Luteal-phase endocrinology

The corpus luteum is formed from the pre-ovulatory follicle under the action of the mid-cycle LH surge. LH is the main luteotrophic hormone in women controlling luteal structure and function during the normal menstrual cycle. Local factors, however, including progesterone are also involved. If conception does not take place, luteolysis occurs as a physiological apoptotic process. Human chorionic gonadotrophin, secreted after implantation, is able to rescue the corpus luteum and extend its lifespan. In ovulation-induction cycles, the negative feedback effect of the ovarian steroids on the pituitary is markedly potentiated, leading to the suppression of endogenous LH secretion during the whole menstrual cycle. The marked suppression of LH secretion disrupts corpus luteum function regardless of the treatment regimen

Genes and Conditions Controlling Mammalian Pre- and Post-implantation Embryo Development

Embryo quality during the in vitro developmental period is of great clinical importance. Experimental genetic studies during this period have demonstrated the association between specific gene expression profiles and the production of healthy blastocysts. Although the quality of the oocyte may play a major role in embryo development, it has been well established that the post -fertilization period also has an important and crucial role in the determination of blastocyst quality. A variety of genes (such as OCT, SOX2, NANOG) and their related signaling pathways as well as transcription molecules (such as TGF-beta, BMP) have been implicated in the pre-and post-implantation period. Furthermore, DNA methylation has been lately characterized as an epigenetic mark since it is one of the most important processes involved in the maintenance of genome stability. Physiological embryo development appears to depend upon the correct DNA methylation pattern. Due to the fact that soon after fertilization the zygote undergoes several morphogenetic and developmental events including activation of embryonic genome through the transition of the maternal genome, a diverse gene expression pattern may lead to clinically important conditions, such as apoptosis or the production of a chromosomically abnormal embryo. The present review focused on genes and their role during pre-implantation embryo development, giving emphasis on the various parameters that may alter gene expression or DNA methylation patterns. The pre-implantation embryos derived from in vitro culture systems (in vitro fertilization) and the possible effects on gene expression after the prolonged culture conditions are also discussed

Comparative study of the intravenous chemoprophylaxix versus local Sulmycin (R) Implant E Sponge use in vaginal hysterectomy

Objective: The aim of this comparative study was to ascertain the efficacy of the Sulmycin (R) Implant E, an antiseptic sponge, on the incidence of peri-and postoperative morbidity in patients subjected to vaginal hysterectomy. Material and methods: This eleven-year study included 228 patients undergoing vaginal hysterectomy. The patients were divided into two groups. Group A included 169 participants with benign diseases (fibroids, dysfunctional uterine bleeding and prolapse) and group B included 59 patients with early stage endometrial cancer or atypical hyperplasia. Women of both groups were further divided into three subgroups: (a) receiving a single dose of intravenous cefuroxime (2 gr) (group A: 55, group B: 19), (b) receiving three doses of intravenous cefuroxime (2 gr) (group A: 54, group B: 19), and (c) locally placed a collagen sponge containing gentamycin (Sulmycin (R) Implant E) (group A: 60, group B: 21). Results: The number of postoperative infections (mainly urinary tract infections) did not differ between women of the three subgroups of patients in both groups. There were no important differences affecting the postoperative hospitalization, healing procedure and adhesion of the cuff between women of the three subgroups in both groups. Conclusion: The local chemoprophylaxis with Sulmycin (R) Implant E, a collagen sponge containing gentamycin and placed on the vaginal cuff, is well tolerated and equally effective as intravenous antibiotics

Effect of the Position of the Polar Body During ICSI on Fertilization Rate and Embryo Development

This prospective study was designed to evaluate and clarify further whether the position of the polar body (PB) in relation to injection site during intracytoplasmatic sperm injection (ICSI) has an impact on fertilization and developmental rates and consequently clinical pregnancy outcome. The study included 264 patients undergoing 306 ICSI cycles from September 2007 to January 2009 performed by the same practitioner. Of all oocytes retrieved, 1736 were in metaphase II (MII). From every woman reaching ovum pick up, all MII-collected oocytes were allocated to 1 of the 4 groups according to PB orientation. In group A, MII oocytes were injected with the PB at 6 o'clock, group B with the PB at 7 o'clock, group C with the PB at 11 o'clock, and a group D with the PB at 12 o'clock. A significantly higher proportion of fertilized oocytes were produced from oocytes that had been injected with the PB at 11 o'clock (79.2%) as compared to those at 6 o'clock (70.5%), 7 o'clock (64.4%), and 12 o'clock (68.8%). Furthermore, embryos derived from oocytes that were injected with the PB at 11 o'clock appeared to be of higher quality score than those of the other groups of oocytes. A higher clinical pregnancy rate (28.7%) was obtained after the transfer of embryos from oocytes that had been injected with the PB at 11 o'clock. Given the higher fertilization, developmental, and pregnancy rate in the 11 o'clock group, it is suggested that this may be the preferred position of the PB at ICSI

Corifollitropin alfa compared with follitropin beta in GnRH-antagonist ovarian stimulation protocols in an unselected population undergoing IVF/ICSI

