Investigation of anti-mullerian hormone [AMH] level and ovarian response in infertile women with endometriosis in IVF cycles

Background: endometriosis, can cause ovarian conflict and reduced ovarian reserve that could lead to lower response to assisted reproductive techniques

Objective: current study was conducted to determine the association between level of anti-mullerian hormone [AMH] and the infertility treatment outcomes in infertile females with endometriosis versus the non-endometriosis infertile subject

Materials and Methods: in this case-control study, 64 infertile females who referred to Shariati Hospital from April 2015 to November 2017 were enrolled. They were divided in two groups of 32 patients [endometriosis and non-endometriosis women]. The anti-mullerian hormone level among all subjects was determined, treatment outcomes were evaluated and association between these factors was assessed

Results: it was seen that the anti-mullerian hormone [p=0.06], the number of retrieved oocytes [p=0.7] and embryos [p=0.7], implantation rate [p=0.6] and clinical pregnancy rate [p=0.9] were similar between two groups. In patients with stage 3 or 4 endometriosis who had lower serum AMH level significantly [p=0.001] less oocytes were retrieved [p=0.001] and less transferrable embryos [p=0.03] were achieved. However, implantation and pregnancy rates did not differ [p=0.7] [p=0.6]

Conclusion: totally, according to the obtained results, it may be concluded that ovarian reserve has more significant role in predicting infertility treatment outcome rather than receptive endometrium

Can letrozole plus HMG protocol improve pregnancy outcomes in frozen-thawed embryo transfer? an RCT

Background: There are different methods in endometrial preparation for frozen-thawed embryo transfer [FET]

Objective: The purpose of this study was to compare the live birth rate in the artificial FET protocol [estradiol/ progesterone with GnRH-agonist] with stimulated cycle FET protocol [letrozole plus HMG]

Materials and Methods: This randomized clinical trial included 100 women [18-42 years] randomly assigned to two groups based on Bernoulli distribution. Group I received GnRH agonist [Bucerelin, 500 micro g subcutaneously] from the previous midlutea lcycle, Then estradiol valerat [2 mg/ daily orally] was started on the second day and was increased until the observation of 8mm endometrial thickness. Finally progesterone [Cyclogest, 800 mg, vaginally] was started. Group II received letrozole on the second day of the cycle for five days, then HMG 75 IU was injected on the7P[th] day. After observing [18 mm folliclhCG10000 IU was injected for ovulation induction. Trans cervical embryo transfer was performed in two groups. The main outcome was the live birth rate. The rate of live birth, implantation, chemical, and clinical pregnancy, abortion, cancellation and endometrial thickness were compared between two groups

Results: Implantation rate was significantly higher in group I. Live birth rate was slightly increased in group I without significant difference [30% vs. 26%]. The rate of chemical and clinical pregnancy was similar in two groups. The abortion rate was lower in letrozole protocol but the difference was not statistically significant. The mean endometrial thickness was not different between two groups

Conclusion: Letrozole plus HMG method cannot improve pregnancy outcomes in frozen-thawed embryo transfer but it has only one injection compare to daily injections in artificial method

Prediction of assisted reproductive technique outcome in elevated early follicular phase follicle stimulating hormone with Mullerian inhibiting substance level

Detection of best predictor of ovarian reserve in patients with temporarily or consistently elevated early follicular phase serum levels of FSH is one of the most important goals in assisted reproductive technique [ART]. To evaluate whether high level of anti-mullerian hormone level is related to success of ART in patients with temporarily or consistently elevated early follicular phase serum levels of FSH. Sixty three women underwent intracytoplasmic sperm injection [ICSI] with GnRH-agonist long protocol or intrauterine insemination [IUI] in a prospective cohort study. FSH, inhibin B and anti-Mullerian hormone [AMH] levels were measured in these women whom were divided to three groups [persistently elevated FSH, variably elevated FSH and, normal FSH level]. Basal characteristics, stimulation parameters, and pregnancy occurrence were evaluated. AMH was significantly higher in women with persistently elevated early follicular phase FSH achieving pregnancy. Women with normal FSH did not have significant difference in AMH level between conceived and non conceived cycles. Women with only one elevated early follicular phase FSH achieving pregnancy did not have significant difference in AMH level with non pregnant women. Response to gonadotropin stimulation, recommendation to oocyte donation significantly differed between the groups. This study has demonstrated that relatively young women with persistently or intermittently elevated day 3 FSH levels have diminished ovarian reserve and lower ART success. However, in women whose FSH levels were constantly elevated, AMH [not inhibin B] concentrations were significantly higher in ART cycles resulting in pregnancy. Therefore, AMH level is a good predictor of ART outcome in patients with elevated early follicular phase serum levels of FSH

Local injury to the endometrium does not improve the implantation rate in good responder patients undergoing in-vitro fertilization

Despite numerous developments in the field of assisted reproduction the implantation rate remains low. Recent studies suggested that local injury to endometrium in controlled ovarian hyper stimulation cycle improves implantation rate. Studies have attempted to intervene in the development of endometrium. The aim of the present study was the exploration of the possibility that local injury of the endometrium increases implantation rate. In this interventional study, 100 good responders to hormone stimulation patients were divided into control group [n=50] and experimental group [n=50] which undergo endometrial biopsy by biopsy catheter] piplle] on day 21 of their previous menstrual cycle with use of contraceptive pills before the IVF-ET treatment. In total, 26 patients were removed from the study because the number of stimulated follicles were below 3, or there was no embryo or there was the risk of OHSS. The remaining patients were 33 in experimental group and 41 in the control group. There were no significant differences between the two groups in terms of the age of the patients, duration of infertility and BMI, base line FSH level and responses to hormone stimulation. The rates of embryo implantation, chemical and clinical pregnancy in the experimental group were 4.9%, 18.2% and 12.1% with no significant differences with the control group [6.7%, 19.5%, 17.1%]. Cancellation rate was 26%. In our study, endometrial biopsy didn't increase the chances to conceive at the following cycle of treatment

[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

effect of L-carnitine on sperm parameters in patients candidated for intracytoplasmic sperm injection

Background: The etiologic cause in near one third of male factor infertility is unknown. The percentage of men with idiopathic infertility who have been successfully treated by the empirical therapeutic modalities is not high

Objective: The aim of this study was to assay the effect of L-carnitine on sperm parameters in patients who needs intracytoplasmic sperm injection [ICSI] as a method for infertility treatment

Materials and Methods: The study population consisted of 65 men [mean age +/- SD: 34.4 +/- 6.07] presenting with primary infertility due to idiopathic oligoasthenoteratozoospermia. L-carnitine was prescribed Igram orally every 8 hours for 3 months. Before and after the ending of the L-carnitine treatment, semen analysis was performed

Results: The proportion of patients who had motile and grade C sperms rose significantly after treatment. Percentile of abnormal shaped sperms decreased significantly after treatment. In approximately 22%, complete asthenozoospermia changed to relative asthenozoospermia

Conclusion: Appearing motile sperms will potentially improve the technique of ICSI. The magnitude of the elevation in normal morphology is not clinically obvious, but it seems that it can be important in obtaining normal-shaped sperms for intracytoplasmic injection. Designing a study on selected patients with complete asthenozoospermia who have not other abnormalities in semen parameters can reveal the real effect of carnitine therapy in this category