Fertility and Sterility - Articles in Press

Calling attention to the use of false “endothelial” cell lines - Corrected Proof

Carolina Sales Vieira, Rui Alberto Ferriani, Maria Regina Torqueti Tolloi — 2010-03-08

Reply of the Authors: We appreciate the interest and the comments of Armando Rojas, Ileana Gonzalez, and Hector Figueroa about our study . Our study was the first designed to compare the endothelial effects of ethinylestradiol (EE) and E2 on nitric oxide (NO) production and protection against oxidative stress in human endothelial cell cultures.

Calling attention to the use of false “endothelial” cell lines - Corrected Proof

Armando Rojas, Ileana Gonzalez, Hector Figueroa — 2010-03-08

To the Editor: In the article by Berlado Andozia et al. , the authors used the cell line ECV304 as a “human endothelial cell line.”

Mood disorders and sexual functioning in women with functional hypothalamic amenorrhea - Corrected Proof

2010-03-08

Objective: To investigate the sexual function of women with functional hypothalamic amenorrhea (FHA) and to test the mediating effects of depression and anxiety on the sexual functioning of women with FHA.Design: In this cross-sectional study, participants completed questionnaires on sexual function, depression, and anxiety.Setting: Tertiary care university hospital.Patient(s): Women with (n = 41) and without (n = 39) FHA recruited from a gynecologic endocrinology unit.Intervention(s): None.Main Outcome Measure(s): The McCoy Female Sexuality Questionnaire assessed sexual function, and the Zung Scale measured depression and anxiety.Result(s): Women with FHA experienced more sexual function problems and significantly higher depression and anxiety compared to women without menstrual dysfunction. In addition, depression offered a significant explanation for the sexual problems experienced by women with FHA.Conclusion(s): The psychologic symptoms that contribute to the onset of FHA partially mediate the relationship between FHA and sexual dysfunction.

Is infertility a risk factor for female sexual dysfunction? A case-control study - Corrected Proof

2010-03-08

Objective: To determine the impact of infertility on female sexual function.Design: A case-control study.Setting: Academic infertility and gynecology practices.Patient(s): One hundred nineteen women with infertility and 99 healthy female controls without infertility between the ages of 18 and 45 years were included in this study.Intervention(s): Anonymous survey and Female Sexual Function Index.Main Outcome Measure(s): Female Sexual Function Index scores, frequency of sexual intercourse and masturbation, and sex-life satisfaction.Result(s): Twenty-five percent of our control group had Female Sexual Function Index scores that put them at risk for sexual dysfunction (<26.55), whereas 40% of our patients with infertility met this criterion. Compared with the control group, the patients with infertility had significantly lower scores in the desire and arousal domains and lower frequency of intercourse and masturbation. The patients with infertility retrospectively reported a sex-life satisfaction score that was similar to that of the controls before their diagnosis, whereas their current sex-life satisfaction scores were significantly lower than those of the controls.Conclusion(s): Women with a diagnosis of infertility were found to be at higher risk for sexual dysfunction on the basis of their Female Sexual Function Index scores compared with women without infertility. The interaction of sexual function and infertility is complex and deserves further study.

Selective blockade of prostaglandin E2 receptor EP2 and EP4 signaling inhibits proliferation of human endometriotic epithelial cells and stromal cells through distinct cell cycle arrest - Corrected Proof

2010-03-08

Objective: To determine interactions between prostaglandin (PG) E2 signaling and proliferation of endometriotic cells to increase our knowledge about PGE2 signaling in the pathogenesis of endometriosis in humans.Design: Immortalized human endometriotic epithelial and stromal cells were used as an in vitro model. Effects of inhibition of PGE2 receptors on proliferation of endometriotic cells and associated cell cycle regulation were determined.Setting: College Veterinary Medicine and Biomedical Sciences, Texas A&M University.Patient(s): Not available.Intervention(s): None.Main Outcome Measure(s): Cell proliferation, cell viability, cell cycle, regulation of cyclins, cyclin-dependent kinases, and cyclin-dependent kinase inhibitors.Result(s): Selective blockade of EP2/EP4 inhibited proliferation of human endometriotic cells by inducing cell cycle arrest at the G1–S and G2–M checkpoints in epithelial cells and at the G2–M checkpoint in stromal cells. This cell cycle arrest during specific checkpoints was associated with distinct regulation of respective cyclins and cyclin-dependent kinases. Inhibition of EP1 did not decrease endometriotic cell proliferation.Conclusion(s): For the first time data from the present study provide a direct molecular link between PGE2 signaling and proliferation of endometriotic cells and suggest that inhibition of EP2/EP4 could be a potential nonestrogen (E) treatment option for endometriosis in women.

Fertility patients' experiences of crossborder reproductive care - Corrected Proof

Eric Blyth — 2010-03-08

Objective: To obtain pertinent information from individuals who have either experienced crossborder reproductive care, or have considered doing so.Design: International online survey of patients in collaboration with patient support groups in Australia and Canada.Result(s): Analysis of data is based on 95 usable responses, of which 28 were from individuals who indicated that they had previously participated in crossborder reproductive care. Key areas investigated in the survey included the reasons for undertaking or considering crossborder reproductive care, the specific reproductive services sought, countries in which reproductive care is sought, and participants' experiences of crossborder reproductive services. This study identified the availability of counseling services and other factors affecting patient experiences as important issues that participants considered should be taken into account by potential users of crossborder reproductive care. The internet and other media were shown to be significant sources of information about reproductive services in other countries.Conclusion(s): This study highlights an essential need for accessible, accurate, and reliable information to help ensure safe and high quality care, as well as emphasizing the role that clinics in patients' home countries, feedback from other patients, governments, regulatory agencies, and Internet-based services might play in making this information more readily available.

Common genetic variation in MTNR1B is associated with serum testosterone, glucose tolerance, and insulin secretion in polycystic ovary syndrome patients - Corrected Proof

2010-03-08

Melatonin plays an important role in many aspects of the human reproductive process. Our results first strongly suggest that MTNR1B mediating some functions of melatonin contributes to the phenotypic expression of polycystic ovary syndrome, which provide a new insight into the role of MTNR1B gene in the pathophysiology of the disease.

Coasting resulting in a sharp decline in serum estradiol does not compromise implantation - Corrected Proof

James D.M. Nicopoullos, Hossam Abdalla — 2010-03-08

Reply of the Authors: We read with great interest the letter by Atabekoğlu et al , and thank them for their interest in our research. We will address their comments in turn.

Coasting resulting in a sharp decline in serum estradiol does not compromise implantation - Corrected Proof

C.S. Atabekoğlu, B. Özmen, Suheyla Isbacar, R. Aytac, M. Sönmezer — 2010-03-08

To the Editor: We read the retrospective analysis of Abdalla and Nicopoullos with great interest. We agree with the results, especially regarding the effects of estradiol drop (E2d). As was previously mentioned in the early studies, no strict, evidence-based criteria were established regarding the initial estradiol level (E2i) to start coasting that would not compromise oocyte/embryo quality or implantation capacity of the embryos. Moreover, there is not a safety threshold of E2d that determines whether to cancel or continue the IVF cycle .

