β-hCG Test Research Articles

Weight Regain following Bariatric Surgery and in vitro Fertilization Outcomes

Introduction: The aim of this study was to estimate the time to pregnancy and live birth and evaluate the effect of weight regain in women with a history of bariatric surgery (BS) who underwent in vitro fertilization (IVF) treatments. Methods: This is a retrospective cohort study. All patients with previous BS who underwent IVF treatment in a tertiary university-affiliated hospital between 2013 and 2022 were included. Time to pregnancy and live birth were compared between patients who regained less than or greater than three points of body mass index (BMI) from the nadir weight after BS. Kaplan-Meier curves and log-rank tests were used to compare groups. Results: A total of 78 patients were included in this study. The positive β-hCG, clinical pregnancy, and live birth rates following BS were 89.4%, 78.9%, and 50.8%, respectively. The median time from the beginning of IVF treatments to a positive β-hCG test was 2.97 months (95% CI: 1.04–4.89 months), to a clinical pregnancy was 7.1 months (95% CI: 3.56–10.91), and to a live birth was 20.2 months. Women who maintained their nadir BMI following BS had nearly twice the chance of achieving a clinical pregnancy (HR 1.967, 95% CI: 1.026–3.771, p = 0.042) and were approximately three times more likely to achieve a live birth (2.864, 95% CI: 1.196–6.859, p = 0.018) than those who regained at least three points of BMI. Conclusion: Weight regain after BS is associated with a lower rate of live births and prolonged time to achieve clinical pregnancy and live birth.

P-799 Augmenting endometrial thickness and implantation rates: investigating the efficacy of autologous blood cell derivative - endosera in women struggling with thin endometrium and infertility

Abstract Study question Could autologous platelet derived growth factor based strategies promote endometrial growth in women with refractory thin endometrium resulting in sustained implantation and live births? Summary answer Autologous platelet derived growth factor based strategies remarkably promote endometrial thickness and receptivity in women with refractory thin endometrium and pregnancy outcomes What is known already Repeated implantation failure (RIF) attributed to thin endometrium poses significant challenge in reproductive medicine. In cases where conventional treatments prove ineffective, couples often contemplate stressful option of surrogacy. Regenerative strategies, such as platelet-rich plasma (PRP), exhibit promise by capitalizing on anti-inflammatory and pro-regenerative attributes of platelet-derived growth factors. Recognizing the imperative for anti-inflammatory microenvironment conducive to successful implantation, Endosera, a cell-free growth factors concentrate tailored for implantation has been formulated. This study seeks to evaluate the effectiveness of Endosera in augmenting endometrial thickness and implantation rates, offering potential remedies for RIF and thin endometrium. Study design, size, duration In this prospective self-controlled study 62 women (24-47 years) were enrolled spanning May 2021 to December 2023. Women experienced >2 failed IVF cycles and multiple cycle cancellations due to refractory thin endometrium with poor endometrial receptivity defined as endometrial thickness of < 7mm despite standard medical therapy, abnormal endometrial pattern and suboptimal endometrialvascularity, negative hysteroscopic screening for endometrial pathology, and negative bacteriologicscreening and despite multiple failed conventional therapies were selected to undergo Endosera treatment. Participants/materials, setting, methods After obtaining informed consent, patients underwent three intrauterine infusions of Endosera on menstrual cycle Day 7, Day 12, and 2 days before frozen embryo transfer (FET). Alongside standard hormone replacement therapy (HRT), 0.8 ml of Endosera was introduced into the uterine cavity. Pregnancy confirmation relied on a positive serum β-HCG test two weeks post-ET, while clinical pregnancy was established by detecting fetal heartbeat through transvaginal ultrasound four weeks post-ET. Main results and the role of chance In this study involving 62 patients facing multiple cancelled IVF cycles due to refractory thin endometrium, the administration of three doses of Endosera demonstrated significant positive outcomes. Average endometrial thickness notably increased from 6.2 ± 1.2 mm to 8.4 ± 1.2 mm (P < 0.0001) after the 2nd Endosera dose, reaching an optimal thickness of ≥ 8mm. Among the participants, 43 achieved positive pregnancy result (69.4%), with 26 (41.9%) delivering healthy babies and 7 (11.3%) uneventful ongoing pregnancies. Poor outcomes included for 2 (3.2%) patients cycle was cancelled due to no endometrial improvement 5(8.1%) miscarriages before 10 weeks, while 12 (19.4%) women didn’t conceive and for 4.8%(3) patients results awaited post ET. No adverse effects were reported, indicating safety of Endosera.Cumulative positive pregnancy outcomes recorded to be 53.2% (33). The formulation, standardized to contain 6-9 times higher growth factor levels than peripheral blood, emphasizes implantation-friendly and anti-inflammatory cytokines. This optimized composition aligns with cyclical requirements of the endometrial phases (proliferation, secretion, and implantation), creating an angiogenic and anti-inflammatory environment crucial for successful implantation. Endosera’s safety, reproducibility, and efficacy in mimicking natural tissue repair and regeneration processes position it as promising solution for refractory thin endometrium-related challenges. Limitations, reasons for caution This study, though demonstrating improved outcomes in refractory thin endometrium cases with Endosera treatment, acknowledges limitations such as a small sample size and absence of a randomized control group. To establish Endosera as a routine adjuvant in IVF, larger study with stringent inclusion criteria for refractory thin endometrium is recommended. Wider implications of the findings Endosera demonstrated notable success with significant improvement in implantation, pregnancy, and live birth rates for refractory thin endometrium patients prompts rigorous randomized controlled studies. These will include diverse populations, validating results and offering patients hope to reduce financial and psychological stress and challenges associated with cycle cancellations and surrogacy. Trial registration number Not Applicable

