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Objective: To find out whether a single-administered GnRH agonist improves the live birth rate in real-life patients undergoing intrauterine insemination (IUI) cycles. Study Design: A prospective, randomized controlled trial in a public single tertiary center in Tampere University Hospital, Finland. Altogether 251 IUI cycles in 163 patients were randomized to triptorelin and a control group between January 2017 and April 2019. In the triptorelin group, the participants had a single administration of a subcutaneous GnRH agonist triptorelin 0.1 mg at the time of implantation. In the control group, there was no luteal phase support. The primary outcome measure was the live birth rate (LBR). The secondary outcome measures were clinical pregnancy rate (CPR) and miscarriage rate. Results: Overall, the live birth rate was lower in the triptorelin group compared to the control group (7.9 vs. 12.1%; p =.297). The clinical pregnancy rates were 12.6 and 13.7%, respectively. There were 2.4% miscarriages in the triptorelin group and no miscarriages in the control group. Ovarian stimulation with letrozole was associated with lower LBR among the triptorelin group, in comparison to the control group (0 vs. 14.7%, p =.020). In contrast, when gonadotrophin was added to the letrozole, LBR was almost doubled compared to the control group (15.9 vs. 8.3%, p =.341). Conclusion: A single administration of GnRH agonist in the luteal phase does not improve LBR in IUI cycles. acceptedVersion

Background: Depression, sleep disturbances, and cognitive difficulties impair the quality of life in people with multiple sclerosis (MS). Similar symptoms are also frequent during the menopausal transition. In clinical practice, it is important to consider the multifactorial causes of these overlapping symptoms and the potential benefits of menopausal hormone therapy (MHT). The objective of this study was to evaluate vasomotor symptoms (VMS), mood, sleep, and cognition of menopausal women with and without MS at baseline and during one year of MHT. Methods: In this prospective baseline-controlled study, peri- and early postmenopausal participants with (n=14) and without (n=13) MS received MHT containing 1 or 2 mg of estradiol and cyclical 10 mg dydrogesterone for one year. VMS frequency, depressive symptoms (measured by Beck Depression Inventory), insomnia severity (Insomnia Severity Index), and cognitive performance (Paced Auditory Serial Addition Test; PASAT, Symbol Digit Modalities Test; SDMT) were evaluated at baseline and at 3 and 12 months of treatment. Differences in the outcome measures between groups at baseline were assessed using the Mann-Whitney U test. Changes during follow-up compared to baseline within groups were evaluated by Wilcoxon Signed Ranks Test. P < 0.05 was considered for statistical significance. MS activity was monitored by clinical assessment and brain MRI at baseline and at 12 months. Results: Depressive symptoms were more common in MS group, while vasomotor and insomnia symptoms were equally common. During follow-up with MHT, VMS frequency decreased in both groups. Depressive symptoms decreased at 3 months (p = 0.031 with MS; p = 0.024 without MS) and the reduction was sustained at 12 months (p = 0.017; p = 0.042, respectively). Alleviation in insomnia symptoms was seen in participants without MS at 3 months (p = 0.029) and in those participants with MS suffering insomnia at baseline (p = 0.016 at 3 months; p = 0.047 at 12 months). Both groups improved their performance in PASAT, but no significant change was observed in SDMT. MS activity at baseline was mainly stable, and no increase in activity was detected during MHT. Conclusion: Improvements in vasomotor, depressive, and insomnia symptoms observed during one year of MHT are encouraging and suggest that larger placebo-controlled studies of MHT in women with MS are warranted. Cognitive implications were inconclusive because the findings in PASAT likely result from practice effect. MHT did not show any adverse effect on MS activity and increasing safety data will hopefully facilitate patient recruitment for future studies. publishedVersion

