To assess the efficacy of ovulation induction and intrauterine insemination (IUI) in couples with diminished ovarian reserve (DOR).

Bilateral testicular tumors are very rare in pediatric patients and only a few case reports have been reported. These patients have a high risk of sterility due to bilateral orchiectomy and subsequent gonadotoxic treatments. Therefore, if possible, testis-sparing surgery should be performed in patients with benign masses and testicular tissue preservation may be recommended in order to maintain fertility in later life. We present a 23 months old boy with synchronous bilateral testicular tumor managed with unilateral orchiectomy and testis-sparing surgery and testicular tissue cryopreservation performed to the controlateral side. We also review the literature on bilateral testis tumors in children.

Aim: Mucus removal that would be done on the day of embryo transfer could be done on Oocyte pick up(OPU) day, and this practice might be related with better pregnancy rates since it is unlikely to cause uterine contractions during the embryo transfer. We compared the effects of mucus removal done on OPU day, transfer day or no removal at all on success rates of the treatment in three groups. Material and Method: We designed a prospective match control study. There were 131 cycles in which mucus removal was done on either OPU day or embryo transfer day (64 and 67 cycles respectively) and in 411 cycles mucus removal was not done, and these patients constituted the control group. Results: After mucus removal on OPU day, mucus removal on embryo transfer day and no mucus removal done at all, pregnancy rates were calculated as 40,6%, 29,9%, and 23,1% respectively and the difference among the groups was statistically significant (p=0,009). Discussion: Mucus removal on OPU day or on embryo transfer day improves pregnancy rates. It can be included in the routine practice, since it may potentially minimize cervical trauma and uterine contractions and thus improve success in IVF/ICSI treatments.

SummaryDigyny, the presence of a third pronucleus due to the failure of second polar body extrusion, is problematic after intracytoplasmic sperm injection (ICSI) practices. Mitochondria have critical roles such as production of adenosine triphosphate (ATP) and regulation of Ca2+ homeostasis during oocyte maturation, fertilization and the following development, while the regulation of meiotic spindle formation, chromosome segregation, pronuclear apposition and cytokinesis is closely associated with the cytoskeleton. In this study, mitochondrial membrane potential, distribution of F-actin and γ-tubulin, and the ultrastructure of three pronuclear (3PN) oocytes were investigated. 3PN oocytes after ICSI procedure were taken from patients who were enrolled in assisted reproduction programmes. For mitochondrial membrane potential analysis, fresh oocytes stained with the mitochondrial membrane potential probe JC-1, were evaluated under fluorescence microscopy. The mitochondrial membrane potential of three pronuclear oocytes showed similar results to normal zygotes. γ-Tubulin was stained strongly at the subplasmalemmal domain and microfilaments were localized at the cortical, but not the perinuclear, area. Cytoplasmic halos were moderately or not detected by electron microscopy; lipofuscin granules, degenerated mitochondria, and multilamellated bodies were seen in the ooplasm. Immunohistochemistry and electron microscopic findings suggested that mitochondrial membrane potential has no direct effect on second polar body extrusion. This abnormality can be associated with an altered cytoskeleton due to poor oocyte quality.

Objective: Fertilization capacity of capacitated sperm decreases exponentially over time, but the reason is still under investigation. The aim of the study was to analyze the effect of prolonged incubation and temperature on sperm fertilization capacity with motility and staining parameters of phospholipase C-zeta (PLCZ), which is considered to be the oocyte activation factor. Materials and Methods: Density gradient washing was applied to semen of 11 infertile patients without severe oligoasthenospermia out of 16 patients. The samples were divided and cultured either at room temperature or at 37 degrees C for 3 days. The spermatozoons were evaluated for motility, PLCZ staining and intensity daily. Results: All parameters decreased both at room and body temperature with increased incubation time. There was a strong correlation between the change in motility and in the percentage of PLCZ stained sperms, but this correlation decreased with incubation time. Conclusion: Prolonged incubation results show the correlation between PLCZ staining parameters and motility. Routine use of PLCZ staining together with semen analysis, will be useful to predict fertilization capacity of the sperm especially for unexplained infertility and fertilization failure cases, and also can increase the success of assisted reproductive technologies (ART) cycles.

