The study aimed to evaluate the impact of the dual trigger with the combination of GnRH agonist and standard dose of recombinant hCG on IVF outcomes in poor ovarian responders with GnRH antagonist protocol. 1283 cycles of 1010 poor responder patients according to Bologna criteria were retrospectively analysed in terms of final oocyte maturation: dual trigger group (250 μg hCG + 0.2 mg triptorelin) or standard group (250 μg hCG). Primary outcome measures were the number of retrieved and mature oocytes. The secondary outcome measures were clinical pregnancy rates and live birth rates.The number of retrieved oocytes, mature oocytes, and the top-quality embryos transferred were significantly higher in the dual trigger group (p < .001). Fertilisation rates (73.6% vs 69.6%, p = .009), implantation rates (18.7% vs 14.6, p = .039), clinical pregnancy rate per embryo transfer (27.5% vs. 19.9%, p = .010) and live birth rate per embryo transfer (21.6% vs. 14.9%, p = .011) were also significantly higher in the dual trigger group as compared to the hCG trigger group. The usage of dual trigger with a GnRH agonist and a standard dosage of hCG could improve clinical pregnancy rates and live birth rates in poor ovarian responders undergoing GnRH antagonist IVF/ICSI cycles.IMPACT STATEMENTWhat is already known on this subject? Dual trigger with standard dose of hCG has been the subject of trials in normal responders to optimise IVF outcomes. The results of these studies showed significant improvements in implantation and pregnancy rates with an increase in the number of mature oocytes retrieved. As a result, dual trigger has become a popular ovulation trigger option in GnRH antagonist cycles.What do the results of this study add? There is limited data about the use of dual trigger in poor ovarian responders (PORs). According to our study, increasing the number of retrieved oocytes, mature oocytes, the number of fertilised oocytes, the number of transferred embryos and top quality embryos transferred by using dual trigger in patients with PORs have a positive impact on pregnancy outcomes.What are the implications of these findings for clinical practice and/or further research? These findings implies potential advantages of dual trigger usage for improving IVF outcomes in PORs. With large sample sized prospective randomised trials, dual trigger with combination of GnRHa and a standard dose of hCG might replace the traditional ovulation trigger with hCG in PORs.

Objective: Intrauterine insemination (IUI) is frequently used to treat patients with ovulation disorders, cervical factor, mild male infertility and unexplained infertility. The aim of this study was to investigate the impact of modified speculum application on the success of IUI in patients with unexplained infertility. Materials and methods: This prospective randomized study reviewed 219 women who had undergone controlled ovarian hyperstimulation (COH)-IUI treatment. In the modified speculum application group (109 patients with 124 cycles), the screw of the vaginal speculum was loosened after passing the internal os with catheter and the vaginal speculum remained in this position to ensure closure of the cervix during the procedure. In the conventional speculum application group (110 patients with 132 cycles), the screw of the vaginal speculum was not loosened to close the lips of cervix after passing the internal os with the catheter and the vaginal speculum was removed after withdrawal of the insemination catheter. The primary outcome was live birth rate. Results: The modified and conventional speculum application groups had statistically similar demographic and clinical characteristics. There were no significant differences between the study and the control groups in terms of the clinical pregnancy rate per cycle and per patient (24.1% vs 18.9% and 26.6% vs 22.7%, respectively), as well as the live birth rate per cycle and per patient (19.3% vs 15.1% and 22% vs 18.1% respectively). Conclusion: Applying gentle mechanical pressure on the portio vaginalis of the cervix using a vaginal speculum during IUI does not improve pregnancy and live birth rates in patients with unexplained infertility. (C) 2019 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V.

