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..

Granulocyte colony-stimulating factor for intracytoplasmic sperm injection patients with repeated implantation failure: which route is best?†

The aim of this study was to assess whether the dual administration of granulocyte colony-stimulating factor (G-CSF) increases the effect of only systemic administration in patients with RIF. This retrospective study included 111 infertile normoresponder cases with two or more unsuccessful in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) treatments, despite the transfer of good quality embryos. Patients were divided into three groups according to using G-CSF and administration route; Group 1 included patients who received subcutaneous (SC) G-CSF only (n = 38), Group 2 comprised patients who received both intrauterine (IU) and SC G-CSF (n = 39), the control group included patients who did not receive G-CSF who were matched by age (n = 34). The IU route of G-CSF was employed on ovulation triggering day. G-CSF was administered via an IU insemination catheter. SC injection was started on the day of oocyte retrieval and administered for 15 days at 100,000 IU/kg. Foetal cardiac activity (clinical pregnancy) was present in 50 patients (46.2%) after embryo transfer, with 20 patients included in SC group (Group 1) (52.6%), 25 in SC + IU group (Group 2) (64.1%) and 8 (23.5%) in control group and significant difference was observed between groups (p: .001). Pregnancy resulted in live birth in 43 patients (39.8%), with 13 patients belonging in Group 1 (34.2%), 25 in Group 2 (61.5%) and 8 (23.5%) in control group; significant differences were observed between groups (p: .001). In conclusion, our results showed that dual administration of G-CSF was significantly more effective that the SC only method.Impact statement What is already known on this subject? A number of studies reported the possible benefits of granulocyte colony-stimulating factor (G-CSF) administration in recurrent implantation failure (RIF) and recurrent pregnancy loss patients; however, it is unclear which administration route is better. What do the results of this study add? Our results showed that G-CSF is a promising and safe agent for increasing live birth rates in patients with RIF. Additionally, dual administration is considered the better method than SC only administration. What are the implications of these findings for clinical practice and/or further research? Clinicians should consider a combination of IU use before ovulation triggering with SC administration starting from the day of oocyte collection for using G-CSF for the treatment of recurrent implantation failure. Additionally, our data show the need for research in the field of administration route of G-CSF for RIF. We suggest that further studies be performed in this field

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

Diet and pravastatin administration prior to in vitro fertilization treatment may improve pregnancy outcome in women with dyslipidemia

In this study, we aimed to identify whether using statins may increase the chance of pregnancy in In Vitro Fertilisation / Intra-Cytoplasmic Sperm Injection (IVF/ICSI) patients with hyperlipidaemia. Therefore, in this retrospective cohort study, 70 patients constituted the study population and all patients were managed by lipid lowering diet. Ten mg pravastatin (pravachol DEVA, Istanbul, Turkey) was added to therapy in case of resistant hypercholesterolaemia after 15 days of the diet. Fifty-one patients were treated with diet only and the remaining nineteen patients were offered both diet and pravastatin. Clinical pregnancy rate was significantly better with the patients who used pravastatin (68.4% vs. 39.2%, p = .029). Ongoing pregnancy rates were 63.2% and 33.3% with pravastatin and diet only, respectively, which were statistically significant (p:.024). According to multivariate analysis, pravastatin use was found independently and statistically significant for clinical pregnancy and ongoing pregnancy rate after IVF/ICSI in patients with dyslipidemia (HR 3.79; 95% CI 1.31–10.97; p:.014 and HR 3.18; 95% CI 1.22–8.27; p:.018). When we analysed stratified data according to the AMH levels, we noticed that as AMH levels increased, the pregnancy rates increased; the most benefit from pravastatin was in the group with AMH levels >2 ng/mL.IMPACT STATEMENT What is already known on this subject? Dyslipidemia in In IVF/ICSI patients with polycystic ovary syndrome had negative impact on pregnancy rates What the results of this study add? The findings of the study support that pravastatin may help to improve pregnancy outcome, especially in normal and high responders, regardless of whether decreased serum LDL or total cholesterol level. What the implications are of these findings for clinical practice and/or further research? As a result of our data, we speculated that it should be routine to investigate the lipid profile in every IVF/ICSI patient and should be treated accordingly, if necessary

Granulocyte colony-stimulating factor in assisted reproductive technology treatment does not increase the risk of adverse perinatal outcomes in twin pregnancies

The aim of the study is to compare the perinatal outcomes of twin pregnancies resulting from assisted reproductive technology (ART) treatment in which granulocyte colony-stimulating factor (G-CSF) was used with those in which it was not. In this retrospective study, the clinical data of 122 dichorionic diamniotic twin pregnancies were reviewed. Pregnancies were divided into two groups, G-CSF-treated and non-G-CSF treated. Maternal age, gestational week at birth, oligohydramnios, gestational hypertension, pre-eclampsia, preterm birth, first-trimester bleeding, gestational diabetes, rupture of membrane, foetal congenital anomalies, admission to the neonatal intensive care unit, birth weight (BW), small for gestational age, BW discordance, Apgar score and placental weight were compared between the groups.IMPACT STATEMENT What is already known on this subject? Granulocyte colony-stimulating factor (G-CSF) administrations increase pregnancy outcomes and do not have a negative effect on perinatal outcomes in singleton pregnancies. What the results of this study add? This study showed that the perinatal outcome of dichorionic diamniotic twin pregnancies conceived after assisted reproductive technology (ART) treatment was similar in the GSF administrated and non-GSF administrated groups. What the implications are of these findings for clinical practice and/or further research? Using G-CSF to increase the success of ART does not seem to have an adverse outcome in the dichorionic diamniotic twin pregnancies

