Comparison of the effect of two combinations of myo-inositol and D-chiro-inositol in women with polycystic ovary syndrome undergoing ICSI: a randomized controlled trial

The purpose of this study was to evaluate the effect of two doses of D-chiro-inositol (DCI) in combination with Myo-inositol (MYO) in women with PCOS undergoing ICSI. This was a multicenter controlled, randomized, double-blind parallel group study with two MYO-DCI formulations for 12?weeks. The study group (SG) was administered 550?mg of MYO + 150?mg of DCI twice daily; the control group (CG) was administered 550?mg of MYO + 13.8?mg of DCI twice daily. The participants comprised 60 women with PCOS undergoing ICSI. At baseline, no differences were found between the two groups regarding age, BMI, HOMA-IR or testosterone levels. The pregnancy and live birth rates were significantly higher in the SG than in the CG (65.5 vs. 25.9 and 55.2 vs. 14.8, respectively) [risk ratio (RR) = 0.4; 95%CI (0.2, 0.79); p?=?.003 and RR?=?0.27; 95%CI (0.10, 0.70); p?=?.002 respectively]. The risk of ovarian hyperstimulation syndrome (OHSS) was lower in the SG (3.44 vs. 18.5%, p?=?.07). The combination of MYO-DCI at high doses of DCI improves the pregnancy rates and reduces the risk of OHSS in women with PCOS undergoing ICSI.     

Comparison of oocyte quality and intracytoplasmic sperm injection outcome in women with isolated polycystic ovaries or polycystic ovarian syndrome

Objective To compare the oocyte quality and intracytoplasmic sperm injection performance in women with isolated polycystic ovaries or polycystic ovarian syndrome. Design Retrospective study. Setting Fertility unit. Population Three study groups were identified: women with PCO-only morphology (50 cycles), PCOS (51 cycles) and age matched control group (104 cycles) with isolated male factor infertility necessitating ICSI. Method Controlled ovarian hyperstimulation and ICSI. Main outcome measures Response to gonadotropin stimulation, oocyte and embryo quality, clinical pregnancy rate and pregnancy outcome. Results Despite a significantly lower total gonadotropin dose, a significantly higher serum E2 level was attained in both the PCOS and the PCO-only groups compared to the control group. Although significantly more oocytes were retrieved in the PCOS and PCO-only groups, the number of 2-pronuclear embryos was similar to controls. No significant differences were noted in the maturity of the oocytes, oocyte dysmorphism, embryo quality, implantation and pregnancy rates among the three groups. However the clinical miscarriage rate was significantly lower in women with PCO-only morphology group (15.4 versus 31%, P < 0.05) than in the PCOS group. Conclusion Women with PCO-only appearance have shown to have similar characteristics to women with PCOS in terms of ovarian response to hMG stimulation, oocyte and embryo quality and pregnancy rates. However miscarriage rates were significantly lower in the PCO-only group than the PCOS group. Our findings suggest that factors unrelated to oocyte and embryo morphology present in PCOS patients may be instrumental in adverse reproductive outcomes in these women.     

The effect of myoinositol on ovarian blood flows in women with polycystic ovary syndrome

To evaluate whether 4 gram myoinositol and 400?mcg folic acid(MYO) therapy has any effects on ovarian stromal blood flow by using pulsed and color Doppler at 3?months follow-up period in polycystic ovary syndrome (PCOS). One-hundred eighty patients were designed into six groups; Group 1: PCOS patients that received OCP containing 30?mcg ethinyl estradiol (EE) plus 3?mg drospirenone (DRP); Group 2: PCOS patients that received MYO; Group 3: PCOS patients that received no medication. Group 4: Healthy patients that received OCP; Group 5: Healthy patients that received MYO; Group 6: Healthy patients that received no medication. Resistance index (RI) and pulsatility index (PI) of both ovaries were assessed. There was a significant increase in RI and PI of both ovarian stromal blood flow women with PCOS who received OCP (Group 1, p?<?.001) and MYO (Group 2, p?<?.001). The rate of increment in both RI and PI values were similar for OCP users (Group 1) and MYO users(Group2) in PCOS patients. MYO therapy reduced ovarian vascularization in both PCOS and healthy users after 3?months and this decrease is especially noticeable in women with PCOS compared to healthy women. OCP therapy also reduced ovarian vascularization just like MYO therapy.     

