Homocysteine concentrations in follicular fluid are associated with poor oocyte and embryo qualities in polycystic ovary syndrome patients undergoing assisted reproduction

background: A poor quality of oocytes and embryos and a low fertilization rate have been found in polycystic ovary syndrome (PCOS) patients. An inverse association between follicular fluid homocysteine (Hcy) levels and oocyte and embryo quality has also been demonstrated. We examined the relationship between follicular fluid Hcy concentrations and oocyte and embryo quality in PCOS patients undergoing assisted reproduction. methods: Fifty-two PCOS patients were included in the study, and underwent GnRH agonist/recombinant FSH treatment. The Hcy, folate, vitamin B12, malonyldialdehyde (MDA) and estradiol (E2) levels were measured in follicular fluid from single oocytes at time of retrieval. One follicle per ovary was sampled and 94 were analysed. Plasma hormones were also measured. Oocytes and embryos were graded (1–3) using standard approaches. results: The concentrations of Hcy, E2, vitamin B12, folate and MDA in plasma were higher than in follicular fluid (all P , 0.001). Significant differences were observed in follicular Hcy levels between Grade 3 and Grade 2 oocytes (P , 0.001). Hcy levels were lower in Grade 1–2 embryos than that in Grade 3 embryos; follicular fluid vitamin B12 levels were lower in patients showing high concentrations of follicular fluid Hcy (P , 0.01). The follicular fluid Hcy levels were negatively correlated with follicular fluid vitamin B12 (r ¼ 20.44), folate (r ¼ 20.68) and fertilization rate (r ¼ 20.85), and positively correlated with follicular fluid MDA (r ¼ 0.51). conclusions: Concentrations of Hcy in follicular fluid on the dOPU may be a useful marker for fertilization rate, and oocyte and embryo quality in PCOS patients undergoing assisted reproduction

Comparison of the ultrashort gonadotropinreleasing hormone agonist-antagonist protocol with microdose flare-up protocol in poor responders: a preliminary study

Objective: To determine the potential effect of the ultrashort gonadotropin-releasing hormone (GnRH) agonist/GnRH antagonist protocol versus the microdose GnRH agonist protocol in poor responders undergoing intracytoplasmic sperm injection (ICSI). Material and Methods: The patients in the Agonist-Antagonist Group (n=41) were administered the ultrashort GnRH-agonist/antagonist protocol, while the patients in the Microdose Group (n=41) were stimulated according to the microdose flare-up protocol. The mean number of mature oocytes retrieved was the primary outcome measure. Fertilization rate, implantation rate per embryo and clinical pregnancy rates were secondary outcome measures. Results: There was no differenc between the mean number of mature oocytes retrieved in the two groups. There were also no statistical differences between the two groups in terms of peak serum E-2 level, canceled cycles, endometrial thickness on hCG day, number of 2 pronucleus and number of embryos transferred. However, the total gonadotropin consumption and duration of stimulation were significantly higher with the Agonist-Antagonist Group compared with the Microdose Group. The implantation and clinical pregnancy rates were similar between the two groups. Conclusion: Despite the high dose of gonadotropin consumption and longer duration of stimulation with the ultrashort GnRt-t agonist/antagonist protocol, it seems that the Agonist-Antagonist Protocol is not inferior to the microdose protocol in poor responders undergoing ICSI.Amaç: ICSI uygulanan zayıf over cevaplı hastalarda ultra kısa GnRH agonist/GnRH antagonist protokolünün mikrodoz GnRH agonist protokolüne karşı potansiyel etkisini belirlemek. Gereç ve Yöntemler: Mikrodoz grubundaki (n=41) hastalar mikrodoz flare up protokolüne uygun olarak stimüle edilirken AgonistAntagonist grubundaki (n=41) hastalara da ultra kısa GnRH-agonist/ antagonist protokolü uygulandı. Bu çalışmanın primer sonuç değeri toplanan ortalama matür oosit sayısı iken, fertilizasyon oranı, embryo başına implantasyon oranı ve klinik gebelik oranı da sekonder sonuç değerleriydi. Bulgular: İki grup arasındaki toplanan ortalama matür oosit sayıları arasında fark yoktu. Serum E2 düzeyleri, iptal edilen sikluslar, hCG günü endometrial kalınlığı, 2 pronukleus sayıları ve transfer edilen embryo sayılarında da iki grup arasında istatistiksel farklılıklar yoktu. Bununla birlikte Agonist-Antagonist grubunda total gonadotropin tüketimi ve stimülasyon süresi Mikrodoz grubuyla karşılaştırıldığında belirgin olarak daha yüksekti. İki grup arasındaki implantasyon ve klinik gebelik oranları ise birbirine benzerdi. Sonuç: Ultra kısa GnRH agonist/ antagonist protokolü ile yüksek doz gonadotropin tüketimi ve daha uzun süreli stimülasyona rağmen ICSI uygulanan zayıf over cevaplı hastalarda Agonist-Antagonist Protokolünün mikrodoz protokolünden daha az etkili olmadığı görülmektedir. (J Turkish-German Gynecol Assoc 2010; 11: 187-93

Laparoscopy versus open surgery for the surgical management of tubo-ovarian abscess (TOA). Is there a beneficial impact of early endoscopic intervention in terms of fertility rates?

