This retrospective cohort study aims to investigate whether additional daily intramuscular progesterone (IMP) for luteal phase support improves live birth rates of programmed frozen-thawed embryo transfer (FET) cycles. The study was conducted at a tertiary level university hospital assisted reproductive technology (ART) center between January 2014 and Jan 2021. Six hundred four infertile patients with single-day 5-6 frozen-thawed blastocyst embryo transfer were enrolled in the study. All patients received either 8% micronized vaginal gel or vaginal progesterone capsules for luteal phase support. Intramuscular progesterone was added to vaginal progesterone depending on the in vitro fertilization (IVF) specialist’s choice. Luteal phase support (LPS) was started 6 days before transfer in frozen-thawed cycles and continued until the end of the first trimester. Cycles were compared depending on vaginal progesterone types (8% gel vs. capsule) and the presence of intramuscular progesterone. The primary outcome was the live birth rate. A total of 604 FET cycles were enrolled. Using 8% micronized progesterone or progesterone capsules did not change the live birth rates (24% vs. 25.9%). As the main result, intramuscular progesterone support with vaginal progesterone compared with only vaginal progesterone did not improve the live birth results (22% vs. 24%). In conclusion, this study demonstrated that routine IMP progesterone given in combination with vaginal progesterone does not improve ART outcomes. This combination may be beneficial in a selective population with a monitored luteal phase. Using any form of vaginal progesterone alone is adequate for LPS.

Objective Endometriosis is a disease characterized by the implantation and growth of endometrial tissue outside the uterus in women of reproductive age, and its etiopathogenesis remains unclear. It is most commonly seen in the ovaries (endometrioma). It is estimated that it negatively affects folliculogenesis, ovulation, embryogenesis and causes infertility by causing endoplasmic reticulum (ER) stress in the ovary through different mechanisms. ER stress occurs when cell homeostasis is disrupted as a result of the accumulation of unfolded or misfolded proteins. In this case, the cell first activates ER stress response pathways, aiming to restore homeostasis and keep the cell alive. If ER stress cannot be coped with, the cell is directed to apoptosis. The aim in our study is to determine the local and/or systemic negative effects of endometriosis on the ovary, the endoplasmic reticulum stress it creates in the ovaries as a result of these effects, and which pathway or pathways are activated in case of stress. Materials and methods ER stress parameters (GADD34, Caspase12, Caspase3, BIP, CHOP, XBP1, ATF4) were investigated using ELISA method in granulosa cells, which are waste cells collected during oocyte retrieval after in vitro fertilization (IVF) treatment from infertile patients diagnosed with unilateral endometrioma and healthy female patients diagnosed with male factor and will not be used in IVF treatment. The study design was planned in 3 groups; Group 1: ovary with endometrioma diagnosed with unilateral endometrioma (n=23), Group 2: ovary without endometrioma diagnosed with unilateral endometrioma (n=23), Group 3: control group male factor (n=20). Conclusions Although no significant difference was observed in ovarian and embryological parameters between the two groups with and without endometrioma, a significantly lower total antral follicle count, AMH levels, oocyte retrieval numbers, oocyte maturation, and embryo quality were detected when compared to the control group. As the size of the endometrioma increased, particularly when exceeding a threshold of 4 cm, it was found that the PERK pathway, an ER stress pathway, as well as the caspase apoptotic process, were activated. We can say that the PERK pathway is primarily preferred among the ER stress pathways examined in the endometrioma group and by dimensioning. The results can be supported by more comprehensive studies.

