Mehmet Ali Akman

Conception rates following assisted reproduction in poor responder patients: a retrospective study in 300 consecutive cycles

Poor response to ovarian stimulation for assisted reproduction treatment is a therapeutic challenge. Oocyte donation may be unacceptable to some patients, and many couples opt to continue with treatment despite low follicle numbers. Minimal data are available regarding conception rates in poor responders who elect to undergo oocyte retrieval. This study summarizes the outcome of assisted reproduction treatment in poor responders who produced four or fewer oocytes during ovarian stimulation, in order to provide better counselling to such patients in the future. Embryo transfers were performed in 208 of 300 cycles demonstrating poor ovarian response. Pregnancy rate (PR) (15.9%) was significantly higher in patients in whom four oocytes were retrieved, compared with patients in whom one or two oocytes were retrieved (2.3 and 4.3% respectively). Younger patients (< or =34 years) had significantly higher PR (19.5%) compared with older patients (> or =35 and < or =39 years, PR 7.2% and > or =40 years, PR 1.5% respectively). One hundred and twenty-six age-matched normal responders in whom three embryos were transferred had higher implantation rates (15.3%) and PR (37.3%) compared with poor responders in whom three embryos were transferred (6.6 and 16.6% respectively; P < 0.05). In this regard, patient age, number of oocytes retrieved and number of embryos available for transfer determine prognosis for the success of IVF in patients who respond to ovarian stimulation with four or fewer follicles for assisted reproduction treatment.

Deleterious effect of the presence of hydrosalpinx on implantation and pregnancy rates with in vitro fertilization

OBJECTIVE To determine the effect of the presence of a unilateral or bilateral hydrosalpinx on the outcome with IVF-ET. DESIGN Retrospective analysis of clinical and laboratory data. SETTING Hospital-based private IVF center. PATIENTS Eight hundred forty-six patients with tubal disease younger than age 40 years undergoing 1,766 stimulation cycles. In 118 cycles, a hydrosalpinx was noted sonographically (group I) whereas, in 1,648 cycles, no such image was documented. MAIN OUTCOME MEASURES Pregnancy and implantation rates. RESULTS Group I displayed a significantly lower pregnancy rate per transfer than group II (16.84% versus 36.83%) and a lower implantation rate (3.92% versus 11.53%). CONCLUSION The presence of hydrosalpinx adversely affects the outcome of IVF.

Successful resection of a heterotopic cervical pregnancy resulting from intracytoplasmic sperm injection

OBJECTIVE To report a case of cervical heterotopic pregnancy after IVF-ET treatment. DESIGN Case report. SETTING Private IVF center. PATIENT(S) A woman who had undergone controlled ovarian hyperstimulation and intracytoplasmic sperm injection-ET for primary male factor infertility. INTERVENTION(S) Resection of cervical heterotopic pregnancy by hysteroscopy. MAIN OUTCOME MEASURE(S) Successful treatment of heterotopic cervical pregnancy. RESULT(S) A successful pregnancy resulting in a term baby. CONCLUSION(S) Hysteroscopic resection can be used to treat a cervical heterotopic pregnancy.

Partners of men with Klinefelter syndrome can benefit from assisted reproductive technologies.

OBJECTIVE To report the birth of a healthy female infant from a father with nonmosaic Klinefelter syndrome (KS) and document the experience of men with KS undergoing assisted conception. DESIGN Retrospective. SETTING Private IVF center. PATIENT(S) Twelve couples with male factor infertility due to Klinefelter syndrome undergoing assisted reproduction treatment. INTERVENTION(S) Controlled ovarian hyperstimulation, testicular sperm extraction, intracytoplasmic sperm injection (ICSI), round spermatid injection (ROSI), and preimplantation genetic diagnosis. MAIN OUTCOME MEASURE(S) Testicular sperm retrieval rate, fertilization rate, and pregnancy outcome. RESULT(S) There was a sufficient amount of motile sperm for injection into mature oocytes in 6 of the 11 testicular biopsies (54.5%). Fertilization rates for ICSI and ROSI cases were 54.2% and 41.6%, respectively. The pregnancy rate per ET was 27.2%. None of the ROSI cases resulted in pregnancy. Two patients had spontaneous abortions at 8 and 18 weeks of gestation, respectively. Only one patient delivered a healthy female baby after 36 weeks of an uneventful pregnancy. CONCLUSION(S) Men with KS can benefit from assisted reproductive technologies, and the testicular sperm retrieval rate among them is promising. Although sex chromosome aberrations among the embryos from men with KS are not common, couples can be offered preimplantation genetic diagnosis before ET.

The reproductive performance of women with hypogonadotropic hypogonadism in an in vitro fertilization and embryo transfer program

Purpose: To evaluate the outcome of women with hypogonadotropic hypogonadism undergoing in-vitro fertilization (IVF).Methods: We retrospectively assessed outcomes in 58 women with hypogonadotropic hypogonadism (HH) and, as matched controls, in 116 women with tubal factor (TF) infertility who underwent assisted reproduction treatment (ART). For ovulation induction, human menopausal gonadotropin (hMG) was used in HH patients and a combination of hMG and gonadotropin releasing hormone (GnRH) agonist was used in TF patients. Conception and implantation rates, as well as duration of stimulation and number of oocytes retrieved, were the main outcome measures.Results:Of the 58 HH patients, 53 (91.3%) responded adequately to ovulation induction and underwent ET. A larger amount of gonadotropins and a longer duration of ovarian stimulation were needed in HH patients than in TF patients. The mean number of retrieved oocytes and implantation rates did not differ between the groups. In addition, there were no differences between the HH and TF groups in pregnancy (53.8 vs. 48.6%) and multiple pregnancy (63.4 vs. 48.4%) rates. In the HH group, the miscarriage rate was 3.4%, and none of these patients developed severe OHSS.Conclusion:IVF in HH patients, in which there was a background of previous failed ovulation induction, was as successful as in women with TF infertility.

A unique case of massive ascites before ovulation associated with gonadotropin therapy

OBJECTIVE To describe a unique case of massive ascites associated with gonadotropin therapy. DESIGN Case report. SETTING Patient in a hospital-based private IVF center. INTERVENTION(S) Ovulation induction with gonadotropins for subsequent IVF. RESULT(S) Ovulation induction with gonadotropins resulted in the accumulation, before ovulation, of 1,200 and 2,000 mL of peritoneal fluid in two consecutive cycles. The stimulation yielded four and six oocytes, respectively. CONCLUSION(S) Gonadotropin therapy can result in ascites before ovulation without an exaggerated ovarian response and without interfering with follicular development.