effects of endometrial injury on intrauterine insemination outcome: a randomized clinical trial

Implantation is considered as the rate-limiting step in success of assisted reproduction techniques, and intrauterine insemination cycles. It might be affected by ovarian superovulation and endometrial local scratching. This study aims to investigate the effect of local endometrial injury on the outcome of IUI cycles. In this randomized clinical trial 144 women with unexplained infertility, mild male factor, and mild endometriosis randomly divided into two study groups through block randomization. The patients were randomly assigned to undergo endometrial biopsy between days 6-8 of the previous menstrual cycle before IUI [n=72, IUI cycles =126] or receive no interventions [n=72, IUI cycles=105]. The pregnancy rate per patient was 17 [23.6%] and 14 [19.4%] in endometrial biopsy and control groups, respectively [p=0.686]. The pregnancy rate per cycle was 17/126 [13.5%] and 14/105 [13.3%] in endometrial biopsy and control groups, respectively [p=0.389]. The abortion rate was comparable between the two groups [6.9% vs. 9.7%; p=0.764]. The ongoing pregnancy rate was found to be comparable between the two study groups, as well [16.7% vs. 9.7%; p=0.325]. Endometrial thickness [p=0.609] was comparable between the groups; however E2 was significantly lower in the endometrial biopsy group [p<0.001]. Application of local endometrial injury in the cycle before the IUI cycles is not associated with increased pregnancy rate per patient and per cycle, decreased abortion, and increased endometrial thickness

Intrauterine administration of recombinant human chorionic gonadotropin before embryo transfer on outcome of in vitro fertilization/ intracytoplasmic sperm injection: a randomized clinical trial

The direct effect of hCG on the human endometrium was studied several times. The objectives of this study were to evaluate the effectiveness of intrauterine injection of recombinant human chorionic gonadotropin [rhCG] before embryo transfer [ET]. In this randomized placebo-controlled clinical trial, a total number of 182 infertile patients undergoing their first in vitro fertilization/ intracytoplasmic sperm injection [IVF-ICSI] cycles were randomly assigned to receive 250 micro g intrauterine rhCG [n=84] or placebo [n=98] before ET. The implantation and pregnancy rates were compared between groups. Patients who received intrauterine rhCG before ET had significantly higher implantation [36.9% vs. 22.4%; p=0.035], clinical pregnancy rates [34.5% vs. 20.4%; p=0.044] and ongoing pregnancy rate [32.1% vs. 18.4%; p=0.032] when compared to those who received placebo. The abortion [2.4% vs. 2.0%; p=0.929] and ectopic pregnancy rates [1.2% vs. 1.0%; p=0.976] were comparable between groups of rhCG and placebo, respectively. Intrauterine injection of 250 micro g of rhCG before ET significantly improves the implantation and pregnancy rates in IVF/ICSI cycles.

Metformin versus chromium picolinate in clomiphene citrate-resistant patients with PCOs: a double-blind randomized clinical trial

Chromium picolinate could be effective in clomiphen citrate resistant PCOS patients. To compare the effects of chromium picolinate vs. metformin in clomiphen citrate resistant PCOS patients. The present randomized clinical trial was performed on 92 women with clomiphen citrate-resistant PCOS at the clinics which were affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The subjects were randomly assigned to two groups receiving either chromium picolinate [200micro g daily] or metformin [1500mg daily] for 3 months. Anthropometric and hormonal profile were measured and compared both before and after the treatment. Ovulation and pregnancy rate was measured in the two study groups, as well. Chromium picolinate significantly decreased fasting blood sugar [FBS] after 3 months of treatment [p=0.042]. In the same way, the serum levels of fasting insulin had significantly decreased leading to an increase in insulin sensitivity as measured by QUICKI index [p=0.014]. In comparison to the patients who received chromium picolinate, those who received metformin had significantly lower levels of testosterone [p=0.001] and free testosterone [p=0.001] after 3 months of treatment. Nevertheless, no significant difference was found between the two study groups regarding ovulation [p=0.417] and pregnancy rates [p=0.500]. Chromium picolinate decreased FBS and insulin levels and, thus, increased insulin sensitivity in clomiphene citrate-resistance PCOS women. These effects were comparable with metformin; however, metformin treatment was associated with decreased hyperandrogenism. Overall, chromium picolinate was better tolerated compared to metformin; nonetheless, the two study groups were not significantly different regarding ovulation and pregnancy rates

Comparison of the effects of letrozole and clomiphene citrate on ovulation and pregnancy rate in patients with polycystic ovary syndrome

For more than four decades clomiphene citrate has been the first line of the treatment for ovulatory disorders. The aim of this study was to compare the effects of letrozole and clomiphene citrate on ovulation and pregnancy rate in patients with polycystic ovary syndrome. In this prospective double-blind study, 100 patients with polycystic ovary syndrome were randomized into two equal groups. The first group received letrozole, 5mg daily [per oral] and the second group received clomiphene, 100mg daily during the 3rd-7th days of the menstrual cycles. Intramuscular human chorionic gonadotropin [hCG] [10,000 IU] was administered to trigger ovulation when at least one mature follicle [>/= 18mm] was developed. Ovulation occurred in 30 patients [60%] of the letrozole group and in 16 patients [32%] of the clomiphene group, which showed a statistically significant difference [P=0.009]. The mean number of follicles with diameter >/= 14 mm on the day of administration of hCG was 1.06 +/- 0.95 in the letrozole group and 1.14 +/- 1.17 in the clomiphene group, which showed non-significant difference [P=0.962]. No difference was found in the endometrial thickness between the two groups. A non-significant increase in pregnancy rate was observed in the letrozole group [26% v 14% P=0.21]. Ovulation rate was higher in letrozole group and administration of letrozole was associated with a non-significant increase in pregnancy rate

double blind, randomized, placebo controlled study to assess the efficacy of ketoconazole for reducing the riskof ovarian hyperstimulation syndrome

In order to evaluate the role of ketoconazole in the prevention of ovarian hyperstimulation syndrome [OHSS] in women with polycystic ovary syndrome [PCOS] undergoing ovarian stimulation with gonadotropins, a prospective, random-ized, double-blind, placebo controlled study was done on one-hundred and nine PCOS women that had been referred to be treated by gonadotropins.All 109 women were assigned for random allocation. Group A [50 patients] received two ampoules of hMG beginning on day 2 or 3 of the cycle and ketoconazole [50 mg/every 48 hours] starting on the first day of hMG treatment. Group B [51 patients] received the same protocol of hMG combined with one tablet of placebo every 48 hours. Main outcome measures were follicular development, E2 levels, and pregnancy rate.The total number of hMG ampoules and duration of treatment to attain ovarian stimulation was higher in group A [p<0.0001]. Serum E2 level and number of patients with dominant follicles on day 9 of the cycle were higher in group B [p<0.0001]. There was no significant difference between serum E2 level and total number of follicles at the time of hCG administration in the two groups. The cancellation rate and OHSS rate were similar in the two groups.Ketoconazole has no effect in prevention of OHSS in PCOS patients undergoing ovarian stimulation. It may however reduce the rate of folliculogenesis and steroidogenesis