In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction

Background: Polycystic ovarian syndrome (PCOS) occurs in 4% to 7% of all women of reproductive age and 50% of women presenting with subfertility. Subfertility affects 15% to 20% of couples trying to conceive. A significant proportion of these women ultimately need assisted reproductive technology (ART). In vitro fertilisation (IVF) is one of the assisted reproduction techniques employed to raise the chances of achieving a pregnancy. For the standard IVF technique, stimulating follicle development and growth before oocyte retrieval is essential, for which a large number of different methods combining gonadotrophins with a gonadotrophin-releasing hormone (GnRH) agonist or antagonist are used. In women with PCOS, the supra-physiological doses of gonadotrophins used for controlled ovarian hyperstimulation (COH) often result in an exaggerated ovarian response, characterised by the development of a large cohort of follicles of uneven quality, retrieval of immature oocytes, and increased risk of ovarian hyperstimulation syndrome. A potentially effective intervention for women with PCOS-related subfertility involves earlier retrieval of immature oocytes at the germinal-vesicle stage followed by in vitro maturation (IVM). So far, the only data available have derived from observational studies and non-randomised clinical trials. Objectives: To compare outcomes associated with in vitro maturation (IVM) followed by vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) versus conventional IVF or ICSI, among women with polycystic ovarian syndrome (PCOS) undergoing assisted reproductive technologies (ART). Search methods: We searched the Menstrual Disorders and Subfertility Group (MDSG) Specialised Register of controlled trials to May 2013 for any relevant trials identified from the title, abstract, or keyword sections. This was followed by a search of the electronic database MEDLINE, EMBASE, LILACS and CINAHL, without language restriction. We also performed a manual search of the references of all retrieved articles; sought unpublished papers and abstracts submitted to international conferences, searched the clinicaltrials.gov and WHO portal registries for submitted protocols of clinical trials, and contacted experts. In addition, we examined the National Institute of Clinical Excellence (NICE) fertility assessment and treatment guidelines and handsearched reference lists of relevant articles (from 1970 to May 2013). Selection criteria: All randomised trials (RCTs) on the intention to perform IVM before IVF or ICSI compared with conventional IVF or ICSI for subfertile women with PCOS. Data collection and analysis: Three review authors (CS, MK and NV) independently assessed eligibility and quality of trials. Primary outcome measure was live birth rate per randomised woman. Main results: There were no RCTs suitable for inclusion in the review, although there are currently three ongoing trials that have not yet reported results. Authors' conclusions: Though promising data on the IVM technique have been published, unfortunately there is still no evidence from RCTs upon which to base any practice recommendations regarding IVM before IVF or ICSI for women with PCOS. Meanwhile, the results of the above-mentioned ongoing trials are awaited and, of course, further evidence from good quality trials in the field is eagerly anticipated. © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd

Tension-free vaginal tape obturator versus Ajust adjustable single incision sling procedure in women with urodynamic stress urinary incontinence

Objective: To assess the efficacy and complications of inside-out transobturator tension-free vaginal tape (TVT-O) in comparison with a single incision sling procedure (Ajust) for the treatment of urodynamic stress urinary incontinence. Study design: Prospective closely matched controlled study. In total, 171 patients were included in the study: 86 women underwent the TVT-O procedure, while in other 85 cases the Ajust procedure was performed. Subjective and objective cure, improvement and failure rates, mean operative time, hospital stay and incidence of complications were assessed. Results: There was no statistically significant difference between the two groups for age, body mass index, parity, menopausal status and severity of prolapse. No major intraoperative complications occurred. There was no significant difference in the mean operative time and the duration of hospital stay between the two groups. The mean follow-up time of the study was 22.3 months (range 12-36 months). For the TVT-O group the objective cure rate was 86%, the improvement rate was 5.9% and the failure rate was 8.1%, while the subjective cure rate was 82.6%. For the Ajust group the objective cure rate was 84.7%, the improvement rate was 4.7%, 10.6% of patients showed no change in their symptoms and the subjective cure rate was 81.2%. Conclusions: The Ajust sling procedure presents success rates, at 22 months' mean follow up, comparable to the TVT-O method. Both techniques seem to be safe and effective for the treatment of urodynamic stress urinary incontinence. © 2013 Elsevier Ireland Ltd. All rights reserved

