scholarly journals EMBRYO GLUE AND CLINICAL PREGNANCY RATES IN ICSI EMBRYO TRANSFER CYCLES: A PROSPECTIVE STUDY

2021 ◽  
Vol 7 (4) ◽  
pp. 1-12
Author(s):  
Salwa Fadhil ◽  
Mohammad Selman ◽  
Manal Al-Obaidi
Keyword(s):  
Embryo Transfer ◽  
Intracytoplasmic Sperm Injection ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Fresh Embryo Transfer ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
A Prospective Study ◽  
Medium Group

Purpose: One of the reasons for failed implantation after transferring good quality embryos in an intracytoplasmic sperm injection cycle is the failure of creation a viscid layer between the embryo and the endometrium. Many modifications have been made in embryo transfer medium to improve implantation and increase pregnancy rates such as adding albumin as a source of energy and adding hyaluronic acid in high concentrations such as in Embryo Glue medium: a human embryo transfer medium. To investigate whether the use of Embryo Glue had any effect on clinical pregnancy rates in intracytoplasmic sperm injection-fresh embryo transfer cycles. Methods: A prospective study included one hundred and twenty-eight infertile Iraqi women who were selected and subjected to a stimulation protocol in an intracytoplasmic sperm injection-fresh embryo transfer cycle. All patients were considered to be eligible for embryo transfer (no visible causes could prevent implantation) and only good quality embryos were transferred to them. Those women were divided randomly into two groups according to type of embryo transfer medium: group A: Embryo Glue medium. group B: Conventional medium. Then group A was subdivided according to age into:  AI (34 women with age < 35 years and represented 50.7%) AII (33 women with age ≥ 35 years and represented 49.3%) While group B was subdivided into:  BI (41women with age < 35 years and represented 67.3%)  BII (20 women with age ≥ 35 years and represented 32.7%). Results: Although there was no significant difference between all groups in causes of infertility, the pregnancy rate was significantly higher in subgroup AII (18 pregnant from 33 women) while only 5 patients became pregnant from 20 patients in subgroup BII.  In all women no more than four good quality embryos were transferred, and when total number of transferred embryos was significantly more in group B than group A (P=0.013), the significant increase in pregnancy rates was only observed in subgroup AII (P=0.048). Even though a highly significant difference in number of repeated implantation failure was in group A than group B (P=0.027), the pregnancy rates were significantly higher in group A (P=0.038). Conclusion: This study concluded that using Embryo Glue has a beneficial effect on old women and increase pregnancy rates, also it has a positive effect on pregnancy rates in repeated implantation failure and increases pregnancy rates even if the women is old.

P–318 Short (seven days) versus conventional (fourteen days) estrogen priming in an artificial frozen embryo transfer cycle: a randomised controlled trial

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Racca ◽  
S Santos-Ribeiro ◽  
D Panagiotis ◽  
L Boudry ◽  
S Mackens ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Transvaginal Ultrasound ◽  
Clinical Pregnancy ◽  
Frozen Embryo Transfer ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Impact

