Comparison of Anti-müllerian Hormone (AMH) and Hormonal Assays for Phenotypic Classification of Polycystic Ovary Syndrome.

OBJECTIVES: The aim is to compare the hormonal status and anti-müllerian hormone (AMH) levels of patients who have different polycystic ovary syndrome (PCOS) phenotypes, polycystic ovarian morphology (PCOM) and healthy women. MATERIAL AND METHODS: A total of 350 PCOS women, 71 women with PCOM and 79 healthy women with normal ovarian morphology (NOM) were observed. PCOS patients were divided into groups according to the phenotypes. Phenotype A- characterized by anovulation, hyperandrogenism and PCOM; phenotype B- defined as anovulation, hyperandrogenism; Phenotype C- identified as hyperandrogenism and PCOM; Phenotype D- outlined as anovulation and PCOM. AMH levels were compared for each group. RESULTS: Among 350 PCOS patients the highest number belonged to phenotype A (n = 117, 33.4%). The rest were distrubuted as follows: phenotype B (n = 89, 25.4%), phenotype C (n = 72, 20.6%), phenotype D (n = 72, 20.6%). Phenotype A (9.17 ± 4.56) had the highest mean AMH levels in our study. Comparison of AMH levels showed a statistically significant difference between phenotypes A and D. There was a statistically significant difference on comparison of AMH between NOM, PCOM and all PCOS phenotypes. CONCLUSIONS: Phenotype A is the most serious form of PCOS and these patients has all three features which are hyperandrogenism, anovulation and ultrasound findings of polycystic ovary (PCO). AMH reflects the severity of PCOS and patients with Phenotype A have higher AMH levels.

Safe and successful use of oocyte in-vitro maturation in two infertile women with multiple sclerosis.

There is evidence to support an impact of ovarian stimulation with gonadotrophin-releasing hormone analogues on the progression or recurrence of multiple sclerosis. In addition, there is no universally acknowledged approach toward ovarian stimulation in patients with multiple sclerosis. This report describes two patients at a large tertiary university hospital who underwent an in-vitro maturation protocol in order to avoid a risk of exacerbating their multiple sclerosis by ovarian stimulation. Both patients were referred to the infertility clinic because of the concern of exacerbation of multiple sclerosis during or after ovarian stimulation treatment. The patients underwent the in-vitro maturation protocol to avoid ovarian stimulating agents. Both patients gave birth to healthy babies at term. They did not suffer any relapses of multiple sclerosis during their treatment or during pregnancy. Exacerbation of disease related to ovarian stimulation encourages the search for a safer approach to these patients. To the authors' knowledge, these are the first babies described in the literature who were born after in-vitro maturation to mothers suffering from multiple sclerosis. In-vitro maturation can thus be recommended as an alternative in suitable women with multiple sclerosis.

The effect of myoinositol on ovarian blood flows in women with polycystic ovary syndrome.

To evaluate whether 4 gram myoinositol and 400 mcg folic acid(MYO) therapy has any effects on ovarian stromal blood flow by using pulsed and color Doppler at 3 months follow-up period in polycystic ovary syndrome (PCOS). One-hundred eighty patients were designed into six groups; Group 1: PCOS patients that received OCP containing 30 mcg ethinyl estradiol (EE) plus 3 mg drospirenone (DRP); Group 2: PCOS patients that received MYO; Group 3: PCOS patients that received no medication. Group 4: Healthy patients that received OCP; Group 5: Healthy patients that received MYO; Group 6: Healthy patients that received no medication. Resistance index (RI) and pulsatility index (PI) of both ovaries were assessed. There was a significant increase in RI and PI of both ovarian stromal blood flow women with PCOS who received OCP (Group 1, p < .001) and MYO (Group 2, p < .001). The rate of increment in both RI and PI values were similar for OCP users (Group 1) and MYO users(Group2) in PCOS patients. MYO therapy reduced ovarian vascularization in both PCOS and healthy users after 3 months and this decrease is especially noticeable in women with PCOS compared to healthy women. OCP therapy also reduced ovarian vascularization just like MYO therapy.

Corrigendum to "Different Effects of Myoinositol plus Folic Acid versus Combined Oral Treatment on Androgen Levels in PCOS Women".