Objective The aim of this study was to evaluate the impact of ovarian endometrioma,particularly its size and bilaterality,on ICSI outcomes.The study sought to determine how endometriomas affect ovarian reserve,ovarian stimulation responses,embryo quality and reproductive outcomes in patients undergoing assisted reproductive technology(ART) due to endometriosis. Materials and Methods This retrospective cohort study analyzed data from ARTcycles performed at Uludağ University ART Center between January2011 and December2024.A total of 460 patients undergoing their first ICSI cycles were included. The study group consisted of 230 patients diagnosed with endometrioma. The control group included 230 patients with unexplained infertility,matched by age,AMH,and AFC using propensity score matching. Patients were classified into five groups:four based on endometrioma size,categorized into percentiles(0-25,25-50,50-75,75-100),and control group of women with unexplained infertility. Comparative assessments were made across the five groups regarding baseline characteristics,basal hormonal parameters,ovarian stimulation profiles. Embryological development parameters and clinical outcomes were analyzed to evaluate differences among the groups. The primary outcome measure was the implantation rate. Results When endometrioma size was categorized into percentiles,Group1 included those with a size≤2.5 cm(n=66),Group2 with a size>2.5–≤4 cm(n=48),Group3 with a size>4–≤6 cm(n=64),and Group4 with a size>6 cm(n=52).Apart from the increase in basal FSH values(p<0.001) corresponding to the size of the endometrioma, no significant differences were observed in other basal hormone parameters, antral follicle count(AFC)(p=0.171),or AMH levels(p=0.273).Additionally,the Follicular Output Rate (FOI)(p=0.454) and Follicular Output Rate Test(FORT)values(p=0.712),which assess ovarian response, were similar across all groups, including the control group. Compared to the control group, the presence of endometriomas was associated with a reduction in the number of oocytes(p<0.001) and blastocyst count(p=0.003) after OPU, while blastocyst formation(p=0.491) and implantation rates(p=0.472)remained unaffected. Although the increase in endometrioma size negatively impacted embryological parameters, it didn't alter the clinical outcomes(p=0.541). Discussion This study demonstrates that ovarian endometriomas reduce the number of oocytes and blastocysts retrieved,suggesting a potential negative impact of increased endometrioma size on ovarian function.Implantation rates were comparable between women with endometriomas and those with unexplained infertility. Conclusion Our study didn't observe significant differences in embryo quality or clinical pregnancy rates in the presence of endometriomas,indicating that the impact of endometriomas on these outcomes is likely limited.Further research is necessary to develop management strategies for endometriomas in ART cycles and to assess long-term outcomes.

This retrospective study seeks to explore whether modifying the gonadotropin dose in cases of poor ovarian response during controlled ovarian hyperstimulation contributes to improved live birth rates in Poseidon Group 3-4 patients. The study took place at a tertiary level university. The electronic database spanning 2012-2021 was scrutinized to identify patients with diminished ovarian reserve (DOR) who underwent intra-cytoplasmic sperm injection – embryo transfer (ICSI-ET). Diminished ovarian reserve was determined using the POSEIDON criteria. Patients were categorized into two groups based on whether dose adjustment was implemented during the initial ultrasound assessment in controlled ovarian hyperstimulation (COH). There were 188 patients in the dose adjustment (DA) group and 310 patients in the fixed-dose (FD) group. The demographic parameters were similar between the groups. The started gonadotropin dose was similar in both groups (300 IU). The median dose adjustment on the first control was +75 IU in the DA group. The follicle output rates, follicle to oocyte indexes, and the embryology parameters were comparable between the groups. The positive pregnancy rate was 19.7% (36/188) in the DA group vs. 19.1% (61/310) in the FD Group (p=0.4). The primary outcome of the study; live birth rates were 12% in the DA group vs. 9% in the FD group, and the results were statistically similar (p=0.3). Our research revealed that adjusting the gonadotropin dose in cases of inadequate ovarian response during COH results in comparable live birth rates to those observed in the fixed-dose group. For patients exhibiting an inadequate response, dose adjustment may be deemed necessary.

