Cem Ficicioglu

Hysteroscopic findings in women with recurrent IVF failures and the effect of correction of hysteroscopic findings on subsequent pregnancy rates

IntroductionOur aim is to evaluate the incidence of unrecognized uterine abnormalities in cases with recurrent IVF failure by screening office hysteroscopy (OH), and impacts of treatment of hysteroscopic findings on the success rate of IVF.Materials and methods The retrospective and descriptive study was conducted at assisted reproduction unit in a tertiary medical center. One hundred and fifty-seven patients with a history of recurrent IVF failures underwent hysteroscopy between May 2009 and March 2012. Hysteroscopy (diagnostic or operative, as appropriate) was performed to evaluate the endometrial cavity in patients with two or more IVF failures and Incidence of abnormal hysteroscopic findings and the clinical pregnancy rate (CPR) in subsequent IVF cycles were assessed.Results In all, 44.9xa0% of the patients included in this study had abnormal hysteroscopic findings and 75 women (48.1xa0%) became pregnant following hysteroscopy. Of these pregnancies, 36 occurred in women with corrected endometrial pathology, the majority of which was identified as endometrial polyps. Implantation rate and clinical pregnancy rate were statistically significant increased after polipectomy.Conclusion Abnormal findings on hysteroscopy are significantly higher in patients with previous ART failure and hysteroscopy could be seen as a positive prognostic factor for achieving pregnancy in subsequent IVF procedure in women with a history of RIF.

The importance of the length of uterine cavity, the position of the tip of the inner catheter and the distance between the fundal endometrial surface and the air bubbles as determinants of the pregnancy rate in IVF cycles.

OBJECTIVEnTo evaluate the relationship between the pregnancy rate (PR) and the positioning of the intrauterine catheter at embryo transfer (ET) under transabdominal ultrasound (US) guidance in in vitro fertilization (IVF) cycles.nnnSTUDY DESIGNnProspective data analysis of 281 consecutive US-guided fresh ETs performed by a single physician at Yeditepe University Hospital IVF Center, Istanbul, Turkey, after controlled ovarian hyperstimulation between April 2012 and March 2013. The length of the uterine cavity (A), the distance between the fundal endometrial surface and the tip of inner catheter (B), the distance between the fundal endometrial surface and the air bubbles (C), and the pregnancy rates (PRs) were recorded.nnnRESULTSnThe mean age of the patients was 33.25±5.5 years. Of all transfers, 115 (40.9%) resulted in a clinical pregnancy. With regard to distance (C), the clinical intrauterine pregnancy rates were 65.2%, 32.2% and 2.6% in the <10mm, 10-20mm, and 20mm distance groups, respectively. The PR was dramatically reduced in cases with >10mm between the fundal endometrial surface and the air bubbles, although this did not reach statistical significance. Between those patients who conceived and those who did not, there was no significant difference in terms of the distance between the fundal endometrial surface and the tip of inner catheter, the ratio of A/B or the ratio of B/C.nnnCONCLUSIONSnThe final position of the air bubble used as an identifier of the position of the embryo at ET can be determinative for PR, although it cannot be predicted. Clinical pregnancy rates appeared higher in cases with air bubbles closer to the fundus and the optimal position of the air bubble seems to be a distance of <10mm from the fundal endometrial surface. It could be advisable to monitor the final position of air bubble at ET for identifying PR. In addition, the depth of uterine cavity may be considered to indirectly be important factor as it affects ET depth. The optimal distance between the fundal endometrial surface and the tip of inner catheter is 1.5-2cm. Further well-designed randomized controlled trials are required to optimize ET technique in the future.

Protective effect of resveratrol against oxidative damage to ovarian reserve in female Sprague-Dawley rats.

An increased accumulation of intracellular levels of reactive oxygen species with time may play an important role in the process of ageing. The antioxidant properties of resveratrol are dependent upon the up-regulation of endogenous cellular antioxidant systems. We evaluated whether resveratrol has protective antioxidant effects on ovarian damage related to oxidative stress in a rat model. Twenty-four female rats were randomly divided into three groups and were given saline (group 1: control); intraperitoneal cisplatin, 4.5u2009mg/kg, two weekly doses in total (group 2); or cisplatin, 4.5u2009mg/kg plus intraperitoneal resveratrol 10u2009mg/kg/day, 24u2009h before the administration of cisplatin (group 3). Serum anti-Müllerian hormone (AMH) concentrations were significantly lower in group 2 than in group 3 (P < 0.01 and P = 0.04, respectively). The evaluation of the atretic and antral follicle counts revealed statistically significant differences between the groups (P = 0.04 and P < 0.01, respectively). A statistically significant difference was observed in the follicle count positive for AMH between the groups (P = 0.01). Oxidative stress plays an important role in the process of ovarian ageing. Because of its natural antioxidant properties, resveratrol may be an effective option in protecting ovarian tissue against oxidative damage.

