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Purpose: To assess the effects of letrozole or tamoxifen coadministration on fertility preservation treatment outcomes., Methods: Retrospective cohort study of 118 breast cancer patients undergoing fertility preservation treatment between 2008 and 2018. Patients who received letrozole (n = 36) or tamoxifen (n = 30) were compared to controls (n = 52) who underwent standard ovarian stimulation protocols. The primary outcome measures included the number of retrieved oocytes, mature oocytes (MII), fertilization, and top-quality embryo rates. The secondary outcome measures included duration of stimulation, gonadotropin dose and peak estradiol level., Results: The number of oocytes retrieved, MII oocytes, fertilization rate, duration of stimulation, or gonadotropin dose were similar in the letrozole and tamoxifen groups, compared to controls. Top-quality embryo rate was lower in the tamoxifen group compared to controls (25% vs 39.4%, respectively, P = 0.034). The abnormal fertilization rate was higher in the letrozole group compared to controls (7.8% vs 3.60%, respectively, P = 0.015). A stepwise logistic regression analysis revealed that letrozole and peak estradiol were significantly associated with abnormal fertilization (OR 11.94; 95% CI 2.35-60.4, P = 0.003 for letrozole and OR 1.075; 95% CI 1.024-1.12, P = 0.004 per 100 unit change in estradiol)., Conclusions: There may be a negative effect of letrozole or tamoxifen on fertilization and embryo quality, in fertility preservation cycles. Further studies are needed to confirm these findings.

Objective: To evaluate the efficacy of sclerotherapy for ovarian endometrioma on the risk of recurrence, clinical symptoms, and reproductive function., Design: Systematic review and meta-analysis., Setting: Not applicable., Patient(s): Patients who underwent sclerotherapy of ovarian endometrioma., Intervention(s): An electronic-based search with the use of Pubmed, Embase, Ovid Medline, Google Scholar, Clinicaltrials.gov, and the Cochrane Central Register of Controlled Trials., Main Outcome Measure(s): Recurrence rate, symptoms relief, fertility outcome, and adverse events., Result(s): Eighteen studies were included in our review. The overall recurrence rates of endometrioma after sclerotherapy ranged from 0 to 62.5%. The risk of recurrence was significantly higher in women who were treated by means of ethanol washing than by means of ethanol retention. The number of oocytes retrieved was higher after endometrioma sclerotherapy compared with laparoscopic cystectomy, but clinical pregnancy rates were similar. There was no difference in the number of oocytes retrieved and the clinical pregnancy rates between the sclerotherapy-treated group with and the untreated group., Conclusion(s): Sclerotherapy for ovarian endometrioma may be considered in symptomatic women who plan to conceive., (Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Study Question: What is the association between the ovarian response and the number of CGG repeats among full mutation and premutation carriers of fragile X (FMR1), undergoing controlled ovarian hyperstimulation (COH) for PGD?, Summary Answer: Ovarian response was normal in full mutation patients but decreased in premutation carriers, although the number of repeats was not statistically significantly associated with the number of oocytes retrieved., What Is Known Already: There is inconsistent data in the literature regarding ovarian response in FMR1 carriers. Studies exploring the ovarian response of full mutation patients are lacking., Study Design, Size, Duration: Retrospective study, a university affiliated tertiary hospital, IVF unit, PGD referral center., Participants/materials, Setting, Methods: We examined the medical records of all women undergoing fresh IVF-PGD cycles due to fragile X. Data recorded included demography, duration of stimulation, amount of gonadotropins administered, number of dominant follicles, maximal E2 levels and number of oocytes retrieved. Data were analyzed using univariate and multivariate mixed models. P-values <0.05 were considered significant. Data were collected from the medical records of 21 patients with a full mutation on the FMR1 gene and 51 premutation carriers. Overall 309 fresh cycles were analyzed., Main Results and the Role of Chance: Premutation carriers displayed reduced ovarian response, as demonstrated by fewer oocytes retrieved. In contrast, full mutation patients had a normal response. Comparison of premutation carriers and full mutation patients showed: mean oocytes retrieved per cycle (8.4 ± 1.1 versus 14.1 ± 1.7, P = 0.005), lower levels of estradiol (E2; 1756 ± 177, versus 2928 ± 263, P = 0.0004), respectively. There was no significant difference between premutation carriers and full mutation patients in regard to fertilization rate, cleavage rate or biopsy rate. No correlation was found between the number of repeats in the premutation carriers and the number of oocytes retrieved or E2 levels. Age and the type of protocol were the only factors found to be in correlation with the number of the oocyte retrieved (P = 0.037, and P = 0.003, respectively) among the premutation carriers. Similarly, no association was found between the number of repeats and the fertilization rate, cleavage rate or biopsy rate among premutation carriers., Limitations, Reasons for Caution: We had a relatively low number of premutation carriers with >100 repeats, which made it challenging to draw a firm conclusions from this group., Wider Implications of the Findings: Physicians must address the increased risk for reduced ovarian response and  primary ovarian insufficiency (POI) among carriers and consider surveillance of ovarian reserve markers. The last, might expedite family plans completion or fertility preservation., Study Funding/competing Interest(s): None., (© The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Objective: Our aim was to compare treatment outcome following in vitro maturation (IVM) compared with IVF in patients with polycystic ovarian syndrome (PCOS)., Study Design: Retrospective evaluation of treatment in women with PCOS who underwent IVM (108) and IVF (108)., Results: We found a significant difference in outcome between IVM and IVF, with an increase in the number of mature oocytes derived (10.5 ± 6.5 vs. 15.3 ± 8.8, p<0.0001) and the cleavage rate (92.4 ± 13.0 vs. 95.2 ± 11.7, p=0.03) in IVM cycles. Due to the lower implantation rate (16.1% vs. 21.6%, p=0.07) we tend to transfer more embryos in the IVM group (3.4 ± 0.8 vs. 2.8 ± 1.0, p<0.0001), but the multiple pregnancy rate in that group was not higher. Importantly, the delivery rate was similar in both groups (26.8% vs. 25%). We also report a yearly change in the success rate of IVM during this period., Conclusions: IVM treatment for PCOS patients may be a valid alternative treatment to IVF with the advantage of eliminating the risk of OHSS and reducing the cost of medication, whilst maintaining high clinical pregnancy rate., (Copyright © 2012. Published by Elsevier Ireland Ltd.)

Objective: To compare the treatment outcomes in in vitro maturation (IVM) cycles primed with human menopausal gonadotropin with those for pure IVM cycles in patients with polycystic ovary syndrome., Design: Prospective observational., Setting: University-based tertiary medical center., Patient(s): Patients undergoing IVM cycles (primed IVM, 47; pure IVM, 118)., Intervention(s): IVM treatment with and without human menopausal gonadotropin stimulation., Main Outcome Measure(s): Pregnancy rates., Result(s): The clinical pregnancy rate demonstrated a tendency toward improvement in the primed IVM group (53.1% vs. 43.6%, 20.1% vs. 14.0% and 40.4% vs. 30.8%, [corrected] respectively) with better implantation and delivery rates (20.1% versus 14.4%; 95% confidence intervals 1.0-3.06 and 40.4% versus 24.6%; 95% confidence intervals 0.1-0.8, respectively). We found no significant difference in pure IVM compared with primed IVM in the number of eggs collected, size of leading follicle, fertility rate, cleavage rate, and the number of embryos transferred. Total mature eggs and maturation rate were significantly higher in the group of pure IVM (11 ± 2.1 versus 8.7 ± 0.5 and 68.5% ± 17.5% versus 60.9% ± 0.4%, respectively). Importantly, the endometrial thickness was significantly improved in primed IVM cycles (7.9 ± 1.9 mm versus 7.1 ± 0.8 mm), possibly leading to better implantation and pregnancy rates., Conclusion(s): Patients who fail to demonstrate endometrial or follicular growth during IVM cycles may benefit from gonadotropin priming during the same cycle., (Copyright © 2011. Published by Elsevier Inc.)

