Assessment of follicular and serum VEGF and IGF-1 in ICSI patients: hMG vs rFSH.

PURPOSE: To investigate the effect of recombinant follicular stimulating hormone (r-FSH) and human menopausal gonadotropin (hMG) on follicular microenvironment via assessment of follicular and serum vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1) levels in intracytoplasmic sperm injection (ICSI) cycles. MATERIALS AND METHODS: Designed as a prospective cohort study. Twenty-five patients underwent controlled ovarian hyperstimulation (COH) with r-FSH and 20 patients underwent with hMG. RESULTS: Both groups were comparable regarding the women's mean age and body mass index (BMI). The amount of VEGF (pg/ml) in serum and follicular fluid in the group I and II were comparable (275 ± 135.3 vs 330.7 ± 190.0; p > 0.05 and 2,081.1 ± 1095.1 vs 1,971.1 ± 975.6; p > 0.05, respectively). The amount of IGF-1 (ng/ml) in serum and follicular fluid in the group I and II were also comparable (225.3 ± 69.3 vs 204.1 ± 56.3, p > 0.05 and 176.1 ± 67.2 vs 185.8 ± 48.7, p > 0.05, respectively). Pregnancy rates were also comparable between groups. CONCLUSIONS: The hMG and r-FSH in COH produced comparable follicular microenvironment regarding follicular VEGF and IGF-l.

Live birth after transfer of vitrified-warmed blastocyst derived from ICSI with frozen-thawed sperm: case report.

OBJECTIVE: A live birth after transfer of vitrified-warmed blastocyst derived from intracytoplasmic sperm injection (ICSI) with frozen-thawed sperm of a male cancer patient is described. MATERIALS AND METHODS: A case report from a tertiary center for assisted reproductive technologies. The 35-year-old male patient had been diagnosed with testicular tumor nine years ago. He had unilateral orchiectomy operation after the diagnosis. Four years after the first operation, he was diagnosed with another testicular tumor in the other testis. He admitted to our center with the demand of sperm preservation before the second surgery. The sperm samples were cryopreserved and stored in liquid nitrogen until required. The patient had no chemotherapy or radiotherapy after the operations. After he completed his oncologic follow up, ICSI was decided with his frozen samples. Although the couple failed to conceive with the fresh cycle, the remaining embryos were frozen and revealed a pregnancy in the subsequent frozen-thawed cycle. RESULTS: A healthy female infant with a birth weight of 3,700 g was born by cesarean section at 38th weeks of the gestation. CONCLUSION: Giving detailed information about fertility-saving management in male patients is important in those who wish to bear children. However, both the patients and physicians should be cautious that preservation should be performed before surgery and/or adjuvant therapy. In this respect, assited reproductive technology (ART) and related facilities yield chance of pregnancy in such population.

Luteal-long GnRH agonist versus flexible-multidose GnRH antagonist protocols for overweight and obese patients who underwent ICSI.

A total of 413 consecutive infertile patients (572 cycles) with a body mass index (BMI) of ≥ 25 kg/m(2) were enrolled into the study. The luteal-long GnRH agonist group (Group I) constituted 211 patients (300 cycles) and the flexible-multidose GnRH antagonist group (Group II) constituted 202 patients (272 cycles). The duration of stimulation (d) (10.1 ± 2.5 vs. 9.2 ± 2.0; p < 0.01); the total dose of gonadotrophin used (IU) (3,099.4 ± 2,885.0 vs. 2,684.0 ± 1,046.4; p < 0.05) and the E2 level on the day of hCG (pg/ml) (2,375.8 ± 1,554.6 vs. 1,905.6 ± 1,598.8; p < 0.01) were significantly lower in Group II when compared with Group I. However, the ongoing pregnancy per embryo transfer (37.0% vs. 25.7%; p < 0.05) and the implantation rate (25.7% vs. 15.6%; p < 0.01) were significantly lower in Group II when compared with Group I. In conclusion, we noted that the luteal-long GnRH agonist protocol produced higher implantation rates and higher clinical-ongoing pregnancy rates in overweight and obese patients when compared with the flexible-multidose GnRH antagonist protocol.

Microdose flare-up vs. flexible-multidose GnRH antagonist protocols for poor responder patients who underwent ICSI.

