Urinary Human Chorionic Gonadotropin Research Articles

P-384 The risk of early pregnancy loss following medicated frozen embryo transfer

Abstract Study question Do exogenous gonadocorticoids protect against early pregnancy loss (EPL) following frozen embryo transfer (FET)? Summary answer Exogenous gonadocorticoids conferred a 59.5% increased risk of EPL (p<.05) without any advantage to biochemical pregnancy rates. This corresponded to a significantly thinner pre-FET endometrium. What is known already During a medicated FET cycle, exogenous progestogens and/ or oestrogens are administered with the intention of inducing endometrial maturation prior to implantation. However, the concomitant administration of both these gonadocorticoids is known to produce secretory changes alongside endometrial proliferation. It is unclear whether this non-physiological morphology is truly favourable for implantation, with some authors reporting similar EPL rates between medicated and “natural” FET cohorts while others have found exogenous gonadocorticoids to reduce the risk of EPL compared to alternative protocols. Study design, size, duration Retrospective, single-centre cohort study assessing the rates of biochemical pregnancy and EPL following 819 FETs. All FETs were conducted between January 2019 and November 2022 within a single British centre. Participants were followed up at 6-8 weeks post-FET to assess for biochemical pregnancy and EPL. The former was defined as a positive urinary human chorionic gonadotropin; the latter was defined as the absence of pregnancy on transvaginal ultrasound despite previous confirmation of biochemical pregnancy. Participants/materials, setting, methods Participants comprised 586 women undergoing medicated FET cycles and 233 women undergoing “natural” cycles. Electronic healthcare records (EHRs) were accessed to record pregnancy outcomes, hormonal therapies and endometrial thickness at 48hrs prior to FET. Binomial variables were compared using Pearson’s chi-squared test; continuous variables were analysed via T-tests and logistic regressions. Cut-offs of 8mm, 9mm and 10mm were applied to endometrial thickness in sub-group analyses. Statistical test were conducted using STATA v18.0 (StataCorp LLC, Texas). Main results and the role of chance Women undergoing medicated FET cycles achieved 16.9% higher rates of biochemical pregnancy compared to women undergoing “natural” cycles (57.7% versus 49.4%, p<.05). However, they also suffered a 59.5% higher rate of EPL (28.8% versus 18.0%, p<.05), which corresponded to significantly thinner endometrium at pre-FET ultrasound in comparison to women on “natural” cycles (9.13mm versus 9.48mm, p<.05). Logistic regressions revealed that, within the medical FET cohort, each 1mm increase in thickness conferred a 13.8% increased risk of EPL (95%CI: 3.1%-25.5% p<.01) but no advantage in biochemical pregnancy rates. “Natural” cycles demonstrated no such association. Endometrial thickness was then dichotomised using three thresholds. Women undergoing medicated FET cycles whose endometrium exceeded 9mm or 10mm had 62.1% and 71.4% greater risk of EPL, respectively, compared to those below either threshold. Biochemical pregnancy rates did not differ. Women undergoing “natural” FET cycles did not exhibit any significant difference using either threshold, suggesting that the disparate EPL rate in medicated cycles may result from non-physiological endometrial stimulation by exogenous gonadocorticoids. The 8mm cut-off was insignificant in both cohorts. Although these results cannot confirm a causal relationship between exogenous gonadocorticoids, endometrial thickness and EPL, they are sufficiently striking to warrant further investigation into their pathophysiological basis. Limitations, reasons for caution EHRs failed to report endometrial thickness for 125 participants (15.3%), limiting statistical power in logistic regressions. Our results cannot be confidently applied to other centres until further studies are conducted. Additionally, our design did not allow for the disparity in EPL rates to be attributed to a particular pathophysiological mechanism. Wider implications of the findings This data generates further uncertainty within the literature with regards to the relative risk of EPL in medicated versus “natural” FET cycles. The empirical evidence to support one protocol over the other is insufficient at present, and thus clinical recommendations should be based on the individual preferences of each patient. Trial registration number not applicable

Single and multi-dose pharmacology of recombinant and urinary human chorionic gonadotrophin in men.

