effect of bromocriptine-rebound method on ongoing pregnancy and live birth after intracytoplasmic sperm injection cycles: a randomized clinical trial

To assess whether bromocriptine-rebound method [BRM] can improve pregnancy outcomes compared to long protocol after intracytoplasmic sperm injection cycles [ICSIs]. A total of 114 women underwent ICSI. Pregnancy outcomes and hormonal data were compared between two groups, i.e. long protocol and BRM. Ovulatory women with normal serum prolactin levels were assigned to either BRM [n = 57 cycles] or long protocol [n = 57 cycles]. Both procedures were carried out in a similar way. However, a group of patients were given bromocriptine daily from the 4[th] day of the preceding cycle until 7 days before gonadotropin stimulation. There were no significant differences in the numbers of developed follicles, total retrieval oocytes, transferred embryo and embryos with superior morphology between the two groups. Also, the values of chemical, clinical and ongoing pregnancies and live births were not significantly different [36.8%, 35.1%, 28.1%, 28.1% in BRM group and 43.9%, 38.6%, 21.1% and 19.3% in long protocol, respectively]. Ongoing pregnancy and live birth were significantly higher in chemical pregnancy in the BRM group [P = .04 and P = .035, respectively]. This prospective study demonstrated that BRM might lead to higher ongoing pregnancy and live birth rates compared to the long protocol in women undergoing intracytoplasmic sperm injection cycles

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

effectiveness of cabergoline for the prevention of ovarian hyperstimulation syndrome

Type 2 receptors for vascular endothelial growth factor are believed to be involved in the pathophysiology of ovarian hyper-stimulation syndrome [OHSS]. The objective of this study was to examine the preventive effects of cabergoline on OHSS and its complications. The study is a non randomized clinical trial conducted in 2006-2008 on 75 patients, which were at risk of OHSS and underwent assisted reproductive techniques. The diagnosis and severity of OHSS were determined using standard criteria. The study included an intervention and a control group. The intervention group comprised of 50 women at risk of OHSS, who were treated with cabergoline [1mg every other day for 8 days] commencing from the day of ovum pick up. The control group comprised of 35 historical cases, which were similar to the case group. The latter group did not receive cabergoline, and their OHSS, if occurred, were managed conservatively after hospital admission. The rates of OHSS, baseline characteristics, ovarian stimulation parameters, and pregnancy occurrence were compared. There was no significant difference between baseline characteristics or ovarian stimulation parameters from the two groups. The incidence of OHSS in the cabergoline-treated group, was significant [P=0.01] lower than that in the control group [12% vs 36%]. Embryo freezing was significantly [P=0.001] lower in the cabergoline group. The findings of the study indicate that cabergoline reduces the incidence of OHSS, and is not associated with adverse effects on pregnancy

Relationship between anti-mullerian hormone and assisted reproductive technique outcome in patients with polycystic ovary syndrome

Anti-mullerian hormone [AMH] levels may represent the ovarian follicular pool and could be a useful marker of ovarian reserve. The clinical application of AMH measurement has been proposed in the prediction of quantitative and qualitative aspects in assisted reproductive technologies. This study aimed to assess the relationship between the serum levels of AMH and results of assisted reproductive technique [ART] outcome in polycystic ovary syndrome [PCOS] patients versus control group. This cohort study was conducted on 61 [PCOS] patients and 28 patients without PCOS [controls] candidates for assisted reproductive technique. Serum levels of AMH were measured on the 3[rd] day of menstrual cycle and all the patients underwent controlled ovarian hyper stimulation and ART. The relationship between AMH serum level with retrieved oocytes, mature oocytes and pregnancy rate were assessed. There was significant correlation between the AMH level with number of total retrieved oocytes and mature oocytes in patients with PCOS and controls [p=0.001]. In PCOS and control groups AMH level in pregnant patients was higher, but it was not statically significant [p=0.65, p=0.46, respectively]. The major outcome of the study [pregnancy] did not differ significantly between two groups. This study revealed that AMH level was higher in pregnant patients undergoing ART; but AMH may not be an accurate predictor for pregnancy in PCOS patients