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OBJECTIVE: Optimizing in vitro maturation (IVM) media to achieve better outcomes has been a matter of interest in recent years. The aim of this prospective clinical trial was to investigate the effects of different media on the IVM outcomes of immature oocytes at the germinal vesicle (GV) stage. METHODS: A total of 400 immature oocytes at the GV stage with normal morphology were retrieved from 320 infertile women aged 31±4.63 years during stimulated intracytoplasmic sperm injection (ICSI) cycles. They were divided into groups of homemade IVM medium (I, n=100), cleavage medium (II, n=100), blastocyst medium (III, n=100), and Sage IVM medium (IV, n=100) and cultured for 24 to 48 hours at 37℃. ICSI was performed, and the rates of fertilization and embryo formation were compared across the four groups. RESULTS: In the 400 retrieved GV oocytes, the total maturation rates showed significant differences in groups I to IV (55%, 53%, 78%, and 68%, respectively, p<0.001). However, there were no significant differences in the fertilization, embryo formation, or arrest rates of metaphase II oocytes across these groups. In all groups, GV maturation was mostly completed after 24 hours, with fewer oocytes requiring 48 hours to mature (p<0.01). Moreover, the rate of high-quality embryos was higher in group IV than in the other groups (p=0.01). CONCLUSION: The quality of the IVM medium was found to affect clinical IVM outcomes. Additionally, blastocyst medium may be a good choice in IVM/ICSI cycles as an alternative IVM medium.
Subject(s)
Female , Humans , Blastocyst , Embryonic Structures , Fertilization , In Vitro Techniques , Metaphase , Oocytes , Prospective Studies , Sperm Injections, IntracytoplasmicABSTRACT
Background: Ovarian hyperstimulation syndrome [OHSS] is one of the most important complications of assisted reproduction treatment. Many substances are involved in the regulation of the vascular permeability, which have been concerned to cause OHSS. Vascular endothelial growth factor [VEGF] has emerged as one of the main angiogenic factors, which could be responsible for increased vascular permeability
Objective: In this study the association of vascular endothelial growth factor -460C/T and +405 G/C polymorphisms and susceptibility to ovarian hyperstimulation syndrome was evaluated
Materials and Methods: In this cross sectional study, VEGF gene polymorphisms were amplified by Polymerase chain reaction- Restriction Fragment Length Polymorphism in 75 women with established OHSS [case group] and 85 normoresponder [control group] which received conventional ovarian stimulation regimen
Results: There was no significant difference in the frequency of -460 C/T polymorphism between cases and controls [p=0.85]. The frequency of +405 G/C polymorphism was significantly higher in the OHSS women [p=0.03, OR=2.44; 95% CI=1.23-4.82]
Conclusion: In women who developed OHSS, VEGF gene polymorphism +405 could be effective. Two of the polymorphisms -460 C/T and +405 G/C were reported to be associated with increased VEGF basal promoter activity. However, only +405 G/C gene polymorphisms were more frequent in cases than controls
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Objectives: Intra-Uterine Insemination [IUI] is one of the methods for infertility treatments. The size of the follicles and endometrial thickness are two important factors in pregnancy rate of patients undergoing controlled ovarian stimulation and intrauterine insemination cycles [COH-IUI]. The aim of this study was to investigate the success rate of IUI and follicular size and other associated factors in infertile couples
Materials and Methods: The study group was the patients who were undergoing COH-IUI. BMI of all women recorded and ovulation induction was propelled and when there was appropriate endometrial thickness and at least one dominant follicle in trans-vaginal ultrasonography. 36 hours after HCG injection, IUI was performed. Then pregnancy rate between patients who had follicle size fewer than 20 mm and higher than 20 mm was assumed
Results: 159 cases of IUI were performed and pregnancy happened in 22[14.1 %]. In non-pregnant group [134 cases], 78 cases had under 20 mm follicles and 47 cases had higher than 20 mm follicles. In pregnant group [22 cases] 10 cases had fewer than 20 mm follicles and 12 cases had higher than 20 mm follicles in the time of HCG injection. Endometrial thickness was 8.01+/-1.42 mm in patients with follicles more than 20 mm
Conclusion: The success rate in controlled ovarian stimulation and intrauterine insemination cycles closely related to obtaining of optimal size of follicles and endometrial thickness
