Is early embryo cleavage a factor to increase success in all types of ICSI indications?.

PURPOSE: The authors aimed to compare early embryo cleavage with pregnancy rates in intracytoplasmic sperm injection/embryo transfer (ICSI/ET) cycles due to male infertility or tubal factor infertility (TFI). MATERIALS AND METHODS: 412 ICSI/embryo transfer cycles undergoing treatment for over two years were prospectively analyzed; 337 of the cycles were due to male infertility, whereas 75 suffered from tubal factors. Non-early cleaved (NEC) embryos were used for ET in 271 male factor and 67 tubal factor cycles, whereas early cleavage embryos were used for embryo transfer in 66 male factor and eight tubal factor cycles. RESULTS: In 66 out of 337 cycles (19.58 %) in male factor group and in eight out of 75 tubal factor cycles (10.66%), early cleavage (EC) embryos were obtained (p = 0.069). The clinical pregnancy rate was significantly elevated in EC subgroup (34.8%) compared to NEC subgroup (20.6%) (p = 0.015) in the male factor infertility group. The clinical pregnancy rate was non-significantly elevated in EC subgroup (37.5%) compared to NEC subgroup (23.8%) (p = 0.410) in the TFI group. CONCLUSIONS: The authors found that the implantation and pregnancy success of EC embryos vary with the therapeutic indication. The success rate would be low even with usage of EC embryos in untreated cycles of TFI.

Investigation of the association between the outcomes of sperm chromatin condensation and decondensation tests, and assisted reproduction techniques.

The main purpose of this prospective study is to examine possible influences of abnormalities of sperm nuclear condensation and chromatin decondensation with sodium dodecyl sulphate (SDS)-EDTA on outcomes of intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI) cycles. Semen samples from 122 IUI and 236 ICSI cycles were evaluated. Before semen preparation for IUI or ICSI, basic semen analysis was performed and a small portion from each sample was spared for fixation. The condensation of sperm nuclear chromatin was evaluated with acidic aniline blue, followed by sperm chromatin decondensation by SDS-EDTA and evaluation under light microscope. Ongoing pregnancy rate was 24% and 26.2% in the IUI and ICSI groups respectively. The chromatin condensation rate was significantly higher in the ongoing pregnancy-positive group compared to the negative group, both in IUI (P = 0.042) and ICSI groups (P = 0.027), and it was positively correlated with ongoing pregnancy rate in both IUI and ICSI groups (P = 0.015, r = 0.214 and P = 0.014, r = 0.312 respectively). Chromatin decondensation rates were not significantly different in neither of the groups. These results indicate that IUI and ICSI outcome is influenced by the rate of spermatozoa with abnormal chromatin condensation. Sperm chromatin condensation with aniline blue is useful for selecting assisted reproduction techniques (ART) patients.

Comparison of follitropin alfa and urinary gonadotropins in IVF cycles.

AIM: The aim of this study was to compare human menopausal gonadotropins with recombinant follicle stimulating hormone-follitropin alpha following a long down-regulation protocol in intra cytoplasmic sperm injection cycles in our clinic, and to review the outcomes in the light of preceding studies. METHODS: This was a retrospective study. Among a total number of 2798 patients who had undergone IVF/ICSI applications, 579 eligible patients were included, and their data were evaluated retrospectively. Three hundred eighteen patients were treated with follitropin alpha and 255 patients were treated with hMG. Total units of follitropin alpha preparations used in ovulation induction, total number of meiois-2 phase oocytes, total number of used oocytes in ICSI cycle, fertilization rate and clinical pregnancy rates of both groups were analyzed. RESULTS: Mean duration of stimulation was longer in the group of patients treated with rFSH-α compared to the second group of patients treated with hMG (8.88 days and 8.55 days, respectively; P<0.05). The number of transferred embryos were 3.08 and 2.68 for patients treated with follitropin alpha and hMG, respectively (P<0.05). Clinical pregnancy rates were %28 and %33 in the groups of patients treated with follitropin alpha and hMG, respectively. Even though a greater clinical pregnancy rate was noted in the hMG group, there was no statistically significant difference between the two groups (P>0.05). CONCLUSION: Our results indicate that there is no statistically significant difference between follitropin alpha and human menopausal gonadotropin in terms of the clinical pregnancy rates.

Diagnosis of late-onset congenital adrenal hyperplasia in clinical practice: current evaluation.