Objective The aim of the thesis study is to comparatively evaluate the effect and mechanism of intraovarian mechanical stimulation and intraovarian PRP injection before the controlled ovarian hyperstimulation (COH) protocol on the development of ovarian follicles through the hippo signaling pathway in cases of premature ovarian insufficiency (POI), which is one of the causes of infertility. Materials and Methods In order to create an experimental POI model and apply intraovarian injections and COH protocol, 45 female Sprague-Dawley rats were divided into 7 different groups. A POI model was created on the subjects by subcutaneously injecting a single dose of 4-Vinylcyclohexene Diepoxide (VCD, 160 mg/kg/day) for 15 days. Intraovarian following VCD injections; Surgical opening and closing, mechanical stimulation with an empty needle, PRP and SF injections were performed, and then the COH protocol was applied. Histomorphological evaluations with H&E staining in the ovarian tissues excised after the sacrifice of the subjects; Serum AMH and TAZ, NAIP, CTGF concentration determinations were performed by ELISA method. Results As a result of VCD injections, a decrease in the number of primordial follicles and primary follicles from ovarian follicles, an increase in the number of atretic follicles, a decrease in AMH concentration, and statistically significant differences in the expression of hippo signaling pathway proteins were observed in the experimental groups. Conclusions In this study, intraovarian PRP injection applied before the COH protocol in the rat experimental POI model had a similar effect to physiological saline injection in disrupting the hippo signaling pathway. The similarity of the effects of mechanical stimulation and PRP injection into the tissue on the activation of primordial follicles and the incompatibility between the Hippo signaling pathway proteins and follicle activation levels showed the need to investigate different mechanisms in the follicle increase due to mechanical stimulation.

Abstract Background An unexpected impaired ovarian response pertains to an insufficient reaction to controlled ovarian hyperstimulation. This deficient reaction is identified by a reduced count of mature follicles and retrieved oocytes during an IVF cycle, potentially diminishing the likelihood of a successful pregnancy. This research seeks to examine whether the characteristics of antral follicles can serve as predictive indicators for the unexpected impaired ovarian response to controlled ovarian stimulation (COS). Methods This retrospective cohort study was conducted at a tertiary university hospital. The electronic database of the ART (assisted reproductive technologies) center was screened between the years 2012–2022. Infertile women under 35 years, with normal ovarian reserve [anti-Müllerian hormone (AMH) > 1.2 ng/ml, antral follicle count (AFC) > 5] who underwent their first controlled ovarian stimulation (COS) cycle were selected. Women with < 9 oocytes retrieved (group 1 of the Poseidon classification) constituted the group A, whereas those with ≥ 9 oocytes severed as control (normo-responders) one (group B). Demographic, anthropometric and hormonal variables together with COS parameters of the two groups were compared. Results The number of patients with < 9 oocytes (group A) was 404, and those with ≥ 9 oocytes were 602 (group B). The mean age of the group A was significantly higher (30.1 + 2.9 vs. 29.4 + 2.9, p = 0.01). Group A displayed lower AMH and AFC [with interquartile ranges (IQR); AMH 1.6 ng/ml (1-2.6) vs. 3.5 ng/ml (2.2–5.4) p < 0.01, AFC 8 (6–12) vs. 12 (9–17), p < 0.01]. The number of small antral follicles (2–5 mm) of the group A was significantly lower [6 (4–8) vs. 8 (6–12) p < 0.01), while the larger follicles (5–10 mm) remained similar [3 (1–5) vs. 3(1–6) p = 0.3] between the groups. Conclusion The propensity of low ovarian reserve and higher age are the main risk factors for the impaired ovarian response. The proportion of the small antral follicles may be a predictive factor for ovarian response to prevent unexpected poor results.

Dehydroepiandrosterone (DHEA) is frequently integrated as an adjuvant in over a quarter of controlled ovarian hyperstimulation (COH) protocols, despite the ongoing debate regarding its impact. This study aimed to evaluate the efficacy and mechanism of action of DHEA on ovarian follicular development and ovarian response in rats with varying ovarian reserves. The study involved 75 rats categorized into 15 distinct groups. The ovarian tissues of rats in both the normal ovarian reserve group and the premature ovarian insufficiency (POI) group, induced by 4-vinylcyclohexene diepoxide (VCD) injection, were subjected to histomorphological and biochemical analyses following the administration of DHEA, either alone or in combination with COH. Follicle counting was performed on histological sections obtained from various tissues. Serum concentrations of anti-M & uuml;llerian hormone (AMH) and the quantification of specific proteins in ovarian tissue, including phosphatase and tensin homolog of chromosome 10 (PTEN), phosphoinositide 3-kinase (PI3K), phosphorylated protein kinase B (pAKT), cyclooxygenase 2 (COX-2), caspase-3, as well as assessments of total antioxidant status and total oxidant status, were conducted employing the ELISA method. The impact of DHEA exhibited variability based on ovarian reserve. In the POI model, DHEA augmented follicular development and ovarian response to the COH protocol by upregulating the PTEN/ PI3K/AKT signaling pathway, mitigating apoptosis, inflammation, and oxidative stress, contrary to its effects in the normal ovarian reserve group. In conclusion, it has been determined that DHEA may exert beneficial effects on ovarian stimulation response by enhancing the initiation of primordial follicles and supporting antral follicle populations.

