Fertility and Reproductive Center

Warsaw, Poland

Fertility and Reproductive Center

Warsaw, Poland

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Krzysztof L.,Fertility and Reproductive Center | Krzysztof L.,Medical University of Gdańsk | Joanna L.,Fertility and Reproductive Center
Ginekologia Polska | Year: 2011

Objectives: To prevent OHSS by interruption of the early stage of stimulation ("internal coasting"). Design: Prospective, randomized study. Material and Methods: 139 women who had unsuccessfully undergone standard long protocol ICSI procedure, complicated by OHSS of moderate or severe degree. The women were randomized to two groups - 68 undergoing stimulation in which, after 2 days of 225 IU hMG there were 2 days without hMG, and then, for the remainder of the stimulation period, 150 IU hMG. The control group (71 women) received standard doses of hMG, as in the first ICSI cycle. The main outcome measures was the prevalence and severity of OHSS, implantation and pregnancy rates. Results: There were 39 cases of OHSS of moderate (32) and severe (7) degree in the control group and 7 (moderate) cases in the investigated group (p = 0.05). No differences were found in the implantation rate and pregnancy rate, the mean number of oocytes fertilized, fertilization rate and the mean number of embryos transferred. Conclusion: Stimulation with internal coasting is safe for women at a high risk of OHSS. It does not negatively influence fertilization, implantation or pregnancy rates. © Polskie Towarzystwo Ginekologiczne.


Lukaszuk K.,Medical University of Gdańsk | Lukaszuk K.,Fertility and Reproductive Center | Kunicki M.,Fertility and Reproductive Center | Liss J.,Fertility and Reproductive Center | And 2 more authors.
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2013

Objective: To examine common clinical determinants, including patient age; levels of anti-Müllerian hormone (AMH), inhibin B, and follicle-stimulating hormone (FSH); antral follicle count (AFC); and number of oocytes retrieved, to predict live births in women undergoing in vitro fertilization. Study design: Women undergoing cycles of intracytoplasmic sperm injection (ICSI) for the first time were reviewed retrospectively, and serum levels of AMH, inhibin B, and FSH, as well as AFC (days 1 and 4 of pre-ICSI menstrual period) and patient age were analyzed as determinants of live birth rates. Results: Of the patients studied, 35.71% (891/2495) became pregnant, with live births achieved in 32.20% (806/2495) of cycles initiated and in 46.37% (806/1738) of embryo transfers. Clinical pregnancy rate was 35.71% (891/2495) for cycles initiated and 51.26% (891/2318) for embryo transfers. Univariate analysis revealed that the odds of live birth significantly decreased with increasing age, declining AMH or inhibin B concentrations, and fewer oocytes retrieved. At AMH levels greater than 5.7 ng/ml, the odds of live birth were 3.18 times greater than for AMH levels less than 1.9 ng/ml [95% confidence interval (CI), 1.89-5.43]. Using multivariate logistic regression, only AMH (OR = 1.89; 95% CI, 1.00-3.60; p < 0.05) and AFC (OR = 1.86; 95% CI, 1.02-3.40; p < 0.05) showed statistically significant associations with live birth. Area under the curve for ROC (ROCAUC) indicated that AMH (AUC = 0.60) surpassed AFC (AUC = 0.59), number of oocytes retrieved (AUC = 0.59), inhibin B (AUC = 0.55), FSH (ROCAUC = 0.54) and chronological age (ROCAUC = 0.53) in predicting live birth. Conclusions: In this assessment of various indices (i.e., age; levels of AMH, inhibin B, and FSH; AFC; and quantity of oocytes retrieved) for predicting live births for IVF patients, AMH, AFC and the quantity of oocytes retrieved constituted the most reliable determinants. © 2013 Elsevier Ireland Ltd.


Lukaszuk K.,Medical University of Gdańsk | Lukaszuk K.,Fertility and Reproductive Center | Lukaszuk K.,University of Varmia and Masuria | Kunicki M.,Fertility and Reproductive Center | And 3 more authors.
Reproductive BioMedicine Online | Year: 2014

