Undergoing Ovulation Induction Research Articles

P-631 Extended letrozole regimen versus routine letrozole regimen in women with polycystic ovary syndrome undergoing their first ovulation induction cycle

Abstract Study question Whether an extended letrozole regimen could result in a higher ovulatory rate than a routine regimen in PCOS women undergoing their first ovulation induction cycle. Summary answer PCOS women using the extended letrozole regimen failed to obtain a statistically higher rate of ovulation in comparison with the routine letrozole regimen. What is known already Letrozole has become the first-line agent for ovulation induction, however, nonresponsive cycles occurred in 10-58.8% of PCOS women during their ovulation induction therapy with letrozole alone. The extended letrozole regimen has been demonstrated to be a feasible method for inducing ovulation in those nonresponders. However, whether it could be applied to all the PCOS women as a first choice in the induction of ovulation remains to be explored. Study design, size, duration This is a prospective randomized controlled trial including 148 women with PCOS undergoing their first ovulation induction cycle with letrozole from January 2021 to October 2022. Participants/materials, setting, methods Participants were randomly assigned to receive an extended letrozole regimen (5 mg letrozole daily for 7 days) or a routine regimen(5 mg letrozole daily for 5 days) for one treatment cycle. Ovulation rate was the primary outcome. Secondary outcomes included the clinical pregnancy rate, the number of preovulatory follicles, the rate of multiple pregnancies. Main results and the role of chance The ovulation rate among women receiving a 7-day regimen was slightly higher than the rate with a 5-day regimen, but it did not reach a statistical significance in both the intention-to-treat analysis (90.54%[67/74]vs. 82.43%[59/74], P = 0.065) and per-protocol analysis (90.54%[67/74]vs. 84.29%[59/70], P = 0.257). The number of preovulatory follicles was nearly identical in the two groups (1.39±0.62 vs.1.37±0.59, P = 0.956), and no cases of ovarian hyperstimulation syndrome were observed. In the per-protocol analysis, the rates of clinical pregnancy (20.27%[15/74]vs.16.95%[10/70], P = 0.343) and live birth (13.51%[10/74]vs.11.43%[8/70], P = 0.976) did not differ significantly between treatment groups. Moreover, all the conceptions were singletons without neonatal defects. Limitations, reasons for caution The major concern of the current research is its single-centre and open label nature. Additionally, the limited number of lean PCOS women with a mean body mass index of 23-25 kg/m2 enrolled in our trial also restrict the generalizability of our findings. Wider implications of the findings Letrozole 5-day regimen remains to be the first choice for PCOS women undergoing ovulation induction therapy. Additional prospective trials with a larger sample size and different subgroups of PCOS are needed to assess the ovulatory effects of different letrozole treatment duration. Trial registration number ChiCTR2100042082

Kisspeptin expression during menstruation in PCOS patients undergoing ovulation induction and the correlation with early pregnancy.

To examine the pattern of kisspeptin expression throughout the menstrual cycle in polycystic ovary syndrome (PCOS) patients under the ovulation induction and identify any possible associations with early pregnancy. A prospective cohort of 80 PCOS women who expressed the desire for fertility was enrolled in this study. All of them received the ovulation induction by using letrozole. Levels of kisspeptin, luteinizing hormone (LH), and estradiol (E2) were measured at three different time points during menstruation. The early pregnancy rate was recorded for the study participants after three ovulation cycles. Kisspeptin levels varied regularly during the menstrual cycle, reaching a peak on the day of hCG injection and decreasing after ovulation. There was no significant correlation between kisspeptin and LH levels. Basal kisspeptin levels decreased after letrozole treatment without a significant difference while LH and E2 levels decreased significantly. PCOS participants who became pregnant early had higher basal kisspeptin levels compared to non-pregnant PCOS patients, which had a significant difference (P = 0.006). And the average basal kisspeptin level in pregnant patients was 2293.0 ± 398.7 pg/ml, with a 95% confidence interval of 1511.5-3074.5 pg/ml. Kisspeptin levels in PCOS women undergoing ovulation induction showed a regular variation, which was similar with the healthy women reported in previous studies. The use of LE may result in PCOS endocrine improvement and fertility achievement. In a certain range, kisspeptin might be a potential predictor for early pregnancy in PCOS patients as people with slightly higher basal kisspeptin levels seemed more likely to be pregnant.

Extended versus conventional letrozole regimen in patients with polycystic ovary syndrome undergoing their first ovulation induction cycle: a prospective randomized controlled trial.

