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Li J, Mo S, Lin Z, Shi Q. Atosiban application in fresh ET cycle is effective for women undergoing repeated embryo implantation failures, especially for advanced-age obese patients. Sci Rep 2023; 13:23044. [PMID: 38155160 PMCID: PMC10754826 DOI: 10.1038/s41598-023-49773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023] Open
Abstract
To assess the effect of atosiban in pregnancy outcomes of the fresh embryo transfer (ET), the retrospective cohort study was conducted. Six hundred and eighty-nine cases (using atosiban) and 1377 age and ET cycle-matched controls were collected from the January 2016 to May 2022 to perform the fresh IVF-ET cycle. The essential characteristics and pregnancy outcomes were analyzed. Conditional logistic regression analysis and subgroup analysis were performed. In the whole samples, atosiban had no effects in the pregnancy outcomes. Subgroup analyses suggested that atosiban could improve the clinical pregnancy in more than 3 ET cycles (OR 1.667, 95% CI 1.108-2.509, P = 0.014). Moreover, the improvement of clinical pregnancy was mainly present in the advanced-age women (age ≥ 35 years: OR 1.851, 95% CI 1.136-3.014, P = 0.013), obesity (BMI ≥ 24 kg/m2: OR 2.550, 95% CI 1.105-5.883, P = 0.028) and cleavage stage embryo (D3 embryo: OR 1.721, 95% CI 1.098-2.696, P = 0.018) among the repeated implantation failures (RIF). Atosiban could also improve the live birth for the obese women. Further, in the RIF, atosiban application was strongly recommended for the advanced-age infertility women, who also had the risk of obesity with the implantation of the cleavage stage embryo. In conclusion, atosiban could improve pregnancy outcomes for the advanced-age and obese women in RIF, especially while implanting the cleavage stage embryo in fresh ET cycle.
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Affiliation(s)
- Jie Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Sien Mo
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhong Lin
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China.
- School of Public Health, Chongqing Medical University, Chongqing, China.
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Zahid S, Hashem A, Minhas AS, Harrington CM, Quesada O, Aggarwal NR, Shufelt CL, Baker VL, Michos ED. Cardiovascular Complications During Delivery Admissions Associated With Assisted Reproductive Technology (from a National Inpatient Sample Analysis 2008 to 2019). Am J Cardiol 2023; 186:126-134. [PMID: 36283885 DOI: 10.1016/j.amjcard.2022.08.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 11/01/2022]
Abstract
Women who conceive through assisted reproductive technology (ART) have a known increased risk of obstetric complications. However, whether ART is also associated with higher risk of developing cardiovascular complications during delivery admissions has not been well established. We used data from the National Inpatient Sample (2008 to 2019) and used the International Classification of Diseases codes to identify delivery hospitalizations and ART procedures. A total of 45,867,086 weighted delivery cases were identified, of which 0.24% were among women who conceived through ART (n = 108,542). Women with an ART history were older at the time of delivery (median 35 vs 28 years, p <0.01) and had a higher prevalence of hypertension, gestational diabetes, and dyslipidemia (all, p <0.01). After adjustment for age, race/ethnicity, co-morbidities, multiple gestation, insurance, and income, ART remained an independent predictor of peripartum cardiovascular complications, including pre-eclampsia/eclampsia (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.45 to 1.51), heart failure (aOR 1.94, 95% CI 1.10 to 3.40), and cardiac arrhythmias (aOR 1.39, 95% CI 1.30 to 1.48), compared with natural