The Effect of Different Luteal Phase Support Applications on Clinical Pregnancy Outcomes in Frozen-Thawed Embryo Transfer.

Purpose: During the frozen-thawed embryo transfer (FET) method, controlled ovarian hyperstimulation is used. At the same time, progesterone support is given for luteal phase support. In this study, we investigated the effects of various luteal phase support agents administered orally, intramuscularly (IM), and vaginally during FET on pregnancy rates. Methods: The files of 166 patients between the ages of 21 and 44 in the Assisted Reproductive Techniques Center of Acibadem Mehmet Ali Aydinlar University Atakent Hospital were analyzed retrospectively between 2016 and 2022. The patients' FSH, LH, E2, P4, AMH, and TSH levels were measured. The GnRH antagonist protocol was initiated on the 2nd or 3rd day of menstruation. Three types of progesterone agents were used in females with PCOS. Three different methods were applied: 50 mg/ml of IM progesterone daily, 90 mg of progesterone gel 2∗1 vaginally, and dydrogesterone acetate tb. orally 3∗1. FET was performed on women who received 21 days of treatment by thawing 5th-day embryos. B-hCG was performed on the 12th day after the transfer, and evaluations were made. The study results were evaluated as follows: for the whole study group, for those <30 years of age, for those 30-35 years of age, and for those >35 years of age. Results: A total of 164 patients, 57 females using vaginal progesterone gel, 30 females using oral progesterone tablet, and 77 females using IM progesterone, who met the inclusion criteria, were included in the study. The pregnancy outcomes of IM progesterone application were statistically significantly higher in the entire study group and the >35 age group when compared to the vaginal progesterone gel application. It was found that the pregnancy outcomes of IM progesterone application increased statistically significantly in the <30 age group when compared to outcomes in the other groups, using vaginal progesterone gel and oral progesterone tb. Conclusions: We found that IM progesterone application was more effective than vaginal progesterone gel application for luteal phase support. Many randomized controlled, especially live birth rate studies, are required before results can more closely approximate those for the general population.

A rare cause of recurrent subconjunctival hemorrhage: ocular vicarious menstruation.

Purpose: Vicarious menstruation is cyclical bleeding in extra-uterine locations that occurs during menstruation or within 48 h of its onset. We aim to present a 43-year-old female with ocular vicarious menstruation, its treatment, and a review of other published cases of ocular vicarious menstruation. Case description: A 43-year-old Caucasian female presented with a 15-year history of recurrent monthly unilateral subconjunctival hemorrhage. The episodes were cyclical and coincided with the onset of menses, lasting for approximately 10 to 14 days. Slit-lamp examination of the right eye showed nasally located subconjunctival hemorrhage. Detailed laboratory findings, including parameters for various hematological disorders, were normal. A follow-up examination 2 weeks later showed that the subconjunctival hemorrhage in the right eye was completely resolved. The patient was prescribed the oral contraceptive levonorgestrel/ethinyl estradiol and marked improvement at the recurrences of subconjunctival hemorrhage was noted during subsequent menses. Conclusion: Ocular vicarious menstruation is among the rarest causes of recurrent subconjunctival hemorrhage. A therapeutic trial of oral contraceptive should be considered in patients that present with ocular vicarious menstruation.

Labor Induction with Intravaginal Misoprostol versus Spontaneous Labor: Maternal and Neonatal Outcomes.

Purpose: To compare the maternal and neonatal outcomes of pregnant women who had labor induction with intravaginal misoprostol or had spontaneous labor in our clinic. Material-Method. The records of 213 pregnant women, who were followed up in Acibadem Maslak University Hospital for vaginal delivery between June 2021 and December 2021, were retrospectively evaluated. The pregnant women, who gave birth, were divided into 3 groups as follows: spontaneous labor (SL), those induced by a single dose of misoprostol (SDM), and those induced by multiple doses of misoprostol (MDM). The groups were compared in terms of delivery type, the vaginal birth rate within 12 hours, need for intervention, duration of the second stage of labor, cesarean section ratio due to fetal distress, time from the last dose to delivery, and 1st and 5th minute APGAR scores. Results: Among the primiparous pregnant women, 84.7% of SL group, 65.2% of SDM group, and 37% MDM group delivered vaginally within 12 hours (p < 0.05). The time from the last misoprostol dose to delivery was also statistically significantly shorter in pregnant women, who received a single dose of misoprostol (483 vs. 720 min, respectively). When the hospitalization time was evaluated, in the SDM group, the MDM group, and the SL group, it was found to be 611, 831, and 379 min, respectively. In multiparous pregnant women, the hospitalization time was 735 min in the SDM group, 494 min in the MDM group, and 261.5 min in the SL group (p < 0.05). Other than the hospitalization time, when the aforementioned variables were studied in multiparous pregnant women, no statistically significant difference among groups was observed (p > 0.05). Conclusion: Intravaginal misoprostol seems to be a promising medical agent for labor induction due to its high delivery rates within 12 hours and the absence of negative fetal outcomes, its ease of storage, and affordable cost.

Comparing the success rate of natural cycle and modified natural cycle protocols for frozen-thawed embryo transfer.

Objective: The aim of the present study is to compare the effects of Natural Cycle and modified Natural Cycle protocols for frozen-thawed embryo transfer on clinical pregnancy rate and live birth rate. Methods: This prospective randomized controlled trial comprised 145 patients scheduled for frozen-thawed embryo transfer and was conducted at a university hospital between 2019 and 2021. The Natural Cycle protocol was administered to 73 patients and the modified Natural Cycle protocol to 72 patients and the clinical outcome was compared between the groups. The main outcome measure was live birth rate. Results: Baseline characteristics and cycle parameters were similar in both groups. There was no difference in clinical pregnancy rate (58.9% and 54.2%, respectively; p = .565) and live birth rate between the Natural Cycle and modified Natural Cycle groups (49.3% and 48.6% respectively; p = .932). Conclusion: This study established that clinical pregnancy and live birth rates were not affected by natural cycle ovulation being spontaneous or hCG-triggered among patients undergoing frozen-thawed embryo transfer. Thus, the protocol for natural cycle frozen-thawed embryo transfers should be chosen according to the priorities of the patient and the physician.