Can an extended letrozole (LE) regimen result in a higher ovulatory rate than a conventional regimen in patients with polycystic ovary syndrome (PCOS) undergoing their first ovulation induction cycle? There was no statistical difference in ovulation rate between patients with PCOS using the extended LE regimen and those using the conventional LE regimen. LE has become the first-line agent for ovulation induction. However, there is still a proportion of non-responsive cycles in patients with PCOS undergoing ovulation induction therapy with LE alone, and the extended LE regimen has been demonstrated to be a feasible method for inducing ovulation in these non-responders. Nevertheless, whether the extended regimen could be applied to all patients with PCOS as a first choice for the induction of ovulation remains to be explored. This was a prospective randomized controlled trial that included 148 female patients with PCOS who underwent their first ovulation induction cycle with LE from January 2021 to October 2022. Participants were randomly assigned to receive an extended (5 mg LE daily for 7 days) or conventional regimen (5 mg LE daily for 5 days) for one treatment cycle. The ovulation rate was the primary outcome. Secondary outcomes included the clinical pregnancy rate, the number of preovulatory follicles, and the rate of multiple pregnancies. The ovulation rate among patients receiving an extended LE regimen was slightly higher than the rate with a conventional LE regimen, but the difference did not reach statistical significance in either the intention-to-treat analysis (90.54% [67/74] vs 79.73% [59/74], P = 0.065; relative risk [95% CI]: 0.881 [0.768-1.009]) or the per-protocol analysis (90.54% [67/74] vs 84.29% [59/70], P = 0.257; relative risk [95% CI]: 0.931 [0.821-1.055]). The number of preovulatory follicles was nearly identical in the two groups (1.39 ± 0.62 vs 1.37 ± 0.59, P = 0.956), and no cases of ovarian hyperstimulation syndrome were observed. With regards to the endometrial parameters, the mean endometrium thickness was slightly thicker with the conventional LE regimen compared to that with the extended LE regimen, though with no statistical difference (9.27 ± 1.72 mm vs 9.57 ± 2.28 mm, P = 0.792). In the per-protocol analysis, the rates of clinical pregnancy (20.27% [15/74] vs 14.29% [10/70], P = 0.343; relative risk [95% CI]: 0.705 [0.34-1.463]) and live birth (13.51% [10/74] vs 11.43% [8/70], P = 0.705; relative risk [95% CI]: 0.846 [0.354-2.019]) did not differ significantly between treatment groups. Moreover, all conceptions were singletons without neonatal defects. The major concerns regarding this study are its single-center and open-label nature. Additionally, the limited number of lean patients with PCOS with a mean body mass index of 23-25 kg/m2 enrolled in our trial also restricted the generalizability of our findings. A change from the standard strategy of ovulation induction in patients with PCOS is not advisable, because a statistically superior effect of the extended LE regimen over a conventional regimen was not detected. The extended LE regimen could be applied with caution in a specific population who failed to respond to a conventional regimen rather than all the patients with PCOS during ovulation induction. Additional prospective trials with larger sample sizes and different PCOS subgroups are needed to assess the ovulatory effects of various LE treatment durations. This study was funded by the Shanghai First Maternity and Infant Hospital, affiliated with Tongji University School of Medicine (grant numbers: 2023B03 to Y.F., 2023B18 to X.Z., and 2020RC02 to Y.F.). The authors report no conflicts of interest. Chinese Clinical Trial Registry (ChiCTR2100042082). 13 January 2021. 21 January 2021.

Evaluation of Inflammation Markers and Pregnancy Outcomes of Patients Undergoing Intrauterin Insemination (IUI) for Unexplained Infertility

Aim: This study aimed to compare the inflammatory markers in patients who had ovulation induction with clomiphene citrate (CC) and who underwent intrauterine insemination (IUI) due to unexplained infertility in patients who could get pregnant and who could not. Materials and Method: The study included 125 females with unexplained infertili-ty who underwent ovulation induction with CC and who underwent IUI at the Health Sciences University Ankara Etlik Zübeyde Hanım Gynecology Training and Research Hospital Assisted-Reproduction Therapy Clinic between July 2019 and December 2019. Of the patients, 104 (83.2%) of them could not get pregnant as a result of IUI, and 21 (16.8%) females got pregnant. Hemogram parameters collected from patients on the day of IUI were recorded. Results: In terms of age, infertility duration, BMI, gravida, parity, number of living children, abortion and stillbirth numbers, no statistically significant difference was found between the two patient groups which were created based on getting pregnant or not (p>0.05). No significant difference was found between the groups in terms of serum estrogen, progesterone, follicle-stimulating hormone (FSH), luteinizing hor-mone (LH), thyroid stimulating hormone (TSH), prolactin, and anti-mullerian hor-mone (AMH) levels, hemoglobin, BM, neutrophil count, lymphocyte count, platelet count, MPV, CRP, and P/L ratio (p>0.05). A statistically significant difference was found in terms of N/L ratio (p

Effect of endometrial injury on pregnancy outcomes in infertile women undergoing intrauterine insemination.

