Investigation of anti-mullerian hormone [AMH] level and ovarian response in infertile women with endometriosis in IVF cycles

Background: endometriosis, can cause ovarian conflict and reduced ovarian reserve that could lead to lower response to assisted reproductive techniques

Objective: current study was conducted to determine the association between level of anti-mullerian hormone [AMH] and the infertility treatment outcomes in infertile females with endometriosis versus the non-endometriosis infertile subject

Materials and Methods: in this case-control study, 64 infertile females who referred to Shariati Hospital from April 2015 to November 2017 were enrolled. They were divided in two groups of 32 patients [endometriosis and non-endometriosis women]. The anti-mullerian hormone level among all subjects was determined, treatment outcomes were evaluated and association between these factors was assessed

Results: it was seen that the anti-mullerian hormone [p=0.06], the number of retrieved oocytes [p=0.7] and embryos [p=0.7], implantation rate [p=0.6] and clinical pregnancy rate [p=0.9] were similar between two groups. In patients with stage 3 or 4 endometriosis who had lower serum AMH level significantly [p=0.001] less oocytes were retrieved [p=0.001] and less transferrable embryos [p=0.03] were achieved. However, implantation and pregnancy rates did not differ [p=0.7] [p=0.6]

Conclusion: totally, according to the obtained results, it may be concluded that ovarian reserve has more significant role in predicting infertility treatment outcome rather than receptive endometrium

Can letrozole plus HMG protocol improve pregnancy outcomes in frozen-thawed embryo transfer? an RCT

Background: There are different methods in endometrial preparation for frozen-thawed embryo transfer [FET]

Objective: The purpose of this study was to compare the live birth rate in the artificial FET protocol [estradiol/ progesterone with GnRH-agonist] with stimulated cycle FET protocol [letrozole plus HMG]

Materials and Methods: This randomized clinical trial included 100 women [18-42 years] randomly assigned to two groups based on Bernoulli distribution. Group I received GnRH agonist [Bucerelin, 500 micro g subcutaneously] from the previous midlutea lcycle, Then estradiol valerat [2 mg/ daily orally] was started on the second day and was increased until the observation of 8mm endometrial thickness. Finally progesterone [Cyclogest, 800 mg, vaginally] was started. Group II received letrozole on the second day of the cycle for five days, then HMG 75 IU was injected on the7P[th] day. After observing [18 mm folliclhCG10000 IU was injected for ovulation induction. Trans cervical embryo transfer was performed in two groups. The main outcome was the live birth rate. The rate of live birth, implantation, chemical, and clinical pregnancy, abortion, cancellation and endometrial thickness were compared between two groups

Results: Implantation rate was significantly higher in group I. Live birth rate was slightly increased in group I without significant difference [30% vs. 26%]. The rate of chemical and clinical pregnancy was similar in two groups. The abortion rate was lower in letrozole protocol but the difference was not statistically significant. The mean endometrial thickness was not different between two groups

Conclusion: Letrozole plus HMG method cannot improve pregnancy outcomes in frozen-thawed embryo transfer but it has only one injection compare to daily injections in artificial method

Low-dose hCG as trigger day and 35 hr later have different ovarian hyperstimulation syndrome occurrence in females undergoing In vitro fertilization: an RCT

Background: ovarian hyperstimulation syndrome [OHSS] is an iatrogenic complication, which can cause high morbidity and mortality. Use of gonadotropin releasing hormone [GnRH] agonist instead of human chorionic gonadotropin [hCG] in GnRH antagonist cycles causes luteinizing hormone surge by GnRH stimulation which reduces the risk of OHSS by reducing the total amount of gonadotropin; however, there is no possibility of transferring fresh embryos

Objective: the current study aimed to evaluate the effect of hCG along with GnRH agonist administration in the occurrence of OHSS and pregnancy rate in females undergoing in vitro fertilization

Materials and Methods: the current randomized clinical trial was conducted on 80 cases in 2 groups. Gonal-F was used to stimulate the oocyte from the second day of menstruation. When follicle size was 12-14 mm, GnRH antagonist was added to the protocol till the detection of more than two follicles greater than 18 mm. Then, GnRH agonist was added to the protocol as a trigger. In group A, 35 hr after the administration of GnRH agonist, the low-dose human hCG, 1500 IU, was used. In group B, low-dose hCG, 1500 IU, was used at the same time by GnRH agonist administration. The rate of pregnancy, OHSS, and its severity were compared between 2 groups within 2 wk

Results: there was no significant difference regarding chemical and clinical pregnancies between the 2 groups. Severe OHSS was significantly higher in group B [p= 0.03]

Conclusion: administration of hCG 35 hr after GnRH agonist administration results in lower rate of severe OHSS

