Gonadotropin releasing hormone agonist triggering for in vitro maturation cycles.

The objective was to evaluate the outcomes of in vitro maturation (IVM) cycles using gonadotropin releasing hormone agonist (GnRH-ag) triggering. A retrospective cohort of IVM cycles from January 2015 to December 2019 in a single university-affiliated centre was examined. Main outcome measures were: (i) IVM maturation rate; and (ii) IVM maturation result. Secondary outcome measures were: (i) metaphase II (MII) rate on the day of egg retrieval; (ii) final MII maturation rate; and (iii) pregnancy rates. A total of 98 IVM cycles were performed during the study period: 50 (51%) were triggered with GnRH-ag (17 received FSH priming and 33 did not) and 48 cycles (49%) were triggered by hCG (37 with FSH priming and 11 without). A significant (p = 0.01) difference was noticed in maturation rate on egg retrieval day, in favour of the GnRH-ag group, although not in the final maturation rate achieved. Pregnancy rates were comparable between treatment sub-groups. GnRH-ag triggering in IVM cycles is an optional triggering mode and can be considered an acceptable option, especially when fertility preservation is a concern. GnRH agonists resulted in higher maturation rate on day of oocyte retrieval, but no difference in the total maturation rate.

Prediction of the efficacy of dinoprostone slow release vaginal insert (Propess) for cervical ripening: A prospective cohort study.

AIM: To evaluate factors predictive of the success of dinoprostone slow release vaginal insert for cervical ripening. METHODS: A total of 169 women who underwent cervical ripening with dinoprostone slow release vaginal insert were included in the study cohort. The correlation between parameters present before cervical ripening with dinoprostone slow release and its success, as well as complications and adverse outcomes were analyzed. RESULTS: Dinoprostone slow release vaginal insert was successful in achieving vaginal delivery in 148 of 169 (87.6%), while sufficient ripening was achieved in 140 (83%) cases. Factors associated with successful vaginal delivery were multiparity and younger gestational age at delivery. Factors predictive of the success of cervical ripening with dinoprostone slow release vaginal insert were lower body mass index (BMI), higher parity and perceived contractions prior to insertion. Intrauterine growth restriction was associated with a significant risk for dinoprostone insert removal. Neonatal outcomes were similar in cases of successful or failed ripening. CONCLUSION: The success of cervical ripening with dinoprostone slow release vaginal insert can be predicted by factors that can be recognized at admission.

Medial or lateral location of the whirlpool sign in adnexal torsion: clinical importance.

OBJECTIVES: The whirlpool sign is used as a sonographic marker for adnexal torsion. The aims of this study were to describe the location of the whirlpool sign (lateral or medial to the ovary) and to evaluate the clinical importance of the location. METHODS: Thirty patients with a confirmed surgical diagnosis of torsion and a positive whirlpool sign on sonography before surgery were included. We examined the sonographic clips of these patients. Classic signs of adnexal torsion were determined: ovarian edema, the presence of a mass, pelvic free fluid, and ovarian ischemia on Doppler imaging. The whirlpool sign was detected on grayscale and color Doppler sonography by moving the transducer to and fro along the axis of suspected torsion. RESULTS: Sixteen of 30 patients had right-sided torsion. Of these, 7 had a lateral whirlpool sign. All 7 of these patients had an ovarian or paraovarian mass. Nine of these 16 patients had a medial whirlpool sign. Of these, 7 had an ovarian or paraovarian mass, and 2 had no mass. Of the 14 patients with left-sided torsion, all had a medial whirlpool sign. Nine of 14 these patients had an ovarian or paraovarian mass, and 5 had no mass. The mean volume of the masses among cases with the lateral whirlpool sign was significantly greater compared to those with the medial whirlpool sign (304 versus 108 cm(3); P = .035). In 25 of 30 cases, the torsed components included the ovary. CONCLUSIONS: The lateral whirlpool sign is associated with enlarged masses in comparison to the medial whirlpool sign. This finding indicates the need to search meticulously for the lateral whirlpool sign in cases with enlarged masses to decide whether to operate on these patients emergently.

Physiological (18)F-FDG uptake patterns in female reproductive organs before and after chemotherapy treatments: assessment by PET/CT.

The current study compares FDG uptake in the ovaries and uterus before and after chemotherapy with regard to the menstrual cycle and patient's age. The FDG PET/CT studies of 182 women of reproductive age (12-50 years) referred for the assessment of various malignancies were evaluated. Patterns and degree of FDG uptake in the ovaries or uterus were correlated with patient's age, chemotherapy and with the phase of the menstrual cycle. Physiological FDG uptake in ovaries of women <35 years who did not receive chemotherapy occurred with two peaks: at the beginning of menstrual cycle and at mid-cycle around ovulation. After chemotherapy, women <35 years showed FDG ovarian uptake during various stages of the menstrual cycle. In women >35 years, there was no difference in FDG ovarian uptake before and after chemotherapy. There was a negative relationship between the time elapsed from end of chemotherapy to the incidence of uptake in the ovary (p < 0.001). Bilateral ovarian uptake was significantly more prevalent in women < 35 years after chemotherapy (p < 0.01), with a significant negative dependence to time from the end of chemotherapy (p < 0.05). There was no statistically significant difference in FDG uptake in the uterus before and after chemotherapy in both age groups, as well as in SUVmax measurements in the ovaries and uterus. Chemotherapy may affect physiological FDG uptake in reproductive organs of women of reproductive age.