Euploidy rates of embryos in young patients with good and low prognosis according to the POSEIDON criteria.

RESEARCH QUESTION: Does an association exist between ovarian reserve, ovarian response and embryonic euploidy in female patients under age 35 years? DESIGN: This was a retrospective analysis of intracytoplasmic sperm injection and preimplantation genetic testing for aneuploidies cycles among patients enrolled at Bahceci Fulya IVF Center between January 2016 and August 2019. A total of 133 patients in POSEIDON group 1 (suboptimal responder; female age <35 years, antral follicle count [AFC] ≥5, number of oocytes retrieved <10) (group A), 133 patients in POSEIDON group 3 (expected low responder; female age <35 years, AFC <5) (group B) and 323 in the non-low-prognosis group (female age <35 years, AFC ≥5 and number of oocytes retrieved >9) (group C) were included. RESULTS: There was no significant difference in euploidy rate per embryo among the three groups (61.7% [145/235] for group A versus 53.5% [68/127] for group B versus 62% [625/1008] for group C; P = 0.13). The cancellation rate in cycles without a euploid blastocyst was significantly lower in group C than groups A and B (8.4% versus 12.8% and 16.5%; P = 0.034). Multivariate regression analysis indicated that the ovarian response group did not significantly affect the probability of obtaining a euploid embryo. Trophectoderm score 'C' (odds ratio 0.520, P = 0.007) and inner cell mass score 'C' (odds ratio 0.480, P < 0.001) were associated with a decreased probability of obtaining a euploid embryo. CONCLUSIONS: These results confirm that POSEIDON group 1 and group 3 and non-low-prognosis patients have different probabilities of euploid embryos being obtained per cycle. However, euploidy rates per embryo are not affected by the patient's ovarian reserve and response.

Measuring the serum progesterone level on the day of transfer can be an additional tool to maximize ongoing pregnancies in single euploid frozen blastocyst transfers.

BACKGROUND: Endometrial preparation with hormone replacement therapy (HRT) is the preferred regimen for clinicians due to the opportunity to schedule the day of embryo transfer and for patients due to the requirement of fewer visits for frozen-warmed embryo transfers (FET). The increasing number of FETs raises the question of the serum P levels required to optimize the pregnancy outcome on the embryo transfer day. METHODS: This prospective cohort study includes patients who underwent single euploid FET. All patients received HRT with oestradiol valerate (EV) and 100 mg of intramuscular (IM) progesterone (P). FET was scheduled 117-120 h after the first IM administration of 100 mg P. The serum P level was analyzed 1 h before the embryo transfer (ET). In all cycles, only embryos that were biopsied on day 5 were utilized for FET. Next generation sequencing (NGS) was used for comprehensive chromosomal analysis. RESULTS: Overall, the ongoing pregnancy rate (OPR) was 58.9% (99/168). Data were then categorized according to the presence (Group I; n = 99) or the absence (Group II; n = 69) of an ongoing pregnancy. No significant differences regarding, female age, body mass index (BMI), number of previous miscarriages, number of previous live birth, sperm concentration, number of oocytes retrieved, number of mature oocytes (MII), rate of fertilized oocytes with two pronuclei (2PN), trophectoderm score, inner cell mass (ICM) score, endometrial thickness (mm), oestrodiol (E2) and P levels prior to IM P administration were found between two groups. The P levels on the day of ET (ng/ml) were significantly higher in Group I (28 (5.6-76.4) vs 16.4 (7.4-60) p = 0.039). The P level on the day of ET was a predictor of a higher OPR (p < 0.001 OR: 1.033 95%CI [1.009-1.056]) after multivariate analysis. The ROC curve showed a significant predictive value of serum P levels on the day of ET for OPR, with an AUC (95%CI) = 0.716 (0.637-0.795). The optimal cut-off value for prediction of the OPR was a P level of 20.6 ng/ml (71.7% sensitivity, 56.5% specificity). CONCLUSIONS: The present study suggests a minimum threshold of the serum P value on the day of ET that needs to be reached in HRT cycles to optimize the clinical outcome. Individualization of the P dosage should be evaluated in further studies.

Does pituitary suppression affect live birth rate in women with congenital hypogonadotrophic hypogonadism undergoing intra-cytoplasmic sperm injection? A multicenter cohort study.

