ABSTRACT
STUDY QUESTION: Can anti-Müllerian hormone (AMH) help predict how many oocytes will be retrieved following double stimulation (DuoStim)? SUMMARY ANSWER: A simple clinical tool can use serum AMH values to predict ovarian response following DuoStim in IVF cycles. WHAT IS ALREADY KNOWN: The knowledge that multiple follicular waves arise during a single ovarian cycle has led to the introduction of unconventional ovarian stimulation protocols. The DuoStim protocol involves two successive ovarian stimulations performed during a single ovarian cycle and has been proposed as an approach for patients with poor ovarian response and for medical fertility preservation. As AMH has been used as a marker of ovarian reserve and stimulation response, the current study aimed to investigate the diagnostic performance of AMH in predicting the number of retrieved oocytes following DuoStim. STUDY DESIGN, SIZE, DURATION: This is a retrospective observational study involving 116 patients who received IVF treatment from January 2021 to September 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study was conducted at a private IVF centre. Only patients who had their AMH measured prior to treatment and had complete patient records regarding their clinical and IVF/ICSI cycle characteristics were included. The primary outcome was the correlation between AMH values and the number of oocytes retrieved following DuoStim. Parametric and non-parametric tests were used to compare baseline characteristics and outcomes. Spearman's R was used to analyse correlations between variables, while the C statistic was used to calculate the diagnostic performance of AMH. MAIN RESULTS AND THE ROLE OF CHANCE: AMH levels were significantly correlated with the total number of oocytes retrieved after the DuoStim (R 0.61; CI 0.44-0.70; P < 0.0001). The difference in the total number of oocytes retrieved between the first (median 4 oocytes, interquartile range (IQR) 2-6) and second (median 6 oocytes, IQR 3.2-8) stimulation was statistically significant (P < 0.0001). However, there was no significant difference in the number of mature oocytes that were retrieved (median of 3 and 4 in the first and second stimulations, respectively). After the first stimulation, 68% of patients had at least one blastocyst available, while after the second stimulation, 74% did (NS). Based on linear regression, each 0.25 ng/ml increase in basal AMH corresponds to one additional oocyte recovered at the end of both stimulations (R2: 0.32, P < 0.0001). LIMITATIONS, REASONS FOR CAUTION: The results are limited owing to the observational nature of the study and the number of participants. WIDER IMPLICATIONS OF THE FINDINGS: Counselling infertile couples regarding the intermediate outcome of IVF (i.e. number of retrieved oocytes) is one of the most demanding tasks that clinicians face. To our knowledge, this is the first study that provides an easy-to-use clinical tool that enables the quantitative prediction of ovarian response following DuoStim, based on serum AMH values. STUDY FUNDING/COMPETING INTEREST(S): No external funding was obtained for this study. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.
Subject(s)
Infertility , Oocytes , Female , Humans , Fertilization in Vitro , Ovary , Ovulation Induction/methods , Retrospective StudiesABSTRACT
Mycoplasma pneumoniae is a common intracellular pathogen, which is responsible for infections of the respiratory tract, particularly in patients between 5 and 30 years of age. Nevertheless, there is increasing evidence that Mycoplasma pneumoniae plays a role in determining clinical presentations different from the respiratory ones. Among extra pulmonary complications skin eruptions are more frequent than others, even with severe clinical features such as Stevens Johnson syndrome. It is important to note that dermatological involvement can occur before, during or after the appearance of respiratory symptoms or without them. We report two patients whose onset of symptoms was not a respiratory tract disease, as usual in Mycoplasma pneumoniae infections, but prolonged and high grade fever with a relevant skin involvement pointing out the importance of researching Mycoplasma pneumoniae in the pathogenesis of peculiar clinical features. The first patient is a 4-year-old boy with signs of Stevens Johnson syndrome while the second patient is a 16-year-old girl with red-purple maculae on both legs and arms; in both cases we detected Mycoplasma IgM antibodies as a part of differential diagnosis. We discuss below the immunological mechanism by which Mycoplasma pneumoniae can determine the clinical features shown by our patients.
