Ovarian Pregnancy Research Articles

Ovarian ectopic pregnancy: clinical characteristics, ultrasound diagnosis and management.

To compare the clinical, ultrasound and biochemical characteristics of ovarian ectopic pregnancy (OEP) with those of tubal ectopic pregnancy (TEP). This was a retrospective case-control study of women with OEP and those with TEP seen at a single center between December 2010 and February 2021. OEP was defined as a pregnancy located completely or partially within the ovarian parenchyma, seen separately to a corpus luteum, if a corpus luteum was present within the ipsilateral ovary. We compared demographic features, risk factors, clinical presentation, ultrasound findings and outcomes, such as blood loss at surgery, need for blood transfusion, length of hospital stay, follow-up and future pregnancy outcome, between cases of OEP and TEP. Overall, 20 women with OEP were identified and compared to 100 women with TEP. A total of15/20(75%) OEPs were diagnosed correctly on the first ultrasound scan. There was no difference between the groups in terms of maternal age, gestational age, gravidity, parity or risk factors. Compared with TEP, OEP was more likely to present with abdominal pain without vaginal bleeding (12/20 (60%) vs 13/100 (13%); odds ratio (OR), 10.0 (95% CI, 3.45-29.20); P < 0.01), contain an embryo with cardiac activity (3/20 (15%) vs 2/100 (2%); OR, 8.7 (95% CI, 1.34-55.65); P = 0.02) and have severe hemoperitoneum on ultrasound (9/20 (45%) vs 8/100 (8%); OR, 9.4 (95% CI, 3.01-29.40); P < 0.01), and had a higher volume of blood loss at surgery (median, 700 mL vs 100 mL; P < 0.01). All surgically managed OEPs had successful laparoscopic treatment (18 excisions, one wedge resection) with preservation of the ovary. Only one (5%) case of OEP required a blood transfusion. OEP is more likely than TEP to contain an embryo and to present with severe hemoperitoneum. In a dedicated early pregnancy setting, the majority of OEPs were detected on an ultrasound scan at the initial visit, facilitating optimal minimally invasive surgical management, reducing the risk of blood transfusion and oophorectomy. Our findings can be used as a reference for clinicians who may not otherwise encounter this rare condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The impact and inflammatory characteristics of SARS-CoV-2 infection during ovarian stimulation on the outcomes of assisted reproductive treatment.

Despite the global prevalence of coronavirus disease 2019 (COVID-19), limited research has been conducted on the effects of SARS-CoV-2 infection on human reproduction. The aims of this study were to investigate the impact of SARS-CoV-2 infection during controlled ovarian stimulation (COS) on the outcomes of assisted reproductive treatment (ART) and the cytokine status of patients. This retrospective cohort study included 202 couples who received ART treatment, 101 couples infected with SARS-CoV-2 during COS and 101 matched uninfected couples. The parameters of ovarian stimulation and pregnancy outcomes were compared between the two groups. The All-Human Inflammation Array Q3 kit was utilized to measure cytokine levels in both blood and follicular fluid. No difference was found in the number of good-quality embryos (3.3 ± 3.1 vs. 3.0 ± 2.2, P = 0.553) between the infected and uninfected groups. Among couples who received fresh embryo transfers, no difference was observed in clinical pregnancy rate (53.3% vs. 51.5%, P = 0.907). The rates of fertilization, implantation, miscarriage, ectopic pregnancy and live birth were also comparable between the two groups. After adjustments were made for confounders, regression models indicated that the quality of embryos (B = 0.16, P = 0.605) and clinical pregnancy rate (P = 0.206) remained unaffected by SARS-CoV-2 infection. The serum levels of MCP-1, TIMP-1, I-309, TNF-RI and TNF-RII were increased, while that of eotaxin-2 was decreased in COVID-19 patients. No significant difference was found in the levels of cytokines in follicular fluid between the two groups. Asymptomatic or mild COVID-19 during COS had no adverse effects on ART outcomes. Although mild inflammation was present in the serum, it was not detected in the follicular fluid of these patients. The subsequent immune response needs further investigation.

Surgical Outcomes and Trends in Incidence of Ectopic Pregnancy.