Abstract Study question What is the impact of seven days versus fourteen days’ estrogen (E2) priming on the clinical outcome of frozen-embryo-transfer in artificially prepared endometrium (FET-HRT) cycles? Summary answer No significant difference in clinical/ongoing pregnancy rate was observed when comparing 7 versus 14 days of estrogen priming before starting progesterone (P) supplementation. What is known already One (effective) method for endometrial preparation prior to frozen embryo transfer is hormone replacement therapy (HRT), a sequential regimen with E2 and P, which aims to mimic the endocrine exposure of the endometrium in a physiological cycle. The average duration of E2 supplementation is generally 12–14 days, however, this protocol has been arbitrarily chosen whereas, the optimal duration of E2 implementation remains unknown. Study design, size, duration This is a single-center, randomized, controlled, open-label pilot study. All FET-HRT cycles were performed in a tertiary centre between October 2018 and December 2020. Overall, 150 patients were randomized of whom 132 were included in the analysis after screening failure and drop-out. Participants/materials, setting, methods The included patients were randomized into one of 2 groups; group A (7 days of E2 prior to P supplementation) and group B (14 days of E2 prior to P supplementation). Both groups received blastocyst stage embryos for transfer on the 6th day of vaginal P administration. Pregnancy was assessed by an hCG blood test 12 days after FET and clinical pregnancy was confirmed by transvaginal ultrasound at 7 weeks of gestation. Main results and the role of chance Following the exclusion of drop-outs and screening failures, 132 patients were finally included both in group A (69 patients) or group B (63 patients). Demographic characteristics for both groups were comparable. The positive pregnancy rate was 46.4% and 53.9%, (p 0.462) for group A and group B, respectively. With regard to the clinical pregnancy rate at 7 weeks, no statistically significant difference was observed (36.2% vs 36.5% for group A and group B, respectively, p = 0.499). The secondary outcomes of the study (biochemical pregnancy, miscarriage and live birth rate) were also comparable between the two arms for both PP and ITT analysis. Multivariable logistic regression showed that the HRT scheme is not associated with pregnancy rate, however, the P value on the day of ET is significantly associated with the pregnancy outcome. Limitations, reasons for caution This study was designed as a proof of principle trial with a limited study population and therefore underpowered to determine the superiority of one intervention over another. Instead, the purpose of the present study was to explore trends in outcome differences and to allow us to safely design larger RCTs. Wider implications of the findings: The results of this study give the confidence to perform larger-scale RCTs to confirm whether a FET-HRT can be performed safely in a shorter time frame, thus, reducing the TTP, while maintaining comparable pregnancy and live birth rates. Trial registration number NCT03930706

CLINICAL OUTCOME AND COST COMPARISON OF CARPAL TUNNEL WOUND CLOSURE WITH MONOCRYL® AND ETHILON®: A PROSPECTIVE STUDY

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 189-192 ◽  
Author(s):  
Anis Dosani ◽  
Sameer K. Khan ◽  
Sheila Gray ◽  
Steve Joseph ◽  
Ian A. Whittaker
Keyword(s):  
Carpal Tunnel ◽  
Wound Closure ◽  
Unit Cost ◽  
Cost Effective ◽  
Cost Comparison ◽  
Absorbable Suture ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
A Prospective Study

This prospective non-randomised two-cohort study compares the use of an absorbable suture (Poliglecrapone [Monocryl]: Group A) and a non-absorbable suture (Polyamide [Ethilon]: Group B) in wound closure after elective carpal tunnel decompression. The primary outcome was scar cosmesis as assessed by the Stonybrook Scar Evaluation Scale (SBSES); the financial cost of wound closure was compared as a secondary outocome. All fifty patients completed follow-up. At six weeks, there was no significant difference in the two groups regarding scar tenderness (p = 0.5), although residual swelling was more evident in the absorbable group (p = 0.2). The mean SBSES score at six weeks was 4.72 in Group A, and 4.8 in Group B (p = 0.3). The unit cost per closed wound of Monocryl was three times than Ethilon (p < 0.05). Ethilon is thus cost-effective without compromising the cosmetic outcome, and we recommend using this as the preferred suture for closure of carpal tunnel wounds.