PURPOSE: To compare the performance of microdose flare-up (MF) and flexible-multidose gonadotropin-releasing hormone (GnRH) antagonist protocols in poor responder patients who underwent intracytoplasmic sperm injection (ICSI). MATERIALS AND METHODS: One hundred and 12 consecutive patients (217 cycles) suspected to have poor ovarian response were enrolled. Group 1 (MF GnRH agonist group) constituted 64 patients (135 cycles) who underwent MF GnRH agonist protocol. Group 2 (flexible-multidose GnRH antagonist group) constituted 48 patients (82 cycles) who underwent flexible-multidose GnRH antagonist protocol. RESULTS: The duration of stimulation (d) (11.5 +/- 2.1 vs. 10.4 +/- 2.7, p < 0.01) and the total dose of gonadotropin used (IU) (5,892.9 +/- 1,725.7 vs. 4,367.5 +/- 1,582.1, p < 0.05) were significantly lower in Group 2 when compared to Group 1. The numbers of retrieved oocyte-cumulus complexes (4.5 +/- 3.6 vs. 5.9 +/- 4.9, p < 0.05), metaphase II oocytes (3.6 +/- 3.1 vs. 4.9 +/- 4.2, p < 0.05), two pronucleated oocytes (2.6 +/- 2.3 vs. 4.0 +/- 3.4, p < 0.05), the number of available embryos at day 3 (2.6 +/- 2.2 vs. 4.2 +/- 3.2, p < 0.05) and the rate of embryos with > or = seven blastomeres and < 10% fragmentation at day 3 (35.9% vs. 65.1%, p < 0.05) were significantly lower in Group 1 when compared to Group 2. The number of embryos transferred (2.2 +/- 1.3 vs. 2.4 +/- 0.9), the clinical pregnancy per embryo transfer (16.3% vs. 25.8%), and the implantation rate (8.6% vs. 12.2%) were comparable between groups. CONCLUSIONS: Although the flexible-multidose GnRH antagonist protocol produced better oocyte and embryo parameters, the clinical pregnancy rate and the implantation rates were comparable between the flexible-multidose GnRH antagonist and MF protocols in poor responder patients.

ICSI cycle outcomes in oligozoospermia.

AIM: The aim of this study was to evaluate the sole effect of sperm concentration on fertilization, embryo quality and pregnancy rates in patients undergoing ICSI cycles. MATERIALS AND METHODS: 560 ICSI cycles performed for male factor infertility were divided into four groups according to sperm concentration retrospectively. Group 1 consisted of 86 couples whose sperm concentration was less than 1x10(6), group 2 consisted of 169 couples whose sperm concentration ranged between 1x10(6) and 5x10(6), group 3 consisted of 95 couples whose sperm concentration ranged between 5x10(6) and 10x10(6) and group 4 consisted of 210 couples whose sperm concentration ranged between 10x10(6) and 20x10(6). RESULTS: Fertilization rate was significantly lower in the first three groups compared to the last group (p<0.05). The first three groups were comparable with each other. There were no differences according to ovarian response to stimulation, embryo quality and clinical pregnancy rates between the four groups. CONCLUSION: Lower sperm concentration has detrimental effects on the outcomes of ICSI cycles. This situation is more evident in men with severe and extremely severe oligozoospermia.

ICSI outcome of patients with severe oligospermia vs. non-obstructive azoospermia.

OBJECTIVE: To compare the results of intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) cycles in men with severe oligoospermia and non-obstructive azoospermia. MATERIALS AND METHODS: This study included 91 ICSI cycles performed due to male factor infertility. Patients are divided into two groups according to source of spermatozoa. Group 1 consisted of 38 cycles in which sperm was obtained from testicles (cases with non-obstructive azoospermia). In Group 2, 53 consecutive cycles were included in which ejaculated sperm was available for ICSI in spite of severe oligospermia (< 100,000/ml). Fertilization, embryo quality and clinical pregnancy rates were compared between the groups. RESULTS: Although, the female age and mean number of oocytes retrieved were similar among the two groups, fertilization rate was significantly lower in the non-obstructive azoospermia (34.6%) group compared to group in which patients underwent ICSI with ejaculate spermatozoa (55.3%) (p < 0.05). However, there were no differences regarding mean number of available grade 1 embryos on day 3 and pregnancy rate between the two groups. CONCLUSION: Testicular sperm from non-obstructive azoospermia patients had significantly lower fertilization rates than the ejaculated spermatozoa from severe oligospermia patients in ICSI cycles. However, it did not bring about improved pregnancy rate.

Effect of sperm morphology on clinical outcome parameters in ICSI cycles.

OBJECTIVE: To assess the effect of isolated teratozoospermia with a normal sperm count and total motility by means of the fertilization rates, embryo quality and clinical pregnancy rate only in ICSI cycles. MATERIALS AND METHODS: We retrospectively analyzed the records of patients who underwent ICSI at Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Fertility and Reproductive Endocrinology between July 2001 and January 2010. Only patients with normal sperm count and total motility were recruited. The remaining cycles were further divided into two groups according to their sperm morphology with respect to Kruger's strict criteria. In Group 1, 537 consecutive cycles were enrolled whose sperm morphology was <4%. In Group 2, 118 cycles were identified with a morphology of > or = 4%. RESULTS: A total of 655 ICSI cycles were included in the final analysis. The fertilization rates were 72.0% and 70.8% in Groups 1 and 2, respectively. There were no differences regarding embryo quality, clinical pregnancy and implantation rates between the two groups. CONCLUSION: Our data suggest that detection of morphology defect has no value in the prediction of fertilization, embryo quality and clinical pregnancy in ICSI cycles.

