Age and dual trigger were found to be significant predictors of live birth in POSEIDON group 3 and 4 women treated with the GnRH antagonist protocol: a retrospective cohort study.

OBJECTIVE: Despite recent advancements in assisted reproductive technology (ART), the effective management of patients with poor ovarian response (POR) remains a formidable challenge. While various treatment strategies and predictors of live births have been documented to provide guidance to fertility specialists in managing poor responders, research efforts have predominantly encompassed all POSEIDON groups. In this study, our objective was to analyze the factors correlated with live births (LB) within a subset of the POSEIDON groups, with a particular focus on POSEIDON groups 3 and 4. PATIENTS AND METHODS: Charts of 406 patients belonging to POSEIDON groups 3 and 4 who underwent ART treatment at a university-affiliated infertility clinic following a gonadotropin-releasing hormone (GnRH) antagonist cycle between January 2016 and December 2021 were analyzed. Clinically significant factors associated with live births were incorporated into a logistic regression model for multivariate analysis to ascertain independent predictors of LB. Additionally, a receiver operating characteristic (ROC) curve analysis was conducted to establish the optimal cut-off values. RESULTS: Live births were achieved in 48 cycles (8.7%). Female age (OR, 0.930; 95% CI: 0.874-0.991; p < 0.024), baseline serum luteinizing hormone (LH) levels (OR, 0.854; 95% CI: 0.741-0.984; p < 0.029), and dual triggers (OR, 4.004; 95% CI: 1.290-12.426; p < 0.016) were identified as independent factors associated with LB following multivariate logistic regression analysis. The optimal age cut-off was determined to be 33 years, with a sensitivity of 70.8% and specificity of 75%. CONCLUSIONS: Younger age, lower baseline serum LH levels, and dual-trigger administration appear to enhance the likelihood of live birth in POSEIDON groups 3 and 4 following treatments with the GnRH antagonist protocol.

Satisfactory medium-long term patient reported outcomes after laparoscopic single-mesh sacrohysteropexy.

Background: There is scarce information on the effectiveness of the laparoscopic single mesh sacrohysteropexy (smSHP). Attachment of a single sheet of flat mesh posteriorly to the cervix provides less mesh use and a less invasive distal mesh fixation. Objectives: To assess medium to long-term follow-up results of patients who underwent laparoscopic smSHP utilising a less invasive technique with single sheet flat mesh. Materials and Methods: In the present retrospective cohort study, the data of 71 women who underwent laparoscopic smSHP for apical uterine prolapse with or without colporrhaphy (anterior and/or posterior) at the urogynaecology unit of a university hospital between January 2008 and January 2020 was reviewed. Data was collected on demographics, presenting symptoms, preoperative findings, surgery, and postoperative outcomes. Main Outcome Measures: Medium to long-term patient-reported outcomes. Results: The median age of the study population was 44 years. Median follow-up duration was 5 years (1-12). Symptomatic recurrence over time and repeat surgery rates were 13.1% and 3.1% respectively. Comparison of the pre-operative and medium to long-term evaluation scores of the pelvic floor distress inventory-20 (PFDI-20) and assessment of the patient global impression of improvement (PGI-I) revealed long-standing improvement in pelvic floor dysfunction. Conclusions: Laparoscopic smSHP appears to be successful and safe with low recurrence and complication rates and provides satisfactory patient reported outcomes. What's new?: Medium to long-term patient-reported outcomes based on PFDI-20 and PGI-I surveys are satisfactory following smSHP.

Multiple myomectomy to aid fertility treatment - surgical and fertility outcomes: a retrospective cohort study.

