Objective: To study whether knowledge of cervical length (CL) is useful in reducing the length of hospital stay in women admitted because of threatened preterm labor. Methods: We performed a single-center, parallel, randomized trial at the Hospital Clínic of Barcelona. Inclusion criteria were single pregnancy, gestational age (GA) between 24+0 and 35+6 weeks, Bishop score <6, no parturition within 24-48 h after admission, and no clinical signs of chorioamnionitis, vaginal bleeding, or nonreassuring fetal status. CL measurement was performed 24-48 h after admission. In the control group, the patient and the physician in charge were blinded. In the study group, this information was given; if CL was >25 mm, early discharge within 12-24 h from randomization was recommended. Length of hospital stay was the main outcome. Results: After randomization, 149 patients had complete follow-up (control group, n = 74; study group, n = 75). The mean (SD) length of stay was significantly shorter - 3.0 (2.2) vs. 4.0 (2.0) days (p = 0.004) - in the study group, with a higher proportion of women remaining hospitalized ≤3 days (relative risk [95% confidence interval] 0.43 [0.26-0.70]), with no differences in GA at delivery or preterm birth rate. Conclusions: Knowledge of CL in women admitted because of threatened preterm labor is useful in reducing length of stay, with no impact on GA at delivery or preterm birth rate.

Objective: To determine whether mitochondrial, oxidative, and apoptotic abnormalities in placenta derived from HIV and combined antiretroviral therapy (cART) containing zidovudine (AZT) could be associated with adverse perinatal outcome. Design: Cross-sectional, controlled, observational study. Methods: We studied obstetric results and mitochondrial, oxidative, and apoptotic state in placenta of 24 treated HIV-infected and 32 -uninfected pregnant women. We measured mitochondrial DNA (mtDNA) content by quantitative reverse transcriptase–polymerase chain reaction (mtND2/n18SrRNA), oxidative stress by the spectrophotometric quantification of lipid peroxidation and apoptosis by Western blot analysis of active caspase-3 respect to β-actin content and analysis of the terminal deoxynucleotidyl transferase dUTP nick end labeling. Results: Global adverse perinatal outcome (defined as preterm delivery or/and small newborns for gestational age) was significantly increased in HIV pregnancies [or 6.7 (1.3–33.2); P < 0.05]. mtDNA content in HIV-infected women was significantly depleted (39.20% ± 2.78%) with respect to controls (0.59 ± 0.03 vs. 0.97 ± 0.07; P < 0.001). A significant 29.50% ± 9.14% increase in oxidative stress was found in placentas of HIV-infected women (23.23 ± 1.64 vs. 17.94 ± 1.03; P < 0.01). A trend toward 41.18% ± 29.41% increased apoptosis active caspase-3/β-actin was found in HIV patients (0.48 ± 0.10 vs. 0.34 ± 0.05; P = not significant), confirmed by transferase dUTP nick end labeling assay. Adverse perinatal outcome did not correlate mitochondrial, oxidative, or apoptotic findings. Conclusions: Placentas of HIV-infected pregnant women under AZT cART showed evidence of mtDNA depletion, increased oxidative stress levels, and apoptosis suggestive of secondary mitochondrial failure, potential base of associated adverse perinatal outcome. Despite the fact that further demonstration of causality would need new approaches and bigger sample sizes, AZT-sparing cART should be considered in the context of pregnancy.

ABSTRACT The immigration of Latin American women of childbearing age has spread the congenital transmission of Chagas disease to areas of nonendemicity, and the disease is now a worldwide problem. Some European health authorities have implemented screening programs to prevent vertical transmission, but the lack of a uniform protocol calls for the urgent establishment of a new strategy common to all laboratories. Our aims were to (i) analyze the trend of passive IgG antibodies in the newborn by means of five serological tests for the diagnosis and follow-up of congenital Trypanosoma cruzi infection, (ii) assess the utility of these techniques for diagnosing a congenital transmission, and (iii) propose a strategy for a prompt, efficient, and cost-effective diagnosis of T. cruzi infection. In noninfected newborns, a continuous decreasing trend of passive IgG antibodies was observed, but none of the serological assays seroreverted in any the infants before 12 months. From 12 months onwards, serological tests achieved negative results in all the samples analyzed, with the exception of the highly sensitive chemiluminescent microparticle immunoassay (CMIA). In contrast, in congenitally infected infants, the antibody decline was detected only after treatment initiation. In order to improve the diagnosis of congenital T. cruzi infection, we propose a new strategy involving fewer tests that allows significant cost savings. The protocol could start 1 month after birth with a parasitological test and/or a PCR. If negative, a serological test would be carried out at 9 months, which if positive, would be followed by another at around 12 months for confirmation.

