Journal of Infertility

The effect of intrauterine insemination for above 35-year unexplained infertility patients

DILAY GOKKORUCU, OĞUZHAN GÜNENÇ — Fri, 21 Jul 2023 00:00:00 +0300

The objective of the study is to evaluate the success of ovarian stimulation (OS) and intrauterine insemination (IUI) treatment for advanced female age (over 35 years) unexplained infertility patients. This was a retrospective study of IUI procedures performed 35 years and over patients from 2017 to 2018 at the infertility department of Konya Education and Research Hospital (a tertiary referral center), in Konya, Turkey. Although several prior studies have documented the poor pregnancy rate outcome of OS and IUI in women aged 40 years and above, we at our setting have continued to provide these services for women who fulfill the criteria for OS-IUI without age restrictions as the demand of the women because of the much lower cost. During the study period there were 142 IUI treatment cycles of which 11 had positive pregnancy test giving a pregnancy rate of %7.7. Simple correlation technique is used to measure the age-related pregnancy sensitivity. We observed in this study that pregnancy rates are lower with increasing age of the female partner. Most pregnancies occur between 35 and 36 years with the ratio %27 and %36 of all pregnancies. We find 38 years and 40 years patients clinical pregnancy rates the same with the ratio %18 of all pregnancies. IUI is a preferred infertility treatment at certain ages because of it is lower cost.

Comparison of ovarian stimulation results in ivf cycles given gonal f (follitropin alfa) and pergoveris (follitropin alfa and lutropin alfa)

Eda Gökdağ, Banuhan Şahin, Ayşe Zehra Özdemir, Yunus Katırcı — Fri, 21 Jul 2023 00:00:00 +0300

The aim of this study is to compare the effect of adding lutropin alfa to follitropin alfa on treatment dose, duration, number of oocytes retrieved, number of embryos formed, number of live births, and ovarian hyperstimulation syndrome (OHSS) compared to follitropin alfa alone ingonadotropin therapy used for ovarian stimulation (OS) in in-vitro fertilization (IVF) cycles. The study comprised infertile women aged 20 to 44 years old who applied to Ondokuz Mays University Medical Faculty Hospital IVF Center between January and June 2021 who were unable to conceive for any reason (unexplained infertility, poor ovarian reserve, male factor etc.) despite one year of regular unprotected intercourse and tried IVF for the first time. For OS, 50 female patients received Pergoveris® (recombinant follitropin alfa and lutropin alfa), while 50 female patients received Gonal-f® (recombinant follitropin alfa). Antagonist protocol was applied to all patients and trigger was made with Beta hCG. All women's age, BMI,infertility etiology and duration, basal follicle stimulating hormone (FSH) value, and antral follicle count were recorded. Gonadotropin dose andinduction times for both groups and the number of oocytes collected, the number of metaphase-2 (M2) oocytes, the number of embryos formed, embryo grade, the number of frozen and transferred embryos and OHSS status were compared. Infertility causes and induction times were similar in the patient groups that received Gonal-f and Pergoveris (p>0.05). The dose of the drug used was higher in the Pergoveris group (p=0,029). The number of collected oocytes, M2 oocytes, and formed-frozen-transferred embryos were comparable for both groups (p>0.05). Embryos transferred on day 3 were higher in patients using Gonal-f, while embryos transferred on day 5 were similar for both groups (p=0.015; p>0.05). Both groups were similarin terms of side effects of live birth, twin pregnancy, abortion, ectopic pregnancy, chemical pregnancy and OHSS (p>0.05). While no embryosdeveloped in eight patients who received Pergoveris, all patients who received Gonal-f developed embryos. In patients who had OS with Gonal-f or Pergoveris drugs in IVF cycles, there is no difference in the number of oocytes collected, formed-transferred-frozen embryos, live birth rate, multiplepregnancy rate, or OHSS.

Microscopic testicular sperm extraction results in patients with Klinefelter Syndrome

Burak Yavuz Kara — Fri, 21 Jul 2023 00:00:00 +0300

Our aim was to evaluate the results of microscopic testicular sperm extraction (mTESE) in patients with KS and determined factors affecting the success of mTESE. Medical records of 182 patients with NOA who underwent mTESE operation in our institution between 2015-2022 were retrospectively reviewed. Testicular volume (measured using Prader-orchidometry), serum total testosterone, follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin levels of the patients and genetic analysis (karyotype analysis and Y chromosome micro-deletion analysis) were evaluated. A total of 30 patients with KS underwent mTESE. While sperm were found in 15 (50%) of the cases, no sperm was found in 15 (50%). Mean age of the cases was 33.4±6.37 years. While the body mass index (BMI) of the cases was 29.9±4.7, it was 31.9±4.5 kg/m2 in the micro-TESE positive group and 27.8±4.1 kg/m2 in the micro-TESE negative group (p=0.01). FSH (p=0.02) and LH (p=0.04) values were significant lower in TESE (+) group. Micro-TESE is an effective sperm retrieval procedure for patients with KS with NOA. In our study FSH and LH levels were found to be lower and BMI was higher in patients with successful spermatozoa in KS patients.

