Previous Menstrual Cycle Research Articles

The Largest Tubal Pregnancy: 14th Week

Subsequent development and implantation of embryo outside the uterine lining are defined as an ectopic pregnancy. Ectopic pregnancies have a wide range of presentations, for example, acute hemoperitoneum to chronic ectopic pregnancy. The case presented is an unusual case of ectopic pregnancy with large hematosalpinx with classic symptoms. To the best of the authors' knowledge, this case is the largest intact tubal ectopic pregnancy reported ever in the 14th week of gestation. A 40-year-old patient presented to the emergency department with lower abdominal pain, mild dysuria, and loose motion. The patient's previous menstrual cycles were regular till four months ago, then started to be irregular, and she had no history of chronic diseases except repeated pelvic inflammatory diseases (PID). Clinically, the patient was hemodynamically stable. On palpation, the abdomen was tender, and cervical movements were not tender. BHCG in the blood came very high. The bedside point-of-care ultrasound (POCUS) showed free fluid in the abdomen and a sac in the left adnexa with a living fetus (visible heartbeats). The conventional ultrasound showed 14 weeks of an extrauterine gestational sac with visible early pregnancy. Differential diagnosis was either an abdominal pregnancy versus a complicated tubal pregnancy. The surgical pathology report confirmed the diagnosis of ectopic tubal pregnancy as the tube was dilated in the middle portion containing chorionic villi, decidual reaction, and the whole gestational sac consistent with the ectopic tubal pregnancy. The patient had a successful laparotomy with salpingectomy and hemostasis and did well after the operation. So, an intact ectopic tubal pregnancy may last until the 14th week of gestation.

The effect of performing hysteroscopy prior to the first in vitro fertilization (IVF) cycle on live birth rate

In this retrospective cohort study, a total of 707 couples underwent in vitro fertilization (IVF) at Hacettepe University Hospital between 01 January 2010 and 01 November 2014 with their chronologically first cycle were evaluated. Patients who have diagnostic hysteroscopy prior to first IVF cycle served as a study group (n = 42) and patients without diagnostic hysteroscopy served as control group (n = 282). In study group in all patients, diagnostic hysteroscopy was performed at the follicular phase of previous menstrual cycle, namely immediately before ovarian stimulation (OS) cycle. Demographic features, clinical characteristics and treatment outcomes were compared between the groups. The logistic regression analysis was performed in order to assess independent predictors of live birth rates (LBRs). There was no statistically significant difference between the groups for demographic features and OS cycle characteristics. Implantation rate (22.2% vs. 21.5%, p=.840), clinical pregnancy rate (33.3% vs. 28.7%, p=.541), and LBRs (23.8% vs. 18.5%, p=.420) were comparable. In logistic regression analysis, performing hysteroscopy prior to first IVF cycles per se without correcting anatomic abnormalities was not an independent predictor of LBRs (OR: 0.72, 95% CI: 0.310–1.68, p=.45). In conclusion, performing diagnostic hysteroscopy prior to first IVF treatment cycle without correcting any anatomic abnormalities did not improve LBRs.

Effect of Etanercept on the Success of Assisted Reproductive Technology in Patients with Endometrioma

Aims: To determine the effects of a tumor necrosis factor inhibitor (etanercept) on pregnancy outcomes in patients with endometrioma who were treated with assisted reproductive technology. Methods: Sixty-eight infertile patients who had endometrioma were included in our retrospective case-control study. We administered etanercept (Enbrel, 50 mg in 1 mL intramuscularly) to 19 patients on the second day of their previous menstrual cycle. All patients were treated with assisted reproductive technology. Pregnancy and live birth rates (LBR) were documented. Results: When all other parameters (age, body mass index, infertility) are supposed to be constant, the clinical pregnancy rate was significantly higher in patients who used etanercept in an antagonist protocol than in patients who did not use etanercept (χ² = 5.547; p = 0.019) but LBR did not reach a statistical significance (χ² = 3.179; p = 0.075). The use of etanercept had an OR of 4.17 (95% CI 1.23–14.14) compared with not using etanercept for clinical pregnancy rate. The use of etanercept increased the rate of pregnancy (χ² = 6.55; p = 0.01). The pregnancy rate with the use of etanercept had an OR of 4.23 (95% CI 1.35–13.25) compared with patients who did not use etanercept. In the same way, the use of etanercept increased LBR twofold, but it is not significant in the border line (χ² = 3.771; p = 0.052). Conclusions: Etanercept may be a new non-hormonal therapy that may be an adjunct to treatment of infertile women with endometrioma. However, the safety of etanercept on embryos and fetuses has not been fully clarified.