To assess the impact of HIV‐infection and highly active anti‐retroviral treatment in mitochondria and apoptotic activation of caspases during pregnancy and their association with adverse perinatal outcome. Changes of mitochondrial parameters and apoptotic caspase activation in maternal peripheral blood mononuclear cells were compared at first trimester of pregnancy and delivery in 27 HIV‐infected and ‐treated pregnant women versus 24 uninfected pregnant controls. We correlated immunovirological, therapeutic and perinatal outcome with experimental findings: mitochondrial DNA (mtDNA) content, mitochondrial protein synthesis, mitochondrial function and apoptotic caspase activation. The HIV pregnancies showed increased adverse perinatal outcome (OR: 4.81 [1.14–20.16]; P < 0.05) and decreased mtDNA content (42.66 ± 5.94%, P < 0.01) compared to controls, even higher in naïve participants. This depletion caused a correlated decrease in mitochondrial protein synthesis (12.82 ± 5.73%, P < 0.01) and function (20.50 ± 10.14%, P < 0.001), not observed in controls. Along pregnancy, apoptotic caspase‐3 activation increased 63.64 ± 45.45% in controls (P < 0.001) and 100.00 ± 47.37% in HIV‐pregnancies (P < 0.001), in correlation with longer exposure to nucleoside analogues. HIV‐infected women showed increased obstetric problems and declined genetic and functional mitochondrial parameters during pregnancy, especially those firstly exposed to anti‐retrovirals. The apoptotic activation of caspases along pregnancy is emphasized in HIV pregnancies promoted by nucleoside analogues. However, we could not demonstrate direct mitochondrial or apoptotic implication in adverse obstetric outcome probably because of the reduced sample size.

STUDY QUESTION: Are the reproductive outcomes of HIV-infected donor oocyte recipient women comparable to those of non-infected women?SUMMARY ANSWER: HIV-infected women have lower clinical pregnancy and live birth rates than non-infected women.WHAT IS ALREADY KNOWN: The literature on the effect of HIV infection on reproductive outcome is scarce at best; the only report to date comparing oocyte donation cycles in HIV-infected women versus non-infected controls found no differences in pregnancy rates between the two groups. However, this study was performed nearly a decade ago and did not evaluate the effect of immuno-virological characteristics of oocyte recipients or the HIV antiretroviral therapy effect.STUDY DESIGN SIZE, AND DURATION: This is a matched-cohort study including 514 oocyte donation cycles, 257 from HIV-infected women and 257 non-infected controls, performed between April 2004 and November 2014.PARTICIPANTS/MATERIALS, SETTING, AND METHOD: Each cycle of an HIV-infected woman (n = 257) was matched with a cycle of a non-infected woman (1:1). Biochemical pregnancy, clinical pregnancy, ongoing pregnancy and live birth in the two groups were compared using a multivariate logistic regression analysis. The effect of antiretroviral treatment options on pregnancy outcomes of HIV-infected women was analyzed using a logistic regression model adjusted for time elapsed from diagnosis, and CD4 levels and viral load prior to embryo transfer.MAIN RESULTS AND THE ROLE OF CHANCE: Cycles of HIV-infected patients receiving oocyte donation presented lower pregnancy and live birth rates than matched non-infected controls. Treatment options and infection parameters analyzed do not seem to affect the reproductive results in HIV-infected women. The variable most influencing pregnancy outcomes was the number of transferred embryos; lower pregnancy rates were obtained after single embryo transfer.LIMITATIONS REASONS FOR CAUTION: Patients with HIV infection have specific health issues, such as infection/treatment side effects, which makes it impossible to find a matching control group of non-infected patients for these variables.WIDER IMPLICATIONS OF THE FINDINGS: HIV-infected women receiving donated oocytes present lower pregnancy rates when compared to non-infected controls, regardless of the antiretroviral treatment followed. The complexity of the treatments (both in medication types and combinations) makes it difficult to define whether any one treatment option is better than the others in terms of pregnancy outcomes in oocyte recipients.