Effect of metformin taken in the ‘fresh’ in vitro fertilization/intracytoplasmic sperm injection cycle upon subsequent frozen embryo replacement in women with polycystic ovary syndrome

Objective.?We aimed to determine whether metformin when taken during a fresh in?vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle affects live birth rate (LBR) in subsequent frozen embryo replacement cycles (FERC).

Design. A retrospective database analysis of women with polycystic ovary syndrome (PCOS) undergoing FERC at a university teaching hospital between 2002 and 2007 (n?=?142). The outcome of FERC in women who had taken metformin in the ‘fresh’ IVF/ICSI cycle (group A, n?=?28) and those who had not (group B, n?=?114) were compared.

Results.?In the first FERC there was a significantly higher LBR (A?=?28.6%, B?=?12.3%, OR 2.86 95% CI 1.06–7.71). Women who had elective cryopreservation due to ovarian hyperstimulation syndrome risk were found to have significantly higher LBRs if metformin was taken in the fresh IVF/ICSI cycle (A?=?44.4%, B?=?7.9%, OR 9.33 95% CI 1.60–54.58).

Conclusions.?Women with PCOS who take metformin during IVF/ICSI may have a higher LBR in subsequent FERC, especially in those who have elective cryopreservation for OHSS risk. The findings of this study are limited by its retrospective design and small sample size and require confirmation in an adequately powered prospective randomized controlled trial.     

d-Chiro-inositol and its significance in polycystic ovary syndrome: a systematic review

Background.?The pathogenesis of polycystic ovary syndrome (PCOS) has been linked to the development of insulin resistance and hyperinsulinemia. The objective of this study is to investigate the effects of insulin sensitising agents such as d-chiro-inositol (DCI) on ovulation and insulin resistance in women with PCOS.

Methods.?This was a systematic review done in an Academic Department of Obstetrics and Gynaecology in the UK of all studies published on PCOS and DCI up till May 2010. Patients were women with PCOS receiving DCI or where the relationship between insulin resistance and DCI had been investigated. Ovulation rates and changes in insulin sensitivity were the main outcome measures.

Results.?Less DCI-IPG was released in PCOS women compared to controls and this seems to correlate positively with insulin resistance and hyperinsulinemia evident in these patients. DCI administration had beneficial effects on ovulation, anthropometric and metabolic markers in PCOS women by enhancing insulin. The effects of metformin in improving insulin action in PCOS women was achieved though the release of DCI-IPG mediators.

Conclusions.?Heterogeneity observed in the methodologies of each study, the scarcity of relevant studies and the small sample sizes used prohibit reliable conclusions to be drawn. Therefore, more studies must be conducted in the future to evaluate accurately the effects of DCI in PCOS.     

Polycystic ovary syndrome: a biopsychosocial understanding in young women to improve knowledge and treatment options

Aim.?To assess psychological features in young women with and without PCOS.

Methods.?Observational, cross-sectional pilot study in young women aged 18–25 with (n?=?24) or without (n?=?22) PCOS (age: 22.41?±?0.39 vs. 21.95?±?0.47 years, p?=?0.46; BMI: 29.17?±?1.54 vs. 22.05?±?0.83?kg/m², p?=?0.0003). The main outcome measures were quality of life, anxiety, depression, risk perception and fears on future health.

