Newsletter 17


Fresh or Frozen Eggs Might Perhaps Not Matter for Donated Eggs

Human embryos have not been easy to freeze and thaw successfully but embryologists have increased success rates over the years. Human ova have been even more difficult to successfully freeze and thaw but again technology seems to be catching up.

NEW YORK (Reuters Health) Jul 23 1010

Frozen eggs could very well be just as successful as fresh eggs for women trying to conceive by egg donation, completely new studies suggest.

Women have been implanted using frozen eggs at a Spanish infertility center conceived at effectively a similar rate as women implanted having fresh eggs - to the researchers' delight, as they reported online June 30th.

Utilizing frozen ova, explained Dr. Nicole Noyes from the New York University Fertility Center, is usually very much more convenient and possibly less expensive than using fresh ova.

frozen embryosfrozen embryos

When the technique ceases being deemed experimental, she suggested, "This field is going to explode."

In the present research, Dr. Ana Cobo and her co-workers at the Valencia Infertility Institute in Spain implanted six hundred women with donor ova by way of in vitro fertilization (IVF). Half of the implanted ova were fresh - inseminated only a few hours after they were removed from donors and implanted in recipient women three days later. The other fifty percent had been frozen for not less than 6 months prior to being warmed up, inseminated, and then transferred.

The research was randomized, prospective, and triple-blinded - so neither the women nor their doctors were aware which type of ova they were benefiting from.

Actually, Dr. Cobo and her group had designed their research to "establish the superiority of the ongoing pregnancy rate of fresh oocytes over that of vitrified oocytes,"

Ten weeks after the eggs were implanted, 44% of women who had received frozen eggs were pregnant, in comparison to 43% of women who were implanted with fresh ova.

"We believe that these data may represent a breakthrough in the current practice of (egg) donation," the authors wrote.

About 3,000 children are delivered from ovum donation annually in the U.S., most utilizing fresh eggs.

However there are several crucial downsides to employing fresh ova for egg donation, Dr. Noyes explained. The principle issue is the fact that doctors have to make certain that the recipient's uterus is able to receive the egg and the same time the donor is just about to have her eggs harvested.

"Coordinating that from a clinic's perspective might be a little bit hard," Dr. Noyes said.

Freezing may also permit a donor's eggs to be divided amongst additional recipients, which might make the process less expensive for women trying to conceive, Dr. Noyes said.


Hum Reprod 2010.

Miscarriage is tough on men, but more stressful on women

A lot of men are affected psychologically when their partner loses a pregnancy, new studies have shown. But they recover more rapidly from their distress compared to women.

Until only recently, professionals believed that a man did not bond with his unborn child, and that miscarriages did not have an impact on men. Whilst various investigators have since documented that men also report feelings associated with loss, sadness, and helplessness, it isn't really clear exactly how severe their distress is, or even how long it continues.

tough on menstress for women

To research, Dr. Grace Kong of Prince of Wales Hospital in Hong Kong and co-workers observed eighty three couples for one 12 months following a miscarriage. They used two tests to measure levels of psychological distress in both men and women: None of the study participants had a medical history of psychological illness.

Immediately following the miscarriage, the research workers observed, greater than 40 percent of the men were suffering significant psychological distress.. By three months, however, only seven percent reported this level of distress, and at twelve months, five percent of the men did.

However among the women, fifty-two percent experienced significant distress immediately following miscarriage, more than 20 percent did three months later, 14 percent did at six months, and 8 percent described distress one year later.

Women in more troubled relationships were more likely to be depressed after miscarrying, as were those who had seen the fetal heartbeat on ultrasound examination previous to losing the pregnancy.

A planned pregnancy was the only significant risk factor for high levels of despression symptoms soon after the event.

The research also observed that men were more prone to be positive concerning the possibility of future pregnancies compared to women.

The outcomes, published in the obstetrics journal BJOG, indicate that the psychological effect of miscarriage on men is "less intense and enduring" than on women.

As both partners were most affected just after miscarriage, Kong and her team point out any interventions to assist these couples should take place just after the pregnancy loss.

SOURCE: BJOG: British Journal of Obstetrics and Gynecology, online July 8, 2010.


The American College of Obstetricians and Gynecologists (ACOG) has reiterated its long-standing opposition to home births.

While giving birth is a natural physiological process that the majority of women experience without having difficulties, supervising of both the woman and also the unborn infant throughout labour and delivery within a hospital or licensed birthing centre is crucial because complications may occur with little if any forewarning even amongst women with low-risk pregnancy.

