A prospective randomized study comparing two commercially available types of human embryo culture media: G1-PLUS™/G2-PLUS™ sequential medium (Vitrolife) and the GL BLAST™ sole medium (Ingamed)

OBJECTIVE

To check the efficacy of two types of commercially available embryo culture medium: G1-PLUS™/G2-PLUS™ sequential (Vitrolife, Gothenburg, Sweden) and GV BLAST™ sole (Ingamed, Maringá, Brazil) with regards to fertilization, cleavage, blastocyst and pregnancy rates.

METHODS

Prospective and randomized study conducted from March to July 2015, using the medical records of 60 patients submitted to Intracytoplasmic Sperm Injection techniques (ICSI). Data regarding the age of patients, together with fertilization, cleavage, blastocyst and pregnancy rates, were collected and compared in relation to the: G1-PLUS™/G2-PLUS™ sequential and GV BLAST™ sole mediums. The data were tabulated and compared using the Pearson's Chi-Square test (95% CI).

RESULTS

There was no significant difference when comparing patients divided into higher and lower fertility age. No significant statistical difference was noted between the fertilization rates (P=0.59), cleavage (P=0.91), evolution to blastocyst (P=0.33) and total pregnancy (P=0.83) when comparing the embryos cultured in the different media analysed.

CONCLUSION

We conclude that the G1-PLUS™/G2-PLUS™ sequential and GV BLAST™ sole mediums are equally effective with regards to fertilization, cleavage, blastocyst development and total pregnancy rates.

Uterine lavage is efficient to recover endometrial cytology sample and does not interfere with fertility rate after artificial insemination in cows

Productivity rates directly depend on the fertility of a herd, which in turn can be influenced by many factors. Semen deposited in the female reproductive tract is foreign to the body and, in response to this invasion, produces an inflammatory reaction, which is characterized by rapid infusion of polymorphonuclear (PMN) cells. Techniques to obtain an endometrial sample are usually invasive and can mask the true inflammatory response. Ultrasound is a noninvasive technique and can contribute to the diagnosis of postartificial insemination (AI) inflammatory response in cattle. The present study was divided into two experiments. The aim of experiment 1 was to compare two methods of endometrial cytology collection, uterine cytobrush (UC) and uterine lavage (UL), and their effects on uterine hemodynamics that provide information about blood flow. The two methods were evaluated by Doppler ultrasound using the spectral and color modes. For that purpose, 19 Nellore cows were synchronized for timed AI and subjected to UC (n = 9) or UL (n = 10). The techniques were performed 4 hours after AI. The results showed that both techniques allow collection of a good quality sample and with enough PMN cells to perform counting. More PMN cells were obtained by UL than UC. There was no difference in uterine blood flow between the UC and UL groups in any of the periods evaluated (34 hours before and 4, 24, and 48 hours after collection of uterine sample). On the basis of results of experiment 1, the effect of UL on fertility was studied in experiment 2. A total of 128 Nellore cows were synchronized for TAI; 35 cows were subjected to endometrial cytology by UL 4 hours after AI, and 93 were not submitted to any procedure (control). Pregnancy diagnosis was performed by transrectal ultrasound 30 days after AI. Pregnancy rates did not differ between UL (54.29%) and control (56.99%) groups. The results of this study showed that UL allows the collection of more representative cells of the surface of the uterus than UC technique and causes no damage to the reproductive tract. Moreover, UL did not affect pregnancy rate when performed 4 hours after AI.

Effect of cryopreservation on the properties of human endometrial stromal cells used in embryo co-culture systems

PURPOSE

Along with comparative investigation of the decidualization potential and IL-6 secretion by fresh and frozen ESCs, we also aimed to evaluate the effectiveness of co-culture systems based on fresh or frozen ESCs in terms of clinical pregnancy rates.

METHODS

Outcome analysis of a total of 215 IVF cycles with co-culture with fresh or frozen ESCs was performed. Endometrial tissue was obtained from 17 healthy donors. Concentrations of secreted prolactin, IGFBP-1, and IL-6 in conditioned media from cultured fresh and frozen ESCs (decidualized or not) were measured using ELISA or ECLIA.

RESULTS

Embryo co-culture with frozen ESCs resulted in a much lower pregnancy rate compared to the alternative system using fresh ESCs. Furthermore, cultivated frozen ESCs showed considerably decreased release of prolactin, IGFBP-1, and IL-6 compared to fresh ESCs, indicating that cryopreservation negatively affects their decidualization potential and cytokine production.

CONCLUSIONS

Altogether, this data illustrates the need for optimization and improvement of the existing autologous endometrial co-culture systems.

