Hashimoto's Thyroiditis Negatively Influences Intracytoplasmic Sperm Injection Outcome in Euthyroid Women on T4 Substitution Therapy: A Retrospective Study.

OBJECTIVE: The objective of this study was to analyze the impact of thyroid autoimmunity (TAI) on reproductive outcome parameters of intracytoplasmic sperm injection (ICSI) cycles as compared to TAI-negative ICSI cycles. DESIGN: In this single in vitro fertilization (IVF) center retrospective study, 86 infertile women with elevated thyroid peroxidase or TGAb levels, but euthyroid after thyroxine replacement (study group), were compared to 69 female patients with no thyroid abnormalities (controls). Following ICSI treatment fertilization rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rate (LBR) were analyzed. MATERIALS, SETTING, METHODS: All subjects with various infertility factors were treated with ICSI in university-based IVF center. Patients in the study group received thyroxine replacement and were euthyroid at IVF treatment. Before the IVF cycles, endocrinological parameters were uniformly assessed: thyroid function and antibodies, reproductive hormones (anti-Müllerian hormone [AMH], follicular stimulating hormone [FSH], luteinizing hormone, E2, PRL, testosterone, DHEAS, 17-OHP, AD) and OGTT (0-60-120 min glucose and insulin). Following descriptive comparison of laboratory parameters, age-adjusted analyses of FR, CPR, MR, and LBR were performed. RESULTS: TAI-positive women were older (mean age 35.31 ± 4.95 vs. 32.15 ± 4.87 years; p = 0.002), had higher FSH (8.4 ± 3.4 vs. 7.4 ± 2.32 U/L; p = 0.024), higher E2 (53.94 ± 47.61 vs. 42.93 ± 18.92 pg/mL; p = 0.025) levels, while AMH (2.88 ± 2.62 vs. 3.61 ± 1.69 ng/mL; p = 0.0002) was lower. There were no differences in TSH levels (1.64 ± 0.96 vs. 1.66 ± 0.65 µIU/mL; p = 0.652) between the two groups. FT3 (2.63 ± 0.58 vs. 2.98 ± 0.55 pg/mL; p = 0.002) was lower and FT4 (1.3 ± 0.29 vs. 1.13 ± 0.21 ng/dL; p = 0.0002) was higher in the TAI-positive group, reflecting clinically irrelevant differences. Egg cell counts (6 ± 3.8 vs. 7.5 ± 3.95; p = 0.015) were lower in TAI and remained so following age adjustment. Although the overall ICSI FR did not differ (62.9% vs. 69.1%, p = 0.12), it was lower for patients under 35 with TAI showing decreasing differences in line with age. The CPR (36.04% vs. 69.56%; p < 0.001) and LBR (23.25% vs. 60.86%; p < 0.001) were lower, the MR (35.48% vs. 12.5%; p = 0.024) was higher in the TAI group, and these differences remained after age adjustment. LIMITATIONS: Since the higher age of the study group may interfere with the effect of TAI, age adjustment calculations were necessary to perform to eliminate this confounding factor. CONCLUSION: Despite optimal thyroid supplementation in clinical or subclinical hypothyroidism, the presence of TAI negatively influences CPR and is connected to a higher MR, thus resulting in a lower LBR after ICSI. Decreased FR with ICSI in TAI patients may also contribute to poorer outcomes, especially in younger women.

Fertility-Sparing Strategies for Early-Stage Endometrial Cancer: Stepping towards Precision Medicine Based on the Molecular Fingerprint.

Endometrial cancer represents the fifth most common cancer in women, and the most common gynecological malignancy in developed countries [...].

Impact of Endocrine Disorders on IVF Outcomes: Results from a Large, Single-Centre, Prospective Study.