Human choriogonadotrophin (hCG) treatment of gonadotrophin-deficient infertile men uses hCG of urinary (uhCG) or recombinant (rhCG) origin, but these treatments have not been compared nor are there studies defining rhCG dosing in men. hCG products were studied in randomized cross-over single-dose studies of standard (Study 1, 1500 IU and 62.5 µg, respectively) or high (Study 2, 5000 IU and 250 µg) dose and a multi-dose population pharmacology study of hCG use. Eight (Study 1) and seven (Study 2) volunteers in cross-over and 52 gonadotrophin-deficient men in the multi-dose study MEASUREMENTS: In cross-over studies, serum testosterone (T), dihydrotestosterone (DHT) and estradiol by liquid chromatography-mass spectrometry (LCMS) and serum hCG, LH, FSH, SHBG and T (observational study) by immunoassays. After standard and high-dose injection, serum hCG and testosterone responses had similar timing and peak concentrations except for a mildly lower early (<48 h) serum testosterone with uhCG. In the multi-dosing study, both hCGs had similar pharmacokinetics (pooled half-life 5.8 days, p < .001), while serum testosterone concentrations were stable after injection and did not differ between hCG products. Bench testing verified that 20% of pens from 4/10 individuals were used inappropriately. Although hCG pharmacokinetics are not formally bioequivalent, the similar pharmacodynamic effects on serum testosterone indicatethat at the doses tested both hCGs provide comparable clinical effects. The starting dose of rhCG for treating gonadotrophin-deficient men should be 62.5 µg (6 clicks) of the rhCG pen.

#86 : Use of Triptorelin Versus Human Chorionic Gonadotropin as Ovulation Trigger

Background and Aims: Gonadotropin releasing hormone agonist (GnRH-a) trigger has been shown to be associated with significantly lower risk of moderate or severe ovarian hyperstimulation syndrome (OHSS) when compared among women at high risk of OHSS. However, trigger failure has been shown to occur in 2% of cycles using GnRH-a as trigger. This study aims to review the use of GnRH-a as ovulation trigger. Method: Retrospective review of records in antagonist cycles from an ART unit in a tertiary hospital from 2017-2021 was performed. Follicles were considered mature when they reach [Formula: see text] 15 mm. Ovulation triggered with urinary human chorionic gonadotropin (uhCG) (5000-10000 IU), recombinant hCG (rhCG) 250 mcg, or triptorelin 0.2 mg when there were [Formula: see text] 3 mature follicles. All embryos obtained from cycles using triptorelin were cryopreserved. Outcome including the number of oocytes retrieved, the follicle to oocyte index, ovarian hyperstimulation syndrome were reviewed. Results: 1378 cycles were included. 1089 cycles had uhCG or rhCG as trigger, while 284 cycles had triptorelin as trigger. Women in the triptorelin group were significantly younger with a lower basal follicle stimulating hormone level and a higher antral follicle count (Table 1). In the triptorelin group, the total number of mature sized follicles, estrogen level at trigger, oocytes retrieved, number of blastocysts were significantly higher compared to the hCG group (Table 2). Follicle to oocyte index was significantly higher in the triptorelin group but the proportion of mature oocytes were similar in both groups. There were no cases of trigger failure and OHSS in the triptorelin group, but 30 cases of OHSS, with18 cases early onset, 12 cases late onset, amongst them 10 cases (1%) were severe OHSS) in the hCG group. Conclusion: GnRH-a trigger is a good candidate as ovulatory trigger in women at risk of OHSS without hampering the laboratory outcome.

FRI439 Spermatogenesis Induction For Hypogonadotrophic Hypogonadism In An Australian Tertiary Hospital Andrology Service

Abstract Disclosure: S. Sarlos: None. M. Herath: None. I. Sim: None. R. Upreti: None. R.I. McLachlan: None. C.A. Allan: None. Infertility affects 8-12% of couples with male factors contributing to 50% and solely responsible in 20-30% of cases. Male infertility due to hypogonadotrophic hypogonadism (HH) is amenable to medical treatment. We report a series of 23 men treated for infertility from HH (congenital n=13, acquired n=10) with a median age of 33 years. Causes included panhypopituitarism (n=11) [empty sella (n=2), adenoma (n=3), craniopharyngioma (n=1), pituitary hypoplasia (n=3), CHARGE syndrome (n=1), cranial radiotherapy (n=1)], Kallmann syndrome (n=1), thalassaemia major (n=1) and idiopathic (n=10). Urinary or recombinant human chorionic gonadotrophin (hCG) as an LH substitute was used based on established protocols. Commencing doses were 1500 IU or 62.5mcg s/cut twice weekly respectively and titrated to achieve normal serum total testosterone. Recombinant FSH was added after 6 months for persisting azoospermia. Wherever possible, men previously treated with long-acting injectable testosterone undecanoate were transitioned to transdermal testosterone for a minimum of 6 months prior to initiation of gonadotrophin therapy. There was wide variability in time to first appearance of sperm (median 16 months, range 4 - 42). In androgen treatment-naive men with acquired HH in adulthood (n=9), sperm was detected at a median 8 months (range 3 - 21 months) and for 4 men, hCG monotherapy was sufficient. For men with congenital causes of HH (n=13), time to first sperm detection was longer (median 17 months, range 12 - 42) and all required addition of FSH. In men previously treated with intramuscular testosterone (n=8), the median time to sperm appearance was 17 months (range 12-24) as compared to 13 months (5-42) in men treated with transdermal testosterone (n=6). To date, 11 of the 16 men actively seeking fertility have had children, with 7 requiring assisted reproduction. Gonadotrophin therapy is an effective fertility treatment for most men with HH. Clinicians can anticipate a longer time to spermatogenesis in men pre-treated with intramuscular androgens and those with congenital HH. Couples often move to assisted reproductive therapy, likely due to considerations such as semen quality, co-existing female factors and/or desire for prompt conception. Presentation: Friday, June 16, 2023

