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Objective: To assess the relationship between SHBG and 18 other hormonal and metabolic parameters in well characterized, normally cycling premenopausal women., Design: Cross-sectional study., Setting: University general clinical research center., Subject(s): A total of 319 young healthy women with ovulatory menstrual cycles., Intervention(s): None., Main Outcome Measure(s): Midfollicular serum SHBG concentrations., Result(s): In our final linear regression model, SHBG was negatively associated with bioavailable T and positively associated with adiponectin, associations that were independent from other parameters. SHBG was also positively associated with estrone sulfate, but only when taking into account confounding variables. Unexpectedly, there was no straightforward relationship between SHBG and insulin resistance according to homeostasis-model assessment., Conclusion(s): Our results highlight the link between androgen action, as reflected by bioavailable T, and circulating SHBG concentrations in all premenopausal women and speak to the importance of the relationship between SHBG and adiponectin, which is at least in part independent from androgen action., Clinical Trial Registration Number: NCT00393172., (Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To describe outcomes of the first 100 consecutive infertility patients participating in a risk-sharing program with uncomplicated eligibility requirements. The program included the costs of FSH-containing gonadotropin preparations and provided a full payment refund if no birth occurred that resulted in a normal infant surviving to an age of 1 month., Design: Retrospective cohort study., Setting: Private IVF center., Patient(s): Infertility patients<35 years of age, considered to be good autologous oocyte IVF candidates at time of program enrollment., Intervention(s): Retrospective analysis of outcomes of fresh IVF-ET and frozen embryo transfer cycles involving conventional treatment protocols., Main Outcome Measure(s): Cumulative successful pregnancy rate., Result(s): Of the first 100 patients enrolled in the program, 82 have had a delivery of a normal infant surviving to an age of 1 month, and another 6 have undelivered ongoing pregnancies at 20+ weeks. Nine participants completed the program without completing a successful treatment cycle, and another three remain enrolled., Conclusion(s): Infertility patients<35 years of age participating in a risk-sharing program with uncomplicated eligibility requirements are very likely to have a successful pregnancy. Other centers may wish to incorporate some of the described program's features into their own risk-sharing IVF programs., (Copyright © 2011. Published by Elsevier Inc.)

Objective: To determine whether isoflavones exert estrogen-like effects in men by lowering bioavailable T through evaluation of the effects of soy protein or isoflavone intake on T, sex hormone-binding globulin (SHBG), free T, and free androgen index (FAI) in men., Design: PubMed and CAB Abstracts databases were searched through July 1, 2008, with use of controlled vocabulary specific to the databases, such as soy, isoflavones, genistein, phytoestrogens, red clover, androgen, testosterone, and SHBG. Peer-reviewed studies published in English were selected if [1] adult men consumed soy foods, isolated soy protein, or isoflavone extracts (from soy or red clover) and [2] circulating T, SHBG, free T, or calculated FAI was assessed. Data were extracted by two independent reviewers. Isoflavone exposure was abstracted directly from studies., Main Outcome Measure(s): Fifteen placebo-controlled treatment groups with baseline and ending measures were analyzed. In addition, 32 reports involving 36 treatment groups were assessed in simpler models to ascertain the results., Result(s): No significant effects of soy protein or isoflavone intake on T, SHBG, free T, or FAI were detected regardless of statistical model., Conclusion(s): The results of this meta-analysis suggest that neither soy foods nor isoflavone supplements alter measures of bioavailable T concentrations in men., (Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the effect of soy isoflavone ingestion on plasma leptin concentrations in premenopausal and postmenopausal women., Design: Randomized, crossover studies, with blinding of participants and laboratory personnel., Setting: Procedures involving free-living individuals were carried out at the University of Minnesota General Clinical Research Center., Patient(s): Fourteen regularly cycling premenopausal women, and 18 postmenopausal women., Intervention(s): Each premenopausal participant consumed, on a daily basis, each of three soy protein powders containing different levels of isoflavones for three menstrual cycles plus 9 days, with plasma samples collected every other day the last 6 weeks of each diet period. Similarly, each postmenopausal participant consumed each of the three powders for 93 days, with plasma samples collected daily on days 64 to 66 and 92 to 94 of each diet period. The powders, dosed on a per-kilogram body weight basis, provided mean isoflavone intakes of 8, 65, and 130 mg/day, for the control, low-isoflavone, and high-isoflavone diet periods, respectively., Main Outcome Measure(s): Plasma leptin concentrations., Result(s): Isoflavone intake had essentially no effect on leptin concentrations in either premenopausal or postmenopausal participants. Concentrations in the premenopausal women were higher during the periovulatory and midluteal phases as compared to the early follicular and midfollicular phases., Conclusion(s): Despite the well-documented effect of estrogens to enhance leptin production, even high levels of isoflavone consumption do not alter leptin concentrations in women. Further studies are needed to more precisely delineate the nature of estrogenic and/or antiestrogenic effects of isoflavones in humans.

