Senses and Sciences

SINGLE VERSUS DOUBLE AGONIST TRIGGER IN ANTAGONIST PROTOCOL CYCLES: A MULTICENTER PROSPECTIVE AND RETROSPECTIVE STUDY

Mohamed Nagy Balbaa — 2024-11-02

Background: The use of GnRH agonist (GnRHa) to induce final oocyte maturation in IVF has become increasingly common due to its proven ability to reduce the incidence of OHSS. It has previously been demonstrated that the LH surge induced by a single bolus of GnRHa at mid-cycle results in a shorter LH surge than in natural cycles. There has been concern, that the GnRHa-induced LH surge may not adequately induce maturation of the oocytes. Objective: The aim of this study is to establish if a second dose of GnRHa repeated 12 h following the initial dose optimizes the cycle outcome in terms of ongoing pregnancy rate in women undergoing intracytoplasmic sperm injection (ICSI) cycles using a GnRH‐antagonist protocol. Methods: This prospective and retrospective study included 160 women, they were divided into two groups, group (A) 80 subjects were triggered by a single dose of 0.3 mg GnRH agonist triptorelin subcutaneously 36 h prior to oocyte retrieval. Group (B) 80 subjects were triggered by 2 doses of GnRH agonist triptorelin the first as in group A + a second dose of 0.2 mg 12 h following the 1st dose. 12 h & 24 h post-trigger luteinizing hormone (LH) values were estimated. 25 patients were followed prospectively and the data of 55 patients was collected retrospectively in each group. Results: there was a statistical significant difference between both groups in favor of group (B) as regard ongoing pregnancy rate and implantation rate, but there was no significant statistical difference as regard oocyte maturity rate, clinical pregnancy rate and OHSS occurence. Conclusion: the double dose GnRHa trigger offers better ongoing pregnancy rate than single dose GnRHa trigger but their efficacy is comparable regarding clinical pregnancy rate, oocyte maturity rate and OHSS occurrence.

Comparative study between three endometrial preparation protocols for frozen-thawed embryo transfer cycles in regularly ovulating women

Aya Atef Elsawy — 2024-11-05

Background: In recent years, with the continuous technical advancement in cryopreservation techniques, frozen embryo transfer (FET) has become mainstream and a viable alternative to fresh embryo transfer. Despite the upward trend in FET, the most optimal priming strategy of the endometrium before FET remains controversial. For ages, the hormone replacement treatment (HRT) cycle protocol has been favored as the first-line regimen for endometrial priming in FET; however, nowadays some patients and physicians may opt for other protocols rather than using high-dose hormones with their potential adverse risks. Objective: The aim of this work is to compare three endometrial preparation protocols for FET; either by HRT cycles, ovulation induction (OI) cycles with aromatase inhibitors (AI), or modified natural cycles (mNC). Methods: This prospective randomized clinical trial included 120 patients preparing for FET. Partipants were randomized into three equal groups according to the protocol of endometrial preparation. Group A underwent HRT protocol by daily 6 mg oral Estradiol valerate, followed by daily 800 mg vaginal progesterone (P4). Group B underwent OI protocol, using 2.5 mg Letrozole, twice daily, for 5 days. Group C underwent mNC protocol, using 5000 IU human chorionic gonadotropin (hCG) as a trigger for ovulation. Results: there were no significant differences between the three groups regarding number of days before FET, mean endometrial thickness, or reproductive outcomes. In normo-ovulatory women, there was a trend toward improved reproductive outcomes in the mNC group regarding implantation, clinical pregnancy, and ongoing pregnancy rates; nevertheless neither of these outcomes reached a statistical significance. Conclusion: In normo-ovulatory women, there was a trend toward improved reproductive outcomes in the mNC group, so we recommend the mNC protocol for endometrial preparation before FET as the protocol of choice in these women.

Outcomes Of Using SMOFlipid Emulsion in Parenteral Nutrition in Neonatal Intensive Care Unit

Mohamed Abdelrahman Khalifa — 2024-11-02

Preterm birth, defined as delivery before 37 weeks of gestation, affects approximately 12.9 million newborns globally each year, making them highly vulnerable to various complications due to the immaturity of their organ systems. This retrospective study investigates the impact of SMOFlipid, a mixed-composite lipid emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil, on clinical outcomes in neonates receiving total parenteral nutrition (TPN) in a neonatal intensive care setting. Conducted at Smouha University Children's Hospitals, the study included 412 preterm neonates between January 2020 and June 2023. The study compares neonates receiving TPN with SMOFlipid (n=207) to those receiving TPN without SMOFlipid (n=205) in terms of sepsis incidence, liver function, and hospitalization duration. The findings reveal a statistically significant reduction in sepsis incidence (15.9% vs. 30.2%, p=0.007) and shorter hospitalization duration (29 ± 10 days vs. 33 ± 14 days, p=0.012) in the SMOFlipid group. Additionally, the study observed faster cholestasis improvement in the SMOFlipid group. These results suggest that SMOFlipid may offer significant clinical benefits, particularly in reducing sepsis risk and improving liver-related outcomes in preterm neonates. However, further prospective studies are needed to validate these findings and explore the long-term effects of SMOFlipid on neonatal health.