A concise infertility work-up results in fewer pregnancies

Abstract STUDY QUESTION Is pregnancy success rate after a concise infertility work-up the same as pregnancy success rate after the traditional extensive infertility work-up? SUMMARY ANSWER The ongoing pregnancy rate within a follow-up of 1 year after a concise infertility work-up is significantly lower than the pregnancy success rate after the traditional and extensive infertility work-up. WHAT IS KNOWN ALREADY Based on cost-effectiveness studies, which have mainly focused on diagnosis, infertility work-up has become less comprehensive. Many centres have even adopted a one-stop approach to their infertility work-up. STUDY DESIGN, SIZE, DURATION We performed a historically controlled cohort study. In 2012 and 2013 all new infertile couples (n = 795) underwent an extensive infertility work-up (group A). In 2014 and 2015, all new infertile couples (n = 752) underwent a concise infertility work-up (group B). The follow-up period was 1 year for both groups. Complete follow-up was available for 99.0% of couples in group A and 97.5% in group B. PARTICIPANTS/MATERIALS, SETTING, METHODS The extensive infertility work-up consisted of history taking, a gynaecological ultrasound scan, semen analysis, ultrasonographic cycle monitoring, a timed postcoital test, a timed progesterone and chlamydia antibody titre. A hysterosalpingography (HSG) was advised routinely. The concise infertility work-up was mainly based on history taking, a gynaecological ultrasound scan and semen analysis. A HSG was only performed if tubal pathology was suspected or before the start of IUI. Laparoscopy and hormonal tests were only performed if indicated. Couples were treated according to the diagnosis with either expectant management (if the Hunault prognostic score was >30%), ovulation induction (in case of ovulation disorders), IUI in natural cycles (in case of cervical factor), IUI in stimulated cycles (if the Hunault prognostic score was <30%) or IVF/ICSI (in case of tubal factor, advanced female age, severe male factor and if other treatments remained unsuccessful). The primary outcomes were time to pregnancy and the ongoing pregnancy rates in both groups. The secondary outcomes were the number of investigations, the distribution of diagnoses made, the first treatment (started) after infertility work-up and the mode of conception. MAIN RESULTS AND THE ROLE OF CHANCE The descriptive data, such as age, duration of infertility, type of infertility and lifestyle habits, in both groups were comparable. In group A, more than twice the number of infertility investigations were performed, compared to group B. An HSG was made less frequently in group B (33% versus 42%) and at a later stage. A Kaplan–Meier curve shows a shorter time to pregnancy in group A. Also, a significantly higher overall ongoing pregnancy rate within a follow-up of 1 year was found in group A (58.7% versus 46.8%, respectively, P < 0.001). In group A, more couples conceived during the infertility work-up (14.7% versus 6.5%, respectively, P < 0.05). The diagnosis cervical infertility could only be made in group A (9.3%). The diagnosis unexplained infertility differed between groups, at 23.5% in group A and 32.2% in group B (P < 0.001). LIMITATIONS, REASONS FOR CAUTION This was a historically controlled cohort study; introduction of bias cannot be ruled out. The follow-up rate was similar in the two groups and therefore could not explain the differences in pregnancy rate. WIDER IMPLICATIONS OF THE FINDINGS Re-introduction of an extensive infertility work-up should be considered as it may lead to higher ongoing pregnancy rates within a year. The therapeutic effects of HSG and timing of intercourse may improve the fertility chance. This finding should be verified in a randomized controlled trial. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained for this study. No conflicts of interest were declared. TRIAL REGISTRATION NUMBER N/A.

