Publications by authors named "Murat Sonmezer"

95 Publications

Intrauterine insemination with ovarian stimulation is a successful step prior to assisted reproductive technology for couples with unexplained infertility.

J Obstet Gynaecol 2021 Jun 21:1-6. Epub 2021 Jun 21.

Faculty of Medicine, Department of Gynaecology and Obstetrics, Ankara University, Ankara, Turkey.

The present retrospective cohort study analysed data of couples with unexplained infertility who underwent two to three intrauterine insemination (IUI) cycles. The inclusion criteria were age 20-40 years, failure to conceive for at least two years of unprotected intercourse, ovulation, normal semen analysis, and tubal patency. Total of 578 IUI cycles of 286 couples with unexplained infertility were included in the final analyses. The mean age and duration of infertility of the study population were 28.8 ± 5.1 and 5.2 ± 3.4 years, respectively. The clinical pregnancy rate (CPR) and live birth rate (LBR) per cycle were 16.6 and 13.1%, respectively. The cumulative CPR following two to three IUI cycles was 33.5% and the cumulative LBR was 26.5% for the entire cohort. The duration of infertility was significantly shorter in women whose IUI attempt were successful ( = .036). Up to three cycles of IUI with ovarian stimulation seems as an effective first-line treatment modality in unexplained infertility.IMPACT STATEMENT Cont rolled ovarian stimulation combined with intrauterine insemination (IUI) is a common infertility treatment as a low-cost, less-invasive alternative to fertilisation (IVF) and was approved as a first line treatment option for unexplained infertility However, the UK National Institute for Health and Care Excellence (NICE) guideline states that IUI is not recommended to couples with unexplained infertility, male factor and mild endometriosis, unless the couples have religious, cultural or social objections to proceed with IVF. Up to three IUI cycles with ovarian stimulation can be considered as an effective treatment modality in unexplained infertility even in couples who could not achieve pregnancy by expectant management for two years. The clinicians should reconsider the NICE recommendation of IVF in the light of recent studies including ours which recommend IUI together when dealing couples with unexplained infertility.
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http://dx.doi.org/10.1080/01443615.2021.1916805DOI Listing
June 2021

Clomiphene Citrate versus Recombinant FSH in intrauterine insemination cycles with mono- or bi-follicular development.

JBRA Assist Reprod 2021 Jul 21;25(3):383-389. Epub 2021 Jul 21.

Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey.

Objective: The present study aims to assess the success of controlled ovarian stimulation in intrauterine insemination cycles stimulated by recombinant-FSH and Clomiphene citrate for either mono- or bi-follicular development.

Methods: We assessed 870 infertile patients treated with controlled ovarian stimulation in intrauterine insemination cycles at a university-based infertility clinic between January 2012 and December 2017. We compared the cycles stimulated by clomiphene citrate and recombinant-FSH in two set-ups; mono- and bi-follicular development. The main outcome measure was the clinical pregnancy rate per cycle.

Results: The demographic and cycle parameters were similar between the groups, except for endometrial thickness on the day of hCG administration, which was higher in the recombinant-FSH group than the clomiphene citrate group. The overall clinical pregnancy rates in clomiphene citrate and recombinant-FSH groups were 9.8% and 10.3%, respectively (p=0.940). Regarding the entire cohort, clinical pregnancy was significantly higher in cases of bi-follicular development when compared to mono-follicular development (16.8% vs. 10.2%, respectively; p=0.009).

Conclusions: Clomiphene citrate and recombinant-FSH have similar success rates in terms of clinical pregnancy, in either mono-follicular development or bi-follicular development. Clomiphene citrate and recombinant-FSH cycles resulted in comparable rates of bi-follicular development, which significantly increases clinical pregnancy rate. Clomiphene citrate and recombinant-FSH have similar success rates in terms of clinical pregnancy, in either mono-follicular development or bi-follicular development.
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http://dx.doi.org/10.5935/1518-0557.20200106DOI Listing
July 2021

hCG day progesterone level has no impact on the frozen thawed embryo transfer cycle outcome.

J Gynecol Obstet Hum Reprod 2021 Jun 15;50(6):102120. Epub 2021 Mar 15.

Infertility Unit, Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.

Objective: To assess the association between hCG day progesterone levels and subsequent frozen-thawed embryo transfer (FET) cycle outcome in infertile women with and without polycystic ovary syndrome (PCOS).

Method: Data of 178 women who underwent FET at a university-based infertility clinic between January 2016 and December 2019 were reviewed. The study group consisted of women who had progesterone elevation (PE) during fresh controlled ovarian stimulation (COS) cycle. A sub-group analysis was also performed in PCOS and non-PCOS patients.

Results: There were no differences in clinical pregnancy (47.7 % vs. 50.7 %, p = 0.729), miscarriage (15.9 % vs. 22.4 %, p = 0.359), and live birth rates (27.3 % vs. 23.9 %, p = 0.652) following FET between women with and without PE in the fresh cycle. The results remained non-significant regarding the clinical pregnancy (46.7 % vs. 53.4 %, p = 0.549), miscarriage (13.3 % vs. 27.6 %, p = 0.133), and live birth rates (26.7 % vs. 19.0 %, p = 0.408) in participants with PCOS (n = 88).

Conclusion: hCG day progesterone level in the fresh COS cycle does not have a significant impact on the subsequent FET cycle neither in PCOS nor in non-PCOS women.
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http://dx.doi.org/10.1016/j.jogoh.2021.102120DOI Listing
June 2021

Ongoing pregnancy and healthy live births following very short ovarian stimulation of incidentally observed big antral follicles in oligoamenorrheic patients with extremely decreased ovarian reserve.

JBRA Assist Reprod 2021 Apr 27;25(2):324-327. Epub 2021 Apr 27.

Ankara University School of Medicine, Ankara, Turkey.