[This corrects the article DOI: 10.1155/2016/3206872.].

Myo-inositol administration positively effects ovulation induction and intrauterine insemination in patients with polycystic ovary syndrome: a prospective, controlled, randomized trial.

Objective: The aim of the study is to investigate the effect of myo-inositol (MYO) on pregnancy rates of patients diagnosed with polycystic ovary syndrome (PCOS) who undergone controlled ovulation induction and intrauterine insemination (IUI). METHODS: A total of 196 infertile patients diagnosed with PCOS and admitted to Dokuz Eylul University Faculty of Medicine were included in the study between March 2013 and May 2016. The patients in group 1 (n = 98) were given 4 g MYO and 400 µg folic acid before and during ovulation induction. The patients undergone controlled ovarian hyperstimulation (COH) with recombinant FSH and IUI. The patients in group 2 (n = 98), were given recombinant FSH directly and 400 µg folic acid. The primary outcome measure of this study was the clinical pregnancy rate. RESULTS: In group 1, 9 patients conceived spontaneous pregnancy. During COH + IUI treatment three cycles were canceled in group 1 and 8 cycles in group 2. Total rFSH dose and cycle duration were significantly lower and clinical pregnancy rates were higher in group 1. The pregnancy rate for group 1 was %18.6 and for group 2 was %12.2. Conclusions: This study shows that MYO should be considered in the treatment of infertile PCOS patients. MYO administration increases clinical pregnancy rates, lowers total rFSH dose and the duration of the ovulation induction.

Different Effects of Myoinositol plus Folic Acid versus Combined Oral Treatment on Androgen Levels in PCOS Women.

Recently, myoinositol (myo-ins) and folic acid combination has gained an important role for treating Polycystic Ovary Syndrome (PCOS), in addition to combined oral contraceptives (COC). We aimed to examine myo-ins effects on anti-Mullerian hormone (AMH) levels and compare them with those ones obtained administering COC. In this prospective study, 137 PCOS patients, diagnosed according to Rotterdam criteria and admitted to the Reproductive Endocrinology and Infertility Outpatient Clinic at Dokuz Eylul University (Izmir, Turkey), were included. After randomization to COC (n = 60) and myo-ins (n = 77) arms, anthropometric measurements, blood pressure, Modified Ferriman Gallwey scores were calculated. Biochemical and hormonal analysis were performed, and LH/FSH and Apo B/A1 ratios were calculated. Data analysis was carried out in demographically and clinically matched 106 patients (COC = 54; myo-ins = 52). After 3-month treatment, increase in HDL and decreases in LH and LH/FSH ratio were statistically more significant only in COC group when compared with baseline (in both cases p > 0.05). In myo-ins group, fasting glucose, LDL, DHEAS, total cholesterol, and prolactin levels decreased significantly (for all p < 0.05). Progesterone and AMH levels, ovarian volume, ovarian antral follicle, and total antral follicle counts lessened significantly in both groups (for all p < 0.05). In PCOS treatment, MYO is observed more effective in reductions of total ovarian volume and AMH levels.

Quantitative Sonographic Differences in Mid-Urethra between Postmenopausal Women with and without Stress Urinary Incontinence.

AIM: The aim of this study was to evaluate midurethral tissue characteristics in continent and stress urinary incontinent postmenopausal women by using transvaginal ultrasound gray-level histogram. METHODS: Thirty-seven patients with stress urinary incontinence (SUI) and 77 patients without SUI were evaluated. Vaginal ultrasound gray-level histograms were performed by 2 gynecologists blinded to patients' SUI statuses. The mean gray-level (MGL) of ultrasound gray-level histogram, representing the echogenicity of a region of interest, was measured in the anterior and posterior midurethral wall along a vertical ultrasound beam. The difference in MGL between anterior and posterior (AP difference) midurethra was calculated. RESULTS: The MGL value of SUI patients was found to be lower in posterior (p = 0.008) and higher in anterior midurethral region (p = 0.001) when compared with control group. In addition, the difference in MGL between anterior and posterior midurethra (AP difference) was found to be higher in SUI group (p < 0.001). Multivariate analysis by logistic regression including confounding factors revealed that AP difference was independently associated with presence of SUI (adjusted OR 1.14, 95% CI 1.08-1.20, p < 0.001). Intra- and inter-observer reproducibility was found to be high with intraclass correlation coefficient of 0.83 and 0.78, respectively. CONCLUSION: Postmenopausal SUI patients might have a distinct midurethral echogenicity pattern with the quantitative ultrasonography.