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Objectives: Rate of infertility in overall is around 15-10%. Intra-Uterine Insemination [IUI] is one procedure for infertility treatment. Luteal phase support defect is a main factor in fail of pregnancy. Goal of this study was to evaluate the effect of luteal phase support with progesterone suppository in patients who undergoing IUI cycles
Materials and Methods: 100 infertile couples who were undergoing IUI treatment included in this study. Ovulation induction was done for all patients. When IUI was done, patients were distributed into two groups. The study group [n=50] received progesterone suppository and control group [n=50] doesn't received any medicine. Then biochemical pregnancy rate, clinical pregnancy rate and abortion rate compared between two study groups
Results: There were no differences in basic characteristics between two groups. Biochemical and clinical pregnancy were parallel in the study and control groups. There were no statistically significant increases in abortion rate between the study groups [P=0.49]
Conclusion: Luteal phase support by progesterone suppository does not improve the pregnancy rate of stimulated IUI cycles
ABSTRACT
Background: Implantation is one of the essential steps for the success of assisted reproductive techniques [ART]. Their success depends on three main factors: embryo quality, endometrial receptivity [ER], and synchrony between embryo and endometrium
There are various factors that regulate the complex process of implantation. In this regard, one may refer to human chorionic gonadotropin [hCG] as the most important factor
Objective: This study aims to investigate the effect of intrauterine hCG injection before embryo transfer [ET] on pregnancy outcome in infertile couples
Materials and Methods: A total of 159 patients undergone In vitro Fertilization/ Intracytoplasmic Sperm Injection [IVF/ICSI] with an antagonist protocol were evaluated. Patients were divided into three groups [n=53]. Group 1 received 500 IU of hCG, group 2 received 1000 IU of hCG intrauterine injection before ET, and the control group underwent ET without hCG preceding intrauterine injection
Results: There was no significant difference among the groups. The implantation rates were 18.86%, 13.52%, and 14.37%, chemical pregnancy rates were 34%, 32.1%, and 35.3%, and clinical pregnancy rates were 34%, 32.1%, and 31.4% respectively
Conclusion: The pregnancy outcome in IVF/ICSI /ET cycles cannot be improved through hCG intrauterine injections before ET
ABSTRACT
Polycystic ovary syndrome [PCOS] is a multifactorial, metabolic disorder. Characteristics are chronic anovulation, polycystic ovaries and hyperandrogenism. The aim of this study was to determine the effect of omega-3 supplementation on visfatin, adiponectin, and anthropometric indices in PCOS women. The study was a randomized double blind placebo-controlled clinical trial. It was conducted on 84 women with polycystic ovary syndrome [26.92 +/- 5.05 years, BMI=31.69 Kg/m[2]] who referred to the fertility and infertility research center and Shahid Sadoughi hospital in Yazd. After the examination, evaluation and paramedical assessment by obstetrician, they were recruited. They took 3 capsules of omega-3 [each one contained 180 mg EPA and 120 mg DHA] or placebo [each contained 1 g paraffin] daily for 8 weeks. Statistical analysis was paired T-test and student T-test, and a p<0.05 was considered statistically significant. After the intervention, visfatin concentration did not change in neither groups. But, at the end of the study, the mean of adiponectin concentration increased [p<0.001] in omega-3 group. Moreover, the mean of changes in this factor was significantly different between groups [p<0.005]. FSH did not change in two groups of the study. However, the mean of LH decreased about 1.74 mlU/ml in omega-3 group [p<0.005]. The mean of change of LH/FSH ratio between groups was significant [p<0.05]. After the intervention, prolactin did not meaningfully change in both groups. Our results showed that 8 weeks of supplementation of omega-3 may have some beneficial effects on PCOS biochemical characteristics such as LH, LH/FSH, and adiponectin