P-305 Enhancing endometrial thickness and implantation rates: a study on the effectiveness of autologous blood cell derivative - endosera in infertile women with thin endometrium

Abstract Study question Could personalized regenerative medicine based strategies promote endometrial growth and receptivity in women with refractory thin endometrium resulting in successful implantation and live births? Summary answer Personalized regenerative medicine based strategies remarkably promote endometrial growth and receptivity in women with refractory thin endometrium resulting in successful implantation and live births. What is known already Repeated implantation failure (RIF) due to thin endometrium is a formidable challenge in reproductive medicine, often steering couples toward the stressful option of surrogacy. Regenerative approaches like platelet-rich plasma (PRP) have shown promise, leveraging the anti-inflammatory and pro-regenerative properties of platelet-derived growth factors. Recognizing the need for an anti-inflammatory milieu for successful implantation, Endosera, a cell-free implantation-friendly growth factors concentrate, has been developed. This study at Bloom IVF Centre-Mumbai, India, aims to assess Endosera’s efficacy in enhancing endometrial thickness and implantation rates, providing potential solutions for RIF and thin endometrium. Study design, size, duration In this prospective self-controlled study 72 women (27-49 years) were enrolled spanning December 2022 to December 2023. Women experienced two or more failed IVF cycles and multiple cycle cancellations due to refractory thin endometrium, negative hysteroscopic screening for endometrial pathology, and negative bacteriologic screening and despite multiple failed conventional therapies were selected to undergo Endosera treatment. Participants/materials, setting, methods After obtaining informed consent, patients underwent three intrauterine infusions of Endosera on menstrual cycle Day 7, Day 12, and 2 days before frozen embryo transfer (FET). Alongside standard hormone replacement therapy (HRT), Endosera was introduced into the uterine cavity. Pregnancy confirmation relied on a positive serum β-HCG test two weeks post-ET, while clinical pregnancy was established by detecting fetal heartbeat through transvaginal ultrasound four weeks post-ET. Main results and the role of chance In this study involving 72 patients facing recurrent implantation failure due to refractory thin endometrium, the administration of three doses of Endosera demonstrated significant positive outcomes. The average endometrial thickness notably increased from 6.4 ± 1.1 mm to 8.7 ± 1.0 mm (P < 0.0001) after the 2nd Endosera dose, reaching an optimal thickness of ≥ 7mm. Among the participants, 34 achieved a positive pregnancy result (47.2%), with 6 (8.3%) delivering healthy babies and 23 (31.9%) experiencing ongoing clinical pregnancies. Adverse outcomes included 2 (2.8%) ectopic pregnancies and 3 (4.2%) miscarriages before 10 weeks, while 36 (50%) women returned negative HCG results. No adverse effects were reported, indicating the safety of Endosera. The formulation, standardized to contain 6-9 times higher growth factor levels than peripheral blood, emphasizes implantation-friendly and anti-inflammatory cytokines. This optimized composition aligns with the cyclical requirements of the endometrial phases (proliferation, secretion, and implantation), creating an angiogenic and anti-inflammatory environment crucial for successful implantation. Endosera’s safety, reproducibility, and efficacy in mimicking natural tissue repair and regeneration processes position it as a promising solution for refractory thin endometrium-related challenges. Limitations, reasons for caution This study, though demonstrating improved outcomes in refractory thin endometrium cases with Endosera treatment, acknowledges limitations such as small sample size and absence of a randomized control group. To establish Endosera as a routine adjuvant in IVF, a larger study with stringent inclusion criteria for refractory thin endometrium is recommended. Wider implications of the findings Endosera demonstrated notable success with significant improvement in implantation, pregnancy, and live birth rates for refractory thin endometrium patients prompts rigorous randomized controlled studies. These will include diverse populations, validating results and offering patients hope to reduce financial and psychological stress and challenges associated with cycle cancellations and surrogacy. Trial registration number Not applicable

Sonographic vascularity indices' study in ectopic pregnancies, after methotrexate treatment

ObjectivesEctopic pregnancy is a crucial problem in Gynaecology. Previous studies concerning the medical treatment of ectopic pregnancies, have used only β-hCG (beta- human chorionic gonadotropin) values, to monitor the successful response to treatment. The current study was a PhD (Doctorate of Philosophy) thesis research, which has evaluated the vascularity indices’ changes. The values of vascularity indices could be used, in combination with β-hCG values and the gestational sac dimensions, in every medically treated ectopic pregnancy. The results could be used, for monitoring the course of all medically treated ectopic pregnancies. Study design72 women of reproductive age have taken part in the study. They have been admitted due to secondary amenorrhea, positive β-hCG test, with or without vaginal bleeding. The participants took part voluntarily and were allocated in two groups. The first group consisted of 37 women, who were possible normal or threatened intrauterine pregnancies (control group). The second group consisted of 35 women, whose sonographic findings suggested ectopic pregnancy, and qualified for methotrexate treatment (study group). Sonographic control and measurement of the vascularity indices (PI – RI) (Pulsatility index – Resistance index) of the ectopic pregnancy was conducted, in combination with β-hCG values for every admitted or outpatient woman.The dimensions of the gestational sac of both groups were measured during four consecutive periods of time. The control group has shown progressively increasing sac dimensions, whereas, in the study group sac dimensions were more stable or growing gradually smaller. The exception where those ectopic pregnancies that ruptured, which have also shown a gradual enlargement of the sac. ResultsThe endometrial thickness of the study group was gradually decreasing up to 76 % per day, and the more eminent, but not statistically significant decrease, was observed in the single dose regiment of methotrexate. Moreover, the quantitative PI and RI were evaluated, and the main finding was that there were no statistically significant decreases in any of the two groups. Concerning the study group, methotrexate treatment was successful, since there was a decrease of up to 80 %, whereas a clearly significant correlation was found between the β-hCG levels and the RI. ConclusionThe vascularity indices could be used safely, in combination with β-hCG levels and the decrease of the gestational sac dimensions, as criteria for the evaluation of response to medical treatment of ectopic pregnancies.