Simple Summary Cryopreservation of ovarian tissue is a promising technique for fertility preservation in cancer patients at increased risk for subfertility. The International Guideline Harmonization Group recommends ovarian tissue cryopreservation for children and young adults before therapy with cumulative doses of alkylating agent at or above 6000-8000 mg/m(2). A therapy that poses a high risk of subfertility is rarely the first-line therapy and many of the patients have already undergone several regimens of chemotherapy. The aim of our study was to assess the effects of chemotherapy exposures on the quality of cryopreserved ovarian tissue. We confirmed the harmful effects of alkylating agents on xenografted ovarian tissue and suggest that cumulative doses which are not regarded as an indication for fertility preservation in children and young adult may decrease the quality of cryopreserved follicles. Purpose and methods: To elucidate whether previous cancer treatment affects graft recovery and follicle numbers, morphology, and development in grafts, cryopreserved ovarian biopsies obtained from 18 cancer patients aged 1-24 years with and without exposure to chemotherapy were xenografted as 1 mm(3) fragments to immunodeficient mice for 22 weeks with exogenous stimulation. Results: Graft recovery showed no association with chemotherapy exposure, pubertal stage, or leukemia contamination. Total follicle number per recovered graft varied between 0 and 1031 in the chemotherapy-exposed and between 0 and 502 in the non-chemotherapy-exposed group. Atretic follicles formed the largest proportion of the follicle pool in chemotherapy-exposed grafts. Increased atresia correlated with exposure to alkylating agents (mean +/- SD 8866.2 +/- 9316.3 mg/m(2)) but not with anthracyclines, pubertal stage, or leukemia contamination. Conclusion: The observation confirms the harmful effects of alkylating agents on ovarian tissue. Therapy at the median cumulative dose of 8866 mg/m(2) leads to the decreased quality of cryopreserved ovarian follicles in children and young adults.

Objective To assess the effect of an additional single mid-luteal dose of gonadotropin-releasing hormone agonist (GnRHa) on pregnancy and perinatal outcomes in hormonally substituted frozen embryo transfer (FET) cycles. Study design A prospective interventional pilot study. Women scheduled for FET were randomly selected to receive standard hormonal replacement therapy (HRT) for endometrial preparation or HRT with a single additional subcutaneous dose of 0.1 mg triptorelin at the time of implantation. If FET was not followed by a pregnancy, women with surplus embryos were scheduled for a single second attempt in a crossover setting. Altogether, 144 FET cycles were analyzed. The carryover effect was tested using a logistic regression model. Logistic regression analysis for binary variables was applied with generalized estimation equation extension to account for dependence among repeated treatments. Results The live birth rate (LBR) was 9.8 percentage points higher and the miscarriage rate 14.7 percentage points lower in the intervention group (n = 72) than in the control group (n = 72), but the differences did not reach statistical significance. Implantation and clinical pregnancy rates were comparable between the groups. No congenital malformations or differences in the median birth weight of newborns were detected. Conclusions Observable but statistically insignificant difference in LBR and miscarriage rate favoring luteal phase GnRHa support was detected. Further, no malformations or effect on fetal growth were observed. Larger studies are needed to confirm the results of this pilot study.

Objective was to evaluate serum anti-Mullerian hormone (AMH) levels in polycystic ovary syndrome (PCOS) and in its different phenotypes in relation to clinical, endocrine and metabolic parameters using a new automated VIDAS((R)) method and to compare it with the Gen II method. Study design was multi-center study including 319 PCOS women and 109 healthy controls. Serum AMH levels measured using VIDAS((R)) were significantly higher in PCOS women than controls (p

