Primary Infertility Patients Research Articles

Low Birth Weight Is Associated with a Decreased Overall Adult Health Status and Reproductive Capability - Results of a Cross-Sectional Study in Primary Infertile Patients.

Individuals born with low birth weight (LBW) risk cardiometabolic complications later in life. However the impact of LBW on general health status and male reproductive function has been scantly analysed. We investigated the clinical and seminal impact of different birth weights (BW) in white-European men presenting for primary couple’s infertility. Demographic, clinical, and laboratory data from 827 primary infertile men were compared with those of 373 consecutive fertile men. Patients with BW ≤2500, 2500–4200, and ≥4200gr were classified as having LBW, normal (NBW), and high BW (HBW), respectively. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Testicular volume was assessed with a Prader orchidometer. Semen analysis values were assessed based on 2010 WHO reference criteria. Descriptive statistics and regression models tested associations between semen parameters, clinical characteristics and BW categories. LBW, NBW and HBW were found in 71 (8.6%), 651 (78.7%) and 105 (12.7%) infertile men, respectively. LBW was more frequent in infertile patients than fertile men (p = 0.002). Infertile patients with LBW had a higher rate of comorbidities (p = 0.003), lower mean testicular volume (p = 0.007), higher FSH (p = 0.02) and lower tT levels (p = 0.04) compared to other BW groups. Higher rates of asthenozoospermia (p = 0.02) and teratozoospermia (p = 0.03) were also found in LBW men. At logistic regression models, LBW was univariably associated with pathologic progressive motility (p≤0.02) and pathologic sperm morphology (p<0.005). At multivariable logistic regression analysis, LBW achieved independent predictor status for both lower sperm motility and pathologic sperm morphology (all p≤0.04). Only LBW independently predicted higher CCI values (p<0.001). In conclusion, we found that LBW was more frequent in infertile than in fertile men. Infertile individuals with LBW showed a higher rate of comorbidities and significantly worse clinical, endocrine and semen parameters compared to other BW groups.

The effect of varicocoelectomy on the relationship of oxidative stress in peripheral and internal spermatic vein with semen parameters.

The aim of this prospective controlled study was to investigate the levels of reactive oxygen species (ROS), including asymmetric dimethylarginine (ADMA), oxidative stress index (OSI) and total oxidant capacity (TOC), and antioxidants with total antioxidant capacity (TAC) in peripheral and internal spermatic veins blood, the relationship of these factors with sperm parameters in the infertile varicocoele patients, and the amelioration effect of varicocoelectomy on these outcomes. Thirty-one primary infertile varicocoele patients and 31 fertile control patients evaluated for determining the levels of ADMA, TOC, OSI, superoxide dismutase (SOD), glutathione (GSH), TAC, and semen analysis. The patients' preoperative SOD, GSH and TAC levels, which were significantly lower than the controls, significantly increased postoperatively. Although SOD and GSH were significantly higher in spermatic vein compared to median cubital vein, TAC was significantly higher in median cubital vein. ADMA, TOC and OSI were significantly higher in the patient group. TOC and OSI were significantly higher in spermatic vein compared to median cubital vein. Postoperative TOC, OSI and ADMA reduced to the control levels. Total antioxidant capacity in the peripheral circulation and oxidative stress index in the internal spermatic vein could give an idea about the possible improvement in sperm count acquired by varicocoelectomy.

Serum Levels of Immunoglobulin A, G &amp; M in Chlamydia trachomatis Infection among Primary and Secondary Infertility Patients

Serum Levels of Immunoglobulin A, G &amp; M in Chlamydia trachomatis Infection among Primary and Secondary Infertility Patients

Association of thyroid disorders in females with primary infertility attending a tertiary-care hospital in northeast India

Background: A close interconnection is present between hypothyroidism and hyperprolactinemia. Failure to ovulate regularly in women of the reproductive age group may occur owing to hypothyroidism. Objective: To look for thyroid disorders among the primary infertile group of female patients and to see the association of serum prolactin level and thyroid-stimulating hormone (TSH) level, if any. Materials and Methods: In this study, we investigated 53 diagnosed female subjects of primary infertility who were sent to the Department of Biochemistry for hormonal investigation. Fifty-three fertile age-matched females were enrolled for the study as control subjects. Serum prolactin and the TSH levels were measured by using chemiluminiscence method (Access 2, Beckman Coulter). Result: Significantly higher prolactin and TSH levels were found among cases when compared with control subjects. A positive association was found between TSH and prolactin levels among the primary infertile female subjects. Conclusion: This study showed significantly higher prolactin and TSH levels among the primary infertile female patients. Therefore, for proper management of infertile cases, it may be necessary to look for thyroid dysfunction and treat it accordingly.