Outcome and recurrence risk of premature progesterone rise in IVF/ICSI cycles using GnRH antagonists for pituitary down-regulation

To assess the outcome and recurrence risk of premature progesterone rise (PPRR) in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles using gonadotropin-releasing hormone (GnRH) antagonists. Materials and Methods: Two hundred and two patients undergoing IVF/ICSI using GnRH antagonists for pituitary down-regulation had measurements of luteinizing hormone (LH), progesterone (P), and estradiol (E2) on specific days of the first and subsequent stimulation cycle. Results: The overall clinical pregnancy rate including the total of 280 cycles was 29.3% (82/280). The incidence of PPRR on the day of triggering for P ≥ 1.5 ng/ml its was 20.8% (42/202). The risk of PPRR ≥ 1.5 ng/ml on the triggering day of the subsequent cycle was 40% if the previous cycle P was ≥ 1.5 ng/ml, 13.3% if the previous cycle P was ≥ 1.2 ng/ml and < 1.5 ng/ml, and 10% if the previous cycle P was < 1.2 ng/ml. Conclusion: The presence of PPRR in IVF/ICSI cycles using GnRH antagonists affects negatively the pregnancy rates and poses a significant risk of recurrence in a subsequent cycle. © 2018 S.O.G. CANADA Inc. All rights reserved

Pathogenesis of endometriosis: The role of genetics, inflammation and oxidative stress

Introduction Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. Materials and Methods The etiology of this multifactorial disease is still unresolved and an increasing number of studies suggest that genetic, hormonal, environmental, immunological and oxidative factors may all play an important role in the pathogenesis of this disorder. Conclusions In this literature review, inflammatory activity, oxidative stress as well as genetic abnormalities and mutations have been studied in an effort to identify factors predisposing to endometriosis. © 2012 Springer-Verlag

Maternal hyperthyroidism after intrauterine insemination due to hypertrophic action of human chorionic gonadotropin: A case report

Purpose of investigation: To report a rare case of maternal hyperthyroidism after intrauterine insemination due to hypertrophic action of hCG. Materials and Methods: A 36-year-old woman after successful intrauterine insemination and triplet pregnancy, developed hyperthyroidism with resistance to medical treatment. Results: All signs of hyperthyroidism resolved and the results of thyroid function tests returned to normal without any medication after embryo meiosis. Conclusions: De novo maternal hyperthyroidism may develop during pregnancy as a result of pathological stimulation of the thyroid gland from the high levels of hCG hormone that can be seen in multiple pregnancies. The risk of hyperthyroidism is related to the number of fetuses. Reversibility of symptomatology can be seen after fetal reduction of multiple pregnancies

Estrogen plus progestin treatment: Effect of different progestin components on serum markers of apoptosis in healthy postmenopausal women

One hundred healthy postmenopausal women were randomly assigned to receive 17β-E2 1 mg/drospirenone 2 mg or 17β-E2 1 mg/norethisterone acetate 0.5 mg for 6 months, and circulating soluble Fas, soluble Fas ligand, and cytochrome c were measured at baseline and at 6 months in 87 women who completed the study. Although cytochrome c levels were undetectable, circulating soluble Fas/soluble Fas ligand ratio decreased in both groups, suggesting a decrease in ligand-mediated apoptosis. Copyright © 2010 American Society for Reproductive Medicine, Published by Elsevier Inc

Cardiotocography alone versus cardiotocography plus Doppler evaluation of the fetal middle cerebral and umbilical artery for intrapartum fetal monitoring: A Greek prospective controlled trial

Objective: The present study was designed to assess the utility of Doppler velocimetry in the setting of non-reassuring cardiotocography tracings. Methods: Two hundred fifty six women with term singleton pregnancies were enrolled in a controlled trial. Patients received either routine cardiotocograpic (CTG) monitoring, or CTG with the addition of Doppler velocimetry in cases of non-reassuring CTG tracings. The results were analyzed according to protocol. Results: In the CTGDoppler group, there was a trend toward lower risk of neonatal metabolic acidosis than in the CTG group, although the incidence was rare. The CTGDoppler group had significantly lower rates of cesarean section for fetal distress, and improved neonatal outcomes. Conclusions: We conclude that intrapartum fetal Doppler velocimetry, when combined with CTG, increases the clinicians' ability to accurately identify fetal hypoxia, and decreases the rate of Cesarean section. © 2012 Informa UK, Ltd