Ovulation induction in polycystic ovary syndrome.

The objective of this narrative review was to suggest a rational order of treatment choices in anovulatory women with polycystic ovary syndrome (PCOS), for whom a multitude of treatment options exist. In obese/overweight women with PCOS the importance of weight reduction should be stressed. Inositol, a dietary supplement with a documented effect on ovulation and without adverse effects in the doses recommended, may be suggested.

Elective cesarean section or not? Maternal age and risk of adverse outcomes at term: a population-based registry study of low-risk primiparous women.

Background: Maternal age at delivery and cesarean section rates are increasing. In older women, the decision on delivery mode may be influenced by a reported increased risk of surgical interventions during labor and complications with increasing maternal age. We examined the association between maternal age and adverse outcomes in low-risk primiparous women, and the risk of adverse outcomes by delivery modes, both planned and performed (elective and emergency cesarean section, operative vaginal delivery, and unassisted vaginal delivery) in women aged ≥ 35 years.

Fragmentation of human cleavage-stage embryos is related to the progression through meiotic and mitotic cell cycles.

Objective: To study whether fragmentation of human embryos is related to the progression through meiotic and mitotic cell cycles.

Design: This report consists of two observational studies.

Setting: Not applicable.

Do endometriomas induce an inflammatory reaction in nearby follicles?

Study Question: Do endometriomas induce an inflammatory reaction with increased cytokine concentrations in nearby follicles and thereby affect follicular development during controlled ovarian stimulation for in vitro fertilization (IVF)?

Summary Answer: With most endometriomas, there is no evidence of increased cytokine concentrations in the ipsilateral leading follicle. Infrequently, the concentration of inflammatory cytokines is increased in the follicular fluid (FF) and associated with diminished ovarian response.

What Is Known Already: The link between peritoneal endometriosis, inflammation and infertility is well established; however, the association between intraovarian inflammation and endometrioma is unknown.

Maternal age and elective cesarean section in a low-risk population.

Objective: To examine the association between maternal age and elective cesarean section in primiparous and para one women in a low-risk population.

Design: Population-based registry study.

Setting: Norway.

In vitro fertilization is a successful treatment in endometriosis-associated infertility.

Objective: To assess success rates of IVF and intracytoplasmic sperm injection in women with various stages of endometriosis.

Design: Retrospective cohort study.

Setting: Reproductive medicine unit in a university hospital.

Interaction between granulosa-lutein cells and monocytes regulates secretion of angiogenic factors in vitro.

Background: Leukocyte infiltration and angiogenesis in the forming corpus luteum are prerequisites for normal ovarian function and may also underlie disorders like ovarian hyperstimulation syndrome. We examined whether ovarian angiogenesis could be affected by an interaction between granulosa-lutein (GL) cells and leukocytes.

Methods And Results: We found that GL cells isolated from the follicular fluid synthesize and secrete the chemokine interleukin-8 (IL-8), which activates IL-8-receptor-specific Ca(2+) and p38 mitogen-activated protein kinase signalling in monocytes and induces a directed migration of these cells towards the chemical gradient.

Sustained fertility from 22 to 41 years of age in women with polycystic ovarian syndrome.

Background: Subfertility due to chronic anovulation is common in women with polycystic ovary syndrome (PCOS) and is often treated with IVF. Women with PCOS have an increased ovarian follicle and oocyte count, increased ovarian reserve and/or a slower rate of follicle atresia. If so, one would expect women with PCOS to display a delayed reduction in fertility with advancing age as compared with eumenorrheic women.

Effect of pregestational maternal, obstetric and perinatal factors on neonatal outcome in extreme prematurity.

Purpose: To investigate the effect of pregestational maternal, obstetric and perinatal factors on neonatal outcome in extreme preterm deliveries.

Methods: Retrospective study of deliveries in a Norwegian tertiary teaching hospital. All women with live births at 24(+0)- 27(+6) weeks of gestation between 2004 and 2007 were included.

The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations.

Objective: To investigate the effect of advanced maternal age (AMA) separately in nulliparous and multiparous women on obstetric and perinatal outcomes in singleton gestations.

Study Design: A historical cohort study on data from 6,619 singleton pregnancies between 2004 and May 2007 was performed. AMA was defined as 35 years and older.

Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing their first treatment cycle of IVF or ICSI.

Objective: To test whether the clinical efficiency of recombinant FSH (rFSH) and highly purified human menotrophin (hMG) differs in terms of pregnancy and live birth rates during the first treatment cycle of IVF or ICSI.

Design: Prospective cohort study.

Setting: Department of Gynecology and Obstetrics, Rikshospitalet, Oslo University Hospital.

Spermatogenesis and fertility outcome in male hypogonadotrophic hypogonadism.

