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

Plasma interleukin-18 levels are increased in the polycystic ovary syndrome: relationship of carotid intima-media wall thickness and cardiovascular risk factors

Objective: To determine serum interleukin (IL)-18 levels and to find out whether IL-18 is associated with carotidintima-media wall thickness (IMT) and various cardiovascular risk factors in women with polycystic ovary syndrome(PCOS).Design: A prospective, controlled study.Setting: University hospital.Patient(s): Sixty women with PCOS and 60 healthy women were included this study.Intervention(s): Serum levels IL-18, homocysteine (Hcy), C-reactive protein (CRP), IL-6, malonyldialdehyde(MDA), lipid and hormone profiles were measured. Carotid IMT was evaluated for both common carotid arteries.Main Outcome Measure(s): Serum IL-18, carotid IMT, Hcy, CRP, IL-6,MDA, and homeostasis model assessmentof insulin resistance.Result(s): The evaluation, which was made without the obesity influence taken into consideration, revealedthat patients with PCOS have increased serum IL-18 levels than that of the control group (214 102 vs. 170 78 pg/mL). The interaction between PCOS and obesity was seen to have statistical significance (F ¼ 67.8).Body mass index (BMI), waist to-hip ratio, Hcy, and homeostasis model assessment of insulin resistance are independentdeterminants of plasma IL-18 in patients with PCOS. Elevated serum IL-18 levels were positivelyand significantly correlated with a greater carotid IMT. For Hcy and carotid IMT, the interaction betweenPCOS and obesity was found in a two-way ANOVA variation analysis (F ¼ 48.5 and F ¼ 81.5, respectively).Conclusion(s): Elevated serum IL-18 levels were associated with cardiovascular risk factors and carotid IMT inpatients with PCOS

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

Estrogen priming GnRH antagonist regimen is an efficient protocol in poor responders

International-Federation-of-Fertility-Societies 21st World Congress on Fertility and Sterility / 69th Annual Meeting of the American-Society-for-Reproductive-Medicine -- OCT 12-17, 2013 -- Boston, MAInt Federat Fertil Soc, Amer Soc Reprod Me

Ten years experience with poor responder patients fulfilling bologna criteria

70th Annual Meeting of the American-Society-for-Reproductive-Medicine -- OCT 18-22, 2014 -- Honolulu, HIAmerican Society for Reproductive Medicin

Factors associated with livebirth in couples undergoing their first in vitro fertilization cycle: An internally validated prediction model

Objective: The aim of the study is to create a new model to predict successful outcome in assisted reproductive techniques

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

Preliminary experience with salvage weekly paclitaxel in women with advanced recurrent ovarian carcinoma

Purpose of investigation: To assess the role of palliative chemotherapy with weekly paclitaxel in patients with recurrent ovarian cancer. Methods: Thirty-two patients with paclitaxel- and platinum-resistant ovarian cancer were treated with weekly paclitaxel at 80 mg/m(2) as a 1-hour intravenous infusion weekly for six weeks every eight weeks (I cycle). This schedule was considered to be given for three cycles. Evaluation of radiographically measurable disease was used in the assessment of response. CA-125 was used to classify responses only in the absence of a measurable lesion. Results: Thirty-two patients were all assessable for response. Of these, nine patients (28.1%) achieved a partial response and one patient achieved a complete response, leading to an overall response rate of 31.2%. Stable disease occurred in six patients (18.8%), and 16 patients (50%) had progressive disease. Nine patients died of progressive disease while on treatment. The median survival for the entire group was 10.5 months (range 2.5-22 months). Grade 3 or 4 leukopenia and neutropenia occurred in eight and six patients, respectively. Four of these patients developed febrile neutropenia without infection. Grade 1 and 2 peripheral neuropathies were observed in 50% of the patients without causing any premature drop out. Severe (grade 3 or 4) peripheral neuropathy was not observed. There were 11 patients with grade 1 or 2 myalgias. Conclusion: Weekly paclitaxel regimen is well tolerated with acceptable toxicity. The favorable toxicity profile and the encouraging antitumor activity observed in this study makes this regimen an option for the salvage treatment of patients with recurrent ovarian cancer