Environmental Tobacco Smoke Exposure during Intrauterine Period, Promotes Caspase Dependent and Independent DNA Fragmentation in Sertoli-Germ Cells.

Objectives. To investigate the effect of cigarette smoke exposure during intrauterine period on neonatal rat testis. Methods. Twenty-five rats were randomized to be exposed to cigarette smoke with the Walton Smoking Machine or to room air during their pregnancies. The newborn male rats (n = 21) were grouped as group 1 (n = 15) which were exposed to cigarette smoke during intrauterine life and group 2 (n = 6) which were exposed to room air during intrauterine life. The orchiectomy materials were analyzed with TUNEL immunofluorescent staining for detection of DNA damage. To detect apoptosis, immunohistochemical analyses with caspase-3 were performed. Primary outcomes were apoptotic index and immunohistochemical scores (HSCORES); secondary outcomes were Sertoli-cell count and birth-weight of rats. Results. Sertoli cell apoptosis was increased in group 1 (HSCORE = 210.6 ± 41.9) when compared to group 2 (HSCORE = 100.0 ± 17.8) (P = 0.001). Sertoli cell count was decreased in group 1 (P = 0.043). The HSCORE for the germ cells was calculated as 214.0 ± 46.2 in group 1 and 93.3 ± 10.3 in group 2 (P = 0.001) referring to an increased germ cell apoptosis in group 1. The apoptotic indexes for group 1 were 49.6 ± 9.57 and 29.98 ± 2.34 for group 2 (P = 0.001). The immunofluorescent technique demonstrated increased DNA damage in seminiferous epithelium in group 1. Conclusions. Intrauterine exposure to cigarette smoke adversely affects neonatal testicular structuring and diminishes testicular reserve.

Intracytoplasmic sperm injection outcomes of obstructive and nonobstructive azoospermic men.

PURPOSE: We aimed to compare the outcomes of intracytoplasmic sperm injection (ICSI) cycles in obstructive and nonobstructive azoospermic men. METHODS: In this retrospective study, we searched the first ICSI cycle parameters of 211 azoospermic men. Our main outcomes were the average fertilization rate, implantation rate, pregnancy and miscarriage rates. RESULTS: The results of this study showed that although the males with obstructive azoospermia had better fertilization and biochemical pregnancy rates than the ones with nonobstructive azoospermia, clinical pregnancy and miscarriage rates among the groups were similar. CONCLUSION: ICSI overcomes the obstacles related to the sperm in its function as a carrier but it cannot alter the message carried by the male gamete.

Serological investigation of the role of selected sexually transmitted infections in the aetiology of ectopic pregnancy.

OBJECTIVES: To investigate the association between selected sexually transmitted infections (STIs) and the later occurrence of ectopic pregnancy. METHODS: A total of 125 women with ectopic pregnancy and 125 pregnant controls were recruited between January 2003 and February 2005 at Dr. Zekai Tahir Burak Women's Health Education and Research Hospital, in Ankara, Turkey. Enzyme-linked immunosorbent assay was used to determine the prevalence of serum antibodies to Chlamydia (C.) trachomatis and to Herpes simplex virus (HSV)-2 IgG and, indirect immunofluorescence test was used to determine the prevalence of serum antibodies to Mycoplasma (M.) hominis and Ureaplasma (U.) urealyticum. RESULTS: The prevalence of C. trachomatis Ig G antibody in women with ectopic pregnancy (31/125; 25%) was significantly higher than in controls (12/125; 9.6%) (crude Odds Ratio [OR]: 3.1, 95% confidence interval [CI]: 1.51-6.38; p = 0.001). However, there was no significant association between C. trachomatis IgM; M. hominis IgG, IgM; U. urealyticum IgG, IGM; and HSV-2 IgG, and ectopic pregnancy. CONCLUSIONS: Previous chlamydial infection plays an important role in the aetiology of ectopic pregnancy. There was no association between M. hominis, U. urealyticum and HSV-2 infections, and ectopic pregnancy.

