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Endometrial fluid associated with Essure implants placed before in vitro fertilization: Considerations for patient counseling and surgical management.

E Scott SILLS ; David J WALSH ; Christopher A JONES ; Samuel H WOOD

Clinical and Experimental Reproductive Medicine.2015;42(3):126-129. doi:10.5653/cerm.2015.42.3.126

Essure (Bayer) received approval from the U.S. Food and Drugs Administration as a permanent non-hormonal contraceptive implant in November 2002. While the use of Essure in the management of hydrosalpinx prior to in vitro fertilization (IVF) remains off-label, it has been used specifically for this purpose since at least 2007. Although most published reports on Essure placement before IVF have been reassuring, clinical experience remains limited, and no randomized studies have demonstrated the safety or efficacy of Essure in this context. In fact, no published guidelines deal with patient selection or counseling regarding the Essure procedure specifically in the context of IVF. Although Essure is an irreversible birth control option, some patients request the surgical removal of the implants for various reasons. While these patients could eventually undergo hysterectomy, at present no standardized technique exists for simple Essure removal with conservation of the uterus. This article emphasizes new aspects of the Essure procedure, as we describe the first known association between the placement of Essure implants and the subsequent development of fluid within the uterine cavity, which resolved after the surgical removal of both devices.
Contraception ; Counseling* ; Fertilization in Vitro* ; Humans ; Hysterectomy ; Laparoscopy ; Patient Selection ; Uterus

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Pregnancy and fertilization potential of immature oocytes retrieved in intracytoplasmic sperm injection cycles.

Duck Sung KO ; Sun Hee LEE ; Dong Wook PARK ; Kwang Moon YANG ; Chun Kyu LIM

Clinical and Experimental Reproductive Medicine.2015;42(3):118-125. doi:10.5653/cerm.2015.42.3.118

OBJECTIVE: The goal of this study was to evaluate the pregnancy potential of immature (metaphase I or germinal vesicle stage) oocytes retrieved in intracytoplasmic sperm injection (ICSI) cycles. METHODS: A total of 1,871 couples with infertility underwent 2,984 ICSI cycles. Cycles in which three or fewer oocytes were retrieved were included in this study in order to evaluate the pregnancy potential of immature oocytes. Cycles were divided into five groups (group I-V), according to the maturation status of the oocytes at the time of cumulus cell removal and ICSI. The fertilization and pregnancy rates after ICSI were analyzed and compared among the study groups based on the maturation status of the retrieved oocytes. RESULTS: The retrieval of only immature oocytes was associated with a significant decrease in the fertilization rate (76.1%+/-37.3% vs. 49.0%+/-49.1%, 66.7%+/-48.7%; group I vs. group II, group III, respectively) and the average number of transferred embryos (1.5+/-0.7 vs. 1.1+/-0.4, 1.1+/-0.6). The cycle cancellation rate was significantly higher when only immature oocytes were retrieved. The clinical pregnancy rate decreased significantly when the transferred embryos had originated from immature oocytes (16.9% vs. 10.3%, 1.2%). CONCLUSION: In ICSI cycles, the fertilization potential and pregnancy potential of the immature oocytes retrieved in ICSI cycles were inferior to those of mature oocytes. Therefore, increasing the number of injectable oocytes and transferrable embryos by using immature oocytes after their spontaneous in vitro maturation does not necessarily improve pregnancy outcomes.
Cumulus Cells ; Embryonic Structures ; Family Characteristics ; Female ; Fertilization* ; Infertility ; Oocytes* ; Pregnancy Outcome ; Pregnancy Rate ; Pregnancy* ; Sperm Injections, Intracytoplasmic*

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The potential role of granulosa cells in the maturation rate of immature human oocytes and embryo development: A co-culture study.

