[Comparison of intracytoplasmic sperm injection outcome of oligoasthenoteratozoospermic and azoospermic men]

Background: With introduction of intracytoplasmic sperm injection with testicular sperm extraction or precutaneouse epididymal sperm aspiration, effective treatment was provided for azoospermic men. The aim of present study was to compare clinical outcome following intracytoplasmic sperm injection using extracted testicular/epididymal sperm or ejaculated severe oligoasthenoteratozoospermic sperm

Methods: After retrospective evaluation of more than four hundred medical records of patients undergoing intracytoplasmic sperm injection Mehr medical institute [between 2011-2012], 45 cycles with severe eligoasthenoteratozoospermia and 34 cycles with azoospermia were included. Patients were treated with gonadotropin releasing hormone agonist. The clinical characteristics and intracytoplasmic sperm injection outcome such as the rate of fertilization, implantation and clinical pregnancy were compared between the two groups. Results were presented as mean +/- standard deviation and number [percent]

Differences between variables were analyzed using student's t test and the chi-square test was used to examine differences between categorical variables. P value less than 0.05 were considered as statistically significant

Results: Mean of female age [29+/-4.9 vs. 30.2+/-5.8], body mass index [26.9+/-5.3 vs. 26.9+/-3.8], estradiol level on human chorionic gonadotropin administration day [1375.6+/-843.9 vs. 1181.8+/-673.1], total number of retrieved oocytes [9.7+/-5.3 vs. 9.2+/-5.9] and metaphase II oocytes [7.7+/-5.1 vs. 7.5+/-5.4] were similar between the two groups. Of 436 and 313 retrieved oocytes, respectively 232 and 163 oocytes were fertilized in oligoasthenoteratozoospermic and azoospermic groups [53.2% vs. 52.1%, P=0.214]. There were not statistical differences between groups in number of transferred top quality embryos [1.5+/-1.2 vs. 1+/-1.2, P=0.09], implantation rate [22.7% vs. 16.9%, P=0.238] and clinical pregnancy rate [21 [47.7%] vs. 11 [35.4%], P=0.199]

Conclusion: Intracytoplasmic sperm injection with precutaneouse epididymal sperm aspiration and testicular sperm extraction are effective methods to treat azoospermic men and its clinical outcome were comparable to ejaculated sever oligoasthenoteratozoospermic cycles. It can be concluded that the influence of sperm quality and origin on intracytoplasmic sperm injection outcome are the same

[In vitro fertilization outcome in patients with polycystic ovary syndrome treated with GnRH analogue]

Polycystic ovarian syndrome [PCOS] is the most common endocrinological disorders that affect approximately 5-7% of women in reproductive age. There is not any consensus about the efficient in vitro fertilization [IVF] protocol for patients with PCOS. The aim of the present study was to compare the half and one-third dose depot gonadotropin-releasing hormone [GnRH] agonist protocols versus the GnRH antagonist protocol in PCOS patients. In the present study, we retrospectively evaluated 119 infertile women with PCOS. The patients entered in the study in accordance with Rotterdam criteria. According to GnRH analogue used for pituitary suppression, patients were divided into three groups: half and one-third dose depot GnRH agonist protocols and GnRH antagonist protocol. In GnRH agonist protocol, half or one-third dose depot Decapeptyl [1.875 mg, 1.25 mg] was injected on 21[st] day of previous cycle. In GnRH antagonist cycles, cetrotide 0.25 mg were administered daily when the leading follicles reached 14 mm. All basal and controlled ovarian hyperstimulation [COH] characteristics were analyzed. Basal characteristics including: age, FBS, prolactin, hirsutism, length of menstrual cycle were similar between 3 groups. Statically significant decreases in days of stimulation, number of gonadotrophin ampoules and metaphase two [MII] oocytes were found in GnRH antagonist protocol [P<0.001, P<0.001 and P=0.045], while the decrease in biochemical pregnancy [P=0.083] and live birth rate [P=0.169] wasn't significant. Number of embryos transferred were similar in the half and one-third dose depot GnRH agonist and GnRH antagonist cycles [P=0.881]. The incidence of OHSS weren't significantly different between 3 groups [5%, 4.9% and 12.8%, P=0.308]. Our study suggest that one-third dose depot GnRH agonist protocol could be a suitable choice for treatment of PCOS because of lower incidence of ovarian hyperstimulation syndrome [OHSS] as compared with half dose depot GnRH agonist and higher pregnancy rate as compared with GnRH antagonist.

[Anti-Mullerian hormone as a predictor of IVF treatment]

Anti-Mullerian Hormone [AMH] is secreted from granulosa cells of growing follicles and is a useful marker of ovarian reserve. Fertility in women is determined by the quality and quantity of follicle pool and ovarian follicular reserve positively correlates with AMH. In this study we aimed to determine if AMH can predict ovarian response in IVF treatments. In this retrospective observational study undertaken in Mehr Institute during 2010 to 2011, we studied the medical records of 101 patients and recorded the concentrations of AMH, day two or three FSH, LH, basal estradiol [E2], E2 on day of HCG administration and the number of metaphase II oocytes. Having undergone ovarian hyperstimulation, the women were divided into three groups: poor responders [retrieved oocytes /= 16]. Overall, 20% of patients were defined as poor responders, 71% as average responders and 10% as high responders. There were significant differences in the concentration of AMH, E2 on day of HCG administration, FSH, the number of metaphase II oocytes and age between the three groups. MII oocyte count correlated positively with AMH [r=0.487], basal E2 [r=0.275] and LH [r=0.07] but it did negatively with FSH [r=-0.26] and age [r=-0.04]. The areas under curve for AMH, FSH, LH, E2 and age were 0.799, 0.32, 0.429, 0.558 and 0.304, respectively. We determined the 0.85 ng/ml AMH concentration as the cut-off point with 71% specificity and 79% sensitivity for the prediction of poor responders. anti-mullerian hormone is an appropriate predicator of ovarian response following induction of ovulation

