Fertility and Sterility RSS feed: Current Issue. Fertility and Sterility ® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility ® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.http://www.fertstert.org/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. Fertility and Sterility0015-0282933February 2010 © 2010 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.fertstert.org/article/PIIS0015028209039673/abstract?rss=yesObjective: To review variations in specific reproductive health outcomes by race and ethnicity. A growing number of reports have explored potential gaps in the quality of reproductive health and healthcare across racial and ethnic groups. Diverse results from numerous investigations have made it challenging for practitioners to confirm the significance of these disparities.Method(s): Three specific areas of the reproductive life cycle were examined: pubertal onset, outcomes from treatment with assisted reproductive technologies (ART), and the menopausal transition. These areas were selected as they encompass a continuum of events across the reproductive life span of women. Outcomes were compared in black, white, Asian, and Hispanic women. Medline searches querying on keywords puberty, IVF, ART, menopause, menopausal symptoms, racial disparity, race, Asian, Japanese, Chinese, African American, black, Hispanic, and Latino were performed to isolate relevant publications for review.Result(s): Differences across race and ethnicity were noted in each clinical endpoint. The most notable findings included earlier puberty in blacks and Hispanics compared with whites, significantly lower live birth rates after ART in all racial and ethnic groups compared with whites, and differences in perimenopausal symptomatology and possibly timing in various racial/ethnic groups compared with whites. Additional research is needed to completely unravel the full significance and basic underpinnings of these disparities. Some of the limitations of the current state of the literature in drawing conclusions about the independent effect of race/ethnicity on reproductive disparities include small samples sizes in some studies, inconsistencies in the characterization of racial/ethnic groups, and incomplete control of potential confounding.Conclusion(s): Race and ethnicity appear to be important correlates of outcomes from the initiation of reproduction functioning through to its conclusion. The ultimate goal of identifying racial disparities in reproduction is to isolate the basic determinants of disparities and formulate strategies to improve outcomes for women at risk. The differences demonstrated in this review of the literature could represent environmental, sociocultural, and/or genetic correlates of race that influence these important milestones.Racial and ethnic differences in reproductive potential across the life cycleSamantha F. Butts, David B. Seifer10.1016/j.fertnstert.2009.10.047Fertility and Sterility 93, 3 (2010)2009-11-24Fertility and Sterility2009-11-24933S0015-0282(10)X0002-4Modern trends681690http://www.fertstert.org/article/PIIS0015028208047262/abstract?rss=yesObjective: To review the existing options for preserving fecundity in young cancer patients, outlining the differences that exist in each individual cancer situation and how these affect our choice of fecundity-preserving measures.Design: Review the pathophysiology data on ovarian function that serve for outlining the advantages and/or drawbacks of certain fecundity-preserving measures such as ovarian freezing and emergency IVF. Provide support arguments for outlining the need for setting locally rooted cancer and fecundity task forces that throw the bases for a multidisciplinary approach in this field.Setting: Review of literature data.Patient(s): Women of reproductive age affected with different types of cancer.Main Outcome Measure(s): Outcome of selected emergency fertility preserving measures such as ovarian tissue freezing followed by grafting or emergency IVF.Result(s): When performed in the 30s—the typical age for breast cancer, the most frequently encountered cancer in women of reproductive age, ovarian freezing hampers ovarian recovery and the chances for spontaneous pregnancy.Conclusion(s): Based on a review of the different situations encountered, we recommend that fecundity-preserving measures offered to young cancer patients, including ovarian freezing and emergency IVF, emanate from multidisciplinary approaches.Cancer and fecundity issues mandate a multidisciplinary approachDominique de Ziegler, Isabelle Streuli, Ioannis Vasilopoulos, Christine Decanter, Pascale This, Charles Chapron10.1016/j.fertnstert.2008.12.028Fertility and Sterility 93, 3 (2010)2009-02-06Fertility and Sterility2009-02-06933S0015-0282(10)X0002-4Editor's corner691696http://www.fertstert.org/article/PIIS0015028208041290/abstract?rss=yesObjective: To ascertain whether increased bone turnover in depot medroxyprogesterone acetate (DMPA) users after peak bone mass is associated with bone mineral loss.Design: Three-year, observational, longitudinal study.Setting: General practice and family planning clinics.Patient(s): Women over age 34: established DMPA users (n = 23), discontinuers (n = 14), and controls (n = 27).Main Outcome Measure(s): Change in spine and hip bone mineral density (BMD).Result(s): Despite increased biochemical markers of bone turnover in DMPA users, there was no decrease in BMD. Bone turnover markers did not correlate with change in BMD.Conclusion(s): In established DMPA users, after peak bone mass, a single normal BMD measurement could provide reassurance for long-term use. Measurement of bone turnover does not predict bone loss in DMPA users.Depot medroxyprogesterone acetate use after peak bone mass is associated with increased bone turnover but no decrease in bone mineral densityJennifer S. Walsh, Richard Eastell, Nicola F. Peel10.1016/j.fertnstert.2008.10.004Fertility and Sterility 93, 3 (2010)2008-11-14Fertility and Sterility2008-11-14933S0015-0282(10)X0002-4Contraception697701http://www.fertstert.org/article/PIIS0015028208042064/abstract?rss=yesObjective: To analyze the value of the hCG ratio of peritoneal serum versus venous serum (RP/V) for early diagnosis and prognostic evaluation of ectopic pregnancy (EP).Design: Retrospective clinical study.Setting: University hospital.Patient(s): One hundred three women with hemoperitoneum and positive urine hCG tests underwent laparoscopy or laparotomy.Intervention(s): Venous serum and peritoneal serum samples were obtained; ultrasound was performed in all the patients; dilatation and curettage was used in 28 patients.Main Outcome Measure(s): Quantitative hCG and RP/V.Result(s): The RP/V in EP (5.55 ± 4.32) is apparently greater than that in hemoperitoneum with intrauterine pregnancy (hIUP; 0.61 ± 0.18). The median RP/V is 4.07 in the EP group versus 0.60 in the hIUP group, with a suggested threshold value of 1.0 for their differential diagnosis. Moreover, the RP/V of EP shows the dominant difference between the patients with active bleeding (8.03 ± 3.29, n = 24) and the patients without active bleeding (4.59 ± 3.88, n = 16) when the hCG level of venous serum is more than 1500 U/L.Conclusion(s): RP/V could instantly diagnose ectopic pregnancy and differentiate it from hIUP.Human chorionic gonadotropin ratio of hemoperitoneum versus venous serum improves early diagnosis of ectopic pregnancyYuDong Wang, Hong Zhao, YinCheng Teng, LiHua Lu, JianQian Tong10.1016/j.fertnstert.2008.10.013Fertility and Sterility 93, 3 (2010)2008-12-01Fertility and Sterility2008-12-01933S0015-0282(10)X0002-4Ectopic pregnancy702705http://www.fertstert.org/article/PIIS0015028208042052/abstract?rss=yesObjective: To evaluate differences in endometrial stromal cell (ESC) migration between patients with and without endometriosis.Design: Differences in ESC migration, cellular morphology, and cytoskeletal-actin dynamics were evaluated in response to platelet-derived growth factor-BB (PDGF-BB) and steroid hormones (17β-estradiol and progesterone).Setting: Medical school research laboratory.Patient(s): Endometrial biopsy samples obtained from 43 women: 23 as controls (endometriosis excluded by laparoscopy), 20 with severe or moderate endometriosis (diagnosed by laparoscopy).Intervention(s): ESCs were treated with and without PDGF-BB, 17β-estradiol, and progesterone.Main Outcome Measure(s): Cellular migration was evaluated by means of chemotaxis experiments in a Boyden chamber. Cellular morphology and cytoskeletal–actin dynamics were evaluated by immunofluorescence.Result(s): Progesterone stimulated the migratory behavior of ESCs derived from women with endometriosis, while 17β-estradiol could stimulate motility of ESCs derived from both controls and women with endometriosis, with a greater effect observed in the latter group. No difference in ESC migratory behavior after PDGF-BB treatment was observed between women with and without the disease. Also, PDGF-BB and steroid hormones could modify the organization of actin cytoskeletal structures.Conclusion(s): Ovarian steroids differently affect the migration of ESCs derived from women with and without endometriosis. This effect is likely to involve cytoskeletal reorganization. Nongenomic signaling pathways induced by steroid hormones might have a role in this phenomenon.Endometrial stromal cells from women with endometriosis reveal peculiar migratory behavior in response to ovarian steroidsDavide Gentilini, Paola Vigano, Edgardo Somigliana, Lucia Maria Vicentini, Michele Vignali, Mauro Busacca, Anna Maria Di Blasio10.1016/j.fertnstert.2008.10.014Fertility and Sterility 93, 3 (2010)2008-11-19Fertility and Sterility2008-11-19933S0015-0282(10)X0002-4Endometriosis706715http://www.fertstert.org/article/PIIS0015028208042015/abstract?rss=yesObjective: To identify prognostic factors for pain and endometrioma recurrence after complete laparoscopic excision of endometrioma(s).Design: Prospective observational study.Setting: Tertiary care university hospital.Patient(s): One-hundred sixty-six consecutive women affected by uni- or bilateral ovarian endometrioma(s).Intervention(s): Laparoscopic conservative treatment of endometriosis.Main Outcome Measure(s): Patient demographic characteristics, surgical findings, and surgical results were prospectively recorded. Postoperative follow-ups were carried out every 3 months to identify pain and/or endometrioma recurrence for a minimum of 3 years.Result(s): Dysmenorrheal, dyspareunia, and chronic pelvic pain recurred in 14.5%, 6%, and 5.4% of women, respectively. Prior surgery for endometriosis, adhesion extension, and use of ovarian stimulation drugs (OSD) were unfavorable prognostic factors for pain symptoms. Ovarian endometrioma recurred in 9.6% of cases; negative factors were prior surgery for endometriosis, OSD, pelvic adhesions, and high American Society for Reproductive Medicine disease scores. Postoperative pregnancy showed a significant protective effect on pain and disease recurrences.Conclusion(s): Prior surgery, presence of adhesions, and ovulation drugs are negative prognostic factors. Pregnancy has a protective effect on disease and pain recurrence.Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective studyMaria Grazia Porpora, Debora Pallante, Annamaria Ferro, Brenda Crisafi, Filippo Bellati, Pierluigi Benedetti Panici10.1016/j.fertnstert.2008.10.018Fertility and Sterility 93, 3 (2010)2008-12-04Fertility and Sterility2008-12-04933S0015-0282(10)X0002-4Endometriosis716721http://www.fertstert.org/article/PIIS0015028208042696/abstract?rss=yesObjective: To compare the sexual function of women with female genital mutilation (FGM) to women without FGM.Design: A prospective case-control study.Setting: A tertiary referral university hospital.Patient(s): One hundred and thirty sexually active women with FGM and 130 sexually active women without FGM in Jeddah, Saudi Arabia.Intervention(s): Women with and without FGM were asked to answer the Arabic-translated version of the female sexual function index (FSFI) questionnaire.Main Outcome Measure(s): The individual domain scores for pain, arousal, lubrication, orgasm, satisfaction, pain, and overall score of the FSFI were calculated.Result(s): The two groups were comparable in demographic characteristics. There were no statistically significant differences between the two groups in mean desire score (± standard deviation) or pain score. However, there were statistically significant differences between the two groups in their scores for arousal, lubrication, orgasm, and satisfaction as well as the overall score.Conclusion(s): Sexual function in women with FGM is adversely altered. This adds to the well-known health consequences of FGM. Efforts to document and explain these complications should be encouraged so that FGM can be abandoned.Sexual function in women with female genital mutilationSharifa A. Alsibiani, Abdulrahim A. Rouzi10.1016/j.fertnstert.2008.10.035Fertility and Sterility 93, 3 (2010)2008-11-24Fertility and Sterility2008-11-24933S0015-0282(10)X0002-4Infertility722724http://www.fertstert.org/article/PIIS0015028208044099/abstract?rss=yesObjective: To examine trends in use of medical services for infertility, by individual characteristics of women.Design: Pooled data from two cycles (1995 and 2002) of the National Survey of Family Growth, a periodically conducted, nationally representative, cross-sectional survey of women 15–44 years of age.Participant(s): The analysis sample was composed of 2,005 women 22–44 years of age with current fertility problems.Intervention(s): None.Main Outcome Measure(s): Ever having used infertility services, and highest level of services used.Result(s): Between 1995 and 2002, ever-use of infertility services by fertility-impaired women age 22–44 years continued to be closely associated with older age, nulliparity, formal marital status, and higher socioeconomic status (education, household income, and private health insurance). Net of these factors, race and Hispanic origin, showed no significant association with either the use of services overall or the highest level of services used. After controlling for compositional changes in these individual characteristics, a slight decline was seen in ever-use of services overall from 1995 to 2002. No effect of survey year was noted in the highest level of services.Conclusion(s): Infertility service use among fertility-impaired women remains closely tied with socioeconomic factors. The “threshold effect” of these factors has shifted upward to the receipt of more costly services such as assisted reproductive technologies. These higher level services remain a relatively small fraction of the services reported in a general population sample of fertility-impaired women.Infertility service use among U.S. women: 1995 and 2002Anjani Chandra, Elizabeth Hervey Stephen10.1016/j.fertnstert.2008.10.049Fertility and Sterility 93, 3 (2010)2008-12-18Fertility and Sterility2008-12-18933S0015-0282(10)X0002-4Infertility725736http://www.fertstert.org/article/PIIS0015028208041344/abstract?rss=yesObjective: To estimate the probability of medical consultation for infertility during the course of a pregnancy attempt and to study its determinants.Design: Pregnancy-based retrospective telephone survey analyzed with a discrete time Cox model.Setting: Two rural counties in Brittany and Normandy, France.Patient(s): A random sample of 901 women from the general population aged 18–60 years reporting 1,460 pregnancy attempts resulting in a live birth between 1985 and 2000 (participation rate, 73%).Intervention(s): None.Main Outcome Measure(s): Probability of medical consultation for involuntary infertility cumulated over time.Result(s): The cumulative probability of medical consultation for involuntary infertility among nulligravid women was 45% after 12 months of involuntary infertility and 75% after 24 months. The probability of medical consultation at any time was half that for parous women (odds ratio 0.4, 95% confidence interval 0.2–0.6). More highly educated women were more likely to have sought medical help for infertility. Only 45% of women who had sought medical advice received infertility treatment.Conclusion(s): Our survival approach provides a description of infertility service use during the course of a pregnancy attempt, and confirms that parity and educational level are strong predictors of medical help-seeking behaviors.When do involuntarily infertile couples choose to seek medical help?Caroline Moreau, Jean Bouyer, Béatrice Ducot, Alfred Spira, Rémy Slama10.1016/j.fertnstert.2008.10.011Fertility and Sterility 93, 3 (2010)2008-11-19Fertility and Sterility2008-11-19933S0015-0282(10)X0002-4Infertility737744http://www.fertstert.org/article/PIIS0015028208042672/abstract?rss=yesObjective: To describe the disparity of assisted reproductive technology (ART) centers in the United States as they relate to residential locations of populations in their reproductive years and state-mandated coverage for infertility services.Design: Cross-sectional study.Setting: Population in reproductive years (women 20–44 years; men 20–49 years) based on US Census 2000 data. Assisted reproductive technology centers registered with the Society for Assisted Reproductive Technology (SART) in 2005.Main Outcome Measure(s): Populations within service area served by in-state and neighboring state ART centers as defined by a 60-minute travel time along road networks from each center.Result(s): Service areas for 387 of 390 ART centers were calculated. Fourteen states had some form of mandated coverage. Underserved states included Alaska, Montana, Wyoming, and West Virginia. The northeastern United States had the greatest percentage of overserved population with 66%–100% study population within 60 minutes of an ART center. Female age stratification showed the highest age group (35–44 years) per state in northern New England and the youngest in Utah and District of Columbia. Median total study population within 60 minutes of an ART center in their own state was higher in mandated versus nonmandated states.Conclusion(s): Disparity of access to care for infertility services exists from the standpoint of population service areas for ART centers and state-mandated coverage. Female age stratification may help anticipate future need for services with existing resource distribution.Access to assisted reproductive technology centers in the United StatesAjay K. Nangia, Donald S. Likosky, Dongmei Wang10.1016/j.fertnstert.2008.10.037Fertility and Sterility 93, 3 (2010)2008-12-10Fertility and Sterility2008-12-10933S0015-0282(10)X0002-4Infertility745761http://www.fertstert.org/article/PIIS0015028208041332/abstract?rss=yesObjective: To assess the indications, safety, utilization, and success of ovarian tissue freezing and transplantation.Design: Prospective longitudinal analysis.Setting: Academic medical centers.Patient(s): Fifty-nine women who underwent ovarian tissue cryopreservation with a slow freezing technique between May 1997 and March 2008. A follow-up was conducted 36.8 ± 3.6 months after the procedure.Intervention(s): Ovarian tissue harvesting and cryopreservation.Main Outcome Measure(s): Indications, safety, and utilization rates.Result(s): The mean age (± SE) was 26.7 ±1.2 years (range 4–44 years). The majority of patients had either hematologic malignancies (45.7%) or breast cancer (22%). Of these, 57.6% underwent hematopoietic stem cell transplantation. No complications occurred and no histologic evidence of cancer was found in the harvested tissue. The median length of storage was 3.5 ± 0.3 years (0.06–10.5 years). Fifty-six of 59 patients have not yet used their ovarian tissue. The reasons for nonutilization were social/personal, being still under treatment, and death in 54%, 38%, and 8%, respectively. Only three women (5.1%) underwent transplantation, two with the heterotopic (abdominal wall) and one with the orthotopic technique. One woman with a heterotopic transplant conceived spontaneously and delivered. Of the three transplants, one ceased function after 9 months and two are still functioning at up to 7 years follow-up.Conclusion(s): Ovarian tissue harvesting appears to be safe but the experience with ovarian transplantation is still limited due to low utilization. As a result, the true value of this procedure remains to be determined.Ovarian cryopreservation and transplantation for fertility preservation for medical indications: report of an ongoing experienceKutluk Oktay, Ozgur Oktem10.1016/j.fertnstert.2008.10.006Fertility and Sterility 93, 3 (2010)2008-11-14Fertility and Sterility2008-11-14933S0015-0282(10)X0002-4Infertility762768http://www.fertstert.org/article/PIIS001502820804421X/abstract?rss=yesObjective: To confirm the beneficial effect of endometrial coculture in patients with repeated failures with assisted reproductive techniques (ART).Design: Patients with previous failures were offered a repetition of ART in conjunction with autologous endometrial coculture.Setting: Private fertility center.Patient(s): Sixty-eight couples who had attempted 92 cycles of IVF or intracytoplasmic sperm injection without obtaining an evolutive pregnancy.Intervention(s): Patients repeated one cycle of ART with concomitant endometrial coculture of their embryos.Main Outcome Measures(s): Comparative pregnancy and delivery rates in conventional ART cycles vs. cycles with autologous endometrial coculture.Result(s): In the previous 92 cycles (146 ETs, fresh plus frozen) only 8 pregnancies were initiated, and all ended in spontaneous abortion. Upon repeating 68 cycles (76 ETs) using coculture, 39 pregnancies were obtained, of which 19 resulted in live births, 10 are ongoing evolutive pregnancies, and 10 ended in spontaneous abortions.Conclusion(s): These results confirm the usefulness of autologous endometrial coculture for the treatment of patients with repeated implantation failure.Beneficial effect of autologous endometrial cell coculture in patients with repeated implantation failureVictoria Eyheremendy, Fernanda G.E. Raffo, Mercedes Papayannis, Julia Barnes, Cintia Granados, Jorge Blaquier10.1016/j.fertnstert.2008.10.060Fertility and Sterility 93, 3 (2010)2009-02-26Fertility and Sterility2009-02-26933S0015-0282(10)X0002-4In vitro fertilization769773http://www.fertstert.org/article/PIIS0015028208042003/abstract?rss=yesObjective: To compare embryologic and clinical outcomes in terms of preimplantation development, implantation, pregnancy rates, and secretome profile of implanted blastocysts from the preimplantation genetic diagnosis program grown in sequential versus endometrial epithelial cell (EEC) coculture system.Design: Retrospective clinical study and prospective experimental study.Setting: In vitro fertilization clinical unit and university research laboratory.Intervention(s): Blastomere biopsy, embryo culture, blastocyst transfer, and protein analysis of the media conditioned from implanted embryos obtained from coculture and sequential systems.Main Outcome Measure(s): Clinical study: blastocyst, implantation, and gestation rates in own and donated oocytes. Experimental study: differential protein analysis of implanted embryos grown in coculture system versus sequential system.Result(s): Of the 12,377 embryos analyzed, the blastocyst rates were 56.0% versus 45.9% in the coculture versus the sequential system, respectively, with own oocytes. With ovum donation, the rates were 70.5% versus 56.4%, respectively. Reproductive outcomes in terms of pregnancy rates (39.1% vs. 27.5%) and implantation rates (33.3% vs. 20.9%,) were statistically higher in EEC coculture versus sequential media. Furthermore, the protein profile of the EEC coculture versus the sequential system was obtained. Interleukin-6 (IL-6) was the most secreted protein by the EEC culture. Further ELISA experiments showed that the IL-6 present in the sequential medium diminished in implanted blastocysts.Conclusion(s): The coculture system favors blastocyst development and implantation rates, given the contribution of the factors secreted by endometrial epithelial cells, such as IL-6.Embryologic outcome and secretome profile of implanted blastocysts obtained after coculture in human endometrial epithelial cells versus the sequential systemFrancisco Dominguez, Blanca Gadea, Amparo Mercader, Francisco J. Esteban, Antonio Pellicer, Carlos Simón10.1016/j.fertnstert.2008.10.019Fertility and Sterility 93, 3 (2010)2008-12-04Fertility and Sterility2008-12-04933S0015-0282(10)X0002-4In vitro fertilization774782.e1http://www.fertstert.org/article/PIIS0015028208042817/abstract?rss=yesObjective: To evaluate the effect of the biopsy of 8-cell to 16-cell bovine embryos on their subsequent development and the effect of whole genome amplification (WGA) on removed blastomeres.Design: Randomized study.Setting: Molecular genetics and animal reproduction laboratories.Patient(s): Cow ovaries obtained from slaughterhouses.Intervention(s): The ovaries were punctured, and the oocytes were matured and fertilized in vitro. On the fourth day after fertilization, 8-cell to 16-cell bovine embryos were biopsied, one quarter of each embryo being removed. The blastomeres were submitted to WGA followed by polymerase chain reaction (PCR). The embryos were returned to culture for evaluation of their development.Main Outcome Measure(s): Subsequent rate of blastocyst development, embryo cell number, WGA efficiency, and sex determination.Result(s): A total of 92 embryos were submitted to biopsy. The blastocyst production was 53.3%, with 44.9% of hatching