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Background Gonadotropins represent an important component of IVF costs. In order to reduce costs, much attention was given to the type of gonadotropins (recombinant versus urinary) and the daily dose. In this study, we decided to focus on gonadotropin wastage, a neglected aspect that may harbor a relevant source of useless economic expenditure. Materials and methods Women who performed oocytes collection following ovarian hyperstimulation with gonadotropins in two Italian IVF Centers were prospectively recruited. They were interviewed using a standardized questionnaire aimed at capturing drug wastage. Physicians of the participating units were blinded to the study. Recruited women were requested to hide their participation to their physicians. Results Three-hundred nine women were recruited. Two hundred eighty-eight (93 %; 95 %CI: 90-96 %) reported to have wasted some drug. For the whole cohort, the median [Interquartile range] IUs of drug used and drug wasted was 2,100 [1,575 - 2,850] and 825 [400 - 1,200], respectively. This corresponds to a median increase in the costs of ovarian hyperstimulation of 39 %. When data on wastage was analyzed separately for the different available drugs, a statistically significant difference emerged (p = 0.026). Reasons behind this difference could not be clearly disentangled. Conclusions IVF is associated with a considerable wastage of gonadotropins. Improving this aspect can allow to reduce the costs of the procedure.

This review explores the pathophysiology associated with anovulation which affects 30% of cases of infertility . It provides an overview of the evidence based management of different groups of anovulation including role of adjuvant therapies. Anovulation can be effectively managed with induction of ovulation , the aim of which is to restore normal physiological ovulatory function. Weight optimization is the cornerstone of management in functional hypogonadotropic hypogonadism and polycystic ovarian syndrome (PCOS). The aim is to achieve monofollicular development, minimizing the risk of ovarian hyperstimulation and multiple pregnancies. The holistic approach involves induction of ovulation along with health education regarding lifestyle modifications and need for long term hormone replacement therapy in appropriate cases.

In Korean women, a westernized lifestyle is associated with an increased risk of breast cancer. Fertility preservation has become an increasingly important issue for women with breast cancer, in accordance with substantial improvements in survival rate after cancer treatment. The methods of controlled ovarian hyperstimulation (COH) for fertility preservation in breast cancer patients have been modified to include aromatase inhibitors to reduce the potential harm associated with increased estradiol levels. Random-start COH and dual ovarian stimulation are feasible options to reduce the total duration of fertility preservation treatment and to efficiently collect oocytes or embryos. Using a gonadotropin-releasing hormone agonist as a trigger may improve cycle outcomes in breast cancer patients undergoing COH for fertility preservation. In young breast cancer patients with BRCA mutations, especially BRCA1 mutations, the possibility of diminished ovarian reserve may be considered, although further studies are necessary. Herein, we review the current literature on the practical issues surrounding COH for fertility preservation in women with breast cancer.

Objective: Ovarian hyperstimulation syndrome (OHSS) is a well-known phenomenon in reproductive medicine, complicating assisted reproduction for 1%–10% of women. When the same phenomenon occurs with...

The authors present an atypical case of complete hydatidiform mole.Woman, 27years old, who went to the emergency room for abdominal pain associated with 10 week pregnancy. Echography revealed the presence of hyper stimulated ovaries leading to diagnosisof spontaneous Ovarian Hyperstimulation Syndrome (OHSS). Blood sample revealed high levels of hCG (300000 U/L), which associated with the ultrasound finding of placenta with vesicular areas, led to the suspicion of CHM,Dilatation and evacuation (D&E) were performed at 11 weeks of gestation. The signs and symptoms of OHSS were the severest on day 4 after D&E, when hCGhad already decreased We must be aware that OHSS can occur duringmolar pregnancy, and can be exacerbated after D&E.

Adjuvant endocrine therapy is an integral component of care for hormone-dependent breast cancer. Tamoxifen is a potent inducer of ovarian function and consequent hyperestrogenism in premenopausal women. However, the incidence rate and risk factors associated this phenomenon remain unclear.Data of patients younger than 60 years who received adjuvant tamoxifen therapy for hormone-dependent breast cancer (stages 0-III) and who underwent regular follow-up of laboratory results for follicle-stimulating hormone and estradiol levels were retrospectively analyzed. Univariate and multivariate analyses were performed to identify clinicopathologic factors related to ovarian hyperstimulation.Among 205 patients, 19 (9.3%) showed high values of serum estradiol during tamoxifen therapy. The mean (± SD) serum concentrations of estradiol and follicle-stimulating hormone were 1047.97 ± 638.8 pg/mL and 11.5 ± 7.3 mIU/mL, respectively. A mean of 400.83 days elapsed from the start of the single administration of tamoxifen to the initial detection of a high concentration of estradiol. Univariate and multivariate analyses showed that younger age (40 years) and only endocrine therapy without chemotherapy were significantly related to a higher prevalence of ovarian hyperstimulation (P = .015, relative risk = 7.49 for age 40 years; P = .017, relative risk = 32.9 for no chemotherapy). Pathologic stages and tumor characteristics were not related to the manifestation of ovarian hyperstimulation.Young age (40 years) and endocrine treatment without chemotherapy were risk factors for the incidence of ovarian hyperstimulation during tamoxifen treatment. Close monitoring of endocrine parameters during treatment with tamoxifen especially in this patient group is essential.

