Publications by authors named "G Mestdagh"

10 Publications

Improving IUI success by performing modified slow-release insemination and a patient-centred approach in an insemination programme with partner semen: a prospective cohort study.

Facts Views Vis Obgyn 2021 Dec;13(4):359-367

Background: Pregnancy rates after in vitro fertilisation (IVF) treatment continue to improve, while intrauterine insemination (IUI) programmes show no such trend. There is a need to improve success rates with IUI to retain it as a viable option for couples who prefer avoiding IVF as a first line treatment.

Objective: To investigate if a modified slow-release insemination (SRI) increases the clinical pregnancy rate (CPR) after intrauterine insemination (IUI) with partner semen.

Materials And Methods: This was a prospective cohort study in a Belgian tertiary fertility centre. Between July 2011 and December 2018, we studied data from an ongoing prospective cohort study including 989 women undergoing 2565 IUI procedures for unexplained or mild/moderate male infertility. These data were analysed in order to study the importance of different covariates influencing IUI success. Generalised estimating equations (GEEs) were used for statistical analysis. Results of two periods (2011-2015, period 1 and 2016-2018, period 2) were examined and compared. From January 2016 (period 2) onwards, a standardised SRI procedure instead of bolus injection of sperm was applied. The primary outcome parameter was the difference in clinical pregnancy rate (CPR) per cycle between period 1 (bolus IUI) and period 2 (modified SRI). Secondary outcome results included all other parameters significantly influencing CPR after IUI.

Results: Following the application of modified SRI the CPR increased significantly, from 9.03% (period 1) to 13.52% (period 2) (p = 0.0016). Other covariates significantly influencing CPR were partner's age, smoking/non-smoking partner, BMI patient, ovarian stimulation protocol and Inseminating Motile Count (after semen processing).

Conclusions: Conclusions: The intentional application of modified slow-release of processed semen appears to significantly increase CPRs after IUI with homologous semen. Future studies should investigate whether SRI, patient-centred measures, or a combination of both, are responsible for this improvement.
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December 2021

Management and outcome of heterotopic interstitial pregnancy: Case report and review of literature.

Ultrasound 2017 Aug 1;25(3):134-142. Epub 2017 Jun 1.

Department of Obstetrics and Gynecology, ZOL Genk, Belgium.

Objective: To report a case of heterotopic interstitial pregnancy after in vitro fertilization-embryo transfer (IVF-ET), presenting with a second trimester uterine rupture. To review the clinical presentations, risk factors, treatment options, and outcome of heterotopic interstitial pregnancies.

Methods: We describe the clinical presentation, management, and outcome of a patient with a heterotopic interstitial pregnancy, diagnosed following second trimester rupture of the interstitial pregnancy. We reviewed all published cases of heterotopic interstitial pregnancies.

Results: A 35-year-old pregnant woman with a past history of right adnexectomy and 16 weeks pregnant with dichorionic diamniotic twins following IVF-ET, was admitted to our department with unexplained recurrent abdominal pain and anemia. Further investigation showed a hemoperitoneum and because of hypovolemic shock an emergency laparotomy was performed, with diagnosis of a ruptured heterotopic interstitial pregnancy. The uterine defect was sutured using simple interrupted sutures. The intrauterine pregnancy progressed uneventful afterwards.We found 86 cases in the published literature, reporting on heterotopic interstitial pregnancies. 80.2% (69/86) occurred after IVF-ET. History of uni- or bilateral salpingectomy is a major risk factor, present in 39.5% (34/86). 37.2% (32/86) presented with cornual rupture. Surgery was performed in 53.5% (46/86) of cases. Medical management was possible in case of unruptured, early diagnosed heterotopic interstitial pregnancy (32.6% (28/86)). Watchful waiting was only possible when the interstitial pregnancy miscarried (5.8% (5/86)). The live birth rate of the intrauterine pregnancy, when viable at presentation, was 70.0% (56/80). The live birth rate of the interstitial pregnancy was only 4.7% (4/86).

Conclusions: The majority of cases are diagnosed by detailed ultrasound in the setting of early follow-up after IVF-ET and are asymptomatic at diagnosis. Yet, a substantial number of patients present with cornual rupture. Risk factors are IVF-ET and a history of salpingectomy. Depending on clinical presentation, treatment options include watchful waiting, medical treatment, or surgery. Unfortunately, the interstitial pregnancy is generally lost, and only has a chance of survival in case of presentation at a viable gestational age. The outcome of the coexisting intrauterine pregnancy is generally good.
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August 2017

Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial.

Lancet 2016 Jun 27;387(10038):2614-2621. Epub 2016 Apr 27.

Institute of Metabolism and Systems Research and Tommy's National Centre for Miscarriage Care and Research, University of Birmingham, Birmingham, UK.

Background: The success rate of in-vitro fertilisation (IVF) remains low and many women undergo multiple treatment cycles. A previous meta-analysis suggested hysteroscopy could improve outcomes in women who have had recurrent implantation failure; however, studies were of poor quality and a definitive randomised trial was needed. In the TROPHY trial we aimed to assess whether hysteroscopy improves the livebirth rate following IVF treatment in women with recurrent failure of implantation.

