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The study aimed to determine the effect of pregnant mare serum gonadotropin (PMSG) administration on ovarian immunohistomrphology and follicular growth in prepubertal female rabbits (Oryctolagus cuniculus). Sixteen animals, aged 75±5 days, were equally assigned into two groups, each containing eight animals. Animals in the control group were administered with normal saline (1 ml), while the treatment group received a single intramuscular injection of PMSG (100 IU). After 72 hours, the animals were euthanized, and their ovaries were dissected. Ovarian sections were stained with hematoxylin and eosin to determine ovarian features, follicle measurements, and classifications. The estrogen receptor beta (ERs-β) expression pattern was recognized by immunohistochemical staining. The diameter of the secondary, preantral, and antral follicles was significantly greater (P

In this study, we evaluated the effects of intrabursal administration of cabergoline and N‐acetylcysteine on ovarian hyperstimulation syndrome (OHSS) in an immature rat model. The study assessed body, ovarian, and uterine weights, as well as the concentrations of vascular endothelial growth factor A (VEGF‐A). Moreover, levels of MDA, 4‐HDA, and nitrites were assessed in ovarian homogenates, and vascular permeability was quantified in the peritoneal cavity. Ovarian morphology was characterized using histology and hematoxylin–eosin staining, determining the count of ovarian follicles and corpus luteum. Our results demonstrated a significant increase in lipoperoxidation, nitrite levels, and VEGF‐A concentrations in the OHSS group compared to the control group. These biochemical alterations corroborate the successful induction of OHSS in the experimental model. Direct injection into the ovarian bursa resulted in reduced vascular permeability and VEGF‐A levels, suggesting that the effects of cabergoline are predominantly ovarian. Particularly, cabergoline did not significantly alter other parameters such as ovarian weight, lipoperoxidation, nitrite levels, or morphology. Conversely, low concentrations of N‐acetylcysteine (25–50 µg/kg) significantly reduced ovarian and uterine weights, VEGF‐A levels, and vascular permeability. Interestingly, this dose–response relationship was not observed at higher NAC concentrations (100–200 μg/kg), suggesting a potential threshold beyond which NAC loses efficacy in these specific parameters. Our results suggest that the localized administration of N‐acetylcysteine shows promise as a therapeutic strategy for OHSS by modulating key parameters associated with the syndrome. These promising results warrant further investigation into its mechanisms and efficacy, potentially expanding therapeutic options for OHSS management. [ABSTRACT FROM AUTHOR]

Ovarian hyperstimulation (OHSS) is an iatrogenic complication, which commonly occurs after controlled ovarian stimulation (COS) in in-vitro fertilization (IVF) cycles. Most patients experience mild to moderate OHSS and can be managed safely in an outpatient setting with regular monitoring from their fertility treatment centre. However, severe OHSS has traditionally been managed on an inpatient basis to ensure regular monitoring and bloods can be performed to ensure there is no deterioration in the patient's condition. The mainstay of treatment remains supportive care even in severe cases of OHSS. This spotlight article aims to show that, with correct patient selection, most patients can be managed safely and effectively in an outpatient setting. [ABSTRACT FROM AUTHOR]

Abstract Importance The first meta-analysis focused only on gonadotropin-releasing hormone (GnRH) antagonists, which helped determine the effect of delay trigger on pregnancy outcomes. Objective To evaluate the impact of delay trigger compared with standard trigger in normal responders undergoing GnRH antagonist protocol in improving pregnancy outcomes. Methods Studies published before April 2023 in PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, VIP and CBM databases were searched. Randomized controlled trials (RCTs) and cohort studies conducted in normal responders reporting the efficacy of delay trigger using GnRH antagonist protocol were included. Data were combined to calculate mean differences (MD) for continuous variables and odd ratios (OR) for categorical variables with their corresponding 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran’s Q test. Results Endpoints, including clinical pregnancy rate (CPR), live birth rate (LBR), the number of oocyte retrievals and embryos, and fertilization rate, were analyzed. Six (6) clinical studies (4 RCTs and 2 cohort studies) with 1,360 subjects were included. The pooled results showed that the number of oocyte retrievals (MD: 1.20, 95% CI: 1.10, 1.30, p

Importance: The first meta-analysis focused only on gonadotropin-releasing hormone (GnRH) antagonists, which helped determine the effect of delay trigger on pregnancy outcomes. Objective: To evaluate the impact of delay trigger compared with standard trigger in normal responders undergoing GnRH antagonist protocol in improving pregnancy outcomes. Methods: Studies published before April 2023 in PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, VIP and CBM databases were searched. Randomized controlled trials (RCTs) and cohort studies conducted in normal responders reporting the efficacy of delay trigger using GnRH antagonist protocol were included. Data were combined to calculate mean differences (MD) for continuous variables and odd ratios (OR) for categorical variables with their corresponding 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran's Q test. Results: Endpoints, including clinical pregnancy rate (CPR), live birth rate (LBR), the number of oocyte retrievals and embryos, and fertilization rate, were analyzed. Six (6) clinical studies (4 RCTs and 2 cohort studies) with 1,360 subjects were included. The pooled results showed that the number of oocyte retrievals (MD: 1.20, 95% CI: 1.10, 1.30, p < 0.01), fertilization rate (MD: 0.64, 95% CI: 0.29, 0.99, p < 0.01) and days of stimulation (MD: 0.95; 95% CI: 0.54, 1.37; p < 0.01) in the delay trigger group was significantly higher than that in the standard trigger group. However, there was no significant difference in the number of embryos (MD: 0.19, 95% CI: -0.29, 0.67, p = 0.44), CPR (OR: 1.12; 95% CI: 0.72, 1.75; p = 0.062), and LBR (OR: 1.23; 95% CI: 0.90, 1.66; p = 0.19) between the two trigger groups. Conclusion: Delaying trigger time in GnRH antagonist protocol increased the number of oocytes retrieved but not the number of embryos. Furthermore, delay trigger shot was not associated with a clinical benefit towards CPR and LBR in women who underwent fresh embryo transfer cycles. Trial registration: The International Prospective Register of Systematic Reviews (PROSPERO), registration number: CRD42023413217. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare serum insulin-like growth factor (IGF)-1 levels on cycle day 2 among poor ovarian responders, age-matched normal responders, and high responders undergoing in vitro fertilization (IVF). The investigation sought to understand the potential correlation between IGF-1 levels and ovarian response, with a focus on advanced maternal age and poor ovarian response. Methods: Conducted at the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies in Baghdad, this clinical experiment involved 30 infertile individuals. The primary outcome measures included Cycle Day 2 IGF-1 serum levels, anti-Müllerian hormone (AMH) levels, antral follicle count (AFC), and retrieved oocytes. Secondary outcomes comprised intrauterine pregnancy, live birth, unfavorable pregnancy outcomes, oocyte maturation, and fertilization. Participants were categorized based on antral follicle count: Group 1 (≤3 AFC) and Group 2 (4 to 10 AFC). Results: In participants with usual responses, 72.5% had 4-10 AFC, while poor responders had ≤3 AFC in 27.5% of cases. Poor responders exhibited higher mean ages, lower mean AMH, and higher mean IGF-1 levels. However, poor responders and normal responders showed similar mean FSH levels. Female age positively correlated with FSH and IGF-1, while negatively correlating with AMH. The study also indicated negative correlations between female AMH, FSH, and IGF-1, along with a positive correlation between IGF-1 and FSH. Conclusion: The findings suggest that FSH, AMH, and IGF-1 readings in fertility-assessed women can serve as indicators of ovarian age and reserve. The observed correlations with age imply a diminishing ovarian function. This study contributes valuable insights into the relationship between serum IGF-1 levels, ovarian response, and aging, particularly in the context of poor ovarian responders undergoing IVF. [ABSTRACT FROM AUTHOR]

