Dynamics of the development of multiple follicles by early versus late hCG administration in ART program.

OBJECTIVE: To evaluate, in patients stimulated with recombinant FSH and GnRH antagonists, whether triggering the final maturation of oocytes affects IVF outcomes. STUDY DESIGN: Five hundred and six IVF procedures were divided into three groups according to the timing of hCG administration: when at least 2 follicles reached the diameter of 17 mm, at least 2 follicles reached 18 mm and at least 2 follicles reached 20 mm. The main outcome was the number of mature oocyte that was the dependent variable of a multivariate model whose independents were, age, AFC, hCG timing, E2 levels at hCG day, number of follicles in different categories of dimension. Secondary endpoints were to compare fertilization, implantation and pregnancy rates in a multilevel multivariate model whose covariates were age, BMI, AFC, embryo quality and cause of infertility. RESULTS: Timing did not result a statistically significant factor influencing the number of oocytes collected, which was influenced by age, AFC, number of follicles between 12.1 and 15.9 mm and E2 levels. Implantation rate and pregnancy rate appear to be affected only by embryo quality. CONCLUSION: The number of oocytes collected and the probability of pregnancy are not associated with the time of hCG administration.

Two cases of complete hydatidiform mole and coexistent live fetus.

The aim of this study was to report the clinical features, management, and outcome of complete hydatidiform mole with a coexisting viable fetus. Two cases are reported. In both cases ultrasound examination demonstrated a normally growing live fetus alongside a normal placenta and an additional intrauterine echogenic mass with features of hydatidiform mole. The hCG levels were significantly increased and fetal karyotypes were normal. A cesarean section performed at 28 weeks' gestation in the first case and at 26 weeks' gestation in the second one resulted in the delivery of live normal infant and two adjoining placentas in both cases. Microscopic examination of the abnormal placentas confirmed complete hydatidiform mole. The babies did well and serial maternal serum hCG levels showed a declining trend and were undetectable by a few months after delivery. Continuation of a twin pregnancy with complete hydatidiform mole (CHMF) is an acceptable option. There is, although, an increased risk of developing maternal and fetal complications. Close surveillance of an ongoing pregnancy is compulsory to detect potential early signs of complications.

Semen quality and hormonal levels in infertile patients with varicocele.

OBJECTIVE: Aim of this study was to evaluate the semen quality and the serum concentration of follicle-stimulating hormone (FSH) and Testosterone (T) in infertile patients with and without varicocele. MATERIAL AND METHODS: 365 infertile patients undergoing Assisted Reproduction Tecnique (ART) were retrospectively included in the study. All subject were evaluated by history, physical examination, semen analysis, semen culture, mixed anti-immunoglobulin reaction test (MAR) for demonstration of sperm agglutination antibodies IgG and IgA, serum FSH and T determination. RESULTS: We observed 97 (26.6%) patients affected by varicocele compared to 268 (73.4%) without varicocele. A significant reduced percentage of motile spermatozoa (24.58 +/- 21.68 vs 21.01 +/- 12.62, p < 0.001) and lower sperm concentration (15.50 +/- 23.30 vs 16.50 +/- 15.22, p < 0.001) were observed in patients with varicocele compared to patients without varicocele. No significant differences were observed in sperm vitality between the two population of men with and without varicocele. Serum FSH (10.42 +/- 10.84 vs 9.11 +/- 18.81, p < 0.001) and Testosterone (5.73 +/- 5.97 vs 5.21 +/- 2.43, p < 0.001) levels were significantly higher in patients with varicocele compared to patients without varicocele. Detection of IgG and IgA sperm antibodies were negative in both man with and without varicocele. CONCLUSION: The direct connection between varicocele and infertility is not clear. The data of the present study suggest that the presence of a clinical varicocele rule out fertility in men affecting the hypothalamic pituitary-gonadal axis.