The impact of serum estradiol and progesterone levels during implantation on obstetrical complications and perinatal outcomes in frozen embryo transfer.

BACKGROUND: This study sought to evaluate obstetric complications and perinatal outcomes in frozen embryo transfer (FET) using either a natural cycle (NC-FET) or a hormone therapy cycle (HT-FET). Furthermore, we investigated how serum levels of estradiol (E2) and progesterone (P4) on the day of and 3 days after embryo transfer (ET) correlated with clinical outcomes in the two groups. METHODS: We conducted a retrospective, single-center study from January 1, 2015, to December 31, 2019. The study included couples who underwent NC-FET or HT-FET resulting in a singleton live birth. Serum levels of E2 and P4 were measured on the day of and 3 days after ET. The primary outcomes assessed were preterm birth rate, low birth weight, macrosomia, hypertensive disorders in pregnancy, gestational diabetes mellitus, postpartum hemorrhage, and placenta-related complications. RESULTS: A total of 229 singletons were included, with 49 in the NC-FET group and 180 in the HT-FET group. There were no significant differences in obstetric complications and perinatal outcomes between the two groups. The NC-FET group had significantly higher serum levels of P4 (17.2 ng/mL vs 8.85 ng/mL; p < 0.0001) but not E2 (144 pg/mL vs 147 pg/mL; p = 0.69) on the day of ET. Additionally, 3 days after ET, the NC-FET group had significantly higher levels of both E2 (171 pg/mL vs 140.5 pg/mL; p = 0.0037) and P4 (27.3 ng/mL vs 11.7 ng/mL; p < 0.0001) compared with the HT-FET group. CONCLUSION: Our study revealed that although there were significant differences in E2 and P4 levels around implantation between the two groups, there were no significant differences in obstetric complications and perinatal outcomes. Therefore, the hormonal environment around implantation did not appear to be the primary cause of differences in obstetric and perinatal outcomes between the two EM preparation methods used in FET.

Effect of extra-low dose levothyroxine supplementation on pregnancy outcomes in women with subclinical hypothyroidism undergoing in vitro fertilization and embryo transfer.

OBJECTIVE: This study was undertaken to test the therapeutic effect of extra-low dose of levothyroxine (LT4; 25 mcg/day) to preconception and pregnant women with subclinical hypothyroidism (SCH). MATERIALS AND METHODS: This is a retrospective study, SCH women who succeeded in their first in vitro fertilization (IVF) cycle between January 1, 2018, to December 31, 2020 were included. SCH is defined as normal serum free thyroxine (T4) level and an elevated serum thyroid stimulating hormone (TSH) level >4 mIU/L. Extra-low dose of levothyroxine (LT4; 25 mcg/day) was prescribed to the SCH women from the establish of diagnosis of SCH to the end of pregnancy. The pregnancy outcomes (miscarriage, live birth, preterm birth, and small for gestational age baby) were compared to the euthyroid pregnant women. RESULTS: Totally, 589 women were screened, and 317 cases received their first time IVF treatment. 167 women were clinically pregnant after IVF treatment, 155 of them were euthyroid and 12 of these women were diagnosed to have SCH. The average age of the participants was 35 years old. There were no significant differences in age, body mass index (BMI), anti-müllerian hormone (AMH), types of embryo transfer, number of embryos to transfer, or embryo stage during transfer between two groups. The live birth rate, miscarriage rate, and preterm birth rate in women with SCH supplemented with extra-low dose of LT4 were non-inferior to euthyroid patients (miscarriage rate: P = 0.7112; live birth rate: P = 0.7028; preterm delivery: P = 0.2419; small for gestational age: P = 0.2419). CONCLUSION: Our result demonstrated that supplementation with extra-low dose of levothyroxine at 25 mcg/day to SCH women can produce the comparable obstetrical and neonatal outcome as that in euthyroid pregnant women. Accordingly, we suggest extra-low-dose of levothyroxine may be considered as a safe and effective alternative for those SCH pregnant women who were not tolerated to the standard dose of levothyroxine.

Diagnosis and management of ovarian vein thrombosis after laparoscopic -assisted vaginal hysterectomy with bilateral salpingectomy: A case report and literature review.

OBJECTIVE: We present a case who developed ovarian vein thrombosis (OVT) after laparoscopic-assisted vaginal hysterectomy with bilateral salpingectomy to share our experience. CASE REPORT: A 46-year-old woman came to our hospital due to severe dysmenorrhea induced by adenomyosis. Medical treatments were given but with unsatisfactory effect. As the patient had completed family planning, a hysterectomy was scheduled. However, on the sixth postoperative day, the patient complained of low abdominal pain with fever on and off. After a series of examinations, right OVT was diagnosed. The patient was treated with antibiotics only. Under close surveillance, the OVT resolved spontaneously, and the patient was discharged. CONCLUSION: Diagnosis of OVT requires highly suspicion owing to its rarity and non-specific presentation. OVT is a potentially serious venous thromboembolism that sometimes can be life threatening. Anticoagulant treatment is still controversial. Conventional Tomography with contrast medium could detect early OVT with high sensitivity and specificity.

Artificial intelligence model to predict pregnancy and multiple pregnancy risk following in vitro fertilization-embryo transfer (IVF-ET).

