Objectives: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in infertile women characterized by both reproductive and metabolic dysfunctions of different degrees. Furthermore, it has been associated with increased cardiovascular disease (CVD) risk and related long-term health sequela. The aim of this study is to evaluate serum homocysteine (Hcy) and C-reactive protein (CRP) levels in women with PCOS and to evaluate their relationship with clinical and laboratory parameters in women with PCOS. Materials and Methods: The prospective single-center study included 45 women with PCOS (study group) and 41 control subjects. Demographic variables and Hcy, CRP, fasting blood glucose, insulin, follicle-stimulating hormone, luteinizing hormone, estradiol, total and free testosterone, dehydroepiandrosterone sulfate, thyroid-stimulating hormone levels, and lipid profiles of the subjects were recorded. homeostatic model assessment for insulin resistance (HOMA-IR) indexes were calculated. Results: Fasting plasma glucose, insulin, HOMA-IR, free and total testosterone levels, and clinical hirsutism were significantly higher in the study group. There was no statistically significant difference in lipid profile between groups. Hcy and CRP levels were higher in the study group, which was not statistically significantly different (P > 0.05). Conclusion: Some of the parameters that are correlated with CVD risk were found to be higher in women with PCOS, although the difference for Hcy and CRP did not reach statistical significance. However, the current study reveals that the CVD risk associated with PCOS deserves more comprehensive prospective studies with long-term outcomes.

Abstract Objectives Since polycystic ovarian syndrome (PCOS) is prevalent in reproductive women with obesity and insulin resistance, adipocytokines are often accused and investigated for pathophysiology. The aim of this study was to evaluate the adiponectin and leptin levels in normal-weight women with PCOS. Methods Forty women with PCOS and 40 age and body mass index (BMI) matched controls were included in the study. Adiponectin and leptin levels in addition to other biochemical parameters were measured. Results Leptin levels were statistically significantly higher in the study group compared to the control group (6.53 ± 2.670 vs 3.37 ± 2.002 ng/mL, p < 0.001 respectively). Although Adiponectin levels were lower in the study group compared to the control group (28.89 ± 16.124 μg/mL vs 31.05 ± 20.507, p = 0.714 respectively) the difference did not reach statistical significance. Leptin levels were positively correlated with fasting glucose, fasting insulin, free testosterone levels and homeostatic model assessment of insulin resistance (HOMA-IR) values. Adiponectin levels were negatively correlated with BMI. Conclusions Adiponectin and leptin have been suggested to play a crucial role in the pathogenesis of PCOS. Different adipocytokine levels in the normal weight PCOS group compared to age and BMI matched controls support the idea that adipose tissue in this group of women has some distinctive features not only in high BMI subgroup but also in normal weight subgroup.