A-350 Myth Debunked: Same UrineAliquot is not Suitable for hCG Test AfterMicroscopic Analysis

Abstract Background It has been imparted in the laboratories that the suspending fluid, Lamina, from Iris IQ 200 Analyzer system is prone to interfere with urine human chorionic gonadotropin (hCG) test, especially on a small volume urine specimen. The myth is that the sample is diluted or contaminated by Lamina, which gives falsely negative result for hCG test. An add-on urine pregnancy test was ordered for a specimen, which was completed urinalysis and microscopic analysis. This is the only urine aliquot available, and it is approximately 2mL. This order raised many concerns among laboratory technicians regarding the accuracy of the result. However, no documents or articles were found to support the suspicions. In this study, A serial of experiments was completed to address this concern. Methods Known pregnant patients were confirmed their pregnancies with serum hCG tests prior to collecting the urine specimens. The experiment was conducted with 4 positive patient urines. A series of samples ran on DXI 800 system and the point-of-care (POC) Alere hCG combo cassettes. Then the same specimen performed urinalysis and microscopic analysis on Iris IQ 200 Analyzer. To evaluate the Lamina impact, the sample concentrations were verified with point-of-care (POC) Alere hCG combo cassettes and later DXI 800 system. Meantime, the significance of sample size was also evaluated in the study. Results The final concentrations of the samples were at &amp;lt;5, 5, 10, 15, 20, 25, 30, 40, 50, and 60 mIU/mL. The cutoff for Alere hCG combo cassettes was verified at 20 mIU/mL for urine, the assay gives the accurate result at and above that value. The results are consistent between immunoassay and POCT prior to and after microscopic analysis. Therefore, no significant interferences were identified with the desired sample volume, 3 mL, or short sample volume, 2mL. The volume usage by iQ 200 Analyzer was less than 500 uL. Conclusion In this study, Lamina doesn't cause any interference with hCG values using Alere hCG combo cassettes despite the short sample volume. However, variations between POC urinary hCG devices may contribute to different outcomes. Therefore, a separate validation is highly recommended if a different POC urinary hCG device is involved.

Human chorionic gonadotropin levels after ovulation triggering as predictors of clinical pregnancy after intracytoplasmic sperm injection: a prospective cohort study

ABSTRACT This study aimed to assess the correlation between human chorionic gonadotropin (HCG) levels after ovulation triggering and clinical pregnancy following intracytoplasmic sperm injection (ICSI), affected by HCG formulation and dose. The study was a prospective cohort study of 100 women who underwent ICSI and controlled ovarian stimulation (COS) using a fixed gonadotropin-releasing hormone (GnRH) antagonist protocol. Women were divided according to the type of ovulation triggering into three groups: (1) urinary HCG (uHCG) group (n = 33); (2) recombinant HCG (rHCG) group (n = 33); and (3) dual trigger group (n = 34). The three groups were compared to each other taking into consideration the HCG levels and their correlations to clinical pregnancy following ICSI. Clinical pregnancy could be predicted by serum HCG levels 34 h after ovulation triggering by uHCG, rHCG and dual trigger at cutoff levels of 73.72, 57.35 and 22.37 mIU/ml, respectively, with sensitivities of 95%, 94.7% and 87%, and specificities of 76.9%, 92.9% and 90.9%, respectively. Follicular fluid (FF) HCG levels could predict clinical pregnancy after ovulation triggering by uHCG, rHCG and dual trigger at cutoff levels of 21.58 mIU/ml, 20.82 mIU/ml and 8.66 mIU/ml, respectively, with sensitivities of 95%, 94.7% and 91.3%, and specificities of 92.3%, 92.9% and 90.9%, respectively. In conclusion, serum and FF HCG levels after ovulation triggering could predict clinical pregnancy following ICSI at variable cutoff levels according to HCG formulation and dose.

Prevalence of Teenage Pregnancy and Associated Factors in Agago District, Uganda: A Community-Based Survey.