In this retrospective multicenter cohort study, women with congenital hypogonadotrophic hypogonadism (CHH) (n = 57) who underwent intra-cytoplasmic sperm injection in-between 2010-2014 were compared to age-matched controls with tubal factor infertility (n = 114) to assess ovarian stimulation cycle and pregnancy outcomes. Live birth rates (LBRs) per started cycle were 31.6 and 24.6% in CHH and controls groups, respectively (p = 0.36). Comparable success rates were also confirmed with the logistic regression analysis (OR: 1.44, 95% CI: 0.78-2.67, p = 0.24). Of the 57 women with CHH, 19 were stimulated with the gonadotropin-releasing hormone (GnRH) antagonist protocol, 13 with the long-GnRH-agonist protocol. Pituitary suppression (PS) was not employed in the remaining 25 cases. Compared to women with PS, women without PS had significantly higher embryo implantation rates (21.6 versus 52.6%, p = 0.03). Although there was a trend favoring no PS, LBRs (25.0 versus 40.0%, p = 0.26) per cycle were short of statistical significance. LBRs per cycle (57.1 versus 31.2%, p = 0.11) and miscarriage rates (11.1 versus 16.7%, p = 0.75) were similar between CHH women who were given estrogen + progesterone and progesterone alone to support the luteal phase. In conclusion, the optimal stimulation protocol appears to be exogenous gonadotropin stimulation alone, without PS, and progesterone-only luteal phase support in CHH patients.

The impact of unilateral salpingectomy on antral follicle count and ovarian response in ICSI cycles: comparison of contralateral side.

OBJECTIVE: To determine the impact of salpingectomy on the ovarian reserve. Comparisons are made with the contralateral side in patients with unilateral salpingectomy undergoing intracytoplasmic sperm injection (ICSI) cycles. STUDY DESIGN: Patients under 40 with unilateral salpingectomy and without history of ovarian surgery were selected for the multicentre retrospective study. Women with bilateral salpingectomy and history of endometriosis were excluded from the study. Antral follicle count, controlled ovarian hyperstimulation (COH) parameters and number of collected oocytes were the main outcome measures of the study. RESULTS: A total of 56 patients were eligible for this study. The mean age of the patients was 31.6 ± 4.7 years. The reasons for the salpingectomy were hydrosalpinx (39.3%, n = 22) and ruptured ectopic pregnancy (60.7%, n = 34). The ongoing pregnancy rate per embryo transfer was 30.6%. There was no statistically significant difference between the operated and non-operated sides in antral follicle count (AFC), follicles ≥ 17 mm and 10-17 mm on day of human chorionic gonadotrophin (hCG), or number of aspirated oocytes. In the subgroup analysis, AFC, number of growing follicles on day of hCG and number of collected oocytes were comparable between the ectopic pregnancy group and hydrosalpinx group. CONCLUSION: The study suggests that salpingectomy is not associated with detrimental effects on AFC and ovarian response.

Progesterone change in the late follicular phase affects pregnancy rates both agonist and antagonist protocols in normoresponders: a case-controlled study in ICSI cycles.

OBJECTIVE: The aim of the presented study is to investigate the impact of progesterone change in the late follicular phase on the pregnancy rates of both agonist and antagonist protocols in normoresponders. STUDY DESIGN: A total of 201 normoresponder patients, who underwent embryo transfer were consecutively selected. 118 patients were stimulated using a long luteal GnRH agonist protocol and 83 using a flexible antagonist protocol. The level of change in late follicular phase progesterone was calculated according to the progesterone levels on the hCG day and pre-hCG day (1 or 2 days prior to hCG day) measurement. RESULTS: Clinical pregnancy rates were comparable between long luteal and antagonist group (35.6 and 41%, respectively). The incidence of progesterone elevation on the hCG day was 11% in long luteal and 18% in antagonist group (p = 0.16). In pregnant cycles, p levels both on the hCG day and pre-hCG day measurement were significantly higher in antagonist than agonist cycles (p = 0.029, p = 0.038, respectively). The change of p level was statistically significant in non-pregnant cycles both for the agonist (-0.17 ± 0.07; 95% CI: -0.29 to -0.37) and antagonist groups (-0.18 ± 0.07; 95%CI: -0.31 to -0.04). CONCLUSIONS: Late follicular phase progesterone levels were stable during the cycles of pregnant patients irrespective of the protocols and were shown to be higher in pregnant patients in antagonist cycles when compared to agonist cycles.

