Background The concept of using a gonadotropin-releasing hormone agonist (GnRH-a) instead of human chorionic gonadotropin for triggering ovulation in patients treated with an antagonist protocol for in vitro fertilization (IVF) has become a routine clinical practice. It may promote oocyte nuclear maturation, resumption of meiosis and cumulus expansion. It seems that this attempt could be beneficial in an in vitro maturation (IVM) oocyte cycle performed for polycystic ovarian syndrome as well as for other indications such as urgent fertility preservation in patients with malignancies or unusual indications. Case presentation We present the case of a Caucasian patient who needed fertility preservation when routine natural IVF treatment did not yield oocyte retrieval, followed by three IVM cycles, priming ovulation with a GnRH-a. In total, 12 oocytes were obtained, all matured 4.5 hours after incubation in maturation media. The fertilization rate after intracytoplasmic sperm injection was 83%. Six good-quality embryos were vitrified. Conclusions It seems that triggering with a GnRH-a in selected cases may replace human chorionic gonadotropin in IVM of oocytes and could be highly beneficial in terms of obtaining high-grade embryos and possible pregnancy.

Increased progesterone level during follicular phase seemed to be associated with decreased pregnancy rate.

Objective: Patients with polycystic ovarian syndrome (PCOS) are at increased risk of ovarian hyperstimulation syndrome (OHSS) in controlled ovarian hyperstimulation cycles. Interventions to reduce the risk of OHSS in these patients include in-vitro fertilization (IVF) with a gonadotropin-releasing hormone (GnRH) antagonist, and retrieval of immature oocytes followed by in-vitro maturation (IVM). The aim of this study was to compare the outcomes of IVM and IVF-GnRH antagonist protocols in women with PCOS undergoing assisted reproductive technology.Study design: Retrospective cohort study. Records of women with PCOS who underwent IVM or IVF-GnRH antagonist protocols between 2010 and 2011 were reviewed. In total, there were 61 IVM cycles and 53 IVF-GnRH antagonist cycles. The treatment protocols were compared in terms of the number of oocytes retrieved, dose of gonadotropin administrated, fertilization rates, quality of embryos, pregnancy, and delivery and abortion rates.Results: The number (mean standard deviation) of mature oocytes did not differ significantly between the two groups (7.11 +/- 5.7 vs 8.16 +/- 5.07 for the GnRH antagonist group and the IVM group, respectively; p = 0.38). The average dose of gonadotropin (1938 IU +/- 838 IU/cycle vs 118 +/- 199 IU/cycle; p < 0.001), fertilization rate (77% vs 60%; p < 0.001) and high-quality embryo rate (58.8% vs 48.3; p < 0.001) were significantly higher in the GnRH antagonist group compared with the IVM group. Pregnancy rates (40% vs 25%; p = 0.08), livebirth rates per pregnancy (71% vs 53%; p = 0.265) and abortion rates (10% vs 27%; p = 0.17) were comparable.Conclusions: The IVM protocol can be an alternative for infertile women with PCOS who wish to prevent the potential adverse effects of gonadotropin treatment. Prospective studies are needed to compare the outcomes of these two treatment protocols. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

ObjectiveTriggering ovulation with GnRH-agonist in GnRH antagonist protocols can prevent Ovarian-HyperStimulation Syndrome (OHSS) in PolyCystic Ovarian Syndrome (PCOS) patients. However large amounts of gonadotropins are used.In-Vitro Maturation (IVM) may be a potential alternative for these patients, without exposure to gonadotropins and risk of OHSS. The aim of this study was to compare the outcomes of IVM versus antagonist protocols in PCOS patients.DesignA prospective randomized controlled trial.Materials and MethodsPCOS patients were enrolled randomly to IVM or antagonist protocol. Patients in IVM group were primed with 150IU rFSH for 3 days and hCG . Patients in the antagonist protocol were treated routinely. The two groups were compared regarding the number of oocytes retrieved, maturation rate / mature oocytes, fertilization and cleavage rates, quality of embryos, OHSS and ongoing pregnancy rates.Results11 and 10 patients were recruited so far for antagonist