BACKGROUND:This study was performed to assess the role of lipopolysaccharide modulators as a marker of microbial translocation among human immunodeficiency virus (HIV)-infected women during pregnancy and to evaluate their association with preterm delivery.METHODS:The study had a prospective cohort design and was performed at the Hospital Clínic in Barcelona, Spain. Thirty-six pregnant women with and 36 without HIV infection, matched on the basis of age and parity, were included. Maternal blood samples were obtained during the first trimester, during the third trimester, and at delivery. Levels of soluble CD14 (sCD14), human lipopolysaccharide-binding protein (LBP), immunoglobulin M endotoxin core antibodies to lipopolysaccharide (EndoCAb), and interleukin 6 (IL-6) were determined. Fetal cord blood levels of sCD14, LBP, and IL-6 were determined. Results were compared between groups.RESULTS:First trimester sCD14 and LBP levels and third trimester sCD14 levels were significantly higher in the HIV-infected group. HIV-infected women with preterm births and spontaneous preterm births had significantly increased levels of sCD14 throughout pregnancy and significantly increased levels of LBP during the first trimester, compared with HIV-infected women with delivery at term or with HIV-negative women. On multivariate analysis, an independent association was observed between first trimester sCD14 levels and preterm delivery among HIV-infected women.CONCLUSIONS:This is the first study to assess inflammatory markers related to microbial translocation during pregnancy among HIV-infected women. Higher levels of sCD14 and LBP were observed in HIV-infected pregnant women and were associated with preterm delivery.

STUDY QUESTION:Is the drug used for final oocyte maturation a factor in determining the prevalence of empty follicle syndrome (EFS)?SUMMARY ANSWER:The drug used for final oocyte maturation is not a factor in determining the prevalence of EFS among women unaffected by infertility.WHAT IS KNOWN ALREADY:Despite satisfactory follicular stimulation and adequate follicular development, cases of EFS, i.e. failure to recover any cumulus oocyte complex, have been reported both with hCG and GnRH agonist triggering. No standard management protocol has been proposed so far.STUDY DESIGN, SIZE, DURATION:Retrospective analysis of oocyte donation cycles performed between August 2006 and April 2013 in a large private fertility centre.PARTICIPANTS/MATERIALS, SETTING, METHODS:The analysis included 12 483 oocyte donation cycles of which 74 were EFS cycles. All cycles were triggered with either hCG or GnRH agonists.MAIN RESULTS AND THE ROLE OF CHANCE:There were no differences in the gonadotropic stimulation, pituitary suppression and triggering drug between cycles where oocytes were recovered successfully and EFS cycles. The total prevalence of EFS was 0.59%. Given the rarity of the syndrome, caution is advised when interpreting the analysis.LIMITATIONS, REASONS FOR CAUTION:The main limitation of this study is its retrospective nature. Although this is the largest analysis of EFS in donors reported so far, its statistical power is limited because the syndrome has a low incidence. In some cycles of EFS from 2006 to 2007 there is a lack of hormone data.WIDER IMPLICATIONS OF THE FINDINGS:Our findings may be generalized to oocyte donors and IVF patients younger than 35 years old, with cycles undergoing final maturation triggering with either hCG or GnRH agonists. The generalization cannot be extended to patients with an ovarian factor as the cause of their reproductive pathology. The theoretical aetiology of a temporary hypothalamic-pituitary hyposensitivity can explain the cycles where a rescue protocol with hCG has been successful.STUDY FUNDING/COMPETING INTERESTS:This work was supported in part by funding from Fundaciò EUGIN. The authors have no conflicts to declare.TRIAL REGISTRATION NUMBER:NA.

