Endometrial microbiota composition is associated with reproductive outcome in infertile patients.

Background: Previous evidence indicates associations between the female reproductive tract microbiome composition and reproductive outcome in infertile patients undergoing assisted reproduction. We aimed to determine whether the endometrial microbiota composition is associated with reproductive outcomes of live birth, biochemical pregnancy, clinical miscarriage or no pregnancy.

Methods: Here, we present a multicentre prospective observational study using 16S rRNA gene sequencing to analyse endometrial fluid and biopsy samples before embryo transfer in a cohort of 342 infertile patients asymptomatic for infection undergoing assisted reproductive treatments.

Multicentric, prospective observational data show sperm capacitation predicts male fertility, and cohort comparison reveals a high prevalence of impaired capacitation in men questioning their fertility.

Research Questions: Can a previously defined relationship between sperm capacitation and the probability of a man generating pregnancy within three cycles, prospectively predict male fertility in diverse clinical settings? A second study asked, what is the prevalence of impaired sperm fertilizing ability in men questioning their fertility (MQF), and does this relate to traditional semen analysis metrics?

Design: In the multicentric, prospective observational study, data (n = 128; six clinics) were analysed to test a published relationship between the percentage of fertilization-competent, capacitated spermatozoa (Cap-Score) and probability of generating pregnancy (PGP) within three cycles of intrauterine insemination. Logistic regression of total pregnancy outcomes (n = 252) assessed fit. In the cohort comparison, Cap-Scores of MQF (n = 2155; 22 clinics) were compared with those of 76 fertile men.

The impact of supervised weight loss and intentional weight regain on sex hormone binding globulin and testosterone in premenopausal women.

What is the impact of intentional weight loss and regain on serum androgens in women? We conducted an ancillary analysis of prospectively collected samples from a randomized controlled trial. The trial involved supervised 10% weight loss (8.5 kg on average) with diet and exercise over 4-6 months followed by supervised intentional regain of 50% of the lost weight (4.

Hyperosmolar glucose injection for the treatment of heterotopic ovarian pregnancy.

Background: Heterotopic pregnancy describes the relatively rare coexistence of one or more intrauterine gestations and one or more extrauterine (ectopic) gestations. We describe a unique clinical case involving successful treatment of an ovarian heterotopic pregnancy through gestational sac aspiration and injection of hyperosmolar glucose.

Case: A 31-year-old woman presented with an ovarian ectopic pregnancy and a viable intrauterine pregnancy after ovulation induction with oral medications.

Polycystic ovary syndrome: current infertility management.

This review summarizes the diagnosis of polycystic ovary syndrome and management of associated infertility. The goal is to guide clinicians through basic evaluation, initial treatment, and briefly describe more complex therapies.

Antichlamydial antibodies, human fertility, and pregnancy wastage.

Genital infections with Chlamydia trachomatis (C. trachomatis) continue to be a worldwide epidemic. Immune response to chlamydia is important to both clearance of the disease and disease pathogenesis.

Metformin and/or clomiphene do not adversely affect liver or renal function in women with polycystic ovary syndrome.

Context: Nonalcoholic fatty liver disease is common to insulin-resistant states such as polycystic ovary syndrome (PCOS). Metformin (MET) is often used to treat PCOS but information is limited as to its effects on liver function.

Objective: We sought to determine the effects of MET on serum hepatic parameters in PCOS patients.

Age does not influence the effect of embryo fragmentation on successful blastocyst development.

We evaluated the rate of blastocyst development in day 3 embryos with appropriate cellular division and investigated whether maternal age modified the effect of embryo fragmentation on blastulation. Our data showed a significant negative correlation between the degree of embryo fragmentation and rate of blastocyst development, but age did not exert an effect on the degree of fragmentation in embryos with appropriate cleaving status, nor did it modify the significant effect embryo fragmentation had on blastocyst formation.

Endometrial thickness predicts endometrial hyperplasia in patients with polycystic ovary syndrome.

Body mass index is predictive of sonographic endometrial stripe thickness, which in turn is predictive of endometrial hyperplasia in patients with polycystic ovary syndrome. For every 1-mm increase in endometrial stripe, the odds ratio of hyperplasia increased by 1.48 (95% confidence interval, 1.

Effect of delayed versus immediate embryo transfer catheter removal on pregnancy outcomes during fresh cycles.

A retrospective study was performed to determine whether the timing of embryo transfer catheter removal effects pregnancy rates in fresh, day 3 IVF cycles. Two hundred eighteen patients were evaluated, and no difference was noted between delayed versus immediate catheter removal techniques.

Metformin does not improve the reproductive or metabolic profile in women with polycystic ovary syndrome (PCOS).