Double vitrification of embryos adversely affects clinical outcomes.

To evaluate the impact of double embryo vitrification on clinical outcomes. This retrospective cohort study included data from January 2013 to March 2021. The study group included women aged 33.3±5.7 years with double-vitrified embryos (n=381), while the control group included women aged 32.1±6.7 years with embryos vitrified once (n=780), all transferred at the blastocyst stage. The primary endpoint was live birth rate (LBR), and secondary endpoints included percent positive βHCG test, clinical/ongoing pregnancy rates, miscarriage/biochemical pregnancy rates and birthweight. LBR was significantly lower in double-vitrified embryos (30.2%) than in embryos vitrified once (45.6%, p<.05). Similarly, double-vitrified embryos were associated with significantly lower positive βHCG tests (46% vs. 63.3%, p<.05) and clinical (34.9% vs. 52.2%, p<.05) and ongoing pregnancy (31.3% vs. 47.3%, p<.05) rates compared to embryos vitrified once. However, biochemical pregnancy (double vitrified: 24.1% vs. vitrified once: 17.9%, p>.05) and miscarriage rates (double vitrified: 10.2% vs. vitrified once: 9.4%, p>.05), as well as mean birthweight (double-vitrified embryos: 2950g vs. embryos vitrified once: 2837g, p>.05) did not differ significantly between two groups. On a secondary comparison, amongst double-vitrified embryos, the subgroup that was cultured for more than 24 hours between warming and second vitrification achieved significantly higher positive βHCG tests (49%) and clinical pregnancy (38%) rates, compared to embryos re-vitrified on the same day of warming (31.8% and 20.5%, respectively, p<.05). Nevertheless, LBR did not differ significantly amongst these study-group embryos (embryos that remained in culture for more than 24 hours: 32.2% vs. embryos that were re-vitrified on warming day: 20.5%, p>.05). Double vitrification of embryos adversely affects clinical outcomes. However, it represents a valuable option concerning embryo wastage, with acceptable success rates.

The POPI-Plus tool: prediction model of outcome of pregnancy in in vitro fertilization from a large retrospective cohort

To create a tool that accurately predicts live birth chances after a positive pregnancy test after elective single embryo transfer (ET). Retrospective cohort. CHUM hospital and Ovo clinic in Montreal, Canada. Patients with a positive pregnancy test result who underwent their first single ET after invitro fertilization (IVF) at the CHUM hospital and Ovo clinic in Montreal, Canada, from 2012 to 2016 were selected. A total of 1,995 patients were included in this study. The data from both centers were combined and divided into training (70%, n = 1,398) and validation (30%, n = 597) sets. The predictive model was developed using backward selection method for the following variables: age of patient at egg retrieval; log β-human chorionic gonadotropin (β-hCG) (β-hCG) 1; log β-hCG 2; and IVF treatment type. Moreover, the classification tree, random forest, and neural network models were generated. The measured outcomes were live birth (live fetus ≥24 weeks of gestation) and nonviable pregnancies. The performance of all models was evaluated by area under the receiver operating characteristic curve (AUC). Advancing age was negatively correlated with live birth. The odds ratio (OR) of age of patient at the time of egg retrieval was 0.95 (95% confidence interval [CI], 0.91-0.99). The log β-hCG 1 and log β-hCG 2 were positively correlated with live birth in the univariate analysis (OR, 4.15 [95% CI, 3.19-5.39], and OR, 3.84 [95% CI, 2.99-4.93], respectively). The β-hCG 1 level needed for a successful pregnancy was lower in frozen ET and modified natural IVF than in simulated IVF (OR, 0.55 [95% CI, 0.34-0.91], and OR, 0.49 [95% CI, 0.26-0.95], respectively). The best performance in terms of the AUC was the updated logistic model: POPI-Plus. The AUC values were 0.76 (95% CI, 0.73-0.79) and 0.78 (95% CI, 0.74-0.82) for the training and validation data, respectively. The other models (classification tree, random forest, and neural network) also performed adequately, with an AUC of ≥0.7, but remained below POPI-Plus. An open-access calculator was generated and can be found on the website of the University of Montreal on the following link: https://deptobsgyn.umontreal.ca/departement/divisions/medecine-et-biologie-de-la-reproduction/the-popi-plus-tool/. The POPI-Plus tool offers individualized counseling for patients after an initial positive β-hCG test result. Future studies will assess its impact on patient anxiety while awaiting viability ultrasound and perform prospective validation on new patients.