pick-up (OPU) protocol. We analyzed 12,483 donation cycles, 74 of which EFS. These cycles were compared to a matched cohort from the donor population; 64 EFS and non-EFS cycles in the same donor were also compared. All EFS cycles were triggered with either βhCG or GnRHa. Multivariate analysis and logistic regression were employed. EFS incidence was 0.59%. There were no differences in gonadotropic stimulation, hypophysary suppression and triggering; this was confirmed when comparing EFS and non-EFS cycles in the same donors. More days of stimulation were needed to reach triggering criteria (10.9 vs. 10.1, p=0.004) in EFS cycles compared to control despite the initial dose of stimulation being the same. In 15 cases triggered with GnRHa, a second trigger and OPU were carried out; rescue triggers with GnRHa did not recover any oocytes (0/2 cases), while βhCG rescue obtained oocytes in 85% (11/13) of cases; ET was performed in 87% of them, resulting in a pregnancy rate of 28.5%. A temporary hypothalamic–hypophysary hyposensitivity can explain the cases where a rescue protocol with βhCG has been successful, suggesting a possible etiology for EFS.

Nurses in ART units have been traditionally involved in patients care and management. However, their role in performing ultrasound (US) is still modest. The objective of this prospective study is to assess the learning curves in 3D transvaginal folliculometry during ovarian stimulation cycles (OSC) in nurses with no previous experience in ultrasound by LC-CUSUM. 4 nurses with at least 2 years of experience in a reproduction unit were enrolled. Initially, all nurses followed 3 hours of theoretical training and performed 20 vaginal US to locate uterus and ovaries in 2D. 3D US were performed from the 8th day of OSC in oocytes donors. Donors were first scanned by an expert operator to make the clinical decision and immediately afterwards by the nurse. A Voluson i with 8.0.1. software was used; 3D folliculometry was performed with SonoAVC; if needed, 2D measurements were also performed using the average of the 2 main perpendicular diameters for each follicle. LC-CUSUM curves were drawn to assess the achievement of competence of each nurse. Criteria for success were: difference of ≤3 follicles of ≥10mm and ≤2 follicles of ≥14mm measured by 3D ultrasound and ≤2 follicles of difference measured in 2D between nurses and experts. 3 of the 4 nurses achieved competence in 3D folliculometry after 68, 107 and 153 ovarian scans (34, 54 and 77 oocyte donors; see graph for visual representation of LC-CUSUM). One did not achieve competence after 200 scans. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Objective: The menstrual cycle is a finely tuned biological process comprising a precisely orchestrated sequence of events: follicular growth, selection and ovulation, extensive endometrial changes, corpus luteum (CL) growth and maturation, and luteolysis. Differences in the length of the menstrual cycle (MCL) have been associated with variable female fecundity. However, the reason for these differences is so far unknown. The donor-recipient model, separating uterine from ovarian factors, allows clarifying the origin of MCL-associated fecundity variations.Study design: We analyzed retrospectively 2015 oocyte donation cycles, resulting in 3427 embryo transfers (ET) and pregnancy follow-up.Results: Surprisingly, we found that oocyte donors MCL of 34-35 days were strongly associated with significantly higher biochemical, clinical and ongoing pregnancy rates in woman who received the embryos, compared to the reference group of MCL of 27-29 days. Moreover, donors with longer MCL presented higher ovarian response to stimulation and lower amount of hormonal stimulation needed to achieve multifollicular growth. Conversely, MCL of <25 days were associated with a poorer ovarian response to stimulation, less cumulus oocyte complexes (COCs) and less mature oocytes (MII) retrieved; however, the quality of oocytes in these women is not associated to their ovarian response, as evidenced by the pregnancy rates obtained when transferred into an adequately prepared endometrium.Conclusions: We conclude that oocyte quality, rather than natural endometrial preparation, is the main reason for the reported higher fecundity of women with longer MCL This result is further confirmed by our data on bleeding length in the donor pool. Response to ovarian stimulation is the definitive test of ovarian reserve; moreover, since different MCLs result from varying length of the follicular phase, longer MCL should be associated with a higher number of follicular recruitment events. We hypothesize that MCL is associated with - and a marker of - ovarian reserve in healthy reproductive age women. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Objectives-Three-dimensional (3D) sonographically based automated volume calculation (SonoAVC; GE Healthcare, Zipf, Austria) is being introduced in folliculometry during ovarian stimulation; however, clear training assessments in this technique are lacking. The learning curve cumulative summation (LC-CUSUM) test provides a quantitative tool to determine when a trainee has learned a procedure. The aim of this prospective study was to assess 3D SonoAVC LC-CUSUM curves in folliculometry.Methods-Analyses were performed on 98 oocyte donors by capturing the ovarian image in 3D and applying the 3D SonoAVC software during ovarian stimulation cycles. Each patient was scanned by an expert operator and by a trainee. Independent LC-CUSUM tests for 4 follicular diameters tracked the competency of 3 trainees in 3D SonoAVC.Results-We found that the numbers of sonographic examinations required by the 3 trainees to identify the correct number of follicles of 10 mm or larger were 38, 32, and 28, respectively; for follicles of 14 mm or larger, they were 29, 28, and 28; for follicles of 18 mm or larger, they were 24, 19, and 27; and for follicles of 21 mm or larger, they were 29, 19, and 24.Conclusions-A variable number of procedures are needed to reach proficiency in 3D SonoAVC, even for trained 2-dimensional sonographers. Assessment of learning curves should be implemented when incorporating 3D SonoAVC in reproduction units.