AIM: Aim of the study was to investigate the need to perform the adrenocorticotropic hormone (ACTH) stimulation test by recognizing the importance of a second look at basal serum 17-alpha hydroxyprogesterone (17-OHP) levels and calculating new serum 17-OHP cut-off level. METHODS: A total of 142 patients who had hyperandrogenism symptoms and had basal serum 17-OHP levels of higher than 1.3 ng/mL were scheduled to have an ACTH stimulation test performed. Prior to ACTH stimulation, 17-OHP levels were recorded and as second-look levels. RESULTS: Patients were divided to two groups, late-onset congenital adrenal hyperplasia (LOCAH) (25/142), non-LOCAH (117/142). There were statistically significant results related to cycle length and menstrual irregularity between two groups (P=0.042, P=0.041, respectively). In the LOCAH group, basal serum 17 OHP levels were higher than non-LOCAH (P=0.001). When basal serum 17-OHP levels were measured a second time, the need for performing the ACTH stimulation test was decreased. According to cut-off levels of 1.3 ng/mL, 100% of patients needing to take the second serum 17-OHP decreased to 83.1%, a cut-off level of 2 ng/mL decreased numbers from 74.65% to 35.92% and for 2.25 ng/mL 58.42% of patients was decreased to 26.77%. In this study we established 2.25 ng/ml is a superior cut-off level for 17-OHP, its sensitivity is 84% and specifity is 50.4%. CONCLUSION: The incidence of LOCAH is 1.35% among the patients with hyperandrogenism symptoms. We found a single measurement of serum 17-OHP level can be unreliable. Second 17-OHP test reduces the need of performing the ACTH stimulation test by approximately 30%.

Elevated LH levels draw a stronger distinction than AMH in premature ovarian insufficiency.

OBJECTIVES: A significant number of individuals have high serum follicle stimulating hormone (FSH) levels but do not meet the criteria for diagnosis of premature ovarian insufficiency (POI) due to ongoing menstruation. We compared a group of women with elevated FSH levels and POI with a control group in terms of biochemical markers. METHODS: In this cross-sectional retrospective study, 38 POI cases and 48 cases of elevated FSH were compared to 89 individuals in a control arm in terms of biochemical markers. The receiver operating characteristics curve was calculated to assess the utility of anti-Müllerian hormone (AMH) levels to discriminate women with elevated FSH levels accompanied by POI from those women with elevated FSH levels but not defineable as having POI. RESULTS: A multiple regression analysis revealed that only the AMH level was significantly different for the discrimination between the control and elevated FSH groups. AMH and estradiol levels were found to be statistically significant for the discrimination between control and POI cases. However, only luteinizing hormone (LH) was found to be significant for distinguishing between women with elevated FSH and POI, interestingly excluding the serum AMH level in this context. CONCLUSIONS: AMH was the most important and superior marker to differentiate both POI cases and patients with an elevated FSH level from the controls; however, it did not show the same resolution for differentiating POI cases from those with elevated FSH. Moreover, we conclude that the serum LH level is the most useful marker for differentiating POI cases from women with elevated FSH levels.

Sperm selection based on motility in polyvinylpyrrolidone is associated with successful pregnancy and embryo development.

The aim of this study was to investigate whether spermatozoon motility in polyvinylpyrrolidone (PVP) is associated with better embryo development and pregnancy rates in ICSI cycles. A total of 123 primary ICSI treatment cycles were included in this study. Semen samples were tested for motility before ICSI procedure in PVP. Within 3 min, the presence or absence of motility was recorded. Sperm functions were examined by the aniline blue (AB) chromatin condensation test and the hypoosmotic swelling test, and the chromatin stability was evaluated by inducing its decondensation with sodium dodecyl sulphate and ethylenediaminetetraacetic acid (EDTA). Fertilisation and embryo scoring were evaluated. Fifty (64%) of 78 women conceived in the PVP (+) group; and 12 (26%) of 45 women conceived in the PVP (-) group; the pregnancy rate was significantly higher in the PVP (+) group (P = 0.003). Semen parameters were observed to be similar in both groups. The mean number of total embryos obtained in ICSI procedure and transferred grade 1 embryos were significantly higher in PVP (+) group (P = 0.01 and P = 0.003 respectively). The presence of sperm motility in PVP is associated with increased pregnancy rate, higher percentage of good quality embryos, sperm chromatin condensation and decondensation.

Effect of different types of intrauterine devices on intrauterine activity.

OBJECTIVE: To compare the effects of various IUDs on intrauterine activity. PATIENTS AND METHODS: 57 women volunteers aged 18 to 25 in the outpatient clinic of the Department of Obstetrics and Gynecology at Cerrahpasa Medical Faculty of Istanbul University were included in the study. All were in good health and menstruating normally. The subjects were introduced to different types of IUDs on the fifth to eighth days of their menstrual cycle. Intrauterine activities with and without naproxen were recorded, for at least 20 minutes each time, with a micro-tip transducer before insertion, just after insertion, and 1 month later. RESULTS: Intrauterine activity increased just after insertion of both IUDs and disappeared 1 month later in copper-T wearing women, but persisted in multiload wearers. Naproxen seemed to be useful in preventing intrauterine activity caused by the IUD. CONCLUSIONS: The IUD itself causes an increase in intrauterine activity which is preventable by naproxen, suggesting the possible role of prostaglandins. Persistence of intrauterine activity depends upon the type of device. Optimal designing of IUDs is required to decrease side effects and make them more acceptable.