Clomiphene citrate 'stair-step' protocol vs. traditional protocol in patients with polycystic ovary syndrome: a randomized controlled trial.

PURPOSE: To evaluate the efficacy of the stair-step protocol using clomiphene citrate (CC) and to assess the uterine and systemic side effects in patients with polycystic ovary syndrome (PCOS). METHODS: A total of 60 PCOS patients who failed to respond to 50 mg/day for 5 days of CC treatment within the cycle were randomly allocated to the control (traditional protocol) and study (stair-step protocol) groups. In the stair-step protocol,patients were treated with CC 50 mg/day for 5 days and then in nonresponsive patients, the dosage was increased to 100 mg/day for 5 days in the same cycle. Patients who failed the 50 mg/day CC treatment in the previous cycle were stimulated with 100 mg/day CC and were accepted as the control group. Ovulation and pregnancy rates, duration of treatment and uterine and systemic side effects were evaluated. RESULTS: Ovulation and pregnancy rates were similar between the stair-step and the control group (43.3 vs. 33.3 %, respectively) (16.7 vs. 10 %, respectively). The duration of treatment was significantly shorter in stair-step compared to traditional protocol (20.5 ± 2.0 vs. 48.6 ± 2.4 days, respectively). There were no significant differences in the systemic side effects between the groups. Uterine side effects were evaluated with endometrial thickness and uterine artery Doppler ultrasound; no significant differences were observed in stair-step compared to traditional protocol. CONCLUSIONS: The stair-step protocol was determined to have a significantly shorter treatment period without any detrimental effect on the ovulation and pregnancy rates.

The impact of adnexal torsion on antral follicle count when compared with contralateral ovary.

STUDY OBJECTIVE: In women with adnexal torsion, there is an absence of data whether ovarian reserve is affected when treated by detorsion and conservative surgery. We aimed to evaluate ovarian reserve by counting the antral follicles and estimating the ovarian volume in the operated side compared with the contralateral ovary. DESIGN: A case-control study (Canadian Task Force classification II-2). SETTING: In vitro fertilization center, Hacettepe University Faculty of Medicine and Etlik Zubeyde Hanim Women's Health and Research Hospital, Ankara, Turkey. PATIENTS: Patients who underwent conservative surgery because of adnexal torsion between January 2008 and August 2012 were retrospectively investigated from patient files and computer-based data. Eighteen patients were eligible for the study protocol and further evaluated for their ovarian reserve with ultrasonography. INTERVENTIONS: Comparing ovarian reserve in the torsioned and contralateral sides with ultrasonography by physicians who were blind to the previously operated side. MEASUREMENT AND MAIN RESULTS: The mean age was 28.3 ± 5.8 years. The mean antral follicle count on the operated and contralateral ovaries were 12.3 ± 8.4 and 11.3 ± 7.4, respectively (p = .23). The respective figure for ovarian volume was 7.6 ± 4.2 and 9.1 ± 5.3 mL (p = .063). Among 3 patients seeking to become pregnant, 1 of them conceived spontaneously and one achieved pregnancy with clomiphene citrate use. CONCLUSION: The finding of the current study suggests that ovarian reserve reflected by the antral follicle count is not compromised in patients treated with detorsion of the twisted adnexa.

Total fertilization failure: is it the end of the story?

PURPOSE: To study parameters that could predict in-vitro fertilization (IVF) success in patients who experienced total fertilization failure (TFF) with intracytoplasmic sperm injection (ICSI) in their previous cycles. METHODS: Cycle characteristics of patients with TFF (Group I, n = 136 cycles), cycles resulting in embryo transfer (ET) following TFF (Group II, n = 36 cycles) and recurrent TFF (Group III, n = 25 cycles) and were studied retrospectively. Demographic features, cycle characteristics of three groups were compared. RESULTS: Follicle count measuring 15-17 mm was significantly higher in group II when compared to group I (p = 0.02). Total number of retrieved oocytes and mature oocytes were significantly higher in group II when compared to groups I and III (p = 0.001). Estradiol level at oocyte pick up (OPU) day was significantly higher in group II when compared to group I (p = 0.02). When the characteristics of ET cycles and preceding TFF cycles of the same patient were compared, total number of retrieved oocytes (5.11 ± 0.72 (95% CI 3.69-6.52) vs. 11.44 ± 1.60 (95% CI 5.29-17.59)) and mature oocytes (3.26 ± 3.66 (95% CI 2.04-4.47) vs. 6.92 ± 5.61 (95% CI 5.09-8.75)) were found to be significantly lower in TFF cycles (p = 0.001). Five biochemical and 5 clinical pregnancies occurred while only 2 healthy babies were born, corresponding to a live birth rate 5.5%. CONCLUSIONS: Increasing the number of retrieved and mature oocytes may increase the success of fertilization in patients with a history of previous failed fertilization. However, live birth rate is still low in embryo transfer cycles.