Objective: This study aims to investigate the possible role of vitamin D deficiency in primary dysmenorrhea by assessing serum 25-hydroxyvitamin D-3 levels in a cohort which includes young Turkish women with primary dysmenorrhea and healthy controls. Materials and methods: A total of 683 women who were aged between 18 and 25 years and who were consecutively admitted to the study center were eligible. After the exclusion of 55 women, 184 women with primary dysmenorrhea were randomly assigned into the dysmenorrhea group and 184 women without dysmenorrhea were randomly allocated into the control group. Results: The dysmenorrhea group had significantly less consumption of dairy products (p = 0.001), lower serum calcium (p = 0.001), lower serum vitamin D (p = 0.001) and higher serum parathyroid hormone (p = 0.001) than those of the control group. Hyperparathyroidism was significantly less frequent whereas vitamin D deficiency was significantly more frequent in the dysmenorrhea group (p = 0.001 for each). The dysmenorrhea patients with vitamin D deficiency had significantly higher visual analogue scale (VAS) scores (p = 0.001). Depression, irritability, mood swings, fatigue, headache and breast tenderness were significantly more frequent in the vitamin D deficiency group (p < 0.05 for all). The VAS scores of the dysmenorrhea patients correlated positively and significantly with serum parathyroid hormone levels (r = 0.666, p = 0.001) whereas these VAS scores correlated negatively and significantly with serum vitamin D levels (r = -0.713, p = 0.001). Discussion: The significant and positive correlation between vitamin D levels and VAS scores and the significant reduction in serum vitamin D levels of the dysmenorrhea patients designate the possible role of vitamin D deficiency in the primary dysmenorrhea. (C) 2018 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V.

Tekrarlayan implantasyon başarısızlığı (TİB), 40 yaşın altında en az üç kez taze ya da donma-çözme siklusunda en az dört adet iyi kaliteli embriyo transferine rağmen klinik gebelik elde edilememesidir. Başarılı bir implantasyon için blastokist aşamasında embriyo, reseptif endometriyum ve endometriyum ile embriyo arasında başarılı bir iletişim gerekmektedir. Kromozomal anomaliler, sperm DNA hasarı, zona kalınlaşması, yetersiz kültür ortamları, embriyo kalitesinin kötü olması TİB etiyolojisinde rol oynayan embriyonik faktörlerdir. Seçilmiş vakalarda zona pellusidanın inceltilmesi veya delinmesi, blastokist transferi, optimal kültür ortamlarının sağlanması implantasyon ve gebelik oranlarını artırabilir. Preimplantasyon genetik tarama canlı doğum oranlarını artırmazken alternatif yaklaşımlar olan karşılaştırmalı genomik hibridizasyon ve tek nükleotid polimorfizm analizi daha geniş kromozom taraması yapma avantajı sağlamaktadır. Embriyonun yeni gelişen zaman aralıklı görüntüleme teknolojisiyle değerlendirilmesi implantasyon potansiyeli en yüksek olan embriyoyu seçmeye yol gösterebilir. TİB etiyolojisinde rol oynayan uterin faktörler arasında ise uterin miyom, endometriyal polip, uterin konjenital anomali, intrauterin adezyon bulunmaktadır. Adenomiyozis ve endometriyoz varlığı akılda tutulmalıdır. Uterin nedenlerin varlığı ultrasonografik ve gerekirse histeroskopik olarak incelenmelidir. Hidrosalpinks şüphesinde histerosalpingografi ya da gerekirse laparoskopi ile değerlendirilmelidir. Hidrosalpinks varlığında salpinjektomi yapılması implantasyon ve gebelik oranlarını artırmaktadır. TİB olan hastalarda implantasyon penceresini yakalamak amacıyla endometriyal reseptiviteyi değerlendiren ''endometrial receptivity array'' yöntemi ile kişiselleştirilmiş embriyo transferi yapılarak başarılı sonuçlar elde edilmesi umut vermektedir. Son yıllarda etiyolojide trombofilik ve immünolojik nedenler üzerinde de durulmakta; immünoterapiler ve antikoagülan tedaviler sıkça kullanılmaktadır. Ancak ampirik tedaviler prospektif randomize çalışmalarla faydaları kanıtlanmadıkça günlük infertilite pratiğinde kullanılmamalıdır. Gelecekte endometriyal gen tedavisi, intrauterin adezyon moleküllerinin kullanımı, embriyo kültürlerinin geliştirilmesi yeni umutlar doğuracaktır. Recurrent implantation failure (RIP) is defined as the lack of clinical pregnancy despite the transfer of at least 3 fresh embryos or 4 good quality embryos in a freeze-thaw cycle under the age of 40. A successful implantation requires an embryo in blastocyst stage, a receptive endometrium and an efficient interaction between embryo and endometrium. Chromosomal abnormalities, damaged sperm DNA, over-thickened zona pellucida, improper culture media and poor embryo quality are embryologic factors considered in the etiology of RIP. Assisted hatching in select patients, blastocyst transfer and providing optimal culture media might improve the rates of implantation and clinical pregnancy. While preimplantation genetic diagnosis does not seem to improve pregnancy rates, novel alternative approaches such as comparative genomic hybridization and single nucleotide polimorphysm analysis enable us perform a broader genomic screening. Assessing the embryo by using newer techniques like time-lapse imaging technology may prove beneficial in detecting the embryo with the highest potential for implantation. Uterine fibroids, endometrial polyps, congenital abnormalities of the uterus and intrauterine adhesions are preceding uterine factors in the etiology of RIP. Adenomyosis and endometriosis should also be kept in mind for a possible etiology. Potential uterine problems require an ultrasonographic and hysteroscopic evaluation. If a hydrosalpinx is suspected, the patient must be evaluated with a hysterosalpingography (HSG) and a diagnostic laparoscopy can be performed. In case there is a hydrosalpinx, proceeding to a salpingectomy may improve the rates of implantation and clinical pregnancy. A new tool, endometrial receptivity array helps in seizing the implantation window and yields promising results by performing individualized embryo transfer in RIP patients. In recent years, trombophilias and immunological causes also became popular areas of research and immunologic and anti coagulant therapies are used frequently. However, empirical therapies are not to be used in routine daily practice before these therapies are supported by randomized controlled trials. In future, endometrial gene therapies, use of intrauterine adhesion molecules and more developed embryo cultures will provide new opportunities.

