Does Male Factor Infertility Affect Intracytoplasmic Sperm Injection Pregnancy Results?

Objective: Male infertility has conflicting results in assisted reproductive technology (ART). In this study we aimed to investigate whether male factor infertility affect intracytoplasmic sperm injection (ICSI) outcomes and pregnancy results in ICSI cycles. Materials and Methods: A total of 1118 ICSI cycles from January 2007 through November 2014 were analyzed retrospectively:596 patients that were treated for male factor infertility, and 522 patients for tubal or unexplained infertility were included in the study. It was investigated whether sperm count has any effect on fertilization and implantation rates. Also the results of embryo quality and pregnancy were compared with the groups. Results: In both groups there was no difference between the numbers of collected oocytes and mature oocytes. Although there was a higher fertilization rate in the control group, no significant difference was spotted between fertilization failure and embryo developmental arrest in groups (P = 0.07 vs P = 0.4, respectively). Between groups, there were no statistically significant differences according to the clinical pregnancy rate per transfer and live birth rates (P = 0.3 vs P = 0.5, respectively). The risk of preterm birth in the infertile male group was significantly higher (P < 0.007). When the patients whom sperm was obtained with surgery were compared with oligozoospermic patients with ejaculated sperm, no significant difference between the implantation rates and clinical pregnancy rates was found (P = 0.1 vs P = 0.3, respectively). Conclusion: The patients who underwent ICSI due to male factor and tubal-unexplained infertility showed no difference according to fertilization, implantation and clinical pregnancy rates. The good quality of sperm retrieved from surgery indicated positive effects on the clinical results

A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls

STUDY QUESTION Is there any difference in the clinical performance of the 3-year one-rod etonogestrel (ENG)- and the 5-year two-rod levonorgestrel (LNG)-releasing contraceptive implants during 3 years of insertion, and between implant and intrauterine device (IUD) contraception, in particular complaints possibly related to hormonal contraceptives? SUMMARY ANSWER The cumulative contraceptive effectiveness after 3 years and method continuation through 2.5 years were not significantly different between ENG and LNG implants, but both outcomes were significantly worse in the non-randomized age-matched group of IUD users than in the combined implant group. WHAT IS KNOWN ALREADY ENG- and LNG-releasing implants are safe and highly efficacious contraceptives with pregnancy rates reported to be 0.0-0.5 per 100 women-years (W-Y). No head-to-head comparative study of the two implants has been undertaken, and little information is available on comparisons of complaints of side effects of implant and copper IUD users. STUDY DESIGN, SIZE, DURATION This was an open parallel group RCT with 1:1 allocation ratio of the ENG and the LNG implants with non-randomized control group of women choosing TCu380A IUD to address lack of reliable data on common side effects typically attributed to the use of progestogen-only contraceptives. After device(s) placement, follow-ups were at 2 weeks, 3 and 6 months, and semi-annually thereafter for 3 years or until pregnancy, removal or expulsion of the implant/IUD occurred. PARTICIPANTS, SETTING, METHODS The study took place in family planning clinics in Brazil, Chile, Dominican Republic, Hungary, Thailand, Turkey and Zimbabwe. Women seeking long-term contraception were enlisted after an eligibility check and informed consent, and 2982 women were enrolled: 1003, 1005 and 974 in the ENG-implant, LNG-implant and IUD groups, respectively; 995, 997 and 971, respectively, were included in the per protocol analysis reported here. MAIN RESULTS AND THE ROLE OF CHANCE ENG and LNG implants each had the same 3-year cumulative pregnancy rate of 0.4 per 100 W-Y [95% confidence interval (CI) 0.1-1.4]. A weight of ≥70 kg at admission was unrelated to pregnancy. Method continuation rates for ENG and LNG implants at 2.5 years were 69.8 (95% CI 66.8-72.6) and 71.8 per 100 W-Y (68.8-74.5), and at 3 years 12.1 (95% CI 5.2-22.0) and 52.0 per 100 W-Y (95% CI 41.8-61.2), respectively. Bleeding disturbances, the most frequent reason for method discontinuation, were significantly more common in the ENG group [16.7 (95% CI 14.4-19.3)] than in the LNG group [12.5 (95% CI 10.5-14.9)] (P 0.019). The 3-year cumulative loss to follow-up was lower in the ENG- than in the LNG-implant group, 8.1 (95% CI 6.4-10.2) and 14.4 per 100 W-Y (95% CI 12.1-17.1), respectively. The median duration of implant removal was 50 s shorter among women with ENG than among women with LNG implant (P < 0.0001). In the observational comparison between IUD and implant users, the 3-year relative risk for pregnancy in IUD group compared with the combined implant group was 5.7 per 100 W-Y (95% CI 4.4-7.3) (P = 0.0003). The 3-year expulsion rate of the IUD was 17.8 per 100 W-Y (95% CI 14.5-21.9), while the discontinuation rate for bleeding disturbances was 8.5 (95% CI 6.7-10.9). Frequency of complaints of headache and dizziness was not significantly different between implant and IUD users (P = 0.16 and 0.77, respectively), acne and bleeding irregularities were more frequent among implant users (P < 0.0001), while heavy bleeding and lower abdominal pain occurred more often among IUD than implant users (P < 0.0001). LIMITATIONS, REASONS FOR CAUTION Few women were ≤19 years old or nulligravida, the proportion of implant users ≥70 kg was <20% and <8% were obese. WIDER IMPLICATIONS OF THE FINDINGS Findings of the study can inform policy makers and clinicians about choice of implant, but also about TCu380A IUD in relation to implants. STUDY FUNDING/COMPETING INTEREST(S) UNDP/UNFPA/WHO/UNICEF/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization (WHO). This report contains the views of an international expert group and does not necessarily represent the decisions or the stated policy of the WHO. TRIAL REGISTRATION ISRCTN33378571 registered on 22 March 2004. The first participant was enrolled on 12 May 200