conception. Likewise, the risk of acute kidney injury (aOR 2.57, 95% CI 2.25 to 2.92), ischemic stroke (aOR 1.73, 95% CI 1.24 to 2.43), hemorrhagic stroke (aOR 1.63, 95% CI 1.27 to 2.11), pulmonary edema (aOR 2.29, 95% CI 2.02 to 2.61), and venous thromboembolism (aOR 1.92, 95% CI 1.63 to 2.25) were higher with ART. However, odds of developing peripartum cardiomyopathy or acute coronary syndrome were not associated with ART. Length of stay (3 vs 2 days, p <0.01) and cost of hospitalization ($5,903 vs $3,922, p <0.01) were higher for deliveries among women with a history of ART. In conclusion, women who conceived with ART had higher risk of pre-eclampsia, heart failure, arrhythmias, stroke, and other complications during their delivery hospitalizations. This may, in part, contribute to their increased resource utilization seen.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York
| | - Anas Hashem
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York
| | - Anum S Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen M Harrington
- Department of Cardiovascular Disease, Massachusetts General Hospital, Boston, Massachusetts
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio
| | - Niti R Aggarwal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Chrisandra L Shufelt
- Division of Internal Medicine, Women's Health Research Center, Mayo Clinic, Jacksonville, Florida
| | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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VanBuren JM, Casper TC, Nishijima DK, Kuppermann N, Lewis RJ, Dean JM, McGlothlin A. The design of a Bayesian adaptive clinical trial of tranexamic acid in severely injured children. Trials 2021; 22:769. [PMID: 34736498 PMCID: PMC8567588 DOI: 10.1186/s13063-021-05737-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trauma is the leading cause of death and disability in children in the USA. Tranexamic acid (TXA) reduces the blood transfusion requirements in adults and children during surgery. Several studies have evaluated TXA in adults with hemorrhagic trauma, but no randomized controlled trials have occurred in children with trauma. We propose a Bayesian adaptive clinical trial to investigate TXA in children with brain and/or torso hemorrhagic trauma. METHODS/DESIGN We designed a double-blind, Bayesian adaptive clinical trial that will enroll up to 2000 patients. We extend the traditional Emax dose-response model to incorporate a hierarchical structure so multiple doses of TXA can be evaluated in different injury populations (isolated head injury, isolated torso injury, or both head and torso injury). Up to 3 doses of TXA (15 mg/kg, 30 mg/kg, and 45 mg/kg bolus doses) will be compared to placebo. Equal allocation between placebo, 15 mg/kg, and 30 mg/kg will be used for an initial period within each injury group. Depending on the dose-response curve, the 45 mg/kg arm may open in an injury group if there is a trend towards increasing efficacy based on the observed relationship using the data from the lower doses. Response-adaptive randomization allows each injury group to differ in allocation proportions of TXA so an optimal dose can be identified for each injury group. Frequent interim stopping periods are included to evaluate efficacy and futility. The statistical design is evaluated through extensive simulations to determine the operating characteristics in several plausible scenarios. This trial achieves adequate power in each injury group. DISCUSSION This trial design evaluating TXA in pediatric hemorrhagic trauma allows for three separate injury populations to be analyzed and compared within a single study framework. Individual conclusions regarding optimal dosing of TXA can be made within each injury group. Identifying the optimal dose of TXA, if any, for various injury types in childhood may reduce death and disability.
