How to deal hyperresponders in ICSI? Coasting versus non-coasting.

Conjoint Annual Meeting of the American-Society-for-Reproductive-Medicine/Canadian-Fertility-and-Andrology-Society -- OCT 15-19, 2005 -- Montreal, CANADAWOS: 000232114601097Amer Soc Reprod Med, Canadian Fertil & Androl So

Outcome of intracytoplasmic sperm injection in patients with polycystic ovary syndrome or isolated polycystic ovaries

Objective: To determine the intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) performance of patients with polycystic ovary syndrome (PCOS) and isolated polycystic ovarian (PCO) morphology. Design: Case-control study. Setting: IVF Center, Hacettepe University Faculty of Medicine. Patient(s): Ninety-nine consecutive infertile women (n = 109 cycles) with PCOS and 58 patients (n = 58 cycles) with isolated PCO morphology were recruited. The control group consisted of 210 patients (n = 232 cycles) with isolated male factor infertility necessitating ICSI. All three groups were matched for female age and body mass index. Intervention(s): Controlled ovarian hyperstimulation and ICSI. Main Outcome Measure(s): Oocyte number, fertilization rate, embryo quality, clinical pregnancy rate, implantation rate, and ovarian hyperstimulation syndrome (OHSS). Result(s): Six (5.5%) cycles in the PCOS group, 6 (10.3%) cycles in the PCO-only group, and 10 cycles (4.3%) in the control group were canceled. Despite a significantly lower total FSH dose used, a significantly higher serum E2 level was attained in both the PCOS and the PCO-only groups compared to the control group. The PCOS and PCO-only groups had significantly higher numbers of retrieved oocyte-cumulus complexes and metaphase II oocytes compared to the control group. The fertilization rates did not differ among the three groups. The mean number of embryos transferred was comparable among the three groups; however, the mean number of grade 1 embryos was significantly higher in the PCOS and PCO-only groups compared to the controls. The clinical pregnancy rates per ET of both the PCOS (66%) and the PCO-only (60%) groups were significantly higher than that of the control group (44%). However, the implantation rates were comparable among the three groups. Four cycles (3.7%) in the PCOS group had OHSS necessitating hospitalization. The respective figures in the PCO-only and the control groups were 1 (1.7%) and 3 (1.3%). Conclusion(s): Patients with the full-blown picture of PCOS or isolated PCO-only morphology behave exactly in the same manner during all stages of assisted reproduction. Owing to the availability of more fertilized oocytes and grade 1 embryos, patients with PCOS or PCO-only morphology are associated with higher clinical pregnancy rates per ET compared to patients with isolated male factor infertility. ©2005 by American Society for Reproductive Medicine

Outcome of in vitro fertilization/intracytoplasmic sperm injection after laparoscopic cystectomy for endometriomas

Objective: To assess the impact of prior unilateral or bilateral endometrioma cystectomy on controlled ovarian hyperstimulation (COH) and intracytoplasmic sperm injection (ICSI) outcome. Design: Retrospective case-control study. Setting: Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Ankara, Turkey. Patient(s): Fifty-seven consecutive infertile patients were enrolled who had previously undergone unilateral (n = 34) or bilateral (n = 23) laparoscopic cystectomy for endometriomas more than 3 cm in diameter and underwent ICSI. The control group consisted of 99 patients with tubal factor infertility. Intervention(s): Controlled ovarian hyperstimulation and ICSI. Main Outcome Measure(s): Cycle cancellation rate, number of oocytes, fertilization rate, embryo quality, clinical pregnancy rate (PR), and implantation rate. Result(s): The mean number of oocytes, metaphase II oocytes, and two-pronucleated oocytes were significantly lower in the bilateral cystectomy group compared to the unilateral cystectomy and control groups. However, all other parameters, including fertilization rate, the mean number of embryos transferred, the mean number of grade 1 embryos transferred, the clinical PR per embryo transfer, and implantation rate, were comparable among the three groups. Within the unilateral cystectomy group, the mean number of oocyte retrieved from the operated site was significantly less than in the contralateral nonoperated site. Conclusion(s): Laparoscopic endometrioma cystectomy does reduce the ovarian reserve. However, diminished ovarian reserve does not translate into impaired pregnancy outcome. © 2006 American Society for Reproductive Medicine

Hysteroscopic resection of minimal subseptum may have detrimental effect on ICSI-ET outcome.