181 Low birth weight is associated with a higher rate of health-significant comorbidities and worse seminal parameters – results of a cross-sectional study in primary infertile patients

INTRODUCTION AND OBJECTIVES: The raise of the developmental origins of adult disease has positioned low birth weight (LBW) as a significant health issue. We assessed prevalence of, and clinical and seminal impact of different categories of weight at birth in a cohort of white-European men presenting for primary couple’s infertility. METHODS: Complete data from 757 consecutive infertile men were analyzed. Patient with birth weight 2500, 2500 e 4200, and 4200 gr were considered as having LBW, normal birth weight (NBW) and high birth weight (HBW), respectively. Comorbidities were scored with the Charlson Comorbidity Index (CCI; categorized 0 vs 1 vs 2). Body mass index (BMI) was considered for each patient using NIH cut offs [normal weight (18.5e24.9), overweight (25.0e29.9), and class 1 obesity ( 30.0)]. Testicular volume (TV) was assessed with a Prader orchidometer. Semen analysis values were assessed based on 2010 WHO reference criteria. Descriptive statistics detailed the association between semen parameters and clinical characteristics and the defined birth weight categories. RESULTS: Of all, LBW, NBW and HBW were found in 52 (6.9%), 605 (79.9%) and 100 (13.2%) men, respectively. Normal BMI value and BMI suggestive for NIH class 1 obesity was more frequently reported in LBW and HBW (p<0.001), respectively. Of all, LBW reported a higher prevalence of comorbidities (p<0.001). Likewise, hypercholesterolemia (p1⁄40.04) and hypertriglyceridemia (p1⁄40.01) were more frequently reported in both LBW and HBW. LBW had a lower mean TV (p1⁄40.02). At semen analysis, LBW men showed a higher rate of both asthenozoospermia (p1⁄40.02) and teratozoospermia (p1⁄40.02). Overall, ejaculated volume (p1⁄40.006), sperm motility (p1⁄40.02) and normal morphology (p1⁄40.04) were significantly reduced in the LBW group. Likewise, LBW patients presented higher FSH levels (p1⁄40.04) but lower circulating testosterone levels (p1⁄40.03) as compared with the other groups. At MVA, LBW achieved independent predictor status for a higher CCI value (OR 3.7; p<0.001), lower sperm motility (OR 2.7; p<0.04), and lower normal sperm morphology (OR 2.3; p<0.04). CONCLUSIONS: Current findings in infertile patients showed that LBW was associated with a significant higher rate of adult diseases. Clinical, endocrine and semen parameters were significantly worse in the LBW group. These data confirmed the importance of the theory of LBW as a significant predictor of impaired health issue.

Association of Thyroid Dysfunction with Female Infertility

Objective:To find association of hyperthyroidism with female infertility.To find association of hypothyroidism with female infertility.Cross sectional study design was conducted.Place and Duration of Study:Random Infertile females were selected amongst the patients who attended the outpatient department of Naseer Teaching Hospital (NTH) Peshawar from June 2013 to June 2014.Material and Methods:This study was done on hundred infertile females. They were selected randomly from amongst the patients who attended the outpatient department of Naseer Teaching Hospital Peshawar. A detailed history of patients was recorded on a proper questionnaire. This included information about patient age, weight, marriage duration, menstrual history, drug history, any symptoms and signs of thyroid disorder etc. Peripheral venous blood samples were collected aseptically with patient written consent and tested for thyroid function.Results:Hundred primary infertile patients were included in the study. Out of these 100 patients, TSH was raised in 14(14 %) of infertile females while 27(27 %) infertile females had low TSH levels. Based on the levels of T3 and T4, all the 41(41 %) thyroid dysfunction cases were subdivided further into overt and subclinical thyroid dysfunction. Our study showed that 5 % were suffering from overt hypothyroidism, 11 % from subclinical hypothyroidism, 7 % overt hyperthyroidism while 18 % were suffering from subclinical hyperthyroidism.Conclusion:This study shows that subclinical thyroid dysfunction is more common than overt thyroid dysfunction in infertile females. Therefore, measurement of serum T3, T4 and TSH levels should be included in the workup of infertility. The patient can revert back to the fertile state with appropriate treatment.

Low body mass index might be a predisposing factor for varicocele recurrence: a prospective study.

