Two successful pregnancies achieved by converting an in vitro fertilization cycle to an intrauterine insemination cycle in five cases with documented premature ovulation.

We here report two successful pregnancies obtained by converting an in vitro fertilization (IVF) cycle to an intrauterine insemination (IUI) cycle in five poor responder patients whose oocyte pick-up (OPU) procedures were canceled due to documented premature ovulation immediately before OPU. To our knowledge, this is the first article that demonstrates that switching an IVF cycle to an IUI cycle when premature ovulation occurs on the day of OPU can produce successful pregnancies, even in poor responder patients.

Outcome of intracytoplasmic sperm injection using fresh and cryopreserved-thawed testicular spermatozoa in 83 azoospermic men with Klinefelter syndrome.

AIM: To report the outcome of intracytoplasmic sperm injection (ICSI) cycles using fresh or cryopreserved-thawed testicular spermatozoa of men with Klinefelter syndrome (KS). METHODS: Medical records of 83 azoospermic men with KS who underwent testicular sperm extraction (TESE) were reviewed. The clinical parameters for predicting sperm retrieval and fertilization, implantation, pregnancy and live birth rates of ICSI cycles in these patients were evaluated. RESULTS: A total of 88 TESE procedures were performed with sperm retrieval rates of 39.8% per cycle (35/88) and 42.1% per patient (35/83). None of the studied clinical parameters were found to be informative in predicting successful sperm recovery. A total of 41 embryo transfer cycles were carried out using fresh testicular spermatozoa in 30, cryopreserved-thawed spermatozoa in 10 and cryopreserved-thawed embryo replacement in one. The fertilization and clinical pregnancy rates were comparable at 52.7% and 51.6% with fresh and 48.3% and 60% with cryopreserved-thawed testicular spermatozoa groups, respectively. Twenty-two clinical pregnancies were obtained, including 14 singletons, five twins, two triplets and one quadruplet and ended with the delivery of 13 singletons and six twins. In total, out of 25 delivered fetuses, four died (3 female, 1 male) following delivery and 21 newborns (14 female, 7 male) were healthy with a female to male ratio of 2:1. Conclusions We concluded that no clinical or laboratory parameter predicts the presence of spermatozoa in patients with KS, except the TESE procedure itself. The use of fresh or cryopreserved-thawed spermatozoa on ICSI cycle outcomes are equally successful in patients with KS.

Birth of a healthy boy using fresh testicular sperm in a patient with Klinefelter syndrome combined with Kartagener syndrome.

OBJECTIVE: To report a case of Klinefelter syndrome combined with Kartagener syndrome. DESIGN: Case report. SETTING: Private IVF center. PATIENT(S): A 35-year-old man with Klinefelter syndrome combined with Kartagener syndrome causing primary infertility. INTERVENTION(S): Testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S): Sperm recovery, fertilization, and live birth. RESULT(S): Ovulation induction of the female partner, recovery of spermatozoa by TESE from the male partner and ICSI of 9 metaphase II oocytes resulted in two fertilized oocytes. The delivery of a healthy boy with normal anatomy and 46,XY karyotype was achieved after the transfer of only one 4-cell grade 1 embryo. CONCLUSION(S): To our knowledge, this case with nonmosaic Klinefelter syndrome combined with Kartagener's syndrome is unique and demonstrates the revolutionary aspects of assisted reproductive technologies (ART) concerning male factor infertility.

[Retrospective evaluation of Toxoplasma gondii seropositivity in fertile and infertile women]. / Fertil ve Infertil Kadinlarda Toxoplasma gondii Seropozitifliginin Retrospektif Olarak Degerlendirilmesi.

Toxoplasma gondii infection is associated with a wide spectrum of clinical pictures in man, changing from asymptomatic infection to severe central nervous system disease. It has been well documented that toxoplasmosis is of crucial importance especially for pregnant women and immunocompromised patients. In addition to the risks of gestation complications and congenital infections, it has been suggested that toxoplasmosis has some unfavorable effects on reproductive capacity in both men and women. The data obtained from limited studies performed in animal models as well as in infertile couples, have supported the relationship between toxoplasma and infertility. The hypothesis concerning infertility mechanisms due to T.gondii in females include development of endometritis and fetal rejection due to local release of T.gondii from latently located cysts in endometrial tissue on stimulation during plansenta formation; impaired folliculogenesis in ovaries and uterine atrophy and reproductive failure due to hypothalamic dysfunction as a result of chronic toxoplasmosis. The aim of this retrospective study was the comparative evaluation of toxoplasma seropositivity rates of fertile and infertile female spouses who were admitted to an in vitro fertilization (IVF) center in Ankara, between 2004-2009 period, from different geographical regions of Turkey. A total of 1314 women (mean age: 31.8 ± 5.6 years) were included to the study. In the study group, 376 (28.6%) were positive for T.gondii IgG, 5 (0.4%) were positive for IgG + IgM and 1 (%0.07) was positive only for IgM antibodies, while total toxoplasma seropositivity was 29.1% (382/1314). Of the 1117 evaluated couples, women with well-defined cause of infertility due to male factors have been grouped as fertile (n= 495) and the others were accepted as infertile (n= 622). Toxoplasma IgG seropositivity was found in 145 (29.3%) of fertile and in 179 (28.8%) of infertile women and the difference between the seropositivity rates was not statistically significant (p= 0.851). Comparison of seropositive and seronegative women in view of demographic characteristics revealed that seropositivity rate increased with age (mean ages were 33.0 ± 5.3 and 31.4 ± 5.6, respectively; p< 0.001); the rate was significantly higher in housewives than women with different occupations (31.4% and 25.7%, respectively; p= 0.003) and higher in women who inhabited in Mediterranean region than in Central Anatolia region (46.4% and 27.2%, respectively; p= 0.019). There were no statistically significant correlation between the seropositivity rates and abortion history and cause of infertility (p> 0.05). In conclusion, these data did not indicate a relationship between toxoplasmosis and female infertility, however advanced molecular, serological and clinical studies are needed for the confirmation of this hypothesis.