Objective: To evaluate the effect of physician training in empathic skills on patients' satisfaction just after their first consultation in a private fertility clinic setting.Design: Prospective study.Setting: Private fertility clinic.Patient(s): Thirteen physicians were evaluated by 2,146 patients.Intervention(s): The empathic training of physicians was centered on emotional intelligence, communication elements, social styles and empathy, and practical workshops. After their first consultation with the physician, patients answered a self-rating questionnaire comprising five scales: information provided, dynamic of the visit, time dedicated, patient-physician interaction, and expertise.Main Outcome Measure(s): Patients' satisfaction scores after the empathic training of physicians. Result(s): For all five scales, the empathic training resulted in a significant change of the global scoring distribution with a shift toward higher scores. The intervention also resulted in a lower likelihood of low scoring (in the lower quartile) for all the items.Conclusion(s): Training in empathic skills of physicians resulted in higher patient satisfaction levels on the perceived information quality, communication skills, and time dedicated at first consultation for fertility treatment. (Fertil Steril (R) 2013;99:1413-8. (C) 2013 by American Society for Reproductive Medicine.)

3D ultrasound is used to monitor follicular development during controlled ovarian hyperstimulation cycles (COH). The technique is accurate, fast, and highly reproducible among users. However, measurements by 3D differ slightly from those obtained by 2D, potentially swaying medical decisions in COH. This retrospective study compares OSC performance after 2D or 3D follicular tracking in a large multi-operator clinical setting. 2969 COH cycles stimulated with GnRH antagonist protocol were analyzed. The first control was performed at COH day 6, and further ones as appropriate. A Voluson-i, with 2D and 3D modes and SonoAVC 8.0.1. software was used. 2D (n = 1426) follicular sizes were calculated with two diameters (2D AA); 3D ones (n = 1543) with sonoAVC relaxed sphere algorithm. Triggering criteria: ≥ 3 follicles ≥ 18 mm; t-test was used for data analysis. The length of the COH was slightly shorter for 3D (9.17 ± 1.6 vs. 8.98 ± 1.5 days, P < 0.001); the amount of gonadotrophins used (2108 ± 556 vs. 2082 ± 577 IU; P = 0.21) and the length of GnRH antagonist administration (5.48 ± 3.6 vs. 5.46 ± 2.3 days; P = 0.85) per cycle was comparable in the 2 groups. A higher number of follicles > 10 mm (5.86 ± 4.47 vs. 7.17 ± 4.5, P < 0.001), > 14 mm (0.59 ± 1.68 vs. 0.80 ± 1.48, P < 0.001), and > 16 mm (0.13 ± 1.74 vs. 0.19 ± 0.73, P = 0.026) was recorded for 3D at the first follicular control. Similarly, the follicle number at the last follicular control was higher for 3D: 18.54 ± 7.45 vs. 19.3 ± 8.31 (> 10 mm, P = 0.003); 11.3 ± 4.74 vs. 11.46 ± 4.86 (> 14 mm, P = 0.036); 7 ± 3.28 vs. 7.24 ± 3.45 (> 16 mm, P = 0.052); 3.26 ± 2.24 vs. 3.49 ± 2.35 (> 18 mm, P = 0.006). COCs were recovered in comparable numbers (14.01 ± 7.5 vs. 14.32 ± 7.8, P = 0.27). Interestingly, the MII and fertilized oocytes number were higher for 3D (10.38 ± 5.82 vs. 11.42 ± 6.49, P < 0.001, and 7.47 ± 4.71 vs. 8.16 ± 5.3, P < 0.001). 3D follicular tracking allows for a more accurate timing of triggering in a multi-operator setting, likely leading to higher follicular cohort efficiency.

