Combined use of oestradiol and progesterone to support luteal phase in antagonist intracytoplasmic sperm injection cycles of normoresponder women: a case-control study.

We evaluated the effect of combined use of oral oestrogen (E2) and vaginal progesterone (P) to support luteal phase in antagonist intracytoplasmic sperm injection (ICSI) cycles. We analysed data from 176 patients who underwent ICSI cycles with antagonist protocol. P 90 mg vaginal gel once a day and micronised E2 of 4 mg/day, were started from the day of oocyte pick up and continued to the 12th day of embryo transfer. Group 1 (n = 79) patients received E2 + P for luteal phase support. In group 2 (n = 97) patients, only P 90 mg vaginal gel was used for luteal phase support. There were no significant differences between group 1 and group 2 patients in terms of clinical pregnancy rates (PRs) (26.58% vs. 20.62%, p = .352), early pregnancy loss rates (6.33% vs. 6.19%, p = .969), incidence of luteal vaginal bleeding (8.86% vs. 8.25%, p = .885) and implantation rates (22.8% vs. 16.9%, p = .298). In conclusion, our study showed no beneficial effect of addition of E2 to luteal phase support on clinical PR in antagonist IVF cycles.Impact statementWhat is already known on this subject? Luteal phase deficiency is defined as a disruption in progesterone and oestrogen production after ovulation. It is clear that, luteal phase supplementation to improve the outcomes in in vitro fertilisation (IVF) cycles is mandatory. As an iatrogenic complication of assisted reproductive technique, decreased luteal oestrogen and progesterone levels lead to decreased pregnancy rates (PRs) and implantation rates.What the results of this study add? In this study, we aimed to present the role of luteal phase oestrogen administration in GnRH antagonist cycles. A total of 176 cases received progesterone vaginal gel form for luteal phase support. Study group received 4 mg oral oestradiol hemihydrate in addition to progesterone. Compared to previous studies, our study consisted of larger number of patients and we used oestradiol through oral route. We found out that luteal oestradiol support did not improve the clinical PR.What the implications are of these findings for clinical practice and/or further research? Our study showed no beneficial effect of addition of oestradiol to luteal phase support on clinical PR in antagonist IVF cycles.

The Predictive Value of First-trimester Thiol/Disulfide Homeostasis in Preeclampsia.

OBJECTIVE: To investigate the efficacy of first-trimester thiol/disulfide homeostasis (t/dh), a new oxidative stress marker, in predicting preeclampsia. STUDY DESIGN: Prospective cohort study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynecology, University of Health Sciences, Zeynep Kamil Women and Children Diseases Training and Research Hospital, Istanbul, Turkey, Department of Obstetrics and Gynecology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey, from March 2016 to February 2019. METHODOLOGY: In this multi-centre,serum samples of women with839 singleton pregnancies were collected between 11+0 to 13+6gestational weeks. A total of 215 singleton pregnant women were included in the study. The patient group consisted of 38 women, who were diagnosed with preeclampsia; while the control group consisted of 177 healthy pregnant women without any complication during pregnancy and after delivery. Totalthiol (TT) was estimated by the sum of existing thiol groups and reduced thiol groups (S-S and -SH). After the native thiols (-SH) and (TT) were determined, the disulfide (-SS) amounts, disulfide/total thiol percent ratios (-SS/-SH + -SS), disulfide/native thiol percent ratios (-SS/-SH), and native thiol/total thiol percent ratios (-SH/-SH + -SS) were calculated. RESULTS: There were no statistically significant differences between the groups in terms of[(-SH), (TT), (-SS), (-SS/-SH), (-SS/-SH + -SS), and (-SH/-SH + -SS)] six t/dh variables(p>0.05).The first-trimester body mass index (BMI) was statistically different between the two groups (p<0.001). In the receiver operating characteristic curve analysis, none of the concentrations of thiol levels and ratios was found to have a significant predictive value for preeclampsia. The BMI was a significant predictor for preeclampsia (area under curve: 0.749, p<0.001). CONCLUSION: Maternal serum t/dh at 11+0 to 13+6 weeks of gestation does not predict preeclampsia and t/dh may be the consequence rather than a cause in the pathogenesis of preeclampsia. Key Words: First-trimester, Preeclampsia, Sulfhydrylcompounds, Thiols.