Primary Ovarian Ectopic Pregnancy: A Case Report

Introduction: Ectopic pregnancy is a serious health problem that leads to maternal mortality and morbidity. The current article was based on the record of a female patient with primary ovarian ectopic pregnancy. Case Presentation: The patient was a 28-year-old female with regular previous menstrual cycle and without using any contraception method. She presented with right lower abdominal pain and amenorrhea. Transvaginal sonography findings revealed a gestational sac in the right ovary. Finally, primary ovarian ectopic pregnancy was diagnosed by laparotomy and confirmed by histopathology. Conclusions: To prevent misdiagnosis, an awareness of this issue should be developed by gynecologists, surgeons, and radiologists. Keywords: Ovary, Ectopic Pregnancy

Ovarian struma - report of a rare case.

A 34-year-old primipara with no live child came to the gynecology department with complaints of increased and prolonged menstrual bleeding and lower abdominal pain for three months. Her previous menstrual cycles were normal. She was married for 15 y. She was para one. It was an intrauterine death at eight months of pregnancy delivered vaginally 14 y ago. Her medical and surgical history was not significant. No history of malignancy in family. On general examination, her vitals were stable. There was no evidence of hyperthyroidism. Her systemic examination was normal. Examination of abdomen revealed no mass or ascites. Cervix was normal on speculum examination. On bimanual examination, a mobile, non-tender cystic mass measuring approximately 10x8 cm was palpable in the right and anterior fornix. Uterus was normal, left fornix felt free. Rectal examination confirmed above findings. Ultrasonogram of abdomen and pelvis showed a right adnexal cyst measuring 7x8x6.2 cm with muItiple septations. CA-125 levels were within normal limits (7.5 U/ml). Thyroid function tests were within normal limits. Exploratory laparotomy was done. Peroperatively, a multicystic mass of size 8x7x8 cm consisting of right tube and ovary was seen in the right adnexa. Uterus and left adnexa were normal. There was no ascites and no omental adhesions. As she was anxious to conceive, only right salphingo-ophorectomy was done. Dye test showed patent left fallopian tube. Postoperative period was uneventful. On gross examination, ovarian cyst measured 8x5x3 cm. External surface was bosselated and cut section revealed a multiloculated cyst with one solid area measuring 3x2x1 cm. Attached fimbrial end of the right fallopian tube measured 3 cm in length [Table/Fig-1]. [Table/Fig-1]: Gross appearance Microscopic examination showed ovarian parenchyma with cystic follicles [Table/Fig-2] and a cyst lined by a single layer of cuboidal to columnar epithelium [Table/Fig-3]. The wall of the cyst showed multiple colloid-filled thyroid follicles of varying sizes lined by a single layer of cuboidal epithelium. Sections from the right fallopian tube showed normal morphology. [Table/Fig-4,​,5].5]. A diagnosis of Benign struma ovarii - cystic variant was then made. [Table/Fig-2]: Ovarian cyst wall showing ovarian parenchyma (H and E x40) [Table/Fig-3]: Areas showing cyst wall lined by a single layer of cuboidal to columnar epithelium. (H and E x100) [Table/Fig-4]: The wall of the cyst shows multiple colloid-filled thyroid follicles of varying sizes (H and E x100) [Table/Fig-5]: Thyroid follicles lined by a single layer of cuboidal epithelium enclosing colloid (H and E x400) Struma ovarii is an uncommon gynecological tumour accounting for 1% of all ovarian tumours and 3 to 5% of all dermoid tumours of ovary [1–3]. The diagnosis rests on histopathological examination of the tissue which shows thyroid follicles filled with eosinophilic colloid. Rarely, degenerative changes such as calcification, fibrosis or hemosiderophages may be seen [4]. Surgical management is the treatment of choice for struma ovarii. For women desiring fertility, simple ovarian cystectomy or salphingo-oopherectomy seems to be optimal [4,5]. In this case, since she was young with no live child and clinically appeared benign, only right salphingo-oopherectomy was done. For benign disease, standard surgical follow up is sufficient and the prognosis is excellent [6].

