Endothelial cell-specific molecule 1 is regulated separately in follicular and serum compartments of PCOS patients: a pilot study.

OBJECTIVE: The aim of our study is to detect endothelial cell-specific molecule 1 (ESM-1) levels in the serum and follicular fluids (FF) of patients undergoing IVF/ICSI for PCOS. The presence of ESM-1 traffic between the serum and follicular compartment was analyzed. PATIENTS AND METHODS: A total of 50 patients, including 25 infertile patients diagnosed with PCOS according to the Revised Rotterdam criteria, and 25 patients in infertility follow-up for reasons other than PCOS, were included in the pilot study. Patients in the control group were required to have no clinical and laboratory findings of PCOS. Non-PCOS controls were selected from patients diagnosed with a male factor or unexplained infertility, and a homogeneous group was formed. Patients in PCOS and control groups were matched in terms of age and BMI. IVF/ICSI was started with antagonist protocol in both groups. Follicular fluids obtained on the day of egg collection were centrifuged, put into RNAlater, frozen, and stored until the day of analysis. Endothelial cell-specific Molecule 1 levels were measured in follicular fluid and serum samples of PCOS patients by enzyme-linked immunosorbent assay (ELISA) using the Human ESM-1 kit. RESULTS: Serum ESM-1 levels of the PCOS group were significantly lower than FF-ESM1 levels (668.6±189.2 vs. 979.0±233.9 ng/L, p<0.02). FF-ESM1 levels of the control group were significantly higher than serum ESM1 levels (639.3±206.4 ng/L vs. 503.2±102.4 ng/L, p<0.01). Serum ESM1 levels of the PCOS group were significantly higher than the control group (668.6±189.2 ng/L vs. 503.2±102.4 ng/L, p<0.01). Similarly, FF-ESM1 levels of the PCOS group were significantly higher than the control group (979.0±233.9 ng/L vs. 639.3±206.4 ng/L, p<0.01). There was no significant correlation between serum and FF-ESM1 levels. A positive and significant correlation was found between FF-ESM1 and serum LH levels in PCOS (r=0.655, p<0.02). Similarly, a positive and significant correlation was found between FF-ESM1 and serum testosterone levels in PCOS (r=0.470, p<0.03). Moreover, a positive and significant correlation was detected between FF-ESM-1, AFC, MII, and total oocyte counts in PCOS. CONCLUSIONS: Serum and FF-ESM-1 are regulated independently of each other in PCOS patients. ESM-1 may play a role in ovulatory dysfunction due to PCOS.

Comparing the effects of endometrial injury with hysteroscopy or Pipelle cannula on fertility outcome.

OBJECTIVE: To compare the effects of mechanical endometrial injury performed with hysteroscopy or Pipelle cannula on fertility outcome in patients with implantation failure. PATIENTS AND METHODS: Sixty patients with a history of two or more failed ICSI despite the transfer of high-quality embryos were equally divided into three groups: Group A - injury with hysteroscopy (n=20), Group B - injury with Pipelle cannula (n=20), Group C - no injury (n=20). Patients in group A underwent endometrial injury with monopolar needle forceps between days 10-12 of the proliferative phase in the preceding cycle before ovarian stimulation. Patients in group B underwent endometrial injury with Pipelle cannula between days 22-24 of the mid-luteal phase in the preceding cycle. Patients in group C had no injuries. Beta-hCG, clinical pregnancy, live birth and miscarriage rates were analyzed among the groups. RESULTS: There were no significant differences in terms of positive pregnancy test, clinical pregnancy and live birth rates between hysteroscopy and Pipelle groups. Compared to the control group, both clinical pregnancy and live birth rates were found to be significantly higher in patients who underwent endometrial injury with hysteroscopy or Pipelle cannula. Miscarriage rates in the control group were significantly higher than those in the Pipella or hysteroscopic injury. CONCLUSIONS: Endometrial injuries performed in the follicular phase with hysteroscopic monopolar forceps or in the secretory phase with Pipelle cannula increase pregnancy and live birth.

Endometrial polyps prevent embryo implantation via creatine and lactate pathways.

OBJECTIVE: This study was planned to investigate the concentration of basic endometrial metabolites such as endometrial choline (Cho), creatine (Cr) and lactate in subfertile women diagnosed with endometrial polyps. PATIENTS AND METHODS: Twenty patients with endometrial polyps detected in routine infertility evaluation and 20 fertile control patients with at least two children were included in the study. The endometrium of the patients in both groups was subjected to spectroscopy at mid-luteal phase and Cho, Cr, and lactate signals were recorded as a ppm. RESULTS: Compared to the fertile group, a decrease in Cr signal and an increase in lactate signal were detected in patients with endometrial polyp. Cho densities of both groups were found to be similar. The Cho peak of patients with endometrial polyp was 3.01 ± 1.22 ppm, while the Cho peak of the control patients was 2.90 ± 1.13 ppm. The Cr peak of patients with endometrial polyp was 1.36 ± 0.33 ppm, while the Cr peak of the control patients was 1.99 ± 0.02 ppm. The lactate peak of patients with endometrial polyp was 0.87± 0.10 ppm, while the lactate peak of the control patients was 0.54 ± 0.32 ppm. CONCLUSIONS: Decreased Cr and increased lactate signals may be evidence of impaired receptivity in subfertile patients with endometrial polyps.