We aimed to evaluate the surgical results for ectopic pregnancy (EP) treated at Fukushima Red Cross Hospital for over a 20-year period from 2002 to 2021. We evaluated the incidence, surgical procedures, site of implantation, amount of hemoperitoneum, and the proportion of cases with risk factors of EP. Two hundred and fifty-nine cases of EP were treated surgically. The incidence of EP seemed to be gradually decreasing in recent years. By pregnancy site, 235 (90.7%) of EPs were tubal pregnancies (TPs), 13 in interstitial pregnancies (IPs), 7 in ovarian pregnancies, and 4 in peritoneal pregnancies. For IPs, human chorionic gonadotropin (hCG) levels were statistically higher than with TP and intraperitoneal bleeding was less than with other EP sites. Thirty-nine patients (15.0%) were with massive hemoperitoneum (>500 mL), and laparoscopic surgery was performed in all patients with massive hemoperitoneum except in two patients. The proportion of cases with risk factors for EP such as Chlamydia trachomatis infection or history of smoking was 5.4% and 40.6%, respectively. Epidemiological research shows that the number of patients with chlamydia infection, rates of smokers, or the occurrence of EP with assisted reproductive technology has been decreasing in recent years in Japan. Appropriate surgical intervention should be selected while considering such as facility capabilities, context, and surgeon skill, especially in critical cases, such as cases involving massive hemoperitoneum and hemorrhagic shock. The recent presumed decrease in the occurrence of EP may partly be associated with the decrease in the occurrence of risk factors.

A Comparative Study of Fresh versus Frozen Embryo Transfer and their Outcomes in Patients with Polycystic Ovarian Syndrome

Background: In in vitro fertilization (IVF)/assisted reproductive technology, fresh embryo transfer is generally preferred over frozen embryo transfer (FET). Still, some research shows that FET could increase the childbirth rate which reduces the amount of ovarian hyperstimulation syndrome (OHSS) and pregnancy problems in females with polycystic ovarian syndrome (PCOS). There is a high risk of aberrant pregnancies, incorrect placentation, and other issues when a fresh embryo is transferred. They are more likely to get OHSS. Fresh embryo transfer reduces the chances to get pregnant as the stimulatory effect will be there for long time, and the endometrium is less receptive for the embryos and vice versa in the case of FET. For IVF, the transfer of fresh embryos is typically preferred over the transfer of frozen embryos. However, some research suggests that the transfer of frozen embryos may increase the live birth rate and decrease the rates of OHSS and pregnancy complications in women with polycystic ovary syndrome. One of the most prevalent endocrine illnesses in women of reproductive age is PCOS. Chronic anovulation, hyperandrogenemia, and clinical signs of hyperandrogenism are hallmarks of polycystic ovary syndrome in the absence of additional diseases such as congenital adrenal hyperplasia, androgen-producing tumors, or Cushing syndrome. Despite the fact that some patients are discovered to be clomiphene citrate (CC) resistant, CC is still the first line of treatment for anovulatory infertility caused by PCOS. Numerous treatments, such as the usage of metformin, ovarian drilling, and gonadotropin therapy, may be taken into consideration in these people. Materials and Methods: Fifty women in all ranging in age from 25 to 45 participated in the study. Half of the study participants are from Wardha, and the other half are from rural areas close to Wardha. Participants were chosen from patients who sought medical attention for issues relating to infertility. We have taken consent from all the patients with the mutual understanding that their medical is being used for a comparative study. All the patients in our study are subjected to IVF following embryo transfer. We have taken n = 50 in which all the patients are PCOS patients with AMH noticeably higher than others. Out of them, we have taken 25 patients who are allocated for fresh Day 5 transfer and 25 of them are allocated for Day 5 FET. We have collected data for a total of 50 patients and compared the β-human chorionic gonadotropin values whether it is positive or negative in each case. We have done a comparative study by comparing the results of patients undergoing fresh versus FET with their ages ranging from 25 to 45 years. Results: The data of fresh Day 5 embryo and frozen Day 5 transfer and their outcome were noted. We concluded that FET has good results compared to fresh embryo transfer.