English

Post coital vaginal tear or rupture is a well known entity to the gynecologist .Coitus- induced vaginal tear in a parous woman with no prior pelvic surgery or other risk factors is a rare clinical presentation. Here we present a case of Post coital vaginal tear which presented as a life threatening emergency. INTRODUCTION: Non obstetric vaginal lacerations differ greatly from lacerations sustained during childbirth and are generally classified into two types. The first type is relatively minor and is associated with normal sexual intercourse. These lacerations usually resolve with minimal treatment. The second type of laceration is deeper and more extensive, often resulting in significant vaginal bleeding. This condition can be life threatening and requires immediate intervention CASE PRESENTATION (Informed consent of the patient and ethical committee has been informed): Mrs. XX, 30 years old lady, P2L2, presented with the complaints of excessive bleeding per vagina since 4 hours to emergency OBG ward at night. She gives h/o passage of clots and had changed about 3 to 4 clothes which was fully soaked .Her previous menstrual cycles were regular 3- 4 days/30 days LMP: day 1. She had both FTND at government hospital, P1-male 9 years, p2-female 6 years. She had undergone laparoscopic sterilization 6 year back. On General physical examination - she was moderately built and nourished and severely anaemic. Her Pulse rate was 120 bpm, feeble, low volume, and BP- systolic was 80 mm Hg, Her tongue was dry , extremities were cold, and tachypnea -20/min was present. Per Abdomen Examination was soft and non tender, and there was no organomegaly. Per Speculum examination revealed an Annular tear about 4 cm present at the cervico- vaginal junction posterolaterally on the right side. On Bimanual examination Uterus was anteverted, normal in size, firm, mobile, fornices free and non tender.

English

INTRODUCTION: Steroid cell tumor of the ovary a very rare androgen secreting tumor accounts for less than 0.1% of ovarian tumors. These tumors may present at any age ranging from 2 to 80 yrs & associated with hormonal activity & virilisation. These tumors are most commonly unilateral, may be both benign or malignant, most of these tumors are usually diagnosed in early stages because of virilisation caused by these tumors. In an extensive literature search (medline & pubmed) from 1979, only around 80 cases of ovarian steroid cell tumors have been reported. As ovarian stromal tumors are infrequent, little attention was given to their response to radiotherapy and chemotherapy. A recent report stated gonadotropin releasing hormone agonist was effective in treating steroid cell tumors. Here we present the case of a rare ovarian steroid cell tumor in a 32 yrs old woman who presented with virilisation. CASE REPORT: A 32 yrs old woman with P2L1D1A1 presented with history of amenorrhea of 7 months duration, hoarseness of voice since 6 yrs, decrease in breast size since 6 yrs, lower abdominal pain which is dull aching type, coarse hair growth over the body since 2 yrs. She attained menarche at the age of 12 yrs. Her previous menstrual cycles were normal. Physical examination revealed male pattern of coarse hair distribution in the beard region, face, chest wall, abdomen, arms and thighs. Both breasts were small in size, no mass palpable per abdominally.

WITHDRAWN: Focal atypical polypoid adenomyoma with hematometra in a young unmarried girl

Young unmarried girl presenting with hematometra with previous normal regular menstrual cycles is not common in any gynecological clinic. On evaluation a rare finding of Focal atypical polypoid adenomyoma was diagnosed. Even rarer presentation in young girls was found. We present hereby a case, which in our knowledge, is the youngest diagnosed case of Focal atypical polypoid adenomyoma.

Reduction in dysmenorrhea severity in women using a 91-day extended regimen oral contraceptive compared to a 28-day regimen oral contraceptive for the treatment of cyclic pelvic pain

Reduction in dysmenorrhea severity in women using a 91-day extended regimen oral contraceptive compared to a 28-day regimen oral contraceptive for the treatment of cyclic pelvic pain

Triptorelin every other day can prevent premature LH surge: a strategy to reduce the daily gonadotrophin-releasing hormone agonists injections

The aim of the study was to compare the use of 100 mcg triptorelin every other day with the usual daily dose of leuprolide in terms of premature LH surge prevention and in vitro fertilization (IVF) outcomes. It was a prospective randomized study. Between January 2010 and December 2010, we selected 90 women with age between 18 and 40 years-old, that would be submitted to IVF cycle. Women with an elevated serum FSH concentration on cycle day 3 (FSH>10 IU/l) were excluded. A computer-based randomization was used to allocate the patients in two groups. In group 1, the pituitary desensibilization was performed with daily subcutaneous administration of 0,5 mg leuprolide acetate beginning in day 21 of the previous menstrual cycle. This dose was continued until ovarian quiescence was demonstrated by vaginal ultrasound following menstruation, when the dose was changed to 0,25 mg / day. In group 2, they received every other day 0,1 mg triptorelin acetate also beginning in day 21 of the previous menstrual cycle and keeping during all ovarian stimulation. All of them received the same protocol for ovarian stimulation using hMG according to the age and ovary response. The groups were compared according to the age, number of oocytes, number of mature oocytes, number of embryos, clinical pregnancy rate and occurrence of premature LH surge. Rates were expressed as percentage. The other results as means. The comparison of means were performed using t student test. To compare rates, it was used chi-square test. The groups didn't present difference in terms of patients' age, number of oocytes, number of mature oocytes, number of embryos and clinical pregnancy rate. Premature LH surge didn't occur in any groups. The use of triptorelin in every other day prevents premature LH surge with the same outcomes of daily leuprolide use. The advantage is a fewer number of injections the patients have to receive.

