Comparison of fixed and flexible progestin-primed ovarian stimulation in women classified in patient-oriented strategies encompassing individualized oocyte number (POSEIDON) group 4.

PURPOSE: This study aimed to compare the fixed and flexible protocols for progestin-primed ovarian stimulation (PPOS) in poor ovarian responders. METHODS: This retrospective study included 95 poor ovarian responders classified using the Patient-Oriented Strategies Encompassing Individualized Oocyte Number group 4 criteria. Treatment involved assisted reproductive medicine using fixed and flexible PPOS protocols at Shiga University of Medical Science between July 2019 and August 2023. PPOS cycles were assigned to the fixed and flexible groups at the discretion of attending physicians. The results of assisted reproductive medicine were compared between groups. RESULTS: The fixed and flexible groups included 68 and 27 patients, respectively. The flexible group obtained more retrieved oocytes and two pro-nuclei than the fixed group, without an early luteinizing hormone surge. Multiple linear regression analysis demonstrated that differences in protocols and anti-müllerian hormone (AMH) levels were related to the number of retrieved oocytes. The differences in protocols were more strongly correlated with the number of oocytes than with the AMH levels. CONCLUSION: Among poor ovarian responders, the flexible PPOS protocol provided more retrieved oocytes than the fixed PPOS protocol, possibly because the total dosage of progestins was lower in the flexible group and progestins were not administered at the time when ovarian stimulation was initiated.

An abdominal-sacral approach with preoperative embolisation for vulvar solitary fibrous tumour: a case report.

BACKGROUND: Solitary fibrous tumours (SFTs) in the female genital tract are uncommon. Resection of these tumours is controversial because it can cause life-threatening haemorrhage. We report a case of vulvar SFT that was excised in a combined abdominal-sacral approach after preoperative embolisation. CASE PRESENTATION: At another hospital, an inoperable intrapelvic tumour was diagnosed in a 34-year-old woman. Computed tomography and magnetic resonance imaging showed that the uterus, urinary bladder and rectum were compressed laterally by a pelvic tumour with a maximum diameter of 11 cm. This mass was hypervascular and had a well-defined border. Transperineal biopsy was performed, and immunostaining revealed that the mass was an SFT. The tumour was supplied by feeding vessels from the right iliac arteries. First, we embolised the feeding vessels. Second, we performed surgical resection in a combined abdominal-sacral approach; no blood transfusion was necessary, and no perioperative complications occurred. The final pathological diagnosis was SFT that was positive for CD34 and signal transducer and activator of transcription 6 according to immunohistochemical staining. CONCLUSION: During a year of follow-up, the disease did not recur. Treatment of pelvic SFT should aim at complete resection through various approaches after careful measures are taken to prevent haemorrhage.

Ovarian cryopreservation for children aged 3 years or younger: A report of three cases.

Ovarian tissue cryopreservation has recently been performed as an option for fertility preservation in prepubertal girls with cancer. In this study, ovarian tissue was cryopreserved from 3 girls of 3 years of age or younger during a 3-year period at our institution. Case 1 was a 1-year-old girl, who was diagnosed with a yolk sac tumor in the sacral region. Case 2 was a 2-year-old girl, who was diagnosed with retroperitoneal neuroblastoma. Case 3 was a 3-year-old girl, who was diagnosed with cerebellar medulloblastoma. All patients had planned to undergo chemotherapy that would affect the ovarian reserve. Because these patients were toddlers, consideration of ethics, the surgical procedure and postoperative management, and optimal method for freezing ovarian tissue was necessary, although gynecologists rarely experience these challenges in daily clinical practice. We herein present the clinical course of these three cases and discuss the peculiarities and countermeasures of ovarian cryopreservation in children.