The Association Between Elevated Progesterone Level on Day of hCG Trigger and Live Birth Rates in ART Cycles: A Single Centre Observational Study

BACKGROUND

The advent of ovarian stimulation within an in vitro fertilization (IVF) cycle has resulted in modifying the physiology of stimulated cycles and has helped optimize pregnancy outcomes. In this regard, the importance of progesterone (P4) elevation at time of human chorionic gonadotrophin (hCG) administration within an IVF cycle has been studied over several decades. Our study aimed to evaluate the association of P4 levels at time of hCG trigger with live birth rate (LBR), clinical pregnancy rate (CPR) and miscarriage rate (MR) in fresh IVF or IVF-ICSI cycles.

METHODS

This was a retrospective cohort study (n=170) involving patients attending the Centre for Reproductive and Genetic Health (CRGH) in London. The study cohort consisted of women undergoing controlled ovarian stimulation using GnRH antagonist or GnRH agonist protocols. Univariate and multiple logistic regression analyses were used to evaluate the association of clinical outcomes. Differences were considered statistically significant if p≤0.05.

RESULTS

As serum progesterone increased, a decrease in LBR was observed. Following multivariate logistical analyses, LBR significantly decreased with P4 thresholds of 4.0 ng/ml (OR 0.42, 95% CI:0.17-1.0) and 4.5 ng/ml (OR 0.35, 95% CI:0.12-0.96).

CONCLUSION

P4 levels are important in specific groups and the findings were statistically significant with a P4 threshold value between 4.0-4.5 ng/ml. Therefore, it seems logical to selectively measure serum P4 levels for patients who have ovarian dysfunction or an ovulatory cycles and accordingly prepare the individualized management packages for such patients.

Surgical approach to a vulval-pubic cartilaginous cyst: A case report and review of published work

Cartilaginous cyst of symphysis pubis is rare and to our knowledge 12 cases have been reported in the published work. Although cartilaginous cysts of the vulva and pubis are likely to present to a gynecologist as a vulval-pubic mass, their diagnosis and management warrants a multidisciplinary team approach because of their rarity and anatomical location. Non-invasive diagnosis includes magnetic resonance imaging and ultrasound scan, while the invasive preoperative biopsy is reserved for cases with a high index of suspicion of malignancy. The surgical approach for the management of vulval-pubic cartilaginous cyst is not well established. The current case demonstrates a joint surgical approach involving a gynecologist and orthopedic surgeon in management of a degenerative cartilaginous cyst. As this condition is benign, every effort should be made to preserve the stability of the pubic symphysis. Symphyseal dysfunction from surgery remains a potential complication for which treatment is not straightforward.

Routine microbiologic culture of kidney transport fluid: a single-center retrospective study

BACKGROUND

Microbiologic culture of renal transplant fluid (RTF) has been performed since the 1950s and remained routine in some transplant centers. Although not evidence based, this conventional practice is relatively time consuming and costly. This single-center study sought to determine the prevalence and clinical significance of positive microbiologic cultures of RTF.

METHODS

Data on RTF were collected retrospectively from renal transplant cases who had samples taken from RTF for microbiology from 2000 to 2006. Review of patient notes and microbiology reports identified positive results, time and type of antibiotic, posttransplantation development of sepsis, and any significant infection.

RESULTS

Over the 6-year period we performed 370 renal transplantations from cadaveric or non-heart-beating donors. The living related or unrelated cases (n = 67) were excluded because we did not obtain RTF samples. Among the 303 remaining recipients, 237 (78%) had microscopy, culture, and sensitivity reports available. Positive cultures were identified in 66 patients, of whom 2% (n = 6) developed postoperative complications, including those related to organisms identified in the RTF in 3 patients.

CONCLUSIONS

Early identification of microorganisms, particularly in transplant patients, affects patient outcomes and quality of life. Routine screening of RTF for contamination allows for RTF-informed treatment of symptomatic patients after transplantation.