Proposed oocyte donation guidelines for stem cell research - Corrected Proof

2010-03-02

To expand the availability of stem cell lines suitable for basic research and clinical application, somatic cell nuclear transfer has been proposed and will require human oocyte donation. The recommendations made by the California Institute of Regenerative Medicine advisory committee on oocyte donation are based on peer-reviewed, best practices, and best clinical judgment and are intended to assist researchers in design and Institutional Review Board (IRB) evaluation of research protocols for oocytes donated exclusively for research purposes.

The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy - Corrected Proof

2010-03-02

Objective: To investigate associations between preconception dietary patterns and IVF/intracytoplasmic sperm injection (ICSI) outcomes validated by biomarkers of the homocysteine pathway.Design: Observational prospective study.Setting: A tertiary referral fertility clinic at the Erasmus University Medical Centre, Rotterdam, The Netherlands.Patient(s): One hundred sixty-one couples undergoing IVF/ICSI treatment.Intervention(s): No interventions other than the Dutch governmental recommendation of folic acid.Main Outcome Measure(s): Dietary patterns, blood and follicular fluid concentrations of folate, vitamin B12, vitamin B6, homocysteine, and fertilization rate, embryo quality, and pregnancy.Result(s): In women, two dietary patterns were identified. The “health conscious–low processed” dietary pattern (variation explained 12.1%) was characterized by high intakes of fruits, vegetables, fish, and whole grains and low intakes of snacks, meats, and mayonnaise, and positively correlated with red blood cell folate (β = 0.07). The “Mediterranean” dietary pattern (variation explained 9.1%), that is, high intakes of vegetable oils, vegetables, fish, and legumes and low intakes of snacks, was positively correlated with red blood cell folate (β = 0.13), and vitamin B6 in blood (β = 0.09) and follicular fluid (β = 0.18). High adherence by the couple to the “Mediterranean” diet increased the probability of pregnancy, odds ratio 1.4 (95% confidence interval 1.0–1.9).Conclusion(s): A preconception “Mediterranean” diet by couples undergoing IVF/ICSI treatment contributes to the success of achieving pregnancy.

Needle immersed vitrification can lower the concentration of cryoprotectant in human ovarian tissue cryopreservation - Corrected Proof

Zhun Xiao, Yan Wang, Lei Li, Shan Luo, Shang-Wei Li — 2010-03-02

Objective: To investigate whether needle immersed vitrification (NIV) can further lower the concentration of cryoprotective agent (CPA).Design: Experimental cross-sectional controlled in vitro study.Setting: University teaching hospital.Patient(s): Human ovarian biopsy tissues were obtained from ten women undergoing gynecology operations.Intervention(s): Ovarian cortical tissues were cryopreserved using slow freezing or vitrification. The vitrification solutions used were as follows: group A: 2.69 mol/L ethylene glycol (EG) + 2.11 mol/L dimethylsulfoxide (DMSO) + 0.5 mol/L sucrose; group B: 2.42 mol/L EG + 1.90 mol/L DMSO + 0.5 mol/L sucrose; group C: 2.15 mol/L EG + 1.69 mol/L DMSO + 0.5 mol/L sucrose; and group D: 1.88 mol/L EG + 1.48 mol/L DMSO + 0.5 mol/L sucrose.Main Outcome Measure(s): Histologic evaluations were performed using light and electron microscopy. Apoptosis was assessed by TUNEL staining. Tissue damage after cryopreservation was measured by the levels of lactate dehydrogenase (LDH) in culture.Result(s): The proportion of normal ultrastructure of granulosa cells and stromal cells in groups B and C was higher than that in group A. The proportion of TUNEL-positive primordial follicles and stromal cells in the NIV groups decreased with reduction of concentration. Additionally, LDH levels in groups B and C were lower than in group A.Conclusion(s): The NIV method could further lower the concentration of CPA. Therefore, we can use the CPA of group C as an optimal concentration for NIV.

Correlation between semen analysis by motile sperm organelle morphology examination and sperm DNA damage - Corrected Proof

2010-03-02

Regression analysis of 538 semen samples demonstrated that percentages of normal nuclear sperm and all spermatozoa with abnormalities of nuclear form at high magnification had significant negative correlation with percentages of DNA fragmentation. On the other hand, there was a positive correlation between percentages of spermatozoa with nuclear vacuoles and those with DNA fragmentation.

Is the 30-item Endometriosis Health Profile (EHP-30) suitable as a self-report health status instrument for clinical trials? - Corrected Proof

Su-Yen Khong, Alan Lam, Georgina Luscombe — 2010-03-02

This prospective study aimed to evaluate the suitability of the Endometriosis Health Profile–30 Questionnaire (EHP-30) as a self-report health status instrument. We compared our results with those from the U.K. and the U.S. and discovered relationships between the EHP-30 and patient characteristics. The results showed that the EHP 30 questionnaire is a user-friendly self-report tool suitable for use in endometriosis-related clinical research.

Regulated upon activation normal T-cell expressed and secreted originating from the epididymis differentially associates with viable and defective spermatozoa - Corrected Proof

Zhen Li, Zhi-jian Sun, Cheng-gong Liao, Li Ma, Bing-fang Ma, Yuan-qiang Zhang — 2010-03-02

Objective: To investigate the expression and cellular distribution of regulated upon activation normal T-cell expressed and secreted (RANTES) in the male reproductive system.Design: Basic research.Setting: University academic medical center.Patient(s): Three adult male organ donors.Main Outcome Measure(s): Reverse transcriptase–polymerase chain reaction (RT-PCR), in situ hybridization, immunohistochemical staining, and immunofluorescence staining were used to examine the distribution of RANTES in human and mouse epididymis. Western blot was used to quantitate the levels of RANTES expression in mouse epididymis on postnatal days. Immunofluorescence staining was applied to detect RANTES association with spermatozoa from mouse epididymis.Result(s): The location of RANTES was restricted to ciliated cells of the efferent duct and apical, narrow, and basal cells of the epididymal ducts, in both humans and mouse. RANTES-positive basal cells were only identified in the epididymal ducts in humans. The signals of RANTES were first detected on day 28 and increased during mouse sexual maturation. We also observed that RANTES was bound on both normal and defective epididymal sperm, but in different patterns.Conclusion(s): RANTES is constitutively expressed in the epididymis and secreted into the lumen of epididymis throughout sexual maturity, and differentially associates with viable and defective spermatozoa.

