Search

Background: During hormone replacement therapy (HRT) to optimize endometrial growth for thawed-frozen embryo transfer (FET), patients normally undergo estrogen administration for 14 days (day 14 group). However, if optimal endometrial thickness is not achieved in 14 days, estrogen treatment is continued for seven more days at a higher dose (day 21 group). This study aimed to determine the effects of this extended estrogen administration regimen on pregnancy outcomes. Methods: A retrospective analysis was performed using our patient database from November 2016 to March 2018. We analyzed 303 cycles of blastocyst-FET and compared patient background characteristics and pregnancy outcomes between day 14 and day 21 groups. Results: In day 21 group, the pregnancy rate tended to be lower while the miscarriage rate and ectopic pregnancy rate were higher than those in day 14 group. However, the differences between the groups were not statistically significant. Conclusions: Delayed endometrial growth resulted in poorer pregnancy outcomes in FET, but the differences were not statistically significant. Thus, it could be meaningful to add estrogen administration for 7 days to avoid the poor outcomes caused by a thin endometrium.

Objective : Ovarian steroid cell tumor (SCT) is a rare tumor with steroid-producing ability. We report a 22-year-old woman with secondary amenorrhea and hirsutism caused by an ovarian SCT-not otherwise specified (NOS), who underwent successfully laparoscopic resection of the tumor. Case report: A 22-year-old null gravida woman presented to a hospital, having amenorrhea for 18 months and increasing facial hair. Physical examination revealed obesity (body mass index, 37.3 kg/m²) with evident facial and trunk hair. Total and free serum testosterone, and dehydroepiandrosterone sulfate levels were found to be elevated. Levels of serum adrenocorticotropic hormone, gonadotropins, cortisol, aldosterone, and ovarian steroids were observed to be within reference intervals. Although polycystic ovaries were not found, a hyperechogenic solid tumor (3 cm) was detected on transvaginal ultrasonography. Laparoscopic resection of the tumor was performed. One month post-surgery, total and free testosterone levels were observed to have decreased, and menstruation resumed two months thereafter. The patient was histologically diagnosed with ovarian SCT-NOS. Expression of ovarian steroidogenic enzymes, which are related to hyperandrogenism, was observed. No disease recurrence has been reported for more than 5 years post-surgery. [ABSTRACT FROM AUTHOR]

Background: Oocyte retrieval failure following an ovarian hyperstimulation protocol is uncommon in assisted reproductive technology (ART) programs. We analyzed the predictive factors for oocyte retrieval failure following controlled ovarian hyperstimulation (COH) with gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist protocols in ART programs. Methods: This study was a retrospective cohort observational study. In total, 744 cycles from 361 patients who underwent controlled ovarian hyperstimulation with GnRH agonist long protocol or antagonist protocol were analyzed. Treatment cycles with oocyte retrieval failure and with one or more oocytes retrieved were compared to determine predictive factors for oocyte retrieval failure using univariate and multilevel multivariate logistic regression analyses. Results: Oocyte retrieval failure occurred in 38 cycles (5.1 %). The oocyte retrieval failure rate of the GnRH antagonist protocol (8.1 %) was significantly higher than that of the GnRH agonist long protocol (3.7 %). On multilevel multivariate logistic analysis, cycles with GnRH antagonist protocol (odds ratio [OR] 3.06, 95 % confidence interval [CI] 1.05-8.96), estradiol level on the day of human chorionic gonadotropin (hCG) injection (OR 0.997, 95 % CI 0.996-0.998), and luteinizing hormone (LH) level on the day of hCG injection (OR 1.19, 95 % CI 1.06-1.33) were independent predictive factors for oocyte retrieval failure. The efficacy of estradiol and LH levels on the day of hCG injection for predicting oocyte retrieval failure was evaluated using receiver operating characteristic curves. In all cycles, the areas under the curve (AUCs) for estradiol and LH were 0.84 and 0.63, respectively, for all cycles; 0.84 and 0.52, respectively, for cycles with GnRH agonist long protocol; and 0.81 and 0.82, respectively, for cycles with GnRH antagonist protocol. Conclusions: Our results suggest that in cycles with GnRH antagonist protocol, the levels of estradiol and LH on the day of hCG injection might be predictive factors for oocyte retrieval failure. This relationship may provide useful information to both patients and physicians for developing better COH protocols in ART programs. [ABSTRACT FROM AUTHOR]