Does cabergoline administration affect endometrial VEGFR-2 expression in a rat model of ovarian hyperstimulation syndrome?

OBJECTIVE: To assess the effect of cabergoline on endometrial vascular endothelial growth factor receptor-2 (VEGFR-2) immunoexpression in an ovarian hyperstimulation syndrome (OHSS) rat model. MATERIAL AND METHODS: Twenty-one immature female Wistar rats were assigned into three groups: group 1, the control group; group 2, stimulated with gonadotropins to mimic OHSS; and group 3, in which an OHSS protocol was induced and thereafter treated with cabergoline (100 µg/kg/day). Body weight, ovarian volume, corpora lutea numbers, and endometrial VEGFR-2 expression were compared between the groups. RESULTS: Weight gain and ovarian volume were highest in the OHSS-placebo group, while cabergoline administration significantly reversed those effects (p = 0.001 and p = 0.001, respectively). VEGFR-2 stained cells were significantly lower in groups 2 and 3 compared to group 1 (p = 0.002). Although VEGFR-2 expression was lowest in group 3, the difference was not statistically significant. Corpora lutea numbers were also similar (p = 0.465). CONCLUSION: While successful implantation requires a vascularized receptive endometrium, impaired expression of VEGFR-2 and disrupted endometrial angiogenesis due to cabergoline administration may be associated with IVF failure in fresh OHSS cycles. The insignificant decrease in endometrial VEGFR-2 expression observed in this research needs to be investigated by further studies involving additional techniques such as immunoblotting and/or RT-PCR analyses.

Placenta specific protein-1 in recurrent pregnancy loss and in In Vitro Fertilisation failure: a prospective observational case-control study.

Observations from studies have provided evidence that Placenta-specific protein1 (PLAC1) is important for the establishment and maintenance of pregnancy and suggest it as a potential biomarker for gestational pathologies. The aim of this study is to investigate whether maternal serum PLAC1 levels have any impact on etiopathogenesis of recurrent pregnancy loss (RPL) and repeated implantation failure after In Vitro Fertilisation (RIF). We conducted a prospective observational case-control study in a Research Hospital. Twenty-eight patients with RPL (group 1), 30 patients with unexplained infertility and RIF (group 2), 29 fertile patients (group 3) were included. The demographic features and serum PLAC1 levels were compared. There was a significant difference in PLAC1 levels between the groups (group 1 = 19.71 + 16.55 ng/ml; group 2 = 4.82 + 1.44 ng/ml; group 3 = 0.89 + 0.62 ng/ml, respectively) (p=.001). Positive correlation was found between serum PLAC1 levels and abortion rates (r = 0.64; p=.001), a negative correlation was found between serum PLAC1 levels and live birth rates (r = -0.69; p=.001). PLAC1 might have a negative effect on implantation in RPL and RIF. There may be a subgroup of PLAC with different bioactivity. There are no relevant studies conducted among these populations, further large-scale studies are needed to assess the molecular role of PLAC1 on implantation.IMPACT STATEMENTWhat is already known about this subject? PLAC1 (placenta-specific protein-1) gene is located on the X chromosome which encodes for a protein that is thought to be important for placental development although its role has not been clearly defined. Studies in the literature have provided evidence that PLAC1 has an important role in the establishment and maintenance of pregnancy and suggest it as a potential biomarker for gestational pathologies. Several reports over the past few years have demonstrated PLAC1 expression in a variety of human tumours including lung cancers, breast cancer, hepatocellular and colorectal cancers, gastric cancers and uterine cancers.What do the results of this study add? There have been no previous studies conducted among patients with recurrent pregnancy loss (RPL) or repeated implantation failure after In Vitro Fertilisation (RIF) that have searched for any association between PLAC1 levels and implantation failure. This study has demonstrated higher PLAC1 levels in infertile women with RIF and RPL for the first time; suggesting that it could have a negative effect on implantation in these populations. PLAC1 could be detected in the serum as a biomarker that is associated with RIF and RPL. What are the implications of these findings for clinical practice and/or further research? Defining the precise role of PLAC1 during implantation will provide new insight into understanding of poor reproductive outcomes such as RIF and RPL and help in developing treatment strategies. Further large-scale studies with more patients are needed to uncover the clinical value of PLAC1 as a biomarker to predict repeated implantation failure and RPL.

Follicular fluid total antioxidant capacity levels in PCOS.

