The Effect of Adenomyosis on the Outcome of Fresh Embryo Transfer in ICSI Cycles: a Retrospective Case-control Study

2020 ◽  
Author(s):  
Siddhartha Nagireddy ◽  
Nellepalli Sanjeeva Reddy ◽  
Monna Pandurangi ◽  
Radha Vembu ◽  
Tamizharasi Muthusamy ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Case Control Study ◽  
Fresh Embryo Transfer ◽  
Retrospective Case ◽  
Live Birth Rates ◽  
Tubal Factor Infertility ◽  
Group A ◽  
Tubal Factor ◽  
Group B ◽  
Control Study

Abstract Background: Adenomyosis is known to cause reduced clinical pregnancies and increased miscarriage rates in ART (Assisted Reproductive Technology) cycles. The detrimental effect was found to be enhanced if these women would undergo fresh embryo transfer without optimal suppression by GnRH agonist treatment. Several mechanisms were proposed as causative factors such as increased myometrial contractions, decreased implantation and altered endometrial receptivity. But the conclusions from previous studies were mutually conflicting. To ensure adequate regression of the disease prior to embryo transfer, these women would commonly undergo freeze-all and subsequent frozen embryo transfer. On contrary to this, fresh embryo transfer may be necessary in certain justifiable clinical situations. The present study was designed as a retrospective case-control study to compare the ICSI-fresh embryo transfer outcomes of women with adenomyosis to those with tubal factor infertility. This study is aimed to find the extent to which adenomyosis compromises the outcomes of fresh embryo transfer in ICSI cycles. Methods: The data of the eligible patients as per the study criteria, was obtained from the hospital medical records of a tertiary care University teaching hospital, in Chennai, South India. The study groups (Group A: women with adenomyosis, GroupB; women with tubal factor infertility) were compared for the fresh embryo transfer outcomes such as pregnancy rate, clinical pregnancy rate, miscarriage and live birth rates. SPSS version 17 software was used and and P<0.05 was considered statistically significant.Results: The data of 89 women included in the study (Group A: 47, and Group B: 42) were analysed. The data analysis showed significantly reduced pregnancy, clinical pregnancy, implantation and live birth rates in Group A compared to Group B (25.7 vs. 52.4%; 23.4 vs. 52.4%; 7.6% vs. 26.2%; 17.0 vs. 47.6%, respectively).Conclusions: We found that adenomyosis is associated with a less favourable outcome in ICSI -fresh embryo transfer. Though these results are justifiable if performed with appropriate indications, the cost-effectiveness and indications of such an approach needs to be evaluated on a larger prospective data.

P–590 Women with hypothalamic hypogonadism have lower live birth rates following frozen embryo transfer

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
R Heidenberg ◽  
A Lanes ◽  
E Ginsburg ◽  
C Gordon
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Polycystic Ovary ◽  
Frozen Embryo Transfer ◽  
Fresh Embryo Transfer ◽  
Ovary Syndrome ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Tubal Factor Infertility ◽  
Tubal Factor