Vaginal sonography and hysteroscopy; comparison in infertility patients

Hysteroscopy is a valuable diagnostic and therapeutic modality in the management of infertility. To evaluate the consistency of hysteroscopy based on a histopathological report from endometrial specimens for intrauterine disorders. This is a cross-sectional study. The study included 115 infertile patients. All were admitted for investigation of infertile women before assisted reproduction in Mehr infertility institute between 2006 and 2007 hysteroscopy, and histological evaluation of endometrial biopsy performed.We compared the efficacy of hysteroscopy in the diagnosis of benign intrauterine pathology in infertile women in whom the diagnosis was confirmed by histological studies. The women had a complete evaluation with preoperative hysteroscopy, and histological analysis of uterine cavity specimens. Sensitivity and specificity, predictive were calculated for hysteroscopy considering the histological study as 100%. Sensitivity and specificity of sonography in diagnosing the polyp were stated 81% and 64% respectively. Sensitivity and specificity of hysteroscopy showed of polyps revealed 85% and 84% respectively. The results indicated that sensitivity and specificity of sonography in diagnosing the myoma were 25% and 98% respectively. Sensitivity and specificity of hysteroscopy in diagnosing the myoma were expressed 50% and 93% respectively. Hysteroscopy is a safe and rapid direct visualisation of the uterine cavity. We believe it should be replaced by the diagnostic hysteroscopy as a first line infertility investigation

Propofol vs. thiopental NA; pregnancy outcome and postoperative nausea and vomiting [PONV] in art cycle

The aim of this study was to compare the side effects, fertilization rate and pregnancy rate [PR] and duration of recovery between Propofol and Thiopental Na after ICSI-vaginal retrieval of oocyte in ART cycle. This study was a prospective, randomized clinical trial. Ninety eight ASA [American Society of Anesthesiologist] physical status I and II women participating in an intracytoplasmic sperm injection [ICSI] program were assessed. All of the patients underwent general anesthesia induction with Propofol and Thiopental Na. The first group [49 cycles] received 2-2.5mg/kg of Propofol, and the second group [49 cycles] received 5mg/kg Thiopental during transvaginal oocyte retrieval. An informed consent form was obtained for each patient's treatment. Variables under study included: female age, cause and duration of infertility postoperative nausea and vomiting [PONV], heamodynamic changes, mean number of oocyte retrieved, oocyte metaphase II, embryo cleaved, embryo transferred, embryo quality and pregnancy rate [PR] and duration recovery. Statistical analysis was carried out by using SPSS. 10 software and statistical test of T-test and chi-square. The PR in Propofol group was 18 [36.7%] and in Thiopental Na group was 19 [38.8%] with no significant differences the mean duration of infertility and weight weren't statistically significant. The mean number of oocyte retrieved [metaphase II], embryo cleaved, embryo transferred and embryo quality weren't significant between the two groups. The incidence of nausea in Propofol group in comparison with Thiopental Na group was lower with significant differences. The incidence of vomiting between two groups was statistically significant [46.9% vs. 28.6% respectively] [p<0.05] between two groups Duration of recovery in Propofol group was 15 +/- 3 min and in Thiopental Na group was 25 +/- 5 min that was statistically significant [P<0.05]. Propofol offered lowerincidence of post operative nausea and vomiting and a quick recovery from anesthesia without any adverse effect on pregnancy outcome. These findings showed that Propofol was a good alternative for Thiopental Na in short time operation, like ICSI -vaginal retrieval of oocytes

Administration of NTG before embryo transfer does not increase pregnancy rate

Recent studies of uterine contractility in IVF-embryo transfer led us to consider an alternative, and possibly complementary, explanation for the high implantation rates of blastocysts. It has been demonstrated that myometrial contractile activity influences embryo implantation, possibly through mechanical displacement of embryos. The aim of this study was to examine the effect of nitroglycerine [NTG] treatment for priming the uterus on the pregnancy outcome of ICSI-ET programs. This study was a prospective, randomized, double-blinded placebocontrolled clinical trial. One hundred consecutive cycles of ICSI-ET on infertile couples were randomly divided into treatment and control groups. The treatment group [50 cycles] received an oral dose of 0.4 mg of NTG, and the control group [50 cycles] received a placebo, 15 minutes before fresh ET. An informed consent from was obtained from each patients. The main outcomes were implantation rate [IR] and pregnancy rate [PR]. The mean age of females in the control group and in the treatment group were 30.1 +/- 5.1 and 31 +/- 5.5 years respectively. Data showed that the mean duration of infertility was not significantly different between control and treatment groups [6.6 +/- 5.8 versus 7.8 +/- 5.1 years, respectively]. The mean number of oocyte retrieval [metaphase II], 2pn, embryo cleaved, embryo transferred and PR weren't different between two Groups [p>0.05]. Overall PR was 36%, it was 38% in treatment group and 34% in control group but there wasn't statistically significant difference between two groups. [p>0.05] NTG didn't increase PR compared to placebo group. These results suggest that NTG treatment before ET isn't effective in the priming of a uterus