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Can a previously defined relationship between sperm capacitation and the probability of a man generating pregnancy within three cycles, prospectively predict male fertility in diverse clinical settings? A second study asked, what is the prevalence of impaired sperm fertilizing ability in men questioning their fertility (MQF), and does this relate to traditional semen analysis metrics?In the multicentric, prospective observational study, data (n = 128; six clinics) were analysed to test a published relationship between the percentage of fertilization-competent, capacitated spermatozoa (Cap-Score) and probability of generating pregnancy (PGP) within three cycles of intrauterine insemination. Logistic regression of total pregnancy outcomes (n = 252) assessed fit. In the cohort comparison, Cap-Scores of MQF (n = 2155; 22 clinics) were compared with those of 76 fertile men.New outcomes (n = 128) were rank-ordered by Cap-Score and divided into quintiles (25-26 per group); chi-squared testing revealed no difference between predicted and observed pregnancies (P = 0.809). Total outcomes (n = 252; 128 new + 124 previous) were pooled and the model recalculated, yielding an improved fit (P0.001). Applying the Akaike information criterion found that the optimal model used Cap-Score alone. Cap-Scores were performed on 2155 men (with semen analysis data available for 1948). To compare fertilizing ability, men were binned by PGP (≤19%, 20-29%, 30-39%, 40-49%, 50-59%, ≥60%). Distributions of PGP and the corresponding Cap-Scores were significantly lower in MQF versus fertile men (P0.001). Notably, 64% of MQF with normal volume, concentration and motility (757/1183) had PGP of 39% or less (Cap-Scores ≤31), versus 25% of fertile men.Sperm capacitation prospectively predicted male fertility. Impaired capacitation affects many MQF with normal semen analysis results, informing diagnosis versus idiopathic infertility.

Ectopic pregnancies are one of the few conditions which constitute a gynecologic emergency, as it may result in a life threatening complication. The incidence in the general population is approximately 2 % [1]; however a significant increase has been reported after the use of In-Vitro Fertilization (IVF), ranging from 2.1 to 8.6 % [2, 3]. An ectopic pregnancy may implant in different places throughout the female pelvis; however, tubal pregnancies are by far the most common implantation site. Ovarian localization of an ectopic gestation accounts for no more than 3 % of all ectopic pregnancies [4]. The clinical signs and symptoms of an ovarian ectopic are the same as those seen with a tubal pregnancy, and the diagnosis is usually made by pathology, due to the fact that an ovarian ectopic pregnancy is often misdiagnosed during surgery as a hemorrhagic corpus luteum. Though of little clinical use today, there are specific diagnostic criteria for an ovarian ectopic described by Spiegelberg in 1878: (1) an intact ipsilateral tube, clearly separate from the ovary; (2) a gestational sac occupying the position of the ovary; (3) a gestational sac connected to the uterus by the ovarian ligament; and (4) ovarian tissue in the wall of the gestational sac [5]. The risk of ovarian pregnancy after assisted reproductive techniques is approximately 0.3 % and is likely to increase with widespread use of these procedures [6–8]. However, given the extremely low incidence of an ovarian ectopic pregnancy, even after ovulation induction and assisted reproduction, it still remains a very rare diagnosis. Ectopic pregnancies may also be seen in the presence of another coexisting simultaneous pregnancy. The diagnosis of co-existing pregnancies may be delayed, as the patient may present without symptoms and normally rising HCG levels, and usually with an intrauterine pregnancy. There are different proposed theories to explain the increased incidence of these pregnancies after assisted reproductive technologies (ART). Those include the high proportion of patients with tubal disease, high levels of estradiol (E2) and progesterone (P), and high numbers of transferred embryos or ovulated oocytes in this population [9–11]. This case report describes the rare occurrence of a tubal pregnancy with a concurrent ipsilateral ovarian ectopic pregnancy.

Objective To compare the rate of congenital anomalies, obstetrical complications, and neonatal complications in antagonist cycles where either GnRH agonist (GnRHa) or hCG was used for final oocyte maturation. Design Retrospective cohort study. Setting University-based tertiary fertility center. Patient(s) Three hundred ninety-two women under 40 years of age who underwent controlled ovarian stimulation using a GnRH antagonist protocol and who had final oocyte maturation triggered with either a GnRHa or hCG that resulted in pregnancy and delivery after 16 weeks' gestation. Intervention(s) GnRHa versus hCG trigger of final oocyte maturation. Main Outcome Measure(s) Congenital anomaly rates, obstetrical complications, and neonatal complications. Result(s) There were no significant differences in the rate of congenital anomalies between GnRHa and hCG trigger (6.6 vs. 9.2%). There were also no differences in the maternal complications (27.6 vs. 20.8%) or neonatal complications (19.7 vs. 20.0%) between the GnRHa trigger and hCG trigger groups. Conclusion(s) GnRHa trigger does not affect the rate of congenital anomalies or obstetrical or neonatal complications and remains a viable option in the prevention of ovarian hyperstimulation syndrome.

