Helena Tinkanen

In vitro fertilization in patients with ovarian endometriomas.

Objective. The objective of the study was to establish whether operative treatment of recurrent ovarian endometriosis improves the prognosis of in vitro fertilization.

Prognostic factors in controlled ovarian hyperstimulation

OBJECTIVE To determine whether the number of retrieved oocytes and the required amount of gonadotropins per oocyte in IVF treatment can be predicted with use of the following independent predictive variables: age, parity, cause of infertility, body mass index, day 3-5 FSH, E2, inhibin B, ovarian volume, the number of follicles, and intraovarian and uterine artery vascular resistance measured by ultrasonography before ovarian hyperstimulation. DESIGN A retrospective analysis. SETTING University hospital infertility clinic. PATIENT(S) Seventy-four consecutive women attending the university hospital infertility clinic for IVF treatment. INTERVENTION(S) The investigated factors were measured on day 3-5 of the cycle, in which luteal phase suppression was begun before ovarian hyperstimulation preparatory to IVF. MAIN OUTCOME MEASURE(S) The amount of gonadotropins required per oocyte and the number of retrieved oocytes were correlated with the predictive factors in stepwise regression analysis. RESULT(S) The best predictive factors for the number of oocytes retrieved were FSH, inhibin B, and parity, explaining 25% of the ovarian response. Intraovarian vascular resistance, parity, FSH, and inhibin B best predicted the amount of gonadotropins needed, explaining 44% of the variation. CONCLUSION(S) FSH, inhibin B, and parity were the independent predictive factors for the number of retrieved oocytes. The same factors and intraovarian vascular resistance predicted the required amount of gonadotropins per oocyte. The main part of the ovarian response cannot be predicted using the factors investigated.

Correlation between serum inhibin B and other indicators of the ovarian function

OBJECTIVE To investigate the correlation between the early follicular phase serum inhibin B levels and other indicators of ovarian reserve. STUDY DESIGN Seventy-four women aged 24-40 years (mean 32) with different infertility etiologies were investigated in the early follicular phase of a spontaneous mentrual cycle. The volume of the ovaries was measured and the total number of follicles <5 mm in size counted by ultrasound. Serum levels of FSH, estradiol (E2) and inhibin B were measured on the same day. In stepwise regression analysis inhibin B levels were correlated with age, body-mass-index, the ultrasound measurements, cause of infertility, parity, FSH and E2. RESULTS FSH, BMI and the number of follicles proved to be statistically significant independent predictive factors for the inhibin B levels, FSH and BMI correlating negatively and the number of follicles positively with inhibin B serum concentrations. CONCLUSION The number of small follicles reflect the inhibin B production of the ovaries. BMI being as strong predictive factor of inhibin B levels as FSH could in part explain the impaired likelihood of conceiving in obese patients.

Low-dose aspirin therapy and hypertensive pregnancy complications in unselected IVF and ICSI patients: a randomized, placebo-controlled, double-blind study

BACKGROUND Low-dose aspirin therapy could improve remodelling of maternal spiral arteries during early placentation and prevent subsequent pregnancy-related hypertensive disorders. We investigated whether low-dose aspirin therapy reduces the incidence of hypertensive pregnancy complications in unselected IVF and ICSI patients when medication was started prior to pregnancy. METHODS A total of 487 patients who underwent IVF/ICSI were randomized to receive 100 mg aspirin (n = 242) or placebo (n = 245) daily, starting on the first day of gonadotrophin stimulation. Pregnant women continued the medication until delivery. A total of 107 patients (52 with aspirin and 55 with placebo) experienced live birth and were included in this follow-up study. The main outcome measure was the incidence of hypertensive pregnancy complications. RESULTS Embryo transfer took place in 227 (94%) women in the aspirin group and in 229 (93%) women in the placebo group. The live birth rate between the aspirin (22.9%) and placebo (24.0%) groups did not differ significantly (P = 0.78). The overall incidence of hypertensive pregnancy complications was 15.4% (8/52) in the aspirin group and 18.2% (10/55) in the placebo group (P = 0.70, 95% confidence interval for the difference of proportions -17 to 11%). There were two cases of severe pre-eclampsia in the aspirin group and three cases in the placebo group. CONCLUSIONS In the present study, the incidence of hypertensive pregnancy complications did not differ statistically significantly between low-dose aspirin and placebo groups in unselected IVF/ICSI patients, when medication was started concomitantly with gonadotrophin stimulation and continued until delivery. The study was registered at clinicaltrials.gov. NCT00683202.