Bu calismada, oosit toplanmasi sirasinda elde edilen folikul sivisinda gebelikle iliskili plazma protein-A (PAPP-A) bakilmasi, bunun oosit maturasyonu, embryo gelisimi ve erken gebelik sonuclari ile iliskisinin degerlendirilmesi, ayrica es zamanli olarak serumda PAPP-A seviyesine bakilmasi ve bunun folikuler sividaki seviyeler ve diger parametreler ile korelasyon gosterip gostermediginin degerlendirilmesi amaclanmistir. Bu degerlendirmede anlamli sonuclar elde edilirse, yardimci ureme tekniginin basarisini onceden tahmin etmekte kullanilabilecek ekonomik ve kolay ulasilabilir uygun bir test bulunabilecek, tedavinin tek ve saglikli bir gebelikle sonuclanmasinda basari oranlari artirilabilecektir. Infertilite nedeni ile merkezimizde takip edilen, ICSI ve ET icin kontrollu overyan hiperstimulasyon yapilmasi planlanan ve calismaya katilmayi kabul eden 55 hasta calismaya dahil edilmistir. Tum hastalara uzun agonist protokol kullanilarak ovulasyon induksiyonu yapilmis, her hastanin ikiser adet folikulunden oositler folikul sivisindan ayrildiktan sonra elde edilen folikul sivilari ve oosit toplanmasi sirasinda alinan kanlari 4000 g’de 10 dakika santrifuj edilmis, supernatanlar aspire edilerek Eppendorf tuplerine konmus ve ornekler PAPP-A tayinine kadar -80oC’de saklanmistir. Isaretlenen oositlerin maturasyonu ve fertilizasyonu degerlendirilmis, olusan embryolarin kaliteleri morfolojik ozelliklerine gore skorlanmistir. Ornekler oda isisinda cozuldukten sonra PAPP-A olcumleri Floresanimmunoassay (FIA) yontemi ile yapilmistir. PAPP-A seviyelerinin embryo kaliteleri ve gebelik oranlari ile korelasyonu degerlendirilmistir. Folikul sivilarinda bakilan PAPP-A degerleri ile ayni folikullerden elde edilen embryo kaliteleri arasinda anlamli bir iliski saptanmamistir. Embryolar kalitelerine gore ayrildiginda, elde edildikleri folikullerin PAPP-A degerleri arasindaki fark da anlamli bulunmamistir. Ancak, gebelik olusan hastalarda oosit toplanmasi sirasinda serumda bakilan PAPP-A degerleri gebelik olusmayan hastalardakine gore anlamli olarak dusuk saptanmistir (p < 0,05). Oosit toplanmasi sirasinda serumda bakilan PAPP-A degeri ≤ 1.5 oldugunda gebelik olasiligi daha yuksek bulunmustur. Bununla birlikte, serum PAPP-A degerleri ile diger parametreler arasinda anlamli iliski bulunmamistir.

The objective of this study is to measure Pregnancy Associated Plasma Protein-A (PAPP-A) in serum and follicular fluid during oocyte retrieval, and to investigate the association of PAPP-A with oocyte maturation, embryo development and early pregnancy results. This prospective cohort study was conducted in single center including fifty-five patients to whom intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) were applied. Long agonist protocol was applied for ovarian stimulation. Follicular fluid was aspirated from two separate follicules of each patient for oocyte retrieval and PAPP-A levels of follicular fluids and serum were measured via Fluorescence immunoassay (FIA). Marked oocytes from these follicles were evaluated for their maturation and fertilization and embryo development were followed. Association of PAPP-A levels with embryo quality and pregnancy rates were assessed. There was not statistically significant association between the follicular fluid PAPP-A levels and the embryo qualities obtained from the oocyte of the same follicle. Also, PAPP-A levels from follicles were not significantly different when compared between high and low quality embryos. In contrast, serum PAPP-A levels at the time of oocyte retrieval were significantly lower in patients who achieved pregnancy when compared to the patients at whom pregnancy was not achieved (p<0.05). PAPP-A level in follicular fluid was not significantly related to embryo quality and pregnancy rates while serum PAPP-A values were significantly different between patients who achieved pregnancy and the patients who could not achieve pregnancy. However, further studies with large number of patients are needed.

GIRIS ve AMAC: Bu arastirmada azospermi, oligospermi ve/veya motilite/morfoloji bozuklugu olan Turk infertil hastalarda HSFY geninin mutasyon analizi planlanmistir.YONTEM ve GERECLER: Arastirmaya uc farkli merkezden toplam 41 infertil Turk hasta katilmistir. Spermatogenez yetmezligine neden olabilecek endokrin ve obstruktif problemleri olmayan, Y kromozomunda mikrodelesyonu olmayan ve normal karyotipe sahip olgular calismaya dahil edilmistir. HSFY geninin mutasyon analizi DNA dizi analizi yontemi ile gerceklestirilmistir.BULGULAR: Calisma grubuna dahil olan olgularda HSFY geninin kodlanan bolgeleri ve bu bolgelere komsu intronik bolgelerinde herhangi bir degisim saptanmamistirTARTISMA ve SONUC: Bu calismada spermatogenez yetersizligi ile HSFY geni arasinda bir iliski saptanmamistir. Genetik heterojenite nedeniyle spermatogenez yetersizligi olan bireylerde molekuler tani uygulamalari oldukca guc olup erkeklerdeki idiyopatik infertileye neden olan gen ve mutasyonlarin aydinlatilmasi icin daha cok calisma yapilmasi gereklidir.

