Beneficial effects of intraovarian injection of platelet-rich plasma in women with poor ovarian response / 대한생식의학회지

Objective@#Infertility can result from a diminished ovarian reserve, but a potential remedy exists in the form of platelet-rich plasma (PRP) administration. This treatment involves both biological factors and tissue trauma mechanisms, which stimulate folliculogenesis, making it a promising and effective strategy. We assessed the impact of direct PRP injections into the ovaries on the fertility outcomes of women classified as poor responders. @*Methods@#A quasi-experimental study was conducted from April 2021 to December 2022, focusing on patients classified as POSEIDON grade 3 or 4. PRP injections were administered into both ovaries. After 3 months, data were collected on anti-Müllerian hormone (AMH) level, follicle-stimulating hormone (FSH) level, and the numbers of oocytes, mature oocytes, and good-quality embryos following ovarian stimulation. We then compared the data from before and after PRP injection. @*Results@#This study included 50 women, with a mean of 39 years (interquartile range [IQR], 35 to 43) and 4 years (IQR, 2 to 6) for age and infertility duration, respectively. FSH levels decreased after treatment, while AMH levels and the numbers of oocytes, metaphase II oocytes, and high-quality embryos increased. However, only the increase in high-quality embryos was significant. The pregnancy and spontaneous pregnancy rates were 20% and 14%, respectively. Notably, women with secondary infertility exhibited a significantly higher pregnancy rate than those with primary infertility. @*Conclusion@#Ample evidence suggests that PRP can enhance ovarian function. However, further studies are needed to identify the appropriate candidates for this procedure, establish the optimal PRP preparation method, and standardize the procedure for its adjuvant use in assisted reproductive technology cycles.

GnRH agonist trigger versus hCG trigger in GnRH antagonist in IVF/ICSI cycles: a review article

Routinely, a bolus of 5.000-10.000 IU human chorionic gonadotropin [hCG] is used for the final follicular maturation and ovulation as a standard method. HCG has the same effect of luteinizing hormone [LH] with long half-life. It has the long lutheotrophic effect which increases the risk of ovarian hyper stimulation syndrome [OHSS]. Recently, gonadotropin-releasing hormone agonist [GnRH-a] trigger has been used for the induction of final follicular maturation and ovulation with the aim of reducing the OHSS risk. Several studies have shown that the releases of endogenous follicular stimulating hormone [FSH] and LH after administration of GnRH agonist in in vitro fertilization [IVF] cycles are able to precede the final follicular maturation leading to removal of fertile oocyte with normal development of the embryo and ultimately pregnancy. But based on the results of some studies, using GnRH-a trigger leads to defect luteal-phase resulting to reduce the implantation and clinical pregnancy rates and also increase abortion in fresh embryo transfer cycles compared to routine IVF cycle with hCG triggering . Also, in recent years, studies have continued to modify the luteal phase support, so that the fresh embryo transfer is possible too. In this review, we examined the benefits, problems, and also ways to reform GnRH agonist triggering complications

[Therapeutic effects of heparin on repeated implantation failures in IVF cycles; A randomized clinical trial]

Repeated Implantation Failure [RIF] is the main cause of IVF failure. Antiphospholipid syndrome is one of the causes of RIF and heparin is its treatment of choice. It is not clear yet whether heparin could be effective in women with other autoimmune disorders or other causes of IVF failure. Since IVF is the choice procedure for various causes of infertility, its application for the treatment of repeated implantation failures is of critical importance. The purpose of this study was to identify the effects of heparin in women with repeated implantation failures. In this randomized clinical trial, 60 women, with two or more unsuccessful IVF cycles, referring to infertility clinic of Shariati Hospital were randomly selected irrespective of their clinical characteristics from 2006 to 2007. Male factors infertility, anatomic, infectious, endocrine, as well as genetic problems had been ruled out in the participants. Women in the treatment group received 5000 IU heparin subcutaneously twice daily, 14 days prior to IVF. Gestational outcomes [Reaching the 30th week of gestation] between the two groups were the same. -hCG tests were seen in 40% and 30% of the intervention and control positive groups respectively with no significant statistical differences. Amongst the participants, 23.3% and 16.7% of the intervention and control groups reached the 30th week of pregnancy, respectively with no significant statistical differences. Women with immunologic or thrombophilic factors had more positive -hCG tests than those with unexplained causes [58.3% vs. 27.8%] in the intervention group; although the difference was not statistically significant. It seems that administration of heparin has no effects on women with unexplained infertility or repeated IVF failures. Although women -hCG tests, more with immunologic or thrombophilic factors had more positive extensive trials are warranted in this regard

Outcome of newborns conceived through artificial reproductive techniques in Tehran Iran

Today there is a rise in the number of newborns conceived by artificial reproductive techniques [ART]. Numerous studies have been performed on the perinatal outcome of these pregnancies. However, there is limited data about the condition of health of these newborns in Iran. Regarding the higher prevalence of probable complications and symptomatic congenital anomalies, we aimed to determine the state of health of newborns born by ART. A total of 109 newborn who were conceived through ART and 479 newborns of spontaneous conception were enrolled into our study. The study was prospective, case-control study in Tehran, Iran, from March 2003 to March 2004. Both case and control groups were adjusted in regard to race, sex, type of delivery, chronic disease of mother, age of mother, and antenatal steroids administration. All newborns were examined by neonatologist after birth and their outcome were followed until hospital discharge or death. Data pertaining to clinical and laboratory findings of newborns and death were entered into a questionnaire and subsequently analyzed by appropriate statistical tests. Confidence interval was 95%. Prematurity, low birth weight [LBW], very low birth weight [VLBW], twins and triplets, small for gestational age [SGA], need for resuscitation at birth, respiratory distress syndrome [RDS] and NICU admission were significantly higher among newborns born after ART than those born through spontaneous conception [p<0.05]. Regression logistic analysis showed that RDS and NICU admission were more strongly associated with weight at birth and gestational age than with method of conception. However, increased rate of SGA in the case group was associated with multiple pregnancy. Also, there was no significant statistical relationship between the method of conception and the prevalence of congenital anomalies, large for gestational age [LGA], congenital pneumonia, necrotizing entrocolitis [NEC], respiratory air leakage syndromes [ALS], hydrops fetalis, hyperbilirubinemia sepsis, meconium aspiration syndrome [MAS], isseminated intravascular coagulopathy [DIC], cardiac failure, lung hemorrhage, hypoglycemia, hypocalcemia, neutropenia, thrombocytopenia and hemolysis. Newborns who were conceived by ART were more likely in need of resuscitation at birth regardless of other factors. Furthermore, newborns born after ART were at higher risk of developing prematur birth, LBW, and multiple birth