Wicharn Choktanasiri

Prevalence and clinical predictors of endometrial hyperplasiain anovulatory women presenting with amenorrhea.

The aim of the present study was to determine the prevalence and clinical predictors of endometrial hyperplasia (EH) in amenorrheic women with anovulation. Fifty-seven women were enrolled in the study. Of these, 43 were diagnosed to have polycystic ovary syndrome (PCOS) and 14 to have idiopathic anovulation. All women received transvaginal sonography to assess endometrial thickness (ET), patterns and abnormalities. At the same time, an endometrial biopsy was taken using a Pipelle instrument. The womens age, body mass index (BMI) and waist-to-hip ratio (WHR) were 32.0±6.0 years, 27.3±6.5 kg/m2 and 0.82±0.06 (mean±standard deviation), respectively. Twenty (35.1%) and 19 (33.3%) women were classified as obese by BMI and WHR, respectively. Hypertension was found in 17 (29.8%) women. The prevalence of EH was 45.6%. Most cases were simple EH, and only one (1.75%) was simple EH with atypia. EH prevalence was 48.8% and 35.7% in PCOS and idiopathic anovulatory women, respectively. Age, BMI, WHR and ET did not predict EH, whereas the endometrial hyperechogenic pattern was a clinical predictor of EH with borderline significance. In conclusion, this study demonstrated that almost half of the anovulatory women with amenorrhea had EH and no significant predictor was found. In view of these findings, an endometrial biopsy should be performed in all women with this disorder.

Comparison of cryopreserved human sperm from solid surface vitrification and standard vapor freezing method: on motility, morphology, vitality and DNA integrity

Solid surface vitrificaition (SSV) is a cryoperservative method that has been used in the cryopreservation of oocytes, and embryos. Here, we report an application of the SSV in the cryopreservation of human spermatozoa. We compared the SSV with a standard freezing method in terms of sperm motility, morphology, vitality and DNA integrity. Sperm motility was determined by computer assisted semen analysis, morphology and vitality were determined by eosin‐methylene blue staining, and DNA integrity was determined by a TUNEL assay. We found that while both cryopreservative methods produced spermatozoa with comparable vitality and motility, the SSV gave slightly, but significantly fewer sperm with DNA damage, and loose tail. We concluded that, a cryopreservation of human spermatozoa by SSV is feasible and provides a quick and practical way to preserve human spermatozoa with a comparable, if not better, quality of the preserved spermatozoa to the standard freezing method.

Efficacy of metformin on ovulation induction in Asian women with polycystic ovary syndrome.

The aim of this study was to assess the efficacy of metformin on induction of ovulation in Asian women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). Twenty PCOS women who did not respond to CC were enrolled in the study. All received 500-1500 mg/day of metformin for 4 weeks. If no dominant follicle was observed with monitoring by transvaginal ultrasound, 50-150 mg of CC per day for 5 days were added. Timing of sexual intercourse was determined or intrauterine insemination was carried out 36 h after administration of human chorionic gonadotropin. A total of six cycles, pregnancy or anovulation despite taking 150 mg of CC were considered as completion of the study. Blood samples were obtained before and at the end of the 4th week of treatment for hormonal assay. Ovulation was observed in 68 (89.5%) of 76 cycles, of which 34 (44.7%) occurred with metformin alone. Twelve women conceived; therefore, the pregnancy rate was 17.6% per ovulated cycle and 60% per woman. One (8.3%) had an abortion. Four women had minimal adverse effect, but one experienced a severe gastrointestinal effect during the fourth cycle. Insulin and androstenedione levels were significantly decreased after 4 weeks of treatment. In conclusion, these series demonstrated the excellent efficacy of metformin on induction of ovulation and pregnancy in Asian women with CC-resistant PCOS.

Effect of estradiol valerate on endometrium thickness during clomiphene citrate-stimulated ovulation

The aim of this study was to examine the effects of estradiol valerate (EV) on the thickness of clomiphene citrate (CC)‐stimulated endometrium.