rate. These results were similar to those of the control group (66.0% and 42.6%) of 103 embryos. Overall, no impact was detected on embryo quality in blastocyst cell number between the two groups. Removed blastomeres were submitted to WGA, resulting in 98.2% of efficiency. However, only 59% of the samples were sexed by PCR.Conclusion(s): Biopsy of 8-cell to 16-cell bovine embryos did not affect their subsequent development. WGA was successful in removed blastomeres.Post-biopsy bovine embryo viability and whole genome amplification in preimplantation genetic diagnosisJuliana Polisseni, Wanderlei Ferreira de Sá, Martha de Oliveira Guerra, Marco Antônio Machado, Raquel Varella Serapião, Bruno Campos de Carvalho, Luiz Sérgio de Almeida Camargo, Vera Maria Peters10.1016/j.fertnstert.2008.10.023Fertility and Sterility 93, 3 (2010)2008-12-25Fertility and Sterility2008-12-25933S0015-0282(10)X0002-4In vitro fertilization783788http://www.fertstert.org/article/PIIS0015028208042830/abstract?rss=yesObjective: To investigate the effects of thawing temperature on sperm function after cryopreservation. The technical aspects of sperm cryopreservation have significantly improved over the last few decades. However, a standard protocol designed to optimize sperm motility recovery after thawing has not yet been established.Design: Prospective study.Setting: Private infertility institute and university-based research laboratory.Patient(s): Eighty consenting normozoospermic patients consulting for infertility.Intervention(s): Spermatozoa from donor semen samples were thawed at different temperatures.Main Outcome Measure(s): Sperm motility, viability, adenosine-5'-triphosphate (ATP) content, acrosomal status, and DNA integrity were evaluated as a function of thawing temperature in cryopreserved human sperm samples.Result(s): Thawing at 40°C resulted in a statistically significant increase in sperm motility recovery compared with thawing at temperatures between 20°C and 37°C. There were no statistically significant differences in sperm viability, acrosomal status, ATP content, and DNA integrity after thawing at 40°C compared with thawing at temperatures between 20°C and 37°C.Conclusion(s): Sperm thawing at 40°C could be safely used to improve motility recovery after sperm cryopreservation.Effect of thawing temperature on the motility recovery of cryopreserved human spermatozoaJuan C. Calamera, Mariano G. Buffone, Gustavo F. Doncel, Santiago Brugo-Olmedo, Sabrina de Vincentiis, Maria M. Calamera, Bayard T. Storey, Juan G. Alvarez10.1016/j.fertnstert.2008.10.021Fertility and Sterility 93, 3 (2010)2008-12-08Fertility and Sterility2008-12-08933S0015-0282(10)X0002-4Male factor789794http://www.fertstert.org/article/PIIS0015028208042738/abstract?rss=yesObjective: To explore the expression and distribution of DNA damage repair and apoptosis marker proteins in human testicular germ cells of infertile varicocele patients; and to compare the expression and distribution with that of young and old fertile men.Design: Retrospective case–control study.Setting: Academic institutions.Patient(s): Testicular specimens were obtained from 8 infertile varicocele patients aged 20–30 years and from 16 fertile volunteers aged 20–82 years.Intervention(s): Testicular germ cell DNA repair markers were assessed using immunohistochemical staining for the cell proliferation marker (proliferating cell nuclear antigen), DNA repair markers [poly(ADP-ribose) polymerase-1 (PARP-1), poly(ADP-ribose), X-ray repair cross-complementing 1, and apurinic/apyrimidinic endonuclease 1], and apoptosis markers (caspase 9, active caspase 3, and cleaved PARP-1).Main Outcome Measure(s): The prevalence and cellular localization of the above markers in testicular tissues of varicocele patients and fertile men of varying ages.Result(s): Statistically significant differences in DNA damage repair–associated proteins and apoptosis markers were observed in infertile men with varicocele compared with fertile young men. Old fertile men showed similar expression of the same markers when compared with infertile varicocele patients.Conclusion(s): The study demonstrates that there is an increase in human testicular germ cell DNA repair and apoptosis in infertile varicocele patients and that their profile resembles that of premature aging.The expression and distribution of deoxyribonucleic acid repair and apoptosis markers in testicular germ cells of infertile varicocele patients resembles that of old fertile menMoetaz M. El-Domyati, Abo-Bakr M. Al-Din, Manal T. Barakat, Hasan M. El-Fakahany, Stanton Honig, Jiasen Xu, Denny Sakkas10.1016/j.fertnstert.2008.10.031Fertility and Sterility 93, 3 (2010)2008-12-04Fertility and Sterility2008-12-04933S0015-0282(10)X0002-4Male factor795801http://www.fertstert.org/article/PIIS0015028208044087/abstract?rss=yesObjective: To evaluate the prevalence of human papillomavirus (HPV) sperm infection and its correlation with sperm parameters in a cohort of young adult males.Design: Cross-sectional clinical study.Setting: Andrology and Microbiology sections at a university hospital.Patient(s): A cohort of 200 young adult male volunteers (18 years old), 100 with previous sexual intercourse and 100 without previous sexual intercourse.Main Outcome Measure(s): Seminal parameters, sperm culture for HPV and fluorescence in situ hybridization (FISH) analysis for HPV detection in the sperm head. Statistical analysis was performed with a two-tailed Student's t-test.Result(s): Results of HPV investigation were compared to sperm parameters and results of FISH analysis. HPV infection was present in sperm cells of 10 subjects among those 100 young adults who already had unprotected intercourse and its presence was associated with reduced sperm motility. Furthermore, infected samples showed that about 25% of sperm had an HPV DNA positivity at the head site, but it is unclear whether it was integrated in the nucleus or not.Conclusion(s): This is the first report estimating the percentage of HPV-positive sperm in infected subjects and the association between HPV infection and sperm motility.Human papillomavirus found in sperm head of young adult males affects the progressive motilityCarlo Foresta, Andrea Garolla, Daniela Zuccarello, Damiano Pizzol, Afra Moretti, Luisa Barzon, Giorgio Palù10.1016/j.fertnstert.2008.10.050Fertility and Sterility 93, 3 (2010)2008-12-18Fertility and Sterility2008-12-18933S0015-0282(10)X0002-4Male factor802806http://www.fertstert.org/article/PIIS0015028208042805/abstract?rss=yesObjective: To verify clinical outcome after injection of spermatozoa that have undergone the acrosome reaction (reacted spermatozoa) vs. those still having an intact acrosome (nonreacted spermatozoa).Design: Prospective, randomized study.Setting: Reproductive Medicine Unit, Italian Society for the Study of Reproductive Medicine, Bologna, Italy.Patient(s): According to a prospective randomization including 71 couples with severe male factor infertility, intracytoplasmic sperm injection (ICSI) was performed under polarized light that permitted analysis of the pattern of birefringence in the sperm head. Twenty-three patients had their oocytes injected with reacted spermatozoa, 26 patient's oocytes were injected with nonreacted spermatozoa, and in 22 patients both reacted and nonreacted spermatozoa were injected.Intervention(s): Intracytoplasmic sperm injection was performed under polarized light to selectively inject acrosome-reacted and acrosome-nonreacted spermatozoa.Main Outcome Measure(s): Rates of fertilization, cleavage, pregnancy, implantation, and ongoing implantation.Result(s): There was no effect on the fertilizing capacity and embryo development of either type of sperm, whereas the implantation rate was higher in oocytes injected with reacted spermatozoa (39.0%) vs. those injected with nonreacted spermatozoa (8.6%). The implantation rate was 24.4% in the group injected with both reacted and nonreacted spermatozoa. The delivery rate per cycle followed the same trend.Conclusion(s): Spermatozoa that have undergone the acrosome reaction seem to be more prone to supporting the development of viable ICSI embryos.Birefringence characteristics in sperm heads allow for the selection of reacted spermatozoa for intracytoplasmic sperm injectionLuca Gianaroli, M. Cristina Magli, Anna P. Ferraretti, Andor Crippa, Michela Lappi, Serena Capitani, Baccio Baccetti10.1016/j.fertnstert.2008.10.024Fertility and Sterility 93, 3 (2010)2008-12-08Fertility and Sterility2008-12-08933S0015-0282(10)X0002-4Male factor807813http://www.fertstert.org/article/PIIS0015028208044130/abstract?rss=yesObjective: To investigate sperm viability, incidence of apoptosis, and intracellular basal and induced reactive oxygen species (ROS) in sperm fractions.Design: Prospective controlled study.Setting: Center for Reproductive Medicine at a tertiary care hospital.Method(s): Liquefied seminal ejaculates (n = 12) prepared by density gradient centrifugation were reconstituted to 2 mL with phosphate-buffered saline. Oxidative stress was induced by hydrogen peroxide (H2O2, 100 μM). Sperm viability, intracellular ROS, and incidence of apoptosis/necrosis in neat, immature, and mature sperm fractions were assessed.Result(s): Before H2O2 exposure, mature spermatozoa fractions showed a significantly lower incidence of apoptotic sperm and intracellular O2−• levels but higher amounts of intracellular H2O2 compared with neat semen. Higher levels of intracellular H2O2 were demonstrated in immature sperm fractions compared with neat or mature fractions. In all sperm fractions, intracellular H2O2 levels correlated with the intracellular concentration of O2−•. After H2O2 exposure, neat semen showed a significantly higher percentage of apoptosis compared with the prepared mature spermatozoa. However, no differences were observed in the incidence of apoptosis between immature and mature sperm fractions.Conclusion(s): There is a differential shift of both intracellular H2O2 and O2-• in each sperm fraction that may affect sperm quality. Sperm apoptosis is related to intracellular H2O2 levels, which in turn are affected by intracellular O-• levels. Oxidative stress was not associated with an increased incidence of apoptosis in immature or mature sperm fractions.Sperm viability, apoptosis, and intracellular reactive oxygen species levels in human spermatozoa before and after induction of oxidative stressReda Z. Mahfouz, Stefan S. du Plessis, Nabil Aziz, Rakesh Sharma, Edmund Sabanegh, Ashok Agarwal10.1016/j.fertnstert.2008.10.068Fertility and Sterility 93, 3 (2010)2008-12-18Fertility and Sterility2008-12-18933S0015-0282(10)X0002-4Male factor814821http://www.fertstert.org/article/PIIS0015028208042714/abstract?rss=yesObjective: To collect follow-up data for infertile men with Y microdeletion.Design: Retrospective, observational survey.Setting: Multicenter IVF units associated with genetics laboratories.Patient(s): Sixty-three patients with Y microdeletion.Intervention(s): Karyotype analysis, Y microdeletion screening, and assisted reproductive technology.Main Outcome Measures: Medical history, karyotype, nature of the AZF deletion, semen parameters, testis biopsy results, choice of assisted reproductive technology, and results of intracytoplasmic sperm injection (ICSI).Results: Abnormal karyotypes were found in 8 men (12.7%), who were azoospermic except 1. Of these 8 men, 5 presented a combined AZFb+c deletion, and 3 had a deletion in AZFc only. Most men (39 of 63) were azoospermic, 3 were cryptoazoospermic, and 19 had extreme oligozoospermia (sperm concentration ≤1.106/mL). Sperm concentration above 1.106/mL was found for 2 men (3.1%). A testis biopsy was performed in 27 azoospermic men, resulting in positive sperm extraction in 6 cases. To date, 42 ICSI cycles with either testicular (n = 5) or ejaculated spermatozoa (n = 37) have been carried out in 23 couples with male partners with AZFc deletion. Eighteen clinical pregnancies were obtained, leading to the birth of 14 babies. Donor insemination had been chosen by 28 couples, leading to the birth of 9 children.Conclusion: Karyotype analysis should be systematically performed in Y microdeleted men. Intracytoplasmic sperm injection can be offered to half of AZFc-deleted patients, providing real opportunities to have a child.Clinical data and parenthood of 63 infertile and Y-microdeleted menCatherine Patrat, Thierry Bienvenu, Laurent Janny, Anne-Karen Faure, Patricia Fauque, Isabelle Aknin-Seifer, Céline Davy, Nicolas Thiounn, Pierre Jouannet, Rachel Lévy10.1016/j.fertnstert.2008.10.033Fertility and Sterility 93, 3 (2010)2008-12-04Fertility and Sterility2008-12-04933S0015-0282(10)X0002-4Male factor822832http://www.fertstert.org/article/PIIS001502820804418X/abstract?rss=yesObjective: To identify Chlamydia