Initial β-hCG levels and 2-day-later increase rates effectively predict pregnancy outcomes in single blastocyst transfer in frozen-thawed or fresh cycles: A retrospective cohort study.

To investigate whether the initial beta-human chorionic gonadotropin (β-hCG) levels and their rate of increase differ after single fresh and frozen blastocyst transfers, and whether these values effectively predict pregnancy outcomes. This retrospective cohort study was conducted at the Sisli Memorial Hospital, assisted reproductive technology, and Reproductive Genetics Center in Istanbul, Turkey, between January 2016 and January 2022. Three thousand two hundred thirty-eight single blastocyst transfers with positive pregnancy test results were evaluated. Of these, 738 were fresh transfer cycles and 2500 were frozen-thawed embryo transfer (FET) cycles. β-hCG test results from 9 days after fresh and FET cycles were compared between the groups with biochemical pregnancy, early pregnancy loss, and live birth outcomes. The threshold values were determined for each pregnancy outcome. The rate of increase between the first and second β-hCG tests performed 2 days apart was determined for each pregnancy outcome. Finally, the listed values were compared between the FET and fresh cycle. Mean baseline β-hCG levels were significantly higher in FET cycles than in fresh cycles, regardless of pregnancy outcomes (P < .005). Baseline β-hCG levels were higher in fresh cycles with live births (171.76 ± 109.64 IU/L) compared to biochemical and clinical pregnancy losses (50.37 ± 24.31 and 114.86 ± 72.42, respectively) (P < .001). Live births in FET cycles resulted in higher baseline β-hCG levels (193.57 ± 100.38 IU/L) compared to biochemical and clinical pregnancy loss groups (68.41 ± 51.85 and 149.29 ± 96.99 IU/L, respectively) (P < .001). The β-hCG threshold for live birth for fresh cycles was 116.5 IU/L (sensitivity 80%, specificity 70%, positive predictive value 90%, negative predictive value 54%) and 131.5 IU/L for FET cycles (sensitivity 71%, specificity 68%, positive predictive value 87%, negative predictive value 50%). The percentage of the area under the curve for single fresh blastocyst transfers was 0.81 and 0.76 for frozen transfers. The rate of increase in β-hCG was similar in fresh and FET cycles. Initial β-hCG levels and 2-day increases are effective parameters for diagnosing pregnancy in fresh and FET cycles. The initial β-hCG level was significantly higher in the FET cycles than in the fresh cycles. Predicting outcomes earlier helps clinicians to manage and follow high-risk pregnancies.

Tubal superfetation following frozen-thawed single-embryo transfers in two separate cycles: Case report and literature review.

Superfetation is a very rare occurrence. In the context of assisted reproduction, it has been reported only as an intrauterine pregnancy after ovarian stimulation and/or embryo transfer in the presence of an undiagnosed ectopic pregnancy. Here we report a case of a 27-year-old anovulatory patient, gravida 1 para 1, who underwent two frozen-thawed single-blastocyst transfers in separate cycles. The patient reported that 12 days after the first transfer, she had menstrual bleeding and stopped her estradiol and progesterone supplementation without undergoing a blood human chorionic gonadotropin (βhCG) test. At her request, a second cycle was immediately initiated, with endometrial thickness measuring 4 mm. Eleven days after the second transfer, the βhCG value was inappropriately high. A right tubal pregnancy corresponding to 8 gestational weeks was diagnosed. Laparoscopy revealed a prominent right tubal pregnancy in addition to a significantly smaller left tubal pregnancy. The discordant tubal pregnancies were confirmed histologically. To our knowledge, superfetation involving a second ectopic pregnancy coexistent with a first, contralateral ectopic pregnancy consequent to consecutive in vitro fertilization procedures has not previously been described in the medical literature. This case emphasizes the importance of routine βhCG testing after every IVF cycle, even if apparently unsuccessful.

Characteristics of Referral Patients with Gestational Trophoblastic Neoplasia in Dr. Hasan Sadikin General Hospital Bandung

Background: : Gestational trophoblastic disease (GTD) is a heterogeneous group of lesions caused by abnormal trophoblast proliferation and the malignant form is called gestational trophoblastic neoplasia (GTN). Dr. Hasan Sadikin General Hospital, located in Bandung, West Java, is one of the main cancer referral hospitals in Indonesia. Consequently, the characteristics of GTN patients in this hospital can represent the general population in the province. This study aimed to elaborate on the characteristics of referral patients with GTN in Dr. Hasan Sadikin General Hospital.Methods: : Medical records of post-molar GTN patients in Dr. Hasan Sadikin General Hospital from between January 2019 to December 2020 were collected and analyzed. GTN was diagnosed according to the International Federation in Gynecology and Obstetrics (FIGO) criteria. Additionally, both the sociodemographic and clinical characteristics of patients were evaluated.Results: The results showed that among the 160 participants in this study, the overall mean age was 33±8.7 years, with a mean βhCG level of 241,461.81±630,557.90 mIU/mL. Moreover, approximately 16.3% had gestosis and 5% were diagnosed with hyperthyroidism. The majority of post-molar observations at the hospital were not carried out according to standards, with only 8.1% of patients receiving optimal surveillance. About 56.8% visited the hospital due to vaginal bleeding, while most histopathological results showed complete hydatidiform moles (44.4%), and choriocarcinomas (16.3%). Most of the patients were diagnosed as stage I (81.9%), had lowrisk FIGO scores (80.6%), and were treated with methotrexate (80.6%).Conclusions: GTN patients in Dr. Hasan Sadikin General Hospital showed clinical characteristics consistent with previous studies. The low percentage of patients receiving optimal post-molar surveillance could cause delayed referral. This suboptimal surveillance might be due to the high cost of βhCG testing, lack of facilities, and low patient compliance in West Java