A Comparison of the Effects of Transdermal Estradiol and Estradiol Valerate on Endometrial Receptivity in Frozen-thawed Embryo Transfer Cycles: A Randomized Clinical Trial

BACKGROUND

The purpose of this study was to determine the optimal endometrial preparation protocol by comparing the clinical outcome of two methods of endometrial preparation in frozen-thawed embryo transfer (FET) cycles, including that is, oral estradiol and 17ß-estradiol transdermal patch.

METHODS

In this randomized controlled trial, women underwent either conventional IVF or intracytoplasmic sperm injection (ICSI) who had at least two top-quality embryos appropriate for cryopreservation and frozen embryos from previous cycles. In the study group (n=45), 17-B estradiol transdermal patches 100 μg were applied from the second day of the cycle and continued every other day. Then, each patch was removed after four days. In the control group (n=45), oral estradiol valerate 6 mg was started at the same time and continued daily.

RESULTS

There was a significant difference in estradiol level on the day of progesterone administration and the day of embryo transfer between the two groups (p= 0.001 in both), but no significant difference was observed between them in biochemical and clinical pregnancy rates (32.6% vs. 33.3%, p=1.000 and 30.2% vs. 33.3%, p=0.810, respectively).

CONCLUSION

It is suggested that estradiol transdermal patches be used instead of oral estradiol in FET cycles. Due to the reduced costs, drug dose, and emotional stress as well as the simplicity of the protocol for patients.

Comparison of pregnancy rate between fresh embryo transfers and frozen-thawed embryo transfers following ICSI treatment

BACKGROUND

The use of assisted reproductive technology (ART) is increasing in the world. The rate, efficacy and safety of ART are very different among countries. There is an increase in the use of intra cytoplasmic sperm injection (ICSI), single fresh embryo transfer (ET) and frozen-thawed embryo transfer (FET).

OBJECTIVE

The objective of this study was to compare pregnancy rate in fresh ET and FET.

MATERIALS AND METHODS

In this retrospective cross-sectional study 1014 ICSI-ET cycles (426 fresh ET and 588 FET) from 753 women undergoing ICSI treatment referred to Fatemezahra Infertility and Reproductive Health Research Center in Babol, Iran from 2008 to 2013 were reviewed.

RESULTS

There were no significant differences between biochemical pregnancy rate (23% versus 18.8%, OR 1.301; 95% CI .95-1.774), gestational sac (95.6% versus 100% in FET, OR 0.60; 95% CI 0.54-0.67), and fetal heart activity (87.2% versus 93.6% OR .46; 95% CI .16-1.32) in fresh ET and FET cycles, respectively. P< 0.05 was considered statistically significant for all measures.

CONCLUSION

Although, the result showed no significantly difference between the fresh ET and the FET cycles, however the embryos are able to be stored for subsequent ART. Therefore, we recommend FET cycles as an option alongside the fresh ET.

Anti-Müllerian hormone levels as a predictor of clinical pregnancy in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer cycles in patients over 40 years of age

Objective

The aim of the current study was to determine the predictive value of anti-Müllerian hormone (AMH) levels for pregnancy outcomes in patients over 40 years of age who underwent in vitro fertilization or intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles.

Methods

We retrospectively analyzed the medical records of 188 women aged 40 to 44 years who underwent IVF/ICSI-fresh ET cycles due to unexplained infertility in the fertility center of CHA Gangnam Medical Center. Patients were divided into group A, with AMH levels <1.0 ng/mL (n=97), and group B, with AMH levels ≥1.0 ng/mL (n=91). We compared the clinical pregnancy rate (CPR) in the two groups and performed logistic regression analysis to identify factors that had a significant effect on the CPR.

Results

The CPR was significantly lower in group A than group B (7.2% vs. 24.2%, p<0.001). In multivariate logistic regression analysis, AMH levels were the only factor that had a significant impact on the CPR (odds ratio, 1.510; 95% confidence interval, 1.172-1.947). The area under the receiver operating characteristic curve for AMH levels as a predictor of the CPR was 0.721. When the cut-off level of AMH was set at 1.90 ng/mL, the CPR was 6.731-fold higher in the group with AMH levels ≥1.90 ng/mL than in the group with AMH levels <1.90 ng/mL (p<0.001).

Conclusion

Our study showed that AMH levels were predictive of clinical pregnancy in infertility patients over 40 years of age. Further prospective studies should be conducted to validate the predictive capability of AMH levels for the outcome of clinical pregnancy.

Impact of endometrial cavity fluid on assisted reproductive technology outcomes

BACKGROUND

The impact of endometrial cavity fluid (ECF) on assisted reproductive technology (ART) outcomes has not been evaluated in a meta-analysis.