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Intrauterine insemination [IUI] is one of the therapeutic approaches for infertility. The objective of this study was to evaluate DNA integrity and apoptosis role in success of IUI in both mild male and female factor infertility. Patients were divided into two groups: M [mild male factor; n=29] and F [female factor; n=31] undergoing single IUI. Ejaculates were analyzed and chromatin quality was assessed using chromomycin A3 [CMA3] staining. In addition, spermatozoal apoptosis was recognized using TUNEL assay. Statistical analyses were done using t-test and Mann Whitney test for sperm apoptosis and sperm chromatin by SPSS. Data were expressed in mean +/- SD for variables. P<0.05 was considered statistically significant. Sperm concentration and progressive motility were higher in F than M group. Sperm with normal morphology were statistically similar in M and F infertile patients [32.7 +/- 15.6% vs. 35.5 +/- 9.07%, p=0.39]. Sperm chromatin immaturity was higher in patients with mild male infertility, when compared with the other group [p<0.01]. Also, 32.0 +/- 5.6% and 30.8 +/- 6.1% of the spermatozoa showed signs of apoptosis in groups M and F, respectively [p=0.49]. Very low [3.4%] clinical pregnancy rates were noticed in patients with mild male factor infertility. Defect in sperm motility as well as high rates of DNA damage and apoptosis may be involved with very low rate of pregnancy outcomes in patients with mild male factor infertility. Therefore, it seems the application of IUI may have better outcomes in patients with female infertility compared to mild male factor infertility
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Based on classical two-cell, two-gonadotropin theory, in the follicle, follicle-stimulating hormone [FSH] and luteinizing hormone [LH] put on their main effects on the granulosa and theca cells. LH is essential for androgens production. Androgens are used for estradiol production by granulosa cells. Profound suppression of LH concentrations in some normogonadotropic patients can cause several adverse effects. The main clinical purpose of this study was that normoresponder women treated with controlled ovarian super ovulation for IVF or ICSI may benefit from co-administration of rLH. 40 patients who were candidates for assisted reproductive technology [ART] were randomly selected. In all patients long luteal protocol was used for ovulation induction. Patients were randomly divided into two groups: Group 1 [n=20] with standard long protocol [GnRH agonist] and r-FSH alone, Group 2 [n=20] with standard long protocol [GnRH agonist] and r-FSH with r-LH. Results were statistically analyzed and compared in two groups. The number of retrieved oocytes, mature oocytes, cleaved embryos, transferred embryos, estradiol levels in Human chorionic gonadotropin [hCG] administration day, implantation rate and clinical pregnancy rate in group 2 were higher but not significantly different. Administration of rLH in late follicular phase had no beneficial effect on outcomes in young women with mean age of 31 years. Maybe a greater sample size should be used to see the effects more accurately; also it is possible that rLH will be useful in older patients
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<p><b>INTRODUCTION</b>At present, about 1% of newborns are delivered through assisted reproductive technologies (ART) worldwide. This study aimed to evaluate and compare the growth parameters of children born in assisted and natural conception at 5 years of age.</p><p><b>MATERIALS AND METHODS</b>In a cross-sectional case control study, weight, height and head circumference of 5-year old children were assessed. The case group consisted of term, singleton babies who were products of ART in the Center for Infertility of Shahid Sadoughi University, Yazd, Iran in 2005. The control group consisted of term, fi rst child, singleton and spontaneously conceived 5-year-old children who were referred for vaccination to primary health care center of Shahid Akbari in 2010.</p><p><b>RESULTS</b>Fifty-eight girls (47.5%) and 64 boys (52.5%) "with equal numbers in each of the 2 groups" were evaluated. Sex distribution, mean ages of fathers and mothers were not statistically significant different in both groups. Children born after ART tend to have lower birth weight, smaller birth head circumference and lower weight at 5 years of age. Having low birth weight (<2500 g), being underweight and having short stature at the age of 5 were more common in babies born through ART.</p><p><b>CONCLUSION</b>Growth retardation is more prevalent in babies born through ART. Thus, growth assessment, parents' knowledge about child physical development, and timely and accurate follow-up of these children are necessary for early detection of any growth disorders.</p>
Subject(s)
Child, Preschool , Female , Humans , Male , Body Height , Body Weight , Cross-Sectional Studies , Growth Charts , Growth Disorders , Diagnosis , Head , Reproductive Techniques, AssistedABSTRACT
