Spontaneous pregnancy rates after reproductive surgery.

With the development of IVF procedures, the role of reproductive surgery in the management of infertile couples has been questioned. Pregnancy rates (PR) after IVF procedures are well known, but recent data on spontaneous PR after reproductive surgery are scarce. This study aimed to prospectively evaluate how often fertility is restored by reproductive surgery and to identify which independent factors influence spontaneous pregnancy after reproductive surgery. Eight hundred eighty-eight infertile women who underwent surgery for infertility were prospectively included. Women who were referred to IVF after surgery, ceased to plan pregnancy and were lost to follow-up were excluded. Spontaneous PR was analysed for 519 women. A total of 252 (48.6%) women, including 30 treated with clomiphene citrate, conceived spontaneously in the 12-18 months observation period following surgery. Multivariate logistic regression showed that woman's age (OR 0.95, 95% CI 0.90-0.99) and duration of infertility (OR 0.86, 95% CI 0.74-0.99) significantly influence spontaneous PR. Each year of infertility lowers spontaneous PR following surgery by 14% and each year of woman's age by 5%. The study shows a relatively high percentage of women conceived spontaneously after reproductive surgery. The role of reproductive surgery in the management of infertility should be re-evaluated.

Determination of serum lysophosphatidic acid as a potential biomarker for ovarian cancer.

A fast and selective analytical method, used to determine the different lysophosphatidic acid (LPA) species in serum, has been developed and validated. LPA species were quantitatively extracted from serum using methanol-chloroform (2:1, v/v). The proteins were precipitated by this solvent mixture and separated by centrifugation in one step. LPA levels were determined in clear extracts using the HPLC-MS/MS method. The linearity of this method was established in the concentration range between 0.1 and 16 microM for all LPA species with a correlation coefficient greater than 0.99. Recovery of all LPA species determined by the serum, fortified at approximately 1 microM and 2-3 microM, was between 93% and 111% with an average R.S.D. of less than 8%. This method was used to determine LPA in numerous sera of healthy controls, patients with benign ovarian tumours and ovarian cancer at different stages. Significantly higher total LPA levels were determined in the sera of patients with different types of tumours (benign and malignant).

Gonadotrophin-releasing hormone agonist protocol of controlled ovarian hyperstimulation as an efficient treatment in Bologna-defined poor ovarian responders.

In this retrospective study the outcomes of two protocols of controlled ovarian hyperstimulation and natural cycle in poor ovarian responders defined according to the Bologna criteria were compared to elucidate which approach is more suitable for the treatment of these patients. We comparatively analyzed 142 cycles of GnRH antagonist (GnRH-ant) protocol, 53 cycles of GnRH agonist (GnRH-a) protocol, and 36 natural cycles. The mean number of oocytes (2.8±1.8) and embryos (1.6±1.2) per aspiration was significantly higher in GnRH-a protocol in comparison to GnRH-ant protocol and natural cycle, but the proportion of immature, fertilized oocytes, and embryos, including the quality of transferred embryos, was very similar in all treatments. The proportion of pregnancies per oocyte aspiration did not differ significantly between treatments (18.9% after GnRH-a, 10.6% after GnRH-ant, 5.6% after natural cycle), but the live birth rate per aspiration was significantly higher after GnRH-a protocol than after GnRH-ant protocol (15.1% vs. 4.2%; p=0.024).

Comparison of GnRH agonist, GnRH antagonist, and GnRH antagonist mild protocol of controlled ovarian hyperstimulation in good prognosis patients.

The reports on how to stimulate the ovaries for oocyte retrieval in good prognosis patients are contradictory and often favor one type of controlled ovarian hyperstimulation (COH). For this reason, we retrospectively analyzed data from IVF/ICSI cycles carried out at our IVF Unit in good prognosis patients (aged <38 years, first and second attempts of IVF/ICSI, more than 3 oocytes retrieved) to elucidate which type of COH is optimal at our condition. The included patients were undergoing COH using GnRH agonist, GnRH antagonist or GnRH antagonist mild protocol in combination with gonadotrophins. We found significant differences in the average number of retrieved oocytes, immature oocytes, fertilized oocytes, embryos, transferred embryos, embryos frozen per cycle, and cycles with embryo freezing between studied COH protocols. Although there were no differences in live birth rate (LBR), miscarriages, and ectopic pregnancies between compared protocols, pregnancy rate was significantly higher in GnRH antagonist mild protocol in comparison with both GnRH antagonist and GnRH agonist protocols and cumulative LBR per cycle was significantly higher in GnRH antagonist mild protocol in comparison to GnRH agonist protocol. Our data show that GnRH antagonist mild protocol of COH could be the best method of choice in good prognosis patients.