Objective: To ascertain the association between basal progesterone (P) levels and the occurrence of preovulatory progesterone rise (PPR) and clinical pregnancy rates (CPRs) in ICSI cycles with GnRH antagonists. Study design: Serum P levels of 464 patients were measured on day 2 and day of hCG of cycles. Cycles with basal P levels > 1.6 ng/mL were cancelled. All embryos were cryopreserved in cycles with P levels >= 2 ng/mL on the day of hCG. The primary outcome measures were the incidence of PPR (P > 1.5 ng/mL) and CPR with regard to basal P. Results: Basal P levels were significantly higher in cycles with PPR than in those without PPR (0.63 +/- 0.31 vs. 0.48 +/- 0.28 ng/mL). Area under the curve for basal P according to ROC analysis to discriminate between elevated and normal P levels on the day of hCG was 0.65 (0.58-0.71 95% CI, p < 0.01). The cut-off value for basal P levels that best discriminates between cycles with and without PPR was 0.65 ng/mL. Cycles with basal P levels above 0.65 ng/mL had a significantly higher incidence of PPR (30.9% vs. 13.5%) but similar clinical and cumulative pregnancy rates (38.8% vs. 31.1% and 41.7% vs. 32.6%, respectively) in comparison to cycles with basal P levels below 0.65 ng/mL. In multivariate regression analysis, basal P levels, LH level on the first day of antagonist administration, and estradiol levels on the day of hCG trigger were the variables that predicted PPR. Conclusion: Basal P levels were associated with increased incidence of PPR but not with CPR. (C) 2017 Elsevier B.V. All rights reserved.

