Comparison of ICSI and conventional IVF in non-male factor patients with less than four oocytes.

BACKGROUND: We aimed to analyse our clinical results for a particular subgroup of patients with poor ovarian response (POR) to clarify if lower number of oocytes is a drawback for proceeding to C-IVF. MATERIALS AND METHODS: In this retrospective study, patient files of all couples (#1733) who underwent oocyte retrieval between January 2017 and December 2019 were reviewed and 191 cases diagnosed with non-male factor infertility in which ≤ 3 cumulus-oocyte complexes available for fertilisation were analysed. Exclusion criteria were: woman age > 42, patients with a history of previous ART trial, prenatal genetic testing cycles and couples undergoing total cryopreservation for any indication. Three groups were constructed depending on the method of fertilisation and on semen quality as follows: IVF non-male factor (Group 1, n = 77); ICSI non-male factor (Group 2, n = 65); ICSI male factor-ICSI/MF n = 49 according to WHO reference values. Main outcome parameters were: fertilisation rate, implantation rate and live birth rate. RESULTS: Fertilisation rate per collected COC was significantly higher in group 1 compared to the other two groups (85.68%, 72.58%, 73.33% respectively, p = 0.004). FR per inseminated oocyte also tended to be higher in group 1 but not reaching a statistically significant level. Both techniques yielded similar implantation rates (20.42%, 28.49%, 23.33% respectively, p = 0.407) and live birth rates (26.8%, 30.6%, 31.1%, respectively, p = 0.643). CONCLUSION: In the presence of normal semen parameters, low egg number is not an indication to perform ICSI. The choice of fertilisation method should be based primarily on semen quality, in combination with the patient's previous history regardless of the ovarian reserve.

Modified natural protocol seems superior to natural and artificial protocols for preparing the endometrium in frozen embryo transfer cycles.

BACKGROUND: Although several studies claim higher success rates in natural cycle (NC) and modified natural cycle (mNC) protocols, currently, there is no consensus on the most effective method of endometrium preparation prior to frozen embryo transfer (FET) cycles. We aimed to find out the best protocol by comparing three different protocols for preparing the endometrium in FET cycles. METHODS: This retrospective cohort study was conducted at a private in-vitro fertilization (IVF) center. Medical records of all patients enrolled in frozen embryo transfer cycles between November 2017 and February 2019 were reviewed. Group I (N.=94) included patients who underwent artificial endometrial preparation (AC), group II (N.=23) confined patients enrolled in mNC and group III (N.=12) included patients who had NC protocol. Main outcome parameters were clinical pregnancy rates, implantation rates and miscarriage rates. RESULTS: There was a tendency towards higher clinical pregnancy rate in mNC group. Clinical pregnancy rates of the three groups were 54.3%, 65.2% and 33.3% respectively (P=0.199). Implantation rate was significantly higher in group II (34%, 50% and 12% respectively, P=0.006). Miscarriage rates were similar for the three groups. CONCLUSIONS: Although not reaching a statistically significant level, there is a tendency towards higher implantation rate and pregnancy rate in mNC protocol compared to true NC and AC protocols.

Artificial oocyte activation after intracytoplasmic morphologically selected sperm injection: A prospective randomized sibling oocyte study.

This study aimed to evaluate the effect of artificial oocyte activation (AOA) by calcium ionophore after intracytoplasmic morphologically selected sperm injection (IMSI) on fertilization, cleavage rate and embryo quality. A total of 194 oocytes from 21 cycles from women with a history of low fertilization rate accompanying teratozoospermia were enrolled over a 3-month period. Mature oocytes from each patient were randomly allocated into two groups after IMSI. In the study group, half of the patients' oocytes (n = 97) were exposed to AOA, and in the control group (n = 97), AOA was not applied. The mean number of mature oocytes, fertilization and cleavage rates were similar between the study and control groups (p > 0.05 for each). However, fertilized oocytes of the AOA group were less likely to produce top quality embryos when calculated per fertilized oocyte (28/80; 35.0% versus 38/71; 53.5%, respectively; p = 0.024) and also per cycle (13/21; 61.9% versus 20/21; 95.24%, respectively; p = 0.006). Our study indicates that AOA may not improve fertilization rates after IMSI and may even reduce the ability of a successfully fertilized oocyte to develop into a top quality embryo. AOA should, therefore, be applied to cases with a defined oocyte activating deficiency.

