Researchers in obstetrics and gynecology and reproductive endocrinology at Cedars-Sinai Medical Center in Los Angeles and the University of Alabama at Birmingham suggest that specialists should consider the routine use of laparoscopic evaluation when women are unable to become pregnant after four cycles of the "fertility pill" clomiphene citrate.

Diagnosing abnormalities earlier
Researchers made their recommendation after reviewing 92 patient cases over an eight-year period. Some physicians have in the past few years forgone laparoscopy, relying only on a special X-ray image of the fallopian tubes. If the tubes appear to be open, patients then may undergo up to six cycles of additional hormone therapy (gonadotropin injections), followed by in vitro fertilization if pregnancy still has not been achieved.

The X-ray procedure, called a hysterosalpingogram, fills the uterine cavity with a dye that flows into the fallopian tubes unless a blockage is present. The resulting X-rays enable physicians to see abnormalities in the tubes, or areas of polyps, scar tissue or fibroid tumors in the uterine cavity -- some of the conditions that can cause infertility or reduced fertility. These images, however, lack the accuracy and diagnostic specificity available with chromotubation -- the injection of a colored fluid -- used during a laparoscopic evaluation.

"Laparoscopy is the gold standard for diagnosing intrapelvic adhesions or tubal disease. By taking advantage of this procedure after a four-cycle trial of clomiphene citrate we may diagnose abnormalities earlier rather than later," says Ricardo Azziz, MD, chairman of Cedars-Sinai's Department of Obstetrics and Gynecology and executive director of the Androgen Excess Society, an international research organization.

"Using the laparoscope, we also often can treat fertility-inhibiting conditions immediately with minimally invasive surgical procedures. In cases when surgical correction is not possible, the laparoscopic findings will guide us to perform in vitro fertilization earlier than later. In either case, the use of laparoscopic techniques can allow many patients to avoid needless cycles of treatments and the related emotional stress and financial burden," says Dr Azziz. Prior to joining Cedars-Sinai, Dr Azziz served as professor in the Department of Obstetrics and Gynecology and in the Department of Medicine at the University of Alabama at Birmingham. Currently he is also professor and vice chairman of the Department of Obstetrics and Gynecology, and professor in the Department of Medicine at The David Geffen School of Medicine at the University of California, Los Angeles. He and his colleagues published the results of their review in the December 2003 issue of the journal Fertility and Sterility.

Before any treatment is started, women who seek help because they have been unable to become pregnant due to irregular or absent ovulation typically undergo a pelvic examination and hysterosalpingogram, and the partner's sperm count is analyzed. If there is no obvious abnormality, ovulation induction with clomiphene citrate is often one of the first treatment options used. If pregnancy has not been achieved after four ovulatory cycles, most specialists in reproductive endocrinology have routinely used laparoscopy to search for anatomical abnormalities. Only in recent years have some specialists suggested forgoing this examination.

Of the 92 cases reviewed in this study, 32 patients (34.8 percent) had a "positive" laparoscopy, defined as findings of advanced stages of endometriosis, a tumor, pelvic adhesions, and/or disorders of the fallopian tubes. Besides these significant abnormalities, more than 29 percent had stage I or stage II endometriosis, which, according to some studies, also may be associated with reduced fertility and may respond to laparoscopic surgery. Only 35.9 percent of patients had a completely normal pelvis.

Analyzing patient demographic data, medical histories, and laparoscopic results, the study's authors attempted to determine if certain factors could help predict which patients would be at high risk for pelvic disorders. They found a higher frequency of endometriosis among women who had painful menstrual periods and those who had previously used natural contraception. Pain during intercourse and the previous use of natural contraception were associated with the presence of tumors (endometriomas). Women who had previously been pregnant and those who had used oral contraceptive pills had a reduced number of pelvic adhesions, while those who had never been pregnant and those who had never used oral contraceptives had a higher incidence of pelvic adhesions.

About 91 percent of the patients in the study had at least one predictor for intrapelvic disease, and almost 40 percent of those with predictors had a positive laparoscopy, compared with only 12.5 percent of those without predictors.

Of those experiencing pain during intercourse, nearly 52 percent had a positive laparoscopy, compared to only 27 percent of women without pain. Patients with no prior history of using oral contraceptives had a 64.3 percent likelihood of a positive laparoscopy, compared with 29.5 percent of women who had used birth control pills. Sixty-four percent of women who had never used contraceptives had positive findings, compared with only 30 percent of those who had used birth control measures.


While these correlations between clinical features and surgical findings were noted, there were no features that could be used to absolutely predict the presence of significant surgical findings. The investigators concluded that laparoscopy should be used routinely after treatment with four cycles of clomiphene citrate, although the technique may be delayed if there are no identifiable predictors for intrapelvic disease.

A useful tool
"Laparoscopy continues to be a useful tool in the workup of an infertile couple," Dr Azziz says. "Using a set of predictors for intrapelvic disease appears to be a valid approach in developing diagnostic and treatment options, although many women with intrapelvic abnormalities may have no identifiable predictors. Together, these techniques may help many couples avoid months of needless therapies."


