Frozen Embryo Transfer in Mildly Stimulated Cycle With Letrozole Compared to Natural Cycle in Ovulatory Women: A Large Retrospective Study

ObjectiveTo evaluate the clinical effect of mild stimulation with letrozole on pregnancy outcomes in ovulatory women undergoing frozen embryo transfer (FET) compared to natural cycle.DesignRetrospective observational study.SettingTertiary care academic medical center.PopulationA total of 6,874 infertile women with regular menstrual cycles (21-35 days) met the criteria for this study in the period from 2013 to 2020.MethodsAll patients who were prepared for and underwent FET were divided into two groups: a modified natural cycle (NC) group (n=3,958) and a letrozole cycle group (n=2,916).Main Outcome MeasuresThe primary outcome of the study was clinical pregnancy rate. Secondary outcome measures were endometrial thickness, rates of implantation, positive HCG test, live birth, early miscarriage and ectopic pregnancy.ResultsThe clinical pregnancy rate was not statistically different between the modified NC-FET group and the letrozole-FFT group before (crude OR 0.99, 95% CI 0.90-1.09, P=0.902>0.05) and after propensity score matching (PSM) (crude OR 1.01, 95% CI 0.91-1.12, P=0.870>0.05). After multivariable logistic regression analysis, the clinical pregnancy rate remained insignificant before (adjusted OR 1.00, 95% CI 0.91-1.10, P=0.979>0.05) and after matching (adjusted OR 1.00, 95% CI 0.89-1.11, P=0.936>0.05), respectively. Similarly, in the crude and adjusted analysis, the positive HCG test, implantation, live birth and early miscarriage rates were also comparable in the letrozole-FFT group and modified NC-FET group before and after matching. Furthermore, the endometrial thickness of letrozole-FFT group was similar to that of modified NC-FET group with adjusted analysis.ConclusionOur observation suggests that mild stimulation with letrozole could produce similar pregnancy outcomes in ovulatory patients who undergo FET when compared with a natural cycle.

P–373 Initial β-hcg levels and the increase rates after 2 days are effective in predicting pregnancy outcomes in single blastocyst transfer in frozen-thawed or fresh cycles

Study question What is the role of the initial β-hCG value and the β-hCG rate of increase after 2 days in the predictability of the pregnancy outcomes? Summary answer The initial β-hCG values and β-hCG increase rates after 2 days are effective in predicting early pregnancy loss (EPL) and live birth rates (LBR). What is known already β-hCG is a glycoprotein-structured hormone secreted by the cyto syncytiotrophoblasts of the blastocyst and detected in the blood at the earliest 6–8 days after fertilization. The β-hCG level increases approximately by doubling in 48 hours in normal pregnancies. There are few studies conducted about the initial β-hCG values and the increase rates after 2 days on the pregnancy outcome of ART cycles and these studies indicated different threshold values and its level still remains unclear. Study design, size, duration This is a retrospective cohort study and was conducted at IVF and Reproductive Genetics Centre, Memorial Sisli Hospital, Istanbul, Turkey between January 2016 and December 2019. A total of 4605 including 3834 FET and 771 Fresh cycles resulted in a positive pregnancy test after a single blastocyst transfer was examined. Participants/materials, setting, methods The initial β-hCG test was applied 9 days after ET, when is the 14th day after ovulation. The latter β-hCG test was applied 2 days later. The cases with missing initial β-hCG tests or second β-hCG tests and missing follow-up during pregnancy were excluded. The mean β-hCG values and the increase rates after 2 days of the cases who had biochemical pregnancy loss (BPL), EPL and achieved live birth were reviewed. Main results and the role of chance The mean initial serum β-hCG level on 9 days after ET in the live birth group was 185.51 ±97.38 IU/L in FET cycles, which was significantly higher than the groups of BPL (62.75 ±50.70 IU/L) and EPL (133.93 ±95.10 IU/L). However, in fresh cycles, these levels in the live birth group was 167.70 ±114.05 IU/L which was significantly higher than the groups of BPL (50.13 ±27.49 IU/L) and EPL (106.55 ±71.80 IU/L). The mean β-hCG levels in FET cycles were significantly found higher than in fresh cycles (P < 0.005) regardless of pregnancy outcomes. The β-hCG threshold value predicting live birth for fresh cycle was found 108 IU/L (sensitivity 71.5%, specificity 70.8%, PPV 87.% and NPV 46.3%), while this value was found 101 IU/L (sensitivity 81.4%, specificity 55%, PPV 81.6% and NPV 53.8 %) for FET cycles. The β-hCG increase rate of threshold value predicting LBR for fresh cycle was 1.92 (sensitivity 90.6%, specificity 36.3%, PPV 80.1% and NPV 57%), while this rate was found 2.01 (sensitivity 90.1%, specificity 38%, PPV 78.4% and NPV 61.1%) for FET cycles. The β-hCG increase rate was not different between fresh and FET cycles. Limitations, reasons for caution Retrospective study Wider implications of the findings: The initial β-hCG values and the increases in β-hCG values after 2 days can be used as effective parameters in the diagnosis of pregnancy outcomes. Early prediction of pregnancy outcomes may help to the clinician to manage and follow-up high risk pregnancies. Trial registration number Not applicable

