Age and dual trigger were found to be significant predictors of live birth in POSEIDON group 3 and 4 women treated with the GnRH antagonist protocol: a retrospective cohort study

OBJECTIVE

Despite recent advancements in assisted reproductive technology (ART), the effective management of patients with poor ovarian response (POR) remains a formidable challenge. While various treatment strategies and predictors of live births have been documented to provide guidance to fertility specialists in managing poor responders, research efforts have predominantly encompassed all POSEIDON groups. In this study, our objective was to analyze the factors correlated with live births (LB) within a subset of the POSEIDON groups, with a particular focus on POSEIDON groups 3 and 4.

PATIENTS AND METHODS

Charts of 406 patients belonging to POSEIDON groups 3 and 4 who underwent ART treatment at a university-affiliated infertility clinic following a gonadotropin-releasing hormone (GnRH) antagonist cycle between January 2016 and December 2021 were analyzed. Clinically significant factors associated with live births were incorporated into a logistic regression model for multivariate analysis to ascertain independent predictors of LB. Additionally, a receiver operating characteristic (ROC) curve analysis was conducted to establish the optimal cut-off values.

RESULTS

Live births were achieved in 48 cycles (8.7%). Female age (OR, 0.930; 95% CI: 0.874-0.991; p < 0.024), baseline serum luteinizing hormone (LH) levels (OR, 0.854; 95% CI: 0.741-0.984; p < 0.029), and dual triggers (OR, 4.004; 95% CI: 1.290-12.426; p < 0.016) were identified as independent factors associated with LB following multivariate logistic regression analysis. The optimal age cut-off was determined to be 33 years, with a sensitivity of 70.8% and specificity of 75%.

CONCLUSIONS

Younger age, lower baseline serum LH levels, and dual-trigger administration appear to enhance the likelihood of live birth in POSEIDON groups 3 and 4 following treatments with the GnRH antagonist protocol.

Longitudinal change in serum inflammatory markers in women with tubo-ovarian abscess after successful surgical treatment: a retrospective study

High levels of serum inflammatory markers are related to extended hospitalisation and more severe disease in the case of tubo-ovarian abscess (TOA). There is scarce information on the serial measurement of inflammatory markers during the postoperative follow-up period of surgically treated TOA. The present study aimed to assess the postoperative longitudinal changes in serum inflammatory markers following surgery for TOA. In this retrospective cohort study, patients who underwent surgery for TOA between January 2010 and March 2020 were reviewed. All inflammatory markers peaked within 48 hours after surgical intervention and then declined with time. The predicted mean of white blood cell count (WBC) to return to normal was 2.5 days (95% CI: 1.0-4.3), which was followed by neutrophil to lymphocyte ratio (NLR) (7.1 days, 95% CI: 4.7-10.8) and C-reactive protein (CRP) (+14 days). In conclusion, serum inflammatory markers increase in the very early post-operative period. While the normalisation period is very slow, it may not be appropriate to use CRP for evaluating the treatment success of TOA surgery. However, WBC and NLR measurements might be useful for follow-up and predicting the need for medical or surgical intervention.Impact statementWhat is already known on this subject? Serum inflammatory markers such as C-reactive protein, white blood cell count, and neutrophil to lymphocyte ratio are usually elevated in women with tubo-ovairan abscess, and high levels of these markers are associated with extended hospitalisation and more severe disease.What do the results of this study add? Our results indicate that the serum inflammatory markers increase and peak within the first 48 hours after surgery for tubo-ovarian abscess. Normalisation of white blood cell count is the fastest in successfully treated patients. However, normalisation of C-reactive protein is slowest, reaching 14 days and might not be as feasible as white blood cell count and neutrophil to lymphocyte ratio in postoperative patient follow-up.What are the implications of these findings for clinical practice and further research? The serum inflammatory markers should be interpreted with caution within 48 hours after surgical treatment for tubo-ovarian abscess. Instead of C-reactive protein white blood cell count, and neutrophil to lymphocyte ratio measurements can be preferred in post-operative follow-up to predict the need for further medical or surgical intervention.

P–700 Increased progesterone to mature oocyte index is associated with lower top-quality embryo rate in GnRH antagonist protocols

Study question

Do progesterone elevation (PE) on trigger day and progesterone to mature oocyte index (PMOI) affect embryo quality and the chance of live birth?

Summary answer

The top-quality embryo rate is decreased by increasing PMOI, but it has no association with absolute serum progesterone levels.

