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To determine a cut-off value for beta-human chorionic gonadotropin (β-hCG) concentrations to predict dizygotic twinning after in vitro fertilization (IVF) and double embryo transfer (DET).This retrospective cohort study included 233 women who conceived after DET at IVF center, Hacettepe University Faculty of Medicine. Patients with serum P-hCG concentration 25 IU/l assayed on day 14 after oocyte retrieval were included into the study.Lower serum β-hCG concentrations were observed in non-viable pregnancy when compared to their viable counterparts. In addition, twins exhibited higher 0- hCG concentrations than singletons did. Receiver operator characteristic (ROC) curve analysis showed a significant relationship between serum βhCG concentrations and the occurrence of twin pregnancy (area under the curve = 0.85, 95% confidence interval = 0.79-0.91, p0.001). For twin pregnancy, when β-hCG ≥ 175 IU/l, sensitivity was 77.3%, specificity was 80.0%, positive predictive value (PPV) was 48.2%, and negative predictive value (NPV) was 93.8%.P-hCG175 IU/I might be used as a new cut-off value for early prediction of viable dizygotic twins following IVF-DET treatment cycles.

Summary Epigenetics has become a major field of reproductive medicine after the epigenetic regulation of gene expression was discovered. The aim of this study was to find out whether or not methylenetetrahydrofolate reductase (MTHFR) gene promoter hypermethylation in the spermatozoa of men who were offered assisted reproduction is associated with idiopathic male infertility. Sperm DNAs from 40 idiopathic infertile men with normozoospermia and 40 controls consisting of healthy fertile men were isolated. Following the modification of DNAs by sodium bisulphite, the methylation status of the MTHFR gene promoter was quantified by pyrosequencing. No significant differences were observed between the clinical characteristics of patients and controls. The percentage of MTHFR promoter methylation in infertile men with normozoospermia (11%) was significantly higher than that in the healthy control (4.3%) group (p = .01). A 9.5% of methylation level was determined via receiver operator characteristic (ROC) analysis as the cut-off value. There were 21 (53%) hypermethylated men among the infertile men and 2 (5%) in the control group (p = .0001). The intragroup analysis of the infertile group did not reveal any statistically significant differences in terms of overall clinical characteristics between hyper- and normo-methylated infertile men. Our results suggest that epigenetic silencing (hypermethylation) of MTHFR could result in an elevated risk of male infertility.

The aim of this study was to measure the mandibular cortical index (MCI), mental index (MI), panoramic mandibular index (PMI) and cortical bone thickness in the zone of the gonial angle (GT) in panoramic radiographies from a large sample of males and females and to determine how they relate to patients' age, gender and dental status.910 panoramic radiographs were obtained and grouped into age, dental status and gender. The MCI, MI, PMI and GT were analysed.Remarkable differences were observed for MCI and GT regarding gender, age groups and dental status on both sides (p 0.05). While age and dental status had an effect on the MI and PMI in females, dental status had an effect on the MI and PMI in males (p 0.05). Also, gender had an effect on the MI and PMI (p 0.05).The effects of age and tooth loss are different in females and males. In females, the harmful effects of tooth loss and age are more prominent according to the PMI and MI measurements. The effects of age and tooth loss in the GT and MCI measurements are similar, and these indices can be accepted as more reliable in studies including both genders.

A live birth after transfer of vitrified-warmed blastocyst derived from intracytoplasmic sperm injection (ICSI) with frozen-thawed sperm of a male cancer patient is described.A case report from a tertiary center for assisted reproductive technologies. The 35-year-old male patient had been diagnosed with testicular tumor nine years ago. He had unilateral orchiectomy operation after the diagnosis. Four years after the first operation, he was diagnosed with another testicular tumor in the other testis. He admitted to our center with the demand of sperm preservation before the second surgery. The sperm samples were cryopreserved and stored in liquid nitrogen until required. The patient had no chemotherapy or radiotherapy after the operations. After he completed his oncologic follow up, ICSI was decided with his frozen samples. Although the couple failed to conceive with the fresh cycle, the remaining embryos were frozen and revealed a pregnancy in the subsequent frozen-thawed cycle.A healthy female infant with a birth weight of 3,700 g was born by cesarean section at 38th weeks of the gestation.Giving detailed information about fertility-saving management in male patients is important in those who wish to bear children. However, both the patients and physicians should be cautious that preservation should be performed before surgery and/or adjuvant therapy. In this respect, assited reproductive technology (ART) and related facilities yield chance of pregnancy in such population.

To determine whether embryos having all top qualified both on Day 3 and Day 5 have higher pregnancy rates than the oth- ers.The study included 143 consecutive cycles were recruited in which Day 5 embryo transfer was available. Cleavage stage embryos were graded according to 1 to 4 scoring system, based on fragmentation, cell symmetry, and blastomere num- ber. Among cleavage stage embryos, Grade 1 and Grade 2a/2b were further stratified as 'top quality' embryos to be transferred, others were defined as control group. Blastocyst stage embryos were graded from 1 to 6 according to intracellular mass (ICM) and trophec- toderm (TE). Day 5 fresh embryo transfer was performed in all cases using soft catheter. Positive pregnancy test was accepted when serum beta-human chorionic gonadotrophin (1-hCG) exceeded 20 mIU/ml.On the cleavage stage, top quality embryo was available in 47 of 143(32.9%) cases. Of the 47 embryos, the number of cases reaching any Grade 4, 3 quality, and early blastocyst on Day 5 were 22 (46.8%), 15 (31.9%), and 10 (21.3%). The respective figures on the control group (n = 96) were 33 (34.4%), 37 (38.5%), and 26 (27.1%) (p0.05). The pregnancy rates were also similar.All top qualified embryos both on Day 3 and 5 did not reveal higher pregnancy rate than the others.