Endocrine disorders negatively influence the ovarian function, and increasing incidence of endocrine diseases with age may have further negative effects on pregnancy rate. Prospective cohort study of 231 consecutively enrolled patients underwent IVF treatment. In patients with known endocrine disorders, the laboratory parameters were corrected before IVF treatment. One hundred sixty one patients (69.7%) had at least one known and treated endocrine disorder (study group), and 70 patients were endocrine negative (control group). Endocrine disorders diagnosed were thyroid disorders (32.5%), diminished ovarian reserve (23.8%), insulin resistance (22.5%), PCOS (15.2%), hyperprolactinaemia (13.4%), obesity (12.1%), hypogonadotropic hypogonadism (0.8%) and congenital adrenal hyperplasia (0.2%). Before the IVF treatment, systematic endocrine laboratory examinations were performed in all patients. Higher age, BMI and FSH were found in the study group, while AMH level was lower. There were no differences in LH, E2, prolactin, TSH, FT3, FT4, TT, DHEAS, androstendione, 17-OHP and SHBG level between the study and control groups. The study group had higher baseline glucose, baseline insulin, 120-min glucose and 120-min insulin level after oral glucose tolerance test. With no difference in the IVF cycles performed, pregnancy rate was lower in the study group (61.43% vs. 34.16%; p = 0.003), and this difference (p = 0.0151) remained in age-corrected rates, as well. The analyses were also performed in individual endocrinology groups. The prevalence of endocrine disorders is high in females participating in IVF programs, and they are often accompanying each other. Even after proper correction, the presence of the endocrine disorder negatively influences the pregnancy rate in IVF treatment.

Prevalence and association of endocrine disorders in women participating in an in vitro fertilization program / Endokrin kórképek elofordulása és társulása in vitro fertilizációs programban részt vevo nok körében

Introduction: Ovulatory dysfunction associated with endocrine diseases is a common leading or associated cause of female infertility, but at optimal reproductive age, causal or ovulation-induction treatment can usually settle fertility. The leading indications for in vitro fertilization (IVF) treatments are currently andrological and originated from age related ovarian infertility, but other accompanying endocrine dysfunctions affect treatment outcomes. Objective: To investigate the incidence of endocrine diseases in female members of couples participating in IVF program. Method: During aptitude tests prior to the IVF program, from the leading indication independently, a detailed endocrinological examination was performed in 231 women (mean age: 34 years). The studies of hypothalamic and ovarian function, thyroid function and thyroid autoimmunity, adrenal function, carbohydrate metabolism and insulin resistance were covered. In addition to the incidence of each endocrine disease, the frequency of their association was analyzed. Results: The distribution of IVF lead indications was in line with the international trends, it was endocrine nature in 87 cases (37.6%; decreased ovarian reserve in 55 cases and chronic anovulation in 32 cases). Associated endocrine abnormalities were found in 141 cases, and a total of 161 women was affected by endocrine dysfunction (69.7%; mean age: 35 years). Endocrine dysfunction incidences in order of frequency were thyroid dysfunction (32.5%), diminished ovarian reserve (23.8%), thyroid autoimmunity (22.5%), polycystic ovarian syndrome (15.6%), insulin resistance (22.5%), obesity (23.8%), hyperprolactinemia (13.4%). The endocrine disease associations were found in all of the cases above. Hypogonadotropic hypogonadism occurred in 2 cases, congenital adrenal hyperplasia occurred in 1 case. No endocrine abnormalities were found in 70 cases (30.3%). Conclusion: Our study confirms the cumulative appearance of endocrine dysfunctions and frequent association in IVF participants with any lead indication. The detailed endocrine examination and proficiency/skill in reproductive endocrinology of IVF practitioners may contribute to IVF treatment success.

Predictive value of bubble sign for tubal patency during office hysteroscopy.

OBJECTIVE: Our purpose was to investigate the predictive value of visible air bubble sign for real tubal patency during hysteroscopic procedures. METHODS: In this cross-sectional study, clinical data of 61 infertile women who underwent diagnostic hysteroscopy and laparoscopy have been analysed. RESULTS: Mean age of patients was 33.45 ± 3.25 years. Bubble sign for the detection of patency demonstrated 73 % (95 % CI: 57-86 %) sensitivity, 70 % (95 % CI: 46-88 %) specificity, a positive predictive value of 83 % (95 % CI: 67-94 %), and a negative predictive value of 56 % (95 % CI: 35-76 %). CONCLUSIONS: A visible tubal "flow" of air bubbles during hysteroscopy was not accurate in the prediction of tubal patency.

Fallopian tubal obstruction is associated with increased pain experienced during office hysteroscopy: a retrospective study.

