Objective
To assess the effects of body mass index (BMI) on the outcome of IVF cycles among poor responders.
Methods
A prospective cohort study in Egypt enrolled 185 poor responders who underwent ...intracytoplasmic sperm injection via an antagonist protocol between 2012 and 2017. Participants were classified into three groups by BMI (calculated as weight in kilograms divided by the square of height in meters): 18.5–24.9 (normal, n=48); 25–29.9 (overweight, n=54); 30 or higher (obese, n=83). Outcomes were clinical pregnancy rate, implantation rate, chemical pregnancy rate, gonadotropin dose, number of oocytes and embryos, and cancellation rate.
Results
There was no significant difference among the three groups in gonadotropin dose; duration of stimulation; endometrial thickness on trigger day; number of oocytes retrieved, injected, or fertilized; number of embryos, transferred embryos, or frozen embryos; or day of embryo transfer. Frequency of implantation (11/81 14% vs 6/96 6% or 5/155 3%), chemical pregnancy (20 42% vs 14 30% or 12 14%) and clinical pregnancy (15 31% vs 12 22% and 9 11%) was significantly higher for normal than for overweight or obese women, respectively.
Conclusion
Implantation, chemical pregnancy, and clinical pregnancy rates were inversely related to increasing BMI.
ClinicalTrials.gov: NCT03457233
Among poor responders, IVF outcomes including implantation, chemical pregnancy, and clinical pregnancy rates were significantly lower for overweight and obese women.
To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS).
Screening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the ...keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis.
All available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them.
Extracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity.
The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively. The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively.
The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases.
Number CRD42021267501.
Purpose: To investigate the ability of anti-Mullerian hormone (AMH) to predict the step up of human menopausal gonadotropins (HMG) dose in women with polycystic ovarian syndrome (PCOS) undergoing ...IVF/ICSI cycles.
Methods: AMH was drawn before ovulation induction in 976 PCOS women scheduled for IVF/ICSI. After all cycles ended, a receiver operating characteristic (ROC) curve analysis was done to investigate the ability of AMH to predict step up of the HMG.
Results: The area under the curve (AUC) was 0.820 95%CI (0.792-0.848), and a cutoff value of 4.6 ng/ml (sensitivity 74%, specificity 82%) for AMH was taken (p < 0.01). Cases were divided into two groups retrospectively; group (A) (AMH ≤4.6 ng/ml), and group (B) (AMH >4.6 ng/ml). No difference in the mean age (p = 0.147); BMI (p = 0.411), basal FSH (p = 0.221), and starting dose (p = 0.195); however, the dose at which the first response occurred was higher in group (B) (p < 0.01). The total dose and number of days were higher in group (B) (both p < 0.01) irrespective of the PCOS subtype or androgen levels. Severe OHSS was also higher in group (B) (p = 0.026).
Conclusions: PCOS with AMH >4.6 ng/ml are resistant to HMG stimulation, require dose step up during ART cycles, and are at higher risk for severe OHSS.
Objective: To assess the relationship between maternal, fetal, and neonatal outcomes and different forms of hypertensive disorders associating pregnancy in women needed intensive care units (ICUs) ...admission.
Methods: A prospective case control study was conducted on 1238 women admitted to hypertensive ICU at three university hospitals. They were classified into four groups. Group I included 472 women with severe preeclampsia (PE), Group II included 243 women with eclampsia (E), Group III included 396 women diagnosed with E associated with HELLP syndrome, and Group IV included 127 women diagnosed as HELLP syndrome. All women received magnesium sulfate to prevent and/or control convulsions and nifedipine to control their blood pressure. Primary outcome parameter was maternal mortality. Other outcomes included maternal morbidities, fetal, and neonatal outcomes.