Human Menopausal Gonadotropin versus Recombinant FSH in Polycystic Ovary Syndrome Patients Undergoing In Vitro Fertilization.

BACKGROUND: We aimed to compare human menopausal gonadotropin (hMG) and recombinant follicle-stimulating hormone (r FSH) with respect to clinical outcomes and the development of ovarian hyperstimulation syndrome (OHSS) for patients with polycystic ovary syndrome (PCOS) treated with in vitro fertilization (IVF). MATERIALS AND METHODS: This prospective randomized controlled trial included a total of 80 women with PCOS. Of these, 38 were randomized to receive treatment with hMG and 42 with rFSH using a long gonadotropin releasing hormone (GnRH) analogue protocol. Outcome measures were cycle characteristics, pregnancy rates, the need for coasting, and OHSS rates. RESULTS: In the hMG group we observed a significantly lower peak estradiol (E2) level (p=0.02), fewer intermediate-sized follicles (p=0.001), lower number of oocytes retrieved (p=0.002) and metaphase II (MII) oocytes (p=0.003). However, there were no significant differences between the groups in the number of fertilized oocytes, fertilization rates, top quality embryo counts, and the number of transferred embryos. There was no difference in pregnancy rates between the groups. OHSS occurred in 11.9% of the rFSH group patients, whereas no OHSS developed in the hMG group. Coasting requirements were lower in the hMG group (19.2% vs. 48.9%, p=0.013). CONCLUSION: Ovarian stimulation with hMG and rFSH provides similar clinical pregnancy rates in PCOS patients treated with a long GnRH agonist protocol in IVF cycles. hMG stimulation appears to be associated with a lower rate of OHSS and decreased coasting requirements (Registration Number: NCT01365936).

Comparison of Ki-67 proliferative index between eutopic and ectopic endometrium: a case control study.

OBJECTIVE: In this study, the Ki-67 proliferative indices among the stages of the endometriosis were compared to clarify whether the proliferation was increased with increasing disease stage. MATERIALS AND METHODS: Thirty-eight patients who underwent surgery either by laparotomy or by laparoscopy with the diagnosis of endometriosis and 21 patients, as controls, who underwent hysterectomy with the diagnosis of myoma uteri and without any endometrial pathology at our hospital between 2005 and 2007 were studied. Biopsy specimens of endometriotic foci and endometriomas in study group, and eutopic endometrium of hysterectomy specimens of control group were studied. RESULTS: Fifty-nine patients were divided into Group 1 (21 patients in control), Group 2 (19 patients in stage I and II of endometriosis), and Group 3 (19 patients in stage III and IV). A moderate correlation between the stage of endometriosis and the degree of Ki-67 staining was found. When Ki-67 immunohistochemical staining was considered according to the threshold value for CA-125 (35 U/mL), Ki-67 positivity was increased with the increase in CA-125 value, but this increase was not statistically significant. CONCLUSION: Endometriosis shows some characteristics of tumors such as high rate of invasion, getting autonomy, and proliferation as the disease progresses with subsequent damage to target organs. When the stage of the disease increases, environment becomes more suitable for increased proliferation and invasion. In this study, the increase in proliferative activity as the severity increases is shown by the increase in Ki-67 index. As more studies are being conducted in this field, pathogenesis will be clarified, which could help in the development of new treatment modalities.

Office hysteroscopy improves pregnancy rates following IVF.

