Demographic distributions and clinical results of assisted reproduction techniques in Turkey in 2019: a descriptive survey.

Objective: The aim of this study was to describe characteristics and outcomes of assisted reproductive technology (ART) cycles performed in 2019 in Turkey. Material and Methods: One-hundred and sixty-five ART centers in Turkey were invited to submit data. The survey was sent to center directors via e-mail with anonymous links by Qualtrics™. The survey involved questions about their patient characteristics, clinical practices, and outcomes. Results: Forty-one (24.8%) centers responded to e-mails, and data gathered from 25 centers was included in the analyses. In 25 centers, 18,127 fresh or frozen transfers were carried out during the study period, of which 7796 (43.0%) were fresh and the rest were either frozen (45.2%) or embryo transfers (ET) with preimplantation genetic testing (PGT) (11.8%). The live birth rate per ET was as 30.6%, 40.1%, and 50.7% in fresh, frozen and PGT cycles, respectively. A single embryo was transferred in 65.3% of all transfers and singleton live births comprised 86.1% of all deliveries. For cycles with intrauterine insemination, 1407 were started in 2019, and 195 clinical pregnancies, 150 live births with 19 multiple pregnancies occurred. A total of 1513 ART cycles were initiated for foreign patients. Russia (29.6%), Germany (7.4%), Iraq (4.6%), Uzbekistan (3.1%), and Syria (1.4%) were the top five countries with most patients coming to Turkey for ART. Conclusion: The survey results are in parallel with the reports of international institutions and organizations. With repeated editions, the data collected with annual surveys can be used to inform ART practices in the coming years.

Individual variation of the percentage of Y-chromosome bearing sperm content in human ejaculates.

The study aimed to determine the variation of Y-chromosome-bearing sperm content among individual ejaculates. A real-time polymerase chain reaction (qPCR) with unique primers was developed and used to calculate the percentage of Y-chromosome-bearing sperm in individual ejaculates from 50 randomly selected men. There was a significant difference in the overall mean ± SD between the proportion of Y-chromosome-bearing sperm and X-chromosome-bearing sperm (45.36 ± 7.88 vs. 54.42 ± 7.88). Of the 50 ejaculates, 17 had more than, and 14 had less than the 99% confidence interval of the mean of the Y-chromosome-bearing sperm (45.58 ± 2.87). These results suggest that the inconsistency in sperm-based sex-selection outcomes appears to be a function of differences in the ejaculates and highlights the need for further study in environmental and genetic factors contributing to X or Y bearing spermatozoan instability.Abbreviations: qPCR: real-time polymerase chain reaction; ROS: reactive oxygen species; DTT: dithiothreitol; SRY: sex-determining region Y.

Live birth after transfer of a tripronuclear embryo: An intracytoplasmic sperm injection as a combination of microarray and time-lapse technology.

Although around 1-4% of human zygotes have been found to be tripronuclear, there is little information about the subsequent development and chromosomal composition of embryos that derive from these zygotes. Herein, we report a pregnancy and subsequent delivery of a healthy newborn after the transfer of a blastocyst that developed from a tripronuclear zygote that had a euploid microarray result.

The risk of ectopic pregnancy following GnRH agonist triggering compared with hCG triggering in GnRH antagonist IVF cycles.

PURPOSE: The aim of this study was to compare the incidence of ectopic pregnancy in GnRH agonist triggered IVF cycles with intensive luteal support versus hCG triggered IVF cycles. METHODS: This study was conducted as a retrospective cohort analysis of women who underwent IVF treatment employing GnRH agonist or recombinant hCG (rhCG) triggers during 2-year period. The medical charts of women who achieved pregnancies were reviewed and their demographic characteristics, infertility reasons and IVF data were recorded. A multiple logistic regression analysis was performed to estimate the association between the triggering medication used to stimulate final oocyte maturation (GnRHa or rhCG) and EP, with adjustment for important confounders: the day of embryo transfer (ETD), the etiology of infertility and estrogen level at the time of triggering. RESULTS: The number of metaphase II oocytes, fertilized oocytes and good quality embryos were significantly higher in the GnRH agonist triggered group compared with the hCG triggered group (p < 0.001 for all). The clinical pregnancy and implantation rates in the hCG triggered cycles were 38.6 and 31.1 %, respectively and 24.7 and 22 %, respectively in the triptorelin triggered cycles. The ectopic pregnancy rates were 5.3 % in the triptorelin triggered group and 1.4 % in the hCG triggered group. The trigger medication and the day of embryo transfer were found to have a significant effect on the probability of developing ectopic pregnancy (p = 0.028, p = 0.046 respectively). However, the estrogen level was not found to have a significant effect on the probability of developing ectopic pregnancy (p = 0.447). CONCLUSIONS: The reasons for higher ectopic pregnancy rates in GnRH agonist triggered cycles relative to hCG triggered cycles may be the decreased receptivity of the endometrium due to insufficient luteal support and higher implantation potential of embryos in correlation with a higher number of good quality embryos obtained in these cycles.

Reproducibility of a time-lapse embryo selection model based on morphokinetic data in a sequential culture media setting.