Conjoint Annual Meeting of the American-Society-for-Reproductive-Medicine/Canadian-Fertility-and-Andrology-Society -- OCT 15-19, 2005 -- Montreal, CANADAWOS: 000232114601595Amer Soc Reprod Med, Canadian Fertil & Androl So

The retention of the embryos in the embryo transfer catheter does not affect ICSI-ET outcome.

Conjoint Annual Meeting of the American-Society-for-Reproductive-Medicine/Canadian-Fertility-and-Andrology-Society -- OCT 15-19, 2005 -- Montreal, CANADAWOS: 000232114601301Amer Soc Reprod Med, Canadian Fertil & Androl So

Ovarian adenomyoma following gonadotrophin treatment for infertility

An ovarian adenomyoma developed in a 38-year-old infertile patient following treatment with exogenous gonadotrophins. Laparoscopic excision was performed. Histological examination showed thick muscular bundles resembling myometrium lined with endometrial glands and stroma. Gonadotrophins might be involved in the pathogenesis of extrauterine adenomyoma

ICSI outcome of patients with severe oligospermia vs non-obstructive azoospermia

Objective: To compare the results of intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) cycles in men with severe oligoospermia and non-obstructive azoospermia. Materials and Methods: This study included 91 ICSI cycles performed due to male factor infertility. Patients are divided into two groups according to source of spermatozoa. Group 1 consisted of 38 cycles in which sperm was obtained from testicles (cases with non-obstructive azoospermia). In Group 2, 53 consecutive cycles were included in which ejaculated sperm was available for ICSI in spite of severe oligospermia (< 100,000/ml). Fertilization, embryo quality and clinical pregnancy rates were compared between the groups. Results: Although, the female age and mean number of oocytes retrieved were similar among the two groups, fertilization rate was significantly lower in the non-obstructive azoospermia (34.6%) group compared to group in which patients underwent ICSI with ejaculate spermatozoa (55.3%) (p < 0.05). However, there were no differences regarding mean number of available grade 1 embryos on day 3 and pregnancy rate between the two groups. Conclusion: Testicular sperm from non-obstructive azoospermia patients had significantly lower fertilization rates than the ejaculated spermatozoa from severe oligospermia patients in ICSI cycles. However, it did not bring about improved pregnancy rate

ICSI cycle outcomes in oligozoospermia

Aim: The aim of this study was to evaluate the sole effect of sperm concentration on fertilization, embryo quality and pregnancy rates in patients undergoing ICSI cycles. Materials and Methods: 560 ICSI cycles performed for male factor infertility were divided into four groups according to sperm concentration retrospectively. Group 1 consisted of 86 couples whose sperm concentration was less than 1 × 106, group 2 consisted of 169 couples whose sperm concentration ranged between 1 × 106 and 5 × 106, group 3 consisted of 95 couples whose sperm concentration ranged between 5 × 106 and 10 × 10 6 and group 4 consisted of 210 couples whose sperm concentration ranged between 10 × 106 and 20 × 106. Results: Fertilization rate was significantly lower in the first three groups compared to the last group (p &lt; 0.05). The first three groups were comparable with each other. There were no differences according to ovarian response to stimulation, embryo quality and clinical pregnancy rates between the four groups. Conclusion: Lower sperm concentration has detrimental effects on the outcomes of ICSI cycles. This situation is more evident in men with severe and extremely severe oligozoospermia