OBJECTIVE: To assess the effects of multiple myomectomy at laparotomy on fertility potential of infertile women who are planning to undergo assisted reproductive technology (ART) treatment. METHODS: A retrospective single centre cohort study was conducted. Data of infertile women who were planning to undergo ART and underwent open myomectomy for multiple fibroids between January 2010 and December 2018 were reviewed. Data were collected on demographics, presenting symptoms, preoperative imaging findings, operative details, and postoperative and IVF outcomes. The primary outcome measure was the necessity for further hysteroscopic surgery prior to subsequent in vitro fertilisation (IVF) cycle. The secondary outcome measure was live birth rate. RESULTS: A total of 55 women were included in the analyses. The median number of fibroids removed was 12 (range, 3-51). Thirteen (26%) women required further surgery before embryo transfer. In women with a breached endometrial cavity, the likelihood of further hysteroscopic division of intrauterine adhesions was increased 18-fold (P=0.017). Thirty-two women underwent 45 IVF cycles, 16 of which resulted in live birth (50%). CONCLUSIONS: Infertile women with large and multiple fibroids could have good fertility outcomes following open myomectomy. Special care must be taken not to damage the uterine cavity. The intraoperative breach of the endometrial cavity seems to increase the risk of intrauterine adhesions, which may further compromise ART treatment and outcomes. Hysteroscopy prior to any embryo transfer cycle may help to optimise the endometrial cavity and fertility outcome in women who underwent multiple myomectomy.

Dual suppression with oral contraceptive pills in GnRH antagonist cycles for patients with polycystic ovary syndrome undergoing intracytoplasmic sperm injection.

OBJECTIVE: To evaluate the effects of a gonadotropin-releasing hormone (GnRH) antagonist protocol, with or without oral contraceptive pill (OCP) pretreatment, in patients with polycystic ovary syndrome (PCOS) undergoing intracytoplasmic sperm injection (ICSI). STUDY DESIGN: In this retrospective cohort study, 410 infertile patients with PCOS were assessed in their first ICSI cycles between January 2006 and June 2013. In Group A (n=208), patients underwent a long luteal GnRH agonist protocol, and in Groups B (n=143) and C (n=59), patients underwent a GnRH antagonist protocol. The patients in Group C also received OCPs containing 30mg of ethinyl oestradiol and 3mg of drospirenone prior to treatment. The main outcome measures were pregnancy and ovarian hyperstimulation syndrome (OHSS) rates. RESULTS: Demographic features, body mass index, duration of infertility, serum baseline hormone levels, cycle outcomes, multiple pregnancy rates, miscarriage rates, OHSS rates, total number of Grade A embryos and total number of transferred embryos were comparable between the groups. Clinical pregnancy rates were 27.4%, 26.6% and 23.7% in Groups A, B and C, respectively (p=0.853). CONCLUSIONS: OCP pretreatment was found to have no beneficial or adverse effects in patients with PCOS undergoing a GnRH antagonist protocol for ICSI, but can be used for cycle scheduling.

The role of ultrasound and symptom-based triage for detection of pathological endometrial changes in patients undergoing tamoxifen therapy for breast cancer.

PURPOSE OF INVESTIGATION: To estimate the value of ultrasonographic screening and symptom-based triage for the detection of endometrial pathologies in breast cancer patients using tamoxifen. METHOD(S): A total of 292 breast cancer patients using tamoxifen were analyzed retrospectively. A total of 115 endometrial biopsies were performed on the basis of ultrasonographic examination and symptomatic status of both premenopausal and postmenopausal patients. Endometrial thickness and symptomatic status were then correlated with histopathologic data to figure out the clinical implications of ultrasonographic screening and symptom-based triage. RESULT(S): The cut-off value of endometrial thickness was 8 mm for asymptomatic postmenopausal patients and the positive predictive value of transvaginal ultrasound for endometrial pathologies was 59%. The positive predictive values of symptom-based triage alone for premenopausal and postmenopausal patients were 37.5% and 48.2%, respectively. CONCLUSION: Transvaginal ultrasound may be a useful method for the detection of pathological endometrial changes in asymptomatic postmenopausal breast cancer patients administered adjuvant tamoxifen. In premenopausal patients, symptom-based triage alone does not seem to be an effective diagnostic tool for endometrial pathologies.