Purpose:In this study we planned to investigate HSFY gene mutations in Turkish infertile men with azoospermia, oligospermia and/or poor motility/morphology. Materials and methods: From three distinct medical centers, 41 Turkish infertile men contributed to this study.The patients included in the study had no endocrine or obstructive causes of spermatogenic failure and no Y microdeletion, and had normal karyotype.Mutation analysis of the HSFY gene was performed by DNA sequencing.Results: No variant could be detected in coding regions and flanking introns of HSFY gene in the study population. Conclusion:This study suggests no relation of HSFY sequence variant with spermatogenic failure and, the clinical molecular approach to diagnosis of individuals with spermatogenic failure is complicated due to extensive genetic heterogeneity and need more study to reveal causative genes and mutations of idiopathic infertility in men.

OBJECTIVE:To determine the potential effect of the ultrashort gonadotropin-releasing hormone (GnRH) agonist/GnRH antagonist protocol versus the microdose GnRH agonist protocol in poor responders undergoing intracytoplasmic sperm injection (ICSI).MATERIAL AND METHODS:The patients in the Agonist-Antagonist Group (n=41) were administered the ultrashort GnRH-agonist/ antagonist protocol, while the patients in the Microdose Group (n=41) were stimulated according to the microdose flare-up protocol. The mean number of mature oocytes retrieved was the primary outcome measure. Fertilization rate, implantation rate per embryo and clinical pregnancy rates were secondary outcome measures.RESULTS:There was no differenc between the mean number of mature oocytes retrieved in the two groups. There were also no statistical differences between the two groups in terms of peak serum E2 level, canceled cycles, endometrial thickness on hCG day, number of 2 pronucleus and number of embryos transferred. However, the total gonadotropin consumption and duration of stimulation were significantly higher with the Agonist-Antagonist Group compared with the Microdose Group. The implantation and clinical pregnancy rates were similar between the two groups.CONCLUSION:Despite the high dose of gonadotropin consumption and longer duration of stimulation with the ultrashort GnRH agonist/ antagonist protocol, it seems that the Agonist-Antagonist Protocol is not inferior to the microdose protocol in poor responders undergoing ICSI.

Objective: To determine serum interleukin (IL)-18 levels and to find out whether IL-18 is associated with carotid intima-media wall thickness (IMT) and various cardiovascular risk factors in women with polycystic ovary syndrome (PCOS).Design: A prospective, controlled study.Setting: University hospital.Patient(s): Sixty women with PCOS and 60 healthy women were included this study.Intervention(s): Serum levels IL-18, homocysteine (Hcy), C-reactive protein (CRP), IL-6, malonyldialdehyde (MDA), lipid and hormone profiles were measured. Carotid IMT was evaluated for both common carotid arteries.Main Outcome Measure(s): Serum IL-18, carotid IMT, Hey, CRP, IL-6., MDA, and homeostasis model assessment of insulin resistance.Result(s): The evaluation, which was made without the obesity influence taken into consideration, revealed that patients with PCOS have increased serum IL-18 levels than that of the control group (214 +/- 102 vs. 170 +/- 78 pg/mL). The interaction between PCOS and obesity was seen to have statistical significance (F = 67.8). Body mass index (BMI), waist to-hip ratio, Hey, and homeostasis model assessment of insulin resistance are independent determinants of plasma IL-18 in patients with PCOS. Elevated serum IL-18 levels were positively and significantly correlated with a greater carotid IMT. For Hcy and carotid IMT, the interaction between PCOS and obesity was found in a two-way ANOVA variation analysis (F = 48.5 and F = 81.5, respectively).Conclusion(s): Elevated serum IL-18 levels were associated with cardiovascular risk factors and carotid IMT in patients with PCOS. (Fertil Steril (R) 2010;93:1200-7. (C)2010 by American Society for Reproductive Medicine.)