Methods: We did a multicentre, randomised controlled trial in eight hospitals in the UK, Belgium, Italy, and the Czech Republic. We recruited women younger than 38 years who had normal ultrasound of the uterine cavity and history of two to four unsuccessful IVF cycles. We used an independent web-based trial management system to randomly assign (1:1) women to receive outpatient hysteroscopy (hysteroscopy group) or no hysteroscopy (control group) in the month before starting a treatment cycle of IVF (with or without intracytoplasmic sperm injection). A computer-based algorithm minimised for key prognostic variables: age, body-mass index, basal follicle-stimulating hormone concentration, and the number of previous failed IVF cycles. The order of group assignment was masked to the researchers at the time of recruitment and randomisation. Embryologists involved in the embryo transfer were masked to group allocation, but physicians doing the procedure knew of group assignment and had hysteroscopy findings accessible. Participants were not masked to their group assignment. The primary outcome was the livebirth rate (proportion of women who had a live baby beyond 24 weeks of gestation) in the intention-to-treat population. The trial was registered with the ISRCTN Registry, ISRCTN35859078.

Findings: Between Jan 1, 2010, and Dec 31, 2013, we randomly assigned 350 women to the hysteroscopy group and 352 women to the control group. 102 (29%) of women in the hysteroscopy group had a livebirth after IVF compared with 102 (29%) women in the control group (risk ratio 1·0, 95% CI 0·79-1·25; p=0·96). No hysteroscopy-related adverse events were reported.

Interpretation: Outpatient hysteroscopy before IVF in women with a normal ultrasound of the uterine cavity and a history of unsuccessful IVF treatment cycles does not improve the livebirth rate. Further research into the effectiveness of surgical correction of specific uterine cavity abnormalities before IVF is warranted.

Funding: European Society of Human Reproduction and Embryology, European Society for Gynaecological Endoscopy.
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June 2016

Implementation of hysteroscopy in an infertility clinic: The one-stop uterine diagnosis and treatment.

Facts Views Vis Obgyn 2014 ;6(4):235-9

Genk Institute for Fertility Technology, ZOL Hospitals, Genk, Belgium.

Magnetic Resonant Imaging (MRI) has demonstrated that we can differentiate the uterus in 3 important functional areas. Exploration of the uterus in the infertile patient should implement the evaluation of the endometrium, the Junctional zone myometrium (JZ), the outer myometrium and the cervical canal. Especially the JZ myometrium should receive our close attention in the exploration and treatment of the infertile patient. MRI cannot be implemented as a screening examination but also limiting the imaging of the womb to a 2 or 3 D ultrasound exam only does not meet the scientific requirements of sensitivity and specificity. Modern ambulatory uterine diagnosis in a one-stop approach includes transvaginal ultrasound, fluid mini Hysteroscopy, contrast sonography and endomyometrial tissue sampling. Transvaginal Ultrasound being the gold standard for global uterine screening has a cardinal importance for diagnosis of myometrial disorders and uterine congenital malformations whereas hysteroscopy remains the gold standard for the evaluation of the endometrium and cervical canal. The major challenge remains to perform a tissue sampling of the endo-myometrium in an ambulatory, patient friendly and reliable way for which the newly designed Trophy hysteroscope provide a satisfactory answer. This one-stop approach opens a total new and advanced dimension to the screening, diagnosis and treatment of uterine pathology in the infertile patient.
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January 2015

The (t)WE lab Simplified IVF Procedure: First Births after freezing/thawing.

Facts Views Vis Obgyn 2014 ;6(1):45-9

Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, ZOL, Campus St Jan, Genk, Belgium.

Background: Infertility care is one of the most neglected health care issues in developing countries (DC), affecting more than 50 million couples. The social stigma of childlessness still leads to isolation and abandonment. Bilateral tubal occlusion due to sexually transmitted diseases and pregnancy-related infections is the most common cause of infertility in DC. Consequently most cases of infertility are only treatable by using assisted reproductive technologies which are either unavailable or too costly. Lowering the laboratory costs associated with IVF is a crucial step to make IVF affordable for a larger part of the world population. We recently developed and described a new simplified method of IVF culturing, called the (t)WE lab method. Our initial results in fresh IVF cycles showed that IVF methodology can be significantly simplified and result in successful outcomes at levels that compare favourably to those obtained in high resource programs.

Case-reports: We report three pregnancies and four live births as a result of transferring five cryo/thawing embryos which were developed after using the simplified (t)WE lab system. The two singleton babies delivered vaginally, for the twin pregnancy a caesarean section was performed. All babies were healthy, the perinatal outcome was uneventful in all cases.

Conclusion: We provide proof-of-principle evidence that transferring cryopreserved/thawed embryos obtained with our (t)WE lab simplified culture system can lead to successful pregnancies and healthy live births.
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December 2014