Uterus transplantation: From animal models through the first heart beating pregnancy to the first human live birth.

Absolute uterine factor infertility affects 3-5% of the general population, and unfortunately this condition is untreatable. There are some available options, including surrogacy or adoption, but neither of these suits each and every woman who desires to have her own genetic child. With recent advances in surgery and transplant immunology, uterus transplantation may be a source of hope for these women with uterine infertility. In the last decade, a number of animal species including rats, mice, rabbits, pigs, sheep, and primates have been used as experimental models, and pregnancies were achieved in some of these. Human data consist of 11 subjects yielding positive pregnancy results with no live births in the second trial from Turkey and, more fortunately, live births from the latest trial from Sweden. In the light of all these studies, uterus transplantation has been proven to be a viable option for women with uterine factor infertility.

Clinical pregnancy after uterus transplantation.

OBJECTIVE: To present the first clinical pregnancy after uterus transplantation. DESIGN: Case study. SETTING: Tertiary center. PATIENT(S): A 23-year-old Mayer-Rokitansky-Kuster-Hauser syndrome patient with previous vaginal reconstruction and uterus transplantation. INTERVENTION(S): Eighteen months after the transplant, the endometrium was prepared for transfer of the thawed embryos. MAIN OUTCOME MEASURE(S): Implantation of embryo in an allografted human uterus. RESULT(S): The first ET cycle with one day 3 thawed embryo resulted in a biochemical pregnancy. The second ET cycle resulted in a clinical pregnancy confirmed with transvaginal ultrasound visualization of an intrauterine gestational sac with decidualization. CONCLUSION(S): We have presented the first clinical pregnancy in a patient with absolute uterine infertility after uterus allotransplantation. Although the real success is the delivery of a healthy near-term baby, this clinical pregnancy is a great step forward and a proof of concept that the implantation phase works.

Uterine rupture at the 29th week of subsequent pregnancy after hysteroscopic resection of uterine septum.

OBJECTIVE: To describe a patient with uterine rupture in the subsequent pregnancy after hysteroscopic resection of a uterine septum. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 30-year-old nulliparous woman, with a history of a first trimester spontaneous abortion, hysteroscopic uterine septum resection by cutting diathermy using the operating hysteroscope, and a second hysteroscopic procedure for a residual septum, was admitted to our clinic with symptoms of hemodynamic shock at the 29th week of gestation. INTERVENTION(S): Immediate laparotomy was performed. MAIN OUTCOME MEASURE(S): Uterine rupture in the second trimester of the subsequent pregnancy with fetal loss. RESULT(S): Midfundal complete uterine rupture was observed at the site of the resected uterine septum, accompanied by an extrauterine exanimate fetus. CONCLUSION(S): Uterine rupture may occur in pregnancies after hysteroscopic resection of the uterine septum. Clinicians who perform this procedure, especially in the cases with repeated procedures using cutting diathermy, must warn and inform their patients about the risks of their later pregnancies.

Concentrations of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and dioxin-like PCBs in adipose tissue of infertile men.

