What is the best treatment for women with polycystic ovarian syndrome and high LH/FSH ratio? A comparison among in vitro fertilization with GnRH agonist, GnRH antagonist and in vitro maturation.

PURPOSE: To evaluate whether high LH/FSH ratio has a clinical impact on patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF) with GnRH-agonist/antagonist protocols or in vitro maturation (IVM) treatments. METHODS: We retrospectively reviewed all PCOS patients with day 3 LH/FSH ratio ≥1.5 who underwent IVF or IVM. The main outcomes measures were embryo quality and pregnancy rate. RESULTS: A total of 75 cycles were included. Among these, 44 patients underwent long agonist protocol, 16 antagonist protocol and 15 IVM. Age, basal LH and FSH levels, as well as duration of infertility were comparable for all groups. The LH level on the day of hCG administration was significantly lower in the antagonist group (0.9 IU/ml) compared to the long agonist group (1.4 IU/ml, p = 0.01). There was no difference in pregnancy rates among the groups: 27.2 % in the long agonist group, 37.5 % in the antagonist group and 26.6 % among the IVM patients. CONCLUSIONS: High LH/FSH ratio had no adverse effect on pregnancy rates in all three treatment modes.

Fertility after high-dose testosterone and intracytoplasmic sperm injection in a patient with androgen insensitivity syndrome with a previously unreported androgen receptor mutation.

We report on a case of a man with familial, X-linked, partial androgen insensitivity, in whom a new point mutation in the androgen receptor (AR) ligand-binding domain (causing a valine-to-alanine substitution at codon 686) was identified. High-dose prolonged testosterone therapy resulted in marked progression in patient's appearance and great improvement in sperm count and characteristics. In combination with intracytoplasmic microinjection, treatment resulted in fertility. This is believed to be the first report of such a case. This case supports high-dose testosterone therapeutic trial in this condition. Furthermore, it underscores the possibility of achieving fertility with current endocrine and assisted reproduction modalities, making some of these X-linked AR mutations paternally transmissible.

Planck distribution of phonons in a Bose-Einstein condensate.

The Planck distribution of photons emitted by a blackbody led to the development of quantum theory. An analogous distribution of phonons should exist in a Bose-Einstein condensate. We observe this Planck distribution of thermal phonons in a 3D condensate. This observation provides an important confirmation of the basic nature of the condensate's quantized excitations. In contrast to the bunching effect, the density fluctuations are seen to increase with increasing temperature. This is due to the nonconservation of the number of phonons. In the case of rapid cooling, the phonon temperature is out of equilibrium with the surrounding thermal cloud. In this case, a Bose-Einstein condensate is not as cold as previously thought. These measurements are enabled by our in situ k-space technique.

Observing atom bunching by the Fourier slice theorem.

By a novel reciprocal space analysis of the measurement, we report a calibrated in situ observation of the bunching effect in a 3D ultracold gas. The calibrated measurement with no free parameters confirms the role of the exchange symmetry and the Hanbury Brown-Twiss effect in the bunching. Also, the enhanced fluctuations of the bunching effect give a quantitative measure of the increased isothermal compressibility. We use 2D images to probe the 3D gas, using the same principle by which computerized tomography reconstructs a 3D image of a body. The powerful reciprocal space technique presented is applicable to systems with one, two, or three dimensions.

Phonon dispersion relation of an atomic Bose-Einstein condensate.

We measure the time oscillations of a freely evolving standing wave of phonons in a Bose-Einstein condensate. We present the technique of short Bragg pulses, which stimulates the standing wave. The subsequent oscillations are observed in situ. The frequency of the oscillations gives the dispersion relation, the amplitude gives the static structure factor, and the decay gives the dephasing time. The new technique gives orders of magnitude more sensitivity than Bragg spectroscopy, allowing for the observation of deviations from the local density approximation. Specifically, it is seen that the phonons undergo a transition from three dimensions to one dimension, when their wavelength becomes longer than the transverse radius of the condensate. The one-dimensional regime contains an inflection point in the dispersion relation, a decrease in the superfluid critical velocity, a minimum in the group velocity, and an increase in the lifetime of the standing wave oscillations.

Addition of dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study.

BACKGROUND: The aim of this study was to evaluate the effect of dehydroepiandrosterone (DHEA) supplementation on in vitro fertilization (IVF) data and outcomes among poor-responder patients. METHODS: A randomized, prospective, controlled study was conducted. All patients received the long-protocol IVF. Those in the study group received 75 mg of DHEA once a day before starting the next IVF cycle and during treatment. RESULTS: Thirty-three women with significantly diminished ovarian reserves were enrolled, 17 in the DHEA group and 16 in the control group. The 33 patients underwent 51 IVF cycles. The DHEA group demonstrated a non-significant improvement in estradiol levels on day of hCG (P = 0.09) and improved embryo quality during treatment (P = 0.04) between first and second cycles. Patients in the DHEA group also had a significantly higher live birth rate compared with controls (23.1% versus 4.0%; P = 0.05), respectively. Six of seven deliveries were among patients with secondary infertility (P = 0.006). CONCLUSION: Dehydroepiandrosterone supplementation can have a beneficial effect on ovarian reserves for poor-responder patients on IVF treatment. Clinicaltrials.gov: NCT01145144.

