Previous Ovarian Surgery Research Articles

Long Term Postoperative Recurrence Rates and Fertility Outcomes after Endometrioma CO2-Laser Vaporization: A 5 years Follow-up Experience

Although cystectomy remains the gold standard for the surgical treatments of endometriomas, concerns about the negative effect on ovarian reserve are rising. Laser-CO2 vaporization of endometriomas has showed encouraging data on ovarian reserve preservation, postoperative pregnancy rates and recurrency. The aim of this study was to assess postoperative recurrence rate and pregnancy rate in patients with endometriomas managed by CO2 fiber laser vaporization after at least 5 years following surgery. Retrospective study. Italian tertiary center from October 2023 to February 2024. We included women aged >18 years who underwent laparoscopic CO2 fiber laser vaporization for endometriomas. Age ≥ 40 years, previous ovarian surgery, previous salpingectomy or hysterectomy, negative histologic finding for endometriosis or any findings of malignancy at histology were exclusion criteria. Ovarian endometriomas were vaporized through laparoscopic CO2 fiber laser. After surgery, patients were included in a surveillance program with periodic clinical follow-up. Seventy-eight patients were included. The mean age was 33.2±4.6 years, the basal AMH was 2.7 ± 1.9 ng/mL and the median diameter of the endometriomas was 4(3-5)cm. The median duration of follow-up was 72.5 months(67-84.5). After surgery, 65.5%(n=36) of women with reproductive desire achieved a pregnancy, 55.6% spontaneously and 44.4% through Assisted Reproduction Techniques, with a mean time to pregnancy of 17.7±18.1 months. A Kaplan-Meier curve for the 7 patients who experienced an ipsilateral recurrence showed that the median time to recurrence was 26 months and the estimated rate of disease-free patients was 91.03% at 100 months (95% CI 82.10%-95.62%). CO2 fiber laser vaporization is an effective and safe surgical treatment of ovarian endometriomas, combining the advantage of being an ovarian tissue-sparing technique with long-term post-operative recurrence rate comparable with that described in literature for the cystectomy.

Serum anti-Mullerian hormon seviyesi ve antral follikül sayısının stimule edilmemiş menstruel siklustaki değişiminin saptanması

Aim: To evaluate the variability of anti-Mullerian hormone (AMH) and antral follicle count (AFC) in an unstimulated menstrual cycle.
 Materials and Method: The study was designed on 50 women who had regular menstrual cycles and did not have any systemic disease or previous ovarian surgery. Serum AMH levels and antral follicle counts of all participants were evaluated three times in the same menstrual cycle in the early and late follicular phase and luteal phase. To evaluate the intracyclic AMH fluctuation according to age, participants were divided into two groups; younger (

P-655 A prospective, observational, multivariate study to evaluate the best predictor of ovarian response, between AMH measured with fully automated assay and AFC.

Abstract Study question Which of AMH (measured with fully-automated assay) or AFC is the best predictive biomarker of ovarian response to exogenous gonadotropins in IVF/ICSI cycles? Summary answer In patients >35 years, AMH predicts the number of oocytes retrieved better than AFC and it has greater discriminating ability to detect suboptimal response. What is known already Individual variability in ovarian response to a starting dose of gonadotropins is a well-known aspect during controlled ovarian stimulation and many efforts have been made for obtaining the personalization of the treatment, identifying different biomarkers (age, basal FSH, BMI, AMH, AFC) that may predict the ovarian response. Among these biomarkers, AMH and AFC demonstrated the best performance in predicting ovarian response. Nevertheless, approximately one in five patients in clinical practice has a discordance between AMH and AFC; in these cases, the clinicians do not know which indicator should be chosen to individualize the protocol and the starting dose of gonadotropins. Study design, size, duration This prospective, observational, multivariate study compared fully-automated AMH with AFC in the prediction of ovarian response, defined as the number of oocytes retrieved and it involved 161 couples attending their first IVF/ICSI cycle between 2019 and 2022 (ClinicalTrials.gov NCT04168892). The patients underwent a GnRH antagonist protocol and received a HMG starting dose exclusively based on their age (150 IU if ≤ 35 years, 225 IU if > 35 years). Two physicians performed all the AFC determinations. Participants/materials, setting, methods The study was conducted at ANDROS Day Surgery Clinic, Palermo, Italy. Inclusion criteria were: female age 18-40 years, BMI 18-30 kg/m2, FSH ≤15 IU/l, normal menstrual cycles, normal uterine cavity, presence of both ovaries. Exclusion criteria were: PCOS, severe endometriosis, previous ovarian surgery, ovarian cysts, endocrinological diseases. Considering a power (1-β) of 90% and an alpha of 0.01, a total sample size of 160 couples was considered sufficient to verify the study hypothesis. Main results and the role of chance Three out of 161 patients were excluded after randomization. Eighty-eight out of 158 patients (55.7%) received 150 IU as starting dose (age=31.03±3.33; range 21-35 years); 70 patients (44.3%) received 225 IU (age=37.68±1.31, range 36-40). 9/158 cycles (5.6%) were suspended for hypo-response. The two groups were different in number of oocytes retrieved (p < 0.05), with higher number in ≤ 35 years group (M≤35=11.30±7.14, M>35=8.77±5.30). Univariate analyses revealed that the number of oocytes retrieved was correlated, in both groups, with AMH (ps < 0.01) and AFC (ps < 0.01), and in ≤ 35 years group with basal FSH (p = 0.03). No relationships were found with cause of infertility, BMI, smoking. Correlation coefficient (ρ) between AMH and AFC was 0.74 (p < 0.01) in ≤ 35 years group and 0.57 (p < 0.01) in > 35 years group. Multivariate Poisson regressions confirmed that AMH and AFC significantly predicted the number of oocytes retrieved in ≤ 35 years group (p < 0.01, Exp(B)=1.08; and p < 0.01, Exp(B)=1.03, respectively), while only AMH was a significant predictor in > 35 years group (p < 0.01, Exp(B)=1.18) (AFC: p = 0.34, Exp(B)=1.01). For prediction of suboptimal ovarian response (<8 oocytes retrieved), ROC analysis showed that AMH was not different from AFC in ≤ 35 years group (AUCAMH=0.811, AUCAFC=0.767; p = 0.331) but significantly better in > 35 years group (AUCAMH=0.858, AUCAFC=0.675; p < 0.001). Limitations, reasons for caution This is a single-center study; a multicenter trial could be useful for a further validation of the results. Moreover, many laboratories do not use automated assays for measuring AMH and this could make the results of this study hardly applicable in all contexts. Wider implications of the findings The results of this prospective trial highlight that, in patients >35 years, automatized AMH predicts the ovarian response better than AFC and it shows greater discriminating ability to detect suboptimal response. This could open new possibilities of individualizing treatment with AMH-based algorithms, especially in patients with the worst reproductive prognosis. Trial registration number NCT04168892

