Reproductive outcome of women 43 years and beyond undergoing ART treatment with their own oocytes in two Connecticut university programs.

PURPOSE: The aim of this study was to analyze the outcomes of IVF/ICSI cycles in women aged 43 and beyond. METHODS: Retrospective analysis of clinical pregnancy and live birth rates in 168 fresh, non donor, ART cycles performed in two Connecticut university IVF programs. RESULTS: In women of 43 and 44 years the overall clinical pregnancy and live birth rates were 8.3% and 5.3% per initiated cycle, respectively. There were no clinical pregnancies in women ≥45 years old. First cycle characteristics were not different from repeated cycles in terms of duration of ovulation induction, number of collected oocytes and transferred embryos (p > 0.05). CONCLUSIONS: Pregnancies can still be achieved with IVF/ICSI up to the age of 44. Since most pregnancies occurred within the first 3 cycles, another attempt may be a reasonable option before resorting to oocyte donation for patients who failed two previous cycles. Women 45 years and beyond do not benefit from ART procedures using their own oocytes.

Random anti-Müllerian hormone predicts ovarian response in women with high baseline follicle-stimulating hormone levels : anti-Müllerian hormone in poor responders in assisted reproductive treatment.

OBJECTIVE: To evaluate the predictive value of random serum anti-Müllerian hormone (AMH) in the assessment of ovarian response in patients with diminished ovarian reserve (DOR; diagnosed after the observation of elevated baseline levels of early follicular follicle-stimulating hormone [FSH]) who were undergoing intracytoplasmic sperm injection-embryo transfer (ICSI-ET) and to compare the random serum AMH and baseline FSH levels in these patients for the prediction of poor ovarian response. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: One hundred and thirty-nine patients who were undergoing ICSI-ET cycles with early follicular FSH level >9 IU/mL. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Poor ovarian response in ICSI-ET cycles. RESULTS: For the identification of women at risk of cycle cancellation, an AMH cut-off level ≤1.2 ng/mL had 97.3 % sensitivity, 31.3 % specificity, 33.9 % positive predictive value, and 96.9 % negative predictive value in the women with high baseline FSH levels. An AMH cut-off level ≥1 ng/mL had a sensitivity of 58.7 % and specificity of 95.1 % for prediction of retrieval of 4 or more oocytes. By using a serum AMH cutoff level of 1.5 ng/mL, the ongoing pregnancies were predicted with 83.3 % sensitivity and 82.5 % specificity and yielded a positive predictive value of 31.2 % and a negative predictive value 98.1 %. CONCLUSION: Measurement of random serum AMH level is a useful tool in the prediction of ovarian response in patients with high serum early follicular FSH levels.

Intravesical migration of an intrauterine device detected in a pregnant woman.

The intrauterine device (IUD) is common method of contraception among women because of its low cost and high efficacy. Perforations are possible; most perforations occur at the time of insertion, yet the complication can occur with a previously inserted IUD. Perforation of the bladder by an IUD is extremely rare. In this report, we present a case in which the IUD perforated the uterus and migrated to the bladder. At the time of the diagnosis, the patient was 8 weeks pregnant.

Comparison of the effects of raloxifene and anastrozole on experimental endometriosis.

OBJECTIVE: To compare the efficacies of anastrozole and raloxifene on endometriosis. STUDY DESIGN: A randomized, placebo-controlled, single-blind, experimental study was performed on 45 adult Wistar female rats in the Experimental Surgery Laboratory at Ondokuz Mayis University in Turkey. Endometrial tissues were implanted on the abdominal peritoneum in 45 rats. Six weeks later, the implant volumes were measured (volume-1) by performing a second laparotomy. Rats were randomized to one of three equal study groups. Saline solution (0.1 cc/rat/week, subcutaneously) was administered to group 1 (control group), anastrozole (0.004 mg/rat/day, orally) to group 2 (anastrozole group), and raloxifene (0.24 mg/rat/day, orally) to group 3 (raloxifene group) for 8 weeks. At the end of administration, a third laparotomy was performed to remeasure implant volumes (volume-2), and implants were totally excised for histopathologic examination. Volume-1 and volume-2 within the groups, as well as stromal and glandular tissues between the groups, were compared. RESULT(S): In the anastrozole and raloxifene groups, volume-2 values were significantly lower than those of volume-1. When compared to the control group, in both anastrozole and raloxifene groups, while glandular tissue scores were found significantly lower, stromal tissue scores were not different than that of the control group. There was no significant difference between both the GT and ST scores of the anastrozole and raloxifene groups. CONCLUSION(S): Anastrozole and raloxifene were seen to have caused equally the regression of the experimental endometriosis statistically significantly.

