Can ovarian double-stimulation in the same menstrual cycle improve IVF outcomes?

OBJECTIVE: To evaluate the double-stimulation protocol efficacy over conventional ovarian stimulation in recovering a more adequate number of oocytes and increase the number of embryos to be transferred or to be genetically analyzed. METHODS: A retrospective and comparative study with 13 patients who underwent unsuccessful in vitro fertilization (IVF) cycles with a conventional antagonist ovarian stimulation protocol and repeat the attempt with a double stimulation protocol. The following variables were analyzed: number of oocytes collected, mature oocytes collected, fertilization rate, blastocyst rate, biopsied blastocyst rate and euploidy rate. RESULTS: The double stimulation protocol had a significant higher number of oocytes collected (p=0.007) and mature oocytes to be injected (p=0.01). There was no statistically significant difference in fertilization (p=0.78) and blastocyst (p=0.59) rates. CONCLUSION: Double stimulation favors patients who are at risk of incurring several attempts of IVF to achieve pregnancy.

Frozen embryo transfer cycles in women with deep endometriosis.

OBJECTIVE: To compare the transfer pregnancy rates with frozen embryos from patients with deep endometriosis and non-endometriosis patients. METHODS: We conducted a retrospective cohort study of review of medical records of 181 women aged 18-40 years, undergoing transfer of frozen embryos into a fertility center. The data collected was from January 2007 to December 2013. RESULTS: Regarding the patients with endometriosis, there was no statistical difference in proportion to compare polycystic ovarian syndrome, male factor, tubal factor and unexplained infertility. CONCLUSION: There was no difference between pregnancy rates obtained from frozen embryo transfer in deep endometriosis compared to other causes of infertility.

Are Patients with Polycystic Ovarian Syndrome Ideal Candidates for Oocyte Donation?

Background. The use of donated oocytes for in vitro fertilization treatment in patients with ovarian failure is universally recognized. But would patients with polycystic ovarian syndrome (PCOS) be a good choice for egg donation programs? Objective. Comparing the pregnancy rates of egg receptors from donor patients diagnosed with PCOS to receptors from donors without PCOS. Design. Retrospective cohort study. Methods. A total of 234 patients who had undergone egg reception program were separated into two groups: Group I, receptors from PCOS donors (n = 36); Group II, receptors from donors without PCOS (n = 198). Medical records were reviewed and the fertilization, implantation, and pregnancy rates were calculated. Results. PCOS patients had an average of 3.23 more oocytes retrieved, but there were no differences in the number of mature oocytes that were used for donation between the groups. We also observed that the number of transferred embryos was also not significantly different, as well as the fertilization and implantation rates. The clinical pregnancy rates were not significantly different: 28% and 26% in Group I and Group II, respectively. Conclusions. Women with PCOS should not be excluded from egg donation programs.

Increased expression of the leptin receptor in human ovaries affected by endometrioma and detection of high levels of leptin in the ovarian endometriomal fluid.

BACKGROUND: This study was designed to investigate leptin levels in the fluid in ovarian endometriomas (OEs) and to compare the expression of leptin and its receptors (OBR) in ovarian tissue affected by endometrioma in infertile women to its expression in the normal ovarian tissue of fertile controls without endometriosis. METHODS: In this case-control observational study, ovarian tissue, blood samples and peritoneal fluid were obtained from 20 women (10 fertile controls without endometriosis or any ovarian disease, who were undergoing tubal ligation surgery, and 10 infertile women with severe endometriosis and OE). The ovarian endometriomal fluid (EF) was aspirated, and peritoneal-implant (PI) biopsies were performed. The tissues removed during the surgeries were immediately frozen in liquid nitrogen to determine expression levels by western blot and leptin levels by ELISA. RESULTS: OBR was expressed at higher levels in the ovarian tissue affected by endometrioma than in the normal ovarian tissue (control = 0.38 ± 0.05, study = 0.60 ± 0.09, p = 0.03), but there was no significant difference in leptin levels between these groups (control = 0.57 ± 0.1, study = 0.35 ± 0.1, p = 0.18). Positive and significant correlations were observed between leptin and OBR in the OE (r = 0.85, p = 0.004) and in the PI (r = 0.87, p = 0.001). ELISA results demonstrate a greater leptin concentration within the EF compared with the serum and the PF (serum = 14.25 ± 1.63, PF = 5.98 ± 2.0, EF = 73.8 ± 16.2, p = 0.0001), but there was no correlation between these variables. A positive, significant and strong correlation was observed between PF leptin levels and the expression of leptin and OBR in PI (leptin: r = 0.78, p = 0.007/OBR: r = 0.68, p = 0.04) and between the EF leptin levels and the expression of leptin and OBR in the OE (leptin: r = 0.88, p = 0.008/OBR: r = 0.89, p = 0.005). CONCLUSIONS: These data suggest that leptin may play an important role in the physiopathology of OE through a modulatory interaction with its active receptor.

