Purpose
The aim of this study is to assess the effect of the endometrial thickness and embryo quality on the implantation potential in natural cycle IVF (NC-IVF).
Methods
A retrospective ...single-center study was performed on 552 single embryo transfers after NC-IVF. The ‘quality' of the embryos was evaluated trough the number and regularity of blastomeres, degree of fragmentation, and nuclear content of cells. Endometrial thickness was measured in millimeters with transvaginal ultrasound on the day of hCG application.
Results
Our findings showed a statistically significant difference in successful implantation until a plateau of 10 mm is reached (
p
= 0.001). Only one pregnancy was achieved where endometrial thickness was less than 7 mm, and this resulted in an early miscarriage. The predictors of favorable implantation were fragmentation (≤ 10%,
p
< 0.05) and the number of blastomeres (preferably 8-cell,
p
< 0.01) on day 3. Embryo quality (
R
= 0.052) and endometrial thickness (
R
= 0.18) were closely related to pregnancy rate. The overall implantation rate per embryo transfer was 18.8%.
Conclusions
Embryo quality and endometrial thickness have a significant impact on implantation in NC-IVF. Highest implantation potential has an 8-cell embryo with ≤ 10% fragmentation in the third day following oocyte retrieval. Endometrial thickness of at least 7 mm seems to be the optimal edge of successful pregnancy.
The aim of the study was to investigate whether altered adipose tissue secretion of various adipokines is secondary to obesity, hyperandrogenism, and hyperinsulinemia or intrinsic to polycystic ovary ...syndrome (PCOS). This cross-sectional study included 151 women diagnosed with PCOS by the Rotterdam criteria and 95 healthy women matched by age, body mass index (BMI), and waist-to-hip ratio (WHR). Clinical, biochemical, and hormonal characteristics were assessed. Serum concentrations of ghrelin and adiponectin were found to be significantly lower and concentrations of leptin and resistin significantly higher in women with PCOS than in healthy women matched by age, BMI, and WHR. A PCOS diagnosis made the largest contribution to predicting serum levels of leptin, adiponectin, resistin, and ghrelin in all stepwise multiple regression models, which included PCOS diagnosis, BMI, WHR, luteinizing hormone, total testosterone, free testosterone and homeostatic model assessment of insulin resistance as independent predictors. Leptin, adiponectin, ghrelin and resistin levels may serve as independent biomarkers for the diagnosis of PCOS.
The role of macroprolactinemia in women with hyperprolactinemia is currently controversial and can lead to clinical dilemmas, depending upon the origin of macroprolactin, the presence of ...hyperprolactinemic symptoms and monomeric prolactin (PRL) levels. Macroprolactinemia is mostly considered an extrapituitary phenomenon of mild and asymptomatic hyperprolactinemia associated with normal concentrations of monomeric PRL and a predominance of macroprolactin confined to the vascular system, which is biologically inactive. Patients can therefore be reassured that macroprolactinemia should be considered a benign clinical condition, resistant to antiprolactinemic drugs, and that no diagnostic investigations or prolonged follow-up should be necessary. However, a significant proportion of macroprolactinemic patients appears to suffer from hyperprolactinemia-related symptoms and radiological pituitary findings commonly associated with true hyperprolactinemia. The symptoms of hyperprolactinemia are correlated to the levels of monomeric PRL excess, which may be explained as coincidental, by dissociation of macroprolactin, or by physiological, pharmacological and pathological causes. The excess of monomeric PRL levels in such cases is of primarily importance and the diagnosis of macroprolactinemia is misleading or inadequate. However, macroprolactinemia of pituitary origin associated with radiological findings of pituitary adenomas may rarely occur with similar hyperprolactinemic manifestations, exclusively due to bioactivity of macroprolactin. Therefore, in such cases with hyperprolactinemic signs and pituitary findings, macroprolactinemia should be considered a pathological biochemical condition of hyperprolactinemia. Accordingly, individualized diagnostic investigations with the introduction of dopamine agonists, or other treatment with prolonged follow-up, should be mandatory. The review analyses the laboratory and clinical significance of macroprolactinemia in hyperprolactinemic women suggesting clinically useful diagnostic and treatment strategies.
