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hmelzeiny.bsky.social

@hmelzeiny.bsky.social
10 followers 9 following 13 posts
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 30/05/2026
Is there any explanation why gestational diabetes was higher in NC compared to AC ? in Rafael et al paper #ESHREjc
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 30/05/2026
Smart question.When we differentiate between early Vs late‑onset PE, the evidence shows that AC is associated only with the late‑onset. The underlying pathophysiology of each subtype remains insufficiently understood. For intervention strategies, we need deeper understanding of the mechanisms.
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 30/05/2026
Agree, Follicular phase E2 is a precursor for up-regulation of P4 receptors, however Supra physiological E2 level may narrow the duration of WOI . Should this also have impact on decidualisation and trophoblast invasion, need to be investigated? #ESHREjc
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 30/05/2026
Average age of women who used NC is 41.80+or-3.56. I believe majority in practice will do NC at that age , however the target population here should be women between 45-50 with regular cycle . Has the study accounted for this age bracket? #ESHREjc
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 29/05/2026
Absolutely , and the proposed N-of-1 trials would be useful for very rare conditions , AC are the only choice for patients like POF , or travelers .also there is an assumption that the reason for patients to utilize AC are the reasons that cause obstetrics complications.
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 29/05/2026
#ESHREjc Single-cell RNA-seq of endometrial biopsies can now characterise decidualisation - Endometrial stromal cell IGFBP-1 + prolactin are validated markers - cfDNA placental fraction at 10–14 weeks correlates with placental mass Ref: Yang et al. Front Immunol. 2023.
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 29/05/2026
#ESHREjc NC-FET is feasible in women ≥35 with regular cycles mNC-FET (triggered ovulation + progesterone support) addresses concerns about LPD while preserving CL function Obstetric risk from AC-FET is not age-stratified — a 38-year-old in an AC-FET carries the same elevated PE risk as a 29-year-old
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 29/05/2026
#ESHREjc First-trimester serum biomarkers — the best current tool: 📍 PlGF ↓ + sFlt-1 ↑ → angiogenic imbalance (standard T1 PE screen, but less sensitive for late-onset PE) 📍 PAPP-A ↓ → trophoblast dysfunction marker 📍 Combining PlGF + MAP + UtA Doppler detects ~75% of preterm PE at 10–14 weeks.
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 29/05/2026
#ESHRE so far it is an association till RCT confirm causation The mechanistic chain: CL absence → ❌ No relaxin → aortic stiffness, no BP drop in T1 ❌ No CL-VEGF → impaired early angiogenesis ❌ Supraphysiological E2 → altered spiral artery remodelling ❌ → impaired renal adaptation Lead preeclampsia.
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 29/05/2026
#ESHREjc I believe this protocol NPP will be used frequently . when scheduling and avoiding weekends transfer is required .i used it in my practice that way ; scan on a Friday when follicles is 15 mm , ET> 7 mm , then I can start P4 on Saturday or Sunday for ET on Thursday or Friday.
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 29/05/2026
#ESHREjc Very interesting protocol, the conditions to initiates P4 before ovulation is when the follicle reaches 15 mm and ET > 7 mm , and if that is the case you would expect that the majority will ovulate and have a corpus luteuim . few studies looking into it , has not been published yet .
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 29/05/2026
#ESHREjc The CL is far more than a progesterone pump. Beyond P4, it secretes relaxin, VEGF, oestrogen metabolites, prostaglandins, prorenin, and 5α-dihydroprogesterone — none of which are replaced in artificial cycles. Each has a distinct role at the implantation window 👇
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hmelzeiny.bsky.social @hmelzeiny.bsky.social · 29/05/2026
Relaxin the most consequential absent factor. ✅ Drives maternal vasodilation via nitric oxide ✅ Promotes renal hyperfiltration (GFR ↑ in early pregnancy) ✅ Induces VEGF expression in endometrial cells → neovascularisation Ref: Conrad & Baker. Am J Physiol. 2013.
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