Gonadotropin-releasing hormone agonist triggering is effective, even at a low dose, for final oocyte maturation in ART cycles: Case series.

OBJECTIVE: To investigate the efficacy of low-dose gonadotropin-releasing hormone (GnRH) agonist for final oocyte maturation in females undergoing assisted reproductive treatment (ART) cycles. MATERIAL AND METHODS: Nine females undergoing ovarian stimulation in a GnRH antagonist protocol who received triptorelin 0.1 mg to trigger final oocyte maturation were included. Treatment outcomes of these patients were compared with those of controls, matched for age and oocyte number (n=14), who received 0.2 mg triptorelin at the same time. The luteal phase was supported with vaginal micronized progesterone and oral estradiol hemihydrate 2 mg twice daily. RESULTS: The mean (±) numbers of retrieved, metaphase II, and fertilized oocytes were 15.66±7.82, 14±7.28, and 10.11±5.86, respectively. The implantation and clinical pregnancy rates were 46.1% and 71.4%, respectively. Of the pregnancies, 2 were live births, 1 was a preterm birth (twins), 2 are on-going, and 2 ended as miscarriages. No case of OHSS was encountered. On comparison of the results of these patients (fresh cycles; n=7) with those of matched controls, there were no significant differences in terms of retrieved mature oocytes, implantation rates, or clinical pregnancy rates (p>0.05). CONCLUSION: These findings suggest that low-dose GnRH agonist triggering has similar efficacy as standard doses in terms of retrieved mature oocytes and clinical pregnancy rates in in vitro fertilization cycles.

The effect of drospirenone (3 mg) with ethinyl estradiol (30 mcg) containing pills on ovarian blood flows in women with polycystic ovary syndrome: a case controlled study.

OBJECTIVE: To evaluate whether oral contraceptive pill (OCP) therapy has any effects on ovarian stromal blood flow by using pulsed and color Doppler at the end of 3 months follow-up period of OCP-users and non-users with or without polycystic ovary syndrome (PCOS). STUDY DESIGN: 200 patients were included in the study. The patients were designed into four groups as follows; Group 1: PCOS patients that received OCP containing 30 mcg ethinyl estradiol (EE) plus 3mg drospirenone for 3 months (DRP n=50); Group 2: PCOS patients that received no medication (n=50); Group 3: Healthy controls that received OCP (EE plus DRP) (n=50); Group 4: healthy controls that received no medication (n=50). Resistance index (RI) and pulsatility index (PI) of both ovarian arteries, hormonal, anthropometric and biochemical parameters were assessed before and after 3 months. RESULTS: There was a significant increament in RI and PI of both ovarian arteries in healthy controls (Group 3) and in women with PCOS (Group 1) who received OCP (p<0.001). The increment rate in both Doppler parameters were significantly higher in women with PCOS (Group 1) than healthy controls (Group 3) (p<0.001). Whereas RI and PI values of both ovaries remained unchanged in all untreated women with or without PCOS (Groups 2 and 4). CONCLUSION: OCP therapy reduced ovarian vascularization in both PCOS and healthy users after 3 months of therapy and this decrease is especially noticeable in women with PCOS.

The effect of intrauterine insemination time on semen parameters.

OBJECTIVE: The purpose of this observational study was to determine whether semen parameters (concentration, motility) were affected by the interval between the onset of postwash sperm incubation and intrauterine insemination (IUI) time. MATERIAL AND METHODS: Semen specimens of 100 normozoospermic men collected at the clinic were allowed 20 minutes for liquefaction at room temperature. Semen samples were subjected to both macroscopic and microscopic examinations. After centrifugation in a density gradient column and sperm-washing medium, the samples were kept in an incubator. After 30 minutes, 60 minutes, and 120 minutes, the concentration and motility were recorded. RESULTS: According the results of the Bonferroni post hoc test, there were significant differences in values of mean sperm count, percent progressive sperm motility, and total motile sperm count between 30 minutes and 120 minutes (p=0.000, p=0.000, and p=0.000) and between 60 minutes and 120 minutes (p=0.000, p=0.000, and p=0.001), but there was no significant difference between 30 minutes and 60 minutes (p=1, p=0.173, and p=1). CONCLUSION: This study demonstrated that sperm parameters are negatively affected from prolonged incubation time. A maximum 60-minute limit of the interval between the onset of postwash sperm incubation and IUI time may increase pregnancy rates.