OBJECTIVES

To evaluate the impact of ECF on the outcome of ART cycles.

SEARCH STRATEGY

PubMed, China Academic Journals Full-text Database, and China Doctoral/Masters Dissertations Full-text Databases were searched for reports published in any language before January 1, 2015, using relevant keywords.

SELECTION CRITERIA

Studies were included if they compared the outcome of ART in women with and without ECF.

DATA COLLECTION AND ANALYSIS

Background information, participants' characteristics, and study outcomes were recorded. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method.

MAIN RESULTS

Six studies evaluating 5928 ART cycles were included. The pregnancy rate was significantly lower in the group with ECF than in the group without ECF (OR 0.74, 95% CI 0.55-0.98; P=0.03). The same association was observed if the analysis included only patients with hydrosalpinx (OR 0.36, 95% CI 0.15-0.86; P=0.02).

CONCLUSIONS

The clinical pregnancy rate after ART is significantly lower among patients with ECF than among those without ECF. In addition, if ECF is found in patients with hydrosalpinx, ART cycles should be cancelled after oocyte retrieval.

Comparison of pregnancy rates in PCOS patients undergoing clomiphene citrate and IUI treatment with different leading follicular sizes

PURPOSE

The objective of the study was to compare the pregnancy rates in PCOS patients undergoing clomiphene citrate (CC) and intrauterine insemination (IUI) treatment with different leading follicular sizes.

METHODS

A total of 358 infertile women with PCOS who underwent 563 clomiphene citrate and IUI treatment cycles were included in this prospective study. Treatment cycles were divided into three groups according to leading follicular size on the day of hCG administration: Group I: follicular size 17-18 mm (n = 177), Group II: 19-22 mm (n = 321), and Group III : >22 mm (n = 65). Pregnancy rates were evaluated. Treatment outcomes of the groups were further analyzed related to endometrial thickness measurement on the day of hCG. For this purpose, cycles were placed into three subgroups as follows: endometrial thickness <7, 8-9, and >9 mm.

RESULTS

There was no statistically significant difference in clinical pregnancy rate per cycle between the groups (8.5, 10, and 9.2 % for Group I, II, and III, respectively, p = 0.86). In further analyses related to endometrial thickness, no significant difference was also found in pregnancy rate among the groups.

CONCLUSION

This results suggest that pregnancy rate is not related to leading follicle size on the day of hCG administration in PCOS patients treated with CC and IUI. In addition, pregnancy rate in women with different follicular sizes is not influenced by the endometrial thickness.

The Impact of Serum Progesterone Levels on the Results of In Vitro Fertilization Treatments: A Literature Review

The aim of this review is to analyze the relationship between preovulatory progesterone (P) rise and in vitro fertilization (IVF) pregnancy outcomes. It also investigates the sources and effects of rises in progesterone levels, including the underlying mechanisms and potential strategies in preventing its elevation during ovarian stimulation. Progesterone is produced in the early follicular phase in the adrenal gland, which shifts toward the ovaries prior to ovulation. Several factors contribute to the etiology of P level increase including the number of multiple follicles, the overdose of gonadotropins and poor ovarian response. Nowadays, the influence of the preovulatory P rise on IVF outcome remains controversial. Several authors have failed to demonstrate any negative impact, while others reported a detrimental effect associated with the rise of P. It seems that P rise (1.5 ng/ml or 4.77 nmol/l) may have deleterious effects on endometrial receptivity, namely, accelerating the endometrial maturation process that subsequently narrows the period for implantation and thus decreases pregnancy rates. Recent studies have proposed different cutoffs according to the ovarian response, which may be a little high in patients with high response in relation to those of normal response or low response. To prevent a P rise, it might be preferable to use milder stimulation protocols, earlier trigger of ovulation, cryopreservation of all embryos and transfer in the natural cycle.

Relationship of polar bodies morphology to embryo quality and pregnancy outcome

The aim of this study was to explore whether the morphology of polar bodies (PBs) estimated at 16-18 h after insemination can be used as an additional marker for predicting human embryo quality or pregnancy outcome. The data from 355 patients who received standard in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment after controlled ovarian hyperstimulation were recruited. Normal fertilized 3048 zygotes from 382 cycles were divided into two groups, PBs intact or fragmented, according to the morphology of PBs assessed at 16-18 h after insemination. Embryo quality and pregnancy outcome were compared between the two groups. It was shown that the day 3 (D3) good embryo rate, good quality blastocyst rate and available embryo rate of the PBs intact group were all significantly higher than that of the corresponding fragmented groups. However, no significant differences in pregnancy rate (PR) or implantation rate (IR) were observed between the intact and fragmented groups. Although PBs morphology estimated at 16-18 h after insemination had little effect on PR or IR in fresh embryo transfer cycles, a better embryo quality can be achieved in the PB-intact group, which is valuable for embryo selection.