Case Report: Breaking barriers - Pregnancy achieved by intracytoplasmic sperm injection of a zona-free oocyte

The zona pellucida is a protective layer surrounding the oocytes and early-stage embryos. It is said to be essential for the process of fertilisation and protecting the pre-implantation embryo. Absence of zona pellucida can pose great problems during in vitro fertilisation (IVF), like impaired fertilisation, polyspermy and hindered embryo development, thus leading to a low implantation rate and unsuccessful pregnancy outcome. This case report demonstrates the successful treatment of primary infertility in a 35-year-old female with significantly low anti-Mullerian hormone (AMH) levels and limited ovarian reserve. Her husband (41 years) had oligoasthenozoospermia. The couple had been trying to conceive for two years before seeking medical assistance. Following an unsuccessful intrauterine insemination (IUI) attempt, the decision was made to pursue IVF with ovarian stimulation. Two oocytes were retrieved after ovum pickup, one of which was at the germinal vesicle (GV) stage and later degenerated, while the other was without the zona pellucida. In this case, the intracytoplasmic sperm injection (ICSI) of zona-free oocyte was chosen to prevent polyspermy, resulting in successful fertilization. The embryo progressed to the eight-cell stage and was transferred on day three. A positive beta-human chorionic gonadotropin (β-hCG) test confirmed pregnancy fourteen days later. In assisted reproductive techniques (ART), zona-free oocytes are a common occurrence, but fertilizing those oocytes is not common; they are usually considered to be of no use and rejected. In the present case, we realized that zona-free gametes are not only capable of getting fertilized and developing into good-quality embryos, but also give successful pregnancy outcomes.

O-132 Comparison of pregnancy rates in antagonist cycles after luteal support with GnRH-agonist versus progesterone – prospective randomized study

Abstract Study question Are pregnancy rates in GnRH-antagonist cycles triggered with hCG and luteal phase support (LPS) with intranasal GnRH-agonist or vaginal progesterone comparable? Summary answer Nasal GnRH-agonist for LPS is associated with higher pregnancy rates compared with standard progesterone support in antagonist-based cycles triggered with hCG What is known already Regardless of its mechanism of action, the use of GnRH-a during the luteal phase in addition to progesterone, either in a single or multiple doses, has become a common practice as a part of ART protocols, based on its association with higher pregnancy and live birth rates . Its use as a sole agent for LPS has not gained the same popularity although studies supporting non-inferiority and even higher live birth rates with GnRH-a as a sole LPS agent have been published. Study design, size, duration A single-center, prospective, randomized study. A total of 150 patients underwent 164 GnRH-antagonist-based IVF cycles triggered with hCG and fresh embryo transfer. The study was conducted between June 9th, 2020, and May 5th, 2022. Participants/materials, setting, methods The study was conducted in the IVF clinic at University-affiliated tertiary medical center. Patients meeting the inclusion criteria who underwent antagonist-based IVF cycles and hCG triggering were enrolled. Computer-based randomization (1:1 ratio) was performed on the day of oocyte pickup (OPU). In both groups LPS was initiated on the evening of the OPU day with either GnRH-agonist nasal spray (Nafareline, nasal spray 200 mcg twice daily)or vaginal micronized progesterone (Utrogestan 300 mg, 3 times daily). Main results and the role of chance A total of 150 patients underwent 164 cycles, 127 cycles of which were included in the study cohort. Of them, 64 (50.4%) and 63 (49.6%) cycles were treated with GnRH-agonist or progesterone respectively as sole luteal phase support. A significantly higher pregnancy rate was found in the GnRH-a group compared with the progesterone group (43.8% versus 25.4% respectively; P = 0.030). After adjustment of several potential confounders such as age, body mass index (BMI), past obstetric history, number of IVF cycles, oocytes retrieved and embryos transferred, GnRH-agonist was still associated with a higher pregnancy rate (odds ratio 3.4, 95% confidence interval 1.4-8.3). Ovarian hyperstimulation syndrome (OHSS) rates were similar between the groups. Significantly higher progesterone levels were measured at β-hCG testing day in the GnRH-a group, both for the cleavage stage embryos (129.1±23.7 nmol/L vs. 97.7±48.9 nmol/L, P = 0.024) and for the blastocysts (127.2±0.1 nmol/L vs. 75.3±49.1 nmol/L, P = 0.034). Limitations, reasons for caution This study is not powered for analysis of clinical pregnancy rates, live birth rates and pregnancy outcomes. Larger studies are needed for research of these outcomes. All patients participating were at low risk for OHSS, therefore the study is underpowered to find significant differences in early or late OHSS.Wider implications of the findings Our findings suggest that intranasal GnRH-agonist administration as a sole luteal support in antagonist-based IVF cycles triggered with hCG results in higher pregnancy rates in comparison with traditional irritating vaginal preparations while not mandating additional support in the first weeks of pregnancy. Trial registration number Clinicaltrials.gov - NCT05484193

Metabolic Syndrome and Assisted Reproductive Techniques.

