Does mid-luteal progesterone predict pregnancy in intrauterine insemination cycles following sequential clomiphene citrate and gonadotropin treatment?

This study aimed to determine whether serum mid-luteal progesterone (MLP) levels measured in the current treatment cycles of infertile women undergoing controlled ovarian hyperstimulation and intrauterine insemination following the sequential use of clomiphene citrate and gonadotropin may predict pregnancy. A total of 107 consecutive anovulatory women were included in this prospective cohort study. Patients with other causes of infertility were also excluded from the study. None of the patients received progesterone treatment for luteal phase support. The data recorded for each woman included age, body mass index, infertility type and duration, basal hormone levels, and previous and current cycle characteristics with MLP levels. Ovulation was confirmed using MLP and sonographic evaluation in all patients. An MLP level of > 3 ng/mL was regarded as a sign of ovulation. After treatment, the patients were divided into 2 groups according to the presence or absence of pregnancy, and the obtained data were compared between the groups. There were no significant differences in age, body mass index, or basal hormone levels between the 2 groups (all P > .05). However, the duration of infertility was significantly shorter in the pregnancy group (P = .003). The anovulation rate in this cohort was 18.7% (n = 20). A total of 15 (14%) were examined. MLP levels were 25.1 ± 13.8 ng/mL and 18.3 ± 14.5 ng/mL in the pregnant and nonpregnant groups, respectively (P:.089). Based on the receiver operating characteristic curve analysis, it was determined that there was no predictive value of the mid-luteal phase progesterone level for pregnancy in patients in whom ovulation was detected. Mid-luteal serum progesterone levels did not predict pregnancy in infertile women who underwent controlled ovarian hyperstimulation with sequential clomiphene citrate plus gonadotropin treatment and intrauterine insemination.

The importance of infertility duration and follicle size according to pregnancy success in women undergoing ovulation induction with gonadotropins and intrauterine insemination.

In this study, we aimed to evaluate the effect of infertility duration and dominant follicle size measured on the day of human chorionic gonadotropin (HCG) administration on pregnancy rates in infertile women undergoing ovulation induction (OI) with gonadotropin (GND). A total of 352 patients aged 20 to 41 years who were diagnosed with unexplained infertility or polycystic ovary syndrome (PCOS) were included in this study. Patients with a history of multifollicular development or follicle stimulating hormone (FSH) value more than 12 IU/ml were excluded from the study. The demographic and clinical features of the patients were obtained from the patients' files and hospital automation system and recorded for each woman. The demographic and clinical features of the patients were recorded. Patients were divided into two groups as live birth (group 1, n = 47) and non-live birth groups (group 2, n = 305). There were no statistically significant differences in regard to age, infertility type, follicle stimulating hormone (FSH) level, oestradiol (E2) level, antral follicle count (AFC), cycle characteristics, GND type, number of follicles, E2 level and endometrial thickness on HCG day, total GND dose, dominant follicle size (p > 0.05). Infertility duration in group 1 was 3.5 ± 2.1; in group 2, 4.7 ± 3.9 years. This difference was statistically significant (p = .014). According to this study, live birth rates after GND + IUIs(intrauterine insemination) were significantly affected by the duration of infertility. But the dominant follicle size and endometrial thickness measured on HCG day in GND and IUI cycles did not have a significant effect on pregnancy rates.IMPACT STATEMENTWhat is already known on the subject? It is thought that the timing of the ovarian triggering is vital for the success of intrauterine insemmination (IUI) treatment.What do the results of this study add? According to our results live birth rates after GND + IUIs were significantly affected by the duration of infertility.What are the implications of these findings for clinical practice and/or further research? It is determined that the duration of infertility is significant and patients should be encouraged to the treatment as soon as possible.

Progranulin and tumor necrosis factor-alpha in lean polycystic ovary syndrome patients.

