Fertilization Outcome In Patients Research Articles

Pregnancy During Recovery from Hematopoietic Stem Cell Transplant for Mycosis Fungoides.

We report a case of spontaneous pregnancy with subsequent full-term live birth following hematopoietic stem cell transplantation (HSCT) for mycosis fungoides in a 24-year-old nulligravida with 4 years of prior infertility due to primary ovarian insufficiency. Four months post-transplant, the patient was found to be 10 weeks pregnant. Her pregnancy was complicated by first trimester fetal exposure to mycophenolate mofetil (pregnancy category D), delayed-onset acute gastrointestinal graft-versus-host disease, and multiple systemic infections. This report highlights the importance of discussing potential fertility outcomes in patients undergoing HSCT, including the necessity for adequate contraception post-transplant, even in the setting of previous infertility.

Comparison of Endocrine Profile andIn VitroFertilization Outcome in Patients with PCOS, Ovulatory PCO, or Normal Ovaries

Aim. To compare the basic endocrine profile and outcomes of in vitro fertilization (IVF) in women with polycystic ovary syndrome (PCOS), ovulatory polycystic ovaries (PCO), or normal ovaries (NO). Methods. The basic clinical features and in vitro fertilization and embryo transfer outcome in patients receiving IVF or intracytoplasmic sperm injection (ICSI) were retrospectively analyzed. Results. The body mass index, basal luteinizing hormone, and testosterone levels were significantly lower in patients with ovulatory PCO compared to those in patients with PCOS. The PCOS patients exhibited the shortest duration of ovarian stimulation and lowest dose of gonadotropin, followed by the ovulatory PCO and NO patients. The ovulatory PCO and PCOS patients showed similar levels of E2 on the human chorionic gonadotropin treatment day and numbers of oocytes, which were both significantly higher than those of the NO patients. The fertilization rate of the PCOS patients was significantly lower than the other two groups. Compared to NO patients, the cleavage rate was lower in both PCOS and ovulatory PCO patients, however, the number of available embryos was significantly more in these two groups. The incidence of the moderate to severe ovarian hyperstimulation syndrome (OHSS) was markedly higher in the PCOS and ovulatory PCO patients. Conclusion. Ovulatory PCO patients do not express similar endocrine abnormalities as PCOS patients. Although the fertilization rate and cleavage rate were relatively low in PCOS patients, ultimately, all the three groups showed similar transferred embryo numbers, clinical pregnancy rates, and implantation rates. Since the incidence of OHSS was much higher in the PCOS and ovulatory PCO patients, we should take more care of these patients and try to prevent severe OHSS.

Long term fertility outcomes after laparoscopic surgery for endometriosis-associated pelvic pain in late adolescents

To determine long-term fertility outcomes in patients treated with laparoscopic surgery between the ages of 18 and 25 years at the Cleveland Clinic Foundation for endometriosis-associated pelvic pain. Retrospective observational case series Young women that underwent laparoscopic surgery for endometriosis-associated pelvic pain at the Cleveland Clinic Foundation between the years 2000 and 2005 were identified by electronic medical records. Exclusion criteria included documented infertility or not actively trying to conceive. Patients completed a phone questionnaire to assess measures for both spontaneous and assisted pregnancies, including whether the patient was currently pregnant, had a term or preterm pregnancy, miscarriage, ectopic pregnancy, or elective termination. Pregnancy rates were compared against an appropriate population utilizing a Chi-square test(P≤0.05). Eighty two patients met our inclusion criteria and 24 completed the phone questionnaire to assess fertility outcomes. These patients had a mean BMI and age at primary surgery of 25.3 and 22.8, respectively. Of the 24 patients that fit inclusion criteria, 21 had at least one pregnancy within the follow-up period (88%) and 19 of these patients had a spontaneous pregnancy(79%). It was determined that the probability of a spontaneous ongoing pregnancy within 1 year leading to live birth in this population was 47.3%(P=0.0013). This study showed that late adolescents who underwent laparoscopic surgery for endometriosis-related pelvic pain had increased pregnancy rates in comparison to a predicted model. Since the fertility of these patients is usually unknown at the time of initial surgery, this study indicates that surgery can be performed in these patients without a negative effect on future fertility outcomes.