There is some evidence regarding the effect of poly unsaturated fatty acid intake on androgen levels and gonadal function in polycystic ovary syndrome [PCOS]. This study was conducted to determine the effect of omega-3 supplementation on sex hormone-binding protein [SHBG], testosterone, free androgen index [FAI] and menstrual status in women with PCOS. This double-blind randomized clinical trial was conducted on 78 overweight/obese women with PCOS. Participants were randomized to receive omega-3 [3gr/day] or placebo for 8 weeks. Data about weight, height and nutrient intake as well as blood samples were collected before and after intervention. Serum concentrations of testosterone [nmol/L] and SHBG [nmol/L] were measured. FAI was also calculated as the ratio of testosterone to SHBG. Seventy eight patients [age: 26.92 +/- 5.46 yrs, Body Mass Index: 31.69 +/- 4.84 Kg/m[2]] completed the study. There was no significant difference in mean age, weight, height, Body Mass Index and intake of energy, and macronutrients between 2 study groups before and after treatment. All the participants had irregular periods. After the trial the percentage of regular menstruation in the omega-3 group was more than the placebo group [47.2% vs.22.9%, p=0.049]. Furthermore, testosterone concentration was significantly lower in the omega-3 group compared with placebo, after supplementation [p=0.04]. SHBG and FAI did not change in either group. Omega-3 supplementation could reduce serum concentrations of testosterone and regulate menstrual cycle without significant effect on SHBG and FAI. Future studies with longer period of supplementation are warranted
Subject(s)
Humans , Female , Polycystic Ovary Syndrome , Androgens , Menstruation , Sex Hormone-Binding Globulin , Testosterone , Double-Blind Method , Body Mass IndexABSTRACT
Preterm labor [PTL] is one of the most important causes in neonatal mortality and morbidity. Late preterm labor [34-36w] includes 75% of such birth. Assisted reproductive technology [ART] pregnant women are at increased risk of PTL. The study has been undertaken to determine whether beginning and continuing 17-alpha hydroxy progesterone caproate can reduce risk of PTL or change neonatal mortality. In a double-blind clinical randomized control trial, 106 women were treated by ART technique for their infertility and in gestational age at 16 weeks entered in our study. In one group, 17-alpha hydroxy progesterone caproate [Femolife] was injected intramuscularly every week until 36 weeks of gestation and in another group; placebo was injected from 16 until 36 weeks of gestetion. Data collected from pregnancy outcomes, infancy, and subsidiary problems were statistically analyzed by a questionnaire. The risk of PTL in placebo group was 2.48 higher than control group that was not significant [Cl: 0.81-9.94]. Femolife side effect in case group was gestational diabetes and local complication was not frequent. NICU admission was not significantly different between groups. Although it seems that 17-alpha hydroxy progesterone caproate does not cause significantly decrease in PTL in singleton ART gestations but any reduction of PTL in such high risk pregnancies may improve final gestational outcome. There is critical need for larger clinical trials to better understanding causes of PTL, specifically late preterm labor, to prevent mortality and morbidity in ART gestation
Subject(s)
Humans , Female , Obstetric Labor, Premature , Reproductive Techniques, Assisted , Double-Blind MethodABSTRACT
Approximately one percent of current live births of the world are conceived via assisted reproductive technologies [ART]. The purpose of this study was to compare the developmental status of children born through assisted and natural conceptions at the age of five years. In a retrospective cohort study, developmental status of 5 years old children was evaluated via Persian version of 60-month Ages and Stages Questionnaires. Case group consisted of 61 singletons, term babies whom were born through ART in the Research and Clinical Center for Infertility, Yazd, Iran in 2005. Control group consisted of 61 term, first child, singleton and spontaneously conceived born five years old children whom were referred to Shahid Akbari primary health care center in 2010. 58 girls [47.5%] and 64 boys [52.5%] were evaluated. Frequency of developmental delay in domains of fine motor [47.5% vs. 24.6%, p=0.008] and problem solving [60.6% vs. 34.4%, p=0.004] were more in ART born children. On logistic regression, fine motor development state was independently affected by maternal educational level [OR: 5.3, 95% CI: 1.67-16.30, p=0.004] and developmental status in problem solving domains was independently affected by maternal educational level [OR: 4.88, 95% CI: 1.25-19.07, p=0.02] and birth weight [OR: 7.1, 95% CI: 1.78-29.01, p=0.006]. Maternal educational level and birth weight are important factors that influenced developmental outcome of ART born children.
