Effect of autologous platelet-rich plasma for treatment of recurrent pregnancy loss: a randomized controlled trial

Objective@#Recurrent pregnancy loss (RPL) is a fertility problem for which no exact mechanism of abortion or efficient treatment has been described. This study was conducted between 2018 and 2019 to investigate the effectiveness of autologous platelet-rich plasma (PRP) in improving the live birth rate of women with RPL who required in vitro fertilization (IVF). @*Methods@#A total of 63 patients with at least two previous pregnancy losses and no specific cause detected for the RPL were included and randomly assigned into two groups (PRP and control). Intrauterine infusion of 0.5 mL of autologous PRP was performed 48 hours before embryo transfer in the PRP group. Women in the control group received standard treatment. @*Results@#Forty patients completed the study. The baseline and cycle characteristics of the participants did not differ significantly between the PRP and control groups. The clinical pregnancy rate was higher in the PRP group (35% vs. 20%, P=0.288). The live birth rate was 15% in the PRP group, but no live births were recorded in the control group (P=0.231). @*Conclusion@#This is the first study to show that intrauterine infusion of PRP in patients with RPL who undergo IVF may increase the chance of live birth.

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

Effects of autologous platelet-rich plasma on implantation and pregnancy in repeated implantation failure: a pilot study

Background: Repeated implantation failure [RIF] is a major challenge in reproductive medicine and despite several methods that have been described for management, there is little consensus on the most effective one

Objective: This study was conducted to evaluate the effectiveness of platelet-rich plasma in improvement of pregnancy rate in RIF patients

Materials and Methods: Twenty women with a history of RIF who were candidates for frozen-thawed embryo transfer were recruited in this study

Intrauterine infusion of 0.5 ml of platelet-rich plasma that contained platelet 4-5 times more than peripheral blood sample was performed 48 hrs before blastocyst transfer

Results: Eighteen participants were pregnant with one early miscarriage and one molar pregnancy. Sixteen clinical pregnancies were recorded and their pregnancies are ongoing

Conclusion: According to this study, it seems that platelet-rich plasma is effective in improvement of pregnancy outcome in RIF patients

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

[Vitrification does not increase the incidence of apoptosis and caspase 3/7 activity in human ovarian tissues]

This study aimed to evaluate the incidence of apoptosis in vitrified and non-vitrified human ovarian tissue by the use of morphological analysis and apoptosis assay techniques. We obtained human ovarian tissue biopsies from 30 women who underwent elective caesarean sections. Tissues were transported to the laboratory in pre-warmed, equilibrated Leibovitz L-15 medium within 2 hours. The tissues were cut into small pieces and divided into two groups, vitrified and non-vitrified [control]. Apoptosis incidence was assessed by light microscope and the TUNEL assay and DNA laddering. Evaluation of caspase 3/7 protein levels was performed by the luminescent assay. We observed no morphological signs of apoptosis in the vitrified samples. There were no apoptosis signals as evidenced by TUNEL staining and no DNA laddering pattern observed in the vitrified group. Caspase 3/7 activity was 2294 +/- 169.19 RLU/microg protein in the non-vitrified control group and 2231 +/- 89.271 RLU/microg protein in the vitrified group, which was not significantly different. The structure of human vitrified ovarian tissue was well preserved. Vitrification could not increase apoptosis and caspase 3/7 activity in human ovarian tissue

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

Human ovarian tissue vitrification/warming has minor effect on the expression of apoptosis-related genes

In this study, we evaluated the incidence of apoptosis at the ultrastructural levels and expression of some apoptosis-related genes in vitrified human ovarian tissue just after warming. Human ovarian tissue biopsies from 23 women after caesarean section were transported to the laboratory within 2 hours, and then they were cut into small pieces. Some pieces were vitrified and warmed and the other samples were considered as control. Apoptosis was assessed by a transmission electron microscope and also by molecular analysis of pro-apoptotic [Fas, FasL, Bax, p53, caspase8, and caspase3] and antiapoptotic [Bcl-2 and BIRC5] genem RNA levels using real-time RT-PCR before and after vitrification. No sign of apoptosis was shown ultrastructurally in vitrified samples. The level of FasL, Bcl-2, Bax, p53, and caspase3 mRNA and Bax:Bcl-2 ratio were similar in non-vitrified and vitrified groups; however, the expression of Fas and caspase8 genes was higher and BIRC5 was lower in vitrified samples compared to non-vitrified group [P<0.05]. The fine structure of human vitrified ovarian tissue was well preserved; moreover, vitrification was shown to affect the expression of some apoptosis-related genes. However, additional study is needed to confirm this observation

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

Super infection of an ovarian dermoid cyst with actinomyces in an infertile woman