Teenage pregnancy remains a common public health and social problem associated with negative health outcomes. We determined the prevalence and factors associated with teenage pregnancy among teenage girls aged 13-17 years in Agago district, Uganda. We conducted a community-based, cross-sectional study between October and November 2020 in Lapono Sub-County, Agago district among teenage girls 13-17 years. Multi-stage sampling technique was used. Parishes, villages, and households were randomly selected (computer generated random numbers were used for household selection). In each household, one participant was randomly selected for interview and pregnancy testing. We collected data on socio-demographic factors using a pre-tested semi-structured questionnaire. All eligible participants were tested for urine human chorionic gonadotropin (hCG). Multivariable logistic regression analysis was done to determine independent predictors of teenage pregnancy, with p<0.05 considered statistically significant. A total of 289 eligible participants, with a mean age of 15.1±1.5 years, were enrolled. Most (n=246, 81.5%) participants had attained primary education, 18 (6.2%) were married, 41 (14.2%) used alcohol, 62 (21.5%) had a history of sexual intercourse and 32 (11.1%) were sexually abused. The prevalence of teenage pregnancy was 2.8% (n=8). Factors significantly associated with teenage pregnancy were alcohol consumption (adjusted odds ratio (aOR): 13.2, 95% Confidence Interval (95% CI): 1.7-100.6, p=0.013) and having secondary/tertiary education (aOR: 10.2, 95% CI: 1.5-71.9, p=0.02). The study findings suggest that teenage pregnancy is still a public health and social problem in Agago district, Uganda. Interventions discouraging alcohol consumption and promoting education among teenagers are key in addressing the burden of teenage pregnancies in the district.

Is Preoperative Urine Human Chorionic Gonadotropin (hCG) Testing Necessary for Pediatric Patients Before Oral and Maxillofacial Surgery Procedures With Sedation?

Human chorionic gonadotropin (hCG) testing is performed prior to surgical procedures to ensure patient and fetal safety. The purpose of this study was to evaluate the utility of routine pregnancy testing prior to elective outpatient oral and maxillofacial surgery procedures being performed with intravenous sedation (IVS). A retrospective cohort study was implemented assessing hCG testing in postmenarche females who underwent elective outpatient oral surgery procedures scheduled with IVS at a tertiary care institution. Medical records were used to identify eligible subjects aged 12 to 45years. The primary predictor variable was age, and the primary outcome variable was urine hCG test result. Age was divided into groups to reflect early adolescence (12 to 14years), mid-adolescence (15 to 17years), late adolescence/early adulthood (18 to 24years) and adulthood (25+ years). Secondary outcome variables included inability to void for hCG testing, change in anesthetic, case cancellation or rescheduling and were measured over a 2year period. Descriptive statistics were performed. Relative risk (RR) and Cochran-Armitage test for trend were calculated to determine the statistical significance of age on inability to void. The sample consisted of 5,006 females, with a median age (IQR, range) of 18.0 (3.6, 12.0 to 43.6) years. There was one positive urine hCG result providing a preoperative pregnancy rate of 0.02%. Fourteen of 1,195 subjects (1.2%) over a 2year period were unable to provide a urine hCG sample. There was a statistically significant trend in inability to void as age groups got older (P=.001). Patients aged 12 to 17years had an increased risk of being unable to void compared to patients 18years and older (RR: 14.30, 95% CI: 1.88 to 108.99, P=.01). The total cost of testing over the 11year observation period was $9,019.59. The risk of surgical cancellations and delayed care due to patients' inability to void preoperatively plus a lack of any positive preoperative urine hCG findings in patients under 18years of age in this study, call into question the necessity of routine preoperative hCG screening in pediatric patients presenting for IVS for elective outpatient oral and maxillofacial procedures.

Effect of Low-Frequency Electrical Stimulation Combined with Tonifying Kidney and Blood Pills on Uterine Rejuvenation after Abortion.

Objective This study aimed to observe the clinical efficacy of low-frequency electrical stimulation therapy combined with tonifying the kidney and activating blood pills to promote uterine recovery after abortion and its effect on heat-shock protein (HSP)70 and HSP90. Methods All cases were women with early pregnancy who underwent an abortion at the Third Affiliated Hospital of Nanchang University from September 2019 to September 2020. They were divided into two groups in accordance with the principle of patient voluntariness: 237 cases in the experimental group and 143 cases in the control group. Patients in both groups were given low-frequency electrical stimulation after surgery. In addition, patients in the experimental group began to take the Dingkun pill orally (one pill per time, two times per day) from the first day of surgery and continued to take it until their menstruation returned to normal. Abdominal pain, the duration of vaginal bleeding, and the amount of bleeding were observed in both groups. Uterine size, endometrial thickness, and urinary human chorionic gonadotropin (HCG) status were also observed at 2 weeks postoperatively to determine preoperative and postoperative HSP70 and HSP90 serum levels. The time of menstrual resumption, menstrual period, and menstrual volume were observed and compared with preoperative menstruation. The occurrence of complications, such as a residual uterine cavity, uterine effusion, menstrual irregularities, and reproductive tract infections, during the follow-up period was also recorded in both groups. Results Comparison of the endometrial thickness (mm) and uterine size (sum of the three diameters) on uterine adnexal ultrasound at 2-week postoperative review was better in the experimental group than in the control group (p < 0.05). No statistically significant difference was found between the two groups in terms of residual uterine cavity and blood accumulation in the uterine cavity and the results of the urine pregnancy test (p > 0.05). Serum HSP70 and HSP90 levels were significantly higher in the control group than in the experimental group 2 weeks after surgery (p < 0.05). Postoperative HSP70 and HSP90 levels were significantly higher than preoperative levels in both groups (p < 0.05). The degree of postoperative abdominal pain in the experimental group was less severe than that in the control group, and the duration was shorter (p < 0.05). No statistically significant differences were observed when comparing the duration of postoperative vaginal bleeding and the amount of bleeding (p > 0.05). The time of the first menstrual resumption and menstrual volume were more satisfactory in the experimental group than in the control group (p < 0.05). No adverse reactions occurred in either group of patients receiving treatment. ConclusionLow-frequency electrical stimulation combined with tonifying the kidney and invigorating blood pills could effectively promote uterine rejuvenation after abortion, conducive to improving patients' postoperative abdominal pain, promoting menstrual recovery and maintaining menstrual flow.