Effects of excision of ovarian endometrioma on the antral follicle count and collected oocytes for in vitro fertilization - Corrected Proof

2010-03-02

We compared the response of operated and nonoperated ovaries to gonadotropin stimulation in 38 women who had had excision of ovarian endometrioma. The antral follicle count, numbers of dominant follicles, and number of oocytes collected in the operated ovaries were significantly lower than in the nonoperated ovaries suggesting reduced ovarian reserve after excision of ovarian endometrioma.

Relevance of the site of assisted hatching in thawed human blastocysts: a preliminary report - Corrected Proof

2010-03-02

Preliminary data from a prospective randomized study of assisted hatching (AH) of thawed human blastocysts demonstrated that the rate of complete hatching was significantly higher for AH performed near the inner cell mass (ICM) than for AH at the side opposite to the ICM. This suggests the existence of polarity in the hatching process in human blastocysts, which requires further evaluation.

Adiponectin levels in women with polycystic ovary syndrome: impact of metformin treatment in a randomized controlled study - Corrected Proof

Birgitta Trolle, Finn Friis Lauszus, Jan Frystyk, Allan Flyvbjerg — 2010-03-02

Objective: To evaluate the effect of metformin in polycystic ovary syndrome (PCOS). As follow-up on a previous paper describing hormonal and metabolic factors, this paper focuses on correlations between adiponectin and anthropometric, hormonal, and metabolic factors in PCOS and the effect of metformin.Design: Randomized, double-blind, placebo-controlled crossover study.Setting: District and university hospital.Patient(s): Fifty-two women with PCOS. Three groups were defined according to baseline adiponectin.Intervention(s): Metformin or placebo for 6 months, followed by 3 months' washout before switching to opposite treatment. Blood tests and measurements were performed before and after treatment periods.Main Outcome Measure(s): Adiponectin, insulin, homeostasis model assessment (HOMA) index, and testosterone.Result(s): Waist-hip ratio (WHR), insulin, and HOMA index were significantly higher in the lower adiponectin group than in the upper and middle group, and high-density lipoprotein (HDL) cholesterol was higher in the upper than in the lower adiponectin group. Multiple regression analysis with adiponectin as the dependent variable and HOMA index, HDL cholesterol, testosterone, and WHR as independent variables showed an R2 of 0.43 with β-coefficients of −0.12 for the HOMA index, 0.72 for HDL cholesterol, and −1.49 for WHR. Testosterone did not contribute to the prediction of adiponectin levels. Metformin had no effect on adiponectin in spite of significant decreases in weight, fasting glucose, and insulin resistance.Conclusion(s): In PCOS, adiponectin levels are closely linked to insulin resistance, HDL cholesterol, and abdominal adiposity and unaffected by metformin.

Effects of resveratrol supplementation on cryopreservation medium of human semen - Corrected Proof

2010-03-02

Objective: To analyze oxidative stress markers and seminal standard parameters after using resveratrol (0.1, 1.0, and 10.0 mM), an important antioxidant, in the cryopreservation of human semen.Design: In vitro prospective study.Setting: Institutional study.Patient(s): Infertile and fertile men.Main Outcome Measure(s): Levels of thiobarbituric acid-reactive species (TBARS), superoxide dismutase (SOD), and catalase (CAT) activities and spermatozoa concentration, motility, and morphology.Result(s): Increased TBARS levels were observed in the post-thawing semen in both fertile and infertile men. Infertile men had lower CAT and SOD activities in prefreezing and post-thawing samples when compared with fertile men. The addition of resveratrol in all the concentrations assayed was able to prevent post-thawing lipoperoxidation in both fertile and infertile men. However, this effect was not dose dependent. The cryopreservation process was not able to change sperm concentration or morphology. However, a decrease in sperm motility was observed in both the fertile and infertile men. The addition of resveratrol was not able to prevent this effect.Conclusion(s): Resveratrol avoids oxidative damages induced by the cryopreservation of human semen, but it is not able to restore the decrease in sperm motility.

Secondary amenorrhea attributed to occlusion of microperforate transverse vaginal septum - Corrected Proof

Jennifer L. Nichols, Eric J. Bieber, Jennifer S. Gell — 2010-02-26

Objective: To present a case of secondary amenorrhea after occlusion of microperforate transverse vaginal septum.Design: Case report.Setting: Academic teaching hospital.Patient(s): A 19-year-old woman with new onset of irregular menses and pelvic pain, with history of menarche at age 14.Intervention(s): Surgical evaluation and treatment, including laparoscopy, hysteroscopy, and excision of septum, followed by repeat surgery with lysis of adhesions due to agglutination of the area previously excised.Main Outcome Measure(s): Awareness of the possibility of secondary amenorrhea occurring due to septal scarring of a perforate transverse vaginal septum.Result(s): Imaging revealed a hematometra and hematocolpos. Examination revealed a transverse vaginal septum. Ultrasound scans and magnetic resonance imaging revealed an enlarged uterus and an endometrial cavity and cervix distended with fluid and debris. Examination under anesthesia revealed a septum approximately 5 mm thick, which was revealed to be benign fibromuscular tissue with chronic nonspecific inflammation.Conclusion(s): This case demonstrates the evolution from a microperforate transverse vaginal septum with regular menses for over 4 years to an occluded septum. Although transverse vaginal septa causing amenorrhea are usually diagnosed at menarche, perforate septa have been shown to lead to hypomenorrhea, dysmenorrhea, dyspareunia, infertility, and issues with vaginal childbirth. We present a case in which a perforate transverse vaginal septum led to secondary amenorrhea.

Embryonic stem cell-like cells established by culture of adult ovarian cells in mice - Corrected Proof

2010-02-26

Objective: To suggest an alternative strategy for deriving histocompatible stems cells without undertaking genetic manipulation.Design: Prospective approach using an animal model.Setting: Stem cell and bioevaluation laboratory, Seoul National University.Animal(s): F1 (C57BL6 X DBA2) and outbred (ICR) mice.Intervention(s): Ovarian stroma cells of less than 40 μm in diameter were subcultured with fibroblast monolayer, and colony-forming cells were characterized.Main Outcome Measure(s): Stemness, genotype, and imprinted gene methylation.Result(s): Two-lines of colony-forming cells were established, which expressed markers specific for embryonic stem cells (ESC) and formed embryoid bodies and teratomas. Complete matching of microsatellite markers with the cell donor strain confirmed their establishment from ovarian tissue, and identification of both homozygotic and heterozygotic chromosomes raised the possibility of their derivation from parthenogenetic oocytes. However, the use of cells smaller than mature oocytes for primary culture, the difference in imprinted gene methylation compared with parthenogenetic ESCs, and failure to establish the ESC-like cells by primary follicle culture collectively suggested the irrelevancy to gametes.Conclusion(s): Coculture of adult ovarian cells with somatic fibroblasts can yield colony-forming cells having ESC-like activity, which may provide an alternative for establishing autologous stem cells from adults that can be obtained without genetic manipulation.