Abstract Study question How do live birth rates differ in anovulatory women with polycystic ovary syndrome and hypothalamic hypogonadism compared to normo-ovulatory women undergoing fresh or frozen embryo transfer? Summary answer Live birth rates are similar among all groups undergoing fresh embryo transfer but are significantly lower in women with hypothalamic hypogonadism undergoing frozen embryo transfer. What is known already Conflicting data exist regarding pregnancy outcomes in patients with tubal factor infertility versus polycystic ovary syndrome (PCOS). Some studies demonstrate higher pregnancy and live birth rates for women with PCOS undergoing fresh embryo transfer, but other studies demonstrate no difference. Women with PCOS have higher live birth rates than those with tubal factor infertility when undergoing frozen embryo transfer. Fewer data are available regarding IVF outcomes in women with hypothalamic hypogonadism (HH) and tubal factor infertility. Several studies report comparable live birth rates with fresh embryo transfer, but there are no data on frozen embryo transfer outcomes. Study design, size, duration Retrospective cohort study of all fresh and frozen autologous embryo transfers performed for patients with oligo-anovulation (PCOS, n = 380 and HH, n = 39) and normo-ovulation (tubal factor infertility, n = 315) from 1/1/2012 to 6/30/2019. A total of 734 transfers from 653 patients were analyzed. Participants/materials, setting, methods Transfer outcomes, including implantation, miscarriage, clinical pregnancy and live birth rates, were assessed in fresh and frozen embryo transfer cycles. Adjusted relative risks (RR) and 95% confidence intervals (CI) were calculated adjusting for age, BMI, stimulation protocol, number of embryos transferred, embryo quality, endometrial stripe thickness and day of transfer. Poisson regression was used for counts and with an offset for ratios. Generalized estimating equations were used to account for patients contributing multiple cycles. Main results and the role of chance For fresh embryo transfer cycles, live birth rates are similar among patients with tubal factor infertility, PCOS and HH (29.5% vs. 37.9% vs. 35.9%, respectively, aRR 1.15 95% CI: 0.91–1.44 and aRR 1.23 95% CI: 0.81–2.00, respectively). When evaluating frozen embryo transfer cycles, patients with HH have lower live birth rates than patients with tubal factor infertility (26.5% vs. 42.6%, aRR 0.54 95% CI: 0.33–0.88) and patients with PCOS (26.5% vs. 46.7%, aRR 0.55 95% CI: 0.34–0.88). Additionally, patients with HH have higher chemical pregnancy rates and miscarriage rates than patients with tubal factor infertility (26.5% vs. 13.0% and 17.7% vs. 6.5%, respectively, RR 2.71 95% CI: 1.27–5.77 and RR 2.03 95% CI: 1.05–3.80, respectively). Point biserial correlation showed no significant correlation between live birth and endometrial stripe thickness in HH patients undergoing frozen embryo transfer (r = 0.028, p-value 0.876). Limitations, reasons for caution This study is limited by its retrospective nature and the small sample size of women with hypothalamic hypogonadism. Additionally, these data represent outcomes from a single academic center, so generalizability of our findings may be limited. Wider implications of the findings: Lower live birth rates for HH patients undergoing frozen embryo transfer cycles are not correlated with endometrial stripe thickness. This may be due to absent gonadotropin signaling on endometrial receptors. A prospective randomized trial of HH patients to modified natural versus programmed frozen embryo transfer would best support this hypothesis. Trial registration number Not applicable

scholarly journals Coronary arteries and aortic valve calcifications in COVID-19: Not only lungs at chest CT

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Marco Fogante ◽  
◽  
Enrico Cavagna ◽  
Giovanni Rinaldi ◽  
◽  
...  
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Chest Ct ◽  
Control Group ◽  
Case Group ◽  
Invasive Ventilation ◽  
Retrospective Case ◽  
Group A ◽  
Group B ◽  
Control Study