We investigated the possible relationship between body mass index (BMI) score and varicocele recurrence in an infertile patient population. A total of 255 primary infertile male patients (138 with varicocele and 117 for control) were included in this study. Height and weight measurements, clinical examination for varicocele, determination of serum hormone levels and spermiogram were performed in all cases. The BMI score was calculated, and patients with varicocele were operated with subinguinal technique and re-examined for recurrences. The varicocele group had significantly lower weight and the BMI score than the control group (P<0.001). Varicocele recurrences were found in 22 patients (16% of them) after the operations. The BMI score was significantly lower in the recurrent group than in the nonrecurrent and control groups (P<0.001). 73% of the recurrent, 50% of the nonrecurrent and 25% of the control group patients' BMI scores were under 25kgm(-2) (P<0.001). In logistic regression analysis, the BMI score was found as a determinant for varicocele recurrence (P=0.027; OR: 1.25). It is concluded that BMI score lower than 25kgm(-2) significantly increases the recurrence rate after varicocele operation, and it can be used as an objective indicator for microsurgical varicocelectomy.

Comparison of Management and Ovulation-Induction Protocols and Infertility Outcomes in Endometriosis

INTRODUCTION: Endometriosis is a well-established reason for infertility and optimal management and ovulation induction protocols in infertility patients with endometriosis are debated. Operative compared with conservative management with antagonist and agonist protocols for ovulation induction are compared. METHODS: One hundred sixty-four patients with endometriosis and endometriomas who were selected for assisted reproductive technology treatment were included. Patients' records were reviewed retrospectively. Eighty-eight patients were operated on who had endometriomas, whereas 76 patients were conservatively managed. In the operated group, 44 patients received antagonist protocol, whereas 43 patients were treated with an agonist protocol. In the conservatively managed group, 46 and 28 patients were treated with antagonist and agonist protocols, respectively. RESULTS: All groups were matched for age, body mass index, and duration of infertility. Operated compared with conservatively managed groups were not statistically different in dosage of gonadotropins used, follicle count, number of oocytes picked up, or clinical pregnancy rates. Subgroups that were treated either with an antagonist or an agonist protocol were statistically similar for follicle counts, total numbers of oocytes and embryos, and pregnancy rates. Primary and secondary infertility patients in either group were further investigated for the benefits of different ovulation induction regimens and analysis revealed no significant difference in follicles, oocytes picked up and embryos as well as pregnancy rates. CONCLUSION: Operatively and conservatively managed patients with endometriosis and endometriomas similarly benefit from antagonist and agonist protocols.

Expression of PARP1 in primary infertility patients and correlation with DNA fragmentation index a pilot study

PurposeSperm DNA damage is associated with poor assisted reproductive technique (ART) outcome, birth of offspring with major congenital malformation, recurrent spontaneous abortions after assisted and spontaneous conception. The presence of sperm in the ejaculate with high levels of DNA damage indicates either a defect or deficiency in sperm DNA repair mechanisms. ADP ribosylation brought about by poly ADP ribosylases (PARP) of proteins helps in recognition of DNA breaks and recruitment of DNA base excision repair (BER) enzymes. This study was planned to analyse the expression levels of PARP1 (PARP family member) in the sperm samples from both infertile (with normal semen parameters) and control (fertile) men and correlate with sperm DNA damage. MethodsThe study included both infertile men (n = 29) and controls (n = 17). The expression level of PARP1 was quantified by qPCR. For all samples Comet assay and sperm chromatin structure assay (SCSA) was performed and DNA fragmentation index (DFI) calculated. ResultsRelative quantification showed that the level of expression of PARP1 was significantly (P < 0.0001) lower and percentage DFI significantly (P = 0.0015) higher in sperm samples from infertile men compared to controls. There was a negative correlation between PARP1 levels and sperm DNA damage. ConclusionAbnormally low expression of DNA repair enzymes explains for the persistence of DNA damage in sperm. Low levels of PARP can explain for persistence of sperm DNA damage. This may be aetiology of infertility or recurrent pre implantation losses following assisted reproduction in cases with idiopathic infertility.

