Our aim was to assess the influence of ratios of oestradiol (E2) to either number of follicles ≥ 14 mm on the day of human chorionic gonadotropin administration (E2/fol) or the number of oocytes retrieved (E2/o) during oocyte pick up and total serum E2 levels on the day of embryo transfer (ETE2) on the outcome of ICSI cycles. The assessed outcomes were number of oocytes retrieved (NRO), number of mature oocytes (NMO), number of fertilised oocytes (NFO), number of transferred embryos (NTE), qualities of oocytes (OQS), qualities of embryos (EQS) and pregnancy rates (PR). Two hundred and twenty-seven ICSI-ET cycles admitted to our IVF clinic during a 2-year period with normal ovarian reserve receiving long luteal GnRH agonist protocol were included. The E2/fol levels correlated positively with NRO (r = 0.202, p = 0.002), NMO (r = 0.199, p = 0.003) and NFO (r = 0.159, p = 0.018). However, we observed negative correlations between E2/o and NMO (r = -0.329, p<0.001), NFO (r = -0.219, p = 0.001), EQ5 (r = -0.203, p = 0.040). Oocyte quality scores were not affected from either E2/fol or E2/o levels. Implantation, clinical and ongoing PRs were comparable between groups categorised due to E2/fol, E2/o and ETE2. It seems that high E2/fol ratio may have beneficial effects on NRO, NMO and NFO while E2/o may adversely affect these parameters. Neither of the E2 levels is associated with pregnancy rates in women with normal ovarian reserve.
To improve clinical appreciation of these lesions, we reviewed the presentation, evaluation, outcome, and therapeutic aspects of painful adnexal masses in adolescent females. During the period January 2005-September 2006, 63 adolescent females with painful adnexal masses were recruited. The patient management and outcomes were documented. The mean age was 15.36±1.6 years, and the mean diameter of the masses was 54.5±1.3 mm. Forty-nine patients (77.7%) underwent surgical management, and 45 of the 49 surgeries were achieved by laparoscopic surgery (91.8%). Two converting laparotomies (4%) were performed. Fourteen patients with a presumed functional cyst were followed up without surgery. Postoperative histopathologic evaluation revealed a benign epithelial ovarian cyst rate of 26.5%, a mature cystic teratoma rate of 22.4%, and a borderline ovarian tumor rate of 4.08%. Non-neoplastic adnexal lesions were encountered in surgeries of 22 cases. The incidence of acute ovarian torsion and true ovarian neoplasm was 9.52% and 55.1%, respectively, and none was malignant. True ovarian neoplasia remains a common indication for surgery in the majority of adolescents. Because most cases are benign, minimal access surgery should be performed whenever feasible.
Closure of the parietal peritoneum has no benefit over non-closure of parietal peritoneum and non-closure is associated with rapid post-operative recovery.
Total gonadotrophin costs are lower using the 375 IU/day gonadotrophin compared to the 450 IU/day in poor responders. Additional 75 IU/day does not give any improvement neither embryology nor pregnancy outcomes.
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