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Affiliation(s)
- John M. VanBuren
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108 USA
| | - T. Charles Casper
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108 USA
| | - Daniel K. Nishijima
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA 95817 USA
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA 95817 USA
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA 95817 USA
| | - Roger J. Lewis
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA 90509 USA
- Berry Consultants, LLC, Austin, TX 78746 USA
| | - J. Michael Dean
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108 USA
| | | | - For the TIC-TOC Collaborators of the Pediatric Emergency Care Applied Research Network (PECARN)
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108 USA
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA 95817 USA
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA 95817 USA
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA 90509 USA
- Berry Consultants, LLC, Austin, TX 78746 USA
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AKCABAY Ç, ÜRÜNSAK İ, KÜÇÜKGÖZ GÜLEÇ Ü, CİHAN E, SUCU M, ATAY Y. Agonist IVF-ICSI-ET sikluslarında luteal faz desteği için verilen östradiol’ün gebelik oranlarına etkisi. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.735887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Li L, Wang P, Liu S, Bai X, Zou B, Li Y. Transcriptome sequencing of endometrium revealed alterations in mRNAs and lncRNAs after ovarian stimulation. J Assist Reprod Genet 2020; 37:21-32. [PMID: 31745762 PMCID: PMC7000608 DOI: 10.1007/s10815-019-01616-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022] Open
Abstract
RESEARCH QUESTION Using RNA-sequencing analysis, we investigated the relationship between ovarian stimulation and endometrial transcriptome profiles during the window of implantation (WOI) to identify candidate predictive factors for the WOI and to optimize timing for embryo transfer. METHODS Twelve women with normal basal hormone levels and regular ovulation were randomly assigned into three groups based on sampling time: late-proliferate phase (P group), and receptive phase in natural cycles (LH+7, N group) and stimulated cycles (hCG+7, S group). Transcriptome profiles of mRNAs and long non-coding RNAs (lncRNAs) were then compared among the three groups. Validation was performed using real-time qPCR. RESULTS Comparison of transcriptome profiles between the natural and stimulated endometrium revealed 173 differentially expressed genes (DEGs), with a > 2-fold change (FC) and p < 0.05, under the influence of supraphysiological estradiol (E2) induced by ovarian stimulation. By clustering and KEGG pathway analysis, molecules and pathways associated with endometrial receptivity were identified. Of the 39 DEGs common to the three groups, eight genes were validated using real-time PCR. ESR1, MMP10, and HPSE were previously reported to be associated with endometrial receptivity. In addition, three novel genes (IL13RA2, ZCCHC12, SRARP) and two lncRNAs (LINC01060, LINC01104) were new potential endometrial receptivity-related markers. CONCLUSION Using mRNA and lncRNA sequencing, we found that supraphysiological E2 levels from ovarian stimulation had a marked impact upon endometrial transcriptome profiles and may result in a shift of the WOI. The precise mechanisms underlying the supraphysiological hormone-induced shift of the WOI require further research. REGISTRATION NUMBER ChiCTR180001453.
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Affiliation(s)
- Lingxiu Li
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peng Wang
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shan Liu
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xueyan Bai
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Binbin Zou
- Beijing NeoAntigen Biotechnology Co. Ltd, Beijing, China
| | - Yuan Li
- Medical Center for Human Reproduction, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Çakar E, Tasan HA, Kumru P, Cogendez E, Usal NT, Kutlu HT, Özkaya E, Eser SK. Combined use of oestradiol and progesterone to support luteal phase in antagonist intracytoplasmic sperm injection cycles of normoresponder women: a case-control study. J OBSTET GYNAECOL 2019; 40:264-269. [PMID: 31455122 DOI: 10.1080/01443615.2019.1631765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We evaluated the effect of combined use of oral oestrogen (E2) and vaginal progesterone (P) to support luteal phase in antagonist intracytoplasmic sperm injection (ICSI) cycles. We analysed data from 176 patients who underwent ICSI cycles with antagonist protocol. P 90 mg vaginal gel once a day and micronised E2 of 4 mg/day, were started from the day of oocyte pick up and continued to the 12th day of embryo transfer. Group 1 (n = 79) patients received E2 + P for luteal phase support. In group 2 (n = 97) patients, only P 90 mg vaginal gel was used for luteal phase support. There were no significant differences between group 1 and group 2 patients in terms of clinical pregnancy rates (PRs) (26.58% vs. 20.62%, p = .352), early pregnancy loss rates (6.33% vs. 6.19%, p = .969), incidence of luteal vaginal bleeding (8.86% vs. 8.25%, p = .885) and implantation rates (22.8% vs. 16.9%, p = .298). In conclusion, our study showed no beneficial effect of addition of E2 to luteal phase support on clinical PR in antagonist IVF cycles.Impact statementWhat is already known on this subject? Luteal phase deficiency is defined as a disruption in progesterone and oestrogen production after ovulation. It is clear that, luteal phase supplementation to improve the outcomes in in vitro fertilisation (IVF) cycles is mandatory. As an iatrogenic complication of assisted reproductive technique, decreased luteal oestrogen and progesterone levels lead to decreased pregnancy rates (PRs) and implantation rates.What the results of this study add? In this study, we aimed to present the role of luteal phase oestrogen administration in GnRH antagonist cycles. A total of 176 cases received progesterone vaginal gel form for luteal phase support. Study group received 4 mg oral oestradiol hemihydrate in addition to progesterone. Compared to previous studies, our study consisted of larger number of patients and we used oestradiol through oral route. We found out that luteal oestradiol support did not improve the clinical PR.What the implications are of these findings for clinical practice and/or further research? Our study showed no beneficial effect of addition of oestradiol to luteal phase support on clinical PR in antagonist IVF cycles.