Metabolic syndrome is a risk factor affecting reproductive health and pregnant outcomes. So far, the effect of this syndrome on the success rate of assisted reproduction techniques (ART) has not been investigated. The aim of this study was to investigate the relationship between metabolic syndrome and the success rate of ART in infertile women in Isfahan. A prospective cohort study performed on 147 women candidates using in-vitro fertilization/intra cytoplasmic sperm injection (IVF/ICSI) and/or ICSI methods referred to Isfahan Infertility Center in two groups with metabolic syndrome(n=49) without metabolic syndrome(n=98), by convenience sampling methods in Isfahan, Iran in 2018. Body mass index (BMI) and waist, abdominal circumference, Serum triglyceride (TG), cholesterol and FBS were measured. If βHCG test was positive (day 15-16 after ART), transvaginal sonography (TVS) was done 15 days later. Pregnant women were followed up to the 20th week of pregnancy. To analyze, t-test, chi-square and logistic regression tests were used. The frequency of metabolic syndrome was 33.4% (n=49). The frequency of ART was not significantly different between women with and without metabolic syndrome (p=0.321). The relative frequency of pregnancy (p=0.907) and abortion (p=0.896) did not show a significant difference between the two groups. Independent t-test showed that the mean FBS, HDL, TG, systolic and diastolic BP, abdominal circumference and BMI in the studied units did not differ significantly based on the occurrence of pregnancy and abortion. According to the results of this study, there was no significant difference between the indicators of metabolic syndrome and the success rate of ART in achieving, pregnancy and pregnant outcomes in the first twenty weeks of pregnancy.

In vitro fertilization outcomes In infertile women with adenomyosis

Objectives: This study aimed to investigate the efficacy of in vitro fertilization (IVF) in infertile patients with adenomyosis and to identify relevant factors. Subjects and methods: Retrospective descriptive study of infertile cases with adenomyosis who received IVF therapy and embryo transfer from November 2013 to October 2022 at the Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy Hospital, excluding cases of oocyte donation or surrogacy. The β-hCG test was examined two weeks following embryo transfer. Then, women with hCG positive test were followed the pregnancy at 6 weeks, 8 weeks, and 12 weeks, and examined some factors that influence the clinical outcome of pregnancy. Results: Among 61 cycles of IVF treatment for infertile patients with adenomyosis, the average number of retrieved oocytes was 10.9±6.6 oocytes. The percentage of mature oocytes was 82.7%, the fertilization rate was 79.5%, the implantation rate was 16.7%, the clinical pregnancy rate was 19.7%, the miscarriage rate was 6.6%, and the ongoing pregnancy rate was 13.1%. In the group with GnRH agonist administration before embryo transfer, the pregnancy rate was greater than in the group without therapy (29.2% vs. 13.5%), and th e pregnancy rate in the group with &gt; 10 oocytes was higher than in the group with ≤ 10 oocytes (28.0% vs 13.5%). However, these differences were not statistically significant (with p &gt; 0.05). The cut-off point of endometrial thickness on the day of hCG injection, 10.25 mm, had a sensitivity of 58.3%, a specificity of 81.6%, an area under the curve (AUC) of 75.6%, and a p-value of 0.006; the cut-off point of endometrial thickness on the day of embryo transfer, 9.75 mm, had an accuracy of 9.75 mm. sensitivity 75%, specificity 71.4%, AUC 78.50%, p = 0.002 for clinical pregnancy prognosis. Conclusion: The IVF treatment of infertile patients with adenomyosis remains challenging, and additional research is required to explain the influence of this disorder on IVF outcomes. Key words: in vitro fertilization (IVF), adenomyosis, β-hCG.

A rare case of primary extragenital choriocarcinoma in the spleen presenting as acute abdominal pain

Abstract Objectives This study reports a rare case of primary extragenital choriocarcinoma in the spleen presenting as acute abdominal pain. We expect this case to provide more valuable information for clinicians in the future. Case presentation The patient was a 22-year-old woman, with a healthy child and a history of bilateral ovarian cyst resection a week before, who presented with severe and sudden pain in the left upper abdomen. The patient was admitted to the emergency department. Emergency ultrasound revealed a huge solid mass in the enlarged spleen. Emergency computed tomography examination suggested acute splenic rupture. Microscopic examination confirmed that the mass contained nested syncytiotrophoblast and cytotrophoblast cells, and the serum beta-human chorionic gonadotropin (β-hCG) level was 54,547.6 IU/L (normal β-hCG level &lt;5 IU/L) after surgery. Primary extragenital choriocarcinoma in the spleen was considered as the cause of splenic rupture. Conclusions Primary extragenital choriocarcinoma of the spleen is extremely rare. Serum β-hCG tests and systemic abdominal ultrasonography are of great value for the diagnosis of the disease.

Comparison between implantation rate of two and three embryo transfers at cleavage- and blastocyst-stage: A three-year retrospective single-center cohort study from a developing country.

In sub-Saharan Africa, multiple embryo transfer is common among fertility clinics for various reasons including endometrial receptivity, number of viable embryos, patient choice, and clinic policy. The study was based on a retrospective analysis of data obtained at the Medical Art Center, Lagos, Nigeria, from January 2018 to December 2020. 518 out of 576 cycles met the inclusion criteria for this study. Implantation was confirmed using β-hCG test results. Our study revealed no significant difference between the total implantation rate of 2-ET and 3-ET. However, there was a significantly higher implantation rate in the 2-ET fresh blastocyst transfer when compared with the 3-ET. 3-ET does not have an implantation rate advantage over 2-ET. Hence, 2-ET is safer to employ when compared to 3-ET for patients in developing countries who cannot afford aneuploidy test for single embryo transfer.