Ovarian Ectopic Pregnancy: A Rare Case Report

Ovarian ectopic pregnancy is rare and constitutes around 3% of all ectopic pregnancies. Its presentation is similar to tubal ectopic pregnancy and is difficult to diagnose based on the presentation and ultrasound findings. Here, we describe one such case which we encountered in our practice. Primigravida patient at early gestation presented with vaginal spotting and pain in lower abdomen. She was suspected as ruptured ectopic pregnancy based on examination and ultrasound findings. Immediate laparotomy was performed and patient was diagnosed to have ruptured ovarian pregnancy intraoperatively. Partial ovariotomy was performed and the case was successfully managed. Histopathology confirmed the diagnosis. Surgery is the mainstay of definitive diagnosis and treatment. Identifying these cases early is imperative as such patients can collapse suddenly and there are high chances of maternal morbidity and mortality.

The diagnostic dilemma in ovarian ectopic pregnancy

Diagnosis of ovarian ectopic pregnancy (OEP) is challenging because of its rarity. We report a case of 30-year-old woman who presented with abdominal pain. Her pelvic ultrasound showed bilateral ovarian cysts and a right adnexal mass which was separated from the right ovary. OEP was diagnosed intraoperatively with histological confirmation. Diagnostic dilemma is expected, either via imaging or intraoperatively as OEP can mimic appearance of ovarian cysts and blood clots. Preoperatively, patients should be counselled adequately regarding the possible intraoperative findings and their treatments. Surgeons should have the technical abilities to perform ovarian ectopic excision or have minimally invasive surgery specialist available to perform the operation. In conclusion, identification of OEP remains a challenge. Therefore, high clinical suspicion and improved imaging skills are warranted.

130 Effect of an appeasing substance application on growth, stress, handling quality and reproduction of Bos indicus beef heifers synchronized to fixed-time AI

Abstract This experiment evaluated the effects of an analogue of bovine appeasing substance (BAS) on growth, stress, handling quality, and reproduction of Nellore heifers. Twenty-nine heifers [body condition score (BCS) = 4.84 ± 0.13; body weight (BW) = 371 ± 0.77 kg; 23 ± 2 months of age)] were assigned to 1 of 2 treatments: 1) Saline solution (0.9 NaCl; n = 14) or BAS (Secure Cattle, IRSEA Group, Quartier Salignan, France; n = 15). Both solutions were applied topically in the nuchal skin area (5 mL/heifers) at the beginning (d -9) of the fixed-time artificial insemination protocol (FTAI). Heifers were allocated in two different pastures according to the treatment (one pasture per treatment) for 15 d (time of action of BAS) and then combined in a single group (both treatments in the same pasture). Heifers were inseminated on d 0, and BW and BCS were collected on d -9 and 40. The temperament in the squeeze chute (entry and exit scores; scale 1 – 3; chute score; scale 1 – 5; greater values mean more reactive heifers) and blood samples were collected on d -9, 0, 7, 14 and 30. The percentual of aggression, accident, and dirtiness in the perineal region were evaluated on d 0 along with time to inseminate, estrus expression scores (scale 1 – 3; 1 = no expression, 2 = low expression, 3 = greater expression), and dominant follicle size. The corpus luteum size was measured on d 7 and 14, and the pregnancy and embryo size on d 40. The BAS vs. Saline-treated heifers tended to have greater BW change (23.6 vs. 20.8 ± 1.03 kg; P = 0.09) and had greater BCS change (0.05 vs. -0.21 ± 0.05; P &amp;lt; 0.01). The BAS vs. Saline-treated heifers tended to have lesser entry scores (1.42 vs. 1.67 ± 0.09; P = 0.09) and percentual of dirtiness in the perineal region (48.3 vs. 71.1 ± 8.67 %; P = 0.06), and no effects of treatment were detected (P ≥ 0.39) for chute score, exit score, aggression, accident and time to inseminate. The BAS vs. Saline-treated heifers had greater estrus scores (2.00 vs. 1.27 ± 0.21; P = 0.03), and no effects were detected (P ≥ 0.11) for ovarian variables, pregnancy rate, and conceptus size. Furthermore, no treatment effects were detected (P ≥ 0.25) for serum concentration of cortisol and plasma concentration of haptoglobin, ceruloplasmin, and progesterone. Therefore, BAS application at the beginning of the FTAI protocol could decrease the temperament and dirtiness in the perineal region and increase the growth and estrus expression of beef heifers.

Angular Pregnancy, a Rare Entity of Ectopic Pregnancy

The angular extra uterine pregnancy is a particular pathology because of its clinical presentation, its diagnosis and its management, with an increased risk of rupture. We report a case of ovarian extra uterine pregnancy managed laparoscopically.