Objective: To determine the possible relationship between serum antimullerian hormone (AMH) concentrations on day 3 and controlled ovarian stimulation and reproductive outcomes in women with polycystic ovary syndrome.Design: Prospective, clinical trial.Setting: University hospital.Patient(s): Sixty women with PCOS.Intervention(s): Serum concentrations of AMH measured on cycle day 3.Main Outcome Measure(s): Clinic pregnancy rate (CPR), implantation rate (IR), and fertilization rate (FR).Result(s): The CPR, IR, and FR were markedly different among the day-3 serum AMH groups (low, moderate, and high AMH groups). The CPR were 33.3, 46.1, and 60.0, respectively, in the low, moderate, and high serum AMH groups on day 3. The embryo IR were 18.6, 26.7, and 36.3, respectively. The FR were 54, 68, and 79, respectively. An AMH level >= 3.01 ng/mL was shown to predict FR with a sensitivity of 86.4% and specificity of 75%. An AMH level >= 3.2 ng/mL was shown to predict IR and CPR with sensitivity and specificity of 72.1% and 72.7%, and 75.6% and 77.3%, respectively.Conclusion(s): On day 3 of the in vitro fertilization stimulation cycle, serum concentrations of AMH can be used as a marker for ovarian response as well as reproductive outcome in assisted reproductive cycles of PCOS patients. (Fertil Steril (R) 2010; 94: 2202-7. (C) 2010 by American Society for Reproductive Medicine.)

Polycystic ovary syndrome (PCOS) shares some or most components of metabolic cardiovascular syndrome, manifested by abdominal obesity, insulin resistance, dyslipidaemia and atherosclerosis. It has been previously demonstrated that folate and vitamin B12 treatment improved insulin resistance in patients with metabolic syndrome. This study first investigated whether PCOS patients have lower or higher vitamin B12, folate and homocysteine concentrations when compared with healthy, age and body mass index matched controls, and, then examined associations between vitamin B12, folate, homocysteine and insulin resistance and obesity in PCOS patients. Homocysteine concentrations and homeostasis model assessment index were higher, whereas concentrations of vitamin B12 were lower in PCOS patients with insulin resistance compared with those without insulin resistance. Serum vitamin B12 concentrations were significantly lower in obese PCOS women in comparison with obese control women (P < 0.05). Fasting insulin, insulin resistance and homocysteine are independent determinants of serum vitamin B12 concentrations in PCOS patients. Insulin resistance, obesity, and elevated homocysteine were associated with lower serum vitamin B12 concentrations in PCOS patients.

During the recent two decades, a remarkable drop in fertility rates has been noticed almost all over the world. A series of studies have showed that environmental factors had the primary role causing the observed adverse trends in the male reproductive health problems. Especially chlorinated hydrocarbons, for instance polychlorinated biphenyls (PCB) and pesticides, could mimic or antagonize the effects of steroid hormones, like estrogens and androgens and possibly interfering with male reproductive capacity. Organochlorine pesticides (OCPs) (i.e. p.p'-DDT, endosulfan...) and PCBs are widespread used chemicals in agriculture and industry for different purposes all over the world. Although direct evidence is lacking, theoretical considerations and epidemiological evidence implicate these compounds as potential hazards to human and wildlife reproductive health. For this purpose, in this study adipose tissue samples have provided from healthy males which were diagnosed as infertile men living in Ankara, Turkey at least for 5 years. Residual levels of OCPs (alpha-BHC, beta-BHC, gamma-BHC, HCB, Endosulfan I, II, p,p'-DDE, and p,p'-DDT) and seven major persistent PCB congeners (PCB 28, 52, 101, 118, 138, 153, and 180) were measured in 25 infertile men and 21 healthy men's adipose tissue samples by GC-ECD. Levels of OCPs and PCBs in adipose tissue of infertile men compared with those provided from controls. When the concentrations of each of the OCP were compared between the fertile and infertile groups, no statistical significance was obtained. Concentrations of each of the PCB congeners were compared between the fertile and infertile groups, no statistical significance was obtained (p > 0.05), except for 2,2',5,5'-Tetrachlorobiphenyl (PCB 52) (p = 0.032) and 2,2',3,4,4',5,5'-heptachlorobiphenyl (PCB 180) (p = 0.017).