One of the most common treatments for infertility is intrauterine insemination (II). The objective of this study was to determine the effect of endometrial injury on pregnancy outcomes in unexplained infertility in women undergoing II. In this randomized clinical trial, 122 women with unexplained infertility who were referred to Shariati Hospital from 2018 to 2020 were enrolled. They underwent ovulation induction using letrozole and gonadotropins. On day 9 of stimulation, they were randomly assigned to two similar groups of the same size. The first group underwent endometrial local injury by pipelle endometrial sampling, and the second group (control group) received no intervention. Only 1 II cycle was performed for each patient. Patients with negative pregnancy outcomes were followed up for 3 months. Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, miscarriage rate, and spontaneous pregnancy rate after the II cycle were compared between the two groups. Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, and miscarriage rate in the same II cycle were not different between the two groups (p>0.05). However, the spontaneous pregnancy rate after the II cycle was significantly higher in the endometrial injury group (p=0.02). Endometrial injury increases pregnancy rates in later cycles but not in the same II cycle.

The efficacy and safety of vitamin D supplementation in women with polycystic ovarian syndrome undergoing ovulation induction using letrozole.

Aim: To examine the role of vitamin D supplementation in PCOS women who failed to ovulation induction by letrozole in previous trials. Materials and Methods: The study included 30 women diagnosed with PCOS and were complaining from primary infertility. Those women had previously been treated for 3 months with letrozole to induce ovulation, but there was failure of response to treatment. Those 30 women were selected from a pool of women who were evaluated for serum vitamin D and were proved to have vitamin D def i ciency (<20 ng/ml). Results: Daily monitoring of ovulation by transvaginal ultrasound was done staring from day 7 till day 25 of the cycle. The main outcomes were the number and the size of follicles. In addition, they were followed up for evidence of pregnancy using biochemical serum and urine examination. Conclusions: When women with polycystic ovarian syndrome are treated with letrozole, vitamin D supplementation enhances both the result of ovulation induction and pregnancy.

Summer versus winter: the impact of the seasons on oocyte quality in in vitro fertilization cycles.

The aim of this study was to determine the effects of seasons (winter vs. summer) on oocyte quality in infertile women undergoing ovulation induction for in vitro fertilization. This retrospective cross-sectional study assessed 155 cycles of in vitro fertilization-induced ovulation in women, with 71 and 84 cycles occurring in the summer and winter, respectively. Oocytes were evaluated for quality, with 788 and 713 assessed during summer and winter, and classified according to Nikiforov's categories: (a) category I, good quality; (b) category 2, medium quality; and (c) category 3, low quality. Thickened zona pellucida (p<0.001), increased perivitelline space (p<0.001), oocyte shape abnormalities (p=0.01), and the presence of refractile bodies (p<0.0001) were more frequent in the summer cycles, whereas cytoplasmic granularity (p<0.001) was more frequent in the winter cycles. In winter, we observed a higher frequency of category 3 (p<0.001) and category 2 (p<0.001) oocytes and a lower frequency of category 1 (p<0.001) oocytes. Oocyte dysmorphisms were found in 70-80% of cases and were more common in winter. The main features include a thickened zona pellucida, enlarged perivitelline space, irregular shape, and cytoplasmic granularity. This implies better-quality oocytes in the summer than in the winter. However, retrospective studies have limitations due to data collection biases and potential confounding variables such as diet and exercise. Future research is needed to confirm these findings and explore the underlying mechanisms.

Oncologic, fertility, and obstetric outcomes with MPA therapy in women with endometrial cancer and atypical endometrial hyperplasia.

Medroxyprogesterone acetate (MPA) is one of the treatments of atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) to preserve the fertility. Efficacy of MPA therapy and fertility and obstetric outcomes after remission were evaluated in EC or AEH patients. Among patients diagnosed with EC or AEH at Tokushima University Hospital between January 2002 and October 2020, we retrospectively analyzed patients, ages range from 26 to 40, who underwent conservative management using MPA (400-600 mg/day). In total, 19 patients underwent MPA therapy. The 18 (94%) patients achieved complete response (CR), and 1 (5%) patient achieved partial response (PR). Relapse occurred in 6 (32%) patients who had achieved CR. Of the patients who relapsed, 4 patients resumed MPA therapy and were in remission. Among 19 patients, 13 patients attempted pregnancy after CR. All of them underwent ovulation induction or assisted reproductive technology. As a result, 20 pregnancies in 10 (77%) patients and 12 live births in 9 (69%) patients were achieved. Rate of spontaneous abortion was 35% (7/20). MPA therapy can produce a high remission rate, and be considered an effective treatment for patients who wish fertility preservation. Around 70% patients who attempt to pregnancy can have at least one baby by infertility treatments. Because recurrence rate after MPA therapy is high, it may be desirable to aim for early pregnancy by active intervention.