Some epidemiological studies suggested the occurrence of an alteration in the male reproductive function in the past 50 years, particularly a decrease in the sperm count and quality, an increase in the malformations frequency of the reproductive apparatus (cryptorchidism and hypospadias) and of testicular cancers. Especially according the laboratory animals studies, polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs) have been suspected to play a crucial and deleterious role in the alteration of human fertility. For this reason, we measured adipose tissue concentrations of PCDDs/Fs and dioxin-like PCBs in 23 fertile and 22 infertile men living in Ankara, Turkey. Adipose tissue samples were analyzed for PCDD/F and 12 dioxin-like PCB congeners using high-resolution gas chromatography/high-resolution mass spectrometry. For the fertile and infertile groups, the World Health Organization (WHO)(PCDD/F)-TEQ concentrations ranged from 3.0 to 15.8 pg/g fat and from 2.8 to 17.2 pg/g fat, respectively (4.4-31.5 and 4.7-22.3 WHO-TEQs/g fat, respectively, including dioxin-like PCBs) (p > 0.05). The mean concentrations of WHO(PCDD/F)-TEQ and WHO(PCB)-TEQ have been calculated as 7.2 and 12.5 pg/g (on a lipid basis) for the fertile group and 7.0 and 9.4 pg/g for the infertile group, respectively. Concentrations of each of the PCDD/F and dioxin-like PCB congeners were compared in fertile and infertile groups among themselves, and no statistical significance was obtained (p > 0.05), except 2,3,7,8-tetrachlorodibenzofuran (p = 0.0029) and 1,2,3,4,6,7,8,9-octachlorodibenzofuran (p = 0.01).

Concentration of polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans and dioxin-like PCBs in human adipose tissue from Turkish men.

There is no previous report from Turkey on chemically determined polychlorinated dibenzo-para-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and dioxin-like polychlorinated biphenyls (PCBs) in human tissues expressed as World Health Organization (WHO) toxic equivalents (TEQs). The objective of this study was to determine the occurrence of PCDDs/Fs, and dioxin-like PCBs in the general adult Turkish population. For this reason we measured adipose tissue concentrations of PCDDs/Fs and dioxin-like PCBs in 23 Turkish men living in Ankara,Turkey in 2004. PCDD/F concentrations ranged between 3.2 and 19.7 pg WHO-TEQ/g fat (5.34 and 42.7 WHO-TEQ/g fat, respectively, including dioxin-like PCBs). The mean concentrations of WHO(PCDD/F)-TEQ and WHO(PCB)-TEQ were 9.2 and 6.67 pg/g on a lipid basis , respectively. Samples were analyzed for PCDD/F and twelve dioxin-like PCB congeners using high resolution gas chromatography/high resolution mass spectrometry (HRGC/HRMS). This study is very important since it is the first report on PCDDs/Fs and dioxin-like PCB contamination in human adipose tissue from Turkey.

No association of the CAG repeat length in exon 1 of the androgen receptor gene with idiopathic infertility in Turkish men: implications and literature review.

While the correlation between the CAG repeat length of the androgen receptor (AR) gene and idiopathic male infertility is still unclear, ethnic background of the population studied may play an important role in this association. The objective of this study was to determine whether changes in the CAG repeat length are associated with spermatogenic defects in Turkish infertile men. Reproductive hormone concentrations and the CAG repeat length in exon 1 of the AR gene in 47 idiopathic infertile men and 32 fertile controls were analyzed. The mean serum luteinising hormone (LH) and follicle stimulating hormone (FSH) levels were significantly higher in the infertile group than those of the control group (p < 0.0001 for both comparisons), whereas the mean serum testosterone level in the infertile group did not differ significantly from that in the control group (p = 0.16). The mean CAG repeat length of the AR gene in the infertile group did not differ significantly from that in the control group (22.28 +/- 0.37 vs 22.41 +/- 0.54, respectively; p = 0.84). In addition, the frequency of having a CAG repeat number (> or = 24) was also comparable between the infertile patients and fertile controls (31.9% vs 40.6%, respectively; p = 0.21). In conclusion, reproductive hormones with elevated LH and FSH, and normal or low testosterone levels were suggestive of partial impairment of testicular function. However, no statistically significant relationship between the length of the CAG repeat and idiopathic impaired sperm production was observed in the Turkish population studied. These results support the findings of previously published European studies, but are contrary to the findings from Caucasian and North American population studies. Thus, ethnicity and genetic backgrounds seem to be important in this association, and studies from a variety of different ethnic and genetic backgrounds using comparable patient subgroups are valuable to further evaluate this association.