Objectives: To compare success rates and complications in women undergoing laparoscopic versus open surgical management of tubo-ovarian abscess. We further examined whether early laparoscopic intervention has any impact on pregnancy rates in a subgroup of infertile patients following frozen-thawed embryo transfer. Material and methods: Hospital records of 48 patients diagnosed with TOA between January 2015 and December 2020, who underwent surgical intervention or received only medical treatment were analyzed. All patients were hospitalized, and parenteral antibiotics were commenced on admission initially. Laparoscopic or open surgery was performed within 48 hours course of intravenous antibiotherapy (early intervention) or later according to the clinical findings and antibiotherapy response. Results: Of 48 patients with TOA, 18 (37.5%) underwent laparoscopic and 30 (62.5%) underwent open surgical intervention. The median postoperative hospital stay was shorter (4.5 days vs 7.5 days, respectively; p = 0.035), and postoperative opioid analgesic requirement was lesser in the laparoscopy group compared to open surgery group (22% vs 53%, respectively; p = 0.034). Intra- and post-operative complication rates were similar between the groups. Of these 48 patients, seven were diagnosed to have TOA following oocyte retrieval, and four of these conceived with frozen thawed embryo transfer all of whom underwent laparoscopic surgery within 48 hours of diagnosis. Conclusions: Minimal invasive surgery should be preferred even in the presence of severely adhesive and inflammatory TOA in order to improve postoperative outcomes. Moreover, early laparoscopic intervention may be considered in infertile patients with an aim to optimize pregnancy rates in a subsequent frozen-thawed embryo transfer

Does Luteal Phase Support Effect Pregnancy Rates in Intrauterine Insemination Cycles? A Prospective Randomised Controlled Study in a Tertiary Center

Intrauterine insemination (IUI) is a common treatment for couples with subfertility. Clomiphene citrate, gonadotropins, and letrozole are used for ovulation induction in IUI cycles. It has been well documented that luteal support with exogenous progesterone after in vitro fertilization is associated with higher pregnancy and live birth rates. Yet, luteal phase support in IUI cycles has become a debatable issue. The aim of this prospective controlled study was to assess the effect of luteal phase vaginal progesterone supplementation on β-hCG positivity and clinical pregnancy rates in women undergoing IUI. This prospective controlled randomised study was conducted at a tertiary infertility center. 87 patients with unexplained infertility or male subfertility who were treated with IUI using gonadotropins were enrolled. Patients in the study group (n = 44) received luteal phase vaginal progesterone supplementation. Patients in the control group (n = 43) did not receive any luteal phase support. There was no statistical difference between two groups in terms of β-hCG positivity and clinical pregnancy rates. Our findings do not show any beneficial effect of luteal phase support in IUI cycles stimulated with gonadotropins. Although luteal phase support in IUI cycles stimulated with gonadotropins is widely adopted, there is a lack of robust evidence

Chronic Inflammation in Women with Polycystic Ovarian Syndrome

OBJECTIVE: Our aim was to assess whether C-reactive protein (CRP) which is not only a marker of inflammation but a strong predictor of atherosclerosis and coronary heart disease was increased among women with polycystic ovary syndrome (PCOS). STUDY DESIGN This cross-sectional study was carried out on 18 women with PCOS and 20 healthy subjects matched for body mass index (BMI) and age. Androgenic hormones, anthropometric measurements, metabolic parameters and serum CRP levels were assessed. Further analysis whether there was a correlation between CRP and other parameters was carried out in the PCOS group as well. RESULTS: The androgenic hormones total testosterone (54.51±13.58 vs. 25.0±14.82 ng/dL, p<0.001), and androstenedione (3.7±1.1 vs. 2.78±1.19 ng/dL, p=0.049) were higher in the study group than in control subjects. Dehydroepiandrostenedione sulfate (DHEAS) (191.66±68.79 vs. 179.85±86.32 mg/dL), fasting insulin (15.1±4.1 vs. 14.5±1.7μIu/mL) and postprandial glucose (105±12.7 mg/dL vs. 97.4±10.8 mg/dL) were similar. Fasting glucose was higher in the study group compared to controls (96.1±7.9 vs. 86.6±8.9 mg/dL, p=0.007). Mean CRP levels were higher in patients with PCOS than in healthy controls (1.40±0.98 mg/dL and 0.88±0.39 mg/dL respectiv ely, p<0.001). Regression analysis revealed no correlation between CRP and other factors studied, except for a positive relationship that existed with BMI (r=0.286, p=0.045). CONCLUSION: PCOS patients have increased levels of inf lamation marker CRP which may also signal the tendency to develop cardiovascular disease in addition to established risk factors among PCOS patients

Zayıf over cevaplı hastalarda ultra kısa GnRH agonist/antagonist protokolünün mikrodoz flare up protokolü ile karşılaştırılması