Iatrogenic Ovarian Hyperstimulation Syndrome in Late Luteal Phase – A Rare Case Report

Ovarian hyperstimulation syndrome is an iatrogenic medical complication unique to stimulatory infertility treatment.Characteristics of the syndrome include cystic ovarian enlargement, increased capillary permeability resulting in extravascularfluid accumulation, and intravascular volume depletion. It is a self-limiting disease in mild cases but can cause renal failure,hydrothorax, and respiratory distress that can cause mortality in severe cases. In this case, we aimed to report moderateovarian hyperstimulation (grade 3) syndrome, ultimately resulting in ovarian torsion and salphingo oophorectomy. Casepresentation-A 29-year-old female known case of polycystic ovarian syndrome underwent ovulation induction 22 days later. Shepresented to our hospital with severe abdominal pain, abdominal distension, and vomiting. She was admitted and diagnosed withGrade 3 Ovarian hyperstimulation syndrome medical management, given the patient got better symptomatically. 10 days later,she presented in casualty with abdominal pain and was diagnosed with right ovarian torsion and right salphingo oophorectomydone. Conclusion: We should rule out risk factors for ovarian Hyperstimulation syndrome before treating any infertility patient.Patients with ovarian hyperstimulation syndrome must be identified early and referred urgently to a tertiary care hospital.Ovarian hyperstimulation syndrome can result in serious morbidity and mortality if left untreated

Adjuvant letrozole administration in gonadotropin releasing hormone antagonist cycles do not affect ploidy status of embryos

ObjectiveTo evaluate the effects of adjuvant letrozole administration on euploid embryo rates in gonadotropin releasing hormone (GnRH) antagonist cycles. MethodsThis retrospective study was conducted by analyzing data of patients that underwent GnRH antagonist cycles with intra-cytoplasmic sperm injection (ICSI) and pre-implantation genetic testing for aneuploidy between 2013 and 2021. Study included a total of 713 patients which 84 of them were received adjuvant letrozole and 629 patients underwent ovulation induction without any adjuvant therapy. ResultsIn patients with letrozole administration, total dose of consumed gonadotropins were significantly lower (2166.80 ± 738.82 IU vs. 2541.96 ± 755.76 IU; p < 0.001, respectively), and duration of stimulation was slightly longer (9.80 ± 1.23 days vs. 9.53 ± 1.38 days; p = 0.037) in comparison to patients without letrozole administration. Overall euploidy rates were found similar among letrozole group and control group (28.02 % ± 31.08 % vs. 23.02 % ± 30.87 %; p = 0.109). Similar rate of euploidy remained even after stratification of patients in accordance with female age. There was no significant difference in terms of live birth rates between letrozole administered group and control group (66.7 % vs 62.2 %, respectively). ConclusionCo-treatment with 5 mg/day letrozole for 5 days does not appear to affect euploidy rates of obtained embryos in GnRH antagonist cycles with ICSI.

THU627 Fertility Outcomes And Anti Mullerian Hormone Levels In Women With Hypopituitarism