Large nuclear vacuoles in spermatozoa negatively affect pregnancy rate in IVF cycles

BACKGROUND

Recently, motile sperm organelle morphology examination (MSOME) criteria as a new real time tool for evaluation of spermatozoa in intracytoplasmic sperm injection (ICSI) cycles has been considered.

OBJECTIVE

The aim was to investigate the predictive value of MSOME in in vitro fertilization (IVF) in comparison to ICSI cycles and evaluation of the association between MSOME parameters and traditional sperm parameters in both groups.

MATERIALS AND METHODS

This is a cross sectional prospective analysis of MSOME parameters in IVF (n=31) and ICSI cycles (n=35). MSOME parameters were also evaluated as the presence of vacuole (none, small, medium, large or mix); head size (normal, small or large); cytoplasmic droplet; head shape and acrosome normality. In sub-analysis, MSOME parameters were compared between two groups with successful or failed clinical pregnancy in each group.

RESULTS

In IVF group, the rate of large nuclear vacuole showed significant increase in failed as compared to successful pregnancies (13.81±9.7vs7.38±4.4, respectively, p=0.045) while MSOME parameters were the same between successful and failed pregnancies in ICSI group. Moreover, a negative correlation was noticed between LNV and sperm shape normalcy. In ICSI group, a negative correlation was established between cytoplasmic droplet and sperm shape normalcy. In addition, there was a positive correlation between sperm shape normalcy and non-vacuolated spermatozoa.

CONCLUSION

The high rate of large nuclear vacuoles in sperm used in IVF cycles with failed pregnancies confirms that MSOME, is a helpful tool for fine sperm morphology assessment, and its application may enhance the assisted reproduction technology success rates.

Transfer of cattle embryos produced with sex-sorted semen results in impaired pregnancy rate and increased male calf mortality

This study investigated the pregnancy rate and calf mortality after transfer of embryos produced using sex-sorted semen. Data for 12,438 embryo transfers performed on dairy farms were analyzed. Of these, 10,697 embryos were produced using conventional semen (CONV embryos) and 1741 using sex-sorted semen from 97 bulls (SEX embryos), predominantly of Ayrshire and Holstein breeds. Of the CONV embryos, 27.4% were transferred fresh, whereas of the SEX embryos, 55.7% were fresh. Recipient attributes (breed, parity, number of previous breeding attempts, and interval from calving to transfer) were comparable for both embryo types, heifers representing 57.8% of recipients in the CONV group and 54.8% in the SEX group. Recipients that were not artificially inseminated or did not undergo a new embryo transfer after the initial embryo transfer and had registered calving in fewer than 290 days after the transfer were considered pregnant. Pregnancy rate for recipients receiving CONV embryos was 44.1%, and for those receiving SEX embryos, it was 38.8%. The odds ratio for pregnancy in recipients receiving CONV embryos was 1.34 compared with SEX embryos (P < 0.001). The proportion of female calves was 49.6% and 92.3% in CONV and SEX groups, respectively. Overall, calf mortality was comparable in both groups. Mortality was similar in CONV and SEX groups (6.6% and 7.7%, respectively) for female calves. For male calves, mortality was 9.2% in the CONV group but significantly higher, 16.0% (P < 0.05), in the SEX group. This study showed that transfer of embryos produced with sex-sorted semen decreased the pregnancy rate by about 12% compared with embryos produced using conventional semen. Mortality of male calves born from SEX embryos was higher than for those born from CONV embryos.

The effect of Lameness before and during the breeding season on fertility in 10 pasture-based Irish dairy herds

Background

The effects of lameness on fertility have been documented frequently but few data are available from seasonally breeding, pasture-based herds (such as those used in Ireland) where cows are housed during the winter months but managed at pasture for the remainder of the year. This study determined the prevalence of lameness in a group of 786 cows in 10 pasture-based Irish dairy herds before, during and after the breeding season and assessed the relationship between lameness and the reproductive performance in these herds through serial locomotion scoring during the grazing period.

Results

Lameness prevalences of 11.6 % before, 14.6 % during and 11.6 % after the breeding season were found and these compared favourably to results from housed cattle and are similar to other studies carried out in grazing herds. A Cox proportional hazards model with locomotion score as time varying covariate was used. After controlling for the effect of farm, month of calving, body condition score at calving, body condition score loss after calving and economic breeding index, cows identified as lame during the study were less likely to become pregnant. Cows lame before the earliest serve date but no longer lame during the breeding season, cows becoming lame after the earliest serve date and cows identified lame both before and after this date were respectively 12 %, 35 % and 38 % less likely to become pregnant compared to cows never observed lame during the study. However, these findings were only significant for cows becoming lame after the earliest serve date and cows lame both before and after the start of breeding.