Recombinant DNA technologies have produced Corifollitropin alfa (CFa) used during IVF/ICSI in order to keep the circulating FSH levels above the threshold necessary to support multi-follicular growth for a week. In this prospective case-control study, we compared 70 participants treated with 150 μg CFa combined with 150 IU of follitropin beta (study group) with 70 subfertile participants with matching baseline characteristics, conforming with the same inclusion criteria and treated with an antagonist protocol using follitropin beta (control group). Live birth was the primary outcome, while secondary outcome measures were IVF/ICSI cycles characteristics, including adverse events and complications. Live birth was determined in reduced rates in the study compared to the control group, reaching statistical significance [6/70 versus 20/70, p = 0.002], as also in the respective number of clinical pregnancies [9/70 versus 23/70, p = 0.005], although the incidence of miscarriage was similar for both groups [6/70 versus 5/70, p > 0.99]. Most of the secondary parameters examined were similar between groups. Logistic regression revealed that protocol and AFC had a direct impact on live birth. Ovarian stimulation with CFa does not seem to constitute an equally effective method as compared with follitropin beta to be offered in a general subfertile population seeking IVF/ICSI treatments. © 2017 Informa UK Limited, trading as Taylor & Francis Group

Mild versus conventional ovarian stimulation for poor responders undergoing IVF/ICSI

Background/Aim: Mild stimulation protocols have been implemented to be offered to subfertile patients who respond poorly to ovarian stimulation. We aimed to compare the efficacy of mild versus conventional gonadotropin-releasing hormone (GnRH)-Agonist and antagonist protocols in poor responders undergoing in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) cycles. Patients and Methods: A total of 58 poorlyresponding patients were divided into two groups: mild group (n=33), receiving clomiphene citrate 100 mg and 0.25 mg of cetrorelix with 150 IU of gonadotrophins daily; conventional group (n=25), undergoing the long GnRHagonist or-Antagonist protocols. The primary outcome was the number of cumulus oocyte complexes (COCs) retrieved. Results: A lower number of COCs [median (range)=1 (0-4) vs. 3 (0-8.4), p<0.001] was retrieved in the mild stimulation compared to the conventional group. Secondary outcomes favored the conventional group, whereas live birth (9.1% vs. 12%), clinical pregnancy (12.1% vs. 20%) and miscarriage rate (40% vs. 40%) were similar in the two groups. Conclusion: Mild ovarian stimulation is inferior to conventional regimes when applied to poor responders undergoing IVF/ICSI, in terms of the numbers of retrieved COCs

Mild versus conventional ovarian stimulation for poor responders undergoing IVF/ICSI

Background/Aim: Mild stimulation protocols have been implemented to be offered to subfertile patients who respond poorly to ovarian stimulation. We aimed to compare the efficacy of mild versus conventional gonadotropin-releasing hormone (GnRH)-Agonist and antagonist protocols in poor responders undergoing in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) cycles. Patients and Methods: A total of 58 poorlyresponding patients were divided into two groups: mild group (n=33), receiving clomiphene citrate 100 mg and 0.25 mg of cetrorelix with 150 IU of gonadotrophins daily; conventional group (n=25), undergoing the long GnRHagonist or-Antagonist protocols. The primary outcome was the number of cumulus oocyte complexes (COCs) retrieved. Results: A lower number of COCs [median (range)=1 (0-4) vs. 3 (0-8.4), p&lt;0.001] was retrieved in the mild stimulation compared to the conventional group. Secondary outcomes favored the conventional group, whereas live birth (9.1% vs. 12%), clinical pregnancy (12.1% vs. 20%) and miscarriage rate (40% vs. 40%) were similar in the two groups. Conclusion: Mild ovarian stimulation is inferior to conventional regimes when applied to poor responders undergoing IVF/ICSI, in terms of the numbers of retrieved COCs

The BMI of men and not sperm parameters impact on embryo quality and the IVF outcome

It has been reported that increased body mass index (BMI) of men influences fecundity but it is not clear if it impacts on sperm parameters. Whether or not BMI of men influence sperm parameters and subsequently in vitro fertilization (IVF) result remains to be clarified. The aim of the present study was primarily to investigate the relationship between the BMI of men and sperm parameters (volume, concentration and motility) and whether or not it impacts on embryo quality and IVF outcome. Secondly, to investigate the impact of BMI of both men and women, in combination with their age, on IVF result. Three hundred and one couples were categorized according to their BMI. Group 1 (n = 64, both men and women had BMI l 25 kg/m(2)), group 3 (n = 142, men had BMI > 25 kg/m(2) and their wives had BMI 25 kg/m(2)). Overall (n = 301) BMI and age of men did not correlate with sperm parameters. Group 1 and group 4, regardless of the BMI of their women, demonstrated the highest quality of embryos and consequently the highest percentage of pregnancy. Furthermore, the score of the combination of both BMI and age of both men and women resulted in a threshold level of less than 800 with a relative high per cent of pregnancy. BMI of men does not correlate with sperm parameters, but influences the quality of produced embryos in such a way that impacts on pregnancy rate