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Our objective was to assess the role of laparoscopic removal of ovarian endometriomas and ablation of peritoneal endometriosis on the outcome of intracytoplasmic sperm injection (ICSI) - Embryo Transfer cycles by comparing with the results of patients with untreated endometriomas and tubal factor without underlying endometriosis confirmed by laparoscopy. For this purpose, between 2002 and 2015, outcomes of 257 ICSI cycles of 150 patients, including 91 cycles of 48 patients in minimal endometriosis, 57 cycles of 25 patients in endometrioma removal, 65 cycles of 53 patients in non-operated endometrioma, and 44 cycles of 24 patients in tubal factor groups were retrospectively analyzed. Basal ovarian reserve was significantly lower, mean starting and total gonadotropin consumption was significantly higher, and mean serum E2 on the day of hCG injection, number of dominant follicles, number of retrieved total, and MII oocytes were all significantly lower in the endometrioma cystectomy group. Fertilization and embryo cleavage rates were also significantly the lowest in the endometrioma cystectomy group, whereas clinical pregnancy and live birth rates were comparable among all groups. The number of transferred embryos and duration of infertility were the most significant predictors of clinical pregnancy and live birth. Basal antral follicle count was also significant in predicting live birth. [ABSTRACT FROM PUBLISHER]

standard GnRH antagonist protocol in poor ovarian responders (PORs) in terms of the outcomes of in vitro fertilization (IVF) treatment Materials and methods: IVF outcomes of 265 cycles in 265 patients (106 in the LPP group, 159 in the standard GnRH antagonist group) were evaluated retrospectively. Results: Mean length of stimulation (11.4 ± 2.7 vs. 10.0 ± 2.7 days; P < 0.05) and the total gonadotropin dose (3403 ± 1060 vs. 2984 ± 1112) used were significantly greater in the LPP group than in the standard GnRH antagonist protocol group. The mean number of oocytes retrieved (3.5 ± 2.6 vs. 3.7 ± 2.8), the number of mature oocytes (2.8 ± 2.2 vs. 2.6 ± 2.2), fertilization rates (65% vs. 62%), the number of embryos transferred (1.6 ± 0.6 vs. 1.7 ± 0.6), and implantation rates (16% vs. 13%) were similar. The cancellation rate did not significantly differ between the groups (9.4% vs. 13.2%). There were no significant differences in the clinical pregnancy (11.3% vs. 13.2%) or live birth rates per patient (3.8% vs. 9.4%) and clinical pregnancy (18.8% vs. 22.6%) or live birth rates per embryo transfer (6.3% vs. 12.9%) between the groups. Conclusion: LPP does not improve IVF outcomes when compared with the standard GnRH antagonist protocol in PORs. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of sperm morphology on success of intrauterine insemination (IUI) in unexplained and male subfertility.Study Design: Basal and post-wash normal percentage of sperm with normal morphology was assessed prospectively in 412 couples with 530 IUI cycles who underwent ovarian hyperstimulation with gonadotropins. The primary outcome was live birth per cycle. Receiver operating characteristics (ROC) curves were used to determine the effectiveness of sperm morphology to predict live birth in IUI cycles.Results: Normal sperm morphology (%) after preparation was higher in patients with live birth (5.4 ± 4.5 vs 4.3 ± 4.1; respectively, p<.05) in study population. In male subfertile group, normal sperm morphology before and after sperm preparation was higher in patients with live birth (1.3 ± 1.4 vs 0.6 ± 0.9; p<0.001 and 4.6 ± 4.4 vs 1.9 ± 2.2; p<0.01, respectively). However, both basal and post-wash normal sperm morphology (%) were similar in patients with and without live birth in unexplained group. The best cut-off value for normal sperm morphology (%) to predict live birth was 4.5% in male subfertile group with a sensitivity of 50.6% and specificity of 61.7%.Conclusion: Morphological evaluation is not a reliable parameter alone for predicting pregnancy outcome in unexplained infertility. In male subfertility, post-wash normal sperm morphology percentage higher than 4.5 increases the probability of live birth. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the effect of luteal phase support on clinical pregnancy and live birth rates after ovulation induction and intrauterine insemination (IUI). Methods: 579 cycles from 2010 to 2013 were retrospectively evaluated. Ovarian stimulation was performed with gonadotropins, and rHCG was used for ovulation triggering. All patients received IUI. 451 cycles were supported by receiving vaginal micronized progesterone capsules (142 cycles) or vaginal progesterone gel (309 cycles) whereas 128 cycles were not supported. Results: Clinical pregnancy (20.6 versus 9.4%; p = 0.004) and live birth rates (14 versus 7%; p = 0.036) were higher for supported group than for unsupported group. Progesterone gel and micronized progesterone subgroups achieved similar clinical pregnancy and live birth rates (21.4 versus 19%, p = 0.567 and 14.2 versus 13.4%, p = 0.807; respectively). Conclusions: Luteal phase support improved the success of IUI cycles affecting both clinical pregnancy and live birth rates when gonadotropins were used for ovulation induction. The use of vaginal progesterone gel or micronized progesterone significantly improves clinical pregnancy rates. The live birth rates were higher in the progesterone gel group, but were similar in the micronized progesterone group compared to the unsupported group. 目的：研究旨在评估促排卵和宫腔内人工授精（IUI）后黄体支持对临床妊娠率和活产率的影响。 方法：回顾分析2010至2013年的579个周期。均使用促性腺激素促卵泡发育，rHCG触发排卵，所有病人接受IUI。451个周期有黄体支持，其中142个周期使用阴道微粒化黄体酮，309个周期使用阴道黄体酮凝胶，128个周期无黄体支持。 结果：黄体支持组临床妊娠率(20.6% vs 9.4%，p=0.004)及活产率(14% vs 7%，P=0.036)均高于无黄体支持组。黄体酮凝胶组和微粒化黄体酮组的临床妊娠率(21.4% vs19%, p=0.567)和活产率(14.2%vs 13.4%, p=0.807)相似。 结论：如使用促性腺激素促排卵，黄体支持将通过影响临床妊娠率和活产率提高IUI的成功率。使用阴道黄体酮凝胶和微粒化黄体酮显著提高临床妊娠率。与无黄体支持组相比，黄体酮凝胶组的活产率稍高一些，但与微粒化黄体酮组相似。 [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy of gradient and swim-up semen preparation techniques on pregnancy rates in couples undergoing intrauterine insemination (IUI) cycles with low dose gonadotropin stimulation with the diagnosis of unexplained or mild male subfertility. Methods: Two hundred and twenty three couples were randomized into swim up or gradient technique groups for sperm preperation. The clinical and on going pregnancy rates per cycle and per patient were evaluated. Results: Both clinical and ongoing pregnancy rates per cycle were significantly higher in the 'gradient' group (19 % and 16.9 %) in comparision with the 'swim up' group (9.7 % and 6.9 %) ( p < 0.05). Clinical pregnancy and on-going pregnancy rates per patient were higher in the 'gradient' group (26.1 % and 23.4 %) when compared to the 'swim up' group (15.2 % and 10.7 %), ( p < 0.05). In the subgroup of 191 unexplained subfertile couples with 290 cycles; the 'gradient' group also revealed significantly higher clinical and ongoing pregnancy rates per cycle (21.6 % and 17.9 %) when compared with the 'swim up' group (10.3 % and 7.1 %) ( p < 0.05). In total of 48 treatment cycles upon 32 couples with mild male factor subfertility no significant difference were found between the two sperm preparation techniques in terms of clinical (% 5.3 vs %6.9, p > 0.05) and ongoing (% 5.3 vs %6.9, p > 0.05) pregnancy rates per cycle. Conclusion: The gradient technique significantly improves clinical outcome in IUI cycles of unexplained subfertile couples when compared to swim up technique. In male subfertile patients, both techniques yield similar clinical outcomes. [ABSTRACT FROM AUTHOR]

