The Association Between Follicular Fluid Sialic Acid Levels, Oocyte Quality, and Pregnancy Rates.

Sialic acid residues perform important roles in both physiological and pathologic processes. Our aim was to measure the levels of sialic acid in the follicular fluid of women undergoing in vitro fertilization (IVF) and to assess correlations between IVF parameters and sialic acid levels. All women meeting the inclusion criteria underwent gonadotropin-releasing hormone agonist treatment and during oocyte retrieval, follicular fluids of mature follicles were collected and pooled for each patient. Correlation analysis was made between sialic acid levels and oocyte quality. Eighty-seven patients meeting the inclusion criteria were enrolled. In terms of oocyte quality and sialic acid, follicular fluid total sialic acid (FF-TSA) levels positively correlated with germinal vesicle oocytes and metaphase I oocytes. In terms of clinical parameters, no correlation between sialic acid levels and body mass index, serum levels of hormones, duration of infertility, and the total dose of gonadotropins was observed. The mean FF-TSA was 86.1±35.19 mg/dl in the clinical pregnancy positive group and was 73.64±22.15 mg/dl in the clinical pregnancy negative group. FF-TSA levels positively correlated with immature oocytes. This can be either as part of the normal oocyte maturation or as a compensatory mechanism against reactive oxygen species during the oocyte maturation process.

Comparison of antagonist mild and long agonist protocols in terms of follicular fluid total antioxidant capacity.

OBJECTIVE: A high dose of prolonged gonadotropins can yield higher numbers of oocytes and embryos. The high dose or prolonged regimens can be associated with ovarian hyperstimulation syndrome (OHSS), multiple gestations, emotional stress, economical burden and treatment dropout. In mild stimulation lower doses and shorter duration times of gonadotropin are used in contrast to the conventional long stimulation protocol in IVF. It has been proposed that supraphysiologic levels of hormones may adversely affect endometrium and oocyte/embryo. Also it has been proposed that oxidative stress (OS) may alter ovarian hormone dynamics and could be further affected by additional exogenous hormonal stimulation. Therefore our aim was to compare follicular fluid total antioxidant capacity (TAC) in antagonist mild and long agonist stimulations. MATERIALS AND METHODS: Forty patients received antagonist mild stimulation, starting on the 5th day of their cycle and forty patients received long agonist treatment. Seventy-five patients undergoing their first IVF cycle were included in the final analysis. Follicular fluid (FF) samples were analyzed for estradiol (E2), antimullerian hormone (AMH) and TAC. RESULTS: FF-Total antioxidant capacity (TAC) levels were higher in the long agonist group as opposed to the antagonist group [1.07 ± 0.04 mmol Trolox equivalent/L vs 1 ± 0.13 mmol Trolox equivalent/L] (Fig. 1). Pregnancy rates were not significantly different between the two treatments. The FF-TAC levels were not different among infertility etiologies (Fig. 3). FF-TAC levels did not have a direct correlation with pregnancy but a positive correlation with the total gonadotropin dose was observed. CONCLUSION: Patients with good ovarian reserves and under the age of 35 effectively responded to mild stimulation treatment. Using lower amounts of gonadotropin, yielded less FF-TAC levels in patients who underwent antagonist mild protocol. In patients under the age of 35, antagonist mild stimulation is a patient friendly and effective procedure when undergoing their first IVF cycle.

Homocysteine in embryo culture media as a predictor of pregnancy outcome in assisted reproductive technology.

The aim of this study was to determine whether homocysteine (hcy) concentrations in embryo culture media correlate with pregnancy outcome in assisted reproductive technology (ART) cycles. Forty patients who underwent single embryo transfer at the infertility clinic of a tertiary care center were recruited for this case-control study. Spent embryo culture media from all patients were collected after single embryo transfer on day 3 (n = 40). Hcy concentrations in embryo culture media were analyzed by enzyme cycling method. Patients were grouped according to the diagnosis of a clinical pregnancy. Sixteen patients were pregnant while 24 patients failed to achieve conception. Mean Hcy levels in the culture media were significantly different between the groups (p < 0.003), as 4.58 ± 1.31 µmol/l in the non-pregnant group and 3.37 ± 0.92 µmol/l in the pregnant group. Receiver operator curve analysis for determining the diagnostic potential of Hcy for pregnancy revealed an area under the curve of 0.792 (confidence interval: 0.65-0.94; p < 0.05). A cut-off value of 3.53 µmol/l was determined with a sensitivity of 83.3%, and a specificity of 68.8%. Lower hcy levels were associated with a better chance of pregnancy and better embryo grades. Hcy may be introduced as an individual metabolomic profiling marker for embryos.