OBJECTIVE: In this study, levels of progranulin (PGRN) and tumor necrosis factor-alpha (TNF-α) were measured to detect the presence of inflammation in lean polycystic ovary (PCOS) patients. METHODS: 40 lean PCOS patients were assessed by Rotterdam criteria. Forty healthy women with regular menstrual cycles and without biochemical and clinical hyperandrogenism were involved in our study. Blood samples were taken from the patient and control groups for the measurement of progranulin (PGRN), tumor necrosis factor-alpha (TNF-α), lipid parameters, glucose, insulin, and other hormones. RESULTS: Serum PGRN and TNF-α levels were significantly higher in patients with lean PCOS, compared with the control group (p = .037, p = .041). PGRN levels were positively correlated with TNF-α levels in lean PCOS patients. CONCLUSION: PGRN is known as a ligand for the TNF-α receptor. PGRN level increase in lean PCOS patients may be due to inhibiting the inflammatory effects of TNF-α. To observe the PGRN and TNF-α connection in obesity, further study is needed in obese PCOS patients and obese control groups.

Influence of Catheter Type and Tenaculum Use on Intrauterine Insemination Outcome.

BACKGROUND: We investigated the impact of the choice of catheter type and tenaculum use on pregnancy related outcomes in intrauterine insemination (IUI) treatments. MATERIALS AND METHODS: A total of 338 consecutive IUI cycles were assessed in this retrospective study. Participants were divided according to the insemination technique - soft catheter (group 1; n=175), firm catheter (group 2; n=100), or tenaculum (group 3; n=63). Clinical, laboratory, semen parameters and pregnancy related outcomes were compared. RESULTS: Demographic characteristics and laboratory parameters were similar between the groups (P>0.05). The clinical pregnancy rate (CPR) was significantly higher in the firm catheter (19%, 19/100) and tenaculum (31.7%, 20/63) groups compared to the soft catheter group (5.1%, 9/175),(P<0.001). There were no significant differences between the groups in live birth and miscarriage rates per clinical pregnancy (P>0.05). CONCLUSION: Our findings indicate that the use of a firm catheter or tenaculum for IUI might result in a higher CPR, but might not have a considerable effect on the live birth rate (LBR). Further prospective randomized studies are required to determine the long-term effects of the catheter type or tenaculum use on IUI success.

Could there be any role of thiol disulphide homeostasis and ischemia modified albumin in the pathogenesis of endometrial polyps?

OBJECTIVE: We searched thiol/disulphide homeostasis and ischemia modified albumin (IMA) in patients with and without endometrial polyp (EP) to evaluate whether there is an association between serum oxidative stress markers and EPs. METHODS: A total of 87 women were enrolled into this study. All patients were evaluated with office hysteroscopy, and then those with EPs underwent operative hysteroscopy. 43 of these women had pathologically confirmed EPs (study group) and 44 had not (control group). Fasting blood samples were obtained from the antecubital vein before the procedure in all women. Thiol/disulphide levels were analyzed with a newly developed method by Erel et al. IMA measurement was performed using an indirect method based on the colorimetric assay as previously defined. RESULTS: There were no significant differences between the 2 groups in terms of demographic characteristics including age, body mass index, and past obstetric history. Similarly no significant difference was observed regarding infertility ratio and smoking status. Native thiol, total thiol, and disulphide levels were found to be 263.6±63.3 µmol/l vs. 280.9±63.8 µmol/l (p:0.208), 296.9±64.9 µmol/l vs. 315.2±67.3 µmol/l (p:0.202), and 16.6±6.5 µmol/l vs.17.1±7.8 µmol/l ( p:0.759) in the study and control groups, respectively. There was also no significant difference with regard to serum IMA level (46.5±12.1 vs. 44.9±12.6; p: 0.539). CONCLUSION: Serum thiol/disulphide homeostasis and IMA levels have no significant effect in the pathogenesis of EPs.

Evaluation of Serum Human Epididymis Protein 4 Levels in Women with Polycystic Ovary Syndrome.