and IVM protocol. No significant differences in number of mature oocytes (11.2±5.7 vs.12.2±8.45), fertilization rate (73% vs. 67%) and top quality of embryos (45.3% vs. 43.9) were observed. The average dose of gonadotropins in the antagonist protocol was 1461 IU±560IU per cycle, compared to 382±108IU in the IVM group (p < 0.001) . Pregnancy rates were comparable - only 9% (1/11) in the antagonist (surprisingly low compared to previous data from our unit of 38% ) and 40% in the IVM group (4/10) (p=0.102). No OHSS developed.ConclusionIVM protocol may be an alternative for infertile women with PCOS who desire to prevent potential adverse effects of gonadotropins treatment and prevent OHSS. These preliminary data demonstrate that IVM has comparable results to standard IVF treatments. ObjectiveTriggering ovulation with GnRH-agonist in GnRH antagonist protocols can prevent Ovarian-HyperStimulation Syndrome (OHSS) in PolyCystic Ovarian Syndrome (PCOS) patients. However large amounts of gonadotropins are used.In-Vitro Maturation (IVM) may be a potential alternative for these patients, without exposure to gonadotropins and risk of OHSS. The aim of this study was to compare the outcomes of IVM versus antagonist protocols in PCOS patients. Triggering ovulation with GnRH-agonist in GnRH antagonist protocols can prevent Ovarian-HyperStimulation Syndrome (OHSS) in PolyCystic Ovarian Syndrome (PCOS) patients. However large amounts of gonadotropins are used.In-Vitro Maturation (IVM) may be a potential alternative for these patients, without exposure to gonadotropins and risk of OHSS. The aim of this study was to compare the outcomes of IVM versus antagonist protocols in PCOS patients. DesignA prospective randomized controlled trial. A prospective randomized controlled trial. Materials and MethodsPCOS patients were enrolled randomly to IVM or antagonist protocol. Patients in IVM group were primed with 150IU rFSH for 3 days and hCG . Patients in the antagonist protocol were treated routinely. The two groups were compared regarding the number of oocytes retrieved, maturation rate / mature oocytes, fertilization and cleavage rates, quality of embryos, OHSS and ongoing pregnancy rates. PCOS patients were enrolled randomly to IVM or antagonist protocol. Patients in IVM group were primed with 150IU rFSH for 3 days and hCG . Patients in the antagonist protocol were treated routinely. The two groups were compared regarding the number of oocytes retrieved, maturation rate / mature oocytes, fertilization and cleavage rates, quality of embryos, OHSS and ongoing pregnancy rates. Results11 and 10 patients were recruited so far for antagonist and IVM protocol. No significant differences in number of mature oocytes (11.2±5.7 vs.12.2±8.45), fertilization rate (73% vs. 67%) and top quality of embryos (45.3% vs. 43.9) were observed. The average dose of gonadotropins in the antagonist protocol was 1461 IU±560IU per cycle, compared to 382±108IU in the IVM group (p < 0.001) . Pregnancy rates were comparable - only 9% (1/11) in the antagonist (surprisingly low compared to previous data from our unit of 38% ) and 40% in the IVM group (4/10) (p=0.102). No OHSS developed. 11 and 10 patients were recruited so far for antagonist and IVM protocol. No significant differences in number of mature oocytes (11.2±5.7 vs.12.2±8.45), fertilization rate (73% vs. 67%) and top quality of embryos (45.3% vs. 43.9) were observed. The average dose of gonadotropins in the antagonist protocol was 1461 IU±560IU per cycle, compared to 382±108IU in the IVM group (p < 0.001) . Pregnancy rates were comparable - only 9% (1/11) in the antagonist (surprisingly low compared to previous data from our unit of 38% ) and 40% in the IVM group (4/10) (p=0.102). No OHSS developed. ConclusionIVM protocol may be an alternative for infertile women with PCOS who desire to prevent potential adverse effects of gonadotropins treatment and prevent OHSS. These preliminary data demonstrate that IVM has comparable results to standard IVF treatments. IVM protocol may be an alternative for infertile women with PCOS who desire to prevent potential adverse effects of gonadotropins treatment and prevent OHSS. These preliminary data demonstrate that IVM has comparable results to standard IVF treatments.