Abstract Polycystic ovarian syndrome (PCOS) is a widespread syndrome that poses unique challenges and constraints to the field of assisted reproductive technology. This condition is the most common cause of anovulation among infertile couples. Debate exists over the best therapeutic course of action when patients with PCOS proceed to IVF. In this review, we evaluate the best-performing and safest methods of IVF preparation, ovarian stimulation, trigger method for maturation of stimulated egg growth, and planning for embryo transfer. Pre-IVF considerations include being aware of individual AMH and vitamin D levels as well as BMI prior to selecting an ovarian stimulation protocol. Numerous supplements such as myo-inositol complement the benefits of lifestyle change and may enhance IVF performance including oocyte yield and pregnancy rate. Concerning stimulation protocols, antagonist cycles with the judicious use of GnRH agonist trigger, pre-treatment with metformin and vitamin D repletion may help mitigate the accompanied risk of ovarian hyperstimulation syndrome (OHSS). Following ovarian stimulation, PCOS patients typically undergo programmed frozen embryo transfer (FET) cycles which are more conducive for women with irregular cycles, but likely carry a higher risk of hypertensive disorders of pregnancy. However, newer stimulated FET protocols using Letrozole may offer improved outcomes. Overall, patients with PCOS require careful individual tailoring of their IVF cycle to achieve optimal results.

This study is aimed to determine the efficacy of a cocktail style treatment by combining GnRH-antagonist, letrozole, and mifepristone on the prevention of ovarian hyperstimulation syndrome (OHSS) in high-risk women. This prospective, randomized controlled clinical trial was performed between January 2018 and December 2018. A total of 170 women who identified as high risk of OHSS during the ovarian hyperstimulation and underwent cryopreservation of whole embryos. On the day of oocyte retrieval, the combination group received 0.25 mg Cetrorelix for 3 d, 5 mg letrozole for 5 d, and 50 mg mifepristone for 3 d, the mifepristone group received 50 mg mifepristone for 3 d. A total of 156 cases were included in final analysis. All the frozen embryo transfer (FET) cycles were followed up until December 2021. The combination group showed significantly decreased incidence of moderate and severe OHSS than mifepristone group (20.5% vs. 42.3%), with remarkably reduced serum estradiol level on hCG + 3 and + 5 d, decreased ovarian diameter, and shortened luteal phase. Oocyte retrieval number, levels of estradiol on hCG + 0 and VEGF, and ovarian diameter on hCG + 5 were associated with the severity of the symptoms. There was no significant difference in cumulative live birth rates (LBRs) between the combination and mifepristone group (74.4% vs. 76.9%). The combination treatment effectively reduces the incidence of moderate/severe OHSS in high-risk women. [ABSTRACT FROM AUTHOR]

Objectives: To explore the effect of abnormally elevated serum alanine aminotransferase (ALT) on pregnancy outcomes in patients with moderate and severe ovarian hyperstimulation syndrome (OHSS) at disease onset. Methods: This was a single‐center retrospective cohort study conducted between January 1, 2014 and October 31, 2021. A total of 3550 fresh in vitro fertilization/intracytoplasmic sperm injection embryo transfer cycles were included, using Golan's three‐degree, five‐level classification to diagnose patients with OHSS. According to the patient's ALT level after diagnosis of OHSS, 123 (3.46%) patients with moderate‐to‐severe OHSS were divided into two groups. A control group included 3427 (96.54%) non‐OHSS patients, and 91 (2.56%) abnormal ALT patients were matched with the control group for propensity scores. Results: There was no difference in baseline data between the abnormal ALT and matched control groups. The incidence of obstetric complications was significantly higher in the abnormal ALT group than in the matched control group (P < 0.05). After adjusting for confounding factors, the incidence of obstetric complications in the abnormal ALT group was still higher than that in the normal ALT group (P < 0.05). Conclusion: In patients with moderate and severe OHSS, higher ALT levels resulted in an increased risk of obstetric and neonatal complications. Synopsis: Abnormally elevated ALT in patients with moderate and severe OHSS during the pathogenesis of OHSS can result in an increased risk of obstetric complications. [ABSTRACT FROM AUTHOR]

Polycystic ovarian syndrome (PCOS) is a widespread syndrome that poses unique challenges and constraints to the field of assisted reproductive technology. This condition is the most common cause of anovulation among infertile couples. Debate exists over the best therapeutic course of action when patients with PCOS proceed to IVF. In this review, we evaluate the best-performing and safest methods of IVF preparation, ovarian stimulation, trigger method for maturation of stimulated egg growth, and planning for embryo transfer. Pre-IVF considerations include being aware of individual AMH and vitamin D levels as well as BMI prior to selecting an ovarian stimulation protocol. Numerous supplements such as myo-inositol complement the benefits of lifestyle change and may enhance IVF performance including oocyte yield and pregnancy rate. Concerning stimulation protocols, antagonist cycles with the judicious use of GnRH agonist trigger, pre-treatment with metformin and vitamin D repletion may help mitigate the accompanied risk of ovarian hyperstimulation syndrome (OHSS). Following ovarian stimulation, PCOS patients typically undergo programmed frozen embryo transfer (FET) cycles which are more conducive for women with irregular cycles, but likely carry a higher risk of hypertensive disorders of pregnancy. However, newer stimulated FET protocols using Letrozole may offer improved outcomes. Overall, patients with PCOS require careful individual tailoring of their IVF cycle to achieve optimal results. [ABSTRACT FROM AUTHOR]