Comparison of a 24-day and a 21-day pill regimen for the novel combined oral contraceptive, nomegestrol acetate and 17 -estradiol (NOMAC/E2): a double-blind, randomized study

BACKGROUND Nomegestrol acetate/17β-estradiol (NOMAC/E(2)) is a new monophasic oral contraceptive combining NOMAC (2.5 mg), a highly selective progesterone-derived progestogen, with E(2) (1.5 mg), which is structurally identical to endogenous estrogen. The objective of this study was to compare the effects on ovarian activity of two different NOMAC/E(2) regimens. METHODS This was a double-blind, randomized study. Healthy, premenopausal women (aged 18-38 years, previous menstrual cycle length 28 ± 7 days) were randomized by computer-generated code to once-daily NOMAC/E(2) for three consecutive 28-day cycles: either 24 days with a 4-day placebo interval (n = 40) or 21 days with a 7-day placebo interval (n = 37) per cycle. Follicular growth (primary outcome measure), plasma hormone profiles and bleeding patterns were assessed. RESULTS There was no evidence of ovulation during treatment with either NOMAC/E(2) regimen. The largest follicle diameter was significantly smaller in the 24-day group than in the 21-day group [mean (SD) mm in cycle 2: 9.0 (3.0) versus 11.3 (5.3) (P = 0.02); in cycle 3: 9.2 (3.0) versus 11.5 (6.0) (P = 0.04)]. Mean FSH plasma levels were significantly lower in the 24-day versus the 21-day group on Day 24 of cycles 1 and 2. Withdrawal bleeding duration was significantly shorter in the 24-day than in the 21-day group [mean (SD) days after cycle 1: 3.5 (1.3) versus 5.0 (2.6) (P = 0.002); after cycle 2: 3.9 (1.6) versus 4.8 (1.7) (P = 0.03)]. CONCLUSIONS The 24-day NOMAC/E(2) regimen was associated with greater inhibition of follicular growth and shorter duration of withdrawal bleeding than the 21-day regimen, suggesting the shorter pill-free interval results in a greater margin of contraceptive efficacy and tolerability, and fewer withdrawal symptoms.

Comparison of short 7-day and long gonadotropin -releasing hormone agonist protocols in the controlled ovarian stimulation for in vitro fertilization

OBJECTIVE: To compare the effects on controlled ovarian stimulation and pregrancy outcomes of a short 7-day gonadotropin-releasing hormone agonist (GnRHa) protocol(7-day protocol)and a GnRHa long protocol (long protocol) as part of controlled ovarian stimulation regimens during in vitro fertilization and embroy transfer (IVF-ET) treatment. DESIGN: Prospective randomized controlled study. MATERIALS AND METHODS: One hundred and forty six infertile patients with tubal factor who accepted IVF-ET treatment from July to November 2007 were included in this study. 7-day protocol group (n=68): GnRHa (decapeptyl, Ferring) was injected 0.1 mg daily from day 2 of the menstrual cycle to day 8. At the same time gonadotropin (Gn) was injected daily from day 3. Long protocol group(n=78): GnRHa (diphereline, Ferring)was injected 1.88 mg singly in the mid-luteal phase of previous menstrual cycle. Once the patient was down regulated, gonadotropin injection was started. On the day of human chorionic gonadotrophin (hCG) injection, serum luteinizing hormone (LH), estradiol (E2) and progesterone (P) were measured by electrochemiluminescence immunoassay. RESULTS: The level of serum progesterone on the day of hCG injection was lower in the 7-day protocol group comparing with the long protocol group (0.58±0.51ng/ml vs 0.83±0.54ng/ml, P< 0.05).There were no significant differences in the levels of serum LH, E2, E2 per oocyte and E2 per mature follicle on the day of hCG injection. Patients in the 7-day protocol group were stimulated for a shorter period (8.97±1.45 d vs 11.41±1.43 d, P< 0.05), injected fewer Gn ampoules (1851.65±616.96 IU vs 2726.44±769.28 IU, P< 0.05),comparing with patients in the long protocol group. When comparing the results in the numbers of oocytes retrieved (14.74±6.72 vs 16.47±8.90), fertilization rate (77.94% vs 77.74%), cleaved embryos rate (94.11% vs 96.10%), top-quality embryos rate (60.68% vs 58.85%), implantation rate (25% vs 33.12%), pregnancy rate (50.00% vs 52.56%) and clinical abortion rate (5.88% vs 14.34%), the 7-day protocol group was similar to those of the long protocol group (P >0.05). CONCLUSIONS: The short 7-day GnRHa protocol and GnRHa long protocol had equal effects on controlled ovarian stimulation and pregrancy outcomes for in vitro fertilization and embroy transfer treatment. Patients who received the short 7-day GnRHa protocol required fewer ampoules of gonadotropin and shorter periods of treatment than those who received the GnRHa long protocol.