In vitro fertilization outcome in frozen versus fresh embryo transfer in women with elevated progesterone level on the day of HCG injection: an RCT

Background: the effect of elevated progesterone level on human chorionic gonadotropin [HCG] day in in vitro fertilization cycles is controversial. Some suppose that rise in progesterone level seems to have a negative impact on implantation and pregnancy by desynchronizing the endometrium, while others disagree

Objective: to evaluate the superiority of the frozen cycle over fresh cycle on live birth in patients with elevated progesterone level on HCG day

Materials and Methods: in this double-blind, randomized clinical trial, 72 women undergoing assisted reproductive technology with elevated progesterone level [>/=1.8 ng/dl] on HCG day were included. The participants were grouped by fresh versus frozen embryo transfer, randomly. Finally, the clinical pregnancy and live birth rate were compared

Results: the implantation rate was 21.51%. The clinical pregnancy rate was 47.22% in fresh embryo transfer group [17/36] and 41.66% in frozen group [15/36] [p=0. 40]. The live birth rate was not significantly difference between two groups [p=0.56]

Conclusion: None of the fresh and frozen cycles are superior to the other and we recommend individualizing the decision for each patient. The frozen cycle may impose more emotional stress on patients

Recurrent IVF failure and hereditary thrombophilia

The largest percentage of failed invitro fertilization [IVF] cycles, are due to lack of implantation. As hereditary thrombophilia can cause in placentation failure, it may have a role in recurrent IVF failure. Aim of this case-control study was to determine whether hereditary thrombophilia is more prevalent in women with recurrent IVF failures. Case group comprised 96 infertile women, with a history of recurrent IVF failure. Control group was comprised of 95 healthy women with proven fertility who had conceived spontaneously. All participants were assessed for the presence of inherited thrombophilias including: factor V Leiden, methilen tetrahydrofolate reductase [MTHFR] mutation, prothrombin mutation, homocystein level, protein S and C deficiency, antithrombin III [AT-III] deficiency and plasminogen activator inhibitor-1 [PAI-1] mutation. Presence of thrombophilia was compared between groups. Having at least one thrombophilia known as a risk factor for recurrent IVF failure [95% CI=1.74-5.70, OR=3.15, p=0.00]. Mutation of factor V Leiden [95% CI=1.26-10.27, OR=3.06, P=0.01] and homozygote form of MTHFR mutation [95% CI=1.55-97.86, OR=12.33, p=0.05] were also risk factors for recurrent IVF failure. However, we could not find significant difference in other inherited thrombophilia's. Inherited thrombophilia is more prevalent in women with recurrent IVF failure compared with healthy women. Having at least one thrombophilia, mutation of factor V Leiden and homozygote form of MTHFR mutation were risk factors for recurrent IVF failure

Evaluation of plasma creatine phosphokinase [CPK] level following a single injection of methotrexate as a predicates of treatment success in ectopic pregnancy

Objective: To evaluate the plasma creatine phosphokinase [CPK] level after a single Injection of methotrexate [MIX] as a predictor of treatment success in ectopic pregnancy [EP]. Materials and methods: In this prospective study, seventy nine women older than 18 years treated with methotrexate for ectopic pregnancy were evaluated for CPK and p-subunit of human chorionic gonadotropin [3hCG] levels, while they received intramuscular MIX at a dose of 50 mg/m2. The day of injection was considered as day 1 [Dl]. CPK level on Dl was compared between the group l [as treatment success group], treated by a single MIX injection, and the group 2, treated by two or three MIX injections or by surgery

Results: The success rate of MIX treatment was 58 [73.3%]. The mean of CPK was higher in treatment success group [groupl] than failure group [group 2] [71.98 +/- 15.711 vs. 64.43 +/- 15.898], but the difference was not significant [p=0.06].The mean of phCG was significantly lower in treatment success group [group 1] than failure group [group 2] [1187.52+/-631.45 vs. 1663.87+/-1096.845; p=0.01]. Ultrasonographic findings of EP were seen in 63 patients, while the means of 3HCG and CPK were higher in these patients than those with normal ultrasonography, but difference was not significant [p=0.37 and p=0.24, respectively]

Conclusion: The sample was not large enough to indicate a significant difference in the CPK level, which can be considered as an indicator for differentiating between the successful and unsuccessful treatment groups. Moreover, the present study did not show any relation between initial 3-hCG and CPK serum levels, so our findings indicate that they are not possibly considered as two independent biomarkers in ectopic pregnancy

Prediction of assisted reproductive technique outcome in elevated early follicular phase follicle stimulating hormone with Mullerian inhibiting substance level