High serum progesterone levels on the day of embryo transfer in patients undergoing artificial frozen-thawed blastocyst transfer: Is there a ceiling effect?

Objective: To evaluate the potential ceiling effect of high serum progesterone levels on the day of embryo transfer for pregnancy outcomes in patients undergoing artificial frozen-thawed blastocyst transfer (FET) cycles. Materials and Methods: This retrospective cohort study included 595 patients who underwent artificial FET cycles. We evaluated progesterone levels and found that 40.6 ng/mL corresponded to the 90th percentile and 23.9 ng/mL corresponded to the 50th percentile. Based on these findings, we categorized progesterone levels as <20 ng/mL (n=220, 37.0%), 20-40 ng/mL (n=312, 52.4%), and ≥40 ng/mL (n=63, 10.6%). The primary outcome measures were the clinical pregnancy rate (CPR) and live birth rate (LBR). Results: Blastocyst morphology grades, including expansion, trophectoderm, and inner cell mass grades, were significantly associated with clinical pregnancy (p<0.001 for all). Progesterone levels between 20 and 40 ng/mL were associated with higher CPR (p=0.043). In the multivariate analysis, only blastocyst expansion and inner cell mass grades were independently and significantly associated with CPR [p=0.011, odds ratio (OR)=1.6, (confidence interval) CI 95%=1.13-2.39, and p=0.007, OR=1.65, CI 95%=1.14-2.39, respectively]. The progesterone level and trophectoderm grade were not statistically significant. Regarding LBR, only blastocyst expansion grades 4 and trophectoderm grades A or B were significantly associated. Conclusion: Based on these data, we speculate that if serum progesterone levels exceed 40 ng/mL on the day of embryo transfer in patients undergoing artificial FET cycles, there is no need to reduce the progesterone dose.

Individualized luteal phase support in frozen-thawed embryo transfer after intramuscular progesterone administration might rectify live birth rate.

Background: The serum P concentrations are suggested to have an impact on pregnancy outcome. However there is no consensus about the optimal progesterone cut-off during the luteal phase. Few studies evaluated the effectiveness of a "rescue protocol" for low serum P concentrations and most of these studies used vaginal progesterone administration. There is paucity of data on the effectiveness of rescue protocol using intramuscular progesterone (IM-P) in frozen-thawed embryo transfer (FET). Methods: This study is a retrospective cohort study included 637 single or double blastocyst FETs with artificially prepared endometrium receiving 100 mg IM progesterone (P) after incremental estrogen treatment. Serum P concentrations were evaluated using blood samples obtained 117-119 hours after the first IM-P administration and 21 ± 2 hours after the last IM-P administration. Patients with serum P concentrations <20.6 ng/ml on the ET day were administrated 400 mg vaginal progesterone for rescue. Results: Demographic and cycle characteristics were similar between patients receiving rescue vaginal P (embryo transfer (ET)-day P concentration < 20.6 ng/ml) and patients who did not need rescue vaginal P (ET-day P concentration ≥ 20.6 ng/ml). Clinical pregnancy, miscarriage, and live birth rates were similar between two groups: 52.9%(45/85) vs 59.6%(326/552), p=0.287; 11.1%(5/45) vs 14.1%(46/326), p=0.583; and 47.1%(40/85) vs 50.7%(280/552), p=0.526, respectively. Logistic regression analysis revealed that the female age (p = 0.008, OR=0.942, 95% CI = 0.902-0.984) and embryo quality (ref: good quality for moderate: p=0.02, OR=0.469, 95% CI =0.269-0.760; for poor: p=0.013, OR= 0.269, 95% CI = 0.092-0.757) were independent variables for live birth. Following rescue protocol implementation, ET-day P concentration was not a significant predictor of live birth. Conclusions: Rescue vaginal P administration for low ET day serum P concentrations following IM-P yields comparable live birth rates.