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P–254 The outcome of artificial reproductive technologies (ART) cycles with transfer of frozen-thawed blastocysts depending on whether expanded on day 5 or day 6

Human Reproduction ◽

10.1093/humrep/deab130.253 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

A Polumiskova ◽

S Tevkin ◽

M Shishimorova ◽

T Jussubaliyeva

Keyword(s):

Pregnancy Rate ◽

Positive Outcome ◽

Reproductive Technologies ◽

Endometrial Receptivity ◽

Ongoing Pregnancy ◽

Miscarriage Rate ◽

Ongoing Pregnancy Rate ◽

Preimplantation Genetic Testing ◽

Group A ◽

Group B

Abstract Study question Is there a difference in ART cycle results after frozen embryo transfer (FET), depending on whether blastocysts were cryopreserved on day 5 or 6? Summary answer There’s no statistical difference in the clinical pregnancy rate (CPR), life birth rate (LBR), miscarriage rate (MR) between embryos frozen on day 5 and 6. What is known already Currently, opinions differ regarding this topic. Previous studies demonstrated no difference in ongoing pregnancy rates between embryos frozen on day 5 (group A) or day 6 (group B) after FET. However, metanalysis (2019) suggested higher CPR and LBR after transferring embryos from group A rather than group B. It has also been established that ovarian stimulation leads to endometrial changes that result in deleterious effects on the implantation window and endometrial receptivity. Consequently, fresh transfers were excluded. Due to hormonal priming of endometrial receptivity, the same pregnancy outcomes should be expected with frozen-thawed blastocysts (day 5 vs 6). Study design, size, duration Retrospective cohort study was conducted between January 2015 and December 2018 with selected group of patients under 40 years of age. Group A consisted of 2275 cryotransfers of blastocyst expanded on day 5; group B included 170 cryotransfers of blastocyst on day 6. Both groups had an average of 1,52 embryos transferred per patient. Participants/materials, setting, methods Embryos were vitrified and warmed with Cryotop method (Kitazato, BioPharma). Blastocysts were scored according to Gardner and Schoolcraft grading system. Only expanded on day or 6 blastocysts of excellent and good (AA, AB, BA, BB) quality were selected. The embryos were cultured in CSC medium (Irvine Scientific) for 2–4 hours prior intrauterine transfer. The cycles with donor gametes, surrogacy and preimplantation genetic testing (PGT) were excluded. Statistical validity was assessed by Pearson’s chi-squared test. Main results and the role of chance The rates of the CPR, the ongoing pregnancy rate (OPR) and the LBR between group A and B were 50,8% (1157/2275) vs 46,5% (79/170) (p = 0,26), 37,4% (852/2275) vs 37,0% (63/170) (p = 0,91), 36,5% (832/2275) vs 35,2% (60/170) (p = 0,73) respectively and no significant differences were found in each category. Moreover, similarly there were no significant differences in the miscarriage rate 26,0% (301/1157) and 21,5% (17/79) (p = 0,37) as well Limitations, reasons for caution The study is limited due to uneven distribution of patients in both groups and by a low number of participants. The grading of blastocysts’ quality is also subjected to a human factor. Wider implications of the findings: This study confirms that frozen-thawed blastocysts do not seem to exhibit a difference in the CPR, OPR, LBR and MR whether they were expanded on day 5 or day 6. The cryopreservation of day 6 blastocyst can increase the chances of the patient for the positive outcome. Trial registration number Not applicable

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P–252 The correlation of first cleavage and blastulation timing to the euploid status of embryos after PGT-A

Human Reproduction ◽

10.1093/humrep/deab130.251 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

E Timotheou ◽

T Chartomatsidou ◽

K Kostoglou ◽

E Papa ◽

C Ioakeimidou ◽

...

Keyword(s):