Although breast cancer (BC) occurs more often in older women, it is the most commonly diagnosed malignancy in women of childbearing age. Owing to the overall advancement of modern medicine and the ...growing global trend of delaying childbirth until later age, we find ever more younger women diagnosed and treated for BC who have not yet completed their family. Therefore, fertility preservation has emerged as a very important quality of life issue for young BC survivors. This paper reviews currently available options for fertility preservation in young women with early-stage BC and highlights the importance of a multidisciplinary approach to fertility preservation as a very important quality of life issue for young BC survivors. Pregnancy after BC treatment is considered not to be associated with an increased risk of BC recurrence; therefore, it should not be discouraged for those women who want to achieve pregnancy after oncologic treatment. Currently, it is recommended to delay pregnancy for at least 2 years after BC diagnosis, when the risk of recurrence is highest. However, BC patients of reproductive age should be informed about the potential negative effects of oncologic therapy on fertility, as well as on the fertility preservation options available, and if interested in fertility preservation, they should be promptly referred to a reproductive specialist. Early referral to a reproductive specialist is an important factor that increases the likelihood of successful fertility preservation. Embryo and mature oocyte cryopreservation are currently the only established fertility preservation methods but they require ovarian stimulation (OS), which delays initiation of chemotherapy for at least 2 weeks. Controlled OS does not seem to increase the risk of BC recurrence. Other fertility preservation methods (ovarian tissue cryopreservation, cryopreservation of immature oocytes and ovarian suppression with gonadotropin-releasing hormone agonists) do not require OS but are still considered to be experimental techniques for fertility preservation.
INFLUENCE OF MALE OBESITY ON FERTILITY Kasum, Miro; Anić-Jurica, Sonja; Čehić, Ermin ...
Acta clinica Croatica (Tisak),
06/2016, Volume:
55, Issue:
2
Journal Article
Peer reviewed
Open access
The aim of this review is to analyze current diagnostic approaches to obesity in
adult men, the potential mechanisms linking obesity to infertility, and treatment options aimed at
improving ...reproductive health. Obesity has become a worldwide epidemic with the estimated prevalence
increasing from 28.8% to 36.9% between 1980 and 2013. In terms of diagnosis, numerous
simple techniques have been developed including body mass index, waist to hip ratio, waist circumference,
bioelectrical impedance analysis, ultrasound and skinfold measurements. Additionally, several
other less available but more accurate techniques have been suggested, such as air displacement plethysmography,
dual energy x-ray absorptiometry, computed tomography and magnetic resonance imaging.
In addition to cardiovascular and other disorders, male obesity can negatively affect the male reproductive
potential through abnormal reproductive hormone levels, reduced semen quality, increased
release of adipose-derived hormones and adipokines, as well as thermal, genetic and sexual mechanisms.
In the management of obesity related male infertility, natural weight loss is the cornerstone and
regular exercise the first-line treatment. Although bariatric surgery results in greater improvements in
weight loss outcomes when compared to non-surgical interventions, further research is required to
clarify its overall influence on male fertility.
The aim of the review is to establish sexual and reproductive functions in men with spinal cord lesion (SCL). Many sexual and reproductive dysfunctions may be found in these patients including ...individual's low self-esteem, delay of orgasm, erectile or ejaculatory disorder and abnormalities of semen, which are characterized by lower sperm motility or viability. Owing to improvements in physical medicine and rehabilitation, the focus has been shifted from keeping patients alive towards ensuring the quality of life and improvements of sexual dysfunctions and later reproduction. Erectile dysfunction can be treated by using phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be retrieved from anejaculatory patients by medically assisted methods utilizing penile vibratory stimulation, electroejaculation, prostate mas-sage, or surgically. Although there is low chance for pregnancy in natural way in most of SCL pa-tients, fatherhood is possible through the introduction of assisted medical management. By use of various medical, technical and surgical procedures for sperm retrieval combined with assisted reproductive methods, high pregnancy rates have been reported comparable to those in able-bodied subfertile patients. Nevertheless, future studies are needed to improve semen quality and methods of assisted ejaculation in patients with SCL.