Estradiol supplementation in intracytoplasmic sperm injection cycles with thin endometrium.

OBJECTIVE: To evaluate the efficacy of estradiol supplementation starting on the day of human chorionic gonadotrophin (hCG) in patients with thin endometrium in intracytoplasmic sperm injection (ICSI) cycles. METHODS: A total of 117 consecutive patients with the endometrial thickness on the hCG day ≤ 8 mm were reviewed. Estradiol supplementation was given in 57 patients and the remaining 60 patients were accepted as control group. Estradiol supplemented (ES) group received estradiol hemihydrate 4 mg/day started on the day of hCG. Luteal phase was supported using the vaginal progesterone gel in both groups. Clinical pregnancy rate, implantation rate, miscarriage rate, endometrial thickness on the day of oocyte pick-up and on the day of embryo transferred were accepted as main outcome measures. RESULTS: There were no statistical differences in terms of clinical pregnancy rate (28.1% vs. 23.3%), implantation rate (16% vs. 10.4%), miscarriage rate (21% vs. 31.6%), endometrial thickness on the oocyte pick-up day (8.5 ± 1.8 vs. 8.4 ± 1.4, mm) and embryo transferred day (9.6 ± 2.9 vs. 10.3 ± 2.4, mm) in the ES group vs. control group. CONCLUSION: Estradiol supplementation starting on the hCG day for the patients with thin endometrium does not provide any benefit on the pregnancy outcome in ICSI cycles.

Subcutaneous progesterone administration provides a similar ongoing pregnancy rate compared with intramuscular progesterone administration in hormone replacement therapy frozen embryo transfer cycles.

Objective: To compare the ongoing pregnancy rates (OPRs) for subcutaneous progesterone (SC-P) to intramuscular progesterone (IM-P) in hormone replacement therapy used in frozen embryo transfer (FET) cycles. Design: Prospective nonrandomized cohort study. Setting: Private fertility clinic. Patients: The study enrolled 224 patients scheduled for hormone replacement therapy (HRT)-FET cycles with SC-P (n = 133) or IM-P (n = 91). The route of P administration was decided according to the patient's preference and accessibility to the hospital. In the first FET cycle of a freeze-all cycle using single blastocyst transfers, a woman aged ≤35 was included. Main Outcomes: Ongoing pregnancy (OP). Results: The demographic, cycle, and embryologic characteristics were similar between groups. The clinical pregnancy rates (86/133[64.7%] vs. 57/91[62.6%]); miscarriage rates (21/86 [24.4%] vs. 10/57 [17.5%]), and OPR (65/133 [48.9%] vs. 47/91 [51.6%]) were comparable between the SC-P and IM-P groups. Binary logistic regression for OP as the dependent factor revealed that blastocyst morphology was found to be a significant independent prognosticator (for poor quality embryos adjusted odds ratio, 0.11; 95% confidence interval, 0.029-0.427) and progesterone route (SC-P vs. IM-P) was an insignificant prognosticator (adjusted odds ratio, 0.694; 95% confidence interval, 0.354-1.358). Conclusions: The OPR for SC-P administration was similar to that for IM-P in HRT-FET cycles. The effect of ET-day P levels may vary regarding the administration route. Randomized controlled trials comparing different P administration routes are needed, and large-scale prospective trials are warranted to evaluate the ET-day P levels on pregnancy outcome.

Does empty zona pellucida indicate poor ovarian response on intra cytoplasmic sperm injection cycles?

The factors behind the empty zona pellucida (EZP) formation and its relationship with in vitro fertilization (IVF) outcomes were analyzed. A total of 104 patients who underwent IVF treatment and collected oocytes including EZP were enrolled in this study. EZP index (EZPI = the ratio of number of EZP to number of cumulus-oocyte complex (COC)) was used for the statistical analysis. Patients were grouped as Group 1 when EZPI ≤ 0.17 (n = 57) and Group 2 when EZPI > 0.17 (n = 47). Type-2 EZP, a variation or an advanced type of oocyte degeneration, is tested. Woman age, basal hormone levels, and total gonadotropin dose were significantly higher in Group 2 compared to Group 1. Total antral follicle count was significantly low in Group 2. Total number of mature oocytes, oocyte quality index, the number of fertilized oocytes, and the numbers of Grade 1 embryos were significantly low in Group 2. On the linear regression analysis, using gonadotropin releasing hormone antagonist protocol (B = 0.086, p = 0.030), the number of ≥17 mm follicle (B = 0.015, p = 0.047), peak serum level of estradiol (B = -3.625; p = 0.014), number of fertilized oocytes (B = -0.02, p = 0.0001) and the day-2 embryo score (B = -0,044, p = 0.001) significantly affected EZPI. An increment of the EZPI may be revealed decreased oocyte quality, and it is also related to the poor ovarian response.