P–671 Dual Trigger(low adjuvant HCG4h after GnRHagonist trigger)have positive impact of overall embryo’s quality, implantation ,clinical pregnancy and live birth rates in high-risk patients for OHSS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
E Petanovsk. Kostova
Keyword(s):  
High Risk ◽  
Live Birth ◽  
Clinical Pregnancy ◽  
Birth Rates ◽  
High Risk Patients ◽  
Live Birth Rates ◽  
Significant Difference ◽  
Risk Patients ◽  
Group A ◽  
Group B

Abstract Study question Study aim is to compare implantation,clinical pregnancy and livebirth rates between giving1500IU of hCG4hours after GnRHagonist,on trigger day or GnRHagonist as alone trigger with luteal support withHCG1500IU.35h later on OPUday. Summary answer Adjuvant doze of1500IUhCG4h after bolus of GnRHagonist on trigger day significantly improve quality of blastocyst,implantation,clinical pregnancy and live birth rates without increasing the risk ofOHSS. What is known already The use of GnRHagonist for final oocyte maturation in antagonist cycle significantly decrease the incidence of OHSS,but there have been studies showing lower pregnancy rates in patients triggered with GnRHagonist compared with hCG in autologous cycles,attributed to a defective luteal phase, especially in high–risk patients despite intensive luteal phase support.To improve the results of IVF,an alternative approach is adding a small bolus dose of hCG(1500IU)35h later,on the OPU day after GnRHagonist trigger which provides more sustained support for the corpus luteum.The question is does low doses of hCGgiven on the same day with GnRHagonist trigger is making better quality oocytes. Study design, size, duration Single center prospective longitudinal cohort study fromJanuary2017 to Decembar2019.The initial inclusion criteria were:women age≥18and≤39years,AMH≥3,3ng/ml and ≥12 antral follicles on basal ultrasound.Patients with history of OHSS and PCO are also included in the study.Patients with applied “freeze-all” technique with peak estradiol≥4000pg/ml on trigger day&gt;18oocytes on the OPU day,and recognized significant risk for developing OHSS were also included.The cumulative implantation,clinical pregnancy and live birth rates were analyzed,only in embryos from the same COS protocol in every patient. Participants/materials, setting, methods A total of 231 patients were entered for final analysis,who underwent a flexible antagonist protocol,ICSI and fresh or thawed ET on 3th(38.53%) or 5th( 61.47%)day in women’s autologous cycles.Patients were randomized in one of two groups: GroupA-Dual trigger group 1500IUof hCG 4h after GnRH agonist application on trigger day and GroupB –1500IU of HCG 35h later,on the OPU day.We used nonparametric and parametric statistical tests.Significant differences were considered all values ​​of p &lt; 0.05 Main results and the role of chance Both groups are homogenous regarding several variables:age,BMI,type of sterility,smoking status,AMH,PCO, spermogram.There is no significant difference between the two(AvsB)groups according to average number of retrieved oocytes(13.6 vs 14.6 p &gt; 0,05),M II oocytes(11.03 vs 11.99 p &gt; 0.05).The dual trigger group(A)had a higher fertility rate(69.99% vs 64.11% p &lt; 0,05)compared with GnRHagonist trigger group(B).There are no significant difference between groups(AvsB)according to cumulative average number of:transferred embryos(2.4vs2.5 p &gt; 0.05)TQE transfered on 3th day(1.5.vs 1.3.p&gt;0.05);transferred blastocyst(2.6 vs2.7 &gt;0.05);cryo embryos(2.5vs1.9 p &gt; 0.05),but there are significant difference according to cumulative implantation rate of transferred blastocyst in favor of group A(48.18% vs 33.89%p&lt;0.05).Analyzes of morphological characteristics of transferred blastocyst depicted in the order of degree of blastocyst expansion,inner cellular mass(ICM)and trofoectoderm(TE) and ranking overall blastocysts quality from“excellent”,“good”,“average” and “pore” ,shows that there are significantly more percentage of patient with embryo transfer of “excellent” or even one “excellent” blastocyst in group A (30.56%,31.94% vs 21.54%,23.08% p &lt; 0.05) in opposite of percentage of patients with embryo transfer with “poore “” blastocyst in group B (37.5% vs 46.15.%p&lt;0.05). Clinical pregnanacy rate (71.68% vs 50.84% p &lt; 0.05) , and live birth rate (60,18% vs 42,58% ), were significantly higher in group A. There were no cases of moderate or severe OHSS in both groups. Limitations, reasons for caution Dual trigger in GnRH antagonist protocols should be advocated as a safe approach but undetected high risk patients are reasons for caution for developing clinically significant OHSS. Wider implications of the findings: Adjuvant low dose of hCG on GnRHagonist trigger day improve clinical pregnancy and live birth rates without increasing the risk of clinically significant OHSS.Protocol of dual trigger and freezing all oocytes or embryos in patients with high risk of developing OHSS is promising technique in everyday practice. Trial registration number 8698