ACOG appreciates the woman's right to make educated choices concerning her delivery and to have a choice in selecting her health care provider, but ACOG would not support programs that endorse for, or those who provide home births. Neither does ACOG uphold the provision of care by midwives who are not certified by the American College of Nurse-Midwives or the American Midwifery Certification Board.

home birth

Childbirth options really should not be determined or motivated by what is trendy, trendy, or even the latest cause célèbre. Regardless of the rosy image painted by home birth advocates, an apparently normal labour and delivery can rapidly turn into life-threatening for both the mother and baby. Seeking a vaginal delivery after cesarean at home is particularly hazardous because if the womb ruptures in the course of labour, both the mother and baby experience an emergency situation with potentially catastrophic outcomes, which includes death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing centre inside a hospital complex, with medical professionals ready to intervene swiftly if required, she puts herself as well as her baby's health and life at needless risk.

Promoters cite the high US cesarean rate as one justification for endorsing home births. The cesarean delivery rate has troubled ACOG in the past several many years and ACOG continues to be dedicated to decreasing it, but there is no clinical strategy to suggest a perfect nationwide cesarean rate as a targeted goal. In 2000, ACOG released its Task Force Report entitled "Evaluation of Cesarean Delivery" to assist medical professionals and institutions in evaluating and lowering, as appropriate, their own cesarean delivery rates. Several factors are responsible for the latest cesarean rate, but emerging contributors include mother's preference and also the increasing number of high-risk pregnancies attributable to mother's age, over weight, obesity, and diabetes.

The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labour and/or delivery may well be life-saving for the mother or baby and reduce the chance of an undesirable end result. ACOG is convinced that the safest environment for labour, delivery, and the immediate postpartum period is in the hospital, or a birthing centre inside a hospital complex, that meets the requirements jointly defined by the American Academy of Pediatrics and ACOG, or in a freestanding birthing center which satisfies the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.

Scientific studies evaluating the actual safety and outcome of births in hospitals with those taking place in other settings within the United States tend to be constrained and have not been scientifically thorough. Furthermore, lay or other midwives attending to home births are not able to conduct life-saving emergency cesarean deliveries and other operative and professional medical treatments that would best protect the mother and child.

ACOG really encourages every single pregnant woman to receive prenatal care and to make a birth plan. The principle objective should be a healthy and safe outcome for both mother and child. Selecting to deliver an infant in the home, however, is to place the process of having a baby above the aim of having a healthy child. For women who choose a midwife to help you deliver your baby, it is essential that they select exclusively American College of Nurse-Midwives-certified or American Midwifery Certification Board-certified midwives that collaborate with a medical practitioner to deliver their baby in a hospital, hospital-based birthing center, or appropriately licensed freestanding birth center.

No Pap Smears for Women Under 21: Guidelines

Pap smears in women under 21 do even more harm than good, brand new recommendations from the American College of Obstetricians and Gynecologists (ACOG) claim.

Typically these kinds of medical tests uncover only human papillomavirus (HPV) infections, which rarely trigger cervical cancer in women under 21..

"They have a better chance of winning the lottery than getting cancer at that age," said Dr. Einstein, who's an ACOG fellow but did not work on the guidelines.

"Over-screening adolescents is really detrimental to young women," he told Reuters Health. "We increase their anxiety, we increase their time away from school and work."

Pap Smears

The fresh guidelines, released on the internet today in Obstetrics & Gynecology, strengthen previous recommendations granted this past November. But they add that adolescents with compromised immunity should not delay until twenty one to be tested.

Even though this group comprises under one percent of adolescents, said Dr. Einstein, they are a lot more susceptible to cancer from HPV.

Earlier recommendations called for yearly cervical cancer screening to begin three years after a woman first becomes sexually active, or by age twenty one.

Previously thirty year cervical cancer rates in the United States have decreased by over fifty percent, due mostly to popular utilization of cervical cancer screening.

In its November 2009 guidelines, ACOG advised that women between twenty one and thirty years undertake cervical cancer screening once every couple of years rather than annually. Those thirty and older could be screened once every three years. The latest recommendations do not make reference to women between twenty one and thirty.


Obstet Gynecol 2010.

Management of endometrial polyps in subfertile women: a systematic review.

Polyps are small growths on a stalk and are almost always benign.

