P–079 A spontaneous LH peak before triggering for intrauterine insemination with donor sperm (IUI-D) is associated to lower live birth rates

Study question

Are live birth rates after IUI with donor sperm (IUI-D) and controlled ovarian stimulation comparable between women with a spontaneous LH peak vs those without?

Summary answer

Biochemical, clinical, ongoing pregnancy rates and live birth rates were higher among women without an LH peak.

What is known already

It is common clinical practice to trigger ovulation in IUI cycles once specific criteria are met; if a natural LH surge appears, adjusting the IUI timing may become necessary. Pregnancy rates seem to be slightly better when IUI is scheduled in relation to the presence or absence of an LH peak in non-stimulated cycles. In IUI with stimulated cycles, however, there is no consensus in the medical literature regarding the best moment to program the IUI, due to different inclusion criteria, different IUI timing and definition of LH peak among studies.

Study design, size, duration

Retrospective cohort study of 9,657 IUI-D cycles performed between 2012 and 2019 in one fertility center. IUI-D without LH peak (n = 6,679) versus IUI-D with LH peak (n = 2,978) were compared. Differences in pregnancy outcomes between study groups were evaluated using a Pearson’s Chi2 test. A p < 0.05 was considered statistically significant.

Participants/materials, setting, methods

The definition used to define an LH peak is > 10UI/L in the last follicular control. In cases without an LH peak, when at least one dominant follicle reached 17mm, ovulation was triggered with human chorionic gonadotropin in the following 24h, and IUI-D was performed 38h after triggering. In cases with an LH peak, ovulation was triggered the 6h following the detection, and IUI-D was also performed 38h later.

Main results and the role of chance

The women BMI and age were comparable between groups, with a mean±SD of 35.2±4.8 years old, and 24.3±4.7 for BMI. Other characteristics such as number of previous inseminations, type of stimulation drug, initial dose, total dose, stimulation length and number of follicles > 16mm in the last follicular control were also comparable. As expected, the LH level at the last follicular control was different between groups, with a mean of 5.1UI/L in the no-LH peak and 21.4IU/L in the LH peak group. The group without an LH peak had higher biochemical, clinical, ongoing and live birth rates compared to the group with LH peak: 27.7% vs. 20.7%; 19.5% vs. 15.5%; 17.7% vs. 13.7%; 16.3% vs. 12.6%, respectively (p-value<0.001).

Limitations, reasons for caution

The main limitation of the study is its retrospective nature. Also, a definition of LH peak based in absolute values was used; a definition based in relative values may lead to different results.

Wider implications of the findings: A definition of LH peak based on absolute numbers is imprecise, and the cut-off of 10UI/L does not allow a good scheduling for IUI. A LH peak based on relative values could improve the detection of patients starting ovulation and the accuracy in programming IUI.

Trial registration number

Not applicable

Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis

Studies that analyze the epidemiology and risk factors for invasive fungal disease (IFD) after engraftment in alloSCT are few in number. This single-center retrospective study included 404 alloSCT adult recipients surviving >40 days who engrafted and were discharged without prior IFD. All patients who received ⩾20 mg/day of prednisone were assigned to primary oral prophylaxis (itraconazole or low-dose voriconazole). The primary end point was the cumulative incidence (CI) of probable/proven IFD using the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. The independent prognostic factors after multivariate analyses were used to construct a post-engraftment IFD risk score. The 1-year CI of IFD was 11%. The non-relapse mortality was 40% in those developing IFD and 16% in those who did not. The intent-to-treat analysis showed that 17% of patients abandoned the assigned prophylaxis. Age >40 years, ⩾1 previous SCT, pre-engraftment neutropenia >15 days, extensive chronic GVHD and CMV reactivation were independent risk factors. The post-engraftment IFD score stratified patients into low risk (0-1 factor, CI 0.7%), intermediate risk (2 factors, CI 9.9%) and high risk (3-5 factors, CI 24.7%) (P<0.0001). The antifungal prophylaxis strategy failed to prevent post-engraftment IFD in 11% of alloSCT. Our risk score could be useful to implement risk-adapted strategies using antifungal prophylaxis after engraftment.

[MRI quantification of myocardial function, perfusion, and enhancement in patients with left-ventricular noncompaction]

OBJECTIVE

Left ventricular noncompaction is a congenital malformation characterized by a myocardium organized into two layers, one compacted and one noncompacted. We aimed to quantify myocardial function, perfusion, and delayed enhancement using MRI in patients with left-ventricular noncompaction and to compare these results with those of normal patients.

