OBJECTIVE: To evaluate the association of increasing body mass index (BMI) on postpartum tubal ligation safety and estimate the rates of procedure complication. METHODS: We conducted a single-institution, retrospective review. Women undergoing postpartum permanent contraception after vaginal delivery from August 2015 to March 2019 were studied. Our primary outcome included a composite morbidity of intraoperative complications (bleeding requiring additional surgery, and extension of incision), blood transfusion, aborted procedure, anesthetic complication, readmission, wound infection, venous thromboembolism, ileus or small bowel obstruction, incomplete transection, and subsequent pregnancy. Statistical analysis included t test, χ2 test, and Wilcoxon rank-sum test, with P<0.05 considered significant. RESULTS: During the study period, 3,670 women were studied: 263 were underweight or normal weight (BMI 24.9 or lower), 1,044 were overweight (25–29.9), 1,371 had class I obesity (30–34.9), 689 had class II obesity (35–39.9), and 303 had class III obesity (40 or higher) at the time of admission. Composite morbidity occurred in 49 cases (1.3%) and was not significantly different across the BMI categories (P=.07). Twelve cases of incomplete transection were noted on pathology reports; however, none of these accounted for the six subsequent pregnancies that were identified. There were no deaths or events leading to death noted in the study population. The length of time to complete the procedure increased across BMI categories (23 minutes in women with normal weight, and 31 in women with class III obesity) (P<.001). CONCLUSION: There was no association between increased BMI and morbidity with women undergoing postpartum tubal ligation. Postpartum tubal ligation should be considered a safe and reasonable option for women, regardless of BMI.
vent the development of severe OHSS and life-threatening complications. Additionally, utilizing freeze-all cycles to avoid pregnancy should be considered for these patients to decrease risk of OHSS and severe late complications.OBJECTIVE: To evaluate the impact of individualized dosing with follitropin delta in sequential controlled ovarian stimulation (COS) cycles as a preventive strategy for OHSS risk.DESIGN: A combined analysis of two large comparative Phase 3 trials of follitropin delta. MATERIALS AND METHODS: Secondary analysis of three stimulation cycles in IVF/ICSI patients included in a randomized, assessorblinded trial comparing two recombinant FSH preparations (ESTHER-1, NCT01956110), and undergoing up to two additional COS cycles while maintaining the same treatment allocation and the assessor-blinded design (ESTHER-2, NCT01956123). A total of 1326 women were randomized in COS cycle 1 and treated with follitropin delta (Rekovelle Ò ) or follitropin alfa (Gonal-f Ò ). Of these, 513 continued to cycle 2 and 188 to cycle 3. In COS cycle 1, the individualized follitropin delta dosing regimen was a fixed daily dose determined by serum AMH and body weight, and the conventional follitropin alfa dosing regimen was 150 IU for the first 5 days after which the daily dose could be adjusted. In COS cycles 2 and 3, the FSH doses were maintained or adjusted according to the ovarian response in the previous cycle.RESULTS: Individualized dosing with follitropin delta resulted in a significant reduction in moderate/severe OHSS and/or preventive interventions (OR¼0.59 [0.38; 0.92], p¼0.018) compared to conventional dosing approach with follitropin alfa in patients undergoing up to three COS cycles. The greatest benefit was observed in the patients in the highest AMH quartile (R25.35 pmol/L; OR¼0.47 (0.26; 0.86); p¼0.012). When evaluating OHSS cases and the preventive interventions separately, individualized dosing with follitropin delta was associated with a significantly lower incidence of moderate/severe OHSS (OR¼0.50 [0.26; 0.97], p¼0.036) and a significantly lower incidence of preventive interventions (OR¼0.56 [0.31; 0.99], p¼0.044), mainly GnRH agonist triggering with no fresh transfer, compared to the conventional dosing approach with follitropin alfa. Across the three cycles, two women were hospitalized due to OHSS in the individualized follitropin delta dosing group compared to eight in the conventional follitropin alfa dosing group.CONCLUSIONS: Individualized follitropin delta dosing decreases risk of moderate/severe OHSS and preventive interventions compared with conventional follitropin alfa treatment, mainly in patients with highest serum AMH. OBJECTIVE: To compare the cumulative live birth rate after treatment with highly purified-human menotropin (HP-hMG; Menopur Ò ) or recombinant follicle stimulating hormone (rFSH; Gonal-F Ò ) in predicted high responder women undergoing assisted reproductive technology.DESIGN: Multicenter, randomized, open-label, assessor-blind, non-inferiority study.MATERIALS AND METHOD...
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