Background: Fertility preservation is an important healthcare focus in the paediatric and adolescent population when gonadotoxic treatments are required. Ovarian stimulation (OS) resulting in oocyte cryopreservation is a well-established fertility preservation option in the adult population. It's utility, however, is little known in young patients. The purpose of this review was to synthesise the available literature on OS in patients =18 years old, to identify gaps in current research and provide suggestions for future research directions. Methods: Using PRISMA guidelines, a systematic review of the literature was performed for all relevant full-text articles published in English in Medline, Embase, the Cochrane Library and Google Scholar databases. The search strategy used a combination of subject headings and generic terms related to the study topic and population. Two reviewers independently screened studies for eligibility, extracted data and assessed the risk of bias. Characteristics of the studies, objectives and key findings were extracted and summarised in a narrative synthesis. Results: Database search and manual review identified 922 studies, 899 were eliminated based on defined exclusion criteria. Twenty-three studies were included and comprised 468 participants aged =18 years who underwent OS (median 15.2, range 7-18 years old). Only three patients were premenarchal, and four patients were on treatment to suppress puberty. Patients had OS for a broad range of indications including oncology treatment, transgender care and Turner syndrome. A total of 488 cycles of OS were completed, with all but 18 of these cycles (96.3%) successfully resulting in cryopreserved mature oocytes (median 10 oocytes, range 0-35). Fifty-three cycles (9.8%) were cancelled. Complications were rare (<1%). One pregnancy was reported from a female who had OS aged 17 years old. Conclusion: This systematic review demonstrates that OS and oocyte cryopreservation is achievable in young females however there are only a few cases in the literature describing OS in premenarcheal children or those who have suppressed puberty. There is little proof that OS can lead to pregnancy in adolescents, and no proof that this can be achieved in premenarchal girls. Therefore it should be regarded as an innovative procedure for adolescents and experimental for premenarcheal girls. [ABSTRACT FROM AUTHOR]

Purpose: To provide an agreed upon definition of hyper-response for women undergoing ovarian stimulation (OS)? Methods: A literature search was performed regarding hyper-response to ovarian stimulation for assisted reproductive technology. A scientific committee consisting of 5 experts discussed, amended, and selected the final statements in the questionnaire for the first round of the Delphi consensus. The questionnaire was distributed to 31 experts, 22 of whom responded (with representation selected for global coverage), each anonymous to the others. A priori, it was decided that consensus would be reached when ≥ 66% of the participants agreed and ≤ 3 rounds would be used to obtain this consensus. Results: 17/18 statements reached consensus. The most relevant are summarized here. (I) Definition of a hyper-response: Collection of ≥ 15 oocytes is characterized as a hyper-response (72.7% agreement). OHSS is not relevant for the definition of hyper-response if the number of collected oocytes is above a threshold (≥ 15) (77.3% agreement). The most important factor in defining a hyper-response during stimulation is the number of follicles ≥ 10 mm in mean diameter (86.4% agreement). (II) Risk factors for hyper-response: AMH values (95.5% agreement), AFC (95.5% agreement), patient's age (77.3% agreement) but not ovarian volume (72.7% agreement). In a patient without previous ovarian stimulation, the most important risk factor for a hyper-response is the antral follicular count (AFC) (68.2% agreement). In a patient without previous ovarian stimulation, when AMH and AFC are discordant, one suggesting a hyper-response and the other not, AFC is the more reliable marker (68.2% agreement). The lowest serum AMH value that would place one at risk for a hyper-response is ≥ 2 ng/ml (14.3 pmol/L) (72.7% agreement). The lowest AFC that would place one at risk for a hyper-response is ≥ 18 (81.8% agreement). Women with polycystic ovarian syndrome (PCOS) as per Rotterdam criteria are at a higher risk of hyper-response than women without PCOS with equivalent follicle counts and gonadotropin doses during ovarian stimulation for IVF (86.4% agreement). No consensus was reached regarding the number of growing follicles ≥ 10 mm that would define a hyper-response. Conclusion: The definition of hyper-response and its risk factors can be useful for harmonizing research, improving understanding of the subject, and tailoring patient care. [ABSTRACT FROM AUTHOR]

Fertility preservation is becoming an integral part of cancer care among women of reproductive age. Despite advances in the treatment of pelvic malignancies, all the currently available treatment approaches, including radiotherapy, chemotherapy, and surgery, place women at high risk for future fertility impairment. With improved long-term survival rates associated with cancer, expanding the reproductive options available is of high priority. Several fertility preservation options are available today for women with gynecologic and non-gynecologic malignancies. Depending on the underlying oncological entity, these can include the following procedures whether alone or in combination: oocyte cryopreservation, embryo cryopreservation, ovarian tissue cryopreservation, ovarian transposition, and trachelectomy. The purpose of this review is to provide the most up-to-date information on the aforementioned fertility-preserving approaches and highlight the current challenges, drawbacks, and areas of research where more data are still very necessary to optimize outcomes in young female oncological patients desiring pregnancy in the future. [ABSTRACT FROM AUTHOR]

This article provides an overview of the ovarian stimulation protocols used in assisted reproductive techniques (ART). Individual approach to ovarian stimulation involves routine measurements of ovarian reserve (OR) prior to in vitro fertilization (IVF) cycle. It helps to identify patients at risk of poor and hyper-response to gonadotrophins. The latter is associated with potentially serious complication of ovarian stimulation, ovarian hyperstimulation syndrome (OHSS). Over the years, different methods have been implemented to reduce the risk of developing ovarian hyperstimulation syndrome in predicted hyper-responders. Modified protocols of controlled ovarian stimulation (COS) allow safe and timely completion of fertility preservation treatment in patient newly diagnosed with cancer prior to start of gonadotoxic therapy. [ABSTRACT FROM AUTHOR]

BackgroundFertility preservation is an important healthcare focus in the paediatric and adolescent population when gonadotoxic treatments are required. Ovarian stimulation (OS) resulting in oocyte cryopreservation is a well-established fertility preservation option in the adult population. It’s utility, however, is little known in young patients. The purpose of this review was to synthesise the available literature on OS in patients ≤18 years old, to identify gaps in current research and provide suggestions for future research directions.MethodsUsing PRISMA guidelines, a systematic review of the literature was performed for all relevant full-text articles published in English in Medline, Embase, the Cochrane Library and Google Scholar databases. The search strategy used a combination of subject headings and generic terms related to the study topic and population. Two reviewers independently screened studies for eligibility, extracted data and assessed the risk of bias. Characteristics of the studies, objectives and key findings were extracted and summarised in a narrative synthesis.ResultsDatabase search and manual review identified 922 studies, 899 were eliminated based on defined exclusion criteria. Twenty-three studies were included and comprised 468 participants aged ≤18 years who underwent OS (median 15.2, range 7-18 years old). Only three patients were premenarchal, and four patients were on treatment to suppress puberty. Patients had OS for a broad range of indications including oncology treatment, transgender care and Turner syndrome. A total of 488 cycles of OS were completed, with all but 18 of these cycles (96.3%) successfully resulting in cryopreserved mature oocytes (median 10 oocytes, range 0-35). Fifty-three cycles (9.8%) were cancelled. Complications were rare (

In this review, we have summarized the evolution in our understanding of a relevance of gonadotropin dosing for cycle outcomes in women attempting to conceive through the utilization of the in vitro fertilization technology. [ABSTRACT FROM AUTHOR]

