Previous mode of delivery and pregnancy outcomes after single euploid embryo transfer: A retrospective study.

RESEARCH QUESTION: Are the pregnancy outcomes (clinical, biochemical and ectopic pregnancies) of women with a history of vaginal birth and women with a history of caesarean section who underwent single euploid embryo transfer at Fakih IVF Fertility Centre comparable? DESIGN: This retrospective cross-sectional chart review with multi-variate analysis, including 1157 women, compared pregnancy outcomes between women with a history of caesarean section and women with a history of vaginal birth who underwent in-vitro fertilization (IVF) at Fakih IVF Fertility Centre. All women who underwent single euploid frozen embryo transfer were included. Fresh and multiple embryo transfers were excluded. The primary outcome was clinical pregnancy, and the secondary outcomes were biochemical and ectopic pregnancies. RESULTS: Regarding pregnancy outcomes, the caesarean section group had fewer clinical pregnancies than the vaginal birth group [299 (61.1 %) vs 417 (67.3 %); p = 0.0346]. The rate of ectopic pregnancy did not differ significantly between the two groups (p = 0.4320). Similarly, there was no significant difference between the two groups regarding biochemical pregnancy [caesarean section group 22 (4.3 %) vs vaginal birth group 26 (4.0 %); p = 0.8122]. CONCLUSION: This study showed a decreased likelihood of clinical pregnancy in women with a history of caesarean section. No significant differences in biochemical or ectopic pregnancies were observed between the groups. These findings have practical clinical implications for counselling patients on the impact of prior caesarean sections in assisted reproduction.

Inhibin A-A Promising Predictive Parameter for Determination of Final Oocyte Maturation in Ovarian Stimulation for IVF/ICSI.

The number of mature oocytes is a key factor in the success of Assisted Reproductive Techniques (ART). Exogenous gonadotropins are administered during ovarian stimulation in order to maximize the number of oocytes available for fertilization. During stimulation, monitoring is mandatory to evaluate individual response, to avoid treatment complications and assist in the determination of the optimal day for final oocyte maturation and oocyte retrieval. Routine monitoring during stimulation includes transvaginal ultrasound examinations and measurement of serum estradiol (E2). Due to multifollicular growth of follicles of varying size, serum E2 levels are commonly supraphysiological and often variable, rendering E2-measurement during ovarian stimulation unreliable as a determinant of oocyte maturity. In contrast to serum E2, serum Inhibin A levels increase once a minimum follicle size of 12-15 mm is achieved. Due to this fact, serum Inhibin A levels could present in combination with ultrasound monitoring a more reliable parameter to determine the optimal follicle size for final oocyte maturation, as only follicles with a size of 12 mm and beyond will contribute to the serum Inhibin A level. This prospective observational, cross-sectional study demonstrates, that on the day of final oocyte maturation serum Inhibin A is strongly correlated to the number of follicles ≥15 mm (0.72) and to the number of retrieved and mature oocytes (ρ 0.82/0.77, respectively), whereas serum E2 is moderately correlated to the parameters mentioned above (ρ 0.64/0.69/0.69, respectively). With an area under the curve (AUC) of 0.91 for Inhibin A, compared to an AUC of 0.84 for E2, Inhibin A can be regarded as a better predictor for the optimal timing of trigger medication with a threshold number of ≥10 mature oocytes. It can be concluded from this data that serum Inhibin A in combination with transvaginal ultrasound monitoring may be a more powerful tool in the decision making process on trigger timing as compared to E2.

Significant Serum Progesterone Variations on the Day of Final Oocyte Maturation in Stimulated IVF Cycles.

Objective: To evaluate intraday serum progesterone levels on the day of final oocyte maturation in women undergoing ovarian stimulation in a GnRH-antagonist protocol. Study design, size, and duration: The study was done as a prospective observational study at a Private IVF centre in Muscat, Oman. 30 patients were recruited from May 2018 to March 2019. Patients: Thirty patients with primary/secondary infertility and an indication for ovarian stimulation for IVF/ICSI treatment. The study was registered at the clinicaltrials.gov under the number: NCT03519776. Main outcome measures: Progesterone levels at 4 time points (8 a.m., 11 a.m., 2 p.m. and 5 p.m.) on the day of final oocyte maturation. Results: A total of 120 samples from 30 patients were included in this prospective study. Progesterone levels on the day of final oocyte maturation showed a significant decline over the day with the mean values at 8 a.m.:1.0 ng/ml, at 11 a.m.:0.8 ng/ml, at 2 a.m.: 0.7 ng/ml and at 5 p.m.:0.6 ng/ml. The difference between the first and the last progesterone level was 0.4 ng/ml, reflecting a 37.8% decline of the progesterone level within 9 h and there was a highly significant decrease in the progesterone levels recorded between 8 a.m. and 11 a.m., between 8 a.m. and 2 p.m., between 8 a.m. and 5 p.m. and 11 a.m. and 5 p.m. (p < 0.001). Conclusion: The study findings have two clinically important conclusions: Firstly, progesterone levels on the day of final oocyte maturation decline significantly from the morning to the afternoon in patients, questioning the reliability of one arbitrarily taken progesterone level regarding the decision to perform a fresh embryo transfer or to cryopreserve the embryos. Secondly, declining progesterone levels 12 h after the last administration of gonadotropins support the theory that enhanced ovarian stimulation at the end of the follicular phase leads to an overload of the capacity of the enzymes metabolizing progesterone further on, therefore resulting in elevated progesterone levels in circulation.

Sex differences in stroke prevention in atrial fibrillation in French primary care. Results of the AFIGP (Atrial Fibrillation In General Practice) database.

BACKGROUND AND OBJECTIVES: Most of the French patients diagnosed with atrial fibrillation (AF) are managed by general practitioners (GPs). The objective was to evaluate stroke prevention in AF patients ahead of the arrival of the non vitamin K oral anticoagulant in France. METHODS: A cross-sectional study using a French GPs database of all patients with a diagnosis of AF consulting their GP between July-2010 and June-2011. Multivariate analyses were used to identify determinants of prevention prescription. RESULTS: Among 15,623 AF patients, 42.5 % were ≥75 years and 40.5 % women, 59.2 % had hypertension, 17.2 % diabetes, 11.4 % heart failure, 4.9 % stroke history. CHADS2 score was ≥1 for 83.1 % and ≥2 for 50.9 % of patients (CHA2DS2-VASc score ≥1 for 93.7 % and ≥2 for 82.3 %). Antithrombotic therapies were vitamin K antagonists (VKA) for 50.7 % of patients, followed by aspirin for 19.9 %, clopidogrel ± aspirin for 4.3 % and none for 25.1 %. For patients with CHADS2 scores ≥1, 73.3 % received an antithrombotic and for those with CHADS2 scores ≥2, 54.9 % were treated by a VKA. An age-stratified multivariate analysis showed that women had an odds ratio to be treated with VKA compared to 0.83 (95 % CI: 0.72-0.95) and 0.66 (95 % CI: 0.59-0.74) when aged <75 years and ≥75 years, respectively. CONCLUSIONS: Most AF patients followed by French GPs required stroke prevention according to European guidelines, but many of them did not receive the recommended antithrombotic treatment. Women over 75 were a third less likely to be treated with recommended anticoagulants than men of similar age.