Aim The main purpose of this study is the determination of serum epididymis protein 4 (HE4) levels in women diagnosed with polycystic ovary syndrome (PCOS) and comparison with non-PCOS healthy controls. Methods All consecutive women, who applied between January 2017 and June 2017 to the gynecology outpatient clinics at the Zekai Tahir Burak Women's Health Training and Research Hospital and met the study criteria, were included in this cross-sectional study. Serum human epididymis protein 4 (HE4) concentrations were measured in each woman and the mean values were compared between the PCOS and non-PCOS groups. Results A total of 90 women (45 with PCOS and 45 without PCOS) were included in the final analysis. There were no statistically significant differences between the groups in terms of age and body mass index (p >0.05). Basal serum HE4 levels were 172.8 ± 139.8 and 131.8 ± 123.1 pmol/L in the PCOS and non-PCOS groups, respectively (p = 0.415). Conclusion The serum HE4 levels were found to be similar in women with and without PCOS. No significant correlation was observed between PCOS parameters and serum HE4 levels.

Decreased ADAMTS-1, -9 and -20 levels in women with endometrial polyps: a possible link between extracellular matrix proteases and endometrial pathologies.

A disintegrin-like and metalloproteinase domain with thrombospondin-type 1 motifs (ADAMTS) protein superfamily includes 19 secreted metalloproteases. Proteolytic substrates of ADAMTS enzymes have been linked to female reproductive function. Herein, we aimed to investigate serum ADAMTS-1, -9 and -20 levels in women with and without endometrial polyps (EPs). The study group (n = 40) consisted of women who had hysteroscopically detected and histologically confirmed EPs whereas control group (n = 40) was recruited from those women without any endometrial pathology. Data recorded for every woman were as follows: age, body mass index, gravidity and parity, number of miscarriages, smoking status and serum ADAMTS-1, -9 and -20 levels. ADAMTS-1, -9 and -20 values were measured by commercially available ELISA kits. No statistically significant differences between the groups were observed in terms of demographics. There were also no statistically significant differences between the groups with regard to ADAMTS-1 and -20 levels, although both of them were lower in the study group. However, ADAMTS-9 was significantly lower in the study group compared to the controls (p = .010). The optimal cut off value of ADAMTS-9 in predicting EPs was found to be 163.2 ng/mL with 100% sensitivity and 35% specificity. In conclusion, ADAMTS-9 protein is decreased in women with EPs. Impact statement What is already known on this subject? Endometrial polyps (EPs) are common and are generally benign gynaecologic disorders. ADAMTS enzymes comprise a zinc metalloproteinase gene family that has roles in vascular biology, inflammation and especially in the control of the function and structure of the extracellular matrix (ECM). ECM plays an important role in the pathogenesis of myomas, adenomyosis and abnormal uterine bleeding, as well as EPs. There is an interest in these proteases, especially with regard to the physiology of ovulation and implantation. They are also associated with carcinogenesis and metastasis. One of the most feared consequences of EPs is the risk of malignancy. Therefore, it is important in gynaecology practice to diagnose these endometrial abnormalities. What do the results of this study add? This is the first study performed to investigate the relationship between some ADAMTS (-1, -9 and -20) proteases and uterine polyps. Our results demonstrate novel molecular mediators contributing to EPs physiopathology. What are the implications of these findings for clinical practice and/or further research? ADAMTS-9 is defined as a tumour suppressor gene in various malignancies. Decreased ADAMTS-9 protein, which is the product of this gene, may have a role in the pathogenesis of EPs. There is a need for further research that should be done with benign-malign EPs.

Effect of time intervals from the end of sperm collection to intrauterine insemination on the pregnancy rates in controlled ovarian hyperstimulation-intrauterine insemination cycles.