The aim of the present study was to investigate the clinical pregnancy and live birth rates in women with extremely low (≤0.4 ng/ml) anti-Müllerian hormone (AMH) concentrations. The study included 101 women (188 cycles) with extremely low AMH concentrations undergoing IVF cycles and compared the number of live births in women with low AMH. Moreover, the study compared the number of live births in women with or without endometriosis stage III/IV. Fourteen clinical pregnancies and 14 live births (including one pair of twins) were recorded; one woman miscarried. Significantly higher clinical pregnancy (P = 0.046) and live birth rates (P = 0.018) were found in women aged <35 years compared with older women. AMH concentration did not differ significantly between women with or without endometriosis and there were six live births in women with endometriosis. This was not significantly different from the rate in healthy women. It is concluded that live births are possible in women with extremely low AMH concentrations. The presence of endometriosis stage III/IV did not affect live birth rates in women with extremely low AMH concentrations although an important limitation of the study is the small number of women included who were affected by that disease. The aim of the present study was to investigate the clinical pregnancy and live birth rates in women with extremely low (≤0.4 ng/ml) anti-Müllerian hormone (AMH) concentrations. Moreover, we compared the number of live births in women with or without endometriosis stage III/IV. We concluded that, in women with extremely low AMH concentrations, live births are possible. The presence of endometriosis stage III/IV did not affect live birth rates in women with extremely low AMH concentrations, although the strong limitation of the study is that it included only a small number of women affected by that disease.


PubMed | Medical University of Gdańsk, Institute of Animal Reproduction and Food Research and Fertility and Reproductive Center
Type: Journal Article | Journal: AJP reports | Year: 2015

IntroductionSperm DNA integrity is a crucial paternal factor affecting fertilization and pregnancy rates, as well as embryo development. CaseThe present case report describes the successful pregnancy after testicular sperm aspiration (TESA) combined with intracytoplasmic sperm injection (ICSI) (TESA-ICSI) in a couple where the male presented high sperm DNA fragmentation. In order to sort damaged sperm presenting DNA fragmentation, magnetic activated cell sorting (MACS) with annexin V microbeads (MACS Miltenyi Biotec, Teterow, Germany) was used. ConclusionThe authors present the first description of a successful medical case using TESA-ICSI annexin V sperm sorting. Additionally, a follow-up of the child at the age of 4 years old was done.


Nelson S.M.,Royal Infirmary | Pastuszek E.,Fertility and Reproductive Center | Pastuszek E.,Medical University of Gdańsk | Kloss G.,Fertility and Reproductive Center | And 6 more authors.
Fertility and Sterility | Year: 2015

Objective To compare new automated antimüllerian hormone (AMH) assay performance characteristics from the new automated Elecsys AMH (Roche; Elecsys) and Access AMH (Beckman Coulter; Access) assays with the existing AMH Gen II ELISA (enzyme-linked immunosorbent assay; Gen II; Beckman Coulter) and AMH ELISA (Ansh Labs) assays. Design Prospective assay evaluation. Setting University-affiliated clinical chemistry laboratory. Patient(s) Patients referred for serum AMH measurement (n = 83) before start of in vitro fertilization cycle between September 2014 and October 2014. Intervention(s) None. Main Outcome Measure(s) Serum AMH concentration. Result(s) Intra-assay coefficients of variation were low; Ansh 9.0%; Gen II ; 5.8%; Access 10.7%; and Elecsys 2.8%. The Passing-Bablok regression equations (pmol/L) were y (Access) = 0.128 + (0.781 × Gen II); and y (Access) = 0.302 + (0.742 x Ansh). For y (Elecys) = 0.087 + (0.729 x Gen II) and y (Elecys) = 0.253 + (0.688 x Ansh Labs). For y (Elecys) = 0.943 - (0.037 × Access). For all the assays, AMH exhibited a moderate positive correlation with AFC (r = 0.62-0.64); number of cumulus oocyte complexes (r = 0.60-0.64); and metaphase II oocytes (r = 0.48-0.50). Accuracy of pregnancy prediction, as determined by area under the receiver operating characteristic curve, was uniformly low for all assays (0.62-0.63). Conclusion(s) The novel automated assays exhibit strong concordance in calibration, but derived values are substantially lower than those obtained from pre-existing assays, with assay-specific interpretation required for routine clinical use. These results highlight the need for an international standard of measurement of AMH. © 2015 American Society for Reproductive Medicine.


Lukaszuk K.,Fertility and Reproductive Center | Lukaszuk K.,Medical University of Gdańsk | Pukszta S.,Fertility and Reproductive Center | Wells D.,Oxford Business Park | And 7 more authors.
Fertility and Sterility | Year: 2015