The purpose of this review is to analyze current medical strategies in the prevention
of ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation for in vitro fertilization.
Owing to ...contemporary preventive measures of OHSS, the incidence of moderate and severe
forms of the syndrome varies between 0.18% and 1.40%. Although none of medical strategies is
completely effective, there is high-quality evidence that replacing human chorionic gonadotropin
(hCG) by gonadotropin-releasing hormone (GnRH) agonists after GnRH antagonists and moderate-
quality evidence that GnRH antagonist protocols, dopamine agonists and mild protocols reduce
the occurrence of OHSS. Among various GnRH agonists, buserelin 0.5 mg, triptorelin 0.2 mg and
leuprolide acetate (0.5-4 mg) have been mostly utilized. Although GnRH trigger is currently regarded
as the best tool for OHSS prevention, intensive luteal support with exogenous administration
of estradiol and progesterone or low-dose hCG on the day of oocyte retrieval or on the day of GnRH
agonist trigger are required to achieve optimal conception rates due to early luteolysis. Among currently
available dopamine agonists, cabergoline, quinagolide and bromocriptine are the most common
drugs that should be used for prevention of both early and late OHSS. Mild stimulation protocols
offer attractive option in OHSS prevention with satisfactory pregnancy rates.
The aim of this review is to provide qualitative evidence-based synthesis regarding efficacy of luteal-phase support on fertility outcome in women undergoing in vitro fertilization (IVF) with respect ...to clinical or live birth rates and pregnancy loss rates. Although the need of luteal phase support in IVF/ICSI cycles is well-known, the optimal start, dosage, route and the duration of the luteal phase support is still subject of debate. Data suggest that the optimal period to start with the luteal phase support would be between 24-72 hours after oocyte-retrieval and should continue at least until a positive pregnancy test is achieved. However, the majority of IVF-centers worldwide provide progesterone support up to 8 weeks of pregnancy. Among the well-established routes of luteal support, oral dydrogesterone and subcutaneous progesterone represent new and interesting routes of progesterone administration. The current studies support these routes of progesterone administration use in terms of comparable pregnancy rates and pregnancy loss rates to vaginal and intramuscular progesterone. Furthermore, the acceptance and tolerability among patients seems to be even better. In the frozen-thawed embryo transfer, dydrogesterone and vaginal progesterone are not effective as monotherapy treatments; however, when combined there is no reason to avoid one or the other in this setting.
Occurrence of bilateral pneumothorax, pneumomediastinum and subcutaneous
emphysema during gynecologic laparoscopic procedure is very rare. We report a case of a 23-year-old
woman who developed ...bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema
during laparoscopic ovarian cystectomy. Carbon dioxide extravasations outside the peritoneal cavity
during laparoscopy may have fatal consequences. Careful monitoring, immediate diagnosis and proper
treatment are crucial for patient safety.
The purpose of this review is to present contemporary measures for preventing the
increase in preovulatory progesterone (P) and its adverse effects on ovarian stimulation in in vitro
fertilization ...(IVF). For the last 20 years, the increase of preovulatory P has been a topic of numerous
discussions because its role is not fully understood in terms of its impact on pregnancy outcome after
IVF. Some studies failed to establish a connection between the preovulatory P increase and successful
IVF outcome regardless of the level of P, while, conversely, most other studies have reported on adverse
effects of elevated P concentrations. Current strategies to prevent the increase in preovulatory P include
an individualized approach with the use of mild stimulation protocols and early application of
human chorionic gonadotropin for ovulation induction among good responders, delay in the transfer
of fresh embryos from 3rd to 5th day, and cryopreservation of all embryos with the thawed embryo
transfer in the natural cycle. Nevertheless, further studies are needed to confirm the current preventive
methods or enable the application of new strategies in order to lower or eliminate the detrimental
effects of preovulatory P rise during ovarian stimulation in IVF.
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