Study question Does extended embryo culture have a different effect on the birthweight of girls and boys? Summary answer The mean birthweight of boys born after fresh and frozen-thawed blastocyst transfer was increased compared with those born after cleavage stage embryo transfer. This effect was not detected among girls. What is known already Previous studies indicate that newborns from frozen-thawed cleavage stage embryos may present with a higher weight than newborns from fresh embryo transfers. With regard to fresh embryos, newborns after a blastocyst transfer have been reported as having higher birthweights than newborns from cleavage stage embryos. Study design, size, duration Retrospective multicentre case-control cohort study. All IVF/ICSI treatments were performed in the time-period from January 2008 to March 2014. Participants/materials, setting, methods Birthweight of singletons born at full-term (≥37 weeks), after fresh or frozen blastocyst embryo transfers (n = 277), were compared with weights of children born after fresh or frozen cleavage stage embryo transfers (Day 2-3) (n = 277). The cases and controls were matched by delivery week, and by gender. Data of IVF/ICSI treatments, and the treatments' outcomes were collected and analysed. Main results and the role of chance The birthweight after a fresh blastocyst transfer was significantly higher (mean 3530.6 g) than that after a transfer of cleavage stage embryos (mean 3418.8 g; weight difference 111.8 g, P = 0.047). The weights of newborns after frozen-thawed blastocyst transfers (mean 3647.5 g) and the frozen-thawed cleavage stage embryo transfers (mean 3650.9 g), were similar (weight difference 3.4 g, P = 0.95). The boys born after transfer of frozen-thawed blastocysts had a significantly higher birthweight (mean 3767.9 g) than girls (3525.2 g; weight difference 242.7 g, P = 0.002), whereas the difference of birthweights between genders was only 13.5 g in cleavage stage (P = 0.863). The same effect was seen after fresh blastocyst transfers (weight difference 211.5 g, P = 0.011), but not after fresh Day 2-3 embryo transfers (weight difference 53.6 g, P = 0.478). Limitations, reasons for caution The study material was large enough to detect differences between birthweights as a whole, but a larger study group would confirm these new findings. To avoid selection bias, the next possible control candidate, fulfilling the selection criteria, was included for matching cases and controls. We have matched the cases and controls by gender and gestational week at birth, with an aim to reduce their impact as confounding factors. Wider implications of the findings Our findings of a similar weight at birth of newborns after frozen-thawed blastocysts and frozen-thawed cleavage stage embryos, when matching for age and duration of pregnancy, are novel. The gender of the newborn has an impact on the birthweight, and the extended embryo culture increases the weight difference between the genders, which is a new finding as well. Study funding/competing interests The study was funded by the Fertility Society of Finland.

In many clinics, good-quality embryos are selected for embryo transfer and cryopreservation at the cleavage stage, and poor-quality embryos are discarded. The aim of this retrospective study was to examine how many repeated IVF cycles could be avoided by culturing the cleavage stage poor-quality embryos to blastocyst stage and transferring them after vitrification and warming (604 IVF and intracytoplasmic sperm injection [IVF-ICSI] cycles were included). Poor-quality cleavage stage embryos not eligible for transfer or cryopreservation were cultured until day 5 or 6, and those developing to the blastocyst stage were vitrified. The rate of vitrified blastocysts and clinical pregnancy and delivery rate of the warmed blastocysts was evaluated. The effect of the extended culture on the cumulative delivery rate, and the number of avoided new treatment cycles was calculated. The surplus blastocysts resulted in clinical pregnancy, spontaneous abortion and delivery rates of 24.6%, 27.3% and 17.2% respectively. The use of surplus blastocysts raised cumulative delivery rate from 43% to 47% and 53 repeated new cycles were avoided. This study shows that the cumulative delivery rate can be increased, and repeated IVF-ICSI treatments avoided by using blastocysts developing from poor-quality cleavage stage embryos, which otherwise would have been discarded.

In Finland, the proportion of children born as a result of in vitro fertilization treatments is annually approximately 3.3%, and the percentage proportion of the population is growing. Their general somatic health status and cognitive development do not differ from spontaneously fertilized children. In vitro fertilization treatments are, however, associated with a slightly elevated risk of preterm delivery, low birth weight and structural abnormalities. The risk of childhood cancer does not appear to be increased in IVF children. The in vitro fertilization process affects the embryonic epigenome, which organizes itself during early embryonic development. These changes may influence the phenotype and health profile of the unborn child. The effect of in vitro fertilization treatments on an individual's long-term health is poorly understood, requiring prospective follow-up studies with sufficiently large datasets. In vitro fertilization treatments are the most effective way to treat infertility, and the treatments are generally safe both for the future mother and the baby being born.