Is Preoperative Urine human Chorionic Gonadotropin (hCG) Testing Necessary for Pediatric Patients Before Oral and Maxillofacial Surgery Procedures?

Is Preoperative Urine human Chorionic Gonadotropin (hCG) Testing Necessary for Pediatric Patients Before Oral and Maxillofacial Surgery Procedures?

Pemeriksaan HCG (Human Chorionic Gonadotropin) Dengan Metode Latex Dan Metode Strip Test Untuk Deteksi Kehamilan

HCG (Human Chorionic Gonadotropin) is a hormone produced by young placental tissue and secreted by urine in the event of abnormal proliferation of chorionic epithelial tissue. The presence of urinary HCG can be used for pregnancy detection. Pregnancy check can be done by latex method and strip test method. This study aims to determine the description of HCG (Human Chorionic Gonadotropin) examination with latex method and strip test method for pregnancy detection. The research used Purposive sampling technique with 25 samples of pregnant women in the first trimester. The determination of gestational age in a simple way is by counting the first day of the last menstrual period (HPHT), 3 weeks, 2 people (8%), 4 week HPHT, 4 (16%), 5 week HPHT, 3 (12%) , 6-week. HPHT was 2 people (8%), HPHT 7-8 weeks there were 6 people (24%), HPHT 9- 12 weeks there were 8 people (32%). Of the 25 samples examined using two methods namely the method of latex and the method of Strip Test, all samples tested positive pregnant (100%).

An Initiative to Improve Efficiency of Emergency Department Adolescent Behavioral Health Visits.

Pediatric mental illnesses are quite prevalent in the United States and worldwide. Prevalence has been increasing, and it is estimated that 13% to 20% of US children have a mental illness that costs an estimated $247 billion per year and affects children's social, emotional, and cognitive development (Perou et al. MMWR Suppl. 2013;62:1-35). Pediatric behavioral health visits to the emergency department (ED) have been on an exponential rise constituting 5% to 7% of ED visits (Kalb et al. Pediatrics. 2019;143(4):e20182192). This requires pediatric emergency physicians to frequently manage pediatric mental health illnesses and interact with pediatric psychiatrists to create an integrated system.There is no universally accepted protocol for medical clearance of psychiatric patients (Corl et al. Med Health R I. 2008 91(11):339-341). Our medical clearance protocol comprised complete blood counts, complete metabolic panel, thyroid panel, urine toxicology screen, blood alcohol, urine human chorionic gonadotropin for females, and electrocardiogram for patients 16 years and older. These tests are obtained and have to result in pediatric ED before admission to the adolescent psychiatry unit, therefore occupying space and contributing to pediatric ED overcrowding. In an attempt to decrease our length of stay (LOS), we worked with multiple stakeholders to modify this protocol.Based on results of the data extrapolated from adult psychiatry studies (Olshaker et al. Acad Emerg Med. 1997;4(2), 124-128; Parmar et al. West J Emerg Med. 2012;13(5), 388-393; Janiak and Atteberry. J Emerg Med. 2012;43(5), 866-870). The medical clearance process was adjusted, and laboratory tests, electrocardiogram, and other ancillary studies were waived. The new protocol indicates testing based on a detailed history, physical examination, and clinical judgment. The new medical clearance protocol was initiated in December 2018. The median ED LOS for patients seen in the ED and admitted to our inpatient unit from January to November 2018 was 290 minutes in comparison with median LOS for December 2018 to December 2019 period, which was 204 minutes, showing a median reduction of 86 minutes with no adverse outcomes.The median number of encounters requiring admission in both these periods was comparable. A downstream effect of this process was also cost savings. The estimated cost savings ranged from $37.45 to $47.5 per patient, not including labor and other indirect costs. The medical clearance process is a daunting process for both patients and their families and emerging data questioning its use. Goal-directed medical clearance may be an efficient and cost-saving medical clearance for patients requiring emergent psychiatric evaluation.

