Comparison of obstetric outcomes of pregnancies after donor oocyte IVF: Three-arm age-matched retrospective cohort study

Background: Oocyte donation has become widely used as a treatment option for infertile couples. The few available studies report conflicting evidence about the risk of hypertensive disorders in donor oocyte pregnancies after adjusting for maternal age and it is unclear whether pregnancy complications and obstetric risks are due to oocyte donation or to confounding factors such as maternal age. The aim of the present study was to evaluate and compare obstetric complications between women who conceived after oocyte donation and age-matched control women with spontaneous conception and self oocyte IVF conception.Methods : The present study comprised of women aged 20-45 years conceived from oocyte donation (n=104) between 1/12/2010 to 15/10/2017. Two age-matched control groups—Self oocyte IVF (n=150) and the other containing women who conceived spontaneously (n=312) were used for comparison of obstetric and perinatal outcomes.Results: Mean maternal age was statistically significantly higher in the Donor oocyte IVF group as compared to  self oocyte ivf and spontaneous conception group. Miscarriage, first trimester bleeding, pregnancy induced hypertension and gestational diabetes mellitus was significantly higher in Donor oocyte IVF group as compared to self-oocyte and spontaneous conception group (p=0.001). Using multiple logistic regression analysis age class adjusted PIH and GDM  incidence was significantly higher in donor oocyte group as compared to spontaneous conception (P=0.010).There was significant variation in perinatal outcomes between the three groups.Conclusion: Oocyte donation should be treated as an independent risk factor for miscarriage, first trimester bleeding, hypertensive disorder and gestational diabetes mellitus in pregnancy

Predictors of oocyte yield in controlled ovarian hyperstimulation IVF/ICSI cycles: a retrospective analysis in a tertiary care centre

Background: The most important predictor of oocyte yield in ART cycles is female age, but other biochemical and ultrasonographic markers done before controlled ovarian stimulation may predict the oocyte yield in women undergoing COS in IVF cycles.Methods: The main aim of the study was to evaluate ovarian reserve markers before COS which can help to individualise treatment protocols to achieve optimal response and minimise risk of complications. It is retrospective observational study, 1924 women undergoing COS in IVF/ICSI cycles in tertiary care centre in India, from January 2010 to June 2017 were included. Results: Univariate analysis showed that age, D2FSH, AMH, D2AFC and E2 on the day of trigger were significant predictors of oocyte yield (p7.82 IU/ml was predictor of poor response (sensitivity 78.13%, specificity 79.53%).Conclusions: A combination of predictors demonstrated superior ability of predicting oocyte yield after controlled ovarian stimulation than compared with any single endocrine marker. D2 FSH though thought to be obsolete, but we found significant predictive ability in terms of oocyte yield in the Indian population

Effect of cardiac surgery on maternal and perinatal outcome in rheumatic heart disease with pregnancy: a comparative study

Background: Rheumatic heart disease remains the commonest heart disease in India with mitral stenosis being the most common lesion and is associated with significant maternal and perinatal mortality and morbidity. The objective of this study was to compare maternal and perinatal outcome in women with rheumatic heart valvular disease who had no surgery or had percutaneous balloon mitral valvuloplasty (PBMV) or had valvular replacement surgery.Methods: It was a retrospective study in 113 women with rheumatic heart disease with various valvular lesion admitted in the hospital in previous 10 years. There were 58 (51.35%) patients without cardiac surgery (Group 1), 24 (21.23%) with PTMC (Group 2) and 31 (27.43%) with valve replacement surgery (Group 3). Maternal and perinatal outcome were compared in three groups.Results: The baseline characteristics were similar in the three group. In cardiac complications New York Heart Association (NYHA) deterioration was significantly higher (24.1%) in non-operated group (Group 1) as compared to Group 2 (12.3%) and Group 3 (16.1%). There was no difference in Group 2 and Group 3. Need of cardiac medication (digoxin) was also highest (67.2%) in Group 1 as compared to Group 2 (24.6%) (p = 0.002) and Group 3 (38.7%) (p = 0.001) but no difference in Group 2 and Group 3. Anticoagulant were given to significantly higher number (54.8% of cases in Group 3 (valve replacement) as compared to Group 1 (3.4%) and Group 2 (12.5%). There was no significant difference in obstetric events and mode of delivery in the three groups. Similarly, there was no difference in fetal outcome in the three groups as regard to mean birth weight, APGAR score, fetal growth restriction, fetal or neonatal death or congenital anomalies in the three groups.Conclusions: Cardiac surgery before or during pregnancy did not significantly improve maternal or perinatal outcome. Only cardiac events and need of medication was reduced with surgery. Hence surgery should be performed judiciously in selected cases