We retrospectively analyzed clinical data from 45,912 in vitro fertilization/intracytoplasmic sperm injection cycles in our reproductive medical center. We compared the clinical outcomes of three different ovarian hyperstimulation protocols in poor ovarian responders (classified by the POSEIDON criteria) to determine the most effective protocol for each POSEIDON group. In POSEIDON groups 1 and 3, the early-follicular-phase long-acting GnRH-agonist long (EFLL) protocol was associated with higher pregnancy rates per transfer and higher live birth rates than the mid-luteal-phase short-acting GnRH-agonist long (MLSL) and GnRH-antagonist protocols. We also examined the relationship between advanced age and reproductive outcomes, and observed a negative correlation between age and live birth rate for each protocol (EFLL: OR = 0.890, 95% CI: 0.870 - 0.911, P < 0.001; MLSL: OR = 0.907, 95% CI: 0.885 - 0.926, P < 0.001; GnRH-antagonist: OR = 0.891, 95% CI: 0.857 - 0.926, P < 0.001). In terms of clinical outcomes, EFLL was the most effective protocol for young poor ovarian responders. However, there were no differences in the implantation rates, clinical pregnancy rates, or live birth rates among the protocols in older patients. Age is thus the most important determinant of oocyte quality, embryo ploidy, and delivery rate.

Infertility affects 1 in 7 couples. An etiological diagnosis is made to plan treatment. In a quarter no diagnosis can be established, hence a diagnosis of unexplained infertility is made. IF conception does not happen after an etiological diagnosis based treatment or unexplained infertility is diagnosed, in-vitro fertilisation (IVF) is the treatment of choice. Over last 4 decades IVF processes have evolved. There are better tests to predict ovarian response and a number of stimulations regimen to choose from. Better prediction means ovarian hyperstimulation can be predicted and minimised. Cryopreservation of gametes and embryos have become vert successful process, to the extent that policy of freeze all for all has been discussed. It is important that advances in this field are properly evaluated before being put in routine clinical practice for not only pregnancy rates but long term outcomes.

Ovarian hyperstimulation syndrome (OHSS) is a severe complication of controlled ovarian stimulation (COS). Pathogenesis of the disease is based on massive transudation of protein-rich fluid from the vascular compartment into the peritoneal, pleural and pericardial spaces, with a variable picture of clinical manifestations depending on its severity. Nowadays OHSS can easily be avoided by several prevention methods, ranging from identification of high-risk patients, choice of a correct protocol stimulation, trigger with gonadotropin-releasing hormone (GnRH) agonists or, finally, the freeze-all strategy. When OHSS occurs, it can usually be managed as outpatient care. Only if severe/critical cases are diagnosed hospitalization is necessary for appropriate rehydration, monitoring of fluid balance and eventual drainage of ascitic fluid. One of the most dangerous complications of OHSS is venous thromboembolism (VTE). Thromboprophylaxis has shown to be cost effective and widely used, while there are controversies regarding the usage of low dose aspirin (LDA) as a preventive measure.

Since the first reported birth following in vitro fertilization in 1978, further developments in assisted reproductive technology (ART) treatments have produced at least 8 million babies worldwide. Cryopreservation techniques have been central to this treatment revolution, increasing cycle efficacy by allowing the banking of supernumerary embryos for later use, as well as affording the prospective patient more time in cases of anticipated fertility decline. Additionally, these techniques have demonstrated promise in increasing the safety of ART treatments, by reducing complications such as ovarian hyperstimulation, leading to increased support for the introduction of a 'total freeze' policy involving deferred embryo transfers. Importantly, the effective cryopreservation of both spermatozoa and oocytes has permitted long-term gamete storage without degradation of quality, facilitating gamete banking for personal use or fertility treatment. Here, we will summarise the indications for applying cryopreservation methods in clinical reproductive medicine, highlighting recent technical advances and examining the evidence base that supports the continued use of cryopreservation in ART.