Objective: The objective of this retrospective study of male patients with hypogonadotrophic hypogonadism (HH) was to assess the outcome of fertility after induction of spermatogenesis by gonadotrophin injections.

Methods: During 1995-2005 17 men with HH were referred to our department for gonadotrophin treatment to stimulate spermatogenesis.

Results: Genetic/idiopathic hypogonadotrophic hypogonadism (IHH) was the most common cause (n = 10) followed by post-operative pituitary failure in three cases.

Differential release of matrix metalloproteinases and tissue inhibitors of metalloproteinases by human granulosa-lutein cells and ovarian leukocytes.

Tissue reorganization during ovulation and corpus luteum formation involves a coordinated action of matrix metalloproteinases (MMPs) and tissue MMP inhibitors (TIMPs). In this study we investigated the cellular source of ovarian MMPs and TIMPs. Cells isolated from the preovulatory human follicle were cultured after immunobead depletion of CD45-expressing cells, which allowed differential assessment of leukocyte and granulosa-lutein cell fractions.

[Cryopreservation of ovarian tissue].

Background: Unfertilized oocytes, embryos and ovarian issue can be cryopreserved before cancer treatment of post-pubertal women. Fertility may be restored by retransplantation in women who are pronounced healthy.

Material And Methods: The article is based on relevant literature and our own clinical experience since 2004, when the procedure was first allowed in Norway.

[Elective single embryo transfer in assisted reproduction].

Background: In Norway, assisted reproduction has been regulated by law since 1987, but the in vitro fertilization (IVF)-clinics are free to decide the number of embryos transferred. During the 1990ies, the number of embryos replaced was reduced from three to two. Triplets almost disappeared, but the twinning rate remained unchanged.

Intracytoplasmic sperm injection (ICSI) in unexplained and stage I endometriosis-associated infertility after fertilization failure with in vitro fertilization (IVF).

Purpose: To investigate possible differences between unexplained and stage I endometriosis-associated infertility in ICSI cycles conducted after low fertilization (<20%) in preceding IVF cycles with normal semen parameters.

Methods: Retrospective cohort study consisting of patients with unexplained (n=48) and stage I endometriosis-associated infertility (n=43) with a minimum of one IVF cycle with <20% fertilized oocytes and normal semen quality, treated with ICSI from January 1997 to January 2006. Age matched male factor infertility patients (n=91) were used as controls.

Pregnancy outcome after IVF and ICSI in unexplained, endometriosis-associated and tubal factor infertility.

Background: This study was undertaken in order to compare pregnancy outcome after IVF and ICSI in unexplained and endometriosis-associated infertility using tubal factor infertility as controls.

Methods: This was a retrospective cohort study of early IVF/ICSI pregnancies verified by serum hCG measurement, comparing the subsequent outcome in unexplained (n = 274) and minimal endometriosis-associated (n = 212) with tubal factor (n = 540) infertility as controls. From January 1990 to December 2002, 1026 conception cycles after treatment with IVF or ICSI complied with the inclusion criteria.

Impact of overweight and underweight on assisted reproduction treatment.

Background: Underweight and overweight may affect reproduction and interfere with treatment of infertility. The purpose of this report is to describe the independent effect of body weight on treatment with IVF and ICSI.

Methods: Records of 5019 IVF or ICSI treatments in 2660 couples were reviewed.

[Congenital malformations in children born after assisted fertilization in Norway].

The aim of this study was to compare the prevalence at birth of birth defects in children born after intracytoplasmatic sperm injection (ICSI) and children born after traditional in vitro fertilisation (IVF). Altogether 553 children were born after ICSI treatment in Norway during the period 1996-1998 (351 singletons, 95 twins-pairs and 4 triplets) while 1731 were born after IVF treatment (1004 singletons, 344 sets of twins and 13 triplets). Birth defects were registered in 5.

Impact of insulin resistance on pregnancy complications and outcome in women with polycystic ovary syndrome.

The aim of the study was to determine the risk of developing gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH)/pre-eclampsia in a cohort of pregnant women with the polycystic ovary syndrome (PCOS) and known insulin sensitivity status. Pregnancies and neonatal outcome were recorded in a prospective cohort study comprising 29 non-insulin-resistant PCOS women, 23 insulin-resistant PCOS women and a control group of 355 women who had conceived after assisted reproduction. Hypertension, pre-eclampsia and GDM were recorded as well as pregnancy duration, method of delivery and birth weight.

[High-risk pregnancy, costs and DRG reimbursement].

Background: The aim of this study was to measure actual costs of delivery of women with high-risk pregnancies in Norway. We calculated the cost difference between Caesarean section delivery and vaginal delivery and compared costs and the reimbursement received by hospitals. The present Norwegian financial system for hospitals has two components: a government reimbursement based on diagnosis-related groups (DRG) covering, in principle, half of hospital costs, and a basic budget received as a block grant.