Objectives: Cardiovascular diseases cause worse outcomes in patients affected by COVID-19. High coronary artery calcium score (CACS) and aortic valve calcifications (AC) increase cardiovascular risk. Our purpose is to evaluate CACS, measured by Weston Score (WS), and presence of AC in chest CT of COVID-19 patients and possibly to investigate their prognostic role. Material and methods: This retrospective case-control study includes 150 hospitalized COVID-19 patients who underwent a chest CT at admission. The case group (Group A) was formed by 50 in-patients in Intensive Care Unit (ICU) under invasive ventilation (IV), while the matching control group for sex, age and BMI (Group B) was formed by 100 in-patients in non-ICU units, not under IV. After, a second case-control selection was originated from these two Groups: the case group (Group A1) composed by 30 patients selected from Group A, and the matching control group for age, sex, BMI and CT lung severity score (LSS) (Group B1) composed by 60 patients selected from Group B. WS and the presence of AC were compared between Groups A and B, and between Groups A1 and B1. Moreover, LSS and WS were correlated. Parametric tests were used for statistical analysis. Material and methods: This retrospective case-control study includes 150 hospitalized COVID-19 patients who underwent a chest CT at admission. The case group (Group A) was formed by 50 in-patients in Intensive Care Unit (ICU) under invasive ventilation (IV), while the matching control group for sex, age and BMI (Group B) was formed by 100 in-patients in non-ICU units, not under IV. After, a second case-control selection was originated from these two Groups: the case group (Group A1) composed by 30 patients selected from Group A, and the matching control group for age, sex, BMI and CT lung severity score (LSS) (Group B1) composed by 60 patients selected from Group B. WS and the presence of AC were compared between Groups A and B, and between Groups A1 and B1. Moreover, LSS and WS were correlated. Parametric tests were used for statistical analysis. Results: Among the 150 patients, 105 (70.0%) were male and 45 (30.0%) female. The age was 70.2 ± 13.3 years. LSS was 7.5 ± 3.9, WS was 6.4 ± 3.0; AC was present in 97/150 (64.7%). WS was significantly higher in Group A than in Group B, respectively, 7.4 ± 4.0 and 5.7 ± 2.6 (p=0.0146), and also the presence of AC, respectively, 41/50 (82.0%) vs 56/100 (56.0%) (p=0.0016). In Group B, LSS and WS had a linear positive correlation (r=0.2240, p=0.0405). Finally, WS and AC were significantly higher in Group A1 compared to Group B1. Conclusions: Both WS and AC were higher in ICU COVID-19 patients than in non-ICU COVID-19 patients: they could have a predictive role in the pejorative evolution of the disease.

P–666 Validating the hypo-androgenic PCOS-like phenotype (H-PCOS), derived from the “lean” PCOS phenotype at younger ages

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Darmon ◽  
E Molinari ◽  
D F Albertini ◽  
P Patrizio ◽  
D H Barad ◽  
...  
Keyword(s):  
Live Birth ◽  
Case Control Study ◽  
Treatment Resistance ◽  
Study Groups ◽  
Case Control ◽  
Clinical Pregnancy ◽  
Retrospective Case ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Control Study

Abstract Study question Is the resistance to standard infertility treatments of the H-PCOS-like phenotype reversed through reconstitution of androgen levels and can principle diagnostic markers of H-PCOS be validated? Summary answer Pre-supplementation with dehydroepiandrosterone (DHEA) eliminated treatment resistance of H-PCOS in comparison to matched infertile controls, also validating previously reported diagnostic features of this condition. What is known already H-PCOS evolves at older ages from a hyper-androgenic “lean” PCOS phenotype at young ages. Its ontogeny diverts from other PCOS phenotype between 20s and mid–30s by going from being hyper- to being hypo-androgenic due to insufficiency in adrenal androgen production, believed to represent an autoimmune process. In contrast to other PCOS phenotypes, the “lean” PCOS phenotype appears highly treatment resistant to standard fertility treatments. Study design, size, duration Retrospective case control study. Participants/materials, setting, methods We investigated 54 H-PCOS patients with qualifying diagnostic criteria1,2 and 50 matched infertility patients without diagnostic H-PCOS criteria as controls. Both study groups underwent routine in vitro fertilization (IVF) cycles, including androgen pre-supplementation in both groups via dehydroepiandrosterone (DHEA) for women diagnosed as hypo-androgenic. Main outcome measures were clinical pregnancy and live birth rates. 1Gleicher et al., J Sterodi Biochem Mol Biol 2017;167:144–152; 2Gleicher N, et al., Endocrine 2018;59(3):661–676 Main results and the role of chance Study groups were similar in age, number of prior IVF cycles and previous live births. H-PCOS patients in contrast to controls, however, demonstrated previously reported characteristics of H-PCOS diagnosis, including a significantly higher DHEA/DHEAS ratio, significantly higher AMH, confirming higher functional ovarian reserve, significantly lower free testosterone and significantly higher sex hormone binding globulin (SHBG), further confirming lower androgens. Finally, H-PCOS patients also demonstrated significantly increased evidence for immune system hyperactivity. Clinical pregnancy and live birth rates were separately assessed in first IVF cycles and cumulatively. Both analyses demonstrated, even after age-adjustments, absolutely no outcome differences in cycle cancellations, numbers of oocytes retrieved, first and cumulative pregnancy and live birth rates. At least one pregnancy was achieved in 12 women in both groups (22.2% and 24.0%) and at least one live birth in 11 (20.4%) vs. 8 (14.8%), respectively. Limitations, reasons for caution As a retrospective case control study, here presented data must be interpreted with caution. The close match between H-PCOS and control patients and the very clear differentiation in patient characteristics between the two groups, however, support the credibility of this study. Wider implications of the findings: This study demonstrated that androgen reconstitution in H-PCOS patients completely reversed treatment resistance compared to well-matched infertile control patients. It also validated previously defined diagnostic criteria of H-PCOS, hopefully facilitating a timelier diagnosis of a, still, widely overlooked condition in female infertility. Trial registration number NA

