Evaluation of effect of silymarin on granulosa cell apoptosis and follicular development in patients undergoing in vitro fertilization

To investigate the effects of silymarin on follicular development, we enrolled 40 healthy women undergoing in vitro fertilization [IVF] due to male factor infertility in this trial. They underwent ovulation induction and on a random and blind basis, patients were assigned to receive silymarin [70 mg X 3/day] or placebo from the beginning of the induction cycle. The number and quality of oocytes retrieved were evaluated and apoptosis of granolusa cells was studied. There was no significant difference between the groups for mean number of follicles >/= 18 mm [P = 0.131], mean number of oocytes retrieved [P = 0.209] or endometrial thickness [P = 0.673]. However, the proportion of total apoptosis in the study group was significantly lower than in the placebo group [P = 0.032]. These data suggest that administration of silymarin in IVF patients concomitantly with gonadotropin results in reduction of granolusa cell apoptosis but does not have any effect in promotion of follicular development, oocyte retrieval or endometrial thickness

[ effect of HCG on in vitro maturation of human immature oocytes and rate of 8 cell embryos mediated by ICSI]

The infertility treatment by using in vitro matured oocyte has many potential applications. It minimizes the risk of ovarian hyper stimulation and is an alternative treatment for women with polycystic ovarian syndrome who may have problems regarding stimulation for IVF. This method may prove important for subjects in need of fertility preservation and also provides information about the final stage of oocyte maturation. The aim of this study was to determine the effect of HCG on the rate of in vitro matured oocyte and 8 cell embryos mediated by ICSI. This experimental study was done in Montaserieh IVF center and Islamic Azad University at Mashhad. One hundred sixty eight immature oocytes aspirated from women undergoing IVF cycles were divided into 3 equal groups and allocated for maturation in 3 medium cultures. All of 3 culture groups contained G1 medium supplemented with HSA 10% [Human Serum Albumin]. Control group had no gonadotropin, but the first experimental group contained HCG 10 ILJ/ml and the second experimental group contained HCG 5 ILJ/ml. Matured oocytes were fertilized by ICSI and numbers of 8-cell embryos were investigated 72 hours after fertilization by invert microscope. The results showed that both of the HCG concentrations significantly increased the rate of matured oocytes and also the rate of 8-cell embryos with respect to control group [p<0.05]. No significant differences were found in rate of matured oocytes between the two experimental groups [p>0.05] while the number of 8-cell embryos was significantly higher in HCG 5IU/ml with respect to HCG 10 IU/ml and control group [p<0.05]. The results suggests that both of the HCG concentrations increase the rate of maturation of immature oocytes and the rate of 8-cell embryos but HCG [5IU/ml] has more effect on the number of 8-cell embryos mediated by ICSI

comparison between the pregnancy outcome after easy embryo transfer and difficult embryo transfer

The role of embryo transfer [ET] in the success of in vitro fertilization/intra cytoplasmic sperm injection treatment is not well understood. In the present study we classified ET technique as difficult and easy types according to certain strict criteria, and compared the pregnancy outcome of the two ET types. This study was performed retrospectively on 295 infertile patients undergoing 308 embryo transfer cycles during May 2006-March 2007 in Mashhad IVF center. These cycles were divided into two groups. Group I had an easy embryo transfer [n=248] and group II had a difficult embryo transfer [n=60]. The ET was considered as easy if the catheter insertion was successfully achieved without difficulty or needed slight manipulations of speculum or outer sheath of the catheter. ET was considered as difficult if slight maneuvers did not result in successful catheter insertion, tenaculum was used, or there was a need to use rigid catheters. Observation of beating fetal heart in a gestational sac of 6-7 weeks considered as positive pregnancy. Comparison of the pregnancy outcome between both groups was performed by using Student t test and Chi-square test. The results were shown as X[2] +/- SD. P value<0.05 was considered statistically significant. The differences between two groups regarding age, number of follicles >/= 14 mm, number of retrieved oocytes, and number of transferred embryos were not significant [P>0.1]. The total number of pregnancies was 55 [17.9%]: 48 [19.4%] in group I and 7 [11.7%] in group II. The difference was not significant [P =0.163]. Although the rate of positive pregnancy with easy ET was higher than difficult ET, there was no significant difference between the two groups [P =0.163]. This may be due to the type of classification of easy and difficult, or fewer patients

Accuracy of pipelle endometrial sampler in evaluation of endometrium

The purpose of this study was to compare the use of pipelle endometrial sampling device based on the quality of material obtained and diagnostic accuracy with conventional dilation and curettage [Dand C] or hysterectomy specimens. This cross sectional study was done on 50 patients who referred to gynecology ward of Imam Reza hospital with abnormal uterine bleeding [AUB] or infertility for endometrial dating. Thirty-eight patients underwent two endometrial samplings [pipelle and conventional D and C] on the same occasion while 12 cases underwent hysterectomy. The procedure of sampling by pipelle was done by one person and the specimens were submitted to a pathologist. The adequacy of the specimen and histoiogical diagnosis were compared. Pipelle obtained adequate sample in 47 of 50 cases [94%]. The histoiogical diagnosis was the same in 85% of cases [40 out of 47]. The sensitivity for endometrial dating and endometrial polyp was 100% and 40%, respectively. Among 7 cases of inconsistent diagnosis, there was one missed malignancy [squamous cell carcinoma of cervix with extension to isthmus and lower segment]. In this case the histoiogical diagnosis of pipelle was inactive endometrium surrounded by pieces of clot. Pipelle endometrial sampling is an easy method for diagnosis of endometrial pathology. Its diagnostic accuracy for endometrial dating is very high, but in management of AUB, replacing conventional D and C with pipelle should be done with caution and preferably completed by other diagnostic techniques