Bahia Namavar JAHROMI ; Zahra MOSALLANEZHAD ; Najmeh MATLOOB ; Maryam DAVARI ; Mohamed Amin GHOBADIFAR

Clinical and Experimental Reproductive Medicine.2015;42(3):111-117. doi:10.5653/cerm.2015.42.3.111

OBJECTIVE: In order to increase the number of mature oocytes usable for intracytoplasmic sperm injection (ICSI), we aimed to investigate the effect of co-culturing granulosa cells (GCs) on human oocyte maturation in vitro, the fertilization rate, and embryo development. METHODS: A total of 133 immature oocytes were retrieved and were randomly divided into two groups; oocytes that were cultured with GCs (group A) and oocytes that were cultured without GCs (group B). After in vitro maturation, only oocytes that displayed metaphase II (MII) underwent the ICSI procedure. The maturation and fertilization rates were analyzed, as well as the frequency of embryo development. RESULTS: The mean age of the patients, their basal levels of follicle-stimulating hormone, and the number of oocytes recovered from the patients were all comparable between the two study groups. The number of oocytes that reached MII (mature oocytes) was 59 out of 70 (84.28%) in group A, compared to 41 out of 63 (65.07%) in group B (p=0.011). No significant difference between fertilization rates was found between the two study groups (p=0.702). The embryo development rate was higher in group A (33/59, 75%) than in group B (12/41, 42.85%; p=0.006). The proportion of highest-quality embryos and the blastocyst formation rate were significantly lower in group B than in group A (p=0.003 and p<0.001, respectively). CONCLUSION: The findings of the current study demonstrate that culturing immature human oocytes with GCs prior to ICSI improves the maturation rate and the likelihood of embryo development.
Blastocyst ; Coculture Techniques* ; Embryonic Development* ; Embryonic Structures* ; Female ; Fertilization ; Follicle Stimulating Hormone ; Granulosa Cells* ; Humans* ; In Vitro Oocyte Maturation Techniques ; Metaphase ; Oocytes* ; Pregnancy ; Sperm Injections, Intracytoplasmic

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Clinical outcomes of three- or five-day treatment with clomiphene citrate combined with gonadotropins and a timed intercourse cycle in polycystic ovary syndrome patients.

Sung Ah BAE ; Jong Kil JOO ; Jong Ryeol CHOI ; Sun Suk KIM ; Kyu Sup LEE

Clinical and Experimental Reproductive Medicine.2015;42(3):106-110. doi:10.5653/cerm.2015.42.3.106

OBJECTIVE: This study aimed to investigate the effect of a new clomiphene citrate (CC) regimen on preventing thin endometrial lining in polycystic ovary syndrome (PCOS) patients receiving CC plus gonadotropin treatment with a timed intercourse cycle. METHODS: A total of 114 women with PCOS were included in this trial. Patients were divided into two groups and treated in accordance with the controlled ovarian stimulation (COS) protocol. In group A, 104 COS cycles in 67 patients were included, and in each cycle 150 mg CC was given for three days, starting from day 3. In group B, 69 COS cycles in 47 patients were included, in which 100 mg CC was given for five days, starting from day 3. The thickness of the endometrium was measured on the day of human chorionic gonadotropin (hCG) injection. Timed intercourse was recommended at 24 and 48 hours after the hCG injection. RESULTS: Additional doses of human menopausal gonadotropin and the number of days of hCG administration were not significantly different between the two groups. Endometrial thickness on the day of hCG administration was significantly larger in group A than group B (9.4+/-2.1 mm vs. 8.5+/-1.7 mm, p=0.004). The pregnancy rate was significantly higher in group A than in group B (38.4% vs. 21.7%, p=0.030). CONCLUSION: Three-day CC treatment resulted in a significantly higher pregnancy rate than the standard five-day CC treatment in a timed intercourse cycle in PCOS patients. Facilitating adequate endometrial growth via the early discontinuation of CC might be a crucial factor in achieving a higher pregnancy rate.
Chorionic Gonadotropin ; Clomiphene* ; Endometrium ; Female ; Gonadotropins* ; Humans ; Ovulation Induction ; Polycystic Ovary Syndrome* ; Pregnancy ; Pregnancy Rate

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Sperm chromatin structure assay results in Nigerian men with unexplained infertility.

