Outcome of ICSI with motile testicular spermatozoa obtained through microscopically assisted testicular sperm extraction in relation to the ovarian response.

INTRODUCTION: To determine the relationship between AFC, basal FSH level, woman's age, the number of oocytes retrieved and the outcome of ICSI with testicular spermatozoa obtained with microscopically assisted testicular sperm extraction. MATERIAL AND METHODS: In this retrospective cohort study, a total of 340 couples who underwent ICSI treatment with testicular sperm were enrolled. Women aged?40years and the first cycles of couples were included. ICSI was performed with motile testicular spermatozoa obtained from 89 men with obstructive azoospermia and 251 men with nonobstructive azoospermia. GnRH-antagonist protocol was used for ovulation induction. Simple linear regression was carried out to analyze relationship between the AFC, basal FSH, woman's age, the number of oocytes, and the live birth rate (LBR). Receiver operator characteristic curves (ROC) were formed to detect cut-off values below which LBR was significantly decreased. ROC curve analysis demonstrated that the cut-off level of the number of oocytes retrieved to predict the LBR was 7. According to this cut-off level, all patients were divided into two groups. Women with retrieved<7 oocytes were included in Group 1 and women with retrieved?7 oocytes were included in Group 2. RESULTS: The mean age of men was 35.1±4.9years. The mean age, mean FSH level and mean AFC of women were 32.1±4.9years, 6.9±2.7 IU/L, 7.6±3.4, respectively. Significant correlations were found between AFC, the number of oocytes retrieved, and the LBR per ICSI cycle with testicular spermatozoa. The LBR was significantly lower in women with AFC<8 than those with AFC?8. Independently, the LBR was significantly lower in cycles with<7 oocytes retrieved compared to those with ?7. Embryo transfer was not achieved in 37 cycles with<7 oocytes (37/167, 22.1%) and 18 cycles with?7 (18/173, 10.4%) because of the absence of transfer-quality embryos (P=0.005). The LBRs were the lowest in cycles with one or two oocytes available (8.3 and 8.3%, respectively), but these rates were not statistically different than those in cycles with 3, 4, 5 and 6 oocytes (14.2, 17.2, 18.5, 17.6%, respectively, P=0.810). CONCLUSIONS: AFC and the number of oocytes retrieved are important prognostic factors in an ICSI cycle with testicular sperm in women ?40years, yielding significantly diminished LBRs with<8 antral follicles and/or<7 oocytes retrieved.

The influence of sperm parameters on the outcome of intracytoplasmic sperm injection-embryo transfer cycle in poor responder women under 35 years of age.

To evaluate the influence of sperm parameters on the outcome of intracytopiasmic sperm injection (ICSI) cycies in poor responaer women under the age of 35 years in a retrospective analysis in a fertility center. MATERIALS AND METHODS: A total of 432 poor responder women who underwent ICSI cycles were evaluated. The interventions included ICSI and microdissection testicular sperm extraction (m-TESE). Main outcome measures included fertilization, cleavage, clinical pregnancy, and delivery rates. RESULTS: Patients were di- vided into four groups according to the sperm parameters and the source of sperm; testicular spermatozoa obtained from men with azoospermia (group 1; n=26), severe oligoasthenoteratozoospermia (OAT) (group 2; n=35), OAT (group 3; n=104), and normal semen analysis (group 4; n=267). Average age of the women, antral follicle count, FSH level, male age, number of previous ICSI cycles, duration of infertility, and the maximal endometrial thickness were similar among the groups. In group 1, the fertilization rate was lower than those in all other groups. Cleavage, clinical pregnancy, and delivery rates were similar among the groups. CONCLUSIONS: Neither sperm parameters nor the source of spermatozoa affects delivery rate through ICSI in poor responder women < 35-years-old.

Influence of Bacillus Calmette-Guèrin vaccination at birth and 2 months old age on the peripheral blood T-cell subpopulations [gamma/delta and alpha-beta T cell].

The neonatal immune system is immature and may be affected by Bacillus Calmette-Guèrin (BCG) vaccine. We investigated the influence of BCG given at two different ages on the peripheral blood (PB) T-cell subpopulations. Forty full term healthy newborns were randomly chosen. Twenty of them were vaccinated with BCG at birth (group I) and the remaining at the age of 2 months (group II). The cell analysis were carried out before (pre-BCGI and pre-BCGII), and 2 months after (post-BCGI and post-BCGII) the vaccination. The analysis of the gamma/delta and alpha/beta T-cell receptor (TCR) antigens was done by two-colour flowcytometer. The purified protein derivative (PPD) response was investigated 2 months after vaccination. The results showed that although T-cell (TCR+ cell) counts showed no difference in PB before and after vaccination in both study groups, the total lymphocyte and non-T cell (TCR- cell) populations increased significantly whereas alphabetaT-cell population significantly decreased after vaccination. On the contrary, gammadeltaT-cell counts in PB increased significantly 2 months after vaccination in group I but not in group II. Total lymphocyte and non-T cell counts in vaccinated infants at 2 months of age (post-BCGI) were significantly higher than in unvaccinated infants of the same age whereas alphabetaT-cell count in vaccinated infants was significantly low. However, total T-cell and gammadeltaT-cell counts showed no difference. PPD positivity was similar in both study groups (61% in group I, 66% in group II). Neither alphabetaT- nor gammadeltaT-cell counts were different in PPD positive and PPD negative infants. Our study shows that BCG causes marked quantitative changes in the PB T-cell subpopulations in young infants.