Calcium gluconate infusion is not as effective as dopamine agonists in preventing ovarian hyperstimulation syndrome.

OBJECTIVE: The aim of the study was to compare the effectiveness of calcium gluconate and cabergoline therapy in the prevention of ovarian hyperstimulation syndrome (OHSS). PATIENTS AND METHODS: Eight hundred and forty-five women who underwent GnRH antagonist protocol and at high risk for developing OHSS were divided into two groups, those given cabergoline (n=435) or calcium gluconate (n=410). In cabergoline group, 0.5 mg of cabergoline was administered once daily p.o. starting on the day of ovulation trigger and continued until the following 8 days. In calcium gluconate group, intravenous calcium gluconate was administered daily for four days starting on the day of oocyte pickup (OPU). 10 ml of 10% calcium gluconate solution was dissolved in 200 ml of physiological saline and administered by intravenous route within 40 minutes. Infusion was started within the first 30 minutes following the OPU and continued on the 1st, 2nd and 3rd days after OPU. RESULTS: Mild OHSS was developed in 367 (89%) patients receiving calcium gluconate infusion, while 251 patients (57%) in the cabergoline group developed mild OHSS. The frequency of mild OHSS in the calcium group was significantly higher than the cabergoline group (p<.001). Moderate OHSS was observed in 32 people (7.8%) in the calcium gluconate group, while it was observed in 184 people in the cabergoline group (42.3%). Calcium gluconate infusion significantly reduced the development of moderate OHSS compared to cabergoline therapy (p<.001). Severe OHSS developed in 11 patients (2.7%) in the calcium gluconate group, while severe OHSS did not develop in those given cabergoline (0%, p<.001). Clinical pregnancy, live birth and abortion rates were similar in the two groups. When logistic regression analysis was performed, a significant correlation was found between age, BMI, AMH, the number of antral follicle count, OHSS history, paracentesis, progesterone on the day of hCG, 2 PN zygotes, and HbA1c levels and the development of OHSS. No correlation was found between the use of metformin or cetrotide and the development of OHSS. CONCLUSIONS: Calcium gluconate treatment is not effective in the prevention of OHSS.

The association between anti-Müllerian hormone and IVF-ICSI outcome in poor responder patients performing long protocol.

PURPOSE OF INVESTIGATION: Ovarian reserve reflects the capacity of the ovaries for a successful pregnancy. Anti-Müllerian hormone (AMH) could be a useful marker to predict ovarian reserve and to adjust controlled ovarian stimulation. The aim of this study was to assess the relationship between AMH and intracytoplasmic sperm injection-in vitro fertilization (IVF-ICSI) outcome in poor responder women. MATERIALS AND METHODS: This study was conducted prospectively for a period of 12 months. Inclusion criteria were FSH value > 15 iu/l or antral follicle number < 4, on the 2nd day of cycle. All patients underwent GnRH agonist stimulation with long protocol. Serum AMH levels were measured in the treatment cycle just before the stimulation. After the treatment, patients who were pregnant formed the study group and patients who were not pregnant formed the control group. Serum AMH level was the main outcome measure. RESULTS: The study and control group consisted of 34 and 70 patients, respectively. No significant difference was found in duration of infertility, antral follicular count, basal E2 and FSH levels. The mean serum AMH level was significantly higher in study group (p = 0.005). The retrieved oocyte number, metaphase 2 oocyte number, and fertilization rate were also significantly higher in the study group. DISCUSSION: Evaluation of serum AMH seems to be a useful marker to predict IVF-ICSI outcome in poor responder patients.

Does dehydroepiandrosterone supplementation really affect IVF-ICSI outcome in women with poor ovarian reserve?

OBJECTIVES: It is difficult to choose the correct fertility treatment in women with poor ovarian reserve. Although various methods have been used, the management of controlled ovarian hyperstimulation is not easy in poor responders. The aim of this study was to evaluate the efficacy of dehydroepiandrosterone (DHEA) on in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) outcome of poor responders. STUDY DESIGN: This was a randomized, prospective controlled trial. Women with serum antimullerian hormone<1 ng/ml or serum follicle-stimulating hormone>15 IU/l and antral follicle count <4 on day 2 of the menstrual cycle were considered to have poor ovarian reserve. All women were treated with a microdose induction protocol. Women in the study group received IVF-ICSI and DHEA 75 mg daily for 12 weeks. Women in the control group received IVF-ICSI without DHEA supplementation. RESULTS: In total, 208 women with diminished ovarian reserve was enrolled in the study, 104 in the study group and 104 in the control group. The number of oocytes retrieved and the fertilization rate were slightly higher in the study group, but the pregnancy rate was higher in the control group. The differences were not significant. CONCLUSIONS: The results failed to show that DHEA supplementation enhances IVF-ICSI outcome in women with poor ovarian reserve.