Does the HCG trigger dose used for IVF impact luteal progesterone concentrations? a randomized controlled trial

Research questionIs there an association between the ovulation trigger dose of human chorionic gonadotrophin (HCG) and endogenous progesterone production during the luteal phase? DesignThis randomized controlled four-arm study, at the Fertility Clinic, Odense University Hospital, Denmark, included women undergoing gonadotrophin-releasing hormone (GnRH) antagonist IVF treatment with ≤11 follicles ≥12 mm. Group 1–3 were triggered with 5000 IU, 6500 IU or 10,000 IU HCG, respectively, receiving 17α-hydroxyprogesterone caproate intramuscularly for luteal-phase support (LPS) to measure endogenous progesterone production. Group 4 received 6500 IU HCG trigger and vaginal progesterone. During the study, the 5000 IU and 10,000 IU HCG groups were switched from urinary to recombinant HCG, as urinary HCG was removed from market. Eight blood samples were drawn during the luteal phase. ResultsNinety-four participants completed the study. There was a significant positive association between the HCG trigger dose and the progesterone at 8 days (P < 0.001), 10 days (P < 0.001) and 14 days (P < 0.001) post-oocyte retrieval. Comparing the groups individually revealed a significant difference in progesterone concentration between low and high trigger doses at 4 days (P = 0.037) and 8 days (P = 0.007) post-oocyte retrieval and between all intervention groups at oocyte retrieval + 6 days: group 1 and 2 (P = 0.011), group 2 and 3 (P = 0.042) and group 1 and 3 (P < 0.001). Higher HCG trigger dose increased the progesterone from the individual follicle. ConclusionsIncreasing HCG trigger doses significantly increased endogenous progesterone concentration during the mid–late luteal phase.

Lateral Flow Assays in Infectious Disease Diagnosis.

BackgroundLateral flow immunoassays are widely used as diagnostic tests in many applications in human and other diagnostic areas. Assays for human applications have been commercially available since the 1980s and initially were primarily used to identify pregnancy by measuring human chorionic gonadotropin in urine and serum/plasma.ContentThe first infectious disease lateral flow assays were commercialized in the late 1980s identifying the presence of Group A Streptococcus pyogenes collected with throat swabs; innumerable other applications followed in the intervening decades. The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) pandemic has brought a vast number of new assays for which emergency use authorization (EUA) has been requested in the USA. These assays have been designed for detection of the antibody response to an infection and viral antigens in respiratory samples. In view of the onslaught of new tests, this review will focus on the use of rapid lateral flow immunoassays for infectious diseases. Principles of lateral flow assays and approaches to the production of high-sensitivity point-of-care assays are presented. Market trends, customer requirements, and future directions of lateral flow assay technology and its applications in the infectious disease diagnostic space are discussed.SummaryLateral flow immunoassays play an important role in infectious disease diagnostics. Advancements in technology have led to improved performance of these assays and acceptance by professional users. With the advent of the SARS-CoV-2 pandemic, the market has reached new levels requiring hundreds of millions of tests per year for professional and even home use.

Prevalence of Empty Follicle Syndrome in King Chulalongkorn Memorial Hospital

Objective: To investigate the prevalence of empty follicle syndrome (EFS), a condition in which no oocytes were retrieved after ovarian stimulation, categorized into genuine EFS (g-EFS) and false EFS (f-EFS), at the King Chulalongkorn Memorial Hospital (KCMH), Thailand. Materials and Methods: A retrospective study was conducted at the infertility clinic of the KCMH. Medical records of the assisted reproductive technology (ART) patients between January 2001 and October 2019 (5,523 patients) were reviewed. Exclusion criteria were the cases where ovulation occurred before oocyte retrieval or the cases with less than four follicles larger than 14 mm diameter on the day of triggering ovulation to minimize the absence of oocyte from the poor response. The patients with EFS, g-EFS, which are EFS with detectable urinary human chorionic gonadotropin (hCG), and f-EFS, which are EFS with undetectable urinary hCG, were identified. Prevalence of EFS was calculated. Results: There were three cases with EFS in the present study, which g-EFS was identified in one case and f-EFS in two cases. The prevalence of EFS was 0.054%, which g-EFS was 0.018% and f-EFS was 0.036%. Conclusion: EFS is a rare condition, particularly the g-EFS. Although EFS is rare, it causes tremendous stress and anxiety to both patients and physicians. Further study in the etiopathogenesis of EFS is required. Keywords: Empty follicle syndrome; Infertility; In vitro fertilization

Utility of Nonspecific Laboratory Testing for Psychiatric Patients Undergoing Medical Screening in a Military Emergency Department.