Some advocate that all women attending for infertility investigation and treatment should have a hysteroscopy (a thin scope is introduced into the uterus) to checkif terhe are any polyps and if present they should be removed. The following study looks at the evidence.


Eur J Obstet Gynecol Reprod Biol. 2010 Aug;151(2):117-21.

The purpose of this systematic review was to appraise the evidence for the impact of polypectomy on conception rates, implantation and live birth rates in women who are trying to conceive spontaneously or by assisted conception. A literature search was carried out to identify all controlled studies that compared the impact of polypectomy or conservative management of the polyp on pregnancy outcome. Among the three studies that fulfilled the inclusion requirements, only one was a randomized controlled trial, which revealed a significantly increased pregnancy rates after polypectomy in women undergoing intrauterine insemination. The other two studies were retrospective and indicated no beneficial effects of polypectomy on women undergoing assisted conception. Polyps diagnosed previous to beginning of controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) should therefore be removed.


Newsletter 16


An autoimmune-mediated strategy for prophylactic breast cancer vaccination

Research from Cleveland Ohio by which shows how an experimental vaccine could prevent the development of breast cancer in mice is an "extremely promising" development.Vincent Tuohy

The team, led by Dr Vincent Tuohy, have been working on the theory of sensitising the body to a protein found in most breast tumours, priming the immune system to kill off any problematic cells before a cancer could take hold.

This was a new approach to tackling the most common cancer in women (12%).

The early results are extremely promising.   The next step will be to trial it with a small group of women with advanced breast cancer and they are anticipating that this will start next year.

The vaccine targets the protein alpha-lactalbumin which is present in most breast cancer tumours and, in a healthy breast, should only be present during whilst breast feeding.

"The researchers have identified that it wouldn't interfere with child-bearing but purely breast feeding, but this is still far too much in the future for us to be contemplating the target age group."

There is temptation towards optimism but in medicine laboratory research and implementation into effective clinical practice can take years.

The full article is to be published in the June issue of Nature Medicine.

The abstract is as follows:-


Ritika Jaini, Pavani Kesaraju, Justin M Johnson1, Cengiz Z Altuntas, Daniel Jane-wit & Vincent K Tuohy

Although vaccination is most effective when used to prevent disease, cancer vaccine development has focused predominantly on providing therapy against established growing tumors. The difficulty in developing prophylactic cancer vaccines is primarily due to the fact that tumor antigens are variations of self proteins and would probably mediate profound autoimmune complications if used in a preventive vaccine setting. Here we use several mouse breast cancer models to define a prototypic strategy for prophylactic cancer vaccination. We selected α-lactalbumin as our target vaccine autoantigen because it is a breast-specific differentiation protein expressed in high amounts in the majority of human breast carcinomas and in mammary epithelial cells only during lactation. We found that immunoreactivity against α-lactalbumin provides substantial protection and therapy against growth of autochthonous tumors in transgenic mouse models of breast cancer and against 4T1 transplantable breast tumors in BALB/c mice. Because α-lactalbumin is conditionally expressed only during lactation, vaccination-induced prophylaxis occurs without any detectable inflammation in normal nonlactating breast tissue. Thus, α-lactalbumin vaccination may provide safe and effective protection against the development of breast cancer for women in their post–child-bearing, premenopausal years, when lactation is readily avoidable and risk for developing breast cancer is high.

Unintended Pregnancies After Essure Sterilization in The Netherlands

The Failure Rate of Hysteroscopic Sterilization

Most women who are in their reproductive years use some form of contraception when they wish to avoid pregnancy.

Surgical options are considered irreversible, although some types of tubal ligation and vasectomies can be reversed by a second surgical procedure.

Tubal ligation is a minor surgical procedure in which the tubes are blocked bilaterally by 1 of several available methods. In most cases, tubal ligation requires an abdominal approach via laparoscopy or minilaparotomy; during the procedure, part of the tube is excised or obstructed by coagulation, clips, or plastic rings. Although tubal ligation is considered safe, it still carries a low risk for intraoperative complications (bowel or bladder injury, vascular damage, and postoperative infection). In addition, patients who have had multiple previous surgeries and those with extensive adhesions may not be good candidates for the procedure. Tubal ligation is considered to be one of the most effective contraceptive methods, but it still has a failure rate of 7.5-36 per 1000 procedures.