Three-dimensional computed tomography combined with hysterosalpingography is useful for both diagnosis and treatment of iatrogenic diverticulum of the uterus - Corrected Proof

2010-02-26

A woman presented with vaginal bleeding after myomectomy. Ultrasonography, magnetic resonance imaging (MRI), and three-dimensional computed tomography (CT) combined with hysterosalpingography (HSG) revealed an iatrogenic diverticulum of the uterus. The three-dimensional CT combined with HSG images were very useful for subsequent surgery.

Progesterone receptor-mediated up-regulation of transthyretin in preimplantation mouse uterus - Corrected Proof

Honglu Diao, Shuo Xiao, Juan Cui, Jerold Chun, Ying Xu, Xiaoqin Ye — 2010-02-26

Transthyretin (TTR), a carrier for thyroxine and retinol, has its messenger RNA (mRNA) expressed in the glandular endometrial epithelium and its protein detected in the glandular endometrial epithelium and the uterine lumen. TTR mRNA is dramatically up-regulated in the preimplantation mouse uterus as well as the P-treated ovariectomized mouse uterus, and in both situations the up-regulation of TTR is blocked by treatment with the P receptor antagonist RU486.

Involvement of the nuclear factor-κB pathway in the pathogenesis of endometriosis - Corrected Proof

2010-02-26

Objective: To evaluate the role of nuclear factor-κB (NF-κB) in the pathogenesis of endometriosis.Design: A literature search was conducted in PubMed to identify all relevant citations.Result(s): Our findings highlight the important role of NF-κB in the pathophysiology of endometriosis. In vitro and in vivo studies show that NF-κB–mediated gene transcription promotes inflammation, invasion, angiogenesis, and cell proliferation and inhibits apoptosis of endometriotic cells. Constitutive activation of NF-κB has been demonstrated in endometriotic lesions and peritoneal macrophages of endometriosis patients. Agents blocking NF-κB are effective inhibitors of endometriosis development and some drugs with known NF-κB inhibitory properties have proved efficient at reducing endometriosis-associated symptoms in women. Iron overload activates NF-κB in macrophages. NF-κB activation in macrophages and ectopic endometrial cells stimulates synthesis of proinflammatory cytokines, generating a positive feedback loop in the NF-κB pathway and promoting endometriotic lesion establishment, maintenance and development.Conclusion(s): NF-κB transcriptional activity modulates key cell processes contributing to the initiation and progression of endometriosis. Because endometriosis is a multifactorial disease, inhibiting NF-κB appears to be a promising strategy for future therapies targeting different cell functions involved in endometriosis development, such as cell adhesion, invasion, angiogenesis, inflammation, proliferation, and apoptosis. Upcoming research will elucidate these hypotheses.

In vitro fertilization and preterm delivery, low birth weight, and admission to the neonatal intensive care unit: a prospective follow-up study - Corrected Proof

Kirsten Wisborg, Hans Jacob Ingerslev, Tine Brink Henriksen — 2010-02-26

Objective: To compare the risk of preterm delivery, low birth weight, and admission of the newborn to a neonatal intensive care unit (NICU) in women pregnant after fertility treatment and subfertile women with the risk in fertile women.Design: Prospective follow-up study.Setting: Aarhus University Hospital, Skejby, Denmark, 1989–2006.Patient(s): A total of 20,080 liveborn singletons.Intervention(s): None.Main Outcome Measure(s): Preterm delivery, low birth weight, and admission of the newborn to a NICU.Result(s): After adjustment we found a statistically significantly increased risk of preterm delivery and very preterm delivery in women who conceived after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) compared with fertile women. Compared with fertile women, the risk of preterm delivery and very preterm delivery was not statistically significantly different in women pregnant after non-IVF assisted reproductive treatment (non-IVF ART) or subfertile women. We found no association between IVF/ICSI and the risk of low birth weight at term or admittance to the NICU.Conclusion(s): The increased risk of preterm delivery after IVF/ICSI may be due to the fertility treatment or unknown characteristics in the couples who undergo IVF/ICSI.

Hyaluronic acid binding and acrosin activity are decreased in sperm from men with spinal cord injury - Corrected Proof

2010-02-26

In this study, acrosin activity and hyaluronic acid binding were compared in sperm from men with spinal cord injury versus sperm from healthy controls. The results showed statistically significantly lower acrosin activity and statistically significantly lower hyaluronic acid binding in spinal cord injured patients compared with controls, indicating functional impairments that may diminish the capacity of the sperm to fertilize oocytes.

The time is now for a new approach to primary ovarian insufficiency - Corrected Proof

2010-02-26

Objective: To articulate the need for a new approach to primary ovarian insufficiency. The condition, also known as premature menopause or premature ovarian failure, is defined by the presence of menopausal-level serum gonadotropins in association with irregular menses in adolescent girls or women younger than 40 years. It can be iatrogenic as related to cancer therapy or may arise spontaneously, either alone or as part of a host of ultrarare syndromes. In a large percentage of spontaneous cases no pathogenic mechanism can be identified.Design: Literature review and consensus building at a multidisciplinary scientific workshop.Conclusion(s): There are major gaps in knowledge regarding the etiologic mechanisms, psychosocial effects, natural history, and medical and psychosocial management of primary ovarian insufficiency. An international research consortium and disease registry formed under the guidance of an umbrella organization would provide a pathway to comprehensively increase basic and clinical knowledge about the condition. Such a consortium and patient registry also would provide clinical samples and clinical data with a goal toward defining the specific pathogenic mechanisms. An international collaborative approach that combines the structure of a patient registry with the principles of integrative care and community-based participatory research is needed to advance the field of primary ovarian insufficiency.

Oocyte cryopreservation outcomes including pre-cryopreservation and post-thaw meiotic spindle evaluation following slow cooling and vitrification of human oocytes - Corrected Proof

2010-02-26

Objective: To report our oocyte cryopreservation (OC) outcomes including meiotic spindle (MS) evaluation of metaphase II (MII) oocytes destined for OC and thaw.Design: Retrospective.Setting: University-based infertility center.Patient(s): Women attempting pregnancy using cryopreserved oocytes.Intervention(s): OC, MS evaluation.Main Outcome Measure(s): Survival, two pronuclear (2PN) fertilization, achieving embryo quality suitable for transfer or refreezing, blastocyst formation.Result(s): Thirty-two OC-thaw cycles resulted in 20 pregnancies, 18 either ongoing or delivered. In 26 cycles, MS evaluation was performed: 262/303 (86%) thawed/recovered oocytes survived, 218/262 (83%) achieved 2PN fertilization, 133/218 (61%) became suitable for day-3 and 122/218 (56%) for day-5 transfer. In total, 58 embryos were transferred resulting in a 62% pregnancy and a 41% implantation rate. Of oocytes evaluated before cryopreservation, 247 (82%) were spindle-positive; 96% of these were also spindle-positive after thawing. Blastocyst formation and suitability for day-5 transfer was achieved more often if a post-thaw spindle was visualized. Of all slow-cooled and vitrified oocytes, a higher percentage of those slow-cooled achieved 2PN fertilization and usability. MS evaluation of oocytes cryopreserved by either method was associated with similar outcomes.Conclusion(s): OC outcomes are improving. An MS was almost always exhibited both before cryopreservation and after thawing, suggesting that, with appropriate technique, OC presents minimal harm to the MII oocyte. A meiotic spindle evaluation might help to further OC technology.