Abstract Disclosure: V.W. Fitz: None. C.O. Sailer: None. I. Remba-Shapiro: None. N. Bomani Gonzalez: None. W. Pierre: None. C. Bormann: None. I. Souter: None. L.B. Nachtigall: None. Background: Disruption of the hypothalamic-pituitary-gonadal (HPG) axis due to pituitary gland disorders presents a challenge for patients who desire conception. Women with hypopituitarism often require assisted reproductive technology (ART) to conceive. Anti-Mullerian Hormone (AMH) has been established as a marker of ovarian reserve in patients with normal HPG function, however, levels in women with hypopituitarism have not been reported. In this cohort, we investigate pre-conception AMH levels, reproductive treatments and fertility outcomes in women with hypopituitarism. Methods: We reviewed a large database and identified 19 patients with hypopituitarism who had undergone fertility treatment and 142 age-matched controls with male factor infertility. Clinical characteristics and AMH levels are shown using mean (SD) or median (IQR). AMH ratio using the lower limit of normal as denominator is used to normalize to the reference range as several assays with different reference ranges were used during the timeframe of data collection. Mann-Whitney U was used to compare AMH levels. A p value of &amp;lt;0.05 was considered statistically significant. Results: Patients with hypopituitarism and controls had a mean age of 33.4 years (2.5) and 33.3 years (2.2) p=0.857, at initial fertility evaluation, respectively. 17/19 (89.5%) patients in the hypopituitarism group experienced spontaneous menarche and had a post-pubertal onset of hypopituitarism. Hormonal deficiencies included GH (9), ACTH (8), TSH (10), FSH/LH (13), and vasopressin (3). Causes of hypopituitarism included 8 pituitary adenomas (7 functioning and 1 non-functioning), 3 Rathke’s cleft cysts, 4 intracranial neoplasms, 2 congenital or idiopathic hypopituitarism and 1 intracranial trauma. Median AMH level was 2.60 ng/mL (0.90-3.50) vs. 3.48ng/mL (1.99-4.70) p=0.017, and AMH ratio was 3.11ng/mL (1.13-4.17) vs. 4.11ng/mL (2.60-6.25) p=0.070, in the hypopituitary group and in controls, respectively. Among the 19 patients with hypopituitarism, 13 underwent ovulation induction (OI) with intrauterine insemination (IUI) or timed intercourse (TIC), 12 underwent in vitro fertilization (IVF), and 6 were treated with both OI and IVF. 18/19 (94.7%) conceived and 16/19 (84.2%) had a livebirth. Four patients (21%) conceived spontaneously. Among the patients who underwent OI, 4/13 (30.8%) had ≥1 livebirth with a median of 2 cycles (range 1-4) until first birth. Among the patients who underwent IVF, 10/12 (83.3%) had ≥ 1 livebirth with a median of 1.50 cycles (range 1-4) until first birth. Conclusions/Impact: Patients with hypopituitarism conceive through a variety of assisted reproductive technologies and may conceive spontaneously. Overall, AMH levels are comparable to age matched controls. Reproductive interventions among women with hypopituitarism are successful, with most patients achieving at least one livebirth. Presentation: Thursday, June 15, 2023

The Value of Anti-Müllerian Hormone in Predicting Ovulation Induced by Aromatase Inhibitors in Women With Polycystic Ovary Syndrome

ObjectivesThis study aimed to evaluate the value of anti-Müllerian hormone (AMH) in predicting ovulation induced by aromatase inhibitors (AI) and pregnancy outcomes in women with polycystic ovary syndrome (PCOS). MethodsFrom January 2018 to December 2020, this prospective cohort study enrolled women with PCOS aged between 18 and 45 years who underwent ovulation induction using AI protocol and intrauterine insemination (IUI) for infertility at a Center for Reproductive Endocrinology and Infertility, University Hospital. Receiver operating characteristic curves were used to estimate the chance of ovulation responses and pregnancy outcomes. ResultsIn total, 64% of 65 women with PCOS were recruited following AI treatment, and the clinical pregnancy rate was 19.4% following IUI. Patients who experienced ovulation had a lower mean serum AMH concentration than non-responders (7.11 ng/mL vs. 8.95 ng/mL, respectively), but the difference was not statistically significant. Between the pregnancy and non-pregnancy groups, statistically significant differences in AMH concentrations were observed (8.71 ng/mL vs. 6.73 ng/mL, respectively, P = 0.040). The area under the curve of the receiver operating characteristic for non-ovulation prediction was 0.445, 95% CI (0.284–0.606) with P = 0.467, and for clinical pregnancy was 0.735, 95% CI (0.561–0.910) with P = 0.104. ConclusionsIn women with PCOS, the AMH level does not predict ovarian responsiveness to AI treatment, but it does predict the success of IUI cycles.