Abstract The aim of this study was to determine whether homocysteine (hcy) concentrations in embryo culture media correlate with pregnancy outcome in assisted reproductive technology (ART) cycles. Forty patients who underwent single embryo transfer at the infertility clinic of a tertiary care center were recruited for this case-control study. Spent embryo culture media from all patients were collected after single embryo transfer on day 3 (n = 40). Hcy concentrations in embryo culture media were analyzed by enzyme cycling method. Patients were grouped according to the diagnosis of a clinical pregnancy. Sixteen patients were pregnant while 24 patients failed to achieve conception. Mean Hcy levels in the culture media were significantly different between the groups (p < 0.003), as 4.58 ± 1.31 μmol/l in the non-pregnant group and 3.37 ± 0.92 μmol/l in the pregnant group. Receiver operator curve analysis for determining the diagnostic potential of Hcy for pregnancy revealed an area under the curve of 0.792 (confidence interval: 0.65–0.94; p < 0.05). A cut-off value of 3.53 μmol/l was determined with a sensitivity of 83.3%, and a specificity of 68.8%. Lower hcy levels were associated with a better chance of pregnancy and better embryo grades. Hcy may be introduced as an individual metabolomic profiling marker for embryos.

Objective: The cryopreservation of prepubertal testicular tissue promises to preserve fertility in boys under cancer treatment. The effects of a seeding process was investigated using different carriers for prepubertal testicular cell suspensions in order to develop an appropriate method for cryopreservation.Materials and Methods: Testicular cell suspensions of 7-8 day old male Wistar rats were frozen by a programmed slow freezing method. The straw and cryotube selected as carriers underwent a seeding process. The morphological effects on spermatogonial stem cells and Sertoli cells were evaluated semi-quantitatively by light microscopy and qualitatively with a transmission electron microscope.Results: The rate of vitality with or without seeding in straw was respectively, 90.6% (+/- 3.0), 89.4 (+/- 1.3) and in cryotube 77.6 (+/- 4.2) and 85.4 (+/- 2.7). The seeding process, showed no significant difference between the straw groups, but a significant difference was seen between the cryotube groups (p< 0.0001). The nuclei, cytoplasmic structures and membranes of Sertoli and spermatogonial stem cells, showed less degeneration in the straw than in the cryotubes when the seeding process was applied.Conclusion: In this study, we compared two carriers to observe the effect of seeding during cryopreservation of prepubertal testicular cell suspensions and found that seeding in straw was the preferable. Keywords:

Amac: Prepubertal testis kriyoprezervasyonu, kanser tedavisi yapilacak erkek cocuklarda fertilitenin korunmasi icin gunumuz teknolojisinde umut vadetmektedir. Kriyoprezervasyonda en uygun yontemin gelistirilmesi icin prepubertal testis hucre suspansiyonunda farkli tasiyicilar kullanarak seeding etkisi arastirildi. Gerec ve Yontem: Yedi-sekiz gunluk Wistar yavru erkek sican testis hucre suspansiyonlari, programli yavas dondurma yontemiyle donduruldu. Tasiyici olarak secilen yuksek guvenlikli straw ve kriyotupe seeding uygulandi. Spermatogonyal kok hucreler ve Sertoli hucreleri uzerindeki morfolojik etki, semi-kantitatif olarak isik, kalitatif olarak gecirimli elektron mikroskobunda incelendi. Bulgular: Canlilik orani, yuksek guvenlikli straw’da seeding uygulanmayan ve uygulanan gruplarda sirasiyla %90,6±3,0, %89,4±1,3, kriyotupte %77,6±4,2 ve %85,4±2,7 bulundu. Seeding uygulanmasiyla, canlilik oraninda straw gruplari arasinda fark gorulmemesine ragmen, kriyotup gruplari arasinda fark anlamliydi (p

OBJECTIVE:To report the first case of a successful pregnancy obtained with an infertile 29-year-old man with a homozygous mutation in the spermatogenesis-specific gene SPATA16 after intracytoplasmic sperm injection (ICSI). DESIGN:Case report. SETTING:Assisted reproductive technology (ART) center. PATIENT(S):A couple who suffered from infertility of whom the husband was globozoospermic and carrying a homozygous mutation in the spermatogenesis-specific gene SPATA16. INTERVENTION(S):Clinical and histopathological evaluation, transmission electron microscopy, stimulation with fixed antagonist protocol, ICSI, activation of fertilization. MAIN OUTCOME MEASURE(S):In vitro fertilization and pregnancy. RESULT(S):Oligoasthenoteratozoospermia was revealed in semen analysis. Total globozoospermia was detected. Chromatin condensation pattern was detected abnormal in 88% of spermatozoa with aniline blue staining. During the ART cycle 12 oocytes were collected. Eleven oocytes were at the metaphase II and one was at the germinal vesicle stage. After the injection, one oocyte fertilized on the following day; the 4-cell stage embryo was transferred. Pregnancy occurred and a healthy boy was delivered after 42 weeks of gestation. CONCLUSION(S):This is the first report of a pregnancy obtained in a man with homozygous SPATA16 mutated globozoospermia.