MATERIAL AND METHODS

We included 12 patients with a myocardial noncompaction / compaction ratio>2.3 at end-diastole in at least one segment apart from the apex and 12 healthy subjects matched for age and sex. We calculated the end-diastolic and end-systolic volumes, stroke volume, ejection fraction, cardiac output, myocardial volume and mass, end-diastolic thickness, and left-ventricular wall thickening and motion. From the delayed enhancement images, we obtained the volume and percentage of hyperenhanced myocardium. Student's t test was used to compare groups.

RESULTS

We observed a statistically significant increase in end-diastolic and end-systolic volumes in patients with left-ventricular noncompaction, as well as decreased ejection fraction, wall motion, and relative maximum upslope in segments 4, 9, and 10. No significant differences were found in delayed hyperenhancement.

CONCLUSION

MRI quantification revealed decreased systolic cardiac function and decreased perfusion (lower relative maximum upslope) in the lower segments in patients with noncompaction.

[Magnetic resonance imaging of the left ventricle in healthy subjects: normal values for morphology, function, perfusion, and viability]

OBJECTIVE

To define normal values of MRI parameters related to cardiac morphology, function, perfusion, and delayed enhancement of the left ventricle and to analyze differences based on age and sex.

MATERIAL AND METHODS

We used 1.5T and 3T MRI scanners to analyze 18 healthy subjects ranging in age from 15 to 77 years old. Dedicated image processing software (Cardio-MR, View Forum, Philips Medical Systems) was used to evaluate morphological and functional parameters (end-diastolic and end-systolic volume, stroke volume, ejection fraction, cardiac output, wall mass, wall thickness, wall thickening, wall motion), perfusion parameters (relative maximum upslope, relative maximum enhancement), and delayed enhancement (percentage of late hyperenhancement). Student's t-test was used for statistical analyses.

RESULTS

Sex differences were observed: end-diastolic and end-systolic volumes, stroke volume, and wall mass were significantly higher in men and the ejection fraction was significantly larger in women. Healthy subjects over 45 years of age had significantly greater wall thickness.

CONCLUSION

We report cardiac MRI reference values for morphological, functional, perfusion, and delayed enhancement parameters. Sex and age should be taken into account as important variables related to some of these parameters.

[Smoking-related interstitial lung diseases: findings at high-resolution CT]

OBJECTIVE

To describe the anatomic and radiologic characteristics common to smoking-related interstitial lung diseases use and to evaluate the association between smoking and these diseases.

MATERIAL AND METHODS

We reviewed the clinical histories of patients with suspected smoking-related interstitial lung diseases from 2001 to 2005 who underwent high-resolution computed tomography and had radiologic findings of desquamative interstitial pneumonia, respiratory bronchiolitis, histiocytosis X, or pulmonary fibrosis. We analyzed the presence of emphysema, ground glass, centrilobar nodules, cysts, honey combing, and overlap among these findings.

RESULTS

Fourteen patients were included. In desquamative interstitial pneumonia, the most common finding was ground glass (100%); in respiratory bronchiolitis, it was centrilobar nodules (100%); cysts were the most common finding in histiocytosis (85.7%) and honey combing was the most common finding in fibrosis (100%). Furthermore, over 75% of the patients had emphysema, which supported the relation with tobacco use. The patients with bronchiolitis also had signs common to the other three diseases (ground glass, honey combing, and cysts).

CONCLUSIONS

There is a relation between smoking and these interstitial diseases, as well as overlapping in their clinical and radiological manifestations.

[Ultrasound and CT study of duodenal pathology]

The radiological evaluation of the duodenum has traditionally been based on barium transit studies; however, ultrasound (US) and computed tomography (CT) are becoming more important in the assessment of this portion of the intestine and the structures that surround it. This report describes and illustrates the CT and US findings for different entities that affect the duodenum, including diseases of the duodenum itself and those of neighboring organs that affect this portion of the small intestine. We classify the pathologies by etiology into congenital, traumatic, iatrogenic and foreign bodies, bezoars, hematologic, inflammatory and neoplastic. Moreover, we present the incidental duodenal and periduodenal findings in US and CT that radiologists should be familiar with given the widespread use of these techniques.