trachomatis DNA by polymerase chain reaction in the upper genital tract of men with obstructive azoospermia compared with men seeking vasectomy reversal.Design: Case–control study.Setting: Tertiary referral center, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.Patient(s): Cases were men with idiopathic obstructive azoospermia, and controls were men with azoospermia secondary to vasectomy.Intervention(s): Chlamydia trachomatis–specific DNA test by polymerase chain reaction on testicular and epididymal biopsy samples, as well as epididymal aspirate.Main Outcome Measure(s): Presence of Chlamydia trachomatis DNA.Result(s): We did not detect the presence of Chlamydia trachomatis–specific DNA by polymerase chain reaction in the epididymis or testis of 36 asymptomatic men with obstructive azoospermia (14 cases, 22 controls).Conclusion(s): Our hypothesis that unrecognized, asymptomatic chlamydial infection will lead to complete bilateral obstruction of the male genital tract remains unproven.Absence of chlamydial deoxyribonucleic acid from testicular and epididymal samples from men with obstructive azoospermiaSreebala Sripada, Maria Rosario Amezaga, Mark Hamilton, Hamish McKenzie, Allan Templeton, Siladitya Bhattacharya10.1016/j.fertnstert.2008.10.063Fertility and Sterility 93, 3 (2010)2008-12-25Fertility and Sterility2008-12-25933S0015-0282(10)X0002-4Male factor833836http://www.fertstert.org/article/PIIS0015028208042702/abstract?rss=yesObjective: To determine whether patients with erectile dysfunction (ED) have a higher incidence of insulin resistance (IR) when compared with controls.Design: Prospective case–control study.Setting: Academic medical center.Patient(s): Twenty-nine nondiabetic men aged 18–66 years were enrolled. Of these, 28 completed the study: 17 had ED, and 11 did not.Intervention(s): Validated ED questionnaires, examination, serum hormones evaluation, and oral glucose tolerance testing.Main Outcome Measure(s): Association of IR with ED.Result(s): The association between worsening degrees of both lower urinary tract symptoms (LUTS) and ED was reaffirmed, as was a potential correlation between the two—epinephrine. There was a negative association between serum levels of epinephrine and scores on the 5-item version of the International Index of Erectile Dysfunction for ED (Spearman correlation coefficient = −0.38). On the other hand, men with ED were not more likely to have IR compared with controls.Conclusion(s): Epinephrine may be the common link between ED and LUTS.Epinephrine is associated with both erectile dysfunction and lower urinary tract symptomsJ.C. Trussell, Allen R. Kunselman, Richard S. Legro10.1016/j.fertnstert.2008.10.034Fertility and Sterility 93, 3 (2010)2008-12-04Fertility and Sterility2008-12-04933S0015-0282(10)X0002-4Male factor837842http://www.fertstert.org/article/PIIS0015028208044191/abstract?rss=yesObjective: To assess the level of circulating endothelial progenitor cells (CEPC) in cycling women compared with men and menopausal women.Design: Controlled clinical study.Setting: Healthy, nonsmoking volunteers.Patient(s): Twelve women, aged 18–40 years, with regular menstrual cycles, 12 menopausal women, and two groups of 12 age-matched men were recruited. Women did not receive any hormone therapy.Intervention(s): Collection of 20 mL of peripheral blood.Main Outcome Measure(s): The number of CEPC, defined as (Lin−/7AAD−/CD34+/CD133+/KDR+) cells per 106 mononuclear cells (MNC), was measured by flow cytometry.Result(s): The number of CEPC was significantly higher in cycling women than in age-matched men and menopausal women (26.5 per 106 MNC vs. 10.5 per 106 MNC vs. 10 per 106 MNC, respectively). The number of CEPC was similar in menopausal women, age-matched, and young men.Conclusion(s): The number of CEPC is influenced by an age–gender interaction. This phenomenon may explain in part the better vascular repair and relative cardiovascular protection in younger women as compared with age-matched men.Impact of age and gender interaction on circulating endothelial progenitor cells in healthy subjectsAlexandra Rousseau, Fida Ayoubi, Christel Deveaux, Beny Charbit, Catherine Delmau, Sophie Christin-Maitre, Patrice Jaillon, Georges Uzan, Tabassome Simon10.1016/j.fertnstert.2008.10.062Fertility and Sterility 93, 3 (2010)2008-12-25Fertility and Sterility2008-12-25933S0015-0282(10)X0002-4Menopause843846http://www.fertstert.org/article/PIIS0015028208047493/abstract?rss=yesObjective: To prospectively assess the reproductive outcome with a small bolus of hCG administered on the day of oocyte retrieval after ovulation induction with a GnRH agonist (GnRHa).Design: Prospective, randomized trial.Setting: Three hospital-based IVF clinics.Patient(s): Three hundred five IVF/intracytoplasmic sperm injection patients after a GnRH antagonist protocol.Intervention(s): Ovulation induction was performed with either 10,000 IU hCG or 0.5 mg GnRHa (buserelin) supplemented with 1,500 IU hCG on the day of oocyte retrieval.Main Outcome Measure(s): Reproductive outcome in the two groups.Result(s): No significant differences were seen regarding positive hCG/ET rate (48% and 48%), ongoing pregnancy rate (26% and 33%), delivery rate (24% and 31%), and rate of early pregnancy loss (21% and 17%) between the GnRHa and 10,000 IU hCG groups, respectively.Conclusion(s): A small bolus of hCG in the GnRHa group secured the luteal phase, resulting in a comparable reproductive outcome in the two groups. However, a nonsignificant difference of 7% in delivery rates justifies further studies to refine the use of GnRHa for ovulation induction.1,500 IU human chorionic gonadotropin administered at oocyte retrieval rescues the luteal phase when gonadotropin-releasing hormone agonist is used for ovulation induction: a prospective, randomized, controlled studyPeter Humaidan, Helle Ejdrup Bredkjær, Lars Grabow Westergaard, Claus Yding Andersen10.1016/j.fertnstert.2008.12.042Fertility and Sterility 93, 3 (2010)2009-02-06Fertility and Sterility2009-02-06933S0015-0282(10)X0002-4Ovulation induction847854http://www.fertstert.org/article/PIIS0015028208042623/abstract?rss=yesObjective: To compare three-dimensional ultrasound parameters, antral follicle count (AFC), ovarian volume, and ovarian vascularity indices with anti-Müllerian hormone (AMH) and other conventional endocrine markers for the prediction of poor response to controlled ovarian hyperstimulation (COH) during assisted reproduction treatment (ART).Design: Prospective study.Setting: University-based assisted conception unit.Patient(s): One hundred thirty-five women undergoing the first cycle of ART.Intervention(s): Transvaginal three-dimensional ultrasound assessment and venipuncture in the early follicular phase of the menstrual cycle immediately before ART.Main Outcome Measure(s): Poor ovarian response and nonconception.Result(s): Antral follicle count (Exp(B): 0.65) and AMH (Exp(B): 0.13) were the most significant predictors of poor ovarian response on multiple regression analysis and their predictive accuracy was similar, with an area under the curve (AUC) of 0.935 and 0.905, respectively. The AFC and AMH, as a combined test, did not significantly improve the level of prediction (AUC = 0.946). The sensitivity and specificity for prediction of poor ovarian response were 93% and 88% for AFC and 100% and 73% for AMH at an optimum cutoff values of ≤10 and ≤0.99 ng/mL, respectively. Age (Exp(B): 1.191) was the only significant predictor of nonconception, although its predictive accuracy was also low (AUC = 0.674).Conclusion(s): The AFC and AMH are the most significant predictors of poor response to ovarian stimulation during ART. The AMH and AFC, either alone or in combination, demonstrate a similar predictive power but are not predictive of nonconception, which is dependent on the woman's age.A prospective, comparative analysis of anti-Müllerian hormone, inhibin-B, and three-dimensional ultrasound determinants of ovarian reserve in the prediction of poor response to controlled ovarian stimulationKannamannadiar Jayaprakasan, Bruce Campbell, James Hopkisson, Ian Johnson, Nick Raine-Fenning10.1016/j.fertnstert.2008.10.042Fertility and Sterility 93, 3 (2010)2008-12-01Fertility and Sterility2008-12-01933S0015-0282(10)X0002-4Ovulation induction855864http://www.fertstert.org/article/PIIS0015028208041381/abstract?rss=yesObjective: To evaluate controlled ovarian hyperstimulation (COH) in women with cancer compared with healthy women.Design: A retrospective cohort study.Setting: Academic assisted reproductive technology (ART) program.Patient(s): Fifty women undergoing oocyte retrieval before cancer treatment and 50 age-matched controls.Intervention(s): None.Main Outcome Measure(s): Number of oocytes and matured oocytes retrieved, number of fertilized oocytes, days of stimulation, dose of gonadotropins.Result(s): There were no significant differences in the number of oocytes retrieved (13 vs. 11.5), the number of matured oocytes retrieved (9.7 vs. 9.6), and the number of oocytes fertilized (7.4 vs. 6.8). However, the patients with cancer had a longer duration of stimulation (10.5 vs. 9.0 days) and higher total dose of gonadotropins (4,174 IU vs. 3,416 IU).Conclusion(s): In our study, reasonable ovarian response was achieved by women with cancer with increased doses of gonadotropins and a longer duration of stimulation.Ovarian stimulation for fertility preservation in patients with cancerRudolpho B. Quintero, Amy Helmer, Jian Qun Huang, Lynn M. Westphal10.1016/j.fertnstert.2008.10.007Fertility and Sterility 93, 3 (2010)2008-11-14Fertility and Sterility2008-11-14933S0015-0282(10)X0002-4Ovulation induction865868http://www.fertstert.org/article/PIIS0015028208042659/abstract?rss=yesObjective: To test whether there was a difference in serum retinol-binding protein 4 (RBP4) levels between subjects with polycystic ovary syndrome (PCOS) and those with a healthy regular menstrual cycle and, in addition, to correlate serum RBP4 levels with a variety of parameters.Design: Clinical study.Setting: University hospital.Patient(s): A total of 74 nonobese women were evaluated. Thirty-seven had PCOS, whereas the remaining 37 served as control subjects.Intervention(s): Serum RBP4 levels were analyzed using ELISA.Main Outcome Measure(s): Serum levels of FSH, LH, TSH, E2, T, insulin, glucose, cholesterol, triglycerides, and RBP4.Result(s): The women with PCOS had higher levels of serum RBP4, waist-to-hip ratio, LH, T, insulin, homeostatic model assessment of insulin resistance, cholesterol, and triglycerides. Logistic regression analyses revealed a significant association between odds ratio (OR) values of PCOS and both T (OR = 1.125; 95% confidence interval [CI] 1.050–1.205), and cholesterol levels (OR = 1.029; 95% CI 1.004–1.056). Age and triglycerides were significantly correlated to serum RBP4 levels by multiple linear regression analysis.Conclusion(s): Our study has shown that [1] elevated RBP4 levels might arise from triglyceride metabolism, and that RBP4 levels might not be influenced by PCOS itself. [2] RBP4 might not be a useful marker of insulin resistance in subjects with PCOS.Serum retinol-binding protein 4 levels in nonobese women with polycystic ovary syndromeTe-Fu Chan, Yung-Chieh Tsai, Pu-Rong Chiu, Yi-Ling Chen, Chien-Hung Lee, Eing-Mei Tsai10.1016/j.fertnstert.2008.10.039Fertility and Sterility 93, 3 (2010)2008-11-24Fertility and Sterility2008-11-24933S0015-0282(10)X0002-4Polycystic ovary syndrome869873http://www.fertstert.org/article/PIIS0015028208042763/abstract?rss=yesObjective: To report the first case series of ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration (TVOA).Design: Retrospective analysis.Setting: In vitro fertilization unit of a tertiary university hospital.Patient(s): Patients who underwent TVOA during a 6-year period.Intervention(s): Surgical intervention due to active bleeding from the ovary.Main Outcome Measure(s): Prevalence and risk factors.Result(s): Among 3,241 patients undergoing TVOA, 7 were diagnosed as having ovarian hemorrhage afterward. All patients were thin, with a body mass index of 19–21 kg/m2, and 4 had polycystic ovary syndrome (PCOS). The prevalence of ovarian bleeding among lean patients with PCOS was 4.5%. The odds ratio for bleeding in lean patients with PCOS vs. all other patients was 50 (95% confidence interval 11–250). The interval between the TVOA and surgical intervention ranged from 5 to 18 hours (mean ± SD, 11.4 ± 5 hours). The Δ decrease in hemoglobin levels was 3.2–9 g/dL (mean 6.1 ± 1.8). In 6 of the 7 patients, laparoscopically guided electrocoagulation was sufficient to achieve hemorrhagic control.Conclusion(s): Although acute hemorrhage is a rare event after TVOA, lean patients with PCOS specifically are at much higher risk for this complication.Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndromeGad Liberty, Jordana Hadassah Hyman, Talia Eldar-Geva, Boris Latinsky, Michael Gal, Ehud J. Margalioth10.1016/j.fertnstert.2008.10.028Fertility and Sterility 93, 3 (2010)2008-12-08Fertility and Sterility2008-12-08933S0015-0282(10)X0002-4Polycystic ovary syndrome874879http://www.fertstert.org/article/PIIS0015028208044233/abstract?rss=yesObjective: To evaluate serum visfatin levels and to determine the effects of metformin treatment on visfatin levels in patients with polycystic ovary syndrome (PCOS).Design: Cross-sectional study.Setting: University hospital.Patient(s): Nineteen patients with PCOS and 21 controls.Intervention(s): Metformin was given to patients with PCOS, and serum visfatin levels were measured before and after treatment.Main Outcome Measure(s): Glucose, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, DHEAS, total T, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), and visfatin levels were measured.Result(s): Serum visfatin levels were significantly higher in women with PCOS than in controls. Visfatin could differentiate between women with and without increased diabetogenic risk at a cut-off value of 19.24 ng/mL, with a sensitivity of 93.3% and a specificity of 84%. In bivariate analysis of subjects, T, insulin, and waist circumference were significantly and positively correlated with visfatin. Treatment resulted in a significant decrease in body mass index and a decrease in visfatin concentration. After therapy, statistically significant decreases in HOMA-IR, fasting insulin, free T, and DHEAS concentrations were observed for the PCOS group.Conclusion(s): Circulating visfatin levels were higher in patients with PCOS than healthy controls, and metformin treatment significantly reduced circulating visfatin concentrations after 3 months of therapy.Effect of metformin on serum visfatin levels in patients with polycystic ovary syndromeMesut Ozkaya, Erman Cakal, Yusuf Ustun, Yaprak Engin-Ustun10.1016/j.fertnstert.2008.10.058Fertility and Sterility 93, 3 (2010)2008-12-25Fertility and Sterility2008-12-25933S0015-0282(10)X0002-4Polycystic ovary syndrome880884http://www.fertstert.org/article/PIIS0015028208042076/abstract?rss=yesObjective: To examine differences in body composition and smoking between mothers of spontaneous monozygotic and dizygotic twins, while taking into account maternal age, gravidity, and educational attainment.Design: Retrospective cohort study.Setting: The Netherlands Twin Register.Patient(s): Mothers of twins (n = 19,357) registered with the Netherlands Twin Register. Data were selected from mothers of spontaneous monozygotic twins (MZ; n = 5663) and mothers of spontaneous dizygotic twins (DZ; n = 8515).Intervention(s): None.Main Outcome Measure(s): The odds of having spontaneous DZ twins versus spontaneous MZ twins as a function of height, body mass index (BMI), and smoking before pregnancy, after accounting for age, gravidity, and educational attainment.Result(s): Compared with spontaneous MZ twinning, spontaneous DZ twinning is significantly associated with increasing height (odds ratio, 1.6; 95% confidence interval [CI], 1.5–1.8 for the tallest versus the shortest height quartile), an increased BMI (odds ratio, 1.3; 95% CI, 1.1–1.4 for overweight vs. normal weight), and smoking before the twin pregnancy (odds ratio, 1.4; 95% CI, 1.3–1.5 for smoker vs. nonsmoker). Maternal age and gravidity, but not educational attainment, had to be included in the model.Conclusion(s): Spontaneous dizygotic twinning is associated with body composition and smoking.Body composition, smoking, and spontaneous dizygotic twinningChantal Hoekstra, Gonneke Willemsen, C.E.M. Toos van Beijsterveldt, Cornelius B. Lambalk, Grant W. Montgomery, Dorret I. Boomsma10.1016/j.fertnstert.2008.10.012Fertility and Sterility 93, 3 (2010)2008-12-04Fertility and Sterility2008-12-04933S0015-0282(10)X0002-4Pregnancy885893http://www.fertstert.org/article/PIIS0015028208042799/abstract?rss=yesObjective: To verify whether, during the luteal–follicular transition, increased inhibin B production by abnormally large follicles modifies the expected relationship between the number of follicles and peripheral inhibin B and FSH levels.Design: Prospective study.Setting: Teaching hospital, France.Patient(s): A total of 192 normo-ovulatory women.Intervention(s): Serum inhibin B and FSH levels and numbers and sizes of antral follicles (3–12 mm) were measured on cycle day 3.Main Outcome Measure(s): The strength of hormonal–follicular correlations was assessed in two groups formed according to the presence (large follicle group; n = 73) or absence (small follicle group; n = 119) of one follicle measuring >7 mm.Result(s): Serum inhibin B and FSH levels were correlated with antral follicle counts (r = 0.32 and r = −0.44, respectively). These relationships were significantly weaker in the large follicle group (r = 0.24 and r = −0.28, respectively) than in the small follicle group (r = 0.51 and r = −0.55, respectively).Conclusion(s): Antral follicle size influences serum inhibin B and FSH levels and alters their expected relationship with the number of antral follicles on day 3. These results contribute to clarifying the controversial role of serum inhibin B and FSH levels in the prediction of ovarian follicular status.Early follicle development alters the relationship between antral follicle counts and inhibin B and follicle-stimulating hormone levels on cycle day 3Michael Grynberg, Estelle Feyereisen, Juliano Brum Scheffer, Panayotis Koutroubis, Rene Frydman, Renato Fanchin10.1016/j.fertnstert.2008.10.025Fertility and Sterility 93, 3 (2010)2008-12-04Fertility and Sterility2008-12-04933S0015-0282(10)X0002-4Reproductive endocrinology894899http://www.fertstert.org/article/PIIS0015028208042829/abstract?rss=yesObjective: To describe a novel use for a tracheobronchial stent to maintain patency after vaginal septum excision in a patient with an obstructed hemivagina and uterine didelphys.Design: Description of a novel technique.Setting: University-affiliated children's hospital.Patient(s): One patient with an obstructed hemivagina and uterine didelphys who presented with hematometria and hematocolpos.Intervention(s): To maintain patency and decrease stenosis risk after vaginal septum excision, a coated tracheobronchial stent was deployed and left in place for 6 weeks.Main Outcome Measure(s): To evaluate ease of stent placement and removal, reepithelialization and patency of the neovagina, and postoperative assessment of pain and recurrent obstruction.Result(s): The tracheobronchial stent was easily positioned and deployed with vaginoscopic guidance. Six weeks later it was removed without any tissue ingrowth or granulation tissue noted. The vaginal walls were nicely epithelialized. Twelve months postoperatively, the patient remained pain free with regular cycles and no evidence of obstruction or abnormality on ultrasound.Conclusion(s): Use of a coated tracheobronchial stent to maintain patency after septum excision in a patient with an obstructed hemivagina presents a safe, easy, and effective option to diminish stenosis risk and avoid infectious complications or hysterectomy.Novel use of a tracheobronchial stent in a patient with uterine didelphys and obstructed hemivaginaAmber R. Cooper, Diane F. Merritt10.1016/j.fertnstert.2008.10.022Fertility and Sterility 93, 3 (2010)2008-12-08Fertility and Sterility2008-12-08933S0015-0282(10)X0002-4Reproductive surgery900903http://www.fertstert.org/article/PIIS0015028208044105/abstract?rss=yesObjective: Evaluation of the presence of a Ca2+-regulated membrane guanylate cyclase signal transudation system in the spermatozoa.Design: Experimental study.Setting: Research university laboratory.Patient(s): Human sperm obtained from healthy donors who met the criteria of the World Health Organization for normozoospermia and bovine semen collected from bulls of proven fertility.Intervention(s): Radioimmunoassay and immunohistochemistry of human and bovine spermatozoa.Main Outcome Measure(s): The membrane guanylate cyclase activity and the presence of membrane guanylate cyclase transduction machinery components in the spermatozoa.Result(s): The identity of a Ca2+-modulated membrane guanylate cyclase transduction machinery in human and bovine spermatozoa has been documented. The machinery is both inhibited and stimulated within nanomolar to semimicromolar range of free Ca2+. The transduction component of this machinery is the rod outer segment membrane guanylate cyclase type 1 (ROS-GC1). The enzyme coexists with three Ca2+-dependent modulators: guanylate cyclase activating protein type 1 (GCAP1), S100B and neurocalcin δ. ROS-GC1 and its modulators are present in the heads and tails of both species' spermatozoa.Conclusion(s): The coexpression of ROS-GC1 and its activators in spermatozoa suggests that the Ca2+-modulated ROS-GC1 transduction system may be a part of the fertilization machinery.Rod outer segment membrane guanylate cyclase type 1 (ROS-GC1) calcium-modulated transduction system in the spermAnna Jankowska, Beata Burczyńska, Teresa Duda, Jerzy B. Warchol10.1016/j.fertnstert.2008.10.048Fertility and Sterility 93, 3 (2010)2008-12-25Fertility and Sterility2008-12-25933S0015-0282(10)X0002-4Reproductive biology904912http://www.fertstert.org/article/PIIS0015028208042842/abstract?rss=yesObjective: To evaluate the effects of tissue culture on the viability and development of follicles in frozen-thawed human fetal ovarian tissue before transplantation into severe combined immunodeficient (SCID) mice and to determine the optimal duration of pretransplant tissue culture.Design: Experimental prospective study.Setting: Animal center and reproductive laboratories in university hospitals.Intervention(s): Frozen-thawed human fetal ovarian tissue samples from 20-week-old abortuses were randomly divided into four groups and cultured in vitro for 0, 3, 6, or 9 days before being xenografted into kidney capsules of bilaterally oophorectomized severe combined immunodeficient (SCID) mice. Grafts were removed 16 weeks after transplantation. Histological analysis and assessment of proliferative cell nuclear antigen (PCNA) expression levels were used to evaluate the survival and development of follicles.Result(s): The proportion of growing follicles was significantly increased in groups cultured before transplantation as compared with the noncultured group. Sixteen weeks after transplantation, the number of follicles in the cultured grafts was higher than that in the noncultured grafts. Grafts cultured for 6 or 9 days showed higher proportions of preantral and antral follicles than grafts cultured for 0 or 3 days. PCNA immunohistochemical analysis indicated that follicle cells were in a proliferative state after culture and transplantation.Conclusion(s): The viability and development of human fetal follicles may be improved by pretransplant tissue culture. The optimal culture duration before transplantation of fetal ovarian tissue is 6 days.Tissue culture before transplantation of frozen-thawed human fetal ovarian tissue into immunodeficient miceChao Lan, Wang Xiao, Deng Xiao-Hui, Hao Chun-Yan, Yu Hong-Ling10.1016/j.fertnstert.2008.10.020Fertility and Sterility 93, 3 (2010)2008-12-23Fertility and Sterility2008-12-23933S0015-0282(10)X0002-4Reproductive biology913919http://www.fertstert.org/article/PIIS001502820900257X/abstract?rss=yesObjective: To evaluate the effects of tumor necrosis factor-alpha (TNF-α) on porcine oocyte maturation, spindle dynamics, and chromosome alignment.Design: Controlled, prospective study.Setting: University hospital and IVF research laboratory.Animal(s): Ovaries collected from slaughtered prepubertal gilts.Main Outcome Measure(s): Oocyte maturation rate and cytoskeleton distribution.Materials and Method(s): Immature porcine oocytes (GV) were exposed to TNF-α at a concentration of 0 (as a control), 1, 5, 10, 100, 200, or 600 ng/mL in M199 medium. Oocytes were cultured for 24 hours to the pre-MI stage or 44 hours to the MII stage. After in vitro maturation for 44 hours, the rates of GV oocytes reaching MII stage were assessed, and MII oocytes were fixed for further examination of the cytoskeleton and the chromosomal distribution.Result(s): The TNF-α concentration at 5 ng/mL decreased the porcine oocyte maturation rate compared with the control after culture for 44 hours, whereas exposure to 10 or 100 ng/mL TNF-α resulted in a significant increase in the frequency of defective spindles or abnormal microfilament distribution. Exposed to 200 ng/mL, TNF-α caused a significantly higher abnormality rate of chromosome alignment when compared with the controls.Conclusion(s): Exposure of porcine oocytes to an elevated TNF-α concentration clearly caused