Coagulation tests at trigger day in patients with Factor V Leiden Mutation to predict implantation failure

Objectives: The aim of this study was to assess the predictive value of coagulation tests at trigger day in patients with isolated factor V Leiden mutation who underwent intracytoplasmic sperm injection cycle (ICSI). Study Design:  Ninety women with isolated factor V Leiden mutation underwent ICSI cycles with an indication of unexplained infertility. In all participants antagonist protocol was used for ovarian hyperstimulation and coagulation tests including activated partial thromboplastin time (APTT), partial thromboplastin time (PT), international normalized ratio (INR), serum fibrinogen and D-dimer levels at trigger day were determined to predict successful implantation. All the clinical parameters specific for the treatment and some patient characteristics were recorded for each participants. Results: There was no significant difference between groups with and without succesfull implantation in terms of age, body mass index, basal hormone levels (follicle stimulating hormone, estradiol, progesterone at day 3 and antimullerian hormone) (P > 0.05). Estradiol and progestrone levels at trigger day were comparable between groups  (P > 0.05). Groups had similar endometrial thickness at embryo transfer day (P > 0.05). Some ovarian stimulation characteristics including initial gonadotropin dose, number of follicles > 17 mm, number of oocytes harvested and number of embryos were similar between groups (P > 0.05). Although there was no significant difference between groups with regard to APTT and PT levels, INR level were significantly lower while D-dimer levels and fibrinogen were significantly higher in cases without implantation (P < 0.05). Conclusion: D-dimer, fibrinogen and INR levels were significant predictors for successful implantation in women with isolated factor V Leiden who underwent ovulation hyperstimulation

Short Term Alterations of Hormone Profile Following Oocyte Pick-Up in Women with Polycystic Ovarian Syndrome to Assess the Effect of Multiple Needle Entries Into the Ovarian Cortex and Stroma

Objective: Some hormonal alterations after ovarian diathermy have been proposed in previous studies. Based on this data, we aimed to analyze some hormone profile changes following oocyte pick-up in women with polycystic ovarian syndrome. Study Designs: A total of 50 women with polycystic ovarian syndrome underwent ovarian stimulation for IVF cycle with an indication of anovulatory infertility. Some hormone profiles with the insulin resistance were assessed before and after oocyte pick-up to (early in the morning before starting stimulation and repeated 1 month later from oocyte pick-up day) assess whether high number of needle entries into the ovarian cortex and stroma result in similar effect with the diathermy. Results: Comparison of some variables revealed significantly decreased HOMA-IR and serum total testosterone concentrations after intervention. Correlation analyses showed significant correlations between number of needle entries, change in HOMA-IR, baseline total testosterone level and change in AMH level. Conclusion: Our data showed significant metabolic and hormonal alterations following oocyte pick up consistent with the effect of ovarian diathermy in women with polycystic ovarian syndrome

Serum Albumin Level Adjusted Progesterone Level on the Trigger Day is Not a Significant Predictor of Clinical Pregnancy

Objective: We aimed to assess the effect of serum albumin level adjusted progesterone levels on the trigger day on clinical pregnancy rate in ICSI cycles. Study Design: A total of 100 women undergoing ICSI cycles due to poor ovarian reserve or tubal factor infertility were included in this study. Serum progesterone and albumin levels on the trigger day were utilized to predict clinical pregnancy among normal and poor responders. Results: There were significant differences between groups with and without successful clinical pregnancy in terms of serum albumin (4.6 vs. 4.3 g/dl), progesterone levels (0.5 ng/mL vs. 0.7 ng/mL) on the trigger day and endometrial thickness (11.5 mm vs. 9.3 mm) (p<0.05, p<0.05 and p<0.05, respectively). In ROC analyses, progesterone level on the trigger day was found to be a significant predictor of clinical pregnancy (AUC=0.652, p=0.015). An optimal cut-off value of 0.55 ng/mL was obtained with 65% sensitivity and 57% specificity. Albumin level adjusted progesterone concentrations on the trigger day were 0.67 ng/mL versus 0.64 ng/mL, but this difference was not statistically significant (p>0.05).  Conclusion: Albumin adjusted progesterone concentrations may be utilized to determine cases for a freeze-all policy

Effect of Total versus Partial Assisted Hatching on the Clinical Pregnancy Rates in Assisted Reproduction Technology