Several attempts have been made to block the tubes proximally (through the uterus) through a hysteroscopic approach. Essure is an expanding spring device made of titanium, stainless steel, nickel, and polyethylene terephthalate fibers that is placed by hysteroscope into the proximal tube through the tubal ostia. Over a few weeks, the device expands and induces fibrosis, resulting in permanent occlusion of the tube.

Contraceptive methods are assessed by their tolerability, patient adherence, and efficacy.

Veersema and colleagues evaluated failure rates associated with Essure.
Study Summary

Essure has been available in The Netherlands since 2002. Between 2002 and 2008, approximately 6000 procedures were performed. The procedures were performed by experienced surgeons, usually without need for local or general anesthesia. As part of the protocol, patients were instructed to use an alternative method of contraception for 3 months after the procedure; at that point, control ultrasonography or hysterosalpingography was performed to confirm the position of the springs. As of 2008, 10 failures were reported to the investigators. In 3 of these cases, only unilateral spring placement was performed because of technical difficulties. In some cases, the position of the spring was misread on hysterosalpingography or ultrasonography and was erroneously thought to be placed correctly. In 2 cases, the patient did not return for the 3-month control visit; patient nonadherence was therefore considered to be the reason for failure.

Proximal tubal obstruction by the hysteroscopic approach is an alternative to permanent surgical methods of contraception. Like other irreversible methods, Essure is recommended to women who have completed their families and desire permanent sterilization. It is also an excellent choice for women who are not good candidates for surgical abdominal procedures because they are presumed to be at high risk for intraoperative complications. Essure may also be offered to women who would be at risk during anesthesia, because Essure placement does not require general (and in most cases local) anesthesia.

Similar to other surgical methods, the experience of the operating surgeon is important. Surgeons who are not experienced with hysteroscopy will find the placement difficult, and the risk for abnormal placement or placement failure then increases.

Patient adherence is always an issue, and the contraceptive efficacy of Essure placement differs between perfect use and typical use. It takes a few weeks after device placement for tubal occlusion to develop, and alternative methods of contraception are recommended during this period. It is also important to confirm the position of the springs 3 months after insertion; the patient must therefore return for hysterosalpingography or ultrasonography. Patients who do not attend this visit may be at risk for unplanned pregnancies if placement of the device was incorrect.

Women with an intracavitary lesion (eg, a congenital anomaly, fibroids, or scarring) may not be eligible for the Essure method. In these women, the tubal ostia may not be well visualized, compromising placement efficacy.

Improving medical student knowledge of female pelvic floor dysfunction and anatomy: a randomized trial.

The objective of the study was to estimate the effect of an interactive computer trainer on improving medical student knowledge and attitudes regarding female pelvic anatomy (PA) and pelvic floor dysfunction (PFD).

Forty-three students were randomized to the trainer and usual teaching vs usual teaching alone. Pre- and postintervention knowledge and attitude questionnaires were completed. Between-group pre- and postintervention scores were analyzed. Multiple linear regression was used to estimate trainer effect on scores, adjusting for confounders. RESULTS: There was no difference in baseline scores between groups (P > .05). The trainer group had significantly higher postintervention knowledge (mean score, 15.6 +/- 1.9 vs 12.6 +/- 2.5; P = .007) and attitude (mean score, 19.2 +/- 2.8 vs 15.8 +/- 3.2; P = .001) scores compared with the usual teaching group. On multiple linear regression, the trainer group had significantly higher postintervention knowledge and attitude scores, after adjusting for year of medical education and prior clerkships.

CONCLUSION: An interactive computer trainer to teach female PA and PFD improves medical student knowledge and attitudes.

Computers in Education

The above study adds to the wealth of information that we have on the importance of computers to improve our knowledge.

The author of this website, David Viniker MD FRCOG has been involved in the application of computing in medical student and patient education for 25 years.

This website,, receives more than 2 million visitor annually. Much has been learned about website design and maximising the benefits of a website - search engine optimisation. A computer program - Keyword SEO Pro - has been developed to assist us.

If you have a website that is underperforming, our team may be able to assist you.



Women's Health

This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

General and Personalised Questions


This website provides medical information of a general nature.

It would not be possible to provide answers to an individual patient over the internet.

A medical opinion for an individual patient requires the doctor

  • To take the full history (story).
  • Examination of the patient is usually required.
  • Investigations (tests) may be required.

There is a search box at the top of every page on the right of this website. If you type in your main problem, you will be offered a series of pages that may assist you.



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The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.

David Viniker retired from active clinical practice in 2012.
In 1999, he setup this website - - to provide detailed
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