Unruptured Ovarian Ectopic Pregnancy- A Case Report

Background: Ectopic pregnancy complicates 2% of all pregnancies, and accounts for 6% of pregnancy-related mortality [1]. It ends with rupture before the end of the first trimester [2]. Case Report: We report a case of a 27 yr old primigravida with unruptured left ovarian ectopic pregnancy treated with a wedge resection of ovary laparoscopically. Post-operative period of the patient was uneventful. Conclusion: Ovarian pregnancies are rare, and unruptured ovarian pregnancies are rarer. Early detection and treatment plays an important role in prevention of serious complications.

Progestins for pituitary suppression during ovarian stimulation in artificial reproductive technology

Background: Progestins can suppress endogenous luteinizing hormone secretion from the pituitary gland. Progestins can be used orally and are less expensive than gonadotrophin-releasing hormone (GnRH) analogs. However, early endometrial exposure to progestin precludes fresh embryo transfer (ET), but the emergence of vitrification for oocyte cryopreservation cycles allows more opportunities for using progestins for pituitary suppression.&#x0D; Objective: To assess the mechanism of pituitary suppression by progestins, the effectiveness of progestins compared with GnRH analogs, the effect of progestins on oocyte and embryo developmental potential and euploidy status, and the cost-effectiveness of progestin-primed stimulation. &#x0D; Methods: A literature search using the keywords “multiple waves of antral ovarian follicular development, In Vitro Fertilization, Ovarian stimulation ” was performed in the PubMed database.&#x0D; Results: The duration of stimulation, gonadotrophin consumption, and oocyte yield were similar in progestins and GnRH analogs. However, progestins were associated with significantly lower gonadotrophin consumption than their analogs. Overall, live birth and clinical pregnancy rates per ET were similar to those of progestins and GnRH analogs. Studies comparing medroxyprogesterone acetate, dydrogesterone, and micronized progesterone suggest similar ovarian responses and pregnancy outcomes. The euploidy status of embryos and obstetric and neonatal outcomes from progestin-primed cycles are similar to those of embryos from conventional stimulation cycles. Despite the lower cost of progestins than GnRH analogs, the mandatory cryopreservation of all embryos followed by a deferred transfer may increase the cost per live birth with progestins compared with an artificial reproductive technology cycle culminating in a fresh ET.&#x0D; Conclusion: Progestins present an effective option for women who do not contemplate a fresh ET, e.g., fertility preservation, anticipated hyper responders, preimplantation genetic testing, oocyte donors, and double stimulation cycles.

Ovarian masses and pregnancy: About 2 cases and literature review (experience of Gyneco-obstetrics service 2 Fez)

Management of adnexal masses during pregnancy can be challenging for the patient and clinician. The specter of a possible malignant tumor may influence the decision to intervene rather than the expected management. The etiologies of ovarian masses vary depending on the age of the parturient, and therefore, benign entities such as functional ovarian cysts, benign cystic teratomas, and serous cystadenomas predominate. In cases of malignancy, these are generally germ cell tumors and borderline, low-grade ovarian tumors. Ultrasound is the primary modality used to detect ovarian masses and assess the risk of malignancy. Morphological criteria identify benign cysts more precisely than malignant tumors. Tumor markers are mainly used to monitor disease status after treatment rather than to establish the diagnosis of ovarian tumor due to lack of specificity, as several markers can be elevated by pregnancy itself (e.g. , CA-125, β-hCG). We report the cases of 2 patients who consulted the emergency room in a context of pelvic pain during pregnancy whose clinical examination aimed first to eliminate an emergency, notably a torsion of the adnexa, then to explore using ultrasound the etiology and characterize the objectified ovarian mass. The care is specific during pregnancy. Expectant management is recommended for most pregnant patients with asymptomatic, unsuspicious cystic ovarian masses. Surgical intervention during pregnancy is indicated for large and/or symptomatic tumors and those that appear highly suspicious for malignancy on imaging tests. The extent of surgery depends on the intraoperative diagnosis of a benign or malignant tumor. Conservative surgery is most often performed. More aggressive surgery is indicated for ovarian malignancies, including surgical staging. Although rarely necessary, chemotherapy has been used during pregnancy with minimal fetal toxicity in patients with advanced ovarian cancer, in which the risk of maternal mortality outweighs fetal consequences.