Etanercept causes regression of endometriotic implants in a rat model

ObjectiveTo determine the effects of etanercept (anti-TNF-α) on surgically induced endometriosis in a rat model.Materials and methodsThis is a prospective, randomized, controlled, experimental study that was carried out at the Experimental Research Center of Yeditepe University (YUDETAM). Thirty female nonpregnant, nulligravid Wistar-Hannover albino rats were used. The summary of the technique: surgical induction of endometriosis, administration of estrogen for 2xa0weeks, and laparotomy; administration of etanercept for 2xa0weeks following the induction of endometriosis and laparotomy; administration of estrogen for 2xa0weeks and necropsy. The volume and histopathological scores of the endometriotic foci were evaluated.ResultsOne-hundred twenty uterine horns were implanted in 30 rats. Endometriosis was completely formatted in 112 lesions (93.3%). No rats were lost. In the etanercept group, the lesions’ volumes were 83.9xa0±xa013.1, 47.2xa0±xa08.4, and 96.7xa0±xa034.8xa0mm3 at the end of the second week (pretreatment stage), at the end of the fourth week (post-treatment stage), and at the end of the sixth week, respectively (Pxa0=xa00.007). Histopathologic scores were 2.3xa0±xa00.2, 1.7xa0±xa00.2, and 1.9xa0±xa00.1, respectively (Pxa0=xa00.08). The changes in the other groups were not statistically significant.ConclusionsEtanercept, a fusion protein consisting of human recombinant soluble TNF receptor-2, neutralizes TNF activity. Anti-TNF therapy could be a new non-hormonal therapeutic option for the treatment of endometriosis in humans.

The effects of different doses of melatonin treatment on endometrial implants in an oophorectomized rat endometriosis model

AimsTo determine the effects of different doses of melatonin treatment on endometrial implants, the activity of antioxidant enzyme superoxide dismutase (SOD), the angiogenesis factor, the vascular endothelial growth factor (VEGF) and the waste metabolite product of lipid peroxidation malondialdehyde (MDA) in an oophorectomized rat endometriosis model.MethodsThirty-two, female, non-pregnant, nulligravid Sprague–Dawley, albino rats were used in this prospective, randomized, controlled and experimental study. Endometriosis was surgically induced in oophorectomized rats, and estradiol treatment was started after the first operation and continued till the end of the study. Second look, third look and necropsy operations were performed in the 2nd, 4th and 6th weeks. Mean volumes, histological scores and biochemical parameters were evaluated throughout the study.ResultsThe mean volumes of endometriotic foci were 98.8xa0mm3xa0±xa017.2 vs. 108.2xa0mm3xa0±xa017.5, 54.1xa0mm3xa0±xa015.6 vs. 25.8xa0mm3xa0±xa03.6, 42.8xa0mm3xa0±xa010.5 vs. 32.7xa0mm3xa0±xa06.0 and histopathological scores were 2.2xa0±xa00.2 vs. 1.7xa0±xa00.1, 2.6xa0±xa00.2 vs. 2.2xa0±xa00.2, 2.6xa0±xa00.1 vs. 2.7xa0±xa00.2 in the 10 vs. 20-mg/kg/day melatonin group at the end of the second, fourth and sixth weeks, respectively. When the groups were compared, no significant differences were seen in the histopathologic scores, SOD and VEGF levels between the groups. However, the endometriotic foci volumes were significantly decreased in both melatonin treatment groups with respect to the control group at the end of the fourth and sixth weeks. Moreover, the mean MDA levels were significantly lower in the control group than in the 10-mg/kg/day melatonin group at the end of the fourth and sixth weeks.ConclusionMelatonin treatment resulted in the regression of endometriotic lesions in oophorectomized rats. Higher doses of melatonin treatment might be more effective in the regression of implants and improvement of histologic scores as well as in the precise evaluation of SOD, MDA and VEGF distributions in the rat experimental models.

