Antalya, Turkey
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Ozgur K.,Antalya IVF | Bulut H.,Antalya IVF | Berkkanoglu M.,Antalya IVF | Humaidan P.,University of Aarhus | Coetzee K.,Antalya IVF
Reproductive BioMedicine Online | Year: 2016

In this matched-controlled study (n = 300), the effect of hysteroscopic surgery performed concurrently with oocyte retrieval on the reproductive outcomes of intracytoplasmic sperm injection (ICSI) freeze-all cycles was investigated in patients screened for intrauterine anomalies. Conventionally, hysterscopic surgery is performed in a different cycle from IVF, delaying treatment completion and increasing patient anxiety. One hundred and fifty patients who had hysteroscopic surgery concurrently with oocyte retrieval (hysteroscopy group) in ICSI freeze-all cycles were matched according to age and oocyte number with 150 ICSI freeze-all cycles, in which the patients required no hysteroscopy (control group). In the hysteroscopy group, hysteroscopy was performed for diagnostic (n = 5) and therapeutic (n = 145) purposes. Blastocyst culture and Cryotop vitrification was performed in both groups. Frozen embryo transfer (FET) was successfully performed in the hysteroscopy group from 35 days after oocyte retrieval. No significant differences were observed for implantation, pregnancy, clinical pregnancy and early pregnancy loss rates in the hysteroscopy and control groups (48.9%, 72.0%, 61.3% and 14.8% versus 48.3%, 75.3%, 64.7% and 14.3%, respectively). Performing hysteroscopic surgery concurrently with oocyte retrieval in a segmented-IVF programme has no negative impact on reproductive outcomes, increases efficiency, and provides patients with low-risk treatment. © 2016 Reproductive Healthcare Ltd.


Ozgur K.,Antalya IVF | Berkkanoglu M.,Antalya IVF | Bulut H.,Antalya IVF | Humaidan P.,University of Aarhus | Coetzee K.,Antalya IVF
Fertility and Sterility | Year: 2015

Objective To investigate the possible effect of controlled ovarian stimulation on the perinatal outcomes of assisted reproductive technology pregnancies, by comparing the outcomes from fresh ET with frozen ET (FET) with blastocysts of similar quality. Design Retrospective observational study. Setting Private fertility center. Patient(s) Seven hundred eighty-four fresh transfers and 382 vitrified-warmed double blastocyst transfers. Intervention(s) None. Main Outcome Measure(s) Miscarriage, perinatal mortality, preterm delivery, live birth, live-birth weights, and gestational age of live births. Result(s) FET resulted in higher implantation rates (51.5% vs. 40.6%), higher live-birth rates per transfer (56.8% vs. 44.3%), and lower ectopic pregnancy rates (0.32% vs. 1.80%). FET pregnancies also had higher day 14 βhCG levels per implantation (148.2 vs. 176.2 IU/L) and higher infant birth weights (singletons Δ109.4 g, twins Δ124 g). Female infants benefitted the most in terms of birth weight. Miscarriage, premature delivery, perinatal morbidity, and live birth per pregnancy were all nonsignificantly different between fresh ET and FET. Conclusion(s) Clinically significant differences between the peri-implantation and perinatal outcomes of fresh ET and FET suggest better endometrial receptivity and placentation in FET cycles. © 2015 American Society for Reproductive Medicine.


Ozgur K.,Antalya IVF | Bulut H.,Antalya IVF | Berkkanoglu M.,Antalya IVF | Coetzee K.,Antalya IVF | Kaya G.,Antalya IVF
Reproductive BioMedicine Online | Year: 2014