a reduction in their maturation from GV stage to MII stage and increased the proportion of oocytes with abnormal chromosome alignment and cytoskeleton structure.Effects of tumor necrosis factor-alpha on porcine oocyte meiosis progression, spindle organization, and chromosome alignmentCai-Hong Ma, Li-Ying Yan, Jie Qiao, Wei Sha, Li Li, Yuan Chen, Qing-Yuan Sun10.1016/j.fertnstert.2009.01.131Fertility and Sterility 93, 3 (2010)2009-03-26Fertility and Sterility2009-03-26933S0015-0282(10)X0002-4Reproductive biology920926http://www.fertstert.org/article/PIIS0015028208044178/abstract?rss=yesObjective: To investigate the effects of androstenedione on ovarian follicle development.Design: Experimental study.Setting: University research laboratory.Animal(s): Female Wistar-Imamichi rats and BDF1 mice.Intervention(s): Rats were injected with androstenedione. Ovarian follicles of mice were cultured in the presence of androstenedione.Main Outcome Measure(s): Ovarian morphology; ovarian cell types undergoing apoptosis; ovarian expression of cytochrome P450 aromatase (P450arom), cytochrome P450 side-chain cleavage (P450scc), and cyclin-dependent kinase inhibitor p27kip1; serum levels of T, E2, and P in rats; and ultrastructure of granulosa cells from cultured follicles of mice.Result(s): In androstenedione-treated rat ovaries, follicular cysts were formed, and apoptotic cells were found in the inner part of granulosa cell layers of antral follicles. Androstenedione administration down-regulated expression of P450arom but up-regulated expression of P450scc and p27Kip1 in the granulosa cells of antral follicles. Serum T levels were significantly increased in androstenedione-treated rats. In mouse follicles exposed to androstenedione, the granulosa cells contained abundant lipid droplets and mitochondria with complex tubular cristae.Conclusion(s): Excess androgen enhances apoptosis in the inner part of granulosa cell layers of antral follicles, resulting in the formation of follicular cysts. It is also demonstrated that androgen stimulates premature luteinization of granulosa cells.Exogenous androstenedione induces formation of follicular cysts and premature luteinization of granulosa cells in the ovaryYuki Okutsu, Masanori T. Itoh, Noriyuki Takahashi, Bunpei Ishizuka10.1016/j.fertnstert.2008.10.064Fertility and Sterility 93, 3 (2010)2008-12-18Fertility and Sterility2008-12-18933S0015-0282(10)X0002-4Reproductive biology927935http://www.fertstert.org/article/PIIS0015028208042039/abstract?rss=yesObjective: To explore potential helping effects of a PDE3-inhibitor (PDE3-I), Org9935, in long-term culture of cumulus–corona–oocyte complexes (COC) and to associate adequate stimuli for efficient oocyte maturation.Design: Experimental in vitro study on mice.Setting: Academic research laboratory.Animal(s): F1 hybrid mice: C57Bl/6j x CBA/ca.Intervention(s): The COCs were selectively retrieved from cultured follicles at the early antral stage and subcultured for 4 days in absence or presence of Org9935 (5 nM to 1 μM).Main Outcome Measure(s): Oocyte nuclear maturation; estradiol and progesterone concentrations in conditioned medium.Result(s): Survival of COCs was dose dependently improved by Org9935. When subculture was done in absence of Org9935; human chorionic gonadotropin (hCG), epiregulin, or hCG + epiregulin induced 0%, 17%, and 21%, respectively, of polar body formation. Concentrations above 50 nM prohibited the reinitiation of meiosis by a hCG + epidermal growth factor stimulus. Epiregulin or hCG + epiregulin induced 63% and 66% polar body rate, respectively, but only after washing out the inhibitor. Acute progesterone production occurs after stimulation with hCG, or hCG + epiregulin, but epiregulin alone induces the lowest response.Conclusion(s): Presence of PDE3-I in cultured COCs improves survival. Washout of PDE3-I is necessary for meiotic resumption to occur. Epiregulin by itself induces meiotic maturation but is a weak inducer of progesterone production.Improvement of in vitro culture of mouse cumulus–oocyte complexes using PDE3-inhibitor followed by meiosis induction with epiregulinSergio Romero, Johan Smitz10.1016/j.fertnstert.2008.10.016Fertility and Sterility 93, 3 (2010)2008-11-19Fertility and Sterility2008-11-19933S0015-0282(10)X0002-4Reproductive biology936944http://www.fertstert.org/article/PIIS0015028208048267/abstract?rss=yesObjective: To compare acH4K12 levels in oocytes during mouse aging and then assess how such changes might affect the developmental potential of oocytes.Design: Experimental animal study.Setting: State key laboratory and university research laboratory.Animal(s): Kunming white strain mice.Intervention(s): Oocytes obtained from TSA treated group or aging mouse group were fertilized and the formation of pronuclei and subsequently developmental potential in vitro or in vivo were assessed.Main Outcome Measure(s): AcH4K12 levels in oocytes were assessed using fluorescence staining, and confocal microscopy and oocyte developmental potentials were determined by in vitro or in vivo methods.Result(s): The AcH4K12 levels in oocytes statistically significantly increased during mouse aging. When histone acetylation of oocytes of young mice was artificially increased by trichostatin A (TSA) treatment, the acH4K12 levels in male and female pronuclei in fertilized oocytes showed statistically significant changes. About 38.9% of TSA-treated oocytes failed to form pronuclei or formed morphologically abnormal pronuclei 6 hours after fertilization, which statistically significantly decreased the blastocyst rate of TSA-treated oocytes when compared with the control group (41.5% vs. 60.5%). A similar reduction in blastocyst development was also observed when oocytes collected in older mice were compared with younger mice (17.3% vs. 69.4%).Conclusion(s): The AcH4K12 levels in oocytes statistically significantly increased during the aging process in mice, and such changes may affect the acetylation patterns and morphology of pronuclei during fertilization and lead to a reduction in oocyte developmental potential.Changes in acetylation on lysine 12 of histone H4 (acH4K12) of murine oocytes during maternal aging may affect fertilization and subsequent embryo developmentLun Suo, Qing-Gang Meng, Yan Pei, Chang-Liang Yan, Xiang-Wei Fu, Thomas D. Bunch, Shi-En Zhu10.1016/j.fertnstert.2008.12.128Fertility and Sterility 93, 3 (2010)2009-03-16Fertility and Sterility2009-03-16933S0015-0282(10)X0002-4Reproductive biology945951http://www.fertstert.org/article/PIIS0015028208044154/abstract?rss=yesObjective: To evaluate the contraceptive ability of a synthetic Bin1b peptide in vivo in the rat.Design: Basic research.Setting: University laboratory animal service center.Animal(s): A peptide-based immunization model was developed; rats were injected with the Bin1b specific peptide.Intervention(s): A synthetic peptide segment, MCRSGERKGDICSDP-conjugated with KLH (Bin1b), was used to immunize male wistar rats. Freund's complete adjuvant was used as a control.Main Outcome Measure(s): Anti-Bin1b levels in sera were evaluated by enzyme-linked immunosorbent assay (ELISA). Anti-Bin1b and control antisera were used to evaluate sperm function inhibition in vitro. The fertility of immunized rats was determined by mating experiment. The testis and epididymides were analyzed by histology.Result(s): Histological studies showed no evidence of orchitis or epididymitis in Bin1b-immunized animals. ELISA results revealed that the titers of anti-Bin1b antibodies in serum increased with the immunization process in immunized rats. Sperm recovered from the corpus epididymidis of the Bin1b-immunized animals exhibited a significant decrease in motility. Immunization of Bin1b also caused a reduction (25%) in fertility after the mating experiment.Conclusion(s): The present study has demonstrated that immunization with Bin1b peptide specifically interferes with sperm motility, resulting in a compromised fertilizing capacity of sperm.Immunization with Bin1b decreases sperm motility with compromised fertility in ratsWenming Xu, Xiaohu Zhang, Wenying Chen, Kin Lam Fok, Dewi Kenneth Rowlands, Yiu-Loon Chui, Hsiao Chang Chan10.1016/j.fertnstert.2008.10.066Fertility and Sterility 93, 3 (2010)2009-01-09Fertility and Sterility2009-01-09933S0015-0282(10)X0002-4Reproductive biology952958.e1http://www.fertstert.org/article/PIIS0015028208047468/abstract?rss=yesObjective: To investigate the effect of Taxol pretreatment on mitochondrial behaviors in vitrified mouse mature oocytes and their parthenogenetic embryos.Design: Experimental animal study.Setting: University research laboratory and state key laboratory.Animal(s): Sexually mature female Kunming white strain mice.Intervention(s): Taxol before vitrification group (Tax). Oocytes were pretreated with M2 containing 1 mmol/L Taxol for 2 minutes at 37C and then vitrified-warmed using the OPS vitrification procedure. Both ED solution and EDFS30 solution contained 1 mmol/L Taxol.Main Outcome Measure(s): Mitochondrial behaviors examined by fluorescence microscopy technology and fluorescence recovery after photobleaching (FRAP) technology.Result(s): In the control group, mitochondria were homogeneously distributed, in slow movement in oocytes, and perinuclearly distributed in 42.6% (n = 115) of their parthenogenetic two-cell embryos. Mitochondria from the toxicity group showed similar localization and movement to those of the control group, but not in the vitrification group. The perinuclear mitochondrial localization pattern of two-cell embryos was statistically significantly lower in both the toxicity (27.2%) and vitrification groups (19.8%) than in the control group. After parthenogenetic activation, the blastocyst formation rate of oocytes in the treated groups (28.1 to 48.6%) was statistically significantly lower than that of control (61.2%), but the rate of Taxol group (47.9%) was statistically significantly higher than that in the vitrification group (28.1%).Conclusion(s): Taxol pretreatment before vitrification helps to reduce the mitochondrial disturbance induced by vitrification in oocytes and their parthenogenetic early-stage embryo.Mitochondrial behaviors in the vitrified mouse oocyte and its parthenogenetic embryo: effect of Taxol pretreatment and relationship to competenceChang-Liang Yan, Xiang-Wei Fu, Guang-Bin Zhou, Xue-Ming Zhao, Lun Suo, Shi-En Zhu10.1016/j.fertnstert.2008.12.045Fertility and Sterility 93, 3 (2010)2009-02-24Fertility and Sterility2009-02-24933S0015-0282(10)X0002-4Reproductive biology959966http://www.fertstert.org/article/PIIS0015028209006037/abstract?rss=yesWe report a case of unilateral adnexal absence with a peritoneal loose body. Laparoscopic findings and medical history suggested that she had adnexal torsion in her childhood followed by its calcification and autoamputation.Autoamputated adnexa presents as a peritoneal loose bodyKaori Koga, Hisahiko Hiroi, Yutaka Osuga, Miwako Nagai, Tetsu Yano, Yuji Taketani10.1016/j.fertnstert.2009.03.038Fertility and Sterility 93, 3 (2010)2009-04-27Fertility and Sterility2009-04-27933S0015-0282(10)X0002-4Images in reproductive medicine967968http://www.fertstert.org/article/PIIS0015028208044129/abstract?rss=yesObjective: To evaluate the size of ovarian damage caused by ovarian drilling in polycystic ovary syndrome, the amount of inflicted damage was assessed for the most frequently used ovarian drilling techniques.Design: Experimental prospective design.Setting: University clinic.Patient(s): Six fresh bovine ovaries per technique.Intervention(s): Carbon dioxide (CO2) laser, monopolar electrocoagulation, and bipolar electrocoagulation were used for in vitro ovarian drilling.Main Outcome Measure(s): Amount of inflicted ovarian damage per procedure.Result(s): Bipolar electrocoagulation resulted in significantly more destruction per burn than the CO2 laser and monopolar electrocoagulation (287.6 versus 24.0 and 70.0 mm3, respectively). The damage found per lesion was multiplied by the regularly applied number of punctures per procedure in daily practice (based on the literature). Again, the bipolar electrocoagulation resulted in significantly more tissue damage than the CO2 laser and monopolar coagulation (2,876 versus 599 and 700 mm3, respectively).Conclusion(s): Ovarian drilling, especially bipolar electrocoagulation, causes extensive destruction of the ovary. Given the same clinical effectiveness of the various procedures, it is essential to use the lowest possible dose that works; thus, the first choice should be CO2 laser or monopolar electrocoagulation. Extensive tissue damage of bovine ovaries after bipolar ovarian drilling compared to monopolar electrocoagulation or carbon dioxide laserMarja-Liisa Hendriks, Paul van der Valk, Cornelis B. Lambalk, Mark