In the present case series our aim is to present seven patients with extremely decreased ovarian reserve and oligomenorrhea, conceived with in vitro fertilization following a very short ovarian stimulation of incidentally detected big antral follicles. The study included women pursuing in vitro fertilization due to premature ovarian failure risk. When an incidental growing antral follicle was detected under ultrasound, immediate ovarian stimulation was initiated if the blood estradiol, luteinizing hormone and progesterone levels were correlated. Serum anti-Mullerian hormone measurements of all patients were consistent with extremely diminished ovarian reserve (ranged between 0.01 and 0.09ng/ml) and FSH levels varied between 13-104IU/l. The mean stimulation length ranged between 2-4 days. A total of 8 oocytes were retrieved; 6 MII, 1 GV and 1 degenerated. All 6 MII oocytes were fertilized with intracytoplasmic sperm injection. Two patients conceived after fresh embryo transfer, whereas the one conceived following frozen thawed embryo transfer. The ongoing pregnancy rate was 50% per transfer, and two of them resulted in a healthy live birth. In conclusion, close monitoring of oligoamenorrheic infertile patients who are at high risk of imminent ovarian failure using ultrasound and blood hormone levels is very important. Albeit low, the possibility of having a healthy pregnancy following "a very short ovarian stimulation" in such a specific patient group is emphasized.
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http://dx.doi.org/10.5935/1518-0557.20200095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083869PMC
April 2021

Comparison of Oocyte and Embryo Quality Between Random Start and Controlled Ovarian Stimulation Cycles in Cancer Patients Undergoing Fertility Preservation.

Reprod Sci 2021 Aug 6;28(8):2200-2207. Epub 2021 Jan 6.

Department of Obstetrics and Gynecology, Center for Human Reproduction and Infertility, Ankara University School of Medicine, Dikimevi, 06100, Ankara, Turkey.

Conventional assisted reproductive technology (ART) cycles may delay cancer treatment and compromise survival, and also increase patients' psychological burden as a result of delayed chemotherapy. The aim of this study was to compare the success rates of random start and conventional start GnRH antagonist protocols in terms of oocyte and embryo outputs in cancer patients. Data of 111 patients with a newly diagnosed cancer who underwent ART for fertility preservation at a university-based infertility clinic between January 2010 and September 2019 were reviewed. The study group underwent random start controlled ovarian hyperstimulation (RS-COH) and the control group underwent conventional start COH (CS-COH). The main outcome measures were the number of total oocytes, MII oocytes, and embryo yield. A total of 46 patients (41.5%) underwent RS-COH and 65 (58.5%) underwent CS-COH. Baseline characteristics were similar between the groups. The most common cancer type in both groups was breast cancer (60.9% vs. 52.3%, respectively). The median duration of stimulation was significantly longer in RS-COH than in CS-COH (12 vs. 10 days; P = 0.005). The median number of MII oocytes was significantly higher in RS-COH than in CS-COH (7 vs. 5 oocytes, respectively; P = 0.020). The MII/AFC ratio was significantly higher in the RS-COH group compared to the CS-COH group (74% and 57% respectively; p = 0.02). In the linear regression analyses, RS-COH protocol did not have a significant impact on MII/AFC (standardized ß coefficient - 0.514; P = 0.289 {adjusted R for the model = 0.779}), oocyte yield (standardized ß coefficient - 0.070; P = 0.829 {adjusted R for the model = 0.840}), and MII rate (standardized ß coefficient - 0.504; P = 0.596 {adjusted R for the model = 0.271}). In conclusion, RS-COH protocol is as effective as CS-COH protocols for fertility preservation in cancer patients.
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http://dx.doi.org/10.1007/s43032-020-00412-2DOI Listing
August 2021

The efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation.

J Turk Ger Gynecol Assoc 2021 Jan 4. Epub 2021 Jan 4.

Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey.

Objective: Progestins are used as an alternative to GnRH antagonists to suppress premature LH surge and flexible protocol has been defined recently. The aim of this study is to compare the efficacy of flexible protocols with dydrogesterone and GnRH antagonist in suppressing LH surge.

Material And Methods: This retrospective case-control study, involving 105 patients, was conducted in an infertility unit of a tertiary referral university hospital, to compare a daily dose of 40 mg dydrogesterone with GnRH antagonist to suppress premature LH surge in controlled ovarian hyperstimulation cycles between July 2018 and July 2019. Dydrogesterone was started when the leading follicle was 12 mm or serum estradiol was over 300 pg/ml. A subgroup analysis of poor responder patients was also performed.

Results: Duration of pituitary suppression was longer in dydrogesterone group. Premature ovulation before scheduled oocyte pick up was observed in 11.5% (6/52) and 0% of the patients receiving dydrogesterone and GnRH antagonist respectively. However, collected oocyte counts and MII oocyte counts were found to be similar between the groups. All of the six patients who had premature ovulation in dydrogesterone group were in poor responder subgroup.

Conclusion: Dydrogesterone can be used as an alternative to antagonist regimen in patients where embryo transfer is not planned in the same cycle. However, flexible regimen may not be appropriate in patients with diminished ovarian reserve as advanced follicular maturation and delayed suppressive effect of oral progesterone may cause premature ovulation. Randomized controlled trials in particular patient groups are required to determine the most effective minimum dose and time of application to ensure treatment success.
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http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0110DOI Listing
January 2021

Transabdominal ultrasound guided oocyte retrieval using vaginal ultrasound probe: Definition of the technique.

J Obstet Gynaecol Res 2021 Feb 17;47(2):800-806. Epub 2020 Dec 17.

Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, Ankara, Turkey.

Purpose: To define whether transabdominal ultrasound guided oocyte retrieval (TUGOR) is a feasible, effective and safe method.

Methods: A total of 64 patients who underwent TUGOR in a tertiary referral university hospital in vitro fertilization (IVF) clinic were enrolled. Indications, total number of oocytes collected, total number and percentage of mature oocytes, duration of procedure, complication rates and total number of fertilized oocytes were assessed.

Results: The indications for TUGOR were as follows; virgin women with decreased ovarian reserve who opted fertility preservation (n = 52, 81.1%), Ewing Sarcoma (n = 1, 1.56%), breast cancer (n = 4, 6.2%), lymphoma (n = 1, 1.56%) endometrioma (n = 1, 1.56%), immature teratoma of the ovary (n = 1, 1.56%), multiple large uterine fibroids (n = 2, 3.1%), adnexal transposition due to bowel surgery (n = 1, 1.56%) and Mayer Rokitansky Küster Hauser Syndrome (n = 1, 1.56%). Total number of oocytes retrieved and mean number of oocytes collected were 315 and 4.92 ± 1.7 (range 1-21), respectively. The mean duration of the procedure was 12.4 ± 1.2 min. The number and percentage of mature oocytes were 272 and 86.3%, respectively. A total of 14 embryos were frozen in four patients and one blastocyst transfer was performed ending up with live birth. Superficial epigastric artery injury occurred in two patients and resolved spontaneously. No oocyte was retrieved in five patients with single growing follicle in the first attempt.