Objective: To report our initial IVF-ET experience combining assisted hatching performed 3 days after oocyte retrieval with day 5 embryo transfer (ET)., Design: Retrospective review of 110 consecutive IVF cycles not involving donor oocytes, including 16 cycles that involved assisted hatching performed 3 days after oocyte retrieval in combination with day 5 ET., Setting: Academic teaching hospital IVF center., Patient(s): Eighty-six consecutive IVF patients undergoing ET., Intervention(s): Assisted hatching using acid Tyrode's solution performed 3 days after oocyte retrieval in selected cases in combination with day 3 or 5 ETs., Main Outcome Measure(s): Clinical pregnancy rate per ET., Result(s): Of the 16 women undergoing day 5 ET following day 3 assisted hatching, 14 had a clinical pregnancy. These included 11 ongoing/delivered singletons and 2 ongoing/delivered twin pregnancies, neither of which was monochorionic. These clinical and ongoing/delivered pregnancy rates compared very favorably with those of 54% and 46%, respectively, for the 35 patients undergoing day 5 ETs without assisted hatching, even though the latter group appeared to be better IVF candidates based on the prognostic factors commonly used to predict success., Conclusion(s): Our experience suggests that day 3 assisted hatching followed by day 5 ET may be a useful combination in selected patients. Although not seen in our small series, an increased risk of monochorionic pregnancies remains a theoretical concern when such a combination is used, since both assisted hatching and blastocyst transfers have been independently linked to an increased risk in some reports.

Objective: To report a laparoscopic technique for placement of a transabdominal cervicoisthmic cerclage., Design: Detailed case report of one of three patients undergoing described procedure., Setting: University hospital., Patient: A 39-year-old infertile patient with a history of cervical adenocarcinoma in situ and two cone biopsies, resulting in an essentially absent exocervix., Intervention(s): Laparoscopic transabdominal cervicoisthmic cerclage placement, as an interval procedure, followed by ET of cryopreserved donor oocyte-derived embryos., Main Outcome Measure(s): Clinical outcome., Result(s): Establishment of a pregnancy delivered at 38 1/2 weeks of gestation by elective cesarean section., Conclusion(s): Patients believed to require a transabdominal cerclage may undergo a laparoscopic interval procedure, obviating the need for a laparotomy before or during pregnancy.

Objective: To report the successful use of recombinant human FSH in a patient with a history of a severe systemic immunoglobulin E (IgE)-mediated reaction to urofollitropin., Setting: University hospital., Patient: A 38-year-old infertility patient who had experienced a whole-body rash with hives, tachycardia, fever, and other symptoms after urofollitropin administration, with confirmation of IgE-mediated sensitivity to urofollitropin by intradermal skin testing., Intervention: In vitro fertilization-ET after the use of recombinant human FSH to stimulate ovarian follicular development., Results: Establishment of a clinical pregnancy., Conclusions: Our case provides evidence for the involvement of nongonadotropin proteins as the direct cause of some adverse reactions from conventional urine-derived human FSH preparations.

Objective: To report an unusual presentation of a patient with unicornuate uterus and a noncommunicating functional rudimentary horn and discuss related patient management issues., Setting: University hospital., Patient: A 27-year-old woman who presented with cyclic abdominal pain after a postpartum tubal ligation., Intervention: Diagnostic studies followed by a laparotomy and resection of the rudimentary horn., Results: Resolution of patient's symptoms., Conclusions: Patients with a unicornuate uterus and a rudimentary horn recognized for the first time during a tubal ligation require individualized management depending in part on the precise nature of the horn.

Objective: To compare the efficacy of a globulin-containing protein source, Synthetic Serum Substitute (Irvine Scientific, Santa Ana, CA) and human serum albumin (HSA) in the early culture of human oocytes and embryos., Design: Oocytes from 31 consecutive IVF cycles were assigned alternately to dishes containing human tubal fluid (HTF) and either Synthetic Serum Substitute or HSA as the protein source. Each semen sample was split for processing in Synthetic Serum Substitute or HSA. Sperm processed in Synthetic Serum Substitute was added to oocytes cultured in Synthetic Serum Substitute, and sperm processed in HSA was added to oocytes cultured in HSA. After determination of fertilization, zygotes were placed in HTF containing the same protein supplement. Before transfer, the embryos were graded morphologically., Main Outcome Measures: Occurrence of normal fertilization and embryo quality as assessed by morphological grading., Results: There was no significant difference in the occurrence of fertilization or in embryo morphological quality between oocytes cultured in Synthetic Serum Substitute as compared with HSA., Conclusions: The use of a globulin-containing protein source in culture for IVF-ET did not improve the fertilization rate or embryo quality. Our design did not allow for demonstration of an effect on pregnancy rate.

