Uncommon but devastating event: total fertilisation failure following intracytoplasmic sperm injection

Fertilisation with intracytoplasmic sperm injection (ICSI) is a consequence of complex molecular interactions between spermatozoon and oocyte. Disruption of the process obviously prompts a frustrating event called total fertilisation failure (TFF). Up to 3% of ICSI cycles may result in TFF, and brief counselling for subsequent cycle management is indispensable. Within this perspective, ICSI cycles of a centre over a 10-year period were analysed to document TFF cases. Initial TFF after ICSI and subsequent ICSI cycle of the same cases were documented to clarify predictive factors of successful outcomes after initial TFF. In subsequent cycles, assisted oocyte activation (AOA) with calcium ionophore and Hypo-osmotic swelling test (HOST)/pentoxifilline for sperm selection was used. In the current analysis, successful fertilisation was achieved in 85% of the cases with previous TFF. The significant contributing factors for successful fertilisation in the latter cycle were: improved oocyte quantity and better sperm morphology. In conclusion, sporadic TFF event in the first and only cycle is usually a technically modifiable condition, but repeated TFF could indicate possible gamete defects, which might not be overcomed in the next modified ICSI cycle

The cycle outcomes of gnrh agonist triggering with different leuprolide acetate doses in high responder patients

70th Annual Meeting of the American-Society-for-Reproductive-Medicine -- OCT 18-22, 2014 -- Honolulu, HIAmerican Society for Reproductive Medicin

C-reactive protein and homocysteine levels are associated with abnormal heart rate recovery in women with polycystic ovary syndrome

Objective: To determine heart rate recovery (HRR) in patients with polycystic ovary syndrome (PCOS) and its relation to C-reactive protein (CRP) and homocysteine (Hcy) levels. Design: Prospective clinical study. Setting: University hospital. Patient(s): Sixty-eight women with PCOS and 68 healthy women were included this study. Intervention(s): Heart rate recovery was evaluated. We measured serum levels of CRP and Hcy. The presence of insulin resistance was investigated using homeostasis model assesment (HOMA-IR). Main Outcome Measure(s): Heart rate recovery, CRP, Hcy. Result(s): Heart rate recovery was significantly decreased in women with PCOS compared with control group women. Subjects with abnormal HRR had significantly greater levels of CRP and Hcy. The PCOS patients with HRR in the top tertile compared with the bottom quartile tended to have lower mean CRP and Hcy levels. The HRR was significantly and negatively correlated with age, CRP, Hcy, HOMA-IR, and body mass index. C-reactive protein and Hcy are independent determinants of HRR. Conclusion(s): The CRP and Hcy levels may affect the development and progression of abnormal HRR in PCOS

Plasma interleukin-18 levels are increased in the polycystic ovary syndrome: relationship of carotid intima-media wall thickness and cardiovascular risk factors

Objective: To determine serum interleukin (IL)-18 levels and to find out whether IL-18 is associated with carotidintima-media wall thickness (IMT) and various cardiovascular risk factors in women with polycystic ovary syndrome(PCOS).Design: A prospective, controlled study.Setting: University hospital.Patient(s): Sixty women with PCOS and 60 healthy women were included this study.Intervention(s): Serum levels IL-18, homocysteine (Hcy), C-reactive protein (CRP), IL-6, malonyldialdehyde(MDA), lipid and hormone profiles were measured. Carotid IMT was evaluated for both common carotid arteries.Main Outcome Measure(s): Serum IL-18, carotid IMT, Hcy, CRP, IL-6,MDA, and homeostasis model assessmentof insulin resistance.Result(s): The evaluation, which was made without the obesity influence taken into consideration, revealedthat patients with PCOS have increased serum IL-18 levels than that of the control group (214 102 vs. 170 78 pg/mL). The interaction between PCOS and obesity was seen to have statistical significance (F ¼ 67.8).Body mass index (BMI), waist to-hip ratio, Hcy, and homeostasis model assessment of insulin resistance are independentdeterminants of plasma IL-18 in patients with PCOS. Elevated serum IL-18 levels were positivelyand significantly correlated with a greater carotid IMT. For Hcy and carotid IMT, the interaction betweenPCOS and obesity was found in a two-way ANOVA variation analysis (F ¼ 48.5 and F ¼ 81.5, respectively).Conclusion(s): Elevated serum IL-18 levels were associated with cardiovascular risk factors and carotid IMT inpatients with PCOS