Acute generalized peritonitis revealing an ovarian pregnancy: a case report

Introduction and importance: Abdominal pregnancy is still seen in developing countries due to inadequate medical facilities. The clinical indicators manifest in various forms and are nonspecific, making it challenging to diagnose and often leading to delayed detection. The occurrence of an infectious complication that leads to the development of generalised acute peritonitis is rare. The author present a case of 34-year-old patient who presented with febril generalised acute peritonitis caused by an abdominal pregnancy. The result of the abdominal ultrasound and the serum β-human chorionic gonadotropin (β-HCG) level led to initial diagnostic confusion. Case presentation: A 34-year-old primigravida with no medical or surgical history of comorbidity prior consulted in the authors’ department for generalised abdominal pain in the context of fever and amenorrhoea for more than 4 months. Physical examination revealed a painful and contracted abdomen. The biological assessment showed white blood cells at 27 100/ul, the haemoglobin level at 11.8 g/dl. The serum β-HCG level was less than 5 UI/l. The abdominal ultrasound noted a peritonitis secondary to an abscess of the appendix. Exploratory laparotmy revealed 200 ml of pus in the peritoneum and a mass in the right iliac fossa at the expense of the ovary with agglutination of the intestines loops. After adesyolysis, a single-piece excision of the mass was performed, the break-in showing a macerated foetus, a right adnexectomy and an appendectomy. The maternal outcome was good. Clinical discussion: Abdominal pregnancy remains an inadequately diagnosed condition in developing countries. This case reminds clinicians that abdominal pregnancy remains a differential diagnosis of all abdominal pain in a woman of childbearing age including when the serum β-HCG level was less than 5 UI/l. Conclusion: It is imperative to increase awareness among pregnant women about high-quality prenatal care, including early obstetric ultrasound, from conception. Meanwhile, healthcare professionals should receive continuous training and the technical platform modernised.

Non-tubal ectopic pregnancy treatment experiences of a tertiary care center.

To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center. A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated. In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% (n = 61) of CSPs were cured with MVA, 24.1% (n = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96mm vs. 17,34 ± 9,87mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic ınflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure (p < 0.05). The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases.

Non-invasive assessment of hormonal fluctuations during pregnancy in guanacos (Lama guanicoe) and its application in a wild population.

Obtaining endocrinological profiles using non-invasive methodologies by the measurement of hormone fecal metabolites is a widely used method to monitor ovarian activity and pregnancy in wild species. These tools allow the obtention of physiological information without causing capture-related stress on the individuals. In this research, we aimed to 1) biologically validate a non-invasive method to assess fecal progestagens and estrogens fluctuations during gestation in guanacos (Lama guanicoe) and 2) apply this technique to assess pregnancy in a wild free-ranging population. Fecal samples were collected through the gestation period (~12months) of female guanacos in a 6.5-ha paddock. An increase in fecal metabolites of both hormones was detected. Progestagens increased gradually, in contrast to estrogens, which remained at basal values for most of the gestation period and peaked only a few days before calving. To assess pregnancy in wild free-ranging animals, fecal samples were collected from a population of La Payunia provincial reserve (Mendoza, Argentina) during the beginning of gestation and at the end of gestation. Through the first months of possible gestation, pregnant females represented between 40 and 80% of the population; at the end of gestation, only 20-40% of the females had confirmed pregnancies. Our results demonstrated that the polyclonal antisera and sexual hormone metabolite assays used here detect variations in the metabolites excreted through feces in guanacos and provide the possibility of non-invasive hormone monitoring of female reproductive status. Also, the findings in wild conditions suggest that natural abortions could have occurred during the first months of gestation. Although some abortions may be natural, the harsh environmental conditions that challenge the support of such a long gestational process may be another relevant factor to consider. The results obtained here enhance our understanding of the reproductive physiology of one of the most emblematic ungulates in South America.