BACKGROUND/AIM:The aim of the study was to compare the luteal estradiol patch/GnRH antagonists priming protocol (LPP) with the standard GnRH antagonist protocol in poor ovarian responders (PORs) in terms of the outcomes of in vitro fertilization (IVF) treatment.MATERIALS AND METHODS:IVF outcomes of 265 cycles in 265 patients (106 in the LPP group, 159 in the standard GnRH antagonist group) were evaluated retrospectively.RESULTS:Mean length of stimulation (11.4 ± 2.7 vs. 10.0 ± 2.7 days; P < 0.05) and the total gonadotropin dose (3403 ± 1060 vs. 2984 ± 1112) used were significantly greater in the LPP group than in the standard GnRH antagonist protocol group. The mean number of oocytes retrieved (3.5 ± 2.6 vs. 3.7 ± 2.8), the number of mature oocytes (2.8 ± 2.2 vs. 2.6 ± 2.2), fertilization rates (65% vs. 62%), the number of embryos transferred (1.6 ± 0.6 vs. 1.7 ± 0.6), and implantation rates (16% vs. 13%) were similar. The cancellation rate did not significantly differ between the groups (9.4% vs. 13.2%). There were no significant differences in the clinical pregnancy (11.3% vs. 13.2%) or live birth rates per patient (3.8% vs. 9.4%) and clinical pregnancy (18.8% vs. 22.6%) or live birth rates per embryo transfer (6.3% vs. 12.9%) between the groups.CONCLUSION:LPP does not improve IVF outcomes when compared with the standard GnRH antagonist protocol in PORs.

Intrahepatic cholestasis of pregnancy (ICP) is an uncommon disorder, which generally occurs in the second and third trimester of pregnancy with symptoms of pruritus. The cause of ICP is unknown but genetic, hormonal and environmental factors contribute to its pathogenesis. The aetiology of ICP is unclear but elevation in oestrogen levels thought to cause ICP is typically seen in the third trimester of pregnancy, and for this reason it is not usually considered in the differential diagnosis of pruritus and liver function disorders in the first trimester of the pregnancy. We present two cases of pregnancy after IVF treatment diagnosed with ICP following the development of OHSS, deteriorating liver function tests and severe pruritus.

Objective: To ascertain the incidence of premature progesterone P rise and its impact on outcomes in controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) cycles, and also to identify variables related with premature P rise.Study design: Four hundred sixty cycles of 460 couples with unexplained infertility having COH-IUI treatment with a starting dose of 75 IU recombinant FSH enrolled in this prospective study. Serum P levels were determined on the day of hCG trigger. Premature P rise was defined as progesterone >= 1 ng/mL. The primary outcome measure was live birth per cycle with regard to P levels of >= 1 ng/mL and >= 1.5 ng/mL. Secondary outcome measures were cycle characteristics associated with P rise.Results: The incidence of premature P rise was 22.0%. P levels on hCG day were significantly lower in cycles with live birth as compared to cycles without live birth 0.49 +/- 0.51 vs. 0.73 +/- 0.82 ng/mL. Live birth rates were significantly lower in cycles with hCG day P levels >= 1.0 ng/mL (%7.9 vs. %22.6) and >= 1.5 ng/mL (%6.4 vs. %20.8). Among age, number of dominant follicles, estradiol, LH and P levels on the day of hCG trigger, it was found that P levels was the only significant variable to predict live birth on multivariate analysis. The number of dominant follicles on hCG day and premature LH surge were the only significant variables related with premature P rise.Conclusion: Premature P is a frequent feature of COH-IUI cycles and associated with decreased live birth rates. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