Is pronuclear scoring a really good predictor for ICSI cycles?

BACKGROUND/AIMS: Since the assessments of the morphology of oocytes, zygotes and/or embryos are of crucial importance to select the best candidate for pregnancy, many morphological evaluation tools have been proposed. Although embryo scoring, particularly cleavage and blastocyst stages, is more convincing due to successful results, zygote scoring still have a bias as different outcomes. In the current study, we designed a prospective study to test the reliability of zygote scoring by focusing on zygote evaluation techniques and its relation with embryo development and embryo selection for transfer. METHODS: A total of 1215 mature oocytes from 139 couples were evaluated for the study. RESULTS: There is no correlation between published zygote scoring technique and embryo development. CONCLUSIONS: We conclude that the inconsistency of data obtained from zygote scoring might be caused by the static nature of pronuclear stage embryos and thus pronuclear scoring seems to be unreliable evaluation technique for embryo selection.

Does 75 IU difference improve the cycle performance in poor responders? Comparison of daily 375 versus 450 IU gonadotrophin doses.

OBJECTIVE: To compare the efficacy on the cycle performance of 375 versus 450 IU/day gonadotrophin on the microdose flare-up protocol in poor responders. STUDY DESIGN: A total of 91 poor responder patients who were treated with the microdose flare-up protocol were enrolled in this study. Group 1 (n = 40) was stimulated with 375 IU/day gonadotrophin. Group 2 (n = 51) was stimulated with 450 IU/day gonadotrophin. Main outcome measurements were accepted as the results of controlled ovarian hyperstimulation, implantation, clinical pregnancy, and live birth rates. RESULTS: Baseline characteristics are similar between the two groups. Higher number of oocyte cumulus complexes and lower total gonadotrophin requirement were noted in Group 1 compared with Group 2. Number of metaphase II oocytes and implantation rates were similar between the groups. A trend toward higher clinical pregnancy and live birth rate was observed in Group 1 but these results did not reach statistical significance. CONCLUSIONS: Total gonadotrophin costs are lower using the 375 IU/day gonadotrophin compared to the 450 IU/day in poor responders. Additional 75 IU/day does not give any improvement neither embryology nor pregnancy outcomes.

Mediterranean climate is associated with early age at menopause and low high-density lipoprotein in postmenopausal women.

OBJECTIVE: The aim of this study was to investigate the effect of three different climates on age at menopause and metabolic factors in postmenopausal women. METHODS: Study population consisted of 232 postmenopausal women with natural menopause who admitted to Dr. Sami Ulus Maternity and Women's Health Teaching and Research Hospital Menopause outpatient clinic for routine check up. Participants were divided into three groups according to climate where they had lived during reproductive span. Black Sea, Mediterranean, and continental climate effects on age at menopause and metabolic factors were investigated. RESULTS: Postmenopausal women living in three different climates were significantly different according to body mass index, gravidity, age at menopause, menarche, and high-density lipoprotein (HDL) (p < 0.05). The lowest mean age at menopause and HDL levels were observed in women living in Mediterranean climate. Adjusted mean age at menopause remained significant (p < 0.05). CONCLUSION: Mediterranean climate is associated with early menopause and low HDL levels.

Diagnostic accuracy and efficacy of color Doppler mapping for tubal patency.