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Affiliation(s)
- Erbil Çakar
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, IVF Center, Istanbul, Turkey
| | - Habibe Ayvaci Tasan
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, IVF Center, Istanbul, Turkey
| | - Pınar Kumru
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, IVF Center, Istanbul, Turkey
| | - Ebru Cogendez
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, IVF Center, Istanbul, Turkey
| | - Nazan Tarhan Usal
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, IVF Center, Istanbul, Turkey
| | - Hüseyin Tayfun Kutlu
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, IVF Center, Istanbul, Turkey
| | - Enis Özkaya
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, IVF Center, Istanbul, Turkey
| | - Semra Kayatas Eser
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, IVF Center, Istanbul, Turkey
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Characterization of Oestrus Cycles in Namibian Swakara and Damara Sheep through Determination of Circannual Plasma Progesterone Levels. J Vet Med 2019; 2019:5320718. [PMID: 31380447 PMCID: PMC6657608 DOI: 10.1155/2019/5320718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/08/2019] [Accepted: 07/01/2019] [Indexed: 11/17/2022] Open
Abstract
A year-long prospective study characterized the seasonality of oestrus cycles in primiparous, nonpregnant Swakara (n=8) and Damara (n=5) ewes through surveillance of plasma progesterone (P4) levels. During this period, Swakara and Damara groups evidently averaged 23 oestrus cycles with an average length of 17 days. Damara ewes showed greater mean peak plasma P4 levels (11.4±0.16ng/ml) than Swakara ewes (5.4±0.11ng/ml) (P<0.05). Oestrus cycles in Damara ewes showed relatively uniform plasma P4 peaks throughout the year ranging from 10.6±0.16 to 12.6±0.24ng/ml. In Swakara ewes, P4 peaks were highest in the autumn oestrus cycles (from 7.1±0.16 to 7.5±0.11ng/ml), rapidly declining through winter to 2.2±0.08ng/ml by midspring and then rapidly increasing to 4.9±0.37ng/ml at the commencement of summer, followed by a gradual increase from 5.7± to 7.1±ng/ml by the start of autumn. The annual mean area under the curve temporal progesterone measurements (AUCPM) in Damara ewes (115.9±18.6ng⁎day/ml) was greater than that in Swakara ewes (58.6±25.3ng⁎day/ml) (p<0.05). For Swakara ewes, the mean AUCPM in summer and autumn cycles (68.2±14.7 and 79.5±10.0ng⁎day/ml, respectively) were greater than those in spring and winter cycles (28.7±12.3 and 55.0±27.3ng⁎day/ml), respectively (P<0.05). There was no seasonal variation in the exposure of the Damara ewes to P4 in between seasons (P>0.05), though, however, the Damara ewes had greater P4 levels than the Swakara ewes (P<0.05). Progesterone profiles showed that Swakara ewes possessed 'residual' seasonality, whereas the Damara ewes were no longer seasonal. The implications of this disparity in the seasonal exposure of Swakara and Damara ewes to luteal P4 on fertility warrant further investigation.
