BACKGROUND

Managing low ovarian response remains challenging despite advancements in assisted reproductive technology (ART). Although several approaches have been proposed, there is no strong evidence that a particular stimulation protocol is superior over the other in terms of improving reproductive outcomes in this group of women. The double stimulation protocol (DuoStim) suggests ovarian stimulation during both the follicular phase and the luteal phase of the same ovarian cycle; hence, facilitating two oocyte retrievals in the shortest amount of time.

OBJECTIVE

This study assessed the effect of the double stimulation protocol (DuoStim) on poor ovarian responders in terms of cumulative live birth rates and clinical pregnancy rates, and compared these outcomes to conventional stimulation protocols.

METHODS

This is a systematic review and meta-analysis of randomized controlled trials (RCT), cohort and cross-sectional studies in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Data from eligible journals were tabulated and analyzed using Cochran’s Q and I² tests.

RESULTS

Eight studies involving poor ovarian responders were included in the meta-analysis. Pooled analysis demonstrated no significant difference between DuoStim and conventional ovarian stimulation protocols in clinical pregnancy rate (OR 0.99, 95% CI 0.75–1.30) and cumulative live birth rate (OR 0.87, 95% CI 0.59–1.28). Fertilization rates were likewise comparable between groups. Nevertheless, several included studies reported higher oocyte yield and greater numbers of mature oocytes and blastocysts with DuoStim

CONCLUSION

Current evidence does not demonstrate significant superiority of DuoStim over conventional ovarian stimulation protocols in terms of clinical pregnancy rates, cumulative live birth rates, or fertilization rates among poor ovarian responders. However, DuoStim appears to be an effective strategy for increasing oocyte yield within a shorter treatment timeframe. Its use may be particularly relevant in selected patients with diminished ovarian reserve, advanced maternal age, or urgent fertility preservation needs. Further high-quality prospective trials are warranted to clarify its impact on reproductive outcomes.

Human ; Ovulation Induction ; Ovarian Stimulation ; Ovarian Reserve ; Fertilization In Vitro

BACKGROUND

The benefits of preimplantation genetic testing for aneuploidy (PGT-A) in the advanced maternal age group are unclear.

OBJECTIVE

This study aims to determine whether PGT-A improves pregnancy outcomes.

METHODS

This is a retrospective cohort study of PGT-A outcomes using next generation sequencing for advanced maternal age women undergoing IVF at CARMI from May 2017 to May 2021. Women were grouped by age: those 35-39 and those 40 and above. Pregnancy rate (PR), live birth rate (LBR), and miscarriage rate (MR) were computed per transfer and per cycle and compared with women who underwent single day-5 frozen transfer of a morphologically chosen embryo.

RESULTS

Overall euploid blastocyst rate was 38.5%: 16.9% for 40 and above and 47.6% for 35- 39 group. There were no transfers in 41.4% due to absence of a euploid embryo. PR and LBR per embryo transfer were higher in the PGT-A versus the non-PGT-A group (61.9% vs 24.1% p = < 0.001 and 42.9% vs 19% p = < 0.001). By age, the findings were similar: higher PR and LBR per-embryo transfer in PGT-A versus non-PGT-A in the 35-39 group (58.4% and 29%, p = 0.006 and 42.9% vs 22.6%, p < 0.001 respectively) and 40 and above (71.4% vs 18.5%, p < 0.001 and 53.6% vs 14.8%, p < 0.001 respectively). MR was increased in the PGT-A versus non-PGT-A group, but this may be due to the small number of events in the population.

CONCLUSION

The study suggests an increase in PR and LBR per embryo transfer in advanced maternal age women undergoing PGT-A. A larger sample size is needed to validate the results.

Human ; Female ; Fertilization In Vitro ; Aneuploidy ; High-throughput Nucleotide Sequencing ; Blastocyst ; Embryo Transfer ; Abortion, Spontaneous

OBJECTIVE: To evaluate the patient characteristics, and clinical outcomes of the total laparoscopic hysterectomy procedures performed in the Philippine General Hospital from January 2011 to June 2014.