Retrieval of immature oocytes from unstimulated ovaries, followed by in vitro maturation (IVM) was originally proposed in order to avoid side effects of gonadotropin administration. The target is to eliminate or significantly reduce the risk of ovarian hyperstimulation syndrome (OHSS) in patients with polycystic ovary syndrome (PCOS), drug cost and burden on patients. This technology was also suggested in treatment of normo-ovulatory women, fertility preservation or infrequent conditions such as failure of oocytes to mature or repeated development of poor quality embryos. In this study we intended to examine the possibility that IVM results may be comparable to standard IVF. A PubMed database search from 1999-2013 was carried out for publications concerning the indications of IVM and study the possibility that IVM results may be comparable to standard IVF. In vitro maturation of the oocytes procedures obtained up to 35% clinical pregnancy rate in young women, comparable with in vitro fertilization (IVF) in many programs. The obstetric and perinatal outcomes of IVM cycles are comparable with IVF/ICSI cycles. In conclusion IVM may gradually replace IVF in certain cases, as the technique continues to develop and pregnancy rates continue to increase, being a promising and simple alternative approach to standard IVF in various indications.

ObjectiveLuteal phase of IVF-ET cycles comes under great scrutiny as a cause of discrepancy between fertilization and pregnancy rates. Supplementation with progesterone (P) may rescue potentially failing corpora lutea and thereby optimize the peri-implantation milieu. However, it is unclear what should be the adequate dosage of P to be administrated in order to improve success rate. Aim of the study: 1. To find out if mid luteal serum P concentrations may serve as a predictive factor for IVF outcome. 2.To determine if increasing P dosage in certain patients at mid luteal phase may improve pregnancy rates.DesignProspective randomised study.Materials and Methods120 patients were enrolled prospectively in the study (1.1.2012-31.12.2012). and received luteal support with vaginal P suppositories, 200 mg/day (Endometrin, Ferring, Israel), started 24 hours after egg collection. Serum P levels were measured 7 days after ET. Considering a cut-off level of 15 ng/ml serum P at this day, patients with higher levels continued same dosage until pregnancy test (control group). Patients with a lower level were randomly allocated into two groups: A- continuing Endometrin (E)©200mg/day; B- increasing (E)©dosage to 300 mg/day until performing pregnancy test. Pregnancy rates were compared between control and group A, and between group A and B.ResultsThere were 67 cycles with serum P level >15 ng/ml and 53 cycles with levels <15 ng/ml in the mid luteal phase. There were no differences regarding cycles characteristics or number of embryos transferred. In patients with mid luteal P >15 ng/ml, pregnancy rate was 37% vs. 26.4% when the level was < 15 ng/ml. (p< 0.05). Increasing P dosage in this group (group B) had no beneficial effect.ConclusionIn an IVF cycles, correlation between mid luteal serum P concentration and pregnancy rates was observed. Level of >15ng/ml may predict a successful outcome. Optimal daily (E)©dose used for luteal support appears to be 200mg, and no beneficial effect was gained from raising it to 300mg. ObjectiveLuteal phase of IVF-ET cycles comes under great scrutiny as a cause of discrepancy between fertilization and pregnancy rates. Supplementation with progesterone (P) may rescue potentially failing corpora lutea and thereby optimize the peri-implantation milieu. However, it is unclear what should be the adequate dosage of P to be administrated in order to improve success rate. Aim of the study: 1. To find out if mid luteal serum P concentrations may serve as a predictive factor for IVF outcome. 2.To determine if increasing P dosage in certain patients at mid luteal phase may improve pregnancy rates. Luteal phase of IVF-ET cycles comes under great scrutiny as a cause of discrepancy between fertilization and pregnancy rates. Supplementation with progesterone (P) may rescue potentially failing corpora lutea and thereby optimize the peri-implantation milieu. However, it is unclear what should be the adequate dosage of P to be administrated in order to improve success rate. Aim of the study: 1. To find out if mid luteal serum P concentrations may serve as a predictive factor for IVF outcome. 