Severe endometriosis: low value of AMH did not affect oocyte quality and pregnancy outcome in IVF patients

OBJECTIVE

The aim of this pilot study was to determine whether the low anti-müllerian hormone (AMH) serum level, due to severe endometriosis, was associated with diminished oocyte yield, poor oocyte/embryo quality and reduced in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) clinical outcomes in young patients (<37 years old).

PATIENTS AND METHODS

A total of 50 IVF cycles of patients younger than 37 with severe endometriosis were retrospectively analyzed in a single center between November 2016 and July 2018. The clinical outcome was then compared to a control group of 84 patients with no story of endometriosis and normal AMH value. AMH value was evaluated within three months before the stimulation. In these two groups, number and maturation of retrieved oocytes, embryo quality, and pregnancy outcomes were evaluated and compared using Student's t-test and Fisher's test.

RESULTS

The number of oocytes retrieved per cycle and the percentage of mature oocytes (MII) were significantly lower (p < 0.001) in IVF patients with severe endometriosis and AMH value ≤ 1.1 ng/ml (Group A; 3.8±2.6 retrieved oocytes, 70% MII) compared to patients without endometriosis and AMH levels > 1.1 ng/ml (Group B; 6.9±4.6 retrieved oocytes, 83% MII). On the other hand, embryo morphology, implantation rate (31% vs. 33%; p = 0.833) and pregnancy rate (50% vs. 49%; p = 1) were comparable in the two groups.

CONCLUSIONS

This study shows that younger patients with an impairment of the ovarian reserve due to severe endometriosis, displayed a diminished oocyte yield but not a reduction in embryo quality and pregnancy outcomes. These results suggest that serum AMH levels should not be adopted as a criterion for discouraging these patients from undergoing IVF/ICSI treatments.

A regression model including fetal orbit measurements to predict parturition in Standardbred mares with normal pregnancy

In the mare, foaling is a critical unpredictable event due to a wide range of gestational length and the absence of clear signs of impending parturition. To predict foaling, pH, inversion sodium potassium and increase of calcium concentration in mammary secretions are used. The aim of this study was to find how many days are left until parturition knowing mare's age (A) and parity (P) combined with ultrasonographic measurements of the fetal orbit in Standardbred mares with normal pregnancy. Eighty healthy Standardbred mares with normal pregnancy were hospitalized for attended delivery. Information about mare's age, parity and breeding date were recorded at admission. Transrectal ultrasonography were routinely performed at admission and every 10 days until parturition using a B-mode real time portable unit equipped with a 5-7.5 MHz linear transducer. The images of the fetal orbit were acquired when cornea, anterior and posterior chamber, vitreous body, lens and optic nerve were visible. Longitudinal diameter (LD) was considered as the distance between the two ocular poles, within the vitreous body; transverse diameter (TD), perpendicular to LD and bisecting the lens, was measured as the distance between cornea and retina. At delivery, length of pregnancy and gestational age at each exam were registered. For each ultrasound examination, days before parturition (DBP) were calculated. Seventy-eight Standardbred mares with normal pregnancies were included in the study. Mares' mean age was 9 ± 5 years old (range 4-20 years) and mean gestation length was 341 ± 7 days (range 327-366 days). Thirty-three mares were primiparous and 45 mares were multiparous. Data were analyzed using a regression tree: P, A, LD and TD were used as covariates. DBP was used as the variable of interest. Nine terminal nodes were identified based on the selected covariates. The first split is produced by the TD: fetuses with TD greater or equal than 2.97 cm are further split according to LD, with a threshold of 3.28 cm. The next split is dictated by A; after a further split on LD, the first terminal node is built, containing 34 fetuses with average DBP equal to 10 days. If the A is ≥ 9.5 years a further split is on P: when mares are multiparous, the TD built two different nodes. Since prediction of mare's foaling date is an important factor in stud farm management, the regression model developed may help the veterinarian to estimate the DBP in Standardbred mares with normal pregnancy.

[Sedation with propofol in endoscopic retrograde cholangiopancreatography: personal experience]

AIM

Adequate sedation is fundamental for the execution of the endoscopic retrograde cholangiopancreatography (ERCP). Propofol is widely used for gastrointestinal endoscopy because of its rapid recovery profile. The aim of this study was to determine, retrospectively, whether the administration of propofol was safe in patients undergoing ERCP, both diagnostic and therapeutic.

MATERIALS AND METHODS

In our GI Unit, from 1st February 2006 to 23 November 2006, we performed 100 ERCP. All the patients were sedated by using midazolam e.v., as pre-anaesthetic agent, and propofol e.v. During the procedure, vital signs were continuously monitored (oxygen saturation, blood pressure, heart rate). Patients were also divided into two groups: less than 80 years of age (group I) and 80 years of age and older (group II). Cardiorespiratory complications were recorded.

RESULTS

Patients were 51 females and 49 males, with a median age of 74 years (range: 23-94 years). Group I was composed by 72 patients (35 F, 37 M) and Group II by 28 patients (16 F, 12 M). There were no episodes of hemodynamic instability or airway obstruction. New ECG changes (1 ischemia, 3 arrhythmias) and 1 significant oxygen desaturation episode (SpO2<90%) occurred in 5% of procedures. If we considered the two groups, the rates of cardiopulmonary complications were 4.1% and 7.1%, respectively in group I and in group II.

CONCLUSIONS

Propofol seems to be safe and effective sedation for ERCP, with a low complication rate, also in patients aged 80 years or older.