In this study, our aim was to assess total antioxidant capacity (TAC) levels in follicular fluid (FF) and their relationship to clinical pregnancy rates in PCOS patients undergoing assisted reproduction (ART). Twenty-two women with polycystic ovary syndrome (PCOS) (Group 1) and 41 women without PCOS (Group 2) were included in this study. Clinical and laboratory parameters and FF TAC levels were investigated. No statistically significant differences were found between the groups with regard to age and baseline parameters. Although we could not demonstrate a significant difference in FF TAC levels between the two groups (p=0.469), there was a significant positive correlation between FF TAC and clinical pregnancy rates, BMI, and the duration of infertility for the entire group (r=0.254, p=0.048; r=0.312, p=0.013; r=0.259, p=0.040; respectively). Owing to the correlation between FF TAC and the clinical pregnancy rates, further studies evaluating the impact of FF TAC levels on ART outcomes in patients with PCOS and other etiologies of infertility are needed.

Sonographic Assessment of the Fetal Penile Development.

The intrauterine diagnosis of micropenis is an important clue in the discernment of some syndromes and hormonal deficiencies. In this study, we tried to establish reference ranges for the fetal penile length and penile width. This prospective cross-sectional study included 179 healthy singleton male fetus pregnancies that were between 17 and 37 weeks of gestation. Of these pregnancies, the fetal penile length and width were measured using trans-abdominal ultrasound. The correlation coefficients of gestational age with penile measurements were calculated. We observed that as the gestational age increased both the penile length and width increased (p < .0001, correlation coefficients R(2) = 0.854 and R(2) = 0.883; respectively). Reference values of the penile length in the Turkish Population were similar to previously evaluated populations including English, American and Israeli populations. The penile width measurement is a convenient way to diagnose micropenis, but penile width measurement alone might miss some penile abnormalities including chordee and hypospadias.

Comparison of bevacizumab and cabergoline in the treatment of ovarian hyperstimulation syndrome in a rat model.

The aim of this study is to investigate the effects of bevacizumab in a rat model of ovarian hyperstimulation syndrome (OHSS) and compare with cabergoline. The study was performed with 24 rats in four main groups (one non-stimulated control and three OHSS treatment groups; bevacizumab, cabergoline and placebo). The rats were randomly assigned to four experimental groups (six rats per group). Efficacy of treatment was assessed on 29th day by measuring weight gain, number of eggs, presence of ascites and ovarian weight. Peritoneal fluid levels of vascular endothelial growth factor (VEGF) were measured using an enzyme-linked immunosorbent assay. Ovarian weights were significantly higher in the OHSS groups than the control group. Ovarian weights in OHSS placebo group were found to be higher than those in OHSS-treatment groups (p = 0.002). VEGF levels were found increased in the OHSS-placebo group compared with the control group (p < 0.05). This increase was not seen in the OHSS groups treated with either bevacizumab or cabergoline. We demonstrate in this study that bevacizumab can lower VEGF production and ovarian weight in rats treated with gonadotropins.

Serum levels of visfatin and possible interaction with iron parameters in gestational diabetes mellitus.

BACKGROUND/AIMS: Visfatin is a novel adipokine with insulinomimetic properties that increases in diabetes. However, for gestational diabetes mellitus (GDM) there are conflicting reports. Recent studies have reported a positive association of serum ferritin concentrations with insulin resistance. Thus, we assessed serum levels of visfatin in pregnant women with varying degrees of glucose tolerance and investigated the possible interaction of visfatin with parameters of iron metabolism. METHODS: Visfatin levels were measured at 24-28 weeks of gestation in 88 women who were divided into three groups according to their response to a 50-gram glucose challenge test and a 100-gram oral glucose tolerance test: control group (n = 28), impaired glucose tolerance (IGT) group (n = 30) and GDM group (n = 30). RESULTS: Visfatin levels were significantly higher in the GDM and IGT group than in control (p < 0.001 for GDM vs. control, and p = 0.004 for IGT vs. control). Serum visfatin was significantly associated with serum ferritin, insulin, age, gravidity, and body mass index. In a linear regression model, the covariates explained only 17% of variability of serum visfatin concentration. Body mass index (p < 0.001) contributed independently to visfatin variance. CONCLUSION: Serum visfatin concentration is significantly higher in GDM and is correlated with ferritin levels.

Antiadhesive role of human amniotic fluid on peritoneal adhesion formation in a rat model. Experimental study.