Cyclooxygenase-2 in testes of infertile men: evidence for the induction of prostaglandin synthesis by interleukin-1β - Corrected Proof

2010-02-26

As we previously reported, testes of men suffering from hypospermatogenesis and germ cell arrest or Sertoli cell-only syndrome show a major increase in the number of macrophages expressing interleukin-1β (IL-1β) and abundant expression of cyclooxygenase-2 (COX-2), the inducible isoform of the key enzyme in the biosynthesis of prostaglandins (PGs), in Leydig cells. In the present study we report [1] a positive correlation between IL-1β levels and COX-2 expression in testes of infertile patients, [2] the induction of COX-2 by IL-1β in mouse Leydig cells (TM3) and human macrophages (THP-1), and therefore [3] evidence for an IL-1β-dependent induction of testicular inflammatory states.

Does the outcome of ICSI in cases of obstructive azoospermia depend on the origin of the retrieved spermatozoa or the cause of obstruction? A comparative analysis - Corrected Proof

2010-02-26

Objective: To compare the outcomes of intracytoplasmic sperm injection (ICSI) for men with obstructive azoospermia and normal spermatogenesis, according to the use of epididymal or testicular spermatozoa and the cause of obstruction.Design: Retrospective study.Setting: Private infertility center.Patient(s): A detailed chart review of a cohort of 1,121 men with obstructive azoospermia who underwent intracytoplamic sperm injection (ICSI) was performed.Intervention(s): Patients were grouped according to the origin of spermatozoa: epididymal (n =331) or testicular (n =790). They were further classified into two subgroups according to the cause of obstruction: congenital bilateral absence of vas deferens (CBAVD; n = 434), and other causes of obstruction (n= 687).Main Outcome Measure(s): Fertilization, clinical pregnancy, and miscarriage rates.Result(s): Fertilization (64.2% vs. 68.0%), clinical pregnancy (42.3% vs. 43.2%), and miscarriage (17.6% vs. 18.4%) rates did not differ between epididymal spermatozoa and testicular spermatozoa, respectively. Fertilization, clinical pregnancy, and miscarriage rates were also similar in the patients with CBAVD or due to other causes of obstruction.Conclusion(s): The source of sperm used for ICSI in cases of obstructive azoospermia and the etiology of the obstruction do not affect the outcome in terms of fertilization, pregnancy, or miscarriage rates.

Fertility preservation by ovarian stimulation and oocyte cryopreservation in a 14-year-old adolescent with Turner syndrome mosaicism and impending premature ovarian failure - Corrected Proof

Kutluk Oktay, Kenny A. Rodriguez-Wallberg, Gulnaz Sahin — 2010-02-26

Objective: To report a novel approach to fertility preservation in adolescents with Turner syndrome mosaicism by repeated controlled ovarian stimulation and oocyte cryopreservation.Design: Case report.Setting: Academic reproductive medicine center.Patient(s): Fourteen-year-old adolescent diagnosed with Turner syndrome mosaicism.Intervention(s): Two cyles of controlled ovarian stimulation and oocyte cryopreservation within 1 year.Main Outcome Measure(s): Recovery of oocytes after controlled ovarian stimulation and oocyte cryopreservation.Result(s): Eleven oocytes were retrieved, of which eight were mature and three were immature during the first cycle. One year later, four mature and three immature oocytes were retrieved after a treatment cycle with even higher gonadotropin doses. All oocytes were cryopreserved by vitrification.Conclusion(s): Controlled ovarian stimulation and oocyte cryopreservation may be an option for fertility preservation in selected adolescents with Turner syndrome mosaicism and impending ovarian failure.

Prospective, randomized study comparing highly purified urinary follicle-stimulating hormone (FSH) and recombinant FSH for in vitro fertilization/intracytoplasmic sperm injection in patients with polycystic ovary syndrome - Corrected Proof

2010-02-26

In a randomized study comparing purified urinary FSH with recombinant FSH for IVF/intracytoplasmic sperm injection in patients with polycystic ovary syndrome, there was no significant difference between the mean total dose of FSH used, duration of stimulation, number of retrieved oocytes, number of mature oocytes, number of embryos transferred, or the ongoing pregnancy rate between the two groups. However, there were significantly more fertilized oocytes, a higher fertilization rate, more top-quality embryos, and more cryopreserved embryos in the urinary FSH group.

Accurate single cell 24 chromosome aneuploidy screening using whole genome amplification and single nucleotide polymorphism microarrays - Corrected Proof

Nathan R. Treff, Jing Su, Xin Tao, Brynn Levy, Richard T. Scott — 2010-02-26

Objective: To develop and validate a whole genome amplification and single nucleotide polymorphism (SNP) microarray protocol for accurate single cell 24 chromosome aneuploidy screening.Design: Prospective, randomized, and blinded study.Setting: Academic reproductive medicine center.Patient(s): Multiple euploid and aneuploid cell lines were obtained from a public repository and blastomeres were obtained after biopsy of cleavage stage embryos from 78 patients undergoing IVF.Main Outcome Measure(s): Accuracy of copy number assignment and consistency of individual SNPs, whole chromosomes, and single cell aneuploidy status were determined.Intervention(s): None.Result(s): Single cells extracted from karyotypically defined cell lines provided 99.2% accuracy for individual SNPs, 99.8% accuracy for whole chromosomes, and 98.6% accuracy when applying a quality control threshold for the overall assignment of aneuploidy status. The concurrence for more than 80 million SNPs in 335 single blastomeres was 96.5%.Conclusion(s): We have established and validated a SNP microarray-based single cell aneuploidy screening technology. Clinical validation studies are underway to determine the predictive value of this methodology.