Pregnancy Rate ◽

Time Lapse ◽

Clinical Pregnancy ◽

Success Rates ◽

Ongoing Pregnancy ◽

Ongoing Pregnancy Rate ◽

Group A ◽

The Mean ◽

Group B ◽

Mean Time

Abstract Study question To examine the correlation of first cleavage and blastulation timing on euploidy rates in IVF cycles after PGT-A. Summary answer The timing of blastulation is observed earlier in the euploid embryos. What is known already Embryo evaluation is one of the most critical processes that affect the clinical outcome in IVF cycles. Conventional morphologic assessment and morphokinetic assessment using time lapse technology are performed in order to select the embryo with the higher implantation potential to be transferred. It is stated that embryos with faster developmental potential, especially early forming blastocysts, show increased euploidy rate and higher implantation potential. Study design, size, duration This study includes ICSI/PGT-A treatments completed between May 2018 and December 2019. 117 blastocysts were biopsied and their euploidy status was analyzed by NGS. These embryos resulted from 32 different ICSI treatments. PGT-A was performed due to: a) repeated IVF failure, b) advanced maternal age, c) recurrent pregnancy loss.ICSI was implemented in all cases and blastocysts were vitrified awaiting the genetic results. Single euploid blastocyst transfer followed and clinical pregnancy rate was monitored. Participants/materials, setting, methods Based on the genetic results, the biopsied embryos were divided into two categories; group A representing the euploid embryos and group B the aneuploid embryos. The timing of 1st cleavage and the timing of blastulation, by means of forming a blastocoel, were investigated and compared between the two groups. The rate of early blastocysts in the two groups was also analysed. Early blastocysts are considered those formed at 96h ±2 of embryo culture post ICSI. Main results and the role of chance After the genetic analysis of the biopsied embryos, 37 blastocysts were included in group A-Euploid embryos and 80 blastocysts in group B-Aneuploid embryos. The mean time of the 1st cleavage division was similar between the two groups, with marginally no statistical significance (group A-euploid:25.9h, group B-aneuploid: 26.9h ,p>0.05). Regarding the blastulation time, it was achieved earlier in group A-Euploid, at a mean time of 102.6h, compared to the mean time of 106h in group B-Aneuploid (p < 0.05). Between the cohort of the Euploid embryos (group A), there was a higher rate of early blastulating embryos, compared to the cohort of aneuploid embryos (Group B) (24% VS 17.5%), although it was not statistically significant (p > 0.05). After transferring 1 euploid blastocyst, the ongoing pregnancy rate was monitored in 76.5%, independently of the 1stcleavage and blastulation time of the transferred embryo. Limitations, reasons for caution Further investigation in larger randomized studies is required, as only a limited number of cases were included in this study. Further analysis of the ongoing pregnancy rate between the euploid blastocysts, depending on other morphokinetic parameters would be of paramount significance, as well. Wider implications of the findings: High clinical pregnancy rates observed independently of the analyzed time points, indicate high success rates obtained after PGT-A/NGS. Additionally, success rates show that trophectoderm biopsy is not hazardous for the embryo viability, if performed properly. Concluding, genetic testing combined with time-lapse microscopy may provide further information to improve IVF outcomes. Trial registration number N/A

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O-200 Frozen embryo transfer: Miscarriage rates depending on the starting day of intramuscular progesterone

Human Reproduction ◽

10.1093/humrep/deab128.011 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

N Kalhorpour ◽

B Martin ◽

O Kulski ◽

J M Mayenga ◽

I Grefenstette ◽

...

Keyword(s):

Pregnancy Rate ◽

Embryo Transfer ◽

Live Birth ◽

Frozen Embryo Transfer ◽

Ongoing Pregnancy ◽

Miscarriage Rate ◽

Ongoing Pregnancy Rate ◽

Group A ◽

Group B ◽

Day Of Embryo Transfer

Abstract Study question Objective was to assess whether adjusting starting day of intramuscular progesterone the day of vaginal supplementation versus day of embryo transfer or later, might affect the outcome of the cycle. Summary answer additional injection of intramuscular progesterone the day of progesterone initiation or later, is not likely to be more effective on live birth and miscarriage rates. What is known already There is no consensus on the most effective method of endometrium preparation prior to FET. However, many studies report that high serum progesterone concentration during the implantation period is associated with optimal live birth rates. Adjusting progesterone treatment the day of embryo transfer seems to be too late and ineffective for rescuing low progesterone levels and should be done before. Study design, size, duration In this single center prospective study from October 2019 to november 2020, 239 patients undergoing hormonal replacement therapy protocol for frozen embryo transfer were randomly divided into two groups: additional injection of intramuscular progesterone the day of progesterone initiation or intramuscular progesterone the day of embryo transfer. We compare these results to our previous protocol beginning intramuscular progesterone day 22 of the treatment. Participants/materials, setting, methods Our frozen embryo transfer protocol consists to initiate GnRH agonist the day 1 of the cycle. After 14 days of estrogens, we introduce vaginal progesterone, prior to embryo transfer. Patients in group A received an additional injection of intramuscular progesterone the day of progesterone initiation. The group B received intramuscular progesterone the day of embryo transfer. For both, intramuscular injection of progesterone was followed every 3 days. Main results and the role of chance 239 patients were enrolled in this study, 125 in the group A and 114 in the group B. The ongoing pregnancy rate in the group A was 26.4 % and miscarriage rate 7.2%, not statistically different from ongoing pregnancy rate and miscarriage rate of women in the group B (22.81 %, p = 0.66/ 6.14%, p = 0.8). The ongoing pregnancy rate in the group D22 was 24.89 % et miscarriage rate 7.2%, not statistically different from ongoing pregnancy rate of women in the group A and B (p = 0.78 and p = 0.31). Limitations, reasons for caution The main limitation of our study is the lack of randomization for the group with additional progesterone IM on day 22. The study is actually followed to enroll more patients in 3 different groups. Wider implications of the findings This study tries to determine optimal adaptive management of hormonal replacement treatment for embryo transfer in patients with potential low progesterone values. Trial registration number no applicable