Conclusions

This study found that the reproductive efficiency was significantly (p < 0.05) lower in cows becoming lame during the breeding season and cows lame before and during the breeding season compared to non-lame cows. Cows no longer lame during the breeding season had a lower Submission Rate to first serve within 3 weeks of earliest serve date. However, the Pregnancy Rate was not significantly (p > 0.05) lower in these animals compared to cows never diagnosed as lame. In addition to lameness status, nutritional status and genetics were found to influence the reproductive performance in pasture-based Irish dairy herds.

A multi-center, randomized, open-label, parallel group study of a natural micronized progesterone vaginal tablet as a luteal support agent in Japanese women undergoing assisted reproductive technology

Purpose

To verify sufficient progesterone supplementation during the luteal phase and to determine the efficacy and safety of a natural micronized progesterone vaginal tablet (FE 999913) in Japanese women undergoing in vitro fertilization‐embryo transfer or intracytoplasmic sperm injection.

Methods

In a multi‐center, randomized, open‐label, parallel group trial, 108 subjects were randomized to receive FE 999913 vaginally twice daily (n = 54) or three times daily (n = 54) for up to 10 weeks. Primary endpoints were the proportion of subjects with serum progesterone concentration ≥10 ng/ml on day 5 and ongoing pregnancy rate at week 5.

Results

Ninety‐four subjects completed the trial and 90 subjects underwent embryo transfer. The proportion of subjects with serum progesterone concentration ≥10 ng/ml on day 5 was 98.9 % and the lower limit of 95 % CI of the difference between the current trial and MEGASET trial was −3.6 %, which was within the non‐inferiority criterion. The ongoing pregnancy rate was 22.2 %, which is similar to that in actual clinical settings in Japan. No safety concerns were observed.

Conclusions

FE 999913 was useful in this trial from the aspects of sufficient supplementation of progesterone, comparable pregnancy rate with that in clinical practice in Japan, and safety.

Clinical trial registration

ClinicalTrials.gov identifier: NCT01710514.

Reproductive outcome following hysteroscopic treatment of uterine septum

BACKGROUND

Septate uterus is the most common uterine anomaly and a cause for miscarriage and infertility. Existing data suggested a better reproductive outcome of uterine septum following hysteroscopic septum resection.

OBJECTIVE

Current study was administered to share our experience in hystroscopic septum resection for reproductive outcome following hysteroscopic treatment of uterine septum and specifically focusing on different treatment protocols after hysteroscopic septum resection.

METHODS& MATERIALS

This study was a cross-sectional study based on secondary data that was obtained from medical records of infertile women who had undergone transvaginal hysteroscopy and used different treatment protocols after hysteroscopic correction of uterine septum in Infertility and Reproductive Health Research Center between April 2005 and February 2014.

RESULTS

The total number of infertile women underwent hysteroscopy uterine septoplasty was 106. The hysteroscopy septoplasty resulted in an overall pregnancy rate of 67% and a live birth 57.5%. Pregnancy rate for patients who had not male infertility was 92.1%. The chi-square test did not reveal any statistically significant difference in side affect, pregnancy, live birth, abortion, preterm deliveries, and term deliveries rate between these patients either with consistent hormone therapy plus IUD insertion or with alternate hormone therapy plus IUD after hysteroscopic metroplasty.

CONCLUSION

The findings of the present study indicated hysteroscopic septum resection to remove a uterine septum in women with infertility is safe and may be an efficacious procedure. Treatment following hysteroscopic septum resection, either the consistent or the alternate protocol is both beneficial to improve pregnancy rate.

Oral dydrogesterone versus vaginal progesterone gel in the luteal phase support: randomized controlled trial

OBJECTIVES

To compare efficacy, satisfaction and tolerability of oral dydrogesterone and micronized vaginal progesterone gel used for luteal supplementation.

STUDY DESIGN

Randomized controlled trial. A total of 853 infertile women undergoing IVF/ICSI treatment in University Hospital Center "Sisters of Mercy", Zagreb, Croatia. Luteal support was provided as Crinone 8%(®) vaginal progesterone gel (90mg) administered daily, or oral dydrogesterone Duphaston(®) (2× 10mg) administered two times daily. Progesterone was administered from the day of oocyte retrieval (day 0) till pregnancy test or in a case of pregnancy, until week 10.

