Background and Objectives: Delayed childbearing in advanced age might be associated with a low prognosis for achieving pregnancy. Therefore, it is important to establish a predictive tool that will optimize the likelihood of a live birth at advanced age. Material and Methods: The retrospective study was conducted at the Ferona Fertility Clinic in Novi Sad (Republic of Serbia), between January 2020 and May 2021. The survey included 491 women aged ≥35 who met the inclusion criteria and who were subjected to an IVF (in vitro fertilization) treatment cycle. Results: The average number of retrieved oocytes, MII (metaphase II) oocytes, and developed embryos significantly decreased in advanced age. Age was also found to have a significant adverse effect on pregnancy and live birth rates. In women aged ≥35, 10/12 MII oocytes or 10/11 embryos are required for reaching an optimal live birth rate/cumulative live birth rate. Optimal CLBR (cumulative live birth rate) per one oocyte was achieved when 9 MII oocyte were retrieved. Conclusions: The study indicates that the cut-off for increased risk is ≥42 year. However, despite low live birth rates, autologous IVF for these women is not futile. An increase in the number of retrieved mature oocytes and a generation of surplus cryopreserved embryos could reinforce LBR (live birth rate) and CLBR. Clinicians should be very cautious in counseling, as autologous IVF may only be applicable to women with good ovarian reserve.

Background and Objectives: Age at menarche is related to various biological and socioeconomic factors in childhood. The aim of the study was to examine the association of age at menarche with general and abdominal obesity in young women. Materials and Methods: A transversal anthropometric survey was conducted with 102 females from 21 to 25 years of age. The surveyed traits included height, weight, waist circumference (WC) and hip circumference (HC). General obesity was assessed using the body mass index (BMI) and abdominal obesity by WC, waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). A retrospective method was used for collecting age at menarche data. Results: The average age at menarche is 12.80 years. Early menarcheal age (14 years) is recorded for 20.6% of subjects. Early menarche age subjects exhibit significantly higher BMI, WC and WHtR in comparison with their late menarche age peers. There is a significant negative correlation between BMI, WC and WHtR values and menarcheal age. Late age at menarche is associated with higher probability of underweight status (BMI < 18.5 and/or WHtR < 0.4). Conclusions: Age at menarche has a negative correlation with general and abdominal obesity. Young women with early age at menarche show statistically higher values of BMI, WC and WHtR, while those with late menarcheal age show greater susceptibility to becoming underweight.

Background/Objectives: Poor responder patients represent the greatest challenge in ART. An inadequate response to COS strongly correlates with a reduced chance of conception. A novel classification of poor responders overcame a deficiency in the Bologna criteria and distinguished an expected and unexpected low ovarian response, allowing for an individual treatment approach to be created. In this study, we compared the clinical outcomes in poor responders, according to two different ovarian stimulation protocols, GnRH agonists and antagonists, classified according to the Poseidon criteria, to determine the most effective protocol for each group. Methods: This retrospective study involved 1323 low-prognosis women ranked according to the Poseidon classification and a control group of normal responders. Results: The GnRH-antagonist protocol showed some advantage in the Poseidon 1b group whereas the GnRH-agonist protocol was more effective in the Poseidon 4 group. There were no differences in live births or miscarriage rates in poor responders among these two protocols. Conclusions: Using both the agonist/antagonist approaches, live birth rates are two or even three times less in Poseidon patients in comparison to normal responders. The number of obtained oocytes, their maturity and quality, and women’s ages were found to be the most influential determinants for a successful outcome. Further investigations into ovarian stimulation strategies are required to enhance oocyte number and live birth occurrence.

Background and Objectives: POSEIDON 4 (P4) patients face the most adverse outcomes among poor responders. Oocyte donation has overcome unsatisfactory live birth rates (LBRs) in P4 patients and has become an indispensable approach. However, many patients refuse oocyte donation despite poor live birth likelihood using autologous oocytes. This study aimed to determine clinical outcomes and live birth chances in P4 patients using autologous and donated oocytes. We also identified influencing factors of fertility outcome in P4 patients who underwent donor cycles. Materials and Methods: Retrospective data of 345 P4 patients who explored the first ovarian stimulation cycle (control group) were compared to 105 patients who failed to conceive and underwent repeated autologous ovarian stimulations with an increased starting gonadotropin dose and 100 unpregnant patients who received donated oocytes. Univariate analysis was used to identify prognostic factors of oocyte donation outcomes in P4 patients. Results: LBRs were significantly higher in the donor oocyte group. A higher number of retrieved and good-quality oocytes without differences in the blastocyst number and LBRs were found in the autologous patient group with adjusted gonadotropin dose compared to the control group. Univariate analysis showed that oocyte and embryo quality as well as blastocyst development had a positive impact on live birth in the donor patient group. Conclusions: Autologous in vitro fertilization (IVF) retreating and oocyte donation should be strongly advised for poor-prognosis P4 patients. Still, efforts in tailoring ovarian stimulation to obtain higher oocyte and embryo numbers in autologous cycles should be continued.

A number of endogenic and exogenic factors tend to affect the body height and body mass index (BMI) of adults. The current study aims at exploring the relationship between age at menarche with body height and BMI in young females. Material and methods: A transversal anthropometric survey was conducted in the period between 2021 and 2024 on 209 female university students between the ages of 21 and 25. The surveyed traits included body height and weight, BMI was calculated based on these values. The age at menarche was obtained by applying the retrospective method. Results: Early menarche (14 godina) was present in 16.7% of women. The average age at menarche was 12.78±1.19 years. The prevalence of short stature (Z-score<-1) and overweight (BMI≥25) was higher in early menarche cases in comparison to those with late menarcheal age (39.4% and 61% v.s. 0% and 2.4%, respectively). The prevalence of tall stature (Z-score>1) and underweight (BMI<18.50) was higher in women with late menarche in comparison with their early menarcheal peers (43.6% and 47.4% v.s. 2.4% and 15.8%, respectively). The odds ratio (OR) equaled 0.393 for short stature, 1.862 for tall stature, 1.789 for underweight and 0.327 for overweight (P<0.05). The categories of age at menarche significantly affected the body height (BETA=0.432) and BMI (BETA=-0.450). Conclusion: Early menarche is associated with short stature and overweight, while late menarche relates to tall stature and a higher risk of being underweight.

Background/ Aim. Infertility is one of the posible causes for a decrease in fertility rates. It is a significant social and medical problem affecting one in six couples worldwide with the current prevalence of infertility being 8- 12% among women aged 20-44. The most significant and influental factor of infertility is women’s age. This study aims to evaluate clinical outcomes among different infertility causes in women aged ≥35, as well as to investigate the prevalence of infertility causes. Methods: medical records were obtained from 873 women subjected to an IVF (in vitro fertilization) treatment cycle. Incidence and clinical outcomes of four infertility causes and factors leading to female cause of infertility were investigated. Results: The highest proportion of couples who had taken part in an assisted reproduction program, did so due to female cause of infertility, particullary due to ovulatory problems. Statistically significant differences between the four causes of infertility were found in terms of the number of retrieved and mature oocytes, fertilization rates. Differences in pregnancy and live birth rates were found between factors leading to female causes of infertility. Conclusions: Female factors, especially ovulatory problems are, as expected, the most common cause of infertility in the investigated age group and are associated with an increased risk of adverse clinical outcomes. This is useful information for the management of infertility but further investigation of infertility causes and prevalence is necessary.