OBJECTIVES:The aim of the study was to measure advanced oxidation protein products (AOPPs) as markers for oxidative stress to evaluate cardiovascular risk in pre- and postmenopausal women and to compare the results with malondialde-hyde (MDA) levels.MATERIAL AND METHODS:Twenty premenopausal women and 84 naturally postmenopausal patients were enrolled in the study. AOPP and MDA plasma levels were measured. The postmenopausal group was further subdivided into two groups: postmenopausal age of 40-49 and of 50-59 years. AOPP and MDA levels were compared between premenopausal, 40-49 and 50-59 year old menopausal women.RESULTS:Plasma AOPP and MDA levels in postmenopausal women were increased when compared with their premeno-pausal peers (123.83 ± 55.51 μmol/L vs. 61.59 ± 16.42 μmol/L and 6.50 ± 1.05 μmol/L vs. 5.98 ± 0.77 μmol/L; respectively). Mean plasma AOPP levels in the two menopausal age groups were both significantly higher from the premenopausal group (118.64 ± 59.1 μmol/L vs. 61.59 ± 16.42 μmol/L and 132.31 ± 48.97 μmol/L vs. 61.59 ± 16.42 μmol/L; respectively). No significant difference was found in mean AOPP levels between postmenopausal subjects of 40-49 and 50-59 years age (118.64 ± 59.12 μmol/L vs. 132.31 ± 48.97 μmol/L). Mean plasma MDA levels of each of two postmenopausal age groups were both significantly higher from the premenopausal group (6.50 ± 1.04 μmol/L vs. 5.98 ± 0.77 μmol/L and 6.50 ± 1.10 μmol/L vs. 5.98 ± 0.77 μmol/L; respectively). However, no statistically significant difference between the two postmenopausal age groups (6.50 ± 1.04 μmol/L vs. 6.50 ± 1.10 μmol/L) was found.CONCLUSIONS:AOPP and MDA levels are elevated in postmenopausal women as compared to their premenopausal peers, suggesting they can be used as markers for cardiovascular risk in postmenopausal women.

In this study, we aimed to determine whether anti-Mullerian hormone (AMH) levels vary between fertile and infertile populations and compare them with basal follicle-stimulating hormone (FSH) levels and antral follicle count (AFC). This was a prospective study that included 177 primarily infertile patients who underwent IVF treatment and 162 healthy fertile patients admitted to our clinic for benign diseases. FSH and AMH levels and the AFC of the infertile and fertile populations were compared between the age categories <30, 30-39 and40. Correlations between AMH, basal FSH, and AFC with age were evaluated. AFC and AMH levels did not differ between the fertile and infertile groups in all age categories. AMH was inversely correlated with age in both the fertile and infertile populations. However, AFC revealed a stronger correlation with age in both the fertile and infertile populations compared with basal FSH and AMH. Age was positively correlated with basal FSH and inversely correlated with AMH and AFC. In conclusion, there was no significant difference between the fertile and infertile populations in terms of AMH or AFC. The decrease in ovarian reserve in infertile patients is directly related to age, not infertility.

To assess the predictive value of early follicular progesterone (EFP) on preovulatuary progesterone (PP) rise in IVF cycles with GnRH antagonist protocol. This is a retrospective study performed between May 2014 and April 2015 on 252 patients underwent IVF treatment. EFP and PP levels were measured in patients underwent IVF treatment with GnRH antagonist protocol. PP level ˃ 1.5 ng/dL on the day of hCG was defined as progesterone rise. The predictive value of EFP levels on PP rise was evaluated. Fifty two patients (20.6%) had progesterone rise on the day of hCG. EFP levels were significantly higher in patients with elevated progesterone levels as compared to patients with normal progesterone levels on the day of hCG (0.67 ± 0.31vs 0.49 ± 0.27, p<0.01 respectively). PP levels were positively correlated with EFP levels (r: 0.25; p<0.001). Area under curve for EFP according to ROC analysis discriminate between elevated and normal progesterone levels was 0.67 (0.59-0.71 95% CI, p<0.01). The cut-off value for EFP levels was 0.54 ng/dl with a sensitivity of 67% and a specificity of 62%. The patients with EFP values below 0.54 ng/ dL had significantly lower elevated progesterone rates on the day of hCG when compared to values above 0.54 ng/dL (12.7% vs 31.5 %, p< 0.001). EFP levels were predictive for preovulatory progesterone rise in IVF cycles with antagonist protocol. Evaluating basal progesterone levels might help the clinician to have the opportunity for preventive strategies including close monitorization of progesterone, use of mild stimulation protocols, early trigger of hCG and freeze all embryos.

