Evaluating the role of endometrial colour Doppler dynamic tissue perfusion measurements in in vitro fertilisation success.

The role of uterine receptivity and endometrial perfusion in in vitro fertilisation (IVF) remains unclear. In our prospective pilot study, we used a new dynamic tissue perfusion measurement method to evaluate this relationship in humans. A standard ovulation induction and embryo transfer method were applied to all the volunteers. On the day of embryo transfer, dynamic images of the uterus were recorded using colour Doppler ultrasound, and these images were uploaded onto PixelFlux Chameleon Software (GmbH, Münster, Germany). After determining the region of interest (ROI), the average velocity, intensity, and area values for all coloured pixels in the ROI, the tissue resistance index (RI) and the tissue pulsatility index were calculated. Endometrial thickness, morphology and dynamic endometrial perfusion parameters were compared between the clinically pregnant and non-pregnant groups. Endometrial thickness, morphology values and endometrial dynamic tissue perfusion measurements were similar between the groups. This study compared perfusion parameters between clinically pregnant and non-pregnant patients by accurately calculating endometrial tissue perfusion using standard software to establish its relationship with implantation success in IVF treatment.IMPACT STATEMENTWhat is already known about this subject? The relationship between IVF success, endometrial receptivity and perfusion is known. Clear valuations of endometrial receptivity require an endometrial biopsy which may cause endometrial damage to the actual IVF cycle. This problem has led researchers to conduct non-interventional studies. Studies have revealed the value of endometrial thickness, pattern and Doppler examination of endometrial uterine arteries in predicting the success of IVF treatment.What do the results of this study add? This prospective pilot study is the first one to use this programme in humans to evaluate uterine receptivity in IVF. Successful results can be obtained by using computer programmes in tissues where perfusion parameters cannot be measured using traditional colour Doppler ultrasonography. Revealing the relationship between tissue perfusion and IVF success will be more effective and accurate with the development of software technologies.What are the implications of these findings for clinical practice and/or further research? To increase the success of IVF treatment, current and new technological developments, as well as imaging methods should continue to be tested.

In-Vitro Fertilization Outcome Predictors in Women With High Baseline Follicle-Stimulating Hormone Levels: Analysis of Over 1000 Cycles From A Tertiary Center.

OBJECTIVE: The present study aimed to evaluate reproductive outcomes and determine the predictors of clinical pregnancy and live birth in women with elevated baseline follicle-stimulating hormone (FSH) levels, who have undergone intracytoplasmic sperm injection (ICSI) treatment. METHODS: This retrospective study included 1011 ICSI cycles of women with high baseline FSH levels (> 10 IU/L), from a tertiary university IVF center between 2010 and 2015. Logistic regression analysis was performed to evaluate the prognostic factors of clinical pregnancy and live birth. RESULTS: Among the 1011 ICSI cycles, the clinical pregnancy and live birth rates per oocyte retrieval were 19.5% and 14.3%, respectively. The live birth rates were 21.1% and 1.7% in women aged ≤30 years and those aged ≥40 years, respectively. In addition, the live birth rate was 1.47-fold higher in women from whom >3 oocytes were retrieved, compared to those from whom ≤3 oocytes were retrieved (p=0.047). Logistic regression analysis indicated that the age categories ≤30y, 36-39y and ≥40y, level of baseline FSH (≥20 IU/L) and the ovarian response (≤3 or >3 oocytes retrieved) were significantly associated with live birth. CONCLUSIONS: Our study indicated that age, baseline FSH level, and ovarian response are independent predictive factors for clinical pregnancy and live birth among women with baseline FSH levels >10 IU/L.

Comparison of montelukast and cabergoline for prevention of ovarian hyperstimulation syndrome: in an experimental rat model.

Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic complication that can occur during assisted reproductive techniques. The aim of this study is to investigate the effects of the leukotriene receptor antagonist (montelukast) treatment in prevention of OHSS and compare to cabergoline treatment. Twenty-four immature female Wistar rats were assigned to four groups. Group 1 was the control group. In the remaining three groups, OHSS was induced through ovarian stimulation with gonadotropins. No treatment was given to Group 2. Group 3 was administered a low-dose 100 mg/kg cabergoline treatment and Group 4 was received 20 mg/kg montelukast. Body weight, ovarian weight, vasculary permability (VP), peritoneal fluid vascular endothelial growth factor (VEGF) values and VEGF immune-expression were compared between the groups. Both cabergoline and montelukast prevented progression of OHSS compared to the OHSS group. Body weight, ovarian weight, VP, peritoneal fluid VEGF values and VEGF expression were significantly lower in both cabergoline- and montelukast-treated rats than in those not treated OHSS group. In conclusion, montelukast is an effective option for prevention of OHSS, as well as cabergoline. Montelukast may be a new treatment option to prevent and control the OHSS.

Diagnosis of pregnancy after conservative management for adnexal torsion due to ovarian hyperstimulation in the same cycle.

We report a case of right adnexal torsion during the embryo implantation period of an IVF/ICSI cycle. A 26-yearold woman who diagnosed as primary infertility was included in an IVF/ICSI program. In the following period right adnexal torsion occurred at the sixth day of the embryo transfer. Laparoscopic detortion was successfully performed with preserving the adnexia. The patient had positive pregnancy test in the subsequent week.

The effects of GnRH analogs on serum and follicular fluid leptin levels and pregnancy outcomes in short protocols of assisted reproductive technology.

OBJECTIVE: To determine serum and follicular leptin levels in patients using gonadotropin releasing hormone agonist and antagonist in Assisted Reproductive Technology short protocol cycles and to evaluate pregnancy outcomes. MATERIAL AND METHODS: Patients randomly selected to join assisted reproductive technology cycles during February 2004-July 2004 were enrolled in this study. Group 1 consisted of 21 patients receiving r FSH+ GnRH agonists, whereas Group 2 consisted of 34 patients who received r FSH +GnRH antagonists. During the ovulation induction period 5 serum samples were collected (induction day 1, day 3 or antagonist starting day, human chorionic hormone day, oocyte pickup day, and twelfth day of embryo transfer). Follicular fluid samples were collected to be evaluated for leptin, estradiol, prolactin and luteinizing hormone. RESULTS: There was no difference in age, basal FSH, basal LH, and basal E2 between groups. Serum leptin levels were similar in both groups. Also, when each group's serum leptin levels were evaluated according to the presence of pregnancy, there was no significant difference in both groups. When follicle leptin levels were evaluated according to the existence of pregnancy, in both groups the follicle leptin levels were lower in pregnant participants but this difference was not statistically significant. When obesity is defined as body mass index over 26.5, there is a correlation between obesity and leptin levels in Group 2. CONCLUSION: Our results have shown that both agonists and antagonists have similar efficacy and effect in poor responder women. Leptin levels in either groups, whether pregnant or non-pregnant were not statistically different. This result shows the need for more studies on leptin in infertility.

Effect of ovarian stimulation with human menopausal gonadotropin and recombinant follicle stimulating hormone on the expression of integrins alpha3, beta1 in the rat endometrium during the implantation period.

OBJECTIVE: To investigate the effect of exogenous ovarian stimulation with human menopausal gonadotropin (hMG) and recombinant follicle stimulating hormone (rFSH) on the expression of integrins alpha(3), beta(1) in the rat endometrium during implantation. STUDY DESIGN: Following three successive normal estrous cycles the animals were divided into five groups: Group I (n=10, control group) received no medication; Group II (n=10) received 10 units of hMG; Group III (n=10) received 20 units of hMG; Group IV (n=10) received 10 units of rFSH; Group V (n=10) received 20 units of rFSH at midday of middiestrous. The rats were then mated with fertile males. The animals were sacrificed on the day of implantation. The uterine horns were placed in fixative and paraffin blocks of the tissue were cut in 5 microm sections. The tissues were stained with primary antibodies; monoclonal anti-integrin alpha(3) and monoclonal anti-integrin beta(1) using immunohistochemical methods. The staining intensities of alpha(3) and beta(1) integrins were calculated separately for epithelium and stroma in each group. RESULTS: Staining intensities of alpha(3) and beta(1) integrins in both the epithelium and the stroma were significantly lower in the treatment groups than the control group (p<0.05). CONCLUSION: Ovarian stimulation by low and high doses of HMG and rFSH may have an effect on endometrial receptivity, possibly via a decrease in expression of integrins in the endometrium during the implantation period.