Background: 2-3 and Day 5 fresh and frozen-thawed embryos are most frequently used in ART, while the results of Day 4 embryo transfers are seldom reported in the literature. However, the use of Day 4 embryos in clinical practice increases flexibility when choosing the embryo transfer day, and enables avoiding embryo transfers on weekends. Methods and findings: We conducted a retrospective cohort study (1.1.2009-31.12.2014) comparing the clinical outcomes of fresh Day 3 (n=1371), Day 4 (n=360) and Day 5 (n=326) and vitrified-warmed Day 3 (n=635), Day 4 (n=175) and Day 5 (n=654) embryos. The live birth rates of fresh Day 3, Day 4 and Day 5 embryo transfers were 26.5%, 31.4% and 24.5%, respectively (p=0.026). The miscarriage rates were 16.6%, 11.7% and 23.0%, respectively (p=0.017). The live birth rates of Day 3, Day 4 and Day 5 vitrified-warmed embryo transfers were 22.0%, 30.9% and 22.6%, respectively (p=0.024). The miscarriage rates were 21.6%, 15.9% and 27.8%, respectively (p=0.049). Conclusions: The results of the present study show that Day 4 embryo transfers produce good clinical outcomes and can be considered for wider utilization at IVF clinics.

The aim of this study was to study the effect of the embryo freezing method on the birth weight of newborns from frozen embryo transfer (FET) cycles, and the pregnancy results of cleavage stage embryos cryopreserved by slow freezing or vitrification.This is a retrospective cohort study undertaken in a University Hospital IVF unit using concurrently both the slow-freezing and the vitrification techniques. All frozen-thawed and vitrified-warmed day 2 and day 3 embryo transfers during the time period from 1 April 2009 to 31 November 2013 were included in the study.There was no statistically significant weight difference between newborns from vitrified or slow-frozen embryos (3588 vs 3670 g). A higher post-thaw viability rate was achieved after cryopreservation by the vitrification technique compared to the slow-freezing protocol (83.4 vs 61.4%). The miscarriage rate was lower in the vitrification group (15.7 vs 29.0%). The live birth rates were similar (19.5 vs 19.1%) in the slow-freezing and vitrification groups, respectively. Among vitrified embryos, 7.4 embryos needed to be thawed to produce one delivery; in the slow-freezing group, that number was 11.9.The freezing method has no impact on the weight of the newborn. With lower post-thaw survival rates and higher miscarriage rates, the slow-freezing cryopreservation protocol is inferior to the vitrification technique.

Introduction. The aim of this study is to report the current status of ovarian tissue cryopreservation among alternatives for fertility preservation in the Nordic countries. Material and methods. A questionnaire was sent to 14 Nordic academic reproductive centers with established fertility preservation programs. It covered fertility preservation cases performed up to December 2014, standard procedures for ovarian tissue cryopreservation and oocyte cryopreservation and reproductive outcomes following ovarian tissue transplantation. Results. Among the Nordic countries, Denmark and Norway practice ovarian tissue cryopreservation as a clinical treatment (822 and 164 cases, respectively) and their programs are centralized. In Sweden (457 cases), ovarian tissue cryopreservation is practiced at five of six centers and in Finland at all five centers (145 cases). Nearly all considered ovarian tissue cryopreservation to be experimental. In Iceland, embryo cryopreservation is the only option for fertility preservation. Most centers use slow-freezing methods for ovarian tissue cryopreservation. Most patients selected for ovarian tissue cryopreservation were newly diagnosed with cancer and the tissue was predominantly retrieved laparoscopically by unilateral oophorectomy. Only minor complications were reported. In total, 46 women have undergone ovarian tissue transplantation aiming at recovering fertility, 17 healthy children have been born and several additional pregnancies are currently ongoing. Whenever patients clinical condition is permissive, oocyte cryopreservation after hormonal stimulation is preferred for fertility preservation. Between 2012 and 2014, a smaller proportion of females have undergone fertility preservation in the Nordic centers, in comparison to males (1: 3). Conclusions. Overall, ovarian tissue cryopreservation was reported to be safe. Slow freezing methods are still preferred. Promising results of recovery of fertility have been reported in Nordic countries that have initiated ovarian tissue transplantation procedures. Funding Agencies|Swedish Research Council; Stockholm County Council