To compare live birth rates after dual trigger of oocyte maturation with GnRH agonist (GnRHa) and low-dose hCG versus GnRHa alone in high responders with peak E(2)4,000 pg/mL at risk of ovarian hyperstimulation syndrome (OHSS).Retrospective cohort study.University-based tertiary-care fertility center.Patients40 years old with peak E(2)4,000 pg/mL at risk of OHSS who underwent IVF/intracytoplasmic sperm injection with GnRH antagonist protocol and triggered with GnRHa alone or GnRHa plus 1,000 IU hCG (dual trigger) for oocyte maturation.GnRHa alone versus dual trigger.Live birth, implantation, and clinical pregnancy rates and OHSS.The dual-trigger group had a significantly higher live birth rate (52.9% vs. 30.9%), implantation rate (41.9% vs. 22.1%), and clinical pregnancy rate (58.8% vs. 36.8%) compared with the GnRHa trigger group. One case of mild OHSS occurred in the dual-trigger group, and there were no cases of OHSS in the GnRHa trigger group.Dual trigger of oocyte maturation with GnRHa and low-dose hCG in high responders with peak E(2)4,000 pg/mL improves the probability of conception and live birth without increasing the risk of significant OHSS.

To determine the ovulation rate after ovulation induction with clomiphene citrate (CC) in women who had previously been ovulatory after a stair-step (CC-SS) ovulation induction.Retrospective cohort.University-based tertiary fertility center.61 anovulatory patients40 years of age with polycystic ovary syndrome who underwent ovulation induction with a CC-SS protocol and a subsequent CC cycle.Ovulation induction with CC.Ovulation rates and cycle characteristics.Of 61 patients who underwent a subsequent CC cycle, 15 (25%) failed to ovulate at the previously ovulatory dose. Of those 15 patients, 13 (86.7%) ovulated after an increase in dose. The total number of follicles ≥15 mm (2.8 ± 1.2 vs. 1.6 ± 0.7) and peak estradiol (E2) levels (604 ± 272 pg/mL vs. 447 ± 218 pg/mL) were statistically significantly higher in the CC-SS cycle compared with the subsequent CC cycle, respectively. The endometrial lining was statistically significantly thinner in the CC-SS than the CC cycle (7.8 ± 1.8 vs. 9.2 ± 2.7, respectively).The majority of patients who ovulate after a CC-SS protocol will ovulate after taking the previously ovulatory CC dose in a subsequent cycle. Those who do not ovulate will likely ovulate with a further increase in CC dose.

Objective To evaluate the percentage (%) of mature oocytes retrieved in patients with a previous history of >25% immature oocytes retrieved who were triggered with gonadotropin-releasing hormone agonist (GnRH-a) and human chorionic gonadotropin (hCG) to induce oocyte maturation. Design Retrospective cohort study. Setting A university-based tertiary fertility center. Patient(s) Patients with a history of >25% immature oocytes retrieved in a prior in vitro fertilization cycle who were triggered with GnRH-a and hCG 5,000 IU or 10,000 IU in a subsequent cycle from January 2008 through February 2012. Intervention(s) Dual trigger of GnRH-a and hCG 5,000 or 10,000 IU. Main outcome measure(s) Percent of mature oocytes retrieved and fertilization rate. Result(s) The proportion of mature oocytes retrieved was significantly higher with a dual trigger compared with the subject's previous cycle (75.0%, interquartile range 55.6%-80.0% vs. 38.5%, interquartile range 16.7%-55.6%). The odds of a mature oocyte retrieved for patients who received a dual trigger was 2.51 times higher after controlling for stimulation protocol, hCG dose, gonadotropin dose, and oocyte retrieval time interval (odds ratio 2.51; confidence interval 1.06-5.96). The implantation, clinical, and ongoing pregnancy rates for the dual trigger were 11.8%, 26.1%, and 17.4%, respectively. Conclusion(s) In patients with a low percentage of mature oocytes retrieved who are triggered with a combination of GnRH-a and hCG, the % of mature oocytes retrieved improved. in vitro fertilization outcomes, however, remain poor, suggesting an underlying oocyte dysfunction.