2017–2018 Assisted Reproduction Cost Analysis Performance Indexes: Lombardy County Case Study

Objective: The aim of the present study was to analyze the IVF success rates and the economic cost per delivery in all the public funded IVF Units in Lombardy in the 2017–2018 period and to assess any significant difference in ART outcomes among the enrolled centers.Methods: Analysis of costs for the 2017 and 2018 fresh transfer delivery rate (DR) and Cumulative delivery rate (CDR) considering both fresh and frozen cycles were extracted from the ART Italian Registry on oocytes retrievals, fresh and frozen embryos and oocytes embryo transfer performed in 22 Lombardy IVF Units.Results: In 2017, 29,718 procedures were performed, resulting in 4,543 pregnancies and 3,253 deliveries. In 2018, there were 29,708 procedures, 4,665 pregnancies and 3,348 deliveries. Pregnancies lost to follow up were 5.0% with a (range of 0–67.68%) in 2017 and 3.4% (range of 0–45.1%) in 2018. The cost reimbursement for the cycles were €2,232 ($2,611) for oocyte retrieval and €2,194 ($2,567) for embryo transfer, excluding ovarian stimulation therapy and luteal phase support. 19.33 (5.80). The DR was 13.23 ± 5.69% (range 2.86–29.11%) in 2017 and 19.33 ± 5.80% in 2018 (range 11.82–34.98 %) and the CDR was 19.86 ± 9.38% (range 4.43–37.88%) in 2017 and 21.32 ± 8.84% (range 4.24–37.11%). The mean multiple pregnancy delivery rate (MDR) was 11.08 ± 5.55% (range 0.00–22.73%) in 2017 and 10.41 ± 4.99% (range 1.33–22.22%) in 2018. The mean CDR cost in euros was 26,227 ± 14,737 in 2017 and 25,018 ± 16,039 in 2018. The mean CDR cost among centers was 12,480 to 76,725 in 2017 and 12,973 to 86,203 in 2018.Conclusions: Our findings show impressive differences in the DR and CDR among centers and the importance of cryopreservation in patients' safety and economic cost reduction suggesting the formulation of specific KPI's (Key performance indexes) and minimal performance indexes (PI) as a basis for the allocation of public or insurance resources. In particular, the reduction of multiple pregnancy rates costs, may lead to a more widespread use of ART even in lower resources countries.

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2017-2018 Assisted Reproduction Cost Analysis performance indexes: Lombardy County Case Study

10.21203/rs.3.rs-279494/v1 ◽

2021 ◽

Author(s):

Paolo Emanuele Levi-Setti ◽

Andrea Busnelli ◽

Annalisa Bodina ◽

Roberto De Luca Roberto ◽

Giulia Scaravelli

Keyword(s):

Multiple Pregnancy ◽

Oocyte Retrieval ◽

Performance Indexes ◽

Frozen Embryos ◽

Reproduction Cost ◽

The Cost ◽

Lost To Follow Up ◽

Mean Cost

Abstract Objective The present study investigated the cost per delivery for all public reimbursed ART cycles performed in Lombardy. MethodsAnalysis of costs for the 2017 and 2018 Delivery and Cumulative Delivery Rates extracted from the ART Italian Registry on oocytes retrieval, fresh and frozen embryos and oocytes performed in 22 Lombardy IVF Units. ResultsIn 2017, 29,718 procedures were performed, resulting in 4,543 pregnancies and 3,253 deliveries. In 2018, there were 29,708 procedures, 4,665 pregnancies and 3,348 deliveries. Pregnancies lost to follow up were 5.0% with a (range of 0 to 67.68%) in 2017 and 3.4% (range of 0 to 45.1%) in 2018. The cost reimbursement for the cycles were €2,232 ($2,611) for oocyte retrieval and €2,194 ($2,567) for embryo transfer, excluding ovarian stimulation therapy and luteal phase support.The mean multiple pregnancy delivery rate (MDR) in all 22 IVF centers was 11.08% ± 5,55% (range 0.00% -22.73%) in 2017 and 10.41% ± 4.99 (range 1.33% - 22.22%) in 2018. The mean cost for delivery in euros was 26,227 ± 14,737 in 2017 and 25,018 ± 16,039. The cost difference among centers was 12,480 - 76,725 in 2017 and 12,973 - 86,203 in 2018.Conclusions Our findings suggest the formulation of specific KPI’s (Key performance indexes) and minimal performance indexes (PI) as a basis for the allocation of public or insurance resources. In particular, the reduction of multiple pregnancy rates costs, may lead to a more widespread use of ART even in lower resources countries.