Fetus in Ovary, Balloon in Uterus: A Serious Missed Diagnosis

Ovarian ectopic pregnancy is one of the non-tubal ectopic pregnancies. It is a very rare, with an estimated incidence of 1/7000-1/40,000 live births and 0.5- 3% of all ectopic Pregnancies. In primary ovarian pregnancy, ovum is fertilized within the follicle itself before being released. Spiegelberg criteria for the diagnosis of ovarian pregnancy are Tube on the involved site should be intact, Gestational sac has to be located in the ovary, The ectopic pregnancy has to be connected to the uterus by the uteroovarian ligament and Ovarian tissue in the wall of the gestational sac should be proven by histopathology. Ovarian Follicle can accommodate the expanding ectopic gestation more readily than the tube but 75% of ovarian gestation rupture in the early first trimester and are usually misdiagnosed as corpus luteal haemorrhage. Advanced ovarian pregnancies with fetal death have been reported. 91% of OEP rupture before the end of 1st trimester. we present a case of Ovarian Ectopic Pregnancy, who reported to our hospital as failed termination of early pregnancy and ongoing second attempt of termination. USG detected a gestational sac with a live fetus of 12 weeks behind the uterus and a foley’s catheter balloon in empty uterine cavity. Subsequently confirmed at surgery as ovarian pregnancy. and proven by histopathology.

A Rare Case of Primary Ovarian Ectopic Pregnancy

Primary ovarian ectopic means implantation of gestational sac in the ovary. It is a rare form of non-tubal ectopic pregnancy and accounts for 3% of all ectopic pregnancy. Most cases ovarian pregnancy terminate with rupture in first trimester of pregnancy, which has a potential for life threatening massive hemorrhage. Etiology is not fully understood but association has been reported with usage of intra uterine device. Diagnosis of ovarian ectopic pregnancy preoperatively is challenging, and most cases are diagnosed intraoperatively. Here we report a case of primary ovarian ectopic pregnancy.

Comparison of Trans-Resveratrol (98% Pure) with Resveratrol (40%) as Rejuvenation Therapy on Ovarian Reserve Parameters and Pregnancy Outcomes in Infertile Adult Women with Poor Ovarian Reserve, Undergoing Assisted Conception Cycles – A Double Arm, Randomized, Open Label Study

This is a Phase IV Randomized, double arm Open labelled trial, conducted at SIMS hospital, Vadapalani, Chennai. It involves all women seeking fertility treatment with poor ovarian reserve, who are planned to undergo assisted conception cycles, including IUI &amp; IVF. The study included women aged between 21 and 45 years, with Poor ovarian reserve with regular menstrual cycles (21–35 days), prestimulation parameters (AFC&lt;5, AMH&lt;1.2 ng/ml), History of previous poor ovarian response &lt;/= 5 oocytes with a conventional stimulation protocol, Couples undergoing the ICSI cycle with ejaculated sperm. The data collected was subjected to statistical testing. The groups were compared in terms of their demographic features and both the groups was found to be equally distributed. Trans-Resveratrol shows that this drug has no advantage over Resveratrol, therapeutically or statistically advantage.

The effect of laparoscopic ovarian drilling on pregnancy outcomes in polycystic ovary syndrome women with more than 2 in-vitro fertilization cycle failures: A pilot RCT.

Background: The effect of laparoscopic ovarian drilling (LOD) before in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles on pregnancy outcomes is an unclear and challenging subject. Objective: To evaluate the impact of LOD before IVF/ICSI cycles on controlled ovarian stimulation and pregnancy outcomes in polycystic ovary syndrome (PCOS) women with a history of more than 2 IVF failures. Materials and Methods: In this randomized clinical trial, women with PCOS diagnosis who referred to Arash Women's hospital, Tehran, Iran for IVF/ICSI cycle from August 2015-January 2018 were evaluated. Eligible participants were allocated into 2 groups randomly (n = 17/each group). The participants in the LOD group (intervention) were treated with laparoscopic couture, and after one month, they underwent IVF/ICSI cycles using the gonadotropin-releasing hormone antagonist protocol. The control group had no intervention. The oocyte and embryo qualities, ovarian hyperstimulation syndrome rate, the rates of chemical and clinical pregnancy and early miscarriage, live birth, and pregnancy complications, were compared between groups. Results: Finally, 34 participants were evaluated. The controlled ovarian stimulation outcomes were similar between groups. The ovarian hyperstimulation syndrome rate in the LOD group was significantly lower than in the control group (p = 0.04). One case of spontaneous pregnancy was reported in the LOD group. No significant difference was observed between groups in clinical pregnancy, miscarriage, and live birth rates. The rates of pregnancy complications (gestational diabetes mellitus, preeclampsia, and preterm birth) were similar between groups. Conclusion: Performing LOD before IVF/ICSI cycles did not improve the pregnancy outcomes in PCOS women, a clinical trial with a larger sample size is needed to prove these results.