Successful reproductive outcome after laparoscopic Strassmann’s metroplasty

Mullerian anomalies cause a significant impact on the reproductive outcomes. A bicornuate uterus is a type of lateral fusion defect, which constitutes 26% of all uterine anomalies. Strassmann’s metroplasty is a unification procedure performed to correct the two smaller uterine cavities into a more spacious single cavity. Improved reproductive performance was reported after unification metroplasty. Laparoscopic route can be adopted for this procedure with all the advantages of minimally invasive surgery. Here, we report a success story of a woman who suffered with six miscarriages and secondary infertility who underwent laparoscopic Strassmann’s metroplasty in a tertiary care center and later delivered a baby by caesarean section

Etiology and management of primary amenorrhoea: A study of 102 cases at tertiary centre

Objective: To determine the prevalence of etiologic causes of primary amenorrhea in Indian population. Materials and methods: A retrospective study was performed using 102 complete medical records of women with primary amenorrhea who attended the Gynaecologic Endocrinology Clinic, Department of Obstetrics and Gynaecology, AIIMS, New Delhi from September 2012 to September 2015. Cases were analysed according to clinical profile, development of secondary sexual characteristics, physical examination, pelvic and rectal examination, X-ray of chest and lumbo-sacral spine, hormone profile, pelvic USG, MRI, and cytogenetic study including karyotype. Results: The three most common causes of primary amenorrhea were Mullerian anomalies (47%), gonadal dysgenesis (20.5%), and hypogonadotropic hypogonadism (14.7%) in the present study. There were 3 cases of Turner syndrome (45,XO), 5 cases of Swyer's syndrome (46,XY) and 2 cases of Androgen insensitivity syndrome (46,XY). One case had pituitary macroadenoma and eight cases (7.8%) were of genital tuberculosis. Conclusions: The present study has currently been the largest case series of primary amenorrhea from North India. Mullerian anomaly is the most prevalent etiological factor leading to amenorrhoea followed by gonadal dysgenesis in our study. Racial, genetic and environmental factors could play role in the cause of primary amenorrhea

Empty follicle syndrome: A challenge to physician

Background: Empty follicle syndrome (EFS) is a condition in which no oocytes are retrieved from normally growing ovarian follicles after ovarian stimulation. It is a rare and frustrating condition of obscure etiology. Objective: The objective of this study was to estimate the incidence of EFS and study factors related to it. Design: This was a retrospective study. Setting: This study was conducted in hospital-based research center. Methods: In 1968 in vitro fertilization cycles from January 2010 to August 2016 were studied. Agonist, antagonist, and miniflare protocols were used for the stimulation. Results: The incidence of EFS is 2.38% (47/1968 cycles). Antagonist protocol group (76.59%, n = 36) had highest incidence of EFS (6.69%). Literature on EFS depicts decreased ovarian reserve (DOR) as the main cause, but only 4.25% of patients had DOR in our study. Interestingly, polycystic ovary syndrome and unexplained infertility were found in 31.9% of the cases. Serum anti-Müllerian hormone (AMH) levels (mean ± standard deviation [SD]) were 4.47 ± 3.54 ng/ml, and antral follicle count (AFC) was 15.30 ± 8.07 (mean ± SD) emphasizing that diminished ovarian reserve is not the main factor for EFS. All patients (n = 95) who underwent ovum pickup on day when any patient had EFS were taken as control. Patients with EFS were compared with controls. A statistically significant difference was not observed in serum AMH (P = 0.38) and AFC (P = 0.52). Conclusion: EFS is an uncommon event. Antagonist cycles have higher chances of empty follicle at ovum pickup. Looking at the profile of patients in this study, we conclude that EFS is not a manifestation of DOR

Comparison of obstetric outcomes of pregnancies after donor-oocyte In vitro fertilization and self-oocyte In vitro fertilization: A retrospective cohort study