scholarly journals Comparative Study Between Mock Embryo Transfer Prior To The Treatment Cycle and Real Embryo Transfer In In Vitro Fertilization

KnE Medicine ◽  
2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Hilma Putri Lubis
Keyword(s):  
In Vitro Fertilization ◽  
Embryo Transfer ◽  
Treatment Cycle ◽  
Uterine Cavity ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Vitro Fertilization ◽  
Significant Difference ◽  
Clinical Pregnancy Rates

<p><strong>Introduction</strong><strong></strong></p><p>A trial or mock embryo transfer (ET) may influence pregnancy rates and it performed prior to ET allows the clinician to assess the uterine cavity and the utero-cervical angle. The aim of this study is to compare the consistency of the type of ET in mock ET with real ET.</p><p><strong>Material &amp; Methods</strong></p><p>A retrospective comparative analysis of  patients who underwent in vitro fertilization or ICSI cycle from January 2014 to December 2014 in Halim Fertility Center was done. The type of transfer was divided into two groups: ‘easy’ or ‘difficult’. An easy ET was defined as a transfer that occurred without the use of manipulation or other instrumentation and difficult ET was considered when additional instrumentation was required.</p><p><strong>Results</strong></p><p>From the study, 103 patients who underwent Mock-ET, we  found 58 patients (56.3%) with easy ET and 45 patients (43.7%) with difficult ET, which with hard catheter ET in 17 patients (16.5%), with osfander assistance in 20 patients (19.4%) and with stylet in 8 patients (7,8%). 58 patients with Easy Mock ET group were entirely easy real ET (100%) and 45 patients with difficult Mock ET group also entirely were difficult real ET (100%). The Statistical analysis shows no significant difference between the mock ET and real ET groups (p&gt;0,05). In easy real ET, clinical pregnancy rates were 32.8% and in difficult real ET, clinical pregnancy rates were 26.7% with no significant difference between the  groups (p&gt;0,05).</p><p><strong>Conclusion:</strong></p><p>Mock ET prior to the treatment cycle is consistent with real ET.</p>

P–347 A comparative RCT of Intrauterine-GCSF versus Subcutaneous-GCSF in Thin Endometrium in IVF-ICSI Cycles

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
P C Jindal ◽  
M Singh
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Endometrial Thickness ◽  
Serum Levels ◽  
Abortion Rate ◽  
Clinical Pregnancy ◽  
Clinical Pregnancy Rate ◽  
Thin Endometrium ◽  
Group A ◽  
Group B