Psychiatric complaints account for a sizable and increasing portion of emergency department (ED) visits. Compared with other medical patients, these patients often require substantial resources because of limited specialized resources and prolonged boarding times, which can be detrimental to the safety and satisfaction of other patients. This can prompt early and indiscriminate laboratory testing to expedite early requests for admission consideration. Numerous emergency medicine literature and clinical policies already recommend against indiscriminate screening labs for these patients, yet many psychiatric services require these tests. This study further evidences the limited clinical utility and high associated costs of mandatory protocol screening labs for psychiatric patients evaluated in military EDs. A retrospective chart review of 441 active duty military patients and their families presenting to Madigan Army Medical Center's ED who received psychiatric diagnoses underwent analysis. A 3-physician review panel evaluated each identified patient case to confirm eligibility and determine whether or not laboratory studies led to a change in patient disposition that was not identified by history, review of systems, physical exam, and known past medical history. The review was approved by the hospital's institutional review board. Contemporary laboratory tests ordered in the evaluation of these patients included complete blood count with differential, complete metabolic panel, thyroid-stimulating hormone, serum ethanol, serum acetaminophen, serum salicylates, urine drug screening, urinalysis, urine human chorionic gonadotropin, and electrocardiograms. Broad screening labs may have altered dispositions for 0.9% (4) of patients. In total, 93% (202) of admitted patients were dispositioned to a psychiatric service. Of the 15 patients admitted to a medical service, 10 involved overdoses or intoxication. One patient had anemia in addition to opioid use disorder as diagnoses and was dispositioned to a medicine service. One pediatric patient was admitted for observation only. The remaining patients had diagnoses based on physical exam and history requiring medical service admission. In total, 7 patients had unknown dispositions, of which 4 carried solely psychiatric diagnoses. The cumulative reimbursement costs of broad testing in the studied population were estimated at $36,325.17 and rarely altered patient disposition. Further testing does not increase the incidence of disposition altering diagnoses and is associated with increased costs. When individual state laws and the clinical assessment by the responsible emergency physician are considered, future standardized ED lab screening evaluations of psychiatric patients in military EDs may be concentrated to breathalyzer alcohol level, urine drug screen, serum salicylates, serum acetaminophen, and urine human chorionic gonadotropin.

The best execution of the DuoStim strategy (double stimulation in the follicular and luteal phase of the same ovarian cycle) in patients who are poor ovarian responders

BackgroundPatients found to be poor ovarian responders (POR) are a challenging patient population for any assisted reproduction technology. Despite attempts at various controlled ovarian stimulation schemes, reproductive outcomes in this patient population have not improved. In recent years, the DuoStim protocol (both follicular and luteal phase stimulation during the same menstrual cycle) has shown a potential for use in patients with POR.MethodsThis retrospective study reviewed the medical records of 304 women who were diagnosed as POR and underwent the DuoStim protocol. We compared follicular phase stimulation (FPS) data and luteal phase stimulation (LPS) data of the same patients. We also compared the effects of different trigger drugs including urine human chorionic gonadotropin (uHCG; 10,000 IU), recombinant human chorionic gonadotropin (rHCG; 250 μg), and gonadotropin-releasing hormone agonist (GnRH-a; 0.2 mg) at the FPS and LPS stages.ResultsPOR undergoing the DuoStim protocol resulted in a significantly higher number of oocytes retrieved, normal fertilised oocytes, cleaved embryos, cryopreserved embryos, and good quality embryos at the LPS stage than at the FPS stage. Trigger drugs at the FPS stage did not affect the FPS stage data. Regardless of the stage, rHCG and GnRH-a yielded significantly more cryopreserved embryos and good quality embryos than uHCG.ConclusionThe use of GnRH-a or rHCG as the trigger drug may be better than uHCG in both the FPS and LPS stages for POR undergoing the DuoStim protocol. This will increase the number of good quality embryos at the LPS stage. We found that the LPS stage results in more oocytes (and therefore more embryos) than the FPS stage.

Analysis of the guidance value of 3D ultrasound in evaluating endometrial receptivity for frozen-thawed embryo transfer in patients with repeated implantation failure.