Factors Affecting the Success Rate of Intrauterine Insemination in the Treatment of Subfertility Following Controlled Ovarian Hyperstimulation

Objectives: To determine the success rate of Intrauterine Insemination following Controlled Ovarian Hyperstimulation inpatients with subfertility and to determine the frequency of prognostic factors affecting the success rate of this treatment modality.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Obstetrics & Gynecology, Pak-Emirates Military Hospital, Rawalpindi Pakistan, rom Feb to Aug 2019.
 Methodology: A total number of 135 sub-fertile patients, aged 18 to 40 years, with a duration of subfertility > 2 years, were included in the study. Couples with bilateral tubal blockade, smoking, combined male and female factor infertility and previous ovarian surgery were excluded. Controlled ovarian hyperstimulation was done with Clomiphene Citrate for five days, followed by ovulation triggered by recombinant human chorionic gonadotropin (HCG) and standard insemination with a prepared sample of the husband’s semen after 36 hours.
 Results: Success of the procedure was seen in 23(17.04%) patients, while the remaining 112(82.96%) were unsuccessful. The mean age was 29.20±4.90 years. Of 135 patients, 83(61.48%) had primary subfertility, and 52(38.52%) had secondary subfertility. The mean duration of subfertility was 5.60±3.35 years. The mean basal FSH was 5.76±2.54 IU/l. The mean number of IUI cycles was 1.39±0.49.
 Conclusion: This study concluded that the success rate of intrauterine insemination following controlled ovarian hyperstimulation in the treatment of subfertility was 17.04%, and the duration and type of subfertility, aetiology of subfertility, basal Follicle-stimulating hormone levels and the number of Intrauterine insemination cycles are the prognostic factors affecting the success of the procedure.

Relationship between serum Prostate Specific Antigen (PSA) in women with polycystic ovary syndrome and some reproductive hormones in Kirkuk city

PCOS is one of the most common endocrine disorders among women between 12 and 45 years of age, affecting 5-10% of women. The patients were included in the current study based on the criteria of Rotterdam in the diagnosis of polycystic ovarian syndrome with at least two of the following three criteria: menstrual cycle disorder, chemical criteria for high levels of androgen, detection of polycystic ovary using ultrasound (10 or more cysts of 2-10 mm in diameter). Sixty (60) patients were diagnosed with the syndrome and 30 healthy women were considered as control groups aged between 16 and 46 years.A number of criteria have been adopted to exclude patients who have had previous ovarian surgery as well as women taking contraceptives, steroids and herbal medicines that affect ovarian function for at least two months. The study was conducted at the Azadi Teaching Hospital in the city of Kirkuk for the period from October 2016 to February 2017.
 Blood collected for all participants on the second or third day of the menstrual cycle. Body mass index (BMI) was calculated and prostate specific antigen (PSA) level and the level of sex hormones such as Anti-mullarian hormone(AMH),Luteinizing hormone(LH),Follicular stimulating hormone(FSH),Testosterone hormone(T) as well as Luteinizing hormone/Follicular stimulating hormone(LH / FSH) ratio were determined. The relationship between PSA and all studied variables was investigated after dividing the study sample into three age groups A (16-25), B (26-35), and C (36-45) years. Each age group included 30 patients with PCOS and 10 women as a control group).The results showed a significant increase (p <0.05) in the level of the PSA, AMH, LH, T and LH / FSH ratio, conversely the level of FSH was significantly reduced (p <0.05) when comparing women patientswith the control group. Correlation results showed a positive correlation between the PSA level and the values of all the studied variables except for FSH, which was inversely correlated with serum PSA in PCOS patients and for most age groups except for category C where AMH showed a negative correlation with PSA. The results also indicated a significant correlation between PSA and T, LH, and LH / FSH ratio for all ages groups. PSA can therefore be considered as a biochemical marker for androgen activity changes in patients with PCOS

IVF characteristics and the molecular luteal features of random start IVF cycles are not different from conventional cycles in cancer patients.

