Does intrauterine saline infusion by intrauterine insemination [IUI] catheter as endometrial injury during IVF cycles improve pregnancy outcomes among patients with recurrent implantation failure?: An RCT

Background: Recurrent implantation failure is one of the most issues in IVF cycles. Some researchers found that beneficial effects of endometrial Scratching in women with recurrent implantation failure, while some authors demonstrated contrary results

Objective: The present study aimed to investigate the effect of intrauterine. Saline infusion as a form of endometrial injury, during fresh in vitro fertilization-embryo transfer cycle, among patients with recurrent implantation failure

Materials and Methods: In this clinical trial study 63 women undergoing assisted reproductive technology were divided into two groups either local endometrial injury by intrauterine saline infusion during day 3-5 of the ongoing controlled ovarian stimulation cycle, or IVF protocol performed without any other intervention in Taleghani Hospital, Tehran, Iran. The main outcome measure was clinical pregnancy rates

Results: Patients who received intra uterine saline infusion [n=20], had significantly lower clinical pregnancy numbers [1 vs. 9, p<0.05] and implantation rates [4.7% vs. 41.6%, p<0.05], compared to controls [n=39]. However, there was no significant difference in miscarriage rates [9.4% vs. 8.7%, p>0.05] and multiple pregnancy numbers [1 vs. 3, p>0.05] between groups

Conclusion: When intrauterine saline infusion as a form of endometrial injury is performed during the ongoing IVF cycles it has negative effect on reproductive outcomes among patients with recurrent implantation failure

Premature progesterone rise at human chorionic gonadotropin triggering day has no correlation with intracytoplasmic sperm injection outcome

Premature luteinization during in vitro fertilization was commonly happened before the introduction of GnRh analogues. High level of unwanted progesterone is associated with adverse pregnancy outcome and is thought to be induced by inappropriate LH elevation. To evaluate the progesterone level on the day of Human Chorionic Gonadotropin [HCG] triggering in GnRh agonist and antagonist protocols, and its correlation with clinical pregnancy rate and miscarriage rate. One hundred and seven women underwent intracytoplasmic sperm injection with long agonist protocol [n=46] or antagonist protocol [n=61]. Blood sample was obtained from each patient for progesterone level measurement in HCG administration day, then patients were divided into two groups according to their serum progesterone levels on the HCG triggering day: progesterone level <1.2 ng/ml, and progesterone level >/=1.2 ng/ml. Clinical pregnancy and miscarriage rates were evaluated as main outcomes and biochemical pregnancy rate and implantation rate were considered as secondary outcomes. The increased prevalence rate of premature progesterone [progesterone level >/=1.2 ng/ml] in total patients was 13.1% [14/107] and in long agonist protocol group and antagonist protocol group was 15.2% [7/46] and 11.5% [7/61] respectively. Premature progesterone rise had no significant correlation with clinical pregnancy rate in total patients [p=0.174], agonist protocol [p=0.545], and antagonist protocol [p=0.129]. Also premature progesterone rise had no significant association with miscarriage rate in total patients [p=0.077], agonist protocol group [p=0.383] and antagonist protocol group [p=0.087]. A significant rise in progesterone levels at the time of HCG triggering doesn't lead to decrease in pregnancy rate and implantation rate and increase in miscarriage rate

Comparison between conventional blind embryo transfer and embryo transfer based on previously measured uterine length

Embryo transfer [ET] is one of the most important steps in assisted reproductive technology [ART] cycles and affected by many factors namely the depth of embryo deposition in uterus. In this study, the outcomes of intracytoplasmic sperm injection [ICSI] cycles after blind embryo transfer and embryo transfer based on previously measured uterine length using vaginal ultrasound were compared. This prospective randomised clinical trial included one hundred and forty non-donor fresh embryo transfers during January 2010 to June 2011. In group I, ET was performed using conventional [blind] method at 5-6 cm from the external os, and in group II, ET was done at a depth of 1-1.5 cm from the uterine fundus based on previously measured uterine length using vaginal sonography. Appropriate statistical analysis was performed using Student's t test and Chi-square or Fisher's exact test. The software that we used was PASW statistics version 18. A p value <0.05 was considered statistically significant. Chemical pregnancy rate was 28.7% in group I and 42.1% in group II, while the difference was not statistically significant [p=0.105]. Clinical pregnancy, ongoing pregnancy and implantation rates for group I were 21.2%, 17.7%, and 12.8%, while for group II were 33.9%, 33.9%, and 22.1, respectively. In group I and group II, abortion rates were 34.7% and 0%, respectively, indicating a statistically significant difference [p<0.005]. No ectopic pregnancy occurred in two groups. The use of uterine length measurement during treatment cycle in order to place embryos at depth of 1-1.5 cm from fundus significantly increases clinical and ongoing pregnancy and implantation rates, while leads to a decrease in abortion rate [Registration Number: IRCT2014032512494N1]

Treatment results of high dose cabergoline as an adjuvant therapy in six patients with established severe ovarian hyper stimulation syndrome

The beneficial role of cabergoline as a prophylactic agent to prevent ovarian hyper stimulation syndrome [OHSS] among high-risk patients has been demonstrated in previous studies. But data for its role as a treatment for established severe OHSS is still limited. We represent the treatment results of high dose oral cabergoline in management of six patients after the syndrome is established. High-dose oral cabergoline [1 mg daily for eight days] was prescribed as an adjuvant to symptomatic treatment for six hospitalized patients with established severe OHSS following infertility treatment cycles. In two cases OHSS resolved rapidly despite the occurrence of ongoing pregnancy. Considering the treatment outcomes of our patients, high dose cabergoline did not eliminate the need for traditional treatments, but it was a relatively effective and safe therapy in management of established severe OHSS, and prevented the increase in its severity following the occurrence of pregnancy

Subclinical hypothyroidism and insulin resistance in polycystic ovary syndrome: is there a relationship?