Findings from the Use of Spinal Anesthesia in the Laparoscopic Treatment of Extrauterine Pregnancy: Could It Represent an Alternative to General Anesthesia?

Introduction: Minimally invasive procedures performed in laparoscopy, such as salpingectomy for ectopic pregnancy, can be combined with a minimally invasive anesthesia. The aim of this study was to assess the feasibility and the intraoperative and postoperative outcomes of laparoscopic surgery for ectopic pregnancy under spinal anesthesia (SA) compared to general anesthesia (GA) from the point of view of the surgeon, anesthesiologist, and patient. Methods: A retrospective cohort study was performed at DAI Materno Infantile of AOU Federico II of Naples, analyzing all medical records of women who met the inclusion criteria between April 2020 and April 2023. Eighty-two women (35 under SA in group A and 47 under GA in group B) undergone elective or emergency laparoscopic salpingectomy for ectopic tubal or ovarian pregnancy were included. Results: Patients in group A reported less pain at 0 h (adjusted mean difference: −1.5; 95% CI: −2.3 to −0.7; p < 0.001) and after 6 h (adjusted mean difference: −1.1; 95% CI: −2.0 to −0.3; p = 0.01) while no statistically significant differences between the two groups at 12 and 24 h after surgery. No differences were observed among the type of analgesic and during the postoperative observation time, except for paracetamol at 0 h in group B. A faster resumption of bowel motility, patient’s mobilization, and a shorter hospital stay were observed in group A compared to group B. Also greater odds of returning faster to daily activities emerged in group A (adjusted OR: 5.39; 95% CI: 1.77–16.37). A greater number of patients in group A were satisfied with the entire procedure compared to those of group B (33 [94.3%] vs. 37 [78.7%]). The general surgeon satisfaction was always very good or excellent in group A. Finally, all surgical steps were well tolerated in group A. Conclusion: In specific settings, SA is a feasible and safe procedure for the laparoscopic treatment of ectopic pregnancy.

#106 : The Efficacy of Intra-Ovarian Infusion of Autologous Platelet-Rich Plasma in Patients with Poor Ovarian Response: A Systematic Review and Meta-Analysis

Background and Aims: Poor ovarian response (POR) is a pathological condition characterized by a reduced ovarian response to gonadotropin stimulation. This condition presents with a low number of developed follicles during the ovulation induction cycle, low blood estradiol (E2) peak, high gonadotropin dosage, fewer retrieved oocytes, increased cycle cancellation rate, and low clinical pregnancy rate. POR is a significant challenge in assisted reproductive technology. Autologous platelet-rich plasma (PRP) has emerged as a potential therapy for POR, but its efficacy remains controversial. This meta-analysis aims to determine the effect of intraovarian infusion of PRP on ovarian reserve and pregnancy outcomes in patients with POR. Methods: This study was designed as a Meta-analysis. Women diagnosed with POR based on POSEIDON or Bologna criteria were included. Primary outcomes included anti-Müllerian hormone (AMH), antral follicle count (AFC), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and E2 levels, while secondary outcomes were the number of retrieved oocytes and embryo quality. Results: Seven prospective cohort studies involving 202 participants were included. Intra-ovarian infusion of autologous PRP significantly increased AMH (SMD: 0.20, 95% CI: 0.05–0.36; P=0.01), AFC (SMD: 0.92, 95% CI: 0.59–1.25, P&lt;0.05), and E2 (SMD: 3.46, 95% CI: 1.13–5.79; P=0.004) levels in patients with POR. PRP also decreased LH levels in POR (SMD: −1.17, 95% CI: −2.28 to −0.06; P=0.04). However, no statistically significant effect on FSH levels in POR was observed (SMD: −0.17, 95% CI: −0.78 to 0.44; P=0.59). Furthermore, PRP positively impacted the number of retrieved oocytes and embryo quality in IVF cycle patients. Conclusion: This meta-analysis indicates that intra-ovarian injection of autologous PRP can improve ovarian reserve and pregnancy outcomes in patients with POR.