Prolonged GnRH suppression period in controlled ovarian hyperstimulation cycles: Impacts on IVF outcomes?

Background: Prolonged GnRH-a administration in IVF cycles may have some advantages related to the treatment outcomes. Objective: In this study, we aimed to analyse the effect of prolonged gonadotropin releasing hormone agonist (GnRH-a) administration on controlled ovarian hyperstimulation outcomes of in vitro fertilization (IVF) patients. Materials and Methods: In this retrospective study, 55 patients with a GnRH-a administration period more than 10 days were compared with 55 patients whose same period was ≤10 days with respect to the demographic characteristics, metaphase II (MII) oocyte ratio, grade I (GI) embryo ratio, blastocyst ratio, fertilization, implantation, and the clinical pregnancy rates. Results: The mean hospital visit count of the prolonged GnRH-a patients was 2.6±0.4. As we expected, total GnRH-a doses used during hypophyseal down regulation were significantly different between the groups (p<0.0001). MII oocyte, G1 embryo and the blastocyst ratios were also significantly different between the groups (p<0.0001; p<0.01 and p<0.05). All the other parameters were insignificant. Conclusion: Prolonged GnRH-a administration during ovarian suppression in IVF patients may have positive impacts on the oocytes and the embryos, but this affect may not be observed in the overall pregnancy rates

Analysis of 232 total fertilization failure cycles during intracytoplasmic sperm injection

Background: The intracytoplasmic sperm injection procedure ending with total fertilization failure is very distressfull event for both the clinician and the patient.Objective: The aim of this study was to identify independent factors which could be used to identify total fertilization failure before the day of intracytoplasmic sperm injection.Materials and Methods: This was a retrospective study of 232 patients who were admitted to a tertiary-care hospital IVF Unit and showed total fertilization failure during intracytoplasmic sperm injection cycles. To sort out the interwined effects of female age, basal FSH, sperm quality, antral follicle count, starting dose of gonadotrophine, sperm extraction technique, cycle length, >14 mm follicle number, oocyte number after oocyte pick up, estradiol and progesterone level on the day of hCG and the MI, MII and GV oocyte number on the fertilization, multiple logistic regression analysis was used.Results: The total fertilization failure rate was 6% and the recurrance rate was 23%. The original model illustrated that the presence of GV oocytes, total oocyte number less than six, <2000 pg/mL E2 concentration on the day of hCG and testicular sperm extraction increases the total fertilization failure risk.Conclusion: It is very difficult to predict total fertilization failure. Sometimes even with one good quality oocyte and sperm and in the case of globozoospermia fertilization can be achieved. Not only azoospermia but also low oocyte numbers increase the chance of total fertilization failure even after intracytoplasmic sperm injectio

Impact of the Duration of Controlled Ovarian Stimulation on Assisted Reproduction Cycle Outcomes