Results.?Women with PCOS demonstrated worsened quality of life (p?=?0.033) and greater anxiety (p?=?0.01) and depression (p?=?0.023) than women without PCOS related to BMI status. Women with PCOS were more likely to perceive themselves as at risk of obesity (p?=?0.012) and infertility (p?<?0.0001), and perceived greater importance in reducing future risk of prediabetes (p?=?0.027), gestational diabetes (p?=?0.039), type 2 diabetes (p?=?0.01), heart disease (p?=?0.005), obesity (p?=?0.0007) and infertility (p?=?0.023) than women without PCOS. Women with PCOS were more likely to have fears about future health related to weight gain (p?=?0.045), loss of femininity (p?=?0.035), loss of sexuality (p?=?0.003) and infertility (p?=?0.019) than women without PCOS.

Conclusions.?Worsened quality of life, anxiety and depression in young women with PCOS is related to BMI. Risk perception is appropriately high in PCOS, yet perceived risks of future metabolic complications are less common than those related to weight gain and infertility.     

Polycystic ovary syndrome and maternal obesity affect oocyte size in in vitro fertilization/intracytoplasmic sperm injection cycles

To determine the impact of maternal metabolic state on oocyte development in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), we retrospectively analyzed a cohort of women with PCOS undergoing IVF/ICSI from 2008-2009 in a university-based fertility center. We determined that women with PCOS and obesity have smaller oocytes than control subjects, and that when further subdivided by body mass index, both PCOS and obesity independently influence oocyte size.     

Serum substance P concentrations to predict oocyte maturation index and clinical pregnancy

Aim: The aim of this study was to assess the predictive value of serum substance P (SP) concentrations on oocyte maturation and clinical pregnancy.

Methods: Ninety-three women with unexplained infertility underwent intracytoplasmic sperm injection (ICSI) cycles. Antagonist protocol was started for each participant and at the day of oocyte pick up, serum samples were obtained from each participant to assess SP concentrations, and these concentrations were utilized to predict mature/total oocyte ratio and clinical pregnancy.

Results: SP concentration was a significant predictor for mature/total oocyte ratio?>?0.75 and clinical pregnancy. In correlation analyses, maturation index was significantly correlated with FSH (r=??0.226, p?=?0.03), estradiol (r?=?0.239, p?=?0.021), peak estradiol (r?=?0.414, p?r?=?0.796, p?p?p?p?p?=?0.003) were significantly associated with clinical pregnancy.

Conclusion: SP concentrations at the day of oocyte pick up may be used to predict clinical pregnancy and may be an indirect indicator for cycle outcome in assisted reproductive technology (ART).     

Oocyte quality in women with infertility associated endometriosis

Abstract

The mechanisms of endometriosis-related infertility remain still unknown. Endometriosis and clinical markers of oocyte quality are a very important problem of reproduction. The purpose of the study is to assess the quality of oocytes in women with infertility associated with endometriosis. The study included infertile reproductive aged women, between 29 and 40 years who underwent IVF and ICSI procedures. The patients were divided into three groups: group I involved 50 (n?=?50) patients with recurrent unilateral endometriomas, group II included 50 patients (n?=?50) unilateral endometriomas after surgical treatment and control group with 30 (n?=?30) patients with tubal factor infertility. Clinical and morphological assessment of oocyte quality was performed in all IVF/ICSI cycles. The results of the study demonstrate a statistically significant increase in the number of immature oocytes of metaphase MI and immature oocytes at the GV germinal vesicle stage in patients with infertility associated with endometriosis, compared with the control group (p<.005). There is deterioration in the quality of the obtained oocytes in patients with the presence of endometrioma more than 3?cm in diameter. The results of this study allow to conclude that endometriomas negatively affect quality of oocyte and ovarian reserve, whereas endometriomas after cystectomy, have a deleterious and sustained effect on ovarian reserve.     

Myo-inositol administration positively effects ovulation induction and intrauterine insemination in patients with polycystic ovary syndrome: a prospective,controlled, randomized trial

Object?ve: The aim of the study is to investigate the effect of myo-inositol (MYO) on pregnancy rates of patients diagnosed with polycystic ovary syndrome (PCOS) who undergone controlled ovulation induction and intrauterine insemination (IUI).