Serum anti-Mullerian hormone (AMH) concentrations constitute a sensitive marker for ovarian ageing. In addition, concentrations of AMH in the follicular fluid constitute a useful marker of embryo implantation in assisted reproduction cycles. The present study measured serum and follicular-fluid AMH concentrations on the day of oocyte retrieval. These data showed that clinical pregnancy rates (25.0, 34.1 and 42.1%, respectively, P < 0.001), embryo implantation rates (24.3, 35.0 and 44.4%, respectively, P < 0.001) and fertilization rates (59.2, 70.9 and 79.5%, respectively, P < 0.001) were markedly different among the low, moderate and high follicular-fluid AMH groups but not among the different serum AMH concentration groups. Follicular-fluid AMH concentrations were negatively correlated with follicular-fluid oestradiol concentrations. The results of this study suggest that follicular-fluid AMH concentration on the day of oocyte retrieval would appear to better reflect the reproductive outcome in PCOS patients undergoing assisted reproduction.

Objective: To describe a patient with uterine rupture in the subsequent pregnancy after hysteroscopic resection of a uterine septum.Design: Case report.Setting: University hospital.Patient(s): A 30-year-old nulliparous woman, with a history of a first trimester spontaneous abortion, hysteroscopic uterine septum resection by cutting diathermy using the operating hysteroscope, and a second hysteroscopic procedure for a residual septum, was admitted to our clinic with symptoms of hemodynamic shock at the 29th week of gestation.Intervention(s): Immediate laparotomy was performed.Main Outcome Measure(s): Uterine rupture in the second trimester of the subsequent pregnancy with fetal loss.Result(s): Midfundal complete uterine rupture was observed at the site of the resected uterine septum, accompanied by an extrauterine exanimate fetus.Conclusion(s): Uterine rupture may occur in pregnancies after hysteroscopic resection of the uterine septum. Clinicians who perform this procedure, especially in the cases with repeated procedures using cutting diathermy, must warn and inform their patients about the risks of their later pregnancies. (Fertil Steril (R) 2009; 91: 934. e1-e3. (C) 2009 by American Society for Reproductive Medicine.)

BACKGROUND:A poor quality of oocytes and embryos and a low fertilization rate have been found in polycystic ovary syndrome (PCOS) patients. An inverse association between follicular fluid homocysteine (Hcy) levels and oocyte and embryo quality has also been demonstrated. We examined the relationship between follicular fluid Hcy concentrations and oocyte and embryo quality in PCOS patients undergoing assisted reproduction. METHODS:Fifty-two PCOS patients were included in the study, and underwent GnRH agonist/recombinant FSH treatment. The Hcy, folate, vitamin B(12), malonyldialdehyde (MDA) and estradiol (E(2)) levels were measured in follicular fluid from single oocytes at time of retrieval. One follicle per ovary was sampled and 94 were analysed. Plasma hormones were also measured. Oocytes and embryos were graded (1-3) using standard approaches. RESULTS:The concentrations of Hcy, E(2), vitamin B(12), folate and MDA in plasma were higher than in follicular fluid (all P < 0.001). Significant differences were observed in follicular Hcy levels between Grade 3 and Grade 2 oocytes (P < 0.001). Hcy levels were lower in Grade 1-2 embryos than that in Grade 3 embryos; follicular fluid vitamin B(12) levels were lower in patients showing high concentrations of follicular fluid Hcy (P < 0.01). The follicular fluid Hcy levels were negatively correlated with follicular fluid vitamin B(12) (r = -0.44), folate (r = -0.68) and fertilization rate (r = -0.85), and positively correlated with follicular fluid MDA (r = 0.51). CONCLUSIONS:Concentrations of Hcy in follicular fluid on the dOPU may be a useful marker for fertilization rate, and oocyte and embryo quality in PCOS patients undergoing assisted reproduction.