The role of anti-mullerian hormone to predict ovarian reserve and in vitro fertilisation success

The determination of ovarian reserve is one of the most critical steps affecting IVF outcomes and can identify women who are high, normal or poor responders to manipulate clinical procedures.The aim of the present study was to demonstrate that AMH reliably predict ovarian reserve, response to stimulation and clinical pregnancy rates (PRs) and the role of AMH in predicting oocyte yield. Prospective stody. 311 consecutive fresh IVF cycles were included. Inclusion criteria were primary infertile patients diagnosed as tubal factor, male factor or unexplained infertility, between 18-41 years-old, with FSH levels on cycle day 3 of ≤12 mIU/mL. Data collected included age, duration of infertility, FSH levels on cycle day 3, serum AMH level, total dosage of gonadotropins, maximum estradiol levels, duration of stimulations, the total number of oocytes retrieved and CPRs. 124 (39,8%) resulted in a clinical pregnancy. In women who did not conceive; age were significantly higher, maximum estradiol levels, AMH and the total number of oocytes retrieved were significantly lower. AMH levels was inversely correlated to age, dosage of gonadotropins and clinical PR and had a highly significant positive correlation with maximum estradiol levels and the total number of oocytes retrieved. Women with significantly lower AMH were older and had significantly higher total dosage of gonadotropins and FSH levels on cycle day 3, lower maximum estradiol levels and PR. There was a trend towards decreasing response to ovarian stimulation after COH and CPR with increasing age and FSH levels on cycle day 3 and decreasing AMH. AMH appears to be reliable predictor of ovarian reserve, ovarian response and clinical PR, and criteria diagnosing categories of response are now established measurement of serum AMH level and thus AMH can be used for consideration of treatment options for individualized management, counseling of patients and set expectations of practitioners.

English

RESULTS: 30 %( n=51) of the total infertile patients studied had uterine abnormalities .34% (n=37) of primary infertility patients had uterine abnormalities whereas 23 %( n=14) of secondary infertility patients also had uterine abnormalities. The acquired and congenital causes for uterine abnormalities accounted for 20 %( n=22) and 14% (n=15) respectively in the primary infertility group whereas it accounted for 17 %( n=10) and 6% (n=4) respectively in the secondary infertility group CONCLUSION: Routine use of diagnostic hysteroscopy in the work-up of infertility is recommended. Diagnostic hysteroscopy has a similar importance in the evaluation of both primary and secondary infertility

Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients

OBJECTIVE:To determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centres.MATERIALS AND METHODS:This retrospective study was conducted at two tertiary care centres (the infertility clinics of Sriram Chandra Bhanj Medical College and Prachi hospital at Cuttack, Odisha) throughout the year in 2008. Women aged 20-40 years with normal hormone profile without male factor infertility were included.RESULTS:Out of 300 cases, 206 (69%) patients had primary infertility. While laparoscopy detected abnormalities in 34% of the cases, significant hysteroscopy findings were noted in 18% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14%) and adnexal adhesion (12%) in primary and secondary infertile patients, respectively, hysteroscopy found intrauterine septum as the most common abnormality in both groups.CONCLUSIONS:Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions, and subseptate uterus, which are usually missed by other imaging modalities.

Intra uterine insemination an experience in rural population

Objective:1) To find out efficacy of various ovulation induction protocols in IUI 2) To find out the efficacy of IUI in treatment of infertility Method: All infertility patients of our OPD underwent a standard investigation protocol The infertility work-up included patients’ history, physical examination, conformation of ovulation by follicular monitoring, tubal patency test by diagnostic laparoscopy, and semen analysis of male partner & PCT. All women underwent a standard treatment protocol that included either natural cycle or ovulation induction to achieve superovulation by clomiphene citrate alone, or combined with gonadotrophins. Follicula monitoring using transvaginal sonography was done from D6-8 onwards and all women were given injection Human chorionic gonadotrophin 5000 U for LH surge when the dominant follicle was ≥18 mm. IUI was Performed at 18 hours and 40 hours from the time of HCG injection. Semen for IUI was prepared by the standard Swim Up technique, or by the Density Gradient method. Progesterone (Transvaginal micronized progesterone 200mg/day) for luteal phase support for 14 days following IUI was given to patients who were affording. Results: Majority of couples were having primary infertility (60.97%) Patients of secondary infertility were of 39.03% only. In our study only 11.82% patients were having multiple factors contributing to infertility. Male factor was in 42.59% of couples as against 30.34% of couples were having only anovulation as causative factor for infertility. Unexplained infertility was present in 13.82% patients only. The outcome variable for success of IUI was occurrence of pregnancy. This was defined by delay in menses associated with presence of positive pregnancy test or a detectable rise in serum beta HCG levels. In our study overall pregnancy rate per cycle was 8.01% & per couple it was 21.65%. Per cycle fecundity according to the factor responsible for infertility, the highest success rate was observed in cervical factor (33.33%). For male factor it was 7.74% and for combined factors overall it was 5.92%. Out of 152 pregnancies that occurred during study 108 had Full Term live birth of the baby (71.05% Miscarriage was there in 9.87% patients only. Only three patients had multiple pregnancies (1.97%) and one patient had ectopic pregnancy. Per cycle fecundity was little better in patients with only anovulation( 10.51%). When we compared various regimen used for ovulation induction for IUI we found that though percentage of pregnancies achieved by Low dose HMG either with (13.89%) or without Clomiohene (15.58%), pregnancy rate achieved with clomiphene alone was 7.43% . This was promising at low affordable cost. In our study, we achieved 40.13% pregnancy with second attempt and collectively with first two attempts pregnancy rate achieved was 71.71%.