OBJECTIVE: To determine the role of human amniotic fluid (HAF) in preventing or reducing postoperative adhesions. STUDY DESIGN: Uterine horn adhesion model was carried out in 24 female Wistar rats. The animals were randomized into 4 groups: (1) control, (2) Ringer's lactate, (3) whole HAF, and (4) HAF depleted from cells and proteins. Adhesion grade and histologic findings of adhesion-carrying tissues were evaluated and groups were compared according to these parameters. RESULTS: Rats treated with whole HAF had less adhesion grade when compared to the control group, but the difference was not statistically significant. On the other hand, centrifuged amniotic fluid treatment significantly reduced peritoneal adhesion grade, fibrosis and inflammation (p < 0.05). CONCLUSION: Whole HAF seems to have no beneficial effect on peritoneal adhesion formation, but HAF depleted of protein and cells does have a positive effect on reducing adhesion formation.

Effect of vitamin D on postoperative adhesion formation in a rat uterine horn adhesion model.

OBJECTIVE: To determine the role of vitamin D for preventing or reducing postoperative adhesions. STUDY DESIGN: The uterine horn adhesion model was carried out in 24 female Wistar rats. The animals were randomized into 4 groups: (1) control, (2) Ringer's lactate, (3) olive oil, and (4) vitamin D. Adhesion grade and histologic findings of adhesion-carrying tissues were evaluated, and groups were compared according to these parameters. RESULTS: Rats treated with vitamin D had less adhesion and lower inflammation grade when compared to the control and Ringer's lactate groups, and the results were statistically significant (p < 0.05). On the other hand, no difference was detected between the groups according to the fibrosis score. CONCLUSION: Vitamin D decreased postsurgical adhesion scores by both visual scores and histologic analyses in a rat model. Further experimental and clinical trials are required to confirm these results.

Is there a detrimental effect of higher gonadotrophin dose on clinical pregnancy rate in normo-responders undergoing ART with long protocol?

BACKGROUND: In recent years, it has become evident that ovarian stimulation, although a central component of in vitro fertilization (IVF), may itself has detrimental effects on oogenesis, embryo quality, endometrial receptivity, and perhaps also perinatal outcomes. OBJECTIVE: To evaluate the effect of higher gonadotrophin dose on clinical pregnancy rate in normo-responder ICSI cycles with long protocol. METHODS: A retrospective study was planned in the Department of Reproductive Endocrinology of Zekai Tahir Burak Women's Health Education and Research Hospital. 362 normo-responders undergoing ICSI cycles with long protocol were included in the study. Group 1 (n = 260): Total gonadotrophin dose <2198 IU and Group 2 (n = 102): Total gonadotrophin dose >2198 IU. Laboratory IVF outcome, clinical pregnancy rate were evaluated. RESULT(S): There was no statistically significant difference between peak estradiol levels, endometrial thickness, fertilization rates among the Group 1 versus Group 2 (p > 0.05). But there was a statistically significant difference in age, baseline FSH, oocyte number, 2PN, and clinical pregnancy among the Group 1 versus Group 2. Clinical pregnancy rate were significantly higher in Group 1 compared with Group 2 (p < 0.001). Lower gonadotrophin dose, 2PN was an independent positive predictor of clinical pregnancy (OR 2.65 for gonadotrophin dose, OR 1.1 for 2PN) CONCLUSION(S): Higher total gonadotrophin dose adversely affect clinical pregnancy in normo-responder patients undergoing ICSI cycles with long protocol.

Secondary cytoreductive surgery outcomes of selected patients with paclitaxel/platinum sensitive recurrent epithelial ovarian cancer.

OBJECTIVE: The aim of this study was to evaluate the effect of secondary cytoreductive surgery (SCRS) on survival and to determine prognostic factors that may predict surgical and survival outcome. STUDY DESIGN: Between 1999 and 2011, data of 67 patients who had SCRS for epithelial ovarian cancer were evaluated. Factors that had an impact on survival were determined by statistical analysis. RESULTS: Univariate analysis showed that the number of chemotherapy cycles after primary surgery, CA 125 level at SCRS, number of recurrent tumors, recurrence before SCRS, disease dissemination, and number of chemotherapy cycles after SCRS were significantly associated with disease free survival after SCRS. In multivariate analysis, serum CA125 level, tumor dissemination, and number of chemotherapy cycles after SCRS were significantly associated with disease free survival. Moreover, univariate analysis showed that recurrence before SCRS was significantly associated with overall survival. CONCLUSION: SCRS may be beneficial for first relapsed, localized paclitaxel/platinum sensitive epithelial ovarian tumors and patients with a low serum CA 125 level and those who will receive ≥ 6 chemotherapy cycles after SCRS. This procedure should be considered in selected patient populations.