In this study, our objective was to determine the effect of adding estradiol hemihydrate (E2) to progestin (P) for luteal phase support on pregnancy outcome in in vitro fertilization (IVF) cycles with poor response to gonadotropins. Ninety-five women with poor ovarian response who underwent controlled ovarian hyperstimulation (COH) with gonadotropin releasing hormone (GnRH) agonist or GnRH antagonist plus gonadotropin protocol for IVF were prospectively randomized into three groups of luteal phase support after oocyte retrieval. Group 1 ( n = 33) received only intravaginal progesterone gel (Crinone 8% gel). Group 2 ( n = 27) and Group 3 ( n = 35) received intravaginal progesterone plus oral 2 and 6 mg estradiol hemihydrate, respectively. Main outcome measures were overall and clinical pregnancy rates (PRs) per patient. Serum LH, E2 and P levels at 7th and 14th days of luteal phase were also measured. Overall and clinical PRs were significantly higher in 2 mg E2 + P than P-only group (44% versus 18% and 37% versus 12.1%, respectively). There were no statistically significant differences between 6 mg E2 + P versus P-only and 2 mg E2 + P versus 6 mg E2 + P groups regarding PRs. Addition of 2 mg/day E2 in addition to P for luteal support significantly increase overall and clinical PRs in cycles with poor response to gonadotropins after IVF. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of luteal phase support on pregnancy rates in ovarian stimulation and intrauterine insemination (IUI) cycles with gonadotropins in couples with unexplained infertility. Design: Prospective randomized controlled trial. Setting: University-based infertility clinic. Patient(s): Two hundred fourteen couples with unexplained infertility who were treated during 427 ovarian stimulation and IUI cycles with recombinant FSH. Intervention(s): Patients underwent ovarian stimulation with recombinant FSH combined with IUI. Patients randomized into the study group (n = 109) received luteal phase support in the form of vaginal progesterone gel (Crinone 8% gel). Patients randomized into the control group (n = 105) received no luteal phase support. Main Outcome Measure(s): Clinical pregnancy and live birth rate per cycle and per patient. Result(s): Demographic data were found to be homogeneous between the study and control groups. Clinical pregnancy rates per cycle and per patient were significantly higher in the study group (21.1% and 39.4%, respectively) compared with the control group (12.7% and 23.8%, respectively). Live birth rate per cycle and per patient was also significantly higher in patients with luteal support (17.4% and 35.8%, respectively) compared with control subjects (9.3% and 18.1%, respectively). Conclusion(s): Luteal phase support with vaginal progesterone gel significantly affects the success of ovarian stimulation and IUI cycles in patients with unexplained infertility. [Copyright &y& Elsevier]

The objective of this cross-sectional study was to identify the prognostic factors that influence the outcome of ovarian stimulation with intrauterine insemination (IUI) cycles using gonadotrophins in couples with unexplained and mild malefactor subfertility. A total of 838 cycles in 456 women with unexplained and mild male-factor subfertility attending a university-based infertility clinic was evaluated. Of these cycles, 139 resulted in pregnancy (16.6% per cycle) and 96 out of 98 ongoing pregnancies resulted in live term birth. Live birth rate per patient and per cycle was 21.1% and 11.4%, respectively. Multivariate logistic regression analysis demonstrated that duration of infertility (P = 0.034), type of infertility (P = 0,003), aetiology of infertility (P = 0.004). number of treatment cycles (P = 0.0001) and number of dominant follicles before human chorionic gonadotrophin (HCG; P = 0.024) were significant independent factors to predict clinical pregnancy. The duration of infertility (P = 0.043), number of treatment cycles (P = 0,0001) and number of dominant follicles before HCG (P = 0,024) were significant independent factors to predict live birth. In conclusion, for subfertile couples having shorter duration of subfertility, multifollicular response to gonadotrophins and in their first treatment cycle are more likely to succeed a live birth with IUI treatment using recombinant gonadotrophins. [ABSTRACT FROM AUTHOR]