Over the past two years, COVID-19 pandemic is an unprecedented health emergency. All countries have taken theirown measures to mitigate the spread of the virus in the first and subsequent mini-outbreaks of infection. In view of thecurrent situation of small outbreaks of COVID-19, guidelines on epidemic prevention should be developed specificallyfor reproductive medical centers. It is necessary to establish a dynamic patient assessment and management systemto identify patients who need priority fertility treatment during epidemic control. Female Patients were assignedas grade A and required hospitalization in the inpatient ward after egg retrieval. Patients who underwent controlledovarian stimulation were classified as grade B, and they can choose to be hospitalizedat home according to their ownconvenience. Patients undergoing frozen embryo transfer (FET) cycle or planned downregulation with gonadotropinreleasinghormone agonists were defined as grade C, who could continue the assisted reproductive technology (ART)treatment cycle with negative COVID-19 nucleic acid test and there was no fever or respiratory symptoms. This briefcomment summarizes the working procedure of the reproductive medical center in the first hospital of Lanzhou Universityin China to minimize the probability of hospital infection and ensure the safe conduct of assisted reproductivetechnology therapy.

Random start protocols are commonly used for oocytes cryopreservation in women with cancer. However, evidence to support their effectiveness is yet modest. This study aims to compare the quality of ovarian response between the ovary carrying the dominant follicle or the corpus luteum (active ovary) and the contralateral ovary (resting ovary). Women with a diagnosis of malignancy who underwent oocytes cryopreservation were reviewed. The main inclusion criterion was the presence of a unilateral dominant follicle or a unilateral corpus luteum on the first day of ovarian hyperstimulation. The primary outcome was the number of mature oocytes retrieved. Intra-patient comparisons between the two ovaries were made using the nonparametric Wilcoxon test for paired data. Forty-three women were included. The number of mature oocytes retrieved from the active and the resting ovaries did not differ, the median [interquartile range—IQR] being 4 [2–7] and 5 [2–8], respectively (p = 0.09). The rate [IQR] of mature oocytes per developed follicle was 58% [40–80%] and 65% [33–87%], respectively (p = 0.42). In addition, no significant difference emerged when repeating the analyses separately for women carrying dominant follicles and for those carrying corpora lutea. This study failed to detect any detrimental effect of the presence of a dominant follicle or a corpus luteus on the ovarian response to hyperstimulation, thus supporting the validity of random start protocols. [ABSTRACT FROM AUTHOR]

Background: Declining fertility in a woman of advanced age is associated with a depletion in ovarian reserve as well as declining oocyte and embryo quality. Determining the predictors of embryo quality may assist in stimulation target and cycle prediction. Objective: This study aims to identify factors affecting embryo quality among women of advanced age receiving intracytoplasmic sperm injection (ICSI) cycles. Materials and Methods: This prospective cohort study was conducted over a period of 12 months, from January until December 2018, on 734 mature oocytes retrieved from 124 women of advanced age (35-45 yr old) receiving ICSI. The Society of Assisted Reproductive Techniques system was used to determine the morphological grading of embryo quality. The fertilization rate, cleavage rate, and pregnancy rate per cycle were expressed as a percentage per cycle for a total of 76 embryo transfers. Possible predictors of high-quality embryos were evaluated using single and multiple regression tests, with p < 0.05 considered as significant. Results: Out of the 586 available embryos, 288 (49.15%) high-quality embryos were obtained. The fertilization and cleavage rates were 86.18% and 97.83%, respectively. The total number of retrieved oocytes (R2 = 0.857) and the total available embryos (R2 = 0.857) were closely related to high-quality embryos. 76 embryo transfers were conducted, with 17 successful conceptions (implantation rate = 22.37% per transfer). There were no miscarriages among the pregnancies. Conclusion: Increasing the number of collected oocytes and the cleavage rate could increase the chance of obtaining more high-grade embryos. This could increase the success of ICSI among women of advanced age. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of the study was to explore the risk factors of ovarian hyperstimulation in patients undergoing long-acting gonadotropin-releasing hormone (GnRH) agonist protocol in follicular phase of ovulation induction therapy and to establish a predictive model. PATIENTS AND METHODS: A total of 1289 patients who received Long-acting GnRH agonist protocol in follicular phase for ovulation induction in the Fujian Provincial Maternity and Child Health Hospital from July 1, 2018, to July 31, 2019, were selected. Among them, 33 patients developed moderate/severe ovarian hyperstimulation syndrome. The relevant indicators of the two groups were followed up for comparison, and Lasso regression was used to screen independent risk factors and construct a nomogram prediction model. A receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the discrimination and calibration of the prediction model. RESULTS: Univariate analysis suggested that the woman’s age, basal antral follicle number (AFC), total gonadotropin (Gn) dose, Gn starting dose, basal estradiol (E2) level, basal anti- Müllerian hormone (AMH) value, number of follicles obtained, Gn start day E2, the difference in follicle-stimulating hormone (FSH) value and Gn starting day were statistically significant. Significant indicators of univariate analysis and clinical significance were included in the Lasso regression model, and AFC, woman’s age, polycystic ovary syndrome, Gn starting dose and number of follicles obtained were finally screened as final predictors. The ROC curve indicated that the area under the curve (AUC) was 0.812. CONCLUSIONS: Ovarian hyperstimulation caused by long-acting GnRH agonist protocol in follicular phase for ovulation stimulation has a certain predictability. Paying attention to the patient’s age, AFC, Gn starting dose, number of follicles obtained, and whether PCOS is evident may lead to early detection of ovarian hyperstimulation syndrome, which has clinical guiding significance. [ABSTRACT FROM AUTHOR]

Objectives: To compare the success of two controlled ovarian hyperstimulation protocols; rFSH + hp-hMG with only rFSH in the GnRH antagonist protocol in diminished ovarian reserve under 35 years of age. Material and methods: Data from January 2015 to June 2019 were abstracted from the hospital records of IVF Clinic. The women younger than 35 years of age who were diagnosed as diminished ovarian reserve and underwent standard GnRH antagonist protocol were included. Patients in Group-1 underwent controlled ovarian stimulation with rFSH alone and Group-2 with rFSH in combination with hp-hMG. Patients in both groups were divided into three subgroups according to their antral follicle count at Day 3: < 4 (a), 4-6 (b), and 7-10 (c). Demographic features and IVF outcomes of the patients were extracted. Results: Total number of retrieved oocytes, was higher in Group-1 than Group-2 (6.5 ± 2.1 vs 5.5 ± 2.3, respectively, p < 0.001). However, there were no significant differences between the two groups in terms of clinical pregnancy rate, implantation rate, miscarriage rate and live birth rate. Although the main study outcome parameters did not show significant difference between Group-1a and Group-2a, the number of mature oocytes (5 ± 2.8 vs 1.8 ± 1.2, respectively, p = 0.006) was higher in Group-1a. Conclusions: We observed no beneficial effect of LH supplementation during IVF for the treatment of women under 35 years old with diminished ovarian reserve in the first treatment cycle when compared with rFSH only in the antagonist protocols. [ABSTRACT FROM AUTHOR]