Pure gonadal dysgenesis and spontaneous pregnancy: a case report.

We report a case of pure gonadal dysgenesis with streak gonads in which spontaneous conception occurred 10 years after the diagnosis. Her pregnancy proceeded as normal, and she gave birth to a live baby at term by cesarean section. A lactation period lasting for 1 year and afterwards proceeded as amenorrheic. Gonadotropins measurements in post-lactational period were at the menopausal levels again. To the best of our knowledge, this is the first case of pure gonadal dysgenesis with streak gonads in which spontaneous conception occurred.

Comparison of the effects of cetrorelix, a GnRH antagonist, and leuprolide, a GnRH agonist, on experimental endometriosis.

AIM: In the present study, we aimed to compare the effects of cetrorelix and leuprolide on endometriosis. METHODS: This randomized, placebo-controlled, single-blind, experimental study was performed on 45 Wistar adult female rats in the Experimental Surgery Laboratory at Ondokuz Mayis University. After the peritoneal implantation of endometrial tissue, rats were randomized to three equal intervention groups: (i) control group, (ii) leuprolide group, and (iii) cetrorelix group. Six weeks later, following implant volume measurements (volume-1) by performing a second laparotomy, saline (0.1 cc/rat) was administered subcutaneously to the control group once a week, leuprolide (0.075 mg/kg) subcutaneously to the leuprolide group twice at 4-week intervals and cetrorelix (0.001 mg/rat/day) subcutaneously to the cetrorelix group for 8 weeks. At the end of the treatment, by performing a third laparotomy, implant volumes were remeasured (volume-2) and implants were totally excised for histopathological examination. The volume-1 and volume-2 values within the groups, and stromal and glandular tissue scores between the groups were compared. RESULTS: In both the leuprolide group and the cetrorelix group, volume-2 as compared to volume-1 had significantly reduced (P < 0.01, P < 0.01 respectively), while there was no significant volume change in the control group (P > 0.05). In this group, when compared with the control group, glandular and stromal tissues had significantly lessened (P < 0.01, P < 0.01 respectively). CONCLUSION: Leuprolide and cetrorelix were found to have similar efficacy in the regression of both the size and the histological structure of experimental endometriotic implants.

Efficacy of imiquimod, an immunomodulatory agent, on experimental endometriosis.

OBJECTIVE: To investigate the efficacy of imiquimod on endometriosis. DESIGN: Randomized, placebo-controlled, single-blind, experimental study. SETTING: Experimental surgery laboratory at a university in Turkey. ANIMAL(S): Thirty Wistar female rats. INTERVENTION(S): After the peritoneal implantation of endometrial tissue, rats were randomized to two equal intervention groups: [1] the control group and [2] the imiquimod group. Six weeks later, after implant volume was measured (volume 1) by performing a second laparotomy, imiquimod (10 mg intraperitoneally per rat, 2 times per wk) was administered to the imiquimod group, and saline solution (0.1 mL SC, once per wk), to the control group, for 8 weeks. At the end of the treatment, a third laparotomy was performed to remeasure implant volumes (volume 2), and implants were totally excised for histopathologic examination. MAIN OUTCOME MEASURE(S): To compare volume 1 and volume 2 within the groups, as well as stromal and glandular tissues between the groups. RESULT(S): In the imiquimod group, volume 2 was statistically significantly reduced compared with volume 1, whereas there was no significant volume change in the control group. In the imiquimod group, when compared with the control group, both glandular and stromal tissues had statistically significantly lessened. CONCLUSION(S): Imiquimod was seen to regress significantly both the size and the histological structure of endometriotic implants.

Efficacy of recombinant human interferon alpha-2b on experimental endometriosis.