OBJECTIVE: To decrease multiple pregnancy risk and sustain optimal pregnancy chance by choosing suitable number of embryos during transfer, this study aims to construct artificial intelligence models to predict the pregnancy outcome and multiple pregnancy risk after IVF-ET. MATERIALS AND METHODS: From Jan 2010 to Dec 2019, 1507 fresh embryo transfer cycles contained 20 features were obtained. After eliminating incomplete records, 949 treatment cycles were included in the pregnancy model dataset and 380 cycles in the twin pregnancy model dataset. Six machine learning algorithms were used for model building based on the dataset which 70% of the dataset were randomly selected for training and 30% for validation. Model performances were quantified with the area under the receiver operating characteristic curve (AUC), accuracy, specificity, and sensitivity. RESULTS: Models built with XGBoost performed best. The pregnancy prediction model produced accuracy of 0.716, sensitivity of 0.711, specificity of 0.719, and AUC of 0.787. The multiple pregnancy prediction model produced accuracy of 0.711, sensitivity of 0.649, specificity of 0.740, and AUC of 0.732. CONCLUSIONS: The AI models provide reliable outcome prediction and could be a promising method to decrease multiple pregnancy risk after IVF-ET.

HLA sharing and maternal HLA expression in couples with recurrent pregnancy loss in Taiwan.

OBJECTIVE: The aim of this study is to investigate the frequency and distribution of human HLA sharing and maternal HLA allele expression in couples with recurrent pregnancy loss in Taiwan. MATERIALS AND METHODS: We retrospectively reviewed couples experienced two or more pregnancy loss before 20th weeks of gestation from March 2014 to November 2020 having HLA determination. Fertile individuals with one or more live-birth offspring receiving HLA allele determination during the same period were included as the control group. The distribution and frequency of HLA sharing were analyzed and presented by descriptive statistics. Fisher Exact Test were used to analyze specific maternal and paternal HLA allele comparing individuals with RPL to fertile group. P-value < 0.05 was thought to be statistically significant. RESULTS: 72 couples were enrolled from March 2014 to November 2020. Regarding the distribution of HLA sharing, HLA sharing between females and their male partners less and equal to 2 pairs were found in 40.3% of the couples. HLA sharing greater and equal to 3 pairs are found in 59.8% couples. HLA sharing was most frequently found in alleles HLA-A02, A11, DQ07, C07 and B60 in descending order. There was a significant lower expression of HLA-B13 in women with RPL compared to women who had successful pregnancy (p = 0.0234). Compared infertile men with fertile men cohort, the frequency of HLA-DR04 (p = 0.0438, OR 2.444, 95% CI 1.0251-5.8287), HLA-DR12 (p = 0.001, OR 30.85, 95% CI 4.0296-236.19) and HLA-15 (p = 0.0357, OR 9.354, 95% CI 1.1610-75.37) were found to be significantly higher in men with RPL. On the contrary, HLA-DR07 (p = 0.0085, OR 0.124, 95% CI 0.0264-0.587) and HLA-DR10 (p = 0.0395, OR 0.048, 95% CI 0.0027-0.8641) were found to be significantly lower in men with RPL. CONCLUSION: We found a tendency to recurrent pregnancy loss in couples with more than 2 pairs of HLA sharing. The similarity of HLA sharing, the expression of maternal HLA-B13 allele and paternal HLA-DR alleles in Taiwanese couples might play a role in recurrent pregnancy loss.

Risks of interstitial cystitis among patients with systemic lupus erythematosus: A population-based cohort study.

OBJECTIVE: To investigate whether the risk of interstitial cystitis increases among the patients with systemic lupus erythematosus. METHODS: This was a nationwide population-based cohort study. Data were obtained from the National Health Insurance Research Database in Taiwan. Women aged >18 years newly diagnosed as systemic lupus erythematosus during 2001-2008 were identified as the control group. The comparison included individuals randomly selected from the National Health Insurance Research Database in the year of 2000, by matching one systemic lupus erythematosus participant with eight non-systemic lupus erythematosus participants with sex and age. These participants were followed up until being diagnosed as interstitial cystitis, or the end of 2011. Women diagnosed with lupus cystitis were excluded from this study. RESULTS: This study included 7240 women with systemic lupus erythematosus and 57 920 women without systemic lupus erythematosus as controls. The incidence rate of interstitial cystitis was significantly higher in the systemic lupus erythematosus group, with an incidence rate ratio of 2.26 (95% confidence interval 1.57-3.27, P < 0.0001). After adjustment, the risk increased by 2.45-fold (adjusted hazard ratio 2.45, 95% confidence interval 1.57-3.27, P < 0.05). Age as a factor increases incidence rate ratios among all age groups, 2.12-, 3.32- and 4.65-fold. Age ≥45 years had an increased adjusted hazard ratio (2.07, 95% confidence interval 1.37-3.13, P < 0.05). Comorbidities, for example, hypertension, diabetes mellitus, dyslipidemia and renal disease, were insignificant. CONCLUSIONS: This is the first population-based cohort study showing a higher incidence of interstitial cystitis among patients with systemic lupus erythematosus. These findings support the concordance of interstitial cystitis with autoimmune diseases, and the temporal relationship to develop interstitial cystitis in patients with systemic lupus erythematosus.

Simplified small-scale backlight unit tester.

A novel design is the concept of using charge coupled device camera embedded with calibrated image processing algorithm as a two-dimensional luminance meter to measure the luminance and uniformity of small-scale backlight of unit. A small-scale backlight unit tester was successfully realized and performed to verify this concept.