BackgroundRepeated implantation failure (RIF) is currently believed by some scholars to be mainly related to the poor endometrial receptivity. Three-dimensional (3D) ultrasound, as a noninvasive examination, has attracted the most attention. This paper further discusses whether 3D ultrasound of the endometrial receptivity index has guidance value in the evaluation of pregnancy outcomes in patients with RIF following frozen-thawed embryo transfer.MethodsA total of 79 patients with RIF were retrospectively analyzed. These 79 patients which were confirmed by the transvaginal ultrasonography detection comprised 36 cases of intrauterine pregnancy, which were included in the pregnancy group, and 43 cases with biochemical pregnancy (the HCG in blood or urine is only transient and can be detected by clinical biochemical methods. The pregnancy sac cannot be seen under ultrasound) or negative results of human chorionic gonadotropin (HCG) examination, which were included in the non-pregnancy group. The endometrial thickness, uterine volume, sub-endometrial blood flow type, pulsatility index (PI) and resistance index (RI) of the spiral artery; the RI and PI of the uterine artery; and the peak systolic velocity/end diastolic velocity (S/D) of the two groups were measured and analyzed.Results(I) There were no significant differences in the age, infertility years, body mass index (BMI), anti-Müllerian hormone (AMH), endometrial thickness on the hCG injection day, estradiol (E2), and progesterone (P) between the pregnant and non-pregnant groups (P>0.05). (II) There were no significant differences in the endometrial thickness, uterine volume, and RI and PI of the uterine artery on the day before the implantation between the two groups (P>0.05). (III) There was statistical difference in the sum of the S/D of the two uterine arteries between the two groups (P<0.05) with a cutoff value of 14.47 (P<0.05). (IV) The RI and PI of the spiral artery in the non-pregnancy group were lower than those in the pregnancy group, and the difference was statistically significant (P<0.05). (V) The differences in the endometrial classification and subendometrial blood flow classification between the two groups were statistically significant (P<0.05).ConclusionsUltrasonographic endometrial blood flow classification, spiral artery blood flow parameters, and uterine artery blood flow parameters can be effective indexes for evaluating endometrial receptivity, and they have a certain clinical significance in evaluating the pregnancy outcome of RIF patients after retransplantation.

Pregnancy Reasonably Excluded Guide (PREG) Evaluation of Pregnancy Status Before Contraceptive Procedures: Improved Availability of Same-Day Insertion.

ObjectiveTo determine whether implementation of the Pregnancy Reasonably Excluded Guide (PREG) in a primary care gynecology clinic improves access to contraceptive procedures and affects the number of urine human chorionic gonadotropin (hCG) tests.Patients and MethodsPREG was administered to 981 women aged 18 to 50 years (1012 visits) who were seen in a primary care gynecology clinic for contraceptive procedures from September 30, 2015, through April 30, 2018. Contraceptive procedures included insertion of an intrauterine contraceptive (IUC) or subdermal contraceptive implant. After PREG review and patient discussion, health care professional decided to perform the procedure with or without hCG measurement or to reschedule if the patient’s pregnancy status was uncertain. We collected data on the rate of same-day contraceptive procedures and the rate of hCG testing. Data from the PREG implementation period were compared with historical data from 185 women undergoing contraceptive procedures before PREG implementation.ResultsMeasurement of hCG was performed in 53% of women before and 24.1% (224 of 1,012 visits) after PREG implementation in the primary care setting. After PREG implementation, 974 0f 1012 patients (96.2%) were eligible for a same-day contraceptive procedure. If traditional criteria, current menses, or a preexisting IUC or implant in place were required for IUC or implant insertion, only 594 patients (58.7%) would have qualified for a same-day procedure. No contraceptive procedures occurred in pregnant women.ConclusionPREG implementation allowed for same-day IUC or implant insertion in 974 women (96.2%) seen for a contraceptive procedure. Most of the women (75.9%) did not require preprocedure hCG measurement.

Metabolic changes in follicular fluids of patients treated with recombinant versus urinary human chorionic gonadotropin for triggering ovulation in assisted reproductive technologies: a metabolomics pilot study.

The main goal of this retrospective cohort study is the assessment of the effects of administration of recombinant-hCG (r-hCG) versus urinary-hCG (u-hCG) on follicular fluid (FF) composition of women who underwent in vitro fertilization (IVF) treatments. We selected 70 patients with infertility attributable to tubal diseases, unexplained infertility, and male factor. Metabolomics analysis of their FFs was performed by 1H nuclear magnetic resonance (1H NMR) spectroscopy in combination with multivariate analysis to interpret the spectral data. Univariate statistical analysis was applied to investigate the possible correlations between clinical parameters and between clinical parameters and metabolites identified by NMR. According to the type of hCG used, significant differences were detected in FFs of women with male factor and unexplained infertility, both in qualitative and quantitative terms, for some metabolites as cholesterol, citrate, creatine, β-hydroxybutyrate, glycerol, lipids, amino acids (Glu, Gln, His, Val, Lys) and glucose. No significant difference was observed in women with tubal diseases. Besides, the number of MII oocytes in the u-hCG-treated groups correlates positively with glutamate in tubal disease and with glycerol in unexplained infertility. In the r-hCG-treated groups, the number of MII oocytes correlates positively with lipid in tubal disease, positively with citrate and negatively with glucose in male infertility. Metabolite composition of FF changes according to different type of hCG treatment and this can be related to oocyte development and subsequent outcome. According to the data of this study, different types of hCG should be used in relation to the diagnosis of infertility to obtain better results in inducing oocyte maturation in women undergoing IVF.