Many retrospective studies have shown that hydrosalpinx is associated with poor in-vitro fertilization (IVF) outcome. The mechanism of the actual cause is not yet fully understood. A clinical practice of performing salpingectomy before IVF has developed, without any evidence from prospective trials. The aim of the present prospective randomized trial was to test if a salpingectomy prior to IVF was effective in terms of increased pregnancy rates. Patients with hydrosalpinx were randomized to either a laparoscopic salpingectomy or no intervention before IVF. A total of 204 patients was available for an intention-to-treat analysis and 192 actually started IVF. Clinical pregnancy rates per included patient were 36.6% in the salpingectomy group and 23.9% in the non-intervention group (not significant, P = 0.067) and the ensuing delivery rates were 28.6% and 16.3% (P = 0.045). The corresponding delivery rates per transfer cycle were 29.5% versus 17. 5% (not significant, P = 0.083). A subgroup analysis revealed significant differences in favour of salpingectomy, in implantation rates in patients with bilateral hydrosalpinges (25.6% versus 12.3%, P = 0.038) and in clinical pregnancy rates (45.7% versus 22.5%, P = 0.029) and delivery rates (40.0% versus 17.5%, P = 0.038) in patients with ultrasound visible hydrosalpinges. The delivery rate was increased 3.5-fold in patients with bilateral hydrosalpinges visible on ultrasound (P = 0.019).

No clear evidence of unfavorable cardiovascular risk factors were found. Increased fat mass and higher insulin levels were, however, found in patients older than 30 yr. High frequency of gestational diabetes is a risk marker for future diabetes. Lifelong follow-up, lifestyle modifications, and attempts to adjust and reduce the glucocorticoid doses seem important.

Context:Patients with classical congenital adrenal hyperplasia (CAH) receive lifelong, often supraphysiological, glucocorticoid therapy. Pharmacological doses of glucocorticoids are an established risk factor for osteoporosis.Objective: Our objective was to evaluate bone mineral density (BMD), fracture prevalence, and markers of bone metabolism in adult females with CAH.Design: This was a cross-sectional observational study. Setting:Tertiary care referral centers were used in this study. Participants:We studied 61 women, aged 18 -63 yr, with genetically verified CAH due to 21-hydroxylase deficiency. They were patients with salt wasting (n ϭ 27), simple virilizing (n ϭ 28), and nonclassical 21-hydroxylase deficiency (n ϭ 6). A total of 61 age-matched women were controls. Main Outcome Measures:History of fractures was recorded. Total body, lumbar spine, and femoral neck BMD were measured by dualenergy x-ray absorptiometry. The World Health Organization criteria for osteopenia and osteoporosis were used. Serum marker of bone resorption, ␤-C telopeptide was studied. Results:The mean glucocorticoid dose in hydrocortisone equivalents was 16.9 Ϯ 0.9 mg/m 2 . Patients had lower BMD than controls at all measured sites (P Ͻ 0.001). In patients younger than 30 yr old, 48% were osteopenic vs. 12% in controls (P Ͻ 0.009). In patients 30 yr or older, 73% were osteopenic or osteoporotic vs. 21% in controls (P Ͻ 0.001). BMD was similar in the two classical forms and had no obvious relationship to genotypes. ␤-C-telopeptide was decreased in older patients. More fractures were reported in patients than controls (P Ͻ 0.001). The number of vertebrae and wrist fractures almost reached significance (P ϭ 0.058). Conclusions:Women with CAH have low BMD and increased fracture risk. BMD should be monitored, adequate prophylaxis and treatment instituted, and glucocorticoid doses optimized from puberty.

Pregnancy and delivery rates are reduced in women with CAH mainly due to psychosocial reasons. The outcome of children did not differ from controls. The unexpected sex ratio in children born to mothers with CAH warrants further research.

Several anxiety symptoms distinguished women with PCOS from a control group matched on BMI. A better understanding of the symptoms is needed to identify and alleviate anxiety symptoms in this vulnerable group.