Comparison of outcomes and direct cost between minimal stimulation and conventional protocols on ovarian stimulation in in vitro fertilization

Aim: To determine whether minimal stimulation with clomiphene and gonadotropin provides outcomes and direct costs comparable with those of a conventional GnRHa‐gonadotropin stimulation protocol for infertile patients undergoing in vitro fertilization.

A comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on superovulation in Asian women with normal ovulatory cycles.

Objective. To compare the effect of the aromatase inhibitor letrozole and clomiphene citrate (CC) on superovulation in women with normal ovulation. Methods. A cross-over randomized study of 22 women with normal ovulation, divided randomly into two equal cohorts, was carried out. Each group of 11 women was randomly allocated to take letrozole or CC for one cycle. After washing out for one cycle, the alternative drug was administered in the subsequent cycle. The number and size of mature follicles, endometrial thickness, and estradiol and progesterone levels were monitored. Results. The number of mature follicles and estradiol levels on ovulation day were significantly lower in the letrozole group than the CC group (p < 0.05 for both). However, no differences between the two groups in endometrial thickness and pattern were observed. Progesterone levels showed ovulation in all cycles. Conclusions. The administration of 50 mg CC on days 3–5 was superior to 2.5 mg letrozole for superovulation induction in women with normal ovulation.

The Effects of Short Abstinence Time on Sperm Motility, Morphology and DNA mDamage

This was an experimental study to determine the influence of short abstinence time on sperm motility, morphology and DNA damage performed at the Assisted Reproductive Technology (ART) unit, Ramathibodi Hospital. Fifty-seven semen samples with normal semen analysis according to World Health Organization (WHO) 1999 and Kruger strict criteria were obtained. Volunteers were instructed to abstain for 3-5 days, 18-30 hours and 4 days for the 1st, 2nd and 3rd semen collection Total motile sperm count (TMSC) was determined using computer-assisted semen analysis (CASA); sperm morphology was determined using eosin-methylene blue staining and DNA damage was assessed by TUNEL assay. The results showed that TMSC was not significantly different between the 1st (3-5 days abstinence time) and 2nd semen collection (18-30 hours abstinence time after the 1st collection) (p value=0.289). The percentage of DNA damage (4.6% vs. 9.8%, p value<0.001) and normal morphological sperm (14.9% vs. 17.2%, p value<0.001) in the 2nd semen collection were significantly lower than the 1st collection, although the value was still in the normal range. Semen parameters of the 3rd collection (4 days abstinence time after the 2nd collection) correlate with those of the 1st collection. We conclude that in normal semen, with an abstinence time of only one day, TMSC was not significantly different between 3-5 days abstinence time and 18-30 hours abstinence time. The result of DNA damage and the percentage of normal morphological sperm were significantly lower in 18-30 hours abstinence time.

Sperm motility and DNA integrity affected by different g-forces in the preparation of sperm in urine specimens

Retrograde ejaculation, a common type of anejaculation, is attributable to many causes, some of which can be treated with medication and some of which cannot. For infertility treatment, sperm must be collected from the urine of the patients. Our study attempts to ascertain the effects of different g‐forces on sperm motility, morphology and DNA integrity in sperm preparation by the Sil‐Select™ density gradient method of isolating sperm from urine specimens. Forty‐seven semen samples with normal semen analyses according to World Health Organisation (WHO) 1999 criteria were included in this study. Semen samples of 1 ml were mixed with 20 ml alkalinised normal urine and then divided equally into tubes A and B. The two samples were prepared by the Sil‐Select™ density gradient centrifugation method at 350 g (tube A) and at 700 g (tube B). Total motile sperm after centrifugation at 700 g was significantly higher than after centrifugation at 350 g [6.7 (0.4–23.0) million versus 3.1 (0.1–13.7) million] (P < 0.001). There was no significant difference between the either the percentage of sperm with normal morphology or with DNA damage between centrifugation at 350 g and 700 g (P > 0.05), although centrifugation at 700 g achieves a higher number of total motile sperm compared with Sil‐Select™ sperm preparation at 350 g centrifugation.