Study question Does laser-induced artificial blastocoel collapse result in better blastocyst cryopreservation survival and higher live birth rate (LBR) in comparison with intact counterparts? Summary answer Compared to vitrification of intact blastocysts, collapsed blastocysts resulted in higher survival and for 5% higher LBR. Neonatal outcomes were comparable in both groups. What is known already Blastocysts have long been considered a stage that is suboptimal for freezing-thawing procedures due to their high fluid content and different cell types. The development of a modified vitrification technique has enabled blastocysts to better survive cryopreservation compared to a slow freezing procedure. Many studies on the optimization of cryopreservation of blastocysts have mentioned the need for artificial collapsing of the blastocoel prior to cryopreservation, thereby reducing the risk of intracellular ice-crystals formation. However, the effectiveness of artificial collapsing on blastocyst survival rate, single vitrified-warmed blastocyst transfer (SVBT) outcome and on safety of such intervention remains to be confirmed. Study design, size, duration A retrospective matched case-control study of transfers of single blastocysts being artificially collapsed (case) or intact (control) before vitrification. A sample size of 306 cycles in both arms was needed to achieve 80% power to detect a difference between the groups of 10% with P Participants/materials, setting, methods Artificial collapsing was introduced into clinical practice gradually. In fresh IVF cycles (performed in university clinic from 2012 until 2014) with supernumerary blastocysts, half of the blastocysts were randomly selected before vitrification for laser-induced artificial collapsing. The other half was vitrified in intact form. Only the first transfers of a single vitrified-warmed blastocyst (n = 818) were included in the study. By matching, 309 pairs of collapsed (study) and intact (control) SVBTs were identified. Main results and the role of chance Both groups were comparable by their characteristics in indications, female age, type and length of ovarian hyperstimulation, insemination method in fresh cycle, protocol for warmed blastocyst transfer, blastocyst quality and day of blastocyst vitrification. Survival rates in case and control group ((309/316) 97.8% and (309/323) 95.7%; P = 0.13) were comparable, but optimal survival rates (100% survival and re-expansion after warming) was significantly higher in artificial collapse group ((247/316) 78.2% and (225/323) 69.7%; P = 0.01). Clinical pregnancy rates ((120/309) 38.8% and (110/309) 35.6%; P = 0.4), miscarriage rates ((15/120) 12.5% and (24/110) 21.8%; P = 0.06) and LBR per transfer ((100/309) 32.4% and (85/309) 27.5%; P = 0.19) or LBR per warmed blastocyst ((100/316) 31.6% and (85/323) 26.3%; P = 0.14) were not statistically different between case and control groups. Since the study was powered to detect a 10% difference, the possibility of type 2 error cannot be excluded. Perinatal outcomes were available for 175 live births. There were 10.5% (10/95) preterm births in the study group vs. 16.3% (13/80) in control group (P > 0.05). Birth weights (3,308 g (SD 592 g) vs 3,308 g (SD 738 g) and sex ratio (50.7% vs 49.2% boys) were also comparable between both groups (P > 0.05). There were no major malformations detected in the study population. Limitations, reasons for caution The research is retrospective, but the cycles from both groups were performed in the same time period. The groups were balanced according to all possible confounders. Blastocysts for vitrification were first categorized by quality groups and embryos from each category were randomized for collapsing or for remaining intact. Wider implications of the findings: No significant difference was found in live births by this sample size. Nevertheless, increasing the success by 5% with the introduction of artificial collapsing can be an important step towards optimizing of blastocyst cryopreservation. To confirm a 5% improvement in results, a sample size of > 2500 cases would be needed. Trial registration number The study has been approved by the National Ethics Committee of the Republic of Slovenia (0120–204/2016–2).

All assisted reproduction techniques are initiated with different induction or ovulation stimulation protocols; in all of them, different doses and regimens of different gonadotropin compositions are used.

This chapter examines the clinical and laboratory presentations of the ovarian hyperstimulation syndrome and describes the clinical and laboratory findings that define an emergency situation in assisted ovarian stimulation. The initial approach to emergency treatment of ovarian hyperstimulation is presented. The differential diagnosis of the syndrome is tabulated, and the importance of distinguishing between the various diagnostic possibilities and its impact on the ongoing management of the condition is emphasized. The pathophysiology of the most common causes of ovarian hyperstimulation is explored in detail.

Since 1978, in the first decades of in vitro fertilization (IVF), the use of ovarian hyperstimulation allowed for the development and transfer of multiple embryos. As IVF technology improved, the number of multiple pregnancies increased, which led to gradual reduction in the number of embryos that were transferred. Embryo freezing (vitrification) was recommended to allow subsequent transfer if the fresh cycle was unsuccessful. However, experimentation has continued to improve pregnancy outcomes. We discuss here the significance of frozen embryo transfer cycle and the impact of uterine and peripheral immunity dominated by NK cells and regulatory T cells and human chorionic gonadotropin on pregnancy outcome in this innovative mode of IVF therapy.