Conclusion: TUGOR is a feasible, effective and safe method of oocyte retrieval for the purpose of fertility preservation or in patients with inaccessible ovaries via transvaginal route undergoing IVF.
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http://dx.doi.org/10.1111/jog.14618DOI Listing
February 2021

The association between operative hysteroscopy prior to assisted reproductive technology and cervical insufficiency in second trimester.

Arch Gynecol Obstet 2021 05 20;303(5):1347-1352. Epub 2020 Nov 20.

Department of Obstetrics and Gynaecology, Cebeci Hospital, Ankara University School of Medicine, Dikimevi, 06100, Ankara, Turkey.

Purpose: To assess the association between operative hysteroscopy prior to assisted reproductive technology (ART) cycle and cervical insufficiency (CI) in the second trimester of pregnancy.

Methods: A retrospective cohort study was conducted. The charts of all women who got pregnant following an ART cycle between January 2015 and June 2018 were reviewed. The study group consisted of pregnant women who underwent operative hysteroscopy within 6 months before conception. The control group consisted of pregnant women who did not undergo hysteroscopy or any type of cervical surgical procedure before conception. The primary outcome measure was CI during the second trimester (13-27 weeks of gestation).

Results: A total of 363 pregnancies achieved by ART cycles were assessed. After the exclusion of multiple pregnancies (n = 19), previous surgical procedures (n = 4) and first-trimester pregnancy losses (n = 80), there were 29 women in the study group and 231 women in the control group. The mean ages of the study and control groups were 31.2 ± 4.06 and 29.82 ± 4.71 years, respectively (P = 0.13). The indications for operative hysteroscopy were uterine septum (n = 19), T-shaped uterus (n = 4), endometrial polyp (n = 4), and submucosal fibroids (n = 2). The rates of CI in the study and control groups were 13.7% (4/29) and 3.4% (8/231), respectively (P = 0.012). The term delivery rates in the study and control groups were 79.3 and 91.8%, respectively (P = 0.044).

Conclusions: Operative hysteroscopy prior to ART cycles is significantly associated with CI between 13 and 27 weeks of gestation. Further investigation with larger cohorts is urgently needed to clarify this issue.
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http://dx.doi.org/10.1007/s00404-020-05863-1DOI Listing
May 2021

Dual trigger in normally-responding assisted reproductive technology patients increases the number of top-quality embryos.

Clin Exp Reprod Med 2020 Dec 28;47(4):300-305. Epub 2020 Oct 28.

Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.

Objective: The feasibility of a gonadotropin-releasing hormone agonist (GnRHa) trigger in normal responders is still a matter of debate. The aim of this study was to compare the number of mature oocytes, the number of good-quality embryos, and the live birth rate in normal responders triggered by GnRHa alone, GnRHa and human chorionic gonadotropin (hCG; a dual trigger), and hCG alone.

Methods: A retrospective cohort study was conducted at the infertility clinic of a university hospital. Data from 200 normal responders who underwent controlled ovarian hyperstimulation and intracytoplasmic sperm injection with a GnRH antagonist protocol between January 2016 and January 2017 were reviewed. The first study group consisted of patients with cycles triggered by GnRHa alone. The second study group consisted of patients with cycles triggered by both GnRHa and low-dose hCG (a dual trigger). The control group consisted of patients with cycles triggered by hCG alone.

Results: The groups were comparable in terms of demographics and cycle characteristics. The numbers of total oocytes retrieved and metaphase II oocytes were similar between the groups. The total numbers of top-quality embryos were 3.2±2.9 in the GnRHa group, 4.4±3.2 in the dual-trigger group, and 2.9±2.1 in the hCG group (p=0.014). The live birth rates were 21.4%, 30.5%, and 28.2% in those groups, respectively (p=0.126).

Conclusion: In normal responders, a dual-trigger approach appears superior to an hCG trigger alone with regard to the number of top-quality embryos produced. However, no clinical benefit was apparent in terms of live birth rates.
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http://dx.doi.org/10.5653/cerm.2020.03804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711097PMC
December 2020

Human Menopausal Gonadotropin Commenced on Early Follicular Period Increases Live Birth Rates in POSEIDON Group 3 and 4 Poor Responders.

Reprod Sci 2021 02 24;28(2):488-494. Epub 2020 Aug 24.

Department of Obstetrics and Gynecology, Ankara University School of Medicine, Cebeci Hospital, 06100, Dikimevi/Ankara, Turkey.

Human menopausal gonadotropin (hMG) has LH activity, and it may have beneficial effects in terms of oocyte quality and endometrial receptivity similar to recombinant LH supplementation. The aim of this study was to assess the effects of hMG, and its commencement time on the outcome of assisted reproductive technology (ART) cycles of POSEIDON group 3 and 4 poor responders. Data of 558 POSEIDON group 3 and 4 poor responders who underwent ART treatment following a GnRH antagonist cycle at a university-based infertility clinic between January 2014 and December 2019 were reviewed. hMG was commenced at the early follicular phase or mid-follicular phase in the study groups. The control group did not receive hMG stimulation. Live birth rate (LBR) was the main outcome measure. The mean duration of stimulation was significantly shorter in early follicular hMG group than in mid-follicular hMG group (11.9 ± 3.6 days vs. 12.8 ± 4 days, respectively; P = 0.027). The mean numbers of oocytes retrieved and MII oocytes were comparable between the groups. The LBRs per embryo transfer in early follicular hMG, mid-follicular hMG, and control groups were 21.9%, 11.7%, and 11.6%, respectively (P = 0.035). In conclusion, there is a significant association between the commencement time of hMG and live birth chance in ART cycles of POSEIDON group 3 and 4 poor responders. Early initiation of hMG together with rFSH seems to be beneficial in this specific population.
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http://dx.doi.org/10.1007/s43032-020-00300-9DOI Listing
February 2021

First pregnancy and live birth in Turkey following frozen-thawed ovarian tissue transplantation in a patient with acute lymphoblastic leukemia who underwent cord blood transplantation.