To evaluate agreement of conventional sperm analysis with computer-aided semen analysis (CASA) regarding concentration, motility, and morphology using samples from infertile men.In this study a total of 195 male partners of couples who underwent evaluation of infertility were included. All semen samples were examined by conventional method and CASA in terms of morphology, motility, and concentration. Pearson correlation analysis and the Bland-Altman method were used to assess correlation and agreement between conventional semen analysis and CASA measurements.When the two methods were compared in terms of concentration, motility, and morphology, there was a statistically significant correlation in all variables. The best correlation was obtained for sperm concentration. However, there was a poor correlation for sperm morphology between conventional method and CASA. Sperm concentration and morphology obtained by CASA were 14% and 87% lower, respectively; motility was 21% higher than the conventional method.Although CASA systems are objective and rapid, they should be evaluated in terms of cost-effectiveness, however they may be useful in over-loaded assisted reproductive technique (ART) clinics.

Aim: The aim of this study was to evaluate the sole effect of sperm concentration on fertilization, embryo quality and pregnancy rates in patients undergoing ICSI cycles. Materials and Methods: 560 ICSI cycles performed for male factor infertility were divided into four groups according to sperm concentration retrospectively. Group 1 consisted of 86 couples whose sperm concentration was less than 1 × 106, group 2 consisted of 169 couples whose sperm concentration ranged between 1 × 106 and 5 × 106, group 3 consisted of 95 couples whose sperm concentration ranged between 5 × 106 and 10 × 10 6 and group 4 consisted of 210 couples whose sperm concentration ranged between 10 × 106 and 20 × 106. Results: Fertilization rate was significantly lower in the first three groups compared to the last group (p < 0.05). The first three groups were comparable with each other. There were no differences according to ovarian response to stimulation, embryo quality and clinical pregnancy rates between the four groups. Conclusion: Lower sperm concentration has detrimental effects on the outcomes of ICSI cycles. This situation is more evident in men with severe and extremely severe oligozoospermia.

Some complications of hysterocopy have been reported with increasing practice of the procedure both for diagnostic and operative procedures. However, complications associated with office hysteroscopy (HS) have not been well documented. A 35-year-old woman was accepted at our center for a second IVF cycle. She had had a history of primary infertility for nine years and no presumptive factors as a cause of infertility had been documented. Office hysteroscopy revealed a regular endocervix, endometrial cavity and bilateral internal tubal ostia. The patient was evaluated by pelvic examination (without any evidence of pelvic inflammatory disease) and transvaginal ultrasonograhy one month after the office HS for routine evaluation before the IVF cycle. There was an image compatible with left hydrosalpinx (6 mm in diameter) in her ultrasonographic examination that had not been detected before by the same physician using the same ultrasound equipment. Following an informative consultation with the patient, laparoscopy was performed and left hydrosalpinx was diagnosed. Salpingectomy was then carried out. The diagnosis of hydrosalpinx was confirmed by histological examination. To the best of our knowledge this is the first report of hydrosalpinx possibly caused by an office HS procedure.

A fetal sublingual cystic lesion was diagnosed by routine prenatal ultrasonography at 21 weeks of gestation and followed up until term in a tertiary care center. Fetal growth was normal as was the amniotic fluid volume. Ex utero intrapartum treatment was performed and the cyst was aspirated to allow breathing and swallowing during planned Cesarean section. The cyst was totally excised when the newborn was 27 days of age and histological examination revealed a mucous cyst of the mouth floor.

The rate of ovarian tumour diagnosis in reproductive age woman has increased parallel to the improvements in diagnostic methods and regular gynaecological visits. Because of this organ saving surgical procedures for the preservation of reproductive and endocrine functions have gained more interest. Conservative surgical approaches for ovarian tumours after surgical staging include cystectomy, unilateral salpingo-oophorectomy and unilateral salpingo-oophorectomy plus contralateral cystectomy. Ovarian tumours diagnosed in young ages tend to be low-stage low-grade malignancies. This not only enables but also necessitates preserving the fertility of women who have not completed their family. In invasive ovarian cancer, fertility saving surgery is confined to early-stage and low-grade disease. But, it also had been reported in advanced stages (up to Stage IIIc). Candidates for those procedures were selected according to the FIGO stage, grade, ploidy state, histological subtypes and patients' desire. Adjuvant chemotherapy is necessary for high-risk patients. The rate of recurrence following conservative and radical surgical procedures in low-stage and low-grade tumours are 9% and 11.6%, respectively; and disease-free and overall survival rates do not differ significantly. Prognosis of borderline ovarian tumours is excellent. Five and 20-year survival rates are 95% and 80%, respectively. Management of borderline tumours has evolved significantly in the last few decades. In contrast to invasive ovarian cancer, borderline tumours can be operated on conservatively at all stages. Chemotherapy is rarely prescribed even in advanced stages. Eighty percent of malignant germ cell tumours are diagnosed less than 30 years of age, and 70-75% of patients have Stage I disease. Conservative surgery is generally used in malignant germ cell tumours even in advanced stages. The relation between ovulation induction and tumour recurrence is not consistent in the literature. Spontaneous pregnancy rates following fertility saving surgery has been reported as 60-88%. Because of this over-treatment of these patients for fertility should be avoided. Briefly, fertility saving surgery can be performed safely in germ cell, borderline and early stage epithelial ovarian tumours in selected cases. Any increment in the rate of tumour recurrence following ovulation induction has not yet been demonstrated. Menstrual irregularities caused by chemotherapy are transient. The congenital malformation rate of ovarian cancer patients is slightly higher than that of the normal population, but no significant difference has been observed between patients who received or did not receive chemotherapy.