Comparison of follicular fluid insulin-like growth factor II and insulin-like growth factor binding protein 4 levels between short 7-day and long gonadotropin-releasing hormone agonist protocols

OBJECTIVE: Insulin-like growth factor II (IGF-II) and Insulin-like growth factor binding protein 4 (IGFBP-4) play a major role in the autocrine and paracrine regulation of folliculogenesis. To explore the individual influence on the intrafollicular microenvironment between the short 7-day gonadotropin-releasing hormone agonist (GnRHa) protocol (7-day protocol) and GnRHa long protocol (long protocol) by comparing the concentrations of IGF-II, IGFBP-4, and the ratio of IGF-II/IGFBP-4 in follicular fluid. DESIGN: Prospective randomized controlled study. MATERIALS AND METHODS: 88 infertile patients with tubal factor who accepted IVF treatment from July to October 2007 were included in this study. 7-day protocol group (n=44): GnRHa (decapeptyl, Ferring) was injected 0.1 mg daily from day 2 of the menstrual cycle to day 8. At the same time gonadotropin (Gn) was injected daily from day 3. Long protocol group (n=44): GnRHa (diphereline, Ferring) was injected 1.88 mg singly in the mid-luteal phase of previous menstrual cycle. Once the patient was down regulated, gonadotropin injection was started. Follicular fluid was obtained from dominant follicles during oocyte retrieval. The levels of IGF-II and IGFBP-4 in follicular fluid were detected separately by radioimmunoassay and enzyme-linked immunosorbent assay. RESULTS: The durations of controlled ovarian stimulation was significantly shorter and total dose of Gn used were significantly lower in the 7-day protocol group. The levels of serum E2 and E2 per mature follicle on the day of hCG injection, the number of oocytes retrieved, fertilization rate, cleaved embryos rate, top-quality embryos rate, implantation rate, pregnancy rate, and clinical abortion rate were similar between the two groups. The concentrations of IGF-II (0.17±0.06ng/ml vs 0.20±0.07 ng/ml, P=0.020) and IGFBP-4 (2915.48±1443.02pg/ml vs 3646.64±1818.67pg/ml, P=0.040) in follicular fluid of the 7-day protocol group patients were significantly lower. There was no significant difference in the ratio of IGF-II/IGFBP-4 (0.07±0.04 vs 0.07±0.03, P=0.471) between the 7-day and long protocol group. Linear correlation analysis showed that the level of follicular fluid IGF-II was positively correlated to total dose of Gn used (r=0.316, P <0.05). CONCLUSIONS: The short 7-day and long GnRHa protocols may affect the concentrations of follicular fluid IGF-II and IGFBP-4. However, the changes of follicular fluid IGF-II and IGFBP-4 concentrations may not contribute to different clinical outcomes.

GnRH antagonist cetrorelix decreases the required dose of FSH and the length of ovarian stimulation in comparison to leuprolide in IVF cycles