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Procriação Medicamente Assistida em Ciclo Natural: Avaliação dos Resultados de um Departamento de Medicina da Reprodução

Acta Médica Portuguesa ◽

10.20344/amp.10195 ◽

2019 ◽

Vol 32 (1) ◽

pp. 25

Author(s):

Mariana Carlos Alves ◽

Andreia Leitão Marques ◽

Helena Barros Leite ◽

Ana Paula Sousa ◽

Teresa Almeida-Santos

Keyword(s):

Embryo Transfer ◽

Assisted Reproduction ◽

Ovarian Stimulation ◽

Lower Cost ◽

Oocyte Retrieval ◽

Clinical Pregnancy ◽

Poor Responders ◽

Natural Cycle ◽

Medically Assisted Reproduction ◽

The Mean

Introduction: Medically assisted reproduction in natural cycle has been investigated, especially in women with poor response to conventional ovarian stimulation, with endometrial receptivity improvement, lower cost and possibility of successive cycles. The disadvantages are: lower profitability per treatment cycle and higher cancellation rate. The aim of this study was to determine the rate of clinical pregnancy in infertile women subjected to medically assisted reproduction in natural cycle.Material and Methods: Retrospective study of 149 medically assisted reproduction without ovarian stimulation of 50 infertile women, between January/2011 and October/2014.Results: The mean age of women undergoing medically assisted reproduction in natural cycle was 36.1 years. Approximately half (46.0%) of the cycles were performed in poor responders. On the day of ovulation trigger, the mean diameter of the follicle was 17.5 mm. Twenty-three cycles (15.4%) were canceled prior to ovulation trigger. In 8 cycles (5.3%), ovulation occurred between ovulation trigger and oocyte retrieval. In the majority of cycles (n = 118; 79.2%) oocyte retrieval was executed, a medically assisted reproduction technique was performed in 71 (47.6%), mostly intracytoplasmic injection. The overall fertilization rate was 77.5%. In 40 cycles (26.8%) there was embryo transfer. The implantation rate and the clinical pregnancy rate by embryo transfer was 35.0% and 25.0%, respectively. Most pregnancies occurred in poor responders, according to Bologna criteria.Discussion: Although the pregnancy rate per cycle started was 6.7%, the rate of clinical pregnancy per embryo transfer is quite satisfactory, being a group of women with unfavorable responses in previous treatments. The relatively high rates of cycle cancellation are mitigated by the greater simplicity and lower cost of these cycles.Conclusion: The results obtained in this study demonstrate that Medically Assisted Reproduction in natural cycle may be an alternative treatment for ovarian stimulation in patients with poor prognosis, whose only alternative would be oocyte donation.

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Surgical Outcome of Medial Rectus Resection in Recurrent Exotropia: A Novel Surgical Formula

Journal of Ophthalmology ◽

10.1155/2015/758463 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Abbie Sheung-Wan Luk ◽

Jason Cheuk-Sing Yam ◽

Henry Hing-Wai Lau ◽

Wilson Wai-Kuen Yip ◽

Alvin Lerrmann Young

Keyword(s):