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A COMPARISON BETWEEN SYNTHETIC AND BIOSYNTHETIC MESHES IN THE SURGICAL TREATMENT OF SEVERE GENITAL PROLAPSE: RESULTS AND COMPLICATIONS

Urogynaecologia ◽

10.4081/uij.2009.3.21 ◽

2010 ◽

Vol 23 (3) ◽

pp. 21

Author(s):

S. Dati ◽

V. De Lellis ◽

P. Palermo ◽

G. Carta

Keyword(s):

Genital Prolapse ◽

Pelvic Organ ◽

Wilcoxon Test ◽

Type I ◽

Replacement Surgery ◽

Group A ◽

Group B ◽

Work Up

The effectiveness, tolerability and complications of two surgical procedures using prosthetic materials with different physical and structural properties were assessed with a full Urogynecology work-up, through a retrospective study of 158 patients with severe genital prolapse (POP-Q staging III-IV) selected from November 2006 to April 2009. Eighty-six patients underwent fascial replacement surgery with ProliftTM System with a dual transobturator access in the anterior district and a transperineal posterior access with a synthetic polypropylene type I mesh (Group A). Seventy-two patients who underwent pelvic organ prolapse surgery with Avaulta/Avaulta PlusTM System with a dual transobturator access in the anterior district and a dual transperineal posterior access with a biosynthetic polypropylene type I mesh coated with a film of hydrophilic porcine collagen were placed in Group B. There were no intra and postoperative complications. Results of mean 20.8 month follow-up showed an effective anatomical cure rate of 89.5% in group A and 86.1% in group B and a low percentage of erosive complications, 8.1% and 5.6% respectively. Validated questionnaires for prolapse, the UDI 6 s.f., the IIQ7 s.f. and the PISQ-12 all showed a statistically significant improvement of quality of life in patients undergoing the two procedures (Wilcoxon test: P<0.001).

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Acute post-operative edema. A major morbidity after hair transplant.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.06.3606 ◽

2019 ◽

Vol 26 (06) ◽

Author(s):

Mufassar Nishat ◽

Ansar Latif ◽

Leena Chaudhary

Keyword(s):

Success Rate ◽

Late Complications ◽

Oral Steroid ◽

Major Morbidity ◽

Hair Transplant ◽

Tumescent Solution ◽

Group A ◽

Male Patients ◽

Group B

Objectives: To evaluate the efficacy of different modalities for the prevention of post-operative edema in patients undergoing hair transplant. Study Design: Prospective study. Place and Duration of Study: Department of Plastic Surgery, Bashir Hospital (private), Sialkot from March 2016 to April 2018. Patients and Methods: Male patients with typical male baldness patterns were serially included in the study. Informed consent was taken both for the surgery and purpose of research. Patients were followed up daily for one week to assess the post-operative edema. However patients were also called for follow up after three months to see the late complications. Patients not giving consent for the study were excluded from the data. Data was entered and analysis done by SPSS v 22. Results: Total 97 patients were operated. Two groups A&B each of 45 and 57 patients were selected randomly. Group A which was administered tumescent solution including steroid showed maximum prevention of edema, success rate (93.3%). Group B having oral steroid course postoperatively for 5 days showed less promising results with success rate of (57.8%). Conclusion: The results of this study revealed that addition of steroid (Triamcinolone) to the tumescent solution had more promising results regarding the prevention of post-operative edema.