scholarly journals Isoflavone in Postmenopausal Women - Are They Really Effective? A Prospective Case Control Study.

2013 ◽  
Vol 7 (1) ◽  
pp. 11-14 ◽  
Author(s):  
TS Bag ◽  
Amit Kyal ◽  
DP Saha ◽  
R Dutta ◽  
S Mondal
Keyword(s):  
Blood Pressure ◽  
Postmenopausal Women ◽  
Case Control Study ◽  
Case Control ◽  
Menopausal Symptoms ◽  
Kupperman Index ◽  
Group A ◽  
Group B ◽  
Control Study ◽  
Prospective Case Control Study

A prospective case control study was conducted at Medical College, Kolkata with the aim of evaluating the role of isoflavone( a class of phytoestrogen –plant compounds having the beneficial effects of estrogen but lesser risks and side effects) in postmenopausal women. 100 postmenopausal women (those who underwent total abdominal hysterectomy and bilateral salpingooopherectomy for different benign indications, aged between 40-50 years and who were menstruating before operation) were alternately distributed into two groups-Group A (n=50, received 60mg of isoflavone and 500mg of calcium per day for 6 months) and Group B (n=50, received 500mg of calcium per day only for 6 months). To evaluate the menopausal symptoms, the menopausal Kupperman index questionnaire was applied. Other outcomes measured were body mass index, blood pressure and lipid profile. Menopausal symptoms in Group A(those using isoflavones) were lower compared to Group B. The present study showed that Kupperman index decreased significantly in Group A (from 28.48 ± 2.03 to 16.32 ± 1.06 i.e. 45% decline) compared to Group B (from 24.56 ± 1.52 to 18.44 ± 1.11 i.e. 25% decline). No differences in blood pressure or body mass index were found during treatment between the two groups. . In our study total cholesterol, triglycerides and low-density lipoproteins (LDL) decreased significantly in Group A compared to Group B. Therefore our clinical study indicates that isoflavone can be an invaluable resource for postmenopausal women for combating menopausal symptoms. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 11-14 DOI: http://dx.doi.org/10.3126/njog.v7i1.8826

Clinical Factors in Trunk Capillary Malformations in the Neonate: When to Suspect Other Associated Malformations? A Case–Control Study

2019 ◽  
Vol 30 (01) ◽  
pp. 122-126
Author(s):  
Carlos Delgado-Miguel ◽  
Miriam Vicente ◽  
Antonio Jesus Serrano-Muñoz ◽  
Miriam Miguel-Ferrero ◽  
Mercedes Diaz ◽  
...  
Keyword(s):  
Case Control Study ◽  
Vascular Malformations ◽  
Venous Malformation ◽  
Clinical History ◽  
Case Control ◽  
Gender And Age ◽  
Group A ◽  
Associated Malformations ◽  
Group B ◽  
Control Study