Objective To compare the prognostic significance of tubal patency investigation by means of laparoscopy, hysterosalpingo-contrast sonography (HyCoSy) with air and saline as a contrast medium, and hysterosalpingography (HSG) in relation to the outcome of intrauterine insemination (IUI) treatment. Study design A retrospective study of 559 consecutive women attending the university hospital infertility clinic for infertility treatment in 1996–2003. Tubal patency was evaluated by laparoscopy in 261 women, by HyCoSy in 217 and by HSG in 81 women before insemination treatment. Altogether, 1240 insemination cycles were evaluated and the results were compared in the three study groups. Results The clinical pregnancy rates per cycle were 14%, 18% and 18% in the laparoscopic, HyCoSy and HSG groups, with no statistically significant difference between the groups. The cumulative pregnancy rates (mean 2.3 cycles) were 30%, 41% and 38%, respectively, with a significant difference between the study groups. In cases of unilateral patency, cumulative pregnancy rates after two cycles were 18% (laparoscopy), 29% (HyCoSy) and 29% (HSG). The numbers of tubal pregnancies were similar in the subgroups. Conclusions Hysterosalpingo-contrast sonography with air and saline as a contrast medium is a very cost-effective tubal investigation method as regards selection of subjects for insemination.

The primary investigations and starting the hormonal treatment of transsexual persons takes place in Helsinki and Tampere University hospitals as part of the real life period. The hormones used are estrogen and anti-androgen for MtoF and testosterone for FtoM persons. The medication suppresses the endogenous sex-hormone production and brings about the desired features of the other sex. While the recommended doses result in physiological hormone levels, higher doses do not hasten or increase the desired changes and are a health risk. After the transition period, the follow up is referred to the person's home district. The physical and psychological status and laboratory values are evaluated at the yearly follow-up doctor visits. Although the hormone doses are lowered and percutaneous administration route is favored upon aging, stopping the medication is not recommended.

Auto-transplant of cryopreserved ovarian tissue in leukemia patients carries a risk to reintroduce malignant cells. Maturation of ovarian follicles in vitro is a promising strategy to overcome the leukemic cell contamination. The follicle development and survival in 14 cryopreserved ovarian tissues with leukemia-specific PCR marker was evaluated after 7 or 14 days culture. Minimal residual disease (MRD) quantification was assessed by real-time quantitative PCR in order to identify the MRD positive (n = 6) and negative (n = 8) samples and to monitor levels of MRD before and after culture. The morphology of ovarian follicles were studied by light microscopy. After culture, no statistical significant differences were detected in follicle densities between MRD positive- and negative samples. Ovarian MRD either decreased below undetectable or fluctuated near the baseline level after 7 and 14 days in culture. This study provides quantitative in vitro evidence that leukemia contamination does not affect the follicle survival in cryopreserved ovarian tissue.

BACKGROUND: Poor ovarian and endometrial responses to gonadotrophin stimulation in assisted reproduction techniques lead to decreased pregnancy rates. The aim of the present study was to test the hypothesis that low-dose aspirin started prior to controlled ovarian stimulation improves ovarian responsiveness, pregnancy rate (PR) and pregnancy outcome. METHODS: A total of 374 women who were to undergo IVF/ICSI were randomized to receive 100 mg of aspirin (n = 186) or placebo (n = 188) daily. Treatment was started on the first day of controlled ovarian stimulation. It was continued until menstruation or a negative pregnancy test. Pregnant women continued the medication until delivery. The main outcome measures were the number of oocytes, number and quality of embryos, the clinical PR and pregnancy outcome. RESULTS: The mean (± SD) number of oocytes (12.0 ± 7.0 versus 12.7 ± 7.2), the total mean number of embryos (5.82 ± 4.35 versus 5.99 ± 4.66), the mean number of top quality embryos (0.99 ± 1.39 versus 1.18 ± 1.51) and the number of embryos transferred (1.64 ± 0.64 versus 1.63 ± 0.71) did not differ in the aspirin and placebo groups. Between the aspirin and placebo group, there was no statistically significant difference in clinical PR per embryo transfer (25.3%, n = 44 out of 174 versus 27.4%, n = 48 out of 175) or clinical PR per cycle initiated (23.7% versus 25.5%). Birth rate per embryo transfer did not differ significantly between the aspirin (18.4%) and placebo (21.1%) groups. The incidence of poor responders [12 (6.5%) versus 13 (6.9%)] was similar in both groups. CONCLUSIONS: The present results indicate that low-dose aspirin treatment does not have any beneficial effect on ovarian responsiveness, PR and pregnancy outcome in unselected women undergoing IVF/ICSI.