The aim of the study was to evaluate the effect of office hysteroscopy (OH) on pregnancy rate in patients undergoing IVF. A total of 1258 patients attending an IVF clinic with normal hysteroscopic findings were enrolled. The impact of timing of OH before embryo transfer on pregnancy rate was investigated. The women were evaluated in three groups: group 1, OH performed 50 days or less before embryo transfer (n=407), group 2, OH between 51 days to 6 months, (n=280) and group 3, OH more than 6 months before embryo transfer (n=571). The implantation rates were 22.1%, 16.1% and 11.1% in groups 1, 2 and 3, respectively. Overall pregnancy rates were 48.2%, 38.9% and 29.9% in groups 1, 2 and 3, respectively. The clinical pregnancy rates were 45.2%, 34.3% and 27.1% and the live birth rates were 36.9%, 27.9% and 22.6%, respectively. Implantation, pregnancy, clinical pregnancy and live birth rates were significantly higher in group 1 compared with groups 2 and 3 (all P<0.05). OH may improve pregnancy rates, but timing of the procedure is important. The endometrial effect is highest when hysteroscopy is performed 50 days or less before embryo transfer. Office hysteroscopy (OH), which helps the clinician for the evaluation of the uterine cavity before IVF treatment, may affect the pregnancy rates depending on when the procedure is performed. A total of 1258 patients attending an outpatient IVF clinic were enrolled in the study. The women were evaluated in three groups: group 1, OH performed 50 days or less before embryo transfer (n=407), group 2, OH between 51 days to 6 months, (n=280) and group 3, OH more than 6 months before embryo transfer (n=571). The implantation, pregnancy and clinical pregnancy rates were significantly higher in group 1 compared with groups 2 and 3. OH may improve pregnancy rates when performed 50 days or less before embryo transfer.

Environmental tobacco smoke exposure during intrauterine period promotes granulosa cell apoptosis: a prospective, randomized study.

OBJECTIVE: To evaluate the intrauterine effect of cigarette smoke on cell death and DNA damage in follicular cells of fetal ovarian tissue. METHODS: A prospective, randomized study was conducted with 25 female wistar-albino rats. The rats were randomized to be exposed either to cigarette smoke or to room air, initiating from proestrous period and during pregnancy. Newborn female rats were categorized as Group 1 (n = 24) that had been exposed to cigarette smoke during intrauterine life and Group 2 (n = 7) that had been exposed to room air during intrauterine life. Bilateral ooferectomies were performed on the 2nd week of their life. TUNEL (in-situ Terminal Deoxynucleotidyl-Transferase Mediated dUTP-Nick-End Labeling) immunofluorescent staining and immunohistochemical analyses with caspase-3 were used for detection of DNA damage and apoptosis. Primary outcomes were apoptotic index and immunohistochemical scores (HSCORE). Secondary outcomes were ovarian follicle counts and birth weights of newborn rats. RESULTS: There was a significant increase of HSCORE and apoptotic index in Group 1. Increased immunofluorescent staining; evaluating DNA damage, with TUNEL method was observed in granulosa cells in Group 1. CONCLUSIONS: Intrauterine exposure to cigarette smoke diminishes ovarian reserve of female offspring, raising the concern about the generational impact of maternal smoking on ovarian function in the human.

Genetic evaluation of severe male factor infertility in Turkey: a cross-sectional study.

OBJECTIVE: To determine the frequency, types of chromosomal abnormalities and Y chromosome microdeletions in patients with severe male factor infertility, and the association between clinical background and genetic abnormality. STUDY DESIGN: A total of 322 infertile men; 136 men with severe oligozoospermia (sperm count <5 million/ml) and 196 with nonobstructive azoospermia were studied between April 2004 and November 2006 at the Dr. Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey. Blood, semen samples, and testicular biopsies of patients were obtained. Hormonal analysis (follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels), semen analysis, karyotype analysis, and PCR screening for Y chromosome microdeletions were performed. RESULT(S): Forty-eight out of 332 (14%) infertile men had a genetic abnormality. Twenty-four (7.2%) cases with karyotype abnormality were detected. The frequencies of karyotype abnormalities were Klinefelter's syndrome 17/24 (71%), translocation 3/24 (12%), mix gonadal dysgenesis 2/24 (8%), XX male 1/24 (4%), and 46XYY 1/24 (4%). Twenty cases (6%) infertile men had only Y chromosome microdeletions. The frequencies of the deleted areas were azoospermia factor (AZF)c 42%, AZFb 25%, AZFa 21%, AZFb, c 8%, and AZFa, c 4%. Four of the cases with Y chromosome microdeletions also had a concurrent karyotype abnormality. CONCLUSION(S): All patients with nonobstructive azoospermia and severe oligozoospermia (sperm count <5 million/ml) should undergo genetic screening.