Abstract Introduction Capillary malformations (CMs) can be sporadic or syndromic, in association with other underlying venous malformation (VM) or lymphatic malformation (LM). The objective of this study is to describe the clinical patterns in the neonate that allow us to differentiate sporadic CMs from those associated with other vascular malformations. Materials and Methods A case–control study was performed in neonates with CM located in the trunk, followed at our institution between 2008 and 2018. The patients were divided into two groups: group A (cases: CM associated with VM or LM) and group B (controls: sporadic CM without associated malformations). Demographic and clinical variables collected in the clinical history were evaluated (color, location, multifocality, bilaterality, position regarding the vascular axis, and involvement of the midline). Results Thirty-eight patients were included (18 cases and 20 controls) without differences in gender and age. In group A, the totality of patients presented CM with uniform color and lateral location (p < 0.001). In this group, bilateral and multifocal involvements were lower than in group B, without significant differences between both groups. The distribution of CMs in group A was always parallel to the vascular axis and the midline was always respected, without observing these characteristics in the group B (p < 0.001). Conclusion The presence of a CM in the trunk of a neonate with uniform color, lateral location, parallel position to the vascular axis, and absence of involvement of the midline should make us suspect other underlying vascular malformations, which should be studied with complementary tests.

scholarly journals Nonsurgical Periodontal Therapy decreases the Severity of Rheumatoid Arthritis: A Case–control Study

2016 ◽  
Vol 17 (6) ◽  
pp. 484-488 ◽  
Author(s):  
Neha Khare ◽  
Bhavuk Vanza ◽  
Deepak Sagar ◽  
Kumar Saurav ◽  
Rohit Chauhan ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Oral Hygiene ◽  
Case Control Study ◽  
Case Control ◽  
Periodontal Therapy ◽  
Clinical Observations ◽  
Nonsurgical Periodontal Therapy ◽  
Group A ◽  
Group B ◽  
Control Study

ABSTRACT Introduction Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions. Several studies suggested a relationship between RA and periodontitis. Recent studies have shown a beneficial effect of periodontal treatment on the severity of active RA. So the aim of this study was to examine the effect of nonsurgical periodontal therapy on the clinical parameters of RA. Materials and methods A total of 60 subjects with moderateto- severe chronic generalized periodontitis and active RA in the age range 18 to 65 were selected for the study. They were divided into two groups. Group A (control group) consisted of 30 subjects with chronic generalized periodontitis and RA, and group B of 30 subjects with chronic generalized periodontitis and RA and they received nonsurgical periodontal therapy (scaling, root planning, and oral hygiene instructions). Evaluation of clinical observations of Simplified Oral Hygiene Index (OHI-S), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL), number of swollen joints (SJ), number of tender joints (TJ), values of erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) for patient's global assessment, 3 months disease activity score (DAS) index, and C-reactive protein (CRP) was done at baseline and 3 months. Statistical evaluation of clinical observations was carried out. Results Group B subjects who received nonsurgical periodontal therapy showed statistically significant improvement in all periodontal and RA parameters at 3 months, compared with group A who did not receive periodontal therapy. Conclusion It can be concluded from the result that nonsurgical periodontal therapy may contribute to reduction in severity and symptoms of RA. Clinical significance Rheumatoid arthritis patients should be evaluated for periodontitis and treated for the same in order to reduce its severity level. How to cite this article Khare N, Vanza B, Sagar D, Saurav K, Chauhan R, Mishra S. Nonsurgical Periodontal Therapy decreases the Severity of Rheumatoid Arthritis: A Case–control Study. J Contemp Dent Pract 2016;17(6):484-488.

scholarly journals Supraphysiological estradiol levels on the hCG trigger day are associated with SGA for singletons born from fresh embryo transfer

2020 ◽  
Author(s):  
Junwei Zhang ◽  
Mingze Du ◽  
Yanli Wu ◽  
Yiwen Xiong ◽  
Yunxia Wang ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Reference Group ◽  
Fresh Embryo Transfer ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Estradiol Levels ◽  
Singleton Pregnancies ◽  
Hcg Trigger ◽  
Fresh Embryos

