Oral contraceptive (OC) pills are commonly used in patients undergoing in vitro fertilization to schedule cycle starts. This often helps with staff scheduling and efficiency. In this paper, the use of OC pre-treatment in assisted reproductive cycles will be discussed. The focus will be on the use of OC in gonadotropin releasing hormone (GnRH) antagonist cycles, GnRH agonist cycles, poor responders and finally in high responders. A recent meta-analysis of six randomized control trials concluded that in cycles with GnRH-antagonist protocols, OC pre-treatment: (1) Increases the duration of stimulation, (2) increases the total dose of gonadotropins and (3) resulted in a small but significant reduction in pregnancy rates. All these studies used pure follicle stimulating hormone for controlled ovarian hyperstimulation. These conclusions, however, may not be valid in cycles where the birth control pill free interval is 5 days, and there is use of combination protocols (luteinizing hormone or human menopausal gonadotropin add back). 17β-estradiol (E2, 4 mg/d) pre-treatment is a viable alternative to using OC. However, in these patients, gonadotropin stimulation should be started on the first day of estrogen discontinuation. In GnRH agonist cycles, pre-treatment with OC reduces the formation of functional ovarian cysts and may reduce the incidence of ovarian hyperstimulation syndrome.

Background/Aim: Spermatozoa from inbred mice provide a useful model to study male infertility as they produce a low number of zygotes with conventional IVF. This study aimed to assess whether the use of zona laser dissection might improve the number of zygotes developing after conventional IVF with inbred spermatozoa. Materials & Methods: Mouse oocytes from an inbred C57BL/6J strain and a hybrid B6D2F1 strain were allocated to either conventional IVF or laser assisted IVF, using spermatozoa from the inbred strain C57BL/6J. Laser assisted IVF involved use of a 1.48 diode microsurgical laser device to ablate three holes into each zona immediately prior to insemination. Results: Use of a laser significantly improved the zygote production rate compared with zona intact oocytes (88.4% vs. 18.3% for inbred oocytes, and 92.3% vs. 1.6% for hybrid oocytes, P < 0.001), and also significantly improved the blastocyst development rate (40.6% vs. 4.2% for inbred oocytes, and 76.9% vs. 0.0% for hybrid oocytes, P < 0.001). Conclusion: Zona laser dissection is a simple technique that avoids the need for ICSI, significantly reduces operator time and allows numerous oocytes to be treated in a short period. Since high numbers of zygotes can develop using laser assisted IVF for this animal model where the spermatozoa are of poor quality, one might speculate that laser assisted IVF may have a possible role in the treatment male infertility in a clinical setting.

Objectives: In general, patients with the low ovarian reserve are difficult to manage and have a relatively poor prognosis. Hormonal changes due to ovarian insufficiency can influence and change the individual menstrual cycle pattern of each patient over time, which may result in difficulties in conceiving naturally. We observed the menstrual cycle pattern of patients with low ovarian reserve in order to distinguish the different stages of ovarian insufficiency. Then, we developed treatment approaches for each patient group based on the natural cycle in vitro fertilization (IVF). Materials and Methods: In 2011, menstrual cycle patterns of 10 patients with anti-mullerian hormone <1.0 nmol/L was observed. Patients were 22-42-year-old (mean 39.3 years). Depending upon the cycle pattern of each patient, we offered individualized treatment approaches based on the natural cycle IVF using the clomiphene citrate (CC) to control the ovulation. Embryos were vitrified at day 2 stage and transferred later in artificial cycles. Results: Based on our observation, we could identify four different stages of ovarian insufficiency. A total of 33 natural cycles were initiated. Premature ovulation occurred in three cycles (9.0%) and no retrieval was attempted in these. Among the attempted 30 oocyte retrievals, 21 (70.0%) were successful. Out of those 21 oocytes, 11 oocytes (36.6% per retrieval) were mature. Intracytoplasmic sperm injection resulted in eight fertilizations (72.7% per mature oocyte). Out of eight transfers, 3 (37.5%) resulted in biochemical pregnancy. Two patients delivered (25.0%), one patient had a miscarriage at 8 weeks of pregnancy. Conclusion: Our experience shows that ovulation can successfully be controlled by the use of CC and does not necessarily require gonadotropin releasing hormone analogues for pituitary suppression. This knowledge opens new scope for development of alternative protocols respecting the patient's own physiology with no need for heavy stimulation. Patients with ovarian insufficiency may benefit from this approach, which can be offered before referring them to egg donation.