Unilateral salpingo-oophorectomy as fertility-sparing surgery for borderline ovarian tumors

Background To investigate recurrence rates and fertility outcomes of patients with borderline ovarian tumors (BOTs) treated with fertility-sparing surgery. Methods This was a retrospective study. All women with BOTs from 2000 to 2006 were evaluated. Clinical outcomes were compared among groups that underwent radical, unilateral salpingo-oophorectomy, or ovarian cystectomy. The effects of clinical characteristics on recurrence were analyzed by independent t test, chi-square test, and Cox proportional hazard model. Results After a mean follow-up period of 56.5 months, all 61 patients were alive. Seven (11.5%) had developed disease recurrence, and all were in the fertility-sparing group. Of these, five were in the cystectomy-only group and two in the unilateral salpingo-oophorectomy group. There was significant difference in tumor recurrence rates between the two groups (hazard ratio: 0.26, 95% confidence interval: 0.11–0.61). Nine pregnancies were achieved in six women, resulting in five deliveries Conclusion Fertility-sparing surgery is an acceptable and safe option for women with BOTs who wish to preserve fertility. Unilateral salpingo-oophorectomy must be considered as the first choice.

In vitro fertilization outcomes in patients experiencing a premature rise in luteinizing hormone during a gonadotropin-releasing hormone antagonist cycle

Patients undergoing controlled ovarian hyperstimulation and pituitary suppression with a GnRH antagonist who experienced a transient premature rise in LH were compared with those who did not have an early surge. Those experiencing a premature LH surge had equivalent clinical and ongoing pregnancy rates per ET.

Comparing serum basal and follicular fluid levels of anti-Müllerian hormone as a predictor of in vitro fertilization outcomes in patients with and without polycystic ovary syndrome

BACKGROUND AND OBJECTIVES:The prediction of in vitro fertilization (IVF) outcomes by anti-Müllerian hormone (AMH) measurement is getting increasing attention from clinicians. This study compares the relationship between serum or intrafollicular AMH levels and IVF outcomes in women with and without polycystic ovary syndrome (PCOS).METHODS:This prospective study was carried out in two university-based fertility clinics. Serum samples were collected on cycle day 3 and follicular fluid (FF) was collected on the day of oocyte retrieval from 26 women with PCOS and 42 normo-ovulatory controls. AMH levels were measured in the samples using immunoenzymatic assay. The relationship between serum or FF AMH levels and IVF outcomes, including number of oocytes retrieved, oocyte maturation rate, fertilization rate, implantation rate, high quality grade embryo rate, and biochemical and clinical pregnancy rates were further assessed.RESULTS:Median serum basal AMH and FF AMH levels were significantly higher in the PCOS group as compared to controls, the values being 14.2 ng/mL vs. 3.2 ng/mL (P<.001) and 8.2 ng/g protein vs. 4.7 ng/g protein (P<.01), respectively. In both groups, serum basal AMH levels showed a positive correlation with number of oocytes retrieved (r=0.323; P=.037 in control vs. r=0.529; P=.005 in PCOS). In the control group, there was a positive relationship between serum basal AMH levels and percentage of matured oocytes (r = 0.331; P=.032) and implantation rate (r=0.305; P=.05).CONCLUSION:Serum basal, and not intrafollicular, AMH levels may be a good predictive factor for quantitative and qualitative IVF outcomes in normo-ovulatory, but not in PCOS patients.

Effects of pioglitazone on ovarian stromal blood flow, ovarian stimulation, and in vitro fertilization outcome in patients with polycystic ovary syndrome

To investigate the effects of pioglitazone on ovarian stimulation, in vitro fertilization (IVF) outcome, and intraovarian stromal blood flow in patients with polycystic ovary syndrome (PCOS). Prospective, randomized, controlled trial. University-affiliated infertility clinic. Sixty infertile patients with PCOS resistant to clomiphene citrate. An IVF protocol involving use of a gonadotropin-releasing hormone (GnRH) antagonist and oral contraceptive pretreatment. Patients were randomized into two groups: pioglitazone (30 mg daily) in the study group or placebo in the control group, commenced on the day on which oral contraceptive intake began. Ovarian stimulation, IVF outcome, and resistance index of the intraovarian stromal artery. The resistance index value on the day of human chorionic gonadotropin (hCG) injection in the study group was statistically significantly higher in the study group than in controls. The serum estradiol level and number of retrieved oocytes were statistically significantly lower in women treated with pioglitazone. However, the number of mature oocytes and fertilized oocytes, and the clinical pregnancy rate were similar in both groups. Pioglitazone therapy reduced intraovarian stromal blood flow and might be beneficial in improving both the response to ovarian stimulation and IVF outcome in PCOS patients.