Clinical and histopathological evidence suggest that the male reproductive system may be negatively impacted in patients with coronavirus disease (COVID-19). The objective of this study is to investigate the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on semen parameters by comparing semen analyses before and after COVID-19 diagnosis in the same patient. We retrospectively analyzed 342 semen analyses by reviewing medical records. The study included two groups of patients: (i) those who underwent two consecutive semen analyses within 6 months, one before (n=114) and one after (n=114) COVID-19 diagnosis, and (ii) a control group (n=114) that was age-matched and did not receive a diagnosis of COVID-19. The study results indicated a significant decrease in semen volume, total sperm count per ejaculate, progressive motile sperm count, total motile sperm count, and normal sperm morphology after SARS-CoV-2 infection in comparison to their respective values before the infection. Subgroup analyses showed that the duration of COVID-19 diagnosis (short-term vs long-term) did not impact the changes in semen parameters. However, fever during the COVID-19 process had a negative effect on semen parameters, particularly sperm concentration, unlike in patients without fever. In conclusion, our findings suggest that SARS-CoV-2 infection is associated with a decline in semen quality, which may potentially impact male fertility. Furthermore, it’s important to note that the negative effects on semen parameters may persist in the long-term. Our results also indicate that fever during active infection could be a significant risk factor that negatively affects spermatogenesis.

Objectives This study aims is to determine the effect of incubation in platelet-rich plasma (PRP) before freezing on sperm viability, motility, and fertilization potential after thawing in sperm cryopreservation applied within the scope of reproductive potential preservation approaches. Materials and methods The participants in this study were selected from the normozoospermic male. Twenty semen samples were collected, and each sample was divided into three aliquots a fresh sample, a vitrified one with cryoprotectant solution, and a vitrified one without cryoprotectant solution.The samples were evaluated in two subgroups. One group was added with an autologous 2% PRP solution, while the other was not and all groups were incubated at 37 0C for 2 hours. Sperm motility, viability, morphology, and acrosomal reaction (ARIC score) were measured and analyzed. Results The incubation of fresh ejaculate with PRP did not change routine sperm parameters, while sperm viability and motility decreased in vitrification protocol using cryopreservation solutions with or without cryoprotectants. It was found that incubation in PRP before freezing did not change the routine sperm parameters in vitrification with cryoprotectant-free solutions and with cryoprotectant-containing solutions. The ARIC scores were not significantly different between the groups. Conclusions The clinical efficacy of high ARIC scores in vitrified samples without cryoprotectant in the acrosomal reaction analysis is controversial, and that further comprehensive studies are needed to show the effectiveness of PRP in sperm vitrification in clinical practice.