OBJECTIVE: To compare the outcomes of embryos that were given a dynamic score based on a preconstructed embryo scoring model and to analyze whether this model complies with our data. MATERIAL AND METHODS: A total of 910 transferred embryos with known implantation data were retrospectively analyzed in this study. All of the embryos were given a dynamic score based on the preconstructed hierarchical embryo scoring model. RESULTS: The highest pregnancy rate was seen in groups C+ and A- (48.2% for each), and the lowest was observed in Group E (19.7%). When implantation and clinical pregnancy rates were compared between groups, it was found that the highest and statistically significant implantation and clinical pregnancy rates were seen in group C+ (32.7% for each, p=0.000). They were dropped down to 29.4% in Group A-. CONCLUSION: The outcomes of the embryos based on the dynamic score do not comply with the results of the preconstructed model. Each IVF laboratory is unique based on its practice. Therefore, we suggest that each IVF laboratory should determine its own embryo selection criteria based on its own data instead of using a preconstructed model.

Frequency of embryo multinucleation detected by time-lapse system and its impact on pregnancy outcome.

OBJECTIVE: To compare the detection rate of multinucleation with the time-lapse system and conventional control timing proposed by European Society of Human Reproduction and Embryology (ESHRE) consensus and evaluate its impact on pregnancy rates. DESIGN: Retrospective study. SETTING: A private IVF center. PATIENT(S): A total of 686 embryos from 511 intracytoplasmic sperm injection (ICSI) cycles. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): A time-lapse system was used to acquire embryo images until ET; the stored data were reviewed for the presence and persistence of multinucleation. The detection rate of multinucleation was compared with ESHRE/ALPHA consensus-proposed embryo evaluating times (23 ± 1, 26 ± 1, 44 ± 1 hours). Morphokinetic characteristics of multinucleated embryos and the effect of multinucleation on pregnancy rate were researched. RESULT(S): Multinucleation was detected in 159 embryos of 145 ICSI cycles. Using ESHRE/ALPHA consensus embryo evaluating times, only 44 (27.6%) out of 159 multinucleated embryos could be identified. In cycles with multinucleated ETs compared with cycles with no multinucleated embryos, clinical pregnancy rates (respectively, 23.4 vs. 44) and implantation rates (respectively, 23.3 vs. 43.6) were significantly lower. Time to 2-cell, 4-cell, and 6-cell stage was significantly longer in multinucleated embryos. Patient age (odds ratio [OR], 0.95; confidence interval [CI], 0.92-0.98) and presence of multinucleation (OR, 0.37; CI, 0.24-0.56) were the only significant predictors of clinical pregnancy rate. CONCLUSION(S): The time-lapse monitoring system seems to be a valuable tool to identify all cases with multinucleation. We conclude that the detection of multinucleation by time-lapse monitoring is associated with lower implantation and clinical pregnancy rates.

Is apolipoprotien E codon 112 polymorphisms associated with recurrent pregnancy loss?

PROBLEM: To compare the prevalence of 112T>C point mutations among women experiencing RPL with fertile control women. METHOD OF STUDY: Buccal swabs were obtained from 232 individuals: 136 with a history of >or=2 abortions, 37 with at least 2 live births and 59 with a history of deep vein thrombosis (DVT). DNA was extracted and PCR amplification of Apo E codons was performed. RESULTS: The allelic frequency of a cytosine at position 112 was 11.4% (31/272) among patients experiencing RPL, compared with a frequency of 5.4% (4/74) among the fertile controls (P = 0.19) and 19.5% (23/118) among individuals with a history of DVT. However, significantly more E3/E4 and E4/E4 genotypes were seen among individuals experiencing RPL and DVT than fertile controls (P < 0.05). CONCLUSION: Apo E4 codon 112C point mutation is, by itself, not associated with an elevated risk of recurrent pregnancy loss, but rather codon 112C in association with codon 158C is a risk factor for RPL.

Letrozole versus human menopausal gonadotrophin in women undergoing intrauterine insemination.

This pilot study was conducted to compare the results of intrauterine insemination (IUI) under ovarian stimulation with either letrozole (Femara) or human menopausal gonadotrophin (HMG). A randomized controlled trial was conducted. Eighty women aged 20-35 years with unexplained infertility of at least 2 years' duration were randomized according to a computer-generated randomization list into the letrozole group and the HMG group. Letrozole was administered at 5 mg/day from day 3 to day 7 of the IUI cycle. HMG injections were started on day 3 at a dose of 75 IU for women under 30 years old and 150 IU for women over 30 years old and monitored periodically by vaginal ultrasound and oestradiol concentrations. The variables selected for analysis were clinical pregnancy rate, endometrial thickness, length of follicular phase and number of preovulatory follicles. No statistically significant difference in clinical pregnancy rates per cycle was found for patients in the letrozole or HMG group (18.4 versus 15.7%). Cost was significantly higher in the HMG stimulation cases (P < 0.001) and no injections were required in the letrozole group. In conclusion, letrozole offers a new treatment regimen in ovarian stimulation regimens for IUI that is cost effective, simple and convenient for the patients.

Administration of alternate day triptorelin for controlled ovarian hyperstimulation is cost effective.

Gonadotropin-releasing hormone agonists in an alternate-day dosage resulted in similar clinical pregnancy rates as the daily protocol. No premature luteinization was reported in either group. Total GnRH agonist dosage in the alternate-day protocol was significantly reduced.