A CORRELATIVE STUDY OF ENDOMETRIAL GLYCOGEN CONTENT AND OTHER CONTRIBUTORY FACTORS ON FEMALE INFERTILITY

Background and Objective: Endometrial glycogen is one of the most important factors for development of the blastocyst in the early stages of gestation which is reconverted into a simple monosaccharide like glucose at the time of implantation. Hence in the present study, the role of glycogen content in the endometrium and other factors like age, duration of infertility pattern of menstruation and other clinical features in causing infertility was studied.Materials and Methods: This study was carried out in the Department of Pathology, Bangalore Medical College after the ethical clearance from the institutional ethics committee. The study included 90 cases with complaints of infertility (primary / secondary). The endometrial tissue was fixed; processed, sectioned and performed Periodic Acid Schiff (PAS) stain for detecting the amount of glycogen in endometrium. The present prospective study was a descriptive study and the values are mentioned in percentages. Result: We observed that, the majority of primary infertility patients were in the age group of 21-25 years and that of secondary were in 26-30 years. Most of the patients 55(74.3%) in primary & 12(75%) had regular cycles. The duration of primary infertility group was 2-3 years and that of secondary infertility group was 4-5 years. The glycogen content in the endometrium was grossly reduced in patients with Luteal Phase Defects. Conclusion: We found that the glycogen content of endometrium was very much deficient in late secretory phase might be one of the major causes for female sterility.

Association between mutations of the luteinizing hormone β subunit and female infertility

To explore the association between mutations of Trp8Arg and Ile15Thr in the luteinizing hormone (LH) gene and female infertility, primary female infertility patients (n=60) and normal healthy women (n=60) were screened for mutations Trp8Arg and Ile15Thr in the LH-β subunit gene by polymerase chain reaction-restriction fragment length polymorphism, and associations were examined between the mutations and female infertility. The results showed that there were significant differences in the allele and genotype frequencies of Trp8Arg and Ile15Thr between the two groups (P<0.05). A significant difference was noted in the LH level among women with different genotypes (P<0.05), and the LH level was highest in women who were homozygous for both mutations. However, there were no significant differences in FSH level and FSH/LH ratio among subjects with different genotypes (P>0.05). In conclusion, polymorphisms of Trp8Arg and Ile15Thr in the LH-β subunit gene occur in infertile women. The polymorphisms correlate with female infertility and may be a risk factor in the pathogenesis of female infertility.

Does metformin affect the ovarian response to gonadotropins for in vitro fertilization treatment in patients with polycystic ovary syndrome and reduced ovarian reserve? A randomized controlled trial

To evaluate the effects of metformin on the ovarian response to gonadotropins given for invitro fertilization (IVF) programs in patients with polycystic ovary syndrome (PCOS) and reduced ovarian reserve. Prospective, parallel, randomized, double-blind, placebo-controlled clinical trial. Academic departments of obstetrics and gynecology, and a private IVF center. Primary infertile patients with PCOS older than 35 years and/or with a basal follicle-stimulating hormone (FSH) level higher than 10 IU/L who were scheduled for IVF cycles. Gonadotropin-releasing hormone agonist flare-up protocol and high starting doses of recombinant FSH plus metformin or placebo tablets. Primary end point: cancellation rate for low ovarian response. Secondary end-points: other clinical, biochemical, and reproductive data. Enrollment was stopped after 88 participants had been randomized and analyzed due to an unacceptable increased risk of poor ovarian response in the metformin arm. Statistically significant differences between the metformin and placebo groups were observed in the dose of gonadotropins used, peak estradiol levels, and the number of dominant follicles, retrieved oocytes, and metaphase II oocytes. In patients with PCOS and reduced ovarian reserve, metformin worsened the response to gonadotropins, and its administration should be stopped before the start of controlled ovarian hyperstimulation for IVF programs. CLINICAL TRIALS IDENTIFICATION NUMBER: NCT01208740.