This study investigates the triple combination of adjuvants (low molecular weight heparin (LMWH)-aspirin-prednisolone) whether it improves the live birth rates of IVF&ICSI patients with previous implantation failure. This retrospective study included 1095 patients with >2 failed either fresh or frozen single embryo transfer cycles between 2014 Jan and 2021 Jan. Patients were divided into two subgroups. Group A consisted of patients with only vaginal progesterone for luteal phase support. Group B consisted of patients with triple (daily subcutaneous LMWH, daily 150 mg aspirin, and daily 16 mg prednisolone) luteal phase supplementation to vaginal progesterone. Demographic parameters, cycle characteristics, embryology, and pregnancy outcomes were compared, and the study's primary outcome was the live birth rate. Demographic parameters were similar between the groups. Positive b-hCG, miscarriage, and live birth rates were similar between groups as Group A vs. Group B, positive b-hCG 30.8% (190/617) vs. 35.4% (169/478), miscarriage rates 4.4% (27/617) vs. 6.7% (32/478), and live birth rates 20.4% (126/617) vs. 23.8% (114/478), respectively. When patients were stratified according to previous failures, live birth rates were still similar. Pregnancy outcomes were significantly improved in only patients with diminished ovarian reserve (Group A vs. Group B, positive b-hCG 24.2% vs. 34.3%, live birth rate 12.1% vs. 21.9%, p < 0.01). Whether the embryo transfer was fresh or frozen-thawed did not affect the results. A combined supplementation of LMWH, aspirin, and prednisolone in the luteal phase does not improve live birth rates of IVF&ICSI patients with previous implantation failure except potentially for patients with diminished ovarian reserve.

The viability of sperm is a crucial factor for achieving a successful pregnancy in intracytoplasmic sperm injection (ICSI) cycles. The aim of this study was to evaluate the accuracy of the hypo-osmotic swelling test (HOST) in fresh and frozen-thawed sperm samples of different origins (ejaculated/testicular). A retrospective analysis was conducted on the outcomes of 2167 oocytes subjected to ICSI using motile and immotile-HOST-positive sperm from 2011 to 2023. We evaluated embryonic development, as well as clinical, obstetric, and neonatal outcomes in four groups based on different sperm origins (ejaculated/testicular) and processing (fresh/frozen). When comparing the results of ICSI between motile and immotile-HOST-positive sperm within each group, it was observed that there were no significant differences in the outcomes for fresh samples. However, for frozen-thawed samples, fertilization rates and blastocyst development rates were significantly lower when ICSI was performed with immotile-HOST-positive sperm compared to motile sperm. Of note, clinical, obstetric, and neonatal outcomes were statistically similar across all groups. Our findings indicate that HOST is more reliable in fresh samples than in those subjected to the freeze-thaw process. Nonetheless, HOST is considered a safe method for selecting viable sperm in all subgroups.

Objective: To elucidate the prognostic factors for intracytoplasmic sperm injection cycle cancellation in patients with endometriosis-related infertility. Study Design: This was a retrospective cohort study and conducted at the Assisted Reproductive Technology center of Uludag University School of Medicine, between the years 2011-2017. The electronic database was screened and infertile patients with endometriosis, without male factor infertility, systemic disease, or undefined adnexal mass, and aged <40 were selected. The endometriosis phenotype of all cycles was classified into three subgroups: superficial endometriosis, ovarian endometrioma and deep infiltrating endometriosis. Cycles were divided into two groups: Group I (Cycle Cancellation) vs. Group II (Embryo transferred). Results: Forty-four cycles were canceled and in 178 cycles, the embryo was able to be transferred. When the groups were compared age and day 3 FSH levels were statistically higher, and anti-Mullerian hormone and antral follicle count were statistically lower in Group I. The presence of adenomyosis was higher in Group I (64% vs. 40% p<0.01). The surgery rate with laparotomy was higher in Group I (54.5% vs. 13.5% p<0.01). Antral follicle count remained as the only independent factor associated with prognoses of the IVF cycle with binary logistic regression analysis. Cancellation rates were similar between the phenotypes of endometriosis. Conclusions: Poor ovarian reserve, advanced age, presence of adenomyosis, and history of laparotomy are negative prognostic factors associated with intracytoplasmic sperm injection cycle cancellation in endometriosis-related infertility. Antral follicle count is the only independent factor in predicting cycle cancellation. The phenotype of endometriosis does not affect the results.

