comparative assessment of intramuscular progesterone and intravaginal progesterone to support luteal phase in IVF cycle

This study was designed to compare the benefits of intramuscular progesterone, 100mg daily, and cyclogest suppository, 400 mg BID, to support luteal phase in IVF cycle. In this Clinical Trial study 162 patients, between 20-40 years, were selected for rapid Zift cycles. Seventy seven cases used 400mg cyclogest suppository BID and 88 used 100 mg daily intramuscular progestron to support luteal phase. Age, duration of infertility, number of follicles and number of embryos were the variables which were assessed. Pregnancy rate and abortion rate were also compared between the two groups who underwent the treatment. Frequency of chemical pregnancy [postitive beta-HCG] was 27.3% in cyclogest and 30.6% in intramuscular progesterone group and there was no significant difference between two groups [NS]. Clinical pregnancy, according to sonography findings on 5[th] week, was seen in 22.1% of cyclogest and 27.1% of intramuscular progesterone group [NS]. Frequency of ongoing pregnancy was 15.6% in cyclogest and 18.5% in intramuscular progesterone group and there was no significant difference between two groups [NS]. In this study, the frequency of pregnancy, including chemical and clinical pregnancy, in intramuscular progesterone group was more than cyclogest group, whereas there was no significant statistical difference between two groups with regard to the number of cases. Therefore, we need to assess the study with more cases

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

Salt preference across different phases of menstrual cycle.

It is well established that women experience food craving for particular foods and gain weight in relation to phases of menstrual cycle. In this study, the preference for different concentrations of salt sprayed on bland popcorn was assessed in 55 healthy women (age 18 to 22 yrs). Salt solutions of 0, 1, 2, 3 and +3 molar strength were used. Samples of sprayed popcorn were consumed in random order and preference marked on a Likert scale. It was observed that women preferred unsalted popcorn in the menstrual phase more than in the luteal phase. The preference for salted popcorn was most during the luteal phase and was proportionate to the strength of the salt solution used. Statistical analysis revealed significant differences in the preference rating between the menstrual phase and the other two phases. There was no significant difference in preference between the luteal and follicular phases.

comparison of intramuscular and intravaginal suppositoar forms of progesterone for supporting the Luteum phase in ART cycles

Up to seventh week of gestation, progesterone secreted from the ovary is necessary to preserve the pregnancy. In the ART cycles GnRH-a is prescribed and oocytes and granulosa cells or retrieved, both causes corpus luteum insufficiency, so corpus luteum should be supported the best way is progesterone prescription. In this research we compare intramuscular and intravaginal suppositoar forms of progesterone for preserve the pregnancy. A prospective cross sectional evaluation on 193 patients was designed. All of them were on IVF or ICSI cycles. The patients were randomly divided into two groups. Intramuscular progesterone was prescribed in 138 and intravaginal progesterone [supp cyclogest] in 54 patients. The outcome of pregnancy was analyzed using statistical trials including t-test and chi-squre. The two groups were similar duo to age - the ethiology causes of infertility - the doses of proscribed HMG ampule - FSH titrago - the number and grade of transferred embryos. The day after HCG presciption until the end the seventh week in the first group [138 patients] intramuscular progestrone [50 mg/bid] and in the second group [54 Patients] supp of cyclogest [400 mg/bid] was presented. The rate of positive pregnancy test, abortion, successful poegnancy in this two groups were similar. Intramuscular or intravaginal progesterone for supporting corpus luteum in IVF or ICSI cycles have the same effect but the intramuscular route is cheaper

Effect of early luteal phase administration of a single dose mifepristone on immunohistochemical distribution of interleukin 1 alpha (IL-1 alpha) and transforming growth factor beta 1 (TGF-beta 1) in mid-luteal phase ovary of the rhesus monkey.

A single low dose administration of a high affinity anti-progestin agent like mifepristone during the early luteal phase inhibits blastocyst implantation in human and non-human primates. Though it has been observed that luteal phase serum concentrations of estradiol and progesterone were not affected by the application of anti-nidatory dose of early luteal phase mifepristone suggesting that ovarian steroidogenic function is not compromised, it is nevertheless possible that ovarian physiology at the local tissue level is affected in this treatment schedule. In the present study, healthy, mature, proven fertile female rhesus monkeys were divided into two groups. Group 2 animals were treated with a single dose of mifepristone (2 mg/kg body weight), while group 1 animals were injected with vehicle (1:4 benzoyl benzoate: olive oil, v/v, s.c.) on day 2 post-ovulation. The morphological examination including that of vascularity, as well as, histometric determination of profiles of immunopositivity for IL-1alpha and TGF-beta1 in stromal, follicular and luteal compartments of mid-luteal phase ovaries from animals with or without a single, anti-nidatory dose of mifepristone applied on day 2 after ovulation failed to reveal any significant change between the two groups. Thus, it appears that early luteal phase administration of a single antinidatory dose of mifepristone does not affect the ovarian physiology in the treatment cycle.