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Abide Yayla C, Ozkaya E, Beydilli Nacak G, Sanverdi I, Devranoglu B, Bostanci Ergen E, Kilicci C, Kutlu T. High estrogen exposure may not be detrimental on endometrial receptivity in women with PCOS. Gynecol Endocrinol 2018; 34:798-803. [PMID: 29658351 DOI: 10.1080/09513590.2018.1460344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
The study aimed to assess the effect of high estrogen exposure and coasting on cycle outcome in women at risk for developing ovarian hyperstimulation syndrome (OHSS). Retrospective case-control study was conducted to figure out the outcomes of GnRH antagonist cycles in which women were at risk to develop OHSS. Women who underwent coasting (n = 100) were compared with a control group of women who did not undergo coasting (n = 287). Effect of endometrial estrogen exposure was determined by calculating area under curve of temporal estrogen measurements (AUCEM) through the cycle. Among 387 women with PCOS, 100 cases were required to undergo coasting to avoid OHSS. All participants reached to embryo transfer stage and clinical pregnancy rate was 44% in group with coasting whereas 39% in group without coasting (p > .05). AUCEM was a significant predictor for the cases who required coasting to avoid OHSS (AUC = 0.754, p < .001). Optimal cut off value was calculated to be 6762 with 71% sensitivity and 67% specificity. ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women with coasting (AUC = 0.496, p > .05). Consistently, ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women without coasting (AUC = 0.494, p > .05). In conclusion, neither coasting nor the high endometrial estrogen exposure was found to have detrimental effect on endometrial receptivity and cycle outcome in PCOS.
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Affiliation(s)
- Cigdem Abide Yayla
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Enis Ozkaya
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Gulay Beydilli Nacak
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Ilhan Sanverdi
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Belgin Devranoglu
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Evrim Bostanci Ergen
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Cetin Kilicci
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
| | - Tayfun Kutlu
- a Department of Obstetrics and Gynecology , Zeynep Kamil Women and Children's Health Training and Research Hospital , İstanbul , Turkey
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Kaponis A, Chronopoulou E, Decavalas G. The curious case of premature luteinization. J Assist Reprod Genet 2018; 35:1723-1740. [PMID: 30051348 DOI: 10.1007/s10815-018-1264-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/11/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Premature luteinization (PL) affects 12.3-46.7% of fresh in vitro fertilization cycles, and there is accumulating evidence confirming its negative effect on success rates. However, despite its clinical significance, PL is poorly understood and defined. This narrative review aims to provide a fresh look at the phenomenon of PL by summarizing the existing evidence and re-evaluating fundamental issues. METHODS A thorough electronic search was conducted covering the period from 1978 until January 2018 in PubMed, Embase, and Medline databases, and references of relevant studies were cross-checked. Meeting proceedings of the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine were also hand searched. RESULTS In the curious case of PL, one should go back to the beginning and re-consider every step of the way. The pathogenesis, definition, measurement methods, clinical implications, and management strategies are discussed in detail, highlighting controversies and offering "food for thought" for future directions. CONCLUSIONS Authors need to speak the same language when studying PL in order to facilitate comparisons. The terminology, progesterone cut-off, measurement methods and days of measurement should be standardized and globally accepted; otherwise, there can be no scientific dialog. Future research should focus on specific patient profiles that may require a tailored approach. Progesterone measurements throughout the follicular phase possibly depict the progesterone exposure better than an isolated measurement on the day of hCG. Adequately powered randomized controlled trials should confirm which the best prevention and management plan of PL is, before introducing any strategy into clinical practice.
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Affiliation(s)
- Apostolos Kaponis
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece
| | - Elpiniki Chronopoulou
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece.
| | - George Decavalas
- Department of Obstetrics and Gynaecology, Patras University School of Medicine, General University Hospital of Patras, Rio, 26504, Patras, Greece
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