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The aim of this study was to evaluate the effects of tubal ligation (TL) via modified Pomeroy method on ovarian reserve and to determine the role of curcumin (Curcuma longa [Indian saffron]) against ovarian reserve decrement after TL. Forty-eight albino Wistar rats were randomly divided into four groups: (1) Control group: a sham operation was performed (n = 12), (2) Tubal ligation group: TL was performed (n = 12), (3) TL+DMSO group: 1 mL/day dimethyl sulfoxide was used for 50 days after TL, (4) TL+Curc group: 100 mg/kg/day curcumin dissolved in DMSO was administrated for 50 days after TL. Pre-operatively and on post-operative day 50, blood samples were collected for AMH evaluation, and oophorectomy was performed for histological and immunohistochemical examinations of ovaries in all groups. No difference in the basal AMH levels was found among the groups (p = 0.249). Compared to the basal, AMH levels were lower in the control, TL, and TL+DMSO groups (p = 0.003, p = 0.004, and p < 0.001, respectively) but not different in the TL+Curc group (p = 0.503) on post-operative day 50. No significant differences in the number of primary, preantral, antral, atretic follicles, and corpus luteum among the groups (p > 0.05) were found. The percentage of granulosa cells stained for caspase-3 in antral follicles and the corpus luteum was higher in the TL+Curc group than in the control and TL groups ([antral follicles; p < 0.01 for both groups], [corpus leteum; p = 0.009 and 0.002 for the control and TL groups, respectively]). It seems that TL does not decrease ovarian reserve and curcumin might have a positive effect on ovarian reserve in the setting of TL., (© 2021. Society for Reproductive Investigation.)

Background/aim: To evaluate the effects of hysterectomy on rat ovaries and the possible protective role of peroxisome proliferator- activated receptor gamma (PPAR-γ) agonist-rosiglitazone against ovarian reserve decrement., Materials and Methods: Forty-five adult Wistar albino rats were randomly divided into three groups. Hysterectomy was performed (n = 15) in group 1 [H]; 1 mg/kg/day PPAR-γ agonist/rosiglitazone was used for 50 days after hysterectomy (n = 15) in group 2 [H + R]; a sham operation was performed (n = 15) in group 3 [control, C]. Blood samples were collected for anti-Müllerian hormone (AMH) evaluation in all groups and simultaneous ovarian Doppler examination was performed in [H] and [H + R] groups before and after (50 days) hysterectomy. All animals were sacrificed to obtain ovaries for histological examination., Results: AMH levels were found to be significantly decreased at postoperative day 50 in all groups (P < 0.05). Histopathologic analysis showed that primary, preantral, and antral follicle counts were significantly higher in the [H] group as compared to the [C] and [H + R] groups (P < 0.05). There was no significant difference between the [C] and [H + R] groups in terms of follicle numbers (P > 0.05). In the ovarian Doppler blood flow analysis, all parameters were significantly decreased in group [H] (P < 0.05), but not in the [H + R] group (P > 0.05) on postoperative day 50., Conclusion: Hysterectomy affects the histopathological structure of rat ovaries and PPAR-γ agonist-rosiglitazone improves the ovarian Doppler blood flow parameters., Competing Interests: The authors declare that there is no conflict of interest., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background/aim: Diminished ovarian reserve (DOR) represents a major challenge in reproductive medicine, as it is often associated with poor ovarian stimulation response, high cycle cancellation rate, and low pregnancy rate. The aim of the present study is to compare the clinical pregnancy rates in intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles in patients with different DOR etiologies., Materials and Methods: Patient data were recorded with a computer-based program called Success Estimation Using a Ranking Algorithm (SERA). Overall, 459 patients were divided into 3 groups according to their DOR etiologies (Group A: idiopathic, n = 81; Group B: age-related, n = 294; Group C: previous ovarian surgery, n = 84)., Results: Out of 459 stimulation cycles, 378 (82.4%) reached the oocyte retrieval stage, while 201 (43.8%) had embryo transfers. There was no significant difference between the patients with different DOR etiologies in terms of embryo transfer and cycle cancellation rate. The patients who had embryo transfer were 44 (52.4%) in Group A, 38 (46.9%) in Group B, and 119 (40.5%) in Group C. There were no significant differences between the three groups (P = 0.114). The percentages of women who had oocyte retrieval were 84.5% in Group A, 70% in Group B, and 80.3% in Group C (P = 0.104). While clinical pregnancy per transfer was 35.8% in Group A, 19.8% in Group B, and 29.5% in Group C, there was no statistically significant difference between the groups (P = 0.113), Conclusion: Although ovulation induction and ICSI-ET outcomes, including clinical pregnancy and live birth rates, were not significantly different with regards to the etiology of DOR, young women with DOR may benefit from assisted reproductive techniques., (This work is licensed under a Creative Commons Attribution 4.0 International License)