Seminal plasma levels of anti-Müllerian hormone and inhibin B are not predictive of testicular sperm retrieval in nonobstructive azoospermia: a study of 139 men - Corrected Proof

2010-02-22

Objective: To evaluate the seminal levels of the Sertoli anti-Müllerian hormone (AMH) and inhibin B in the testicular sperm extraction (TESE) in nonobstructive azoospermia.Design: Prospective study.Setting: Reproductive biology division in a university hospital.Patient(s): One hundred thirty-nine men.Intervention(s): Men were classified on the basis of positive and negative TESE.Main Outcome Measure(s): Seminal levels of AMH and inhibin B, serum levels of FSH and inhibin B, testicular volume, sperm retrieval, and spermatogenesis.Result(s): The mean serum FSH and inhibin B concentrations were 21.4 IU/L and 54.68 pg/mL. Spermatozoa were retrieved in 43.17% of the men. Mean seminal AMH and inhibin B concentrations were 12.06 ± 37.30 pmol/L and 142.72 ± 950.91 pmol/L, respectively. Seminal AMH and inhibin B levels were simultaneously undetectable in 35.97% of subjects. Seminal plasma levels of AMH and inhibin B were positively correlated, as were seminal and serum inhibin B concentrations. The successful and failed TESE groups did not differ significantly in terms of either AMH or inhibin B seminal plasma concentrations. Combining the latter parameters with the serum FSH level did not improve the predictive value for successful TESE. The presence or absence of germ cells did not have a statistically significant relationship with seminal plasma AMH and inhibin B concentrations.Conclusion(s): There is no value in seminal plasma levels of AMH and inhibin B as criteria for sperm extraction in men with nonobstructive azoospermia.

Management of transverse vaginal septum using the Olbert balloon catheter to mobilize the proximal vaginal mucosa and facilitate low anastomosis - Corrected Proof

Lawrence C. Layman, Paul G. McDonough — 2010-02-22

Objective: To mobilize and make available for anastomosis the maximal amount of mucosa from the expanded upper vaginal tissue and avoid postoperative narrowing of the vagina.Design: Technique paper.Setting: Tertiary care medical center.Patient(s): Patients with a hematocolpos due to transverse vaginal septum.Intervention(s): Pull through of proximal distended vagina using an Olbert balloon catheter.Main Outcome Measure(s): To avoid midvaginal narrowing due to retraction of the suture line in the surgical management of transverse vaginal septum with hematocolpos.Result(s): High-pressure balloon expansion of the proximal hematocolpos optimizes the vaginal mucosa available for final anastomosis.Conclusion(s): The use of a high-pressure dilatation balloon permits high intraballoon pressures that facilitate the surgical management of transverse vaginal septum and limit postoperative narrowing of the vagina.

Polymerase chain reaction-based detection of chromosomal imbalances on embryos: the evolution of preimplantation genetic diagnosis for chromosomal translocations - Corrected Proof

2010-02-22

Objective: To develop and assess a polymerase chain reaction (PCR)-based preimplantation genetic diagnosis (PGD) approach for detection of chromosomal imbalances in embryos.Design: A prospective study of embryos derived from chromosome translocation carriers that have undergone PGD using a novel molecular-based approach.Setting: A reference molecular genetics laboratory specialized in the provision of transport PGD services and a private IVF clinic.Patient(s): Twenty-seven couples carrying 12 different reciprocal translocations and 2 Robertsonian translocations.Intervention(s): Preimplantation genetic diagnosis from chromosome translocation carriers on blastomeres biopsied from cleavage stage embryos.Main Outcome Measure(s): Embryo diagnosis rate, pregnancy rate (PR), implantation rate, take-home-baby rate.Result(s): Overall, 241/251 (96.0%) embryos were successfully diagnosed for chromosome rearrangements. Preimplantation genetic screening was included in the protocol of 12 couples, involving analysis of 90 embryos, 84 (93.3%) of which were successfully diagnosed and 53 (63.1%) showed aneuploidies. Embryos suitable for transfer were identified in 24 cycles. Eighteen couples achieved a clinical pregnancy (75.0% PR/embryo transfer), with a total of 31 embryos implanted (59.6% implantation rate). Ten patients (1 triplet, 1 twin, and 8 singleton pregnancies) have delivered 13 healthy babies, and the other patients (3 twins and 5 singletons) have currently ongoing pregnancies.Conclusion(s): The PCR-based PGD protocol for translocations has the potential to overcome several inherent limitations of fluorescence in situ hybridization-based tests, providing potential improvements in terms of test performance, automation, turnaround time, sensitivity, and reliability.

Is ectopic pregnancy possible after hysterectomy? - Corrected Proof

Savita Bansal, Manju Saini, Meena Harsh, Amrita Kaur, Jaya Chaturvedi — 2010-02-22

Objective: To determine whether ectopic pregnancy should be suspected in young women with abdominal pain even after hysterectomy.Design: Case report.Setting: The patient presenting with abdominal pain in the emergency department was referred to a tertiary care center.Patient(s): A young woman who had had a subtotal hysterectomy 3 years prior for atonic postpartum hemorrhage during her last caesarean section presented with acute abdominal pain.Intervention(s): Urgent ultrasound showed a gestational sac of 9 weeks + 3 days. Emergency laparotomy was done for suspected ectopic pregnancy.Main Outcome Measure(s): Ultrasound, operative findings, and histopathology.Result(s): Tubal ectopic pregnancy was confirmed on laparotomy and histopathology.Conclusion(s): Early suspicion can avoid missing early and treatable ectopic gestation before life-threatening complications develop.

Reliability of narrow-band imaging (NBI) hysteroscopy: A comparative study - Corrected Proof

2010-02-22

Objective: To evaluate the usefulness of narrow-band imaging (NBI) technology for improving the diagnostic reliability of hysteroscopy.Design: Prospective controlled clinical study (Canadian Task Force classification II-2).Setting: University hospital.Patient(s): Three hundred ninety-five outpatient women undergoing diagnostic hysteroscopy were enrolled.Intervention(s): All patients underwent fluid minihysteroscopy with white light (WL) and NBI exploration with endometrial eye-directed biopsy.Main Outcome Measure(s): Hysteroscopic findings with WL and NBI were compared with histology, which was considered the gold standard.Result(s): Overall, the number of correct diagnoses with NBI was significantly higher than with WL. For differentiating normal from abnormal endometrial histopathology, the use of NBI showed a significantly higher specificity (0.93 vs. 0.78) and negative predictive value (0.92 vs. 0.81); NBI hysteroscopy significantly improved the sensitivity for the diagnosis of proliferative endometrium (0.93 vs. 0.78), chronic endometritis (0.88 vs. 0.70), low-risk hyperplasia (0.88 vs. 0.70), and high-risk hyperplasia (0.60 vs. 0.40).Conclusion(s): The use of NBI improved the reliability of diagnostic hysteroscopy. The high specificity and the low number of false negatives may reduce the number of unnecessary biopsies or of those performed in wrong areas. Moreover, compared with WL observation, NBI hysteroscopy showed significantly higher sensitivity for the detection of chronic endometritis and low-risk and high-risk hyperplasia.