Asthma is a chronic reversible obstructive airway disease, which is common among children and leads to respiratory impairment. Studies showed that asthma is more common among children born after in vitro fertilization (IVF) than among spontaneously conceived children. However, it is unknown which component of the IVF procedure contributes to this putative link. Therefore, the aim of this prospective follow-up study was to differentiate the possible effect of ovarian hyperstimulation from that of the in vitro culture procedure on asthma and rhinitis in 9-year-old children conceived with IVF. The study comprised three groups of singletons: (I) conceived with ovarian hyperstimulation-IVF (COH-IVF, n = 95); (II) conceived with modified natural cycle-IVF (MNC-IVF, n = 48); and (III) naturally conceived to subfertile couples (Sub-NC, n = 68). Parents filled out the validated Dutch version of the asthma questionnaire of the International Study of Asthma and Allergies. Asthma prevalence in the groups did not differ: COH-IVF n = 8 (8%); MNC-IVF n = 0 (0%); and Sub-NC n = 4 (6%). Adjustment for confounders did not alter the results. Conclusion: Neither ovarian hyperstimulation nor the in vitro culture procedure was associated with asthma and rhinitis at 9 years. IVF children had a similar prevalence of asthma compared with children conceived naturally by subfertile couples. Trial registration: ISRCTN76355836 What is Known: • An increased risk for asthma has been observed in children born after in vitro fertilization at preschool and school age.• The association between IVF and asthma may be partly explained by parental subfertility. What is New: • IVF children do not have a higher prevalence of asthma than children of subfertile couples conceived naturally.• Ovarian hyperstimulation used in IVF is not associated with asthma in 9-year-old children of subfertile couples. Electronic supplementary material The online version of this article (10.1007/s00431-019-03436-2) contains supplementary material, which is available to authorized users.

Background: The ‘freeze-all’ practice refers to the cryopreservation of all mature oocytes or viable embryos after ovarian stimulation. The development of the vitrification technique has been crucial to make this approach a reality, since it increases the post-thaw survival rates and permits comparable implantation rates with fresh embryos. Nonetheless, as implantation probabilities are comparable to fresh embryo transfer in normo-responder patients, the freeze- all strategy has demonstrated no benefits overall. Method: Narrative review in which we give an overview of this approach, discuss recent advances in the field, as well as for whom, when and how it is recommended to emply the freeze-all technique. Results: However, there is some clinical evidence that shows its feasibility. Thus, it has been demonstrated that elevation of progesterone at the end of ovarian stimulation decreases the implantation rates after the transfer of day 6 blastocysts in fresh and some uterine pathologies; freeze-all is also the preferred option for patients undergoing pre-implantation genetic testing, since there is an improvement of the results and it allows for inclusion of all blastocysts of the cohort. In high responders, the freeze-all strategy optimizes the response whilst also minimizing the risk of ovarian hyperstimulation syndrome. Conclusion: Due to the different cases that a reproductive expert might encounter, it is essential to highlight benefits and drawbacks of this practice.

Objective This observational, clinical study was designed to assess the role of sirtuin 1 (SIRT1), sirtuin 6 (SIRT6), and resveratrol in in vitro fertilization (IVF). Methods Paired serum and follicular fluid (FF) samples were obtained from 30 consecutive patients (age: 36.43 ± 4.17 years, body mass index: 22.90 ± 2.05 kg/m2, duration of infertility: 5.10 ± 2.80 years) who received IVF treatment. SIRT1, SIRT6, and resveratrol levels were measured by enzyme-linked immunosorbent assay. Results Ovarian hyperstimulation resulted in significantly higher serum SIRT1 levels in pregnant women (8 patients) compared with non-pregnant women (22 patients). SIRT6 levels remained unchanged after ovarian hyperstimulation, but were significantly lower in pregnant women compared with non-pregnant women before and after hyperstimulation. Both SIRTs were detected in FF, but they appeared to be independent of their serum levels. After correction for confounders, FF SIRT6 levels were positively related to mature oocytes (F = 6.609), whereas serum SIRT1 and SIRT6 levels were related to clinical pregnancy (F = 10.008, F = 5.268, respectively). Conclusions Our study shows that SIRT1 and SIRT6, but not resveratrol, are involved in human reproduction and they may have a role in oocyte maturation and clinical pregnancy in IVF.

Recent rapid advances in assisted reproduction (ART) have led to global increase in usage of in vitro fertilization. This in turn has resulted in clinicians and imaging specialists encountering increase in complications associated with ART. The specialists dealing with infertility should be aware of potential complications associated with ART. Early diagnosis of these problems is based on clinician's suspicion and radiologist's awareness of these complications. Many of these conditions may be life threatening. Hence, early diagnosis and treatment of these complications can safeguard the fetal and maternal health.

Available evidence show that follicular flushing does not improve oocyte yield or clinical outcomes in the overall ART population and in selected populations such as poor responders or women undergoing natural IVF cycles. They may increase costs and prolong the procedure while providing no benefit.