Study Objective: To evaluate the short-term changes in ovarian reserve markers after laparoscopic cystectomy performed for endometriotic and nonendometriotic cysts., Design: Prospective case-control study (Canadian Task Force classification II-2)., Setting: The Reproductive Endocrinology Clinic of a training and research hospital., Patients: Thirty-four women with endometrioma ≥ 4 mm (group 1) and 33 women with nonendometriotic cysts of matched size (group 2) who underwent surgery during the same period., Interventions: The follicular phase follicle-stimulating hormone (FSH), estradiol (E2), and antimüllerian hormone (AMH) levels and the antral follicle count (AFC) of both groups were analyzed preoperatively and 2 months after laparoscopic cystectomy. The pre- and postoperative values were compared within the same group and between the 2 groups., Measurement and Main Results: Preoperative FSH and E2 levels were similar in both groups. However, preoperative AMH levels and AFC were significantly lower in group 1 (endometrioma) compared with group 2 (nonendometrioma; p = .004 and p = .025, respectively). In both groups there was a significant decrease in the AMH levels after surgery (3.1 ± 1.9 ng/mL to 2.5 ± 1.6 ng/mL, p < .001, and 5.7 ± 3.7 ng/mL to 4.8 ± 3.3 ng/mL, p = .04). AMH levels exhibited a significant decrease in the unilateral and bilateral endometrioma groups after cystectomy (p < .001 and p = .025, respectively). However, preoperative and postoperative changes in AMH and AFC were similar in groups 1 and 2 for both unilateral and bilateral cysts (p = .586 and p = .267)., Conclusion: Preoperative AMH and AFC levels are lower in both unilateral and bilateral endometriomas compared with nonendometriotic cysts. The AMH levels decreased after cystectomy in both endometriotic and nonendometriotic cysts. However, in the short-term period the amount of change in ovarian reserve tests in both unilateral and bilateral cysts was similar for both endometrioma and nonendometriotic cysts., (Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.)

Study Objective: In women with adnexal torsion, there is an absence of data whether ovarian reserve is affected when treated by detorsion and conservative surgery. We aimed to evaluate ovarian reserve by counting the antral follicles and estimating the ovarian volume in the operated side compared with the contralateral ovary., Design: A case-control study (Canadian Task Force classification II-2)., Setting: In vitro fertilization center, Hacettepe University Faculty of Medicine and Etlik Zubeyde Hanim Women's Health and Research Hospital, Ankara, Turkey., Patients: Patients who underwent conservative surgery because of adnexal torsion between January 2008 and August 2012 were retrospectively investigated from patient files and computer-based data. Eighteen patients were eligible for the study protocol and further evaluated for their ovarian reserve with ultrasonography., Interventions: Comparing ovarian reserve in the torsioned and contralateral sides with ultrasonography by physicians who were blind to the previously operated side., Measurement and Main Results: The mean age was 28.3 ± 5.8 years. The mean antral follicle count on the operated and contralateral ovaries were 12.3 ± 8.4 and 11.3 ± 7.4, respectively (p = .23). The respective figure for ovarian volume was 7.6 ± 4.2 and 9.1 ± 5.3 mL (p = .063). Among 3 patients seeking to become pregnant, 1 of them conceived spontaneously and one achieved pregnancy with clomiphene citrate use., Conclusion: The finding of the current study suggests that ovarian reserve reflected by the antral follicle count is not compromised in patients treated with detorsion of the twisted adnexa., (Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.)

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Objectives: To compare the success of two controlled ovarian hyperstimulation protocols; rFSH + hp-hMG with only rFSH in the GnRH antagonist protocol in diminished ovarian reserve under 35 years of age. Material and methods: Data from January 2015 to June 2019 were abstracted from the hospital records of IVF Clinic. The women younger than 35 years of age who were diagnosed as diminished ovarian reserve and underwent standard GnRH antagonist protocol were included. Patients in Group-1 underwent controlled ovarian stimulation with rFSH alone and Group-2 with rFSH in combination with hp-hMG. Patients in both groups were divided into three subgroups according to their antral follicle count at Day 3: < 4 (a), 4-6 (b), and 7-10 (c). Demographic features and IVF outcomes of the patients were extracted. Results: Total number of retrieved oocytes, was higher in Group-1 than Group-2 (6.5 ± 2.1 vs 5.5 ± 2.3, respectively, p < 0.001). However, there were no significant differences between the two groups in terms of clinical pregnancy rate, implantation rate, miscarriage rate and live birth rate. Although the main study outcome parameters did not show significant difference between Group-1a and Group-2a, the number of mature oocytes (5 ± 2.8 vs 1.8 ± 1.2, respectively, p = 0.006) was higher in Group-1a. Conclusions: We observed no beneficial effect of LH supplementation during IVF for the treatment of women under 35 years old with diminished ovarian reserve in the first treatment cycle when compared with rFSH only in the antagonist protocols. [ABSTRACT FROM AUTHOR]