Subject(s)
Humans , Male , Female , Child, Preschool , Fertilization in Vitro , Child Development , Surveys and Questionnaires , Natural Childbirth , Retrospective Studies , Cohort StudiesABSTRACT
GnRH agonist and antagonist were developed to control the premature release of LH surge. There is some difference between two protocols. We compared the outcome of frozen-thawed embryo transfer in infertile women who used GnRH agonist or antagonist protocol for previous COH cycle and evaluation of any adverse effect of GnRH antagonist on oocyte and embryo. The study group included all infertile women who referred to Yazd Research and Clinical Center for Infertility. Overall 20-35 years old women who were candidate for frozen-thawed embryo transfer with regard to inclusion and exclusion criteria were participated in the study. The patients based on previous control ovarian stimulation [COH] protocol divided in to two groups: GnRH agonist long protocol [n=165] and GnRH antagonist multiple dose protocol [n=165]. Frozen-thawed embryos were transferred after endometrial preparation in both groups. Main outcome measures were: implantation, chemical and clinical pregnancy rate. The implantation and clinical pregnancy rate following cryopreserved embryo transfer in GnRH agonist group and antagonist group were 16.3% vs. 15.7% [p=0.806] and 38.1% [63/165] vs. 36.9% [61/165] [p=0.915] and chemical pregnancy rate was 44.8% [74/165] vs. 43.6% [72/165] [p=0.915] respectively. There was no statistically difference between two groups in terms of implantation and pregnancy rate. Although pregnancy rate in fresh embryo transfer in antagonist cycles was lower than agonist groups, Therefore decrease in these parameters might be due to detrimental effect of GnRH antagonist on the endometrium, not embryo or oocyte
Subject(s)
Humans , Female , Cryopreservation , Fertilization in Vitro , Sperm Injections, Intracytoplasmic , Gonadotropin-Releasing Hormone/analogs & derivatives , Gonadotropin-Releasing Hormone , Pregnancy Rate , Pregnancy Outcome , Embryo ImplantationABSTRACT
Endometriosis is one of the most common gynecologic disorders. It is a complex trait and both genetic and environmental factors have been implicated in its pathogenesis. There is growing evidence indicating that exposure to environmental contaminants is a risk factor for endometriosis. Glutathione-S-Transferase M1 [GSTM1] is one of the genes involved in detoxification of endogenous and exogenous compounds. Several studies have indicated an association between GSTM1 null mutation and endometriosis. In this study, the possible association between the GSTM1 gene null genotype and susceptibility to endometriosis in woman from central and southern Iran was investigated. One hundred and one unrelated premenopausal women with endometriosis and 142 unrelated healthy premenopausal women without endometriosis were enrolled in the study. Genomic DNA was extracted from Peripheral blood in all subjects. GSTM1 null genotyping was performed by polymerase chain reaction [PCR]. There was no significant difference between frequencies of GSTM1 null genotype in case and control groups [50.5% Vs. 52.1%, p=0.804]. Furthermore, this genotype was not associated with severity of endometriosis in our sample [p=0.77]. Further studies involving gene-environment and gene-gene interactions, particularly combination of GSTM1 and other GST gene family polymorphisms are needed
Subject(s)
Humans , Female , Glutathione Transferase , Polymorphism, Genetic , Genomics , Polymerase Chain Reaction , Genetic Predisposition to DiseaseABSTRACT
Abnormal uterine bleeding is a common presentation of uterine abnormalities among premenopausal and postmenopausal women. To evaluate and compare the diagnostic accuracy of saline contrast sonohysterography and hysteroscopy for detecting the cause of abnormal uterine bleeding. A total of 65 women with abnormal uterine bleeding were enrolled in this study. A prior saline contrast sonohysetrography followed by a hysteroscopy was performed in all cases. Sensitivity, specificity, positive and negative predictive value and test accuracy were calculated. As the most common abnormality, SCSH showed hyperplasia in 19 patients while hysteroscopy diagnosed polyp in 15 cases. A sensitivity of 73.3%, 71.4% and 90.9% were reported for polyp, hyperplasia and submucous myoma respectively whereas the specificity was calculated 96% for polyps, 82.3% for hyperplasia and 90.7% for submucous myoma. Comparing with hysteroscopy, sonohysterography showed a high sensitivity and specificity for detecting submucous myoma but not for endometrial polyp and endometrial hyperplasia