Vaginal Microbiota Characteristics of Pregnancy of Unknown Location Women in China(VMCPULW): Study Protocol for a Prospective Cohort

Background: Pregnancy of unknown location (PUL) is a kind of pregnancy that has a positive beta-human chorionic gonadotropin (β-hCG) test result but the location of pregnancy cannot be determined by ultrasound. Early determination of the location of the pregnancy is important for subsequent treatment. However, there is no study on the characteristics of vaginal microbiota in pregnant women with unknown locations and a model for judging it by vaginal microbiota combined with clinical indicators. Therefore, we designed this study to compare the characteristics of vaginal microbiota in intrauterine and ectopic pregnancy populations during pregnancy with unknown locations and to establish a prediction model for pregnancy locations in PUL populations with clinical indicators.Methods: This is a prospective, multicenter cohort study. 576 eligible participants will be included in this study. Vaginal microbiota was collected from all participants at inclusion, and color Doppler ultrasound was performed weekly. After the locations of pregnancy were determined, participants of intrauterine pregnancy were followed up to their early pregnancy outcome, and participants of ectopic pregnancy were followed up until a none-pregnancy level of β-hCG was confirmed. Discussion: The regular method of judging the location of pregnancy is by color Doppler ultrasound and β-hCG test. We hope to provide earlier clinical methods of prediction for women with unknown locations of pregnancy through this study.Trial registration: Chinese Clinical Trial Registry: ChiCTR2000035378, registration date: 9 August 2020. http://www.chictr.org.cn/index.aspx

A ruptured cornual pregnancy: a case report

A cornual gestation is a rare form of ectopic gestations accounting for 2-4% of all tubal pregnancies with a high rate of mortality among to 2%-2.5%. A 25 years old woman prima gravida was presented to the obstetrical emergency department with 8 weeks amenorrhea, lower abdominal pain and vaginal bleeding. A clinical diagnosis of ectopic pregnancy was made and confirmed using Ultrasonography and serum beta-hCG test. On laparotomy exploration authors found a left cornual ruptured ectopic pregnancy then authors made a left cornual resection with left salpingectomy. There were no postoperative complications.

The differential diagnosis of constitutional delay of puberty and hypogonadotropic hypogonadism in boys

Backgraund: The problem of differential diagnosis of constitutional delay of puberty/CPD and hypogonadotropic hypogonadism/HH in boys is discussed, as boys have similar genetic mechanisms and appearance. Aims: to determine accuracy of the criteria for the differential diagnosis of CDP and HH. Materials: The study included 56 boys14,40,7 years old with delayed puberty (G1P1-3/testicular volume 3сm3). We excluded patients with hypergonadotropic hypogonadism, treated with sex steroids or gonadotropins for 12 months, with endocrine/somatic diseases affecting puberty. At the first visit, we evaluated anthropometric data, bone age, testicular volume, hormones and the results of the gonadotropin-releasing hormone test/GnRH agonist test and the human chorionic gonadotropin test/hCG test. The HH was defined by a testicular volume 3сm3 after 2 years follow-up. The patients were divided into two groups: the first group with CDP and testicles 3cm3 (n=50) and the second group with HH and testicles 3cm3 (n=6). Results: At the first visit in boys with CDP corrected target height was less (Me SDS -1,8 vs -0,4, р=0,02), bone age was less (Ме SDS -2,5 vs - 0,2 р=0,03), testicular volume was more (Ме 1,9 vs 0,5, p=0,0003), hormones were significantly higher, such as, LH (Ме 1,1 vs 0,1mIU/ml, p=0,0002), FSH (Ме 1,9 vs 0,2IU/l, p=0,00007), inhibinB (Ме 142,3 vs 31,3pg/ml, p=0,00009), maxLH (Ме 18,9 vs 0,6mIU/ml, p=0,00007), maxLH/FSH (Ме 2,3 vs 0,4, p=0,0002) on the GnRH agonist test and testosterone (Ме 14,4 vs 1,1nmol/l, p=0,0001) on the hCG test than in boys with HH. The LH 0,3 mIU/ml had 86% sensitivity, 100% specificity; maxLH/FSH1- 92% sensitivity, 100% specificity; testosterone 2,7 nmol/l on the hCG test - 98% sensitivity, 100% specificity for differential diagnosis of CDP and HH in boys. However, maxLH 3,5 mIU/ml on the GnRH agonist test, FSH 0,5 IU/l, inhibinB 58 pg/ml had 100% sensitivity and specificity for diagnosis of CDP. Conclusions: The inhibinB 58 pg/ml, LH 0,3 mIU/ml, FSH 0,5 IU/l or maxLH 3,5 mIU/ml, maxLH/FSH 1,0 on the GnRH agonist test, testosterone 2,7 nmol/l on the hCG test have an excellent accuracy for the differential diagnosis of CDP and HH in prepubertal boys with delayed puberty.

