Meiotic Spindle View improves the Outcome of IVF in Poor Responders: A Retrospective Analytical Study from an Indonesian IVF Center.

OBJECTIVE: Previous studies have shown that the meiotic spindle is not always aligned with the first polar body (PB) in metaphase II human oocytes. Polarized Light Microscopy (PLM) has been used to observe and locate the meiotic spindle to avoid disrupting it while injecting oocytes. The aim of this study is to evaluate the relationship between meiotic spindle view and IVF-ICSI outcomes in poor responder women. METHODS: This study was a retrospective analytical study, carried out from January to November 2019; involving 115 poor responder women who underwent IVF-ICSI cycles at the Halim Fertility Center, Indonesia. The patients were divided into two groups: group I without meiotic spindle viewing (non-MSV) as control group, and group II with meiotic spindle viewing (MSV) as the case group. The meiotic spindles were imaged before ICSI with Oosight microscopy. Baseline characteristics and IVF-ICSI outcomes of both groups were compared. RESULTS: Our study included 115 poor responder women with non-MSV group (71 women), and an MSV group (44 women). The results showed that there was no significant difference in the fertilization rate between the two groups (p>0.05), but the embryo cleavage rate was higher in the MSV group when compared to the non-MSV group; and there was a significant difference between the two groups (p<0.05). The fertilization rate was higher in aligned than misaligned spindle and there was a significant difference between the two groups (p<0.05). Good quality embryo was higher in MSV group than non-MSV group (59.05% vs. 63.95%). CONCLUSIONS: Meiotic spindle view might improve the outcome of IVF in poor responder women.

Applying Vernix Caseosa for Accidental Foetal Lacerations during Caesarean Delivery: A Case Series.

The caesarean section is a frequently performed method of delivery. Although the caesarean section is a low-risk and safe surgery, there is an increase in maternal and infant morbidity and mortality due to caesarean delivery. One of the most common infant morbidities is foetal laceration. Caesarean delivery has a 1-2% risk of laceration to the foetus. Various methods have been proposed to deal with laceration wounds. Studies have been conducted on vernix caseosa, which can heal wounds on the skin. This case series report aims to demonstrate that vernix caseosa application is a wound healing method that is highly effective, costless, and of immediate availability.

Dual trigger with gonadotropin-releasing hormone agonist and recombinant human chorionic gonadotropin improves the outcome of intrauterine insemination.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of dual trigger, which is a combination of gonadotropinreleasing agonist (GnRH-a) and recombinant human chorionic gonadotropin (hCG) in the final oocyte maturation, in the outcome of intrauterine insemination (IUI). METHODS: This retrospective observational study was conducted from January 2016 to October 2018 and involved 639 IUI cycles at the Halim Fertility Center, Indonesia. Controlled ovarian stimulation was performed during IUI cycles. The ovulation triggers were divided into two groups: group I received a combination of GnRH-a and recombinant hCG as a dual trigger, and group II received only recombinant hCG as a single trigger. The baseline characteristics, cycle parameters, and IUI outcomes of both groups were compared. RESULTS: Our study included a total of 639 IUI cycles, 334 were in the dual trigger group and 305 in the single trigger group. The clinical pregnancy rates were significantly higher in the dual trigger group than in the single trigger group (P<0.001). Based on the multivariate analysis, the dual trigger increased the clinical pregnancy rate by 2.524 times than that by the single trigger. CONCLUSION: Our data showed that the dual trigger combination of GnRH-a and recombinant hCG significantly improves the outcome of intrauterine insemination.

Bilateral hydronephrosis and hydroureter associated with 21-22 weeks gestational age of cervical ectopic pregnancy: a case report.

Cervical ectopic pregnancy is a rare form of ectopic pregnancy. This incidence represents less than 1% of all ectopic pregnancies with reported incidence rates varying from 1:1,000 to 1:95,000 pregnancies. Cervical ectopic pregnancy is difficult to diagnose. Hydronephrosis and hydroureter have never been reported as complications of cervical ectopic pregnancy, and both are diagnosed after laparotomy. The potential morbidity, highlighted in this case study, demonstrates the importance of early diagnosis of a cervical ectopic pregnancy so that early intervention and treatment can be employed.

Does oval oocyte have an impact on embryo development in in vitro fertilization?

OBJECTIVE: To compare the outcomes of embryo development between oval-shaped oocyte as an abnormal morphology oocyte and a normal morphology oocyte in In Vitro Fertilization (IVF). METHODS: This study was a comparative analytical study with retrospective approach which lasted from September 2014 until November 2015. For this study, we used secondary data (medical records) from 24 patients submitted to IVF at the Halim Fertility Center. The oocyte morphology was divided into two groups: normal-shaped oocyte and oval-shaped oocyte. RESULTS: Our study included 120 oocytes with 60 oval-shaped oocytes and 60 normal oocytes. We found fertilization rates of 68.3% in the normal oocyte group and 61.7% in the oval-shaped oocyte group; and there was no significant difference between the normal oocyte group and the oval-shaped oocyte group (p > 0.05). In the normal oocyte group, 65% had reached day 3 embryos, and in the oval-shaped oocyte group it was 50%, with no significant difference between the groups (p > 0.05). We also found 46.7% transferrable embryos in the oval oocytes group compared to 63.3% in the normal oocytes group, with no significant difference between the groups (p > 0.05). CONCLUSION: There was no significant difference in fertilization rates and embryo quality between normal morphology oocytes and oval-shaped oocytes.