Comparison of low-dose oxytocin and dinoprostone for labor induction in postterm pregnancies: a randomized controlled prospective study.

AIMS: The aim of this study was to compare the efficacy of oxytocin and dinoprostone in achieving successful labor induction and vaginal delivery in postterm women with an unfavorable cervix. METHODS: Postterm women with an uncomplicated pregnancy and a Bishop score of ≤6 were randomized to receive either dinoprostone vaginal pessary (Propess®) or low-dose oxytocin. The primary outcomes were the length of the induction-to-delivery period and the incidence of vaginal delivery. RESULTS: A total of 144 women were available for the analysis. The overall vaginal delivery rates were 75% (54/72) for the dinoprostone group and 80.6% (58/72; p = 0.35) for the oxytocin group; the mean induction-to-vaginal delivery interval was 13.3 and 10.3 h in the dinoprostone and the oxytocin group, respectively (p = 0.003). Uterine hyperstimulation was 7.4% compared with 6.8% (p = 0.8), and abnormal fetal heart rate was 26.4% compared with 18% (p = 0.2), respectively. CONCLUSION: Both oxytocin and dinoprostone seem to have similar obstetric outcomes in postterm pregnancies with an unfavorable cervix, except for a significant superiority of oxytocin for delivery in a shorter period.

What is the impact of cervical invasion on lymph node metastasis in patients with stage IIIC endometrial cancer?

PURPOSE: The aim of this study was to evaluate whether the presence of cervical invasion has altered the site of lymph node (LN) metastasis in stage IIIC endometrial cancer (EC) patients. METHODS: Fourty-six patients who had systematic pelvic and para-aortic lymphadenectomy surgery for EC and staged as IIIC were included in the study. Patients with cervical invasion were defined as Group A and patients without cervical invasion were defined as Group B. The groups were compared according to surgical-pathologic characteristics. Chi-square and Annova table test were used to examine the effect of cervical invasion on LN metastasis. RESULTS: The mean age of patients was 59 years (range 38-81) and tumor size was 47 mm (range 10-80). Twenty-three patients had cervical involvement (Group A) and 23 had no cervical metastasis (Group B). Groups were not different with regard to cell type, grade, depth of myometrial invasion, tumor size, adnexal involvement, peritoneal metastasis and lymphovascular space invasion. Among 46 patients obturator LN was the most involved site of LN metastasis, however, when there is cervical metastasis external iliac LN was found to be the most involved LN site. Patients without cervical invasion had 21.7% of external iliac LN metastasis while patients with cervical invasion had 60.9% of external iliac LN metastasis. Also, cervical invasion has increased the risk of pelvic LN and obturator LN involvement from 82.6 to 95.7% and 39.1 to 52.2%, respectively. CONCLUSION: Cervical invasion may have an effect on lymphatic spread and change the site of metastatic LNs. Large prospective studies are needed to clarify the alteration of LN metastasis in cervix invaded EC patients.

A prospective evaluation of lymphatic dissemination in endometrial cancer: is it adequate to perform lymph node dissection up to the inferior mesenteric artery?

OBJECTIVE: This study aimed to assess para-aortic metastases relative to the inferior mesenteric artery (IMA). In addition, the clinicopathologic features of these patients are discussed. MATERIALS AND METHODS: Between 2007 and 2009, a total of 78 consecutive patients who had open systematic pelvic and para-aortic lymphadenectomy surgery for endometrial cancer extending to the renal vessels and who were treated at the gynecologic oncology department were included in this prospective study. The para-aortic lymph nodes (PALNs) removed from these patients were classified as supramesenteric (between the renal vein and the IMA) or inframesenteric (between the IMA and the presacral). Patients' clinical data, pathologic tumor characteristics, and operative and early postoperative data were recorded after surgery. Descriptive statistics were calculated using the SPSS 17.0 package program. RESULTS: Of these 78 patients, 18 (21.3%) had metastatic nodal involvement. From a total of 12 patients with PALN metastasis, 7 had only supramesenteric and 1 had only inframesenteric nodal involvement, whereas 4 had both supramesenteric and inframesenteric metastases. Of the 5 patients in the inframesenteric±supramesenteric group, none had a grade 1 tumor. On the other hand, of the 7 patients with only supramesenteric metastasis, 57.1% (n=4) had a grade 1 tumor and 42.8% (n=3) had less than half of myometrial invasion. CONCLUSIONS: In the case of well-defined risk factors in which a lymphadenectomy is indicated according to current guidelines from the International Federation of Gynecology and Obstetrics, a PALN dissection should be extended up to the renal vessels. We also conclude that tumor grade, histologic type, and myometrial invasion cannot be used as markers to decide on supramesenteric lymphadenectomy in endometrial cancer.