Epidermoid cyst of the cecum: a case report.

Pure, benign epidermoid cysts of the abdominal viscera are rare. There have been only six reports of epidermoid cysts of the cecum in the literature. A 31-year-old female with a previous cesarean delivery was admitted to our hospital with inguinal pain. After admission to the hospital, she was operated with the initial diagnosis of adnexal mass. During the operation, no adnexal pathology was identified. A heterogeneous mass originated from the posterior surface of the cecum was observed. It had no connection with the lumen. The mass was then removed with dissection. Macroscopically, the mass was 9x7 cm in diameter and wall thickness was 0.1 cm. The inner and outer surfaces were smooth. It was filled with a dense yellow, thick-fatty material with no tooth, hair, bone, or calcification areas. On microscopic examination, the inner lining was composed of mature keratinized stratified squamous epithelium with a granular layer. In view of the later findings, the case was reported as epidermoid cyst of the cecum. Although epidermoid cysts are rarely seen in visceral organs, this case is the seventh case of cecum-originated epidermoid cyst that has been reported in the literature. The histogenesis of epidermoid cyst is unknown. These cysts are generally accepted to be sequestration cysts that may be either congenital or acquired. Acquired epidermoid cysts are believed to be traumatic or iatrogenic. The cesarean delivery may have been a cause of this condition in the present case. On ultrasonographic examination, these cysts can be misdiagnosed as ovarian cysts.

Serum anti-müllerian hormone, follicle stimulating hormone and antral follicle count measurement cannot predict pregnancy rates in IVF/ICSI cycles.

PURPOSE: To investigate whether serum anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), or antral follicle count (AFC) are predictive for clinical pregnancy in in vitro fertilization (IVF) patients. METHODS: Serum AMH, inhibin B, FSH, luteinizing hormone (LH), estradiol (E2), prolactin, and thyroid stimulating hormone (TSH) levels and AFC of 189 women under 40 years of age were investigated. Pregnant and non-pregnant women were compared. RESULTS: Forty-seven (24.8 %) clinical pregnancies were observed in 189 women. There was no significant difference in terms of mean age, duration of infertility, body mass index, AMH, LH, FSH, E2, TSH, Inhibin B, AFC and total oocyte number between women who did and who did not become pregnant. Additionally, there was no significant difference in clinical pregnancy rates between the quartiles of AMH, FSH and AFC. (P values were 0.668, 0.071, and 0.252, respectively.) CONCLUSION: Serum AMH and FSH, and AFC cannot predict clinical pregnancy in IVF patients under 40; the pregnancy rate tends to increase as AMH increases, although this remains non-significant.

The association between homocysteine in the follicular fluid with embryo quality and pregnancy rate in assisted reproductive techniques.

PURPOSE: To investigate the association between follicular fluid homocysteine levels and embryo quality and pregnancy rates in patients undergoing assisted reproduction. METHODS: Fifty infertile women who were admitted to our clinic were enrolled in the study. Ovulation induction was performed by using GnRH agonist and gonadotropins. For each patient, homocysteine level in the follicular fluid was measured by using nephelometric method after the oocyte pick-up. The association between the homocysteine concentration in the follicular fluid and the oocyte-embryo quality, pregnancy rates and hormone levels were investigated. RESULTS: Mean ± SD Hcy was 9.6 ± 2.02 µmol/L and 14.9 ± 2.93 µmol/L in pregnant and non-pregnant women, respectively (p < 0.0001). There were no statistically significant differences between pregnant and non-pregnant women in mean age, duration of infertility, body mass index, the oocyte-embryo quality parameters, and hormone levels. Homocystein did not have any correlation with M2, late M2, and total number of oocytes, number of fertilized oocytes and transferred embryos, and embryo quality grade. Area under curve (AUC) of hcy for prediction of pregnancy failure was 0.922 (p = 0.0001, 95% Confidence interval 0.85-0.99). A threshold of 11.9 µmol/L of hcy had a sensitivity of 82%, specificity of 100%, positive predictive value of 100% and negative predictive value of 91.6% for prediction of pregnancy failure. The subgroup analysis in male factor infertility group (n = 28), showed that mean homocystein was 9.9 ± 2.44 µmol/L and 14.1 ± 2.72 µmol/L in pregnant and non-pregnant women, respectively (p = 0.002). CONCLUSION: Low follicular fluid homocysteine level is associated with a better chance of clinical pregnancy.