Ovarian tissue cryopreservation and transplantation among alternatives for fertility preservation in the Nordic countries - compilation of 20 years of multicenter experience.

The aim of this study is to report the current status of ovarian tissue cryopreservation among alternatives for fertility preservation in the Nordic countries.

Vascular resistance in uterine and ovarian arteries: its association with infertility and the prognosis of infertility

In this study we investigated the blood flow in uterine (u.a.) and ovarian arteries (o.a.) in healthy women and infertility patients and the relationship of vascular resistance to the etiology and the prognosis of infertility. A total of 101 consecutive infertility patients referred to hospital for investigations were studied by Doppler ultrasound. Couples with male infertility were excluded. The control group comprised 19 healthy women having regular menstrual cycle and no history of infertility. The pulsatility index (PI) in o.a. and u.a. was measured in pre- and post-ovulatory phase of the menstrual cycle. The PI values of the controls were compared with those of the patients with various infertility etiologies. The PI values of the infertility patients who subsequently delivered were compared with those of the patients failing to deliver. Infertility patients had high PI in o.a. and u.a. in the luteal phase more often than controls. High vascular resistance in u.a. and o.a. in the luteal phase reduce the take-baby-home rate.

The role of vascularisation of the corpus luteum in the short luteal phase studied by Doppler ultrasound

One hundred infertility patients were investigated by Doppler ultrasound and 17 were found to have a short luteal phase (<10 days) (SLP), which is regarded a subgroup of luteal insufficency (LPD). The vascularisation within the corpus luteum (CL) was investigated using vaginal Doppler ultrasound. The values were compared with those of a control material. In both groups the resistance to blood flow was lowest on the fifth postovulatory day and grew from the ninth postovulatory day towards the end of the luteal phase. The results in these groups did not differ significantly. In both groups serum progesterone values had a slight negative correlation with pulsatility index (PI) and resistance index (RI) measured within the CL. The defect in vascularisation of the CL is not a reason for SLP, and Doppler ultrasound measurements from the CL do not help in the diagnosis of SLP.

Bone marrow remission status predicts leukemia contamination in ovarian biopsies collected for fertility preservation.

Bone marrow remission status predicts leukemia contamination in ovarian biopsies collected for fertility preservation

Doppler Ultrasound Studies in Pelvic Inflammatory Disease

Ten women with tubo-ovarian abscess caused by pelvic inflammatory disease (PID) were investigated by transvaginal Doppler ultrasound during the acute and healing phases of the infection. The pulsatility index (PI) of the uterine arteries was measured and compared with the values obtained from 19 healthy women. Each control patient was investigated three times during a single menstrual cycle. In PID patients, the PI values were significantly lower than in controls in the same phase of the menstrual cycle. When C-reactive protein was > 50, the PI values were lowest and reverted to normal values when the infection subsided. In a case of chronic infection, the PI did not rise to normal despite normal infection parameters. Doppler ultrasound seems to offer a new method of assessing PID.

Virilization during pregnancy caused by ovarian mucinous cystadenocarcinoma

During normal pregnancy maternal circulating testosterone levels increase especially during the third trimester. Serum levels of total testosterone may rise up to seven times and of free testosterone up to five times nonpregnant levels (1) and this physiological condition does not cause virilization. The pregnancy-associated ovarian tumor-like virilizing conditions are rare. They include luteoma, hyperreactio luteinalis and sex cord tumors. Luteoma of pregnancy and hyperreactio luteinalis are benign conditions, and after the delivery the tumors disappear spontaneously and androgen levels normalize. Of the androgen producing ovarian sex-cord tumors, thecomas are benign, but Sertoli-Leydig-cell tumors, also called androblastomas, can be malignant. Granulosa-theca cell tumors, which also can be malignant, usually produce estrogen, but androgen producing tumors have also been reported (2). Also nonfunctional tumors of the ovary may cause increased androgen production. The incidence of steroid production of the nonfunctional ovarian tumors during pregnancy is higher compared with the nonpregnant premenopausal stage. The reason for this phenomenon might be high chorion gonadotropin (hCG) levels during pregnancy, which reinforce the stimulatory effect of the expanding mass on the surrounding stroma (4). Another explanation might be steroid production of the epithelial tumor, which has been shown to happen in vitro (3). Tumor tissue could also produce factors, which stimulate the stroma to increased steroid production. Krukenberg tumor, serous and mucinous cystadenocarcinomas are malignant and cystadenomas, Brenner tumor and teratomas are benign tumors reported to cause virilization during pregnancy (4). We present here a patient with pregnancy-associated virilization, caused by a large ovarian mucinous cystadenocarcinoma producing extremely high androgen levels.