Abstract Study question Does GCSF by intrauterine route leads to better result in the treatment of thin endometrium as compared to GCSF by the subcutaneous route, in IVF-ICSI Cycles? Summary answer Yes, GCSF by intrauterine route leads to better result in the treatment of thin endometrium as compared to subcutaneous-GCSF, in ART Cycles? What is known already GCSF, is a member of the colony stimulating factor family of cytokines and growth factors. GCSF receptors are expressed in high concentration on dominant follicle, particularly at preovulatory stage.The endometrium also shows an increased expression of these receptors. GCSF concentration rises in the follicular fluid at the same time. Serum levels of GCSF are found to be in direct correlation with levels of GCSF in follicular fluid. Serum levels increase progressively from the day the embryo-transfer to the day of implantation. GCSF has been found to be beneficial in patients with thin endometrium and recurrent implantation failure. Study design, size, duration This was a RCT conducted between 2018–2019. 30 patients with thin endometrium were enrolled in each group. In either group, GCSF was given if endometrium was less than 7mm on day 14, maximum of two doses were administered. Patients undergoing frozen embryo transfer were recruited in the study, after meeting the inclusion and exclusion criteria. Primary outcome measured was increase in endometrium thickness and the secondary outcome was the clinical pregnancy rate and abortion-rate. Participants/materials, setting, methods 60 patients with thin endometrium were randomly divided into two groups. Group A: Inj. GCSF (300 mcg/1 ml) subcutaneously on Day 14 onwards alternate days for two doses. Group B: Inj. GCSF (300 mcg/1 ml) instilled slowly into the uterine cavity using an intrauterine insemination (IUI) catheter under USG guidance. Endometrial thickness was assessed after 48 h. If endometrial thickness was found to be &lt; 7 mm, a second infusion of GCSF was carried out. Main results and the role of chance In the subcutaneous group (group-A) the mean endometrial thickness before GCSF injection was 5.8 ± 0.6 mm and, after injection it increased to 6.9 ± 0.4 mm. Similarly, in the intrauterine group (group-B) the mean endometrial thickness before GCSF was 5.9 ± 0.7 which increased to a mean of 7.9 ± 0.5 after GCSF instillation. The difference between endometrial thickness before and after intrauterine infusion of GCSF was more than that in the subcutaneous group. In group-A, 08 patients conceived out of 30 patients ( clinical pregnancy rate 26.6%) and in group B 11 conceived out of 30 patients in whom GCSF was instilled intrauterine (pregnancy rate 36.6%). Thus, there was a difference in the clinical pregnancy rate in the two groups, the intrauterine group yielding a higher clinical pregnancy rate, but it was not statistically significant. Because of the thin endometrium, we found an abortion rate of 25% (2/8) in the subcutaneous-GCSF group, and an abortion rate of 18% (2/11) in the intrauterine GCSF group. Limitations, reasons for caution There are few potential limitations because of the small sample size. Confounders such as obesity, smoking and alcohol intake, presence of adenomyosis and endometriosis, were not taken into consideration. Though prevalence of obesity is usually low in Indian women. Habits of smoking and alcohol are exceedingly uncommon in Indian women. Wider implications of the findings: Use of GCSF plays an important role in management of patients of thin endometrium undergoing embryo transfer. It is an easily available and economical preparation in developing countries and the intrauterine instillation of GCSF can be easily practiced in an ART unit with good results in resistant thin endometrium patients. Trial registration number Not applicable

Outcomes of Flank-Free Modified Supine Percutaneous Nephrolithotomy Based on BMI

2020 ◽  
pp. 1-6
Author(s):  
Esam Desoky ◽  
Khaled M. Abd Elwahab ◽  
Islam M. El-Babouly ◽  
Mohammed M. Seleem
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Supine Position ◽  
Normal Weight ◽  
Significant Difference ◽  
Group A ◽  
Morbid Obese ◽  
Group B ◽  
A Prospective Study ◽  
Nonobese Patients ◽  
The Impact

<b><i>Objective:</i></b> To evaluate the impact of body mass index (BMI) on the outcomes of percutaneous nephrolithotomy (PCNL) in the flank-free modified supine position. <b><i>Patients and Methods:</i></b> A prospective study was carried out in the urology department during the period from May 2015 to October 2019 on 464 patients admitted for PCNL. The patients were divided into 4 matched groups according to their BMI: group A, normal weight with 18.5 ≤ BMI &#x3c;25 kg/m<sup>2</sup>; group B, overweight with 25 ≤ BMI &#x3c;30 kg/m<sup>2</sup>; group C, obese with 30 ≤ BMI &#x3c;40 kg/m<sup>2</sup>; and group D, morbid obesity with BMI ≥40 kg/m<sup>2</sup>. All operative data as well as postoperative outcomes are recorded and compared to each other. <b><i>Results:</i></b> The 4 studied groups were matched regarding age. The comorbidities were slightly higher in groups C and D. The operative time and fluoroscopy time were slightly high in obese and morbid obese groups but with no significant difference. The rate of complications either major or minor was comparable in all groups. No significant difference was seen among all groups regarding hemoglobin loss, stone-free rate, hospital stay, and need for auxiliary procedures. <b><i>Conclusions:</i></b> The outcome of PCNL in flank-free modified supine position is not affected by changes in BMI. The procedure can be performed in obese and morbid obese patients safely with results similar to and comparable to nonobese patients.