Are the IVF parameters and the steroidogenic luteal characteristics of random-start IVF cycles different from conventional cycles in cancer patients? No; controlled ovarian stimulation cycles randomly started at late follicular phase (LFP) and luteal phase (LP) are totally comparable to those conventional IVF cycles started at early follicular phase (EFP) in terms of the expression of the enzymes involved in cholesterol utilization and steroid hormone biosynthesis pathways, gonadotropin receptor expression and, estradiol (E2) and progesterone (P4) production in addition to the similarities in ovarian response to gonadotropin stimulation, oocyte yield, fertilization rate and embryo development competency in cancer patients. Random start ovarian stimulation protocols are commonly employed for oocyte and embryo freezing for fertility preservation in cancer patients with time constraints who do not have sufficient time to undergo ovarian stimulation initiated conventionally at EFP of the next cycle. No data is available regarding the molecular steroidogenic features of these cycles analyzed together with the clinical IVF characteristics in cancer patients. We aimed to address this question in this study to help understand how similar the random start cycles are to the conventional start ones. A clinical translational research study conducted in 62 cancer patients undergoing IVF for fertility preservation between the years 2017 and 2022. Sixty-two patients who were diagnosed with different types of cancer and underwent ovarian stimulation for oocyte (n = 41) and embryo (n = 21) cryopreservation using GnRH antagonist protocol and human menopausal gonadotropins before receiving cancer treatment/surgery were enrolled in the study. For patients with breast cancer and endometrial cancer the aromatase inhibitor letrozole was used with gonadotropin stimulation. Ovarian stimulation was initiated conventionally at EFP in 22 patients and served as control while it was started at LFP in 20, and mid-LP in the other 20 patients. The luteinized granulosa cells (GCs) were recovered from follicular aspirates during oocyte retrieval procedure and used for the experiments separately for each individual patient. The expression of the enzymes involved in sex steroid biosynthesis (StAR, 3β-HSD, Aromatase) and cholesterol synthesis (3-hydroxy 3-methylglutaryl Co-A reductase (HMG-Co-A reductase)), utilization (hormone sensitive lipase (HSL)), and storage (Acetyl-Coenzyme A acetyltransferase 1 (ACAT-1)), and gonadotropin receptor expression status were analyzed using immunoblotting and RT-PCR methods. Laser confocal immunofluorescence imaging was applied to analyze and compare the expression patterns of the steroidogenic enzymes and their relation with mitochondria. In vitro E2 and P4 production by the cells were compared among the groups. Baseline demographic and IVF characteristics of the patients undergoing the conventional start and random start IVF cycles were similar. Duration of gonadotropin stimulation was significantly longer in LFP and LP start cycles in comparison to the conventional ones. Ovarian response to gonadotropin stimulation, mature and total oocyte yield, fertilization and Day 5 blastulation rates of the embryos were comparable between the conventional versus random start cycles. When the luteal GCs of these random start cycles were analyzed we could not find any gross differences between these cycles in terms of the viability index and gross light microscopic morphologic features. More detailed analysis of the molecular luteal characteristics of the cells using RT-PCR, immunoblotting methods revealed that the expression profiles of the gonadotropin receptors, and the enzymes involved in sex steroid biosynthesis and cholesterol synthesis/utilization, and the steroidogenic activity of the luteal GCs of the random start cycles are almost identical to those of the conventional start cycles. Confocal image analysis demonstrated similar patterns in the signal expression profiles of the steroidogenic enzymes and their co-localization within mitochondria. N/A. Caution should be exercised when interpreting our data and counseling cancer patients seeking fertility preservation because it is still unclear if previous exposure to cancer drugs, different ovarian pathologies or infertility etiologies, previous ovarian surgery and/or any other underlying diseases that are concomitantly present with cancer may cause a difference between conventional and random start stimulation protocols in terms of IVF parameters, luteal function and reproductive outcome. Relatively low number of patients in each stimulation protocol and pooling of luteal GCs for each patient rather than individual analysis of each follicle and oocyte are additional limitations of our study. Our findings provide reassurance that random start protocol offers cancer patients an equally good prospect of fertility preservation as conventional IVF. Funded by the School of Medicine, the Graduate School of Health Sciences of Koc University and Koç University Research Center for Translational Medicine (KUTTAM), equally funded by the Republic of Turkey Ministry of Development Research Infrastructure Support Program. All authors declare no conflict of interest. N/A.

