[Show abstract][Hide abstract] ABSTRACT: 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. We only included long GnRH agonist protocols in which endogenous FSH levels were suppressed. We correlated the serum concentration of cycle day (CD) 7 FSH with the number of oocytes retrieved, cleaving embryos and pregnancy rate. RESULTS: We found that a CD7 FSH concentration above 22 IU/L was associated with poor response regardless of the daily dose of FSH injected and a lower pregnancy rate. CONCLUSIONS: We concluded that CD7 FSH concentration during stimulation could be used to guide FSH dosing in poor responders. If the CD7 FSH concentration is above 22 IU/L increasing the dose of FSH in an attempt to recruit more growing follicles is unlikely to be successful.
Reproductive Biology and Endocrinology 02/2013; 11(1):12. · 2.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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. Treated samples were exposed to a 30-second infrared laser pulse of 50 mW/cm(2) at 905 nm, a wavelength thought to increase light-sensitive cytochrome c oxidase in the mitochondrial electron transport chain. Samples were then incubated at 37°C, and aliquots were analyzed at 30 minutes and 2 hours using computerassisted semen analysis. After incubation, 250 μL of each sample was frozen at 280°C until DNA fragmentation analysis by flow cytometry. A significant increase in motility, most prominent in oligospermic and asthenospermic samples (85% increase), was observed 30 minutes after the treatment (P < .0001). No significant increase in DNA damage compared with control samples was observed. Significant changes in sperm motion kinetics were observed. Low-level laser light exposure appears to have a positive short-term effect on the motility of treated spermatozoa and did not cause any increase in DNA damage measured at 2 hours. We conclude that some cases of asthenospermia may be related to mitochondrial dysfunction. The implications of this study in terms of future clinical applications needs further investigation.
Journal of Andrology 07/2011; 33(3):469-73. · 3.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
Fertility and sterility 04/2011; 95(8):2492-3. · 3.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
University of Toronto affiliated infertility clinic.
A 33-year-old woman with a 3-year history of secondary infertility.
In vitro fertilization and embryo transfer.
This patient successfully conceived after the GnRH antagonist-induced demise of the first cohort of follicles and the emergence of a second wave of follicles followed by oocyte retrieval on cycle day 30 and fresh embryo transfer.
This case report is consistent with previous observations of multiple waves of follicle recruitment and growth per cycle. The window of implantation may not be adversely affected by prolonged or even variable estrogen exposure in the follicular phase of the cycle.
Fertility and sterility 02/2010; 94(1):350.e8-11. · 3.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
Fertility and sterility 10/2009; 93(1):272-5. · 3.97 Impact Factor