Impact of isolated obesity on ICSI outcome.

The aim of this study was to assess the impact of isolated obesity on the outcome of intracytoplasmic sperm injection (ICSI). A total of 775 patients undergoing 1113 ICSI cycles were categorized on the basis of body mass index (BMI): group 1 (BMI 18.5-24.9 kg/m(2); normal weight; n = 627 cycles), group 2 (BMI 25.0-29.9 kg/m m(2); overweight; n = 339 cycles) and group 3 (BMI >or=30 kg/m(2); obese; n = 147 cycles). Sixty-three (10.0%) cycles in group 1, 53 (15.6%) cycles in group 2 and 26 cycles (17.7%) in group 3 were cancelled (P < 0.05 for group 1 versus groups 2 and 3). Despite the significantly higher total gonadotrophin consumption in groups 2 and 3 compared with group 1, the mean serum oestradiol level on the day of human chorionic gonadotrophin administration was significantly higher in group 1 (P < 0.05). The number of cumulus-oocyte complexes, metaphase II oocytes, and two-pronucleated oocytes were significantly lower in group 3 compared with group 1 (P < 0.05). However, fertilization rate, the mean number of embryos transferred, the mean number of grade 1 embryos transferred, clinical pregnancy, implantation, multiple pregnancy and miscarriage rates were comparable among the three groups. The rate of cycles with cryopreservable embryos was significantly lower in groups 2 and 3 compared with group 1 (P < 0.05).

Vaginal hysterectomy: results and complications of 886 patients.

The aim of this study was to determine the feasibility, results and complications of vaginal hysterectomy. A total of 886 consecutive patients who had undergone vaginal hysterectomy for benign gynecological diseases were retrospectively analysed. Vaginal hysterectomy was successfully performed in 96.1% of the nulliparous and 99.9% of the parous patients. The mean duration (min) of the operation was 89.1+/-29.1. The operation time (min) of the nulliparous women was significantly higher than that of the primiparous and multiparous women (109.3+/-40.2 vs 81.1+/-33.2 and 85.1+/-28.3, respectively). The overall complication rate was 14.6%. The intraoperative and postoperative complication rates were 4.1% and 10.5%, respectively. The most common intraoperative complication was bladder injury (2.5%). Vaginal hysterectomy for benign gynaecological diseases has high feasibility with acceptable complication rates.

CYP1A1 gene polymorphism and risk of endometrial hyperplasia and endometrial carcinoma.

The cytochrome P4501A1 (CYP1A1) is involved in the metabolism of environmental carcinogens and estrogen. We hypothesized that CYP1A1 genetic polymorphism may be a susceptibility factor for endometrial hyperplasia (EH) and endometrial carcinoma (ECa). We therefore evaluated this hypothesis in patients with EH and ECa and control subjects using allele-specific polymerase chain reaction-based method in a Turkish population. The patients with CYP1A1 Ile/Val genotype had a fivefold higher risk of having EH than those with Ile/Ile. In contrast, a higher frequency of any Val genotype (Ile/Val and Val/Val) was found in patients with EH, indicating that persons carrying any Val allele are at increased risk for developing EH. In the ECa group, patients were also more likely to have CYP1A1 Ile/Val allele, with an adjusted odds ratio of 3.0. Moreover, there was a statistically significant increase in relative risk association with any Val genotype between patients and controls, suggesting that individuals carrying any Val genotype are at increased risk for developing ECa. We concluded that variant alleles of the CYP1A1 gene might be associated with EH and ECa susceptibility. Further studies with a large sample size should be considered to address issues of interactions between CYP1A1 and other risk factors.

Placental site trophoblastic tumor in a patient with brain and lung metastases.

Placental site trophoblastic tumor is a rare neoplasm that arises from intermediate trophoblasts and shows diversity of biological behaviors, resulting in the absence of consistency in treatment modalities. A case of placental site trophoblastic tumor that extended to the cervix, with primary manifestation of amenorrhea and yellow foul-smelling vaginal discharge, is presented. Total abdominal hysterectomy was performed initially, and serial measurements of human chorionic gonadotropin levels were obtained. She was admitted with metastases to brain and lung 1.5 years after surgery. Combination chemotherapy (etoposide-methotrexate-dactinomycin/cyclophosphamide-vincristine) and radiotherapy were administered. There was no significant response to chemoradiotherapy. Despite changing chemotherapy regimen, she is still alive with progressive disease.

An extraordinary case of four primary tumors in the same patient, involving the uterine cervix, lung, skin, and rectum.

Four primary cancers in one patient are fairly rare. Here we present a case of four primary tumors in such a patient. These cancers were cervical carcinoma and lung carcinoma, which occurred synchronously, and basal cell carcinoma of the skin and rectal carcinoma which occurred metachronously. A successful resection of two synchronous and two metachronous cancers, which has never previously been reported in this specific combination, is described.