2.To determine if increasing P dosage in certain patients at mid luteal phase may improve pregnancy rates. DesignProspective randomised study. Prospective randomised study. Materials and Methods120 patients were enrolled prospectively in the study (1.1.2012-31.12.2012). and received luteal support with vaginal P suppositories, 200 mg/day (Endometrin, Ferring, Israel), started 24 hours after egg collection. Serum P levels were measured 7 days after ET. Considering a cut-off level of 15 ng/ml serum P at this day, patients with higher levels continued same dosage until pregnancy test (control group). Patients with a lower level were randomly allocated into two groups: A- continuing Endometrin (E)©200mg/day; B- increasing (E)©dosage to 300 mg/day until performing pregnancy test. Pregnancy rates were compared between control and group A, and between group A and B. 120 patients were enrolled prospectively in the study (1.1.2012-31.12.2012). and received luteal support with vaginal P suppositories, 200 mg/day (Endometrin, Ferring, Israel), started 24 hours after egg collection. Serum P levels were measured 7 days after ET. Considering a cut-off level of 15 ng/ml serum P at this day, patients with higher levels continued same dosage until pregnancy test (control group). Patients with a lower level were randomly allocated into two groups: A- continuing Endometrin (E)©200mg/day; B- increasing (E)©dosage to 300 mg/day until performing pregnancy test. Pregnancy rates were compared between control and group A, and between group A and B. ResultsThere were 67 cycles with serum P level >15 ng/ml and 53 cycles with levels <15 ng/ml in the mid luteal phase. There were no differences regarding cycles characteristics or number of embryos transferred. In patients with mid luteal P >15 ng/ml, pregnancy rate was 37% vs. 26.4% when the level was < 15 ng/ml. (p< 0.05). Increasing P dosage in this group (group B) had no beneficial effect. There were 67 cycles with serum P level >15 ng/ml and 53 cycles with levels <15 ng/ml in the mid luteal phase. There were no differences regarding cycles characteristics or number of embryos transferred. In patients with mid luteal P >15 ng/ml, pregnancy rate was 37% vs. 26.4% when the level was < 15 ng/ml. (p< 0.05). Increasing P dosage in this group (group B) had no beneficial effect. ConclusionIn an IVF cycles, correlation between mid luteal serum P concentration and pregnancy rates was observed. Level of >15ng/ml may predict a successful outcome. Optimal daily (E)©dose used for luteal support appears to be 200mg, and no beneficial effect was gained from raising it to 300mg. In an IVF cycles, correlation between mid luteal serum P concentration and pregnancy rates was observed. Level of >15ng/ml may predict a successful outcome. Optimal daily (E)©dose used for luteal support appears to be 200mg, and no beneficial effect was gained from raising it to 300mg.

Animals study revealed that redistribution of mitochondria was correlated with oocytes maturation and that a lack of redistribution suggested incomplete cytoplasmic maturation and lower developmental competence. The aim of the study was to determine the pattern of spreading through the cytoplasm and percentage of cytoplasm occupied by mitochondria during human nuclear oocytes maturation. Prospective Observational Study. Sixty nine oocytes obtained from 21 patients aged 34±3.2 years that underwent in vitro fertilization (IVF) treatment with ICSI were in different maturation stage: germinal vesicle(GV)=15, meiosis(M) I=16, M II=38 oocytes, respectively. Immature oocytes and non fertilized mature oocytes were allocated for study and stained by Mito-Tracker Green FM. The distribution, area and percentage of cytoplasm occupied by mitochondria were analyzed by fluorescent microscopy and ImageJ software (NIH), respectively. The distribution of mitochondria through the oocyte cytoplasm was mostly homogenously diffuse, central located and peripheral in M II, M I and GV oocytes, respectively. Of The M II oocytes, 60.5% presented an evenly diffuse pattern and of the GV stage oocytes, 53.3% presented a peripheral distribution. The area and the percentage of cytoplasm occupied by mitochondria was 352340±37942, 348955±35675 and 278501±65989 area units (p=0.001, M II vs. GV and M I vs. GV, Kruskal-Wallis test) and 93±9.4%, 85±13% and 75±10.5% (median=100, 86.4, 73.9) in M II, M I and GV oocytes, respectively (p=0.001, M II vs. GV, Kruskal-Wallis test). Mitochondria were distributed mainly in the peripheral region in immature oocytes and homogenously in M II oocytes, revealing qualitative and quantitative information of spreading and localization within the cytoplasm. This pattern of distribution may play an important role in the cytoplasmic maturation of human oocytes and their further development.