OBJECTIVE: To evaluate the effect of the embryo transfer duration of standard and simple embryo transfer method. STUDY DESIGN: This study was a retrospective cohort study conducted at a tertiary ART Centre, between June 2018- September 2018. Day 5 fresh embryo transferred patients aged between 18 - 40, BMI <35 kg/m2 without uterine pathology were enrolled in the study. Patients were divided into two groups. Group-1 consisted of patients who had successful implantation and Group-2 consisted of patients who did not have implantation. Groups were compared according to their embryo transfer durations. Ninety-two patients were enrolled in the study. Also, sub-steps of as; cleaning of the cervical mucus and placing the outer catheter in the cervix, loading the embryo to the catheter, the period between embryo loading and embryo transfer, and following that, time spent for retracting the outer catheter evaluated. RESULTS: Between Group-1 and Group-2, there was no significant difference for the period of cervical cleaning and placing the outer catheter into the cervix (Respectively; 63 sec vs. 76 sec; p=0.18), the period of embryo loading (Respectively; 69sec vs. 71sec; p=0.46), the period between embryo loading and embryo transfer (Respectively; 10 sec vs. 10 sec; p=0.74, retracing the outer catheter (Respectively; 25.5sec vs. 24sec; p=0.42 and the total period of embryo transfer (182sec vs. 182.5 sec; p=0.55). CONCLUSION: The embryo transfer duration is not related to implantation rates. The duration of the embryo transfer process steps is not a distinguishing factor if a good-quality embryo transfer is done.

This retrospective study aims to determine the more predictive ovarian reserve marker when there is discordance between anti-Mullerian hormone (AMH) and antral follicle count (AFC) in patients with diminished ovarian reserve (DOR). Patients who underwent ICSI because of DOR were divided into three groups. Group 1: patients with low AMH (<1.1 ng/ml) and AFC (n < 7), group 2: patients with low AMH (<1.1 ng/ml) and normal AFC (n >= 7) and group 3: patients with normal AMH (>= 1.1 ng/dl) and low AFC (n < 7). Demographic values, follicle output rate (FORT) score and follicle to oocyte index (FOI) score of the groups were compared. Totally, 662 cycles were enrolled in the study. There were 418 cycles in group 1, 167 cycles in group 2 and 77 cycles in group 3. As the primary result, FORT and FOI scores were higher in group 3 than the other two groups. Median FORT Score with quartiles: group 1: 100 (66-150), group 2: 71 (57-100), group 3: 136 (96-200), p<.01 - median FOI score with quartiles: group 1: 83 (50-140), group 2: 71 (40-100), group 3: 116 (66-216), p<.01. In conclusion, serum AMH level has more predictive value for stimulation success if there is discordance with AFC.Impact Statement What is already known on this subject? Female age, serum Anti-Mullerian Hormone (AMH) levels, and antral follicle count (AFC) are commonly used to assess ovarian reserve and predict response to ovarian stimulation. AMH and AFC are both positively correlated with ovarian reserve. What do the results of this study add? If there is discordance between AFC and AMH in patients with diminished ovarian reserve (DOR), the ovarian response is better in patients with high AMH and low AFC than the patients with low AMH and high AFC. What are the implications of these findings for clinical practice and/or further research? It is important to assess both AFC and AMH before controlled ovarian hyperstimulation, to predict ovarian response in DOR patients, rather than assessing AFC or AMH alone.

