Fertility Outcomes In Women Research Articles

Basal serum testosterone predict ovarian response and in vitro fertilization outcome in women with diminished ovarian reserve

Diminished ovarian reserve predicts disappointing pregnancy chances. Little data have concerned predictor for in vitro fertilization (IVF) outcome in women with diminished ovarian reserve. To investigate the association of basal testosterone (T) levels with ovarian response and in vitro fertilization (IVF) outcome in women with diminished ovarian reserve. Retrospective cohort study. We reviewed data of patients underwent their first IVF cycle, without polycystic ovary syndrome (PCOS) or endometriosis, from 2009-2010. Diminished ovarian reserve was defined as basal FSH value >10IU/L or FSH:LH ratio >3. The association of basal FSH, LH, E2, T levels with ovarian response and IVF outcome were analyzed with SPSS statistical package. We reviewed 1598 IVF cycles. Complete clinical data of 223 women with diminished ovarian reserve were analyzed. The mean age of patients was 34.51 ± 5.12 years old. Antral follicle count (AFC) was 6.59 ± 3.66. Levels of basal serum FSH, LH, E2 and T were10.55 ± 3.90IU/L, 3.57 ± 1.88 IU/L, 0.15 ± 0.10 nmol/L and 1.37 ± 0.61 nmol/L. The average total dose of gonadotropins was 2666.13 ± 960.33IU. The numbers of large follicles (>14 mm) on HCG day, oocyte retrieved and high-quality embryo were 6.20 ± 2.94, 7.76 ± 3.97 and 1.34 ± 1.37. Endometrial thickness on hCG day was 1.02 ± 0.25cm. The pregnancy rate was 29.60%. Basal T was correlated with the numbers of large follicles on HCG day (r = 0.132, P=0.049), numbers of oocyte retrieved (r = 0.144, P=0.031), two pronuclei (r = 0.137, P=0.041). On the other hand, significantly negative correlations were observed between basal T and basal FSH (r = -0.16,P=0.017), total dose of gonadotropins (r = -0.154, P=0.02). A testosterone level of 1.12nmol/L was shown to predict pregnancy outcome with a sensitivity of 83.3% and specificity of 42.3%, P=0.039. In women with diminished ovarian reserve, basal T was a predictor for ovarian response and IVF outcome.

Clinical impact of scavenger receptor class B type I gene polymorphisms on human female fertility

The goal of this study was to evaluate the association of SCARB1 single nucleotide polymorphisms (SNPs) and fertility outcomes in women undergoing IVF. Between November 2007 and March 2010, granulosa cells and follicular fluid were collected from women undergoing IVF. Five SCARB1 SNPs were sequenced and progesterone levels were measured in the follicular fluid. Fertility measurements were defined as the presence of gestational sac(s) and fetal heartbeat(s). The study group consisted of 274 women (mean age of 36.4 ± 4.6 years). The racial/ethnic composition was 55% Caucasian (n = 152), 25% African-American (n = 68), 12% Asian (n = 34), 5% Hispanic, (n = 14) and 2% other (n = 6). There was a significant difference in the genotype frequencies of the SCARB1 SNPs across the groups. Subjects who were homozygous for the minor allele in the rs5888 SNP had higher follicular progesterone levels than those who were homozygous for the major allele (P = 0.03). In the Caucasian group, carriers of the minor A allele of the rs4238001 SNP had lower follicular progesterone levels compared with homozygous carriers of the major G allele (P = 0.04). In this group, follicular progesterone levels were highly predictive of the rs4238001 SNP (P = 0.03). In the entire cohort, minor allele carriers of rs4238001 did not have any viable fetuses at Day 42 following embryo transfers (P = 0.04). In the African-American group in particular, there was also an association between rs10846744 and gestational sac(s) (P = 0.006), and fetal heartbeat(s) (P = 0.005). In part, SCARB1 rs4238001 and rs10846744 SNPs may contribute to human female infertility.