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Transmyometrial oocyte recruitment: a safe surgical procedure alternative to the transvaginal retrieval when ovaries are inaccessible

10.21203/rs.3.rs-85878/v1 ◽

2020 ◽

Author(s):

Domenico Baldini ◽

Cristina Lavopa ◽

Giovanni Vizziello ◽

Pasquale Todaro ◽

Antonio Malvasi ◽

...

Keyword(s):

Surgical Approach ◽

Oocyte Retrieval ◽

Efficacy And Safety ◽

Ongoing Pregnancy ◽

Ongoing Pregnancy Rate ◽

Follicular Aspiration ◽

Group A ◽

Alternative Approaches ◽

Icsi Outcomes ◽

Group B

Abstract Background: This study aims to investigate the intra-cytoplasmic semen injection (ICSI) outcomes and the potential complications of transmyometrial oocyte retrieval performed in patients with one or both inaccessible ovaries.Methods: From January 2004 to December 2018 were evaluated 11,273 oocytes retrievals, of which 594 not conventional procedures for inaccessible ovaries through transvaginal retrieval. Despite alternative approaches tested by clinicians during the oocyte pick up (OPU), in 113 of these patients (Group A) were indispensable the needle’s passage through the myometrium, compared to as many controls (Group B) from the 481 remaining women without this necessity. The two resulting groups were matched for their reproductive outcomes and the relative developed complications.Results: No statistically significant differences were found between the two Groups in terms of number of eggs/embryos obtained, ongoing pregnancy rate and spontaneous miscarriage. A complete absence of complications as peritoneal and endometrial bleeding after 4 and 24 hours from the transmyometrial access was reported for the whole cohort.Conclusions: This study shows that the transvaginal transmyometrial oocyte retrieval does not affect the OPU outcome even if the passage of the needle occurs through the endometrium, not inducing significant complications. Thus, here we support both efficacy and safety of transmyometrial follicular aspiration as a valid surgical approach in conditions of inaccessible ovaries.

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Aspiration Alone, Aspiration Plus Steroid Injection and Aspiration Plus Ethanol Injection for Treatment of Dorsal Wrist Ganglions: A Comparative Study among Three Methods

Journal of Enam Medical College ◽

10.3329/jemc.v6i1.26375 ◽

2016 ◽

Vol 6 (1) ◽

pp. 19-22

Author(s):

Khandoker Abdur Rahim

Keyword(s):

Success Rate ◽

Treatment Modalities ◽

College Hospital ◽

Ethanol Injection ◽

Medical College ◽

Ganglion Cysts ◽

Group A ◽

Group B ◽

Dorsal Wrist Ganglion

Background: There are varieties of treatment modalities to treat dorsal wrist ganglion cysts. But none of these has been the standard. So, we designed this study to compare among different treatment modalities.Objective: To compare the effects of aspiration alone, aspiration plus methylprednisone injection and aspiration plus ethanol injection into the dorsal wrist ganglions.Materials and Methods: This prospective study was performed in Dhaka Medical College Hospital, Dhaka from March 2010 to May 2011. Sixty six patients with dorsal wrist ganglions were treated in three groups aspiration alone in 24 patients (Group A), aspiration plus methylprednisolone injection into the cyst in 20 patients (Group B) and aspiration plus ethanol injection, then reaspiration of the ethanol from the cyst after 35 minutes, in 22 patients (Group C). Elastic compression bandage was applied in all patients and recommended for 3 weeks. Follow-up was done at 1, 3, 6 and 12 months and conclusive assessment was done during final visit.Results: The success rate in Group A was seen in 9 patients (37.5%), in Group B in 11 (55%) and in Group C in 14 (63.5%) patients. The most frequent side-effect was pain during ethanol injection which was relieved by reaspiration of cyst.Conclusion: Injection of ethanol into the dorsal wrist ganglion was associated with higher success rate compared to aspiration and methylprednisolone injection. Further studies with larger sample size should be performed to assess the effect of ethanol injection in this disease.J Enam Med Col 2016; 6(1): 19-22