Objective. The objective of the study was to establish whether operative treatment of recurrent ovarian endometriosis improves the prognosis of in vitro fertilization. Methods and material. A retrospective analysis of one hundred endometriosis patients admitted to Tampere University Hospital for IVF treatment. Forty-five patients had an ovarian endometrioma during IVF treatment, 36 of the cases being recurrences after a previous operation. Fifty-five patients had ovarian endometriomas operated without recurrence. The patient groups with or without endometriosis did not differ in age, duration of infertility, sperm parameters, amount of gonadotropins required per oocyte and number of retrieved oocytes. Results. The patients with ovarian endometriosis had more embryos (mean 3.9) than women without endometriomas (mean 2.8) (p

Bone marrow remission status predicts leukemia contamination in ovarian biopsies collected for fertility preservation

The role of metformin in the treatment of infertility in women with polycystic ovary syndrome (PCOS) is still controversial. OBJECTIVE AND OUTCOMES: We investigated whether metformin decreases the early miscarriage rate and improves the pregnancy rates (PR) and live-birth rates (LBR) in PCOS.This was a multicenter, randomized (1:1), double-blind, placebo-controlled study. Three hundred twenty women with PCOS and anovulatory infertility were randomized to metformin (n = 160, Diformin; obese women, 1000 mg two times daily; nonobese subjects, 500 mg + 1000 mg daily) or identical doses of placebo (n = 160). After 3 months' treatment, another appropriate infertility treatment was combined if necessary. If pregnancy occurred, metformin/placebo was continued up to the 12th week.Miscarriage rates were low and similar in the two groups (metformin 15.2% vs. placebo 17.9%, P = 0.8). Intent-to-treat analysis showed that metformin significantly improved PR and LBR (vs. placebo) in the whole study population (PR: 53.6 vs. 40.4%, P = 0.006; LBR: 41.9 vs. 28.8%, P = 0.014) and PR in obese women (49.0 vs. 31.4%, P = 0.04), and there was a similar trend in nonobese (PR: 58.6 vs. 47.6%, P = 0.09; LBR: 46.7 vs. 34.5%, P = 0.09) and in obese women with regard to LBR (35.7 vs. 21.9%, P = 0.07). Cox regression analysis showed that metformin plus standard infertility treatment increased the chance of pregnancy 1.6 times (hazard rate 1.6, 95% confidence interval 1.13-2.27).Obese women especially seem to benefit from 3 months' pretreatment with metformin and its combination thereafter with routine ovulation induction in anovulatory infertility.

Radiation therapy and cytotoxic agents, especially alkylating agents targeted to the area of reproductive organs and testicles, are toxic to gametes. The treatments reduce the number of ovarian follicles. Getting pregnant is recommended as soon as possible (once the patient is considered cured from malignancy). In men, cryopreservation of semen should be remembered before cytotoxic treatments. Conservative surgery of early stage cancers of reproductive organs, GnRH agonist drug therapy, in vitro fertilization, and cryopreservation of embryos are means of maintaining fertility.

Ten women with tubo-ovarian infectious complex caused by pelvic inflammatory disease were investigated with vaginal Doppler sonography during the acute and healing phase of the infection. Doppler velocity waveforms were quantitated by the resistance index (RI) and pulsatility index (PI). A low resistance blood flow was found at the margin of the infectious complex. An RI' value < 0.5 was detected in 6 patients in the acute or subacute phase of infection. The severity of the infection as determined by C-reactive protein values was inversely correlated to RI and PI. The process of angioneogenesis is speculated to be responsible for this increased flow. The tubo-ovarian infectious process must be remembered in the differential diagnosis, when an adnexal mass with low resistance blood flow is found in the ultrasound examination.

