Role of serum betaHCG measurement in prediction of empty follicle syndrome

One of important matter in treatment of patients who need in vitro fertilization and embryo transfer to uterus is retrieval of good quality and enough number of oocytes. Unfortunately, in some cases though ovary had good appearance in ultrasound and hormonal aspect, no oocyte was retrieved after HCG injection, which this condition is known as empty follicle syndrome. The aim of this study is to determine the relationship between serum betaHCG and empty follicle syndrome [EFS] in infertile women undergoing ovulation induction. This research was a prospective and case control study over 1009 patients, which 135 patients were omitted due to different reasons and amongst 874 remaining patients, 23.3% had undergone IVF and 76.7% of them had undergone intracytoplasmic sperm injection. All patients with HMG and GnRHa treatment had undergone long protocol. Then the numbers of mature oocytes were assessed during treatment and level of serum betaHCG was measured on time of HCG injection and oocytes retrieval and it was compared with retrieved oocytes. In evaluation of results of this study, no oocytes were found in 34 [3.9%] patients [group I] and less than 50% matured follicles were found in 92 [10.5%] patients [group II] and finally more than 50% matured follicles were found in 748 [85.5%] patient [group III]. Mean level of serum betaHCG was [154.6 +/- 107] in group I, [141.7 +/- 90.4] in group II and [156 +/- 56.6] in group III, 36 hours after HCG injection. The results showed no significant difference between betaHCG and EFS [P=0.194]

Relationship between ovarian volume, BMI and follicular number and clomiphene response in polycystic ovary syndrome

Polycystic ovary syndrome [PCOS] is one of the most common causes of anovulation in women during reproduction years. In this syndrome the first choice for ovulation induction is clomiphene citrate. Approximately 15-25% of patients have been shown to be resistant to even high levels clomiphene and fail to ovulate. To assess the relationship between ovarian unresponsiveness to clomiphene and some clinical and paraclinical factors in PCOS, a prospective, randomized clinical trial was performed on patients referring to the Royan Institute between May 1998 to May 2000. Fifty three PCOS patients with at least 5 successive years of infertility and an age range of 25-35 years were randomly selected. All patients suffered from oligomenorrhea, hirsutism and in all patients baseline concentrations of FSH, LH, testosterone, FBS, fasting insulin, androstandione, 17-alpha-hydroxy progesterone and DHEAs were determined. In all patients the body mass index [BMI], ovarian volume and the number of follicles in each ovary were measured. After transvaginal sonography on 3rd day of menstrual cycle, the patients were treated with clomiphene citrate in 2 cycles. In the first cycle 100 mg/day clomiphene citrate was administered from day 5 to day 9 of the cyle and if no response, the second cycle included 150 mg/day clomiphene citrate and the rate of ovulation was studied. With respect to ovulation the patients were divided in 2 groups, group 1 with ovulation and group 2 without ovulation Usingt student test, the two groups were statistically compared. The ovarian volumes were 8.6 +/- 4.3ml [Mean +/- SD] and 8.74?3.7ml in groups 1 and 2, respectively. The BMI in the 2 groups were 28.0 +/- 3.8 and 29.72 +/- 4.36 [mean +/- SD], respectively. No siginficant difference were observed between the 2 groups in these cases. However, 72.4% of patients in group 1 and 45.8% in group 2 had <10 follicles in each ovary [p < 0.05]. There results suggest no correlation between ovarian volume or BMI and response to clomiphene. However, our findings are highly suggestive of a correlation between number of primary follicles in each ovary and responsiveness to clomiphene, and thus measurement of primary follicle number in ovaries may be a predictive factor for clomiphene responsiveness

[Vaginal progestrone versus intramuscular in assisted reproduction [a comparative study]]

Progestrone is one of the important hormones in preparation of uterine endometrium for implantation of the fertilized ovum, and hyposecretion of this hormone can cause infertility and abnormalities in menstruation cycle of the women. With rising Assisted Reproduction comparative Treatment [ART], the number of patients with his abnormality and consequently their need to use external progesterone has increased. Since progesterone exists in different forms, the research is focused upon comparing the natural oil soluble progesterone with other types which are used as vaginal or rectal suppository. A prospective study with randomized clinical trial was done on the patients who were being treated in ART cycles in which superovulation using GnRH-a+hMG was done during 1996 in Royan Institute. Over this period of time, 185 cases of embryo transfusion was performed from which 88 patients [the first group] were randomly treated with progestrone suppository, and 97 [the second group] were treated with progestrone injection. Incidence of pregnancy in the first group was 22 [25%] and in the second group was 25 [25.8%], which statistically indicates no significant difference [p=0.90]. In these patients progesterone level of the blood serum was measured five and seven days after hCG injection. The average progesterone level in blood serum of the first group was 52.72 ng/ml and of the second group was 49.29 ng/ml, which statistically indicated no significant difference [p=0.764]. These findings suggest that the effect of different forms of this progestine drug on promoting secretory phase of endomertium and thus preparing uterus for implantation of the embryo is the same. Therefore, the choice of type drug should be based on the patients condition and their own preference