Luteal phase support in ovarian induction cycles using human chorionic gonadotropin or oral progestagens

To determine the efficacy of luteal phase support with human chorionic gonadotropin [hCG] or oral progesterone during human menopausal gonadotropin [hMG] ovulation induction. Between September 1999 and March 2001, a total of 91 couples with infertility were recruited at Al-Hammadi Hospital, Riyadh, Kingdom of Saudi Arabia and Badeea Hospital, Jordan. In this prospective trial 46 couples were allocated to luteal phase support with hCG injections, while 45 couples were allocated to Duphaston [oral progestogens] as luteal support. In the group of hCG luteal support, 46 patients completed 46 cycles of hMG therapy, and 8 pregnancies [5 ongoing pregnancies] ensued, with a general total pregnancy rate of 17.4%. In the progesterone [Duphaston] luteal support group, 45 patients with the similar indications to the previous group were studied and 8 pregnancies [5 ongoing pregnancies] were reported with a general total pregnancy rate of 17.8%. Only one spontaneous abortion occurred among the patients in a cycle supported with supplemental hCG, while 2 abortions occurred in the Duphaston supported group. Despite theoretical reasons to use luteal phase support during hMG-stimulated cycles, our data showed no improvement in pregnancy rates from such treatment

Morphometrie study of GnRH analogue, HMG and HCG effects on infrastructure of human endometrial glandular epithelium in early luteal phase

GnRH analogue, HMG and HCG administration are common protocol for ovulation induction in assisted reproductive technology [ART]. Since implantation rate in stimulated ART cycles is lower than unstimulated cycles and as endometrium plays an important role in embryo receptivity, effect of this protocol on the ultrastructure of human endometrial glandular epithelium was studied at LH 4 [embryo transfer time]. In this research endometrial biopsies were obtained from fertile women as well as infertile women who had undergone this protocol at LH 4. Quantitative and qualitative studies on endometrial glandular epithelium was performed by transmission electron microscopy [TEM] and morphometry and the results were statistically compared between the two groups. Qualitative results revealed presence of nuclear channel system [NCS], sub vacuole of glycogen and giant mitochondria [GM] in both groups. Similarly, in quantitative analysis, the volume fractions [Vv] of glycogen, mitochondria and rough endoplasmic reticulum to cell and also the Vv of euchromatin to nucleus were statistically not different [P> 0.05]. These results suggest that ovulation induction by GnRH analogue, HMG and HCG are not associated with advanced endometrial development and consequently, embryo transfer at this stage [before advanced endometrial development which occurs normally at LH 7 to LH 10] may cause a lower rate of implantation

Contranidatory activity of early luteal phase administration of mifepristone in the rhesus monkey.

The contranidatory action of mifepristone (RU 486) given as a single application at different dosages to mated rhesus monkeys (Macaca mulatta) on second day after ovulation has been examined in the present study. In group 1, monkeys (n = 3) received only vehicle (benzyl benzoate: olive oil, 1:4, v/v) and were treated as controls. In group 2 monkeys (n = 4), RU 486 was given by gavage at 10 mg/kg in group 4 (n = 5). The patterns of cycles and profiles of serum estrogen and progesterone were monitored for assessing the occurrence of implantation and pregnancy. At a single dose of 10 mg/kg, RU 486 was found to be ineffective in preventing nidation, resulting pregnancy in three females out of four treated monkeys. Similarly, an s.c. administration of 1 mg/kg could provide pregnancy protection in two of the four treated monkeys. In these monkeys, however, the menstrual cycle characteristics were not affected as compared to pretreatment cycles. Interestingly, the administration of 2 mg/kg, s.c., RU 486 could provide a hundred percent pregnancy protection in mated monkeys, and there was no significant changes in the pattern of menstrual cycle characteristics. It appears that an early post-ovulatory administration of RU 486 may be successfully used in human as an effective once-a-month, early luteal phase contranidatory agent.

Estudo ecográfico dos ovários em ciclos induzidos pelo citrato de clomifeno / Echographic study of ovaries in induced cycles by clomiphene citrate

Durante 1982 e 1983 foram estudadas 10 pacientes portadoras de esterilidade anovulatória, tratadas com 50 mg de citrato de clomifeno por dia, via oral, entre o 5§ e o 9§ dia do ciclo menstrual. Nenhuma apresentava hiperprolactinemia (avaliada por 3 meses) e o aspecto do muco cervical sugeria boa estimulaçäo estrogênica endógena. Para se avaliar o efeito da medicaçäo realizou-se ecografia seriada, a partir do 7§ - 9§ dia até evidência de rotura folicular e fase lútea inicial. A par disso, estimaram-se as concentraçöes sangüíneas de FSH, LH e 17ß estradiol (E2) a partir do 11§ ao 14§ dia. A concentraçäo sangüínea de progesterona foi feita em duas colheitas, entre o 19§ e 23§ dia. As conclusöes foram: (1) a ecografia pélvica seriada é método eficaz para a monitoragem da induçäo da ovulaçäo. Além do baixo custo, tem a vantagem de ser método näo invasivo, inócuo e capaz de fornecer imagens imediatas; (2) na nossa casuística o diâmetro folicular médio, no dia pré-ovulatório, foi 27,7 mm; (3) a síndrome do folículo luteinizado näo roto (LUF) ocorreu em 20,0% dos casos; (4) os níveis de E2 no plasma ultrapassam os limites fisiológicos quando há mais de um folículo dominante em desenvolvimento