Objective: The objective of this study was to investigate the effect of total or partial assisted hatching on the clinical pregnancy rates in assisted reproduction technology. Study Design: This was a case-control study conducted from the beginning of January 2016 to the end of June 2017. A total of 404 cycles were included in this case-control study. Study population was divided into 3 groups: Group 1: Partial assisted hatching (n=118), Group 2: Total assisted hatching (n=81) and Control group (n=205). Results: In women of all ages, clinical pregnancy rates were similar between groups with total or partial assisted hatching compared to control group (p>0.05). The rates were also similar in subgroups of women with blastocyst or cleavage stage embryo transfers (p>0.05). Partial or total embryo hatching did not result in favorable outcome compared to control group either in women over 35 or younger than 35 years of age (p>0.05). In whole study group pregnancy rate was significantly higher in group with blastocyst stage embryo transfers (22.4 % versus 48.8%, p<0.05) Conclusion: Partial or total assisted hatching do not have any impact on the clinical pregnancy rates, no significant impact was determined in subgroup of women either

Does the Modification of Starting Gonadotropin Dose During ICSI Cycle Have Any Significant Impact on Cycle Outcome?

OBJECTIVE: The aim of this study was to figure out the impact of gonadotropin dose alteration requirements due to high response or unresponsiveness on intracytoplasmic sperm injection cycle outcomes in a standard group of patients. STUDY DESIGN: One hundred cycles with same gonadotropin dosage along the stimulation were compared with 100 cycles in which gonadotropin dose alterations were needed due to high response or unresponsiveness. Groups were compared in terms of age, body mass index, serum follicle stimulating hormone and estradiol levels, antral follicle count, gonadotropin dosage, duration of stimulation, endometrial thickness at trigger day, number of total, mature and immature oocytes and finally the clinical pregnancy rates. RESULTS: There were significant differences between groups with regard to gonadotropin starting dose, total gonadotropin dose, duration of stimulation, estradiol level at trigger day, number of total oocytes and metaphase 1 oocyte number. Clinical pregnancy rates were similar between groups. CONCLUSION: Dose alteration requirement along intracytoplasmic sperm injection cycle result in high number of total and metaphase 1 oocyte yields, higher starting gonadotropin and total gonadotropin dose, duration of stimulation and estradiol level at trigger day, however clinical pregnancy rates were similar between groups

Combined use of oestradiol and progesterone to support luteal phase in antagonist intracytoplasmic sperm injection cycles of normoresponder women: a case-control study

We evaluated the effect of combined use of oral oestrogen (E2) and vaginal progesterone (P) to support luteal phase in antagonist intracytoplasmic sperm injection (ICSI) cycles. We analysed data from 176 patients who underwent ICSI cycles with antagonist protocol. P 90 mg vaginal gel once a day and micronised E2 of 4 mg/day, were started from the day of oocyte pick up and continued to the 12th day of embryo transfer. Group 1 (n = 79) patients received E2 + P for luteal phase support. In group 2 (n = 97) patients, only P 90 mg vaginal gel was used for luteal phase support. There were no significant differences between group 1 and group 2 patients in terms of clinical pregnancy rates (PRs) (26.58% vs. 20.62%, p = .352), early pregnancy loss rates (6.33% vs. 6.19%, p = .969), incidence of luteal vaginal bleeding (8.86% vs. 8.25%, p = .885) and implantation rates (22.8% vs. 16.9%, p = .298). In conclusion, our study showed no beneficial effect of addition of E2 to luteal phase support on clinical PR in antagonist IVF cycles.Impact statement What is already known on this subject? Luteal phase deficiency is defined as a disruption in progesterone and oestrogen production after ovulation. It is clear that, luteal phase supplementation to improve the outcomes in in vitro fertilisation (IVF) cycles is mandatory. As an iatrogenic complication of assisted reproductive technique, decreased luteal oestrogen and progesterone levels lead to decreased pregnancy rates (PRs) and implantation rates. What the results of this study add? In this study, we aimed to present the role of luteal phase oestrogen administration in GnRH antagonist cycles. A total of 176 cases received progesterone vaginal gel form for luteal phase support. Study group received 4 mg oral oestradiol hemihydrate in addition to progesterone. Compared to previous studies, our study consisted of larger number of patients and we used oestradiol through oral route. We found out that luteal oestradiol support did not improve the clinical PR. What the implications are of these findings for clinical practice and/or further research? Our study showed no beneficial effect of addition of oestradiol to luteal phase support on clinical PR in antagonist IVF cycles