Ovarian hyper stimulation syndrome (OHSS) and venous thromboembolic are known complications of ovarian stimulation therapy. Pulmonary embolism accounts for 7.9% of the episodes of thromboembolic diseases reported in OHSS. We describe a case of 33-year-old Bahraini woman who presented to the Bahrain Defense Force Hospital (Banoon Center) with a history of 13 years primary infertility, and previous unsuccessful intrauterine insemination. Through the In-vitro fertilization (IVF) treatment cycle she had Ovarian hyperstimulation which was further complicated with ovarian bleeding and pulmonary embolism.Our case addresses this rare complication and its management challenges related to the event of thromboembolic disease with anticoagulants in the presence of bleeding. Keywords: OHSS, Pulmonary embolism

Objective This study aimed to examine the effect of interactions between serotonin (5-HT), brain-derived neurotrophic factor (BDNF), and kisspeptin on the reproductive potential in women receiving in vitro fertilization (IVF). Methods Paired serum and follicular fluid (FF) samples were obtained from 30 consecutive patients receiving IVF. Primary and secondary outcome measures were the rate of chemical/clinical pregnancy and the number of mature oocytes and embryos, respectively. Serum and FF 5-HT, BDNF, kisspeptin, and platelet-activating factor (PAF) levels were measured by enzyme-linked immunosorbent assay. Results In response to ovarian hyperstimulation, serum 5-HT and kisspeptin levels significantly increased, whereas serum BDNF and PAF levels remained unchanged. These factors were detected in FF, but they were unrelated to serum levels. FF 5-HT and BDNF levels were positively correlated. Serum kisspeptin levels were negatively correlated with FF BDNF and serum and FF PAF levels. Women who were pregnant had significantly lower FF BDNF levels compared with women who were not pregnant (21.96±12.75 vs 47.63±52.90 µg/mL). Multivariate stepwise linear regression and logistic regression analyses showed that only 5-HT and kisspeptin improved IVF outcome. Conclusions This study indicates a role of serotoninergic mechanisms in success of IVF, but the contribution of interacting neuropeptides requires additional investigation.

Objective To study if the follicle-stimulating hormone receptor (FSHR) variant asparagine/serine in amino acid 680 (N680S) can predict hypersensitivity to gonadotropins in women undergoing assisted reproduction. Patients and methods In this retrospective study, 586 women undergoing their first in-vitro fertilisation treatment were enroled, and their FSHR N680S genetic variant was analysed. The main outcome measures were number of retrieved oocytes and any grade of ovarian hyperstimulation syndrome (OHSS). Experimental studies were performed on FSHR variants transfected into eukaryotic cells treated with 1–90 IU recombinant follicle-stimulating hormone. The receptors’ ability to induce a second messenger 3′,5′-cyclic AMP was measured. Results The proportion of women who developed OHSS was 6% (n=36). None of the women who developed this condition had the homozygous serine variant. The N680S polymorphism in the FSHR was associated with the condition, Ptrend (genotype)=0.004 and Pallelic (alleles)=0.04. Mean oocyte number was 11±6 in women without OHSS and 16±8 in women who developed OHSS (P=0.001), despite exposure to lower total hormonal dose in the latter group. The odds ratio for developing OHSS in carriers of the asparagine allele was 1.7 (95% confidence interval: 1.025–2.839, P=0.04). A higher receptor activity in cells expressing asparagine compared with the serine was also evident at all concentrations of recombinant follicle-stimulating hormone used (P

Is analysis of serum concentration of anti-Mullerian hormone (AMH) beginning to qualify as one of the crucial investigations in modern reproductive medicine, some 60 years after the French endocrinologist Alfred Jost suggested its existence? The number of studies on AMH reported on PubMed is increasing rapidly, and the clinical conditions for which the analy-sis is being considered vary substantially. Thus, analysis of AMH has been advo-cated for a number of diverse endocrine and clinical conditions: as a new and uni -fying test in the diagnostic procedure of polycystic ovaries and polycystic ovary syndrome (PCOS)

Ovarian hyperstimulation syndrome is a rare, but potentially life-threatening iatrogenic disorder arising from ovulation induction or ovarian hyperstimulation for assisted reproduction techniques. We report a case of a 26-year-old multiparous woman, an anonymous egg donor, who died a few hours after undergoing a procedure to donate eggs at an in vitro fertilization clinic. Her husband alleged that medical negligence had led to her death. The autopsy confirmed death due to ovarian hyperstimulation syndrome. We know of no previous descriptions of fatal ovarian hyperstimulation syndrome in an anonymous egg donor in medico-legal literature.

El síndrome de hiperestimulación ovárica es una complicación frecuente que se puede presentar en pacientes que reciben tratamientos de inducción de la ovulación; presentamos el caso de una paciente que posterior a esta terapia presenta falla renal aguda.

Article type: Case Report Thromboembolic phenomena are the serious consequences of assisted reproductive technology. We present a case of cerebral sinus vein thrombosis (CVST) following ovarian hyper stimulation syndrome (OHSS). Ten days after recovering from OHSS, the patient presented in the emergency department with thunderclap headache. Her Magnetic Resonance Venography (MRV) showed occluded left transverse sinus and left sigmoid sinus. The patient was treated with low molecular weight heparin. She made a good recovery and was independent in activities of daily living in follow up after six months. Disturbances of the coagulation system may occur in moderate OHSS and also persist even after the clinical symptoms of OHSS have resolved.