This study investigated the use of hysteroscopic Essure device placement for the treatment of hydrosalpinx-related infertility in patients with laparoscopic contraindications and compared their pregnancy outcomes following assisted conception treatment with those of patients having had laparoscopic tubal ligation. A total of 102 infertile patients were diagnosed with unilateral or bilateral hydrosalpinges: 26 patients had laparoscopic contraindications and were treated hysterscopically and 76 patients were treated laparoscopically. In total, 66 intracytoplasmic sperm injection (ICSI) and 39 frozen embryo transfer (FET) procedures were performed. In the hysteroscopy group, 13 ICSI and eight FET in 16 patients resulted in 10 pregnancies (pregnancy rates 47.6% per transfer and 62.5% per patient), and in the laparoscopy group, 53 ICSI and 31 FET embryo transfers in 54 patients resulted in 36 pregnancies (pregnancy rates 42.9% per transfer and 66.7% per patient). Live birth rates per assisted reproduction procedure were 23.8% (5/21) in the hysteroscopy group and 32.1% (27/84) for the laparoscopy group. The hysteroscopic placement of Essure devices to isolate hydrosalpinx prior to assisted conception treatment produced pregnancy outcomes comparable to those produced following laparoscopic tubal ligation. The live birth rates indicate that a larger, more comparative, prospectively randomized study is required. Infertile patients with tubal disease require surgical treatment before they can continue with fertility treatment. There are two main surgical methods that can be used, hysteroscopic and laparoscopic, the latter being the standard surgical method. However, some patients have disease that makes the use of laparoscopy inappropriate. For these patients the placement of Essure® devices by hysteroscopic surgery maybe the most suitable treatment method. One hundred and two patients were diagnosed with unilateral or bilateral hydrosalpinges - tubal disease. Twenty six patients had to have hysterscopic surgery and 76 patients had laparoscopic surgery. After their tubal surgery some patients continued to have fertility treatment, 66 ICSI and 39 frozen embryo transfers (FET) were performed. Thirteen ICSI and 8 FET embryo transfers in 16 patients from the hysteroscopy group resulted in 10 pregnancies, a 47.6% per transfer and 62.5% per patient pregnancy rate. Fifty three ICSI and 31 FET embryo transfers in 54 patients from the laparoscopic group resulted in 36 pregnancies, a 42.9% per transfer and 66.7% per patient rate. Live birth rates per ART procedure were 23.8% (5/21) in the hysteroscopic group compared with 32.1% (27/84) for the laparoscopic group. The hysteroscopic placement of Essure® devices for tubal disease prior to fertility treatments resulted in pregnancy outcomes that were comparable to the outcomes obtained following laparoscopic surgery. © 2014, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.


Ozgur K.,Antalya IVF | Humaidan P.,University of Aarhus | Coetzee K.,Antalya IVF
Reproductive Biology | Year: 2016

Currently up to 4% of infants born in developing countries are conceived through assisted reproductive technology (ART). Even though most of these conceptions occur and progress without complications, ART procedures and processes may increase iatrogenesis through complications in - and after conception. We herein review and discuss the clinically and scientific implications and evidence of iatrogenesis, and show how the evolution in ART technologies and procedures has led to the current presumption that frozen embryo transfer might be a more optimal strategy than fresh embryo transfer, in terms of not only reproduction, but also of maternal and fetal outcomes. There is increasing scientific evidence to support the notion that controlled ovarian stimulation could induce significant changes to the endocrine profile of a reproductive cycle, especially to the reproductively important early luteal phase. These changes may not only have a negative effect on implantation and early placentation, but also on the mother, the fetus, and the infant. The overt consequences of controlled ovarian stimulation include ovarian hyperstimulation syndrome, reduced embryo implantation, increased ectopic pregnancy, and altered placentation and fetal growth. The cumulative scientific evidence from this review suggests that GnRHa trigger in segmented ART might constitute the future routine treatment regimen for IVF patients, providing a safe, effective, and patient friendly treatment. © 2016 Society for Biology of Reproduction & the Institute of Animal Reproduction and Food Research of Polish Academy of Sciences in Olsztyn.


PubMed | University of Aarhus and Antalya IVF
Type: Journal Article | Journal: Reproductive biology | Year: 2016

Currently up to 4% of infants born in developing countries are conceived through assisted reproductive technology (ART). Even though most of these conceptions occur and progress without complications, ART procedures and processes may increase iatrogenesis through complications in - and after conception. We herein review and discuss the clinically and scientific implications and evidence of iatrogenesis, and show how the evolution in ART technologies and procedures has led to the current presumption that frozen embryo transfer might be a more optimal strategy than fresh embryo transfer, in terms of not only reproduction, but also of maternal and fetal outcomes. There is increasing scientific evidence to support the notion that controlled ovarian stimulation could induce significant changes to the endocrine profile of a reproductive cycle, especially to the reproductively important early luteal phase. These changes may not only have a negative effect on implantation and early placentation, but also on the mother, the fetus, and the infant. The overt consequences of controlled ovarian stimulation include ovarian hyperstimulation syndrome, reduced embryo implantation, increased ectopic pregnancy, and altered placentation and fetal growth. The cumulative scientific evidence from this review suggests that GnRHa trigger in segmented ART might constitute the future routine treatment regimen for IVF patients, providing a safe, effective, and patient friendly treatment.