Methods: A total of 196 infertile patients diagnosed with PCOS and admitted to Dokuz Eylul University Faculty of Medicine were included in the study between March 2013 and May 2016. The patients in group 1 (n?=?98) were given 4?g MYO and 400?μg folic acid before and during ovulation induction. The patients undergone controlled ovarian hyperstimulation (COH) with recombinant FSH and IUI. The patients in group 2 (n?=?98), were given recombinant FSH directly and 400?μg folic acid. The primary outcome measure of this study was the clinical pregnancy rate.

Results: In group 1, 9 patients conceived spontaneous pregnancy. During COH?+?IUI treatment three cycles were canceled in group 1 and 8 cycles in group 2. Total rFSH dose and cycle duration were significantly lower and clinical pregnancy rates were higher in group 1. The pregnancy rate for group 1 was %18.6 and for group 2 was %12.2.

Conclus?ons: This study shows that MYO should be considered in the treatment of infertile PCOS patients. MYO administration increases clinical pregnancy rates, lowers total rFSH dose and the duration of the ovulation induction.     

Increased plasma viscosity in young women with polycystic ovary syndrome using an oral contraceptive containing 35 μg ethinyl estradiol and 2 mg cyproterone acetate

Objectives.?To investigate the influence of 6 months of treatment with an oral contraceptive (OC) containing 35?μg ethinyl estradiol and 2 mg cyproterone acetate on plasma viscosity (PV) in young women with polycystic ovary syndrome (PCOS).

Design.?Patients with PCOS were assessed for PV before and after 6 months of treatment with an OC containing 35?μg ethinyl estradiol and 2 mg cyproterone acetate. PV was determined by a viscometer Type 53610/I SCHOTT-Instruments, Mainz at 37°C.

Settings.?Subjects were recruited from the Department of Obstetrics and Gynaecology, Division of Reproductive Endocrinology at the University Hospital of Patras, Greece.

Patients.?The study included 66 young women with PCOS.

Main outcome measures.?PV.

Results.?In PCOS women as a whole, PV at baseline was 1.249?±?0.049 mm²/s (n?=?66). After 6 months of treatment with an OC containing 35?μg ethinyl estradiol and 2 mg cyproterone acetate, PV was increased to 1.268 ± 0.065 mm²/s (p?=?0.038). The difference between PV before and after 6 months of treatment with an OC containing 35?μg ethinyl estradiol and 2 mg cyproterone acetate (Δviscosity) was 0.01864 ± 0.071452 mm²/s. ΔViscosity was related to Δfibrinogen (r?=?0.270, p?=?0.046), to Δhematocrit (r?=?0.514, p?=?0.09) and to Δtriglycerides (r?=?0.292, p?=?0.021).

Conclusion.?Young women with PCOS presented an increased PV under OC treatment with 35?μg ethinyl estradiol and 2 mg cyproterone acetate.     

Endometrial injury in the menstrual cycle prior to assisted reproduction techniques to improve reproductive outcomes

Abstract

Objective: Oral contraceptive pills (OCP) are widely used for treating women with polycystic ovary syndrome (PCOS). Metformin has beneficial effects on insulin resistance and endothelial functions. The aim of this study was to investigate the effects of treatment with drospirenone/ethinyl estradiol (EE) alone or in combination with metformin on the flow-mediated vasodilatation (FMD) and carotid intima media thickness (CIMT) in women with PCOS.

Methods: Fifty women with PCOS (mean age 23?±?5) were randomized to oral treatment of OCP alone (n?=?25) or an OCP combination with metformin (n?=?25) for 6 months. FMD from the brachial artery and CIMT were calculated. The hormonal profile, HOMA-IR score, basal insulin and glucose levels were studied in both groups. Before and after 6 months' treatment, echocardiographic measurements and laboratory tests were also obtained.