Smooth endoplasmic reticulum aggregations in all retrieved oocytes causing recurrent multiple anomalies: case report.

OBJECTIVE: To document the relationship between smooth endoplasmic reticulum (SER) aggregations and recurrent fetal anomalies. DESIGN: Case report. SETTING: Private IVF center. PATIENT(S): A 28-year-old woman with an 11-year history of primary infertility. INTERVENTION(S): Three consecutive cycles of intracytoplasmic sperm injection (ICSI) in the same patient. MAIN OUTCOME MEASURE(S): Clinical pregnancy, live birth, fetal anomaly. RESULT(S): In three consecutive ICSI cycles, a total of 59 MII oocytes were retreived in the same patient, all displaying SER aggregations. The fertilization rate per cycle was 80%, 50%, and 42%, respectively. A total of 12 embryos were transferred in three ICSI cycles, of which 11 were grade 1 embryos. Two of the three cycles ended up with clinical ongoing pregnancies but with multiple fetal anomalies. CONCLUSION(S): This is the first case reported with SER aggregations in all retrieved oocytes in three consecutive ICSI cycles. The repetetive multiple fetal anomalies possibly related to oocyte dysmorphism are of concern.

The effect of retained embryos on pregnancy outcome in an in vitro fertilization and embryo transfer program.

OBJECTIVE: The purpose of this study was to determine the incidence of retained embryos and its impact on pregnancy outcome in the absence of known risk factors like blood and mucus in the transfer catheter. The factors that could be associated with embryo retention were also investigated. STUDY DESIGN: The results of all embryo transfer procedures performed at Ankara IVF Center between January 2003 and December 2005 were analyzed retrospectively. Three hundred and five embryo transfers, in which the transfer catheter was contaminated with blood or mucus, were excluded and the remaining 1,454 embryo transfers, with clean catheter, were enrolled into the study. Both fresh (n=1,422) and frozen (n=32) embryo transfers were included. RESULTS: The overall incidence of retained embryos during study period was 2.8% (41/1,454) following a clean initial embryo transfer. The mean age of the female partner, mean number of retrieved oocytes, MII oocytes, fertilized oocytes and the embryos transferred were similar in patients with and without retained embryos. The 1,454 embryo transfers performed during the study period resulted in 712 pregnancies (49%), of which 639 proved to be clinical pregnancies with a rate of 44%. The implantation rate was 22.8%. Pregnancy outcomes including positive beta-hCG (58.5% versus 48.7%), biochemical (4.7% versus 5.1%) and clinical pregnancy rates (53.6% versus 43.6%), implantation rate (24% versus 22.7%) and multiple pregnancy rate (36.3% versus 44.7%) were not significantly different between patients with and without retained embryos. An influence of individual physicians and embryologists on the frequency of retained embryos was not detected. The type of embryo transfer catheter used did not show any difference in terms of embryo retention. The cleavage stages of embryos were not different between groups. Although it was not statistically significant, the number of embryos transferred appeared to be a potentially confounding factor for retained embryos (p=0.053) and it might be significant in a slightly larger sample. When transfer of one or two embryos was compared to three or more embryos, the likelihood of retained embryos increased from 1.2% (4/321) to 3.2% (37/1,133). CONCLUSION: Retained embryos in the transfer catheter and immediate retransfer of them have no adverse impact on clinical pregnancy and implantation rates unless other previously reported signs of difficult transfer are also observed.

Genetic aspects of human male infertility: the frequency of chromosomal abnormalities and Y chromosome microdeletions in severe male factor infertility.

OBJECTIVE: The main purpose of this study is to detect the frequency and type of both chromosomal abnormalities and Y chromosome microdeletions in patients with severe male factor infertility and fertile control subjects. The association between the genetic abnormality and clinical parameters was also evaluated. METHODS: This study was carried out in 208 infertile and 20 fertile men. Results of 208 patients, 119 had non-obstructive azoospermia and 89 had severe oligoasthenoteratozoospermia (OAT). Seventeen out of 119 (14.3%) azoospermic patients and two out of 89 (2.2%) patients with OAT had Y chromosome microdeletions. In total, 19 cases with deletions were detected in 208 infertile men, with a frequency of 9.1%. The AZFc locus, mainly DAZ gene cluster was the most frequently deleted region. Five other cases with azoospermia (4.2%) and two cases with OAT (2.2%) had a chromosomal abnormality, with a total number of seven (3.4%). Including Y chromosome deletions and structural chromosome abnormalities, the rate of genetic abnormalities was 12.5% (26/208) in our patients. On the other hand, 20 men with proven fertility and fathers of five cases with microdeletions were genetically normal. Y chromosome deletions and chromosomal abnormalities were associated with various histological alterations in testis. Sertoli cell-only (SCO) syndrome and maturation arrest predominated in these cases, whereas hypospermatogenesis occurred more frequently in genetically normal patients. CONCLUSION: Various chromosomal abnormalities and deletions of Y chromosome can cause spermatogenic breakdown resulting in chromosomally derived infertility. All these findings strongly support the recommendation of genetic screening of infertile patients.