Recent meta-analyses suggest that flushing follicles during the oocyte retrieval is not beneficial for patients with a normal response to ovarian stimulation. The rate at which oocytes are recovered after flushing is not mathematically compatible with cumulus oocyte complexes always being free floating in the follicle. Furthermore, some residual fluid always remains in the follicle after aspiration. For patients with a small number of follicles, follicle flushing is likely to increase oocyte yield and the potential for pregnancy enough to be clinically significant.

Objective: The objective of this study is to compare implantation and singleton live birth rates between natural cycle in vitro fertilization (NCIVF) and stimulated IVF. Stratify the results by age and antimullerian hormone (AMH). Design: Retrospective cohort trial of patients who underwent unstimulated IVF between 2007 and 2011. Stimulated patient data from the 2010 Centers for Disease Control (CDC) report. Setting: Private practice. Patients: Infertility patients < 43-year-old. Intervention: None. Main Outcome Measures: (1) Implantation rates stratified by age and AMH (2) singleton pregnancy rates. Results: A total of 1288 cycles of NCIVF were compared to 94,976 cycles from CDC. In patients <35 years the implantation rates for NCIVF and stimulated IVF were 35.1% versus 36.9%. In patients 35-37, 38-40 and 41-42 years old, the NCIVF and stimulated IVF implantation rates were 33.9% versus 27.0%, 30.4% versus 17.7%, and 21.4% versus 9.6%. NCIVF implantation rates were independent of AMH at all ages and all levels of AMH. The singleton live birth rates per embryo transfer for both NCIVF and the CDC reported stimulated IVF were similar for all age groups. Conclusions: Implantation rates were superior in patients 35-40 undergoing NCIVF compared with stimulated IVF. In NCIVF implantation rate was independent of AMH. The live singleton birth rates per embryo transfer for NCIVF and stimulated IVF are similar.

Introduction: Endometriosis is a clinical disease that is associated with poor outcomes in in vitro fertilization programs with a decrease in oocyte retrieval, oocyte quality, implantation and pregnancy rates.Based on the observations that the majority of the oocytes obtained in patients diagnosed with endometriosis have some characteristics, we conducted a retrospective study to reveal a more definite picture and to establish a simple way of prediction of the outcome. Materials and Methods: The patients were triaged in two groups based on the diagnosis of endometriosis. After denudation, the oocytes were examined by inverted microscope with ×200 magnification just before intracytoplasmic sperm injection. Oocytes with a centrally dark and granular cytoplasm were diagnosed to have degenerative signs. Results: Data of 792 patients were reviewed retrospectively. The percentage of oocytes with degenerative signs is significantly higher in endometriosis (27.4%) group compared with control group (7.9%) ( P < 0.001). Although, there is a tendency to lower pregnancy rate in endometriosis group (38.7%) the difference is not statistically significant (50.4%) ( P = 0.077). Conclusion: The oocytes have a characteristic appearance of dark and granular ooplasm in endometriosis cases. This finding can be used as a clue in cases in which the presumptive diagnosis has not verified by laparoscopy. The typical morphology also has an adverse effect on clinical outcome.

Objective: The objective of this study is to evaluate the short-term effect of elevated estrogen levels on the coagulation system, as measured by D-dimer in in vitro fertilization (IVF). Design: Prospective open cohort trial. Setting: University affiliated IVF division. Patients: A total of 62 IVF patients. Interventions: Serum 17B estradiol (E2) and D-dimer levels were measured in patients undergoing long protocol IVF at down regulation (DR) (E2 ≤200 pmol/L) and on the day of oocyte retrieval (OR). Data was analyzed and correlated with clinical and laboratory parameters. Main Outcome Measures: Serum D-dimer levels at DR and oocyte pick-up days and their association with clinical and laboratory parameters. Results: From DR to OR day serum D-dimer levels increased in 31 (66%) and decreased in 16 (34%) women. Mean increased was by 21% ( P < 0.024). Among women with an increase in D-dimer levels, mean increase was 44% above levels on DR day. D-dimer levels increased among all patients with a body mass index (BMI) ≥30 kg/m ² and among 57.6% of patients with BMI <30 kg/m ² ( P < 0.009) and increase tended to be higher among obese patients ( P = 0.06). Prothrombin time (PT) on DR day was shorter among patients whose D-dimer levels increased ( P < 0.017). Conclusions: D-dimer serum levels increase during ovarian stimulation; however, levels rarely exceed the normal range. Therefore, short-term exposure to supraphysiological E2 levels in IVF does not seem to affect thromboembolic status as expressed by D-dimer levels. D-dimer increase was associated with a shorter PT on DR day and tended to be comprehensive and higher among overweight women. Therefore, obesity may pose a risk factor for thromboembolism.

