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Hussein RS, Elnashar I, Abou-Taleb HA, Zhao Y, Abdelmagied AM, Abbas AM, Abdalmageed OS, Abdelaleem AA, Farghaly TA, Youssef AA, Badran E, Ibrahim MN, Amin AF. Progesterone/Oestradiol ratio can Better Predict Intracytoplasmic Sperm Injection Outcomes than Absolute Progesterone Level. J Hum Reprod Sci 2021; 14:28-35. [PMID: 34083989 PMCID: PMC8057156 DOI: 10.4103/jhrs.jhrs_57_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/10/2020] [Accepted: 01/12/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Several parameters were proposed to predict the impact of premature luteinization on intracytoplasmic sperm injection (ICSI) outcomes such as isolated progesterone (P) level, progesterone to oocyte ratio, and progesterone/estradiol ratio (P/E2). Aim: The aim of this study is to compare the predictive value of P/E2 ratio and isolated P level on the ovulation triggering day for pregnancy outcomes in fresh GnRH antagonist ICSI cycles. Settings and Design: A retrospective cohort study conducted in a university-affiliated in vitro fertilization center between January 2017 and April 2019. Methods: The study included women who underwent their first- or second-ranked GnRH antagonist ICSI cycles with day-3 embryo transfer. P/E2 ratio was calculated as (P [ng/mL] × 1000)/E2 (pg/mL). Cutoff values of ≥1.5 ng/ml for high P (HP) and ≥0.55 for HP/E2 ratio were chosen based on the literature. Statistical Analysis: A receiver operating curve was performed to detect the predictability of serum P/E2 and P for the ongoing pregnancy rate. First, patients were divided according to either P level (low P < 1.5 ng/mL and HP ≥1.5 ng/mL) or P/E2 ratio (low P/E2 <0.55 and HP/E2 ≥ 0.55). Patients were further divided into four subgroups: (Group A: HP and HP/E2 ratio, Group B: low P and low P/E2 ratio, Group C: HP only, and Group D: HP/E2 only). A multivariate regression analysis models were used to account for the effect of the cycle confounders on the likelihood of pregnancy. Results: A total of 402 ICSI cycles were analyzed. The area under the curve was 0.67 and 0.59 for P/E2 and P, respectively. P/E2 showed a significant association with ongoing pregnancy (adjusted odds ratios [aOR]: 0.409, 95% confidence interval [CI] 0.222–0.753, P = 0.004) while HP revealed no significant predictive value (aOR: 0.542, 95% CI 0.284–1.036, P = 0.064) after the multivariate analysis. Conclusions: P elevation may not present as an independent predictor for cycle outcomes. P/E2 ratio has a better prognostic value than P alone in predicting pregnancy of GnRH antagonist cycles.
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Affiliation(s)
- Reda S Hussein
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ihab Elnashar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hisham A Abou-Taleb
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Yulian Zhao
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed M Abdelmagied
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, Taibah University, Medina, KSA
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Osama S Abdalmageed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Abdelaleem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Tarek A Farghaly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Youssef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Esraa Badran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mostafa N Ibrahim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed F Amin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Rehman R, Zafar A, Ali AA, Baig M, Alam F. Impact of serum and follicular fluid kisspeptin and estradiol on oocyte maturity and endometrial thickness among unexplained infertile females during ICSI. PLoS One 2020; 15:e0239142. [PMID: 33112855 PMCID: PMC7593084 DOI: 10.1371/journal.pone.0239142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/31/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To relate serum and follicular fluid (FF) kisspeptin and estradiol levels in different stages of stimulation during Intracytoplasmic Sperm Injection (ICSI) with oocyte maturity and endometrial thickness among unexplained infertile females. Methods This cross-sectional study was carried out at the Australian Concept