Recurrent implantation failure is more frequently seen in female patients with poor prognosis.

BACKGROUND: This study evaluated the characteristics and results of patients who suffer from recurrent implantation failure (RIF). MATERIALS AND METHODS: In this cross sectional study, a total of 2183 cases who were evaluated retrospectively at the Istanbul University Cerrahpasa Medical Faculty, Department of Obstetrics and Gyneacology, IVF unit between 2000-2007. According to the data gathered, we included 1822 cases in this study. We compared 185 patients with RIF to 1637 women without RIF. RESULTS: Pregnancy was achieved by 589 couples out of 1822 (32%). The implantation rate was 10%, which declined to 5.8% after the fourth attempt. In the RIF group, patients' mean age was higher and there were more overweight women, the duration of fertility was longer, day 3 follicle stimulation hormone (FSH) levels and the total gonadotropin dose administered were higher, mean level of Estradiol (E2) on the human chorionic gonadotropin (hCG) day was lower, and the mean level of progesterone on the hCG day was elevated compared to the non-RIF group. Although the comparison of MII oocyte number was not significant, the mean number of fertilized oocytes was found to be significant in favor of the non-RIF group. The endometrial thicknesses were found to be similar for both groups. Comparison of sperm motility and morphology were statistically significant in favor of the RIF group. CONCLUSION: In our study, we have found that the group with RIF were comprised of patients with poor prognosis who were older, overweight, had a longer infertility duration, a higher FSH level, and needed more gonadotropin doses in controlled ovarian hyperstimulation (COH). Sperm motility and morphology were better in the RIF group compared to the non-RIF group, and multiple pregnancy rates were lower in RIF patients.

Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles.

OBJECTIVE: To evaluate predictive role of day-3 serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) in ovarian hyperstimulation syndrome (OHSS) in patients undergoing IVF/ICSI cycles. MATERIALS AND METHODS: Forty-one women with moderate/severe OHSS and 41 age matched women without OHSS were compared to evaluate the predictive value of certain risk factors for OHSS. AFC, and E(2), FSH, LH, AMH, inhibin-B levels measured on day 3 of the menstrual cycle before controlled ovarian hyperstimulation. RESULTS: Mean FSH was significantly lower (p < 0.0001); and mean LH, AFC and AMH were significantly higher in women with OHSS compared to women without OHSS (p = 0.049, p < 0.0001 and p < 0.0001, respectively). There was no significant difference in inhibin B (p = 0.112) and estradiol (p = 0.706) between the groups. The ROC area under curve (AUC) for AMH presented the largest AUC among the listed risk factors. AMH (AUC = 0.87) and AFC (AUC = 0.74) had moderate accuracy for predicting OHSS while Inhibin B (AUC = 0.58) and LH (AUC = 0.61) had low accuracy. The cut-off value for AMH 3.3 ng/mL provided the highest sensitivity (90%) and specificity (71%) for predicting OHSS. It's positive (PPV) and negative predictive values (NPV) were 61% and 94%, respectively. The cut-off value for AFC was 8 with 78% sensitivity, 65% specificity, 52% PPV and 86% NPV. CONCLUSION: Measurement of basal serum AMH and AFC can be used to determine the women with high risk for OHSS.

Different serum anti-Müllerian hormone concentrations are associated with oocyte quality, embryo development parameters and IVF-ICSI outcomes.

