Lorraine Kasaven

and 8 more

Objective: To assess the relationship between number of oocytes retrieved during social egg freezing (SEF) cycles with various clinical, biochemical and radiological markers; e.g. age, body mass index (BMI), baseline anti-Mullerian hormone (AMH), antral follicle count (AFC), Oestradiol level (E2) and total number of follicles ≥12mm at trigger. Main outcome measures: To describe the characteristics and outcomes of women who underwent SEF. Methods: A retrospective cohort of women embarking on SEF between 2008 and 2018 from a single London UK fertility clinic. Results: 483 stimulation cycles were undertaken in 373 women. The median age at freeze was 38 (26-47) years. The median numbers of oocytes retrieved per cycle was 8 (0-37), and total oocytes cryopreserved 8 (0-45) per woman. BMI, E2 level and number of follicles ≥12mm at trigger were all significant predictors of oocyte yield. Multivariate analysis confirmed no significant relationship between AFC or AMH, whilst on univariate analysis statistical significance was proven. 36 women returned to use their oocytes, with 41 autologous egg thaw cycles undertaken. 12 successful livebirths were achieved by 11 women. The overall livebirth rate was 26.8% per cycle. No livebirths occurred in women ≥40 years old and 82% of all livebirths were in women aged 36-39 at freeze. Conclusions: This study demonstrates clinical, biochemical and radiological markers can predict oocyte yield in SEF cycles. However, subsequent reproductive outcomes highlight women embarking upon SEF should be encouraged to do so before the age of 37 years, and no later than 40 to optimise successful livebirth.
Objective: To investigate conservative and excisional/ablative treatment outcomes for cervical intraepithelial neoplasia grade 2 (CIN2) following introduction of virological test of cure. Design: Retrospective study of prospectively collected data. Setting: Teaching hospital colposcopy unit. Population: 331 sequential biopsy-proven CIN2 cases. Methods: CIN2 cases diagnosed 01/07/2014-31/12/2017 were followed-up until colposcopy discharge and then using the national cervical cytology database. Outcomes were defined: Cytological/histological regression was absence of high-grade CIN on biopsy and/or high-grade dysplasia; Virological regression was cytological/histological regression and negative human papillomavirus testing; Persistence was biopsy-proven CIN2 and/or moderate dyskaryosis; Progression was biopsy-proven CIN3+ and/or severe dyskaryosis. Main outcome measures: Regression, persistence, progression rates; median regression/progression times; referral to discharge interval; subsequent CIN. Results: Median follow-up was 22.6 months (range: 1.9-65.1). 175 (52.9%) patients were initially managed conservatively. 77.3%(133/172) regressed, 13.4%(23/172) persisted and 9.3%(16/172) progressed to CIN3+. 97(56.4%) patients achieved virological regression. Median regression and progression times were 6.1 (range 2.4-30.4) months and 7.6 (range 3.8-43.3) months, respectively. 156 (47.1%) patients underwent initial excision/ablation, with a 89.4%(110/123) virological cure rate. Patients managed conservatively vs. planned excision spent a median of 16.4 and 11.7 months respectively, within colposcopy follow-up. 7 (4.0%) and 3 (1.9%) patients developed further CIN in the conservative and treatment groups respectively, during median 17.2 months post-discharge. Conclusions: Conservative management is a reasonable and effective management strategy in appropriately-selected women with CIN2. The above data provide useful information for clinicians and patients deciding management options. Funding: none Keywords: CIN2; conservative; management; expectant; regression; progression; persistence; excision; HPV; virological