Background: The association between blood types and ovarian reserve is investigated in this study. Materials and Methods: As an index of ovarian reserve, women with a follicle stimulating hormone (FSH) level of ≥10 mIU/ml in the early follicular phase were designated as having diminished ovarian reserve. In this prospective study, early follicular phase serum FSH and estradiol levels and blood types were evaluated in 500 patients who were admitted to the Infertility Department of Ministry of Health Etlik Zübeyde Hanım Women’s Health Training and Research Hospital between January 2012 and June 2012. Women with serum FSH level <10 mIU/ml formed group I, and women with serum FSH ≥10 mIU/ml formed group II. The prevalence of blood types in each group and their association with ovarian reserve were analyzed. Results: Out of 500 patients, 438 women were in group I, while 62 women were in group II. There was no statistically significant difference among the two groups in terms of blood group proportions (p=0.69), this did not change after age adjustment (p=0.77). The presence of A antigen (in A and AB blood type) (p=0.91), the blood type O (p=0.70), and the blood type B (p=0.51) were not statistically related to ovarian reserve after age adjustment. There was also no statistically significant correlation between rhesus factor and ovarian reserve after age adjustment (p=0.83). The only factor that affected ovarian reserve was age of patients (p=0.006). Conclusion: Blood groups do not constitute a risk or protective factor for ovarian reserve. Therefore, blood groups do not have any predictive value in evaluating ovarian reserve. [ABSTRACT FROM AUTHOR]

Aim: Hypogonadotropic hypogonadism (HH) is a rare clinical condition resulting from gonadal insufficiency due to low pituitary gonadotropin levels. Since ovulation occurs rarely in these patients, the probability of spontaneous pregnancy is very low. The study aimed to evaluate the in vitro fertilization (IVF) treatment outcomes in patients with HH and to compare these results with that of patients with unexplained infertility (UI) who underwent IVF treatment. Material and Methods: In this study, 36 cycles of 28 HH patients who underwent IVF treatment and 72 cycles of 68 patients who underwent IVF treatment for UI were included. Demographic data, ovarian hyperstimulation and cycle outcomes, clinical pregnancy rates, and predictive factors for clinical pregnancy were evaluated retrospectively, and the two groups were compared. Results: In the HH group, clinical pregnancy, and live birth rates per cycle after IVF were significantly higher compared with the UI group (n=16, 44.4% vs. n=17, 23.6%, p=0.027; and n=14, 38.9% vs. n=14, 19.4%; p=0.030, respectively). Although the number of antral follicles (p=0.001) and retrieved oocytes (p=0.042) were significantly higher in the UI group, the number of mature oocytes and grade I-II embryos were similar in the HH and UI groups. The total gonadotropin dose used and duration of stimulation in the HH group were significantly higher than in the UI group (both p=0.001). Conclusion: HH patients responded well to IVF treatment and had better IVF outcomes compared to women who underwent IVF for UI. No prognostic factor that affected pregnancy success in HH patients was detected. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the live birth rates in patients with poor ovarian response according to the POSEIDON classification and to evaluate the factors affecting live birth rates in different POSEIDON subgroups. The database of 2,200 patients between 2007 to 2021 including clinical and laboratory findings who underwent infertility treatment for IVF at Etlik Zubeyde Hanim Women's Health and Research Hospital were evaluated. Patients with complete medical records, at least one measurement of anti-Müllerian hormone (AMH) and antral follicle count (AFC) within the three months prior to the initiation of ovarian stimulation, a history of at least one poor ovarian response during IVF/ICSI cycles were included. Patients with incomplete medical records, history of pelvic surgery, premature ovarian insufficiency (FSH≥25 IU/l) or male factor infertility were excluded. The demographic characteristics of the patients, body mass index (BMI), obstetric history\laboratory values during the treatment period (AMH, FSH, LH, E2, progesterone, β-hCG), ultrasonographic findings (antral follicle count, endometrial thickness), presence of comorbidities, IVF treatment protocols and gonadotrophin doses that was used, number of IVF cycles and pregnancy outcomes were evaluated. The patients were classified into four groups according to the POSEIDON criteria (age, AMH and AFC). The study included 773 patients with complete medical and laboratory information. According to the POSEIDON criteria, 221 patients were classified as Group 1, 83 patients as Group 2, 261 patients as Group 3 and 208 patients as Group 4. The live birth rates were highest in Group 1 (35.3%), followed by Group 3 (26.4%), Group 2 (21.7%) and Group 4 (13.5%) (p<0,001) (figure 1). The mean number of total collected oocytes, mature oocytes, and oocytes subjected to ICSI were highest in Group 1, followed by Group 2, Group 3, and Group 4 (p<0,001). Comparing the live birth rates to the quality of transferred embryos, the average number of grade 1 embryos was found to be higher in patients who had a live birth (x̄ =0.68) compared to patients who did not (x̄ =0.57) (p=0.015). Factors affecting the live birth rates were demonstrated in (figure 2). Patient age and ovarian reserve were found as significant determinants of ART success. The predictive value of the patient age on live birth rates could be higher than the ovarian reserve. Additionally, the number and morphology of the transferred embryos, IVF treatment protocol, mature oocyte count, oocytes subjected to ICSI and BMI have prognostic value in predicting live birth rates in patients with poor ovarian reserve. [ABSTRACT FROM AUTHOR]