PubMed | Antalya IVF
Type: | Journal: Reproductive biomedicine online | Year: 2017

In this retrospective observational study, the pregnancy, perinatal and obstetric outcomes of patients diagnosed with unicornuate uteri were compared with those of patients with normal uteri after undergoing intracytoplasmic sperm injection (ICSI) with fresh and cryopreserved embryo transfer. From a select population of 9676 infertile patients receiving IVF treatment, 75 (0.78%) were diagnosed with unicornuate uteri between January 2009 and December 2015. Fifty of them underwent ICSI treatment, with 90 fresh and cryopreserved embryo transfers. No significant differences were found between the biochemical, clinical and implantation rates of the first treatment cycles of the two groups; the ongoing pregnancy rate was significantly lower (P = 0.042; 34.0 versus 53.0%) in the unicornis group, as the result of a clinically higher clinical pregnancy loss rates (22.0 versus 15.9%). Twenty-three clinical pregnancies resulted from the 50 first treatment cycles in the unicornis group, resulting in 14 live births, one ongoing pregnancy, five miscarriages, one ectopic pregnancy and two terminations. The 14 live births were delivered at 35.9 gestational weeks, with seven preterm (<37 weeks) and four low birth weight deliveries. Patients with unicornuate uteri are at increased risk of miscarriage, preterm delivery, low birth weight delivery and reduced live birth rates.


PubMed | Vitale and Antalya IVF
Type: Journal Article | Journal: Andrologia | Year: 2016

Conventional sperm freezing methods perform best when freezing sperm samples containing at least hundreds of spermatozoa. In this severe male factor infertility case series, we examined the reproductive outcomes in 12 intracytoplasmic sperm injection cases where spermatozoa used were frozen in Cell Sleepers. Cell Sleepers are novel devices in which individual spermatozoa can be frozen in microdroplets. The case series included five men with obstructive azoospermia, six with nonobstructive azoospermia and one with cryptozoospermia, in whom microscopic sperm retrievals from testicular sperm extraction (TESE), micro-TESE extracts and a centrifugation procedure resulted in less than 50 spermatozoa. A total of 304 microscopically retrieved spermatozoa were frozen in 20 Cell Sleepers using a rapid manual cryopreservation method. A total of 179 mature oocytes were injected with recovered thawed spermatozoa, resulting in a fertilisation rate of 65.9% (118 of 179), with no total fertilisation failures. In 10 cases, an embryo transfer was performed, three on day 3 and seven on day 5, resulting in a per cycle pregnancy rate of 58.3% (seven of 12). Four of the pregnancies have progressed past 20 gestation weeks. The recovery and use of spermatozoa that were frozen in Cell Sleepers was uncomplicated and effective and eliminated the need to perform any microscopic sperm retrieval procedures on the day of oocyte collection. Modification of the routine sperm cryopreservation methodology to include the use of Cell Sleepers increases the range of sperm samples that can be effectively cryopreserved, to include men with severe male factor fertility.


PubMed | Antalya IVF
Type: Comparative Study | Journal: Journal of assisted reproduction and genetics | Year: 2015