Sexual function in patients with deep infiltrating endometriosis.

INTRODUCTION: Endometriosis is a benign condition that causes pain and infertility. Sexual dysfunction, particularly deep dyspareunia, is common in patients with endometriosis and interferes with quality of life and conjugal satisfaction. AIM: The study aims to assess sexual function in women with deep infiltrating endometriosis. METHOD: Fifty-seven women diagnosed with deep infiltrating endometriosis were recruited from Hospital Universitário Pedro Ernesto (HUPE) between July and December 2011. The control group comprised 38 healthy women recruited at the HUPE family planning clinic. MAIN OUTCOME MEASURES: The main outcomes are full-scale and individual domain scores on the Female Sexual Function Index (FSFI), a validated questionnaire for functional assessment of sexual function in women. RESULTS: Patients with endometriosis had more pain in intercourse than controls, which correlates with lower scores in the FSFI pain domain. However, there were no statistically significant between-group differences in overall (full-scale) FSFI scores. CONCLUSION: Women with endometriosis exhibit significant dysfunction in the pain domain of the FSFI questionnaire, but this finding was not sufficient to affect the overall sexual function.

Diagnostic hysteroscopy using liquid distention medium: comparison of pain with warmed saline solution vs room-temperature saline solution.

STUDY OBJECTIVE: To compare pain intensity and degree of satisfaction reported by patients undergoing hysteroscopic examinations using saline solution kept at room temperature (control group) or saline solution heated to 37.5°C (test group). DESIGN: Randomized, controlled, prospective study (Canadian Task Force Classification I). PATIENTS: Sixty-four women underwent diagnostic hysteroscopy during the second half of 2008. INTERVENTION: In both the test and control groups, examinations were performed using the vaginoscopy technique without use of a speculum or Pozzi tenaculum forceps. Pain was assessed using a visual analog scale immediately after the examination and at 1 and 15 minutes after the procedure. MEASUREMENTS AND MAIN RESULTS: Immediately after the examination, mean (SD; 95% confidence interval) pain intensity in the warmed saline solution group was 3.84 (2.71; 2.89-4.79), and in the room-temperature saline solution group was 4.31 (3.02; 3.18-5.44) (p = .51). At 1 and 15 minutes after the procedure, pain intensity in the 2 groups was, respectively, 2.41 (2.00; 1.66-3.16) and 2.43 (2.49; 1.57-3.30) (p = .96), and 1.83 (2.30; 1.02-2.64) and 1.85 (2.06; 1.08-2.62) (p = .96). Differences were not significant. Time to complete the examination was 3.80 (1.32; 3.34-4.26) minutes in the test group, and 3.75 (1.10; 3.34-4.15) minutes in the control group (p = .82). The satisfaction rate with the warmed distention medium was 84% (95% confidence interval, 72%-96%), and with the room-temperature saline solution was 85% (73%-97%) with saline at room temperature (p = .48). CONCLUSION: There was no statistically significant difference between the 2 groups insofar as pain, duration of the examination, and degree of patient satisfaction.