Objective: To determine the usefulness of semiconductor-based next-generation sequencing (NGS) for cleavage-stage preimplantation genetic diagnosis (PGD) of aneuploidy. Design: Prospective case-control study. Setting: A private center for reproductive medicine. Patient(s): A total of 45 patients underwent day-3 embryo biopsy with PGD and fresh cycle transfer. Additionally, 53 patients, matched according to age, anti-Müllerian hormone levels, antral follicles count, and infertility duration were selected as controls. Intervention(s): Choice of embryos for transfer was based on the PGD NGS results. Main Outcome Measure(s): Clinical pregnancy rate (PR) per embryo transfer (ET) was the primary outcome. Secondary outcomes were implantation and miscarriage rates. Result(s): The PR per transfer was higher in the NGS group (84.4% vs. 41.5%). The implantation rate (61.5% vs. 34.8%) was higher in the NGS group. The miscarriage rate was similar in the 2 groups (2.8% vs. 4.6%). Conclusion(s): We demonstrate the technical feasibility of NGS-based PGD involving cleavage-stage biopsy and fresh ETs. Encouraging data were obtained from a prospective trial using this approach, arguing that cleavage-stage NGS may represent a valuable addition to current aneuploidy screening methods. These findings require further validation in a well-designed randomized controlled trial. Clinical Trial Registration Number: ACTRN12614001035617.


PubMed | Medical University of Gdańsk, Medical University of Bialystok, Polish Academy of Sciences, Technical University of Gdansk and Fertility and Reproductive Center
Type: Journal Article | Journal: Annals of agricultural and environmental medicine : AAEM | Year: 2016

Vitamin D is essential for the proper functioning of the human body. There is also evidence of its strong association with fertility problems in women. This review aims to evaluate the relationship between vitamin D and diseases affecting womens fertility (polycystic ovarian syndrome (PCOS), uterine leiomyomas and endometriosis), and in vitro fertilization (IVF) outcome. A systematic review of the literature was conducted in Scopus and PubMed for relevant English language publications since 1989. Vitamin D influences the functioning of the reproductive system in women and has been associated with PCOS, uterine leiomyomas, endometriosis and in vitro fertilization (IVF) outcome. However, further studies on larger groups of patients are needed to establish what role vitamin D plays in the treatment of female infertility.


PubMed | Medical University of Gdańsk, Polish Academy of Sciences and Fertility and Reproductive Center
Type: Journal Article | Journal: AJP reports | Year: 2015

Preimplantation genetic diagnosis (PGD) is well established method for treatment of genetic problems associated with infertility. Moreover, PGD with next-generation sequencing (NGS) provide new possibilities for diagnosis and new parameters for evaluation in, for example, aneuploidy screening. The aim of the study was to report the successful pregnancy outcome following PGD with NGS as the method for 24 chromosome aneuploidy screening in the case of Robertsonian translocation. Day 3 embryos screening for chromosomal aneuploidy was performed in two consecutive in vitro fertilization (IVF) cycles, first with fluorescent in situ hybridization (FISH), and then with NGS-based protocol. In each IVF attempt, three embryos were biopsied. Short duration of procedures enabled fresh embryo transfer without the need for vitrification. First IVF cycle with the embryo selected using PGD analysis with the FISH method ended with pregnancy loss in week 8. The second attempt with NGS-based aneuploidy screening led to exclusion of the following two embryos: one embryo with 22 monosomy and one with multiple aneuploidies. The transfer of the only euploid blastocyst resulted in the successful pregnancy outcome. The identification of the euploid embryo based on the NGS application was the first successful clinical application of NGS-based PGD in the case of the Robertsonian translocation carrier couple.


PubMed | Poznan University of Medical Sciences and Fertility and Reproductive Center
Type: Review | Journal: Journal of endocrinological investigation | Year: 2016

Fertility is referred to the capability for having offspring and can be evaluated by fertility rate. Womens fertility is strictly dependent on individuals age. The fertility peak occurs in the early 20s, and it starts to decline in the third and fourth decades of life (falling sharply after age 35).The aim of this work is to review the available data concerning fertility in women of late reproductive age, especially the role of serum anti-Mllerian hormone (AMH) levels.There are a lot of factors responsible for decrease of fertility in women of late reproductive age. These factors can be classified as oocyte-dependent (decrease in oocyte quantity and quality) and oocyte-independent (reproductive organs [uterus, oviducts] status and general health). Anti-Mllerian hormone (AMH) is a dimeric glycoprotein of the transforming growth factor- (TGF-) superfamily produced directly by the ovarian granulosa cells of secondary, preantral, and early antral follicles. It has been used as an ovarian reserve marker since 2002. Anti-Mllerian hormone seems to be the best endocrine marker for assessing the age-related decline of the ovarian pool in healthy women. Evaluation of AMHs predictive value in the naturally aging population is important for counseling women about reproductive planning as well as for treatment planning for women experiencing hormone-sensitive gynecological conditions such as endometriosis and fibroids.AMH can be considered as an indicator of fertility in late reproductive age women and pregnancy outcome in assisted reproductive technology cycles. AMH can strongly predict poor response in the controlled ovarian stimulation.

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