Retrospective Study ◽

Subgroup Analysis ◽

Surgical Outcome ◽

Large Angle ◽

Medial Rectus ◽

Success Rates ◽

Significant Difference ◽

Recurrent Exotropia ◽

The Mean ◽

Successful Outcomes

Purpose. To evaluate the surgical outcomes of unilateral or bilateral medial rectus (MR) muscle resection for recurrent exotropia after bilateral lateral rectus (BLR) muscle recession based on a novel surgical formula.Methods. Forty-one consecutive patients with unilateral or bilateral MR muscle resection for recurrent exotropia after BLR muscle recession were included in this retrospective study. All surgeries were performed according to the formula: 1.0 mm MR muscle resection for every 5 prism dioptres (PD) of exotropia, with an addition of 0.5 mm to each MR muscle operated on.Results. The mean recurrent exotropia distant deviation was 28 PD ± 11.2 (range 14 to 55 PD). Overall at postoperative 1 month, 36 (88%) achieved successful outcomes, 4 (10%) had undercorrection, and 1 (2%) had overcorrection. At postoperative 6 months, 29 (71%) achieved successful outcomes, 12 (29%) had undercorrection, and none had overcorrection. Subgroup analysis showed no statistically significant difference in success rates between unilateral and bilateral MR groups.Conclusion. Unilateral or bilateral MR muscle resection using our surgical formula is a safe and effective method for calculating the amount of MR resection in moderate to large angle recurrent exotropia, with a low overcorrection rate.

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COMPLICATED INGUINAL HERNIAS;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.03.3232 ◽

2019 ◽

Vol 26 (03) ◽

Author(s):

Naveed Akhtar ◽

Syed Shams- Ul-Hassan ◽

Muhammad Sabir ◽

M. Nauman Ashraf

Keyword(s):

Inguinal Hernia ◽

Hospital Stay ◽

Wound Infection ◽

P Value ◽

Emergency Setting ◽

Complication Rates ◽

Success Rates ◽

Inguinal Hernias ◽

Significant Difference ◽

The Mean

Background: Herniorrhaphy and hernioplasty are the two most common modalities used with different degree of success and complication rates in the treatment of inguinal hernia. Several studies show that use of mesh is superior to the non-mesh operations in inguinal hernia surgery.It is generally believed that the use of biomaterials should be limited to non-infected surgical fields.Now the concept regarding use of mesh in complicated hernias is changing as shown by many studies. Current study is being planned to observe the outcomes of the mesh hernioplasty in treatment of complicated inguinal hernias in emergency so that in future appropriate and safe technique may be suggested for repair of complicated hernias in emergency setting. Objectives: To compare the outcome of hernioplasty and herniorrhaphy in emergency for the treatment of complicated (Irreducible/obstructed) inguinal hernias regarding wound infection and hospital stay. Material & Methods:… Study Design: Randomized control trial. Setting: Surgical ward, Sheikh Zayed Hospital, Rahim yar khan. Period:09 months from 01-01-2016 to 30-09-2016. Sample Size: A total of 64 patients with 32 patients were included in each group, with confidence level of 95% and power of 80% and anticipated mean level of hospital stay in group 1 of 5±3.4 days versus 3±2.1 days in group 2. Sampling Technique: Non-probability, consecutive sampling. Results: In this study there were total 64 cases with 32 in each group. The mean age was 41.69±11.06 years and the mean duration of hernia obstruction was 12.83±4.97 hours. There was no significant difference in terms of age, duration of hernia and hernial obstruction between both groups. Seroma was seen in 5 (7.81%) out of 64 cases while wound infection was seen in 8 (12.50%) of cases. Seroma was seen in 2 (6.25%) out of 30 cases in herniorrhaphy as compared to 3 (9.38%) out of 32 cases with hernioplasty with p value of 0.64. Wound infection was seen in equally 4 (12.50%) out of 32 cases in both groups with p value of 1.0. Duration of hospital stay was 4.66±1.36 in patients with herniorrhaphy as compared to 4.53±1.37 days with hernioplasty with p value= 0.82. There was no significant difference in terms of age groups, duration of hernia and its obstruction between both groups regarding seroma. There was also no significant association among any of the confounding factors regarding the wound infection and length of the hospital stay between the both groups. Conclusion: We can perform hernioplasty as compared to herniorrhaphy for complicated inguinal hernia with similar complications and better success rates in the same emergency setting.