Background: Previous trials have shown that neither conventional IVF nor natural cycle IVF is an effective treatment option for poor ovarian responders. However, none of the trials has examined the efficacy of accumulating embryos with serial minimal stimulation cycles, vitrifying the resulting embryos and transferring them in a remote cycle (IVF Lite protocol). Women with poor ovarian reserves, who commonly do not respond to conventional stimulation protocols, are left with few options when planning a family. The current study was undertaken to evaluate the efficacy of serial minimal stimulation in vitro fertilization (msIVF) cycles with vitrification of embryos for treatment of poor ovarian responders (PORs) as compared to conventional IVF protocols. Materials and Methods: This is a retrospective data analysis of PORs from June 2010 to November 2012. A total of 222 patients were included in the study. Ninety-seven patients underwent serial minimal stimulation cycles with vitrification and embryo banking (IVF Lite Group) and 125 patients underwent conventional controlled ovarian stimulation for IVF. The patients identified as PORs based on the Bologna criteria were included in the analysis. In the IVF Lite group, embryos were vitrified using Cryotec vitrfication protocol on Day 3. Once six embryos were banked with us, a frozen embryo transfer was planned. A maximum of 3 embryos were transferred. Main outcome measure was the clinical pregnancy rate defined as positive fetal heartbeat at 12 weeks of pregnancy. Results: There was no significant difference in the number of metaphase II (MII) oocytes retrieved between the both groups. The difference in the number of gonadotropins units required to produce one MII oocyte between the two groups was statistically highly significant: 680.4 units for the IVF Lite group and 4956.2 units for the conventional IVF group. The IVF Lite group had a higher percentage of good grade embryos. In the IVF Lite group, each patient underwent an average of 2.96 cycles of embryo accumulation before planning a frozen embryo transfer. An average of 6.2 embryos were accumulated for each patient. The clinical pregnancy rate (CPR) per embryo transfer was higher in the IVF Lite group (27.81%) than the conventional IVF group (15.15%). The CPR per patient was much higher in the IVF Lite (48.45%) than the conventional IVF group (24.0%). Conclusion: The results obtained in the current study demonstrate that the IVF Lite protocol consisting of ms-IVF, ACCU-VIT and rET is a very successful approach in treating poor responders. Very favorable rates of pregnancy can be achieved with IVF Lite protocol.

Introduction: Embryo transfer (ET) techniques and modifications have been extensively studied recently as one the main variables affecting in vitro fertilization (IVF) pregnancy rates; many of ET independent variables have been studied with discordant results: A better understanding of endometrial movements could help improve ET efficiency and IVF success. Objectives: The aim of this study was to record and study microdrop in utero movements after ET by ultrasound (US). Materials and Methods: 18 patients underwent pelvic US for 4 h following ET, at 15 min intervals. ET occurred on day + 3 of embryo development following IVF stimulation. The microdrop that contained the embryos consisted of 25 ΅L of culture media and was randomly placed 1-3 cm from the fundus. Results: The microdrop could be seen leaving the catheter and deposited in the final 3 cm of the uterine cavity. In the following US, endometrial wave movements flowing from the cervix to fundus and fundus to cervix could clearly be seen, and these waves started at both ends simultaneously. The microdrop moved from the fundus to about 1 cm from the isthmus, and back again. There were times when it was virtually stationary. In all cases, after 1 h the microdrop had moved from its original position. The intensity of the endometrial movements was different in every patient. Discussion: The endometrial waves that start immediately after ET probably serve to keep the embryo within the uterine cavity, and to select the most appropriate place for implantation. This study shows for the first time microdrop movements after ET. Given this endometrial activity, we should not be concerned about positioning the embryo correctly at transfer as simply ensuring the catheter is within the uterine cavity should be enough, avoiding endometrial damage.

Aim: Aim of the study is to correlate Serum Anti-Mullerian Hormone (AMH) levels, Follicular phase Follicle stimulating Hormone (FSH) levels and Antral Follicular Count (AFC) with ovarian response in ART (Assisted reproductive Techniques) cycles. Materials and Methods: Seventy patients undergoing ART cycles for various factors were included in the study. They were divided in two groups according to number of oocytes retrieved at ovum pick up procedures. Four or less number of oocytes were considered as poor response (n=32) and more than four oocytes were considered as good response (n=38). Two groups were compared for their Age, Duration of Marriage, Follicular phase FSH, AMH levels, pregnancy rates and cycle cancellation rate. Results: We found that the age and duration of infertility were not statistically different in two groups. AMH value in poor responders was 1.20ng/ml and in good responders it was 3.38 ng/ml with statistically significant difference (p< 0.05). The difference in FSH levels (7.36 Vs5.99) and AFC (5 Vs 12) was statistically significant. Pregnancy rate in poor responder group was very low as compared to good responders (6.25 Vs 18.42). In good responders none of the cycle got cancelled whereas in poor responders group five cycles got cancelled (15.63%) either due to failure to retrieve mature oocytes or failed fertilization due to poor quality of oocytes. Conclusion: It appears that AMH serum Levels baseline FSH and antral follicular count are associated with ovarian response in ART cycles and can be served as markers for ovarian reserve.

Background/Aim: To investigate which FSH, recombinant or urinary, works better in low responders patients after initial stimulation with clomiphene citrate (CC) and antagonist protocol. Matherial and Methods: Retrospective study with historical controls in an University-affiliated infertility center. A total of 140 patients with a previous low response in an IVF / ICSI cycle were included. 70 patients undergoing GnRH antagonist cycle received controlled ovarian stimulation with oral clomiphene citrate (CC) and human menopausal gonadotropins (Group A). Similarly, 70 patients were stimulated with oral CC and a recombinant follicle-stimulating hormone (rFSH) and recombinant Luteinizing hormone (LH) combination(Group B). The primary outcome was clinical pregnancy and implantation rate; secondary outcome variables were duration of stimulation and canceled cycles. Result(S): There were no differences between the groups (A vs B) respect to the clinical pregnancy rate (29.1% vs. 31.6%) or implantation rate (27.4% vs. 29.8%). The duration of the stimulation was similar (10.1 vs. 10.8 days), but this difference was not significant. Conclusions: More studies are required to optimize the CC/gonadotropin stimulation protocol. A possible benefit of rFSH/rLH in this soft protocol was not shown.

In vitro fertilization was performed successfully in a patient with achondroplasia. Clinical difficulties were encountered and are discussed.

In this paper, we are reporting a case of heterotopic pregnancy, which occurs as complications of clomiphene citrate.