HCG (1500IU) administration on day 3 after oocytes retrieval, following GnRH-agonist trigger for final follicular maturation, results in high sufficient mid luteal progesterone levels - a proof of concept

BACKGROUND: Controlled ovarian hyperstimulation (COH) which combining GnRH antagonist co-treatment and GnRH agonist trigger with an additional 1500 IU hCG luteal rescue on day of oocytes retrieval, has become a common tool aiming to reduce severe ovarian hyperstimulation syndrome (OHSS). In the present, proof of concept study, we evaluate whether by deferring the hCG rescue bolus for 3 days, we are still able to rescue the luteal phase. METHODS: Patients undergoing the GnRH-antagonist protocol, who were considered at high risk for developing severe OHSS and received GnRH-agonist for final oocyte maturation, were included. For luteal phase support, all patients received an “intense” luteal support. Those who had no signs of early moderate OHSS on day 3 after oocytes retrieval were instructed to inject 1500 IU of HCG bolus (hCG group). Ovarian stimulation characteristics and mid luteal progesterone levels were compared between those who received the HCG bolus and those who did not. RESULTS: Eleven IVF cycles were evaluated, 5 in the hCG group and 6 in the intense luteal support only group. While no in-between group differences were observed in ovarian stimulation characteristics, significantly higher mid luteal progesterone levels (>127 nmol/L vs 42.1 ± 14.5 nmol/L, respectively) and a non-significant increase in pregnancy rate (40% vs 16.6%, respectively), were observed in those who receive the hCG bolus compared to those who did not. CONCLUSIONS: hCG luteal rescue should be offered 3 days after oocytes retrieval only to those patients with no signs of early moderate OHSS. Further studies are required to elucidate the appropriate regimen of luteal HCG administration in patients undergoing final follicular maturation with GnRH-agonist

Geometric Pattern Matching in d-Dimensional Space

We show that, using the L1 metric, the minimum Hausdorff distance under translation between two point sets of cardinality n in d-dimensional space can be computed n) for 3 ! d 8, and in time O(n n) for any d ? 8. Thus w

Geometric Pattern Matching in d-Dimensional Space

. We show that, using the L1 metric, the minimum Hausdorff distance under translation between two point sets of cardinality n in d- dimensional space can be computed in time O(n (4d\Gamma2)=3 log 2 n) for d ? 3. Thus we improve the previous time bound of O(n 2d\Gamma2 log 2 n) due to Chew and Kedem. For d = 3 we obtain a better result of O(n 3 log 2 n) time by exploiting the fact that the union of n axis-parallel unit cubes can be decomposed into O(n) disjoint axis-parallel boxes. We prove that the number of different translations that achieve the minimum Hausdorff distance in d- space is \Theta(n b3d=2c ). Furthermore, we present an algorithm which computes the minimum Hausdorff distance under the L2 metric in d-space in time O(n d3d=2e+1 log 3 n). 1 Introduction We consider the problem of finding the resemblance, under translation, of two point sets in d-dimensional space for d 3. In many matching applications, objects are described by d parameters; thu..

Geometric Pattern Matching in d-Dimensional Space

We show that, using the L1 metric, the minimum Hausdorff distance under translation between two point sets of cardinality n in d-dimensional space can be computed in time O(n (4d\Gamma2)=3 log 2 n) for 3 ! d 8, and in time O(n 5d=4 log 2 n) for any d ? 8. Thus we improve the previous time bound of O(n 2d\Gamma2 log 2 n) due to Chew and Kedem. For d = 3 we obtain a better result of O(n 3 log 2 n) time by exploiting the fact that the union of n axis-parallel unit cubes can be decomposed into O(n) disjoint axis-parallel boxes. We prove that the number of different translations that achieve the minimum Hausdorff distance in d-space is \Theta(n b3d=2c ). Furthermore, we present an algorithm which computes the minimum Hausdorff distance under the L 2 metric in d-space in time O(n d3d=2e+1+ffi ), for any ffi ? 0. 1 Introduction We consider the problem of finding the resemblance, under translation, of two point sets in d-dimensional space for d 3. In many matching appli..

Ongoing pregnancy rates in women with low and extremely low AMH levels. A multivariate analysis of 769 cycles.