Fertility preservation in patients with early cervical cancer: Radical trachelectomy

Objectives The goal of this review is to summarize the latest literature on the subject of radical trachelectomy and fertility outcomes in patients with early-stage cervical cancer. Methods We analyzed the published literature in search of all articles addressing surgical techniques, intraoperative and perioperative outcomes, and obstetrical results in patient undergoing radical trachelectomy for cervical cancer. Results It is estimated that 43% of all cases of cervical cancer in the United States are diagnosed in women younger than 45 years of age. As of 2007, a total of 520 patients had been reported to have undergone a radical vaginal trachelectomy. The majority of patients (60%) had a diagnosis of squamous cell carcinoma; adenocarcinoma was the second most common histologic subtype (40%). Data on outcomes after radical abdominal trachelectomy are less extensive—only approximately 50 cases have been reported worldwide. Approximately 43% of patients who undergo a radical trachelectomy subsequently attempt to become pregnant. Seventy percent of these women are successful at achieving a pregnancy. Conclusions Radical trachelectomy is safe and feasible and pregnancy outcomes are very favorable. All patients interested in future fertility who are diagnosed with cervical cancer are encouraged to discuss radical trachelectomy with their physician.

Proximal tubal occlusion and salpingectomy result in similar improvement in in vitro fertilization outcome in patients with hydrosalpinx

Proximal tubal occlusion and salpingectomy result in similar improvement in in vitro fertilization outcome in patients with hydrosalpinx

Cut-off Value of Reactive Oxygen Species for Predicting Semen Quality and Fertilization Outcome

Though the role of reactive oxygen species (ROS) in male infertility is widely investigated worldwide, there is a lack of adequate information on the cut-off value of ROS beyond which ART outcome may be adversely affected. The objective of the present study is to establish an upper level of ROS in semen samples which can be considered as a potential marker of good semen quality. Semen ejaculates were randomly collected from 338 male partners of infertile couples. The upper critical limit (UCL) of ROS was calculated from the control chart of normozoospermic patients and found to be 0.75×106 counted photons per minute (cpm)/10 million cells. This was further validated by estimating ROS in 17 proven fertile men and 38 patients undergoing intra cytoplasmic sperm injection (ICSI). As expected, all abnormal semen samples exhibited higher ROS as compared to nomozoospermic and proven fertile samples. All semen samples from proven fertile volunteers were found to be <0.075×106 cpm/10 million cells. On the basis of the calculated UCL, ICSI patients were divided into two groups: Group I (<UCL) and Group II (>UCL). The semen parameters, fertilization rate and pregnancy outcome were found to be significantly affected in Group II. Significant difference in live birth-rates was observed between Group I (47.6%) and Group II (17.6%) while no live-birth was recorded for ROS level >0.1×106 cpm/10 million cells. It is concluded that the upper cut-off value of normal semen samples that correlates with good semen quality is, therefore, in the order of 0.075–0.1×106 cpm/10 million cells. In addition to the WHO [] semen analysis, this range is expected to assist andrologists and clinicians in predicting semen quality and fertilization outcome in patients with male factor infertility undergoing ICSI.

