The impact of endometriosis on fertility

Although the prevalence of endometriosis in infertile women seemed to be nearly 50%, all women with endometriosis are not infertile..

The impact of sweeping the membranes on cervical length and labor: a randomized clinical trial

Objectives: The aim of the study was to investigate to what extent sweeping of the membranes contributes to cervical shortening and if cervical shortening is related to the time to onset of labor and duration of the active phase of labor. Methods: This prospective randomized clinical trial was performed at Baskent University between February and March 2011. Women were randomly assigned to receive membrane sweeping (Sweeping Group) (n=69) or no membrane sweeping (Control Group) (n=71). Cervical length was measured (cervix1) in both groups by examiner 1 and the Bishop Score was determined in the control group and sweeping was performed in the sweeping group by examiner 2. Two days later the patients had another cervical length measurement (cervix 2) by examiner 1, blinded to the group and results of the examiner 2. t test, Mann-Whitney U test and Chi-square test were used for statistical analyses. Results: Cervix 1 was 27.4}8.4 mm and 29.6}8.9 mm (p= 0.14), cervix 2 was 23.3}8.8 mm and 23.8}8.5mm (p= 0.28) and cervical shortening was 5}4 mm and 5}4mm (p= 0.446), time to onset of labor was 6.3}4.6 and 5.7}4.1 (p= 0.38) and duration of labor was 5.8} 2.89 and 5.7} 2.4 (p= 0.82) for the sweeping and the control groups, respectively. Conclusions: Sweeping of the membranes does not reduce cervical length and does not shorten time to onset of labor and duration of the active phase of labor. NCT01309308: Sweeping the Membranes, Cervical Length and Duration of Labor

A novel approach for congenital absence of the uterine cervix: Office hysteroscopic versapoint canalization using real-time trans-abdominal sonography guidance

Herein, we report a novel technique for cervical agenesis via office hysteroscopy using Versapoint using real-time trans-abdominal sonography guidance. Fourteen days after the canalization procedure, a second hysteroscopy was performed to remove the silicone catheter and insert a Cupper T380a intrauterine device, which aimed to prevent a neocervical canal occlusion. This is the first case report of a patient with congenital cervical agenesis undergoing canalization with Versapoint in an office hysteroscopy; laparoscopy was not performed for assistance

Przegląd chorób układu krążenia w ciąży

Abstract With recent advances in prenatal care, the incidence of direct causes of maternal death has declined and indirect causes have gained significant importance. Thromboembolism, hypertension and cardiovascular diseases are the most common indirect causes of maternal death. Acute myocardial infarction, stroke, venous thromboembolism, peripartum cardiomyopathy, aortic dissection and amniotic fluid emboli are responsible for the majority of the maternal deaths from cardiovascular causes. The issue of pregnancy of heart transplant – and Turner syndrome – patients requires extensive research. Obstetricians should possess good knowledge of cardiovascular complications of pregnancy because a high index of suspicion and early diagnosis, together with timely and appropriate interventions may save the life of the fetus and the mother.Streszczenie W związku z rozwojem medycyny, częstość występowania bezpośrednich przyczyn zgonów matek, np. krwotoków, znacząco się zmniejszyła. Jednak obserwuje się wzrost śmiertelności matek spowodowanych innymi, niebezpośrednimi przyczynami takimi jak: choroba zakrzepowo-zatorowa, nadciśnienie indukowane ciążą oraz choroby układu sercowo-naczyniowego. Zawał mięśnia sercowego, udar mózgu, zakrzepica żylna, kardiomiopatia okołoporodowa, tętniak rozwarstwiający aorty oraz zator płynem owodniowym są odpowiedzialne za większość przypadków śmiertelności matczynej wywołanej chorobami układu sercowo-naczyniowego. Na szczególną uwagę zasługują coraz częściej pojawiające się pacjentki po transplantacji serca oraz ciężarne z zespołem Turnera. Położnicy powinni posiadać rozległą wiedzę dotyczącą chorób układu krążenia i możliwych ich powikłań podczas ciąży, ponieważ wczesna diagnoza oraz właściwa interwencja mogą uratować życie płodu i matki

A novel approach using a minimal number of injections during the IVF/ICSI cycle: Luteal half-dose depot GnRH agonist following corifollitropin alfa versus the corifollitropin alfa with a GnRH-antagonist cycle