RESULTS

The on-going pregnancy rates were comparable between Crinone 8%(®) vaginal progesterone gel and oral dydrogesterone - Duphaston(®) (28.1% versus 30.3%; OR 1.11 (0.82-1.49 with 95% CI)). Overall satisfaction and tolerability were significantly higher in the dydrogesterone group than in the Crinone group. Vaginal bleeding, interference with coitus and local adverse side effects such as vaginal irritation and discharge occurred significantly more in Crinone group than in dydrogesterone group.

CONCLUSIONS

Oral dydrogesterone is effective drug, well tolerated and accepted among patients and can be considered for routine luteal support.

CLINICAL TRIAL REGISTRATION NUMBER

NCT01178931; www.clinicaltrials.gov.

Reproductive performance of lactating dairy cattle after intrauterine administration of a prostaglandin F2α receptor antagonist 4 days after insemination

Previous research has determined that PGF2α detrimentally affects pregnancy via direct effects on early embryonic development. Because early embryonic loss is relatively prevalent in lactating dairy cows, we hypothesized that pregnancy retention (and resulting conception rates) would be improved by administering a PGF2α receptor antagonist (AL-8810) shortly after insemination. Multiparous, lactating Holstein dairy cows were randomly assigned to receive one of four intrauterine treatments: (1) control group-untreated cohort (CON; n = 93); (2) control group-vehicle infusion (CON-V; n = 90); (3) 2000 nM AL-8810 infusion (AL-2000; n = 96); or (4) 10,000 nM AL-8810 infusion (AL-10,000; n = 93). Treatments were administered transcervically 4 days after insemination in the horn ipsilateral to the CL. There was no effect of treatment on conception rate (36.6%, 38.9%, 25.0%, and 35.5% for CON, CON-V, AL-2000, and AL-10,000, respectively) or calving rate (24.7%, 24.4%, 16.7%, and 28.0% for CON, CON-V, AL-2000, and AL-10,000, respectively). There was a significant effect of treatment on return to estrus with CON-V (23.6 ± 0.6) and AL-10,000 (23.3 ± 0.6) groups having a longer interval to next estrus over the CON group (21.5 ± 0.6; P < 0.05). Prior treatment did not affect conception to the subsequent insemination. It is important to note that although the addition of AL-8810 into the uterus on Day 4 after insemination did not increase conception rates in the present experiment, it also did not have a negative impact. Furthermore, the treatment procedure itself did not impair the establishment of pregnancy (CON vs. CON-V, AL-2000, and AL-10,000). These results demonstrate that a therapeutic agent can be administered directly into the uterus on Day 4 after insemination without detrimentally affecting conception rates.

Clomiphene citrate affects the receptivity of the uterine endometrium

Purpose

To investigate whether clomiphene citrate (CC) affects uterine receptivity or not, we evaluated pregnancy rates (PR) during the hormone replacement cycle (HRC) according to the period between the last day of CC administration and the day of embryo transfer (ET).

Methods

From March 2008 through March 2010, a total of 378 treatment cycles among 378 patients who received CC and had to avoid fresh ET due to a thin uterine endometrium were recruited. All patients underwent thawed ET using HRC. PRs were evaluated according to the period between the last CC treatment and the day of ET.

Results

PR for the groups in which the period between the last CC treatment and the day of ET increased to more than 91 days were significantly higher than that for group in which the period was less than 90 days (p < 0.05).

Conclusions

A lower PR was shown by the patients who underwent thawed ET in the HRC within 90 days after their last CC treatment, which shows that CC affects the receptivity of the uterine endometrium.

Culturing surplus poor-quality embryos to blastocyst stage have positive predictive value of clinical pregnancy rate

BACKGROUND

Clinical reproductive centers produce large amounts of surplus poor-quality embryos annually, how to maximize the use of these embryos, and which of them have the potential to develop into blastocyst stage and influencing factors were lack of systematic research.

OBJECTIVE

To investigate the fate of surplus poor-quality embryos which were cultured to obtain blastocyst, determine the factors which may influence the blastulation, and discuss their application in predicting of the pregnancy outcomes.

MATERIALS AND METHODS

Day 3 (D3) after embryo transfer and freezing, surplus poor-quality embryos from IVF/ICSI cycles were cultured to blastocyst by the sequential method, then the blastulation outcomes were observed. Focusing on the blastulation rate of those embryos with different number cells and different embryonic grade; and last the relationship between the pregnancy outcomes of remained poor-quality embryos with successful blastulation or failed blastulation groups were studied.