A comparative study of obstetric outcomes in electively or spontaneously reduced triplet pregnancies.

PURPOSE: This study aimed at evaluating the pregnancy outcomes of IVF triplets which are spontaneously or electively reduced to twins and to compare them with non-reduced triplets and twins. METHODS: Retrospective analysis of trichorionic triplets and dichorionic twins of IVF pregnancies. RESULTS: Preeclampsia rate was significantly higher in triplet group (p = 0.014). Premature contractions requiring tocolysis were seen more often in spontaneous reduction and triplet groups compared to elective reduction and twin groups (p < 0.001). Elective reduction and twin groups had significantly lower rate of infants weighing less than 1,500 g than those of triplets (p < 0.001). Highest rate for infants weighing over 2,500 g was found in primary twin group. Preterm delivery rates were significantly lower in both twin and elective reduction groups compared to triplet and spontaneous reduction groups (p < 0.001). Proportion of women giving birth at term was not different in elective reduction and twin groups, and they were significantly higher compared to spontaneous reduction group (p = 0.024). Perinatal mortality rates of both elective reduction and twin groups were significantly less than those in the triplet group (p = 0.045 and p < 0.001, respectively). CONCLUSIONS: Obstetric outcomes of triplets from IVF or ovulation induction cycles undergoing elective reduction are better than ongoing triplet and spontaneous reduction groups and are similar to that of dichorionic twins.

Intrauterine fetal loss associated with Candida glabrata chorioamnionitis: report of two cases.

Chorioamnionitis is most commonly the result of an ascending infection caused by bacteria found within the lower genital tract. Yeast infections causing chorioamnionitis are very uncommon. Candida glabrata is a yeast that is considered to be a commensal of the vagina but vaginitis and rarely upper genital tract infection have been described. We report two cases of fungal chorioamnionitis occurring in pregnancies with a history of in vitro fertilization and cervical cerclage, both resulting in fetal loss. The histological features in conjunction with the positive cultures enabled C. glabrata to be identified as the causative organism producing severe chorioamnionitis. C. glabrata was probably introduced into the cervix at the time of embryo transfer, and during stitching the cervix. To prevent unfavorable outcomes in pregnant women, we recommend that vaginal and in particular cervical swabs should be taken prior to cervical procedures and appropriate treatment should be provided.

The levels of hepatocyte growth factor in serum and follicular fluid and the expression of c-Met in granulosa cells in patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate the levels of hepatocyte growth factor (HGF) in follicular fluid (FF) and the expression of c-Met in granulosa cells (GCs) with respect to the quality of the oocyte and embryo both in patients with polycystic ovary syndrome (PCOS) and in the normal ovary during controlled ovarian hyperstimulation cycles. DESIGN: Prospective controlled study. SETTING: University hospital. PATIENT(S): Fifty-nine women undergoing IVF treatment (of whom 21 had PCOS and 38 were in the control group). INTERVENTION(S): A total of 168 FF samples were collected at the time of oocyte retrieval. The HGF levels were measured by ELISA, and the mRNA expression of c-Met in GCs was detected by real-time polymerase chain reaction. MAIN OUTCOME MEASURE(S): The predictive values of HGF levels in serum and FF and the mRNA expression of c-Met in GCs for successful fertilization and oocyte-embryo quality. RESULT(S): The levels of HGF in serum and FF and the c-Met expression in GCs were similar between the PCOS and control groups. Granulosa cells of fertilized oocytes (2PN) had a significantly higher level of c-Met expression than that in oocytes that failed to fertilize. The mean HGF level in FF was significantly higher in the grade 1 embryos than in the grades 2-4 embryos. CONCLUSION(S): This study suggests that HGF/c-Met signaling may be a crucial determinant of fertilization success.