J Assist Reprod Genet 2020 Aug 16;37(8):2033-2043. Epub 2020 Jun 16.

Bone Marrow Transplantation Unit, Department of Hematology, Ankara University Faculty of Medicine, Ankara,, 06620, Turkey.

Purpose: To report the first live birth after frozen-thawed ovarian transplantation in Turkey and the second case for an acute lymphoblastic leukemia (ALL) survivor in the world.

Methods: A 19-year-old patient underwent ovarian tissue cryopreservation (OTC) before cord blood transplantation in 2010. She was diagnosed as ALL with a bone marrow biopsy revealing 90% blast ALL-L2 type, and karyotype analyses indicated reciprocal translocation at t(9;22)(q34;q11). The patient received the Berlin-Frankfurt-Munster (BFM) protocol, and complete remission was achieved before fertility preservation. Serum AMH level was measured as 1.5 ng/ml, and 12 antral follicles were counted on ultrasound. She was informed about fertility preservation options and decided to proceed with OTC, with her signed consent before cord blood transplantation in April 2011. Ovarian tissue transplantation (OTT) was performed in 2017 when the patient was menopausal with serum FSH levels > 100 IU/ml and estradiol < 20 pg/ml and hematologically in molecular remission. Detailed molecular analysis, standard histology, and immunohistochemistry demonstrated that the thawed tissue is free of malignant cells.

Results: Six months following OTT, she had spontaneous menstruation with serum FSH 11 IU/ml and estradiol 53 pg/ml. Two consecutive IVF cycles yielded three top-quality embryos. Following three embryo transfer cycles, one fresh and two frozen, a healthy term live birth was achieved. Frozen-thawed-transplanted tissues were extracted during caesarean delivery upon the patient's request after a total period of 25 months in vivo, and histopathological evaluation revealed that the tissue was free of leukemic infiltration.

Conclusion: The authors report the first pregnancy and live birth in Turkey and the second live birth in the world following transplantation of frozen-thawed ovarian tissue in a leukemia survivor. As the transplanted tissues were removed during caesarean delivery, histological findings prove the functionality and the malignant-free status of the transplanted tissue during the grafted period.
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http://dx.doi.org/10.1007/s10815-020-01850-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468030PMC
August 2020

Endometrioma surgery is associated with increased risk of subsequent assisted reproductive technology cycle cancellation; a retrospective cohort study.

J Obstet Gynaecol 2021 Feb 4;41(2):259-262. Epub 2020 Jun 4.

Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.

The aim of this study was to assess the effect of laparoscopic removal of endometrioma on assisted reproductive technology (ART) outcome. A retrospective cohort study was conducted at a university hospital between January 2014 and December 2017. The ART group consisted of 26 women who underwent 44 ART cycles in the presence of ovarian endometrioma and the surgery group consisted of 53 women who underwent 58 ART cycles after laparoscopic removal of ovarian endometrioma/s. There were no statistically significant differences between the groups regarding demographic parameters and background features including cycle parameters. The live birth rates in the ART and Surgery groups per embryo transfer were 23.7 and 26.1%, respectively (  =  .800). The rate of cycle cancellation due to poor response and/or failed oocyte retrieval was significantly higher in the Surgery group than ART group (13.7 vs. 0%, respectively;  = .018). In conclusion, cystectomy significantly increases the risk of cycle cancellation due to poor ovarian response, which might be catastrophic individually. However, it does not seem to affect the live birth rates.IMPACT STATEMENT Both the presence of an endometrioma or surgical removal may have deleterious effects on fertility potential. Our results confirm that although cystectomy has no benefit on the number of oocytes collected and live birth rate, it increases the risk of cycle cancellation significantly in assisted reproductive technology cycles following endometrioma surgery. Postponing cystectomy until a freeze-all cycle may be the best option to maximise the number of oocytes retrieved and to maximise the ovarian response.
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http://dx.doi.org/10.1080/01443615.2020.1754366DOI Listing
February 2021

The association between adenomyosis and recurrent miscarriage.

Eur J Obstet Gynecol Reprod Biol 2020 Jul 5;250:107-111. Epub 2020 May 5.

Ankara University School of Medicine, Department of Obstetrics and Gynaecology, Ankara, Turkey.

Objective(s): To assess the association between the ultrasonographic presence of adenomyosis and recurrent miscarriage (RM).

Study Design: A prospective matched case-control study was conducted between March 2018 and December 2018 at Ankara University Hospital. A total of 132 women were assessed with transvaginal ultrasonography for the presence of adenomyosis markers. The case group consisted of 66 women with RM. The control group consisted of 66 women without RM or any other gynaecologic conditions. The rates of ultrasonographic adenomyosis, using strict criteria, were compared between the groups. Other etiologic factors for RM were described in the case group. The primary outcome was the ultrasonographic diagnosis of adenomyosis.

Results: The ultrasonographic diagnosis of adenomyosis, using diagnostic criteria of at least two markers, was significantly higher in the RM group when compared to the control group (19.7% vs. 6.1%, respectively; P = 0.035). The most common ultrasonographic finding in the RM group was heterogeneous myometrium (18.2%). In the RM group, there was at least one possible risk factor (including adenomyosis) for RM in 42 women (63.6%). The prevalence of adenomyosis in nine women with unexplained RM was 13.6%.

Conclusion(s): The prevalence of adenomyosis was significantly increased in women with RM compared to healthy controls. Adenomyosis and uterine anomalies were the most common risk factors associated with RM.
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http://dx.doi.org/10.1016/j.ejogrb.2020.05.006DOI Listing
July 2020

Does different subfertility etiology affect pregnancy rates in intrauterineinsemination cycles?

Turk J Med Sci 2019 Oct 24;49(5):1439-1443. Epub 2019 Oct 24.

Department of Obstetrics and Gynecology, School of Medicine, Ankara University,Ankara,Turkey

Background/aim: To investigate the relationship between subfertility etiologies and success rates in controlled ovarian stimulation and intrauterine insemination (COS–IUI) cycles.

