Basic understanding of gonadotropin-releasing hormone-agonist triggering.

A single bolus of human chorionic gonadotropin (hCG) at midcycle has been the gold standard for triggering final oocyte maturation and ovulation in assisted reproductive technology cycles. More recently, gonadotropin-releasing hormone (GnRH)-agonist (GnRH-a) triggering has been introduced. The GnRH-a trigger may allow a more physiologic surge of both luteinizing hormone (LH) and follicle-stimulating hormone, although whether the combined surge will result in improved oocyte and embryo quality remains to be seen.

Non-synchronized endometrium and its correction in non-ovulatory cryopreserved embryo transfer cycles.

The aim of this case series study was to investigate the effect of adjusting the length of progesterone exposure on clinical pregnancy rates in cryopreserved embryo transfer cycles of patients with out-of-phase classic endometrial dating. Eighty infertile women with previous implantation failure and good-quality embryos underwent endometrial biopsy before cryopreserved embryo transfer and were included in this study. The main outcome measures were clinical pregnancy rate and histologic endometrial dating.

Coenzyme Q10 Supplementation and Oocyte Aneuploidy in Women Undergoing IVF-ICSI Treatment.

Background: The age-related reduction in live-birth rate is attributed to a high rate of aneuploidy and follicle depletion. We showed in an animal model that treatment with Coenzyme Q10 (CoQ10) markedly improved reproductive outcome. The aim of this study was to compare the post-meiotic oocyte aneuploidy rate in in vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI) patients treated with CoQ10 or placebo.

Seminal hyperviscosity is not associated with semenogelin degradation or sperm deoxyribonucleic acid damage: a prospective study of infertile couples.

Objective: To investigate the association between seminal hyperviscosity, the extent of semenogelin degradation, and sperm DNA integrity (DNA fragmentation index [DFI] and high DNA stainability [HDS]) in semen from infertile couples.

Design: Prospective study.

Setting: University-affiliated fertility center.

Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertilization?

Background: When stimulating a patient with poor ovarian response for IVF, the maximal dose of gonadotropins injected is often determined by arbitrary standards rather than a measured response. The purpose of this study was to determine if serum FSH concentration during an IVF stimulation cycle reflects follicular utilization of FSH and whether serum FSH values may inform dose adjustments of exogenous FSH.

Methods: In this retrospective cross sectional study we studied 155 consecutive IVF cycles stimulated only with recombinant human FSH.

The aging oocyte--can mitochondrial function be improved?

In recent years, social and cultural trends have resulted in women delaying childbirth, thereby leading to reproductive senescence as a growing public health problem. We discuss potential etiologies for age-related female reproductive decline. We bring supportive evidence to the central role of mitochondrial dysfunction and oxygen radicals in the process of aging in general and reproductive senescence specifically.

Addition of low dose hCG to rFSh benefits older women during ovarian stimulation for IVF.

Background: To compare the outcome of IVF cycles in women receiving controlled ovarian stimulation with recFSH or recFSH plus low dose hCG.

Methods: A retrospective case control study, performed at a private practice affiliated with an academic institute. Patients were infertile women who were treated with IVF/ICSI and controlled ovarian stimulation in a long GnRH agonist protocol using either low dose hCG in addition to recFSH [N = 88] or recFSH alone [N = 99].

Effect of long-term combined oral contraceptive pill use on endometrial thickness.

Objective: To estimate whether there is any association of long-term use of combined oral contraceptive pills (OCP) with adverse endometrial growth.

Methods: We reviewed the charts of 137 patients with history of OCP use undergoing endometrial preparation with estrogen for frozen embryo transfer. Endometrial thickness was measured by transvaginal ultrasonography on day 10 after menses and patients were divided into two groups (less than 7 mm and 7 mm or more).

A novel luteinizing hormone/chorionic gonadotropin receptor mutation associated with amenorrhea, low oocyte yield, and recurrent pregnancy loss.

Objective: To study the cause for poor oocyte yield, amenorrhea, and recurrent pregnancy loss in a patient undergoing IVF.

Design: Case report.

Setting: University-affiliated private IVF clinic.

The effects of low-level laser light exposure on sperm motion characteristics and DNA damage.

The objective of this study was to determine the effects of low-level laser light exposure on the motility of spermatozoa and on DNA damage. Thirty-three semen samples were collected for routine analysis and were classified as normospermic, oligospermic, or asthenospermic. After routine semen analysis was performed, residual semen was divided into treated and control aliquots.

The contribution of mitochondrial function to reproductive aging.

Purpose: The number of women attempting to conceive between the ages of 36 and 44 has increased significantly in the last decade. While it is well established that women's reproductive success dramatically declines with age, the underlying physiological changes responsible for this phenomenon are not well understood. With assisted reproductive technologies, it is clear that oocyte quality is a likely cause since women over 40 undergoing in vitro fertilization (IVF) with oocytes donated by younger women have success rates comparable to young patients.

Use of letrozole challenge test to adjust gonadotropin dose in non-down-regulated cycles.

The use of a letrozole challenge test to predict ovarian response is described. The authors show that a ratio of cycle day 7 to cycle day 3 post-letrozole FSH level >1.5 is associated with poor ovarian response.

Oral nimodipine inhibits the ovarian cycle in mice.

Nimodipine, a calcium-channel blocker that can cross the blood-brain barrier, has been shown to inhibit pulsatile GnRH release in vitro. We now show that oral nimodipine can effectively inhibit the ovarian cycle in mice in a dose-related manner.

The effect of age on in vitro fertilization outcome: is too young possible?

Purpose: The negative correlation between fecundity and age in women has been extensively documented although data on reproductive performance in very young women is sparse. The objective of this study was to determine whether age ≤25 years has an impact on reproductive outcome in women undergoing IVF-ET.

Methods: IVF outcome in 85 infertility patients aged 19-25 years was compared to that in 69 infertility patients aged 30-35 years.

Failed fertilization after clinical intracytoplasmic sperm injection.

Intracytoplasmic sperm injection (ICSI) has resulted in pregnancy and birth for many couples, including those with severe male factor infertility. However, even after ICSI, complete failure of fertilization occurs in 1-3% of cycles. Most cases occur due to low number of mature oocytes, failure of oocyte activation or non-availability of appropriate spermatozoa for injection.

CD56brightCD16- natural killer cells accumulate in the ovarian follicular fluid of patients undergoing in vitro fertilization.

CD56(bright)CD16(-) natural killer (NK) cells that express CXCR3 accumulate in the follicular fluid of patients with a good response to ovarian stimulation. It is conceivable that granulosa cells of good responders that express the chemokine CXCL10 recruit these NK cells to support follicular angiogenesis.

An ongoing pregnancy from two waves of follicles developing during a long follicular phase of the same cycle.

Objective: To report an ongoing pregnancy after in vitro fertilization (IVF) with ovarian stimulation using a gonadotropin-releasing hormone (GnRH) antagonist that resulted in two waves of follicular growth.

Design: Case report.

Setting: University of Toronto affiliated infertility clinic.

The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients.

We present a hypothesis emphasizing the role of mitochondrial dysfunction in reproductive senescence and suggesting the use of mitochondrial nutrients as an adjuvant treatment in older patients with infertility.

Monozygotic twins in infertile patients with advanced maternal age: case reports and review of the literature.

Objective: To report two cases of successful monozygotic twin pregnancies in women undergoing infertility treatment and to review possible etiologic factors.

Design: Case report and review of the literature.

Setting: University of Toronto-affiliated infertility clinic.