Sezaryen skar gebeligi erken gebelik nedeniyle basvuran hastalarin yaklasik 1/1800’unde saptanmaktadir. Gecirilmis sezaryen oykusu olan hastalarda ektopik gebeliklerin %6.1’ini olusturmaktadir. Nadir gorulmesine ragmen maternal morbidite ve mortaliteye sebep olabilmesi ve son yillarda sezaryen oranlarindaki artisa bagli olarak gorulme sikliginin artmasi nedeniyle onem tasimaktadir. Tedavisinde lokal veya sistemik metotreksat, lokal potasyum klorid, histereskopi, laparaskopi, laparatomi, uterin kuretaj ve uterin arter embolizasyonu gibi degisik yontemler kullanilmasina ragmen ilk ve en etkin tedavi secenegi tartismalidir. Olgumuz transvajinal ultrasonografi esliginde lokal tek doz metotreksat uygulamasi ile komplikasyonsuz bir sekilde tedavi edilmistir; bu tedavi yontemi sezaryen skar gebeliginde ilk tedavi secenegi olarak onerilebilir.

Son yillarda dehidroepiandrosteronun dusuk over rezervli hasta grubunda infertilite tedavisine yaniti arttirdigi saptanmistir. Bu olgu serisinde, 35 yasindan buyuk ve kotu over rezervi, yuksek 3. gun FSH’si ve dusuk antral folikul sayisi ile kanitlanmis uc hastada kisa sureli dehidroepiandrosteron kullanimi ile spontan gelisen ve saglikli bicimde terme ulasan gebelik olgulari ve bu konudaki guncel literatur bilgileri gozden gecirilmektedir. Dehidroepiandrosteron ile yapilan cok genis randomize calismalar bulunmasa da literaturdeki olgu sunumlari ve burada sunulan vakalar, bu androjenin dusuk over rezervli hastalarda spontan gebelik sansini arttirdigini kanitlamaktadir. Gebeliklerin ileri anne yasina ragmen saglikli canli dogum ile sonuclanmalari da oosit kalitesini iyilestirdigi fikrini desteklemektedir.

Cesarean scar pregnancy (CSP) is a rare kind of ectopic pregnancy caused by the implantation of the gestational sac on cesarean section scar. CSP can cause massive bleeding and uterine rupture. Due to the lack of prospectiver and omized controlled studies on CSP; there is no clear consensus about diagnosis and treatment In this report, a CSP case reported, treatel with single dose methotrexate (MTX) and vaginal misoprostol combination. Although; single dose MTX and vaginal misoprostol combination was successful in our patient, the patients should be monitored carefully during this treatment against silent rupture and massive hemorrhage. The reandomized comprehensive studies are needed to reveal the reliability of a single dose of MTX and misoprostol combination therapy.

Intauterine device (IUD) is an effective and safe contraceptive method which is commonly used worldwide. However, spontaneous or iatrogenic IUD fracture was rarely occurred during usage. We present the case about spontaneous fracture of one arm of copper IUD and the spontaneous expulsion of the broken piece in a 30-year-old woman 2 years after insertion. The patient recoursed to our clinic due to finding of a foreign body at vaginal outlet. Copper IUD was dislocated in transvaginal ultrasonographic (TVUSG) examination and echogenicity of left transverse arm was not identified in transvers section. Although IUD fracture seems rarely, it must be born in mind especially when dislocation exists. Distance to fundus and its location, besides the continuity of its echogenicity and integrity should be observed during routine controls.

It has been reported recently that dehydroepiandrosterone (DHEA) supplementation in older patients with low ovarian reserve increases the response to infertility treatment. Three women of age >3S years with low ovarian reserve parameters including high FSH, low AFC have been treated with DHEA for various time intervals are reported here. They conceived spontaneously after a few months of treatment which resulted in healthy newborns. Although there are not many randomized controlled trials about the value of DHEA treatment in infertile patient population, previous case reports support that DHEA increases spontaneous pregnancy rates. Considering healthy livebirths of the relatively older age of the mentioned cases, DHEA might be improving also oocyte quality as an additional impact.