MP30-19 HUMAN SPERM IGF2 mRNA LEVELS INVERSELY CORRELATE WITH EMBRYO GROWTH VELOCITY DURING EARLY STAGE OF EMBRYO DEVELOPMENT

You have accessJournal of UrologyCME1 Apr 2023MP30-19 HUMAN SPERM IGF2 mRNA LEVELS INVERSELY CORRELATE WITH EMBRYO GROWTH VELOCITY DURING EARLY STAGE OF EMBRYO DEVELOPMENT Rossella Cannarella, Scott Lundy, Nina Desai, Sarah Vij, and Aldo E. Calogero Rossella CannarellaRossella Cannarella More articles by this author , Scott LundyScott Lundy More articles by this author , Nina DesaiNina Desai More articles by this author , Sarah VijSarah Vij More articles by this author , and Aldo E. CalogeroAldo E. Calogero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: IGF2 is a potent growth factor capable of influencing cell division and modulating numerous cellular functions. IGF2 mRNA has been identified in human spermatozoa, but little is known about its function in in early embryo development. The aim of this study is to evaluate whether IGF2 levels in spermatozoa is associated with early growth kinetics of human embryos in couples undergoing ICSI. METHODS: This study was conducted on patients undergoing ICSI treatment with fresh oocytes and fresh ejaculated spermatozoa. Couples with infertility due to suspected female factor (e.g., impaired oocyte quality as in patients with severe endometriosis and premature ovarian failure) were excluded from the study. Following clinical use, a surplus aliquot of the semen sample used for ICSI was used to analyze the levels of IGF2 mRNA. The kinetic parameters of each embryo were correlated with the amount of IGF2 mRNA measured in the same swim-up sperm sample used for ICSI. RESULTS: 16 patients were enrolled and a total of 131 embryos were collected. Patients were divided into two groups based on the βhCG test results. We found no statistically significant difference in IGF2 mRNA levels and embryo morphokinetic parameters between the two groups (Table 1). At the correlation analysis, we found a significant negative correlation between sperm IGF2 mRNA levels and the time of pronuclei (tPN) fading (r= -0.2572, p= 0.0078, n=106 embryos), and between sperm IGF2 mRNA and t2 (r= -0.2368, p= 0.0145, n=106 embryos). In contrast, sperm IGF2 mRNA levels were not significantly correlated with tPN, t3, t4, t5, t6, t7, t8, t9, t morula (tM), t blastocyst (tB), and time of expanded blastocyst (tEB) (Table 1). CONCLUSIONS: These results suggest a role for sperm IGF2 mRNA in the very early embryo development (tPN fading -t2). This evidence may help in identify the etiology of apparently idiopathic couple infertility. Indeed, since prolonged t2 has been associated with a poor chance of embryo development into a viable blastocyst, a low level of sperm IGF2 mRNA level can delay t2 and lead to no blastocyst formation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e398 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rossella Cannarella More articles by this author Scott Lundy More articles by this author Nina Desai More articles by this author Sarah Vij More articles by this author Aldo E. Calogero More articles by this author Expand All Advertisement PDF downloadLoading ...

Factors Affecting Pregnancy Rate in Infertile Women Underwent in Vitro Fertilization / Intracytoplasmic Sperm Injection Cycle

Intracytoplasmic sperm injection is more being used for non-male factor indications, although it was developed for overcoming infertility of males because pregnancy rate of in vitro fertilization is still &lt; 40%. This work aims at evaluating the vitro sperm injecting cycle fertilization/ Intracytoplasmic efficiency in infertile women and the factors that predicting clinical pregnancy rate. Al-Nahrain University at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, we conducted a randomized clinical trial from 1st Sep. 2018 to 1st Sep. 2020. 40 women complaining from infertility underwent IVF / ICSI protocols were sampled for this work. Positive serum βhCG test were used to evaluate pregnancy r, two weeks following transferring embryo. In this study, 12 infertile women got pregnant with pregnancy rate of 30%. Duration of stimulation, number of mature eggs, fertilized eggs, and grade I transferred embryo, and changes in percentages in endometrial zone at day of pickup in comparison with that at day of hCG were significantly higher (P &lt; 0.05) in pregnant women than those who were not pregnant. Failure rate of pregnancy is still high and the most important factors that associated with failure of IVF/ICSI outcome were short duration of gonadotropin stimulation, few number of mature eggs and embryos, and suboptimal endometrial receptivity. Keywords: IVF, ICSI, infertility, pregnancy rate, predictors, Iraq.

Luteal function in cyclic goats treated with human chorionic gonadotropin administered by intramuscular or intravaginal routes at the time of artificial insemination.