STUDY DESIGN: Retrospective cross sectional study.

METHODS: The medical records of all patients admitted for an elective total laparoscopic hysterectomy in PGH from January 2011 to June 2014 were reviewed. Patients' demographic data, intraoperative and postoperative outcomes and complications were extracted and analyzed.

RESULTS: Data for 67 patients were analyzed. The patients operated on were mostly parous, premenopausal (94%) women with a mean age of 46.3 years, and a BMI of 23.2 kg/m2. Most of the women were admitted for uterine fibroids (55.2%), adenomyosis (26.9%), and benign ovarian new growths (9.0%). Fifteen surgeries were converted to laparotomy (22.4% failure rate). Majority (93.3%) of the conversions were due to technical difficulty in performing the hysterectomy. The mean uterine height was 10.8 cm, and mean uterine width was 8.4 cm. The mean operation time of the converted group (207.7 mins) was comparable to the TLH group (235.6 mins). The estimated blood loss for the TLH group (337.5 cc) was significantly less than that of the converted group (556.7 cc). The mean hospital and postoperative stay of the patients were 4.7 days and 2.4 days, respectively. The only intraoperative complication documented was hemorrhage (n=3). There were 2 minor postoperative complications noted (3%).

CONCLUSION: The patients who successfully underwent a TLH procedure were mostly parous, non-obese, premenopausal women, with non-bulky uterine sizes. Mayoma uteri and adenomyosis were the most common indications for surgery. Patients who underwent successful TLH had significantly less intraoperative bloss loss compared to patients whose surgeries were converted to laparotomy.

Human ; Female ; Hysterectomy ; Laparoscopy

A 4-year old female was admitted to the hospital for evaluation of an abdominal mass. Early appearance of secondary isosexual characteristics such as breast enlargement, axillary and pubic hair, and vaginal bleeding were noted. Pertinent laboratory examination results included a very much elevated serum estradiol, low LH and FSH titers and a negative 24-hour urine hCG. With an identifiable focus in the pelvis that would consolidate the clinical presentation and laboratory findings, our pre-operative diagnosis was: Pseudoprecocious puberty secondary to a functioning ovarian newgrowth probably granulosa cell tumor. The final histopathologic diagnosis unexpectedly was mixed germ cell tumor predominantly yolk sac (endodermal sinus tumor) with areas of dysgerminoma. This is the first locally documented case of ovarian endodermal sinus tumor with the symptomatology of precocity.
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Premature pubarche is the development of pubic hair without the development of other secondary sexual chacteristics before the age of 8 in girls. Traditionally, considered to be benign, premature pubarche has been associated with polycystic ovarian syndrome and the metabolic syndrome. This is the case of a 7-year-old female with warty lesions on the right thumb and labia majora, and an incidental finding tanner stage 2 pubic hair. 17-OHP and testosterone levels were normal, DHEAS level at the pubertal range. Her clinical profile places her at risk, and as such, monitoring is warranted for early detection of polycystic ovarian syndrome and metabolic syndrome in the future.
Human ; Female ; Child ; POLYCYSTIC OVARY SYNDROME ; WARTS

OBJECTIVE: This study aimed to determine the efficacy of dinoprostone gel as a cervical priming agent when used prior to operative hysteroscopy.

METHODS: This is a double-blind randomized controlled trial. Forty five women for operative hysteroscopy were randomly allocated to either 500mcg dinoprostone gel or to no intervention. Baseline cervical dilatation, time and ease of cervical dilatation, side effects and complications were noted.

RESULTS: Twenty-four (24) and 21 patients were randomized to the dinoprostone and control group, respectively. Results show a statistically significant difference in baseline cervical dilatation [8.41 versus 4.61 mm (P
Human ; Female ; Hysteroscopy ; Uterine Perforation ; Dinoprostone ; Labor Stage, First ; Lacerations ; Iatrogenic Disease ; Uterine Cervical Diseases ; Uterine Hemorrhage ; Pain