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Outcome of using a modified surgical technique for the repair of complex vesicovaginal fistulas in Nigeria

Urogynaecologia ◽

10.4081/uij.2017.196 ◽

2017 ◽

Vol 30 (1) ◽

Author(s):

Aniefiok J. Umoiyoho ◽

Emmanuel C. Inyang-Etoh

Keyword(s):

Obstetric Fistula ◽

Conventional Technique ◽

Control Group ◽

Study Group ◽

Success Rates ◽

Modified Technique ◽

Repair Technique ◽

Significant Difference ◽

The Mean ◽

Repair Techniques

The relatively low effectiveness of available surgical repair techniques for complex obstetric fistula has justified the need for continued exploration of more effective repair techniques. Subjects who presented at a vesicovaginal fistula referral centre in Nigeria were randomized into the study group (modified technique) and the control group (conventional technique). Success rates between the two groups were compared. The study comprised 29 patients in each arm of the study. The mean age of patients in the study group was 23.9 ± 9.6 years and 24.4 ± 2.1 years among patients in the control group with the vast majority of the patients in the both groups being married, 75.9% and 86.2% respectively. In both groups, the majority were secundipara, 55.2% in the study group and 44.8% in the control group. The majority (41.4% in the study group and 44.8% in the control group) of the patients in both groups had attained primary level of education. The mean duration of the fistulas among patients in the study population was 1.1 ± 0.3 years with over half (50.0% among patients in the study group and 53.5% of patients in the control group) of the patients had their fistula for less than one year. A highly statistically significant difference in success rate between patients in the study group and patients in the control group was obtained (p=0.0004). The modified repair technique presented by this study has proved to produce superior results when compared to the conventional repair technique in the management of complex obstetric fistulas in Nigeria.

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P–651 Strict embryo-endometrial synchrony does not contribute to the successful pregnancy during vitrified-warmed embryo transfer with hormone replacement cycles

Human Reproduction ◽

10.1093/humrep/deab130.650 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

T Takahashi ◽

K Ota

Keyword(s):