Evaluation and Interpretation of AMH in Female Infertility

Anti-Müllerian hormone (AMH) is a glycoprotein that secreted by the granulosa cells of the pre-antral and antral ovarian follicles that have a diameter <8 mm. By inhibiting both initial recruitments of primordial follicles into primary follicles and also the sensitivity of antral follicles to follicle stimulating hormone (FSH) in cyclic recruitment AMH acts as a “follicular gatekeeper”. AMH is recognized as an early marker of the decline in the follicular pool. Although AMH levels are accepted to be stable all through the menstrual cycle, inter- and intracycle variability are detected in the studies with the highly sensitive automated assays. Besides aging, body mass index, obesity, oral contraceptive use, previous ovarian surgery, chemotherapy, BRCA mutations, and ethnicity play a role on the AMH levels. Polycystic ovary syndrome (PCOS) is related with increased AMH level and thus proposed to be used as a diagnostic criterion. However, there is no universally accepted threshold value for AMH that can be used in the diagnosis of PCOS. AMH levels have also been used for designing an ideal treatment protocol in assisted reproduction. AMH measurements can be utilized for the prediction of poor or hyper ovarian response. The value of AMH levels in the prediction of pregnancy outcome remains controversial.

P-425 Premature follicular-phase progesterone increase in ART cycles and endometrial receptivity: evaluation of new, more reliable predictors

Abstract Study question Is plasma Progesterone (P) at HCG administration more sensitive in predicting endometrial receptivity in fresh IVF cycles than PFI (progesterone-follicles index) and POI (progesterone-oocytes index)? Summary answer Our data suggest that POI predicts endometrial receptivity defect better than the P assay alone, thus allowing better decision making. What is known already The premature increase in plasma P in the follicular phase of stimulated IVF cycles has been associated with a lower embryo implantation rate because of reduced endometrial receptivity. There is still no consensus on how this impediment to implantation should occur and what threshold should be used. Moreover,since the efficacy of P increase in conditioning reproductive outcomes is more intense in patients with normo- and poor-response and generally inversely proportional to the ovarian response to stimulation, PFI and POI, which better reflect the average amount of P secreted from the follicles, have been suggested as potential additional markers of receptivity. Study design, size, duration Retrospective analysis of fresh IVF-ET cycles. PFI was obtained dividing the plasma P level on the day of hCG administration by the number of follicles ≥14 mm; POI by the number of oocytes retrieved. Pearson correlations, ROC curves, multivariate logistic regression analysis and Cox regression were performed to evaluate the predictive value of PFI and POI for the main outcomes we considered: ongoing pregnancy rate (OPR) and live birth rate (LBR). Participants/materials, setting, methods Women undergoing IVF cycles at San Paolo University Hospital in Milan between 2016 and 2021 were enrolled. As exclusion criteria, we considered previous ovarian surgery, endometriosis, severe male factor and cycle interruption before the embryo transfer. We collected the following data: age of the woman; stimulation protocol; total amount of FSH administered; P and Estradiol (E2) levels and number of follicles >14 mm on induction day; number of oocytes collected; OPR and LBR. Main results and the role of chance A total of 662 fresh embryo transfers (ETs) were performed and 214 pregnancies were achieved. We observed a statistically significant difference in age, number of total embryos and POI between women who became pregnant and those who did not. Specifically, Pearson’s correlation revealed a significant positive correlation between pregnancy and number of total embryos (r = 0.165, p < 0.001), and a significant negative correlation between pregnancy and age (r = 0.201, p < 0.001) and POI (r=-0.096, p = 0.013). Multivariate logistic regression revealed POI to be the most significant predictive parameter of pregnancy, with a odds ratio of 4.374 (p = 0.007, CI: 1.496-12.797). The ROC curve confirmed the highest predictive value of POI for OPR. Finally, Cox regression showed that POI <0.18 was correlated with better OPR (odds ratio=1.419, p = 0.012), suggesting the potential clinical impact of identifying an optimal cut-off of POI to reconsider patient management. Limitations, reasons for caution The results of this study are limited by the small population size. Wider implications of the findings Since the effect on endometrial receptivity of increased plasma P is inversely proportional to ovarian response,we suggest using a marker that accounts for response characteristics. POI has been found to be a reliable index for predicting IVF-ET cycle outcomes,supporting a limit beyond which the fresh embryo transfer should be reconsidered. Trial registration number N/A

P-603 Presence of an asymmetrical response to ovarian stimulation in patients with low ovarian reserve

