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Tubal Patency Assessment (Focusing on Hysterosalpingo-Contrast Sonography)
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
This issue was studied in a series of 180 couples with unexplained infertility of at least 1 year [39]. Of these, 40 patients (22.2%) became spontaneously pregnant within 6 months after HyCoSy. The mean time to conception was 75 days, but about half (45%) of pregnancies occurred within the first 30 days. In another follow-up of Australian patients, 50% of women who had no prior pregnancies at the time of HyCoSy became pregnant within 6 months after the procedure [40].
The Use of Ovarian Markers
Published in Botros Rizk, Yakoub Khalaf, Controversies in Assisted Reproduction, 2020
Neena Malhotra, Siladitya Bhattacharya
Beyond IVF, ovarian reserve tests have found limited utility in the management of women with fertility problems. They have not been found to be more useful than age alone in the prediction of pregnancy in women presenting with unexplained infertility or mild male infertility (73).
IVIg Treatment for Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
The aforementioned clinical trials have been included in four published meta-analyses summarized in Table 30.2 [51–55]. None of the meta-analyses showed benefit of treatment with IVIg for primary aborters. Two of the analyses demonstrated significant benefit only for secondary aborters (Table 30.2) [51,54]. None of the studies included in the meta-analysis selected patients for inclusion based on immunologic testing. All were included based on reproductive history alone. How can the effect of an immunomodulatory treatment be evaluated if the subjects receiving the treatment were not determined to have any detectable immune abnormalities that would merit their inclusion into the study? The sample size required to show an effect would depend on the prevalence of immunologic problems among the unselected patients. Indeed, IVIg was shown to increase the success rate in patients undergoing IVF for treatment of unexplained infertility based on meta-analysis with a sample size of over 8000 patients [54]. A number of clinical trials have demonstrated increased live birth rates after treatment with IVIg when patients are selected based on immunologic testing provided treatment is given prior to conception [3,11,38,48,49].
The role of oxidant status on the etiopathogenesis of unexplained infertility and intracytoplasmic sperm injection – embryo transfer success: a case-control study
Published in Journal of Obstetrics and Gynaecology, 2022
Raziye Şentürk, Esra Nur Tola, Mustafa Bozkurt, Duygu Kumbul Doğuç
In order to homogenise the study group and exclude the effects of the infertility aetiology on oxidant status, only patients with UI were recruited in the present study. Evaluating only UI patients are the strengths of this study. When evaluating the role of oxidant status on the success of IVF, regression analysis was used for adjusting for the variables that could affect IVF success including implantation, clinical pregnancy and live birth rate. To exclude the effect of the factors that known to affect IVF success was another strength of this study. The main limitation of this study is its small sample size and the lack of power calculation. The present study included only UI patients undergoing an IVF cycle, and therefore, the results cannot be generalised to all UI patients undergoing ovulation induction with/without IUI. Another limitation is the lack of oocyte quality evaluation which is closely related to fertilisation. Also, IVF is a supraphysiologic process in which many other factors including laboratory conditions may affect its success. In spite of these limitations, present study is one of the few studies evaluating TAS, TOS, and OSI in UI patients. It is important to know that oxidative stress causes unexplained infertility and poor embryo quality in women with unexplained infertility. The resent study may shed a light on new studies to improve embryo quality and IVF success in unexplained infertile cases.
Do follicular fluid advanced glycation end products levels affect the ovarian response in unexplained infertility?
Published in Gynecological Endocrinology, 2021
Banu Seven, Yasemin Tascı, Cavidan Gülerman, Tuba Candar, Kuntay Kokanalı, Yasemin Yüksel, Yesim Bardakcı, Yaprak Engin-Ustün
Despite the large number of therapeutic agents developed for ovarian stimulation in recent years, some patients do not receive the benefits related to COS because they do not respond to treatment [23]. Unexplained infertility can be defined as the lack of an obvious cause of infertility in a couple and management of infertile couples with idiopathic cause needs individualized treatment. Our study showed that the increased level of AGEs in the FF during COS in unexplained infertility is associated with decreased ovarian response, however, it does not provide information about pregnancy outcomes. This suggests that a decrease in AGEs level may lead to an increase in ovarian response. Therefore, some approaches to decrease the level of AGEs (for example avoiding foods containing high level of AGEs, such as dry-heat processed foods or novel treatment targeting AGE-RAGE pathway) may be useful in increasing the ovarian response. However, further prospective randomized studies with more participitans are needed to fully clarify these issues.
Does multifollicular development and number of intermediate follicles contribute to the effect of luteal phase support with vaginal progesterone gel in intrauterine insemination cycles?
Published in Gynecological Endocrinology, 2020
Vehbi Yavuz Tokgoz, Mehmet Sipahi, Yunus Aydin, Ahmet Basar Tekin
The present retrospective cohort study was conducted at two university-based tertiary hospital between January 2012 and December 2016. The study was approved by the Local Ethics Committee and Institutional Review Board. A total of 458 patients were retrospectively evaluated. Couples who have mild male factor infertility and unexplained infertility were included in the study. Inclusion criteria were as follows; at least 1-year infertility, at least one patent fallopian tube confirmed by hysterosalpingography (HSG) or laparoscopy, ovulatory menstrual cycles and normal semen analysis according to the World Health Organization (WHO) criteria. Exclusion criteria includes: bilateral tubal occlusion, mild or severe endometriosis, day 3 serum FSH (follicle-stimulating hormone) > 13 IU/L, abnormal thyroid function tests, hyperprolactinemia, total motile sperm count (TMSC) < 5 millions or severe teratospermia (<4% normal forms) following semen preparation and more than 3 follicles above the size of 17 mm on the day of ovulation triggering.