Comparison of follicular fluid and serum cytokine concentrations in women undergoing assisted reproductive treatment with GnRH agonist long and antagonist protocols

BACKGROUNDnThis study investigated whether follicular fluid (FF) and serum (S) concentrations of cytokines in women undergoing assisted reproductive treatment (ART) were different in GnRH antagonist cycles compared to agonist long ones.nnnMETHODSnA retrospective clinical study was performed at a University ART center. A total of 85 women who underwent ART either with agonist long (n = 34) or antagonist protocol (n = 51) were analyzed. FF and serum samples were collected at the time of oocyte retrieval and measured for interleukin (IL)- 1beta, IL-6, IL-8, IL-12, tumor necrosis factor (TNF)-alpha by the enzyme-linked immunosorbent assay (ELISA) technique, using commercially available kits and nitric oxide (NO) by the nitrate/nitrite colorimetric assay. The results were compared between GnRH antagonist and agonist cycles.nnnRESULTSnNo significant difference was found in the FF concentrations of those cytokines between the two protocols. The serum values were also similar in the two groups except IL-6 (14.3 +/- 4.8 vs. 20.5 +/- 12.2 pg/ml; p = 0.008) and NO (1.4 +/- 1.1 vs. 2.2 +/- 1.9 microm; p = 0.038) levels which were found to be significantly lower in antagonist cycles.nnnCONCLUSIONSnThere is no significant difference in follicular microenvironment in terms of IL-1beta, IL-6, IL-8, IL-12, TNF-alpha, and NO levels between agonist long and antagonist cycles. However, serum IL-6 and NO levels were lower in women given antagonists.

Can pentoxifylline improve the sperm motion and ICSI success in the primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD), previously known as immotile cilia syndrome, can cause respiratory and reproductive problems. Because of the impaired motion of microtubules the patients suffer upper respiratory tract problems. Infertility is an other issue of these patients. Several attempt have been proposed to bring back sperm motion and to improve intracytoplasmic sperm injection (ICSI) results. With our case we have described the management of a male infertility that causes from immotile cilia. The role of ICSI with incubated and activated ejaculatory sperm by pentoxifylline in the patient of PCD or as commonly named immotile cilia syndrome.

The comparision of effect of microdose GnRH-a flare-up, GnRH antagonist/aromatase inhibitor letrozole and GnRH antagonist/clomiphene citrate protocols on IVF outcomes in poor responder patients.

Abstract Purpose: To compare the effects of microdose GnRH-a flare-up, GnRH antagonist/aromatase inhibitor letrozole and GnRH antagonist/clomiphene citrate protocols on IVF outcomes in poor responder patients. Methods: Of 225 patients, 83 patients were in microdose flare-up group (Group 1), 70 patients were in GnRH antagonist/letrozole group (Group 2) and 72 patients were in GnRH antagonist/clomiphene citrate group (Group 3). Demographic and endocrine characteristics, the total number of oocytes retrieved, cancellation rate and clinical pregnancy rate were collected Results: Total dosage of gonadotropins (pu2009=u20090.002) and serum E2 levels on the day of hCG administration (pu2009=u20090.010) were significantly higher and duration of stimulations (pu2009=u20090.03) was significantly longer in group 1. The number of oocytes retrieved was significantly greater in group 1 and 2 when compare to those of group 3 (pu2009=u20090,000). There was a trend towards increasing cycle cancellation rates with GnRH antagonist/clomiphene citrate and GnRH antagonist/letrozole. Conclusion: Our finding suggest that the results of microdose flare-up protocol are better than other two used treatment protocols, in terms of maximum estradiol levels, number of mature oocytes retrieved, and cancellation rate and it still seems to be superior the ovarian stimulation regime for the poor responder patients.

Efficacy of melatonin and hyaluronate/carboxymethylcellulose membrane in preventing adhesion reformation following adhesiolysis in a rat uterine model

Aim:u2002 To evaluate the efficacy of hyaluronate/carboxymethylcellulose (HA/CMC) membrane and melatonin separately and in combination in reducing adhesion reformation following adhesiolysis of surgically induced adhesions in a rat uterine horn adhesion model.

The significance of the number of CGG repeats and autoantibodies in premature ovarian failure

The objective of this study was to determine whether there was a threshold for the number of CGG repeats in the FMR1 (fragile X) gene in premature ovarian ageing and premature ovarian failure and to investigate the association of this sequence with serum concentrations of anti-Müllerian hormone (AMH), inhibin B, anti-thyroid and anti-adrenal autoantibodies. In this prospective randomized controlled preliminary study, the number of triple CGG repeats and serum concentrations of FSH, AMH and aforementioned autoantibodies were evaluated in 79 women who were younger than 40 years old. FSH concentrations were between 12 and 50 IU/ml (premature ovarian ageing) in 30 women and were higher than 50 IU/ml (premature ovarian failure) in nine women; FSH concentrations were normal in 40 women. All women whose FSH concentrations were higher than 12 IU/ml had CGG repeats greater than 30. No women whose FSH concentrations were normal had a repeat number above 30. There was no significant relationship between the levels of antibodies and either CGG repeat numbers or FSH concentrations. In conclusion, the number of CGG repeats between 30 and 40 might be used to predict premature ovarian ageing and premature ovarian failure in infertile women.