Detection of best predictor of ovarian reserve in patients with temporarily or consistently elevated early follicular phase serum levels of FSH is one of the most important goals in assisted reproductive technique [ART]. To evaluate whether high level of anti-mullerian hormone level is related to success of ART in patients with temporarily or consistently elevated early follicular phase serum levels of FSH. Sixty three women underwent intracytoplasmic sperm injection [ICSI] with GnRH-agonist long protocol or intrauterine insemination [IUI] in a prospective cohort study. FSH, inhibin B and anti-Mullerian hormone [AMH] levels were measured in these women whom were divided to three groups [persistently elevated FSH, variably elevated FSH and, normal FSH level]. Basal characteristics, stimulation parameters, and pregnancy occurrence were evaluated. AMH was significantly higher in women with persistently elevated early follicular phase FSH achieving pregnancy. Women with normal FSH did not have significant difference in AMH level between conceived and non conceived cycles. Women with only one elevated early follicular phase FSH achieving pregnancy did not have significant difference in AMH level with non pregnant women. Response to gonadotropin stimulation, recommendation to oocyte donation significantly differed between the groups. This study has demonstrated that relatively young women with persistently or intermittently elevated day 3 FSH levels have diminished ovarian reserve and lower ART success. However, in women whose FSH levels were constantly elevated, AMH [not inhibin B] concentrations were significantly higher in ART cycles resulting in pregnancy. Therefore, AMH level is a good predictor of ART outcome in patients with elevated early follicular phase serum levels of FSH

effect of exercise in PCOS women who exercise regularly

To determine the prevalence of polycystic ovary syndrome [PCOS] in women who exercise regularly. All women under age 45 from an industrial company who had past history of exercising more than 6 months enrolled in this cross-sectional study. Prevalence of PCOS and comparison of BMI between PCOS and non-PCOS subgroups was done. The diagnosis of PCOS was based on the revised 2003 Rotterdam ESHRE/ASRM consensus criteria and exclusion of related disorders. The prevalence of PCOS in was 8.8%; 95% CI; 8.5%- 9.1%. In obese subjects, mean BMI differed significantly between PCOS and non-PCOS women [29.3 +/- 3.3 kg/m[2] vs. 27.8 +/- 2 kg/m[2], P=0.03]. In lean subjects, there was no statistically significant difference in terms of BMI between PCOS and non-PCOS women [21.4 +/- 1.9 kg/m[2] vs. 21.2 +/- 2 kg/ m[2], P>0.05]. Obese PCOS patients show more difficulty in losing weight by exercise than lean PCOS patients. The role of hormonal alterations and PCOS per se in the responsiveness of weight loss to exercise remains to be determined

Outcome of newborns conceived through artificial reproductive techniques in Tehran Iran

Today there is a rise in the number of newborns conceived by artificial reproductive techniques [ART]. Numerous studies have been performed on the perinatal outcome of these pregnancies. However, there is limited data about the condition of health of these newborns in Iran. Regarding the higher prevalence of probable complications and symptomatic congenital anomalies, we aimed to determine the state of health of newborns born by ART. A total of 109 newborn who were conceived through ART and 479 newborns of spontaneous conception were enrolled into our study. The study was prospective, case-control study in Tehran, Iran, from March 2003 to March 2004. Both case and control groups were adjusted in regard to race, sex, type of delivery, chronic disease of mother, age of mother, and antenatal steroids administration. All newborns were examined by neonatologist after birth and their outcome were followed until hospital discharge or death. Data pertaining to clinical and laboratory findings of newborns and death were entered into a questionnaire and subsequently analyzed by appropriate statistical tests. Confidence interval was 95%. Prematurity, low birth weight [LBW], very low birth weight [VLBW], twins and triplets, small for gestational age [SGA], need for resuscitation at birth, respiratory distress syndrome [RDS] and NICU admission were significantly higher among newborns born after ART than those born through spontaneous conception [p<0.05]. Regression logistic analysis showed that RDS and NICU admission were more strongly associated with weight at birth and gestational age than with method of conception. However, increased rate of SGA in the case group was associated with multiple pregnancy. Also, there was no significant statistical relationship between the method of conception and the prevalence of congenital anomalies, large for gestational age [LGA], congenital pneumonia, necrotizing entrocolitis [NEC], respiratory air leakage syndromes [ALS], hydrops fetalis, hyperbilirubinemia sepsis, meconium aspiration syndrome [MAS], isseminated intravascular coagulopathy [DIC], cardiac failure, lung hemorrhage, hypoglycemia, hypocalcemia, neutropenia, thrombocytopenia and hemolysis. Newborns who were conceived by ART were more likely in need of resuscitation at birth regardless of other factors. Furthermore, newborns born after ART were at higher risk of developing prematur birth, LBW, and multiple birth