Materials And Methods: The medical records of 218 couples who applied to a university-based fertility center were analyzed retrospectively. Detailed infertility examination data and pregnancy outcomes were compared according to different subfertility etiologies. The study groups with regard to subfertility etiologies were minimal–mild endometriosis, unexplained infertility, and mild male infertility. The primary outcome measure was live birth rate.

Results: There were no statistically significant differences between the groups regarding demographics except for total motile sperm count. Live birth rates in the male infertility group were comparable to the endometriosis and unexpected infertility groups (6.6%, 11.9%, and 10.3%, respectively; P = 0.63).

Conclusion: The success rate of the mild male subfertility group following COS–IUI cycles for live birth rates was similar to those of the endometriosis and unexplained subfertility groups.
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http://dx.doi.org/10.3906/sag-1902-200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018345PMC
October 2019

The association of thyroid stimulating hormone levels and intrauterine insemination outcomes of euthyroid unexplained subfertile couples.

Eur J Obstet Gynecol Reprod Biol 2019 Sep 17;240:99-102. Epub 2019 Jun 17.

Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.

Objective: To investigate the effect of different TSH (0.5-2.49 mIU/L and 2.5-4.5 mIU/L) levels on intrauterine insemination (IUI) outcomes of euthyroid unexplained subfertile patients who are negative for thyroid antibodies.

Study Design: In this retrospective cohort study, data of euthyroid subfertile patients who underwent IUI due to unexplained infertility at a university-based infertility clinic between January 2013 and December 2014 were reviewed. A total of 156 patients of them were categorized into two groups according to pre-conceptional TSH levels. The first study group consisted of patients with serum TSH levels 0.5-2.49 mIU/L and the second study group consisted of patients with serum TSH levels 2.5-4.5 mIU/L. The primary outcome measure was live birth rate.

Results: Demographics and cycle characteristics of the study groups were similar. There were no statistically significant differences between the study groups regarding main outcome measures (live birth rate, P = 0.82; clinical pregnancy rate, P = 0.64; miscarriage rate, P = 0.57).

Conclusion: Pre-conceptional TSH levels ranging between 0.5-4.5 mU/L does not appear to have a significant effect on IUI outcome of euthyroid women who are negative for thyroid antibodies.
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http://dx.doi.org/10.1016/j.ejogrb.2019.06.022DOI Listing
September 2019

The impact of adding hp-hMG in r-FSH started GnRH antagonist cycles on ART outcome.

Gynecol Endocrinol 2019 Oct 11;35(10):869-872. Epub 2019 Apr 11.

Department of Obstetrics and Gynecology, Faculty of Medicine, Ankara University, Ankara, Turkey.

While luteinizing hormone (LH) activity is believed to play a role in follicle maturation, human chorionic gonadotropin (hCG) might play an important role in implantation process. We aimed to investigate whether addition of human menopausal gonadotropin (hMG) in recombinant-follicle-stimulating hormone (r-FSH) started GnRH antagonist controlled ovarian hyperstimulation (COH) cycles might enhance implantation rate and improve fertilization (IVF) success. A total of 246 patients undergoing GnRH antagonist IVF cycles were analyzed. One hundred and twenty-three cycles (%50) were treated with only r-FSH and 123 cycles were treated with r-FSH plus hp-hMG combination. Total gonadotropin doses, total number of oocytes retrieved, metaphase 2 (MII) oocytes, top quality embryos, fertilization and implantation rates, clinical pregnancy rates (CPRs) and ovarian hyperstimulation syndrome (OHSS) rates were compared between the groups. Both groups were comparable in terms of demographic details and baseline characteristics. Peak estradiol and progesterone levels in hCG trigger day, number of retrieved oocytes and top quality embryo counts, fertilization rates were similar between the groups. In r-FSH + hp-hMG group, significantly higher implantation rates (35.3% 24.3%, =.017), CPRs (51.2% 35.8%, =.015) and lower OHSS rates (1.6% 7.4%,  = .03) were observed respectively compared to r-FSH only treated patients. In conclusion, addition of hp-hMG on the day of antagonist initiation might increase CPRs. A better endometrial receptivity associated with higher implantation rates might be achieved due to hCG component in hp-hMG.
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http://dx.doi.org/10.1080/09513590.2019.1600667DOI Listing
October 2019

Random start controlled ovarian hyperstimulation for fertility preservation during incidental pregnancy: a case report of blastocyst vitrification from matured oocytes.

Gynecol Endocrinol 2019 Jul 23;35(7):564-566. Epub 2019 Feb 23.

a Department of Obstetrics and Gynecology , Ankara University School of Medicine , Ankara , Turkey.

Here, we present a diffuse large B cell lymphoma patient admitted for fertility preservation before cancer therapy and whose pregnancy was recognized incidentally just after the start of random start controlled ovarian stimulation (RSCOH) during the stimulation cycle. Despite an optimal homogenous growth of follicle cohort, majority of the retrieved oocytes were immature after GnRHa trigger. Possible effects of extremely high serum progesterone and/or β-hCG levels on oocyte maturation are discussed with the surprising high rate of maturation and subsequent good embryo development. It seems that in case of need for pregnancy termination as a result of an urgent cancer therapy, RSCOH can be started and patients may benefit from overnight maturation of oocytes.
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http://dx.doi.org/10.1080/09513590.2019.1576608DOI Listing
July 2019

Utility of Gonadotropin-Releasing Hormone Agonists for Fertility Preservation: Lack of Biologic Basis and the Need to Prioritize Proven Methods.

J Clin Oncol 2019 01 8;37(1):84-86. Epub 2018 Nov 8.

Volkan Turan, Yale University School of Medicine, New Haven, CT, and Yeni Yuzyil University School of Medicine, Istanbul, Turkey; Giuliano Bedoschi, MD, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Kenny Rodriguez-Wallberg, MD, PhD, Karolinska Institute and University Hospital, Stockholm, Sweden; Murat Sonmezer, MD, Ankara University School of Medicine, Ankara, Turkey; Fernanda Silva Pacheco, MD, Classiclínica, Porto Alegre, Rio Grande do Sul, Brazil; Ozgur Oktem, MD, Koc University School of Meidcine, Istanbul, Turkey; and Hugh Taylor, MD, and Kutluk Oktay, MD, PhD, Yale University School of Medicine, New Haven, CT.