Results: After 6 months' treatment we observed a small decrease in FMD in the OCP group (14.9?±?9.4 versus 14.4?±?9.9, p?=?0.801) and a slight increase in the combination group (14.5?±?9.1 versus 15.0?±?8.0, p?=?0.715) but neither of them reached significance. CIMT increased in the OCP group (0.048?±?0.011 to 0.050?±?0.010?cm, p?=?0.433) and decreased slightly in the combination group (0.049?±?0.012, 0.048?±?0.011?cm, p?=?0.833).

Conclusion: We demonstrated that adding metformin to OCP treatment may have beneficial effect on FMD and CIMT that represent vascular function in patients with PCOS. These results suggest that adding metformin to OCP treatment for PCOS could preserve the cardiovascular system and improve it.     

Can AMH levels predict the need for increased medication during IVF/ICSI in PCOS women?

Purpose: To investigate the ability of anti-Mullerian hormone (AMH) to predict the step up of human menopausal gonadotropins (HMG) dose in women with polycystic ovarian syndrome (PCOS) undergoing IVF/ICSI cycles.

Methods: AMH was drawn before ovulation induction in 976 PCOS women scheduled for IVF/ICSI. After all cycles ended, a receiver operating characteristic (ROC) curve analysis was done to investigate the ability of AMH to predict step up of the HMG.

Results: The area under the curve (AUC) was 0.820 95%CI (0.792–0.848), and a cutoff value of 4.6?ng/ml (sensitivity 74%, specificity 82%) for AMH was taken (p?4.6?ng/ml). No difference in the mean age (p?=?0.147); BMI (p?=?0.411), basal FSH (p?=?0.221), and starting dose (p?=?0.195); however, the dose at which the first response occurred was higher in group (B) (p?p?p?=?0.026).

Conclusions: PCOS with AMH >4.6?ng/ml are resistant to HMG stimulation, require dose step up during ART cycles, and are at higher risk for severe OHSS.     

Effect of myo-inositol and melatonin versus myo-inositol,in a randomized controlled trial,for improving in vitro fertilization of patients with polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) induces anovulation in women of reproductive age, and is one of the pathological factors involved in the failure of in vitro fertilization (IVF). Indeed, PCOS women are characterized by poor quality oocytes. Therefore, a treatment for enhancing oocyte quality becomes crucial for these patients. Myo-Inositol and melatonin proved to be efficient predictors for positive IVF outcomes, correlating with high oocyte quality. We tested the synergistic effect of myo-inositol and melatonin in IVF protocols with PCOS patients in a randomized, controlled, double-blind trial. Five-hundred twenty-six PCOS women were divided into three groups: Controls (only folic acid: 400?mcg), Group A (Inofolic® plus, a daily dose of myo-inositol: 4000?mg, folic acid: 400?mcg, and melatonin: 3?mg), and Group B (Inofolic®, a daily dose of myo-inositol: 4000?mg, and folic acid: 400?mcg). The main outcome measures were oocyte and embryo quality, clinical pregnancy and implantation rates. The treatment lasted from the first day of the cycle until 14 days after embryo transfer. Myo-inositol and melatonin have shown to enhance, synergistically, oocyte and embryo quality. In consideration of the beneficial effect observed in our trial and on the bases of previous studies, we decided to integrate routinely MI and M supplementation in the IVF protocols. The same treatment should be taken carefully in consideration in all procedures of this kind.     

Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome

Background.?Polycystic ovary syndrome (PCOS) is the most common endocrine cause of hirsutism, acne and pattern alopecia, often characterised by ovulation disorders (usually manifested as oligo- or amenorrhea). In addition, 30–40% of women with PCOS have impaired glucose tolerance, and a defect in the insulin signalling pathway seems to be implicated in the pathogenesis of insulin resistance. For this reason, insulin-lowering medications represent novel approach in women with PCOS. The aim of this study was to evaluate the effects of myo-inositol (MYO), an isoform of inositol, belonging to the vitamin B complex, in the treatment of cutaneous disorders like hirsutism and acne.