Comparison of the efficacy of Lecirelin and hCG for ovulation induction in mares

Ovulating agents are very useful drugs in equine breeding, hCG being the first intention molecule, whereas GnRH agonists are especially interesting for any mare immunized against hCG, like repeat breeders and embryo donor mares. In Europe, no long acting GnRH agonist is available in veterinary practice. Saline solutions of buserelin or triptorelin, which is only available for human treatments in Europe are commonly used for equine ovulation induction (Dordas-Perpinya et al. Reprod. Dom. Anim. 2020; 55:374-383). An alternative, Lecirelin which is licensed in cattle and rabbits, has been evaluated in donkeys (Carluccio et al. Therio. 2007;68:914-919). The aim of our study was to compare the efficacy of lecirelin with hCG in horses. Forty mares underwent ovulation induction on four consecutive cycles, two cycles with hCG and two cycles with lecirelin, including one spontaneous estrus and one following chemical luteolysis. Mares were examined on a daily basis to check ovarian follicles diameter, uterine edema, and cervical softening. Once they presented a preovulatory follicle over 35 mm, and uterine edema (>=2) (Mc Kinnon. Equine diagnostic ultrasonography. 1998; 79-102) and a soft cervix, they were randomly injected with saline solution containing 200 µg of Lecirelin or 1500 IU of hCG intravenously. After induction, they were scanned every 12 hours until ovulation. Mares were inseminatedwith a mix of fresh semen of two fertile stallions 20 hours after induction on the spontaneous cycles. Pregnancy diagnosis was performed at day 12 and day 14. As each mare is her own control, statistical analysis was performed by χ², Fisher's test and Student's test for matched data. Follicle size at injection did not differ significantly between the two induction treatments (p>0,05), with or without distinction of spontaneous and induced cycles. Rates of ovulation in the 24-48 hours post-injection did not significantly differ between lecirelin (71%) and hCG (83%) on estrus following chemical luteolysis (p>0,05) or spontaneous estrus (43% for lecirelin and 68% for hCG) (p>0,05). We observed significantly more spontaneous ovulations occurring within the first 24 hours after induction with hCG (27% on spontaneous estrus, and 15% after chemical luteolysis) than with lecirelin (5% on spontaneous estrus, 7% after chemical luteolysis) (p < 0,05). Pregnancy rates were not significantly different following induction by lecirelin (67%) or hCG (57%) (p>0,05). These results highlight the usefulness of saline solution of lecirelin licensed in Europe for bovine and rabbit for induction and synchronization of ovulation for mares with control cycles. Lecirelin may be particularly suitable for embryo donor mares with a reduced hCG response.

Successful in vitro fertilization following conservative surgery for synchronous endometrioid tumor of ovary and uterus

BackgroundSuccessful pregnancy outcome in women with synchronous ovarian and endometrial cancers is very rare. We report successful pregnancy outcome in a young woman managed conservatively for synchronous endometrial and ovarian cancer.Case presentationThirty years old nulliparous lady presented following exploratory laparotomy, left salpingo-oophorectomy and hysteroscopic polypectomy for left adnexal mass. Histology revealed endometrioid carcinoma of left ovary and moderately differentiated adenocarcinoma in the resected polyp. She underwent staging laparotomy along with hysteroscopy which confirmed above findings without any evidence of further tumor spread. She was treated conservatively with high dose oral progestin (megestrol acetate, 160 mg) and leuprolide acetate 3.75 mg monthly injections for three months along with four cycles of carboplatin and paclitaxel based chemotherapy followed by monthly injection of leuprolide for further three months. After failure of spontaneous conception, she underwent ovulation induction for six cycles along with intrauterine insemination which failed. She underwent in vitro fertilization with donor egg followed by elective cesarean section at 37 weeks of gestation. She delivered a healthy baby of weight 2.7 kg. Intraoperatively 5 × 6 cm right ovarian cyst was found which drained chocolate coloured fluid on puncture and cystectomy was carried out. Histological examination revealed endometrioid cyst of right ovary. Uterus was spared as she wanted to preserve her fertility. She is being followed periodically and is normal nine months following delivery. She is on injection Depot medroxy progesterone acetate once every three months.

The importance of infertility duration and follicle size according to pregnancy success in women undergoing ovulation induction with gonadotropins and intrauterine insemination

In this study, we aimed to evaluate the effect of infertility duration and dominant follicle size measured on the day of human chorionic gonadotropin (HCG) administration on pregnancy rates in infertile women undergoing ovulation induction (OI) with gonadotropin (GND). A total of 352 patients aged 20 to 41 years who were diagnosed with unexplained infertility or polycystic ovary syndrome (PCOS) were included in this study. Patients with a history of multifollicular development or follicle stimulating hormone (FSH) value more than 12 IU/ml were excluded from the study. The demographic and clinical features of the patients were obtained from the patients’ files and hospital automation system and recorded for each woman. The demographic and clinical features of the patients were recorded. Patients were divided into two groups as live birth (group 1, n = 47) and non-live birth groups (group 2, n = 305). There were no statistically significant differences in regard to age, infertility type, follicle stimulating hormone (FSH) level, oestradiol (E2) level, antral follicle count (AFC), cycle characteristics, GND type, number of follicles, E2 level and endometrial thickness on HCG day, total GND dose, dominant follicle size (p > 0.05). Infertility duration in group 1 was 3.5 ± 2.1; in group 2, 4.7 ± 3.9 years. This difference was statistically significant (p = .014). According to this study, live birth rates after GND + IUIs(intrauterine insemination) were significantly affected by the duration of infertility. But the dominant follicle size and endometrial thickness measured on HCG day in GND and IUI cycles did not have a significant effect on pregnancy rates. IMPACT STATEMENT What is already known on the subject? It is thought that the timing of the ovarian triggering is vital for the success of intrauterine insemmination (IUI) treatment. What do the results of this study add? According to our results live birth rates after GND + IUIs were significantly affected by the duration of infertility. What are the implications of these findings for clinical practice and/or further research? It is determined that the duration of infertility is significant and patients should be encouraged to the treatment as soon as possible.