BACKGROUND: The ideal test for ovarian reserve should permit the identification of women who have no real chance of pregnancy with IVF treatments consequent upon an extremely reduced ovarian reserve. The aim of the current study was to evaluate pregnancy rates in patients with low AMH levels (0.2-1 ng/ml) and extremely low AMH levels (<0.2 ng/ml) and to determine the cumulative pregnancy rates following consecutive IVF treatments. METHODS: We conducted an historical cohort analysis at a tertiary medical center. Serum AMH levels were measured at initial clinic visit and prior to all following treatment cycles in 181 women (769 cycles) with an initial AMH level ≤1 ng/ml, undergoing IVF-ICSI. Main outcome measures were laboratory outcomes and pregnancy rates. RESULTS: Seventy patients undergoing 249 cycles had extremely low AMH levels (≤0.2 ng/ml), whereas 111 patients undergoing 520 cycles had low AMH levels (0.21-1.0 ng/ml). Number of oocytes retrieved per cycle, fertilized oocytes and number of transferred embryos were significantly lower in the extremely low AMH levels group compared to the low AMH levels (P<0.003). Crude ongoing pregnancy rates were 4.4% for both groups of patients. Among 48 cycles of women aged ≥42 with AMH levels of ≤0.2 ng/ml no pregnancies were observed. But, in patients with AMH levels of 0.2-1.0 ng/ml, 3 ongoing pregnancies out of 192 cycles (1.6%) were observed. However, in a multivariate regression analysis adjusted for age and cycle characteristics, no significant differences in ongoing pregnancy rates per cycle between the two groups were evident. Cumulative pregnancy rates of 20% were observed following five cycles, for both groups of patients. CONCLUSIONS: Patients with extremely low AMH measurements have reasonable and similar pregnancy rates as patients with low AMH. Therefore, AMH should not be used as the criterion to exclude couples from performing additional IVF treatments

Defensive Medicine among Obstetricians and Gynecologists in Tertiary Hospitals

<div><p>Objective</p><p>To describe the daily work practice under the threat of defensive medicine among obstetricians and gynecologists.</p> <p>Study Design</p><p>A prospective cross-sectional survey of obstetricians and gynecologists working at tertiary medical centers in Israel.</p> <p>Results</p><p>Among the 117 obstetricians and gynecologists who participated in the survey, representing 10% of the obstetricians and gynecologists registered by the Israel Medical Association, 113 (97%) felt that their daily work practice is influenced by concern about being sued for medical negligence and not only by genuine medical considerations. As a result, 102 (87%) physicians are more likely to offer the cesarean section option, even in the absence of a clear medical indication, 70 (60%) follow court rulings concerning medical practices, and 85 (73%) physicians mentioned that discussions about medical negligence court rulings are included in their departments' meetings.</p> <p>Conclusions</p><p>Defensive medicine is a well-embedded phenomenon affecting the medical decision process of obstetricians and gynecologists.</p> </div

Activated ovarian endothelial cells promote early follicular development and survival

Abstract Background New data suggests that endothelial cells (ECs) elaborate essential “angiocrine factors”. The aim of this study is to investigate the role of activated ovarian endothelial cells in early in-vitro follicular development. Methods Mouse ovarian ECs were isolated using magnetic cell sorting or by FACS and cultured in serum free media. After a constitutive activation of the Akt pathway was initiated, early follicles (50–150 um) were mechanically isolated from 8-day-old mice and co-cultured with these activated ovarian endothelial cells (AOEC) (n = 32), gel (n = 24) or within matrigel (n = 27) in serum free media for 14 days. Follicular growth, survival and function were assessed. Results After 6 passages, flow cytometry showed 93% of cells grown in serum-free culture were VE-cadherin positive, CD-31 positive and CD 45 negative, matching the known EC profile. Beginning on day 4 of culture, we observed significantly higher follicular and oocyte growth rates in follicles co-cultured with AOECs compared with follicles on gel or matrigel. After 14 days of culture, 73% of primary follicles and 83% of secondary follicles co-cultured with AOEC survived, whereas the majority of follicles cultured on gel or matrigel underwent atresia. Conclusions This is the first report of successful isolation and culture of ovarian ECs. We suggest that co-culture with activated ovarian ECs promotes early follicular development and survival. This model is a novel platform for the in vitro maturation of early follicles and for the future exploration of endothelial-follicular communication. Capsule In vitro development of early follicles necessitates a complex interplay of growth factors and signals required for development. Endothelial cells (ECs) may elaborate essential “angiocrine factors” involved in organ regeneration. We demonstrate that co-culture with ovarian ECs enables culture of primary and early secondary mouse ovarian follicles