Comparison of Cumulative Live Birth Rate (CLBR) According to Patient Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) Stratification Among Low Prognosis Women Undergoing IVF-ICSI Cycles.

Background: The purpose of the current study was to evaluate patient-oriented strategies encompassing individualized oocyte number (POSEIDON) criteria, validate stratification of low prognosis women, and prognosticate their reproductive potential in terms of cumulative live birth rate (CLBR) in Indian women. Methods: Out of 4048 women who underwent IVF/ICSI, 3287 women met the criteria for final evaluation of CLBR. They criteria were divided into (a) group 1a as cases with <4 oocytes retrieved and 1b with 4-9 oocytes retrieved; (b) group 2a as cases with <4 oocytes retrieved and 2b with 4-9 oocytes retrieved; (c) group 3 (<35 years, AMH <1.2 ng/ml, AFC <5); and (d) group 4 (≥35 years, AMH <1.2 ng/ml, AFC <5). Non-POSEIDON group was sub-divided into normo-responders (10-20 oocytes) and hyper-responder (>20 oocytes). Results: Overall CLBR was two-fold lower in POSEIDON group as compared to non-POSEIDON group (p<0.001). For every one-year increase in the age, the odds of CLBR decreased by 4% (OR 0.96, CI 0.93-0.99) in POSEIDON group and by 5% (OR 0.95, CI 0.92-0.98) in non-POSEIDON group. For every unit increase in number of oocytes retrieved, the odds of CLBR increased by 1.22 times (OR1.22, CI 1.16-1.28) in POSEIDON group and by 1.08 times (OR 1.08, CI 1.05-1.11) in non-POSEIDON group. Among POSEIDON groups, the highest values in CLBR belonged to group 1b followed by 3, 2b, 4, 1a, and 2a. Conclusion: POSEIDON stratification of low-prognosis women undergoing IVF may be considered valid to prognosticate and counsel women undergoing IVF. Prospective studies will strengthen its validity among different ethnic populations.

Multivariate analysis of oocyte donor and recipient factors affecting cumulative live birth rate in oocyte donor IVF (OD-IVF) cycles.

OBJECTIVE: To study donor and recipient factors affecting cumulative live birth rate (CLBR) in oocyte donor IVF (OD- IVF) cycles. METHODS: The present retrospective study was conducted at the ART center of a tertiary care referral hospital after ethical approval, and included all OD-IVF cycles done between January 2014 - October 2019. Donor parameters included age, body mass index (BMI), ovarian reserve markers, serum estradiol (E2) on trigger day, and number of total/grade 1 oocytes; recipient parameters included age and BMI. The primary outcome was CLBR resulting from one complete donor-recipient (D-R) cycle through fresh/frozen embryo transfer. Secondary outcomes included number of total and grade 1 oocytes, fertilization rate, cleavage rate and clinical pregnancy rate (CPR). RESULTS: We analyzed 262 D-R cycles for donor characteristics and 260 cycles for CLBR. The mean age of the recipients was 35.20±4.05, and for donors it was 25.29±2.03 years. The CPR and CLBR per started cycle was 60% and 55.7%, respectively. Recipient BMI and grade 1 oocytes were found to be independent predictors of CLBR in multivariate analysis. As the number of grade 1 oocytes increased, the likelihood of live births increased by 10% (95% CI, 1.04 - 1.32, p=0.008). Recipient BMI ≥25kg/m2 reduced the chances of CLBR by 50% (95% CI, 0.27 - 0.81, p=0.007). CONCLUSIONS: Number of grade 1 oocytes and recipient BMI significantly affect CLBR in OD-IVF cycles. Recipients with BMI ≥25kg/m² may be advised to lose weight and improve CLBR likelihood.

Successful IVF outcome after repeat laparoscopic ovarian drilling in a case of resistant PCOS.

Ovulation induction (OVI) is the first-line treatment option for infertile women with polycystic ovary syndrome (PCOS). We report a case of resistant PCOS who responded to OVI after laparoscopic ovarian drilling (LOD) but suffered miscarriages in first trimester on three occasions, had late-onset moderate ovarian hyperstimulation syndrome (OHSS) in one cycle and recurrent anovulation. She underwent one in vitro fertilisation (IVF) cycle but it resulted in poor oocyte yield (four oocytes) and failed conception. Second LOD followed by IVF resulted in successful outcome in terms of good oocyte yield and successful live birth as well as supernumerary embryos frozen for future use. Repeat LOD may be considered in selected PCOS patients who fail to have successful pregnancy outcome despite multiple OVI cycles, have chronic anovulation, persistently raised serum antimullerian hormone and luteinising hormone, history of OHSS during OVI and prior poor response in IVF cycle.

Raised neutrophil lymphocyte ratio and serum beta hCG level in early second trimester of pregnancy as predictors for development and severity of preeclampsia.

Early detection and prediction of preeclampsia (PE) may avert serious materno-fetal complications. This prospective nested study was conducted to evaluate the role of serum beta human chorionic gonadotropin (hCG) and the neutrophil-lymphocyte ratio (NLR) in predicting the development and severity of PE. Four hundred and forty primigravidas, between 16 to 18 weeks of gestation, were recruited in the study. Serum beta-hCG and NLR were measured at the time of recruitment and they were followed and monitored for the development of PE and severe PE. Out of these 440 women, 64 (14%) developed PE; of which 25 (39%) developed severe PE. The mean values of NLR and serum beta hCG were significantly higher in patients developing PE and severe PE. NLR, with a cutoff value of 5.6, predicted the development of PE with 73.4% sensitivity and 88.6% specificity and severe PE with sensitivity 93.3% and specificity 86.6% respectively. The sensitivity and specificity of serum beta hCG in predicting the development of PE was 75% each for a cutoff value of 25,415 IU/mL whereas these values were 86.7%, and 79.1% respectively, for a cut-off value of 29,654 IU/mL for predicting the development of severe PE. These findings suggest that NLR and serum beta hCG can be used as excellent biomarkers in predicting both the development of PE and its severity. Multicentric studies involving subjects of multiple ethnicities should be done for establishing its utility as a routine screening test.