A Kidney Transplant Recipient With Coronavirus Disease 2019: Utility of a Prognostication Score.

BACKGROUND: Cytokine release storm (CRS) is a potentially fatal, hyperinflammatory condition common to both coronavirus disease 2019 (COVID-19) and reactive hemophagocytic lymphohistiocytosis (rHLH). We present our experience with the use of a diagnostic score, developed for rHLH, in a kidney transplant recipient hospitalized with COVID-19. METHODS: We applied the H-Score to risk-stratify our patient to help predict his hospital course. This study was exempt from requiring specific Institutional Review Board approval, but met all the criteria required by our institution for this type of study and report including consent from the patient. RESULTS: The calculated H-Score for our patient fell below the diagnostic cut-off value for rHLH. Because rHLH is characterized by CRS, we expected him to have a milder hospital course with COVID-19. Correlating with his below cut-off H-score, the patient had a more benign than expected hospital course. CONCLUSIONS: Because this is only a single case, we plan to retrospectively review a series of patients to validate our initial experience-that a low H-Score may correlate with a milder hospital course in kidney transplant patients with COVID-19.

Effect of controlled ovarian hyperstimulation on pregnancy rates after intrauterine insemination.

OBJECTIVE: Our objective was to evaluate the effect of controlled ovarian hyperstimulation on pregnancy rates after intrauterine insemination of washed husband's sperm. STUDY DESIGN: In a private practice setting at the Infertility, Gynecology, and Obstetrics Medical Group in San Diego, 79 treatment programs included intrauterine insemination during natural cycles, 195 included clomiphene stimulation, and 53 had human menopausal gonadotropin stimulation. Pregnancy rates and monthly fecundabilities were calculated by life-table analysis and compared by the Z test. RESULTS: By life-table analysis the cumulative probability of pregnancy after intrauterine insemination with no ovulation induction is 21.0% after six cycles with a monthly fecundability of 3.4%. With clomiphene the pregnancy rate is 32.7% with a monthly fecundability of 6.1%, and with human menopausal gonadotropin the pregnancy rate is 60.7% with a monthly fecundability of 13.0%. The human menopausal gonadotropin group had a significantly higher pregnancy rate and monthly fecundability as compared with the other two groups. There were no differences between the no-stimulation and the clomiphene groups. CONCLUSIONS: Human menopausal gonadotropin stimulation results in a significantly higher pregnancy rate and monthly fecundability after intrauterine insemination as compared with no stimulation or clomiphene use.

Pregnancy rates with fresh versus computer-controlled cryopreserved semen for artificial insemination by donor in a private practice setting.

From late 1970 through December 1987, 580 women began 733 treatment programs (a total of 3405 insemination cycles) with fresh semen for artificial insemination by donor. The unadjusted pregnancy rate was 48.5% and the cumulative pregnancy rate after seven cycles by life-table analysis was 59.6% with a monthly fecundability of 11.9%. From 1988 to the present, 113 women have begun 115 treatment programs (a total of 371 insemination cycles) with cryopreserved semen for artificial insemination by donor. The unadjusted pregnancy rate to date is 18.3% and the cumulative pregnancy rate after seven cycles by life-table analysis is 48.6% with a monthly fecundability of 5.9%. This report shows that using cryopreserved semen for artificial insemination by donor will take somewhat longer to produce a pregnancy but the ultimate pregnancy rate will be similar to that with fresh semen for artificial insemination by donor.