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This study aimed to describe outcomes in four women aged 28-34 years with central cytoplasmic granulation (CCG) of the oocytes who underwent in vitro fertilization/intracytoplasmic sperm injection (ICSI) using gonadotrophin-releasing hormone (GnRH) agonist to replace human chorionic gonadotrophin (hCG) as a trigger of final oocyte maturation. The initial ICSI procedure showed that all four women had CCG of the ooplasm and poor quality embryos. Subsequent ICSI used an antagonist protocol with a GnRH agonist trigger replacing the agonist protocol, plus hCG triggered ovulation. Ooplasm and embryo quality were improved in all four patients. All four became pregnant and gave birth to live infants. This study provides GnRH agonist triggering that may improve ooplasm granularity and embryo quality.

Objective: To assess whether progesterone elevation is the only factor in determining outcomes of in vitro fertilization (IVF)., Design: Retrospective cohort study., Setting: Infertility clinic at Kaohsiung Chang Gung Memorial Hospital, Taiwan., Patient(s): One thousand five hundred eight women undergoing a total of 1,508 IVF cycles., Intervention(s): None., Main Outcome Measure(s): Clinical pregnancy and live-birth rates., Result(s): Patients were classified into four subgroups according to their progesterone concentration on the day of human chorionic gonadotropin (hCG) triggering. The clinical pregnancy and live-birth rates were statistically significantly associated with the age of the woman, the day of embryo transfer, the progesterone concentration on the day of hCG administration, the number of transferred embryos, and the number of top-quality embryos transferred. However, after omitting the women with the highest progesterone concentration (≥1.94 ng/mL), only four factors-patient age, day of embryo transfer, number of transferred embryos, and number of top-quality embryos transferred-were statistically significantly associated with the clinical pregnancy and live-birth rates., Conclusion(s): Progesterone concentration on the day of hCG administration is not the only factor determining the clinical pregnancy and live-birth rates. Fresh embryos from women should be frozen with extremely high progesterone concentrations. Each patient's general condition and the capacity for frozen-thawed embryo transfer should be considered before implantation., (Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Study Objective: To evaluate the effects of salpingectomy on the ovarian response to gonadotropins and in vitro fertilization-embryo transfer (IVF-ET) cycle outcomes in women with tubal factor infertility., Design: A retrospective study (Canadian Task Force Classification II-3) SETTING: An in vitro fertilization laboratory in a university hospital in Taiwan., Patients: We analyzed the outcomes of 288 consecutive fresh IVF-ET cycles in 251 consecutive women with tubal factor infertility from January 2001 to December 2011. Two hundred eighty-eight cycles were divided into 2 groups comprising 103 cycles with laparoscopic salpingectomy and 185 cycles with prior bilateral tubal sterilization, laparoscopic tuboplasty, or proximal tubal occlusion as the control group., Interventions: Controlled ovarian hyperstimulation and IVF-ET., Measurements and Main Results: The main outcome was measured by comparing the duration of stimulation, number of gonadotropin ampoules per cycle, number of follicles, number of oocytes retrieved, fertilization rate, implantation rate, clinical pregnancy rate, and live birth rate. We observed no significant difference in any ovarian response parameter between the salpingectomy and nonsalpingectomy groups. Implantation rates, clinical pregnancy rates, and live birth rates were similar. The mean numbers of follicles and oocytes retrieved ipsilateral to the operated side in the salpingectomy group were similar to the numbers of follicles and oocytes retrieved from the nonoperated ovary., Conclusions: Laparoscopic salpingectomy did not have a negative effect on the ovarian response in women with tubal factor infertility., (Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the differences between the right and left ovarian responses in patients undergoing standard in vitro fertilization (IVF) treatment., Design: Prospective, observational study., Setting: A university hospital in Taiwan., Patient(s): Seven hundred eighty-nine consecutive patients undergoing IVF or intracytoplasmic sperm injection., Intervention(s): None., Main Outcome Measure(s): The number of oocytes retrieved, fertilization rates, number of grade 1 zygotes and number of embryos produced, embryo arrest-free rate, and mean number of top-quality embryos on the day of transfer., Result(s): The number of follicles > or = 16 mm in diameter on day 2.5 versus 2.2 of human chorionic gonadotropin (hCG) administration, the number of follicles > or = 10 mm in diameter on hCG day 6.5 versus 6.1, the number of oocytes (3.6 vs. 3.0), the percentage fertilization (79.9 vs. 74.6%), and the mean number of mature oocytes and grade 1 zygotes (2.3 vs. 1.8 and 1.79 vs. 0.93, respectively), and the mean available number of top-quality embryos on transfer day 1.39 versus 0.73 were all statistically significantly greater in the right compared with the left ovary; however, the pregnancy and implantation rates were similar., Conclusion(s): There are statistically significant differences between the right and left ovarian responses in IVF patients with healthy ovaries, and the right ovarian responses are superior to the left ovarian responses., (Crown Copyright 2010. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the results of IVF and intracytoplasmic sperm injection (ICSI) in extremely low oocyte retrieval cycles., Design: Case-control study., Setting: An IVF laboratory in a university hospital in Taiwan., Patient(s): Between January 2003 and December 2007, infertile couples with one, two, or three oocytes per retrieval were divided into two groups: 56 IVF cycles based on 28 demographic characteristics from the ICSI group., Intervention(s): None., Main Outcome Measure(s): Fertilization rate, cycle cancellation rate, clinical pregnancy rate, and implantation rate per transfer., Result(s): The normal fertilization rate was significantly higher after ICSI than after standard IVF (86.4% vs. 69.3%). The cycle cancellation and complete fertilization failure rates were comparable between the two groups. The clinical pregnancy rate per transfer (38.5% vs. 21.6%), implantation rate (23.5% vs. 11.1%), and live birth rate per transfer (30.8% vs. 13.7%) had a favorable trend, but no statistically significant differences, in the ICSI group compared with the IVF group., Conclusion(s): A higher normal fertilization rate can be achieved by ICSI in comparison with conventional IVF in extremely low oocyte retrieval cycles., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to evaluate the influences of tropical weather on patients with different ovarian responses in the treatment of assisted reproductive technology., Methods: Six-hundred fourty-seven women underwent their first treatment cycles were retrospectively analyzed. Patients received embryo transfer either 3 days or 5 days after oocyte retrieval, depending on the number and quality of embryos on day-2., Results: Significant correlations were demonstrated in the top quality embryo rates of day-3 and day-5 embryo transfers with temperature, humidity, and atmosphere pressure. The cumulative light hours negatively correlated with the implantation and pregnancy rates of day-3 embryo transfer (-.282 and -.282, respectively), while they positively correlated with those of day-5 embryo transfer (.225 and .224, respectively)., Conclusions: These results clearly suggest that weather may exert influences on the outcome of assisted reproductive technology. Patients with different ovarian responses or blastocyst culture and transfer may modify weather influences.

