P-333 The influence of hormonal stimulation on uterine peristalsis measured by ultrasound speckle tracking in women with IVF/ICSI treatment compared to normal ovulating women

Study question

To investigate possible effects of ovarian stimulation during IVF/ICSI on uterine peristalsis features using ultrasound speckle tracking compared to normal ovulating women.

Summary answer

Patients with a normal uterus treated with exogenous hormones during IVF/ICSI treatment show significantly increased contraction amplitude and power parameters compared to normal ovulating women.

What is known already

Uterine peristalsis plays a role in procreation. Subjective visual inspection of uterine peristalsis is extensively researched throughout the menstrual cycle. Studies on uterine peristalsis in IVF/ICSI patients show higher frequency of uterine contractions during the periovulatory phase. Recently, a new automated quantitative method was validated to objectively analyse uterine strain using speckle tracking. Besides objective insight in frequency, also information on amplitude, power and coordination of motion is available. The effect of exogenous hormones on uterine contraction features has not objectively been studied using this new method.

Study design, size, duration

This multicentre prospective observational cohort study was performed between 2020 and 2022 in the Catharina Hospital in Eindhoven, the Netherlands, Embryolab Fertility Centre in Thessaloniki, Greece and University of Naples, Federico II in Naples, Italy. 30 normal ovulating patients served as controls. The primary outcomes were the contraction features frequency, amplitude, direction, velocity, power and coordination in women undergoing IVF/ICSI on the day of follicle aspiration compared to controls on cycle day 9 – 14.

Participants/materials, setting, methods

19 women undergoing IVF/ICSI were included regardless of the treatment cycle number and stimulation protocol. Indication for IVF/ICSI treatment was male subfertility (n = 8), idiopathic subfertility (n = 5), tubal factor (n = 2), primary ovarian insufficiency (n = 2) or combined (n = 2), all women had normal uteri on transvaginal ultrasound. The control group consisted of 30 healthy pre-menopausal women with normal uteri on ultrasound and spontaneous regular cycles.

Main results and the role of chance

Each patient underwent a 2.5 – 4 minute transvaginal ultrasound of the uterus in mid-sagittal plane. The various contraction features were extracted using a quantitative dedicated speckle tracking algorithm analysis studying motion of the subendometrial junctional zone.

Mean age of IVF/ICSI patients was 32.7 years and mean BMI was 25.6. Mean age of healthy controls was 33.8 years, BMI was 23.4, and cycle length was 27.44 days. Characteristics of IVF/ICSI patients and healthy volunteers showed no statistically significant differences. Both groups predominantly consisted of nulliparous women.

In IVF/ICSI patients the contraction amplitude was significantly higher compared to controls (0.062 vs 0.040; p < 0.001). The contraction power (combination of amplitude and frequency) appeared to be significantly higher in IVF/ICSI patients compared to controls (1528.18 vs 683.44; p < 0.001). No significant differences were found in contraction frequency and coordination. Even though the mean coordination did not show statistically significant differences, the values were less scattered in IVF/ICSI patients, with a much smaller range of coordination values (1.04 – 3.06) compared to healthy volunteers (1.02 – 50.33).

Limitations, reasons for caution

The reported difference between IVF/ICSI patients and controls in contraction amplitude and power may not solely be attributed to the administration of exogenous hormones. The difference may also be due to an underlying cause for infertility in these patients. Another limitation of this study is the small sample size.

Wider implications of the findings

Future research should explore which uterine contraction profile is associated with viable pregnancy: during the natural menstrual cycle, or when treated with hormones. The question arises whether it is preferred to transfer the embryo in the stimulated cycle or implement a freeze-all policy and transfer during the natural menstrual cycle.

Trial registration number

NCT02310802

Coronary-cameral fistulas in adults (first of two parts)

This is a case series and review of the literature adding 11 new cases. Coronary-cameral fistulas (CCFs) are infrequent anomalies which are in general co-incidentally found during diagnostic coronary angiography (CAG). To delineate the characteristics of congenital and acquired CCFs in adults, we performed a PubMed search for papers dealing with congenital or acquired CCFs in adults. Publications on coronary-vascular fistulas or paediatric subjects were not included. From the world literature, a total of 243 adult patients were identified who had congenital (65%) or acquired (35%) CCFs. In this review, which is part one of a two-part series on CCFs, we describe and discuss the congenital fistulas, give an overview on the published literature and report details of our own series of 11 patients with MMFs and solitary macro CCFs. Of the congenital group, 85% were small or large solitary macro CCFs (cut-off 1.5 mm) and 15% were coronary artery-ventricular multiple micro-fistulas (MMFs). Apical hypertrophic cardiomyopathy was reported in some of the reviewed subjects with MMFs (3/24 = 13%) but not was seen in our own series. Conservative medical management was generally the treatment of choice in congenital MMFs; prophylactic implantable cardioverter defibrillators (ICD) were implanted in 2/24 (8%) of subjects, especially when extensive micro-fistulisations were involved. None of the patients of our own series required an ICD, as the MMFs were of limited size. Congenital or acquired CCFs in adults are infrequent anomalies having a wide spectrum of clinical presentation may varies from asymptomatic to severely devastating states requiring different treatment modalities.

The effectiveness of oral nutritional supplementation in the healing of pressure ulcers

OBJECTIVE

To investigate the effectiveness of an oral nutritional supplement that is rich in protein and enriched with arginine, vitamin C and zinc on the healing of pressure ulcers.

METHOD

Thirty-nine patients with grade III or IV pressure ulcers were enrolled into this open intervention study. Subjects received an oral nutritional supplement daily for three weeks. Wound area and the wound condition of the ulcers were assessed weekly.

RESULTS

After three weeks of supplementation, median wound area reduced significantly (p < 0.001) from 23.6 cm2 (1.6-176.6 cm2) to 19.2 cm2 (1.2-132.7 cm2), a reduction of 29%. Median healing of wound area was 0.34 cm2 per day, taking approximately two days to heal 1 cm2. Within three weeks the amount of exudate in infected ulcers (p = 0.012) and the incidence of necrotic tissue (p = 0.001) reduced significantly.

CONCLUSION

Nutritional intervention in the form of a specific oral nutritional supplement resulted in a significant reduction in wound area and an improvement in wound condition in patients with grade III and IV pressure ulcers within three weeks.

The effect of a liquid nutrition supplement on body composition and physical functioning in elderly people

BACKGROUND & AIMS

The elderly are at an increased risk of poor nutritional status which is mutually interacting with functional status. We evaluated the effects of a liquid nutrition supplement on anthropometric and functional indices in elderly people.

METHODS

Subjects (n=68; mean age=82+/-7 years) with body mass index <or=25 kg/m(2) received either a supplement or a placebo for 6 months. Anthropometric (body weight, bioelectrical impedance, calf circumference), biochemical (albumin, prealbumin), functional parameters (handgrip strength, timed 'up and go' test) and dietary intake were measured. Activities of daily living and Nottingham Health Profile (NHP) were assessed.

RESULTS

No compensation of energy intake occurred. After 6 months, the supplement group had gained more weight (+1.6 kg) than the placebo group (+0.3 kg) (P=0.03). No other significant changes in anthropometric, functional or blood parameters were seen. There was a significant improvement on the section 'sleep' of the NHP (mean change+/-SE=-0.38+/-0.19 for supplement vs 0.24+/-0.19 for placebo, P=0.03).

CONCLUSION

Dietary supplementation led to an increase in body weight and had a positive influence on sleep in elderly persons. Supplementation did not affect energy intake from regular meals and thus resulted in additional energy intake.