Background: To compare the pregnancy rate in infertile couples with mild to moderate oligozoospermia receiving ovarian hyperstimulation and IUI, with that of medical management with CC.Methods: A total 120 couples with males having sperm concentration between 5 to 20 million/ml, normal serum gonadotropins and testosterone, and a presumptively fertile partner were enrolled in this prospective clinical study, during the study period of 19 months, 31st January 2019 till 1st September 2020. 120 couples were divided randomly into two groups A (n=60) and B (n=60). In group A, 60 couples were subdivided equally into 3 groups, each having 20 couples. Ovarian hyperstimulation protocols with IUI were used in different subgroups in group A. A total of 216 IUI cycles done for 60 couples. While in group B, 60 males with oligozoospermia were prescribed CC treatment 25mg/day on alternate days for 3 months.Results: Out of 60 patients in group A, 24 achieved pregnancy with a cycle fecundity rate of 4% in CC+IUI, 9.87% in HMG+CC+IUI and 21.67% in HMG+IUI. 5 out of 60 patients in group B achieved pregnancy with cycle fecundity rate of 2.78%.Conclusions: These data suggest that acceptable pregnancy rates can be achieved with IUI combined with ovarian hyperstimulation in males with oligozoospermia. The role of CC treatment in males with oligozoospermia in improving the pregnancy outcome is extremely mearge. Thus, owing to the cost effectiveness and non-invasive modality, IUI is preferred prior to other more invasive and potentially costly reproductive technologies in the treatment of male factor subfertility.

The empty follicle syndrome (EFS) is defined as a failure to aspirate any oocyte (s) from the follicles after ovarian hyperstimulation in preparation for IVF/ICSI. It is a frustrating and vague syndrome; and a controversial one concerning its existence, causes and possible treatment. Recurrent EFS or the recovery of immature oocytes thereafter is a more challenging problem. Delayed injection after leaving the immature oocytes for in vitro-maturation (IVM) has been suggested to be a possible option if immature oocytes are retrieved. Here, we present a case of repeated retrieval of a few immature oocytes after a first incidence of EFS. IVM was tried twice for those immature oocytes. Unfortunately, in this case IVM was unsuccessful and the oocytes failed to mature in vitro. Assistance is required for future management of these unfortunate couples.

In vitro fertilization (IVF) is not associated with neurological abnormalities in offspring's early childhood. Yet, it is unclear whether this is also true for school age. Neither do we know the role of parental subfertility in offspring's neurological development. The present study examined neurological condition at 9 years of 57 singletons born after controlled ovarian hyperstimulation IVF (COH-IVF), 46 singletons born after modified natural cycle IVF (MNC-IVF) and 66 singletons born to subfertile parents after natural conception (Sub-NC). To assess the effect of subfertility, the groups were pooled to form a subfertile group, and compared with a prospectively followed fertile reference group (n = 282). The sensitive Minor Neurological Dysfunction (MND) examination was used, resulting in the detailed Neurological Optimality Score (NOS) and the prevalence of the clinically relevant complex MND. Neurological condition of the three subfertile groups did not differ significantly: median NOS was 53 in each subfertile group and the prevalence of complex MND in the three subfertile groups was 30%, 37% and 36%, respectively. However, the NOS was lower and the prevalence of complex MND higher in children born to subfertile couples than in children of fertile couples (adjusted mean difference [95% CI]: -4.48 [-5.53 to -3.42]) and adjusted OR [95% CI]: 5.13 [2.60-10.16], respectively). We conclude that ovarian hyperstimulation, in vitro procedures, and the combination of both were not associated with a less favourable neurological outcome of 9-year-old singletons. However, the presence of parental subfertility was associated with less favourable neurological outcome of offspring at 9 years follow up.

Our aims were to investigate the presence of pituitary glycoprotein hormones in preterm and donor milk, and to examine the effects of Holder pasteurization and refrigeration on the levels of these hormones. We measured follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone (TSH) in milk samples from mothers who delivered prematurely (n = 27) and in samples of mothers who delivered at term and donated milk to the Mother&rsquo, s Milk Bank of Iowa (n = 30). The gonadotropins and TSH were present in similar amounts within human milk produced for preterm and term infants. FSH increased 21% after refrigeration (p &lt, 0.05), while LH declined by 39% (p &lt, 0.05). Holder pasteurization decreased LH by 24% (p &lt, 0.05) and increased TSH by 17% (p &lt, 0.05). Holder pasteurization followed by refrigeration resulted in a 21% increase in FSH and a 41% decrease in LH (both p &lt, 0.05), resulting in more than a 3-fold increase in donor milk FSH:LH ratios (p &lt, 0.05 versus fresh donor milk). Despite structural similarities, the gonadotropins are differentially impacted by Holder pasteurization and refrigeration, and this results in marked alterations in the relative amount of FSH and LH that may be administered to preterm infants, potentially swinging hormonal balance towards ovarian hyperstimulation in females and hypogonadism in males.