We present super infection of an ovarian dermoid cyst with actinomyces in an infertile patient. This is a case-report study for evaluation a couple with male factor infertility, who was a good candidate for intracytoplasmic sperm injection [ICSI], while a 10 cm dermoid cyst was found in the woman's right ovary. Patient complained of pelvic pain, intermittent fever, dysmenorrhea, and dyspareunia. The cyst was extracted using laparoscopy, whilst in histopathological examination, an actinomycosis super infection was reported. Actinomyc super infection of an ovarian dermoid cyst is a very rare incident which can also occur in women with no history of intrauterine device [IUD] usage or previous fertility

Knowledge and Attitude of Women Regarding the Human Papillomavirus (HPV) Infection, Its Relationship to Cervical Cancer and Prevention Methods

This study aimed to determine knowledge and attitude of women to HPV and its association with cervical cancer and prevention methods. In a cross-sectional study, 500 women, aged between 20 and 50 presenting to local health centers in Tehran, were asked about demographic factors and questioned about cervical cancer, HPV, and prevention methods. Responses were tabulated and summarized. Although knowledge of HPV, its relation to cervical cancer and prevention methods among Iranian women is not enough, their attitude towards education in this regards is extremely high. The results reflect the need of advertising and educational programs for public about HPV prevention methods, to reduce the prevalence of this infection and its severe consequences.

Increase in concentration of soluble HLA-G in high-quality embryos after intracytoplasmic sperm injection / 대한해부학회지

Non-invasive methods are normally preferred to conventional invasive methods when selecting suitable embryos to improve pregnancy rates after assisted reproduction techniques. One of the most recognized non-invasive methods is to examine the supernatants of embryo culture media. Soluble human leukocyte antigen, class I, G (sHLA-G) antigen is a non-classical class I molecule that has been widely considered as a marker of pregnancy failure or implantation success. In the current study of some Iranian patients, we examined the concentration of sHLA-G at different time points after intracytoplasmic sperm injection and compared the rates to the morphology and quality of the selected embryos. We showed that the concentration of sHLA-G increases over time in high-quality embryos. We conclude that there is a positive relationship between morphology, quality, and sHLA-G concentration. We suggest that this relationship can be used to increase the chance of a successful pregnancy.

Evaluation of homocysteine levels in patients with polycystic ovarian syndrome

To determine the level of plasma homocysteine in patients with polycystic ovary syndrome [PCOS] compared with healthy controls. In this prospective case-control study on 85 PCOS women and 83 controls matched by body mass index [BMI], homocysteine levels were assessed. The mean level of homocysteine was 16.25 +/- 11.94 micromol/L in patients with PCOS and 11.58 +/- 3.82 micromol/L in controls [p=0.002]. Patients with PCOS had a significantly higher risk for hyperhomocysteinemia compared with BMI-matched control women. These data suggest that homocysteine levels are elevated in the PCOS population. Further studies are needed to characterize this relationship

correlation between serum and peritoneal fluid CA125 level in women with pelvic endometriosis

Despite a high prevalence of endometriosis, there still exist many challenges in diagnosing the disease. This study aims to evaluate non-invasive and practical diagnostic methods by measuring serum and peritoneal fluid CA 125 levels in patients with endometriosis. A secondary aim is to determine the correlation between these markers with the stage of disease as well as the relationship of the two markers with each other. This is a cross-sectional study of 60 women who underwent laparoscopy for benign conditions. Based on laparoscopic findings and biopsy results, patients were divided to two groups; one group included patients with pelvic endometriosis [35 patients] and the second enrolled patients free from endometriosis [25 patients]. Serum and peritoneal fluid specimens were provided at the time of laparoscopy and CA125 levels were then assessed by electrochemiluminescence immunoassay. Mean serum and peritoneal fluid CA125 levels were significantly higher in women with endometriosis as compared to the control group [26.42 +/- 24.34 IU/ml versus 12.64 +/- 6.87 IU/ml in serum and 2203.54 + 993.19 IU/ml versus 1583.42 +/- 912.51 IU/ml in peritoneal fluid, p<0.05]. CA 125 levels also varied proportionally with the stage of endometriosis; but showed a significant difference only in higher stages of the disease, both in serum and peritoneal fluid. We calculated the cut-off value suggesting a diagnosis of pelvic endometriosis as 14.70 IU/ml for serum and 1286.5 IU/ml for peritoneal fluid CA125. A linear correlation between CA 125 levels in serum and peritoneal fluid in patients with pelvic endometriosis has also been observed. Serum and peritoneal fluid CA 125 levels are simple and non-surgical tools for diagnosing and staging pelvic endometriosis. These markers are of greater diagnostic value in higher stages of the disease