Results: There was a significant difference among the study groups regarding the need for blood transfusion (58.1%, 70%, 84.3%, and 42.5% respectively, p < .001), number of transferred units (2.4 ± 1, 2.9 ± 0.9, 3.4 ± 1.1, and 3.5 ± 0.8 respectively, p < .001), placental abruption (23.3%, 16.5%, 30.3%, and 19.7% respectively, p < .001), pulmonary edema (14.8%, 22.6%, 19.9%, and 34.6% respectively, p < .001), multiple complications (12.5%, 12.3%, 19.9%, and 26% respectively, p < .001), and maternal mortality (1.9%, 4.1%, 6.1%, and 5.5% respectively, p < .001). Regarding fetal and neonatal outcomes, there was a significant difference among the four groups regarding Apgar score at 1 and 5 min, neonatal birth weight, neonatal intensive care unit (NICU) admission, NICU admission days, intrauterine growth restriction, perinatal death, respiratory distress syndrome, intraventricular hemorrhage, sepsis, and the need for mechanical ventilation (p < .001). Higher rate of vaginal delivery was reported in women with HELLP (40.9%) and severe PE (39.8%) and higher rates of performing cesarean section (CS) in women with eclampsia (77.8%). Maternal mortality is significantly related to delivery with CS, younger maternal age with lower parity, and the presence of placental abruption or pulmonary edema. For Groups III and IV, which included HELLP cases, there are significant differences between both groups as regards HELLP classes according to Mississippi classification, also significant differences were seen between both groups as regards, maternal mortality, abruptio placenta, pulmonary edema, multiple organ damage, NICU admission, perinatal deaths, and need for mechanical ventilation.
Conclusion: Both maternal mortality and morbidity (placental abruption and need for blood transfusion) are significantly higher in women with HELLP syndrome worsens to become class 1 regardless of whether eclampsia is present or not.
Synopsis: Maternal mortality and unfavorable outcome are significantly higher in women with HELLP syndrome whether it was associated with eclampsia or not.
Background
Hydrosalpinx is considered one of the obstacles that could hinder the success of IVF techniques due to the toxic effect of the hydrosalpinx fluid pouring into the uterine cavity. Tubal ...disconnection by either hysteroscopic or laparoscopic approaches is considered the standard in the operative management of hydrosalpinx prior to IVF cycles. The aim of the current study was to compare the success rate of hysteroscopic tubal occlusion using electro-coagulation with laparoscopic tubal disconnection in cases of hydrosalpinx prior to in vitro fertilization (IVF).
Methods
A total of 108 women with unilateral or bilateral hydrosalpinx, who were candidates for tubal occlusion before IVF, were equally randomized into two groups. Group A (
n
= 54) underwent hysteroscopic tubal occlusion using the roller-ball electro-coagulation of the interstitial part of the tube and the uterine cornual area, and group B (
n
= 54) underwent laparoscopic tubal disconnection using bipolar coagulation and a proximal tubal cut. Operative time, complications, postoperative pain measured by the visual analogue score (VAS score), and postoperative hospital stay were recorded for both groups. The success rate of tubal occlusion was assessed 1 month later using a post-menstrual hysterosalpingogram (HSG).
Results
Laparoscopic tubal disconnection was more successful than the hysteroscopic approach regarding tubal occlusion rate (96.15% vs. 86.67% respectively,
p
= 0.044). The operative time and postoperative pain VAS scores in the hysteroscopy group (3.65 ± 1.03 min and 1.81 ± 1.35, respectively) were significantly lower than that in the laparoscopy group (17.48 ± 4.70 min and 4.06 ± 1.65, respectively) with
p
< 0.001.
Conclusion
Although laparoscopic tubal disconnection is more successful, the hysteroscopic approach is an alternative which has its own limitations that can be assessed by hysterosalpingogram, especially when laparoscopy is contraindicated, technically difficult, or refused by the patient.
Trial registration
It was first registered at ClinicalTrials.gov on 30/07/2019 with registration number
NCT04037813
.
Objective This study aimed to evaluate the effect of endometrial scratch injury (ESI) in infertile women undergoing in vitro fertilization (IVF). Methods We screened MEDLINE, CENTRAL, EMBASE, Web of ...Science, and the Cochrane Central Register from inception to April 2023 using keywords related to endometrial scratch, implantation, infertility, and IVF. We included 41 randomized, controlled trials of ESI in IVF cycles (9084 women). The primary outcomes were the clinical pregnancy, ongoing pregnancy, and live birth rates. Results The clinical pregnancy rate was reported in all 41 studies. The odds ratio (OR) for the clinical pregnancy rate had an effect estimate of 1.34 with a 95% confidence interval (CI) of 1.14 to 1.58. The live birth rate was reported in 32 studies with 8129 participants. The OR for the live birth rate had an effect estimate of 1.30 with a 95% CI of 1.06 to 1.60. The multiple pregnancy rate was reported in 21 studies with 5736 participants. The OR for the multiple pregnancy rate had an effect estimate of 1.35 with a 95% CI of 1.07 to 1.71. Conclusion ESI increases the clinical pregnancy, ongoing pregnancy, live birth, multiple pregnancy, and implantation rates in women undergoing IVF cycles.