Üremeye yardımcı tedavi uygulamalarında tercih edilen tedavi yaklaşımına göre semen parametrelerinin embriyoloji laboratuvarı sonuçlarına ve klinik başarıya etkisi değişmektedir. Semen parametreleri abstinens süresine ve androloji laboratuvarında uygulanan yıkama protokollerine göre değişmekte ve insemine edilecek sperm materyalinin kalitesini etkilemektedir. Bu çalışmada normozoospermik erkeklerde kısa abstinens süresinin rutin semen parametrelerine, sperm kromatin ve DNA bütünlüğüne, oksidatif strese karşı gelişen antioksidan kapasiteye etkisinin değerlendirilmesi amaçlandı. Aynı hastadan ardışık ejakülasyonla 2-5 günlük abstinens süresi sonrası (n=36) ve 1 saat abstinens süresi sonrası (n=36) alınan numuneler yıkama öncesi ve yıkama sonrası değerlendirildi. Yıkama öncesinde sperm volümünün ve total motil sperm sayısının kısa abstinens grubunda anlamlı olarak azaldığı bulundu. Yıkama sonrasında gruplar arasında motilitenin değişmediği, konsantrasyonun kısa abstinens grubunda anlamlı olarak azaldığı görüldü. Abstinens süresi kısa tutulduğunda sperm kromatin hasarının ve DNA fragmantasyon oranının azaldığı, antioksidan kapasitede bir değişiklik oluşturmadığı saptandı. Sonuç olarak normozoospermik olgularda, abstinens süresinin kısa tutulması sperm konsantrasyonunu ve total progressif motil sperm sayısını azaltmakla birlikte, uygulanacak üremeye yardımcı tedavi yaklaşımına göre inseminasyonda kromatin ve DNA bütünlüğü açısından daha kaliteli sperm kullanılmasına imkan sağlayacaktır. Ardışık ejakülasyon ve abstinens süresindeki kısalma aktioksidan kapasitede olumlu ya da olumsuz bir etki oluşturmamaktadır.

The aim of this study was to determine whether Kisspeptin and Kisspeptin receptor in the follicular microenvironment is necessary for human oocyte maturation and fertilisation. The cumulus cell (CC) and follicle fluids (FF) obtained from the first aspirated follicles (n = 52) from 32 patients were divided into three groups considering nuclear maturation and fertilisation results of oocytes: (1) Metaphase I or germinal vesicle stage oocytes (incomplete nuclear maturation, n = 10), (2) unfertilised metaphase II oocytes (incomplete cytoplasmic maturation, n = 16), and (3) fertilised metaphase II oocytes (completed nuclear-cytoplasmic maturation, n = 26). The gene expression levels were assessed by RT-PCR. The levels of Kisspeptin (KISS1) and Kisspeptin receptor (KISS1R) were measured by ELISA. There were no significant efficacy KISS1 and KISS1R gene expressions in cumulus cells in terms of oocyte nuclear maturation stage (Group 1, vs Group 2 + Group 3) (respectively p = .49; p = .45). In terms of the cytoplasmic maturation stage (Group 2, vs Group 3); KISS1 and KISS1R expressions in CCs were comparable (respectively p = .07; p = .08). In FFs, KISS1 and KISS1R concentrations were similar between all groups (respectively p = .86; p = .26). In conclusion, the relative KISS1 and KISS1R expressions in CC and also KISS1 and KISS1R level of FF were independent of oocytes nuclear and/or cytoplasmic maturation. Impact statement What is already known on this subject? It has been demonstrated that Kisspeptin is an essential regulator of reproductive function and plays a key role in the modulation of GnRH secretion and gonadotropin release. Still, no information is available about the link between gene expression or concentration in the follicular microenvironment and oocyte development. What do the results of this study add? The study has shown that the relative Kisspeptin (KISS1) and Kisspeptin receptor (KISS1R) and expressions in cumulus cell (CC) and also KISS1 and KISS1R levels of follicle fluids (FF) were independent of oocytes nuclear and/or cytoplasmic maturation. What are the implications of these findings for clinical practice and/or further research? Based on the findings, it is difficult to establish a concept that kisspeptin can directly induce oocyte maturation. Nevertheless, to confirm these findings, further studies with a larger sample size are needed.