The effect of post-wash total progressive motile sperm count and semen volume on pregnancy outcomes in intrauterine insemination cycles: a retrospective study.

OBJECTIVE: The purpose of this study was to determine the impact of post-wash total progressive motile sperm count (TPMSC) and semen volume on pregnancy outcomes in intrauterine insemination (IUI) cycles. MATERIAL AND METHODS: The retrospective study included a total of 156 cycles (141 couples) and was performed in our center over a 24-month period. The semen parameters were recorded for each man and each insemination. The semen samples were re-evaluated after the preparation process. Post-wash TPMSC values were divided into four groups; Group 1: <1×10(6); Group 2: 1-4.9×10(6); Group 3: 5-9.9×10(6); Group 4: 10×10(6) and >10×10(6). Post-wash inseminated semen volume was divided into three groups; Group 1: 0.3 mL; Group 2: 0.4 mL; Group 3: 0.5 mL. The effect of post-wash total progressive motile sperm and semen volume on pregnancy outcomes was evaluated. RESULTS: The pregnancy rates per cycle and per couple were 27.56% and 30.49%, respectively. There was not a significant relationship between the inseminated semen volume and pregnancy rate (p>0.05). However, a significant linear-by-linear association was documented between the TPMSC and pregnancy rate (p=0.042). CONCLUSION: Our findings suggest that the post-wash inseminated semen volume should be between 0.3-0.5 mL. An average post-wash total motile sperm count of 10×10(6) may be a useful threshold value for IUI success, but more studies are needed to determine a cut-off value for TPMSC.

Comparison of the effects of 2 different doses of remifentanil infusion for sedation during in-vitro fertilization procedure.

OBJECTIVE: To compare the sedation level, hemodynamic effects, patient and physician satisfactions following sedation achieved by 2 different doses of remifentanil (R) infusion with additional bolus infusions of propofol for in vitro fertilization (IVF) procedure. METHODS: A double-blind prospective randomized study was implemented on 86 ASA I-II grade female patients, 18-40 years of age that underwent IVF procedure. This study was performed in the Department of Anesthesiology and Obstetrics and Gynecology, School of Medicine, Dokuz Eylul University, Izmir, Turkey between November 2006 to August 2008. Group R1 received 0.1 mcg/kg/min while Group R2 received 0.15 mcg/kg/min infusion dose remifentanil. Side effects, total doses of remifentanil and propofol administered, heart rate (HR), systolic arterial pressure and diastolic arterial pressure values have been recorded. Fertilization, cleavage, and pregnancy rates together with prognosis of pregnancies were compared. RESULTS: Groups did not show statistically significant differences for hemodynamic parameters of HR and MAP (p = 0.281). Comparison of the satisfaction levels of 2 groups showed that anesthesiologist satisfaction was superior in R1 (p = 0.009) whereas surgeon satisfaction was superior in R2 (p = 0.01). Both groups reported good patient satisfaction levels (p = 0.31). There were no differences between the groups in terms of fertilization, cleavage, pregnancy rates and prognosis of pregnancies (p>0.05). CONCLUSION: Both doses of remifentanil provided stable hemodynamics along with fast and uncomplicated recovery.

IVM is an alternative for patients with PCO after failed conventional IVF attempt.

PURPOSE: To determine if IVM of oocytes from unstimulated cycle is a treatment option for patients who did not deliver after standard IVF-ET. METHOD: Twenty three women with PCO, thirteen of them with normal cycles and all <35 years old, who failed IVF served as their own control. During the control IVF cycle patients were stimulated with 1730.7 ± 639.5 IU recombinant FSH, a long Buserelin acetate protocol was used and embryo transfer was performed on day 2 or 3 after ICSI. After failed IVF immature oocytes were aspirated transvaginally from antral follicles during spontaneous menstrual cycle. Embryo transfer was performed 2 or 3 days later. RESULT: 11.4 ± 4.8 mature oocytes and 6.7 ± 3.2 embryos were produced with IVF, which served as the control, compared to 9.7 ± 4.5 mature oocytes and 6.2 ± 3.2 embryos with IVM. There was one clinical pregnancy in the IVF group which did not result in a live birth where as five singleton and one pair of twins with healthy live births and one miscarriage in the IVM group. CONCLUSION: IVM does not involve ovarian stimulation with possible financial and health consequences. It may be an useful treatment after unsuccessful IVF.

