ABSTRACT
This study evaluated the characteristics and results of patients who suffer from recurrent implantation failure [RIF]. In this cross sectional study, a total of 2183 cases who were evaluated retrospectively at the Istanbul University Cerrahpasa Medical Faculty, Department of Obstetrics and Gyneacology, IVF unit between 2000-2007. According to the data gathered, we included 1822 cases in this study. We compared 185 patients with RIF to 1637 women without RIF. Pregnancy was achieved by 589 couples out of 1822 [32%]. The implantation rate was 10%, which declined to 5.8% after the fourth attempt. In the RIF group, patients' mean age was higher and there were more overweight women, the duration of fertility was longer, day 3 follicle stimulation hormone [FSH] levels and the total gonadotropin dose administered were higher, mean level of Estradiol [E2] on the human chorionic gonadotropin [hCG] day was lower, and the mean level of progesterone on the hCG day was elevated compared to the non-RIF group. Although the comparison of MII oocyte number was not significant, the mean number of fertilized oocytes was found to be significant in favor of the non-RIF group. The endometrial thicknesses were found to be similar for both groups. Comparison of sperm motility and morphology were statistically significant in favor of the RIF group. In our study, we have found that the group with RIF were comprised of patients with poor prognosis who were older, overweight, had a longer infertility duration, a higher FSH level, and needed more gonadotropin doses in controlled ovarian hyperstimulation [COH]. Sperm motility and morphology were better in the RIF group compared to the non-RIF group, and multiple pregnancy rates were lower in RIF patients
ABSTRACT
BACKGROUND: Although folic acid deficiency is known to be one of the factors in the development of spina bifida and other neural tube defects (NTD) the exact pathophysiology still remains unclear. Progesterone is an endogenous hormone which increases significantly during pregnancy. AIMS: We aimed to study the possible negative effects of high dose progesterone on neural tube development in early chick embryos. In order to test our hypothesis, early chick embryos were exposed to physiological saline, normal and high doses of progesterone. SETTINGS AND DESIGN: 160 fertile, specific pathogen free white leghorn eggs (Gallus gallus), all at stage eight of development were divided into four equal groups. MATERIALS AND METHODS: The first group was incubated without any operation. The second group was injected with physiological saline. The third and fourth groups were injected with two and twenty times more than physiologic doses of progesterone respectively. After 48 hours of incubation, all embryos were analyzed for the presence of NTDs under light microscopy. STATISTICAL ANALYSIS USED: None. RESULTS: At 48 hours of incubation, 84% (135/160) of the embryos passed characteristics of Stage 12 development and were included to the study. None of the eggs in the first three groups showed NTDs, whereas 81.8% (27/33) of the eggs in the fourth group showed NTDs. CONCLUSIONS: Our study showed that progesterone at levels twenty times more than its physiologic level might cause NTDs. Further studies are needed to explain the mechanisms of this teratogenic effect.