AIM: To evaluate the diagnostic accuracy of color Doppler mapping for tubal patency, comparing its results with those of hysterosalpingography (HSG) and laparoscopy. MATERIAL AND METHODS: A prospective clinical study was conducted in 36 subfertile women who were offered laparoscopy after HSG evaluation. All infertile couples were evaluated with basic infertility procedures. After HSG assessment, laparoscopy was offered when evidence of either unilateral or bilateral tubal obstruction was observed. One day before the operation, transvaginal ultrasound scanning of the pelvis and color Doppler mapping were performed. The findings of sonography, HSG and laparoscopy were compared. RESULTS: Sixty-four of 72 fallopian tubes were evaluated and four patients were excluded from the analysis because of technical difficulties. The sensitivity of color Doppler mapping for detecting tubal patency was 76.2% with a specificity of 81.4%. The positive and negative predictive values were 66.7% and 87.5%, respectively. The concordance rate was 79.7%. The false positivity rate for color Doppler mapping and HSG were observed as 19% and 35%, respectively. CONCLUSION: Color Doppler mapping as an adjunct to an abnormal HSG may decrease the need for laparoscopic intervention for the diagnosis of tubal disorders.

Coexistence of endometriosis and uterine septum in patients with abortion or infertility.

AIM: To investigate the coexistence of endometriosis and uterine septum patients whose complaints are abortion and infertility. METHODS: Ninety-two patients with a uterine septum and 191 patients who had undergone diagnostic laparoscopy for infertility were reviewed. The incidence of endometriosis in patients with a uterine septum was compared with patients with a normal uterine cavity; then the incidence of endometriosis was compared in association with having a preoperative diagnosis of presumed unexplained infertility in women with a partial or complete uterine septum. RESULTS: There was no significant difference between the patients who had a uterine septum and those with a normal cavity in terms of the incidence of endometriosis (P = 0.39). Also, the incidence of endometriosis was not significantly different in patients who had a complete or partial uterine septum (P = 0.49). Endometriosis was observed in 8.7% of the patients who were presumed to have unexplained infertility in the complete uterine septum group and in 18.8% of the patients in the partial uterine septum group; but the difference was not statistically significant when complete and partial uterine septum groups were compared according to the type of infertility (partial uterine septum group, P = 0.13; complete uterine septum group, P = 0.28). CONCLUSION: An increased incidence of endometriosis was not observed in patients with a septate uterus. The reason for infertility in women with a partial uterine septum may be related to endometriosis.

Influence of family structure on sexual behavior of Turkish female adolescents.

BACKGROUND: The aim of this study was to evaluate the link between romantic relationship and/or sexual activity of adolescents, and family structure. METHODS: Medical records of 1087 adolescent girls were evaluated for age, statute (student, working, out-of-school), incidence of romantic relationship and sexual activity, and family structures. RESULTS: Teenager students had significantly less romantic relationships and experience of sexual intercourse than other groups. Parent-adolescent communication was negatively correlated with absence of romantic relationship and sexual intercourse. CONCLUSION: Adolescents who have left school and are working constitute a population having higher romantic relationships and sexual intercourse experiences compared with the student adolescents. Good relationships with parents were associated with less risky sexual behavior. Close relationships with school delay the onset of sexual activity.

Lyophilised hMG versus rFSH in women with unexplained infertility undergoing a controlled ovarian stimulation with intrauterine insemination: a prospective, randomised study.

PURPOSE: To compare the efficacy of lyophilised urinary hMG (HP-hMG) with recombinant FSH (rFSH) in women with unexplained infertility undergoing a controlled ovarian hyperstimulation with intrauterine insemination (IUI). METHODS: Forty-nine consecutively seen women with unexplained infertility were randomised to a controlled ovarian hyperstimulation with IUI cycle either with rFSH or HP-hMG. The outcome was compared by independent samples t-test. RESULTS: The mean patient age and duration of infertility were not different (29.5 +/- 5.7 and 4.9 +/- 2.7 years in rFSH; 28.8 +/- 3.2 and 6 +/- 4.2 in HP-hMG group) (p = 0.6 and p = 0.2). The mean body mass index (BMI) and basal hormones were similar. Total dose of gonadotropin used (710 +/- 236 vs. 636 +/- 185 IU) and duration of the cycles (9 +/- 2.1 vs. 8.3 +/- 2.3 days) showed no significant difference (p = 0.2). Number of follicles, serum oestradiol (E2), and the endometrial thickness on the day of hCG were comparable. Two singletons in each group were obtained. CONCLUSIONS: These data suggest that HP-hMG and rFSH may be equally suitable in mild ovarian stimulation for unexplained infertility. Further data derived from larger study population are needed to determine whether higher amounts of two gonadotropins in this subgroup might produce any benefits or unfavourable effects.