Objective: Corifollitropin alfa is a good choice for assisted reproductive technology (ART) cycles because fewer injections are needed than with other agents. In this retrospective cohort, we analyzed luteal injected half-dose depot gonadotropin hormone-releasing hormone (GnRH) agonist cycles in women who received corifollitropin alfa and those who underwent a conventional corifollitropin alfa cycle with a GnRH antagonist. Material and Methods: In this retrospective cohort, we analyzed luteal injected half-dose depot GnRH agonist cycles in women who received corifollitropin alfa and those who underwent a conventional corifollitropin alfa cycle with a GnRH antagonist at the Division of Reproductive Endocrinology and IVF Unit, Obstetrics and Gynecology Department, Baskent University School of Medicine, Adana, Turkey, from March 2014 to August 2015. The patient's baseline characteristics were similar between the two groups. Forty-five patients underwent the long protocol, in which a half-dose of depot GnRH agonist was administered on day 21 of the preceding cycle. Forty-nine patients underwent the GnRH-antagonist protocol. Corifollitropin alfa was administered on the menstrual cycle day 3. Results: The mean ages of the two groups were similar (32.77+/-5.55 vs. 34.2+/-4.51 years ["for the long-and antagonist-protocol groups, respectively"]). The total number of retrieved oocytes, the fertilization rate, and the number of transferred embryos were similar between the two groups. The only significant difference between the two protocols was the number of injections during the controlled ovarian stimulation (COH) cycle, which included the depot-agonist injection in the long-protocol group (4.46+/-1.64 vs. 5.71+/-2.51, p=0.006). The clinical pregnancy and implantation rates were similar in the two protocols (16/45 [35.6%] vs. 16/49 [32.7%] for the intention to treat and 32.5+/-6.82% vs. 36.25+/-8.58%, respectively). Conclusion: Our results show that ART cycles could be performed with fewer injections using corifollitropin alfa and a half-dose of depot GnRH agonist

The combination of dehydroepiandrosterone, transdermal testosterone, and growth hormone as an adjuvant therapy in assisted reproductive technology cycles in patients aged below 40 years with diminished ovarian reserve

Objective: To evaluate to the efficacy of testosterone, dehydroepiandrosterone (DHEA) and growth hormone (GH) supplementations in patients with diminished ovarian reserve (DOR) in assisted reproductive technology (ART) cycles. Materials and Methods: A retrospective cohort including 33 women with 81 ART cycles were aged and ovarian reserve matched 52 women with 102 conventional in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) protocol. Administration of DHEA for 12 weeks and transdermal testosterone for 4 weeks as pretreatment adjuvant and luteal start GH in DOR patient treatment arm compared to conventional IVF/ICSI cycles. Results: The number of follicles > 14 mm, number of oocytes, number of metaphase 2 oocytes and fertilisation rate were significantly higher in ISIK protocol (IP). The clinical pregnancy rate (CPR) per embryo transfer of the IP was 38.2% (13/34). The cancellation rate of cycles decreased significantly from 54.5 % (24/44) to 8.1% (3/37) with the IP, while the OPR was 35.3% (12/34). Conclusions: Our study has shown that even the poorest responders could achieve clinical pregnancy after inducing ovarian folliculogenesis with a combination of transdermal testosterone, DHEA

The impact of sweeping the membranes on cervical length and labor: a randomize clinical trial

Objectives: The aim of the study was to investigate to what extent sweeping of the membranes contributes to cervical shortening and if cervical shortening is related to the time to onset of labor and duration of the active phase of labor. Methods: This prospective randomized clinical trial was performed at Baskent University between February and March 2011. Women were randomly assigned to receive membrane sweeping (Sweeping Group) (n=69) or no membrane sweeping (Control Group) (n=71). Cervical length was measured (cervix 1) in both groups by examiner 1 and the Bishap Score was determined in the control group and sweeping was performed in the sweeping group by examiner 2. Two days later the patients had another cervical length measurement (cervix 2) by examiner 1, blinded to the group and results of the examiner 2. t test, Mann-Whitney U test and Chi-square test were used for statistical analyses. Results: Cervix 1 was 27.4 +/- 8.4 mm and 29.6 +/- 8.9 mm (p = 0.14), cervix 2 was 23.3 +/- 8.8 mm and 23.8 +/- 8.5mm (p = 0.28) and cervical shortening was 5 +/- 4 mm and 5 +/- 4mm (p = 0.446), time to onset of labor was 6.3 +/- 4.6 and 5.7 +/- 4.1 (p = 0.38) and duration of labor was 5.8 +/- 2.89 and 5.7 +/- 2.4 (p = 0.82) for the sweeping and the control groups, respectively. Conclusions: Sweeping of the membranes does not reduce cervical length and does not shorten time to onset of labor and duration of the active phase of labor

