Microdose flare-up gonadotropin-releasing hormone [GnRH]agonist versus GnRH antagonist protocols in poor ovarian responders undergoing intracytoplasmic sperm injection

Background: Microdose flare-up GnRH agonist and GnRH antagonist have becomemore popular in the management of poor ovarian responders [POR] in recent years;however, the optimal protocol for POR patients undergoing in vitro fertilization hasstill been a challenge

Methods: In this observational study design, two hundred forty four poor ovarian responderswere retrospectively evaluated for their response to GnRH agonist protocol[group-1, n=135] or GnRH antagonist protocol [group-2, n=109]. Clinical pregnancyrate was the primary end point and was compared between the groups. Student t-test,Mann Whitney U test and 2-test were used to compare the groups. The p<0.05 wasconsidered to show a statistically significant result

Results: The mean total gonadotropin doses were 3814 +/- 891 IU in group 1 and3539 +/- 877 IU in group 2 [p=0.02]. The number of metaphase-II oocytes [3.6 +/- 2.4 vs.2.8 +/- 1.9, p=0.005] and implantation rates [27.8% vs. 18.8%, p=0.04] in group 1 andgroup 2, respectively were significantly different. The fertilization rate in group 1and group 2 was 73% vs. 68%, respectively [p=0.5] and clinical pregnancy rate was19.8% vs. 14.4%, respectively [p=0.13]

Conclusion: The GnRH agonist microdose flare-up protocol has favorable outcomeswith respect to the number of oocytes retrieved and implantation rate; nevertheless,the clinical pregnancy rate was found to be similar in comparison to GnRH antagonistprotocol in poor ovarian responders. GnRH antagonist protocol appears to bepromising with significantly lower gonadotropin requirement and lower treatmentcost in poor ovarian responders

Vaginal micronized progesterone capsule versus vaginal progesterone gel for luteal support in normoresponder IVF/ICSI-ET cycles

To compare the outcomes of luteal phase support by micronized progesteron vaginal capsule 600mg/day and progesterone vaginal gel 180 mg/day in the normoresponder IVF/ICSI-ET cycles of the patients down-regulated via GnRH agonist long protocol or fixed antagonist protocol below 40 years of age. A total of 463 normoresponder cycles between January 2013 and December 2013 were retrospectively analyzed. Those with a BMI>28 kg/m[2], any kind of uterine, ovarian or adnexial pathology, any significant systemic, endocrine or metabolic disease or who were reported as azoospermia, were excluded from the study. The patients were grouped according to the usage of micronized progesterone vaginal capsule 600 mg/day [Group 1] or progesterone vaginal gel 180 mg/day [Group 2] as luteal phase Treatment cycle characteristics and pregnancy outcomes were compared between groups. Group-I included 220 cycles and group 2 included 243 cycles. Although the MII oocyte percentage among the total number of MII oocytes was significantly higher in Group-II [77.5% and 80.2%; p=0.034], positive beta-hCG [32.3% and 21.8%; p=0.015] and clinical pregnancy [27.3% and 17.7%; p=0.018] rates were significantly higher in Group-I. No difference was observed between groups regarding the ongoing pregnancy rates [23.2% and 17.3%; p=0.143]. Micronized progesterone vaginal capsule 600 mg daily used for luteal support in the IVF/ICSIET cycles was observed to significantly increase the biochemical and clinical pregnancy rates compared to progesterone vaginal gel 180 mg daily. However, no difference was observed between two groups regarding ongoing pregnancy rates