The relationship between the change in serum high sensitivity C-reactive protein levels and IVF success.

The aim of this study was to assess whether the extent of the change in high sensitivity C-reactive protein (hs-CRP) levels is related with in vitro fertilization (IVF) success. A total of 69 IVF cycles using long luteal GnRH agonist protocol at the IVF unit, were prospectively studied. The serum levels of hs-CRP were measured on the day of initiation of gonadotrophin stimulation and 7 days after embryo transfer. CRP ratio was defined as the levels of CRP on day 7 of transfer/day of initiation of ovarian stimulation. Clinical pregnancy rates were examined. The mean concentrations of hs-CRP were not significantly different on the first day of ovarian stimulation and on day 7 after embryo transfer among pregnant and non-pregnant women. There was a significant rise in hs-CRP levels at 7th day after embryo transfer as compared with the first day of gonadotrophin treatment in both groups (10.58 ± 11.35 versus 3.61 ± 2.86 mg/L for pregnant women and 9.14 ± 11.36 versus 3.24 ± 2.68 mg/L for non-pregnant women, p = 0.001). In addition, the mean CRP ratio was not different between the pregnant and non-pregnant groups. Our data show that serum hs-CRP levels increase during IVF treatment, but the extent of the rise in CRP levels is not a predictive marker of IVF success.

Regression of endometrial autografts in a rat model of endometriosis treated with etanercept.

OBJECTIVE: To determine the efficacy of anti-tumor necrosis factor therapy (etanercept) for treating endometriosis in the rat endometriosis model. STUDY DESIGN: A randomized, placebo-controlled, blinded study using rat endometriosis model. After the peritoneal implantation of endometrial tissue, twenty-eight Wistar female rats were randomized to two equal intervention groups: the control group and the etanercept-treated group. After measuring implant volume, pretreatment blood and peritoneal fluid samples were obtained. A vehicle treatment of 2 mL saline to the rats in control group and 0. 4 mg/kg etanercept SC once weekly were administered in the etanercept-treated group. After four weeks treatment period, the volumes and histopathological properties of the implants were evaluated. A scoring system was used to evaluate preservation of epithelia. Endometrial explants were evaluated immunohistochemically for tumor necrosis factor receptor type 2 (TNFR2). A scoring system was used to evaluate expression grade of TNFR2. RESULTS: There was not a significant difference in spherical volume between control (131.0 (60.3-501.2)) and treatment groups (72.8 (31.2-149.6)) (p>0.025). There was a significant change in between the volumes of implants before and after treatment in etanercept group (p<0.05). At the end of the treatment significant differences among the groups were found in histopathological and immunohistochemical parameters (p<0.05) also histologic scores and HSCORES were decreased in the treatment group significantly (p<0.05). CONCLUSION: These results indicate that etanercept was found to effectively reduce the development of endometriosis in this experimental rat model.

Laparoscopic treatment of ovarian cysts in adolescents and young adults.