Background: Children born after in vitro fertilisation (IVF) are under greater risk of development of some health problems than those children born after spontaneous conception Yet it is not exactly known what the prevalence of asthma and other allergic diseases among these children is.Aims of the study: To investigate the prevalence of asthma, allergic rhinitis and atopic dermatitis in children born after IVF, and controls born after spontaneous pregnancy using questionnaires of International Study of Asthma and Allergies in Children (ISAAC).Methods: We recruited 158 children (mean age: 4.60 +/- 2.14 years) born after IVF pregnancies and 102 children (mean age: 5.27 +/- 2.8 years) as control group to investigate the prevalences of asthma, atopic dermatitis and allergic rhinitis. The questions in the questionnaire were asked to the parents by telephone or face to face.Results: Wheezing ever has been reported in 19% of the children born after IVF and in 17.6% of the control group (p > 0 05). No significant differences were found between groups, in terms of use of any anti-asthma drugs, physician diagnosed asthma and admission to emergency room with wheezing (p > 0.05). In addition, prevalence of allergic rhinitis and atopic dermatitis were also comparable between two groups (p > 0.05).Conclusions: Prevalences of asthma, allergic rhinitis and atopic dermatitis are similar in children born after IVF and children born after spontaneous conception. (C) 2008 SEICAP. Published by Elsevier Espana, S.L. All rights reserved.

Objectives: To determine the incidence of chromosome abnormalities among couples for whom intracytoplasmic sperm injection (ICSI) treatment was indicated and fetuses conceived through the ICSI procedure. Methods: All cytogenetic results were evaluated retrospectively. Patients undergoing ICSI (n = 508) were classified according to the referring indications as: (1) males with severe infertility (87 azoospermia and 34 oligoasthenoteratozoospermia, OAT), (2) prior to ICSI (56 males and 61 females), and (3) following an unsuccessful ICSI procedure (132 males and 138 females). Fetuses conceived through ICSI (n = 475) were also classified into 4 groups according to the additional risk factors for chromosome abnormalities: ICSI (n = 185), ICSI + advanced maternal age (AMA, n = 215), ICSI + positive triple test result (TT, n = 50), and ICSI + abnormal ultrasound findings (USG, n = 25). Results: An abnormal karyotype was found in 31.03% of males with azoospermia and 14.71% of males with OAT, in 3.57% of males and 1.64% of females in the group prior to ICSI, and in 5.30 and 5.07%, respectively, in the group following unsuccessful ICSI treatment. Gonosomal aneuploidies were predominant in males with azoospermia and autosomal rearrangements in males with OAT, while low-level sex chromosome mosaicism was found in females. The overall frequency of chromosome abnormalities in fetuses was 4.42% and varied in the different groups from 1.62% in ICSI, 2.79% in ICSI + AMA, 10.0% in ICSI + TT to 28.0% in ICSI + USG. The frequencies of the different types of chromosome abnormalities were as follows: balanced 1.05%, unbalanced 3.37%, familial 0.84%, de novo 3.37%, autosomal 3.58%, gonosomal 0.84%, numerical 1.89%, structural abnormalities 2.53%, and mosaicism 1.26%. Conclusion: Our results indicate that cytogenetic investigations of the ICSI parents and fetuses are essential for the families, genetic counselors and also reproductive centers. In fetal karyotyping, de novo structural chromosome abnormalities and mosaicism should be taken into consideration.

Objective: To investigate the effect of an angiotensin-converting enzyme inhibitor, lisinopril, on serum androgen and sex-hormone-binding globulin (SHBG) levels in hypertensive women with polycystic ovary syndrome (PCOS).Design: Prospective, observational study.Setting: Infertility Clinic of the Sani Konukoglu Hospital, Gaziantep, Turkey.Patient(s): Ten hypertensive women with PCOS.Intervention(s): Lisinopiril, 10 mg/day, for 4 weeks.Main Outcome Measure(s): Serum levels of gonadotropins, DHEAS, total T, free T, 17alpha-hydroxyprogesterone (17-OHP), androstenedione, E2, SHBG, TSH, and PRL were determined.Result(s): Hypertension treatment with lisinopril ( 10 mg/day for 4 weeks) resulted in a statistically significant decrease in serum free T levels. However, there was no difference in the SHBG levels.Conclusion(s): Use of lisinopril, an angiotensin-converting enzyme inhibitor, results in decreased free T levels independently of SHBG. It may affect the free T levels by affecting the ovarian renin-angiotensin system. (Fertil Sterils((R)) 2002:77:526-8. (C) 2002 by American Society for Reproductive Medicine).