Sanja Vujisic

We present a case of a primary infertile patient with diagnosed polycystic ovary syndrome, who in an assisted reproduction procedure was stimulated with GnRh agonists and gonadotropins, and who subsequently developed a severe ovarian hyperstimulation syndrome. The patient’s condition was further worsened after the pregnancy was confirmed. She spent 21 day at the intensive care unit and 55 days in the hospital. The pregnancy resulted in the birth of the healthy child, delivered by caesarean section at 38th week of pregnancy.

The aim of the study was to determine the presence of interleukin (IL)-12, IL-15, IL-18 and p40 subunit of IL-12/IL-23 in follicular fluid from spontaneous cycles and the relation between the concentration of selected cytokines and IVF-embryo transfer outcome. IVF-embryo transfer and enzyme immunoassay (EIA) (R&D Systems, Minneapolis, MN, USA and MBL, Nagoya, Japan) were used. Follicular fluid of women included in the IVF-embryo transfer procedure contained common p40 subunit of IL-12/IL-23 (median 70.1 pg/ml), IL-15 (median 1.3 pg/ml) and IL-18 (median 38.2 pg/ml). There was a significant negative correlation between follicular fluid concentrations of IL-15 and IL-18 (R=-0.392, P=0.003). Significantly higher concentrations of common p40 subunit of IL-12/IL-23 (median 79.8 pg/ml) were found in the follicular fluid taken from follicles containing oocytes, when compared with those without an oocyte (median 44.5 pg/ml, P=0.006). Patients who achieved clinical pregnancy had significantly decreased concentration of IL-15 (median 0.8 pg/ml) compared with patients without successful IVF-embryo transfer outcome (median 1.4 pg/ml, P=0.047). Follicular fluid collected from spontaneous cycles contains detectable levels of p40 subunit of IL-12/IL-23, IL-15 and IL-18. Increased concentrations of p40 subunit of IL-12/IL-23 in follicles containing oocytes suggest an important role of this cytokine in reproduction. Possible negative value of IL-15 as a predictor of IVF-embryo transfer success remains to be determined.

To evaluate whether the number of ovarian antral follicles, ovarian volume, and ovarian stromal blood flow change with age and to prospectively analyze whether three-dimensional ultrasonographic measurements predict ovarian response and IVF outcome. Prospective analysis. Assisted reproductive unit. Fifty-six consecutive women 22 to 43 years of age with normal basal serum FSH concentrations who were undergoing their first IVF cycle. Number of ovarian antral follicles, ovarian volume, and ovarian stromal flow index were determined by three-dimensional and power Doppler ultrasonography. Pretreatment measurements were compared with number of recovered oocytes, fertilization rates, and pregnancy rates. As patient age increased, significant trends in ovarian volume, number of follicles, and stromal vascularity decreased. Three-dimensional ovarian measurements and fertilization rates differed significantly among age groups. For each age group, a higher number of antral follicles, greater ovarian volume, and favorable ovarian stromal vascularity was associated with higher number of retrieved oocytes and increased pregnancy rates. Increasing patient age is associated with poor ovarian response, as represented by smaller ovarian volume, lower antral follicle count, and poor stromal vascularity. Three-dimensional power Doppler ultrasonography can help to individualize IVF in patients regardless of age.

To compare efficacy and efficiency of ovarian stimulation therapy. Retrospective study compares ovarian response as number of retrieved oocytes, fertilization rates, endometrial patterns, number of pregnancies and pregnancy rates to different stimulation protocols. The least number of cancelled cycles was in long protocols with buserelin. There was no difference in overall number of retrieved oocytes between the rFSH and HMG protocols, but 75% of the patients undergoing both protocols had higher number of oocytes after rFSH. The highest pregnancy rate (35.13%) was with rFSH. There was no statistical correlation between endometrial pattern and type of protocol used. Data showed the 9 mm cut-off value for endometrial thickness, and RI = 0.58 for subendometrial blood flow between the pregnant and non-pregnant group of patients. Nitriderm patches significantly decreased (P < 0.05) subendometrial RI of the patients with impaired uterine perfusion, increased endometrial thickness and achieved better morphology. These findings demonstrate that rFSH alone and in long protocol gives better results in wide patient population. Nitriderm patches seem to have good impact on pregnancy rate, but further studies are necessary before making any statements.

To evaluate the role of CA 125 in prediction of in vitro fertilization and embryo transfer (IVF/ET) outcome. Serum CA 125 concentrations were evaluated in the spontaneous and stimulated cycles of 33 patients. CA 125 was measured using a microparticle enzyme immunoassay (MEIA) (Abbott, Diagnostics, USA). Follicular growth, endometrial thickness and subendometrial blood flow were evaluated by transvaginal color Doppler ultrasound. Statistical analysis was performed by Wilcoxon rank-sum test and Friedman test. There was no statistically significant difference (P > 0.05) of CA 125 values between spontaneous and stimulated cycles, and between pregnant and non-pregnant patients. A CA 125 rise from the late proliferative to the early secretory phase (P < 0.05) was obtained only in the stimulated cycles. There was no relationship between CA 125, follicle number, endometrial thickness and resistance index of the subendometrial vessels. CA 125 levels are not predictive of ovarian and endometrial response. Hormonal stimulation does not effect serum CA 125 concentration. There was no influence of CA 125 levels on IVF/ET outcome in stimulated cycles.