This study aimed at evaluating the pain experienced during office hysteroscopy, with selective tubal cannulation and chromopertubation, by women with and without tubal obstruction in order to determine if such condition would be associated with increased pain during the examination. Women with a history of infertility underwent in-office hysteroscopy with selective chromopertubation using a continuous flow office hysteroscope with a 5 Fr operating channel fitted with a 4 Fr catheter for the injection of methylene blue dye. Experienced pain was recorded on a Visual Analog Scale (VAS) during diagnostic hysteroscopy after access to the uterine cavity. Of 90 women, 58 (66.4%) were found with at least one patent fallopian tube and inserted in the group "any", meanwhile 32 (33.6%) were categorized into group "none" as both tubes were judged obstructed. There was no significant difference between groups in BMI and primary infertility rate, but the difference was significant concerning mean age (32.6 vs. 35.8; p < 0.001). The mean VAS score was 3.34 (± 1.07) in the group "any" and 4.25 (± 1.11) in "none". Comparing the VAS score of the two groups, the difference was significant (p < 0.001). Tubal occlusion may have a potential role in the pain experienced by women undergoing in-office hysteroscopy. Women with bilateral tubal occlusion experienced a higher level of pain compared with patients with at least one patent fallopian tube. Operators may use milder intrauterine pressure of fluid distension medium when these patients are undergoing in-office hysteroscopy to reduce discomfort.

The effect of localization and histological verification of endometrial polyps on infertility.

AIM: Our purpose is to investigate if transcervical resection of endometrial polyps improves the fertility in ovulatory infertile women, and whether polyp histology, intrauterine location, and the technique of polypectomy have any influence on the pregnancy rates. METHODS: In this retrospective study, clinical data of 87 ovulatory infertile women who underwent hysteroscopy and polypectomy, and their 12-month follow-up have been analyzed. Subgroups according to the method of polyp removal (resectoscope or curettage), the polyp localization (utero-tubal, anterior, posterior, lateral, multiple) and the histological result were interpreted. RESULTS: Mean age of patients was 33.99 ± 4.24 years. There were no differences in the BMI and basal FSH levels between the subgroups. Pregnancy was recorded in 30 (34.5%) within the next 12 months without any difference between the subgroups of polypectomy method applied. Posterior wall polyp resection increased the pregnancy chance (OR 5.02), but no other differences were observed in 1-year pregnancy rates to other localizations. Removal of polyps which had normal endometrial histology had lower pregnancy rates as compared to that of polyps with hyperplasia or endometrial polyp histology results (OR 0.25). CONCLUSIONS: Polypectomy improved the conception rate in the subsequent year regardless of the intrauterine localization and the method of its surgical removal. Therefore, we can conclude that polypectomy should be considered in infertile women.

Suprapubic pressure facilitates the procedure of office hysteroscopy: A randomized controlled trial.

AIM: To minimize the experienced pain during office hysteroscopy, a number of technical approaches and maneuvers are used. The aim of the study was to assess the effect of suprapubic pressure (SuPuP) applied during hysteroscopy. The impact of this maneuver on experienced pain (assessed by visual analog scale [VAS]) and duration of passage through the cervical canal was measured and compared to a reference group with no SuPuP. METHODS: Hysteroscopy was performed in study subjects as part of their infertility work-up. Patients were randomized into two groups as part of a controlled trial. In group 1, SuPuP was applied while inserting the scope; in group 2, SuPuP was not applied. Pain experienced during the procedure was measured on a 0-10 VAS. Duration of passage through the cervical canal was measured by analyzing the video of the procedure. The effect of SuPuP was estimated by testing for between-groups differences in these outcomes. RESULTS: The number of patients included the study was 60. Mean (SD) VAS score was 3.40 (1.276) in group 1 compared to 3.33 (0.802) in group 2 (P = 0.809). Mean (SD) time of passage through the cervical canal in group 1 was 30.5 (18.37) seconds compared to 43.0 (24.51) seconds in group 2 (P = 0.029). CONCLUSION: Applying suprapubic pressure could facilitate the procedure by significantly shortening the duration of the passage through the cervical canal, but significantly not reduces the pain experienced during hysteroscopy. Further studies are to be undertaken to investigate the advantages of suprapubic pressure during office hysteroscopy.