OBJECTIVE: Since late 1990s, GnRH antagonists have been used to inhibit pituitary function and avoid premature luteinization and ovulation in IVF cycles. Differently from GnRH agonists, antagonists provide immediate inhibition of pituitary receptors. Our aim was to compare IVF cycles in which pituitary inhibition was achieved by either GnRH agonist (leuprolide) or antagonist (cetrorelix). DESIGN: Retrospective analysis at a private infertility center. MATERIALS AND METHODS: 257 IVF cycles performed in patients < 37 years old were retrospectively analyzed and compared considering the modality of pituitary inhibition: GnRH agonist (leuprolide; n=119) or antagonist (cetrorelix; n=138). Leuprolide was started in the luteal phase of the previous menstrual cycle, whereas cetrorelix was prescribed when at least one follicle ≥ 15mm was detected. Controlled ovarian hyperstimulation was performed with recombinant FSH for all patients. Oocyte maturation was induced with recombinant-hCG when there was at least one follicle ≥ 18mm and oocyte retrieval was performed 35 hours later. Outcomes were compared and p values <0.05 were considered significant. RESULTS: The length of ovarian stimulation was shorter and the total required amount of r-FSH was lower for antagonist cycles (table). The other outcomes showed no statistically significant difference.Table 1ResultsGnRH AGONISTGnRH ANTAGONISTpcycles with ET119138age (mean)32.7732.040.087∗days of stimulation (mean)11.0210.11<0.0001∗number of oocytes (mean)9.5111.430.05∗M2 (mean)7.078.540.039∗fertilization rate78.4%80.4%0.312∗∗transferred embryos (mean)2.462.300.060∗total r-FSH dose (mean)2,304.21,760.3<0.0001∗implantation rate18.4%19.9%0.681∗∗clinical pregnancy rate35.3%34.1%0.895∗∗clinical miscarriage rate19.0%19.1%1.0∗∗ongoing pregnancy rate28.6%27.5%0.889∗∗∗ Mann-Whitney test, ∗∗ Fisher's exact test. Open table in a new tab ∗ Mann-Whitney test, ∗∗ Fisher's exact test. CONCLUSIONS: Our findings are in concordance with previous reports that evaluated the use of GnRH antagonists in IVF cycles. There was no difference in the total number of oocytes retrieved, although the mean number of mature oocytes turned to be higher for patients treat with cetrorelix. Pregnancy and miscarriage rates were also equivalent between both groups. Finally, our results suggest that the use of the GnRH antagonist cetrorelix correlates to shorter ovarian stimulation and lower total requirement of exogenous FSH.

Comparisons of Different Dosages of Gonadotropin-Releasing Hormone (GnRH) Antagonist, Short-Acting form and Single, Half-Dose, Long-Acting form of GnRH Agonist during Controlled Ovarian Hyperstimulati

Objective: Both gonadotropin-releasing hormone (GnRH) analogs and antagonists have been used for pituitary desensitization during controlled ovarian hyperstimulation (COH). We aimed to determine the minimum effective daily dose of GnRH antagonist in women undergoing COH. We also compared the efficiency of a GnRH antagonist and a GnRH agonist. Materials and Methods: Women undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer were divided into five groups: (1) cetrorelix 0.25 mg (n=86); (2) cetrorelix 0.2 mg (n=28); (3) cetrorelix 0.15 mg (n=30); (4) leuprolide acetate (LA) 0.5 mg/day (n=58); (5) single half-dose LA depot 1.88mg (n=49). Cetrorelix was administered daily from menstrual day 8 until the day of human chorionic gonadotropin administration. LA or LA depot was started on day 21 of the previous menstrual cycle. Results: We observed lower gonadotropin (Gn) dosages, estradiol (E2) levels and reduced risk of ovarian hyperstimulation syndrome (OHSS) in the GnRH antagonist groups. A higher risk of luteinizing hormone (LH) surge was noted in cetrorelix 0.2 and 0.15mg groups. Gn dosages (IU)/E2 levels (pg/mL) in each group were: (1) 1,949.4/1,191.1; (2) 1,869.6/1,010.8; (3) 1,856.7/1,023.6; (4) 2,184.5/1,323.6; and (5) 2,103.5/1,313.5, respectively. LH/OHSS risks were: (1) 3.5%/5.8%; (2) 7.1%/3.6%; (3) 13.3%/3.3%; (4) 3.4%/8.6%; and (5) 2%/8.2%, respectively. Number of oocytes/embryos/grade Ⅰ, Ⅱ embryos were: (1) 9.4/7.9/5.8; (2) 7.5/4.2/3.6; (3) 6.3/4.1/3.1; (4) 12.3/8.9/6.6; and (5) 11.8/8.4/6.1, respectively. There was no significant difference in terms of clinical outcomes between groups 1, 4 and 5, except for higher abortion rates (AR) in group 1. Pregnancy rate (PR)/implantation rate (IR) ratios in groups 1, 4, and 5 were statistically higher than those in groups 2 and 3. Chemical PR/IR/AR were: (1) 30.2%/5.9%/7%; (2) 21.4%/5.1%/7.1%; (3) 16.7%/4.1%/10%; (4) 32.8%/5.5%/8.6%; and (5) 30.6%/5.7%/8.2%, respectively. Conclusion: The lowest effective dosage of cetrorelix for pituitary desensitization during COH luteolysis is 0.25 mg, resulting in a comparable PR but a higher AR when compared with GnRH agonist.