OBJECTIVE: To evaluate the association between different basal serum levels of anti-Müllerian hormone (AMH) and oocyte-embryo quality and IVF outcomes. MATERIALS AND METHODS: Two hundred and nine infertile women who underwent in vitro fertilization treatment with intracytoplasmic sperm injection (ICSI) between January 2009 and February 2011 were included in the study. Mean age, BMI, FSH, E(2), inhibin B, duration of infertility, total gonadotropin dose, antral follicle count, morphology of all oocytes, percentage of MII, early cleavage rate, the number of good quality embryos in transfer and ongoing pregnancy (>12 weeks) rates were evaluated. RESULTS: Six groups were formed according to the percentiles as <10% (≤0.89 ng/ml; n = 21), 10-25% (0.89-1.40 ng/ml; n = 31), 25-50% (1.40-2.89 ng/ml; n = 53), 50-75% (2.89-4.83 ng/ml; n = 28), 75-90% (4.83-8.06 ng/ml; n = 55), >90% (>8.06 ng/ml; n = 21). Central granulation, cytoplasmic granulation, oocyte postmaturity, percentage of embryos, early cleavage and percentage of transferred good quality embryos were significantly different in five groups (ANOVA test). Ongoing pregnancy rate (PR) was the lowest in <10% (9.5%), and the highest in 50-75% group (39.3%). (P = 0.040) CONCLUSION: Different AMH levels may predict the quality of oocytes, presence of postmaturity and nucleoli Z score, early cleavage and ICSI outcomes.

An alternative treatment option in tubal ectopic pregnancies with fetal heartbeat: aspiration of the embryo followed by single-dose methotrexate administration.

OBJECTIVE: To present 13 cases of unruptured tubal ectopic pregnancies successfully treated with ultrasound-guided aspiration and local and systemic methotrexate (MTX) administration. DESIGN: Case series. SETTING: University hospital. PATIENT(S): Thirteen women with an unruptured tubal ectopic pregnancy. INTERVENTION(S): Transvaginal ultrasound-guided aspiration of the tubal ectopic pregnancy followed by MTX administration into the gestational sac (half of the calculated total dose of 25 mg/m(2)) and intramuscular injection (the remaining half of the calculated total dose of 25 mg/m(2)). MAIN OUTCOME MEASURE(S): Recovery of the patients, successful conservative treatment of the tubal ectopic pregnancies with preservation of the fallopian tubes. RESULT(S): Twelve (92%) of 13 women were successfully aborted, without need for salpingectomy or salpingostomy. CONCLUSION(S): Transvaginal ultrasound-guided aspiration of fetus followed by local and systemic methotrexate administration can be safely used to treat unruptured tubal ectopic pregnancies.

Serum anti-Müllerian hormone level as a predictor of poor ovarian response in in vitro fertilization patients.

PURPOSE: To evaluate the clinical value of day 3 serum anti-Müllerian hormone (AMH) compared with day 3 serum follicle-stimulating hormone (FSH) and human chorionic gonadotropin (hCG) day estradiol (E2) levels and antral follicle count (AFC) in the prediction of poor ovarian response in controlled ovarian hyperstimulation (COH). METHODS: AMH, FSH and AFC on day 3 as well as hCG day E2 levels were determined in 164 subjects. Receiver operating curve analyses and area under curves (AUC) of the study parameters were performed. Predictive values of the levels of day 3 AMH, FSH, AFC, and hCG day E2 as clinical parameters of ovarian response to COH were studied. RESULTS: Thirty-eight women were defined as poor responders. The day 3 AMH and hCG day E2 levels and AFC of normal responders were significantly higher than those of the poor responders. In predicting poor response, the AUC of day 3 AMH level was significantly higher than that of day 3 FSH level but was similar to the hCG day E2 level. Day 3 AMH, FSH and hCG day E2 levels and AFC were found to predict a poor response. Day 3 AMH and hCG day E2 levels were more predictive compared with day 3 FSH level and AFC. The cut-off level of AMH was ≤2 with a sensitivity of 78.9% and a specificity of 73.8%. CONCLUSION: Day 3 AMH has the ability to predict a poor response to COH and it is more predictive than day 3 FSH and AFC.

Expression and comparison of gap junction protein connexin 37 in granulosa cells aspirates from follicles of poor responder and nonpoor responder patients.