Antiretroviral therapy during pregnancy is critical to preventing human immunodeficiency virus vertical transmission. Physiological changes during pregnancy can alter drug kinetics. The aim of this study was to assess the pharmacokinetics (PK) of saquinavir (SQV) boosted with ritonavir during pregnancy and postpartum. Fourteen human immunodeficiency virus-positive pregnant women started SQV 500 mg new tablet formulation plus ritonavir at a dose of 1000/100 mg twice a day + 2 nucleoside retrotranscriptase inhibitors during pregnancy. At weeks 24 and 34 of pregnancy and 6 weeks postpartum, a 12-hour PK study was conducted. PK parameters were calculated using Win Nolin software version 4.1. At week 24, the geometric mean values for SQV area under the plasma concentration–time curve from 0–12 hours (AUC0–12), the maximum observed plasma concentration (Cmax), trough plasma concentration (Cmin), and the elimination half-life (t1/2) were 24.80 mg·h−1·mL−1, 4.66 mg/mL, 0.93 mg/mL, and 4.31 hours, respectively. At week 34, AUC0–12, Cmax, Cmin, and t1/2 were 12.71 mg·h−1·mL−1, 3.23 mg/mL, 0.26 mg/mL, and 4.06 hours, respectively. Finally, at 6 weeks postpartum, mean values for SQV AUC0–12, Cmax, Cmin, and t1/2 were 28.94 mg·h−1·mL−1, 3.92 mg/mL, 0.86 mg/mL, and 3.60 hours, respectively. Although PK parameters in week 24 and postpartum were very similar, those for week 34 showed an important reduction: −71.20%, −30.61%, −48.73%, and −5.81% in Cmin, Cmax, AUC0–12, and t1/2, respectively, compared with week 24, but no statistically significant differences were shown between patients. No vertical transmissions were reported. Therapeutic drug monitoring of SQV during pregnancy should be considered, mainly during the third trimester, to ensure adequate drug exposure throughout the entire pregnancy.

Objectives:To assess the association between HIV infection and both spontaneous and iatrogenic preterm delivery (PTD), and to explore the impact of HAART on both entities. Methods:A matched retrospective cohort study was carried out on 517 HIV-infected pregnant women who consecutively attended a university referral hospital between 1986 and 2010. Two controls were assigned for each case. They were matched by ethnicity, smoking, maternal age and educational level. Exclusion criteria were multiple pregnancy and active injection drug use (IDU). PTD was defined as delivery less than 37.0 weeks. Spontaneous PTD included preterm premature rupture of membranes. Iatrogenic delivery was considered if medically indicated. Factors associated with PTD among HIV-infected women were analyzed by logistic regression. Results:A total of 1557 pregnant women were analyzed (519 HIV-infected and 1038 noninfected). The incidence of PTD was 19.7% in HIV-infected women and 8.5% in controls [odds ratio (OR) 2.6; 95% CI 1.9–3.6]. There was a significantly higher incidence of both spontaneous [adjusted OR (AOR) 2.1; 95% confidence interval (CI) 1.5–3.0] and iatrogenic prematurity (AOR 3.2; 95% CI 1.8–5.7). Iatrogenic PTD was significantly associated with the use of HAART during the second half of pregnancy, whereas spontaneous PTD was not related to HAART. Conclusion:There is a significant association of HIV infection with PTD, both spontaneous and iatrogenic PTD. HAART use was predominantly associated with iatrogenic PTD.