Ovarian Response can be Predicted in Women with PCOS who have Ovulation Induction with Letrozole

To compare the clinical, metabolic, and hormonal characteristics of patients with and without selected dominant follicles in infertile women with PCOS who used letrozole for ovulation induction. A descriptive cohort study. Department of Obstetrics and Gynaecology of Bagcilar Research and Training Hospital, Istanbul, Turkey, from October 2019 to November 2021. Eighty-eight female patients with PCOS, who underwent ovulation induction by giving 5mg/day letrozole, were screened for demographic characteristics, laboratory values, and dominant follicle development. Those who were given letrozole as the first treatment agent, those who took clomiphene citrate (CC) and started letrozole the following month, and those who were treated with letrozole and given letrozole again were recorded separately. Seventy-five patients responded to letrozole and developed a dominant follicle; 13 patients did not develop a dominant follicle. Threshold values were determined for statistically significant parameters between patients with and without dominant follicles. Follicle development occurred in 85.2% of the women. A statistically significant variable in clinical and metabolic values, between ovulating and non-ovulating groups could not be found. There was a significant difference between the two groups for the serum AMH value, total testosterone value, and FSH level. The authors found that follicle response was higher in those with AMH values less than 11.89ng/mL, FSH levels higher than 6.25Iu/L, and total testosterone less than 0.96ng/mL. In this study, the pregnancy rate was found to be lower than in the literature(11%). Among the women with PCOS who had ovulation induction with letrozole, follicle development was higher in women with lower FSH, androgen and AMH values. Letrozole, Aromatase inhibitor, Androgens, Ovulation induction, AMH.

Deep Learning Based Two-Dimensional Ultrasound for Follicle Monitoring in Infertility Patients

Abstract Background: A two-dimensional (2D) ultrasound examination is the primary technique for follicle monitoring, but 2D ultrasound follicle monitoring has significant inter- and intra-observer variability in the measurement of follicle diameter. The aim of this study was to propose a novel deep learning-based automated model for accurate 2D ultrasound follicle monitoring and validate the reliability and repeatability in clinical practice. Methods: A prospective trial including 300 infertile women undergoing ovulation induction (single follicle cycles) or controlled ovarian hyperstimulation (multiple follicle cycles) was conducted in the reproductive center. After 2D ultrasound image acquisition, the mean diameter of each targeted follicle was measured using an automated model, experts, and a novice. Designating the expert assessment as the gold standard, the reliability and repeatability of the automated model for single and multiple follicle cycles were evaluated using the intraclass correlation coefficient and Bland-Altman plots. Results: A total of 228 and 1065 follicles from single and multiple follicle cycles, respectively, were included. The accurate recognition rate of follicle boundaries using the automated model was 0.931. The inter-observer variability of follicle mean diameter measurements in single and multiple follicle cycles were 0.970 and 0.984 for the automated model and experts, and 0.965 and 0.978 for a novice and experts, respectively. Bland-Altman plots showed that 95% limits of agreement for follicle diameter measurement between the automated model and experts (−2.02 to 2.39 mm and −0.68 to 1.50 mm) was lower than a novice and experts (−1.69 to 2.74 mm and −0.58 to 1.73 mm) for both single and multiple follicle cycles. The intraclass correlation (ICC) of follicle diameters ≥10 mm calculated by the automated model was significantly higher than follicle diameters &lt;10 mm in multiple follicle cycles (0.834 vs. 0.609). There were no significant differences between the two groups in single follicle cycles (0.967 vs. 0.970). Conclusion: A deep learning-based automated model provides an accurate and fast approach for novices to improve the reliability and receptivity of 2D ultrasound follicle monitoring, especially in multiple follicle cycles and for follicles with a mean diameter ≥ 10 mm.

