[Effect of cervical mucus aspiration with insulin syringe on pregnancy rate in ART cycles]

A huge number of inefficient embryo implantation caused by embryo transfertechniques. Cervical mucus aspiration is the most important factor in successful embryo transfer.Based on reports pregnancy rate in woman with positive culture of cervical mucus is lower thanwomen with negative culture. Mucus plague on the catheter tip can cause improper embryoimplantation. This study evaluated the effect of cervical mucus aspiration on embryo transferresults.A Randomized Clinical trial study was performed on 340 women [in twogroups] by cycles of ART [Assisted reproductive technology] such as IVF [In vitro Fertilization] orICSI [Intra cytoplasmic sperm injection] referred to the Research and Clinical Center of Infertilityand Madar Hospital of Yazd. Male's and female's age, duration and cause of infertility were machedin two groups. The long time protocol was used for induction of the ovaries. In 170 patients, cervical mucus aspiration was done with insulin syringe [A or case group]. In the control group orgroup B [170 women], cervical mucus was aspirated only with cotton swabe. The patients werefollowed up by beta-HCG serum level measurement on the day 14 after embryo transfer. The datawere analyzed by Chi-square and t-test.Mean of men's age in group A was 35.26 +/- 5.2 years and in group B was 35.13 +/- 5.4 years.Mean of women's age in group A was 29.8 +/- 5.3 years and in group B was 30.2 +/- 5.4 years. Mean ofinfertility duration was 8.6 +/- 4.6 years in both groups. Mean of follicle number, oocytes number, embryos number, cause of infertility and IVF/ICSI method in both groups were similar and therewas no significant difference. Pregnancy rate in group A, was more than group B, [26.9% Vs19.2%], but was not statistically significant.Cervical mucus aspiration with insulin syringe before embryo transfer can increase thepregnancy rate. This has confirmed by other studies, so it seems that cervical mucus aspirationbefore embryo transfer is useful

[Comparison of progesterone administration before and after embryo transfer in ART cycles]

Nowadays the wide spread use of GnRH agonists in ART protocols has emerged the need for luteal phase support by progesterone. However the time of starting progesterone administration is still obscure, some investigators recommend the day of oocyte retrieval and the others later. The present study was designed to investigate the effect of the progesterone administration timing before or after embryo transfer on the outcome of ART. A randomized clinical trial was designed to study a total of 575 women referred to Shahid Sadooghi University of Medical Sciences and Yazd Madar Hospital, undergone ART treatment. Using long GnRH-a protocol, the patients were randomly divided into two groups. Progesterone administration was started on oocyte retrieval day in the first group [n= 307], versus after embryo transfer in the second group [n=268]. Pregnancy rate were analyzed using statistical trials including x[2] and T. Regarding the age of couples, the duration and etiology of infertility, the number of follicles, retrieved oocytes and zygotes [3.0 +/- 1.4 in first group versus 2.8 +/- 1.4 in second group] no statistically significant difference was observed. The outcome, defined as a positive pregnancy test was not different in two groups. Considering the results and the disturbances following intramuscular injection of progesterone including the risk of bleeding, the administration of progesterone after embryo transfer is recommended

[ Study of Complications in 1120 Cases of Transvaginal Ultrasound - guided Oocyte Pick-up in IVF Centre of Yazd]

To determine the prevalence of oocyte pick up complications in 1120 cycles of IVF. In this prospective study 1120 pationts that were reffered to infertility clinics for IVF were enrolled. The patients with the infertility following COH by regimens of CC + hMG/hCG, hMG/hCG, hMG + GnRH-a/hCG were punctured by transvaginal sonography, preformed after injection of sedatives. The follicular aspiration was performed only by vaginal preparation with sterile distilled water .The patients were discharged in an hour. Vaginal bleeding was observed in 190 cases [17%], who were not severe and treated with vaginal pack and discharged after 2 hours after exit the vaginal pack. 15 patients [1.3%] with severe abdominal pain were hospitalized for 24 hours, one with hypovolemic signs was operated by laparoscopy and ruptured ovary was cauterized. 3 cases [0.35%] with fever, chills and abdominal pain managed with diagnosis of PID. One patient with history of 2 previous laparatomy before IVF cycle, didn't respond to medical treatment and after further investigation pararectal abscess diagnosed which was managed surgically. Considering the number of patients, transvaginal follicular puncture is a safe procedure in oocyte retrieval.In patients with history of PID, previous surgery and endometrioma prophylactic antibiotic was given at the time of oocyte puncture

[Does intracytoplasmic sperm injection overcome the reduce of fertilization rate by increasing maternal age?]

The aim of this study was to determine the effects of maternal age in fertilization rate of intracytoplasmic sperm injection comparison with IVF. In this prospective clinical trial study, 200 couples with male subinfertility that referred to infertility clinic were enrolled. Couples were selected on the basis of semen parameters and divided randomly into two groups of IVF and ICSI. Couples were divided into different subgroups based on age of females .The fertilization rate of every subgroups were assessed and compared together. Results were analyzed by Chi-square method. After induction ovulation with standard protocols, 525 oocytes were retrieved during egg collection in ICSI groups versus 474 in IVF. After selection of good quality oocytes, IVF and ICSI was done as routine .The fertilization rate of every age group was measured and compared with age increased. In IVF group, the fertilization rate was 41.3% in patients <35 years versus 26.7% in older than 35 years old .The mean fertilization rate was 89.3% in patients <35 comparison with 75.2% in women >35 years old by ICSI .On the other hand, the mean cleavage rate of IVF cycles was significantly lower in patients >35 years in IVF [49.5%] versus younger patients [P value<0.001] but this finding was not observed by ICSI [85.17% VS 85.15%].Reduction of fertilization rate with increase of female age was statistically meaningful [P value <0.001] in IVF and ICSI. These findings suggest that fertilization of oocyte reduce consequently with maternal age increased, therefore, ICSI can not overcome this problem their cause is not clear and may refer to chromosomal or structural abnormality in oocytes