Influence of follicular fluid GDF9 and BMP15 on embryo quality.

OBJECTIVE: To evaluate the association between follicular fluid levels of propeptide and mature forms of growth differentiation factor (GDF) 9 and bone morphogenetic protein (BMP) 15 with subsequent oocyte and embryo quality. DESIGN: Prospective clinical study. SETTING: University hospital. PATIENT(S): Eighty-one infertile patients who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). INTERVENTION(S): The expression levels of the propeptide and mature forms of follicular fluid GDF9 and BMP15 were determined by western blot analysis. The levels of follicular fluid hormones (FSH, E2, and P) were measured with automated chemiluminescent enzyme immunoassays. MAIN OUTCOME MEASURE(S): The relationships between the levels of GDF9 and BMP15, hormones, oocyte maturation, and embryo quality. RESULT(S): Mature GDF9 levels were significantly correlated with the nuclear maturation of oocytes. The mean mature GDF9 level was 4.87±0.60 in the high-embryo-quality group and 1.45±0.81 in the low-embryo-quality group. There were no statistically significant differences in embryo quality among the patients regarding propeptide GDF9 and BMP15 expression status. There was a negative correlation between follicular fluid levels of P and the mature form of GDF9. CONCLUSION(S): Higher mature GDF9 levels in the follicular fluid were significantly correlated with oocyte nuclear maturation and embryo quality.

In vitro oocyte maturation from unstimulated cycles: does it offer a realistic chance to overcome the problem of repeated oocyte maturation arrest in IVF?

This report describes the use of in vitro oocyte maturation in two patients with history of repeated oocyte maturation arrest (OMA) from in vitro fertilization. Based on these two cases, in vitro oocyte maturation from unstimulated cycles seems not an alternative treatment option for the patients with history of OMA.

Randomized, controlled trial of priming with 10,000 IU versus 20,000 IU of human chorionic gonadotropin in women with polycystic ovary syndrome who are undergoing in vitro maturation.

Preretrieval priming with 10,000 IU hCG can improve oocyte maturation rates in vitro for women undergoing in vivo maturation treatment, though the optimum dose is unknown. This prospective, randomized, controlled trial demonstrated no improvement in oocyte maturation rates with 20,000 IU of hCG compared with 10,000 IU of hCG and therefore no benefit of the higher dose.

Does fetal gender affect cytotrophoblast cell activity in the human term placenta? Correlation with maternal hCG levels.

BACKGROUND: Pregnant women with female fetuses have higher maternal serum human chorionic gonadotropin (hCG) levels than pregnant women with male fetuses. Ki-67, a cell proliferation and activity marker, is confined mostly in the nuclei of villous cytotrophoblasts of the human placenta. In this study, we examined the effect of fetal gender on the cytotrophoblast cell activity in human term placenta, with special regard to maternal serum and cord blood hCG levels. METHODS: Thirty-four uncomplicated, singleton, term pregnancies (17 male and 17 female fetuses) were recruited in the study. hCG was measured in maternal peripheral serum and umbilical cord blood. Placental samples were collected in each patient during the cesarean section. Cytotrophoblast cell activity was measured by using immunohistochemistry for Ki-67 antigen. Ki-67 staining index values of the cytotrophoblasts were compared between the female and male placentas. RESULTS: Maternal serum and cord blood hCG levels were higher in pregnant women with female fetuses than in those carrying male fetuses. There was no sex difference in Ki-67 immunostaining rates of the cytotrophoblast cells. There was no correlation between maternal serum and cord blood hCG levels and Ki-67 staining index values of the cytotrophoblast cells. CONCLUSIONS: The difference in maternal serum and cord blood hCG levels in correlation with the fetal gender is not associated with cytotrophoblast cell activity in the human term placenta. The gender of the fetus does not seem to affect the regulation of cytotrophoblast cell proliferation.