Predictive factors for sperm retrieval rate of microscopic testicular sperm extraction in patients with non-obstructive azoospermia

Abdullah Acikgoz, Burak Yavuz Kara, Mesut Şengül — Fri, 21 Jul 2023 00:00:00 +0300

In our study, we evaluated the predictive factors for sperm retrieval rate of micro-TESE in patients with NOA. We retrospectively reviewed the medical records of 175 patients with the diagnosis of NOA, who had undergone the micro-TESE operation in our institution between the dates of 2015 and 2022. Testicular volume, serum total testosterone, follicular stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin levels of the patients and the genetic analyses results were evaluated. Patients characteristics and laboratory findings were compared in order to detect factors that effecting sperm retrieval. A total of 175 patients underwent micro-TESE. The mean duration of infertility was 5.73±4,8 years. While sperm were found in 124 (70.9%) of the cases, no sperm was found in 51 (29.1%) cases. A statistically significant difference was found between the two groups in terms of age and body mass index (p: 0.042 and p: 0.02, respectively). Infertility duration, testicular volumes, smoking duration, previous varicocele and undescended testicular surgery, previous mumps, FSH, LH, Total Testosterone, Estradiol and Prolactin variables of sperm positive and negative groups were compared in terms of sperm retrieval success and there was no significant difference. Micro-TESE is an effective sperm retrieval procedure for patients with NOA. In our study older age and high BMI were signiﬁcantly associated with the probability of successful sperm retrieval. There have been many studies exploring the predictive factors associated with successful sperm retrieval by micro-TESE in men with NOA, but no reliable predictive factor has yet been found that could provide sufficient information about the routine clinical application of micro-TESE.

Stem cell therapy in premature ovarian insufficiency

Shalala Mammadova — Fri, 21 Jul 2023 00:00:00 +0300

Premature ovarian insufficiency (POI) is defined as decreased ovarian function before the expected age of menopause. It is well known that POI increases the risk of cardiovascular diseases, osteoporosis, cognitive and mood disorders. Appropriate hormone replacement reduces these adverse risks and improves quality of life, but does not affect overall survival. Potential etiologies of POI include chromosomal abnormalities, genetic mutations, autoimmune factors, iatrogenic causes such as surgery, chemotherapy, and radiation therapy. It has been suggested that there is a significant relationship between reproduction and DNA damage. DNA damage in ovarian granulosa cells is involved in the pathogenesis of POI. Depletion of oocytes with damaged DNA occurs through different mechanisms of cell death, such as apoptosis, autophagy, and necroptosis, mediated by phosphatase and tensin homolog (PTEN)/phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/forkhead transcription. Mesenchymal stem cells are characterized by their ability to self-renew and play an important role in the regeneration of injured tissues. Recent advances in stem cell therapy may be promising new therapeutic options in POI patients. In this article, we reviewed the topic of stem cell therapy in premature ovarian failure.

A rare case: Tuba uterine evisceration from the drain site incision

Gülnur Çoban, Ayşe Zehra Özdemir — Fri, 21 Jul 2023 00:00:00 +0300

A known but uncommon consequence of surgical drainage is herniation from the drain site. Surgery drainage may be required for preventative or therapeutic reasons. Yet, surgical drains can result in difficulties despite their advantages. These issues could arise after open or laparoscopic surgery. We present a 25-year-old female patient in whom the left tuba uterine was eviscerated through the drain site incision after cesarean section. The patient was discharged on the 3rd postoperative day after the repair with good general condition. Consideration should be given to drain site hernias as an important complication following surgical drain placement. As a result, routine intraperitoneal drainage should be minimized and possible complications should be considered.

OHVIRA syndrome with uterus didelphis in a pediatric patient

Ayse Seyma Tastan, Ayşe Zehra Özdemir — Fri, 21 Jul 2023 00:00:00 +0300

Herlyn-Werner-Wunderlich syndrome, or obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), is an infrequent Mullerian duct anomaly. Uterus didelphys, ipsilateral renal agenesis, and unilateral obstructed hemivagina are observed in this anomaly. Usually, symptoms are pelvic pain and mass. But if the patient has not been diagnosed in the early years, infertility could be the first sign. Being able to make diagnoses for these patients, clinicians should have enough information about this syndrome. A 12-year-old virgin patient presented with a urinary tract infection and was diagnosed as a case of OHVIRA syndrome with uterine didelphys. Urinary tract infection has been rarely reported as the first clinical manifestation of this syndrome. She was cured with hemivaginal septal resection and her hematometra was drained. Ohvira syndrome is an infrequent condition. Because of this when a young patient has pelvic mass and pain with renal anomalies, it is important to keep this disease in mind.

A case of aggressive angiomixoma as a rare diagnosis present to our clinic

Gonca Evci, Ayse Zehra Özdemir — Fri, 21 Jul 2023 00:00:00 +0300

Aggressive angiomyxoma is a rare mesenchymal tumor that primarily originates from the perineum and pelvic region, has a high risk of local recurrence but a low tendency to metastasize, especially seen in women in the 4th decade of life. Patients often apply with nonspecific symptoms. Pathology should be performed for the definitive diagnosis of cases thought to be aggressive angiomyxoma based on clinical finding and imaging methods. Histopathology and immunohistochemistry are the gold standard for definitive diagnosis. Wide local excision is used in the treatment. In our article, we describe a 29-year –old patient aggressive angiomyxoma who presented with the complaint of swelling in the right vulvar region.