Objective: The aim of our study is to examine the relationship between adenomyosis and chronic endometritis and to discuss its possible effects on pathogenesis. Design: Prospective analysis of previous patients’ pathology specimens Setting: A tertiary university hospital’s department of obstetrics and gynecology. Patients: Patients who underwent hysterectomy at were divided into two groups according to the presence or absence of adenomyosis. A propensity score matching analysis was performed to minimize selection bias in patient groups. A total of 146, 73 patients in each group, were included in the study. Methods: The previous specimens of the patients were re-evaluated with the CD38 immunohistochemistry staining method. A positive diagnosis of CE was made in the presence of plasma cells. In particular, basal endometrial thickness was measured in endo-myometrial transition zones. Main outcome measures and Results: The adenomyosis group was significantly younger than the group without adenomyosis (47.14 ± 4.24 vs. 50.36 ± 7.02, p = 0.012). 17 (11.6%) patients in the adenomyosis group were diagnosed with chronic endometritis, while 7 (4.8%) patients in the control group were diagnosed with chronic endometritis, and a statistically significant difference was found (p<0.05). Basal endometrium could be measured in a total of 112 (76.7%) patients, while basal endometrial loss was observed in 34 (23.3%) patients. Chronic endometritis was found in 16 (47%) of the patients with basal endometrial loss. The baseline endometrial thickness of 112 (76.7%) of the patients could be measured, but only 8 (7.1%) of them had chronic endometritis. There was a statistically significant difference between the groups (p<0.001). In multivariate analysis, there was a statistically significant relationship between basal endometrial loss and CE. Conclusion(s): A significant relationship was observed between adenomyosis and chronic endometritis.

Objective: To determine the optimal leading follicle size for triggering final oocyte maturation in POSEIDON groups 3 and 4 poor responders undergoing ART cycles. Design: Retrospective cohort study. Setting: University based Infertility Centre. Population: Data of 294 POSEIDON groups 3 and 4 poor responders aged between 20 and 42 years who underwent ICSI following a GnRH antagonist cycle between January 2015 and July 2021 were reviewed. Methods: Among the 342 patients eligible in our database, 294 fulfilling inclusion criteria were assessed for final analyses. Cycles were categorized into two groups according to occurrence of premature ovulation. Premature ovulation was defined as visualization of rupture of at least one of the leading follicles on the day of oocyte retrieval. In addition, number of oocytes retrieved, number of MII oocytes, MII/antral follicle count (AFC) ratio and follicle-oocyte index (FOI) were compared between different leading follicle sizes. Main Outcome Measures: Number of oocytes retrieved, number of MII oocytes, MII/antral follicle count (AFC) ratio and follicle-oocyte index (FOI). Results: Among all, 47 (16.2%) had premature ovulation between the trigger and oocyte pick-up days. The mean size of the leading follicle on the day of trigger was significantly higher in the premature ovulation group than the controls (19.8±2.4 mm vs.18.7±2 mm, respectively; P<0.001). Multivariate logistic regression analyses identified baseline LH (Odds ratio {OR} 1.144, 95% confidence interval {CI} 1.052-1.243; P=0.002), number of follicles >11 mm on the day of trigger (OR 0.580, 95% CI 0.438-0.767; P<0.001), and leading follicle size (OR 1.361, 95% CI 1.130-1.641; P=0.001) as independent predictors of premature ovulation. According to the one-way ANOVA test and non-linear curve estimation model the FOI and MII/AFC ratios peaked when the leading follicle size was between 16-17 mm, respectively. Conclusion: Individualized trigger based on leading follicle size can provide maximum efficiency in ovarian stimulation in POSEIDON expected poor responders. While late trigger may result in premature ovulation, early trigger may also result in less MII. Triggering when the leading follicle size is between 16.5 and 17 mm can help to prevent these negative outcomes and achieve optimal cycle outcome.