Aim: Evidence is accumulating that motor and cognitive development are interrelated. This study investigates associations between motor development in infancy and cognitive function at 4 years of age. Method: This study is part of the Groningen prospective cohort study on the development of children born after assisted reproductive techniques such as in vitro fertilization. The study group consisted of 223 children (119 males, 104 females) born to subfertile couples (median gestational age 39.6wks, range 30-43wks). Motor behaviour was assessed with the Infant Motor Profile (IMP) at 4 months, 10 months, and 18 months. IQ was evaluated at 4 years with the Kaufman Assessment Battery for Children, Second Edition. Latent class growth modelling was used to analyse relations between IMP and IQ scores. Results: Infants with low total IMP scores had an IQ that was 8.9 points lower at 4 years than infants with typical IMP scores (95% confidence interval 3.6-14.1). Also, low scores in the domains of variation and performance were associated with a lower IQ at 4 years of age, by 6.1 points and 13.2 points respectively. Interpretation: Motor development in relatively low-risk infants is associated with cognition at 4 years of age. In particular, low motor variation and performance are associated with a lower IQ at 4 years of age. What this paper adds: Motor development in infancy is directly related to cognitive function at 4 years of age. This relationship is most pronounced for infant motor variation and performance. The size of the differences in IQ is clinically relevant.

The usefulness of various pathways inhibitors, Everolimus, an inhibitor of mammalian target of rapamycin (mTOR), Infliximab, a monoclonal antibody which blocks the tumor necrosis factor-a (TNF-a), Erlotinib, a tyrosine protein kinase inhibitor of the epidermal growth factor receptor (EGFR), Metformin, an activator of AMP-activated protein kinase enzyme (AMPK) and vascular permeability reducers were explored in an ovarian hyperstimulation syndrome (OHSS) rat model. Sixty-three female Wistar rats were randomly divided in seven groups. The control group received saline, while the OHSS group received recombinant -- follicle-stimulating hormone (rec-FSH) for four consecutive days. The other five groups received rec-FSH for 4 d and Everolimus daily, Infliximab once, Erlotinib daily, Metformin daily and Vitamin C daily, respectively. All groups received human chorionic gonadotropin (hCG) at the fifth day. The efficacy of Everolimus administration for various intervals was also explored. Significantly reduced ovarian weight was observed in the Everolimus group (rec-FSH + hCG + mTOR inhibitor) compared to the OHSS group (p < 0.001). The Everolimus group also showed the lowest progesterone (PRG) concentration (p = 0.007). The Erlotinib group (rec-FSH + hCG + EGFR inhibitor) presented with the lowest graafian follicle number, while the Everolimus group was characterized by the lowest corpus luteum number. The vascular permeability and the estradiol levels did not differ between groups. Finally, the Everolimus intra-comparison showed no difference in all measured outcomes. Studying the different pathways linked to vascular endothelial growth factor (VEGF) pathway, we conclude that targeting mTOR pathways is beneficial for reducing ovarian weight and PRG levels in an OHSS animal model.

Objective To evaluate whether the uterine environment is associated with the risk of ectopic implantation by comparing outcomes of fresh and frozen-thawed embryo transfers. Design Retrospective historical cohort. Setting Not applicable. Patient(s) We used the Society for Assisted Reproductive Technologies (SART) database to identify pregnancies that resulted from fresh and frozen blastocyst transfers from 2008 to 2011. Intervention(s) None. Main Outcome Measure(s) We determined the proportion of ectopic (EP) versus intrauterine-only pregnancies resulting from fresh or frozen embryo transfers in autologous and donor-oocyte cycles. Generalized estimation equation regression models were used to adjust for maternal and treatment characteristics. Result(s) Among 103,070 cycles that resulted in a clinical pregnancy, 1.38% were ectopic. The odds of EP were 65% lower in women who had a frozen compared with a fresh transfer in autologous cycles. Donor-oocyte transfers had lower odds of EP compared with autologous cycles, with no difference between fresh and frozen donor transfers. Women who had both a fresh and a frozen transfer with autologous oocytes had a higher risk of EP in their fresh cycles compared with their frozen cycles. Conclusion(s) Embryo transfers in cycles without ovarian hyperstimulation, such as frozen or donor cycles, were associated with lower rates of EP compared with fresh autologous cycles, suggesting that a difference in the tubal-uterine environment contributes to abnormal implantation after IVF.

Tamoxifen is a popular medication used in the adjuvant therapy of hormone sensitive breast cancer. In this case report we describe a 39 years old woman presented with ovarian hyperstimulation on the underlying thamoxifen treatment and consecutive ovarian torsion.

Role of intrauterine insemination (IUI) in infertile couples is evaluated. Patients selected for the study belonged to two categories-Unexplained infertility(34 patients) and Male infertility (30 patients). In all the patients selected for IUI ovarian hyperstimulation was carried out with clomiphene citrate. Two techniques of sperm preparation were used - swim-up technique and mono-percoll gradient separation technique. Pregnancy rates of 15.6% per patient and 7% per cycle respectively were achieved which are comparable with other studies. Mono-percoll sperm separation technique was found more effective in treatment of Male infertility (oligo-asthenospermic semen sample).

