When should patients abandon treatment?

Couples with RIF need counseling regarding when they should abandon IVF cycles and be offered alternative treatment options such as gamete donation or surrogacy. Although there are no epidemiological data on cumulative success rates following various treatments in RIF patients, a rational approach based on current literature is presented. Patients below 40 years of age, after correction of the RIF-related condition may extend the number of subsequent cycles up to nine. Patients aged 40–42 years may benefit from six further cycles, which should be performed in a short period, avoiding a significant delay that has aging-related negative effects on both pregnancy rates and pregnancy outcome. Patients older than 42 years have very low live-birth rates per cycle and should be counseled that less than five cycles should be further offered without delaying entering an oocyte-donation program. © 2020 by Taylor & Francis Group, LLC

Monitoring COS and HRT cycles

The aim of monitoring the COS during an IVF/ICSI cycle is the retrieval of an adequate number of oocytes and timing the triggering for final oocyte maturation. Ultrasound scanning of the number and size of follicles is the main monitoring method, while measurement of serum estradiol levels together with ultrasonography does not seem to add any benefits. In HRT cycles, the endometrium is prepared for frozen-thawed embryo transfer with the administration of estradiol and progesterone. During the administration of estradiol, the endometrial thickness is assessed by transvaginal ultrasound. This measurement determines the onset of progesterone treatment and finally the time of frozen-thawed embryo transfer. © 2018 Elsevier Inc

Ovarian stimulation protocols

Ovarian stimulation for in vitro fertilization treatment of infertility, aiming to the production of many oocytes to increase the possibility of pregnancy, may be performed with conventional and novel protocols. The conventional protocols include the gonadotrophin-releasing hormone (GnRH) agonist and GnRH antagonist protocols, which have similar efficacy in terms of live birth rate, but the antagonists are safer with lower risk of ovarian hyperstimulation syndrome. Generally, the types of gonadotropins have shown rather comparable results. The novel protocols, the random-start and the double stimulation protocols, have been developed to facilitate fertility preservation for oncological patients and to increase the oocyte yield in poor responders. © 2023 Elsevier Inc. All rights reserved

Suggested Method for the Management of Heterotopic Cervical Pregnancy Leading to Term Delivery of the Intrauterine Pregnancy: Case Report and Literature Review

This is a case report and literature review regarding early diagnosis and management of a cervical heterotopic pregnancy. A 41-year-old gravida 2 para 0 with premature ovarian failure was treated successfully in an invitro fertilization program with donor oocytes. A transvaginal ultrasound scan revealed the presence of a heterotopic pregnancy, with an intrauterine embryo and an intracervical embryo. Both embryos had positive heartbeats. Aspiration of the cervical pregnancy was followed by Foley catheter placement and cervical cerclage suturing. Monitoring of the patient resulted in elective uncomplicated cesarean section delivery at 38 weeks following an uneventful pregnancy. Given the lack of guidelines for the management of heterotopic cervical pregnancy, we reviewed the literature suggesting the most effective method. The value of early diagnosis andmanagement is concluded from the literature, in support of our management principles. © 2015 AAGL

Smoking and AMH levels in women with normal reproductive history

To investigate the effect of age and smoking on the AMH levels in normal cycling healthy women with normal reproductive history. In 137 women, blood samples were taken on day 3 of a spontaneous cycle. Serum FSH, LH, E2, progesterone and AMH were measured in all blood samples. For the statistical analysis of the data, t test, Pearson's correlation and linear regression analysis were performed. Of 137 women (43%), 59 were smokers. Age was positively correlated with serum FSH and LH levels (r = 0.584, P < 0.001 and r = 0.330, P < 0.001, respectively) and negatively correlated with serum AMH levels (r = -0.882, P < 0.001). There were no significant differences in FSH, LH, E2, progesterone and AMH levels between smokers and non-smokers. Multiple stepwise linear regression analysis showed that in both smokers and non-smokers, age was the most significant determinant of AMH levels (r = -0.889, P < 0.001 and r = -0.944, P < 0.001, respectively), while smoking was not related to AMH levels. Aging significantly decreases AMH levels in women with normal cycles and normal reproductive history, while smoking does not seem to have significant effects on AMH levels

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-β, 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. ©2015 Bentham Science Publishers

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

Complications of polycystic ovary syndrome in assisted reproduction technology

[No abstract available