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http://dx.doi.org/10.1200/JCO.18.00420DOI Listing
January 2019

A retrospective comparative study of prednisolone use in antagonist co-treated assisted reproductive technology cycles for patients with good prognosis.

Turk J Obstet Gynecol 2018 Sep 3;15(3):147-151. Epub 2018 Sep 3.

Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.

Objective: To investigate the impact of peri-implantation prednisolone use and its duration in antagonist co-treated assisted reproductive technology (ART) cycles of patients with good prognosis.

Materials And Methods: Infertile patients treated with gonadotropin-releasing hormone antagonist protocol between January 2010 and June 2013 were included. The patients in group A (n=196) received no prednisolone. The patients in groups B (n=397) and C (n=371) received 5 mg oral prednisolone daily, for 4 and 12 days following embryo transfer, respectively. The main outcome parameter was live birth rate.

Results: The ages of the groups were 30.1±4.6, 31.5±4.5, and 30.9±4.7 years, respectively (p=0.163). There was no statistically significant difference between the groups regarding cycle characteristics. Implantation rates were 20.7%, 24.6%, and 23.8%, respectively (p=0.163). Miscarriage rates were 1.5%, 3.5%, and 3.2%, respectively (p=0.859). Live birth rates were 28.7%, 29.3%, and 32.8%, respectively (p=0.482).

Conclusion: Empiric prednisolone administration during the peri-implantation period does not seem to have beneficial effects in ART cycles of patients with good prognosis.
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http://dx.doi.org/10.4274/tjod.12244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127480PMC
September 2018

Protocol shift from agonist to antagonist or vice versa after an unsuccessful intracytoplasmic sperm injection cycle on the same patient does not improve outcome.

Taiwan J Obstet Gynecol 2018 Jun;57(3):417-420

Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.

Objective: While there's a growing data on the comparison of GnRH agonist and GnRH antagonist protocols, no clear study exists on the effects of both protocols on the same patient. The aim of the present study was to compare the success rates of protocol shift and proceeding with the same protocol after an unsuccessful intracytoplasmic sperm injection (ICSI) cycle.

Materials And Methods: Three hundred and forty-five normal responder patients who had a previously failed ICSI cycle between January 2011 and December 2015 were reviewed. The study (n = 73) and control (n = 93) groups in the first cohort were composed of patients whose protocol were shifted to antagonist and who proceeded with agonist. The study (n = 33) and control (n = 146) groups in the second cohort were composed of patients whose protocol were shifted to agonist and who proceeded with antagonist.

Results: Total dose of gonadotropins, maximum estradiol levels, and number of oocytes collected were significantly higher in agonist protocol than in antagonist protocol (P = 0.021, P = 0.013, and P = 0.003, respectively). Cycle cancellation rates were significantly lower in agonist protocol than antagonist protocol (P = 0.005). The pregnancy rates in patients who shifted to antagonist and proceeded with agonist were 57.8% and 50.8%, respectively (P = 0.399). The pregnancy rates in patients who shifted to agonist and proceeded with antagonist were 33.3% and 47.9%, respectively (P = 0.202).

Conclusion: Protocol shift following a failed ICSI cycle with either agonist or antagonist protocol does not affect outcome.
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http://dx.doi.org/10.1016/j.tjog.2018.04.016DOI Listing
June 2018

Highly elevated human epididymis protein 4 (HE4) following endometrioma rupture: a case report.

J Obstet Gynaecol 2018 Aug 7;38(6):885-886. Epub 2018 Mar 7.

a Department of Obstetrics and Gynecology , Ankara University School of Medicine , Ankara , Turkey.

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http://dx.doi.org/10.1080/01443615.2017.1404014DOI Listing
August 2018

Hysteroscopic Corrections for Complete Septate and T-Shaped Uteri Have Similar Surgical and Reproductive Outcome.

Reprod Sci 2018 12 5;25(12):1649-1654. Epub 2018 Feb 5.

1 Department of Obstetrics and Gynecology, Ankara University School of Medicine, Cebeci, Ankara, Turkiye.

Aim: To compare the surgical results and reproductive performances of patients with ESHRE/ESGE (European Society for Human Reproduction and Embryology/European Society for Gynaecologic Endoscopy) class U1a and U2b uterine anomalies after hysteroscopic correction.

Methods: A retrospective cohort study was conducted at a university hospital infertility clinic. Ninety-six patients with class U2b (complete septate uterus) and 78 patients with class U1a (T-shaped uterus) uterine anomalies who underwent hysteroscopic correction between January 2009 and December 2015 were recruited.

Results: The operation time was significantly longer in class U2b anomalies (26.5 ± 5.3 minutes) than class U1a anomalies (22.8 ± 5.8 minutes; mean difference [95% confidence interval [CI]: 3.6 ± 0.9 [1.8-5.3]; P < .001). Six out of all complete septate patients and 3 of T-shaped patients were reoperated due to postoperative synechia or to further enlarge the cavity. There were no differences between the groups regarding intraoperative (blood loss and uterine rupture) and postoperative (bleeding and infection) complications. After surgical correction, the term delivery rates increased from 3% to 71% ( P < .001) in class U2b and from 4% to 62.1% ( P < .001) in class U1a. The chance of live birth significantly increased after hysteroscopic correction both in class U2b (odds ratio [OR] 106.1; 95% CI, 29.1-387.1; P < .001) and class U1a (OR 35.7; 95% CI, 11.6-109.9; P < .001). The postoperative reproductive performances of both anomalies were similar.

Conclusion: Both types of anomalies seem to have similar severity and prognosis. Patients with both types of anomalies have excellent reproductive outcome after hysteroscopic correction.
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http://dx.doi.org/10.1177/1933719118756774DOI Listing
December 2018

Final oocyte maturation with two different GnRH agonists in antagonist co-treated cycles at risk of ovarian hyperstimulation syndrome.

Reprod Biomed Online 2017 Jan 17;34(1):5-10. Epub 2016 Oct 17.