STUDY OBJECTIVE: To investigate the laparoscopic management of ovarian cysts in adolescents and young adults. DESIGN: A retrospective chart review study. SETTING: Zekai Tahir Burak Women's Health Research and Education Hospital. PARTICIPANTS: A total of 282 females aged 25 years or younger underwent laparoscopic surgery for a presumed benign ovarian cyst. Patients were grouped as adolescents (ages 12-19, n = 79) or young adults (ages 20-25, n = 203). MAIN OUTCOME MEASURES: Surgical approach, operative findings and the correlation of intraoperative diagnosis with the definitive pathological reports. RESULTS: The mean age of the patients was 21.2 years. At laparoscopic surgery, 89 patients (31.6%) had endometriomas, 47 (16.7%) had dermoid cysts, and 37 (13.1%) had paraovarian cysts. Ninety-seven patients (34.4%) had simple ovarian cysts. Pathological reports revealed that young adults were more likely to have endometriomas (34.0% vs 7.6%, P < 0.01), but dermoid cysts and simple ovarian cysts were more frequent (20.3% vs 15.3%, P < 0.01 and 60.7% vs 40.9%, P < 0.01, respectively).in adolescents. Eleven of the cases (3.9%) were found to have mucinous cystadenomas and fourteen (5.0%) to have serous cystadenomas. Four cysts were malignant (1.4%). Cystectomy was performed in 205 cases (72.7%), fenestration of cyst wall was performed in 53 cases (18.8%), and aspiration was applied in 22 cases (7.8%). The types of operation were not significantly different among adolescents and young adults (P > 0.05). The operative diagnosis was highly correlated with the final pathological reports (kappa value= 0.901, P < 0.001). There were no operative and postoperative complications in our series. CONCLUSION: With a careful preoperative screening, the laparoscopic surgery of ovarian cyst is an efficient and safe treatment for adolescents and young adults.

The effect of laparoscopic ovarian cystectomy versus coagulation in bilateral endometriomas on ovarian reserve as determined by antral follicle count and ovarian volume: a prospective randomized study.

OBJECTIVE: To evaluate the effect of two different laparoscopic methods on ovarian reserve as determined by antral follicle count (AFC) and ovarian volume in patients with bilateral endometriomas. DESIGN: Randomized prospective study. SETTING: Tertiary education and research hospital. PATIENT(S): Forty-eight patients with bilateral endometriomas. INTERVENTION(S): AFC and ovarian volumes determined before and after surgery; coagulation and cystectomy performed on one randomly selected side of each patient for their endometriomas; in vitro fertilization and embryo transfer. MAIN OUTCOME MEASURE(S): Ovarian reserve damage as determined by AFC and ovarian volume, and number of dominant follicles and retrieved oocytes after controlled ovarian hyperstimulation. RESULT(S): In vitro fertilization and embryo transfer were performed for 37 of 48 patients. The number of dominant follicles and the retrieved oocytes were assessed after controlled ovarian hyperstimulation. The postprocedural AFC was 3.67±1.26 and 4.75±0.60 after cystectomy and coagulation, respectively. A statistically significantly greater decrease in AFC was found after cystectomy as compared with coagulation. Postprocedural ovarian volumes were 6.27±1.95 and 9.87±2.01 after cystectomy and coagulation, respectively. A decrease in ovarian volume was found after cystectomy when compared with coagulation. CONCLUSION(S): The decreases in AFC and ovarian volume were found for both coagulation and cystectomy, but the decrease was statistically significantly more frequent in cystectomized ovaries than in coagulated ovaries. Also, in the in vitro fertilization cycles, the ovarian response to ovulation induction was statistically significantly reduced in cystectomized ovaries as compared with coagulated ovaries.

Effect of bevacizumab on postoperative adhesion formation in a rat uterine horn adhesion model and the correlation with vascular endothelial growth factor and Ki-67 immunopositivity.

We investigated whether adhesion formation is prevented by the inhibition of angiogenesis in a rat uterine horn adhesion model. A single-dose of bevacizumab was effective in preventing postoperative intraperitoneal adhesion formation among 30 Wistar albino rats that underwent serosal injury by use of a standard technique after laparotomy with intraperitoneal bevacizumab.

Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility.