Clinical outcome of cystectomy compared with unilateral salpingo-oophorectomy as fertility-sparing treatment of borderline ovarian tumors

To compare recurrence rates and fertility outcomes of patients with borderline ovarian tumors (BOTs) who underwent unilateral salpingo-oophorectomy with those of patients who underwent cystectomy only. Retrospective study. Gynecologic oncology department of a tertiary center. Sixty-two patients with BOTs who underwent fertility-preserving surgery. Unilateral salpingo-oophorectomy (USO, n = 40) or cystectomy only (n = 22). Tumor recurrence rate, incidence of pregnancy. All 62 patients were alive with no clinical evidence of disease after a mean follow-up of 88 months. There was no statistically significant difference in mean tumor recurrence rates between patients who had undergone cystectomy only and those who had undergone USO (22.7% and 27.5%, respectively). In the cystectomy-treated group, the disease-free interval was shortened (23.6 compared with 41 mo), but the difference was not significant. However, the mean follow-up period for the cystectomy group was significantly shorter than for the USO group. Of the 62 patients, 25 (40.3%) attained 38 pregnancies, resulting in 35 deliveries. Our results support previous findings that conservative surgery is an acceptable option for women with BOTs who wish to preserve fertility. Cystectomy, like oophorectomy, appears to be an adequate treatment, provided that the patient is willing to undergo careful and prolonged follow-up.

Proximal tubal occlusion and salpingectomy result in similar improvement in in vitro fertilization outcome in patients with hydrosalpinx

To evaluate and compare the clinical impact of proximal tubal occlusion and salpingectomy when performed before IVF in patients with hydrosalpinges. Prospective randomized study. Assisted reproduction unit in an obstetrics and gynecology department in a university hospital in Greece as well as assisted reproduction unit in an urban clinic in a major city in Greece. One hundred fifteen patients with unilateral or bilateral hydrosalpinges who were candidates for IVF treatment. Laparoscopic proximal tubal occlusion, laparoscopic salpingectomy, controlled ovarian hyperstimulation, IVF, and embryo transfer. Implantation rate, clinical-pregnancy rate, ongoing-pregnancy rate, abortion rate, and ectopic-pregnancy rate. Patients who underwent proximal tubal occlusion before IVF demonstrated significantly increased implantation, clinical-pregnancy, and ongoing-pregnancy rates compared with those with no surgical intervention and demonstrated implantation, clinical-pregnancy, and ongoing-pregnancy rates comparable to those who underwent salpingectomy. Proximal tubal occlusion, when performed in women with unilateral or bilateral hydrosalpinges before their IVF treatment, represents a potentially beneficial surgical procedure, increasing significantly the chances for successful implantation and for clinical and ongoing pregnancy. Proximal tubal occlusion may be viewed as a valid alternative when salpingectomy is technically difficult or not feasible.

Ovarian response and in vitro fertilization outcome in patients with reduced ovarian reserve who were stimulated with recombinant follicle-stimulating hormone or human menopausal gonadotropin

Failure of the ovaries to respond to gonadotropin stimulation is a negative prognostic factor that may indicate reduced ovarian reserve. Simultaneous evaluation of basal FSH and E2 response to GnRH analogue (GnRH-a) stimulation (F-G test) can be used to identify patients at risk of poor response and allows effective drug regimen selection for IVF (1, 2). In patients with reduced ovarian reserve, only one study has compared rFSH with high-purified FSH in a GnRH-a short protocol (3). The aim of this study was to compare ovarian response and IVF outcome in patients with reduced ovarian reserve receiving hMG or rFSH after cessation of GnRH-a.

In vitro fertilization following laparoscopic ovarian diathermy in patients with polycystic ovarian syndrome.

To evaluate the in vitro fertilization outcome in patients with polycystic ovarian syndrome previously treated by laparoscopic ovarian diathermy. We designed a prospective study to compare in vitro fertilization stimulation parameters and pregnancy rate for two groups of women with polycystic ovarian syndrome. In the first group, we included 23 patients previously treated by laparoscopic ovarian electrodiathermy (group A), in the second group we included 36 women who did not undergo surgical treatment (group B). All patients underwent the same ovarian hyperstimulation protocol and a standard in vitro fertilization and embryo transfer technique. In a limited number of women (five in group A and eight in group B) we measured the levels of sex steroids in follicular fluid. Statistical analysis was performed by means of chi-square test or Fisher's exact test to compare frequencies and by means of the Student's t-test or ANOVA test to compare means. Significance was set at p < 0.05. In group A we found a significantly higher ongoing pregnancy rate (28.6% in group A vs 7.3% in group B), a significantly lower estradiol peak level (1722.73 +/- 522.24 in group A vs 2314.48 +/- 692.60 in group B), a trend for lower abortion rates and an improvement in the number of patients administered human chorionic gonadotropin than in group B. The levels of estradiol, testosterone and androstenedione in follicular fluid were significantly lower from small to intermediate and to large follicles in group A, while in group B only estradiol and androstenedione were different. Lower levels of androstenedione and testosterone were found in each follicular pool of group A, compared to the respective pool in group B. We report a significantly better ongoing pregnancy rate after in vitro fertilization and embryo transfer procedures in women pretreated by means of laparoscopic ovarian electrocautery. These results may be related to lower androgen levels in the follicular fluid.

