Ovarian stimulation in women with high and low body mass index: GnRH agonist versus GnRH antagonist.

This study evaluated women with a high body mass index (BMI) (>40 kg/m(2)) and low BMI (<18 kg/m(2)) undergoing assisted reproduction treatment and determined whether the type of gonadotrophin-releasing hormone (GnRH) analogue used has an impact on cycle parameters and outcome. The study analysed 65 women with high BMI and 118 with low BMI. In the former group, polycystic ovarian syndrome was significantly more prevalent in the agonist long protocol (ALP) group (P=0.01) and gonadotrophin consumption was lower, peak oestradiol concentrations and total number of oocytes retrieved were higher in the ALP group compared with the antagonist (ANT) group. Implantation rate (IR), pregnancy rate (PR) per embryo transfer and early pregnancy loss rate (EPLR) were similar in both stimulation groups, with overall rates of 21.6%, 55.4% and 44.4%, respectively. In women with low BMI, peak oestradiol concentrations, total oocytes retrieved, mature oocytes and transferred embryos were higher in the ALP group compared with ANT group. IR, PR/embryo transfer and EPLR were similar in both groups, with overall rates of 24.3%, 52.5% and 16.1%, respectively. In all patients, no difference was found between ALP and ANT protocols concerning treatment outcome. Contrary to the reasonable EPLR observed in women with low BMI, the high rate found in women with high BMI is remarkable.

Early clinical pregnancy loss rate in poor responder patients does not change compared to age-matched normoresponders.

OBJECTIVE: To investigate the early clinical pregnancy loss rate (ECPLR) of singleton gestations in poor responder (PR) patients. DESIGN: A retrospective study. SETTING: Private assisted reproductive technology center. PATIENT(S): A total of 2,157 singleton clinical pregnancies were identified, 195 from PR and 1,962 from normoresponder (NR) patients. Poor response was accepted as retrieval of four or fewer oocytes. Patients who yielded more than five oocytes were accepted as NR control group. INTERVENTION(S): Patients were age stratified as or=40 years. MAIN OUTCOME MEASURE(S): Comparative evaluation of ECPLR in PR and NR patients according to age. RESULTS: Out of 195 singleton clinical pregnancies achieved in poor responders, 31% resulted in early clinical pregnancy loss; ECPLR were 22%, 32%, and 59% in the or=40 year age groups, respectively. When ECPLR in singleton gestations of PR patients was compared with that of NR patients according to age, no significant differences were found for all age groups. CONCLUSION(S): Early clinical pregnancy loss rate was not found to differ significantly between PR and NR patients at all age groups. Therefore, PR patients should be counseled about their lower probability of clinical pregnancy but similar ECPLR compared with their age-matched NR counterparts.

Assisted reproductive technique outcome in testicular sperm extraction-intracytoplasmic sperm injection cycles with poor female response: a report on 8 years' experience.

OBJECTIVE: To evaluate the outcome in couples composed of azoospermia and a poor responder female undergoing assisted reproductive techniques (ARTs). STUDY DESIGN: A retrospective study was performed involving 97 men suffering from nonobstructive azoospermia (NOA) whose partners had a poor response to ovarian stimulation. Poor response was defined as retrieval of fewer than 5 oocytes. Main outcome measures were implantation rate (IR), clinical pregnancy rate per embryo transfer (CPR/ET) and early pregnancy loss rate (EPLR). RESULTS: Overall IR, CPR/ET and EPLR were found to be 16%, 23% and 15%, respectively, which were significantly lower than those in NOA men with normoresponder partners except EPLR (25%, 52% and 24%, respectively). When the results were further stratified according to number of oocytes retrieved and body mass index, no significant difference was observed between the groups. However, when the results were analyzed according to the woman's age, a significantly lower CPR/ ET was found in poor responder women aged > or = 38 years (11% vs. 33%; p = 0.03). CONCLUSION: Although success of ART is suggested to be high once motil spermatozoa are found in testicular sperm extraction in NOA cases, poor response to ovarian stimulation might be considered as one of the strongest determinants of the outcome.

Comparison of transvaginal sonography, saline infusion sonography and hysteroscopy in the evaluation of uterine cavity pathologies.

AIMS: To determine whether performing transvaginal sonography (TVS) and saline infusion sonography (SIS) before hysteroscopy could reduce the number of diagnostic hysteroscopies performed for the evaluation of uterine cavity abnormalities. METHODS: Two hundred and twenty three women with suspected uterine cavity abnormalities were prospectively evaluated by TVS, SIS and hysteroscopy, and had histological evaluation of the endometrium with hysteroscopic biopsy or dilatation and curettage (D&C). One hundred and sixty five patients (74%) were premenopausal and 58 patients (26%) were postmenopausal. RESULTS: The positive predictive value (PPV) for endometrial polyps was 69% for TVS, 78% for SIS and 81% for hysteroscopy in premenopausal patients. In the postmenopausal group, TVS and SIS could detect only 24% of endometrial polyps, whereas 70% were diagnosed by hysteroscopy. The PPV for submucous fibroids was 47% for TVS, 81% for SIS and 77% for hysteroscopy in the premenopausal group. CONCLUSIONS: In premenopausal patients, SIS and hysteroscopy are equally accurate in the diagnosis of endometrial polyps and submucous fibroids. Hysteroscopy is the most accurate test for polypoid lesions in the postmenopausal group. Performing TVS, SIS and D&C could reduce the number of diagnostic hysteroscopies performed for the evaluation of uterine cavity abnormalities by 71.5% in premenopausal patients. However, this rate decreases to 40% in the postmenopausal group.