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Kalem M.N.,Ankara University | Kalem Z.,In Vitro Fertilization Center | Yuce E.,Ankara University | Eser A.,Ankara University | Duvan Z.C.I.,Ankara University
Turk Jinekoloji ve Obstetrik Dernegi Dergisi | Year: 2015

In the last 20 to 30 years, early diagnosis of pregnancy has markedly decreased ectopic pregnancy-related maternal mortality, and the necessity for surgical treatment. With modern approaches in the treatment of ectopic pregnancy, surgical therapy has been replaced by medical therapy and medical treatment by spontaneous follow-up in appropriate cases. However, this current trend has led to some problems, including the maximization of ultrasonographic interpretations, misunderstandings in serial human koryonik gonadotropin hormon measurements, and complications due to inappropriate methotrexate use. The aim of the present study was to review the literature relating to the diagnosis and follow-up of early pregnancies, to underline some of the important considerations, and to help avoid possible iatrogenic errors. © 2015, Turkish Society of Obstetrics and Gynecology. All rights reserved.


Dain L.,Carmel Medical Center | Ojha K.,St Georges Hospital | Ojha K.,London Bridge Gynecology Fertility and Genetic Center | Bider D.,Sheba Medical Center | And 4 more authors.
Fertility and Sterility | Year: 2014

Design: Retrospective cohort analysis of ovum donation cycles conducted from 2005 to 2012.Objective: To evaluate the effect of local endometrial injury (LEI) on clinical outcomes in ovum donation recipients.Setting: Two private IVF centers.Patient(s): Total 737 ovum donation cycles.Intervention(s): LEI by endometrial "scratch" with the use of a Pipelle catheter.Main Outcome Measure(s): Clinical pregnancy and live birth rates.Result(s): No statistically significant differences were found in clinical pregnancy rates and live birth rates in cycles subjected to LEI compared with those without. Combination of LEI with fibroid uterus resulted with significantly higher clinical pregnancy rates compared with LEI in normal uterine anatomy.Conclusion(s): This is the first study done in ovum recipients who underwent LEI by a "scratch" procedure after failed implantation. Unlike most previous reports, which found improved pregnancy rates with the use of "scratch effect" or "minor endometrial injury" after repeated implantation failures in standard IVF with own eggs, we did not find any changes in implantation rates in a population of egg recipients following this procedure. In view of a possible positive effect of LEI in cycles with a previous four or more failures, prospective randomized controlled studies are warranted to better define the target population who may benefit from this intervention. © 2014 American Society for Reproductive Medicine.


Dain L.,Carmel Medical Center | Bider D.,Sheba Medical Center | Levron J.,Sheba Medical Center | Zinchenko V.,In Vitro Fertilization Center | And 2 more authors.
Fertility and Sterility | Year: 2013

Objective To evaluate the combined effect of endometrial thickness and anatomic uterine factors on clinical outcome in oocyte donation recipients. Design Retrospective analysis of oocyte donation cycles conducted between 2005 and 2010. Setting Two private IVF centers. Patient(s) A total of 737 donor oocyte cycles. Intervention(s) None. Main Outcome Measure(s) Clinical pregnancy and live birth rates. Result(s) No statistically significant difference was found in clinical pregnancy rates and live birth rates in cycles with endometrial thickness <6 mm compared with those with endometrial thickness >10 mm. However, a relatively high rate of live births was found within a medium range of endometrial thickness (8.2-10 mm). All intrauterine adhesion cases occurred in cycles with thinner endometrium. Conclusion(s) No statistically significant difference was found in clinical pregnancy rates and live birth rates in cycles with endometrial thickness <6 mm compared with those with thickness >6 mm. A relatively high rate of live births was found within a medium range of endometrial thickness (9.1-10 mm). © 2013 by American Society for Reproductive Medicine.


PubMed | Carmel Medical Center, Bnai Zion Medical Center, In Vitro Fertilization Center, Sheba Medical Center and 2 more.
Type: | Journal: Archives of gynecology and obstetrics | Year: 2016

To examine the effects of fibroid uterus on pregnancy outcomes and endometrial features in ovum donation recipients.Retrospective analysis of 744 ovum donation cycles was conducted in two private IVF centers between 2005 and 2012. All the recipients underwent transvaginal ultrasound examination, including endometrial thickness and grade measurements. Clinical pregnancy, spontaneous miscarriage, and live birth rates were regarded as the primary outcomes.Leimyomas not distorting the uterine cavity were diagnosed in 264 (35.5%) of the cycles. This group exhibited lower endometrial thickness (8.331.8 vs. 8.732.03mm, p=0.009), lower rates of Grade A (16.1 vs. 30.1%, p<0.0001), and higher rates of grade C endometrium (10.2 vs. 5.5%, p<0.0001), compared to the group with sonographically normal uterine cavity. In addition, significantly higher spontaneous miscarriage rates were found in fibroid uteri group (25 vs. 14.5%, p=0.036).Our study results suggest that uterine fibroids not distorting the uterine cavity could constitute a risk factor for spontaneous miscarriage in oocyte donation cycles, possibly via their adverse effect on endometrial receptivity. Further well-designed trials should widely explore this subject, particularly focusing on impact of myomectomy on fertility rates in these patients.


PubMed | McGill University, Afyon Kocatepe University, In Vitro Fertilization Center, Kahramanmaras Sutcu Imam University and Koç University
Type: Journal Article | Journal: Fertility and sterility | Year: 2016

To compare the clinical outcome of single-embryo transfer (SET) with double-embryo transfer (DET) in invitro maturation (IVM) cycles performed in patients with polycystic ovary syndrome (PCOS), and to determine which factors predict those outcomes.A retrospective analysis.Private assisted reproduction center.One hundred and fifty-nine women with PCOS.Invitro maturation with elective SET or DET conducted between September 2007 and May2014.Live-birth rates.Single-embryo transfer was performed in 83 patients (52.2%), and DET was performed in 76 patients (47.7%). When compared with the patients who had DET, the patients who had SET were statistically significantly younger (32.4 3.5 vs. 24.1 4.2years) and had a shorter infertility duration (9.2 4.5 vs. 4.4 2.1years), fewer previous ART cycles (<2 prior attempts, 39.5% vs. 6%; 2 prior attempts, 60.5% vs. 0), fewer collected oocytes (15.1 4.6 vs. 12.6 3.8), fewer metaphase II oocytes (9.0 4.1 vs. 5.7 2.9), fewer fertilized oocytes (8.2 3.7 vs. 3.6 2.3), and a higher implantation rate (27% vs. 47%). The SET and DET groups had similar embryo quality and similar clinical pregnancy (44.6% vs. 44.7%) and live-birth rates (34.9% vs. 34.2%). Twin pregnancy rates were statistically significantly higher in the DET compared with the SET groups (9.2% vs. 2.4%).Invitro maturation is a successful assisted reproduction technique that can be an alternative to conventional invitro fertilization in women presenting with PCOS-related infertility. Our observations suggest that SET is a feasible option to prevent multiple pregnancies while maintaining the live-birth rate.

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