Laparoscopic myomectomy in patients with uterine myomas associated with infertility

Although myomectomy is widely accepted in women of childbearing age who wish to retain their fertility, the extent to which myomas affect fertility and whether their removal improves this remain unclear. This study aimed to elucidate the favourable surgical approach in women with uterine myomas and infertility. This retrospective, follow-up study was carried out in three centres in Germany. Data on women who had undergone myomectomy via laparoscopy, laparotomy or conversion to laparotomy in 2000–04 were collected and analysed. Fertility outcome after myomectomy was assessed by follow-up postal questionnaire in a subgroup of women with myoma-associated infertility. Data on 159 women with otherwise unexplained infertility were included (mean age 35 years (range 17–47), mean number of myomas 2.4 (range 1–8) and mean myoma size 6.1 cm (range 0.5–20)). Women who underwent laparoscopy had fewer complications. 39.6% (63/159) of women completed the questionnaire, which showed that the pregnancy rate after myomectomy was 46% in this group. No uterine rupture occurred. Laparoscopy is associated with fewer postoperative complications and since no preoperative or intraoperative factors seem to influence the fertility outcome in women with uterine myomas, it is the treatment of choice in these patients.

G546A polymorphism of growth differentiation factor-9 contributes to the poor outcome of ovarian stimulation in women with diminished ovarian reserve

The growth differential factor-9 (GDF-9) gene, an oocyte-specific factor, was screened in 106 Chinese women with diminished ovarian reserve (DOR), and three single-nucleotide polymorphisms, c.G169A, c.C447T and c.G546A, were detected. We found GDF-9 c.G546A, but not c.G169A or c.C447T, to be correlated with the poor ovarian stimulation and in vitro fertilization outcomes in women with DOR.

Polycystic Ovaries and Adrenal Insufficiency in a Young Pubescent Female with Lipoid Congenital Adrenal Hyperplasia Due to Splice Mutation of the StAR Gene: A Case Report and Review of the Literature

We report a case of Lipoid Congenital Adrenal Hyperplasia (LCAH) secondary to Steroidogenic Acute Regulatory (StAR) gene mutation in an adolescent female with bilateral ovarian cysts. StAR gene defects follow an autosomal recessive mode of inheritance and typically present with severe adrenal insufficiency during infancy. Both sexes can be affected equally. XY males often present with sex reversal, while XX females may develop gonadal failure later in life due to premature loss of ovarian follicles. Recently there have been reported cases of successful fertility outcomes in women with LCAH. In our case report, we describe the clinical, biochemical and molecular analysis of a 16 year-old XX adolescent female who was suspected of having LCAH upon discovery of bilateral ovarian cysts in the context of adrenal insufficiency. Examination of the StAR gene revealed a homozygous splice site mutation. The patient is currently undergoing estradiol therapy to suppress ovarian cyst formation.

Effect of body mass index on in vitro fertilization outcomes in women

BACKGROUND:Obesity has become a major health problem across the world. In women, it is known to cause anovulation, subfecundity, increased risk of fetal anomalies and miscarriage rates. However, in women going for assisted reproduction the effects of obesity on egg quality, embryo quality, clinical pregnancy, live birth rates are controversial.OBJECTIVES:To assess the effect of women’s body mass index (BMI) on the reproductive outcome of non donor In vitro fertilization (IVF)/Intracytoplasmic sperm injection (ICSI). The effects of BMI on their gonadotrophin levels (day 2 LH, FSH), gonadotrophin dose required for ovarian stimulation, endometrial thickness and oocyte/embryo quality were looked at, after correcting for age and poor ovarian reserve.MATERIALS AND METHODS:Retrospective study of medical records of 308 women undergoing non donor IVF cycles in a University affiliated teaching hospital. They were classified into three groups: normal weight (BMI<25 kg/m2), overweight (BMI>25 <30 kg/m2) and obese (BMI>30 kg/m2). All women underwent controlled ovarian hyper stimulation using long agonist protocol.RESULTS:There were 88 (28.6%) in the normal weight group, 147 (47.7%) in the overweight and 73 (23.7%) in the obese group. All three groups were comparable with respect to age, duration of infertility, female and male causes of infertility. The three groups were similar with respect to day 2 LH/FSH levels, endometrial thickness and gonadotrophin requirements, oocyte quality, fertilization, cleavage rates, number of good quality embryos and clinical pregnancy rates.CONCLUSION:Increase in body mass index in women does not appear to have an adverse effect on IVF outcome. However, preconceptual counselling for obese women is a must as weight reduction helps in reducing pregnancy-related complications.

