Choosing the optimal dose of human menopausal gonadotropins for ovarian stimulation in ICSI cycles

Objective: To identify the most important predictive variables for ovarian response and establishing a model that could predict the most suitable starting gonadotropin (Gn) dose to optimize ovarian stimulation thus avoiding the undesirable side effects of ovarian hyperstimulation and minimizing cancelation rates. Study design: Retrospective observational multicenter study. Materials and methods: Data of 233 normo ovulatory females below the age of 39 undergoing their first intracytoplasmic sperm injection (ICSI) trial were collected. All patients were on long protocol and human menopausal gonadotropin (HMG) was used for ovulation induction. Patients with at least 5 oocytes retrieved and good quality embryos transferred were included in the analysis. Results: Multivariate analysis revealed that predictive variables of statistical significance on Gn dose were age, body mass index (BMI), follicle stimulating hormone (FSH) and estradiol after downregulation (E2-DR). Fitting these factors in a model to calculate the starting Gn dose revealed this equation: Dose = 1.035 Age + 2.355 FSH + 0.340 BMI + 0.241 E2--DR – 15.266. The concordance probability index for this model is 60%. Conclusion: Age, basal FSH, BMI and E2 after downregulation are important predictors of ovarian response when considering a long protocol of ovarian stimulation and could help in selecting the appropriate starting dose of GN

Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis

Abstract Objective To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS). Data sources Screening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis. Study eligibility criteria All available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them. Study appraisal and synthesis methods Extracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity. Results The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively. The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively. Conclusions The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases. Trial registration Number CRD42021267501