyright © 1976 The American Fertility Society
I
L I
')
1
ENDOMETRIAL BIOPSIES ON THE INFERTILE PATIENT
I
r
l 1 ..
~
f
QUESTION
Should endometrial biopsies be done on the infertile patient before menses, and, if so, what are the risks and what type of consent is obtained?
"
M.D. ANSWER
r
l
It has been our practice to perform endometrial biopsies on infertile patients during the week before an expected menses, since we believe that such timing permits better tissue samples, easier scheduling, and the performance of hysterosalpingography in sequence with endometrial biopsy. It is to be noted that, when these procedures are combined, the hysterosalpingogram is done first and the biopsy last. The only added risk is that of interruption of an early pregnancy. In the truly infertile patient this risk is minimal. In· those instances in which an early pregnancy is present the pregnancy is seldom interrupted. We have reported 1 18 pregnancies in 9100 patients in whom studies for infertility had been done premenstrually. All of the 18 had tubal patency studies and 15 of the 18 had endometrial biopsies. At the time of the report, 14 of the 18 had delivered nor-
mal children, 3 were undelivered but were apparently normal. The outcome in one patient was not known. No radiation effects were noted. Similar experiences have been reported by others. Other risks, such as infection, morbidity, and embolization, are probably the same with premenstrual and onsetof-menses biopsies. Written consent is not obtained. However, the risks, particularly those relating to the possible presence of pregnancy and the effects of radiation thereon, are carefully explained to patients and appropriate notes made regarding these matters on the patients' records. If either the patient or physician, or both, are unwilling to assume the risks, the patient is required to abstain from intercourse during the cycle in which the procedures are done. RoBERT B. WILSON, M.D. Professor Emeritus Mayo Foundation Rochester, Minnesota June 15, 1976
REFERENCE 1. Wilson RB, Lee RA, Jensen PA: Inadvertent
infertility investigations in pregnant women. Fertil Steril17:126, 1966
We solicit questions for "Quiz the Expert" dealing with current advances or concerns in the ~eld offert~lity and sterility. Each question published will be answered by an individual with special expertise. Questions should be directed to the Editor, Roger D. Kempers, M.D., 200 First Street, S.W., Rochester, Minn. 55901. Questions should not exceed 250 words.
1115
1116
QUIZ THE EXPERT
September 1976
BICORNUATE UTERUS AND ECTOPIC PREGNANCY QUESTION
I have a 26-year-old patient who had a right salpingectomy in January 1975 for an ectopic pregnancy. In October 1975 she had a left ectopic pregnancy, and, to retain her fertility, a salpingostomy with insertion of a polyethylene catheter was performed. The latter was removed 3 months later. A follow-up hysterosalpingogram revealed a patent left tube and a bicornuate uterus. Is there an association between bicornuate uterus and ectopic pregnancy? Would you recommend unification of the uterus prior to another attempt at conception? A. FREn TuRNER, MAJoR, USAF, MC Chief, Obstetrics and Gynecology United States Air Force Hospital, Yokota (PACAF) APO San Francisco, California ANSWER
An extensive review of standard obstetric and gynecologic texts revealed no evidence of an association between bicornuate uteri and ectopic pregnancies. However, it is estimated that one out of four women with a double uterus will have some type of reproductive problem, such as a premature delivery or repeated early abortions. 1 Gros et aP reported two ectopic pregnancies in 57 women with bicornuate uteri. In reviewing the literature from 1974 to the present, I find that no other
authors have commented upon such an association. Repeated spontaneous abortions or premature labors are associated with congenital anomalies of the uterus. 3 Therefore, a bicornuate uterus is not an indication for a plastic unification unless there is a history of premature delivery, repeated abortion, or infertility, after all other possible endocrine and metabolic causes of fetal wastage are excluded. Rum ANsBACHER, M.D., M.S., CoL., MC USA Assistant Chief, Department of Obstetrics and Gynecology Fort Sam Houston, Texas August 3, 1976 REFERENCES 1. Jones HW, Jones GES: Double uterus as an
etiological factor in repeated abortion: indications for surgical repair. Am J Obstet Gynecol 65:325, 1953 2. Gros A, David A, Serr DM: Management of congenital malformations of the uterus: fetal salvage. Acta Eur Fertil 5:301, 1974 3. Willson JR, Beecham CT, Carrington ER: Obstetrics and Gynecology, Fourth Edition. St. Louis, CV Mosby Co, 1971, p 288 SUGGESTED READING 1. Gibbs CE: Diagnosis and treatment of uterine
conditions that may cause prematurity. Clin Obstet Gynecol 16:159, 1973