Since the advent of assisted reproductive technology (ART), the utilization of ART procedures has become increasingly popular among women seeking to establish pregnancy. Radiologists are therefore likely to encounter the various complications of ART therapy. The most common is ovarian hyperstimulation syndrome; others are multiple, ectopic, and heterotopic pregnancies. Ultrasonography is considered the initial modality to investigate ART complications, However, nonspecific symptoms might need the use of an additional imaging modality, such as computed tomography or magnetic resonance imaging, as a problem-solving tool. This article briefly discusses the steps involved in assisted reproduction. Its aim is to help radiologists become familiarized with the multimodality imaging features of the spectrum of ART-related complications. Their key imaging features and differential considerations are emphasized. This will facilitate the provision of precise and timely diagnoses, and aid the avoidance of fatal consequences. [ABSTRACT FROM AUTHOR]

Study Question: What are couples' preferences for fresh embryo transfer versus freezing of all embryos followed by frozen embryo transfer and the associated clinical outcomes that may differentiate them?Summary Answer: Couples' preferences are driven by anticipated chances of live birth, miscarriage, neonatal complications, and costs but not by the differences in the treatment process (including delay of embryo transfer linked to frozen embryo transfer and risk of ovarian hyperstimulation syndrome (OHSS) associated with fresh embryo transfer).What Is Known Already: A policy of freezing all embryos followed by transfer of frozen embryos results in livebirth rates which are similar to or higher than those following the transfer of fresh embryos while reducing the risk of OHSS and small for gestational age babies: it can, however, increase the risk of pre-eclampsia and large for gestational age offspring. Hence, the controversy continues over whether to do fresh embryo transfer or freeze all embryos followed by frozen embryo transfer.Study Design, Size, Duration: We used a discrete choice experiment (DCE) technique to survey infertile couples between August 2018 and January 2019.Participants/materials, Setting, Methods: We asked IVF naïve couples attending a tertiary referral centre to independently complete a questionnaire with nine hypothetical choice tasks between fresh and frozen embryo transfer. The alternatives varied across the choice occurrences on several attributes including efficacy (live birth rate), safety (miscarriage rate, neonatal complication rate), and cost of treatment. We assumed that a freeze-all strategy prolonged treatment but reduced the risk of OHSS. An error components mixed logit model was used to estimate the relative value (utility) that couples placed on the alternative treatment approaches and the attributes used to describe them. Willingness to pay and marginal rates of substitution between the non-cost attributes were calculated. A total of 360 individual questionnaires were given to 180 couples who fulfilled the inclusion criteria, of which 212 were completed and returned Our study population included 3 same sex couples (2 females and 1 male) and 101 heterosexual couples. Four questionnaires were filled by one partner only. The response rate was 58.8%.Main Results and the Role Of Chance: Couples preferred both fresh and frozen embryo transfer (odds ratio 27.93 and 28.06, respectively) compared with no IVF treatment, with no strong preference for fresh over frozen. Couples strongly preferred any IVF technique that offered an increase in live birth rates by 5% (P = 0.006) and 15% (P < 0.0001), reduced miscarriage by 18% (P < 0.0001) and diminished neonatal complications by 10% (P < 0.0001). Respondents were willing to pay an additional £2451 (95% CI 604 - 4299) and £761 (95% CI 5056-9265) for a 5 and 15% increase in the chance of live birth, respectively, regardless of whether this involved fresh or frozen embryos. They required compensation of £5230 (95% CI 3320 - 7141) and £13 245 (95% CI 10 110-16 380) to accept a 10 and 25% increase in the risk of neonatal complications, respectively (P < 0.001). Results indicated that couples would be willing to accept a 1.26% (95% CI 1.001 - 1.706) reduction in the live birth rate for a 1% reduction in the risk of neonatal complications per live birth. Older couples appeared to place less emphasis on the risk of neonatal complications than younger couples.Limitations, Reasons For Caution: DCEs can elicit intentions which may not reflect actual behaviour. The external validity of this study is limited by the fact that it was conducted in a single centre with generous public funding for IVF. We cannot rule out the potential for selection or responder bias.Wider Implications Of the Findings: If a strategy of freeze all was to be implemented it would appear to be acceptable to patients, if either success rates can be improved or neonatal complications reduced. Live birth rates, neonatal complication rates, miscarriage rates, and cost are more likely to drive their preferences than a slight delay in the treatment process. The results of this study have important implications for future economic evaluations of IVF, as they suggest that the appropriate balance needs to be struck between success and safety. A holistic approach incorporating patient preferences for expected clinical outcomes and risks should be taken into consideration for individualized care.Study Funding/competing Interest(s): No external funding was sought for this study. A.M. is the chief investigator of the randomized controlled trial 'Freeze all'. S.B. is an Editor in Chief of Human Reproduction Open. The other co-authors have no conflicts of interest to declare. Graham Scotland reports non-financial support from Merck KGaA, Darmstadt, Germany, outside the submitted work.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Abstract Background We previously reported that tamoxifen (TAM)-induced ovarian hyperstimulation (OHS) is associated with high serum concentrations of estradiol in premenopausal women with breast cancer. To investigate risk factors for TAM-induced OHS, we performed a retrospective multicenter study. Methods Premenopausal patients who received surgical therapy for endocrine-dependent breast cancer (n = 235) were recruited in this study and classified into 4 groups: group A, treated with TAM alone; group B, TAM treatment after 2-year-combined therapy with a gonadotropin-releasing hormone (Gn-RH) agonist; group C, TAM treatment after chemotherapy; group D, 5-year-combined therapy with TAM and a Gn-RH agonist. A serum estradiol value of more than 300 pg/mL or mean follicular diameter of more than 30 mm was defined as OHS. Results The incidence of OHS in group A (n = 13/26, 50.0%) was significantly higher than those in group B (n = 17/63, 27.0%), group C (n = 20/110, 18.2%), and group D (n = 0/36, 0%). The incidence of OHS was significantly correlated with aging, and the median serum concentration of estradiol in the presence of OHS was 823.0 pg/mL. The incidence of OHS (less than 47 years old) was 62.5% in group A, 48.6% in group B, and 28.2% in group C, respectively. Notably, the incidence rate of OHS following amenorrhea in group C (n = 13/20, 65.0%) was significantly higher than that in group B (n = 1/17, 5.9%). Conclusions These findings indicate that the onset of OHS following amenorrhea was common in the post-chemotherapeutic group, while its ratio was low in the group after Gn-RH analog treatment, suggesting that combined treatment-based management involving TAM therapy is necessary for premenopausal patients with breast cancer.