Department of Obstetrics and Gynecology, Ankara University School of Medicine, Kadın Hastalıkları ve Doğum AD, 06100 Cebeci, Ankara, Turkey.

Triptorelin 0.2 mg and leuprolide 1 mg subcutaneous injections for triggering final follicular maturation were compared in patients with a high risk for ovarian hyperstimulation syndrome (OHSS). Infertile patients treated with GnRH antagonist protocol between January 2014 and March 2016 were recruited. Patients with high serum oestradiol levels on HCG day (>3000 pg/ml) indicating a risk of OHSS consisted of the study groups (A and B). Patients with serum oestradiol levels less than 3000 pg/ml consisted of the control group (C). A single injection of 0.2 mg triptorelin, 1 mg leuprolide and 10000 IU HCG were administered for final oocyte triggering in groups A (n = 63), B (n = 74) and C (n = 131), respectively. Demographic parameters were comparable between the groups. No cases of severe or moderate OHSS occurred in any group. The clinical pregnancy rates were 31.7%, 37.8% and 32.8% in groups A, B and C, respectively. Both injections had comparable efficacy in clinical outcome and OHSS risk. Regardless of preferred drug, GnRH agonist trigger for final oocyte maturation seems to be safe for patients with high OHSS risk, and can be safely used in fresh embryo transfer cycles.
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http://dx.doi.org/10.1016/j.rbmo.2016.10.004DOI Listing
January 2017

Mini-laparotomic Colpotomy for a Cervicovaginal Leiomyoma: Preservation of hymenal integrity.

Int J Reprod Biomed 2016 Mar;14(3):217-20

Department of Obstetrics and Gynecology, School of Medicine, Ankara University, Ankara, Turkey.

Background: Leiomyomas are the most common benign tumors of the uterus. Removal of the prolapsed pedunculated submucous myoma represents a distinct entity. Evaluation and treatment of such cases may need intervention via the hymen.Mini-laparotomic management of a pedunculated submucous myoma while preserving hymen integrity in a virginal patient is described as a safe alternative..

Case: A 30-year old, nulliparous virgin woman admitted to the outpatient- clinic with the complaint of irregular menstrual bleeding ongoing for three months. Pelvic ultrasound revealed a 5×6 cm solid mass in the cervico-vaginal location that filled the vaginal margins. Due to the patient's consistent desire for preserving hymenal integrity, mini-laparotomic colpotomy was performed and the mass was removed successfully.

Conclusion: Mini-laparotomic colpotomy, preserving hymen integrity, provides excellent visualization and it is a convenient and effective tool in the management of a cervicovaginal pedunculated submucous myoma.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899768PMC
March 2016

Does adding endometrial scratching to diagnostic hysteroscopy improve pregnancy rates in women with recurrent in-vitro fertilization failure?

Gynecol Endocrinol 2016 Dec 3;32(12):957-960. Epub 2016 Jun 3.

a Department of Obstetrics and Gynecology , Center for Research on Human Reproduction, Ankara University School of Medicine , Ankara , Turkey.

Objective: To investigate the effect of additional endometrial scratching procedure during hysteroscopy on assisted reproductive technology (ART) cycle outcomes in repeated implantation failure (RIF) patients without endometrial or uterine abnormalities on hysteroscopic evaluation.

Materials And Methods: Three hundred and forty-five RIF patients who underwent ART at a university-based infertility clinic between January 2011 and June 2015 were recruited in this retrospective cohort study. Uterine cavities of all included patients were evaluated by diagnostic hysteroscopy 7-14 days prior to the subsequent ART cycle. Women without endometrial abnormalities were allocated into two groups; the scratching group was consisted of patients who underwent endometrial scratching by using monopolar electric energy with needle forceps during hysteroscopy, and the control group was consisted of patients who underwent only diagnostic hysteroscopy.

Results: The implantation rate was significantly higher in the scratching group than the control group (37.7% versus 24.5%; p = 0.04). Clinical and ongoing pregnancy rates were also found to be significantly higher in the scratching group than the control group (37.7% versus 27.6%; p = 0.03; and 33.3% versus 23%; p = 0.03, respectively).

Conclusion: Endometrial scratching during diagnostic hysteroscopy seems to enhance implantation and as well pregnancy rates in comparison to diagnostic hysteroscopy alone.
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http://dx.doi.org/10.1080/09513590.2016.1190818DOI Listing
December 2016

Dual trigger with gonadotropin-releasing hormone agonist and recombinant human chorionic gonadotropin improves in vitro fertilization outcome in gonadotropin-releasing hormone antagonist cycles.

J Obstet Gynaecol Res 2016 Sep 15;42(9):1146-51. Epub 2016 May 15.

Department of Obstetrics and Gynecology, Center for Research on Human Reproduction, Ankara University Medical Faculty, Ankara, Turkey.

Aim: The aim of this study was to evaluate whether dual trigger with leuprolide acetate plus recombinant human chorionic gonadotropin (hCG) improves in vitro fertilization outcome in gonadotropin-releasing hormone antagonist cycles.

Methods: A total of 156 patients diagnosed with mild male factor, unexplained or tubal factor infertility were enrolled in the study. All subjects were allocated into one of two groups: the dual trigger group (leuprolide acetate 500 μg + recombinant hCG 250 μg) and the standard group (recombinant hCG 250 μg) according to the selected trigger method. Oocyte trigger was performed when at least three follicles >17 mm were observed. Pregnancy rate, number of collected oocytes, number of metaphase II oocytes, number of grade-A embryos, cycle cancellation rate, and ovarian hyperstimulation syndrome rate were the main outcome measures for the study.

Results: The mean number of grade-A embryos (1.6 ± 1.5 vs 1.1 ± 1.4, P = 0.01) and of metaphase II oocytes (7.9 ± 4.6 vs 6.3 ± 5.8, P = 0.02) was significantly higher in the dual-trigger group. Pregnancy rate was significantly higher in the dual-trigger group than in the standard group (54.8 vs 37.5%, P = 0.006). Two cases of mild ovarian hyperstimulation syndrome were observed in each group.

