New legislation concerning assisted reproduction treatments was introduced in Turkey in March 2010 in order to reduce the number of multiple pregnancies. This new legislation limits the number of embryos to be transferred to one under 35 years of age in the first or second treatment cycles and to two in the third or further cycles or for 35 and older ages. The aim of this multicentre study was to investigate the effect of this new law on clinical pregnancy and multiple pregnancy rates. Outcomes were compared in equal periods of 2.5 months before and after the new law, and further investigation was conducted for two different age groups: <35 and ≥ 35. The clinical pregnancy rates decreased from 39.9 to 34.5% and multiple pregnancy rates decreased from 23.1 to 5.3% (P<0.001) for the overall population. The outcomes of the <35 age group and ≥ 35 age group were also similar to that of the overall population. These results suggest that under the new legislation multiple pregnancy rates are significantly reduced without causing a significant decline in the pregnancy rates.

Purpose Laser assisted zona thinning is a technique used for facilitating embryo's hatching process and is commonly used for the embryos of poor prognosis patients with advanced maternal age, repeated implantation failures, poor embryo quality or thick zona pellucida. The aim of this study was to investigate the effect of zona thinning on both good or poor prognosis patients of two different age groups. Methods We investigated two different age groups (group 1: <35 years and group 2: ≥35 years ) and compared the effect of assisted zona thinning (groups 1A and 2A) versus not-thinned controls (groups 1B and 2B) in both groups.Results The clinical pregnancy rates were 57% and 56% in groups 1A and 1B (p=0.86), 43% and 38% in groups 2A and 2B (p=0.59) respectively. Conclusions Our results suggest that laser assisted zona thinning of day 3 embryos has no beneficial effect on clinical pregnancy and implantation outcomes.

SummaryThe negative effects of cryopreservation on sperm parameters are well documented but little information is known about molecular basis of the process. The aim of the present study was to investigate the possible effects of sperm cryopreservation on main apoptotic signs including DNA fragmentation and caspase-3 activation and to determine if these effects vary according to sperm parameters. Sperm samples of 72 patients were cryopreserved. The patients were sub-grouped as normozoospermic or non-normozoospermic patients according to their semen parameters. DNA fragmentation rates and caspase-3 activation levels were analyzed before and after cryopreservation in both groups. Mean DNA fragmentation rate was increased significantly from 23.98% in neat semen samples to 27.34% after cryopreservation (P = 0.03). DNA fragmentation rates were slightly higher in non-normozoospermic patients compared with the normozoospermic patients in both the neat semen and after cryopreservation (23.25 and 24.71% vs. 26.32 and 28.36%, respectively) although the difference obtained were not statistically significant. An increasing trend for caspase-3 activations (0.093 vs. 0.116) was observed after cryopreservation but the differences were not statistically significant. Caspase-3 activation was found to be slightly higher in non-normozoospermic patients both in the neat semen and after cryopreservation compared with the normozoospermic patients but the differences were not statistically significant. Caspase-3 expression was also shown using immunocytochemistry in both fresh ejaculated sperm and thawed sperm after cryopreservation but at different localizations. The cryopreservation process had detrimental effects on sperm quality but the quality of the sperm samples was not adversely effective for the apoptotic markers including DNA fragmentation and caspase-3 activation patterns. In fact, it was the cryopreservation process itself that adversely effected the above apoptotic markers and apoptosis. It was concluded therefore that sperm cell cryopreservation triggers apoptosis after thawing and this process adversely affects semen parameters.