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Learning curve in performing radiofrequency ablation of accessory pathways in patients with Wolf-Parkinson-White syndrome

Medicinski pregled ◽

10.2298/mpns0610468v ◽

2006 ◽

Vol 59 (9-10) ◽

pp. 468-471

Author(s):

Dejan Vukajlovic ◽

Aleksandar Neskovic

Keyword(s):

Radiofrequency Ablation ◽

Learning Curve ◽

Success Rate ◽

Radiofrequency Energy ◽

Operator Experience ◽

Wpw Syndrome ◽

Accessory Pathways ◽

Group A ◽

Group B

Introduction. This study examines the effect of operator experience on radiofrequency ablation (RFA) of accessory pathways success rate in patients with Wolff-Parkinson-White (WPW) syndrome. Material and methods. The first 100 consecutive patients with WPW syndrome treated by radiofrequency ablation at our Clinic, were divided into group A (first 50 patients) and group B (the following 50 patients). Various parameters were compared between these 2 groups. Results. The success rate in group A was 69% and in group B 92%, p<0,01. There were 6 patients with recurrent WPW syndrome, after 3 months of follow-up, 5 were from group A and 1 from group B, p<0,05. Significantly more applications of radiofrequency energy were delivered in group A (10,0?4,8 in group A and 6,2 ?3,1 in group B, p<0,05). Two patients from group A presented with complications: one had intermittent complete AV-block, and the other pericardial effusion. Conclusion. This study shows a clear learning curve in performing RFA of accessory pathways in patients with WPW syndrome. .

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P–211 Double warming and double vitrification for euploid embryos does not affect implantation nor ongoing pregnancy rate

Human Reproduction ◽

10.1093/humrep/deab130.210 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

B A Hashimi

Keyword(s):

Statistical Analysis ◽

Pregnancy Rate ◽

Small Sample ◽

Trophectoderm Biopsy ◽

Ongoing Pregnancy ◽

Ongoing Pregnancy Rate ◽

Patient Counselling ◽

Significant Difference ◽

Group A ◽

The Mean

Abstract Study question Does exposure of embryos to double vitrification and double warming affect the chances of ongoing pregnancy for patients undergoing PGT-A and transfer euploid embryos? Summary answer Our analysis shows that there is no statistically significant difference in implantation or ongoing pregnancy rate between single or double vitrification/warming cycles. What is known already The use of PGT-A is increasing in the last years and progressively more patients opting in for this, in order to reduce time to pregnancy. Implantation failures prior to genetic testing or the incidence of no-result embryos post PGT-A are some of the scenarios that expose the embryos to multiple rounds of vitrification/warming cycles. The exact effect that such exposure has on embryos is still to be investigated and confirmed as to whether it affects the outcome (i.e. implantation/ongoing pregnancy rate) or the future health of the child. Study design, size, duration Our analysis is a retrospective observation study of data collected from 151 consecutive frozen euploid embryo transfers (FET). These were performed at a single centre between January-December 2020. Two groups were created for this study. The first group includes euploid embryos that were transferred post being exposed to single vitrification/warming (n = 126). In the second group euploid embryos were exposed twice to vitrification/warming (n = 25). Statistical analysis using chi-square test and statistical significance was calculated when p ≤ 0.05. Participants/materials, setting, methods Blastocysts from 151 patients were split into two groups based on the number of vitrification/warming cycles that they underwent prior to FET. The first group includes embryos that were subjected to trophectoderm biopsy and were then vitrified (n = 126). The second group includes embryos that were initially vitrified without undergoing PGT-A analysis. Following implantation failures, their remaining embryos were warmed, biopsied and re-vitrified. Post PGT-A analysis euploid embryos were then re-warmed and transferred (n = 25). Main results and the role of chance For the first group (A), 450 blastocysts (day 5–7) were subjected to trophectoderm biopsy, where 5-cells taken, and embryos were then vitrified. Post PGT-A analysis 260 euploid embryos identified. From them 126 embryos transferred in frozen replacement cycles, where the mean embryo age for the group was 36.1±4.2. The grade of embryos transferred were of 4BC or better based on Gardner’s grading system. The implantation and ongoing pregnancy rate for this group was 62%. For the second group (B), 101 blastocysts (day 5–7) warmed, in order to undergo trophectoderm biopsy and were then re-vitrified. Post PGT-A analysis 49 euploid embryos identified. From them, 25 embryos transferred in frozen replacement cycles, where the mean maternal age for the group was 35.05±5.2. The grade of embryos transferred were of similar quality to group A. The implantation and ongoing pregnancy rate for this group was 64%. Statistical analysis confirmed that there is no statistical difference between the groups (p = 0.74). In addition, 60% of patients (n = 5) who had double vitrification, double biopsy and double warming have ongoing pregnancy. In conclusion, for transferrable quality euploid blastocysts, double vitrification has comparable reproductive outcomes as in single vitrification, thereby supporting the efficacy of double vitrification/warming when necessary. Limitations, reasons for caution This study uses a small sample size of patients. The data are observational and were retrospectively analysed so unknown confounders could not be assessed. The addition of more cycles and further multivariate analysis, including the child’s health is essential for confirmation of the findings. However, initial results are very reassuring. Wider implications of the findings: Our study has implications for clinical practice and patient counselling. Especially in patients that they choose to undergo PGT-A with pre-vitrified embryos post implantation failures with non PGT-A tested embryos. Trial registration number N/A