OBJECTIVE: To localize gap junction protein connexin 37 (Cx37) in granulosa cells obtained from aspiration of follicles, and to compare differences between poor responder and nonpoor responder patients in assisted reproductive technology. DESIGN: Prospective clinical study. SETTING: IVF unit of a university hospital. PATIENT(S): Seventy patients with various causes of infertility, undergoing an IVF treatment. INTERVENTION(S): Controlled ovarian hyperstimulation, serum hormone level measurements, ultrasonography scanning of ovarian follicles, oocyte retrieval after hCG administration and embryo transfer. MAIN OUTCOME MEASURE(S): Outcome of the IVF treatment and expression rate of Cx37 in granulosa cells. RESULT(S): Connexin 37 was expressed in the granulosa cells of all the patients. Connexin 37 rate in granulosa cells in the poor responder group was 81.32 +/- 35.86% (distribution: 2.95%-99.9%), while it was 88.98 +/- 23.73% (distribution: 6.30%-100.00%) in the nonpoor responder group. Connexin 37 rates between the two groups were not significantly different. CONCLUSION(S): Connexin 37 is expressed in the granulosa layer of follicles in the human ovary, and expression of Cx37 in granulosa cells was not different between poor responder and nonpoor responder patients.

Regional clinical practice patterns in reproductive endocrinology: a collaborative transnational pilot survey of in vitro fertilization programs in the Middle East.

BACKGROUND: This research describes current clinical and demographic features sampled from reproductive endocrinology programs currently offering in vitro fertilization (IVF) in the Middle East. METHODS: Clinic leadership provided data via questionnaire on patient demographics, demand for IVF services, annual cycle volume, indications for IVF, number of embryos transferred, twinning frequency, local regulations governing range of available adjunct therapies, time interval between initial enrollment and beginning IVF as well as information about other aspects of IVF at each center. RESULTS: Data were received from representative IVF clinics (n = 13) in Cyprus, Egypt, Iran, Israel, Jordan, Lebanon, Qatar, Saudi Arabia and Turkey. Mean (+/- SD) age of respondents was 47.8 +/- 8 yrs, with average tenure at their facility of 11.2 +/- 6 yrs. Estimated total number of IVF programs in each nation responding ranged from 1 to 91. All respondents reported individual participation in accredited CME activity within 24 months. 76.9% performed embryo transfers personally; blastocyst transfer was available at 84.6% of centers. PGD was offered at all sites. In this population, male factor infertility accounted for most IVF consultations and the majority (59.1%) of female IVF patients were < 35 yrs of age. Prevalence of smoking among female IVF patients was 7.2%. Average number of embryos transferred was 2.4 (+/- 0.4) for patients at age < 35 yrs, and 2.9 (+/- 0.8) at age > 41 yrs. For these age categories, twinning (any type) was observed in 22.6 (+/- 10.8)% and 13.7 (+/- 10.4)%, respectively. In 2005, the average number of IVF cycles completed at study sites was 1194 (range 363-3500) and 1266 (range 263-4000) in 2006. Frozen embryo transfers accounted for 17.2% of cycles at these centers in 2005. Average interval between initial enrollment and IVF cycle start was 8 weeks (range 0.3-3.5 months). CONCLUSION: This sampling of diverse IVF clinics in the Middle East, believed to be the first of its kind, identified several common factors. Government registry or oversight of clinical IVF practice was limited or nonexistent in most countries, yet number of embryos transferred was nevertheless fairly uniform. Sophisticated reproductive health services in this region are associated with minimal delay (often < 8 weeks) from initial presentation to IVF cycle start. Most Middle East nations do not maintain a comprehensive IVF database, and there is no independent agency to collect transnational data on IVF clinics. Our pilot study demonstrates that IVF programs in the Middle East could contribute voluntarily to collaborative network efforts to share clinical data, improve quality of care, and increase patient access to reproductive services in the region.

Transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose for treatment of unruptured tubal heterotopic pregnancy.

OBJECTIVES: To report a case of tubal heterotopic pregnancy (HP) treated conservatively with transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose. METHODS: Aspiration of the tubal ectopic pregnancy and hyperosmolar glucose instillation was performed with a 16-gauge needle under transvaginal ultrasound guidance. RESULTS: Unruptured tubal HP with positive cardiac activity was treated successfully without any further interventions, and intrauterine pregnancy has reached full-term without any complications. CONCLUSIONS: Early diagnosis of this life-threatening condition is the key to its successful treatment. Transvaginal ultrasound-guided aspiration and hyperosmolar glucose injection can be safely performed for the treatment of unruptured tubal HP.

Detection of an inguinal ovary at controlled ovarian stimulation that was successfully treated by repositioning.

