Cem Korkmaz

Opinions of infertile Turkish women on gamete donation and gestational surrogacy

OBJECTIVE To determine the approval levels of infertile Turkish women concerning gamete donation and gestational surrogacy. DESIGN Opinion survey. SETTING Assisted reproductive treatment center at Gulhane Military Medical Academy. PATIENT(S) 368 women who had applied for infertility treatment. INTERVENTION(S) The patients were asked to answer a questionnaire that included questions about the patients sociodemographic status, previous medical history with infertility treatment, and opinions on gamete donation and gestational surrogacy. MAIN OUTCOME MEASURE(S) Opinions of patients concerning gamete donation and gestational surrogacy. RESULT(S) Our data in this first study on infertile Turkish women show that some patients approve of gamete donation (23.3% for accepting oocytes and 3.4% for accepting sperm) and gestational surrogacy (15.1%). CONCLUSION(S) Donation and surrogacy are alternate treatments for the serious condition called infertility. As there are patients who would like to use these treatments, each of these patients should have the right to try any of them.

Comparison of three sperm retrieval techniques in spinal cord-injured men: Pregnancy outcome

Aim. To compare pregnancy outcomes between three sperm retrieval techniques – electroejaculation, testicular sperm extraction (TESE) and prostatic massage – in spinal cord-injured men. Method. Forty-four patients who became paraplegic due to spinal cord injuries by land mines and bullets, and who underwent infertility treatment during 1998–2005, were included. Eight men were treated with rectal probe electroejaculation, 26 with TESE and ten with prostatic massage. The pregnancy rate and live birth rate resulting from the embryo transfers of all cycles were calculated. Results. Eight singleton pregnancies were achieved, two in the electroejaculation group, four in the TESE group and two in the prostatic massage group. Live birth rate was not significantly different between the three groups. Conclusion. Our results show that the different sperm retrieval techniques used to obtain semen in spinal cord-injured men resulted in similar pregnancy outcomes.

The relationship between meiotic spindle imaging and outcome of intracytoplasmic sperm injection: a retrospective study

Meiotic spindle analysis with a non-invasive technique, the PolScope, is used to protect the meiotic spindle from damage during microinjection. To evaluate the predictive feature of PolScope, we have designed a retrospective study to analyse the correlation between the meiotic spindle visualisation with regard to spindle location and outcomes of assisted reproductive technologies (ART), including patient age, previous cycles, the number of the collected oocytes, fertilisation rates (FR), pronuclear scoring (PNS) and embryo scoring of the days from two to five. All of the data belonging to 1496 oocytes from 190 patients were statistically analysed. We found that the oocytes having PolScope visualised spindle have higher FR, and also observed that when the spindle located at 0°–30° according to the first polar body, gave the highest FR. PNS gave higher scores in the spindle visualised group, but spindle angle did not affect PNS outcomes. Although a correlation was found between spindle visualisation and developed embryo qualities, particularly at day 2 and 3, spindle angles did not affect embryo quality. We conclude that PolScope microscopy has an efficiency to estimate FR, and cleavage stage embryo development.

Pregnancy outcomes in a university hospital after legal requirement for single-embryo transfer