INFLUENCE OF OXIDATIVE STRESS ON OOCYTE QUALITY AND PROTECTIVE ROLE OF MELATONIN AS AN ANTIOXIDANT

Poor oocyte quality is a critical factor of female infertility. Reactive oxygen species are produced within the follicle especially during the ovulatory process. It has been reported that oxidative stress may be a cause of poor oocyte quality. Melatonin, a pineal hormone, is detected in the human follicular fluid. Recent reports have shown that melatonin works as a potent radical scavenger. This study was undertaken to examine a relationship between oxidative stress and poor oocyte quality and whether melatonin improves oocyte quality as an antioxidant. To investigate the effect of oxidative stress and melatonin on oocyte maturation, oocytes were recovered from preovulatory follicles 48 h after injection of 10 IU of equine chorionic gonadotropin (eCG) in immature ICR mice. Oocytes were then incubated in the presence or absence of hydrogen peroxide (H2O2; 1, 10, 100, 1000 μM). After 12 h incubation, oocytes with a first polar body were defined as mature oocytes. The percentage of the mature oocytes was significantly decreased (0%) by addition of H202 (≥10 μM) compared with control (62%). When oocytes were incubated with H202 (10 μM) in the presence of melatonin (1, 10 ng/ml), the decrease in the percentage of mature oocytes caused by H202 was blocked by melatonin (10 ng/ml) addition. It is, therefore, suggested that oxidative stress inhibits oocytes maturation and melatonin showed a protective activity against oxidative stress. Follicular fluid was sampled at the oocyte retrieval in IVF-ET patients. Intrafollicular concentrations of 8-hydroxy-2′-deoxyguanosine (8-OHdG) or Hexanoyl-lysine adduct (HEL) were determined by ELISA as an oxidative stress marker. 8-OHdG concentrations in women with high rates (≥30%) of degenerate oocytes were significantly higher than those in women with <30% degenerate oocytes, suggesting a close relationship between oxidative stress and poor oocyte quality. In order to reduce oxidative stress in the follicles, melatonin (3 mg/day, at 22:00) was orally given to IVF-ET patients (n=56), who failed to achieve a fertilization rate of at least 50% in the previous IVF-ET cycle, from the fifth day of the previous menstrual cycle to the day of oocyte retrieval of the IVF-ET cycle. Fifty-nine women underwent IVF-ET without melatonin treatment. The fertilization rate was improved by melatonin treatment compared with the previous IVFET cycle (20.0±19.0 % vs. 50.0±38 %), and 11 women (19.6%) conceived. On the other hand, without melatonin treatment, the fertilization rate was not changed (20.9±16.5 % vs. 22.8±19.0 %) and 6 women (10.2%) conceived. Intrafollicular melatonin concentrations were significantly increased (112±51 vs. 432±260 pg/ml) and intrafollicular concentrations of 8-OHdG and HEL were significantly decreased by melatonin treatment (17.4±8.8 vs. 11.6±0.7 ng/ml, 25.0±7.2 vs. 19.2±2.5 nmol/L, respectively). In conclusions, oxidative stress causes toxic effect on oocyte maturation and melatonin protects oocytes from oxidative stress. Melatonin administration is likely to improve oocyte quality. (platform)

Expression of complement system regulatory molecules in the endometrium of normal ovulatory and hyperstimulated women correlate with menstrual cycle phase

The present study describes the temporal expression of complement regulatory molecules membrane cofactor protein (MCP), decay accelerating factor (DAF), CR1, and CD59 in the human endometrium throughout the normal menstrual cycle and in patients submitted to ovarian hyperstimulation. During its proliferative phase, the endometrium expresses MCP, with increased expression during the secretory phase. Phase-dependent expression also was observed for DAF and CD59, mainly in the secretory phase. Expression of CR1 was not detected. These results suggest the presence of complement system activity during the menstrual cycle, with greater expression of regulatory molecules during the secretory phase to protect the epithelial integrity of human endometrium.

Toremifene for premenstrual mastalgia: a randomised, placebo‐controlled crossover study