Fertility outcomes in women with hypopituitarism

Fertility outcomes in women with hypopituitarism

Laparoscopic Management of Hydrosalpinx

Hydrosalpinx is a common cause of female infertility. Lower implantation and pregnancy rates have been reported in women with hydrosalpinges. How hydrosalpinx exerts its negative effect on the implantation process is not clearly understood. Mechanical factors, toxicity of the hydrosalpingeal fluid, and receptivity dysfunction may explain the impaired IVF outcome in the presence of hydrosalpinx. Laparoscopic surgery has a place in the diagnosis and management of hydrosalpinx. Analysis of the results of laparoscopic management of hydrosalpinx underscores the positive role of laparoscopy in fertility outcomes in women with this pathological tubal disease. Laparoscopic salpingectomy should be offered in those women who have bilateral disease or in cases where hydrosalpinges are large enough to be visible on ultrasound. Further randomized trials are required to assess other surgical treatment options for hydrosalpinx, such as laparoscopic salpingostomy, laparoscopic or hysteroscopic tubal occlusion, and drainage of hydrosalpinx before or during oocyte retrieval.

P-865: In vitro fertilization outcomes in women with polycystic ovarian syndrome using recombinant follicle-stimulating hormone with or without the addition of human menopausal gonadotropin

While women with PCOS often have high sensitivity to stimulation with gonadotropins, their IVF cycles may be complicated by overstimulation, poor oocyte quality, decreased pregnancy rates and increased miscarriages. Increased LH levels may be responsible for these difficulties posing an interesting possibility that COH with FSH alone rather than with LH-containing products may offer better cycle outcomes for these women. We sought to compare IVF outcomes in PCOS patients when stimulated with FSH alone versus a combination of FSH+hMG after midluteal GnRH agonist suppression.

Fertility outcomes in women with hypopituitarism

Women with hypopituitarism are known to have a poor outcome once pregnancy has been achieved by ovulation induction. There are no data, however, recording the efficacy of ovulation induction and pregnancy rates in this group of subfertile women. The outcome of fertility treatments in all 19 women with hypopituitarism attending the fertility clinics of University College London Hospitals over the past 20 years was audited. Ovulation was achieved in almost all women (95%) but occurred in only 60% of treatment cycles. Pregnancy was achieved in 47% of women or 11% of cycles resulting in a live birth rate of 6.7% per cycle. Seven of the 18 pregnancies (39%) miscarried. Only 42% of women treated achieved a live birth. Ovulation induction in women with hypopituitarism yields relatively low pregnancy rates in comparison to other causes of anovulation and a high miscarriage rate. Pituitary hormone deficiency beyond gonadotrophins has a major adverse effect on achieving pregnancy.

Transvaginal hydrolaparoscopy, its history and present indication

The investigation of the infertile couple by hysterosalpingography and laparoscopy is currently a highly debated issue. The purpose of this paper is to review whether transvaginal hydrolaparoscopy (THL), a new culdoscopic approach, in combination with minihysteroscopy and chromopertubation test can be offered as a complete one‐stop endoscopic exploration. The technique allows complete endoscopic exploration of the reproductive tract in an office or outpatient setting and has been validated during the past years for its accuracy, safety and patient tolerance. Although further prospective randomized studies are required to prove the superiority and cost‐benefit of transvaginal hydrolaparoscopy as diagnostic tool in comparison with hysterosalpingography (HSG) and laparoscopy, the technique can be proposed as a safe first‐line investigation predicting the fertility outcome in women.