Intestinal vaginoplasty: seven years' experience of a tertiary center - Corrected Proof

Ates Karateke, Berna Haliloglu, Onur Parlak, Cetin Cam, Hakan Coksuer — 2010-02-22

Objective: To investigate the long-term effects of intestinal vaginoplasty in cases with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome.Design: Prospective study.Setting: Division of Pelvic Reconstructive Surgery, Department of Gynecology and Obstetrics, at a women's and children disease education and research hospital.Patient(s): Between 2003 and 2009, 29 patients with MRKH syndrome underwent intestinal vaginoplasty.Intervention(s): Two of the patients were treated with ileal and 27 with sigmoid vaginoplasty.Main Outcome Measure(s): The age, marital status, associated anomalies, method used for bowel transposition (isoperistaltic/antiperistaltic), type of abdominal incision, and intra- and postoperative complications were evaluated.Result(s): One of the patients for whom ileal vaginoplasty was performed had 40 cm ileal necrosis requiring bilateral ileostomy for 2 months. Introital stenosis was detected in 15 cases (79%) who were unmarried, while none of the married cases had introital stenosis. However, all patients responded to finger-dilatation. All married patients were sexually satisfied after operation. An intraluminal abscess developed in the proximal segment of the neovagina owing to stricture occurring above abdominoperineal tunnel 2 years after operation. In another patient who had a rudimentary uterine horn, hematometra developed 3 years after operation and treated with resection.Conclusion(s): In our experience, sigmoid vaginoplasty seems to be a favorable procedure which provides excellent long-term results for the patients with vaginal agenesis.

Conventional testicular sperm extraction combined with the microdissection technique in nonobstructive azoospermic patients: a prospective comparative study - Corrected Proof

2010-02-22

Objective: To perform conventional and microdissection testicular sperm extraction (TESE) at the same session and compare their effectiveness.Design: Prospective comparative study.Setting: University hospital setting.Patient(s): The study included 335 patients with nonobstructive azoospermia.Intervention(s): Microdissection TESE was performed to 77 patient with atrophic testes. An additional 258 patients underwent conventional TESE using three incisions on three quadrants of the testis (upper, middle, and lower). Microdissection TESE was performed by enlarging the middle incision vertically when no spermatozoa could be detected using the conventional technique.Main Outcome Measure(s): Sperm retrieval, fertilization, clinical pregnancy rate (PR), and live birth rate were evaluated. The relation between sperm retrieval rate and FSH level and testis volume was also investigated.Result(s): Spermatozoa was detected in 33.7% of patients using conventional TESE. The spermatozoa detected increased to 50.8% using microdissection TESE. The increase was statistically significant. In the primary microdissection TESE group, the surgical retrieval rate was 20.8%. The overall sperm retrieval rate was 43.9%. There was a significant relation between the sperm retrieval rate and testis volume, whereas there was no relation between sperm retrieval rate and FSH levels. The overall fertilization rate, clinical PR, and live birth rate were 57.1%, 50.4%, 36.4%, respectively.Conclusion(s): Conventional TESE combined with microdissection TESE can be used in selected patients. Sperm retrieval rate of TESE can be low in patients with atrophic testes.

Vaginal management of a “late” ectopic pregnancy after vaginal hysterectomy - Corrected Proof

Dalmo Borges Ramos, Newton Eduardo Busso, Cristiano Eduardo Busso — 2010-02-22

Objective: To describe the first vaginal approach to an ectopic pregnancy after hysterectomy.Design: Case report.Setting: Private hospital.Patient(s): A 38-year-old woman presenting with an ectopic pregnancy 5 months after having a vaginal hysterectomy due to uterine myomatosis.Intervention(s): Vaginal adnexectomy.Main Outcome Measure(s): Vaginal surgery as a plausible approach for this very particular situation (ectopic pregnancy in hysterectomized patient).Result(s): After vaginal surgery with removal of the left tube (containing a gestacional sac) and ovary, the patient fully recovered.Conclusion(s): Vaginal surgery can be a safe option for ectopic pregnancy resolution in noncomplicated cases.

Successful pregnancy by insemination of spermatozoa in a woman with a human seminal plasma allergy: should in vitro fertilization be considered first? - Corrected Proof

2010-02-22

Objective: To raise the possibility that pregnancy can be obtained by assisted reproductive techniques in patients with human seminal plasma allergy.Design: Case report.Setting: University hospital.Patient(s): A woman consulted for a 3-year primary infertility. She reported lack of intercourse because of a seminal plasma allergy.Intervention(s): One intrauterine insemination associated with antihistamine treatment was performed with carefully washed spermatozoa.Result(s): Immediately after the insemination, the patient had an allergic reaction treated by steroids. Fortunately, this single attempt led to a successful pregnancy, and the patient gave birth to a healthy girl.Conclusion(s): Pregnancies can be obtained in patients with seminal plasma hypersensitivity by means of intrauterine insemination. However, serious complications may occur after performing intrauterine insemination, which is not a totally reliable method to prevent an allergic reaction. Thus a multidisciplinary team should follow such patients carefully and watch for the potential risks and side effects. In vitro fertilization may represent the more cautious option.

Mayer-Rokitansky-Küster-Hauser syndrome: fertility counseling and treatment - Corrected Proof

David E. Reichman, Marc R. Laufer — 2010-02-22

To date, no literature has focused on the counseling of patients with Mayer-Rokitansky-Küster-Hauser syndrome as relates to their unique fertility challenges. This article is presented as a guide to practitioners in the counseling of patients with varying Mayer-Rokitansky-Küster-Hauser phenotypes regarding individual reproductive potential.

Robert T. Morris, M.D.—appreciation of an enlightened surgeon and pioneer of ovarian transplantation - Corrected Proof

Roger G. Gosden — 2010-02-22

Objective: To show that ovarian transplantation is a promising strategy for preserving fertility in young women and children who have cryopreserved tissue before undergoing potentially sterilizing treatment for cancer and other conditions.Conclusion: Credit for the first transplants is because of a forgotten pioneer, Robert Morris of New York, who was an innovative surgeon as well as a model clinical investigator over a century ago.

Modification of the triplet repeat primed polymerase chain reaction method for detection of the CTG repeat expansion in myotonic dystrophy type 1: application in preimplantation genetic diagnosis - Corrected Proof

2010-02-19

Objective: To overcome problems associated with the use of triplet repeat primed polymerase chain reaction (TP-PCR) in preimplantation genetic diagnosis (PGD) of myotonic dystrophy type 1 (DM1).Design: Clinical research study.Setting: UCL Centre for PGD and Centre for Reproductive and Genetic Health.Patient(s): Seven couples undergoing PGD for DM1.Intervention(s): A modified TP-PCR protocol (mTP-PCR) for the reliable detection of both expanded and nonexpanded alleles in DMPK was optimized using single lymphocytes. Four cycles of PGD were performed with TP-PCR for diagnosis and a further 10 cycles with mTP-PCR.Main Outcome Measure(s): Amplification efficiency, allele dropout, diagnosis rate, and delivery rate.Result(s): Preliminary testing showed that the TP-PCR amplification efficiency was higher using lymphocytes versus buccal cells. Single lymphocytes gave very high amplification efficiencies for both protocols (99% to 100%). There were no false-positive or false-negative results for 148 single lymphocytes tested with mTP-PCR compared with 9% (5 out of 54) false-positive results with TP-PCR, indicating the improved accuracy of the modified protocol. In embryos, the diagnosis rate was 95.6% with mTP-PCR and 75% with TP-PCR.Conclusion(s): For PGD of DM1, mTP-PCR is recommended. It may also be applied as a rapid screen for DMPK expansions in individuals with symptoms of DM1, relatives of known mutation carriers, or in prenatal diagnosis.