Objective: To investigate the impact of duration of controlled ovarian stimulation on vitro fertilization outcomes. Study Design: Medical records of 3194 IVF and ICSI cycles from the assisted reproduction unit of a tertiary hospital were retrospectively analyzed using a computer based database. Characteristics of cycles with duration of stimulation ≤ 8 days (group I), 9 to 12 days (group II) or ≥13 days (group III) were studied retrospectively. Subgroup analysis was also done for poor responders, patients with polycystic ovary syndrome and normoresponders. Results: Estradiol on trigger day, number of retrieved oocytes, mature oocytes and fertilized oocytes were significantly higher in group II compared to the other two groups when all cycles were analyzed (p<0.001). No significant difference was observed regarding clinical and ongoing pregnancy rates between groups. Regarding poor responders, the number of mature oocytes and the number of fertilized oocytes were higher in group II compared to the other groups (p=0.028, p=0.038, respectively). Ongoing pregnancy rates were significantly lower in group III compared to other groups (p= 0.041). In patients with polycystic ovary syndrome, number of retrieved oocytes was significantly lower in group III compared to group II (p=0.047) and number of mature oocytes was significantly lower in group III compared to the other groups (p=0.005). No significant difference was found in the clinical and ongoing pregnancy rates. Number of retrieved oocytes, clinical and ongoing pregnancy rates were comparable between three groups for normoresponders. Conclusion: Prolonged cycles have a detrimental effect only on ongoing pregnancy rates in poor responders

Female Adnexial Tumor of Probable Wolffian Origin (FATWO) without Ki-67 Expression Reflecting Low Malignant Potential in a 55-Year-Old Woman

Female adnexial tumors of probable Wolffian origin (FATWO) are rare tumors derived from the remnants of the mesonephric duct. These tumors generally exhibit a low malignant potential, but recurrence and or metastasis is possible during the course of the disease according to the tumors’ possible malignant potential. We report a case of FATWO without estrogen and progesterone receptors and with negative immunostaining for Ki-67 (a proliferation marker) as a probable low-malignant-potential tumor. A 55-year-old woman presented with a complaint of heavy menstrual bleeding and pelvic pain. Pre-operative ultrasonographic evaluation revealed an intramural uterine leiomyoma of 4 cm in diameter and a right adnexial solid mass measuring 5 cm in diameter. Following total abdominal hysterectomy and bilateral salpingo-oophorectomy, immunostaining based on the labeled streptavidin-biotin method was performed on sections from representative blocks of paraffin-embedded tissues sampled from the mass, revealing a low mitotic index with negative Ki-67 immunostaining. Immunohistochemical staining with promising new markers and pathological investigation of the entire tumor are needed to determine the malignant behavior of an individual FATWO. Ki-67 is a helpful marker for determining Wolffian duct tumors’ potential malignant behavior

Sociodemographic and clinical features of postpartum depression among Turkish women: a prospective study

WOS: 000369821100001#REF!Background: Postpartum depression (PPD) is moderate to severe depression in a woman after she has given birth. Findings from several well-designed studies reflect great variability in rates, from 10 to 22%, and also in risk factors for PPD. This variability may reflect geographical location. The incidence and risk factors for PPD among Turkish women are not well documented. It is, however, important to understand the risk factors to develop preventive intervention strategies. This study aims to examine the prevalence of PPD and associated risk factors among a sample of women receiving services at a tertiary obstetrics hospital in Ankara, Turkey. Methods: A sample of 671 women, between 36 and 40 gestational weeks, were enrolled and screened for depressive symptomatology using the Hospital Depression Inventory. Sociodemographic and clinical data were also collected. At a subsequent postpartum evaluation, 6-8 weeks post-delivery, 540 of the 671 were screened using the Edinburgh Postnatal Depression Scale (EPDS) for PPD. Results: Eighty-three (15.4%) of the 540 women had scores above the cutoff point (> 13) on the EPDS. Statistically significant correlations were found between antenatal, prenatal and postpartum depression scores (r = 0.24). Women reporting suicidal thoughts during pregnancy (OR: 6.99), history of past PPD (OR: 6.64), physical violence during pregnancy (OR: 6.20) or during the postpartum period (OR: 5.87), previous psychiatric history (OR: 4.16), depressive symptoms during pregnancy (OR: 1.70), subjectively lower level of satisfaction with the pregnancy (OR: 0. 69), a history of premenstrual syndrome (PMS) (OR: 2.05), and unplanned pregnancy (OR: 1.69) had higher odds for developing PPD. Conclusion: One in six mothers screened as positive for PPD. Women who had previously been diagnosed with PPD, reported suicidal thoughts during pregnancy, or had been exposed to physical violence were at especially high risk for postpartum depression. To prevent and treat postpartum depression, special attention should be paid to women reporting these characteristics