OBJECTIVE: To investigate the efficacy of recombinant human interferon alpha-2b on endometriosis. STUDY DESIGN: The randomized, placebo-controlled, single-blind, experimental study was performed on 30 Wistar female rats in the Experimental Surgery Laboratory at Ondokuz Mayis University in Turkey. After the peritoneal implantation of endometrial tissue, rats were randomized to two equal intervention groups: (1) the control group and (2) the interferon group. Six weeks later, after implant volume was measured (volume-1) by performing a second laparotomy, interferon alpha-2b (100,000 IU subcutaneously per rat, three times at 48 h intervals) was administered to the interferon group, and saline solution (0.1 ml SC, once per week), to the control group, for 8 weeks. At the end of the treatment, a third laparotomy was performed to remeasure implant volumes (volume-2), and implants were totally excised for histopathologic examination. Volume-1 and volume-2 within the groups, as well as stromal and glandular tissues between the groups were compared. RESULTS: In the interferon group, volume-2 was statistically significantly reduced compared with volume-1, whereas there was no significant volume change in the control group. In the interferon group, when compared with the control group, both stromal and glandular tissues had statistically significantly lessened. CONCLUSIONS: Interferon alpha-2b was seen to regress significantly both the size and the histological structure of endometriotic implants.

Conjoined twins: historical perspective and report of a case.

In this article we review the historically important cases of conjoined twins (Biddenden Maids, Siamese twins, Blazek sisters) and contemporary knowledge regarding incidence, etiopathogenesis, antenatal diagnosis, antenatal management, and outcome of conjoined twins. We also present a case of male cephalothoracoomphalopagus, which is extremely rare.

CA-125 levels in ruptured and unruptured tubal ectopic pregnancies.

AIM: This prospective, single-blind and controlled clinical study aimed to research if CA-125 levels could be a useful test in the differential diagnosis of intact and ruptured tubal ectopic pregnancy. METHODS: Sixty-five women with tubal ectopic pregnancy of 5-10 weeks' duration (27 women with ruptured tubal ectopic pregnancy [REP] and 38 women with unruptured tubal ectopic pregnancy [UREP]) and 65 women with normal intrauterine pregnancy (NIUP) of the same gestational age were studied prospectively. Serum CA-125 levels were measured in all women and these levels were compared among the REP, UREP, and NIUP groups. RESULTS: The mean CA-125 levels didn't show any significant difference between the REP and NIUP groups (P > 0.05). The mean CA-125 levels of these two groups were higher than that in the UREP group (P < 0.01, P < 0.001, respectively). The dispersion ratios of the CA-125 levels had a statistically significant difference between the REP and UREP groups (chi(2): 42.44, P < 0.0001). CA-125 levels weren't correlated with gestational weeks in the REP and UREP groups (r: 0.005, P > 0.05; r: 0.008, P > 0.05, respectively). CONCLUSION: In intact tubal ectopic pregnancies, expectant or managed with medical treatment, the increase of CA-125 levels in the serial measurements could be a supplementary test for an early diagnosis of tubal rupture.

Maternal mortality rates in the last eight years: A university hospital-based study from Turkey.

OBJECTIVE: To analyze the cause of changing maternal mortality ratios (MMRs) in a tertiary women's health center in Turkey in the last eight years. MATERIALS AND METHODS: Charts of patients seen between 1998 and 2005 were retrospectively reviewed. Statistical analysis was performed using the Chi-square test. The results were accepted to be significant when the p value was <0.05. RESULTS: During this period, 27 pregnancy-related deaths were identified via hospital death records. The MMR was found to have decreased in rate by approximately 50% from 822.2/100,000 live births in the previous report including the years 1978-1997 to 412.0/100,000 during the last eight years (p < 0.01). Pregnancy-induced hypertension was still the most frequent cause of maternal death. The decrease in MMR was due to the decrease in the ratio of maternal infection (26.4% in 1978-1997 to 7.4% in 1998-2005, p < 0.01). CONCLUSION: Although treatment in the antenatal care and health service has decreased maternal deaths, it was discovered that the MMR has not reached the optimum levels found in developed countries in the last eight years. Also the percentage of direct obstetric deaths (with the exception of those caused by infection) showed no change and was similar to that found in the previous report (1978-1997).

Do basal inhibin A and inhibin B levels have value in the diagnosis of polycystic ovary syndrome?