Background: We aimed to evaluate plasma viscosity in subjects with polycystic ovary syndrome (PCOS) and detect its relationship with cardiovascular risk factors. Materials and Methods: A total of 96 newly diagnosed women with PCOS aged between 17 and 30 years, along with 67 age, sex, and body mass index matched healthy control subjects were recruited in the study. The diagnosis of PCOS was based on revised 2003 Rotterdam consensus criteria. Plasma viscosity, hormonal and metabolic parameters were measured. Plasma viscosity was measured using a Brookfield DV-II Pro viscometer at 37°C. Results: Total testosterone, luteinizing hormone, plasma viscosity, and fibrinogen levels were significantly higher in women with PCOS (P0 < 0.05). They had significantly higher fasting insulin, triglyceride levels, and homeostasis model assessment of insulin resistance ( P < 0.05). A significant correlation was observed between plasma viscosity and fibrinogen, and serum dehydroepiandrosterone sulfate (DHEA-S) levels. There was a positive correlation between plasma viscosity and fibrinogen ( r = 0.223, P < 0.05) Negative correlation was observed between plasma viscosity and serum DHEA-S levels (r = −0.211, P < 0.05). Conclusions: Plasma viscosity is an important hemorheologic variable and directly determines the blood flow at the microcirculatory level. High plasma viscosity indicates increased resistance to blood flow at the tissue level. Because of direct contact of endothelial cells to plasma, high plasma viscosity seems to associate with endothelial dysfunction. In this study, we clearly demonstrated that plasma viscosity was elevated in patients with PCOS, probably indicating that they had higher cardiovascular risk.

Objective: The objective of this study was to determine if the use of intramuscular (IM) progesterone (P) plus vaginal P (Crinone ^® 8%, once daily) versus vaginal P alone improves outcome in oocyte recipient cycles. Design: Retrospective data analysis. Setting: Academically affiliated private fertility center. Patients: A total of 106 women undergoing donor recipient cycles utilizing two different luteal phase support protocols based on physician preference. Intervention (s): Group I received IM P plus vaginal P and Group II received vaginal P alone starting on the day of the donor's egg retrieval. Main Outcome Measures: Pregnancy rate (PR), clinical pregnancy rate (CPR), implantation rate (IR); live birth rate (LBR). Results: The PR, CPR, and LBR in were significantly higher in Group I (n = 79) than in Group II (n = 27). Conclusions: In oocyte recipient cycles, the use of IM P plus vaginal P significantly increased the PR, CPR, IR and LBR versus vaginal P alone.

Patients with primary ovarian insufficiency (POI) are classically oriented to egg donation due to the lack of currently available efficient treatments. In response to this shortcoming, modified natural in vitro fertilization cycle (mnIVF) combined with dehydroepiandrostenedione (DHEA) neoadjuvant treatment is an original therapeutic tool at our disposal. A 33-year-old patient with idiopathic POI was prescribed DHEA neoadjuvant treatment. She rapidly recovered her menstrual cycle and after 3 months of DHEA, basal follicle-stimulating hormone has decreased drastically. Then, a mnIVF was performed. The patient got pregnant and gave birth to a healthy girl. She became pregnant a second time under DHEA only. Coupled with DHEA neoadjuvant treatment, a mnIVF could be a useful therapeutic tool for extremely poor prognosis patients with POI.