Üremeye yardımcı tedavi (ÜYT) uygulamalarında ilk basamak olan intrauterin inseminasyonda (IUI) kadın yaşı, vücut kitle indeksi (VKİ), stimülasyon süresi, abstinens süresi ve semen parametreleri başarıyı etkileyen prognostik faktörler arasındadır. Her ÜYT merkezinin rutin tedavi yaklaşımları ve laboratuvar uygulamaları sonucunda elde ettiği klinik başarı dikkate alınarak kendi prognostik faktörleri oluşturulmalı ve tedavi sürecinin yönetimi bu perspektifte düzenlenmelidir. Bu retrospektif çalışmada Ocak 2019-Şubat 2020 tarihleri arasında ÜYT merkezimizde gerçekleştirilen 245 IUI siklusu değerlendirilmiştir. IUI tedavisi uygulanan hastaların etiyoloji, yaş, VKİ, ejakülatın yıkama öncesi ve yıkama sonrası sperm parametreleri, abstinens süresi ve ejakulat yıkama işlemi boyunca geçen zaman periyotları değerlendirilmiştir. Kadın ve erkek yaşı, kadın VKİ, etiyoloji, infertilite süresi, siklus sayısı ve abstinens süresi bakımından gruplar arası farklılık saptanmaz iken, erkek VKİ artışının gebelik başarısını azalttığı saptandı. Semen volümü, yıkama öncesi ve sonrası sperm konsantrasyonu ve total motil sperm sayısının gebelik başarısı açısından belirleyici etkisinin olmadığı, yıkama sonrası motil sperm ve immotil sperm yüzdesinin belirleyici olduğu görüldü. Numune verilmesi ve yıkama sonrasından IUI işlemine kadar geçen sürelerin klinik başarıyı etkilemediği, fakat yıkama öncesi uzun inkübasyon süresinin gebelik şansını azalttığı saptandı. Küçük örneklem grubuyla yapılan bu çalışmada IUI tedavisinde klinik başarıda yıkama öncesi semen parametrelerinin belirleyici bir etkisinin olmadığı, erkek obezitesi ve numune hazırlama süreçlerinin prognostik faktörler olarak göz önünde bulundurulması gerektiği sonucuna varıldı.

Objective To determine the predictive value of cryopreserved embryos during single fresh blastocyst transferMethods This retrospective cohort study was conducted at a tertiary university hospital ART center. Patients who underwent a single fresh blastocyst transfer were selected from the electronic database. Patients with diminished ovarian reserve, uterine pathology, advanced age (>40 years) were excluded from the study. Patients were divided into two groups. Group A consisted of patients with only one available embryo for the fresh transfer. Group B consisted of patients with cryopreserved embryos apart from the fresh transferred embryo. Demographic and embryology parameters, pregnancy results were compared.Results Demographic values, ovarian reserve parameters were comparable between groups. The number of the picked-up oocyte, metaphase-2 oocyte, and two-pronucleus embryo was lower in Group A. Positive pregnancy rates were two-fold higher in Group B (23.4% vs. 50.9% p < .01). Pregnancy results did not change depending on the number of cryopreserved embryos in Group B.Conclusion According to our results, the presence of cryopreserved embryos results in higher pregnancy rates in patients with fresh blastocyst embryo transfer independent from the woman's age and ovarian reserve. Thus, these results may help us to predict the implantation rate before embryo transfer.

Objective: To evaluate the correlation between the gene expression of prostaglandin-endoperoxide synthase-2 in the cumulus-oocyte complex with the level of prostaglandin-endoperoxide synthase-2 in follicular fluid and follicle diameter, oocyte maturation, and fertilization capacity.Study Design: As the study group, 26 cumulus-oocyte complexes and 26 follicular fluids obtained from immature (n=10) or unfertilized mature oocytes (n=16) and as the control group, 26 cumulus complexes and 26 follicular fluids surrounding mature and fertilized oocytes were retrieved one by one totally from 32 patients in 32 intracytoplasmic sperm injection cycles. Results: There was no significant efficacy of prostaglandin-endoperoxide synthase-2 gene expressions in cumulus complexes and the level of prostaglandin-endoperoxide synthase-2 in follicular fluids in terms of oocyte maturation stage. The level of prostaglandin-endoperoxide synthase-2 in follicular fluids and follicle diameters showed a significantly positive correlation in the mature and fertilized oocyte group (r=0.414; p=0.035). Conclusions: Although the prostaglandin-endoperoxide synthase-2 gene expressions in immature oocytes and their cumulus cells were similar to those in oocytes that have completed their nuclear and cytoplasmic maturation, the level of prostaglandin-endoperoxide synthases-2 in the follicular fluid and follicle diameter correlation may lead to new clinical approaches in cases of premature follicular rupture before oocyte maturation is completed.