Infertility Medical Centre from March 2017 till March 2018. Fifty unexplained infertile females, booked for ICSI, were included in the study. Serum kisspeptin and estradiol were estimated by Enzyme-Linked Immunosorbent Assay in all four stages; 1: follicular stimulation, 2: ovulation induction, 3: oocyte pickup, and 4: embryo transfer. FF was aspirated during oocyte retrieval (stage 3) for the analysis of KP and estradiol. Pregnancy outcomes were categorized as non-pregnant, preclinical abortion, and clinical pregnancy. Results The age of the study subjects was 32.04 ± 2.29 (Mean±SD) years, with mean BMI of 28.51 ± 4.15 (Mean±SD) kg/m2. Mean serum kisspeptin and estradiol levels increased in all subjects as the stimulation proceeded stages 1–3; however, the mean dropped after retrieval of the oocytes (stage 4). Out of 27 female subjects who completed the cycle, 17 remained non-pregnant, 4 had preclinical abortion, and 6 acquired clinical pregnancy. The FF kisspeptin concentration was significantly higher than serum concentrations and positively correlated with serum and FF estradiol concentrations. FF-kisspeptin correlated with serum kisspeptin in Stage 3 (r = 0.930, p<0.001), maturity of oocyte (r = 0.511, p = 0.006) and endometrial thickness (r = 0.522, p = 0.005). Kisspeptin in stage 3 was also found to correlate with endometrial thickness (r = 0.527, p = 0.005) and with estradiol (r = 0.624, p = 0.001) independently. Conclusion Increase in serum and FF-kisspeptin and estradiol levels from stages 1 to 3, resulted in an optimum endometrial thickness, probability of fertilization of oocytes and chances of clinical pregnancy in Assisted Reproductive Techniques /ICSI cycles of unexplained infertile females.
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Affiliation(s)
- Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Amara Zafar
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Mukhtiar Baig
- Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faiza Alam
- Department of Physiology, University of Karachi, Karachi, Pakistan
- * E-mail:
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Baig M, Azhar A, Rehman R, Syed H, Tariq S, Gazzaz ZJ. Relationship of Serum Leptin and Reproductive Hormones in Unexplained Infertile and Fertile Females. Cureus 2019; 11:e6524. [PMID: 32025443 PMCID: PMC6991145 DOI: 10.7759/cureus.6524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship between serum leptin and reproductive hormones in females with unexplained infertility (UI). METHODOLOGY It was a case-control study conducted in the Gynecology and Obstetrics Department and Infertility Clinic, Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan. A total of 235 primary infertile females with an unidentified cause of infertility were selected from the Infertility Clinics. The patients were excluded if they were found to have polycystic ovary syndrome, endometriosis, tubal blockage, irregular menstrual cycles, hyperthyroidism, hypothyroidism, hyperprolactinemia, hyperandrogenemia, fasting blood sugar >110 mg/dl, and male factor infertility. A total of 205 healthy, fertile females were selected from the general population. The blood samples of both groups were collected on the 12th and 21st day of their menstrual cycle. Serum leptin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and E2 levels were measured. Statistical analysis was executed using the SPSS version 16 (SPSS Inc., Chicago, IL). RESULTS No significant difference was observed in leptin values of fertile and UI females, 37.110±1.19 vs. 35.321±0.901. In the preovulatory phase (12th day) of the cycle, infertile subjects with body mass index (BMI) <20 and 20-24.9 had significantly higher values for leptin (p<0.05), whereas, with an increase in BMI, leptin levels were reduced in these females. Leptin was reduced further in the luteal phase of infertile females with BMI 25-30, with a significantly lower value for FSH (p<0.005), LH (p<0.005), and estradiol (p<0.005. In infertile subjects, it correlated with estradiol (r=0.501, p<0.005), BMI (r=0.903, p<0.001), and progesterone (r=0.146, p<0.05). CONCLUSION Low levels of leptin observed to have an increase in the BMI of UI females were associated with a reduced estradiol and progesterone production in the luteal phase of the cycle.