incidence of preeclampsia in Intra-Cytoplasmic Sperm Injection pregnancies

We aimed to evaluate the association between infertility etiology in Intra-Cytoplasmic Sperm Injection [ICSI] pregnancies and preeclampsia; besides, we aimed to discuss the effect of the paternal factor in the pathogenesis of preeclampsia. We hypothesized that preeclampsia is more common in ICSI pregnancies with male factor. It is known that maternal exposure to paternal sperm cells over a time period has a protective effect against preeclampsia. Male partners with azospermia have no sperm cells in their seminal fluid, whose female partners will not be able to develop some protective immunity against preeclampsia. We hypothesized that the infertile couples with male factor [partner with azoospermia and also oligospermia] would be an ideal model to test the partner-specific protective immunity against preeclampsia, as the women had no chance to develop adequate protective immunity via the partner's sperm exposure. This Single-center, retrospective study included 508 infertile couples admitted to our IVF center between January 2001 and March 2008. The data regarding the maternal age, etiology of the infertility, the pregnancy rates, abortus ratio and viable pregnancy rates was collected from the case files. Antenatal complications such as preeclampsia, placenta previa, abruptio placenta, premature rupture of membranes, premature labor, oligohydramnios, gestational diabetes, postmaturity, postpartum complications and neonatal outcomes were evaluated via the file records and phone interviewing. The study population was divided into two main groups according to the etiology of infertility. 301 of the study population [group 1] was infertile due to male factor and 207 of the study population [group 2] was female factor and unexplained infertility cases.Group 1 patients were divided further into two subgroups: group 1a included 56 cases in which TESE [testicular sperm extraction] was used to obtain the sperm cells as the male factor was severe and as there was no sperm cells in seminal fluid. Group 1 b consists of 245oligospermic cases who obtained sperm cells via conventional methods. The mean ages of women in Group one and two were 30.22 +/- 5.06 and 31.58 +/- 4.36 years respectively [p=0.001]. 129 cases [42,8%] from group one and 106 cases [51,2%] from Group two ended in first trimester and early second trimester [<24 gestational weeks] pregnancy loss. In group one, only 172 cases of 301 pregnancies passed over 24 weeks of gestational age, whereas in group two, 101 cases of 207 patients passed over 24 gestational weeks. There was no significant difference between two groups regarding chemical pregnancies and early pregnancy loss [p=0.314]. There was no significant difference between the groups regarding placenta previa, gestational diabetes, oligo hydramnios and intrauterine growth retardation. One one pregnancy was 1.5 times more vulnerable for preeclampsia. Pregnancies with azoospermic and oligospermic partners had an increased risk for developing preeclampsia

Association between serum estradiol level on the hCG administration day and IVF-ICSI outcome

Estradiol [E[2]] is required for follicular development and lay an important role in embryo implantation. The aim of this study was to assess the impact of serum E[2] levels on the day of hCG administration in IVF-ICSI patients who are performed controlled ovarian hyperstimulation [COH]. A total of 203 women who were undergone one time IVF cyclus were evaluated in this cross sectional study. All the patients were treated either with long protocol or with microdose flare protocol. The patients were categorized into five groups according to the serum E[2] levels on the day of hCG administration. The mean number of the retrieved oocytes was [NRO] 10.6 +/- 6.7, mean fertilization rate was 55.7 +/- 24.8, and implantation rate was 9.0 +/- 19.2. Of 203 patients, 43 [21%] patients were pregnant. When the overall results are examined, the number of the retrieved oocytes and the number of transferred embryos were better in patients with serum E[2] levels >4000 pg/ml and these values were statistically significant. There were no statistical difference in patients 37 years or older. In women 4000 pg/ml. In site of the lack of high quality evidence to support a positive association between serum E[2] levels and IVF-ICSI outcomes, this study shows that high E[2] levels during COH might be associated with an increased potential of pregnancy depending on better ovarian response. When the overall results are examined, the best scores were in patients with serum E[2] levels >4000 pg/ml

Comparison of the efficacy and cost-effectiveness of highly purified urinary follicle stimulating hormone [HP-uFSH] and recombinant follicle stimulating hormone [rFSH] in Poor Responders

We aimed to compare the clinical results and effectiveness of two gonadothropin treatment protocols; HP-uFSH and rFSH in poor responders. While HP-uFSH was given to 58 patients, rFSH was given to 62 patients. The patient selection criteria were the same [FSH value>15 iu/l or antral follicle number<4, on the second day of menstruation]. Endometrial thickness on hCG day [mm] was 9.0 +/- 2.7 and 7.8 +/- 2.7 in HP-uFSH group and rFSH group, respectively and this difference was statistically significant. Contrarily, fertilization rate [%] was better in rFSH than HP-uFSH [76.6 +/- 15.9 vs. 68.2 +/- 17.8] and this value was also statistically significant. Percentage of cancelled cycles [%] was 14 +/- 34 in HP-uFSH group and this parameter was significantly lower than rFSH group [29 +/- 45]. rFSH is as efficacious as HP-uFSH in poor responders. Fertilization rate was better in rFSH than HP-uFSH. Since rFSH is more expensive, the final treatment cost with rFSH to obtain a pregnancy was slightly higher, but this difference was not statistically significant [20060 TL vs. 17150 TL]