OBJECTIVE: To evaluate the reproductive outcomes of patients with a uterine septum and otherwise unexplained infertility who underwent hysteroscopic metroplasty, and to compare them with those of patients with the same diagnosis who did not have hysteroscopic metroplasty. METHODS: The present retrospective study included 127 patients with diagnosis of a uterine septum and otherwise unexplained infertility. The reproductive outcomes of 102 patients who underwent hysteroscopic metroplasty (group 1) and 25 patients who rejected the operation (group 2) were compared. RESULTS: Of the 102 patients who underwent hysteroscopic metroplasty, 44 (43.1%) were able to achieve pregnancy, as compared with 5 (20%) of the 25 patients who did not undergo the operation (P=0.03). The abortion rate was 11.4% (5/44) in group 1, compared with 60% (3/5) in group 2 (P=0.02). The live birth rate was 35.3% (36/102) in group 1, as compared with 8% (2/25) in group 2 (P=0.008). CONCLUSIONS: The results indicate that hysteroscopic metroplasty improves reproductive outcome for patients with a uterine septum and otherwise unexplained infertility.

Efficacy of anti-tumor necrosis factor therapy on endometriosis in an experimental rat model.

OBJECTIVE: To show the efficacy of anti-tumor necrosis factor therapy (etanercept) for treating endometriosis in an experimental model. DESIGN: A randomized, placebo-controlled, blinded study using rat endometriosis model. SETTING: Experimental research center of Ankara Education and Research Hospital. ANIMAL(S): Twenty-two Wistar female rats. INTERVENTION(S): After peritoneal implantation of endometrial tissue, rats were randomized to two equal intervention groups: control and etanercept-treated groups. After measuring implant volume, blood and peritoneal fluid samples were obtained. Vehicle treatments of 2 mL saline to rats in control and 0.4 mg/kg etanercept SC once weekly were administered in treatment group. Four weeks later, a third laparotomy was performed to remeasure implant volumes, blood, and peritoneal fluid samples. MAIN OUTCOME MEASURE(S): To compare spherical volume, peritoneal fluid and serum levels of VEGF, IL-6, and TNF-α between groups. RESULT(S): There was a significant difference in spherical volume between control [131.0 (60.3-501.2)] and treatment groups [72.8 (31.2-149.6)] (p < 0.025). In etanercept-treated group, a significant difference was found between peritoneal fluid and serum levels of VEGF, IL-6, and TNF-α (p < 0.01). CONCLUSION(S): These results indicate that etanercept was found to effectively reduce the development of endometriosis.

Inflammatory-metabolic parameters in obese and nonobese normoandrogenemic polycystic ovary syndrome during metformin and oral contraceptive treatment.

Our aim was to evaluate the optimal treatment strategy addressing cardiovascular risk in obese and nonobese patients with polycystic ovary syndrome (PCOS). We planned a prospective randomized clinical study. Normoandrogenemic and oligoamenorrheic women with PCOS and impaired glucose tolerance (n = 96) were enrolled in the study. Six months of treatment with metformin HCL or oral contraceptive pills (OCPs) were given to the patients. Group 1 were obese and receiving metformin. Group 2 were obese and receiving OCPs. Group 3 were nonobese and receiving metformin, and Group 4 were nonobese receiving OCPs. ADMA, homocysteine, high sensitive C-reactive protein (hs-CRP) and homeostasis model assessment estimate of insulin resistance (HOMA-IR) were investigated. ADMA, homocysteine, hs-CRP and HOMA-IR were similar in obese and nonobese groups before the treatment. After 6 months of treatment, a significant decrease was observed in ADMA, homocysteine and HOMA-IR levels in Groups 1 and 3. An increase in ADMA and hs-CRP levels was observed in Groups 2 and 4. In this study, metformin treatment leads to improvement in hormonal and metabolic parameters and decreases ADMA and homocysteine levels possibly independent of BMI. However, the use of oral contraceptives in obese and nonobese patients with PCOS with impaired glucose tolerance increases ADMA and hs-CRP levels and creates an increase in the metabolic risk.

Conservative laparoscopic management of adnexal torsion.