To compare in vitro fertilization (IVF) outcomes between standard GnRH antagonist protocol and luteal phase estradiol/ GnRH antagonist priming protocol in the poor responders. Prospective randomized trial. One hundred and five poor responders according to ESHRE Bologna criteria whose ages were between 25 to 45 were included to the study. Based on computer generated randomization 52 patients used luteal phase estradiol/ GnRH antagonist priming protocol and 53 patients used standard GnRH antagonist protocol prospectively. Patients with luteal phase estradiol/ GnRH antagonist priming protocol took 0.1 mg transdermal estradiol on alternate days for 3 times starting from 7th day after ovulation in the previous cycle. In addition, on the second day after application of patch daily subcutaneous cetrorelix 0.25 mg was started and continued for 3 days. Both of two groups underwent controlled ovarian hiperstimulation starting on day 3 of menstural cycle with flexible antagonist protocol Primary outcomes of the study were the number of oocytes retrieved, clinical pregnancy, implantation and cycle cancellation rates. Secondary outcomes were peak estradiol levels, the number of mature oocytes, fertilization rates. Student's t-test was used for continuous variables, and the chi-square test was used for categorical variables. The baseline characteristics as age, body mass index, antral follicle count, basal FSH, basal E2, the number of prior IVF attempts and duration of infertility were similar between the two groups. The mean number of oocytes retrieved (3.7 ± 2.8 vs. 3.8 ± 2.8), the number of mature oocytes (2.6 ± 2.2 vs. 3 ± 2.3), fertilization rates (61.1% ± 37.8% vs. 71% ± 31.3%) and the number of embryos transferred (1.6 ± 0.6 vs. 1.7 ± 0.6) were also similar. The cancellation rate was not different between groups (15.1% vs 11.1%). There were no significant differences between groups in terms of the implantation (8.4% vs 8.8%), clinical pregnancy (13.2% vs. 13.3%) and ongoing pregnancy rates (9.4% vs. 4.4%) per started cycle. Luteal phase estradiol/ GnRH antagonist priming protocol has no effect to improve the IVF outcomes in terms of improved cycle cancellation and pregnancy outcome as compared to standard GnRH antagonist protocol in patients with poor response to gonadotropins after IVF.

OBJECTIVE:To compare the efficacy of intrauterine insemination (IUI) cycles undergoing ovarian hyperstimulation with recombinant FSH (rFSH) or clomiphene citrate (CC) in couples with unexplained and male subfertility. STUDY DESIGN:Two hundred and nineteen subfertile couples were enrolled in this randomized prospective study. Patients were randomly assigned to receive 75IU rFSH or 100mg CC for two cycles. Cycles with more than four dominant follicles and/or serum E2 levels higher than 1500pg/ml were cancelled. Primary outcomes were live birth rates per patient and per cycle, secondary outcomes were clinical and multiple pregnancy rates. RESULTS:One hundred and nine women received rFSH and 110 received CC. Both cumulative clinical pregnancy and live birth rates per patient were significantly higher in gonadotropin group (43.1% and 37.6%) as compared to CC group (28.2% and 20%) (p<0.05 and p<0.01, respectively). Live birth rate per cycle were significantly higher in gonadotropin group (24.3%) in comparison with CC group (13.8%) (p<0.05). However, clinical pregnancy rate per cycle was not different between groups (28.4% vs 20%) (p>0.05). There was no significant difference between gonadotropin and CC group groups in terms of multiple pregnancy rates (10.4% vs 12.5%, p>0.05). Continuous variables were compared with Student's t test. Categorical variables were compared with Chi square test. CONCLUSION:rFSH has significantly higher cumulative clinical pregnancy and live birth rates when compared to CC with similar multiple pregnancy rates in subfertile patients undergoing IUI.