[Epicardial VT ablation : In whom, when, how and why?] / Epikardiales Mapping und Ablation bei ventrikulären Tachykardien : Bei wem, wann, wie und mit welchen Erfolgsaussichten?

Ventricular tachycardia (VT) is a leading cause of cardiovascular death and remains the main cause of sudden cardiac death. Implanted cardiac defibrillators (ICD) improve survival but the recurrent ICD therapies, mostly ICD shocks, are associated with an increased mortality and deleterious psychological effects. In this regard and based on the results of multicenter studies, the current European guidelines recommend early referral for catheter ablation. The ablation strategy (isolated endocardial approach or combined epi-/endocardial) depends mostly on the underlying myocardial disease. Thus, almost all patients with right ventricular dysplasia and Chagas disease, the majority of those with dilative cardiomyopathy, and some patients with ischemic cardiomyopathy (mostly posterior wall infarction or large transmural anterior wall infarction) have an epicardial scar as the underlying substrate for recurrent VT episodes. Thus, in this group of patients, isolated endocardial VT ablation may be associated with an increased VT recurrence and therefore an epicardial approach is also needed. Cardiac imaging (cardio-CT/MRI with late enhancement[MRI LE]) can reliably identify the distribution and characteristics of the myocardial scar and may be helpful in planning the ablation strategy. When performed in highly specialized centers, epicardial catheter ablation of VT leads to a significant reduction of recurrent VT episodes compared to the endocardial VT ablation alone and with lower complication rates.

Intracytoplasmic morphologically selected sperm injection and congenital birth defects: a retrospective cohort study.

Our objective was to study the birth defect rates in intracytoplasmic morphologically selected sperm injection (IMSI) pregnancies. A cohort of couples presenting male factor infertility between January 2006 and January 2014 was retrospectively analyzed. Discharge letters and a telephone interview were performed for assessing pregnancy outcome. All clinical data were reviewed by a board certified medical geneticist. Main outcomes were fetal/birth defect and chromosomal abnormality rates. Two thousand two hundred and fifty-eight pregnancies were available for analysis, of them, 1669 (73.9%) resulting from ICSI and 2258 (26.1%) achieved by IMSI. Pregnancy outcome distribution did not show a significant difference. For the fresh embryo transfer cohort, fetal/birth defect rate was 4.5%, chromosomal aberration rate was 1.0%, and structural malformation rate was 3.5%. IMSI vs. ICSI pregnancies were less likely to involve a fetal/birth defect: 3.5% vs. 4.8%, respectively, but did not reach a statistical significance OR 0.71 (95% CI 0.39-1.22). Split by multiplicity, this trend existed only for singleton pregnancies; 1.4% structural malformations rate vs. 3.8%, respectively, OR 0.35 (95% CI 0.11-0.9). The frozen cohort demonstrated a significantly lower birth defect rate (OR 0.25, 95% CI 0.09-0.58). We conclude that IMSI procedure does not involve an increased malformation rate and may offer a reduced anomaly incidence. Further studies are required.

How to improve IVF-ICSI outcome by sperm selection.

In previous studies, a new IVF method of intracytoplasmic morphologically selected sperm injection (IMSI) was introduced, based on motile sperm organellar morphology examination (MSOME). It was concluded that microinjection of morphologically selected sperm cells with strictly normal nucleus, defined by MSOME, improves IVF-ICSI outcome. The aim of the present study was to confirm this conclusion in new, enlarged study groups. Comparison between 80 couples, who underwent an IVF-IMSI trial, with matched couples, who underwent a standard IVF-ICSI procedure, confirmed that pregnancy rate following IVF-IMSI was significantly higher, and abortion rate significantly lower than in the routine IVF-ICSI (60.0 versus 25.0%, and 14 versus 40% respectively, P

ART success and in vivo sperm cell selection depend on the ultramorphological status of spermatozoa.

Management of male infertility has recently shifted from treatment of the subfertile man towards techniques of assisted reproduction (ART). This study aimed to evaluate the possible role of the ultramorphological status of the spermatozoon with respect to sperm selection in vivo and prediction of ART success. Ultramorphological sperm parameters were assessed retrospectively for 92 males with sufficient sperm density (10(7) spermatozoa ejaculate-1) whose wives conceived following a stepwise discarding of the female genital tract barriers, using intra-uterine insemination (IUI) (n = 26), in vitro fertilization (IVF) (n = 45) or intracytoplasmic sperm injection (ICSI) (n = 21). In parallel, sperm samples of 71 fertile males were examined. Normal ultramorphology of all head and tail subcellular organelles was found to be essential for the ability of spermatozoa to pass the lower female genital tract. The ultramorphological migration threshold for this barrier is apparently higher than that essential for oocyte fertilization. No specific indication associated with passage through the upper genital tract was found. A high prevalence of axonema defects was found to impair the ability of sperm cells to penetrate the oocyte investment. The natural fertility index, based on routine sperm parameters and the ultrastructural status of the spermatozoon's subcellular organelles was confirmed to be beneficial for directing patients to ART. A discriminative score based on axonema integrity was found to contribute additional information for the first choice decision between conventional ART and ICSI (75% prediction ability). Thus it may be helpful in finding the simplest and least expensive procedure with the greatest long-term chance for pregnancy.