Objective: To determine the potential effect of the ultrashort gonadotropin- releasing hormone (GnRH) agonist/GnRH antagonist protocol versus the microdose GnRH agonist protocol in poor responders undergoing intracytoplasmic sperm injection (ICSI). Material and Methods: The patients in the Agonist-Antagonist Group (n=41) were administered the ultrashort GnRH-agonist/ antagonist protocol, while the patients in the Microdose Group (n=41) were stimulated according to the microdose flare-up protocol. The mean number of mature oocytes retrieved was the primary outcome measure. Fertilization rate, implantation rate per embryo and clinical pregnancy rates were secondary outcome measures. Results: There was no differenc between the mean number of mature oocytes retrieved in the two groups. There were also no statistical differences between the two groups in terms of peak serum E2 level, canceled cycles, endometrial thickness on hCG day, number of 2 pronucleus and number of embryos transferred. However, the total gonadotropin consumption and duration of stimulation were significantly higher with the Agonist-Antagonist Group compared with the Microdose Group. The implantation and clinical pregnancy rates were similar between the two groups. Conclusion: Despite the high dose of gonadotropin consumption and longer duration of stimulation with the ultrashort GnRH agonist/ antagonist protocol, it seems that the Agonist-Antagonist Protocol is not inferior to the microdose protocol in poor responders undergoing ICSI. (J Turkish-German Gynecol Assoc 2010; 11: 187-93)Ama&ccedil;: ICSI uygulanan zayıf over cevaplı hastalarda ultra kısa GnRH agonist/GnRH antagonist protokol&uuml;n&uuml;n mikrodoz GnRH agonist protokol&uuml;ne karşı potansiyel etkisini belirlemek. Gere&ccedil; ve Y&ouml;ntemler: Mikrodoz grubundaki (n=41) hastalar mikrodoz flare up protokol&uuml;ne uygun olarak stim&uuml;le edilirken Agonist- Antagonist grubundaki (n=41) hastalara da ultra kısa GnRH-agonist/ antagonist protokol&uuml; uygulandı. Bu &ccedil;alışmanın primer sonu&ccedil; değeri toplanan ortalama mat&uuml;r oosit sayısı iken, fertilizasyon oranı, embryo başına implantasyon oranı ve klinik gebelik oranı da sekonder sonu&ccedil; değerleriydi. Bulgular: İki grup arasındaki toplanan ortalama mat&uuml;r oosit sayıları arasında fark yoktu. Serum E2 d&uuml;zeyleri, iptal edilen sikluslar, hCG g&uuml;n&uuml; endometrial kalınlığı, 2 pronukleus sayıları ve transfer edilen embryo sayılarında da iki grup arasında istatistiksel farklılıklar yoktu. Bununla birlikte Agonist-Antagonist grubunda total gonadotropin t&uuml;ketimi ve stim&uuml;lasyon s&uuml;resi Mikrodoz grubuyla karşılaştırıldığında belirgin olarak daha y&uuml;ksekti. İki grup arasındaki implantasyon ve klinik gebelik oranları ise birbirine benzerdi. Sonu&ccedil;: Ultra kısa GnRH agonist/ antagonist protokol&uuml; ile y&uuml;ksek doz gonadotropin t&uuml;ketimi ve daha uzun s&uuml;reli stim&uuml;lasyona rağmen ICSI uygulanan zayıf over cevaplı hastalarda Agonist-Antagonist Protokol&uuml;n&uuml;n mikrodoz protokol&uuml;nden daha az etkili olmadığı g&ouml;r&uuml;lmektedir. (J Turkish-German Gynecol Assoc 2010; 11: 187-93

Endometrioma surgery is associated with increased risk of subsequent assisted reproductive technology cycle cancellation; a retrospective cohort study

The aim of this study was to assess the effect of laparoscopic removal of endometrioma on assisted reproductive technology (ART) outcome. A retrospective cohort study was conducted at a university hospital between January 2014 and December 2017. The ART group consisted of 26 women who underwent 44 ART cycles in the presence of ovarian endometrioma and the surgery group consisted of 53 women who underwent 58 ART cycles after laparoscopic removal of ovarian endometrioma/s. There were no statistically significant differences between the groups regarding demographic parameters and background features including cycle parameters. The live birth rates in the ART and Surgery groups per embryo transfer were 23.7 and 26.1%, respectively (p  =  .800). The rate of cycle cancellation due to poor response and/or failed oocyte retrieval was significantly higher in the Surgery group than ART group (13.7 vs. 0%, respectively; p = .018). In conclusion, cystectomy significantly increases the risk of cycle cancellation due to poor ovarian response, which might be catastrophic individually. However, it does not seem to affect the live birth rates.IMPACT STATEMENT What is already known on this subject? Both the presence of an endometrioma or surgical removal may have deleterious effects on fertility potential. What do the results of this study add? Our results confirm that although cystectomy has no benefit on the number of oocytes collected and live birth rate, it increases the risk of cycle cancellation significantly in assisted reproductive technology cycles following endometrioma surgery. What are the implications of these findings for clinical practice and/or further research? Postponing cystectomy until a freeze-all cycle may be the best option to maximise the number of oocytes retrieved and to maximise the ovarian response