Conversion from assisted reproductive technology to intrauterine insemination in low responders: Is it advantageous? - Corrected Proof

John M. Norian, Eric D. Levens, Kevin S. Richter, Eric A. Widra, Michael J. Levy — 2010-02-19

Objective: To examine cycle outcomes among patients demonstrating an attenuated ovarian response that proceeded to oocyte retrieval to those converted to intrauterine insemination (IUI).Design: Retrospective cohort study.Setting: Large private fertility center.Patient(s): First planned autologous assisted reproductive technology (ART) cycles among women demonstrating a poor ovarian response to hyperstimulation (≤4 follicles ≥14 mm, peak E2 <1,000 IU/L at hCG administration).Intervention(s): Oocyte retrieval or IUI conversion.Main Outcome Measure(s): Live birth and clinical pregnancy.Result(s): A total of 269 IUI conversions and 167 oocyte retrievals followed a poor ovarian response to gonadotropins among first planned ART cycles. Number of follicles ≥14 mm (2.3 vs. 3.5) and peak E2 levels (555 vs. 743 pg/mL) were lower for IUI conversions compared with those proceeding to ART. Peak E2 was similar between groups after adjusting for follicle number (IUI: 611 pg/mL; ART: 652 pg/mL). Stimulation response was similar between treatment groups with equivalent follicle numbers. Undergoing oocyte retrieval was associated with significantly improved pregnancy (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.8–7.4) and live birth outcome (OR 3.5, 95% CI 1.7–8.0) after adjusting for age and follicle number.Conclusion(s): Among women demonstrating a poor ovarian response to gonadotropins, proceeding with planned ART resulted in significantly higher pregnancy rates than converting these cycles to IUI.

Vaginal progesterone gel for luteal phase support in IVF/ICSI cycles: a meta-analysis - Corrected Proof

2010-02-19

Objective: To investigate whether vaginal progesterone gel may result in similar or higher pregnancy rates compared with all other vaginal progesterone forms when used for luteal-phase support.Design: Meta-analysis of randomized controlled trials using odds ratios (OR) and 95% confidence intervals (CI).Patient(s): Infertile women undergoing IVF or ICSI.Intervention(s): Vaginal progesterone gel 90mg once or twice daily versus any other vaginal progesterone form for luteal phase support.Main Outcome Measure(s): Clinical pregnancy rates.Result(s): Seven randomized controlled trials, involving 2,447 patients, were included in the analysis. No difference was observed in the overall clinical pregnancy rate when comparing vaginal progesterone gel with any other vaginal progesterone form. Moreover, clinical pregnancy rates were similar in protocols using only GnRH agonists and when comparing vaginal gel with the traditional treatment of 200 mg × 3 vaginal progesterone capsules.Conclusion(s): This meta-analysis provides solid evidence that no significant difference exists between vaginal gel and all other vaginal progesterone forms in terms of clinical pregnancy rates.

Evaluating the performance of serum antimullerian hormone concentration in predicting the live birth rate of controlled ovarian stimulation and intrauterine insemination - Corrected Proof

2010-02-19

Objective: To evaluate the role of serum antimullerian hormone (AMH) concentration in predicting live birth outcome in controlled ovarian stimulation and intrauterine insemination (IUI).Design: Retrospective analysis.Setting: Tertiary assisted reproduction unit.Patients: 243 patients undergoing IUI treatment.Intervention(s): Archived early follicular phase serum samples taken at the start of the first treatment cycle before ovarian stimulation were retrieved from patients undergoing IUI treatment.Main Outcome Measure(s): First-cycle and cumulative live birth rates.Result(s): Patients attaining a successful live birth, either in the first cycle or cumulatively after three cycles, had significantly higher serum AMH concentrations than those failing treatment. Serum AMH concentration correlated positively with antral follicle count (AFC) and duration of stimulation and inversely with maternal age, serum FSH concentration, and total dose of gonadotropin used. After controlling for age, body mass index, AFC, and FSH, AMH remained the only significant predictor of cumulative live birth. The area under the receiver operating characteristic curve was 0.668 in predicting cumulative live birth. Serum AMH concentration was significantly higher in overresponders.Conclusion(s): Serum AMH concentration was significantly higher in subjects with a live birth from the first cycle or after three cycles of stimulated IUI treatment compared with those failing treatment. Serum AMH concentration has a modest predictive value on ovarian overresponse.

Prospective randomized comparison of human oocyte cryopreservation with slow-rate freezing or vitrification - Corrected Proof

2010-02-19

Objective: To compare cryopreservation of mature human oocytes with slow-rate freezing and vitrification and determine which is most efficient at establishing a pregnancy.Design: Prospective randomized.Setting: Academically affiliated, private fertility center.Patient(s): Consenting patients with concerns about embryo cryopreservation and more than nine mature oocytes at retrieval were randomized to slow-rate freezing or vitrification of supernumerary (more than nine) oocytes.Intervention(s): Oocytes were frozen or vitrified, and upon request oocytes were thawed or warmed, respectively.Main Outcome Measure(s): Oocyte survival, fertilization, embryo development, and clinical pregnancy.Result(s): Patient use has resulted in 30 thaws and 48 warmings. Women's age at time of cryopreservation was similar. Oocyte survival was significantly higher following vitrification/warming (81%) compared with freezing/thawing (67%). Fertilization was more successful in oocytes vitrified/warmed compared with frozen/thawed. Fertilized oocytes from vitrification/warming had significantly better cleavage rates (84%) compared with freezing/thawing (71%) and resulted in embryos with significantly better morphology. Although similar numbers of embryos were transferred, embryos resulting from vitrified oocytes had significantly enhanced clinical (38%) pregnancy rates compared with embryos resulting from frozen oocyte (13%). Miscarriage and/or spontaneous abortion rates were similar.Conclusion(s): Our results suggest that vitrification/warming is currently the most efficient means of oocyte cryopreservation in relation to subsequent success in establishing pregnancy.

Proceedings from the Conference on Reproductive Problems in Women of Color - Corrected Proof

2010-02-19

The purpose of the National Institutes of Health conference on Reproductive Problems in Women of Color that convened on July 25, 2009 was to bring investigators together to examine data related to reproductive health care access and ethnic disparities in reproductive problems, fertility treatments, and pregnancy outcomes. One of the goals discussed at this conference was to initiate a research network of investigators interested in studying these problems through the development of an American Society of Reproductive Medicine special interest group and Society of Assisted Reproductive Technology writing groups.