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The role of F-18 FDG PET/CT and breast MRI in the management of breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10778 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10778-10778

Author(s):

A. Iagaru ◽

R. Masamed ◽

H. Silberman ◽

S. Keesara ◽

P. S. Conti

Keyword(s):

Breast Cancer ◽

High Risk ◽

Fdg Pet ◽

Breast Mri ◽

Pet Ct ◽

Group A ◽

Group B ◽

Fdg Pet Ct ◽

Work Up

10778 Background: F-18 FDG PET/CT combines functional and morphologic information in a single study, thus becoming a powerful imaging tool for diagnosis, staging and establishing the response to therapy in various malignancies, including breast cancer (BC). Breast MRI (BMRI) is gaining a major role in the management of high risk BC patients (pts), demonstrating high sensitivity and specificity for detection of small lesions. It is not clear whether to request both studies prior to therapy or opt only for one. We were therefore prompted to review our experience with PET/CT and BMRI in BC. Methods: This is a retrospective study of 21 pts with BC, 30–76 years old (average: 52±13.5), who had BMRI and PET/CT from June 2002 to May 2005. 6 pts (group A) had BMRI and PET/CT in the preoperative period (3–78 days, average: 25) and 15 pts (group B) had BMRI and PET/CT as follow-up after surgery (4–175 days, average: 51.3). The interval between the PET/CT and BMRI ranged 2–188 days (average: 52.7). Specificities and sensitivities for BC and metastases detection using PET/CT and MRI were calculated using pathology (17 pts) or clinical follow-up (4 pts) as gold standard. Results: In group A, BMRI identified BC in 4 pts, while PET/CT did so in 5 pts. All were proven to be malignancy on pathology. In group B, BMRI detected recurrent BC in 8 pts, with 88.9% sensitivity (95% CI: 56.5–98) and 83.3% specificity (95% CI: 43.6–96.9). In the same patient population, PET/CT was 33.3% sensitive and 91.7% specific. As a whole body exam, PET/CT revealed metastases in 6 pts (100% sensitive and 90% specific). Overall, sensitivities and specificities for BC detection were 85.7% (95% CI: 60.1–95.9) and 85.7% (95% CI: 48.7–97.4) for breast MRI, and 75% (95% CI: 40.9–92.8) and 92.3% (95% CI: 66.7–98.6) for PET/CT. Conclusions: BMRI is more sensitive than PET/CT for detection of breast lesions. However, PET/CT detected distant metastases in 6 of the 21 pts (100% sensitive, 90% specific). Larger prospective studies, with the addition of dedicated breast PET and dual time imaging are needed to define the sequence of studies during initial work-up. Our study suggests that PET/CT and BMRI should be considered complimentary imaging tools in the pre- and perioperative work-up of pts diagnosed with BC and at high risk for metastatic disease. No significant financial relationships to disclose.

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