Paul FADUOLA ; Charles Oluwabukunmi KOLADE

Clinical and Experimental Reproductive Medicine.2015;42(3):101-105. doi:10.5653/cerm.2015.42.3.101

OBJECTIVE: Several publications have established a relationship between sperm DNA damage and male factor infertility, based on data from America, Europe, and Asia. This study aimed to compare the extent of sperm DNA damage in sperm samples from Nigerian men with unexplained infertility and in sperm samples from a fertile group composed of sperm donors who had successfully impregnated a female partner naturally or through assisted conception. METHODS: A total of 404 men underwent male fertility evaluation at Androcare Laboratories and Cryobank participated in this study. Semen analysis and a sperm chromatin structure assay (SCSA) were performed on all subjects. RESULTS: The men in the unexplained infertility group were slightly older than the men in the fertile sperm group (36+/-10 years vs. 32+/-6 years, p=0.051). No significant difference was observed between the two groups in semen analysis parameters (p> or =0.05). Men in the unexplained infertility group with normal semen parameters had a significantly higher DNA fragmentation index (DFI) than men in the fertile sperm group (27.5%+/-7.0% vs. 14.1%+/-5.3%, p<0.05). In the unexplained infertility group, 63% of the men had a DFI greater than 20%, compared to 4% in the fertile sperm group. In the unexplained infertility group, 15.2% of the subjects had a DFI greater than 30%, compared to 1% in the fertile sperm group. CONCLUSION: Our study showed that the SCSA may be a more reliable predictor of fertility potential than traditional semen analysis in cases of unexplained infertility.
Americas ; Asia ; Chromatin* ; DNA Damage ; DNA Fragmentation ; Europe ; Female ; Fertility ; Fertilization ; Humans ; Infertility* ; Male ; Semen ; Semen Analysis ; Spermatozoa* ; Tissue Donors

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The effect of artificial shrinkage and assisted hatching on the development of mouse blastocysts and cell number after vitrification.

Hye Jin KIM ; Ki Hwan LEE ; Sung Baek PARK ; Young Bae CHOI ; Jung Bo YANG

Clinical and Experimental Reproductive Medicine.2015;42(3):94-100. doi:10.5653/cerm.2015.42.3.94

OBJECTIVE: The goal of this study was to ascertain optimal assisted hatching (AH) method in frozen embryo transfer. We compared the effect of depending on whether mechanical or laser-AH was performed before or after the vitrification of embryo development rate and blastocyst cell numbers. METHODS: In order to induce superovulation, pregnant mare's serum gonadotropin followed by human chorionic gonadotropin were injected into 4- to 5-week-old female mice. 2-cell embryos were then collected by flushing out the oviducts. The Expanded blastocysts were recovered after the collected embryos were incubated for 48 hours, and were then subjected to artificial shrinkage (AS) and cross-mechanical AH (cMAH) or quarter-laser zona thinning-AH (qLZT-AH) were carried out using the expanded blastocysts before or after vitrification. After 48 hours of incubation, followed by vitrification and thawing (V-T), and blastocysts were fluorescence stained and observed. RESULTS: The rate of formation of hatched blastocysts after 24 and 72 hours of incubation was significantly higher in the AS/qLZT-AH/V-T group than in the other groups (p<0.05). The cell number of the inner cell mass was higher in AS/V-T/non-AH and AS/V-T/cMAH groups than those of others (p<0.05). In the control group, the number of trophectoderm and the total cell number were higher than in the AS-AH group (p<0.05). CONCLUSION: The above results suggest that AS and AH in vitrification of expanded blastocysts lead to the more efficient formation of hatched blastocysts in mice.
Animals ; Blastocyst* ; Cell Count* ; Chorionic Gonadotropin ; Embryo Transfer ; Embryonic Development ; Embryonic Structures ; Female ; Fluorescence ; Flushing ; Gonadotropins ; Herpes Zoster ; Humans ; Mice* ; Oviducts ; Pregnancy ; Superovulation ; Vitrification*

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Clinical characteristics in Taiwanese women with polycystic ovary syndrome.