Assisted reproductive technologies are known to alter the developmental environment of gametes and early embryos during the most dynamic period of establishing the epigenome. This may result in the introduction of errors during active DNA methylation reprogramming. Controlled ovarian hyperstimulation, or superovulation, is a ubiquitously used intervention which has been demonstrated to alter the methylation of certain imprinted genes. The objective of this study was to investigate whether ovarian hyperstimulation results in genome-wide DNA methylation changes in mouse early embryos. Ovarian hyperstimulation was induced by treating mice with either low doses (5 IU) or high doses (10 IU) of PMSG and hCG. Natural mating (NM) control mice received no treatment. Zygotes and 8-cell embryos were collected from each group and DNA methylomes were generated by whole-genome bisulfite sequencing. In the NM group, mean CpG methylation levels slightly decreased from zygote to 8-cell stage, whereas a large decrease in mean CpG methylation level was observed in both superovulated groups. A separate analysis of the mean CpG methylation levels within each developmental stage confirmed that significant genome-wide erasure of CpG methylation from the zygote to 8-cell stage only occurred in the superovulation groups. Our results suggest that superovulation alters the genome-wide DNA methylation erasure process in mouse early pre-implantation embryos. It is not clear whether these changes are transient or persistent. Further studies are ongoing to investigate the impact of ovarian hyperstimulation on DNA methylation re-establishment in later stages of embryo development.

• PicoAMH for predicts ovarian hyperstymulation syndrome better than antral follicle counts alone. • PicoAMHis useful to optimize stimulation protocols of in-vitro fertilization. • PicoAMH studies have to be done in larger populations for utility in PCOS. Our study aims to evaluate the diagnostic performance of a high-sensitivity picoAnti-Müllerian Hormone (picoAMH) for predicting ovarian response in women undergoing controlled ovarian hyperstimulation and occurrence of ovarian hyperstimulation syndrome. Retrospective cohort study at a single academic fertility center including all patients with picoAMH ELISA who underwent controlled ovarian hyperstimulation. The primary outcome was the number of oocytes retrieved, and secondary outcomes included cycle cancellation and ovarian hyperstimulation syndrome. Patients were grouped into poor, normal, and hyper-responders based on number of oocytes retrieved. The mean AMH and antral follicle count (AFC) were significantly different between normal response vs. hyper response group (p < 0.0001). Only serum AMH and not AFC was significantly increased in patients diagnosed with ovarian hyperstimulation syndrome (OHSS). For prediction of OHSS, receiver operating characteristic (ROC) analysis revealed that AMH (area under the ROC curve [AUC] = 0.85) was significantly better than the AFC (AUC = 0.64). The serum AMH cut-off at sensitivity of 80% for predicting OHSS among hyper responders from ROC curve was 3.67 ng/ml. Serum AMH measured by picoAMH ELISA showed superior correlation to number of oocytes retrieved when compared to AFC in the age group over 40 years old (r2 = 0.74 and r2 = 0.4, respectively) This study shows great utility of picoAMH ELISA for predicting ovarian response to controlled ovarian hyperstimulation (COH). Diagnostic performance of picoAMH for prediction of OHSS is superior to the AFC in our cohort. [ABSTRACT FROM AUTHOR]

Ovarian hyperstimulation syndrome (OHSS) is a complication of ovulation induction. Deep vein thrombosis (DVT) can occur as a consequence of this syndrome, but it is an infrequent event. The authors describe the case of a woman who became pregnant after ovulation induction and developed severe OHSS and, subsequently, DVT of the right brachiocephalic trunk, internal and external jugular veins, and right subclavian vein. Thrombophilia studies were positive, revealing the presence of four mutations. The pregnancy was bichorionic and biamniotic twins and, during the course of the pregnancy, she developed severe cholestasis. In the follow-up of this situation, she underwent abdominal ultrasound which revealed the presence of liver nodules. Three years after delivery, the patient remains anticoagulated and under surveillance of liver nodules by annual MRI., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Santos et al.)

Background & aim: Ovarian hyperstimulation syndrome (OHSS) is a rare but most potentially life-threatening disorder in women under in vitro fertilization (IVF). This study aimed to determine the effect of low-dose human chorionic gonadotropin (hCG) on the prevention of OHSS and IVF outcome. Methods: This single-blind non-randomized clinical trial was performed from October 2008 to November 2012 in Motahari Hospital, Urmia, Iran. Overall, 202 infertile women undergoing IVF treatment were divided into two groups based on OHSS risk factors. Then, 87 women with serum estradiol level of 5000-8000 pg/ml received 5000 units of intramuscular hCG, and 115 women with serum estradiol level of > 8000 pg/ml, who were at high risk for OHSS, received 1600 units of hCG. Data were analyzed using independent t-test and Chi-square test in SPSS, version 16. Results: There were no significant differences in age, infertility duration, infertility factor, quality of embryo, pregnancy rate and number of abortions and OHSS rate between the groups (P>0.05). The group that received 1600 units of hCG was in a better condition regarding the mean number of ova (11.45±5.41 versus 9.24±4.24; P=0.01), mean number of good quality ova (11.10± 5.47 versus 8.68± 4.03; P=0.001), and mean number of embryos (7.38± 4.24 versus 5.53± 2.85; P=0.001). There was no significant difference in the rate of OHSS incidence and cancellation of embryo transfer between the two groups (1600 and 5000 units). Conclusion: Overall, the current study indicated that prescribing 1600 units of hCG in women who are at risk of hypersensitivity reaction may induce similar or perhaps better results regarding the quantity and quality of ova and embryos, however, OHSS risk is not completely eliminated by using a lower dose of hCG. It is therefore suggested to perform randomized clinical trials with greater sample size to verify these results.

In Korean women, a westernized lifestyle is associated with an increased risk of breast cancer. Fertility preservation has become an increasingly important issue for women with breast cancer, in accordance with substantial improvements in survival rate after cancer treatment. The methods of controlled ovarian hyperstimulation (COH) for fertility preservation in breast cancer patients have been modified to include aromatase inhibitors to reduce the potential harm associated with increased estradiol levels. Random-start COH and dual ovarian stimulation are feasible options to reduce the total duration of fertility preservation treatment and to efficiently collect oocytes or embryos. Using a gonadotropin-releasing hormone agonist as a trigger may improve cycle outcomes in breast cancer patients undergoing COH for fertility preservation. In young breast cancer patients with BRCA mutations, especially BRCA1 mutations, the possibility of diminished ovarian reserve may be considered, although further studies are necessary. Herein, we review the current literature on the practical issues surrounding COH for fertility preservation in women with breast cancer. [ABSTRACT FROM AUTHOR]