Salpingectomy improves in-vitro fertilization outcome in patients with a hydrosalpinx: blind victimization of the fallopian tube?

Introduction A recent series of studies has shown that the outcome of in-vitro fertilization (TVF) is poor in patients with hydrosalpinges (Sims et al, 1993; Andersen et al, 1994; Kassabji et al, 1994; Vandromme et al, 1995; Katz et al, 1996) and that this outcome can be improved by performing salpingectomy (Poe-Zeigler et al, 1995; Shelton et al, 1996) of the diseased tube(s), especially since it became clear that bilateral salpingectomy does not compromise ovarian stimulation in an IVF/embryo transfer programme (Oehninger et al, 1989; Verhulst et al., 1994). The majority of publications originate from the same group at the Jones Institute for Reproductive Medicine of the Eastern Virginia Medical School, Norfolk, Virginia, USA. In view of these data some authors suggest that new and repeat IVF patients should be counselled regarding the detrimental effect of a hydrosalpinx on medically-assisted procreation and the potential benefit of excision. There are, however, pathological, clinical and reproductive data to dispute this view.

Subzonal insemination: a prospective randomized study in patients with abnormal sperm morphology

To evaluate in a prospective randomized study the outcome of subzonal insemination (SUZI) in patients with male subfertility. In a period of 7 months, 48 patients underwent IVF treatment for male subfertility reasons. Normal insemination and SUZI were performed on sibling oocytes. Patients were divided into three groups depending on the sperm morphology (strict criteria): group 1, 10% to 14%; group 2, 5% to 10%; group 3, 0% to 5%. Private fertility center in Leuven, Belgium. The fertilization rates, cleavage rates, implantation rates, and pregnancy rates between the normally inseminated and the SUZI-treated group were compared. The fertilization rate with SUZI was significantly higher (32%) than after normal insemination (7%). The difference was striking in groups 2 and 3 (35% and 33% versus 11% and 4%). This study indicates that SUZI increases the fertility outcome in patients with male subfertility and that there is a marked difference in fertilization rate when morphology, using strict criteria, is < 10%.

Evaluation of pattern of tubo-peritoneal abnormalities potentially responsible for infertility in Zaria, Nigeria: hysterosalpingographic assessment

Background: Structural abnormalities on hysterosalpingography (HSG) are among the important factors in the evaluation of female infertility. Aim and Objective: This study is mainly concerned with the pattern of tubal and peritoneal abnormalities and their effects on fertility outcome. Materials and Methods: A prospective study of 220 consecutive patients who underwent HSG between December, 2011 and May, 2013, at Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria. Clinical notes and radiological findings were analyzed for demographic data, tubal and peritoneal pathologies. Fertility outcome in patients with abnormal findings was compared with those with normal findings. Results: A total of 121 (55.0%) patients had normal tubes on HSG. Tube abnormalities were found in 99 (45.0%) patients; 37 (37%) patients with primary and 62 (63%) patients with secondary infertility. Totally, 203 (92.3%) patients had normal peritonea contrast medium spillage on HSG. Peritoneal cavity abnormality (pelvic adhesion) affected 17 (7.7%) patients; 8 (47%) patients with primary and 9 (53%) patients with secondary infertility. The fertility outcome showed that after 1-year of follow-up, 3 (2.6%) of the 116 patients with abnormal findings (tubal and peritoneal abnormalities) got pregnant, while 25 (34.7%) of the 72 patients with normal findings (tubal, peritoneum, cervical canal and endometrial cavity) got pregnant. The difference noted was statistically significant (P = 0.0000). Conclusion: Fertility outcome in patients with tubo-peritoneal abnormalities at HSG was low.