Progesterone therapy administered 24 hours before embryo transfer in ICSI cycle improves embryo implantation and pregnancy in women with Luteal Phase Defect

Ovulation induction by human menopausal gonadotrophin [HMG] results in temporal luteal phase defect. Luteal support therapies are required to support embryo implantation in stimulated cycle especially in luteal phase defect infertile women. The objective of the present study was to investigate the clinical significance of progesterone, aspirin and HCG on human embryo implantation in women with luteal phase defect following ICSI and embryo transfer [ET]. The female patients were divided into six groups depending on the type of the luteal support protocols [LSP]. Group 1 [No= 54], received 10 mg oral progesterone [P], group 2 [No= 35] received P plus HCG, group 3 [No= 59] received P plus HCG plus oral aspirin, group 4 [No= 47] received vaginal P administered 24 hours before embryo transfer plus oral aspirin, group 5 [No= 40] received vaginal P administered 12 hours after embryo transfer plus oral aspirin and group 6 [No= 46] received intramuscular P plus oral aspirin. The LSP were continued for at least 12 weeks, when the B-HCG test was positive, [tested two weeks after embryo transfer]. Statistical analysis of the clinical data showed no significant differences between the LSP in regard to patient's age, body mass index [B/M2], basal FSH/LH ratio and estradiol concentration at the day of HCG injection. The ICSI rate, percentages of embryos developed in vitro, and the numbers of the transferable quality embryos were similar in all groups [P>0.05]. The pregnancy rate was significantly higher [P < 0.05], in group 4 compared to other groups [38.66% versus 24.51%[G I], 22.53% [G 2], 28.66% [G 3], 25% [G 5], 21.60% [G 6]. The percentages of viable fetal sac development per patient were 31.49 [17/54] in G 1, 42.86 [15/35] in G 2, 49.16 [29/59] in G 3, 59.58 [28/47] in G 4, 32.50 [13/40] in G 5, and 34.79 [16/46] in G 6. The percent of viable gestation sac was significantly higher in group 4 compared to other groups [P < 0.05]. The administration of 400 mg /day vaginal progesterone 24 hours before ET and 100 mg/day aspirin five days after ET results in significant improvements in pregnancy and embryo implantation rates and development of viable fetuses in luteal phase defect infertile women undergoing ICSI-ET

clinical significance of luteal support therapy in the stimulate cycle following the transfer of superovulated embryos

Ovulation induction by gonadotropin in in-vitro fertilization [IVF] program results in luteal phase defect [LPD]. Luteal support therapies are considered to be important treatment to support the implantation of transferred superovulated and IVF embryos. The objective of the study was to investigate the effect luteal support protocols [LSP] on embryo implantation of 2-cell, 4-cell, and 8-cell and morulae following superovulation and embryo transfer as an animal model for human embryo transfer. Mature healthy hamsters were superovulated by human menopausal gonadotropin [hMG] and human chorionic gonadotropin [HCG]. Embryo transfer was performed on day 6 of the cycle. The LSP consisted of 0.04 mg progesterone [P]/day, injected intramuscularly [LM, protocol one] and 0.04 mg P plus 2.5 international units [I. U.] hCG/72 hours [Protocol two] and 0.04 mg P plus 2.5 IV plus 0.20 mg/ day intraperitoneal injection of aspirin. All the luteal support protocols started from day 5 to day 16 of the cycle. The animals were divided in to a control and treated groups. The control and treated groups were subdivided into subgroups according to embryo developmental stages [2-cell, 4-cell, 8-cell and morulae]. Superovulation [SO] caused a significant [P<0.01] increase in the number of morphologically abnormal embryos compared to the control group. The implantation rates of the SO embryos were significantly [P<0.05] decreased compared to the control group. The implantation rates of the 8-cell and morula embryos of the SO group were significantly higher than the 1-cell and 2-cell embryos in protocol's one, two and three. Significantly higher implantation rates of all the embryo stages were observed in protocol three compared to protocols two and one. It was concluded from the results of the study that SO markedly affected luteal function of the corpus luteum and reduced embryo implantation. Luteal support protocols particularly supplementation of progesterone with HCG and aspirin resulted in significant improvements in the implantation of 2-cell, 4-cell, 8-cell and morula embryos

Women age and embryo implantation following intracytoplasmic spermlnjection and embryo transfer in infertile patients

The most common cause of reduction in human embryo implantation afterin vitro fertilization and embryo transfer [IVF-ET] is the female age. The increase in the age of women results in reduction in the performance of the reproductive function. The aim of the present work was to determine the effect of age of women on intracytoplasmic sperm injection, in vitro embryo cleavage, embryo transfer rate, embryo implantation and pregnancy rates following intracytoplamic sperm injection and embryo transfer [ICSI-ET]. The male patients had asthenospermia with mean sperm motility of 17.15% and the mean sperm motility index was 31.21. The female patients were divided into three groups, group one, 145 women with age <31 years, group two, 129 women with age group from 31-40 years and group three, 49 women with age >40 years. The ovulation induction was induced by human menopausal gonadotropin [hMG] and human chorionic gonadotropin [hCG]. The baseline ofFSHand LH levels on cycle day 3 were significantly increased [P<0.05] in group 3 versus group 1 and 2. The estradiol concentration and the number of dominant follicles and thickness of endometrium were significantly decreased in group 3 compared to group 1 and 2 [P<0.01]. The number of the hMG ampoules was significantly [P< 0.01] higher in group 3 compared to group 1 and 2. The number of the matured oocytes per patient was significantly lower in group 3 compared to group I and 2 [P<0.05]. The ICSI rate was significantly higher in group I compared to group 2 and 3 [86.01% versus 79.07% and 75.68%, P<0.005]. Similar observations were reported in regard to embryo developmental rate and the number of embryo transferred per patient [P<0.05]. The differences between group 2 and 3 in regard to the number of embryo transferred per patient were also statistically significant. The percentage of transferable embryo quality was significantly higher in group I compared to group 2 and 3 P<0.05] and between group 2 and 3 [P<0.025]. The pregnancy rate per patient was significantly reduced in group 3 compared to group I [P<0.05]. The percentage of fetal sac development per implanted embryo was significantly reduced in group 3 compared to group 1 and 2 [25% versus 66.67%, 64.52%]. The percentage of fetal sac development per patient was significantly reduced in group three [>40 years] compared to group one [< 31 years] and group two [31-40 years]. It was concluded from the results of the present study that the advancing age of woman [more than 40 years] adversely affects ICSI, embryo transfer, embryo cleavage rates in addition to pregnancy rate. It also reduces embryo implantation and the development of viable gestation sac in the pregnant women. These effects may involve alterations in the function of the endometrium as well as the quality of the oocytes in aged women