Human chorionic gonadotropin (hCG) has been used to improve goats reproductive efficiency. This study aimed to (i) evaluate if hCG administered by the intramuscular (i.m.) or intravaginal (i.vag.) route can be detected by a rapid β-hCG test in blood plasma samples and (ii) document ovarian effects of hCG administered by both routes at the time of artificial insemination (AI) performed 60 h after oestrus synchronization in goats. Twenty-two Alpine goats received two i.m. injections of 30 μg of d-cloprostenol (Prolise®, Tecnopec, São Paulo, Brazil) 7.5 days apart. One day after the onset of oestrus (at the time of AI), the goats were randomly allocated to one of the three groups that received: control (n=7): 0.3ml of saline solution intravaginally; hCGi.m. (n=7): 300 IU of hCG (Vetecor®; Hertape-Calier, São Paulo, Brazil) i.m. and hCGi.vag. (n=8): 300 IU of hCG deposited intravaginally. Blood samples were drawn at -1, 3, 6, 9 and 24 h after as well as on days 3, 7, 10, 13, 17 and 21 after hCG treatment/AI. All animals tested negative for hCG (ECO Diagnóstica, Corinto, Brazil) at -1h, and all control animals tested negative throughout the entire blood collection period. All hCGi.m. animals tested positive from 3h until D3 post-AI but only 50% of hCGi.vag. goats tested positive during the present study. In all animals studied, mean circulating P4 concentrations increased (p < .05) from D3 to D7 after AI and then declined (p < .05) from D10 to D17 in control and hCGi.m. groups and from D17 to D21 in the hCGi.vag. group. Total cross-sectional luteal area (CLA), mean colour Doppler area (DA), DA/CLA, mean high-velocity Doppler area and HVDA/CLA all declined (p < .05) by D17-D21 in all animals studied. In summary: (i) human chorionic gonadotropin could consistently be detected in blood samples using the rapid β-hCG test only in the hCGi.m. group; and (ii) there were no significant differences in the mean pregnancy rate, circulating P4 concentrations and various luteal parameters studied among Control, hCGi.m. and hCGi.vag. dose.

DIAGNOSTIC ACCURACY OF B-HCG AND NITRAZINE PAPER TEST IN VAGINAL WASHINGS TAKING AMNIOTIC FLUID POOLING AS GOLD STANDARD OF DIAGNOSING PREMATURE RUPTURE OF MEMBRANES

Background: Premature Rupture of Membranes (PROM) is common in obstetrics and management of such patients depends on whether the rupture has occurred or not. With membranes ruptured the fetus is deprived of protection provided within the amniotic cavity. Beta-Human chorionic gonadotrophin (β-HCG) is a hormone and is present in high concentration in amniotic fluid as well as in the blood and urine of the mother and is studied as possible predictor of preterm labour and as marker of PROM.&#x0D; Objective: To compare the diagnostic accuracy of B-hCG &amp; nitrazine paper test in vaginal washings taking amniotic fluid pooling as gold standard for diagnosing premature rupture of membranes.&#x0D; Material &amp; Methods: It was a comparative cross-sectional study conducted at Unit Department, of Obstetrics &amp; Gynecology, Lahore General Hospital, Lahore. After that vaginal washings were taken for β-hCG testing. A pregnancy test kit (Accu Check) was used for detection of β-hCG in vaginal fluid washings. According to amount of µ-hCG in the washings the result has been positive as early as 40 Seconds but for labeling the result negative 5 minutes complete reaction time has been observed. On netrizine kit, the positive test is indicated by distinct colour band on both; control and test side.&#x0D; Results: Mean age of women was 27.17+4.55 years. Mean age of gestation was 36.16 + 3.30 weeks. Sensitivity &amp; specificity of Nitrazine Paper Test were 92.17% &amp; 66.67%. However the PPV &amp; NPV for Nitrazine Paper Test was 98.15% &amp; 30.77% respectively. Sensitivity &amp; specificity of β-hCG Test was 94.35% &amp; 75%. However the PPV &amp; NPV for β-hCG test was 98.64% &amp; 40.91% respectively.&#x0D; Conclusion: Results of this stud y showed that B-subunit of hCG measured by over-the-counter available pregnancy test kit is a dependable quick and easy test for detection of premature rupture of membranes. This test can be performed on the bed side of the patient without Lab involvement. This test can be promoted as an additional help for the diagnosis of doubtful and ambiguous cases of premature rupture of membranes.

A Comparison of Triple and Double Sperm Washing for Density Gradient Preparation in Intrauterine Insemination Cycles when Overnight Incubation of Specimens Occurred: A Retrospective Cohort

Background: The number of sperm washes to maximize outcomes for intra-uterine insemination has not been well investigated. Therefore, we undertook to compare the pregnancy and live birth rates of triple sperm washing and double sperm washing for density gradient preparation for intrauterine insemination (IUI) cycles. Methods: A retrospective cohort study including 279 couples (136 couples with triple sperm washing and 143 couples with double sperm washing) with a diagnosis of unexplained infertility and mild male subfertility who had IUI cycles between April 2015 and April 2017 were evaluated. After overnight incubation of the sperm, subjects underwent either traditional double sperm washing or Triple sperm washing which consists of use of a third gradient and spinning procedure to the conventional double gradient sperm washing in order to obtain a higher quantity of motile sperm. Results: Total sperm count after triple washing was higher than double sperm washing (98.25 ± 62.06 vs. 81.08 ± 31.57; p = 0.003). Positive β-hCG test and live birth per cycle were higher in triple sperm washing (25.8% vs. 13.3%, p = 0.009; 18.4% vs. 9.8%, p = 0.039; respectively) than in the double sperm washing group. Conclusions: The use of motile sperms obtained from triple sperm washing may increase the rates of pregnancy and live birth in IUI cycles of women with unexplained and mild male factor infertility. A prospective randomized study should be undertaken to confirm the results.