MYO administration improves reproductive axis functioning in PCOS patients reducing the hyperinsulinemic state that affects LH secretion.

Thyroid autoimmunity is the most prevalent autoimmune state that affects up to 5-20% of women during the age of fertility. Prevalence of thyroid autoimmunity is significantly higher among infertile women, especially when the cause of infertility is endometriosis or polycystic ovary syndrome. Presence of thyroid autoimmunity does not interfere with normal embryo implantation and have been observed comparable pregnancy rates after assisted reproduction techniques in patients with or without thyroid autoimmunity. Instead, the risk of early miscarriage is substantially raised with the presence of thyroid autoimmunity, even if there was a condition of euthyroidism before pregnancy. Furthermore the controlled ovarian hyperstimulation, used as preparation for assisted reproduction techniques, can severely impair thyroid function increasing circulating estrogen levels. Systematic screening for thyroid disorders in women with a female cause of infertility is controversial but might be important to detect thyroid autoimmunity before to use assisted reproduction techniques and to follow-up these parameters in these patients after controlled ovarian hyperstimulation and during pregnancy.

Purpose Endometriosis may influence different aspects of reproductive physiology including folliculogenesis, ovulation, embryo quality, and fertilization. Recent data demonstrate that patients with endometriosis-associated infertility undergoing in vitro fertilization (IVF) have a reduction of pregnancy rates compared to women with other indications for IVF. The aim of the study is to evaluate the outcomes of IVF after controlled ovarian hyperstimulation (COH) with GnRH antagonist (GnRH-ant) or GnRH agonist (GnRH-a) in severe endometriosis patients. Methods A total of 101 patients with severe endometriosis undergoing IVF cycles were retrospectively enrolled into two groups in relation to hypothalamic inhibition before COH, obtained respectively with leuprorelin and cetrorelix. We evaluated characteristics of COH and clinical outcomes (overall pregnancy rate, implantation rate, spontaneous miscarriages, ectopic pregnancies, and clinical pregnancy rates). Results The group treated with GnRH-ant presented a similar number of MII oocytes and good quality embryos while using a lower amount of gonadotropins. Outcomes of COH with both GnRH-ant and GnRH-a were similar in patients with stage III-IV endometriosis. The number of retrieved oocytes, the number of obtained embryos, the implantation rates, and the clinical pregnancy rates were similar with GnRH-ant and GnRH-a protocols. Conclusions Considering the pregnancy outcomes, COH with both GnRH-ant and GnRH-a protocols do not present statistical differences in patients with severe endometriosis, but the GnRH-ant protocol could be more convenient in term of gonadotropins amount and patient discomfort.

The improvement of reproductive parameters after DHEA supplementation in poor responders may be explained through the effect that this pro-hormone exerts on follicular microenvironment.

It is a known fact that abnormal seminal liquid specimens contain abnormal amounts of oxygen free radicals and reactive oxygen species (ROS), and that the use of antioxidant molecules both in vivo and in vitro leads to improvement of semen quality in terms of motility, reduction in DNA damage, with obvious consequences on the fertilization potential. Myo-inositol has been observed to have anti-oxidant properties and be present in much greater concentrations specifically in seminal liquid than in the blood. Moreover, there seems to be a direct relationship between myo-inositol and mitochondrial membrane potential (MMP) and sperm motility. Studies performed in vivo have demonstrated that a dietary supplementation with myo-inositol in men undergoing assisted reproduction techniques may improve sperm quality and motility in oligoasthenospermia (OAT) patients. In the following study we utilized myo-inositol in vitro to verify its effect on semen quality in both normal and OAT patients undergoing in vitro fertilization (IVF) with respect to standard sperm medium. In vitro incubation of seminal liquid carried out using myo-inositol (Andrositol-Lab, Lo.Li. Pharma-Roma, Italy) at a concentration of 15 μl/ml improved progressive motility in both normospermia and OAT subjects. In our opinion, myo-inositol may prove to be a useful strategy to improve sperm preparation for clinical use in IVF.

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