External cephalic version can safely be performed with most breech presentations.

Purpose To investigate the impact of a 3-month course of intracortical injections of autologous platelet-rich plasma (PRP) upon ovarian reserve markers versus no intervention in women with low ovarian reserve prior to undergoing assisted reproductive technology (ART). Methods Prospective controlled, non-randomized comparative study conducted in a private fertility clinic, in Venezuela. Women with abnormal ovarian reserve markers (FSH, AMH and AFC) who declined oocyte donation were allocated to one of the following groups according to patient choice: monthly intracortical ovarian PRP injections for three cycles, or no intervention. Primary outcomes were the change in FSH, AMH and AFC pre-and post-treatment. Secondary outcomes included the number of oocytes collected and fertilized, biochemical/clinical pregnancy rates and miscarriage and live birth rates. Results Eighty-three women were included, of which 46 received PRP treatment and 37 underwent no intervention. Overall median age was 41 years (IQR 39-44). There were no demographic differences between the study groups. At the 3-month follow-up, women treated with PRP experienced a significant improvement in FSH, AMH and AFC, whereas there was no change in the control group. Furthermore, overall rates of biochemical (26.1% versus 5.4%, P = 0.02) and clinical pregnancy (23.9% versus 5.4%, P = 0.03) were higher in the PRP group, while there was no difference in the rates of first trimester miscarriage and live birth between groups. Conclusion PRP injections are effective and safe to improve markers of low ovarian reserve prior to ART, although further evidence is required to evaluate the impact of PRP on pregnancy outcomes.

Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis.

Objective: To investigate the applicability of PLCζ analysis in assisting the clinical decisionmaking process when considering artificial oocyte activation (AOA) for infertile males in assisted reproductive technology (ART). Design:To screen 46 males (43 infertile/13 fertile) using our PLCζ assay.Setting: Fertility unit/university laboratory.Patients: Infertile males with (1) abnormal sperm morphology, (2) total fertilization failure, low fertilization rate (<50%), or repeated fertilization failure in ART. Intervention(s):We analysed PLCζ levels in sperm from fertile and infertile males. Eligible patients subsequently underwent ICSI/AOA with calcimycin (GM508). Main Outcome Measure(s): PLCζ localization, level and the proportion of sperm expressingPLCζ. Thresholds of PLCζ-deficiency, fertilization rates, pregnancy rates and live birth rates of AOA and non-AOA cycles.Results: Compared with 13 controls, 34 of the 43 infertile males had significantly lower levels of PLCζ and/or a significantly lower proportion of sperm exhibiting PLCζ. Of these 34 patients, 15 showed a significant PLCζ reduction in both parameters, which we termed 'PLCζ deficiency'. Five PLCζ-deficient patients opted for AOA; all 5 achieved fertilization and 4 achieved clinical pregnancies and live births. Fertilization rate improved significantly from 18.6% (intracytoplasmic sperm injection, ICSI) to 56.8% (ICSI/AOA) (p<0.001). The clinical pregnancy rate and live birth rate with AOA were both 40% per initiated cycle. Youden index analysis revealed that the cut-offs below which infertile males were likely to benefit from AOA were 71% for the proportion of sperm expressing PLCζ and 15.57 arbitrary units for mean PLCζ level. Conclusion:PLCζ analysis is a useful diagnostic tool to determine patient eligibility for subsequent AOA treatment.