Objective: Ovarian hyperstimulation syndrome (OHSS) is a well-known phenomenon in reproductive medicine, complicating assisted reproduction for 1%–10% of women. When the same phenomenon occurs without ovulation induction, it is called spontaneous ovarian hyperstimulation syndrome (sOHSS). This extremely rare condition can be mistaken for other serious and more-prevalent conditions. There are algorithms proposed to guide the diagnosis. However, none of those algorithms include the role of surgical intervention to the best of our knowledge. This review of published literature on sOHSS evaluates the indications and types of abdominal surgical interventions in cases of sOHSS. Methods: A review of literature through medical electronic databases was carried out to describe the previously reported cases and the indications for abdominal surgical interventions in such cases until the end of 2016. Neonatal sOHSS cases were excluded. Results: Seventy-four cases were reported in 60 articles. The mean age of the women was 27 ± 6.96 years, with the youngest being 12 and the oldest being 40. One case had sOHSS in 4 consecutive pregnancies and another had it in her seventh pregnancy for the first time. Abdominal surgical intervention other than cesarean section was performed in one-third (20/74) of the patients. Suspicion of ovarian malignancy was the commonest indication for abdominal surgery in 55%. Other indications were management of suspected ovarian torsion or ovarian bleeding, therapeutic ascetic tap, and resection of ovarian tissue to decrease disease burden. Conclusions: sOHSS is a rare condition that needs to be kept in the differential diagnosis when the clinical picture is suggestive. The most-common indication for abdominal nonobstetric surgical intervention in such cases is suspicion of ovarian malignancy. When following the algorithms proposed for the diagnosis are not conclusive, conservative and principally diagnostic surgical intervention should be the approach. [ABSTRACT FROM AUTHOR]

Background: One the main aspects of in vitro fertilization (IVF) cycle is to avoid any possible systemic damage on women undergoing a controlled ovarian hyperstimulation (COH). The aim of this work is to evaluate renal and hepatic function blood tests in patients undergoing controlled ovarian hyperstimulation during IVF cycles. Materials and Methods: We performed a prospective cohort analysis. All patients re- ceived a long stimulation protocol with gonadotropin-releasing hormone (GnRH) analogues by daily administration, since the twenty-first day of the previous ovarian cycle followed by COH with recombinant follicle-stimulating hormone (FSH). The daily dose of exogenous gonadotropins for every single patient was modified according to her follicular growth. The oocytes were retrieved during the oocyte pick up and fertilized by standard procedures of intracytoplasmic sperm injection (ICSI). The blood samples to evaluate renal and hepatic functions were taken at the 7th day of ovarian stimulation. Results: We enrolled 426 women aged between 19 and 44 years, with a mean body mass index (BMI) of 24.68 Kg/m2. The mean value of blood urea nitrogen was 14 ± 3.16 mg/ dl, creatinine: 1 ± 0.45 mg/dl, uric acid: 4 ± 1.95 mg/dl, total proteins: 7 ± 3.93 mg/dl, aspartate aminotransferase: 18 ± 6.29 mU/ml, alanine aminotransferase: 19 ± 10.41 mU/ ml, alkaline phosphatase: 81 ± 45.25 mU/ml, total bilirubin 1 ± 0.35 mg/dL. All of the results were considered as a normal range following the Medical Council of Canada. Conclusion: Our data suggest that, unlike ovarian hyperstimulation syndrome (OHSS), COH patients did not show any alteration to renal and hepatic functions.

A 19-year-old girl with a short stature and presenting low intelligence quotient, illegible speech, and a greatly distended abdomen was seen at the gynecological outpatient department. She underwent investigation and was found to have large abdominopelvic multicystic ovaries with no malignant features and CA125 levels within the normal range for premenopausal women. Her thyroid-stimulating hormone (TSH) was markedly elevated. She received a diagnosis of untreated severe hypothyroidism with benign giant ovarian cysts, posing a grave risk of cyst rupture and imminent complications. The parents were counseled, and they accepted the risk, agreeing to conservative therapy. Levothyroxine replacement therapy was initiated, and after one month, her TSH levels normalized. Follow-up ultrasonography after one month of her therapy revealed a marked decrease in ovarian cyst size. Thyroid replacement therapy was continued, and at the end of three months, the cysts disappeared, and the ovaries, much smaller, showed polycystic ovarian morphology. Careful analysis of clinical signs, investigations, and appropriate therapy helped avoid unnecessary surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Jain et al.)

Background: We previously reported that tamoxifen (TAM)-induced ovarian hyperstimulation (OHS) is associated with high serum concentrations of estradiol in premenopausal women with breast cancer. To investigate risk factors for TAM-induced OHS, we performed a retrospective multicenter study.Methods: Premenopausal patients who received surgical therapy for endocrine-dependent breast cancer (n = 235) were recruited in this study and classified into 4 groups: group A, treated with TAM alone; group B, TAM treatment after 2-year-combined therapy with a gonadotropin-releasing hormone (Gn-RH) agonist; group C, TAM treatment after chemotherapy; group D, 5-year-combined therapy with TAM and a Gn-RH agonist. A serum estradiol value of more than 300 pg/mL or mean follicular diameter of more than 30 mm was defined as OHS.Results: The incidence of OHS in group A (n = 13/26, 50.0%) was significantly higher than those in group B (n = 17/63, 27.0%), group C (n = 20/110, 18.2%), and group D (n = 0/36, 0%). The incidence of OHS was significantly correlated with aging, and the median serum concentration of estradiol in the presence of OHS was 823.0 pg/mL. The incidence of OHS (less than 47 years old) was 62.5% in group A, 48.6% in group B, and 28.2% in group C, respectively. Notably, the incidence rate of OHS following amenorrhea in group C (n = 13/20, 65.0%) was significantly higher than that in group B (n = 1/17, 5.9%).Conclusions: These findings indicate that the onset of OHS following amenorrhea was common in the post-chemotherapeutic group, while its ratio was low in the group after Gn-RH analog treatment, suggesting that combined treatment-based management involving TAM therapy is necessary for premenopausal patients with breast cancer. [ABSTRACT FROM AUTHOR]

Asthma is a chronic reversible obstructive airway disease, which is common among children and leads to respiratory impairment. Studies showed that asthma is more common among children born after in vitro fertilization (IVF) than among spontaneously conceived children. However, it is unknown which component of the IVF procedure contributes to this putative link. Therefore, the aim of this prospective follow-up study was to differentiate the possible effect of ovarian hyperstimulation from that of the in vitro culture procedure on asthma and rhinitis in 9-year-old children conceived with IVF. The study comprised three groups of singletons: (I) conceived with ovarian hyperstimulation-IVF (COH-IVF, n = 95); (II) conceived with modified natural cycle-IVF (MNC-IVF, n = 48); and (III) naturally conceived to subfertile couples (Sub-NC, n = 68). Parents filled out the validated Dutch version of the asthma questionnaire of the International Study of Asthma and Allergies. Asthma prevalence in the groups did not differ: COH-IVF n = 8 (8%); MNC-IVF n = 0 (0%); and Sub-NC n = 4 (6%). Adjustment for confounders did not alter the results.Conclusion: Neither ovarian hyperstimulation nor the in vitro culture procedure was associated with asthma and rhinitis at 9 years. IVF children had a similar prevalence of asthma compared with children conceived naturally by subfertile couples.Trial registration: ISRCTN76355836 What is Known: • An increased risk for asthma has been observed in children born after in vitro fertilization at preschool and school age. • The association between IVF and asthma may be partly explained by parental subfertility. What is New: • IVF children do not have a higher prevalence of asthma than children of subfertile couples conceived naturally. • Ovarian hyperstimulation used in IVF is not associated with asthma in 9-year-old children of subfertile couples. [ABSTRACT FROM AUTHOR]

