Successful pregnancy after ovulation induction with human chorionic gonadotropin in a woman with selective luteinising hormone deficiency

Selective LH deficiency has been described in several men, but only in two women who presented normal pubertal development but secondary amenorrhoea due to anovulation. Despite its rarity, this condition represents a valuable model for studying the processes regulated by FSH or LH during late folliculogenesis and ovulation in humans. A woman previously diagnosed with selective LH deficiency due to a homozygous germline splice site mutation in LHB (IVS2 + 1G→C mutation) was submitted to an individualised ovarian induction protocol, first with recombinant LH and then with highly purified urinary hCG. Ovarian follicle growth and ovulation were achieved, and a healthy baby was born after an uneventful term pregnancy. The treatment described herein demonstrates that the clinical actions of exogenous LH or hCG in inducing late-stage follicular development in women with deficient LH production or performance might be interchangeable or inevitable, once FSH-dependent early follicular growth is assured.

A Clinical Predictive Model of Progesterone Elevation on the Day of HCG Administration Was Establish Based on the Basal P, BMI and Ovarian Induction Regimen

Background The progesterone elevation (PE) on the day of human chorionic gonadotrophin (hCG) is associated with a significant decrease in the probability of clinical pregnancy after fresh embryo transfer. The goal of this study was to develop a nomogram to explore the baseline indexes to predict the occurrence of PE (0.9ng/ml) on the day of HCG administration before IVF/ICSI treatment.Methods The patients who were performed a GnRH agonist or antagonist pituitary suppression protocol during controlled ovulation stimulation(COS) in reproductive center of Changzhou maternal and child health care hospital from 2017-2019 were included. The nomogram was built from all participants.Results Three variates significantly associated with the PE occurrence on the HCG administration of infertility women were the type ovulation regiment, basal P and BMI. This predictive model showed good calibration and discriminatory abilities, with an area under the curve (AUC) of 0.639（95%CI 0.596~0.681）. Hosmer and Leme show test were performed for evaluating both calibration and discrimination and confirmed our nomogram is a user-friendly graphical representation of the model (χ2= 4.750，P=0.784)Conclusion The nomogram presents graphically association factors (type ovulation regiment, basal P and BMI) and prediction models which can offer simple and useful guidance to avoid the PE occurrence on the HCG administration for clinicians and infertility patients.

P–722 Role of medical practices in early drop-out in infertility care

Study question What is the burden of early infertility care drop-out in the context of full reimbursement of infertility care and are medical practices associated with drop-out? Summary answer Medical practices seem associated with early infertility care drop-out whose burden remains high despite the equality of care policy in France What is known already More than half of couples drop out of their infertility treatment before pregnancy. Direct costs of infertility care are widely cited as the major barrier to continuation of care. In France, infertility treatments are fully reimbursed. Data from US IVF centres have shown a high estimated drop-out from the beginning and at each step of infertility treatment. Some studies have suggested a difference in medical practices during infertility care between couples who have dropped out and couples who have continued care Study design, size, duration Cohort study of all women aged 18–49 years who started infertility treatment between January–August 2016 in mainland France with a private practitioner and who had not been successfully treated at a 24-month follow-up. Participants/materials, setting, methods The cohort was based on the French national health insurance and hospital databases that exhaustively record reimbursed healthcare. Infertility treatment included ovarian induction by gonadotropin and clomifene. Outcome was infertility care drop-out within 3 months after starting treatment. Stratified analyses were performed based on the first treatment prescribed, with three categories: clomifene prescribed by a general practitioner, clomifene by a gynaecologist or gonadotropin by a gynaecologist Main results and the role of chance Among women unsuccessfully treated by ovarian induction, 31.1% dropped out of infertility care within 3 months. Women who started treatment with a general practitioner were more frequently socially disadvantaged (40.6%), less closely monitored (ultrasound and hormonal tests had not been done in 53.6% and 64.8%, respectively) and dropped out more frequently (46.8%). Where the prescriber of treatment was a gynaecologist, older age (35–39 and 40–43 years) was associated with higher probability of early drop-out with OR 1.5 (95% CI 1.3–1.7) and 2.2 (95% CI 1.9–2.5) for gonadotropins and 1.2 (95% CI 1.1–1.3) and 1.9 (95% CI 1.7–2.2) for clomifene. Disadvantaged social status was associated with higher early infertility care drop-out, whereas good monitoring was associated with a lower probability of early drop-out in all three categories of treatments and prescribers Limitations, reasons for caution These medical and administrative data did not allow us to explore medical practices in greater depth, notably the doctor-patient relationship Wider implications of the findings: This is the first estimation of early infertility care drop-out in a general population where treatment is fully reimbursed, exploring the implication of medical practices in early drop-out. Better access to good medical practices is needed for less socially advantaged people, beyond the current equality of care policy in France. Trial registration number N/A

Malignant Ovarian Dysgerminoma Following Ovulation Induction in Patients with Polycystic Ovarian Syndrome: A Literature Review and Two Case Reports

Background: The relation of ovarian induction drugs to development of ovarian cancer is still unclear. Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that has been reported as a risk factor for ovarian cancer in some studies. Case presentation: We report two cases with polycystic ovarian syndrome who developed a malignant ovarian dysgerminoma following use of ovulation induction drugs. One of them was diagnosed during fifth month of pregnancy by intracytoplasmic injection (ICSI). Both cases were treated with conservative surgery. Conclusion: We reported 2 cases of ovarian dysgerminoma in patients with PCOS following ovarian stimulation. A large multicenter observational study is recommended to investigate a possible association.

Gestational Tubal Choriocarcinoma Presenting as a Pregnancy of Unknown Location following Ovarian Induction

The management of pregnancy of unknown location (PUL) can be a challenging situation, since it can present as several different conditions. Here we describe a rare case of gestational choriocarcinoma arising in the fallopian tube after ovarian induction in an infertile patient. The patient received clomiphene for ovarian induction and had rising levels of human chorionic gonadotropin (hCG) over nine months without sign of pregnancy. After referral to our center, the patient was diagnosed with a paraovarian tumor, which revealed a gestational choriocarcinoma arising in the fallopian tube; the final diagnosis was supported by pathological and cytogenomic analysis. Malignancies, such as gestational trophoblastic disease, should be in the differential diagnosis of PUL; the early recognition of these conditions is key for the proper treatment and favorable outcome.

Stimulation of ovulation in program of auxiliary reproductive technologies in women over 40 years (review of literature)

The article presents modern literature data on the stimulation of ovulation in programs of assisted reproductive technologies in women over 40, the advantages and disadvantages of conventional ovarian induction schemes, the clinical and economic effectiveness of the use of coryphollitropine-a for folliculogenesis.