OBJECTIVE To present our in vitro fertilization outcomes after implementation of the Turkish government policy limiting the number of transferred embryos to one, in women under the age of 35, and two, in women over age 35; and to demonstrate the feasibility of this policy. STUDY DESIGN We retrospectively reviewed the records of 423 patients who underwent ovarian stimulation, oocyte pick-up, intracytoplasmic sperm injection and embryo transfer due to primary or secondary infertility over a 22-month time interval. Clinical pregnancy was defined as a fetal heartbeat in the seventh gestational week. Embryo transfers were carried out on day 3 or 5. Descriptive statistics are given as the number of subjects and percentages. RESULTS A total of 353 embryo transfers were performed: 261 (73.9%) were single-embryo transfer (244 (69.1%) elective and 17 (4.8%) non-elective) and 92 (26.1%) were double-embryo transfer. Of the 244 elective single-embryo transfers, 6.6% (n=16) were performed using frozen-thawed embryos. The average patient age was 29.6±4.5 years in the single-embryo group and 36.5±2.4 years in the double-embryo group. The cumulative pregnancy rates per oocyte pick-up were similar in both groups: 41% (n=107) in the single-embryo group and 43.4% (n=40) in the double-embryo group (p=0.678). The cumulative live birth rate of the single-embryo group (32.1%) was not statistically different from the double-embryo group (35.8%) (p=0.518). The twin pregnancy rate after single-embro transfer was significantly lower than with double-embryo transfer (2.8% (n=3) vs. 32.5% (n=13); p<0.001) and 62.5% of the twin pregnancies occurred in women 35 years or older who underwent double-embryo transfer. No significant difference in the spontaneous abortion rates was recorded between the single- and double-embryo transfer groups (16 (6.1%) vs. 6 (6.5%); p=0.894). CONCLUSION Single-embryo transfer results in a pregnancy rate comparable to double-embryo transfer, with a significantly reduced multiple pregnancy rate. Double-embryo transfer in patients over age 35 should be reconsidered because of the resulting high rate of multiple pregnancy.

Do quantitative birefringence characteristics of meiotic spindle and zona pellucida have an impact on implantation in single embryo transfer cycles

ObjectiveThe aim of this study was to determine whether quantitative PolScope characteristics of meiotic spindle and zona pellucida could be used as a non-invasive marker to predict implantation success in elective single embryo transfer cycles.MethodsQuantitative birefringence parameters; including mean retardance, area, length and polar body deviation angle of meiotic spindle and mean retardance and width of inner zona pellucida belonging to 53 transfer oocytes from elective single embryo transfer cycles were retrospectively analyzed. The relevant PolScope features were compared between 20 conception and 33 non-conception cycles.ResultsMeiotic spindle mean retardance, area, length and inner zona pellucida mean retardance and width did not reveal a statistically significant difference between transfer oocytes from conception and non-conception cycles. Deviation angle of the polar bodies was also comparable between the groups. Spindle and inner zona PolScope characteristics of transfer oocytes were not correlated with the maternal age.ConclusionQuantitative PolScope features of meiotic spindle and inner zona pellucida can not be used as a non-invasive marker to predict assisted reproductive technology success in elective single embryo transfer cycles.

Is pronuclear scoring a really good predictor for ICSI cycles

Background/Aims. Since the assessments of the morphology of oocytes, zygotes and/or embryos are of crucial importance to select the best candidate for pregnancy, many morphological evaluation tools have been proposed. Although embryo scoring, particularly cleavage and blastocyst stages, is more convincing due to successful results, zygote scoring still have a bias as different outcomes. In the current study, we designed a prospective study to test the reliability of zygote scoring by focusing on zygote evaluation techniques and its relation with embryo development and embryo selection for transfer. Methods. A total of 1215 mature oocytes from 139 couples were evaluated for the study. Results. There is no correlation between published zygote scoring technique and embryo development. Conclusions. We conclude that the inconsistency of data obtained from zygote scoring might be caused by the static nature of pronuclear stage embryos and thus pronuclear scoring seems to be unreliable evaluation technique for embryo selection.

The protective effects of acetyl L-carnitine on testis gonadotoxicity induced by Cisplatin in rats.