OBJECTIVE: To report a rare case of an ectopic ovary placed in the inguinal canal that was detected while performing a controlled ovarian hyperstimulation (COH). DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A couple with primary infertility for 4 years was referred to our infertility clinic. The woman's medical history revealed a left inguinal operation at age 7. On vaginal ultrasound, only the right ovary could be seen. An infertility workup conducted for the man revealed teratospermia. The couple was subsequently admitted to the in vitro fertilization (IVF) program. While having a COH, the woman experienced a painful swelling in the inguinal area, and an ovarian image with follicular growth on the left inguinal region was observed with ultrasound. Afterward, surgery was performed, and the ectopic ovary in the left inguinal region was detected. INTERVENTION(S): Detection of an inguinal ovary with a controlled ovarian hyperstimulation procedure and surgical repositioning of the ectopic ovary. MAIN OUTCOME MEASURE(S): Controlled ovarian hyperstimulation, transabdominal ultrasound, transvaginal ultrasound. RESULT(S): The ectopic ovary was successfully repositioned with surgery. CONCLUSION(S): Patients must be closely monitored while performing COH. In patients who do not have a unilateral ovary, a painful inguinal mass should alert the physician to the possible presence of an ectopic ovary in the inguinal canal.

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.

Follicular fluid concentrations of vascular endothelial growth factor, inhibin A and inhibin B in IVF cycles: are they markers for ovarian response and pregnancy outcome?

OBJECTIVE(S): The aim of this study was to measure concentrations of vascular endothelial growth factor (VEGF), inhibin A and inhibin B in follicular fluid (FF) of women undergoing to in vitro fertilization (IVF) cycles and to determine their relationship with ovarian response and pregnancy. STUDY DESIGN: Follicular fluid was collected from 58 patients undergoing oocyte retrieval for IVF. Ovulation was induced with GnRH analogues and gonadotropins. Follicular fluids of mature follicles (>17 mm) were aspirated and pooled for each patient. Follicular fluid steroid hormone levels (E2, P) and VEGF, inhibin A, inhibin B concentrations were studied. The serum levels of E2, P and VEGF were also assessed on the day of the oocyte retrieval. These parameters and characteristics of the cycles were compared between the pregnant (group 1) and non pregnant (group 2) patients. RESULTS: The serum and FF VEGF levels were found to be significantly lower in the group in whom the pregnancy was achieved (P < 0.001). The FF inhibin A and FF inhibin B were found to be significantly higher in pregnant group (P < 0.001). However, age, day 3 FSH, dosage of gonadotropin administered, fertilization rate, sperm count, motile and morphologically normal sperm percentage were not significantly different in the two groups. There was an negative correlation between VEGF and number of follicles, number of oocytes, FF inhibin A, FF inhibin B. The number of oocytes retrieved, the fertilization rate were positively correlated with FF inhibin B and FF inhibin A. CONCLUSION: This study demonstrated that decreased FF VEGF, serum VEGF and elevated FF inhibin A and B are associated with better ovarian response and high pregnancy rate.

Infertility due to intrauterine residual fetal bone fragments.

A case of intrauterine retention of fetal bone diagnosed 8 years after termination of a pregnancy is presented. The patient had a history of hypermenorrhea infertility, and persistent vaginal discharge beginning after the abortion. Transvaginal sonography demonstrated an intrauterine foreign body. Curettage was performed, and fetal bone fragments were found within the removed materials.

Conservative treatment of cervical ectopic pregnancy with transvaginal ultrasound-guided aspiration and single-dose methotrexate.

OBJECTIVE: To present a case of cervical ectopic pregnancy successfully treated with ultrasound-guided aspiration and single-dose methotrexate administered systemically. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 27-year-old nulliparous woman with a cervical ectopic pregnancy. INTERVENTION(S): Transvaginal ultrasound-guided aspiration of the cervical ectopic pregnancy followed by single-dose methotrexate administered systemically. MAIN OUTCOME MEASURE(S): Recovery of the patient, successful conservative treatment of the cervical ectopic pregnancy, with preservation of the uterus. RESULT(S): The cervical ectopic pregnancy was successfully aborted, and the reproductive capability of the patient was preserved. CONCLUSION(S): Transvaginal ultrasound-guided aspiration in combination with single-dose methotrexate administered systemically can be safely used to treat cervical ectopic pregnancies.