Polycystic ovary syndrome [PCOS] is the most common hyperandrogenic disorder among women and is often defined as hyperandrogenic syndrome. These patients are at risk for oligo/amenorrhea, chronic anovulation, infertility, obesity, spontaneous abortion, insulin resistance, hyperinsulinemia and metabolic syndrome. Thyroid disorders especially hypothyroidism is more common in these people. In PCOS patients, subclinical hypothyroidism may aggravate insulin resistance. The goal was to find any relationship between subclinical hypothyroidism and insulin resistance in PCOS patients. In this prospective cross sectional study we included all PCOS patients coming to infertility clinic of Taleghani Hospital in 2010-2012 who had the criteria of Rotterdam for PCOS. Then the clinical examination was done for them and height, weight, body mass index and lab data were measured including thyroid hormone and biochemical profile. The data were analyzed by SPSS software version 20. Among 75 PCOS patients, 19 [25.5%] had subclinical hypothyroidism and 56 patients [74.4%] were euthyroid. The prevalence of insulin resistance was 22.7% and 77.3% of patients had no insulin resistance were normal. We could find no relationship between insulin resistance and subclinical hypothyroidism in PCOS patients

Comparison of oral dydrogesterone with suppository vaginal progesterone for luteal-phase support in in vitro fertilization [IVF]: a randomized clinical trial

Luteal phase support is mandatory in assisted reproductive technologies [ART] for optimizing outcome, so the luteal phase is supported with either progesterone, addition of estradiol to progesterone, hCG or gonadotropin releasing hormone [GnRH] agonists. Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment. To compare oral dydrogestrone with vaginal progesterone for luteal-phase support in IVF. We performed this prospective, randomized trial in a tertiary infertility care unit in Taleghani Hospital, Tehran, Iran. In total 80 Women with a history of male factor infertility undergoing controlled ovarian stimulation for IVF treatment [fresh cycle] randomly were divided in two groups [group A or oral dydrogesterone group and group B or vaginal progesterone group]. The inclusion criteria were the use of GnRH analogue down-regulation and age less than 40 years old with regular menstrual cycles. All women were euthyroid and normoprolactinemic. Group A [n=40] received 10 mg dydrogesterone QID [40mg daily] and group B [n=40] received 400 mg suppository vaginal progesterone [cyclogest] twice per day [800 mg daily]. Clinical pregnancy rate in cyclogest group was higher than dydrogesterone group but the difference was not significant [p=0.52], furthermore the miscarriage rate in two group was the same .The difference between two groups regarding antral follicle, embryo number, luteal-phase duration, endometrial thickness, oocyte number and metaphase-II was not significant [p>0.05]. The results showed that oral dydrogesterone is as effective as vaginal progesterone for luteal-phase support in women undergoing IVF

influence of sperm morphology, total motile sperm count of semen and the number of motile sperm inseminated in sperm samples on the success of intrauterine insemination

The present study aimed to analyze the prognostic value of sperm morphology, total motile sperm count [TMSC] and the number of motile sperm inseminated [NMSI] on the outcome of intrauterine insemination [IUI]. This cross sectional study was carried out 445 women undergoing 820 IUI cycles. All of the patients underwent controlled ovarian hyper stimulation with clomiphen citrate and human menopausal gonadotropin [HMG] followed by intrauterine insemination with the husband's sperm. Pregnancy rate [PR] per cycle in correlation to sperm morphology, TMSC and NMSI was obtained. Statistical analysis of the data was done by the SPSS version 13 [Chicago, USA]. A total of 81 clinical pregnancies were obtained for a pregnancy rate per cycle of 9.9%. When the TMSC was 5x10[6] to <10x10[6], the PR per cycle was significantly higher than the subgroups <1x10[6], 1x10[6] to <5x10[6] and >/= 10x10[6] [15%, 5.6%, 5.1%, 10.8%, respectively]. Sperm morphology was in itself a significant factor that affected the likelihood of IUI success. Nonetheless, the most significant difference of the PR per cycle with sperm morphology was in the subgroup <5% [2.1% vs. 97.9%].When the NMSI was >/= 10x10[6], the PR per cycle was significantly higher than the subgroups<5x10[6] and 5x10[6] to< 10x10[6] [11.2%, 4.1%, 5.2%, respectively]. The study showed that TMSC 5x10[6] to < 10x10[6] and normal sperm morphology >/= 5% and NMSI >/= 10x10[6] are useful prognostic factors of IUI cycles