Objective: To evaluate the effect of body mass index (BMI) on in vitro maturation (IVM) outcomes in women with polycystic ovaries., Design: Retrospective, cohort study., Setting: Tertiary IVF unit., Patient(s): One hundred thirteen women with polycystic ovaries., Intervention(s): One hundred sixteen cycles of IVM. Patients were divided into subgroups according to their BMI: underweight, normal weight, overweight, obese, and morbidly obese. We evaluated the effects of BMI on the number of oocytes matured in vivo, maturation rate in vitro, fertilization and cleavage rates, number of embryos transferred, implantation rates, pregnancy rates, and delivery rates., Main Outcome Measure(s): Pregnancy rate and delivery rate., Result(s): The number and quality of oocytes among women with different BMIs were similar. There was no significant difference in the endometrial thickness and rates of implantation, pregnancy, and delivery among women with different BMIs. The pregnancy rate in underweight women was 50%, normal weight 47.9%, overweight 29.1%, obese 27.2%, and in morbidly obese women was 30.7%. The miscarriage and delivery rates were also similar., Conclusion(s): The results of IVM are independent of BMI., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

The proportions of good, fair, and poor embryos in 13 women with bilateral endometriomas were compared with those of 39 women without endometriomas and were found to be similar (47.2% vs. 41.1%, 28.3% vs. 32.8%, and 24.3% vs. 26.0%, respectively). Therefore, it appears that the presence of bilateral endometriomas during IVF treatment is not associated with reduced embryo quality., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To produce age-related normograms for serum antimüllerian hormone (AMH) level in infertile women without polycystic ovaries (non-PCO)., Design: Retrospective cohort analysis., Setting: Fifteen academic reproductive centers., Patient(s): A total of 3,871 infertile women., Intervention(s): Blood sampling for AMH level., Main Outcome Measure(s): Serum AMH levels and correlation between age and different percentiles of AMH., Result(s): Age-related normograms for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles of AMH were produced. We found that the curves of AMH by age for the 3rd to 50th percentiles fit the model and appearance of linear relation, whereas the curves of >75th percentiles fit cubic relation. There were significant differences in AMH and FSH levels and in antral follicle count (AFC) among women aged 24-33 years, 34-38 years, and ≥39 years. Multivariate stepwise linear regression analysis of FSH, age, AFC, and the type of AMH kit as predictors of AMH level shows that all variables are independently associated with AMH level, in the following order: AFC, FSH, type of AMH kit, and age., Conclusion(s): Age-related normograms in non-PCO infertile women for the 3rd to 97th percentiles were produced. These normograms could provide a reference guide for the clinician to consult women with infertility. However, future validation with longitudinal data is still needed., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate whether there is additional value for saline instillation sonohysterography (SIS) as a routine screening tool when baseline transvaginal sonography (TVS) is normal., Methods: Two-hundred ninety four infertility patients underwent baseline TVS and were categorised according to the results. TVS findings were negative in study group (n = 124) and positive (any abnormalities) in control group (n = 170). All the patients were further investigated by SIS. Hysteroscopy was performed whenever SIS results were suspicious. Our main outcome measure was accuracy of SIS in detecting intracavitary lesions using pathology reports as gold standard., Results: In the study group, out of 124 SIS tests, 13 (10.4%) showed positive findings and were further investigated by hysteroscopy. Three out of the 13 (23.0%) had subsequent positive hysteroscopy findings, however, no (0.0%) abnormality was found on pathologic examination. In the control group, out of 170 SIS tests, 62 (36.4%) showed positive findings, and were further investigated by hysteroscopy. Forty-two cases out of the 62 (67.7%) had subsequent positive hysteroscopic findings. Pathological examination was positive in 35 out of the 42 (83.3%) positive hysteroscopies., Conclusion: Routine SIS for patients with normal TVS did not contribute additional findings. However, in patients with any suspicious findings on TVS (including extracavitary lesions), SIS was beneficial.

Objective: To evaluate the association between endometrial injury, implantation and pregnancy rate., Design: We performed a literature search using the keywords endometrial injury, local endometrial injury, endometrial biopsy, endometrial receptivity, implantation, in vitro fertilization, and implantation failure and conducted the search in Medline, EMBASE, and Cochrane Database of systematic reviews., Setting: None., Patient(s): None., Intervention(s): None., Main Outcome Measure(s): None., Result(s): Clinical and basic science data regarding the association between endometrial injury and improved implantation rate are limited. However, current evidence suggests that endometrial injury before IVF among women with previous repeated IVF failure is associated with increased rates of implantation, clinical pregnancy, and live birth., Conclusion(s): Endometrial injury may have a beneficial role in implantation and improve the pregnancy rate. However, there are still many unanswered question including patients selection, timing, technique and number of endometrial biopsies needed., (Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To assess ovarian response among carriers of FMR1 premutation who undergo preimplantation genetic diagnosis (PGD)., Design: Retrospective study., Setting: Academic IVF unit., Patient(s): Of 18 carriers of FMR1 premutation referred to PGD, eight had <100 CGG repeats and ten had >or=100 CGG