OBJECTIVE: To analyze the effect of time intervals from the end of sperm collection to IUI on the pregnancy rates in couples who treated by COH-IUI cycles with gonadotropin due to unexplained infertility. METHODS: 556 couples who underwent the first COH-IUI treatment with gonadotopin due to unexplained infertility were included. Semen samples were obtained by masturbation in a private room near the laboratory on the day of insemination. For each semen samples, time between the delivery time to the laboratory and starting time of sperm washing procedure was noted as semen collection to sperm washing (SC-SW) interval, the time between the starting time of sperm washing procedure and insemination time was noted as sperm washing to insemination (SW-IUI) interval and the time between the delivery time to the laboratory and insemination was noted as semen collection to insemination (SC-IUI) interval. Clinical pregnancy was defined as positive pregnancy test followed by the presence of an intrauterine gestational sac with fetal cardiac activity by transvaginal ultrasonography at least 4 weeks after IUI. RESULTS: Among 556 couples, there were 84 cases of succesful clinical pregnancy and pregnancy rate was calculated as 15.1%. Intervals from SW to IUI and SC to IUI were significantly shorter in pregnant women than in non-pregnant (p<0.001 and p=0.007, respectively). SW performed ≤40min after SC resulted in higher clinical pregnancy rates than did SW performed >40min after SC (19.1% vs. 6.3%, respectively) (p<0.001). IUI performed ≤60min after the end of SW had higher pregnancy rates (16.9%) compared to IUI performed >60min after the end of SW (4.0%) (p=0.017). Likewise, IUI performed ≤90min after SC resulted in higher pregnancy rates than did IUI performed >90min after SC (18.9% vs. 12.0%, respectively) (p=0.029). CONCLUSION: IUI outcome is enhanced by shorter intervals from SC to SW, from SW to IUI, and from SC to IUI in gonadotropin-IUI cycles for unexplained infertile couples.

The effect of a pre-procedure information video on anxiety levels in patients undergoing hysterosalpingography: A prospective case-control study

Objective: To evaluate the effect of a pre-procedural information video on anxiety levels in patients undergoing hysterosalpingography (HSG). Material and Methods: Among a total of 131 primary or secondary infertile patients, 66 were shown an information video and 67 control patients received standard care between August 2014 and January 2016. The video included information on the procedure, personnel, and the room for the procedure; the video was shown on the morning of the procedure. Patients were randomized using the complete randomization technique through which patients were included in the study and control groups week by week, randomly. The Beck Anxiety Inventory scale was conducted to the patients one hour before the procedure. Results: There were no differences in demographic data. The history of previous gynecologic operations was higher in the control group. The Beck Anxiety score was significantly lower in the study group compared with the control group (6 vs 10). Conclusion: Our findings suggest that as an easy intervention to implement, a pre-procedural video education may be a beneficial tool for the management of HSG-related anxiety.

Role of Versican and ADAMTS-1 in Polycystic Ovary Syndrome.

OBJECTIVE: ADAMTS-1 is a matrix metalloproteinase which cleaves versican in the cumulus oocyte complex under the effect of luteinizing hormone surge in the periovulatory period. Altered levels may have a role in the pathogenesis of polycystic ovary syndrome (PCOS). We aimed to determine the serum versican and ADAMTS-1 (a disintegrin and metalloproteinase with thrombospondin motif-1) levels in PCOS patients and compare the results with healthy controls. METHODS: Thirty-eight patients with PCOS and forty healthy controls aged between 15 and 22 years were included in the study. They were sampled according to their basal hormone, serum versican, and ADAMTS-1 levels. Serum versican and ADAMTS-1 levels were measured by enzyme-linked immunosorbent assay. A multivariate logistic regression model was used to identify the independent risk factors of PCOS. RESULTS: Serum versican levels were significantly decreased in the PCOS group when compared with the controls. The best versican cut-off value for PCOS was calculated to be 33.65 with 76.74% sensitivity and 52.94% specificity. Serum versican levels, homeostasis model assessment of insulin resistance index, a Ferriman-Gallwey score higher than 8, and oligomenorrhea were the strongest predictors of PCOS. Serum versican levels were significantly decreased in PCOS patients. Besides, serum ADAMTS-1 and versican levels were significantly and positively correlated with each other. CONCLUSION: Serum versican levels were significantly decreased in patients with PCOS. This suggests a possible role of versican in ovulatory dysfunction and in the pathogenesis of PCOS.