Embryo Transfer ◽

Endometrial Thickness ◽

Hormone Replacement ◽

Time Lapse ◽

Successful Pregnancy ◽

Logistic Analysis ◽

Significant Difference ◽

The Mean ◽

Multivariate Logistic Analysis

Abstract Study question Does strict embryo-endometrium synchronization relate to pregnancy during vitrified-warmed embryo transfer (ET) with hormone replacement (HRT) cycles? Summary answer A 12-hour delay in the embryo-endometrial synchrony was acceptable, and this delay was not an independent predictor of pregnancy during vitrified-warmed ET with HRT cycles. What is known already Embryo-endometrium synchrony is considered to be necessary for successful pregnancy in both fresh and frozen-thawed cycles. Until now, the date of ET has been determined by the synchronization of the embryo developmental stage and the endometrium on a daily basis. To date, with the advent of the time-lapse incubator, it is possible to observe the embryo development from fertilization over time and to calculate the exact time from fertilization of the transferred embryo. However, there are very few studies on the extent to which increases the accuracy of synchronization between embryo and endometrium contributes to a successful pregnancy. Study design, size, duration This retrospective cohort study included 319 consecutive cycles during vitrified-warmed ET with HRT between August 2016 and August 2018. This study was conducted in an academically affiliated private practice. Participants/materials, setting, methods We analyzed 319 vitrified-warmed single-blastocyst transfer cycles. All frozen expanded blastocysts were inseminated by intracytoplasmic sperm injection (ICSI) and cultured in a time-lapse incubator. We calculated time for the in vitro culture of the embryo after ICSI (t1) and time for progesterone-priming (t2) up to ET. The difference between t1 and t2 (delta-t) was used as an indicator of embryo-endometrium synchrony. We examined the relationship between delta-t and treatment outcomes using multivariate logistic analysis. Main results and the role of chance The mean patient’s age at oocyte retrieval was 35.7 (SD 4.3). The number of pregnant cycles was 157 in all treatment cycles (pregnancy rate, 49.2%). The mean value of delta-t was 9.9 h (SD 2.6) in all cycles. There was no significant difference of delta-t in pregnant (mean, SD: 10.0 h, 2.8 h) and non-pregnant cycles (mean, SD: 10.0 h, 2.3 h). Treatment cycles were classified according to the quartile of delta-t, and we examined the percentages of pregnant cycles in each group. There were no significant differences in pregnancy rates among the groups (p = 0.75). On multivariate logistic analysis, patient’s age (adjusted odds ratio [aOR]: 0.94, 95% confidence interval [CI]: 0.89–0.99), previous treatment cycles (aOR: 0.74, 95% CI: 0.56–0.99), endometrial thickness at ET (aOR: 1.19, 1.04–1.36), and good quality blastocysts (>3BB according to Gardner’s classification) at vitrification (aOR: 2.49, 95% CI: 1.23–5.05) were independent predictive factors for pregnancy. On the other hand, delta-t did not contribute to pregnancy (aOR: 1.00, 95% CI: 0.99–1.00). Limitations, reasons for caution We did not examine the effects of embryo-endometrium synchrony during vitrified-warmed ET in a natural cycle. Therefore, careful interpretation of the significance of embryo-endometrium synchrony during the vitrified-warmed ET should be taken. Wider implications of the findings: We showed the embryo-endometrium synchrony did not contribute to the pregnancy during vitrified-warmed ET with HRT cycles. These results cast doubt on the existence of an optimal implantation window by changing the timing of ET with the results of gene expression testing of the endometrium. Trial registration number Not applicable

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Elective single versus double embryo transfer: live birth outcome and patient acceptance in a prospective randomised trial

Reproduction Fertility and Development ◽

10.1071/rd13412 ◽

2015 ◽

Vol 27 (5) ◽

pp. 794 ◽

Cited By ~ 5

Author(s):

Nicolás Prados ◽

Rocío Quiroga ◽

Cinzia Caligara ◽

Myriam Ruiz ◽

Víctor Blasco ◽

...

Keyword(s):

Embryo Transfer ◽

Live Birth ◽

Controlled Trial ◽

Randomised Trial ◽

Multiple Pregnancy ◽

Multiple Births ◽

Delivery Rate ◽

Patient Acceptance ◽

Increased Risk ◽

Double Embryo Transfer

The purpose of this study was to determine which strategy of embryo transfer has a better trade-off in live birth delivery rate versus multiple pregnancy considering patient acceptance: elective single embryo transfer (eSET) or elective double embryo transfer (eDET). In all, 199 women <38 years of age undergoing their first IVF treatment in a private centre were included in a prospective open-label randomised controlled trial. Patients were randomised into four groups: (1) eSET on Day 3; (2) eSET on Day 5; (3) eDET on Day 3; and (4) eDET on Day 5. Per patient, main analysis included acceptance of assigned group, as well as multiple and live birth delivery rates of the fresh cycle. Secondary analysis included the rates of subsequent cryotransfers and the theoretical cumulative success rate. Of 98 patients selected for eSET, 40% refused and preferred eDET. The live birth delivery rate after eDET was significantly higher after eDET versus eSET (65% vs 42%, respectively; odds ratio = 1.6, 95% confidence interval 1.1–2.1). No multiple births were observed after eSET, compared with 35% after eDET. Although live birth delivery is higher with eDET, the increased risk of multiple births is avoided with eSET. Nearly half the patients refused eSET even after having been well informed about its benefits.