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.

scholarly journals The effect of pre-incision urethral plate width and glanular width on the outcome of Tubularized Incised Urethral plate repair surgery in distal penile Hypospadias, A prospective study

2020 ◽  
Author(s):  
Tarek Abd Elbaky ◽  
Diaa Eldin Taha ◽  
Hossam Nabeeh ◽  
Khaled Zein elabden ◽  
Mohamed Galal
Keyword(s):  
Cosmetic Outcome ◽  
Urethral Plate ◽  
Tubularized Incised Plate ◽  
Significant Difference ◽  
Urinary Stream ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
A Prospective Study ◽  
Plate Width

Abstract Objective:To determine the cosmetic and functional outcomes of hypospadias repair in relation to the width of the urethral plate in addition to granular width and configuration.Materials and methodsThe study was a prospective evaluation of patients operated for hypospadias after approval of ethical committee a formal consent were taken from parents. The urethral plate width (UPW) and glans width (GW) of the patients were measured preoperatively using standard calipers. The width of the urethral plate was correlated to the cosmetic outcome (using hypospadias objective penile evaluation [HOPE]) and functional outcome (using the urinary stream) of hypospadias repair.All patients were managed via the same technique using Snodgrass tubularized incised plate repair (TIP). All operations were performed by a single surgeon. All intaoperative data were recorded. All patients were followed up for 1 year. Success was defined as slit shaped meatus at the tip of the glans with no stenosis, fistula or diverticulum.Results:All 38 patients were evaluated at 6 months and 1 year follow up. The mean age at surgery was 4.5 ± 2.1 years. Overall, the mean ± SD of UPW was 10.92 ± 1.24 mm. a 24 patients (61.5 %) (Group A) had a urethral plate width of less than 8 mm while 14 patients (35.9 %) (group B) had a urethral plate width greater or equal to 8 mm. the mean ± SD of GW was 9.52 ± 1.56 mm. Success was documented in 36/38 patients (94.3%).The only complication was Fistula in two patient (6.7 %), glans dehiscensce in three patients (10%). Success rate was not statistically different in correlation of UPW and GW (p=0.5).The only statistically significant difference between all patients was a longer operative time in the patients with deficient urethral plate compared to others with adequate urethral plate (p= 0.005). The urinary stream was straight in 32 boys and sprayed in 6. Overall, mean ± SD HOPE score was 39.1 ± 8.83. A significant correlation found between the cosmetic outcome of the two groups and HOPE score (p = 0.06).Conclusions:The pre-incision urethral plate width and glanular width was not correlated with the TIP outcome. A better HOPE score is associated with wide urethral plate.

The freeze-all strategy versus agonist triggering with low-dose hCG for luteal phase support in IVF/ICSI for high responders: a randomized controlled trial

2020 ◽  
Vol 35 (12) ◽  
pp. 2808-2818 ◽  
Author(s):  
Samuel Santos-Ribeiro ◽  
Shari Mackens ◽  
Biljana Popovic-Todorovic ◽  
Annalisa Racca ◽  
Nikolaos P Polyzos ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Gnrh Agonist ◽  
Luteal Phase ◽  
Low Dose ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Fresh Embryo Transfer ◽  
Luteal Phase Support ◽  
Low Dose Hcg ◽  
Severe Ohss