Is there any role of interleukin-6 and high sensitive C-reactive protein in predicting IVF/ICSI success? A prospective cohort study.

OBJECTIVES: Studies have established a relationship between proinflammatory factors and implantation failure in IVF/ICSI cycles. Likewise, low-grade chronic inflammation is generally blamed for predisposing infertility. In the present study, we aimed to find a relationship between serum IL-6 and hs-CRP levels and IVF/ICSI cycle outcomes. METHODS: A total of 129 patients who consented to participate and attended the IVF unit of our department for the treatment of infertility have been enrolled in this prospective cohort study. Serum levels of high sensitive C-reactive protein and interleukin 6 have been detected at the beginning of the IVF/ICSI ovulation induction cycle. Cycle outcomes have been compared between patients with and without clinical pregnancy achievement following ART treatments. IVF/ICSI cycle outcomes of these two groups were also comparable except the number of >14 mm follicles, retrieved oocytes, metaphase II oocytes, and fertilized oocytes (2 pronuclei) which were in favor of the clinical pregnancy group. RESULTS: Mean serum hs-CRP levels were 3.08 mg/L (0.12-35.04) and 2.28 mg/L (0.09-22.52) patients with and without clinical pregnancy respectively. Mean serum IL-6 levels were 2 pg/mL (1-10.2) and 2 pg/mL (1-76.9) patients with and without clinical pregnancy respectively. Both tests were found to be statistically insignificant in predicting the success of the ART cycle in terms of implantation, clinical pregnancy, miscarriage, and live birth. CONCLUSIONS: In the present study, we have not found any significant effect of hs-CRP and IL-6 levels in the IVF cycle. However, in the light of this and previous studies, large-scale research may prove the exact influence of these markers on IVF success.

Recurrent implantation failure is associated with increased levels of fetuin-A/alpha2-Heremans-Schmid-glycoprotein.

OBJECTIVE: Recurrent implantation failure is defined as the absence of implantation, after two or three consecutive cycles of in-vitro fertilization (IVF), intracytoplasmic sperm injection or frozen embryo replacement. Human fetuin-A/alpha2-Heremans-Schmid-glycoprotein is a plasma protein secreted by the liver that modulates insulin action in adipocytes. Increased fetuin-A promotes adipocyte dysfunction which results in decreased adiponectin and increased fatty acids and inflammatory cytokines. Fatty acids and inflammatory cytokines were previously reported in implantation failure. Also, fetuin-A inhibits receptor tyrosine kinase activity in trophoblast growth factors which decrease trophoblast viability and invasion. In this study, we aimed to find the association between fetuin-A and implantation failure. STUDY DESIGN: A total of 78 women were included in this case-control study. Serum fetuin-A concentrations were measured in 42 women with recurrent IVF failure and 36 healthy women with regular cycles. RESULTS: The mean serum fetuin-A levels of implantation failure and control women were 257.77 ± 32.18 and 219.59 ± 48.86 respectively with a p-value <0.001 (independent samples t-test). Our results showed a statistically significant difference between serum fetuin-A levels of implantation failure women and controls. CONCLUSION: So far reasons for implantation failure are only partially understood. The current study reveals the association between implantation failure and fetuin-A. Further studies with large population sizes are needed to investigate whether fetuin-A can be used as a marker before controlled ovarian stimulation began or regulation of fetuin-A levels with treatment or lifestyle interventions can improve implantation success.

Gonadotropin releasing hormone antagonist use in controlled ovarian stimulation and intrauterine insemination cycles in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the effect of the GnRH antagonist on gonadotropin ovulation induction in women with PCOS. MATERIALS AND METHODS: A total of 175 intrauterine insemination (IUI) cycles in women with polycystic ovary syndrome (PCOS) were included in the study. Women in the control group (n = 87) underwent controlled ovarian stimulation (COS) with recombinant follicle stimulating hormone (r-FSH) only, while women in the study group (n = 88) were administered r-FSH plus cetrorelix. RESULTS: As expected, the mean value of luteinizing hormone and progesterone, on the day of human chorionic gonadotropin administration were statistically significantly lower in patients receiving GnRH antagonist than the control group (p = 0.002). Premature luteinization occurred in only one of the patients in the GnRH antagonist group (1.1%) and in 15 of the 88 cycles in the control group (17.2%), showing a significant difference between the two groups (P = 0.001). The clinical pregnancy rate per cycle was higher in GnRH-antagonist group compared to the control group but the difference did not reach to a statistical significance (25% vs 14.9%, P = 0.096). CONCLUSIONS: Adding GnRH-antagonist in COS/IUI cycles in women with PCOS resulted in a lower incidence of premature luteinization but did not improve pregnancy rates. However, owing to some benefits, antagonist therapy could be considered as a reasonable alternative to IVF in order to reduce PCOS patients'emotional distress.

Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score ≤ 5.

BACKGROUND: We aimed to evaluate the efficacy and safety of dinoprostone for cervical ripening and labor induction in patients with term oligohydramnios and Bishop score ≤ 5. METHODS: This was a prospective case-control study, which included 104 consecutive women with a Bishop score≤5. Participants were divided into two groups. Women with term isolated oligohydramnios and Bishop score≤5 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (prostaglandin E2; Group A, n=40). The control group, Group B, consisted of 64 cases of pregnancy with normal amniotic fluid volume (amniotic fluid index≥5 cm) and Bishop score≤5, and was matched for patient's age and parity. The primary outcome was time from induction to delivery; the secondary outcomes were the caesarean section (CS) rate, uterine hyperstimulation, rate of failed induction, and neonatal complications. RESULTS: The mean time interval from induction to delivery was not different between the two groups (p=0.849), but there was a statistically significant difference between the groups in terms of the CS rate (p=0.005). There were no differences between the groups in neonatal outcome or perinatal morbidity or mortality. CONCLUSION: Dinoprostone appears to be a safe alternative for induction of labor in pregnancies with oligohydramnios. Induction of labor with dinoprostone in term pregnancies with isolated oligohydramnios is associated with increased rate of CS but there is no higher risk of perinatal complications.

The significance of anthropometric and endocrine parameters in ovulation induction with clomiphene citrate in women with polycystic ovary syndrome.

OBJECTIVES: To investigate factors associated with the response to ovarian stimulation in patients with polycystic ovary syndrome. Methods: The records of patients with polycystic ovary syndrome and infertility who underwent ovulation induction with clomiphene citrate were reviwed between January 2011 and December 2014 in Etlik Zübeyde Hanim Women's Health Training and Research Hospital Ankara, Turkey. The anthropometric and endocrine factors of patients who were resistant to treatment at a dose of 150 mg/day (n=84) were compared with those who responded with growth of at least one graaffian follicle at a dose of 50 mg/day (n=342). Results: Of the parameters examined, body mass index, luteinizing hormone level, and luteinizing hormone/follicle stimulating hormone ratio were significantly higher in the clomiphene citrate-resistant group compared with the responsive group. Conclusion: Reproductive treatment in patients with polycystic ovary syndrome show different outcomes. Significantly higher body mass index, luteinizing hormone level, and luteinizing hormone/follicle stimulating hormone ratio observed in clomiphene citrate resistant group can be a possible explanation for this impedance.

Seasonal variation of human sperm cells among 4,422 semen samples: A retrospective study in Turkey.

We aimed to assess the possible presence of a seasonal pattern in three parameters of semen analysis: sperm concentration, morphology, and motility as a function of the time of ejaculation and sperm production (spermatogenesis) in normal and oligozoospermic men. This retrospective study included a consecutive series of 4,422 semen samples that were collected from patients as a part of the basic evaluation of the infertile couples attending the Reproductive Endocrine Outpatient Clinic of a tertiary women's hospital in Ankara, Turkey, between January 1, 2012 and December 31, 2013. The samples were classified according to sperm concentration: ≥15 x106/mL as normozoospermic samples and 4 -14.99 x106/mL as oligozoospermic samples and seasonal analysis of the semen samples were carried out separately. When the data was analyzed according to the season of semen production, there was no seasonal effect on the sperm concentration. A gradual and consistent decrease in the rate of sperm with fast forward motility was observed from spring to fall with a recovery noticed during the winter. The percentage of sperms with normal morphology was found to be statistically significantly higher in the spring samples compared with the summer samples (p=0.001). Both normozoospermic and oligozoospermic semen samples appeared to have better sperm parameters in spring and winter. The circannual variation of semen parameters may be important in diagnosis and treatment desicions. ABBREVIATIONS: WHO: World Health Organization; mRNA:messenger ribonucleic acid.