Ming I HSU

Clinical and Experimental Reproductive Medicine.2015;42(3):86-93. doi:10.5653/cerm.2015.42.3.86

Polycystic ovary syndrome (PCOS) is one of the most common hormonal endocrine disorders in women of reproductive age. It consists of a heterogeneous collection of signs and symptoms that together form a disorder spectrum. The diagnosis of PCOS is principally based on clinical and physical findings. The extent of metabolic abnormalities in women with PCOS varies with phenotype, body weight, age, and ethnicity. For general population, the prevalence of hyperandrogenism and oligomenorrhea decreases with age, while complications such as insulin resistance and other metabolic disturbances increase with age. Obese women with PCOS have a higher risk of developing oligomenorrhea, amenorrhea, hyperandrogenemia, insulin resistance, and lower luteinizing hormone (LH) to follicle stimulation hormone (FSH) ratios than non-obese women with PCOS. The LH to FSH ratio is a valuable diagnostic tool in evaluating Taiwanese women with PCOS, especially in the diagnosis of oligomenorrhea. Overweight/obesity is the major determinant of cardiovascular and metabolic disturbances in women of reproductive age.
Amenorrhea ; Body Weight ; Diagnosis ; Female ; Humans ; Hyperandrogenism ; Insulin Resistance ; Luteinizing Hormone ; Obesity ; Oligomenorrhea ; Phenotype ; Polycystic Ovary Syndrome* ; Prevalence

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Reduction of the cetrorelix dose in a multiple-dose antagonist protocol and its impact on pregnancy rate and affordability: A randomized controlled multicenter study.

Ayman S DAWOOD ; Adel ALGERGAWY ; Ahmed ELHALWAGY

Clinical and Experimental Reproductive Medicine.2017;44(4):232-238. doi:10.5653/cerm.2017.44.4.232

OBJECTIVE: To determine whether reducing the cetrorelix dose in the antagonist protocol to 0.125 mg had any deleterious effects on follicular development, the number and quality of retrieved oocytes, or the number of embryos, and to characterize its effects on the affordability of assisted reproductive technology. METHODS: This randomized controlled study was conducted at the Fertility Unit of Tanta Educational Hospital of Tanta University, the Egyptian Consultants' Fertility Center, and the Qurrat Aien Fertility Center, from January 1 to June 30, 2017. Patients' demographic data, stimulation protocol, costs, pregnancy rate, and complications were recorded. Patients were randomly allocated into two groups: group I (n=61) received 0.125 mg of cetrorelix (the study group), and group II (n=62) received 0.25 mg of cetrorelix (the control group). RESULTS: The demographic data were comparable regarding age, parity, duration of infertility, and body mass index. The dose of recombinant follicle-stimulating hormone units required was 2,350.43±150.76 IU in group I and 2,366.25±140.34 IU in group II, which was not a significant difference (p=0.548). The duration of stimulation, number of retrieved oocytes, and number of developed embryos were not significantly different between the groups. The clinical and ongoing pregnancy rates likewise did not significantly differ. The cost of intracytoplasmic sperm injection per cycle was significantly lower in group I than in group II (US $494.66±4.079 vs. US $649.677±43.637). CONCLUSION: Reduction of the cetrorelix dose in the antagonist protocol was not associated with any significant difference either in the number of oocytes retrieved or in the pregnancy rate. Moreover, it was more economically feasible for patients in a low-resource country.
Body Mass Index ; Embryonic Structures ; Female ; Fertility ; Follicle Stimulating Hormone ; Gonadotropins ; Humans ; Infertility ; Oocytes ; Parity ; Pregnancy Rate* ; Pregnancy* ; Reproductive Techniques, Assisted ; Sperm Injections, Intracytoplasmic

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Impact of sperm DNA fragmentation on clinical in vitro fertilization outcomes.

Hwa Young CHOI ; Seul Ki KIM ; Seok Hyun KIM ; Young Min CHOI ; Byung Chul JEE

Clinical and Experimental Reproductive Medicine.2017;44(4):224-231. doi:10.5653/cerm.2017.44.4.224