repeats., Intervention(s): Controlled ovarian stimulation (COH) and PGD., Main Outcome Measure(s): Correlation between the number of CGG repeats and the level of E2 at day of hCG administration, number of retrieved oocytes, number of two-pronuclear (2PN) zygotes, and dose of recombinant FSH., Result(s): There was a positive correlation between CGG repeats and the level of E2 at day of hCG administration, number of retrieved oocytes, and number of 2PN zygotes. There was a negative correlation between number of CGG repeats and the total dose of gonadotropins. The E2 level and the number of retrieved oocytes and 2PN zygotes were significantly higher and the dose of gonadotropins significantly lower for premutation patients with >or=100 CGG repeats compared with <100 CGG repeats., Conclusion(s): There is a positive correlation between E2 level, retrieved oocytes, 2PN zygotes, and number of CGG repeats. Premutation carriers with <100 CGG repeats suffer from impaired ovarian response and decreased fertilization rate., (Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To test whether the follicular fluid (FF) concentration of anti-Mullerian hormone (AMH) is associated with oocyte maturation, fertilization rate, and embryonic development in patients with polycystic ovary syndrome (PCOS) undergoing IVF., Design: Prospective., Setting: Academic assisted reproductive technology program., Patient(s): Twenty-two samples of FF from 11 patients with PCOS who underwent IVF/ET were analyzed for AMH levels (group A). Twelve women with normal ovulatory cycles served as a control group (group B). The oocytes and preembryos were closely followed until ET., Method(s): FF was obtained at oocyte retrieval for IVF/intracytoplasmic sperm injection. AMH levels were studied using immunoenzymometric assay., Intervention(s): None., Main Outcome Measure(s): FF, AMH levels, oocyte maturation, fertility rate, and embryonic cleavage rate., Result(s): The mean FF AMH level was 57.3 +/- 79.5 pmol/mL in group A, compared with 70 +/- 120.14 pmol/mL in group B. In group A, the mean AMH level of good-quality embryos was 37.4 +/- 23.4 pmol/mL, compared with 61.9 +/- 102 pmol/mL in a the poor-quality subgroup. No significant correlation was observed between FF AMH levels and oocyte maturation, fertilization, or cleavage rate., Conclusion(s): This study suggests that there is an association between FF AMH levels and the quality of embryos in patients with PCOS. However, owing to large variance and the number of participants, no statistical significance was reached. The degree of maturation of retrieved oocytes, as well as the success of fertilization, was not found to correlate with FF AMH., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the outcome of ovarian stimulation and in vitro fertilization (IVF) in women undergoing fertility preservation prior to chemotherapy compared with healthy patients with infertility due to tubal factor., Study Design: Case control, retrospective study in an academic IVF unit. The study participants were 21 cancer patients and 1 patient with focal proliferative glomerulosclerosis, undergoing emergency IVF or intracytoplasmic sperm injection (ICSI; Group A) and 22 patients undergoing IVF for tubal factor (Group B). All patients underwent controlled ovarian stimulation, ovum pick-up, and embryo freezing or transfer. The outcome measures included: dose of gonadotropins, mean estradiol and progesterone levels, length of stimulation, number of retrieved oocytes, number of 2 pronuclei zygotes, fertilization rate, and clinical pregnancy rate. Student's t-test was used for assessment of group comparisons., Results: Patients in Group A (mean age 32.8+/-5.7 years) underwent 22 emergency IVF cycles for fertility preservation prior to chemotherapy. The mean number of days until human chorionic gonadotropin administration was 10.4+/-4.8. Eleven cycles involved normal insemination while nine involved ICSI. In one cycle three arrested immature oocytes were retrieved, and in one cycle no oocytes were retrieved. Donor sperm was used in 9 cycles. Tamoxifen was part of the treatment protocol in 6 IVF cycles of breast cancer patients. The mean age of the women in Group B was 34+/-4.2 years. There were no significant differences in any of the main outcome measures between the two groups. Thawed embryos were transferred in four cancer patients: two patients had colon cancer, one had breast cancer and one had pseudomyxoma peritonei. Two of these four women conceived and gave birth to healthy newborns., Conclusions: Emergency IVF is a promising approach for preserving fertility in cancer patients. Current treatment protocols offer a minimal time delay until chemotherapy is commenced, and the ovarian stimulation outcomes are comparable to those of women with tubal factor., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

Objective: To describe isolation and in vitro maturation of primary oocytes from the ovarian cortex in the presence of hypothalamic pituitary down-regulation., Design: Case report., Setting: Tertiary care university-affiliated hospital., Patient(s): An 18-year-old patient was given treatment with the ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine) protocol for Hodgkin's disease. She underwent ovarian tissue cryopreservation while being cotreated with GnRH agonist because of disease relapse., Intervention(s): Laparoscopic oophorectomy, ovarian tissue cryopreservation, and in vitro maturation of primary oocytes., Main Outcome Measure(s): Maturation of primary oocytes isolated from the medium used for preparation of ovarian tissue., Result(s): Twenty-one immature germinal vesicle-stage oocytes were isolated from the medium of dissection. All were incubated in in vitro maturation medium, and five were maturated and frozen., Conclusion(s): The fact that germinal vesicle-stage oocytes were present in our patient's medium despite hormonal down-regulation demonstrates that GnRH agonist does not completely inhibit antral follicle development.