Abstract The effects of supraphysiological estradiol (E2) on neonatal outcomes and the significance of specific E2 concentrations remain unclear. The purpose of this study was investigate whether supraphysiological E2 levels on the hCG trigger day are associated with small size for gestational age (SGA) in singletons born from fresh embryo transfer (ET) cycles. Patients with singleton pregnancies with delivered after transfer of fresh embryos, during the period of July 2012 to December 2017 at our center were included. We excluded cycles involving a vanishing twin, maternal age >35 years, basal FSH ≥10 mIU/ml, AMH ≤1 ng/ml or incomplete records. We then divided all cycles into 5 groups by E2 level on the day of hCG trigger: group A, <2000 pg/ml (reference group); group B, 2000 pg/ml≤E2<2999 pg/ml; group C, 3000 pg/ml≤E2<3999 pg/ml; group D, 4000 pg/ml≤E2<4999 pg/ml; and group E, ≥5000 pg/ml. The prevalence of SGA among singletons from fresh ET was the primary outcome. The SGA rate significantly increased when the E2 level was ≥4000 pg/ml, as observed by comparing groups D (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.16–2.76, P=0.01) and E (OR: 1.68, 95% CI: 1.10–2.56, P=0.02) with the reference group. Multivariate logistic regression indicated that a serum E2 level of at least 4000 pg/ml on the hCG trigger day was associated with increased SGA and with significant differences for groups D (adjusted OR [AOR]: 1.65, 95% CI: 1.05–2.59, P=0.03) and E (AOR: 1.60, 95% CI: 1.03–2.53, P=0.04) relative to the reference group. In conclusion，for fresh ET cycles, supraphysiological E2 ≥4000 pg/ml on the hCG trigger day increases the risk of singleton SGA.

A Preliminary Case-Control Study: Peritoneal Approach in Congestive Heart Failure Treatment

2021 ◽  
pp. 1-7
Author(s):  
Paolo Ria ◽  
Gianluca Borio ◽  
Carlo Rugiu ◽  
Isabella Corino ◽  
Luisa Zanolla ◽  
...  
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Major Event ◽  
Event Free Survival ◽  
Free Survival ◽  
Group A ◽  
Number Of Visits ◽  
Group B ◽  
Control Study

<b><i>Background:</i></b> Congestive heart failure (CHF) associated with worsening renal function is a very common disorder, and, as well known, the goal of the treatment is reducing venous congestion and maintaining a targeted extracellular volume. The objective of the study is to evaluate regular peritoneal ultrafiltration treatment compared to a standard conservative approach in NYHA III–IV CHF patients. In particular, the primary endpoints of the study were the major event-free survival and the total days of medical care per month (which consist of the days of hospitalization and the number of outpatient visits). <b><i>Material and Methods:</i></b> This is a retrospective case-control study. Twenty-four patients were included in the present study. Twelve consecutive patients were treated with peritoneal treatment (group A) and 12 matched for age, gender, and severity of disease with a standard approach. Patients were observed over a maximum period of 18 months. Information on events, hospitalizations, and number of visits was collected during follow-up. <b><i>Results:</i></b> During the follow-up, we observed a major event in 4 patients in group A (33.3%) and in 8 patients in group B (66.7%). In group B, we observed 7 deaths and 1 ICD shock, while in group A, 3 deaths and 1 ICD shock. The number of visits per month was significantly lower in patients treated with the peritoneal method (1.2 [0.4–4.1] vs. 2.5 [2.0–3.1]; <i>p</i> = 0.03). The total days of medical care was significantly lower in group A (2.0 [1.1–5.5] vs. 4.4 [3.0–8.7]; <i>p</i> = 0.034). A multiple event analysis according to the Andersen-Gill model showed a significant event-free survival for group A. During the follow-up, we did not observe any episode of peritonitis in the treated group. <b><i>Conclusions:</i></b> Our study shows that the peritoneal technique is a good therapeutic tool in well-selected patients with CHF. In accordance with prior experience, this intervention has not only an important and significant clinical impact but also potential economic and social consequences.

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