Abstract Study question Does ovarian reserve decline with a symmetrical manner between right and left ovaries in poor responders (POR) with diminished ovarian reserve (DOR)? Summary answer Asymmetrical ovarian response to ovarian stimulation with the left-side dominance was found in POR with DOR. What is known already Ovarian follicles are produced during fetal stage and not regenerated after birth. Thus, the number of ovarian follicles declines with age, resulting in infertile POR with DOR. In the morphometric study of human neonatal ovaries, no significant difference was found in the number of follicles between the right and left ovaries in the same individual. A previous study demonstrated that there is a difference in the number of follicles between right and left ovaries in patients with normal ovarian reserve with the right-side dominance, suggesting the asymmetrical activation and growth of follicles. Study design, size, duration A retrospective analysis was conducted in patients with POR with DOR based on the Bologna Criteria. Inclusion criteria was patients who received more than five times of ovarian stimulations followed by oocyte retrievals. Data were obtained from a total of 265 participants who received IVF-ET treatments from April 2015 to March 2021 after receiving written informed consents under an approval from the institutional ethical committee. Patients with the history of previous ovarian surgery were excluded. Participants/materials, setting, methods The enrolled patients were received ovarian simulation under short or GnRH antagonist protocols for oocyte retrieval. We collected the data of retrieved oocyte number as well as the outcome of IVF from medical chart. We defined the right-left asymmetry of ovarian reserve (%) based on the number of retrieved oocytes from dominant side ovary per total number of retrieved oocytes. Statistical significance was determined using Dunnett or chi-square tests, with P < 0.05 being statistically significant. Main results and the role of chance The average age of participants was 37.2±5.99 years of age exhibiting low serum AMH levels (average 0.09±0.20 ng/ml). We analyzed 2,181 cycles of ovarian stimulation (average 8.3±3.9 cycles/patient). The number of retrieved oocytes were 3, 882 in total cycles (average 12.8±7.1/patient). Among participants, 22 cases (8.4%) showed left and right equal in the number of retrieved oocytes, whereas >70% asymmetry was observed in 107 cases (40.7%) and >80% asymmetry was detected in 60 cases (22.8%). In 18 cases (6.9%), oocytes were collected from one side ovary only showing 100% asymmetry. In the cases with >70 and 100% asymmetry, the left-side dominance was 1.3-fold and 5.0-fold higher than right-side dominance, respectively. In cases with 100% asymmetry, there was no difference in the number of cryopreserved high-quality embryos between left and right sides of ovary. Limitations, reasons for caution Although we enrolled POR with DOR patients who received ovarian stimulations more than five times, the duration of ovarian stimulation was different among patients. It affects the numbers of ovarian stimulation cycles and retrieved oocytes in each patient. Wider implications of the findings Considering the finding of right-side dominance in the number of follicles with normal ovarian reserve, the activation and development of follicles might be accelerated in the right side due to asymmetric blood supply to the ovaries, and thus follicles are likely remained in the left-side ovary with low ovarian reserve. Trial registration number not applicable

Assisted reproductive treatment outcomes of women with endometriomas: Either with or without previous ovarian surgery.

The present study aimed to evaluate and compare the assisted reproductive technique (ART) outcomes of women with endometriomas either with or without prior endometrioma surgery. A total of 122 women with endometriomas underwent intracytoplasmic sperm injection-embryo transfer (ICSI-ET) at a tertiary IVF Center, between 2014 and 2019, were included in this retrospective study. Of this group, 38 patients had recurrent endometriomas and 84 patients had primary endometrioma without a previous endometrioma surgery. The outcomes of ART treatment including cancellation rates before ET, numbers of oocytes obtained, implantation, clinical pregnancy and live birth rates were compared between the groups. A logistic regression model including potential confounders as age and presence of male factor infertility was used to evaluate the possible effect of recurrent endometriomas on the live birth. The baseline characteristics of the groups were similar. The poor ovarian response rate, defined as the harvest of fewer than four oocytes, was identified in 35.7% and 42.1% of primary and recurrent endometrioma groups, respectively. The implantation (27.2±42.7% vs 24.1±41.4%, P=.74), clinical pregnancy/ET (30.9% vs 27.6%, P=.93 ) and live birth rates/ET (22.1% vs 17.2%, P=.79) CONCLUSION: The ART outcomes of patients with primary and recurrent endometriomas do not seem different in terms of response to ovarian stimulation and live birth rates after ICSI. These results may indicate that the recurrence of the endometrioma might not have a further detrimental effect on ART outcome than the disease itself.

Oocyte accumulation for fertility preservation in women with benign ovarian tumours with a history of previous surgery, multiple or large cysts

Research questionWhat are ovarian stimulation cycle outcomes and acceptance rates of an oocyte accumulation programme in young women with benign ovarian tumour (BOT)? DesignRetrospective cohort study conducted at the Academic Assisted Reproductive Technology and Fertility Preservation Centre, Lille University Hospital, between January 2016 and December 2019. The number of metaphase II oocytes per cycle and per patient after accumulation were evaluated. Two groups were identified for the analysis: endometrioma (‘endometrioma’) and dermoid, mucinous or serous cyst (‘other cysts’). ResultsA total of 113 fertility-preservation cycles were analysed in 70 women aged 27.9 ± 4.8 years. Almost all women had undergone previous ovarian surgery before fertility preservation (89%). Mean anti-Müllerian hormone levels before ovarian stimulation was 12.5 ± 8.7 pmol/l. A total of 6.4 ± 3.4 oocytes were retrieved, and 4.3 ± 3.4 metaphase II (MII) oocytes were vitrified per cycle. All agreed to the oocyte accumulation programme and all underwent at least one cycle. To date, 36 (51%) patients achieved two or three fertility- preservation cycles. After accumulation, 7.0 ± 5.23 MII oocytes were vitrified per patient. No difference was found in ovarian response and oocyte cohort between the ‘endometrioma’ and ‘other cysts’ groups. Questionnaires completed after oocyte retrieval revealed abdominal bloating and pelvic pain in most patients, with no difference according to the type of cyst. No serious adverse events occurred. ConclusionsOocyte accumulation should be systematically offered to young women with BOT irrespective of histological type, as it seems to be well-tolerated. Long-term follow-up is needed to assess the efficiency of oocyte accumulation to optimize the chances of subsequent pregnancies.