What is known already

Progesterone elevation have been reported to significantly decrease pregnancy and implantation rates. The main mechanism of this adverse effect is mainly related to an asynchrony between the endometrium and the embryo. Many of the previous studies have failed to show a significant impact of PE on embryo quality and the success of subsequent frozen-thawed embryo transfer (FET) cycle. However, PMOI was suggested to be more predictive than PE of ART outcome and might be associated with embryo quality.

Study design, size, duration

A single-centre retrospective cohort study was conducted. All FET cycles performed in a university hospital infertility centre between January 2016 and December 2019 were reviewed. A total of 44 patients who had PE (&gt;1.5 ng/ml) on trigger day and 134 patients who did not have PE were assessed.

Participants/materials, setting, methods

The study group consisted of patients who had PE (&gt;1.5 ng/mL) during fresh COS cycle and the control group consisted of patients who did not have PE. In addition to effect of PE on subsequent FET cycle outcome, an association between PMOI and embryo quality was assessed. The threshold level to define increased PMOI (&gt;0.12 ng/ml) was calculated as the median level of the whole study cohort.

Main results and the role of chance

The mean ages of the study and control groups were 30.4±5.4 years and 31.1±5.6 years, respectively (P = 0.413). Although the number of oocytes collected and MII oocytes were significantly higher in patients with PE, the total number of frozen embryos were similar between the groups. There were no significant differences concerning the outcome measures including live birth rate in the subsequent FET cycle between participants with and without PE (27.3% vs. 23.9%, respectively; P = 0.652). The rate of top-quality embryos was similar between participants with and without PE (43% vs. 52%, respectively; P = 0.370). However, the rate of top-quality embryos was significantly lower in cycles with PMOI&gt;0.12 ng/ml than in cycles PMOI&lt;0.12 ng/ml (42% vs. 56%, respectively; P = 0.027).

Limitations, reasons for caution

The retrospective design and the small sample size derived from a single institution.

Wider implications of the findings: Increased PMOI, which is associated to lower top-quality embryo rate, may in turn result in diminished cumulative live birth rate.

Trial registration number

Not applicable

An evaluation of transvaginal ultrasound-guided aspiration of simple adnexal cysts

We carried out this clinical study to evaluate the benefits the risks of transvaginal ultrasound-guided aspiration in a group of patients. The study group consisted of 22 premenapausal women who were detected as having benign adnexal cysts, based on ultrasound appearances. Before the procedure, all patients were evaluated thoroughly by pelvic examination, transvaginal ultrasound and serum measurements of CA-125. Oestradiol CA-125, follicle stimulating hormone, luteinising hormone and progesterone were analysed in aspirated cystic fluids as well as cytological evaluation. It was concluded that measurements of follicle stimulating hormone, luteinising hormone, oestradiol and progesterone concentrations in cystic fluid had no prognostic significance. But CA-125 levels over 55 iu/ml were likely to predict the recurrence of the cysts. Cytological examination of the aspirated cystic fluids revealed that 21 cysts were benign functional cysts, but one was serous cystadenoma. We observed recurrence following aspiration in five patients (22.7%) who were followed for 6 months. Patients with simple ovarian cysts will benefit from transvaginal ultrasound-guided aspiration by being saved from surgery and its related complications. However, its use should be limited to those masses that appear to be completely cystic with well-defined borders, because of the risk of the intra-abdominal spillage of the contents of complicated cysts.

Treatment of chronic anovulation resistant to clomiphene citrate (CC) by using gonadotrophin-releasing hormone agonist (GnRH-a) ovarian suppression followed by recombinant follicle-stimulating hormone (r-hFSH) treatment (Suprecur, Puregon)

We performed a prospective study to assess the effects of a starting dose of 50 units of recombinant follicle stimulating hormone (Puregon) during gonadotrophin-releasing hormone agonist therapy (Suprecur) on follicular development in patients with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). In a prospective clinical trial, 25 women with clomiphene citrate-resistant PCOS who wanted to become pregnant were treated by a low-dose step-up protocol of SC recombinant follicle stimulating hormone administration during gonadotrophin-releasing hormone agonist therapy, monitored by transvaginal ultrasonography and retrospectively by serum endocrine assays taken at each monitoring visit. Cancellation of cycles, ovulation, rate and size of follicles growth, serum E2 concentration and pregnancy were recorded. All patients exhibited a response: 22 patients ovulated, of whom 10 conceived. Using the low-dose protocol during gonadotrophin-releasing hormone agonist therapy permitted induction of ovulation safely and successfully in patients with clomiphene citrate-resistant PCOS who were patients previously difficult to treat with the conventional ovulation induction protocol.