Hysteroscopic resection of uterine septum improves reproductive performance in women with unexplained infertility

To evaluate the reproductive outcome after hysteroscopic metroplasty in women with a septate uterus, with particular focus on patients suffering from unexplained infertility. Materials and methods: Hysteroscopic septum resection was performed on 181 patients with uterine septa, including 98 patients with infertility and 83 patients with secondary infertility. Patients were placed into 1 of 3 groups: those with unexplained infertility, those who had experienced 1 miscarriage, and those who had experienced 2 or more miscarriages. All were analyzed retrospectively in terms of their reproductive outcome. Results: After undergoing the hysteroscopic septum resection, 43 out of 98 primary infertility patients became pregnant (43.8%). This figure was lower than the pregnancy rates for patients who had experienced 1 miscarriage or 2 or more miscarriages, 70.2% and 82.6%, respectively (P < 0.05). In spontaneous pregnancies, the miscarriage rate for those who had experienced 1 previous miscarriage decreased from 88.1% (37/42) to 13.6% (3/22, P < 0.001); for those who had experienced 2 or more previous miscarriages, it decreased from 96.5% (168/174) to 17.1% (7/41, P < 0.001). The term delivery rate and live birth rate also rose significantly in all of the groups (P < 0.05). The rate of cesarean sections was 28 out of 107 births, or 26.1%. Conclusion: The reproductive prognosis for patients with unexplained infertility can be improved significantly by performing hysteroscopic metroplasty. Vaginal delivery is a safe way of giving birth for these patients.

Fertilization rate of sibling oocytes after intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF) on primary infertility patients

OBJECTIVE: Our Center recommends ICSI on half of retrieved oocytes to lower the risk of fertilization failure in patients with primary infertility, and in women > 38 years of age who are at greater risk for poor oocyte quality and fewer oocyte numbers post controlled ovarian hyperstimulation.

Laparoscopic ovarian diathermy vs clomiphene citrate plus metformin as second-line strategy for infertile anovulatory patients with polycystic ovary syndrome: a randomized controlled trial

The purpose of this study was to compare the effectiveness of laparoscopic ovarian diathermy (LOD) vs clomiphene citrate (CC) plus metformin in infertile patients with CC-resistant polycystic ovary syndrome (PCOS). Fifty primary infertile patients with CC-resistant PCOS were assigned randomly to receive LOD followed by a 6-month observation (group A) or 6-cycle course of CC plus metformin (group B). Reproductive and safety outcomes were analyzed. No significant difference between 2 groups in pregnancy (15/92 women [16.3%] vs 14/107 women [13.1%]; P = .521) and live-birth (13/92 women [14.1%] vs 12/107 women [11.2%]; P = .536) rates per cycle was observed. With the use of a Cox regression analysis, patients under medical treatment, compared with patients who received surgical treatment, had a relative risk of pregnancy of 1.2 (95% confidence interval, 0.61-2.44; P = .582) and a relative risk of live-birth of 1.4 (95% confidence interval, 0.63-2.96; P = .425). LOD and CC plus metformin seem to be 2 effective approaches to treat infertility in patients with CC-resistant PCOS.

Reproductive outcome of septate uterus following hysteroscopic septum resection

OBJECTIVE:To evaluate the reproductive outcome following hysteroscopic septum resection in patients with primary and secondary (recurrent pregnancy loss [RPL] and bad obstetric history [BOH]) infertility.STUDY DESIGN:Retrospective study.MATERIALS AND METHODS:Hysteroscopic septum resection was performed on 26 patients with a history of either recurrent pregnancy loss, BOH or infertility. The septum resection was performed using a bipolar versapoint system. Reproductive performance of these patients after septum resection was analyzed. The main outcome measures were clinical pregnancy and live birth rates.RESULTS:Hysteroscopic septum resection was performed on seven patients with the history of secondary infertility. Post operatively, the pregnancy rate was 86% (n=6), and the live birth rate was 67% (n=4). After septum resection in 19 primary infertile patients, 6 (32%) patients conceived which resulted in live birth rates of 67% (n=4).CONCLUSION:Hysteroscopic septum resection using bipolar versapoint system is an effective and safe approach for the removal of septum. Hysteroscopic septum resection in women with septate uterus significantly improves the live birth rates and future fertility is not impaired.