Conclusion: This novel and more physiological trigger approach using 500 μg leuprolide acetate plus 250 μg recombinant hCG may lead to an increase in the number of metaphase II oocytes, grade-A embryos, and may improve pregnancy rates.
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http://dx.doi.org/10.1111/jog.13021DOI Listing
September 2016

Herlyn-Werner-Wunderlich Syndrome: A Rare Cause of Pelvic Pain and High CA 19-9 Levels in an Adolescent Girl.

APSP J Case Rep 2016 Jan-Apr;7(1). Epub 2016 Jan 1.

Department of Radiology, Ankara University School of Medicine, Ankara, Turkey.

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare developmental anomaly that includes uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis. A 13-year-old girl presented with chronic abdominal pain. Magnetic resonance imaging revealed uterus didelphys, hematometrocolpos and renal agenesis on the right side with imperforate hymen. Subsequently the patient was found to have Mullerian duct anomalies. CA 19-9 level was high. At laparoscopy combined with vaginoscopy hematocolpos was drained following which she improved clinically and CA 19-9 level returned to normal.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715886PMC
January 2016

Heavy metal and trace element concentrations in blood and follicular fluid affect ART outcome.

Eur J Obstet Gynecol Reprod Biol 2016 Mar 11;198:73-77. Epub 2016 Jan 11.

Ankara University School of Medicine, Department of Obstetrics and Gynecology, IVF Unit, Turkey. Electronic address:

Objectives: To assess the effects of heavy metal and trace element concentrations in blood and follicular fluid on assisted reproductive technology cycle outcome.

Study Design: A prospective study was conducted between January 2012 and July 2012 in a university hospital infertility clinic. One hundred and one patients with unexplained infertility who underwent intracytoplasmic sperm injection using GnRH-antagonist protocol were recruited. Concentrations of four toxic metals (Cd, Pb, Hg, As) and three trace elements (Cu, Zn, Fe) were measured both in blood and follicular fluid specimens. Patients were evaluated in two groups; the study group consisted of patients with ongoing pregnancy (n=20) and the reference group consisted of patients experienced assisted reproductive technology failure, miscarriage or biochemical pregnancy (n=81).

Results: Demographics and cycle parameters were comparable between the groups except for median number of day 3 Grade A embryos. Statistically significant negative correlations were found between blood Pb levels and number of MII oocytes, implantation, clinical pregnancy and ongoing pregnancy rates. Results of the log binomial regression revealed 2.2% lower risk for ongoing pregnancy for each 1μg/dL higher blood Pb concentration while holding the other variables in the model constant (RR 0.978; 95% CI 0.956-0.998; P=.041). Also, the results revealed 71.9% lower risk for ongoing pregnancy for each 1μg/dL higher follicular fluid Cu concentration while holding the other variables in the model constant (RR 0.288; 95% CI 0.085-0.92; P=.039).

Conclusion: Blood concentrations of Pb and follicular fluid concentrations of Cu seem to have significant impacts on assisted reproductive technology cycle outcome.
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http://dx.doi.org/10.1016/j.ejogrb.2016.01.001DOI Listing
March 2016

Follicular fluid norepinephrine and dopamine concentrations are higher in polycystic ovary syndrome.

Gynecol Endocrinol 2016 Jun 11;32(6):460-3. Epub 2016 Jan 11.

a Department of Obstetrics and Gynecology , Ankara University School of Medicine , Ankara , Turkey and.

The aim of the present study was to compare follicular fluid (FF) levels of norepinephrine (NE) and dopamine (DA) in polycystic ovary syndrome (PCOS) and non-PCOS patients who underwent in vitro fertilization (IVF). Forty-seven PCOS patients (study group) and 61 patients with male factor infertility (control group) who underwent IVF using GnRH agonist protocol were recruited. Concentrations of NE and DA were measured in FF specimens of all patients. Demographic characteristics were comparable between the groups. Significantly higher levels of NE were measured in FF of PCOS patients (median: 61.05 nmol/l) compared to those with male infertility (median: 49.82 nmol/l). Similarly, significantly higher levels of DA were measured in FF of PCOS patients (median: 23.70 nmol/l) compared to those with male infertility (median: 18.28 nmol/l). In conclusion, the FF concentrations of both catecholamine are increased in PCOS patients when compared to non-PCOS patients.
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http://dx.doi.org/10.3109/09513590.2015.1130808DOI Listing
June 2016

Oogonial Precursor Cell-Derived Autologous Mitochondria Injection to Improve Outcomes in Women With Multiple IVF Failures Due to Low Oocyte Quality: A Clinical Translation.

Reprod Sci 2015 Dec;22(12):1612-7

Laboratory of Molecular Reproduction and Fertility Preservation, Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA Deparment of Pathology, New York Medical College, Valhalla, NY, USA.

Background: Mitochondrial dysfunction has been suggested as a major cause of age-induced decline in oocyte quality. In the past, donor oocyte cytoplasmic transfer showed some success but was abandoned due to the concerns with heteroplasmy. Recent studies indicated presence of oogonial precursor cells (OPCs) in the human ovary, which could be an autologous source of "healthy mitochondria." We sought to investigate the clinical efficacy of OPC-derived autologous mitochondrial injection (AMI) to improve oocyte quality in women with multiple in vitro fertilization (IVF) failures.

Methods: The OPCs were isolated from laparoscopically obtained ovarian cortical pieces by cell sorting using a monoclonal anti-vasa homolog (anti-DDX) antibody. They were then disrupted and mitochondria were isolated. Reconstituted mitochondria were injected into each oocyte during intracytoplasmic sperm injection. Paired comparisons were made between the first failed cycles and the post-AMI cycles.

Results: Of the 15 women undergoing ovarian stimulation, 2 were canceled and 3 decided to pool oocytes for later AMI. In remaining 10 (mean age 34.7 ± 4.1), AMI significantly improved fertilization rates (49.7 ± 31.3 vs 78.3 ± 18.9; P = .03) with a trend for better embryo grades (2.3 ± 0.3 vs 3.1 ± 0.7; P = .08). Four of 10 women conceived after single frozen embryo transfer and 3 after confirmation of diploidy via array comparative genomic hybridization (aCGH) (clinical pregnancy/embryo transfer = 4/10).

Conclusion: These data show encouraging results for AMI in comparison to previous failed IVF cycles.
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http://dx.doi.org/10.1177/1933719115612137DOI Listing
December 2015
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