BACKGROUND Cisplatin, an effective antineoplastic agent, damages normal cells in a manner related to chemotherapy. Acetyl L-carnitine protects cells against mitochondrial and nuclear damage induced by chemotherapy. AIMS Animal experiment. STUDY DESIGN The aim of this study was to examine the protective effects of acetyl L-carnitine on cisplatin-induced gonadotoxicity in testicular structures. Twenty-four male Wistar albino rats were divided into four Groups (n=6): Group 1 (control) was administered saline; Group 2 was administered acetyl L-carnitine; Group 3 was administered cisplatin; and Group 4 was pre-treated with acetyl L-carnitine before cisplatin administration. METHODS After 72hr of treatment with cisplatin, the rats were sacrificed, and the testicular tissues were removed. Morphometric, histomorphologic and immunohistochemical analyses were conducted. RESULTS At the end of the experiment, Group 3 was characterised by statistically significant weight loss, a degenerative appearance of the seminiferous tubules in the peripheral region, separation of spermatogenic cell series from the tubular wall, cellular debris in the lumen and central interstitial oedema. Sperm morphology appeared to be abnormal. Tubular diameter and wall thickness decreased, and the number of TUNEL- and active caspase-positive cells increased compared with the other Groups. The histological findings in Group 4 were better than those in Group 3. CONCLUSION It was concluded that the prophylactic use of acetyl L-carnitine protects against cisplatin-induced testicular tissue damage.

Giant Oocytes with Two Meiotic Spindles and Two Polar Bodies: Report of Two Cases

With the advent of IVF technology, the terms normal and abnormal oocytes have been defined and one type of abnormal oocyte is the “giant oocyte”. Giant oocytes are defined to have a 30% larger diameter and twice the volume of normal oocytes[1,2]. Giant oocyte is a rarery observed phenomenon among humans and embryos may develop from these oocytes [2,3].The first hypothesis for the mechanism of their formation is cytoplasmic fusion of two oogonia and the second one is the lack of cytokinesis during mitotic divisions in an oogonium [4]. Fertilization and progression of a giant oocyte is suspected to be the cause of digynic triploidy, which is defined as triploidy with two maternal and one paternal complements [5]. In this case report, we present two giant oocytes, each shown to have two meiotic spindles via visualization by polarization microscope. Because giant oocytes can develop into embryos that are morphologically normal, but genetically abnormal, an embryologist has to be aware of this phenomenon. For this reason, the scientific aim of this report is to present the polarization microscopic properties of giant oocytes and increase the awareness of such oocytes among embryologists.

The impact of the time interval on in-vitro fertilisation success after failure of the first attempt.

Abstract The aim of this study was to identify the optimal time interval for in-vitro fertilisation that would increase treatment success after failure of the first attempt. This retrospective study evaluated 454 consecutive cycles of 227 infertile women who had two consecutive attempts within a 6-month period at an IVF centre. Data were collected on duration of stimulation, consumption of gonadotropin, numbers of retrieved oocytes, mature oocytes, fertilised eggs, good quality embryos on day 3/5 following oocyte retrieval and clinical and ongoing pregnancy. There were significant increases in clinical pregnancy rates at 2-, 3- and 4-month intervals. The maximum increase was after two menstrual cycles (p = 0.001). The highest rate of ongoing pregnancy was in women that had the second attempt after the next menstrual cycle following failure of IVF (27.2%). After IVF failure, initiating the next attempt within 2–4 months increases the clinical pregnancy rates.

Do Bmı or Waıst-to-Hıp Ratıo Interfere wıth The Number of Oocytes Retrıeved ın IVF Cycles?

The effect of obesity on ovarian response to ovulation induction and on in vitro fertilization (IVF) outcome is controversial. This controversy might stem from the fact that almost all studies on the subject use body mass index (BMI) for obesity measurement. We aimed to determine which obesity measure predicts the possible effect of obesity on ovarian response in IVF patients. In this retrospective study, patients who presented for IVF and underwent an antagonist protocol were included. Their histories and cycle properties were recorded, as well as their BMI and waist-tohip (W/H) ratios. A total of 35 patients were included. While normal BMI significantly lowered the gonadotropin dose, normal W/H ratio increased the antral follicle count (AFC). Both BMI and W/H ratio did not significantly affect either the number of oocytes retrieved or the metaphase II oocytes. Ovulation induction during IVF cycles can overcome the adverse effects of obesity on ovarian reserve. Large-sample-sized, well-designed studies must be performed to clarify the best obesity measurement method for infertility treatment and to determine the real effect of obesity on IVF success.