Context: Functioning gonadotroph adenomas (FGAs) are pituitary tumors secreting biologically active gonadotropins. The published literature includes only small case series or individual case reports. This review summarizes the published data on this rare entity and, based on them, suggests guidance on the follow-up of these patients. Evidence Acquisition: A review of articles in English retrieved from the PubMed up to December 2013 was conducted. The following terms were used for the search: “functioning gonadotroph adenomas,” “FSH secreting adenomas,” “LH secreting adenomas,” “gonadotroph adenomas,” “ovarian hyperstimulation,” “macroorchidism,” “testicular enlargement,” and “precocious puberty.” Evidence Synthesis: All reported cases of FGA were assessed, and information on presenting manifestations, management approaches, and long-term outcome was reviewed. Conclusions: FGAs cause distinct manifestations and, based on the limited published literature, they are mostly macroadenomas. Their pathogenesis re...

Objective To observe the effect of electroacupuncture (EA) on egg quality of polycystic ovarian syndrome (PCOS) patients, and to explore its mechanism. Methods Two hundred patients who received in vitro fertilization-embryo transfer (IVF-ET) were divided into an EA group (102 cases) and a control group (98 cases) according to random number table. All the patients in the two groups were given Diane-35 and gonadotropin-releasing hormone agonist (GnRH-a) for ovarian hyperstimulation. Besides, EA intervention was applied to Shenshu ( BL 23), Qihai ( GV 6), Zusānl ( ST 36), Sānyīnjiāo ( SP 6), Neiguān ( PC 6) and Z gōng ( EX-CAl), etc. in the EA group. Then egg quality, final outcome of pregnancy and levels of tumor necrosis factor-a (TNF-α) were compared between the two groups. Results (1) EA intervention significantly improved high quality embryo rate of PCOS patients ( P P P Conclusion EA improves egg quality of PCOS patients and increases the clinical pregnancy rate of IVF-ET, the mechanism may be related to TNF-α levels.

Ischemic stroke is a very rare complication but classic ovarian hyperstimulation. We report the cases of three young women aged 35, 37 and 27 years. All three were victims of ischemic formed by proximal occlusion of the middle cerebral artery secondary to ovarian hyperstimulation. The first and the third had a proximal occlusion of the right middle cerebral artery occlusion and the second of the left middle cerebral artery. The last two have benefited from a patient intravenous thrombolysis. The first patient did not receive thrombolysis because it was out of time. Against by their evolution was different. The first has almost recovered its deficit, the second sequelae quite heavy after craniectomy and the third died despite her craniectomy.

Ovarian hyperstimulation is a dreaded complication of ovarian stimulation protocols in infertility and is known to complicate about 5-10% of ART cycles. Following gonadotropin therapy, OHSS (Ovarian hyperstimulation) usually develops several days after assisted ovulation or oocyte retrieval. But it is quite rare with clomiphene therapy which in general causes unifollicular development. Here we are presenting an interesting case of ovarian hyperstimulation which presented with rupture and massive hemoperitoneum resulting in hemodynamic instability. It is all the more rare because the agent used for ovarian stimulation was clomiphene citrate at its minimum dose.

We present interesting PET/CT and ultrasound findings in a 36-year-old lactating woman with stage T2 N0 M0 right breast cancer undergoing oocyte retrieval for fertility preservation. Her cancer treatment plan included neoadjuvant chemotherapy; therefore, the patient wanted to undergo an oocyte retrieval procedure for fertility preservation. She underwent a transvaginal ultrasound-guided oocyte retrieval procedure in the morning and a staging F-FDG PET/CT later the same day. At the time of PET imaging, she had been breast-feeding her 9-month-old infant with only her left breast.

OBJECTIVE: To compare the effects of different protocols of controlled ovarian hyperstimulation on thyroid function with those of the natural menstrual cycle. STUDY DESIGN: Prospective controlled study. SETTING: University Medical Center. PATIENTS: A total of 97 women without a history of endocrine disease undergoing intrauterine insemination either in a natural cycle, or with mild ovarian hyperstimulation, or in vitro fertilization (IVF). MAIN OUTCOME MEASURES: estradiol (E2), thyroxine binding globulin (TBG), free thyroxine (FT4), total thyroxine (TT4) and thyroid stimulating hormone (TSH) during the midluteal phase. RESULTS: In the IVF group midluteal E₂, TBG, and TT₄ were significantly higher; midluteal FT₄ was significantly lower (mean difference: -1.46 pmol/L; P < 0.001) and midluteal TSH was significantly higher (mean difference: 0.52 mU/L; P = 0.015). CONCLUSIONS: Ovarian hyperstimulation in IVF is associated with lower midluteal FT₄ and higher midluteal TSH levels compared to the natural cycle.