Endometriosis Lowers the Cumulative Live Birth Rates in IVF by Decreasing the Number of Embryos but Not Their Quality.

Endometriosis and infertility are closely linked, but the underlying mechanisms are still poorly understood. This study aimed to evaluate the impact of endometriosis on in vitro fertilization (IVF) parameters, especially on embryo quality and IVF outcomes. A total of 1124 cycles with intracytoplasmic sperm injection were retrospectively evaluated, including 155 cycles with endometriosis and 969 cycles without endometriosis. Women with endometriosis had significantly lower ovarian reserve markers (AMH and AFC), regardless of previous ovarian surgery. Despite receiving significantly higher doses of exogenous gonadotropins, they had significantly fewer oocytes, mature oocytes, embryos, and top-quality embryos than women in the control group. Multivariate analysis did not reveal any association between endometriosis and the proportion of top-quality embryo (OR = 0.87; 95% CI [0.66–1.12]; p = 0.3). The implantation rate and the live birth rate per cycle were comparable between the two groups (p = 0.05), but the cumulative live births rate was significantly lower in in the endometriosis group (32.1% versus 50.7%, p = 0.001), as a consequence of the lower number of frozen embryos. In conclusion, endometriosis lowers the cumulative live birth rates by decreasing the number of embryos available to transfer, but not their quality.

Extra Gastrointestinal Stromal Tumor Pada Ovarium, Kasus Jarang

Objective : This article objective is to describe a woman with extra gastrointestinal stromal tumor (extra GIST) in ovary; Method : A case report and literature review; The author reports a woman 54 years old with complaints of swelling in the abdomen. Tumors suspected originate from ovary with an extension to abdominal wall. The patient had history of previous ovarian tumor surgery with pathological anatomy diagnosis was thecoma. Working diagnosis of the patient was residif ovarian malignancy and then suboptimal debulking was performed. Microscopically, ovarian tumors appear cellular and diffuse, partially arranged fascicles. Cells with rounded-spindle nuclei, mitosis ≥ 4 per 10 HPF. The conclusion was malignant thecoma which metastasizes to peritoneum and omentum. Differential diagnosis were GIST and leiomyosarcoma. Immunohistochemistry examination was performed with Calretinin and CD117 to rule out the differential diagnosis. Calretinin were negative and CD117 were strongly positively smeared. Based on the morphology and positive CD117 results, diagnosis was extra GIST of ovary.; Conclusion: Extra GIST in the ovary is an unusual location so that it can be misdiagnosed as a gynecological disorder. The differential diagnosis at this location is quite limited including thecoma, fibrothecoma and leiomyosarcoma.Keywords: extra gastrointestinal stromal tumor, ovary, thecoma

Extra Gastrointestinal Stromal Tumor Pada Ovarium, Kasus Jarang

Objective : This article objective is to describe a woman with extra gastrointestinal stromal tumor (extra GIST) in ovary; Method : A case report and literature review; The author reports a woman 54 years old with complaints of swelling in the abdomen. Tumors suspected originate from ovary with an extension to abdominal wall. The patient had history of previous ovarian tumor surgery with pathological anatomy diagnosis was thecoma. Working diagnosis of the patient was residif ovarian malignancy and then suboptimal debulking was performed. Microscopically, ovarian tumors appear cellular and diffuse, partially arranged fascicles. Cells with rounded-spindle nuclei, mitosis ≥ 4 per 10 HPF. The conclusion was malignant thecoma which metastasizes to peritoneum and omentum. Differential diagnosis were GIST and leiomyosarcoma. Immunohistochemistry examination was performed with Calretinin and CD117 to rule out the differential diagnosis. Calretinin were negative and CD117 were strongly positively smeared. Based on the morphology and positive CD117 results, diagnosis was extra GIST of ovary.; Conclusion: Extra GIST in the ovary is an unusual location so that it can be misdiagnosed as a gynecological disorder. The differential diagnosis at this location is quite limited including thecoma, fibrothecoma and leiomyosarcoma.Keywords: extra gastrointestinal stromal tumor, ovary, thecoma

Previous ovarian surgery increases the risk of tubal factor infertility

Aim: Previous ovarian surgery for endometriosis results in decreased ovarian reserve and poor response to treatment in women with infertility. However, the impact of previous overall ovarian surgery on the incidence of infertility is unclear. Therefore the authors investigated impact of previous ovarian surgery on infertility incidence. Materials and Methods: This is a case-control study using retrospectively collected data in women who received infertility treatment (cases) or delivered babies (controls) at a tertiary center between 2003 and 2012. Results: The frequency of previous ovarian surgery was similar in both groups (p > 0.05) but it was higher in women with tubal infertility than their matched controls (p < 0.05). Also, the frequency of previous reproductive organ surgery was higher in the case group and in women with tubal or unexplained infertility (p < 0.05). Conclusion: Previous ovarian surgery is not associated with entire infertility, but may increase tubal factor infertility through adhesion formation and damage to adjacent tubes.

Influence of stage and grade of breast cancer on fertility preservation outcome in reproductive-aged women.