We report a case of a live twin birth after laparoscopic treatment of a ruptured heterotopic pregnancy. A 29-year-old woman, with a history of right salpingectomy for ectopic pregnancy, became pregnant after transfer of three embryos at in vitro fertilization treatment. At the ninth week of gestation, she was admitted to our clinic with abdominal pain. Ultrasonographic examination revealed a triplet heterotopic pregnancy consisting of an intrauterine twin pregnancy and an ectopic pregnancy in the left fallopian tube. An immediate laparoscopy was planned and left salpingectomy was performed. In the postoperative period, intrauterine twin pregnancy continued uneventfully; at the 35th week of gestation, two healthy infants with birth weights of 2,206 and 2,426 g were delivered. Heterotopic pregnancies must be kept in mind after assisted reproductive techniques. Early diagnosis allows successful laparoscopic treatment without sequel. Laparoscopic surgery is an appropriate method to manage selected patients with heterotopic tubal pregnancy.

Results: In both groups, progressive motility of neither initial nor processed sperm specimens was significantly different (P > 0.05). When comparisons of semen parameters in groups were performed in the initial specimen, sperm concentration and total motile sperm count (TMC) were significantly different between the groups (P = 0.03, P = 0.04, respectively). After processing specimens a definite significant difference was found in sperm concentration and inseminated motile sperm count (IMC) between pregnancy and nonpregnancy cycles (P = 0.03, P = 0.03, respectively). Although TMC > 10 × 10 provided a pregnancy rate (PR) of 18% compared with TMC < 10 × 10 (PR: 10%), no significant differences were detected (P > 0.05).

OBJECTIVE: The aim of this study was to assess the effect of supplementation day of hMG to rFSH on IVF outcome in patients with inadequate response to previous ovarian stimulation.DESIGN: A retrospective observational study.MATERIALS AND METHODS: A total of 75 infertile couples undergoing ICSI were evaluated retrospectively. Following pituitary down-regulation with leuprolide acetate, 37 patients received a combination of rFSH and hMG both were started on the first day of ovulation induction (group A), whereas 38 patients were given rFSH started on the first day of OI; and hMG was added on the 5th or 6th day of OI (Grup B). The differences between Group1 and Group 2, were tested by Student's t test or Mann Whitney U test. Pearson Chi-square test was applied for categorical comparisons.Table 1Stimulation outcome of the groupsParameterGroup AGroup BpDuration of stimulation (days)8.94±1.1510.37±1.80<0.001Total rFSH dose (IU)1822.87±804.422862.77±1392.840.001Total hMG dose (IU)1197.97±514.01726.31±469.21<0.001Estradiol level on hCG day (pg/ml)2726.15±1063.642002±1119.320.06Follicles ≥14 mm on hCG day (n)9.75±4.198.92±4.140.377Oocytes retrieved (n)12.27±7.419.78±5.960.107Mature (M2) oocytes (n)9.59±6.768.10±4.710.509 Open table in a new tab Table 2Embryology data and cyle outcome of the groupsParameterGroup AGroup Bp2PN embryos (n)5.66±4.914.63±3.690.295Grade A embryos (%)75.383.30.93Fertilization rate (%)66.555.60.108Implantation rate (%)5.38.60.326Clinical pregnancy rate (%)21.628.90.466 Open table in a new tab CONCLUSIONS: Supplementation day of hMG to rFSH does not have any significant effect on IVF success in GnRHa down regulated ICSI patients with suboptimal response to previous ovarian stimulation. OBJECTIVE: The aim of this study was to assess the effect of supplementation day of hMG to rFSH on IVF outcome in patients with inadequate response to previous ovarian stimulation. DESIGN: A retrospective observational study. MATERIALS AND METHODS: A total of 75 infertile couples undergoing ICSI were evaluated retrospectively. Following pituitary down-regulation with leuprolide acetate, 37 patients received a combination of rFSH and hMG both were started on the first day of ovulation induction (group A), whereas 38 patients were given rFSH started on the first day of OI; and hMG was added on the 5th or 6th day of OI (Grup B). The differences between Group1 and Group 2, were tested by Student's t test or Mann Whitney U test. Pearson Chi-square test was applied for categorical comparisons. CONCLUSIONS: Supplementation day of hMG to rFSH does not have any significant effect on IVF success in GnRHa down regulated ICSI patients with suboptimal response to previous ovarian stimulation.