Objective: Semen parameters are directly correlated with the infertility of the male. Incidence rates of male factor infertility, azoospermia and cryptozoospermia differ according to many factors such as geographic region, age, occupation and body weight. The aim of the present study is to determine the incidence of male factor infertility, azoospermia and cryptozoospermia among patients who have been admitted to three separate infertility clinics in Turkey for infertility investigation and analyze the outcomes of these patients. Material and methods:A total of 9733 men, who have been admitted to 3 infertility clinics in Turkey due to infertility between March 2011 and October 2016, were included in the study. Male infertility, azoozpermia and cryptozoospermia incidence were calculated according to WHO criteria. Results:Male factor infertility was determined in 3114 (32%) of the patients including cases with azoospermia and cryptozoospermia. Azoospermia cases were observed in 570 (5.85%) and cryptozoospermia in 850 (8.73%) men. Azoospermic, and cryptozoospermic patients constitute 18.3%, and 27.2% of the male infertility cases. Sperm retrieval rates in diagnostic or oocyte pick-up plus testicular sperm extraction groups were found to be comparable (16.39%, and 41.3%, respectively). Conclusion:The data obtained may help to estimate the number of in vitro fertilization cycles and TESE cases, to determine social security policies, and reproductive potential, and in the light of these data to establish social insurance policies. These data will help patients to decide on treatment alternatives, and guide the urologists about the issue.Keywords: Azoospermia; cryptozoospermia; infertility. ÖZAmaç: Semen parametreleri erkek infertilitesi ile direkt ilişkilidir. Erkek faktörlü infertilite, azoospermi ve kriptozoospermi insidansı coğrafi bölge, yaş, meslek ve vücut ağırlığı gibi birçok faktöre göre değişmek-tedir. Bu çalışmanın amacı, Türkiye'de 3 farklı infertilite kliniğine infertilite nedeniyle başvuran hastalar arasında erkek faktörlü infertilite, azoospermi ve kriptozoospermi oranlarını belirlemek ve bu hastaların sonuçlarını analiz etmektir. Gereç ve yöntemler:Mart 2011 ve Ekim 2016 tarihleri arasında, Türkiye'de 3 farklı infertilite kliniğine infertilite nedeniyle başvuran 9733 erkek çalışmaya alınmıştır. Bulgular:Hastaların 3114'ünde (%32) erkek faktörlü infertilite (azoospermi ve kriptospermi vakaları dahil) belirlenmiştir. Hastaların 570'inde (%5,85) azoospermi, 850'sinde (%8,73) kriptozoospermi belirlenmiştir. Azoospermi vakaları erkek infertilite vakalarının %18,3'ünü, kriptozoospermi vakaları ise %27,2'sini oluş-turmaktadır. Azoospermik ve kriptozoospermik hastalarda tanısal ya da oosit toplama işlemi ile eşlenik testiküler sperm ekstraksiyonu gruplarının sperm bulma oranları benzer (%16,39-%41,3 sırasıyla) bulunmuştur.Sonuç: Elde edilen sonuçlar in vitro fertilizasyon siklusu ve TESE vakalarını tahmin etmede ve bu veriler ışığında sosyal güvenlik politikalarının belirlenmesine, üreme potansiyelinin ...

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Summary The aim of the present study was to investigate several common conditions that may potentially be correlated with follicular oxidative status during an intracytoplasmic sperm injection (ICSI) cycle and that include the serum oestrogen level on the day of oocyte pick-up, maternal age and pregnancy outcome. Patients that were enrolled in the study were classified randomly into three groups using their numerical order. The first group were classified based on maternal age (<35 and ≥35 years) (n = 398), the second group on the serum oestradiol (E2) level on the day of human chorionic gonadotropin (hCG) administration (levels >90th percentile and ≤ 90th percentile) (n = 491) and the third group on pregnancy outcome (positive/negative) (n = 376). The groups were matched for the other variables (stimulation protocol, dose of gonadotropin, duration of stimulation, antral follicle count, body mass index, basal follicle stimulating hormone (FSH), and E2 levels and day of hCG trigger) to prevent the possible contribution of those parameters to the results. Each group was matched for other variables (stimulation protocol, dose of gonadotrophin, duration of stimulation, antral follicle count, body mass index, basal FSH and E2 levels and day of hCG trigger) that may have affected the outcome, except for the parameter under investigation. Maternal age (P = 0.044,168 r = 0.418), oestrogen level on day of hCG administration (P = 0.001, r = 0.436) and pregnancy outcome (AUC = 0.65, P = 0.071) were found to be correlated with follicular oxidative status. The results obtained will help us to shield patients from possible situations that may cause oxidative stress and therefore adverse outcomes of an ICSI cycle.

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Excess embryos obtained from intracytoplasmic sperm injection cycles may be cultured and observed until day 5 if the couple receiving treatment do not want them to be cryopreserved. In order to investigate the correlation between blastocyst formation in extended culture and pregnancy outcome, 194 patients treated in two separate IVF units were examined retrospectively. The patients were separated into two groups: group 1 with at least one blastocyst formed in culture, and group 2 with no blastocyst formation. The pregnancy rates were 60.0% and 41.7% for groups 1 and 2, respectively. The pregnancy rate in group 1 was statistically significantly higher than in group 2 (P = 0.01). The results suggest that the developmental potential of embryos obtained from a single assisted reproduction treatment cycle may be similar and that blastocyst formation in vitro may help to predict the pregnancy outcome of that cycle.