Does breast cancer spread and aggressiveness affect fertility-preservation results? Retrospective cohort study of women with breast cancer undergoing fertility-preservation treatment. age 18-38 years and use of gonadotrophin releasing hormone antagonist protocol; exclusion criteria: recurrent cancer, previous oncological treatment, previous ovarian surgery and known ovarian pathology. Stimulation cycle outcomes of women with low-stage breast cancer were compared with those with high-stage disease. Patients with low-grade (G1-2) were compared with those with high-grade (G3) malignancies. total number of mature oocytes; secondary outcomes: oestradiol level and number of follicles wider than 14 mm on the day of trigger, number of retrieved oocytes and cryopreserved embryos. The final analysis included 155 patients. Patients with high-grade tumours (n = 80; age 32 years [28-35]) had significantly lower number of mature oocytes compared with patients with low-grade cancer (n = 75; age 32 years [28-35]; seven mature oocytes [4-10] versus 13 mature oocytes [7-17]; P = 0.0002). The number of cryopreserved embryos was also lower in the high-grade group (three [2-5] versus five [3-9]; P = 0.02). Stage-based analysis revealed a similar number of mature oocytes in high-stage (n = 73; age 32 years [28-35]) compared with low-stage group (n = 82; age 33 years [28-35]; eight mature oocytes [4-13] versus nine mature oocytes [7-15]; P = 0.06). High-grade breast cancer has a negative effect on total number of mature oocytes and cryopreserved embryos.

The impact of different etiologies of diminished ovarian reserve on pregnancy outcome in IVF-ET cycles

Background/aim Diminished ovarian reserve (DOR) represents a major challenge in reproductive medicine, as it is often associated with poor ovarian stimulation response, high cycle cancellation rate, and low pregnancy rate. The aim of the present study is to compare the clinical pregnancy rates in intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles in patients with different DOR etiologies. Materials and methods Patient data were recorded with a computer-based program called Success Estimation Using a Ranking Algorithm (SERA). Overall, 459 patients were divided into 3 groups according to their DOR etiologies (Group A: idiopathic, n = 81; Group B: age-related, n = 294; Group C: previous ovarian surgery, n = 84). ResultsOut of 459 stimulation cycles, 378 (82.4%) reached the oocyte retrieval stage, while 201 (43.8%) had embryo transfers. There was no significant difference between the patients with different DOR etiologies in terms of embryo transfer and cycle cancellation rate. The patients who had embryo transfer were 44 (52.4%) in Group A, 38 (46.9%) in Group B, and 119 (40.5%) in Group C. There were no significant differences between the three groups (P = 0.114). The percentages of women who had oocyte retrieval were 84.5% in Group A, 70% in Group B, and 80.3% in Group C (P = 0.104). While clinical pregnancy per transfer was 35.8% in Group A, 19.8% in Group B, and 29.5% in Group C, there was no statistically significant difference between the groups (P = 0.113).ConclusionAlthough ovulation induction and ICSI-ET outcomes, including clinical pregnancy and live birth rates, were not significantly different with regards to the etiology of DOR, young women with DOR may benefit from assisted reproductive techniques.

Effects of cancer stage and grade on fertility preservation outcome and ovarian stimulation response.

Do the stage and grade of malignancy affect the fertility preservation outcome in females? Patients with high-grade cancer have a decreased number of retrieved mature oocytes and cryopreserved embryos. Cancer has local and systemic effects on the host. The effects of cancer spread and aggressiveness on the ovarian function and stimulation response remain unclear. Retrospective cohort study evaluating data of all fertility preservation treatment cycles among women with cancer at the reproductive unit of the McGill University Health Centre in the period from 2008 to 2017. Study inclusion criteria were age 18-38 years, first stimulation cycle, GnRH-antagonist protocol and early follicular phase stimulation start. Only one stimulation cycle per patient was included. Patients with ovarian pathology, previous ovarian surgery and previous chemo- or radiotherapy were excluded. The outcomes of women with low-stage cancer (local tumor Stage I-II, no lymph node involvement, no metastases) were compared with those with high-stage disease (local tumor Stage III-IV, lymph node involvement or metastases). Similarly we compared those with low-grade (G1-2) and high-grade (G3-4) malignancies. The primary outcome measure was the number of mature oocytes retrieved. The secondary outcomes included the total number of retrieved oocytes, the number of vitrified oocytes, and the number of frozen embryos. We used Student's t-test for normally distributed data and Wilcoxon test for skewed data. To determine factors associated with good fertility preservation outcome defined as over 10 retrieved mature oocytes, we used multivariate logistic regression. A total of 147 patients were included in the final analysis. Age, body mass index, ovarian reserve parameters of the study groups in stage- and grade-based analyses were similar. Compared to women with low-stage cancer (n = 83), those with high-stage cancer (n = 64) required a higher dose of gonadotropin (P = 0.02). The number of retrieved mature oocytes (9 (7-13) versus 8 (5-12); P = 0.37) and vitrified oocytes (10 (7-15) versus 10 (7-13); P = 0.53) were similar between the two groups. However, in cycles where fertilization of all retrieved oocytes was performed, the fertilization rate (82.7% versus 71.5%; P = 0.03) and the number of vitrified embryos (6.2 ± 3.2 versus 4.3 ± 2.1; P = 0.01) were higher in the low-stage group. Compared to patients with low-grade cancer (n = 62), those with high-grade disease (n = 85) had significantly lower number of retrieved mature oocytes (11 (7-15) versus 8 (5-11); P = 0.002) and vitrified oocytes (12 (8-15) versus 10 (7-11); P = 0.005). The number of vitrified embryos was lower in high-grade group (6.5 ± 3.5 versus 4.6 ± 2.3; P = 0.03) in cycles where the fertilization was performed. In multivariate logistical analysis, the low-grade cancer was significantly associated with retrieval of over 10 mature oocytes (OR = 4.26; 95% CI 1.82-9.98; P = 0.0009). The main limitations of the study include its retrospective design and the relatively small sample size in the embryological outcome analysis. The results of our study should be viewed with caution as different malignancy types were included in the study groups, although their distribution between the study groups was similar. Cancer grade seems to have a negative impact on the fertility preservation outcome and the ovarian stimulation response. Authors have not received any funding to support this study. There are no conflicts of interest to declare.