Objective
To assess the value of intrauterine PRP to improve IVF outcome in women with previous implantation failure.
Methods
Screening of Pubmed, Web of Science, and other databases from inception ...to August 2022 using the keywords related to “platelet-rich plasma” OR “PRP” AND “IVF” “implantation failure.” Twenty-nine studies (3308 participants) were included in our analysis, 13 were RCTs, 6 were prospective cohorts, 4 were prospective single arm, and 6 were retrospective analyses. Extracted data included settings of the study, study type, sample size, participants’ characteristics, route, volume, timing of PRP administration, and outcome parameters.
Results
Implantation rate was reported in 6 RCTs (886 participants) and 4 non-RCTs (732 participants). The odds ratio (OR) effect estimate was 2.62 and 2.06, with 95% CI of 1.83, 3.76, and 1.03–4.11, respectively. Endometrial thickness was compared in 4 RCTs (307 participants) and 9 non-RCTs (675 participants), which showed a mean difference of 0.93 and 1.16, with 0.59–1.27 and 0.68–1.65 95% CI, respectively.
Conclusion
PRP administration improves implantation, clinical pregnancy, chemical pregnancy, ongoing pregnancy, live birth rates, and endometrial thickness in women with previous implantation failure.
Maged, AM, Ogila, AI, Mohsen, RA, et al. Endometrial scratch injury in infertile women seeking conception through natural or intrauterine insemination cycles: A systematic review and meta‐analysis. ...Int J Gynecol Obstet. 2021; 00: 1–20. doi:10.1002/ijgo.14030
The above article, published online on 17 November 2021 on Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal's Editor‐in‐Chief, Professor Michael Geary, the International Federation of Gynecology and Obstetrics and John Wiley & Sons Ltd. The journal was made aware of concerns regarding the considerable overlap with a previously published systematic review.1 The authors responded to the concerns raised and it was found that some of the source clinical trial data could not have been accessed in this systematic review. As a result, the journal is issuing this retraction.
1 Bui BN, Lensen SF, Gibreel A, Martins WP, Torrance H, Broekmans FJ. Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination. Cochrane Database of Systematic Reviews 2022, Issue 10. Art. No.: CD011424. DOI: 10.1002/14651858.CD011424.pub4.
Objectives
To compare the effects of whole‐body vibration (WBV) and aerobic exercise on the hormonal profile and inflammatory status in women with premenstrual syndrome (PMS).
Methods
A prospective, ...randomized, pre–post‐test, single‐blind, controlled trial was conducted in 105 women diagnosed with PMS. They were randomized into three equal groups. All women received magnesium and vitamin B complex supplementation once daily. WBV training was added three times per week to the WBV group. The aerobic exercise group added aerobic exercise three times per week, while the control group received no additional intervention. The Premenstrual Syndrome Questionnaire (PMSQ) was used to assess PMS symptoms. Blood analysis was performed to measure hormone assays (estradiol, progesterone, prolactin, and cortisol) and high‐sensitivity C‐reactive protein at the start and after the end of the treatment program.
Results
There was no statistically significant difference between WBV and aerobic exercise according to PMSQ and high‐sensitivity C‐reactive protein (P = 0.99 and P = 0.98, respectively), but there was a statistically significant difference between both groups in cortisol, progesterone, prolactin, and estradiol (P = 0.001), with more favor given to the WBV group.
Conclusion
WBV and aerobic exercise have positive effects on women with PMS, with more favor given to WBV.
Synopsis
Whole‐body vibration and aerobic exercise have positive effects in women with premenstrual syndrome with more favor to whole‐body vibration.