Highly purified Human Menopausal Gonadotropins and recombinant FSH are wildly used in the Assisted Reproductive Technology (ART) era. There are only several studies compared the effectiveness of the two preparations in patients undergoing In Vitro Fertilization (IVF) with antagonist protocol. The aim of this study was to compare ART results of HP-hMG and rFSH for in GnRH antagonist cycles. Retrospective case control study. Records of all antagonist cycles of patients undergoing IVF in our unit from January 1st 2011untill December 31 2011 were reviewed. There were 216 ART antagonist cycles: 140 stimulated with rFSH and 76 with hp-hMG. For every case (stimulation with hp-hMG) two controls (stimulation with rFSH) were matched for patient's age and infertility diagnosis. The two treatment protocols were compared regarding the length of stimulation, amount of gonadotropins used, number of oocytes retrieved, fertilization, cleavage and pregnancy rates. Matching was possible for 53 cases with 96 controls. In the hp-hMG group BMI was higher (27.1±5.2 vs. 25.2±5.3 P=0.039). The hp-hMG group had statistically significant more previous ART cycles (4.3±2.8 compared to 3.0±2.6 P value 0.008) and elevated basal FSH (7.1±3.0 vs. 6.0±2.1 P=0.008). The stimulation duration, endometrium thickness on the day of hCG admission and estradiol level on the day of hCG admission were comparable between the two groups. The amount of gonadotropins used was higher in the hp-hMG group (1993±840 vs. 1342±511 P < 0.001). The number of oocytes retrieved was higher for the rFSH group (8.4±5.3 vs. 6.1±5.2 P = 0.01). Fertilization rate were comperable. Pregnancy and live birth rates were comparable: 37.5% and 18.8% in the rFSH group compared to 32.6% and 15.4% in the hp-hMG group. It appears that in an antagonist protocol, different gonadotropins products are equally effective. The choice of one or the other product should depend upon the availability, convenience of use and the cost of the product.

In vitro maturation (IVM) of the oocyte procedure obtained a 35% clinical pregnancy rate in young women, comparable with in vitro fertilization (IVF) in many programs. The IVM obstetrics and perinatal outcome are comparable with IVF/ICSI. The improvement in treatment and protocol has produced good results.IVM holds great promise as a concomitant treatment to assisted reproductive technologies, and when fully developed, it may be the procedure of choice, not only for infertile patients but also for obtaining oocytes for donation or fertility preservation. IVM may gradually replace IVF as pregnancy rates continue to increase.

