Thursday, 23 August, 2007

Uterine Washing for Increased Success In IVF?

The results of a new study have suggested that broad-spectrum antibiotic therapy, in the form of intravenous administration plus intra-uterine lavage, could help increase the chances of a successful IVF pregnancy in couples who have had one or more failed IVF cycles. Researchers from the Feinstein Institute for Medical Research and the New York Presbyterian Medical Center’s MacLeod Laboratory, in New York, USA, conducted the small retrospective study to investigate whether giving broad-spectrum antibiotic therapy to couples after a failed IVF cycle would help improve the chances of achieving a successful pregnancy in the next IVF cycle.

The study was conducted after “two decades of favorable experience with antibiotic therapy, initially given orally, later administered intravenously with uterine lavages, both in terms of reversing infertility and improving pregnancy outcome.”
In their paper published in the Internet Journal of Gynecology and Obstetrics, the researchers report the analysis of 52 consecutive couples (mean age of the women 38.5 years) treated between January 2002 and April 2004. All of the couples had a history of primary or multiple failed IVF cycles. Before initiating the antibiotic therapy both partners in each couple underwent antibody testing, bacterial testing (including for Chlamydia) and culturing. The result of the culture studies did not affect the recommendation of antibiotic therapy.

The women in each couple received the following: 10 days of intravenous clindamycin at the full therapeutic dose, plus five intra-uterine lavages (with a combination of ampicillin, gentamicin, fluconazole and metronidazole for one hour, followed by filling the uterine cavity and cervical canal with a metronidazole-containing gel) performed on consecutive days in the first five days of intravenous therapy. The antibiotic treatment was completed with a three-week course of oral doxycycline. The men received intravenous clindamycin (although half declined and were given oral co-amoxiclav as a substitute) and a three-week course of oral doxycycline. Overall there were two cases of mild diarrhea, which responded to treatment, and no other complications were seen.

The outcomes in the antibiotic-treated patients were compared with those of three historical control groups, derived from previously published studies of couples in conventional repeat IVF cycles. In each comparison, the antibiotic-treated group was found to have a significantly higher standardized delivery rate – these rates were from 33.8-46.1 percent in the antibiotic-treated group, compared with 6.4-22.8 percent in the three control groups. The researchers discuss the outcomes in detail in the full paper. For example, the only pregnancy-related complication in the antibiotic-treated group was one cases of pre-eclampsia. They emphasize that further research is required, and conclude: “These findings suggest that a certain number of failures during IVF cycles are due to an intra-uterine infection that could affect the course of the pregnancy, the mode of delivery, and cause maternal and fetal complications.”

I shudder to think what could be lapped up by the "failed IVF" patients if anecdotal reports based on a single clinic's experience finds its way into the front pages of daily newspapers. This was a retrospective "experience-based" study with no scientific value, but has found itself in all the leading dailies globally because the editors want a catchy byeline!

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