Endometrial biopsy findings in infertility: analysis of 12,949 cases.

OBJECTIVE: Endometrial biopsy has been an important way of assessing infertile couples for several years. In this review of a wide-ranging series of endometrial biopsies of infertile couples in the Turkish population it was our aim to find the distribution of results according to the years 1956-1966, 1967-1980, 1981-1992. SETTING: University hospital. SUBJECTS: 12,949 endometrial biopsies, referred to our gynecological pathology laboratory for infertility investigation between 1956 and 1992. METHOD: Patient report files from pathology laboratory data, analyzed retrospectively. The assessment of the biopsies is made by the same pathologist. RESULTS: 78.8% of cases had primary infertility, 21.2% secondary. Most of them were in the age group 26-35 years (48.8%). 37.58% of cases were found to show normal secretory endometrium, 20.95% proliferative endometrial changes, and 28.22% signs of luteal phase defect (LPD). Other local endometrial factors were also encountered, but in 1.79% the sample was considered insufficient for diagnosis. Moreover, in nine cases, malignancy was diagnosed with the help of endometrial biopsy. During the study period, cases of normal secretory endometrium and tuberculous endometritis were observed to decrease and LPD to increase significantly. It is worthy to note that in only 28 (0.21%) cases had endometrial biopsies been performed during a pregnancy cycle. CONCLUSION: We conclude that endometrial biopsy not only shows the hormonal response of endometrium but gives additional information about the local factors of endometrium concerning atrophy, specific and non-specific infections, and malignancy.

The effect of intrauterine insemination on uterine activity.

Intrauterine insemination (IUI) may lead to very painful uterine cramps, which are due to the effect of the prostaglandin (PG) content of human semen. The purpose of this study is to present the reactivity of the human uterus to the placement of raw semen in the intrauterine space and to evaluate the related response patterns. A statistically significant uterine activity change was observed between the periods before and after intrauterine insemination. Three minutes after IUI, an increase in uterine activity was observed; it became most prominent at five to ten minutes. This stimulation was sustained for 30 minutes and decreased gradually. Although there is an increase in uterine activity following intrauterine insemination, neither pelvic pain nor abdominal discomfort was reported. According to this observation, we suggest that a semen volume of 1 mL might be used safely for intrauterine insemination.

Maternal, umbilical, uterine and amniotic prostaglandin E and F2 alpha levels in labour.

This paper confirms the important role played by prostaglandins in the induction of uterine contractions and the initiation of human labour, although the exact mechanism of action in labour remains unclear. Seventeen pregnant women at term were studied. Of these nine were in labour and the remainder underwent elective section. Prostaglandin E and F2 alpha levels were measured in maternal, umbilical and uterine plasma and amniotic fluid by radioimmunoassay. Levels of prostaglandin E were generally higher than prostaglandin F2 alpha but they were significantly lower in maternal and uterine plasma. Levels of prostaglandin F2 alpha were significantly higher in maternal plasma during labour. The highest levels of prostaglandin were found in amniotic fluid. Measurements indicate that the decreasing ratio of prostaglandin E/F2 alpha is more important in the initiation of labour than absolute levels of either prostaglandin.

[Anti-prostaglandins in therapy for side effects of intrauterine contraceptive devices]. / Rahim ici kontraseptif araclarin yan etkilerinin tedavisinde anti-prostaglandinler.

PIP: 43 women aged 21-35 with 0-4 parity wearing Lippes Loop IUD were studied in a double-blind trail during 3 menstrual cycles to find out if proquazon, a prostaglandin (PG) synthesis inhibitor, prevented the adverse effects of the IUD. IUDs increase the PG level in the endometrium. Higher PG levels result in pain through uterine cramping and endometrial bleeding caused by increased vascular permeability (70- 10-0 ml. blood loss vs. the normal amount of 35 ml). 200 mg of proquazon was administered 3/day (t.i.d.) for 79 cycles and 1 capsule of placebo was given for 50 cycles. Proquazon mitigated pain and reduced the incidence of severe pain: pain was absent in 33 (42% cycles with proquazon vs. 7 (14%) with placebo; light pain occurred in 29 (37%) vs. 15 (30%) respectively; medium strong pain occurred in 12 (15%) vs. 17 (34%), respectively; and severe pain was observed in 5 (6.3%) vs. 11 (22%), respectively.^ieng

Uterine activity during sleep.

REM-related increases in uterine activity were found in 10 healthy young adult volunteer subjects. Contraction baseline pressures were elevated compared with NREM sleep, stage 2 sleep, stages 3 and 4 slow wave sleep (SWS), and stage 0. Contraction amplitudes during REM sleep were greater than those during SWS and stage 0, while contraction rates differed only between REM sleep and SWS. The results strongly indicated a cycle of genital activity in women that parallels the penile erection cycle in men. The implications of this finding and suggestions for future research are discussed.