ObjectiveThe maturation of mammalian oocytes is a process involving nuclear and cytoplasmatic maturation. Mitochondria, being the most abundant organelles in the cytoplasm and the source of ATP for the oocytes may have an essential role in cytoplasmatic maturation.The aim of the study was to elucidate the relationship between mitochondrial distribution and pattern of spreading through the cytoplasm during different stages of human nuclear oocytes maturation.DesignProspective study.Materials and Methods12 patients underwent intracytoplasmatic sperm injection (ICSI) treatment. After denudation, Meiosis(M)II oocytes were injected. Immature (germinal vesicle-GV and M I) oocytes were separated and kept in a different wells. Immediately after embryo transfer, those immature oocytes (as well as non fertilized mature oocytes-MII) were allocated for study (n=47 oocytes). All oocytes were stained by Mito-Tracker Green FM. The distribution of mitochondria was observed by fluorescent microscopy. The area of the cytoplasm and the percentage of cytoplasm occupied by mitochondria was analyzed using Image J software (NIH).ResultsThe area of the cytoplasm was 357035.3±38812.0, 347091.7±41280.4 and 303264.7±48490.2 area units (Image J software) (P=0.053, Kruskal -Wallis test) and the percentage of cytoplasm occupied by mitochondria was 92.2±9.4%, 86.8±12.4% and 74.3±14.3% (median-100, 88.4, 68.1) in MII, MI and GV oocytes (n=31,10,6 respectively) (P=0.012, Kruskal- Wallis test). The distribution pattern was mostly homogenously diffuse (56.3%), central located (50%) and semi peripheral (50%) in MII, MI and GV oocytes respectively.ConclusionThere are evident changes in the distribution and pattern of spreading of mitochondria during maturation of human oocytes. Mature oocytes were larger and the mitochondria occupied a significant fraction of their cytoplasm in a homogenously distribution. This pattern of redistribution may play an important role in the maturation of human oocytes and their further development. ObjectiveThe maturation of mammalian oocytes is a process involving nuclear and cytoplasmatic maturation. Mitochondria, being the most abundant organelles in the cytoplasm and the source of ATP for the oocytes may have an essential role in cytoplasmatic maturation.The aim of the study was to elucidate the relationship between mitochondrial distribution and pattern of spreading through the cytoplasm during different stages of human nuclear oocytes maturation. The maturation of mammalian oocytes is a process involving nuclear and cytoplasmatic maturation. Mitochondria, being the most abundant organelles in the cytoplasm and the source of ATP for the oocytes may have an essential role in cytoplasmatic maturation. The aim of the study was to elucidate the relationship between mitochondrial distribution and pattern of spreading through the cytoplasm during different stages of human nuclear oocytes maturation. DesignProspective study. Prospective study. Materials and Methods12 patients underwent intracytoplasmatic sperm injection (ICSI) treatment. After denudation, Meiosis(M)II oocytes were injected. Immature (germinal vesicle-GV and M I) oocytes were separated and kept in a different wells. Immediately after embryo transfer, those immature oocytes (as well as non fertilized mature oocytes-MII) were allocated for study (n=47 oocytes). All oocytes were stained by Mito-Tracker Green FM. The distribution of mitochondria was observed by fluorescent microscopy. The area of the cytoplasm and the percentage of cytoplasm occupied by mitochondria was analyzed using Image J software (NIH). 12 patients underwent intracytoplasmatic sperm injection (ICSI) treatment. After denudation, Meiosis(M)II oocytes were injected. Immature (germinal vesicle-GV and M I) oocytes were separated and kept in a different wells. Immediately after embryo transfer, those immature oocytes (as well as non fertilized mature oocytes-MII) were allocated for study (n=47 oocytes). All oocytes were stained by Mito-Tracker Green FM. The distribution of mitochondria was observed by fluorescent microscopy. The area of the cytoplasm and the percentage of cytoplasm occupied by mitochondria was analyzed using Image J software (NIH). ResultsThe area of the cytoplasm was 357035.3±38812.0, 347091.7±41280.4 and 303264.7±48490.2 area units (Image J software) (P=0.053, Kruskal -Wallis test) and the percentage of cytoplasm occupied by mitochondria was 92.2±9.4%, 86.8±12.4% and 74.3±14.3% (median-100, 88.4, 68.1) in MII, MI and GV oocytes (n=31,10,6 respectively) (P=0.012, Kruskal- Wallis test). The distribution pattern was mostly homogenously diffuse (56.3%), central located (50%) and semi peripheral (50%) in MII, MI and GV oocytes respectively. The area of the cytoplasm was 357035.3±38812.0, 347091.7±41280.4 and 303264.7±48490.2 area units (Image J software) (P=0.053, Kruskal -Wallis test) and the percentage of cytoplasm occupied by mitochondria was 92.2±9.4%, 86.8±12.4% and 74.3±14.3% (median-100, 88.4, 68.1) in MII, MI and GV oocytes (n=31,10,6 respectively) (P=0.012, Kruskal- Wallis test). The distribution pattern was mostly homogenously diffuse (56.3%), central located (50%) and semi peripheral (50%) in MII, MI and GV oocytes respectively. ConclusionThere are evident changes in the distribution and pattern of spreading of mitochondria during maturation of human oocytes. Mature oocytes were larger and the mitochondria occupied a significant fraction of their cytoplasm in a homogenously distribution. This pattern of redistribution may play an important role in the maturation of human oocytes and their further development. There are evident changes in the distribution and pattern of spreading of mitochondria during maturation of human oocytes. Mature oocytes were larger and the mitochondria occupied a significant fraction of their cytoplasm in a homogenously distribution. This pattern of redistribution may play an important role in the maturation of human oocytes and their further development.