False-Negative Urine Human Chorionic Gonadotropin Testing in the Clinical Laboratory

Background Human chorionic gonadotropin (hCG) assays are used to detect pregnancy, and urine point-of-care tests are frequently used to triage patients. Under certain conditions, urine tests can fail to detect pregnancy, which can have serious consequences for patient management. Objectives To understand the prevalence of different factors contributing to false-negative urinary hCG testing results at our institution. Methods Clinical data for patients with negative urine hCG results and subsequent positive or equivocal serum hCG results within a 1-year period were reviewed. Results Out of 9447 negative urine hCG results, 11 potential missed diagnoses were identified, with early gestational age as the most common factor, followed by β-core hook effects. Conclusions Although false-negative urine hCG test results are rare, understanding the commonly encountered reasons for inaccurate testing results can help clinical centers develop strategies to minimize risk for patients.

The Relationship Between Endometrial Thickness and Endometrial Pattern With Pregnancy Rate Based on Positive Serum Beta-Human Chorionic Gonadotropin

Objectives: Infertility is defined as the lack of pregnancy after one year of sexual contact without using any contraception. The aim of this study was to investigate the association between endometrial thickness (ET) and endometrial pattern with beta-human chorionic gonadotropin (B-HCG) test in women undergoing the induction of ovulation who referred to the infertility clinic of Ali ibn-e Abitalib hospital in Zahedan. Materials and Methods: This cross-sectional study was conducted at Ali ibn-e Abitaleb hospital in Zahedan (Iran) in 2017. The ET and endometrial pattern were estimated using transvaginal sonography and the pregnancy rate was determined based on B-HCG test. Finally, the data were analyzed by SPSS using the Chi-square test and independent t-test. Results: A total of 200 individuals with a mean age of 29.6 ± 5.6 years were evaluated in this study. The negative or positive B-HCG distribution was significantly different in terms of the endometrial pattern (P=0.001) so that 35.3% of women had B-HCG positive cases in the three-line pattern of ET while in the homogenous pattern, 3.3% had B-HCG positive cases. In addition, the pregnancy rate in women with ET greater than 7 mm was significantly higher compared to those women with ET less than 7 mm thickness (35.1% vs. 12.8%, P<0.001). Conclusions: Overall, the results of this study showed a significant correlation between the endometrial pattern and ET and pregnancy rate based on positive B-HCG test.

Negative Urine B-hCG Pregnancy Test in Chronic Ectopic Pregnancy – a Case Report

Ectopic pregnancy (EP) is a gynecological emergency that can bring catastrophic condition leading tubal rupture and hemorrhagic shock. Chronic ectopic pregnancy is a very rare type of tubal pregnancy presenting with a tubal mass with negative B hCG (beta human chorionic gonadotropin test. We present a case in twenty seven years old female with a history of six weeks of amenorrhea with complain of acute lower abdominal pain and per-vaginal bleeding. Urine pregnancy test (UPT) was negative. A total left salpingoectomy was undertaken and the histopathological examination revealed the presence of chorionic villi, suggesting the diagnosis of chronic ectopic tubal pregnancy. It is obvious that ectopic pregnancy could not be excluded with negative urine B-hCG test.