Luteal oestradiol for patients with serum oestradiol levels lower than expected per oocyte.

Although the efficiency of progesterone in providing luteal phase support has been established, the role of oestradiol supplementation during the luteal phase remains controversial. We evaluated pregnancy outcomes of patients who had a ratio of serum E2 levels on the hCG day to the number of oocytes retrieved (oestradiol/oocyte ratio - EOR) levels of <100 pg/ml by supporting them with additional oestradiol during the luteal phase. In total, 150 patients with an EOR < 100 pg/ml of oestradiol undergoing antagonist intracytoplasmic sperm injection (ICSI) cycles were randomly assigned into two groups to receive either oral oestradiol (4 mg/d) plus vaginal progesterone (90 mg, 2 × 1/day) (group 1) or vaginal progesterone (90 mg, 2 × 1/d) alone (group 2). Implantation rate following transfer of a single embryo did not differ between the two groups (group 1 = 33.3%; group 2 = 34.9%; p = 0.85). Similarly, both groups gave comparable clinical pregnancy rates per embryo transfer with 31.7% in group 1 compared with 28.6% in group 2 (p = 0.69). In conclusion the study suggests that the addition of 4 mg oral E2 to progesterone does not increase the probability of pregnancy.

Different treatment modalities and outcomes in cesarean scar pregnancy: a retrospective analysis of 31 cases in a university hospital.

OBJECTIVES: There is no standardized treatment modality or a generally accepted guideline in cesarean scar pregnancy (CSP) treatment. The aim of this study is to retrospectively evaluate the outcomes of the different treatment modalities used in CSP treatment. MATERIAL AND METHODS: 31 CSP patients retrospectively evaluated between May 2011 and February at Uludag University Hospital in Bursa, Turkey included in the study. A graphical flowchart according to the treatment modalities and timeline graphics of the patients were used. Main outcome measures were recurrent CSPs and healthy pregnancies in clinical follow-up after a successful CSP treatment. RESULTS: 31 CSP patients were treated with six different treatment modalities in our series. Recurrent CSP was diagnosed in three patients after a successful CSP treatment. All of these recurrent CSPs were treated with D/C procedure in their first CSP. Six patients conceived again in clinical follow-up after successful treatment of CSP. CONCLUSIONS: CSP is a serious maternal complication that risks the mother's life, and this problem is growing because of the increased cesarean rates. Invasive procedures applied to the uterus in CSP treatment may cause recurrent CSP in the next pregnancy of the patient. When considering the treatment options of the CSP, minimally invasive treatment modalities and the subsequent gestation of the patient should be taken into account.