Objective: To present the experience of a large referral center with patients with the rare but specific syndrome of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis., Design, Patients: Between 1953 and 1991, 15 patients with the syndrome were evaluated by the authors; each patient's records were carefully reviewed., Main Outcome Measures: For each patient, the clinical course, specific anatomic findings, treatment(s) offered, and obstetrical outcome are presented., Results: The specificity of the association of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis was confirmed by our series, the largest in the literature to date. The findings suggest a specific development anomaly of the müllerian ductal system, probably secondary to a wolffian duct anomaly. The most common clinical presentation was that of the onset of pelvic pain and/or dysmenorrhea shortly after menarche, in association with the finding of a vaginal/pelvic mass. When a communication between the two sides existed, symptoms of abnormal vaginal discharge and bleeding were common. Optimal outcome appears to have occurred for patients initially managed using a conservative surgical approach, i.e., simple vaginal septum resection combined with conservative treatment of associated endometriosis. Obstetrical outcome in our patients was similar to that in patients with the more common combination of uterus didelphys and sagittal vaginal septum., Conclusion: A greater awareness of the syndrome of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis should lead to its prompt diagnosis, allowing for early and appropriate surgical intervention as well as decreased long-term morbidity.

Objective: To study the effect of human follicular fluid (FF) and the specific contribution of its epidermal growth factor (EGF) component on the in vitro maturation of cumulus-enclosed mouse oocytes., Design: A previously described mouse oocyte model system was used to study the effect of FF on oocyte maturation before and after extraction of EGF by immunoprecipitation. Follicular fluid specimens enclosing both mature and immature human oocytes were tested., Main Outcome Measures: The endpoints assessed were the percentage of oocytes undergoing germinal vesicle breakdown (GVBD) and polar body one formation at different intervals over a 24-hour period and the final degree of cumulus expansion achieved., Results: A concentration-related stimulatory effect of mature FF was noted when compared with the spontaneous increase of GVBD and polar body one formation observed for the EGF-free control medium. Overall, the effect of immature FF was inhibitory. After extraction of EGF from FF by immunoprecipitation from both immature and mature FF, the rates of GVBD and polar body one formation were decreased in both groups. The addition of 5 ng/mL of EGF to the extracted groups reversed this effect on polar body one formation. Cumulus expansion was maximal for oocytes incubated with mature FF and minimal for those incubated with EGF-free media., Conclusions: The positive effect of mature human FF on mouse oocyte maturation and cumulus expansion is to a large extent because of the presence of EGF.

We describe the first successful outcome of a case of combined tubal and intrauterine quadruplet pregnancy in the literature. The patient's risk factors for combined pregnancy included a history of PID as well as the use of hMG therapy. A laparoscopic salpingectomy was performed, followed by a multifetal pregnancy reduction procedure. Two healthy infants were delivered at 37 weeks of gestation.

Objective: Immature mammalian oocytes cultured in vitro undergo inadequate cytoplasmic maturation and hence have a limited potential for fertilization. Our primary objective was to determine if the addition of epidermal growth factor (EGF) to the in vitro culture system would have a positive effect on oocyte cytoplasmic maturation., Design: We studied the effect of different EGF concentrations on both denuded and cumulus-enclosed mouse oocytes cultured in vitro., Main Outcome Measures: The percentage of oocytes undergoing germinal vesicle breakdown (GVBD) and polar body one formation over time as a function of EGF concentration was determined., Results: A dose-related positive effect of EGF on both GVBD and polar body one formation over time was observed for mouse oocytes. As well, a similar effect of EGF was seen on immature human oocytes that had not been stimulated with exogenous gonadotropins., Conclusions: The use of EGF may allow for the performance of successful in vitro fertilization procedures using immature human oocytes retrieved during unstimulated cycles.

Nicotine at concentrations found in the cervical mucus of female smokers appeared to enhance in vitro human sperm penetrability through ovulatory bovine cervical mucus. Sperm motility parameters were not affected by the addition of nicotine to semen samples incubated with BWW medium. Overall, these results suggest that a direct inhibitory effect of nicotine on sperm penetrability through cervical mucus is not responsible for the apparent increase in cervical factor infertility present in smoking women.

Smoking histories were compared in 901 women with infertility of different types and 1264 women admitted for delivery at seven collaborating hospitals. The relative risk for infertility associated with cigarette smoking prior to the infertility diagnosis for nulliparous cases or first live birth for controls was calculated using a multivariate logistic-regression model to control for potential confounding factors, including center, age, religion, education, number of sexual partners, and contraceptive use. The adjusted risk for infertility attributed primarily to cervical factor (n = 96) was 1.7 (P = 0.04), to tubal disease unrelated to endometriosis (n = 225) was 1.6 (P = 0.009), to ovulatory factor (n = 389) was 1.0 (not significant [NS]), and to endometriosis (n = 191) was 0.9 (NS). The authors conclude that cigarette smoking is significantly associated only with certain types of primary female infertility.