Dendritic cells (DCs) are bone marrow derived immune cells that have been shown to promote angiogenesis. We sought to determine whether the presence of DCs in ovarian follicular fluid (FF) and/or their maturation state is correlated with follicular blood flow. Observational human cohort study. We studied 21 patients undergoing IVF in our institution. The first aspirated dominant follicle in each ovary was measured and blood flow parameters were analyzed using pulsed doppler ultrasound. FF samples (n=36) were then collected, immunostained and analyzed by flow cytometry. DCs were identified as CD45+CD11c+HLADR+ cells. To assess DC maturity, geometric means of HLADR expression on DCs were derived using CellQuest software. Blood flow impedance was determined using the resistance index (RI) according to the formula: RI=(peak systolic velocity–end diastolic velocity)/peak systolic velocity. The percentage of DCs out total CD45+ hematopoietic cells within the FF was strongly correlated to both day 3 FSH levels (r=0.853, P<0.001) and LH levels (r=0.83, P<0.0001). The presence of CD45+ hematopoietic cells correlated with end diastolic velocity of blood flow to the follicle (r=0.475, P=0.003). Although the RI to blood flow did not correlate with the presence of total DCs within the FF (r=-0.08,P=0.97), it was inversely correlated significantly with the maturity of DCs as indicated by their expression of HLADR (r=-0.36, P=0.043). The presence of total DCs in the follicular fluid is associated with poor ovarian reserve parameters. In accordance to our previous findings that the presence of mature DCs within the ovarian follicle correlates with ovarian response to gonadotropins, we now report that their presence correlates with improved follicular blood flow. The notion that mature DCs within the ovarian follicle are important for angiogenesis and oocyte development is intriguing and warrants further investigation.

Polycystic ovarian syndrome (PCOS) patients are at increased risk of ovarian hyperstimulation syndrome (OHSS) in controlled ovarian hyperstimulation cycles. Inducing oocyte maturation with Gonadotropin Releasing Hormone (GnRH) agonists, in patients stimulated with GnRH antagonist protocols can prevent this complication. In these protocols, ovarian stimulation requires large amounts of gonadotropins. Earlier retrieval of immature oocytes followed by in vitro maturation (IVM) may be a potential alternative intervention for these patients, without exposure to gonadotropins and the risk of OHSS. The aim of the study was to compare the outcomes of IVM versus antagonist protocols for In-Vitro Fertilization (IVF) in women with PCOS. A retrospective cohort study. Records of all treatment cycles of PCOS patients that underwent IVM or IVF with antagonist protocols in our unit between 01.01.2011 to 31.12.2011 were reviewed. There were 32 IVM cycles and 32 GnRH antagonist IVF cycles. The two treatment protocols were compared regarding the number of oocytes retrieved, maturation rate (IVM protocol) or mature oocytes (antagonist protocol), fertilization and cleavage rates, quality of embryos and pregnancy rates. When comparing IVF antagonist protocol to IVM we observed no significant differences in the number of oocytes retrieved, mature oocytes achieved (9.7±8.87 vs.12.2±7.26 P=0.214), fertilization rate (56% vs. 61.5%, P=0.584) and quality of embryos. The average dose of gonadotropins in the IVF-antagonist protocol was 1575 IU±700IU per cycle, compared to nill gonadotropins in the IVM group. Importantly, pregnancy rate in the IVM cycles and IVF cycles was 21.87% and 36.4% respectively (P=0.312). IVM protocol may be a good alternative for infertile women with PCOS who desire to prevent the potential adverse effects of gonadotropins treatment. Further prospective studies are needed to compare the results, advantages and disadvantages of these two treatment protocols.