RESULTS

Of 127 patients with 569 poor-quality in vitro cultured embryos, there were formation of 248 blastocysts from 91 patients (43.59%), which lead to development of 138 high-quality blastocysts (24.25%). With the increase in cells number of D 3 blastomeres, the blastulation rate gradually increased, that, 7-cell blastomeres blastulation rate was the highest (70.59%), and 8-cell blastomeres is a little below (70.37%); while the embryonic levels and blastulation rate did not show this positive relationship. The clinical pregnancy rate and implantation rate of those who had successful blastulation (67.03% and 42.39%) were higher than of those who failed to develop to blastocyst (p=0.039).

CONCLUSION

Day 3 poor-quality embryos with successful blastulation or with failed blastulation had predictive value on pregnancy outcomes. For embryo transfer 7-8 cells grade III-IV embryo is better than 4-5 cells grade I-II embryo, in case of lack good-quality embryos.

Effect of vitamin D insufficiency treatment on fertility outcomes in frozen-thawed embryo transfer cycles: A randomized clinical trial

BACKGROUND

Frozen- thawed embryo transfer is an essential part of ART treatment and outcomes of this procedure are associated with several clinical factors. Several studies have showed an increase level of IVF outcomes in women with sufficient vitamin D.

OBJECTIVE

whether treatment of vitamin D insufficiency can improve pregnancy rates in frozen-thawed embryo transfer cycles.

MATERIALS AND METHODS

This is an interventional, randomized clinical trial. Serum 25-(OH) vitamin D level of 128 women who had undergone IVF/ICSI with cryopreservation of embryos was checked. One hundred fourteen infertile women with insufficient serum vitamin D (less than 30 ng/ml) were included in the study. Fifty seven women were treated with supplementary vitamin D, 50000 IU weekly, for 6-8 weeks and fifty seven women were received no supplementation. One hundred six women completed frozen thawed embryo transfer cycles and included in the final analysis. Primary and secondary outcomes were chemical and clinical pregnancy respectively.

RESULTS

Our study did not show any significant difference between vitamin D insufficient and treated women in term of chemical (29.40% vs. 29.10% respectively, p=1.00) or clinical (25.50% vs. 21.80% respectively, p=0.81) pregnancy rates.

CONCLUSION

Vitamin D insufficiency treatment is not associated with higher pregnancy rate in frozen-thawed embryo transfer cycles.

Acceptable pregnancy rate of unstimulated intrauterine insemination: a retrospective analysis of 17,830 cycles

Purpose

To evaluate the pregnancy rate (PR) of unstimulated intrauterine insemination (IUI).

Methods

This was a retrospective study in a private fertility clinic. Between 2004 and 2013, a total of 4,045 women underwent 17,830 cycles of unstimulated IUI. The etiologies of subfertility in the couples were unexplained (51 %), male factor (36 %), coital problems (9.5 %), and cervical factor (3.5 %).

Results

The PRs/cycle, between the 1st and 9th trials, in women <35, 35–37, 38–40, 41–42, and >42 years of age were 8.2, 7.3, 5.5, 3.6, and 0.9 %, respectively. In 10,076 cycles in which the male partner had a total motile sperm count ≥5 million, the PRs in the respective age groups were 9.9, 8.6, 6.1, 4.8, and 1.2 %. The largest‐sized reported PRs for clomiphene citrate (CC)/IUI in the respective age groups were 11.5, 9.2, 7.3 4.3, and 1.0 % (4,199 cycles in total, Dovey et al., FertilSteril, 2008;90:2281–2286). There were no significant differences in PRs between unstimulated IUI and CC/IUI.

Conclusion

PR for unstimulated IUI was similar to the reported PR for CC/IUI. Although this was a retrospective study without a control group, to reduce multiple pregnancy rate, we believe that unstimulated IUI is a reasonable treatment.

The effect of luteal phase progesterone supplementation on natural frozen-thawed embryo transfer cycles

Objective

To evaluate the effect of progesterone supplementation during the luteal phase on pregnancy outcome in natural frozen-thawed embyo transfer (FTET) cycles.

Methods

In this retrospective cohort study, 228 consecutive patients who underwent FTET cycles between January 2009 and September 2012 were included. One hundred forty-five patients received luteal progesterone support (P group) but 83 patients did not receive any progesterone supplementation during luteal phase (control group).

Results

There were no differences in patients' characteristics between the two groups. The two groups were similar with respect to the characteristics of previous fresh in vitro fertilization cycle in which embryos were cryopreserved including the numbers of oocytes retrieved, mature oocytes, fertilized oocytes, grade 1 or 2 embryos and frozen embryos. Also, significant differences were not observed between the P and control groups in clinical pregnancy rate, embryo implantation rate and multiple pregnancy rate. However, miscarriage rate was significantly lower in the P group and live birth rate was significantly higher in the P group than in the control group (P<0.05, P<0.05).

