Suleyman Tosun

Outcome of 1114 ICSI and embryo transfer cycles of women 40 years of age and over

The purpose of this study was to contribute to the development of strategies to obtain acceptable outcomes in assisted reproduction treatments in women over 40 years of age. A retrospective study was carried out on the database of the German Hospital in Istanbul using data from the years 1997 to 2004. A total of 1114 embryo transfer cycles were assessed. The pregnancy, implantation and delivery rates of the assessed population were 18.2, 8.3 and 10.9% respectively. The results showed that the demographics and outcome of cycles of women at 40 years differed significantly from those over 40. Cycles in which six or more oocytes were retrieved displayed better characteristics and outcome than those with five or fewer. The clinical pregnancy and delivery rates after transfer of three embryos were similar to four or more. Therefore, women over 40 years with a good ovarian response and at least three embryos available for transfer have an acceptable pregnancy and delivery rate with a low multiple pregnancy risk.

Outcome of assisted reproduction treatment in patients with endometrial thickness less than 7 mm

Endometrial thickness is one of the parameters contributing to the outcome of assisted reproduction treatment. The aim of the current study was to investigate the pregnancy rate and the outcome when the endometrial thickness was <7 mm during a treatment cycle. Treatments conducted between January 2000 and December 2004 at the German Hospital in Istanbul were reviewed retrospectively. A total of 175 embryo transfer cycles with an endometrial thickness of <7 mm on the day of oocyte retrieval were assessed. The 175 oocyte retrieval-embryo transfer cycles resulted in 53 pregnancies (30%), of which 11% were biochemical pregnancies, 26% were miscarriages and 58% were delivered. The clinical pregnancy rate was 26%, miscarriage rate was 31% and live birth rate was 17%. However, the results were quite good when the patient age was <35 years or the number of oocytes retrieved was over five or the number of available embryos to transfer was three or more. In conclusion, when the endometrial thickness is <7 mm during an treatment cycle, the couple should be informed about the chance of pregnancy and the outcome. In a young normoresponder woman with at least three embryos available for transfer, transfer could be carried out, otherwise embryo freezing should be recommended.

Subclinical pregnancy losses among women undergoing in-vitro fertilization with ICSI.

Background: The purpose of this study is to asses the frequency of subclinical pregnancy loss (SPL) among women undergoing controlled ovarian hyperstimulation (COH) and in-vitro fertilization with ICSI. Methods: The study was retrospectively conducted in a private IVF center. SPL was defined by a temporary rise in serum βhCG, along with the absence of signs of intra- and extra-uterine pregnancy by transvaginal ultrasonography. Overall 5273 COH and ICSI cycles with embryo transfer (ET) were segregated according to serum E2 levels percentiles (-24th, 25th, 74th, and 75th), women age and the type of spermatozoa for assisted fertilization (ejaculated and surgically retrieved). Those groups were assessed for SPL rates. Results: Among the 3125 (59.25) conception cycles, 305 (9.7%) were diagnosed as SPL. There was no difference in SPL rate among E2 percentile groups. Women older than 35 years of age had significantly higher rate of SPL compared to younger women. There was also no difference in SPL rate among pregnancies in whom surgically retrieved spermatozoa used or ejaculated spermatozoa used for assisted fertilization. Conclusion: Our results demonstrated that SPL rate was not influenced by the levels of E2 during COH or the origin of spermatozoa used for assisted fertilization. However, maternal age was found to be detrimental for SPL.

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.