Estrogen priming GnRH antagonist regimen is an efficient protocol in poor responders

International-Federation-of-Fertility-Societies 21st World Congress on Fertility and Sterility / 69th Annual Meeting of the American-Society-for-Reproductive-Medicine -- OCT 12-17, 2013 -- Boston, MAInt Federat Fertil Soc, Amer Soc Reprod Me

Follicular flushing using double lumen needle yields more oocytes in mono-follicular poor responders

Objective: To compare the efficacy of follicular flushing (FF) with double lumen needle and direct follicularaspiration with single lumen needle in terms of oocyte yield in mono-follicular responder patients undergo ing assisted reproduction techniques (ART).Materials and Methods: Prospective ‘quasi-experimental’ study was carried out in an IVF center. Infertilewomen 18-42 years of age with diminished ovarian reserve who revealed a single follicle >17 mm on theday of oocyte retrieval were included in the study. Follicular flushing up to 8 times was performed in FFgroup using an 17-G double lumen needle. Direct follicular aspiration using a 17-G single lumen needle with out FF was performed in direct aspiration group. Total numbers of collected oocytes, metaphase 2 oocytes,fertilization and pregnancy rates were compared among groups.Results: A total of 206 women underwent oocyte retrieval procedure; 106 women were assigned to FF and 100women into direct aspiration arm. Overall oocyte retrieval rate was 50.4% in all cases. The total oocyte retrievalrate was higher (65/106, 61.9%) in FF group, than in direct aspiration group (39/100, 39%, p = 0.001). Metaphase 2oocyte rate was also higher in FF group (47/106, 44.3% vs 29/100, 29% p = 0.04). Fertilization rates, total number ofpatients with a cleavage stage embryo and grade 1 cleavage embryo were similar among the groups (p>0.5).Numbers of positive hCG, ongoing pregnancy and miscarriage rates were similar among groups.Conclusion: Follicular flushing using double lumen needle in mono-follicular responder patients with dimin ished ovarian reserve yields more oocytes and mature oocytes than direct aspiration of follicles

Ten years experience with poor responder patients fulfilling bologna criteria

70th Annual Meeting of the American-Society-for-Reproductive-Medicine -- OCT 18-22, 2014 -- Honolulu, HIAmerican Society for Reproductive Medicin

Anti-Mullerian hormone and insulin resistance in classic phenotype lean PCOS

Purpose This study is designed to explore the correlation between AMH levels and IR in normal weight PCOS women. Materials and methods This prospective study was conducted on 55 patients, who were admitted to obstetrics and gynecology department of a university clinic. Study group was consisted of 34 patients diagnosed as polycystic ovary syndrome (PCOS) according to the Rotterdam Criteria, whereas control group was consisted of 21 healthy volunteers without any features of clinical or biochemical hyperandrogenism, who had regular menstrual cycles. BMI C 25 kg/m2 were considered overweight and obese and excluded. Blood samples were obtained during days 2–3 after spontaneous menses or progesterone-induced withdrawal bleeding after overnight fasting for at least 12 h. The weight, height, hip and waist circumferences of the patients were measured. Fasting insulin and glucose (FPG) levels were used for calculating different insulin resistance indexes (Homeostatic Model Assessment (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI)). Results No significant difference was found between PCOS and control groups regarding the mean age, BMI, waist to hip ratio (WHR), mean values of FPG, FPG/insulin ratio and HOMA B (p[0.05). AMH values were significantly higher in PCOS cases when compared with controls (4.7 vs. 3.4 ng/mL) (p\0.05).The mean values of HOMAIR and QUICKI indexes were significantly higher among PCOS cases when compared with controls. E2 levels were significantly lower and Total-T were significantly higher in PCOS patients. When PCOS cases are categorized according to the existence of IR, no difference in Total-T and AMH levels between both groups. Although not statistically significant, a negative correlation of AMH with HOMA-IR and a positive correlation with QUICKI index were found. Among the hormone parameters, AMH was found to be positively correlated with Total-T (r = 0.332, p = 0.013). Conclusion Although the relation between AMH and androgen production is supported by current evidence, the mechanism underlying the relation between AMH and insulin resistance is not clear yet