Conclusion

Our results suggest that luteal phase progesterone supplementation decreases miscarriage rate and improves live birth rate in natural FTET cycles.

Ultra-short term clomiphene citrate in high responder women with polycystic ovary syndrome: a case series

OBJECTIVE

To evaluate a new trial of short-term clomiphene citrate (CC) in high responder women with polycystic ovary syndrome (PCOS).

STUDY DESIGN

This case series was conducted in the infertility outpatient clinics of two centres. Ovulation induction was performed with CC 50-100mg a day in six high-responder women with PCOS who had a history of cancellation of treatment because of ≥3 mature follicles between March 2010 and June 2013. Induction was initiated on the third day of their cycles and the duration of induction was only two days. Demographic data of the patients, number of mature follicles on hCG day, ovulation rate, luteal phase length, pregnancy rate, and type of pregnancy were recorded. All data were analysed by SPSS packet programme (SPSS, 17.0, SPSS Inc., Chicago, IL, USA).

RESULT(S)

The median number of mature follicles and duration of the follicular phase were 1.3 (1-2) and 11.9 (11-14) days, respectively. The ovulation rate was 80% (12/15) and pregnancy rate per cycle was 26.6%.

CONCLUSION(S)

If this hypothesis is supported by large prospective randomised controlled studies, ultra-short term ovulation induction with CC may provide an alternative approach for high-responder women with PCOS who have a history of treatment cycle cancellations.

Intrauterine administration of recombinant human chorionic gonadotropin before embryo transfer on outcome of in vitro fertilization/ intracytoplasmic sperm injection: A randomized clinical trial

BACKGROUND

The direct effect of hCG on the human endometrium was studied several times.

OBJECTIVE

The objectives of this study were to evaluate the effectiveness of intrauterine injection of recombinant human chorionic gonadotropin (rhCG) before embryo transfer (ET).

MATERIALS AND METHODS

In this randomized placebo-controlled clinical trial, a total number of 182 infertile patients undergoing their first in vitro fertilization/ intracytoplasmic sperm injection (IVF-ICSI) cycles were randomly assigned to receive 250μg intrauterine rhCG (n=84) or placebo (n=98) before ET. The implantation and pregnancy rates were compared between groups.

RESULTS

Patients who received intrauterine rhCG before ET had significantly higher implantation (36.9% vs. 22.4%; p=0.035), clinical pregnancy rates (34.5% vs. 20.4%; p=0.044) and ongoing pregnancy rate (32.1% vs. 18.4%; p=0.032) when compared to those who received placebo. The abortion (2.4% vs. 2.0%; p=0.929) and ectopic pregnancy rates (1.2% vs. 1.0%; p=0.976) were comparable between groups of rhCG and placebo, respectively.

CONCLUSION

Intrauterine injection of 250μg of rhCG before ET significantly improves the implantation and pregnancy rates in IVF/ICSI cycles.

REGISTRATION ID IN IRCT

IRCT2012121711790N1 This article extracted from fellowship course thesis. (Masoumeh Younesi).

Accurate diagnosis as a prognostic factor in intrauterine insemination treatment of infertile saudi patients

BACKGROUND

The study meant to define the prognostic factors that help in prescribing intrauterine insemination (IUI) for infertility treatment which remains an area of continuous improvements.

METHODS

The diagnostic indications of a cohort of IUI-treated patients and their corresponding pregnancy rates (PRs) were randomly and prospectively studied among Saudi cohort of 303 patients for a period of 20 months. The indications of IUI cases were statistically analyzed for those eligible patients over a period of twenty months (January 2010 till August 2011), and the PR that corresponded to each group was investigated as well. P-value less than 0.05 was considered significant.

RESULTS

The highest PR, 18.87%, of the polycystic ovarian syndrome (PCOS)-only diagnosed patients, was significantly higher than the average PR of all other indications combined, 7.22%, (p = 0.011, compared to all other groups combined). The second highest PR, 14.0%, of the tubal factor (TF)-only indication, was double the PR average of all other indications combined, though it did not reach significance. However, PCOS and TF accompanied by other indications caused the PR to drop to 5.88% and 5.56%, respectively. However, a group of some hormonal-imbalance based indications had the least PR (0.0% to 2.70%). Those indications were elevated serum FSH, hyperprolactinemia, hypogonadotrophy, hypothyroidism and endometriosis. The rest of the indications had an average PR (8.33% to 11.11%).

CONCLUSION

There is a reasonable chance of conception after IUI treatment for female factor infertility except in cases with sever hormonal imbalance. The PCOS cases having the best success chances.