The purpose of this matched-cohort study was to assess endometrial receptivity to blastocyst implantation in fresh embryo transfer by comparing implantation outcomes of fresh embryo transfer with frozen embryo transfer, where two blastocysts of good quality were transferred in good prognosis patients.Fresh embryo transfer from intracytoplasmic sperm injection cycles and artificial frozen embryo transfer cycles performed from January 2012 to December 2013 at a private clinic were retrospectively analyzed and the pregnancy, clinical pregnancy, and implantation rates statistically compared. Cycles were stratified and matched according to the blastocyst expansion grade (grade 2, 3, 4, or 5) of the two blastocysts transferred. Five hundred ninety-eight fresh embryo transfer cycles were matched with 545 frozen embryo transfer cycles across four blastocyst cohorts.In this study of 1143 blastocyst transfer cycles, fresh embryo transfer resulted in reduced pregnancy, clinical pregnancy, and fetal heart implantation rates in all four blastocyst cohorts. The fetal heart implantation rates for fresh embryo transfer ranged from 16.7 % in the grade 2 to 47.3 % in the grade 5 cohort, compared to 23.1 % in the grade 2 to 57.4 % in the grade 5 cohort for frozen embryo transfer. The trends in increasing pregnancy outcomes relative to increasing blastocyst expansion were similar in fresh embryo transfer and frozen embryo transfer.Blastocysts of good quality transferred in frozen embryo transfer had a significantly greater chance of implantation and clinical pregnancy compared to blastocysts of matched quality transferred in fresh embryo transfer, suggesting reduced endometrial receptivity in fresh embryo transfer.


PubMed | Antalya IVF
Type: | Journal: Journal of assisted reproduction and genetics | Year: 2016

In this retrospective cohort study, we investigated the best embryo transfer strategy in ICSI cycles with 4 oocytes collected at oocyte retrieval.Women who underwent antagonist co-treatment COS for ICSI treatment between January 2010 and December 2015 at a private ART clinic (N=2263). Eight hundred seventy-nine women (group 1) had 4 oocytes collected at oocyte retrieval, of whom 645 (group A) had cleavage stage embryo transfer (ET), and 234 (group B) had blastocyst ET. One thousand three hundred eighty-four women (group 2) had 10-15 oocytes collected at oocyte retrieval, of whom 676 (group C) had cleavage stage ET, and 708 women (group D) had blastocyst ET. Blastocyst vitrification was performed using the Cryotop method and FET using artificial cycles.In group 1, the cancellation rate was significantly lower in group A (25.2 vs 38%). The pregnancy rate (PR), clinical PR, implantation rate (IR), and live birth rate (LBR) per ET and per oocyte retrieval were all lower in group A. The clinical PR, IR, and LBR per ET of vitrified-warmed blastocyst ET were significantly the highest. In group 2, the cycle cancellation rate was significantly lower in group C (3.5 vs 13.4%). The PR, clinical PR, and IR per ET and per oocyte retrieval were all lower in group C. The LBR per ET was significantly lower, but the LBR per oocyte retrieval was not significantly lower in group C. Again, the PR, clinical PR, and IR per ET of vitrified-warmed blastocyst ET were significantly the highest.Day 5 ET strategy has been reserved for normal or high responders. The improved pregnancy outcomes from blastocyst culture and cryopreservation may challenge ART to extend this benefit to poor responders.


PubMed | University of Aarhus and Antalya IVF
Type: Journal Article | Journal: Journal of assisted reproduction and genetics | Year: 2016

In segmented ART treatment or so-called freeze-all strategy fresh embryo transfer is deferred, embryos cryopreserved, and the embryo transferred in a subsequent frozen embryo transfer (FET) cycle. The purpose of this cohort study was to compare a GnRHa depot with an oral contraceptive pill (OCP) programming protocol for the scheduling of an artificial cycle FET (AC-FET) after oocyte pick-up (OPU).This retrospective cohort study was conducted on prospectively performed segmented ART cycles performed between September 2014 and April 2015. The pregnancy, treatment duration, and cycle cancellation outcomes of 170 OCP programmed AC-FET cycles were compared with 241 GnRHa depot programmed AC-FET cycles.No significant difference was observed in the per transfer pregnancy and clinical pregnancy rates between the OCP and GnRHa groups, 72.0 versus 77.2%, and 57.8 versus 64.3%, respectively. Furthermore, the early pregnancy loss rate was non-significantly different between the OCP and GnRH protocol groups, 19.8 versus 16.7%, respectively. However, nine (5.29%) cycles were cancelled due to high progesterone in the OCP protocol group, while no cycles were cancelled in the GnRHa protocol group and the time taken between OPU and FET was 19days longer (54.7 vs 35.6days) in the OCP protocol compared to the GnRHa protocol.The results of this AC-FET programming study suggests that the inclusion of GnRHa depot cycle programming into a segmented ART treatment will ensure pregnancy, while significantly reducing treatment duration and cycle cancellation.

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