Homocysteine levels in women with polycystic ovary syndrome treated with metformin versus rosiglitazone: a randomized study

BACKGROUND: Elevated levels of plasma homocysteine (Hcy) have been implicated as a significant risk factor for cardiovascular disease. Although long-term treatment with metformin can increase Hcy levels in patients with type II diabetes mellitus or coronary heart disease, it is becoming an increasingly accepted and widespread medication in polycystic ovary syndrome (PCOS). In the literature, only one study has demonstrated that metformin increases Hcy levels in PCOS patients, but the effect of other insulin sensitizers on Hcy levels have not been reported previously in women with PCOS. We aimed to assess the effects of metformin and rosiglitazone on plasma Hcy levels in patients with PCOS. METHODS: Thirty women were randomized to two groups: 15 women in group 1 received 850 mg of metformin twice daily for 3 months. In group 2, 15 women received 4 mg of rosiglitazone for 3 months. In both groups, body mass index, menstrual pattern, and plasma total Hcy, insulin, glucose and lipid metabolism parameters were recorded at baseline and at 3 months. RESULTS: Hcy levels increased from 8.93 6 0.49 to 11.26 6 0.86 mmol/l (P 5 0.002) and from 10.70 6 0.86 to 12.36 6 0.81 mmol/l (P 5 0.01) in the metformin and rosiglitazone groups, respectively. Apolipoprotein (Apo) A1 levels increased from 127.10 6 6.85 to 145.7 6 7.18 mg/dl (P 5 0.018) in the metformin group. Total cholesterol (total-C), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein (a) and Apo B levels decreased in the metformin group, but the change was not significant. Total-C levels decreased from 161.15 6 8.94 to 150.23 6 8.73 mg/dl (P 5 0.026), HDL-C decreased from 43.13 6 2.65 to 39.15 6 2.52 mg/dl (P 5 0.005) and LDL-C levels decreased from 93.83 6 6.06 to 80.7 6 2.30 mg/dl (P 5 0.021) in the rosiglitazone group. CONCLUSION: Treatment with insulin sensitizers in women with PCOS may lead to increases in Hcy levels

The effect of raloxifene on left ventricular hypertrophy in postmenopausal women: A prospective, randomized, and controlled study

Objective: In healthy women, there is a progressive age-related increase in myocardial mass that is not seen in their male counterparts and occurs primarily in postmenopausal women. Raloxifene is a selective estrogen receptor modulator that has estrogenic actions on bone and the cardiovascular system. The aim of this study was to investigate the effect of raloxifene on myocardial hypertrophy in postmenopausal patients. Methods: A total of 22 postmenopausal osteoporotic women were included in this open-label, randomized, prospective, controlled study. Patients were randomized into two groups: 11 of the patients (group 1) were treated with raloxifene 60 mg/day, and the other 11 patients (group 2) were defined as the control group. Quantitative 2-dimensional and M-mode echocardiographic examination was performed in all patients at the beginning and repeated at the end of the 6-month follow-up period. Left ventricle mass (LVM) and left ventricle mass index (LVMI) were calculated for all patients. Results: The mean age of the patients was 57.2 +/- 3.9 years, and baseline clinical characteristics and echocardiographic parameters were similar between the two groups. After 6 months of raloxifene treatment, there was no difference in echocardiographic parameters of LVM and LVMI compared with the control group (201.2 +/- 25.9 gr vs. 169.7 +/- 46.2 gr, p=0.14 and 120.4 +/- 25.9 gr/m(2) vs. 105.5 +/- 26.3 gr/m(2), p=0.195, respectively). There was also no significant difference in LVM and LVMI in the within-group analysis of both groups. Conclusion: Raloxifene therapy does not affect myocardial hypertrophy in postmenopausal women after 6 months of treatment

Evaluation of Polycystic Ovary Syndrome Patients with Strain Echocardiography

Objectives: Polycystic Ovary Syndrome (PCOS) is characterized by several metabolic abnormalities that may lead to insulin resistance, diabetes, and atherosclerosis which are associated with chronic inflammatory processes and oxidative stress. Due to this fact PCOS patients are at increased risk of cardiovascular diseases. We used echocardiographic quantification tools to detect subclinical changes in myocardial functions. Materials and Methods: Echocardiographic, hormonal and metabolic measurements were performed in twenty-six women with PCOS and twenty-three healthy volunteers. The age of the attendants ranged between 20 and 31 years. PCOS was diagnosed by using the Rotterdam criteria. We compared the myocardial functions of PCOS patients without any cardiovascular symptoms with healthy volunteers by using strain echocardiography. Results: No differences were found between the two groups' strain, strain rate and myocardial velocity measurements. Conclusion: According to our study PCOS patients without any clinical cardiovascular symptoms have no impairment in myocardial functions. These results should be further confirmed in larger controlled studies