In the present study we aimed to investigate whether basal inhibin A and B levels in women with polycystic ovary syndrome (PCOS) would be used in diagnosis of the condition. Forty women with PCOS and 40 women with normal cycles (control group) were evaluated. There was no statistically significant difference in mean age and mean body mass index between the two groups (p > 0.05). Serum levels of inhibin A and B, follicle-stimulating hormone (FSH), luteinizing hormone and total testosterone, and total ovarian volume, were determined in the PCOS group and the control group on day 3. In the PCOS group, total follicle number was obtained by counting follicles of diameter > or =2 mm in both ovaries. Results were evaluated using Student's t test, Pearson correlation and regression tests. There was no significant difference in mean basal inhibin A or inhibin B levels between the two groups. Basal inhibin B levels showed a statistically significant negative correlation with basal FSH levels and a positive correlation with total follicle number in the PCOS group (p < 0.05 and p < 0.01, respectively). We conclude that basal inhibin A or B levels cannot be used in the diagnosis of PCOS.

Follow up of the regression of the placenta left in situ in an advanced abdominal pregnancy using the Cavalieri method.

In this abdominal pregnancy, the dead fetus was delivered through an abdominal incision at the 36th gestational week. The placenta invaded the small intestine and the omentum was left in situ. The placental degeneration was monitored using serial serum beta-human chorionic gonadotropin values. In certain periods, the follow up of the placental regression was carried out using the Cavalieri method with abdominal ultrasound. It was seen that the placental volume had decreased by 83% at the end of 1 year. To the best of our knowledge, this is the first time this method has been used for this purpose.

Inhibin B levels on cycle day 3 to predict the ovulatory response in women with PCOS undergoing ovulation induction via low dose step-up gonadotropin protocol.

BACKGROUND: In this prospective clinical single blind study, we aimed to investigate whether day 3 serum inhibin B levels in women with polycystic ovarian syndrome(PCOS) are of predictive value for the estimation of the ovarian response to gonadotropins. METHODS: Ovulation induction with low dose step-up gonadotropin protocol, starting with 75 IU/day, was performed for 30 cycles on 25 patients with PCOS. Day 3 serum inhibin B, follicle-stimulating hormone(FSH) and estradiol, and midluteal serum progesterone levels were measured during each cycle. The correlations between day 3 inhibin B levels and day 3 FSH, day 3 estradiol and midluteal progesterone measurements, as well as the amount of gonadotropin required to provide an ovulatory cycle were investigated. RESULTS: Five (27.8%) out of 18 cycles with day 3 inhibin levels <50.0 pg/ml; and 11 (91.7%) out of 12 cycles with levels > or = 50.0 pg/ml were ovulatory (chi(2)=9.38, p<0.01). Moreover, day 3 inhibin B levels had statistically significant negative correlation with the gonadotropin used; and significant positive correlation with the midluteal progesterone levels (p<0.05). There wasn't any significant relation between day 3 FSH and estradiol levels with the gonadotropin used and progesterone levels. CONCLUSIONS: It has been observed that as day 3 serum inhibin B levels increased in women with PCOS, the ovulatory response to gonadotropins and the rate of ovulatory cycles increased significantly.

Comparison of the effects of transdermal estrogen, oral estrogen, and oral estrogen-progestogen therapy on bone mineral density in postmenopausal women.

It is now clear that estrogen intervention reduces bone loss in postmenopausal osteoporosis. The aim of this study was to investigate whether the route of estrogen administration or addition of progesterone changes this positive effect. Transdermal estrogen (T-E), oral estrogen (E), and oral estrogen plus progestogen (E-P) were administered to 15, 18, and 17 postmenopausal women, respectively, who all had normal bone mineral density (BMD) before hormone replacement therapy (HRT). Calcium (500 mg/day) was routinely added to all HRT regimens. The BMD of the lumbar spine (L2-L4) was measured initially and at the end of the first and second years of treatment. The paired-sample t test, independent-sample t test, and Pearson correlation analysis were used for the statistical evaluation. The initial BMD measurements and the values at the end of the first and second years of the therapy were not significantly different either within or among the groups (P > 0.05). These results indicate a similar therapeutic value of each HRT regimen in the prevention of bone loss in postmenopausal women.