Abstract STUDY QUESTION Does the freeze-all strategy in high-responders increase pregnancy rates and improve safety outcomes when compared with GnRH agonist triggering followed by low-dose hCG intensified luteal support with a fresh embryo transfer? SUMMARY ANSWER Pregnancy rates after either fresh embryo transfer with intensified luteal phase support using low-dose hCG or the freeze-all strategy did not vary significantly; however, moderate-to-severe ovarian hyperstimulation syndrome (OHSS) occurred more frequently in the women who attempted a fresh embryo transfer. WHAT IS KNOWN ALREADY Two strategies following GnRH agonist triggering (the freeze-all approach and a fresh embryo transfer attempt using a low-dose of hCG for intensified luteal phase support) are safer alternatives when compared with conventional hCG triggering with similar pregnancy outcomes. However, these two strategies have never been compared head-to-head in an unrestricted predicted hyper-responder population. STUDY DESIGN, SIZE, DURATION This study included women with an excessive response to ovarian stimulation (≥18 follicles measuring ≥11 mm) undergoing IVF/ICSI in a GnRH antagonist suppressed cycle between 2014 and 2017. Our primary outcome was clinical pregnancy at 7 weeks after the first embryo transfer. Secondary outcomes included live birth and the development of moderate-to-severe OHSS. PARTICIPANTS/MATERIALS, SETTING, METHODS Following GnRH agonist triggering, women were randomized either to cryopreserve all good-quality embryos followed by a frozen embryo transfer in an subsequent artificial cycle or to perform a fresh embryo transfer with intensified luteal phase support (1500 IU hCG on the day of oocyte retrieval, plus oral estradiol 2 mg two times a day, plus 200 mg of micronized vaginal progesterone three times a day). MAIN RESULTS AND THE ROLE OF CHANCE A total of 212 patients (106 in each arm) were recruited in the study, with three patients (one in the fresh embryo transfer group and two in the freeze-all group) later withdrawing their consent to participate in the study. One patient in the freeze-all group became pregnant naturally (clinical pregnancy diagnosed 38 days after randomization) prior to the first frozen embryo transfer. The study arms did not vary significantly in terms of the number of oocytes retrieved and embryos produced/transferred. The intention to treat clinical pregnancy and live birth rates (with the latter excluding four cases lost to follow-up: one in the fresh transfer and three in the freeze-all arms, respectively) after the first embryo transfer did not vary significantly among the fresh embryo transfer and freeze-all study arms: 51/105 (48.6%) versus 57/104 (54.8%) and 41/104 (39.4%) versus 42/101 (41.6%), respectively (relative risk for clinical pregnancy 1.13, 95% CI 0.87–1.47; P = 0.41). However, moderate-to-severe OHSS occurred solely in the group that received low-dose hCG (9/105, 8.6%, 95% CI 3.2% to 13.9% vs 0/104, 95% CI 0 to 3.7, P &lt; 0.01). LIMITATIONS, REASONS FOR CAUTION The sample size calculation was based on a 19% absolute difference in terms of clinical pregnancy rates, therefore smaller differences, as observed in the trial, cannot be reliably excluded as non-significant. WIDER IMPLICATIONS OF THE FINDINGS This study offers the first comparative analysis of two common strategies applied to women performing IVF/ICSI with a high risk to develop OHSS. While pregnancy rates did not vary significantly, a fresh embryo transfer with intensified luteal phase support may still not avoid the risk of moderate-to-severe OHSS and serious consideration should be made before recommending it as a routine first-line treatment. Future trials may allow us to confirm these findings. STUDY FUNDING/COMPETING INTEREST(S) The authors have no conflicts of interest to disclose. No external funding was obtained for this study. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT02148393. TRIAL REGISTRATION DATE 28 May 2014 DATE OF FIRST PATIENT’S ENROLMENT 30 May 2014

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