A.M. Broeckaert, Roy Homburg, Peter G.A. Hompes10.1016/j.fertnstert.2008.10.046Fertility and Sterility 93, 3 (2010)2008-12-18Fertility and Sterility2008-12-18933S0015-0282(10)X0002-4Techniques and instrumentation969975http://www.fertstert.org/article/PIIS0015028208042027/abstract?rss=yesObjective: To develop an efficient freezing method suitable for large-scale cryopreservation of human embryonic stem cells (hESCs).Design: Experimental study.Setting: Research institute.Patient(s): None.Intervention(s): Two genetically modified hESC lines, H9-EF1-GFP and CHA-hES3-EF1-GFP, were cryopreserved in cryovials using a combination of two equilibration methods (one-step and stepwise) and two cooling vehicles (cryo-container and program-controlled freezer). After thawing, the survival and differentiation rate were compared among groups.Main Outcome Measure(s): The hESC survival was assessed by alkaline phosphatase staining and differentiation status was determined by flow cytometry using an SSEA-4 antibody.Result(s): In both H9-EF1-GFP and CHA-hES3-EF1-GFP cells, the survival rate was highest in the group using stepwise equilibration and program-controlled freezer, and lowest in the group using one-step equilibration and cryo-container. In the groups using cryo-container, the survival and the frequency of undifferentiated cells in both cell lines was highly improved in a stepwise equilibration compared with one-step. Thawed hESCs were positively stained with pluripotent markers SSEA-4, TRA-1-60, TRA-1-81, and alkaline phosphatase. The karyotypes and expression of three germ layer markers in both cell lines were not changed after freezing/thawing.Conclusion(s): The stepwise equilibration of Knockout Serum Replacement and cryoprotectant during freezing and thawing resulted in higher survival rates by reducing osmotic damage irrespective of cooling vehicles.High concentration of synthetic serum, stepwise equilibration and slow cooling as an efficient technique for large-scale cryopreservation of human embryonic stem cellsJi Yeon Lee, Jeoung Eun Lee, Dong Ku Kim, Tae Ki Yoon, Hyung Min Chung, Dong Ryul Lee10.1016/j.fertnstert.2008.10.017Fertility and Sterility 93, 3 (2010)2008-11-19Fertility and Sterility2008-11-19933S0015-0282(10)X0002-4Techniques and instrumentation976985http://www.fertstert.org/article/PIIS001502820804274X/abstract?rss=yesObjective: To explore several culture systems that may prove efficient in driving human embryonic stem cells (hESCs) toward a germ cell lineage.Design: Embryoid bodies (EBs) derived from a female hESC line [HES-3 (XX)] and male hESC line [HES-4 (XY)] were cultured in six different culture conditions: [1] mitotically inactivated porcine ovarian fibroblasts (POF), [2] 100% conditioned medium from POF, [3] 50% conditioned medium from POF, [4] forskolin, [5] trans-retinoic acid (RA), and [6] forskolin and RA.Setting: Department of Obstetrics and Gynecology, National University of Singapore Research Laboratories, Singapore.Patient(s): None.Intervention(s): None.Main Outcome Measure(s): None.Result(s): Expression data for both HES-3 and HES-4 differentiating cultures strongly indicated that inactivated POFs encouraged differentiation of hESC EBs into a germ cell lineage. VASA and other germ cell markers were found to be elevated in all six culture conditions.Conclusion(s): Overall, POFs proved to be the best system for initiating germ cell differentiation, as shown by increases in the expression of several germ cell marker genes in EBs that were cocultured with POFs.Comparative evaluation of different in vitro systems that stimulate germ cell differentiation in human embryonic stem cellsMark Richards, Chui-Yee Fong, Ariff Bongso10.1016/j.fertnstert.2008.10.030Fertility and Sterility 93, 3 (2010)2008-12-08Fertility and Sterility2008-12-08933S0015-0282(10)X0002-4Techniques and instrumentation986994http://www.fertstert.org/article/PIIS0015028208044269/abstract?rss=yesObjective: To investigate a possible difference between true ovarian volume and ovarian volume estimated with two-dimensional (2D) transvaginal ultrasound.Design: Prospective clinical and laboratory study.Setting: University hospital research laboratory.Patient(s): Premenopausal girls and women from three Danish national fertility centers (A: n = 42; B: n = 6; C: n = 18), who had one entire ovary removed for cryopreservation of ovarian cortex.Intervention(s): Transvaginal 2D ultrasound measurement of ovarian volume before oophorectomy. True ovarian volume was obtained by weighing the ovary.Main Outcome Measure(s): Ovarian volume estimated by weight and ultrasound.Result(s): Ovarian tissue density was 1.00 g/mL. Mean ovarian volume by ultrasound vs. weight in the three groups was as follows: A: 6.3 mL vs. 7.8 mL; B: 5.4 mL vs. 6.8 mL; and C: 2.8 mL vs. 6.1 ml. Ovarian volume obtained by ultrasound was at least 27% smaller than the true ovarian volume.Conclusion(s): Ovarian volume was severely underestimated by transvaginal 2D ultrasound measurement.True ovarian volume is underestimated by two-dimensional transvaginal ultrasound measurementMikkel Rosendahl, Erik Ernst, Per Emil Rasmussen, Claus Yding Andersen10.1016/j.fertnstert.2008.10.055Fertility and Sterility 93, 3 (2010)2008-12-23Fertility and Sterility2008-12-23933S0015-0282(10)X0002-4Techniques and instrumentation995998http://www.fertstert.org/article/PIIS0015028208044294/abstract?rss=yesObjective: To establish reliable methods for cryopreservation of human embryonic stem cells (hESCs).Design: Prospective experimental study.Setting: University laboratory.Patient(s): One hESC line.Intervention(s): The attachment rates and recovery rates of cryopreserved hESCs using three different cryopreservation methods were compared.Main Outcome Measure(s): The hESCs were frozen and thawed by conventional cryopreservation, programmable cryopreservation, and vitrification method. The efficiency of cryopreservation was assessed by attachment rate and recovery rate.Result(s): The attachment rate and recovery rate after thawing of hESCs frozen by the conventional cryopreservation method were significantly lower than those of hESCs frozen by programmed cryopreservation and vitrification methods. Vitrification resulted in the highest attachment rate and recovery rate compared with the other two methods. Human ESCs after vitrification and programmable cryopreservation still expressed pluripotent markers, maintained normal karyotype, and retained their pluripotency.Conclusion(s): Our data show that programmable cryopreservation and vitrification methods are appropriate for cryopreservation of hESCs, whereas the conventional slow-rate freezing method is not appropriate for cryopreservation of hESCs.Comparison of three methods for cryopreservation of human embryonic stem cellsYang Li, Ji-chun Tan, Ling-song Li10.1016/j.fertnstert.2008.10.052Fertility and Sterility 93, 3 (2010)2008-12-23Fertility and Sterility2008-12-23933S0015-0282(10)X0002-4Techniques and instrumentation9991005http://www.fertstert.org/article/PIIS0015028209039594/abstract?rss=yesObjective: To discuss the diagnosis of spinal muscular atrophy in a child conceived using donor gametes.Design: None.Setting: None.Patient(s): Offspring of gamete donors.Intervention(s): None.Main Outcome Measure(s): None.Result(s): A child conceived using gametes from anonymous sperm and ova donors was diagnosed with spinal muscular atrophy type 1.Conclusion(s): Gamete donor facilities are not required to perform extensive genetic testing on their donors; however, the well-being of the children conceived through assisted reproductive technologies should be a primary objective of reproductive medicine. The risk for specific medical problems in donor offspring can be significantly reduced by incorporating carrier screening for common, severe disorders such as spinal muscular atrophy into donor screening practices. Future efforts should focus on communicating the limitations of genetic screening to donor gamete recipients and educating them about their reproductive options.Spinal muscular atrophy (SMA) after conception using gametes from anonymous donors: recommendations for the futurePamela Callum, Maria Teresa Urbina, Rena E. Falk, Jorge A. Alvarez-Diaz, Isaac Benjamin, Charles A. Sims10.1016/j.fertnstert.2009.10.039Fertility and Sterility 93, 3 (2010)2009-12-03Fertility and Sterility2009-12-03933S0015-0282(10)X0002-4Case report summaries1006.e11006.e2http://www.fertstert.org/article/PIIS0015028209035092/abstract?rss=yesObjective: To describe a new FOXL2 gene mutation in a woman with sporadic blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) and hypergonadotropic hypogonadism.Design: Case report.Setting: University medical center.Patient(s): A 28-year-old woman.Intervention(s): Clinical evaluation, hormone assays, gene mutation research.Main Outcome Measure(s): FOXL2 gene mutation.Result(s): The patient with hypergonadotropic hypogonadism was diagnosed with BPES due to a new FOXL2 gene mutation.Conclusion(s): Blepharophimosis-ptosis-epicanthus inversus syndrome is a rare disorder associated with premature ovarian failure (POF). The syndrome is an autosomal dominant trait that causes eyelid malformations and POF in affected women. Mutations in FOXL2 gene, located in chromosome 3, are related to the development of BPES with POF (BPES type I) or without POF (BPES type II). This report demonstrates a previously undescribed de novo mutation in the FOXL2 gene—a thymidine deletion, c.627delT (g.864delT)—in a woman with a sporadic case of BPES and POF. This mutation leads to truncated protein production that is related to a BPES type I phenotype. This report shows the importance of family history and genetic analysis in the evaluation of patients with POF and corroborates the relationship between mutations on the FOXL2 gene and ovarian insufficiency.A new FOXL2 gene mutation in a woman with premature ovarian failure and sporadic blepharophimosis-ptosis-epicanthus inversus syndromeFrederico José Silva Corrêa, Adriano Bueno Tavares, Rinaldo Wellerson Pereira, Mauricio Simões Abrão10.1016/j.fertnstert.2009.08.034Fertility and Sterility 93, 3 (2010)2009-12-07Fertility and Sterility2009-12-07933S0015-0282(10)X0002-4Case report summaries1006.e31006.e6http://www.fertstert.org/article/PIIS0015028209038059/abstract?rss=yesObjective: To ascertain meiotic aneuploidy of the human egg using array comparative genomic hybridization to evaluate the 23–paired chromosome copy number of first polar body as an objective prognosticator of embryo viability for embryo transfer in the same cycle.Design: Case report.Setting: Independent-sector IVF program.Patient(s): A 41-year-old woman with a history of 13 failed cycles of IVF.Intervention(s): Polar body biopsy of metaphase II eggs.Main Outcome Measure(s): Birth.Result(s): Two of the nine eggs were euploid, and the resulting embryos, although morphologically inferior to sibling embryos, were selected for transfer to the uterus, resulting in the birth of a normal healthy baby.Conclusion(s): Selection of euploid eggs, as an objective parameter of subsequent embryo viability and with the opportunity to transfer embryos in the same cycle could maximise the opportunity for live birth after IVF even in cases with poor prognosis.Live birth after polar body array comparative genomic hybridization prediction of embryo ploidy—the future of IVF?Simon Fishel, Anthony Gordon, Colleen Lynch, Ken Dowell, George Ndukwe, Ehab Kelada, Simon Thornton, Lucy Jenner, Ellen Cater, Anthony Brown, Jose Garcia-Bernardo10.1016/j.fertnstert.2009.09.055Fertility and Sterility 93, 3 (2010)2009-11-24Fertility and Sterility2009-11-24933S0015-0282(10)X0002-4Case report summaries1006.e71006.e10http://www.fertstert.org/article/PIIS0015028209038114/abstract?rss=yesObjective: To describe a case of successful pregnancy after IVF-ET in a patient with previous thermal ablation of the endometrium by uterine balloon therapy (UBT).Design: Case report.Setting: University hospital.Patient(s): Polymorbid patient who received UBT and became pregnant after IVF-ET.Intervention(s): UBT, IVF-ET, and caesarean section.Result(s): After UBT, the patient underwent IVF-ET and gave birth to a healthy newborn at 36 weeks' gestation with a birth weight 2900 g and placenta accreta.Conclusion(s): Patients who wish to become pregnant after endometrial ablation should undergo preconception consultation and hysteroscopic examination.Successful pregnancy after thermal balloon endometrial ablation followed by in vitro fertilization and embryo transferDavid Kuzel, Lucie Bartosova, Karel Rezabek, Dusan Toth, Josef Cindr, Michal Mara10.1016/j.fertnstert.2009.09.061Fertility and Sterility 93, 3 (2010)2009-11-25Fertility and Sterility2009-11-25933S0015-0282(10)X0002-4Case report