Factors influencing the duration of exclusive breastfeeding in a group of Turkish women.

This study was conducted to evaluate the influence of demographic characteristics, hospital practices, maternal psychosocial factors, and knowledge about infant feeding and breast milk on duration of breastfeeding. The mothers of 91 healthy, term infants delivered at a university hospital between June 1998 and December 1998, and first seen in the well-child unit within 10 days of delivery, participated in the study. Forty-nine (54%) infants were exclusively breastfed at 4 months of age. Cox regression analysis showed a negative association between formula supplementation during the hospital stay and duration of exclusive breastfeeding. The median age for starting non-breast milk liquids was 1 month for those who received formula in the hospital and 3 months for those who did not (P = .001). The hospital practices were more predictive of the duration of exclusive breastfeeding in this study group than mothers' knowledge of infant feeding or psychosocial factors. Thus, hospital practices should be reevaluated.

Bone density values in healthy Turkish infants.

OBJECTIVE: To determine values of bone density of Turkish infants under one year of age. DESIGN: Cross sectional. METHODS: This study included 1, 2, 4, 6, 9 and 12 months old 164 male and female healthy infants who were evaluated by dual energy X-ray absorbtiometry. RESULTS: The values for each age were computed. There was no significant difference between boys and girls. A significant relationship was found between bone mineral density, bone mineral content, total body calcium and calcium/body surface, and age, height, body weight, head circumference and body surface area. Multiple regression analysis showed that body mineral density was affected by weight, height, head circumference and body mass index. Body mineral content and total calcium content were affected by weight and height. CONCLUSION: The results will serve as reference values for healthy 1-12 months old Turkish infants.

Iron status in breast-fed full-term infants.

The aim of this study was to evaluate the iron status of full-term babies breast-fed exclusively for four months and the importance of iron supplementation. One hundred sixteen term infants followed up since the newborn period by a well baby clinic were included in the study. Iron deficient and/or anemic infants were excluded from the study at four months. Some of the infants (51) were later given appropriate complementary food besides breast-feeding (Group A) and some (42) were given ferrous sulfate (1 mg/kg/d) (Group B). Blood count and serum iron and ferritin measurements were done at four and six months of age. At the 4th month, iron deficiency was found in 23 (19.8%) infants, 11 of which had iron deficiency anemia. At the 6th month, 23 (45%) infants in Group A were iron deficient and 11 (21.6%) of them had iron deficiency anemia. In Group B, three (7.1%) infants were iron deficient and one (2.4%) of them also had iron deficiency anemia (p < 0.0001). Significant iron deficiency and iron deficiency anemia have been found in four-month-old exclusively breast-fed full-term infants. It is observed that complementary food alone is insufficient; there is need for iron supplementation.

Are ferric compounds useful in treatment of iron deficiency anemia?

The effect of ferric compounds in therapy of iron deficiency anemia is doubtful; however, the absorption of iron is not affected negatively by food or drugs. In our Well Baby Clinic, ferric polymaltose (6 mg/kg/d) was given to 59 infants (Group 1) and ferrous sulphate (same doses) was given to 64 infants (Group 2) (74 +/- 9 d, 70 +/- 7 d, respectively). These infants had iron deficiency anemia, and their therapy was continuous. Ferric polymaltose was not as effective as ferrous sulphate, although it increased hemoglobin and serum iron. Mean corpuscular volume and serum ferritin were not significantly changed after therapy. For this reason, we prefer to use only ferrous salts in therapy.

Causes of fetal and neonatal death.

Autopsy was performed on 601 out of 654 (91.9%) fetus and newborn cases of death which occurred during a four-year period between 1988-1991 at Istanbul University Cerrahpasa Faculty of Medicine, Gynecology Department and Neonatal Unit. According to autopsy findings, among the main causes of death in newborns were infection, hyaline membrane disease, congenital anomalies, perinatal hypoxia and immaturity, and in the fetal period, perinatal hypoxia, asphyxia and congenital anomalies. In these cases, when pathologic and clinical findings were examined, it was observed that in 204 out of 301 newborn cases (67.8%) the clinical findings were well correlated with the autopsy findings; in 97 (32.2%) of the remaining cases the main disease and primary causes of death could not be determined through clinical findings; in 69 (23%) cases, in addition to the clinical diagnosis on autopsy, minor defects were determined on autopsy which were not directly related to death. When clinical and autopsy findings were compared, diagnoses with the highest discordance were pulmonary hemorrhage infection and intracranial hemorrhage.

[Relation between the granulocyte count and protein and glucose levels in the cerebrospinal fluid in children with acute bacterial meningitis]. / Akut bakteriyel menenjitli çocuklarin beyin-omurilik sivilarindaki granulosit sayisi, protein ve seker düzeyi arasindaki iliskiler.

Cerebro-spinal fluid (CSF) findings of 171 children with acute bacterial meningitis were found to be as follow: granulocyte count 2879 +/- 804 per mm3, protein level 181 +/- 23 mg/dl, the ratio of BOS sugar to blood sugar % 46 +/- 2. There is some correlation between granulocyte count and sugar level (r: -0.17, p less than 0.05) and protein level and sugar level (r: -0.21, p less than 0.05), but no correlation between granulocyte count and protein level (r: 0.10, p greater than 0.05).