P-510 Impact of ART on quality of life in predicted hyper-responders: conventional IVF versus in-vitro maturation of oocytes

Study question

Do in-vitro maturation (IVM) of oocytes and conventional IVF (cIVF) have different effects on quality of life (QoL) in women with polycystic ovaries (PCO)?

Summary answer

Women with PCO who have IVM treatment experienced a lower impact on QoL compared to their counterparts who underwent cIVF.

What is known already

While studies in predicted hyper-responders have shown that success rates of IVM are lower compared to cIVF, cIVF is associated with more hormonal side effects and complications including OHSS. According to a recent discrete choice experiment among hyper-responders in the Netherlands, not only success rates may play a role in these women’s preferences for fertility treatment, but also projected risks, burden, and costs. It is currently unknown whether the increased efficiency of cIVF in hyper-responders may come at the expense of impact on QoL and whether IVM may be associated with a lower impact on mental health parameters.

Study design, size, duration

This is a single-centre, observational prospective study including 149 women with polycystic ovaries on ultrasound scan who had their first cycle of IVM (n = 75) or cIVF (n = 74) in a tertiary referral hospital. Patients were included between May 2017 and March 2021.

Participants/materials, setting, methods

Patients <37 years embarking on ART with their partner were asked to complete the Hospital Anxiety and Depression Scale (HADS) and the Fertility Quality of Life Questionnaire (FertiQoL) at three timepoints: intake at the fertility clinic (T1), at oocyte retrieval (T2) and after the first cycle outcome was known (T3). The primary objective was to determine the impact of ART on QoL. Statistical analysis included descriptive statistics and the use of general linear models.

Main results and the role of chance

In total, 124/149 (83.2%) patients completed questionnaires at two timepoints and 97/149 (65.1%) patients returned complete questionnaires. Mean age (28.92 ± 3.48y vs. 30.63 ± 3.23y, p = 0.003) was different in both groups. BMI (25.76 ± 5.81kg/m2 vs. 24.25 ± 4.83kg/m2, p = 0.089) and duration of infertility (27.12 ± 18.31 months vs. 31.00 ± 20.14 months, p = 0.270) were similar in IVM and cIVF patients, respectively. The distribution of PCOS phenotypes A, B, C and D, and PCOM was comparable in both groups (p = 0.142).

Univariable analysis showed that women undergoing cIVF had worse side effects scores at T2 than women who had IVM (5.09 ± 3.24 vs. 3.08 ± 2.43, p < 0.001).

According to multivariable ANOVA, the impact of IVM on anxiety and depression scores was similar to that of cIVF. Patients undergoing IVM had better scores for the FertiQol Subscale for Treatment Tolerability (68.54 ± 16.75 vs. 59.09 ± 22.68, p = 0.011), suggesting that cIVF caused more mental symptoms and daily life disruption. The Relational Subscale at T3 indicated that IVM patients suffered less impairment of sexuality and communication. Finally, social interactions at T3 were more severely affected by cIVF than IVM based on the social FertiQoL subscale (74.57 ± 19.64 vs 66.96 ± 17.60, p = 0.039).

Limitations, reasons for caution

The type of ART was not assigned randomly, thus selection bias was highly likely because of the study design. The willingness to trade off chance of pregnancy for lower burden and risks may have influenced the choice of ART type and may have modulated susceptibility to impact on QoL.

Wider implications of the findings

Patients utilizing IVM may expect fewer side effects, more tolerability to treatment and less impact on their relationship and social life compared to those who opt for cIVF. Lower efficiency may be an acceptable trade-off for the benefits of IVM. These findings should be corroborated by an RCT.

Trial registration number

clinical trials.gov NCT03066349

Unilateral milia-type intradermal tophi associated with underlying urate subcutaneous deposition: an uncommon cutaneous presentation of gout

Tophi develop during the most advanced clinical stage of gout, and are usually located on or around the joints. However, unusual skin features caused by intradermal and/or subcutaneous deposition of tophaceous material at locations other than articular regions have been reported. We present the case of a patient with a condition that has been recently termed 'miliarial gout'. which is only the second such case, to our knowledge. A 51-year-old woman, who had a chronic joint disease that had been diagnosed and treated as psoriatic arthritis, presented with multiple asymptomatic, yellowish-white, firm papules (1-3 mm in size) on erythematous areas on the outside of her left leg. On histological examination of a skin biopsy, uric acid crystals were seen in the dermis and subcutis. The patient also had a raised level of serum urate, consistent with a diagnosis of gout. Treatment with allopurinol led to rapid improvement. Intake of corticosteroids and diuretics was a possible triggering factor for the development of cutaneous tophi in this patient.

[Childhood dermatosis in a dermatology clinic of a general university hospital in Spain]

BACKGROUND AND OBJECTIVES

Pediatric dermatology is a relatively new subspecialty for which few epidemiological studies are available. We aimed to determine the work load associated with this subspecialty and the most common presenting complaints among pediatric patients in the general dermatology clinic of our hospital.

METHODS

A descriptive study was performed based on hospital records to analyze patients aged 16 years or under seen in our department in 2005 and their diagnoses.

RESULTS

Pediatric dermatology accounts for 12.1 % of the work load in our department (1,329/10,998 patients were <or= 16 years old). By disease groups, tumors and infections were the most common diagnoses and accounted for 55.4 % of all cases. A long way behind was eczema (15.0 %) and diseases affecting hair follicles, nails, and sweat and sebaceous glands (8.8 %). The most common individual diagnosis was melanocytic nevus (19.8 %), followed by viral warts (12.1 %), atopic dermatitis (8.9 %), molluscum contagiosum (8.4 %), and acne (7.0 %).

CONCLUSIONS

In most developed countries, atopic dermatitis is the most common dermatologic disease in children. In our study, however, melanocytic nevus was the most common presenting complaint, reflecting perhaps that there are more children in Spain with multiple nevi due to overexposure to sunlight or because of concern about melanoma among the population. Another possibility is that Spain has fewer cases of atopic dermatitis than more industrialized countries in northern Europe. Measures to avoid exposure to sunlight and use of sunscreen should be promoted during infancy. This could help slow the increase of melanoma in the adult population.