Estrogen in Luteal Phase Support: Effects on IVF-ICSI Antagonist Protocol Pregnancy Results

Aim: This study aimed to investigate the effect of luteal phase support (LPS) with estradiol in addition to progesterone on pregnancy outcomes in patients who underwent ovulation induction with GnRH antagonist protocol in in vitro fertilization- intracytoplasmic sperm injection (IVF-ICSI).&#x0D; Materials and Methods: This retrospective study was carried out at reproductive medicine center of Necmettin Erbakan University Meram Medical Faculty. The study enrolled 128 patients undergoing ICSI on an antagonist protocol for controlled ovarian hyperstimulation. Study group administered 7.8 mg transdermal estradiol (E2) daily in addition to progesterone for LPS (n=64). Control group administered only progesterone for LPS (n=64). All women received 200 mg progesterone 3x1 intravaginal daily and 50 mg progesterone intramuscular injection per two days for LPS. Blood samples were drawn 12 days after embryo transfer for β-hCG. If the result is negative, treatment was discontinued, if positive, estradiol was discontinued and progesterone support was continued until the 10th week of gestation. Pregnancy outcomes were the main endpoint.&#x0D; Results: There was no difference between groups in terms of biochemical pregnancy, clinical pregnancy, abortus and ongoing pregnancy rates.&#x0D; Conclusion: In our study, the use of estrogen for luteal phase support in GnRH antagonist protocol did not show any difference on pregnancy outcomes.

Association of anti-mullerian hormone and free androgen index level on response to clomiphene citrate in PCOS infertile women

BackgroundPolycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility. Clomiphene citrate, insulin-sensitizing drugs, aromatase inhibitors, gonadotropins, or laparoscopic ovarian drilling are various methods used for ovulation induction in women with PCOS. PCOS women with high levels of anti-mullerian hormone (AMH) and free androgen index (FAI) do not respond well to ovulation induction. This prospective observational study explores the relationship between FAI and AMH levels on ovarian response to clomiphene citrate in infertile women with PCOS. MethodsThis prospective observational study included 40 infertile with PCOS who underwent ovulation induction with clomiphene citrate with dose ranging from 50 to 150 ​mg. Participants were classified into four phenotypes by NIH(National Institute of Health) consensus panel criteria. The clinical and endocrine parameters of participants who were sensitive to clomiphene were compared to those who were resistant. ResultsThe most common phenotype was A, with all three features of PCOS: hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. There was no significant difference in clinical and endocrine parameters among the different phenotypes of PCOS except AMH and FAI values. The mean FAI was 9.39 ​± ​1.11 and AMH 7.26 ​± ​0.48 (ng/ml) in clomiphene resistant and 5.31 ​± ​1.93 and 3.69 ​± ​1.84 (ng/ml) respectively in clomiphene-sensitive women. Women with FAI > 7.5 and AMH >7 ​ng/ml might be resistant to clomiphene. ConclusionFAI and AMH values were significantly higher in women resistant to clomiphene induction. AMH and FAI may help women with PCOS to tailor their ovulation induction protocol.

The association between serum fatty acids and pregnancy in PCOS women undergoing ovulation induction

Background Long-term dietary fat intake is thought to affect metabolism and pregnancy of polycystic ovary syndrome (PCOS) patients, and the type of fatty acids one consumes plays an important role. Previous studies mostly used questionnaires to analyze the type and proportion of fatty acids. Methods This prospective study included 91 PCOS patients. Serum fatty acids were measured by the gas chromatograph-mass spectrometry method before ovulation induction. We compared the fatty acids between the pregnancy group and the nonpregnancy group and explored the influence of the fatty acids on live births and pregnancy loss. Results Nervonic acid was lower in the pregnancy group than in the nonpregnancy group (0.25% vs. 0.30%, p = .017). The following trans-fatty acids were significantly lower in the pregnancy group than in the nonpregnancy group: trans-10-heptadecenoic acid, trans-vaccenic acid, trans-11-eicosenoic acid, and brassidic acid. The level of polyunsaturated fatty acids in the live birth group was significantly higher than the pregnancy loss group (16.95% vs. 15.10%, p = .039). Among individual PUFAs, the levels of linoleic acid (p = .043), docosapentaenoic acid (p = .024), alpha-linolenic acid (p = .042), and eicosapentaenoic acid (p = .035) were higher in the live birth group than in the pregnancy loss group. After adjusting for infertility duration, age, and body mass index, our findings suggested an inverse association between pregnancy and nervonic acid, trans-10-heptadecenoic acid, trans-vaccenic acid, trans-11-eicosenoic acid, and brassidic acid and pregnancy. Conclusions Our findings indicate that polyunsaturated fatty acids are associated with live birth in PCOS patients. Serum trans-fatty acids and nervonic acid might be risk factors for nonpregnancy. The mechanism of the influence of different fatty acids on pregnancy and live birth merits further exploration.