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Surgical Outcomes of Trabeculectomy in Uveitic Glaucoma: A Long-Term, Single-Center, Retrospective Case-Control Study

Journal of Ophthalmology ◽

10.1155/2021/5550776 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Rina Kanaya ◽

Riki Kijima ◽

Yasuhiro Shinmei ◽

Akihiro Shinkai ◽

Takeshi Ohguchi ◽

...

Keyword(s):

Success Rate ◽

Surgical Outcomes ◽

Success Rates ◽

Uveitic Glaucoma ◽

Surgical Success ◽

Case Series Study ◽

Significant Difference ◽

The Mean ◽

Age And Sex

Purpose. To evaluate the long-term outcomes of trabeculectomy with mitomycin C (MMC-TLE) in patients with uveitic glaucoma (UG). Patients and Methods. This was a retrospective, nonrandomized case series study. MMC-TLE was performed on 50 eyes with UG between February 2001 and January 2015 at Hokkaido University Hospital. Age- and sex-matched patients with primary open angle glaucoma (POAG) who underwent MMC-TLE were matched by age and sex and enrolled as controls. Surgical success was defined as an intraocular pressure (IOP) less than 18 or 15 mmHg. The Kaplan–Meier survival curves for surgical failure were analyzed. Results. The mean preoperative IOP in UG and POAG was 27.6 ± 10.6 and 18.0 ± 4.5 mmHg, respectively. After the surgery, the mean IOP in UG and POAG was reduced to 11.7 ± 4.2 and 12.2 ± 3.8 mmHg at 12 months, 11.9 ± 7.0 and 12.1 ± 3.1 mmHg at 36 months, and 13.0 ± 5.2 and 10.6 ± 1.2 mmHg at 120 months, respectively. The success rates (IOP <18 mmHg, IOP reduction >20%) in UG and POAG were 91.7% and 88.0% at 12 months, 82.2% and 75.6% at 36 months, and 66.5% and 61.8% at 120 months, respectively. The success rates (IOP <15 mmHg) in UG and POAG were 64.0% and 58.0% at 12 months, 55.1% and 45.5% at 36 months, and 47.9% and 37.8% at 120 months, respectively. There was no significant difference in the success rate between UG and POAG at 120 months after surgery by either definition of surgical success. Conclusions. MMC-TLE effectively reduced IOP in both UG and POAG. There was no significant difference in the success rate between UG and POAG. Following sufficient inflammation suppression, surgical outcomes of UG may be comparable with those of POAG.

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P–616 Novel approaches for preventing ovarian hyperstimulation syndrome in breast cancer patients