To compare oral contraceptive (OC) pretreatment plus microdose GnRH-a in flare-up protocol and non-OC microdose GnRH-a in flare-up protocol among poor responder ICSI patients.

Some epidemiological studies suggested the occurrence of an alteration in the male reproductive function in the past 50 years, particularly a decrease in the sperm count and quality, an increase in the malformations frequency of the reproductive apparatus (cryptorchidism and hypospadias) and of testicular cancers. Especially according the laboratory animals studies, polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs) have been suspected to play a crucial and deleterious role in the alteration of human fertility. For this reason, we measured adipose tissue concentrations of PCDDs/Fs and dioxin-like PCBs in 23 fertile and 22 infertile men living in Ankara, Turkey. Adipose tissue samples were analyzed for PCDD/F and 12 dioxin-like PCB congeners using high-resolution gas chromatography/high-resolution mass spectrometry. For the fertile and infertile groups, the World Health Organization (WHO)(PCDD/F)-TEQ concentrations ranged from 3.0 to 15.8 pg/g fat and from 2.8 to 17.2 pg/g fat, respectively (4.4-31.5 and 4.7-22.3 WHO-TEQs/g fat, respectively, including dioxin-like PCBs) (p > 0.05). The mean concentrations of WHO(PCDD/F)-TEQ and WHO(PCB)-TEQ have been calculated as 7.2 and 12.5 pg/g (on a lipid basis) for the fertile group and 7.0 and 9.4 pg/g for the infertile group, respectively. Concentrations of each of the PCDD/F and dioxin-like PCB congeners were compared in fertile and infertile groups among themselves, and no statistical significance was obtained (p > 0.05), except 2,3,7,8-tetrachlorodibenzofuran (p = 0.0029) and 1,2,3,4,6,7,8,9-octachlorodibenzofuran (p = 0.01).

Objective: To compare the efficacy of microdose GnRH agonist (GnRH-a) flare-up and multiple dose GnRH antagonist protocols in patients who have a poor response to a long luteal GnRH-a protocol.Design: Prospective, randomized, clinical study.Setting: University hospital.Patient(s): Forty-two poor responder patients undergoing intracytoplasmic sperm injection (ICSI)-embryo transfer cycle.Intervention(s): Twenty-one patients received microdose leuprolide acetate (LA) (50 mu g twice daily) starting on the second day of withdrawal bleeding. The other 21 patients received 0.25 mg of cetrorelix daily when the leading follicle reached 14 mm in diameter.Main Outcome Measure(s): Serum E-2 levels, number of growing follicles and mature oocytes, embryo quality, dose of gonadotropin used, cancellation, fertilization, implantation rate and pregnancy rate (PR).Result(s): The mean serum E-2 concentration on the day of hCG administration was significantly higher in the microdose GnRH-a group than in the GnRH antagonist group (1,904 vs. 1,362 pg/mL). The clinical PRs per started cycle of microdose GnRH-a and GnRH antagonist groups were 14.2% and 9.5%, respectively. There were no statistically significant differences in the other ovulation induction characteristics, fertilization and implantation rates.Conclusion(s): Microdose GnRH-a flare-up protocol and multiple dose GnRH antagonist protocol seem to have similar efficacy in improving treatment outcomes of poor responder patients. (Fertil Steril (R) 2009;91:2437-44. (C) 2009 by American Society for Reproductive Medicine.)