To determine whether metformin, when given to women with polycystic ovary syndrome (PCOS), promotes folliculogenesis by prompting a drop in free sex steroids resulting in a compensatory follicle stimulating hormone (FSH) rise, we conducted a randomized, double-blind, placebo-controlled crossover clinical trial. Eight mid-reproductive age PCOS participants with mean obese body mass index (BMI) and normal glucose tolerance received 8 weeks of metformin, given in a step-up fashion to a maximum dose of 2000 mg daily or placebo with daily urine sampling, 4-6 weeks washout, and crossover to the remaining arm for 8 weeks. To confirm the effects of metformin on glucose and other metabolic markers, a hyperinsulinemic, euglycemic 3-dose clamp (physiologic: 30 mU/m(2) per minute, high: 400 mU/m(2) per minute) followed each treatment.

Follicle curetting at the time of oocyte retrieval increases the oocyte yield.

Purpose: To determine whether follicle curetting at the time of oocyte retrieval increases oocyte yield.

Methods: Retrospective review of all patients who underwent oocyte retrieval from July 1, 2003 to June 30, 2005.

Main Outcome Measure: Number of oocytes retrieved.

Luteal support with intravaginal progesterone increases clinical pregnancy rates in women with polycystic ovary syndrome using letrozole for ovulation induction.

Objective: To determine the effect of intravaginal micronized P on pregnancy rates in clomiphene citrate and letrozole ovulation induction cycles in women with polycystic ovary syndrome (PCOS).

Design: Retrospective chart review.

Setting: University-based assisted reproductive technology program.

Case series of rosiglitazone used during the first trimester of pregnancy.

Prior to 2007, use of the insulin sensitizer metformin was widely advocated in patients with polycystic ovarian syndrome (PCOS) both to promote ovulation and decrease the incidence of PCOS-associated obstetrical complications. However, the gastrointestinal disturbances associated with metformin led many to discontinue its use. Rosiglitazone is an insulin sensitizer that, because of minimal associated gastrointestinal disturbance, was used as an alternative to metformin in PCOS patients.

Supervised short-term nutrition and exercise promotes weight loss in overweight and obese patients with polycystic ovary syndrome.

Thirty-two mid-reproductive-aged overweight and obese patients with polycystic ovary syndrome, most of whom had never exercised regularly, lost 3% to 4% of baseline weight, body mass index, and circumference of waist and hip while participating for 8.8 +/- 2.7 weeks in a medically supervised fitness program.

Effects of polycystic ovarian syndrome on in vitro fertilization-embryo transfer outcomes are influenced by body mass index.

Objective: To determine whether polycystic ovary syndrome (PCOS) adversely impacts IVF-embryo transfer outcomes in obese compared to lean patients.

Design: Retrospective chart review.

Setting: University-affiliated infertility program.

The nucleolar channel system of human endometrium is related to endoplasmic reticulum and R-rings.

The nucleolar channel system (NCS) is a well-established ultrastructural hallmark of the postovulation endometrium. Its transient presence has been associated with human fertility. Nevertheless, the biogenesis, composition, and function of these intranuclear membrane cisternae are unknown.

Assessment of the proliferative status of epithelial cell types in the endometrium of young and menopausal transition women.

Background: We determined protein and mRNA expressions of markers of normal human endometrial proliferation and hypothesized that dysregulation of the endometrial response to estradiol (E(2)) and progesterone would be observed in the older menopausal transition (MT) women compared with mid-reproductive age (MRA) controls.

Methods: Endometrial biopsies were prospectively obtained from MRA and MT non-randomized healthy volunteers during proliferative (+/- exogenous E(2)) and secretory (MRA only) menstrual cycle phases. mRNA and/or nuclear protein expressions of proliferative markers (MKI67, PCNA and MCM2), cell-cycle regulators (cyclins A1, E1 and D1 and cyclin dependent kinase Inhibitor B; CCNA1, CCNE1, CCND1 and CDKN1B) and sex-steroid receptors [estrogen receptor (ER) and progesterone receptor (PR)] were assessed in endometrial lumen, gland and stroma.

A prospective comparison of the impact of uterine artery embolization, myomectomy, and hysterectomy on ovarian function.

Purpose: To prospectively compare uterine artery embolization (UAE) versus myomectomy and hysterectomy with regard to ovarian function as measured by postprocedure follicle-stimulating hormone (FSH) levels and symptoms.

Materials And Methods: Fifty-five patients were prospectively enrolled in the study: 33 patients who underwent UAE, seven who underwent myomectomy, and 15 who underwent hysterectomy. Patients had serum FSH and estradiol levels measured on the third day of the menstrual cycle before their procedure and at regular follow-up visits for as long as 6 months.

Lessons learned from the WHI: HRT requires a cautious and individualized approach.

The Women's Health Initiative (WHI) was a randomized, double-blinded, placebo-controlled study that evaluated the benefits and risks of hormone replacement therapy (HRT) for healthy postmenopausal women. The results indicated that HRT: 1) does not confer cardiovascular or cognitive protection; 2) increases breast cancer risk in women with a uterus; 3) increases stroke risk in women with hysterectomy; and 4) does not improve overall quality of life. HRT does, however, decrease fracture rates and vasomotor symptoms.