Human Reproduction ◽

10.1093/humrep/deab130.615 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

N Tatiana ◽

Y Martirosyan ◽

I Dmitrieva ◽

A Biryukova ◽

A Parokonnaya

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Aromatase Inhibitors ◽

Gnrh Antagonist ◽

Oocyte Retrieval ◽

Serum Estradiol ◽

Breast Cancer Patients ◽

Gnrh Antagonists ◽

Significant Difference ◽

The Mean

Abstract Study question In this study we tried to assess the effectiveness of the use of aromatase inhibitors (AI) for the rapid relief of symptoms of hyperstimulation in patients with breast cancer. Summary answer AI showed great efficiency for OHSS prevention and are particulary useful in fertility preservation, when supraphysiologic estradiol levels cause a negative impact and delay treatment. What is known already To date the only unequivocally accepted method for fertility preservation is cryopreservation of embryos and unfertilized oocytes. However, controlled ovarian stimulation is associated with supraphysiological serum estradiol level. The majority of guidelines recommend to use aromatase inhibitors during ovarian stimulation (OS) in breast cancer patients with high estrogen receptor expression to protect them from the potential deleterious effects of elevated estrogen. Following oocyte retrieval the patients will be receiving chemotherapy, which is not desirable for hyperstimulated ovaries. The prolonged use of AI seems to be an interesting approach in such cases. Study design, size, duration This research was conducted at the V.I. Kulakov NMRC for OG&P to demonstrate management tactics for OHSS prevention after OS in patients with breast cancer. It included 21 patients seeking cryopreservation of oocytes and embryos. The main outcomes included the results of dynamic steroidogeneses assessment, the size of the ovaries, main features of oogenesis and the onset of the menstrual blleding. All patients signed an informed consent form approved by Ethics Committee. Participants/materials, setting, methods The mean age of the participants was 26.7. The patients presented prior to gonadotoxic treatment for luminal A or B breast cancer, were randomly divided into two groups of 11 and 10 people and underwent conventional OS with letrozol (2.5 mg/day). Starting from the day of oocyte retrieval the AI dosage iIn the 1st group was increased to 0.75 mg/day; the 2nd group received GnRH antagonist (0.5 mg/day) instead of AI for 5 consecutive days. Main results and the role of chance The mean age, BMI and AMH were not different among groups. There was no statistically significant difference in the duration of stimulation and starting and total doses of gonadotropins. The mean number of retrieved oocytes was 15.3 for the 1st group and 16.1 for the 2nd group (p = 0.834). There was no significant difference in a number of mature oocytes between the groups (66.1% vs. 72.4% in the 2nd group, p = 0.059) or in how many of them formed into 2pn embryos after fertilization (80% vs. 73.9% in the 2nd group, p = 0.616). Steroid hormone levels were analyzed during OS and on days 2 and 5 after oocyte retrieval. The rapid decline in serum estradiol and progesterone levels manifested with ovary size reduction and the onset of menstrual bleeding, which were achieved on 3rd to 5th day of AI administration in the 1st group and on 5th to 7th day of GnRH antagonist administration in the 2nd group. Limitations, reasons for caution Further research is required to compare the mechanisms of luteolysis induced by aromatase inhibitors and GnRH antagonists to natural luteal regression. Wider implications of the findings: Our data has demonstrated a greater efficiency of AI compared to GnRH antagonists in reducing the risk of OHSS. These findings could be useful for future research and clinical use in patients without cancer but with a high risk of developing OHSS combined with segmentation of IVF treatment. Trial registration number none

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Evaluation of the Fetal Heart Rate during Amniocentesis in Fetuses with Normal and Abnormal Karyotype

Macedonian Medical Review ◽

10.2478/mmr-2014-0005 ◽

2014 ◽

Vol 68 (1) ◽

pp. 25-27

Author(s):

Marija Hadzi-Lega ◽

Ana Daneva-Markova ◽

Eva Sozovska

Keyword(s):

Heart Rate ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Chromosomal Abnormalities ◽

Multiple Pregnancy ◽

Invasive Procedure ◽

Abnormal Karyotype ◽

Significant Difference ◽

The Mean ◽

Heart Rate Reaction

Abstract Introduction. We monitored the fetal heart rate (FHR) during amniocentesis in fetuses at 16-22 weeks of gestation and investigated whether an abnormal FHR was associated with chromosomal abnormalities. Methods. This prospective study involved 600 women at 16-22 weeks of gestation who underwent genetic amniocentesis. The FHR, expressed as beats for minute, was recorded before (FHR1), immediately after (FHR2) and 60 min after (FHR3) the invasive procedure. Structural malformations detected by ultrasound and multiple pregnancy were excluded from the study. Results. Chromosomal abnormalities have been diagnosed in 27 fetuses. Mean FHR decrease after amniocentesis has been observed in normal and in abnormal fetuses. The mean variation during amniocentesis was significant in both groups (P<0.01). The comparison between the mean FHR of the two groups showed no differences in FHR1 and FHR2 (P>0.05) but a significant difference in FHR3 (P<0.05). Conclusion. The FHR decreased after amniocentesis; the decrease was larger in chromosomally abnormal fetuses than in normal fetuses. This difference in heart rate reaction to amniocentesis might be due to cardiac defects or developmental delay associated with the abnormal karyotype.

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