recommended for you


mac cosmetics cheap June 16, 2015
<a href="">mac cosmetics outlet</a> <a href="">mac cosmetics set</a> <a href="">mac cosmetics romania online</a> <a href="">mac cosmetics store</a> <a href="">discount mac cosmetics online</a>
[url=]mac cosmetics cheap[/url]
mac cosmetics headquarters June 15, 2015
<a href="">buy mac cosmetics online uk</a> <a href="">mac cosmetics ingredients</a> <a href="">mac cosmetics outlet</a> <a href="">mac cosmetics usa online</a> <a href="">mac cosmetics professional</a>
[url=]mac cosmetics headquarters[/url]
mac cosmetics locations June 12, 2015
<a href="">what is mac cosmetics</a> <a href="">mac cosmetics nederland</a> <a href="">mac cosmetics usa online</a> <a href="">shop mac cosmetics online</a> <a href="">mac cosmetics shop online</a>
[url=]mac cosmetics locations[/url]
andyths November 14, 2014
锘?15:33:42 <a href=>Moncler Jas Dames Jassen grijs Nieuwste Verkoop Online</a>tommers skrm GMTStudents during the Substances Scientific discipline Design unit at North Carolina Declare College joined that will develop the claw develop which will variations colour when considering in contact go out with rape medicine. Rohypnol, Xanax, plus GHB regularly go undetected simply because they're usually unscented along with without color. Rohypnol, was previously throughout whitened tablet pc type yet a short while ago this has been designed they can be inexperienced with a violet central. The software creator designed the modification in an attempt to determine meddled refreshments with organizations. Nonetheless simple designs involving.Individuals while in the Materials Science Technological innovation division in New york State College collaborated that will develop a good nail bed develop which will shifts colors t<a href=>air max zoom lebron james 828</a>aking into consideration hold of go out with rape medicines. Rohypnol, Xanax, plus GHB usually choose undiscovered considering they are regularly odor free as well as without color. Rohypnol, was once inside bright pill type but a short while ago many experts have formulated they can be environment friendly having a purple heart. The software creator designed the progress to establish meddled beverages on night clubs. Nevertheless common designs of.$10,Thousand pay back regarding threesome which took 16 firearms by South carolina handgun shop$10,One thousand compensate pertaining to group exactly who stole 18 weapons with Structured gun shopUpdated: Saturday, July 28 2014 Nine:34 In the afternoon EDT2014 08 26 09:27:40 GMTSurveilence pictures with the crimeGreer Police say any Table dresser for Alcoholic drinks, Tobacco, Pistols and also Explosives is usually becoming a member of various other agencies with giving a prize regarding details top to your police arrest of such answerable for break-ins of weapons at a keep around Greer in Come july 1st.Greer Shop dead any Table dresser with Liquor, Tobacco smoking, Weapons together with Explosives is usually joining additional institutions during offering a reward for data that leads into the detain of these liable for break-ins associated with guns from a retail outlet throughout Greer inside Come early july.Law enforcement officials reveal poorly lit holes throughout rooms inside Virtual assistant. grown-up uniqueness storePolice explain shady openings with partitions in Virtual assistant. mature unique storeUpdated: Friday, September 35 2014 Eight:15 Evening EDT2014 Up to 29 10:14:Fifty seven GMTThe grownup special storeFederal court papers discuss prior to now, who owns grown-up unique shop in Express Highway around Bristol, Veterans administration.And folk with

<a href=>air max 1 premium atmos elephant</a>
<a href=>Moncler Himalaya Down Jassen voor Heren Zwart Nieuwste Verkoop Online</a>
<a href=>air jordan retro 6 lakers cheap</a>
<a href=>Moncler Down Jacket Dames Jassen Khaki Kleur Nieuwste Verkoop Online</a>
<a href=>cheap air jordan 6 for sale</a>
Joevia November 05, 2014
锘縲", Justice Bampton probably would not pick up things relevant to generating infractions.

"I gives further more shown to the plethora of concerns through which The law Bampton will probably deal, and also the stretch of time which is why which is the situation, in the end.Half inch

Legal representative Normal Steve Rau explained they to become frustrated that will Justice Bampton ended up announced designed for ingest driving a car as well as driving a vehicle not having owing care.

Speaking about Learning the alphabet broadcast this morning, Mister Rau will not discuss regardless of whether Justice Bampton seemed to be ideal to stay servicing on the standard, although claimed she had executed using variance for a lot of yrs inside Location Judge.

The Attorney All round claimed this judge's recruitment while using judiciary ended up being "essentially an indoor topic to the court".

"I'm extremely self-confident the key Proper rights will cope with that will perfectly.Inch

Your Outsider: Bullies, suggestions and material pros

Beholden to help not a soul Currently, any severity associated with demi lovato within a important unit, a radius of Health and wellbeing products federal express continues unbroken, Uber Adelaide links, and many more.閿樼笂ver Demise For Disk jockey Henry Smith

Inside of a record published thru Smith's aerial recording business Soaring Tv for pc, Milliseconds Greene said she would "like to consider massive as a result of staff members along at the medical facility with regards to treatment plus compassion".

Any record proclaimed Master of science Greene has questioned they, her family be allowed to mourn inside peace.

A good Hovering Television representative stated: "Mike launched Flying Tv for pc Several years past and the corporation says his history are going to be FTV still go from muscle that will sturdiness.In

Smith's career started at healthcare facility r / c well before getting started with BBC Radio station One inch 1974.

During '83, Johnson took control of the particular weekday lunch clearly show along with took around the Morning meal Demonstrate throughout 1986, profiting Paul Learn.

Paying tribute, Read through explained: "The media is overwhelming. Darlene in addition to John were being a beautiful few it's genuinely nasty to listen to.Inches

"He was really a mainstay with Airwaves A single, ended up being extremely prosperous a tv personality also, and commenced way up his or her own organization that they had been great at.

"Mike was a pretty affable male, brilliantly business for example. It's actually a real decrease and features

<a href=>Nike Air Max 90 Premium Tape DarkGreen Red Camo</a>
<a href=>Nike Air Max 90 Premium Tape Blue Hero Camo</a>
<a href=>Nike Free 3.0 V5 Men Black Purple</a>
<a href=>Nike Free Run+ 2 Women MainBlack LightRed</a>
<a href=>Nike Free 5.0 v5 Women Blue Orange</a>