background: Low-dose aspirin therapy could improve remodelling of maternal spiral arteries during early placentation and prevent subsequent pregnancy-related hypertensive disorders. We investigated whether low-dose aspirin therapy reduces the incidence of hypertensive pregnancy complications in unselected IVF and ICSI patients when medication was started prior to pregnancy. methods: A total of 487 patients who underwent IVF/ICSI were randomized to receive 100 mg aspirin (n ¼ 242) or placebo (n ¼ 245) daily, starting on the first day of gonadotrophin stimulation. Pregnant women continued the medication until delivery. A total of 107 patients (52 with aspirin and 55 with placebo) experienced live birth and were included in this follow-up study. The main outcome measure was the incidence of hypertensive pregnancy complications. results: Embryo transfer took place in 227 (94%) women in the aspirin group and in 229 (93%) women in the placebo group. The live birth rate between the aspirin (22.9%) and placebo (24.0%) groups did not differ significantly (P ¼ 0.78). The overall incidence of hypertensive pregnancy complications was 15.4% (8/52) in the aspirin group and 18.2% (10/55) in the placebo group (P ¼ 0.70, 95% confidence interval for the difference of proportions 217 to 11%). There were two cases of severe pre-eclampsia in the aspirin group and three cases in the placebo group. conclusions: In the present study, the incidence of hypertensive pregnancy complications did not differ statistically significantly between low-dose aspirin and placebo groups in unselected IVF/ICSI patients, when medication was started concomitantly with gonadotrophin stimulation and continued until delivery. The study was registered at clinicaltrials.gov. NCT00683202.

To confirm tubal patency in hysterosalpingo-contrast sonography (HyCoSy) by transvaginal hydrolaparoscopy (THL).A prospective study.Infertility clinic at a university hospital.Fifty-six infertile women with a history of tubal risk factor(s) who underwent HyCoSy and THL between 2003 and 2006.After performing HyCoSy, the tubal patency was verified by THL.Altogether, 51 women and 101 tubes could be examined. Using HyCoSy, 61 of the tubes were considered patent and 40 occluded. THL confirmed 82 tubes patent and 19 occluded. Of 61 tubes found to be patent in HyCoSy, 60 were also patent in THL. In contrast, of 40 tubes occluded in HyCoSy only 18 tubes were confirmed to be occluded by THL. The concordance was 77%. The sensitivity of HyCoSy was 95%, the specificity 73%, the negative predictive value 98% and the positive predictive value 45%.HyCoSy is a reliable method when tubal patency is demonstrated. In cases of suspected tubal occlusion, THL is an inexpensive and safe outpatient procedure to exclude benign tubal spasm and confirm the presence of true occlusion.

Objective: To investigate the correlation between the early follicular phase serum inhibin B levels and other indicators of ovarian reserve. Study design: Seventy-four women aged 24–40 years (mean 32) with different infertility etiologies were investigated in the early follicular phase of a spontaneous mentrual cycle. The volume of the ovaries was measured and the total number of follicles

Objective: To determine whether the number of retrieved oocytes and the required amount of gonadotropins per oocyte in IVF treatment can be predicted with use of the following independent predictive variables: age, parity, cause of infertility, body mass index, day 3–5 FSH, E 2 , inhibin B, ovarian volume, the number of follicles, and intraovarian and uterine artery vascular resistance measured by ultrasonography before ovarian hyperstimulation. Design: A retrospective analysis. Setting: University hospital infertility clinic. Patient(s): Seventy-four consecutive women attending the university hospital infertility clinic for IVF treatment. Intervention(s): The investigated factors were measured on day 3–5 of the cycle, in which luteal phase suppression was begun before ovarian hyperstimulation preparatory to IVF. Main Outcome Measure(s): The amount of gonadotropins required per oocyte and the number of retrieved oocytes were correlated with the predictive factors in stepwise regression analysis. Result(s): The best predictive factors for the number of oocytes retrieved were FSH, inhibin B, and parity, explaining 25% of the ovarian response. Intraovarian vascular resistance, parity, FSH, and inhibin B best predicted the amount of gonadotropins needed, explaining 44% of the variation. Conclusion(s): FSH, inhibin B, and parity were the independent predictive factors for the number of retrieved oocytes. The same factors and intraovarian vascular resistance predicted the required amount of gonadotropins per oocyte. The main part of the ovarian response cannot be predicted using the factors investigated.

