Objective: This study was designed to evaluate the prevalence of Human Papilloma Virus (HPV) in semen and document the cycle outcomes in couples with previous intra-cytoplasmic sperm injection (ICSI) failures. Material and methods: One hundred and seventeen couples with at least two ICSI attempts were included in the study. HPV infection in semen and DNA fragmentation in samples were analyzed by commercially available kits. The percentage of spermatozoa with fragmented DNA (DNA fragmentation index: DFI) was determined during fluorescence microscopic examination as previously described. The cycle outcomes of couples with or without HPV infected male partners were recorded. Results: According to our results, the prevalence of HPV was 7.7% in asymptomatic males with at least two previous ICSI failures. The increased DFI (>30%) was observed in 82.9% of the cases. In HPV-positive cases significantly lower number of good quality embryos were obtained. The implantation and pregnancy rates were similar in infected and non-infected males (p>0.05). The early miscarriage rate was slightly higher in HPV- positive group (33% vs. 10%, p>0.05). Conclusion: In cases with previous ICSI failures, the prevalence of HPV infection in semen is not higher than previously reported infertile populations. The reproductive outcome might be impaired in HPV-positive semen due to lower number of good quality embryos, which needs to be clarified by further large population-based studies. Cite this article as: Tangal S, Taşçı Y, Pabuçcu EG, Çağlar GS, Haliloğlu AH, Yararbaş K. DNA fragmentation index and human papilloma virus in males with previous assisted reproductive technology failures. Turk J Urol 2019; 45(1): 12-6.

Objective: To investigate the effect of co-administration of letrozole in an ovarian stimulation protocol using recombinant FSH and GnRH antagonists for ICSI in normo/high responders. Methods: Computerized data of 320 antagonist ICSI/ET cycles with or without letrozole were retrospectively analyzed. In 105 cases, letrozole (5 mg/day) was started at the second day of the cycle continued for 5 days. At the second day of letrozole, gonadotropins were added. The remaining 215 cases were stimulated with recombinant FSH only. In all cases on day 6, GnRH antagonist was started. Ovarian stimulation protocols with or without letrozole were compared for cycle outcome parameters. Results: In cycles with letrozole, significantly lower gonadotropin consumption and lower peak estradiol levels were found. In cycles with letrozole, mean number of metaphase II and fertilized oocytes retrieved were significantly higher compared to cycles without letrozole. The pregnancy and clinical pregnancy rates were similar. Conclusion: Should the number of oocytes retrieved being higher in letrozole group might indicate that letrozole might contribute to successful ovarian stimulation with a lower dosage of gonadotropins. Despite the lower peak estradiol levels, pregnancy rates being similar to other group also support the idea that letrozole can contribute to normal potential of implantation.

Objective. To evaluate the efficacy and safety of intravenous (IV) fluid and diazepam therapy compared with the IV-fluid only therapy for the resistant hyperemesis gravidarum (HG) cases. Methods. Medical records of 74 HG cases who were refractory to standard management were reviewed. All patients hospitalised were administered IV fluid and multivitamin combination as the first-step therapy. Patients who were refractory to first-step therapy were given IV fluid (Group 1, n = 43) or IV fluid and diazepam (Group 2, n = 31) depending on the patients' desire. Groups were matched for demographic characteristics, rehospitalisation requirement, patient satisfaction and neonatal outcomes. Results. Thirteen of the 74 patients were excluded from the study because of unknown maternal and fetal outcome. The mean gestational age was 10.4 ± 2.4 year. Age, parity, body mass index and educational level were similar between the two groups. Mean diazepam dose was 62.8 ± 24.5 mg (range 40–160) in Group 2 (n = 31). The number of hospitalisation was significantly lower, and patient satisfaction was significantly higher in Group 2. There were no differences for the obstetrics outcomes between the groups. Conclusions. The addition of diazepam to IV fluids was associated with less hospitalisation in women with hyperemesis gravidarum. Safety of diazepam therapy in early pregnancy deserves further study.