To assess obstetric and virological characteristics of HIV-infected women who underwent termination of pregnancy (TOP) in the era of highly active antiretroviral pregnancy (HAART). A retrospective cohort study was carried out among 399 HIV-infected pregnant women who attended a single center from Jan 2000 until Dec 2009. A total of 89 out of 399 HIV-infected pregnant women asked for a voluntary TOP during the study period (22.3%). Median maternal age was 32 years old. A 37.5% (30/80) of women were HCV-co infected. Active or past injection drug use was reported in 21 cases (27.3%). Cocaine use was declared in 6 cases. Most women had previous pregnancies (78/85; 91.2%). In 30 cases (33.71%) a previous TOP had been performed, including 13 women who underwent TOP more than once during the study period. According to HIV infection parameters, sixty-five out of 89 women were taking HAART (73%). Detectable viral load was present in 47.5% of HIV-pregnant women (29/61), though being 11 of them under HAART. Indications for termination of pregnancy included exposure to teratogenic agents (13/89; 14.6%), fetal abnormalities (4/89; 4.5%), maternal severe illness (4/89; 4.5%), obstetric complications (2/89; 2.2%), and in 66 cases (74.2%) there was no other reason apart from HIV infection for TOP. Among those women who considered HIV as a sufficient indication for TOP, 21 of them did not need or did not use HAART (31.8%). Median gestational age at the procedure was 10 weeks (range 6.0 – 20.0). In 64 cases (71.9%) curettage was performed before 12 weeks. After 12 weeks, medical termination of pregnancy was performed, and in 8 cases curettage was also required. A 22.3% of HIV-infected pregnant women underwent pregnancy termination, not infrequently in the second trimester of pregnancy (25/89; 28.1%). There was no other reason for TOP apart from the HIV infection in 74.2% of cases. Two thirds of the study population had previous TOP. Efforts should be made in family planning policies to avoid unintended pregnancies among HIV-infected women.

ObjectiveOvarian stimulation with the GnRH antagonist protocol is a well established option in oocyte donor program. The induction of final oocyte maturation can be performed with a GnRH agonist instead of hCG. Nonetheless the type of agonist used or its dose are not well defined and further tailoring might still be needed.DesignThe present retrospective study explored the use a of slightly higher dose of GnRH agonist for ovulation induction by testing the hypothesis that a higher triggering dose might elicit a more powerful gonadotropin surge and influence subsequent oocyte maturation rate and quality.Materials and MethodsSixty-six oocyte donors was trigger with triptorelin 0.3 mg and compared to 164 cycles performed by same donors trigger with standard dose, 0.2 mg triptorelin.ResultsNo differences were observed in donor age (27 ± 4 vs 26.2 ± 4 P=0.24), gonadotropin starting dose (217 ± 37 vs 211 ± 35 IU P=0.3), total gonadotropin requirement (2122 ± 500 vs 2040 ± 459 IU P=0.23), duration of stimulation (10.4 ± 1 vs 10.1 ± 1 d P=0.18), number of follicles≥14 mm on triggering day (14.1 ± 5 vs 12.7 ± 5 P=0.052) between the 0.3 mg and 0.2 mg dose groups. As expected due to the inclusion on cycles with a higher ovarian response in the 0.3 mg group the number of obtained COC (18.7 ± 10 vs 15 ± 8 P=0.003), mature (14.9 ± 8 vs 12 ± 6 P=0.004) and fertilized (2PN) oocytes (11.1 ± 6 vs 8.7 ± 5 P=0.003) was significantly higher. In contrast the proportion of mature (MII) oocytes (79 ± 20% vs 81 ± 16% P=0.43) and fertilization rates (72 ± 16% vs 73 ± 19% P=0.8) and corresponding recipient pregnancy rates 53.1% vs 51.1% P=0.82 were not significantly different.ConclusionA higher dose of a GnRH agonist used for trigger has yielded a comparable proportion of mature and fertilized oocytes compared with the standard dose. Consequently we did not find any benefit in increasing the dose of the GnRH agonist which suggests that the gonadotropin surges elicited by the two different