Aims:The aim of this study is to evaluate and compare multiple obstetric and perinatal outcomes between donor-oocyte in vitro fertilization (IVF) and self-oocyte IVF group. Settings and Design: This study was done in a tertiary care center with ART unit. This was a retrospective comparative cohort study. Materials and Methods: The present study comprised all women between 20 and 45 years who conceived from oocyte donation (n = 78) between December 1, 2010, and December 31, 2016, and compared with all women who underwent self-oocyte IVF (n = 112). The process involved controlled ovarian stimulation and retrieval of the donor oocytes, preparation of recipient endometrium, and pregnancy management. Obstetric and perinatal outcomes were compared. Statistical Analysis Used: Chi-square test was used for categorical variables. Analysis for confounding variables was performed using multivariable linear and logistic regression analysis. Results: Baseline characteristics between the two groups were comparable. Miscarriage, first-trimester bleeding, pregnancy-induced hypertension (PIH), and gestational diabetes mellitus were significantly higher in donor-oocyte IVF group compared to self-oocyte cycles (P = 0.001). Using multiple logistic regression analysis, age class adjusted PIH incidence was significantly higher in donor-oocyte group as compared to self-oocyte group (P = 0.010). There was no significant variation in perinatal outcomes between the donor- and self-oocyte IVF cycles (P > 0.05). Conclusion: Oocyte donation should be treated as an independent risk factor for PIH

Comparison of obstetric outcomes of pregnancies after donor oocyte IVF: Three-arm age-matched retrospective cohort study

Background: Oocyte donation has become widely used as a treatment option for infertile couples. The few available studies report conflicting evidence about the risk of hypertensive disorders in donor oocyte pregnancies after adjusting for maternal age and it is unclear whether pregnancy complications and obstetric risks are due to oocyte donation or to confounding factors such as maternal age. The aim of the present study was to evaluate and compare obstetric complications between women who conceived after oocyte donation and age-matched control women with spontaneous conception and self oocyte IVF conception.Methods : The present study comprised of women aged 20-45 years conceived from oocyte donation (n=104) between 1/12/2010 to 15/10/2017. Two age-matched control groups—Self oocyte IVF (n=150) and the other containing women who conceived spontaneously (n=312) were used for comparison of obstetric and perinatal outcomes.Results: Mean maternal age was statistically significantly higher in the Donor oocyte IVF group as compared to  self oocyte ivf and spontaneous conception group. Miscarriage, first trimester bleeding, pregnancy induced hypertension and gestational diabetes mellitus was significantly higher in Donor oocyte IVF group as compared to self-oocyte and spontaneous conception group (p=0.001). Using multiple logistic regression analysis age class adjusted PIH and GDM  incidence was significantly higher in donor oocyte group as compared to spontaneous conception (P=0.010).There was significant variation in perinatal outcomes between the three groups.Conclusion: Oocyte donation should be treated as an independent risk factor for miscarriage, first trimester bleeding, hypertensive disorder and gestational diabetes mellitus in pregnancy

Prognostic Significance of HE4 Tissue Expression in Serous Epithelial Ovarian Carcinoma

Abstract Neerja Bhatla Background Human Epididymis protein 4 (HE4) is expressed in ovarian cancer. Preoperative serum testing is still not widely available. This pilot study aimed to investigate the magnitude of expression of HE4 in tissue sections of serous epithelial ovarian carcinoma, its correlation with clinical outcome, and the feasibility of HE4 immunohistochemistry as a prognostic marker. Materials and Method In this ambispective study, immunohistochemistry (IHC) was used to evaluate tissue sections of ovarian serous epithelial carcinoma at primary cytoreductive surgery. On HE4 immunohistochemistry (IHC), the magnitude of HE4 expression was assessed categorically as high or low HE4 expression and semiquantitatively by the H-score, and correlated with clinical outcome in terms of survival status, progression-free survival, and overall survival. Results Of 32 cases, most (n = 31, 96.8%) were positive for HE4 IHC. The mean age was 49 ± 8.2 years; 29 (90.6%) patients were in FIGO stage IIIC; 25 (78.9%) had ≥1cm residual disease after surgery; 31 (96.8%) received adjuvant chemotherapy, either 3-weekly (n = 25, 81.2%) or dose-dense weekly (n = 6, 18.8%) regimen. The majority (n = 31, 96.8%) had a high-grade tumor, of whom 19 (59.4%) had high HE4 expression and 13(40.6%) patients had H-score in the range of 5 to 8. The mean H-score was 6.97 ± 3.61 (range 0 to 12). The overall survival of the study population at 64 months was 36.65% (95% CI: 8.59–66.34), with median overall survival of 59 months. A new scoring system was developed combining categorical HE4 expression and serum CA-125 levels; the combination of HE4 expression with postoperative CA-125 levels was found to be the best prognostic marker for overall survival (p = 0.05). A composite score of 2 identified patients with poor progression-free survival (HR 4.64, p = 0.039) and overall survival (HR 5.45, p = 0.05). Conclusion The new composite scoring system using HE4 IHC with postoperative serum CA-125 levels offers an extremely useful option for prognosticating patients with serous epithelial ovarian carcinoma than serum CA-125 alone. This is useful where preoperative records are not available to the treating clinician