The Importance of CD56 and CD98 Levels in Patients with Recurrent Implantation Failure

Aim: Despite major advances in assisted reproductive techniques, clinical pregnancy rates remain around 31% with fresh embryo transfer and around 41% with oocyte donations. We also know that the implantation process itself and the window period defined as the "implantation phase'' are significantly important for successful in-vitro fertilization (IVF) cycles. With this study we have tried to determine any differences in immunohistochemical staining for CD56 and CD98 within the implantation phase endometrium of patients with recurrent implantation failure and of a control group that eventually had a successful IVF cycle. Material and Method: This study was retrospectively performed on a total of 36 patients selected out of a database of 6260 patients who received their IVF cycles from 2004 to 2010. Patients were defined as implantation failure if they did not have a positive result for b-HCG testing following at least 3 IVF cycles with a total of at least 8 embryo transfers. The control group was formed with patients who had success (positive b-HCG testing) on their first IVF treatment. Results: Comparison of means for CD 56 staining percentages, CD 98 staining percentages, CD 98 staining power, and CD 98 staining score showed significant difference between the control group and the study group (p<.001). The endometrium of patients without recurrent implantation failure is significantly more stainable by CD 98 than that of patients with recurrent implantation failure. Discussion: We suggest that CD 56 and CD 98 staining for endometrium tissue can be a part of diagnostic testing for patients who are candidates for IVF treatments. We need further studies to determine the correlation between the overall chance for pregnancy and these types of immunohistochemical staining for patients receiving IVF treatment

Outcome of intracytoplasmic sperm injection after preinstillation of a gonadotropin releasing hormone agonist in the uterine cavity just before embryo transfer

Objective: To evaluate the effects of a gonadotropin releasing hormone agonist (GnRHa) injection prior to embryo transfer on implantation and pregnancy rate. Materials and Methods: We performed a retrospective analysis of patients undergoing in vitro fertilization (IVF) therapy with and without GnRHa preinstallation into the uterine cavity just before embryo transfer between January 2012 and March 2013 in a single IVF center of a university hospital. Patients were evaluated based upon implantation, pregnancy, live birth, and miscarriage rates. Results: GnRHa was injected into the uterine cavity of 108 patients prior to embryo transfer which were regarded as study group. One thousand forty-seven patients who were not injected GnRHa were regarded as the control group. Pregnancy rates were 44.4% and 41.7% in the GnRHa and control groups, respectively. Live birth rates were 27.8% and 26.1%, miscarriage rates were 15.7% and 15.7%, and implantation rates were 31% and 30%, respectively and there were no difference between groups statistically (p>0.05). Conclusion: No statistically significant differences in implantation, pregnancy, live birth, or miscarriage rates were observed in patients treated with GnRHa prior to embryo transfer, relative to the controls. Therefore, GnRHa injection into the uterine cavity prior to embryo transfer is not recommended as a means of increasing implantation or pregnancy rates in IVF. However, prospective randomized controlled studies are needed to clarify the effect of GnRHa instillation in the uterine cavity for embryo implantation in IVF

Effect of cervical mucus aspiration before intrauterine insemination

Abstract Objective: To determine whether cervical mucus aspiration before intrauterine insemination (IUI) has any effect on clinical pregnancy rates. Method: The outcomes of 186 IUI cycles in 95 consecutive patients in whom mucus was aspired prior to IUI were compared retrospectively with those of 1057 IUI cycles in 505 women. Results: The pregnancy rate was 15.1% (28 pregnancies for 186 cycles) in the cervical mucus aspiration group and 9.9% (105 pregnancies for 1057 cycles) in the control group (P = 0.05). Mucus aspiration led to significantly increased pregnancy rates for women with unexplained infertility (24% in the aspiration group vs 9.5% in the control group; P = 0.04). Conclusion: Cervical mucus aspiration before IUI might improve clinical pregnancy rates by yet-to-be-defined mechanisms