Assisted reproductive technologies are known to alter the developmental environment of gametes and early embryos during the most dynamic period of establishing the epigenome. This may result in the introduction of errors during active DNA methylation reprogramming. Controlled ovarian hyperstimulation, or superovulation, is a ubiquitously used intervention which has been demonstrated to alter the methylation of certain imprinted genes. The objective of this study was to investigate whether ovarian hyperstimulation results in genome-wide DNA methylation changes in mouse early embryos. Ovarian hyperstimulation was induced by treating mice with either low doses (5 IU) or high doses (10 IU) of PMSG and hCG. Natural mating (NM) control mice received no treatment. Zygotes and 8-cell embryos were collected from each group and DNA methylomes were generated by whole-genome bisulfite sequencing. In the NM group, mean CpG methylation levels slightly decreased from zygote to 8-cell stage, whereas a large decrease in mean CpG methylation level was observed in both superovulated groups. A separate analysis of the mean CpG methylation levels within each developmental stage confirmed that significant genome-wide erasure of CpG methylation from the zygote to 8-cell stage only occurred in the superovulation groups. Our results suggest that superovulation alters the genome-wide DNA methylation erasure process in mouse early pre-implantation embryos. It is not clear whether these changes are transient or persistent. Further studies are ongoing to investigate the impact of ovarian hyperstimulation on DNA methylation re-establishment in later stages of embryo development. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether unexplained infertility at a young age demonstrates manifestations of decreased ovarian reserve. Methods: A total of 100 women were divided into two equally sized groups. The study group comprised women aged ≤ 37 years diagnosed with unexplained infertility, and the control group included age-matched women with either mechanical factor or severe male factor infertility. Results: Both groups were comparable in their basic characteristics. Overall, women with unexplained infertility presented with inferior ovarian reserve results set against women of the control group. The number of ≥ 14-mm follicles on the day of hCG administration was significantly lower in the study compared with the control group (7.0 ± 4.5 vs. 10.4 ± 4.1 follicles, respectively, P < 0.001). Likewise, basal serum FSH was higher in the study compared with the control group (8.4 ± 5.5 vs. 6.4 ± 1.7 IU/L, respectively, P = 0.015), while antral follicle count was lower (10.9 ± 6.6 vs. 16.2 ± 6.6 follicles, respectively, P < 0.001). Furthermore, women with unexplained infertility required a higher total dose of FSH for ovarian stimulation (2,923 ± 1,701 vs. 2,196 ± 941 IU/L, respectively, P = 0.010), but exhibited a lower number of retrieved oocytes (9.3 ± 6.3 vs. 15.6 ± 7.9 oocytes, respectively, P < 0.001), alongside a lower number of achieved embryos (5.3 ± 4.0 vs. 8.0 ± 4.7 embryos, respectively, P = 0.002). Interestingly, the cumulative clinical pregnancy rate was not significantly different between the two groups (44% vs. 58%, respectively, P = 0.163). Conclusions: Young women ≤ 37 years of age with unexplained infertility have clear manifestations of sub-optimal ovarian reserve set against controls. Our findings suggest that unexplained infertility at a young age may be a risk factor for developing poor ovarian response, specifically as a quantitative, rather than a qualitative, risk factor. [ABSTRACT FROM AUTHOR]

Cesarean section in a mother with a sextuplet pregnancy is challenging for an anesthesiologist. Several perioperative complications are likely because of the overdistended uterus and associated changes in the mother. We are reporting the case of a woman with a sextuplet pregnancy who came for an emergency cesarean. She also had a background history of polycystic ovarian syndrome (PCOS) and ovulation induction for conception. Early pregnancy was complicated by ovarian hyperstimulation syndrome. She required cervical cerclage in early pregnancy. The emergency cesarean was done as she went into preterm labor and six premature babies were delivered at 29 weeks of gestation. Cesarean was done under spinal anesthesia. Preeclampsia and postpartum hemorrhage complicated the perioperative period., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ethy Ahammedunni et al.)

Background: Ovarian hyperstimulation syndrome (OHSS) is the most serious and potentially life-threatening iatrogenic complication associated with ovarian stimulation during assisted reproductive technology protocols. The aim of this study was to evaluate the role of dopamine agonist as a preventive strategy of OHSS in women at high risk in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycles. Methods: Seventy women at risk to develop OHSS undergoing IVF/ICSI treatment cycle were included. The study group received 0.5 mg of cabergoline for 8 days from the day of human chorionic gonadotropin administration in comparison to those who undergo no treatment for the prevention of OHSS. The reduction of the incidence of OHSS was the primary outcome. Results: The actual incidence of OHSS was 8.33% in the cabergoline group and 20.58% in the control group. Thus, the incidence of OHSS was significantly reduced, by almost 60%, in the cabergoline group in comparison with the control group (relative ratios: 0.4, 95% confidence interval: 0.18–0.79). Conclusion: Prophylactic treatment with the dopamine agonist, cabergoline, reduces the incidence of OHSS in women at high risk undergoing IVF/ICSI treatment. However, the effects of cabergoline on important outcomes, namely, live birth, miscarriage, and congenital abnormalities are still uncertain.

Objective: Ovarian torsion is an acute abdomen requiring prompt intervention. Ovarian torsion seldom occurs during pregnancy. However, with in vitro fertilization (IVF) treatments, ovarian hyperstimulation may increase the size of the ovaries and result in the occurrence of adnexal torsion. Here, we report two cases of ovarian torsion after IVF and discuss the optimal management of this emergency medical condition. Case Report: The first case was a 23-year-old woman who received IVF–embryo transfer due to tubal factor infertility. Sudden-onset, lower abdominal pain developed at the 6th week of pregnancy. Conservative treatment with antibiotics was the initial approach, but a right oophorectomy had to be performed due to right ovarian torsion with hemorrhagic and gangrenous changes. The second case was a 38-year-old woman diagnosed with bilateral ovarian torsion at 8 weeks' gestation due to the sudden onset of low abdominal pain. Laparoscopy was arranged immediately after the diagnosis was confirmed. The left ovary was successfully preserved due to prompt intervention. Both pregnancies continued without problems after surgery. Conclusion: Ovarian hyperstimulation during IVF–embryo transfer treatment is a risk factor for developing adnexal torsion. Early diagnosis and prompt surgical intervention is the only way to protect the ovary and preserve the pregnancy. Laparoscopic surgery in early pregnancy causes no harm to the fetus and should be encouraged once the diagnosis is confirmed. Delaying surgery may induce serious infection and jeopardize the lives of both the fetus and mother.