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Affiliation(s)
- Mukhtiar Baig
- Medical Education and Simulation, King Abdulaziz University, Jeddah, SAU
| | - Abid Azhar
- Karachi Institute of Biotechnology and Genetic Engineering, University of Karachi, Karachi, PAK
| | - Rehana Rehman
- Biological and Biomedical Sciences, Aga Khan University, Karachi, PAK
| | - Hareem Syed
- Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Saba Tariq
- Pharmacology and Therapeutics, The University of Faisalabad, Faisalabad, PAK
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Zhang W, Tian Y, Xie D, Miao Y, Liu J, Wang X. The impact of peak estradiol during controlled ovarian stimulation on the cumulative live birth rate of IVF/ICSI in non-PCOS patients. J Assist Reprod Genet 2019; 36:2333-2344. [PMID: 31485870 DOI: 10.1007/s10815-019-01568-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/15/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The study aimed to investigate the impact of the peak E2 level during controlled ovarian hyperstimulation (COS) on the cumulative live birth rate (cLBR) in non-PCOS women with normal ovarian reserve. MATERIALS AND METHODS Women between 20 and 39 years were included. Donor cycles and patients who never experienced embryo transfer were excluded. Multivariable regression and smooth curve fitting were applied for statistical analysis. RESULTS A total of 1141 patients were included. The mean age, basal AFC, peak E2 level, and number of retrieved oocyte were 30.0 ± 3.7 years old, 16.8 ± 6.7, 3911.0 ± 1302.9 pg/ml, and 13.6 ± 5.5, respectively. In the overall population of the cohort, cLBR, miscarriage rate, and preterm birth rate were 66.9%, 7.4%, and 13.7%, respectively. The results of multivariable regression analysis failed to show the impact of peak E2 on the cLBR [OR (95%CI) 0.995 (0.982, 1.009), P = 0.486]. However, the result of smooth curve fitting indicated that when the peak E2 was lower than 2185 pg/ml, the cLBR increased about 12% with 100 pg/ml increasing of the peak E2. When the peak E2 was higher than 6136 pg/ml, the cLBR decreased about 10% with 100 pg/ml increasing of the peak E2. CONCLUSION We concluded that the peak E2 level on hCG trigger day is associated with the cLBR in a segmental pattern. There should be an appropriate range of the peak E2 level during COS to achieve a relative best cLBR in non-PCOS patients using stimulating protocol mainly based on GnRH agonist; however, the cutoff value must vary in different centers.
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Affiliation(s)
- Wanlin Zhang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Military Medical University, Xi'an, 710038, China
| | - Ying Tian
- Department of Gynecology, Traditional Chinese Medicine Hospital of Shaanxi Province, Xi'an, 710003, China
| | - Duo Xie
- Department of Obstetrics and Gynecology, 986 Hospital of Air Force, Xi'an, China
| | - Ye Miao
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Military Medical University, Xi'an, 710038, China
| | - Jin Liu
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Military Medical University, Xi'an, 710038, China
| | - Xiaohong Wang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Tangdu Hospital, Air Force Military Medical University, Xi'an, 710038, China.
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Rehman R, Tariq S, Tariq S, Hashmi F, Baig M. Mid-luteal estradiol levels of poor/good responders and intracytoplasmic sperm injection. Pak J Med Sci 2017; 33:182-186. [PMID: 28367196 PMCID: PMC5368305 DOI: 10.12669/pjms.331.11692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective: To assess mid-luteal estradiol (E2) levels in poor and good responders and determine its effect on the outcome after intracytoplasmic sperm injection (ICSI). Methods: The current study was carried out in females who underwent ICSI from June 2011 to September 2013 in “Islamabad Clinic Serving Infertile Couples”. They were categorized into good and poor responders on the basis of female age ≤40 years, basal follicle stimulating hormone ≤12 mIU/ml, and antral follicle count >5, respectively. Their mid-luteal E2 measured on the day of embryo transfer was stratified into groups (A-E) on the basis of 20th, 40th, 60th and 80th percentile values. The outcome was categorized into non-pregnant with beta human chorionic Gonadotrophin (hCG) 5-25 m IU/ml, and clinical pregnancy with beta hCG>25 m IU/ml. Results: The conception rate was 12% (63/513) in poor responders and 72% (237/329) in good responders respectively. The mid-luteal E2 levels were higher in conception as compared to non-conception cycles (p<0.001) in good and poor responders. Conclusion: Maximum pregnancies in poor and good responders (53% and 98% respectively) with mid-luteal E2 levels above 80th percentiles confirm the role of the increase in mid-luteal E2 for augmentation in conception rate of females after ICSI.