triggering doses are equally efficient. ObjectiveOvarian stimulation with the GnRH antagonist protocol is a well established option in oocyte donor program. The induction of final oocyte maturation can be performed with a GnRH agonist instead of hCG. Nonetheless the type of agonist used or its dose are not well defined and further tailoring might still be needed. Ovarian stimulation with the GnRH antagonist protocol is a well established option in oocyte donor program. The induction of final oocyte maturation can be performed with a GnRH agonist instead of hCG. Nonetheless the type of agonist used or its dose are not well defined and further tailoring might still be needed. DesignThe present retrospective study explored the use a of slightly higher dose of GnRH agonist for ovulation induction by testing the hypothesis that a higher triggering dose might elicit a more powerful gonadotropin surge and influence subsequent oocyte maturation rate and quality. The present retrospective study explored the use a of slightly higher dose of GnRH agonist for ovulation induction by testing the hypothesis that a higher triggering dose might elicit a more powerful gonadotropin surge and influence subsequent oocyte maturation rate and quality. Materials and MethodsSixty-six oocyte donors was trigger with triptorelin 0.3 mg and compared to 164 cycles performed by same donors trigger with standard dose, 0.2 mg triptorelin. Sixty-six oocyte donors was trigger with triptorelin 0.3 mg and compared to 164 cycles performed by same donors trigger with standard dose, 0.2 mg triptorelin. ResultsNo differences were observed in donor age (27 ± 4 vs 26.2 ± 4 P=0.24), gonadotropin starting dose (217 ± 37 vs 211 ± 35 IU P=0.3), total gonadotropin requirement (2122 ± 500 vs 2040 ± 459 IU P=0.23), duration of stimulation (10.4 ± 1 vs 10.1 ± 1 d P=0.18), number of follicles≥14 mm on triggering day (14.1 ± 5 vs 12.7 ± 5 P=0.052) between the 0.3 mg and 0.2 mg dose groups. As expected due to the inclusion on cycles with a higher ovarian response in the 0.3 mg group the number of obtained COC (18.7 ± 10 vs 15 ± 8 P=0.003), mature (14.9 ± 8 vs 12 ± 6 P=0.004) and fertilized (2PN) oocytes (11.1 ± 6 vs 8.7 ± 5 P=0.003) was significantly higher. In contrast the proportion of mature (MII) oocytes (79 ± 20% vs 81 ± 16% P=0.43) and fertilization rates (72 ± 16% vs 73 ± 19% P=0.8) and corresponding recipient pregnancy rates 53.1% vs 51.1% P=0.82 were not significantly different. No differences were observed in donor age (27 ± 4 vs 26.2 ± 4 P=0.24), gonadotropin starting dose (217 ± 37 vs 211 ± 35 IU P=0.3), total gonadotropin requirement (2122 ± 500 vs 2040 ± 459 IU P=0.23), duration of stimulation (10.4 ± 1 vs 10.1 ± 1 d P=0.18), number of follicles≥14 mm on triggering day (14.1 ± 5 vs 12.7 ± 5 P=0.052) between the 0.3 mg and 0.2 mg dose groups. As expected due to the inclusion on cycles with a higher ovarian response in the 0.3 mg group the number of obtained COC (18.7 ± 10 vs 15 ± 8 P=0.003), mature (14.9 ± 8 vs 12 ± 6 P=0.004) and fertilized (2PN) oocytes (11.1 ± 6 vs 8.7 ± 5 P=0.003) was significantly higher. In contrast the proportion of mature (MII) oocytes (79 ± 20% vs 81 ± 16% P=0.43) and fertilization rates (72 ± 16% vs 73 ± 19% P=0.8) and corresponding recipient pregnancy rates 53.1% vs 51.1% P=0.82 were not significantly different. ConclusionA higher dose of a GnRH agonist used for trigger has yielded a comparable proportion of mature and fertilized oocytes compared with the standard dose. Consequently we did not find any benefit in increasing the dose of the GnRH agonist which suggests that the gonadotropin surges elicited by the two different triggering doses are equally efficient. A higher dose of a GnRH agonist used for trigger has yielded a comparable proportion of mature and fertilized oocytes compared with the standard dose. Consequently we did not find any benefit in increasing the dose of the GnRH agonist which suggests that the gonadotropin surges elicited by the two different triggering doses are equally efficient.