Improved fertilization, degeneration, and embryo quality rates with PIEZO-intracytoplasmic sperm injection compared with conventional intracytoplasmic sperm injection: a sibling oocyte split multicenter trial.

OBJECTIVE: To investigate whether PIEZO-intracytoplasmic sperm injection (PIEZO-ICSI) increases the fertilization rate, decreases the degeneration rate, and increases the utilization rate per oocyte injected compared with conventional intracytoplasmic sperm injection (ICSI). DESIGN: Sibling oocyte split multicenter trial. SETTING: Fertility clinics. PATIENTS: Women with a diagnosis of infertility who used ICSI as their method of insemination and had ≥6 mature oocytes for injection. INTERVENTIONS: Participants had their mature oocyte cohort divided, where half were injected using conventional ICSI and the other half were injected using PIEZO-ICSI. For patients with an uneven oocyte number, the extra oocyte was injected using conventional ICSI. The injection technique used first was also randomized to ensure that there was no bias due to order of injection. MAIN OUTCOME MEASURE: The primary outcome measure was the fertilization rate after injection. RESULTS: A total of 108 patients underwent a sibling split use of conventional ICSI and PIEZO-ICSI. The fertilization rate was 71.6% in PIEZO-ICSI, which significantly increased compared with that in conventional ICSI 65.6%. In addition, the oocyte degeneration rate decreased in PIEZO-ICSI compared with that in conventional ICSI (6.3% vs. 12.1% respectively), and the blastocyst quality increased, as measured by the number of grade A and B quality blastocysts present on day 5 of development (33.3% vs. 27.5%). No significant differences in the aneuploidy or utilization rate, clinical pregnancy, or live birth outcome after single embryo transfer were noted between the two injection techniques. CONCLUSIONS: This trial supports the possibility that PIEZO-ICSI increases the fertilization rates, decreases the oocyte degeneration rates, and increases the blastocyst quality compared with conventional ICSI; however, it does not appear to influence the clinical pregnancy or live birth rate per transfer. CLINICIAN TRIAL REGISTRATION NUMBER: Australian and New Zealand Clinical Trial Registry ACTRN12620000407998.

ANZSREI consensus statement on elective oocyte cryopreservation.

BACKGROUND: One in six Australian women and couples suffer infertility. A rising proportion relates to advanced maternal age, associated with poorer oocyte quality and in vitro fertilisation (IVF) outcomes. Internationally, oocyte cryopreservation technology applied to oocytes vitrified before 35 years provides similar live-birth statistics compared to IVF treatment using fresh oocytes. Oocyte cryopreservation is accessible in Australasian settings and elective uptake is increasing. For women accessing treatment, oocyte cryopreservation may expand future family building options. AIMS: To develop the first Australasian Certification in Reproductive Endocrinology and Infertility (CREI) subspecialist-led consensus guideline on oocyte cryopreservation. METHODS: The ANZSREI ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence group) met in 2017 and 2018 and identified clinical aspects of care for inclusion and review. Review of the available evidence was conducted and consensus statements prepared. Areas of dissent of expert opinion and for further research were noted. RESULTS: Consensus was reached on definition and best practice in oocyte cryopreservation for freeze method, controlled ovarian stimulation, medical risk reduction and treatment and outcomes counselling. The term 'social egg freezing' may marginalise, stigmatise or attribute social blame to women, and there is a need to revise this to a neutral and non-judgemental term such as elective or planned oocyte cryopreservation. CONCLUSION: Oocyte cryopreservation has the potential to improve cumulative live birth outcomes for women. Implementation of this guideline should facilitate an optimal approach for providing care.

Selective versus universal third trimester ultrasound: Time for a rethink? An audit of current practices at a metropolitan Sydney hospital.

INTRODUCTION: Routine third-trimester ultrasound (T3US) is not recommended in evidence-based clinical guidelines despite occurring frequently. This study investigated the incidence, indication for, results and follow-up needs of T3US performed at a Sydney metropolitan teaching hospital. METHODS: Audit of T3US amongst singleton pregnancies at St George Hospital, Sydney: retrospective review October-December 2012, prospective cohort with clinician survey February-April 2013. Data included are as follows: maternal demographics, aneuploidy screening results, T3US ordering patterns, results, follow-up management and pregnancy outcomes. Comparison of demographic characteristics and pregnancy outcomes was performed for women undergoing T3US vs. no T3US. RESULTS: One thousand and thirty-five women (623 retrospective, 412 prospective) were included, of whom 560 (54%) received at least one T3US. Characteristics of retrospective and prospective cohorts were similar, so combined data are presented. Most initial T3USs were for valid indications (463 of 560; 83%), most frequently low-lying placenta at morphology (19%), reduced fundal height (10%) and to follow-up fetal concerns at morphology ultrasound (9%). One hundred and sixty-two out of 560 (29%) of initial T3US were not normal, predominantly related to accelerated or reduced fetal growth. Detection of SGA babies was significantly higher in the T3US group (32% SGA babies detected vs. 0% if no T3US, P < 0.001). However, overall detection rates remained low, with 5.2% and 3.0% of babies who had a T3US unexpectedly <10th and <3rd centile birthweight, respectively. DISCUSSION/CONCLUSION: The majority of women received at least one, usually indicated, T3US in routine practice at our metropolitan Sydney hospital. This may impact obstetric care, resource allocation and patient well-being. Detection of small for gestational age fetuses was poor.

Frontal lobe meningioma mimicking preeclampsia: A case study.

We report a case of a left frontal lobe meningioma presenting in a woman with proteinuric preeclampsia in her first term pregnancy. The patient had a background of antepartum migraines that resolved in the second trimester of pregnancy. Postpartum, she required urgent surgery and sustained convulsions after surgery. She had no residual disease and has had another successful pregnancy. This case highlights the importance of cerebral imaging in the context of an atypical clinical course of preeclampsia. Although headaches are common in pregnancy and usually benign, other, more serious, diagnoses should be considered with atypical headaches, a change in the nature of the headache, and headaches that persist despite appropriate treatment. A full neurological examination including fundoscopy to exclude papilloedema should be performed and abnormal findings require further investigation.