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Affiliation(s)
- Rehana Rehman
- Dr. Rehana Rehman, MBBS, M.Phil, PhD Physiology, Aga Khan University, Karachi, Pakistan
| | - Sundus Tariq
- Dr. Sundus Tariq, MBBS, M.Phil. Assistant Professor of Physiology, University Medical & Dental College, Faisalabad, Pakistan
| | - Saba Tariq
- Dr. Saba Tariq, MBBS, M.Phil. Assistant Professor of Pharmacology & Therapeutics University Medical & Dental College, Faisalabad, Pakistan
| | - Faisal Hashmi
- Dr. Muhammad Faisal Hashmi, MBBS. Postgraduate Trainee, Services Hospital Lahore, Pakistan
| | - Mukhtiar Baig
- Dr. Mukhtiar Baig, MBBS, M.Phil, PhD. Professor of Clinical Biochemistry, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
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Jawed S, Rehman R, Ali MA, Abdullah UH, Gul H. Fertilization rate and its determinants in intracytoplasmic sperm injection. Pak J Med Sci 2016; 32:3-7. [PMID: 27022334 PMCID: PMC4795883 DOI: 10.12669/pjms.321.8329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To identify predictors of fertilization rate in patients of unexplained infertility after intracytoplasmic sperm injection (ICSI). Methods: Retrospective analysis of females (282) enrolled in quasi experimental design for ICSI at “Islamabad Clinic Serving Infertile Couples” was carried out from July 2013 till June 2014. Females with unexplained infertility were included, whereas well defined male and female causes of infertility were excluded. Fertilization rate (FR) was calculated as percentage transformation of micro injected oocytes into two pronuclei. Categorical variable of FR defined on the basis of 50% FR grouped females; Group I with FR ≤50% and Group II with FR >50%. The groups were compared in terms of demographic variables, base line hormones and oocyte parameters. Univariate logistic regression was executed to obtain odds ratio with 95% confidence interval to quantify the association of predictors like age, duration of infertility, oocytes parameters, hormones; Estradiol, progesterone, follicle stimulating hormone (FSH), luteinizing hormone, prolactin and cytokines interleukin-Iβ (IL-Iβ) with the FR. Results: In our study out of 282 females, 19 (6.73%) were in group I and 263 (93.26%) comprised of Group II. Females with high FR(group II) had low Progesterone and FSH (p=0.04, p=0.02) respectively. Mature oocytes (OR: 0.35; 95% CI 1 – 2.56) and IL-Iβ in follicular phase (OR: 1.04; 95% CI: 0.000- 1.20) were significant positive predictors of FR while peak progesterone and FSH had significant negative effect on it Conclusion: Fertilization of oocytes in females of unexplained infertility depended on maturity of oocytes and optimal amounts of ILI- β released by developing follicles in the follicular phase of stimulation cycles of ICSI.
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Affiliation(s)
- Shireen Jawed
- Dr. Shireen Jawed, M.Phil Physiology, Assistant Professor of Physiology, Islam Medical & Dental College, Sialkot, Pakistan
| | - Rehana Rehman
- Dr. Rehana Rehman, PhD Physiology, Assistant Professor of Physiology, Aga Khan University, Karachi, Pakistan
| | - Mohammad Ashfaq Ali
- Dr. Mohammad Ashfaq Ali, M.Phil Bio Chemistry, Assistant Professor, Liaquat National Medical College, Karachi, Pakistan
| | - Umme Hani Abdullah
- Umme Hani Abdullah, Medical student, Aga Khan University, Karachi, Pakistan
| | - Hina Gul
- Hina Gul, Senior Research Analyst, Prontolinks International (Pvt) Ltd, Lahore, Pakistan
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