OBJECTIVE: We studied the association between sperm DNA fragmentation (SDF) and several clinical in vitro fertilization outcomes. METHODS: We retrospectively analyzed 169 consecutive fresh IVF cycles. Semen was collected on the day of oocyte retrieval, and we assessed standard semen parameters and the SDF level (by terminal deoxynucleotidyl transferase dUTP nick-end labeling). Poor ovarian response (POR) was defined as the collection of three or fewer mature oocytes. Oocytes were inseminated by the conventional method or intracytoplasmic sperm injection. RESULTS: SDF did not affect the fertilization or pregnancy rate, but did have a significant effect on the miscarriage rate. In the miscarriage group (n=10), the SDF level was significantly higher (23.9% vs. 14.1%) and number of mature oocytes was significantly lower (4.3 vs. 7.6) than in the live birth group (n=45). Multiple regression analysis showed that SDF was an independent predictor of miscarriage (odds ratio, 1.051; 95% confidence interval, 1.001–1.104). The cutoffs for the SDF level and number of mature oocytes that could predict miscarriage were >13% and ≤3, respectively. In the low-SDF group (≤13%), the miscarriage rate was similar in POR patients and those with a normal ovarian response (NOR; 14.2% vs. 4.3%). In the high-SDF group (>13%), the miscarriage rate was significantly higher in the POR group than in the NOR group (60.0% vs. 13.3%, p=0.045). CONCLUSION: Our study demonstrated that a high SDF level (>13%) was associated with a high miscarriage rate, and that it mainly contributed to miscarriage in the POR group. The results suggest that SDF measurements should be considered in couples with POR in order to predict the prognosis of the pregnancy.
Abortion, Spontaneous ; DNA Fragmentation* ; DNA Nucleotidylexotransferase ; DNA* ; Family Characteristics ; Female ; Fertilization ; Fertilization in Vitro* ; Humans ; In Vitro Techniques* ; Live Birth ; Methods ; Oocyte Retrieval ; Oocytes ; Pregnancy ; Pregnancy Rate ; Prognosis ; Retrospective Studies ; Semen ; Sperm Injections, Intracytoplasmic ; Spermatozoa*

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T helper cell subsets and related cytokines in infertile women undergoing in vitro fertilization before and after seminal plasma exposure.

Marziyeh AZAD ; Sara KESHTGAR ; Bahia Namavar JAHROMI ; Zahra KANANNEJAD ; Behrouz GHARESI-FARD

Clinical and Experimental Reproductive Medicine.2017;44(4):214-223. doi:10.5653/cerm.2017.44.4.214

OBJECTIVE: In vitro fertilization (IVF) is a well-known method for the treatment of infertility. The present study aimed to compare the differences between infertile women with successful and unsuccessful IVF outcomes regarding the expression of T helper (Th) cell transcription factors and a group of related cytokines before and after exposure to their husbands' seminal plasma. METHODS: This study was performed on 19 couples with unexplained infertility undergoing IVF treatment. Among the studied group, nine and 10 couples had successful and unsuccessful IVF outcomes, respectively. This study was carried out using real-time polymerase chain reaction. RESULTS: Before seminal plasma exposure, the expression levels of T-bet (p < 0.007), interferon-γ (p=0.013), and tumor necrosis factor (TNF)-α (p=0.017) were higher in the infertile women with IVF failure than in those with successful IVF outcomes, while those of GATA3 (p < 0.001), Foxp3 (p=0.001), and interleukin (IL)-35 (p < 0.003) were lower. After seminal exposure, the expression of T-bet (p=0.02), Rorc (p < 0.001), TNF-α (p=0.001), Foxp3 (p=0.02), and interferon-γ (p=0.001) increased in the unsuccessful IVF group, while the expression of Foxp3 (p=0.02), Rorc (p < 0.001), IL-23 (p=0.04), IL-17 (p=0.02), IL-6 (p < 0.001), transforming growth factor-β (p=0.01), and IL-35 (p < 0.001) increased in the successful IVF group. CONCLUSION: In summary, IVF failure was associated with imbalanced Th1/Th2/Th17/Treg responses. Moreover, our results show that seminal plasma might have a positive effect on IVF outcomes via changes in peripheral blood T cell subsets.
Cytokines* ; Family Characteristics ; Female ; Fertilization in Vitro* ; Humans ; In Vitro Techniques* ; Infertility ; Interleukin-17 ; Interleukin-23 ; Interleukin-6 ; Interleukins ; Methods ; Real-Time Polymerase Chain Reaction ; Semen* ; T-Lymphocyte Subsets ; T-Lymphocytes, Helper-Inducer* ; Transcription Factors ; Tumor Necrosis Factor-alpha

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