summaries1006.e111006.e13http://www.fertstert.org/article/PIIS0015028209038084/abstract?rss=yesObjective: To present a case of complicated deep infiltrating endometriosis managed by a multidisciplinary minimally invasive approach.Design: Case report.Setting: Tertiary care university hospital.Patient: A 32-year-old woman with deep infiltrating endometriosis involving the rectovaginal septum, the rectum, and the left ureter, complicated by silent left renal function loss.Intervention(s): Laparoscopic left nephrectomy, ureterectomy, excision of a left ovarian endometrioma, removal of a large rectovaginal nodule, and segmental bowel resection with minilaparotomic end-to-end anastomosis.Main Outcome Measure(s): Multidisciplinary diagnosis and minimally invasive surgical approach to deep infiltrating endometriosis involving the rectum and the urinary tract.Result(s): Collaboration between gynecologists, urologists, and colorectal surgeons enabled a successful management of the case in one surgical intervention providing minor risk of complications, shorter hospital stay, and faster functional recovery.Conclusion(s): Deep infiltrating endometriosis is a global pathology that may involve different structures. A multidisciplinary, minimally invasive approach should be recommended to achieve appropriate disease management.A multidisciplinary, minimally invasive approach for complicated deep infiltrating endometriosisRenato Seracchioli, Linda Manuzzi, Mohamed Mabrouk, Serena Solfrini, Clarissa Frascà, Fabio Manferrari, Filippo Pierangeli, Roberto Paradisi, Stefano Venturoli10.1016/j.fertnstert.2009.09.058Fertility and Sterility 93, 3 (2010)2009-11-24Fertility and Sterility2009-11-24933S0015-0282(10)X0002-4Case report summaries1007.e11007.e3http://www.fertstert.org/article/PIIS0015028209025011/abstract?rss=yesIn a retrospective cohort review of third-party reproduction, we observed that surrogate body mass index (BMI) negatively impacts implantation rates in oocyte-donor in vitro fertilization cycles. A BMI ≥35kg/m2 cutoff is associated with a statistically significant decrease in pregnancy rates but not miscarriage rates.Surrogate obesity negatively impacts pregnancy rates in third-party reproductionDaniel A. DeUgarte, Catherine M. DeUgarte, Vicken Sahakian10.1016/j.fertnstert.2009.07.1005Fertility and Sterility 93, 3 (2010)2009-09-07Fertility and Sterility2009-09-07933S0015-0282(10)X0002-4Correspondence10081010http://www.fertstert.org/article/PIIS0015028209034554/abstract?rss=yesIn the present retrospective analysis of outpatient health insurance members of the Statutory Health Insurance (SHI) in total and a subgroup of the Techniker Krankenkasse (TK), the effect of the commencement of the SHI Modernization Act (so-called GMG) on the supply and expenditure situation regarding assisted reproductive technologies (ART) in Germany was examined. The implementation of the GMG in Germany in 2004 resulted in a conspicuous decrease of infertility treatments (from 2002–2005 by approximately 60% in the whole SHI population, and by 55% in the TK) for couples with involuntary childlessness, whereby the extremely raised compulsory copayments to the insurance benefits were identified as the determining factor.Effects of the Statutory Health Insurance Modernization Act on the supply and expenditure situation in cases of assisted reproductive technologies in GermanyEva Susanne Dietrich, Wenke Wevers10.1016/j.fertnstert.2009.07.1665Fertility and Sterility 93, 3 (2010)2010-01-11Fertility and Sterility2010-01-11933S0015-0282(10)X0002-4Correspondence10111013http://www.fertstert.org/article/PIIS0015028209034633/abstract?rss=yesIn 109 women with primary RSA the presence of at least one live-born infant within 5 years of follow-up has been found positively associated with ACA intensity.Immunologic factors and reproductive success in women with primary repeated spontaneous abortionFulvia Gloria-Bottini, Maria Nicotra, Andrea Magrini, Egidio Bottini10.1016/j.fertnstert.2009.08.007Fertility and Sterility 93, 3 (2010)2009-10-01Fertility and Sterility2009-10-01933S0015-0282(10)X0002-4Correspondence10141015http://www.fertstert.org/article/PIIS001502820903458X/abstract?rss=yesWe studied the effect of metformin or placebo in a lifestyle modification program combined with oral contraceptives (OC) on quality-of-life parameters measured by the polycystic ovary syndrome (PCOS) questionnaire in obese adolescent women with validated PCOS. The quality-of-life indicators were measured at baseline and conclusion for five domains on the PCOS questionnaire, with equal improvement in scores in both placebo and metformin groups, suggesting that the addition of metformin does not add improvement to quality-of-life measures above those observed with lifestyle modification and OC treatment.Improvement in quality-of-life questionnaire measures in obese adolescent females with polycystic ovary syndrome treated with lifestyle changes and oral contraceptives, with or without metforminMiranda Harris-Glocker, Kristin Davidson, Lynda Kochman, David Guzick, Kathleen Hoeger10.1016/j.fertnstert.2009.08.006Fertility and Sterility 93, 3 (2010)2009-09-24Fertility and Sterility2009-09-24933S0015-0282(10)X0002-4Correspondence10161019http://www.fertstert.org/article/PIIS0015028209034530/abstract?rss=yesThe objective was to evaluate the viral infection effects on infertility treatment outcome in HIV-1 or hepatitis C (HCV) monoinfected infertile serodiscordant couples, in a retrospective case-controlled, university-based study. Clinical pregnancy rate for HIV-1 or HCV infertile serodiscordant couples was not significantly different from that for seronegative controls.HIV-1 or hepatitis C chronic infection in serodiscordant infertile couples has no impact on infertility treatment outcomeNadia Prisant, Roland Tubiana, Gilles Lefebvre, Pascal Lebray, Anne Genevieve Marcelin, Vincent Thibault, Ouriel Rosenblum, Manuela Bonmarchand, Danielle Vauthier-Brouzes, Jean Louis Golmard, Christine Katlama, Catherine Poirot10.1016/j.fertnstert.2009.07.1663Fertility and Sterility 93, 3 (2010)2009-09-03Fertility and Sterility2009-09-03933S0015-0282(10)X0002-4Correspondence10201023http://www.fertstert.org/article/PIIS0015028209040576/abstract?rss=yesTo the Editor: We read with interest the article by Meuleman et al. . The high incidence of endometriosis (47%) and other pelvic pathology (29%) in this cohort makes a strong case to offer laparoscopy and hysteroscopy to couples with “unexplained infertility” (a diagnosis of exclusion). This diagnosis, however, requires confirmation of tubal integrity, and the issue is whether laparoscopy should be the first line investigation to establish tubal patency. The investigators did not say how many women in their cohort had a completely normal pelvis after laparoscopy and hysteroscopy.High prevalence of endometriosis in infertile women with normal ovulation and normospermic partnersKrithiga Ilangavan, Emmanuel Kalu10.1016/j.fertnstert.2009.11.027Fertility and Sterility 93, 3 (2010)2009-12-25Fertility and Sterility2009-12-25933S0015-0282(10)X0002-4Letters to the editore10e10http://www.fertstert.org/article/PIIS0015028209040564/abstract?rss=yesTo the Editor: In the article by Meuleman et al. I appreciated the new understandings brought by the investigators and the unexpected demonstration that pelvic pain was not explained by the existence of endometriotic lesions in 46% of cases in infertile women.Endometriosis: is laparoscopy justified without previous ultrasonogram and magnetic resonance imaging (MRI)?Jean Belaisch10.1016/j.fertnstert.2009.11.026Fertility and Sterility 93, 3 (2010)2010-01-07Fertility and Sterility2010-01-07933S0015-0282(10)X0002-4Letters to the editore11e11http://www.fertstert.org/article/PIIS0015028209040588/abstract?rss=yesWe thank colleagues Belaisch, Ilangavan, and Kalu for their interest in our work . Our conclusion that reproductive surgery is indicated in infertile women with regular menstrual cycles whose male partners have normal sperm quality is justified. First, significant pelvic (including endometriosis), tubal or uterine pathology was observed in two-thirds of our patients and can be interpreted as significant comorbidity and justification for surgery according to the National Collaboration Centre for Women's and Children's Health guidelines . Second, a completely normal hysteroscopy and laparoscopy test was only observed in one-third of our patients , but in this “normal” group diagnostic hysteroscopy and laparoscopy can still be clinically justified to confirm the diagnosis of unexplained infertility, as a normal hysterosalpingography does not exclude significant pelvic pathology .Reply of the Authors: Endometriosis: is laparoscopy justified without previous ultrasonogram and magnetic resonance imaging (MRI)? & High prevalence of endometriosis in infertile women with normal ovulation and normospermic partnersChristel Meuleman, Carla Tomassetti, Dirk Timmerman, Thomas D'Hooghe10.1016/j.fertnstert.2009.11.028Fertility and Sterility 93, 3 (2010)2009-12-25Fertility and Sterility2009-12-25933S0015-0282(10)X0002-4Letters to the editore12e12http://www.fertstert.org/article/PIIS001502820903862X/abstract?rss=yesTo the Editor: We read with great interest the study by Singer et al. , and we would like to comment on the relationships among antimüllerian hormone (AMH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels in polycystic ovary syndrome (PCOS).Serum AMH, FSH, and LH levels in PCOSNeoklis A. Georgopoulos, Alexandros D. Saltamavros, George Decavalas, Athanasia Piouka, Ilias Katsikis, Dimitrios Panidis10.1016/j.fertnstert.2009.10.006Fertility and Sterility 93, 3 (2010)2010-01-11Fertility and Sterility2010-01-11933S0015-0282(10)X0002-4Letters to the editore13e13http://www.fertstert.org/article/PIIS0015028209038631/abstract?rss=yesWe appreciate the interest of Dr. Georgopoulos and colleagues in our study. In response to our observation of an inverse relationship between FSH and anti-Müllerian hormone (AMH) among women undergoing in vitro fertilization they have offered their own observation that among women with polycystic ovarian syndrome the FSH/AMH relationship is not present. They further offer evidence that AMH concentration is directly related to luteinizing hormone (LH) among women with polycystic ovaries (PCO).Reply of the Authors: Serum AMH, FSH, and LH levels in PCOSDavid H. Barad, Norbet Gleicher, Tomer Singer10.1016/j.fertnstert.2009.10.007Fertility and Sterility 93, 3 (2010)2010-01-11Fertility and Sterility2010-01-11933S0015-0282(10)X0002-4Letters to the editore14e14http://www.fertstert.org/article/PIIS001502820903708X/abstract?rss=yesThis handbook-sized work is intended for childless couples that have just discovered infertility. For them, this book reads and teaches with schoolmaster authority. The author, former head and founder of the Human Assisted Reproduction Unit at the Rotunda in Dublin, was the first in Ireland to implement a human assisted reproduction unit specially tailored to the needs of infertility couples. Professor Harrison, in his 35-plus years of clinical service in this field, has counseled countless couples about to enter this difficult passage in life.The Smart Guide to Infertility: Myths and RealityJohn E. Buster10.1016/j.fertnstert.2009.09.029Fertility and Sterility 93, 3 (2010)2009-11-19Fertility and Sterility2009-11-19933S0015-0282(10)X0002-4Book reviews10241024http://www.fertstert.org/article/PIIS0015028209037091/abstract?rss=yesEvidence-based medicine is the integration of best research evidence with clinical expertise and patient values.1 With the rapid advancement of our knowledge and technologies in the field of infertility, integrating the best research evidence into practice is vital to optimize the care of infertile couples. Staying current and critically appraising the latest research is a challenging aspect of practicing evidence-based medicine. The editors of the Biennial Review of Infertility have simplified this challenge by assembling a diverse group of evidence-based experts to review cutting edge topics in reproductive medicine.Biennial Review of InfertilityWendy S. Vitek10.1016/j.fertnstert.2009.09.030Fertility and Sterility 93, 3 (2010)2009-11-19Fertility and Sterility2009-11-19933S0015-0282(10)X0002-4Book reviews10241025http://www.fertstert.org/article/PIIS0015028210000130/abstract?rss=yesAlan H. DeCherney, M.D. Bethesda, MarylandEditorial Board10.1016/S0015-0282(10)00013-0Fertility and Sterility 93, 3 (2010)2010-02-01Fertility and Sterility2010-02-01933S0015-0282(10)X0002-4FrontmatterA2A2http://www.fertstert.org/article/PIIS0015028210000142/abstract?rss=yesTable of Contents10.1016/S0015-0282(10)00014-2Fertility and Sterility 93, 3 (2010)2010-02-01Fertility and Sterility2010-02-01933S0015-0282(10)X0002-4FrontmatterA3A3