Objective: To examine expression of androgen receptor (AR), AR cofactors, estrogen (E) receptor alpha, E receptor beta, progesterone receptor, steroid receptor coactivator-1, and aromatase in human luteinized granulosa cells collected during oocyte retrieval., Design: Prospective real-time reverse transcriptase-polymerase chain reaction study., Setting: Academic medical center., Patient(s): A total of 198 samples were brought into the study., Intervention(s): Patients underwent the long protocol for assisted reproductive technology. Luteinized granulosa cells were collected transvaginally with ultrasound guidance. Quantitative reverse transcriptase-polymerase chain reaction was performed to quantify the mRNA expression of the investigated genes., Main Outcome Measure(s): The expression levels were determined as ratios between the studied genes and the reference gene beta-actin., Result(s): There is little AR expression in human luteinized granulosa cells immediately preceding ovulation under controlled ovarian hyperstimulation. All aspirated follicles, despite their antral size, displayed a similar mRNA expression of the investigated genes in the luteinized granulosa cells., Conclusion(s): This study supports the possibility of a transition of androgen action from being an enhancer of follicular differentiation (through the AR) to being a substrate of E synthesis (through aromatase) at the time of oocyte retrieval. The present study also demonstrates no effect of follicular size upon the status of steroid receptor mRNA expression in the luteinized granulosa cells when follicles were at least >1.5 mL.

Objective: To evaluate the mRNA levels of connexins in different sizes of luteinized follicles., Design: Semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR) to determine the connexin mRNA levels in the granulosa cells of 91 luteinized follicles., Setting: Academic tertiary care medical center and research unit of university., Patient(s): Ninety-one female patients on controlled ovarian hyperstimulation (COH)., Intervention(s): Sonoguided aspiration to collect the oocytes and the granulosa cells simultaneously., Main Outcome Measure(s): The RT-PCR data are normalized by comparing the intensity of the connexins to the intensity of internal controls (beta-actin). The follicles are grouped according to the size and the mRNA levels of the connexins. The correlations among the size of the follicles, the outcome of oocytes, and the mRNA levels of the connexins are compared by Fisher's exact test and Mann-Whitney test., Result(s): The mRNA levels of the connexins are low in the follicles equal or larger than 5.5 mL. High cx43 levels are linked to good prognosis of oocytes., Conclusion(s): The luteinized granulosa cells from the large follicles are relatively quiescent in the connexin mRNA expression. In addition to the volume, the mRNA levels of cx43 may serve as a marker to predict the outcome of oocytes.