Ninety-four infertility patients were studied by Doppler ultrasound during spontaneous ovulatory menstrual cycles. The pulsatility index (PI) in uterine and ovarian arteries was measured in the follicular and midluteal phase of the cycle. Associations between high PI values and hormones (estradiol, progesterone, prolactine. testosterone, follicle stimulating hormone) measured during the investigated cycle and age were evaluated. A high PI in uterine arteries in the follicular phase was associated with low estradiol (E2) and progesterone (P) levels in the studied cycle. In the luteal phase PI values of uterine arteries have no obvious association with E and P levels, and other vasoactive compounds influence the perfusion of uterus during this period. The other hormones analysed and age did not correlate with vascular resistance in spontaneous ovulatory cycles.

The intra- and interobserver variation in Doppler ultrasound measurements of uterine arteries (UA) and the variation of pulsatility index (PI) in UA in successive menstrual cycles in the same patient was studied. The intra- and interobserver variability of measurements was similar. In all three series the difference between two measurements was smaller with lower PI values. Cycle-dependent changes, biological variation and random measurement are foremost in causing variability and no systematic error was evident. Doppler ultrasound measurements from UA can be used when patient groups are compared, but in the case of an individual patient, large limits of agreement must be borne in mind.

In this study we investigated the blood flow in uterine (u.a.) and ovarian arteries (o.a.) in healthy women and infertility patients and the relationship of vascular resistance to the etiology and the prognosis of infertility. A total of 101 consecutive infertility patients referred to hospital for investigations were studied by Doppler ultrasound. Couples with male infertility were excluded. The control group comprised 19 healthy women having regular menstrual cycle and no history of infertility. The pulsatility index (PI) in o.a. and u.a. was measured in pre- and post-ovulatory phase of the menstrual cycle. The PI values of the controls were compared with those of the patients with various infertility etiologies. The PI values of the infertility patients who subsequently delivered were compared with those of the patients failing to deliver. Infertility patients had high PI in o.a. and u.a. in the luteal phase more often than controls. High vascular resistance in u.a. and o.a. in the luteal phase reduce the take-baby-home rate.

One hundred infertility patients were investigated by Doppler ultrasound and 17 were found to have a short luteal phase (

The concentrations of adrenaline and noradrenaline were determined in venous plasma and cerebrospinal fluid (CSF) of 41 pregnant women at term scheduled for elective or 'hot' caesarean section and in 7 healthy non-pregnant women scheduled for elective surgery. Group 1: 10 pregnant women at term with a normal history of their pregnancy; group 2: like group 1, but in active labour for more than 4 h; group 3: 10 pregnant women with insulin-dependent diabetes mellitus with or without slightly elevated arterial blood pressure; group 4: 11 women with pre-eclampsia gravis; group 5: 7 healthy non-pregnant women of fertile age. The highest values of mean arterial blood pressure and of venous plasma noradrenaline were found in the pre-eclamptic group 4, mean arterial blood pressure and plasma noradrenaline levels correlated to each other. However, concentrations of noradrenaline in CSF in group 4 did not differ significantly from the other groups. It is speculated that a different origin of hypertension may be the reason for the normal noradrenaline concentrations in CSF. This finding is in contrast to earlier findings in which noradrenaline levels in CSF were elevated in patients with essential hypertension.

Ten women with tubo-ovarian abscess caused by pelvic inflammatory disease (PID) were investigated by transvaginal Doppler ultrasound during the acute and healing phases of the infection. The pulsatility index (PI) of the uterine arteries was measured and compared with the values obtained from 19 healthy women. Each control patient was investigated three times during a single menstrual cycle. In PID patients, the PI values were significantly lower than in controls in the same phase of the menstrual cycle. When C-reactive protein was > 50, the PI values were lowest and reverted to normal values when the infection subsided. In a case of chronic infection, the PI did not rise to normal despite normal infection parameters. Doppler ultrasound seems to offer a new method of assessing PID.