The relationship between anti-Müllerian hormone serum level and body mass index in a large cohort of infertile patients

To evaluate the relationship between serum Anti-Müllerian hormone (AMH) level and body mass index (BMI) in infertile patients. Medical records of patients with infertility evaluated between January 2013 and February 2018 in the Reproductive Medicine Department of a private hospital were reviewed. Patients with the following criteria were excluded from the study: polycystic ovary syndrome, primary ovarian insufficiency, AMH values > 10 ng/mL, current oral contraceptive users and previous ovarian surgery or endometriosis, and anovulation of other causes, except decreased ovarian reserve. A total of 2204 infertile patients were included (mean age 34.58 ± 4.3 years, mean BMI 22.35 ± 3.6 kg/m2, and mean serum AMH 2.44 ± 2.17 ng/ml). In the entire group of patients, serum AMH level was positively correlated with BMI after adjustment for age (beta = 0.059, p < 0.005). When the association between serum AMH level and BMI was analysed in subgroups of patients, after adjustment for age, we found a positive correlation between the two parameters in patients ≤ 35 years old (< 0.05), of normal weight (p < 0.05) and with normal ovarian reserve (p < 0.05). After adjustment for age, BMI ≥ 25 kg/m2 was significantly associated with higher AMH values in comparison to normal weight patients. In infertile patients, AMH is positively correlated with BMI, especially in patients younger than 35 years, of normal weight and with normal ovarian reserve. Moreover, the presence of mild excess adiposity seems to be associated with higher AMH values. Our data contradict the previous studies showing a negative impact of excess adiposity on AMH serum levels.

Effects of stage and grade of cancer on fertility preservation outcome in female patients

To evaluate the effects of cancer stage and grade on fertility preservation outcome and ovarian stimulation response. Retrospective cohort study. We evaluated 402 fertility preservation treatment cycles. The inclusion criteria were age 18-38 years, first stimulation cycle, GnRH-antagonist protocol only, and early follicular phase stimulation start only. Patients with ovarian pathology, previous ovarian surgery and previous chemo- or radiotherapy were excluded. Women with low-stage cancer (stage I, II and no lymph node involvement) were compared with those with high-stage disease (stage III, IV or lymph node involvement). Similarly those with low-grade (grade I, II) and high-grade (grade III, IV) disease were compared. Primary outcome was the number of mature oocytes retrieved. Secondary outcomes included total number of oocytes retrieved, total number of vitrified oocytes, and number of frozen embryos. A power calculation was performed. A sample size of 60 in each group has 80% power of showing a 20% difference in primary outcome with an alpha of 5%. To determine factors associated with good fertility preservation outcome (over 10 mature oocytes retrieved), we used multivariate logistical regression. A total of 147 patients were included in the analysis. The demographic and ovarian reserve parameters of study groups in stage- and grade-based analyses were similar. Compared to women with low-stage cancer (n = 83), those with high-stage cancer (n = 64) required a higher dose of gonadotropin (p = 0.02). The number of mature oocytes retrieved and frozen oocytes as well as the number of immature oocytes (GV and MI) and maturation rate were similar between the two groups. However, in cycles where fertilization of retrieved oocytes was performed (n = 53), the fertilization rate (p = 0.03) and the number of vitrified embryos (p = 0.01) were higher in the low-stage group. Compared to patients with low-grade cancer (n = 62), those with high-grade disease (n = 85) had significantly lower number of mature retrieved (10.5 (7-15) vs. 8 (5-10.5); p = 0.002) and totally vitrified (11.5 (8-15) vs. 10 (6.5-11); p = 0.005) oocytes. Similarly the number of vitrified embryos was lower in high-grade group (p=0.03) in cycles where the fertilization was performed. In multivariate logistical analysis, the grade of cancer was found to be one of the factors significantly associated with good fertility preservation outcome (p=0.004; OR=3.93; 95%CI 1.50 - 10.33), along with AFC and number of follicles >14 mm on the trigger day. In women with malignancy, the grade of cancer has a significant negative impact on the number of mature oocytes retrieved and cryopreserved embryos.