OBJECTIVE: To evaluate our experience with adnexal torsion (AT) in 36 patients and the outcomes of the patients who were managed conservatively via laparoscopy. MATERIAL AND METHODS: A prospective study was conducted on 36 patients who underwent operations for AT via laparoscopy between January 2008 and December 2009. Data including age, previous history, time of onset of symptoms, time of admission to hospital, gray-scale and color Doppler US findings, time interval between hospital admission and surgery, type of intervention, operative findings and postoperative gray-scale and Doppler US findings were recorded. RESULTS: In 29 (80.5%) patients, a preoperative diagnosis of AT was confirmed clinically. The mean age of the patients was 26.5, with a range of 11 to 44. Ovarian blood flow was assessed by color Doppler US ultrasonography in 30 patients preoperatively. In 11 (36.6%) patients, this was found to be normal. In 19 (63.3%) patients, ovarian blood flow was found to be pathological or absent. Laparoscopic conservative treatment was performed in 34 patients. In two patients, salpingo-oophorectomy was performed. No thromboembolic complications were seen. Postoperative ultrasonographic examinations confirmed normal ovarian morphology and Doppler blood flow in all patients with no recurrence. CONCLUSION: Early diagnosis and treatment are key factors in managing AT. According to the results of the present study, given its demonstrated safety and benefits, in women of reproductive age, a conservative approach of untwisting the adnexa and salvaging the ovary via laparoscopy should be considered in AT cases in which the time from the onset of symptoms to surgery does not exceed 44 hours, regardless of the color and number of twists.

Treatment with oxytocin antagonists before embryo transfer may increase implantation rates after IVF.

This report aimed to examine the effects of atosiban on pregnancy outcome after IVF-embryo transfer. A prospective, randomized, placebo-controlled clinical study was performed. A total of 180 women undergoing intracytoplasmic sperm injection who had top-quality embryos were randomly allocated into treatment and control groups. All the patients had infertility due to tubal factor, hormonal-anovulatory disorders, male factor or unexplained reasons. The treatment group received intravenous administration of atosiban before embryo transfer with a total administered dose of 37.5 mg. In the control group, the same number of cycles was performed with placebo medication. The clinical pregnancy rate (PR) per cycle and implantation rate (IR) per transfer were 46.7% and 20.4% in the atosiban-treated group, which were significantly higher than in the control group (28.9% and 12.6%, respectively, P=0.01). The miscarriage rates of groups 1 and 2 were 16.7% and 24.4%, respectively (P=0.01). These results have indicated that atosiban increases the IR and PR after IVF-embryo transfer. These results suggest that atosiban treatment before embryo transfer is effective in priming of the uterus for implantation. This is the first study to investigate the possible contributions of atosiban for improving the PR after IVF-embryo transfer.

Results of 2500 office-based diagnostic hysteroscopies before IVF.

The aim of the study is to assess the diagnostic accuracy, findings and feasibility of office-based diagnostic hysteroscopy in an IVF population. A total of 2500 consecutive infertile patients were enrolled prospectively prior to IVF treatment. Diagnostic hysteroscopy was performed on each subject in an office setting in the study IVF centre. A total of 1927 patients (77.1%) had a normal uterine cavity, while the remainder of the sample (n=573) demonstrated endometrial pathology on hysteroscopy (22.9%). Of the patients with endometrial pathology, 192 patients had endometrial polyps (7.68%), 96 patients had submucosal fibroids (3.84%), 31 patients had polypoid endometria (1.24%), 27 patients had intrauterine adhesions (1.08%) and 73 patients had uterine septa (2.92%). Diagnostic office-based hysteroscopy is routinely performed in the IVF clinic to assess the endometrial cavity. In such an unselected population, a significant percentage of patients had evidence of uterine pathology that may have impaired the success of IVF. Safety, ease of use, high diagnostic accuracy and high patient tolerance makes office-based hysteroscopy an ideal procedure.