Methods.?Fifty patients with PCOS were enrolled in the study. BMI, LH, FSH, insulin, HOMA index, androstenedione, testosterone, free testosterone, hirsutism and acne were evaluated at the baseline and after receiving MYO therapy for 6 months.

Results.?After 3 months of MYO administration, plasma LH, testosterone, free testosterone, insulin and HOMA index resulted significantly reduced; no significant changes were observed in plasma FSH and androstenedione levels. Both hirsutism and acne decreased after 6 months of therapy.

Discussion.?MYO administration is a simple and safe treatment that ameliorates the metabolic profile of patients with PCOS, reducing hirsutism and acne.     

The combined therapy myo-inositol plus d-chiro-inositol, rather than d-chiro-inositol, is able to improve IVF outcomes: results from a randomized controlled trial

Purpose

The present study aims to investigate the effects of the combined therapy myo-inositol (MI) plus d-chiro-inositol (DCI) or d-chiro-inositol treatment in oocyte quality.

Methods

Polycystic ovary syndrome (PCOS) women undergoing IVF-ET were treated with myo-inositol combined with d-chiro-inositol in the physiological ratio (1.1 g myo-inositol plus 27.6 mg of d-chiro-inositol; INOFOLIC^® combi Lo.Li.pharma) or d-chiro-inositol alone (500 mg; Interquim, s.a., Barcelona, Spain) to evaluate the umber of morphological mature oocytes, total International Units (IU) of recombinant FSH administered and the number of grade 1 embryos.

Results

The data clearly showed that only the combined therapy was able to improve oocyte and embryo quality, as well as pregnancy rates, in PCOS women undergoing IVF-ET.

Conclusion

The present paper further supports the hypothesis that MI plays a crucial role in the ovary in PCOS women. In particular, due to the physiological role played by MI and DCI, the combined therapy should represent a better choice.     

A comparative study of dydrogesterone and micronized progesterone for luteal phase support during in vitro fertilization (IVF) cycles

The aim of the present study was to compare the efficacy, tolerability and patients’ satisfaction after the use of oral dydrogesterone with vaginal micronized progesterone for luteal-phase support (LPS) among infertile women undergoing in vitro fertilization (IVF). A total of 210 women (aged 20–40 years old) with a history of infertility, who underwent controlled ovarian stimulation for fresh intra-cytoplasmic sperm injection-embryo transfer cycles, were included in the study. Consequently, they were randomized to receive LPS with dydrogesterone 20?mg twice daily (n?=?96) or micronized progesterone 400?mg twice daily at the day of oocyte retrieval (n?=?114). The clinical success rate (31% versus 33%; p?=?0.888), miscarriage rate (5.0% versus 3.0%; p?=?0.721), ongoing pregnancy rate (30.0% versus 30.0%; p?=?1.000), implantation (22.0% versus 24.0%; p?=?0.254) and multiple pregnancy rate (5.30% versus 7.20%; p?=?0.394) were comparable among the two groups. Serum progesterone levels were significantly lower among the patients receiving dydrogesterone than the control group (13.62?±?13.83?ng/ml versus 20.66?±?18.09?ng/ml; p?=?0.001). However, there was no statistically significant difference regarding the patients’ satisfaction (p?=?0.825) and tolerability (0.790) between the two groups. Our results showed that oral dydrogesterone (40?mg/day) is as effective as vaginal micronized progesterone considering its clinical outcomes and patients’ satisfaction and tolerability, for LPS among women undergoing IVF.     