Comparison of in vitro fertilization outcome in women with and without sonographic evidence of polycystic ovarian morphology

Objective: This study compared the outcome of in vitro fertilization (IVF) treatment in women who had polycystic ovaries (PCO) seen on an ultrasound scan, but who had no clinical symptomatology associated with polycystic ovary syndrome, with that of women who had normal ovarian morphology on ultrasound examination. Methods: Outcome of IVF 39 women with PCO evidence by ultrasound compared with 102 women, who had normal ovarian morphology by ultrasound. All 141 women had normal early follicular phase serum follicle stimulating hormone (FSH) concentration, were less than 40 years of age and used the long protocol pituitary suppression with gonadotropin-releasing hormone agonist therapy. Results: On average, the women with PCO produced more follicles and oocytes than the women with normal ovaries, but the fertilization cleavage and pregnancy rates were similar. Conclusion: Although the response to follicular stimulation in PCO women is better than that for women with normal ovaries, the outcome of pregnancy in vitro fertilization is similar.

Safety of conservative management and fertility outcome in women with borderline tumors of the ovary

Objective To assess the safety of fertility-sparing treatment and the remaining chance of childbearing after surgery. Design Retrospective clinical study. Setting Gynecology department of a university teaching hospital. Patient(s) Seventy-five women underwent surgical management in our institution between 1986 and 2001 for borderline tumors of the ovary. Intervention(s) Fifty-nine patients were treated by radical, fertility-compromising surgery. The remaining 16 patients underwent conservative surgery, preserving the uterus and at least some functional ovarian tissue. Seven unilateral adnexectomies, one simple cystectomy, and two adnexectomies associated with contralateral cystectomy were performed. Main outcome measure(s) Recurrence, survival, and pregnancy rates. Result(s) The observed recurrence rates after radical and conservative surgery were 0.0% and 18.7%, respectively. No disease-related deaths occurred in any group; there is no significant difference in survival rates. We can report 12 pregnancies in 7 of 11 women who underwent fertility-sparing management and who wished to become pregnant. Conclusion(s) In certain circumstances, conservative management offers a safe solution for borderline tumors of the ovary. Recurrence is noted significantly more often after this type of treatment, but all cases of recurrent disease can be detected with close follow-up and can be treated accordingly. No significant change in survival rates was found. Moreover, the pregnancy rate in women desiring pregnancy, those treated conservatively, was as high as 63.6%.

Comparison of follicle steroidogenesis from normal and polycystic ovaries in women undergoing IVF: relationship between steroid concentrations, follicle size, oocyte quality and fecundability.

Studies of ovarian stimulation for IVF have suggested a relationship between follicle size and pregnancy rates. Furthermore the follicular endocrine environment is correlated with oocyte quality. The aim of this study was first to verify the relationship between follicular steroid content, follicular size, oocyte maturity and fertilization outcome in women with normal ovaries following recombinant human FSH (rhFSH). Secondly this study was extended to women with polycystic ovarian syndrome (PCOS). Fifty-nine patients (31 normal, 28 PCOS) underwent conventional IVF with rhFSH induction. Follicular diameter was classified as small (8-13 mm) or large (>14 mm) and sex steroid content was analysed for each group. Oocyte maturity was studied according to nuclear maturation the day after fertilization. In both ovulation groups, 17 beta-oestradiol and progesterone concentration were significantly higher in large follicles with meiotically competent oocytes compared with those containing meiotically incompetent oocytes. Testosterone levels were increased in PCOS follicles compared with normal patients, with no difference between corresponding sub-groups of follicles with meiotically competent oocytes. The relationship between follicle size and embryo development showed that 14 mm could be a threshold value following rhFSH induction in normal or PCOS women.

