comparison of the effects of transdermal estradiol and estradiol valerate on endometrial receptivity in frozen-thawed embryo transfer cycles: a randomized clinical trial

Background: The purpose of this study was to determine the optimal endometrial preparation protocol by comparing the clinical outcome of two methods of endometrial preparation in frozen-thawed embryo transfer [FET] cycles, including that is, oral estradiol and 17 beta-estradiol transdermal patch

Methods: In this randomized controlled trial, women underwent either conventional IVF or intracytoplasmic sperm injection [ICSI] who had at least two top-quality embryos appropriate for cryopreservation and frozen embryos from previous cycles. In the study group [n=45], 17-B estradiol transdermal patches 100 microg were applied from the second day of the cycle and continued every other day. Then, each patch was removed after four days. In the control group [n=45], oral estradiol valerate 6 mg was started at the same time and continued daily

Results: There was a significant difference in estradiol level on the day of progesterone administration and the day of embryo transfer between the two groups [p=0.001 in both], but no significant difference was observed between them in biochemical and clinical pregnancy rates [32.6% vs. 33.3%, p=1.000 and 30.2% vs. 33.3%, p=0.810, respectively]

Conclusion: It is suggested that estradiol transdermal patches be used instead of oral estradiol in FET cycles. Due to the reduced costs, drug dose, and emotional stress as well as the simplicity of the protocol for patients

effect of intrauterine human chorionic gonadotropin injection before embryo transfer on the implantation and pregnancy rate in infertile patients: a randomized clinical trial

Background: Implantation is one of the essential steps for the success of assisted reproductive techniques [ART]. Their success depends on three main factors: embryo quality, endometrial receptivity [ER], and synchrony between embryo and endometrium

There are various factors that regulate the complex process of implantation. In this regard, one may refer to human chorionic gonadotropin [hCG] as the most important factor

Objective: This study aims to investigate the effect of intrauterine hCG injection before embryo transfer [ET] on pregnancy outcome in infertile couples

Materials and Methods: A total of 159 patients undergone In vitro Fertilization/ Intracytoplasmic Sperm Injection [IVF/ICSI] with an antagonist protocol were evaluated. Patients were divided into three groups [n=53]. Group 1 received 500 IU of hCG, group 2 received 1000 IU of hCG intrauterine injection before ET, and the control group underwent ET without hCG preceding intrauterine injection

Results: There was no significant difference among the groups. The implantation rates were 18.86%, 13.52%, and 14.37%, chemical pregnancy rates were 34%, 32.1%, and 35.3%, and clinical pregnancy rates were 34%, 32.1%, and 31.4% respectively

Conclusion: The pregnancy outcome in IVF/ICSI /ET cycles cannot be improved through hCG intrauterine injections before ET

Results from adding recombinant LH for assisted reproductive technology treatment: a randomized control trial

Based on classical two-cell, two-gonadotropin theory, in the follicle, follicle-stimulating hormone [FSH] and luteinizing hormone [LH] put on their main effects on the granulosa and theca cells. LH is essential for androgens production. Androgens are used for estradiol production by granulosa cells. Profound suppression of LH concentrations in some normogonadotropic patients can cause several adverse effects. The main clinical purpose of this study was that normoresponder women treated with controlled ovarian super ovulation for IVF or ICSI may benefit from co-administration of rLH. 40 patients who were candidates for assisted reproductive technology [ART] were randomly selected. In all patients long luteal protocol was used for ovulation induction. Patients were randomly divided into two groups: Group 1 [n=20] with standard long protocol [GnRH agonist] and r-FSH alone, Group 2 [n=20] with standard long protocol [GnRH agonist] and r-FSH with r-LH. Results were statistically analyzed and compared in two groups. The number of retrieved oocytes, mature oocytes, cleaved embryos, transferred embryos, estradiol levels in Human chorionic gonadotropin [hCG] administration day, implantation rate and clinical pregnancy rate in group 2 were higher but not significantly different. Administration of rLH in late follicular phase had no beneficial effect on outcomes in young women with mean age of 31 years. Maybe a greater sample size should be used to see the effects more accurately; also it is possible that rLH will be useful in older patients

Effect of oocyte activation with calcium ionophore on ICSI outcomes in teratospermia: a randomized clinical trial

Chemical activation is the most frequently used method for artificial oocyte activation [AOA], results in high fertilization rate. This prospective, randomized, unblinded, clinical study aimed to evaluate the efficiency of oocyte activation with calcium ionophore on fertilization and pregnancy rate after intracytoplasmic sperm injection [ICSI] in infertile men suffer from teratoospermia. Thirty eight women with teratoospermic partner underwent ICSI with antagonist protocol. A total of 313 metaphase 2 [M2] oocytes were randomly divided into two groups: In the oocytes of the control group [n=145], routine ICSI was applied. Oocytes in the AOA group [n=168] immediately after ICSI, were entered in culture medium supplemented with 5 Micro calcium ionophore [A23187] for 5 minutes and then washed at least five times with MOPS solution. In both groups, the fertilization was evaluated 16-18 hours after ICSI. The number of fertilized oocytes and embryos obtained were significantly different between two groups [p=0.04]. There was no significant difference between the two studied groups regarding the fertilization and cleavage rate [95.33% vs. 84.4%, p=0.11; and 89.56% vs. 87.74%, p=0.76, respectively]. Implantation rate was higher in AOA group than in control group, but the difference was not significant [17.64% vs. 7.4%, p=0.14]. No significant differences were observed in chemical and clinical pregnancy rate between groups [47.1% vs. 16.7%, p=0.07; and 41.2% vs. 16.7%; p=0.14, respectively]. We didn't find significant difference in the implantation, fertilization, cleavage and pregnancy rates between the two groups but could significantly increase the number of fertilized oocytes and embryos obtained. Finally oocyte activation with calcium ionophore may improve ICSI outcomes in infertile men suffer from teratoospermia. Further study with more cases can provide greater value