To investigate the efficacy of toremifene in the treatment of premenstrual mastalgia. Double-blind, placebo-controlled crossover study. Three Finnish general practices from the districts of Satakunta Central Hospital and Tampere University Hospital. POPULATION A total of 62 women aged 25-45 years with premenstrual mastalgia during at least three previous menstrual cycles. Women were randomised to receive toremifene 20 mg daily or placebo from day 15 of the menstrual cycle until menstruation for three consecutive cycles. After a wash-out cycle, the women were crossed over to receive placebo or toremifene for three additional cycles. Cyclic breast pain relief assessed by visual analogue scale (VAS) score. Quality-of-life scores assessed by a modified 36-item Finnish Depression Scale, with a score ranging from 0 to 108. Acceptability of treatment. About 32 women were randomised to receive toremifene first and 30 to receive placebo first. Twenty-nine and 27 participants in the groups treated with toremifene first or placebo first completed the treatment, respectively. There were significant reductions in VAS scores in both groups after three treatment cycles. This was significantly greater in the toremifene-treated group (VAS: 1.8 in the toremifene group and 3.7 in the placebo group, P= 0.004). Treatment effect between treatment cycles was significant (P= 0.001). Quality of life was similar during the toremifene and placebo cycles. CONCLUSION This study demonstrates that the antiestrogenic compound, toremifene, is able to relieve premenstrual breast pain without major adverse effects. There was a 64% reduction in median pain scores in the toremifene-treated cycles compared with a 26% reduction in placebo-treated cycles.

Clinical Features of Donors and Recipients That May Impact on the Results of an Oocyte Donation Program

To review the significance of clinical and laboratory variables in donors and clinical features in recipients that may have a significant impact on implantation, pregnancy and abortion rates Patient retrospective observational study in IVF private clinic affiliated to the University of Buenos Aires. Student#x0027;s τ and χ2 tests were used for comparison. From February 2003 to December 2004, 92 stimulation cycles were initiated in 66 young and healthy donors, ending in 307 embryo transfers to 250 recipients. Donor#x0027;s and recipient#x0027;s ages ranged between 19 and 30 years and 28 to 49 years, respectively. All cycles were performed using the ICSI procedure due to the utilization of cryopreserved sperm samples. Donors were selected through clinical and gynecologic evaluation and genetic screening. The routine protocol in all donors included the administration of 0,5 mg. GnRh agonist (leuprolide acetate) on day 21of the previous menstrual cycle. Ovarian stimulation was performed using 300 IU (IM) urinary FSH/per day. All recipients underwent a preliminary, gynecologic, cardiologic and haematologic work-up. Each one received micronized 17β- estradiol (4 -6 mg/d) orally. Menopausal women started estradiol upon admission to treatment and patients with ovarian function were desensitized administerering a depot GnRH agonist (leuprolide acetate or triptorelin). Male partner submitted a semen sample to be evaluated and cryopreserved before treatment. Five different parameters were used to analyze the donor population: age (< 25 and ≥25 years old); history of a previous pregnancy; serum E2 levels on the day of hCG (below or above 1500 pg/ml); number of metaphase II oocytes obtained (< 15 and ≥15 oocytes) and number of recipients used per donor (< 4 o ≥4 recipients). Recipients were grouped according to: age (< 40 o ≥40 years old), menopausal status and presence or absence of gynecologic pathology. Implantation, pregnancy and miscarriage rates were compared in all groups. Implantation, clinical pregnancy and miscarriage rates were 21.5%, 39.08% and 21.6%, respectively. When donors#x0027; characteristics were analyzed, pregnancy and abortion rates were not significantly different in any of the groups. Implantation rates were significantly higher when the oocytes transferred originated from younger donors (26.34% vs. 18.24%, p=0.0255), when estradiol values were higher (24.01% vs. 17.21%, p= 0.048), and when higher number of metaphase II oocytes were obtained (24.34% vs. 16.78%, p=0.026). We did not see significant differences in the recipients#x0027;s groups selected. The following chart summarizes the results. Tabled 1 Better implantation rates in the recipients were obtained in the subgroups of younger donors with better ovarian response. However pregnancy and abortion rates did not differ, probably because of the low number of patients studied. None of the variables evaluated in recipients showed significant impact in the final results.

A new method for estimating the effectiveness of emergency contraception that accounts for variation in timing of ovulation and previous cycle length

To develop a new method for estimating the effectiveness of emergency contraception (EC) by using information about previous menstrual cycle length, accounting for the variation in the day of ovulation within the menstrual cycle, and comparing the validity of the new and previous methods. Secondary analysis of a data set with a biological marker of ovulation and its distribution in the cycle. Based on a sample of cycles with known length and a known biological marker of ovulation, we simulated trials of predetermined EC effectiveness and then calculated estimates of EC effectiveness based on old and new methods. Under some conditions, all methods produced biased estimates of effectiveness with simulated trials, especially when the actual effectiveness was low. The systematic bias was minimized with the new method. The new method was robust with regard to the distribution of the day of intercourse in women presenting for EC. Future studies of EC effectiveness should consider both the uncertainty in predicting the day of ovulation and previous cycle length. Our estimates of daily fecundity should be replicated with other data sets.