The Impact of Laparoscopic Treated Endometrioma on the Live Birth Rate in IVF/ICSI Cycles Compared with Unexplained Infertility: A Prospective Randomized Study

BACKGROUND: It is estimated that 30–70% of patients who undergo treatment for infertility are afflicted with endometriosis. AIM: The objectives of this study are to evaluate the impact of laparoscopic treated endometrioma compared to unexplained subfertility on the live birth rate in women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). METHODS: This randomized prospective study included 120 women who contacted the department of IVF in the period from 2010 to 2015. Women were divided into two groups according to the findings obtained by laparoscopy. The treated endometrioma group (n = 60) with unilateral ovarian endometriomas and the non-endometriosis group (n = 60) with unexplained infertility undergoing the first cycle of IVF-embryo transfer (IVF-ET) were included in the study. In all participants, ICSI was used and all had fresh embryo transfer per cycle. The primary outcome was to live birth. RESULTS: Our results demonstrated that clinical pregnancy rates (p = 0.54) and live birth rate (p = 0.63) are similar. The preservation of a good ovarian response to stimulation by gonadotropins after laparoscopic ovarian cystectomy was presented. Laparoscopic cystectomy is followed by good IVF/ICSI outcome into the level expected in women with unexplained subfertility. CONCLUSION: Therefore, operative treatment is justified by not altering the live birth rate. Additional study is needed to be considered cystectomy before IVF as an effective approach for managing endometriosis-associated infertility

Autologous platelet rich plasma intracortical ovarian injection restored ovarian function and foliculogenensis in poor responders after one month: a control pilot study

Objective: The aim of our study was to evaluate whether autologous Platelet-Rich Plasma (PRP) injected in the ovarian cortex has therapeutic potency in restoring ovarian function in poor ovarian responders (PORs) after one-month therapy. PRP is beginning to be used in the treatment of ovarian infertility with a possible explanation for its role in improving the follicular microenvironment as well as the influence of growth factors on ovarian stem cells in postnatal oogenesis. Methods: This prospective randomized study included women who contacted the department of IVF in the period from 2017-2018. Women were selected according to the ESHRE consensus on the definition of PORs. A total of 30 women were divided in two groups according to the patient choice: ovarian PRP injection (15 patients) or no intervention (15). PRP was prepared by Regen ACR®-C Kit according to the manufacturer’s guidelines. Approximately 3-5 ml of the PRP was injected in ovarian cortex using transvaginal ultrasound guidance. The serum concentration of FSH, LH, estradiol and AMH were determined before the treatment and day-3 of first menstrual cycle after treatment in order to monitor ovarian function. Results: After PRP treatment, the women had significant improvement in ovarian reserve. AMH level in serum was significantly increased, p<0,05 (p=0,02), FSH level significantly decreased, p<0,01(p=0,003) and number of antral follicles after applying the PRP significantly increased, p<0,001 (p=0,0007). Conclusions. One-month therapy with PRP has the potency of significantly recovering ovarian function both in its hormonal and follicular development abilities

The day of embryo transfer affects delivery rate, birth weights, female-to-male ratio, and monozygotic twin rate

Objective To compare the reproductive outcomes between the transfer of cleavage-stage embryos and blastocysts in two different age groups of patients. The reproductive capacity of women decreases by age. This decrease in capacity is directly related to a lower ovarian reserve and errors in the meiotic spindle of the oocyte, which increase chromosomal abnormalities and the formation of aneuploidy embryos with lower chances of implantation. Materials and Methods A total of 1400 intracytoplasmic sperm injection cycles were analyzed. The study patients were divided into two age groups [aged < 36 years (Group I) and aged ≧ 36 years (Group II)]. The groups were subdivided according to the day of embryo transfer (ET)—Day 3 (ET3) and Day 5 (ET5). Results In both age groups, transfer of blastocysts resulted in a higher clinical pregnancy rate and deliveries. An increased twin birth rate was observed in patients who were younger than 36 years on both transfer days compared with those who were older than 36 years of age. There was an elevated percentage of newborn males on ET5 in both age groups. Monozygotic twinning (MZT) rate was observed only among younger patients (<36 years of age), specifically on ET5 compared with ET3. There was no significant difference in the mean birth weight of singleton and twins between the ET3 and ET5 subgroups in the younger group of patients except for the triplets who were significantly heavier in the ET5 group compared with the older group (≧36 years of age) where significant difference was found only on the mean birth weight of singleton. Conclusion The study suggests that if a blastocyst can be obtained in patients of advanced age (≧36 years), it improves their baby take-home rates. Younger patients (aged < 36 years) should undergo elective single blastocyst transfers to reduce multiple pregnancy rates

Impact of active female smoking on controlled ovarian stimulation in intracitoplasmic sperm insemination cycles

Aim To examine the impact of smoking among females on controlled ovarian stimulation (COS), at intra-cytoplasmatic sperm injection (ICSI) outcome. Methods A prospective analysis of outcomes of 876 women (fresh, non donor cycles) of which 559 (63.8%) were non-smokers, 317 (36.2%) were smokers, underwent standard COS/ICSI treatment. Results Among smokers, the average time of COS, expressed in days, was significantly longer compared with non-smokers (10.5±2.10 vs. 10±1.90 p<0, 05). There were no registered significant differences in the number of retrieved oocytes, (10.4±6.8 vs10.3±6.9), mature oocytes (8.6±5.8 vs. 8.4±5.9), in the group of non-smokers versus smokers. However, smoking and age have a significant impact of the number of high-quality embryos, i.e. older smokers had a lower number of high-quality transferred embryos (non-smokers ≥ 35 years : smokers ≥ 35 years; 1.9±1.1 vs. 1.6±1). On multiple logistic regresion analysis, factor that had a significantly negative impact of clinical pregnancy was maternal age. Conclusion Smoking among patients entering the COS and ICSI fertilization process had insignificant negative impact on the final outcome of the process resulting in reduced pregnancy rate. The chance for the pregnancy declines with age, but smoking did not significantly influence the outcome. Key words: in vitro fertilisation, high - quality embryos, clinical pregnancy rat

Novel method of treating ovarian infertility: is Platelet-Rich Plasma a new promising therapy in the future?

Introduction. In today's modern society, the treatment of patients with poor ovarian reserve presents a medical challenge of increased clinical importance. The use of platelet-rich plasma (PRP) is a new hope that improves pregnancy chances. Increased use of the PRP in a number of in vitro centers around the world as well as publication of the first experience in in vitro fertilization entailed the need for this systematic review. Methods. PubMed, Cochrane and Ovid Medline were searched between 2000 and 2019 under the following strategy: [ and and ]. Fourteen original articles published in medical scientific journals were analyzed in this study. The evidence level and quality assessment were made based on the most up-to-date, reliable, scientific evidence as well as from the number of additional relevant citations. Results. Taking the current available proof and evidence into consideration, we can conclude that the PRP method improves the ovarian function and increases the chances of clinical pregnancy. In addition, we assume that, over time, the PRP method objectively improves the ovarian reserves. Recent studies support the theory of increasing the number of preantral follicles, followed by appropriate growth and reduction of follicular atresia. Conclusion. The improvement of the quantity and quality of oocytes with the intra-ovarian application of PRP potentially suggests a new concept of ovarian aging, where the ovarian microenvironment plays a crucial role