Assessment of Maximal Fertilization Rates with Intracytoplasmic Sperm Injection

Purpose: Maximal fertilization rates following ICSI wereassessed using two essential steps: immobilization of spermand aspiration of oocyte cytoplasm. Methods: ICSI procedure was performed for couples(N = 42) in whom the male suffered severe infertility or failureof fertilization in previous IVF cycle using different oocytecytoplasmic aspiration and sperm immobilization methods.Outcome in four patient groups was measured by oocytedamage, fertilization rate, and pregnancy rate. Results: Maximal fertilization (90%) were achieved from thegroup which used immobilization of sperm by hard-touching thetail with a pipette and optimal aspiration of oocyte cytoplasm. Conclusions: The results suggest that if the immobilizationof sperm and aspiration of oocyte cytoplasm are handledright during ICSI, this procedure can be expected to yielda 90% fertilization rate.     

The effect of follicular antimullerian hormone levels of non-obese,non-hyperandrogenemic polycystic ovary syndrome patients on assisted reproduction outcome

Our aim is to investigate the follicular fluid concentrations of antimullerian hormone and its effect on assisted reproductive technology (ART) outcome in non-obese, non-hyperandrogenemic polycystic ovary syndrome patients. Subjects were categorized according to in vitro fertilization (IVF) indications: Group 1 PCOS (n:16), Group 2 male factor infertility (n:19) and Group 3 unexplained infertiliy patients (n:19). Follicular fluid antimullerian hormone levels (FF AMH) on the day of oocyte retrieval were analysed and ART outcome was studied. FF AMH levels in group 1, 2 and 3 were 35.70?ng/ml (median); 17.90?ng/ml (median); 17.90?ng/ml (median), respectively (p?=?0.18). There were correlations between the FF AMH levels and follicle, oocyte, 2PN and embryo numbers in pathophysiology of polycystic ovary syndrome (PCOS) patients (p?=?0.012; 0.024; 0.027; 0.013 respectively). There were no correlations between the FF AMHand ART outcome parameters in group 2 and 3. FF AMH levels were not different between the groups who were pregnant or not (p?=?0.06). In conclusion there were no significant differences in terms of FF AMH levels in the three groups. FF AMH levels can predict the recovery of oocytes but not oocyte quality, embryo quality or pregnancy in non-obese non-hyperandrogenemic PCOS patient.     

Relationship between follicular fluid hormone levels,embryo quality,and maternal age during<Emphasis Type="Italic">in vitro</Emphasis> fertilization after the short or long protocol with a gonadotropin releasing hormone agonist

Purpose  To examine the relationship between embryo quality and follicular fluid hormonal level in short and long protocol gonadotrophin releasing hormone agonist treatment cycles. Methods  A total of 90 patients had non-polycystic ovary syndrome (non-PCOS) and 10 had PCOS. A total of 100 subjects underwentin vitro fertilization (IVF). Thirty-six subjects underwent conventional IVF and 64 subjects underwent intra-cytoplasmic sperm injection (ICSI). The dominant follicles were initially retrieved and a hormonal assay was done. A total of 32 patients underwent a short protocol and 66 patients were treated with the long protocol. Estradiol (E₂), progester-one (P₄), total testosterone (TIE) and androstenedione (ASG) levels in follicular fluid (FF) were compared in the two treatment groups (short and long protocol), in regard to maternal age and oocyte/embryo quality. Results  The retrieval FF volume was not significantly different between the PCOS and non-PCOS patients; however, P₄ was significantly lower with PCOS (P < 0.01). Analysis of four different hormone levels was not significantly different between the short and long protocol groups. No significant relationship was found between four hormone levels in regard to oocyte morphology and embryo quality. The levels of P₄ of younger women was significantly lower than that of older women; furthermore, a significantly higher TTE and ASG were found in the younger women. Progesterone was found to statistically significantly increase with FF volume. Conclusion  Follicular fluid P₄ from the younger group was significantly lower, and TTE and ASG was significantly higher when compared to the older group. Analysis of four different hormone levels revealed no significant difference between the short and long protocol groups. No significant relationship was found between four hormone levels, oocyte morphology, and embryo quality.