Deprivation indicators as predictors of life events 1981-1992 based on the UK ONS Longitudinal Study.

STUDY OBJECTIVE: To investigate the association between the level of social deprivation in electoral wards and various life events. Life events include mortality, self reported long term illness, and for...

Comparison of operative and fertility outcome between groups of women with intrauterine adhesions after adhesiolysis

We evaluated intraoperative difficulty and fertility outcome in women with intrauterine synechiae of different severity after hysteroscopic adhesiolysis. The 86 women were recruited before fertility treatment, during hysterosalpingogram (HSG) or diagnostic hysteroscopy, over 3 years. Fifty-eight women had a history of pregnancy terminations or miscarriages, and 28 had undergone myomectomy or correction of congenital uterine anomalies by conventional surgical procedures. Group A (11 women) had over 50% of the fundal cavity obliterated by fibrous tissue, and no tubal ostia could be seen; group B (26 women) had less than 50% of the fundal cavity obliterated by fibrous tissue, and one tubal ostium could be seen; group C (49 women) had a single adhesion thicker than 1 cm. Postoperative hemorrhage requiring treatment occurred in three women from group A and two from group B. All had subsequent HSGs, and three from group A (with previous myomectomies) required a second operation and still failed to achieve an adequate fundal cavity. All patients subsequently received in vitro fertilization. Three women from group A became pregnant. Ten in group B became pregnant, eight of whom delivered or have a continuing pregnancy. In group C, 17 became pregnant, of whom 13 delivered or have a continuing pregnancy. Adhesions after suturing the uterine cavity after open myomectomy or corrective surgery seem to cause maximum damage and yield poor results in both hysteroscopic correction and reproductive performance.

In-vitro fertilization outcome in women with hydrosalpinx

Recent studies have suggested that the presence of hydrosalpinx has a negative effect on in-vitro fertilization (IVF) outcome, with markedly diminished implantation and pregnancy rates, and increased early pregnancy loss. We evaluated the impact of hydrosalpinx on IVF outcome in a large population with tubal factor infertility: 63 patients with hydrosalpinx and 60 without hydrosalpinx (no hydrosalpinx) underwent 103 and 89 IVF cycles respectively. Hydrosalpinx was diagnosed by hysterosalpingography and/or laparoscopy prior to IVF. Patients were further subdivided into those with or without elevated quantitative serum Chlamydia trachomatis IgG antibody (Ab) titres. All couples with elevated serum Ab titres (l: 16 or more) were treated with doxycycline (100 mg bid.) 10 days prior to the first IVF cycle. In all, 88 women (71.5%) had elevated C. trachomatis Ab: 47 women (74.6%) with hydrosalpinx had elevated titres, compared to 41 (68.3%) in the no hydrosalpinx group. There were no significant differences in mean age, number of mature oocytes obtained, and number of embryos transferred between the two groups. There was a trend for a higher implantation rate and ongoing pregnancy rate in the no hydrosalpinx group compared to the hydrosalpinx group (12.6 versus 9.8%, and 33.7 versus 24.8% respectively); however, this did not reach statistical significance. The incidence of early pregnancy loss was similar in the two groups. Two ectopic pregnancies were noted in the hydrosalpinx group compared to none in the no hydrosalpinx group. As expected, the prevalence of elevated titres of C. trachomatis IgG Ab in patients with tubal factor infertility presenting for assisted reproductive treatment was high. In contrast to recently published reports, our study did not confirm a negative effect of hydrosalpinx on IVF outcome when antibiotic treatment was given prior to assisted reproductive treatment. Prospective multicentre studies evaluating the effect of hydrosalpinx and its treatment on IVF outcome are needed.