Does low-dose aspirin improve pregnancy rate in women undergoing frozen-thawed embryo transfer cycle? A pilot double-blind, randomized placebo-controlled trial.

AIM: To evaluate the effect of adjuvant low-dose aspirin therapy on clinical pregnancy rate and uterine perfusion in women undergoing frozen-thawed embryo transfer (FET) cycles. METHODS: This study was performed as a pilot randomized, double-blind placebo-controlled trial, from May 2012 to February 2015. Overall, 60 available eligible women who were candidates for FET were randomly assigned to two groups receiving either 100 mg oral aspirin (n =30) or placebo (n =30). The primary outcome measure was clinical pregnancy rate. Secondary outcome measures were pulsatility index (PI), resistance index (RI), implantation rate, live birth rate and miscarriage rate. RESULTS: There was no significant difference in endometrial thickness, PI and RI. However, the study group had higher rates of clinical pregnancy, implantation, live birth (P = 0.042, P = 0.031 and P = 0.007, respectively) and lower rate of miscarriage (P = 0.020) as compared to the control group. Twin birth rate was comparable between the two groups. CONCLUSION: Our pilot study demonstrated that administration of low-dose aspirin in FET cycles results in better pregnancy, implantation and live birth rates without changing the uterine hemodynamics or endometrial thickness. However, further randomized clinical studies in larger populations are needed to confirm these findings.

Hysteroscopic polypectomy without cycle cancellation in IVF/ICSI cycles: a cross-sectional study.

OBJECTIVE(S): To evaluate the effect of hysteroscopic polypectomy during ovarian stimulation phase on in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) cycles outcomes. STUDY DESIGN: This cross sectional study was performed in female infertility department of Royan Institute from January 2011 to December 2013. In total, 160 patients who were diagnosed incidentally polyp/polyps less than 20mm during the stimulation phase for oocyte recoveries were recruited; of these, fifty eight cases underwent hysteroscopic polypectomy without cycle cancellation non-randomly. Polyp resection was performed through hysteroscopic polypectomy during ovarian stimulation. The interval between polypectomy and embryo transfer (ET) was 3-17 days. The women who did not undergo hysteroscopic polypectomy and matched for polyp size were selected as control group. The outcomes of IVF/ICSI cycles were compared between groups. RESULTS: The data analysis showed the two groups were comparable in terms of patients' characteristics and stimulation outcomes. The implantation rate was not significantly different between groups (P=0.3). The clinical pregnancy and live birth rates were similar between groups (%34.9 vs. %32.5 and %30.2 vs. %27.9, P=0.9 and P=0.8). No pregnancy was observed in patients who had the interval between hysteroscopic polypectomy until ET less than 5days and the multivariable logistic regression analysis revealed that the interval between polyp resection and ET was significant predictor for live birth rate (odds ratio: 1.2, confidence interval: 1.01-1.5, P=0.04). DISCUSSION(S): For the management of the polyps less than 20mm which have been diagnosed during the stimulation phase, the performance of hysteroscopic polypectomy without cycle cancellation does not improve the pregnancy and live birth rates. Therefore, it seems that the continuation of the treatment cycle and ignorance of these polyps is the appropriate treatment choice and the performance of hysteroscopic polypectomy and frozen embryo transfer program could be the next treatment option.

Effect of oocyte dysmorphisms on intracytoplasmic sperm injection cycle outcomes in normal ovarian responders.

AIM: The aim of this study was to identify the influence of oocyte dysmorphisms on clinical outcomes after intracytoplasmic sperm injection cycle in normal responders. MATERIAL AND METHODS: In the prospective study, morphology of 1999 metaphase II oocytes retrieved from 316 intracytoplasmic sperm injection cycles was evaluated from March 2011 to March 2013 at Royan Institute. Controlled ovarian stimulation was performed by long standard agonist protocol. Oocyte morphology was assessed before sperm injection by one embryologist. The associations between fertilization rate, embryo quality and the independent variables were analyzed using odds ratio (OR) calculated with unconditional logistic regression test. RESULTS: From all retrieved oocytes, 1543 (77.1%) showed at least one morphologic aberration. Presence of cytoplasmic vacuoles and high cytoplasmic viscosity were associated with a significant decrease in the fertilization rate (OR: 0.5; P = 0.004 and OR: 0.6; P = 0.03, respectively). The results showed that oocyte morphology did not affect embryo quality. The number of gonadotrophin injections used showed a direct relation with presence of large perivitelline space. No significant difference was observed among four groups (women with total normal morphologic oocytes [group 1], women with total extracytoplasmic dysmorphic oocytes [group 2], women with total cytoplasmic dysmorphic oocytes [group 3] and women with total oocytes containing multiple dysmorphic features [group 4]) in terms of implantation and clinical pregnancy rates. CONCLUSIONS: Metaphase II oocyte morphology had minor impacts on fertilization rate, pronuclear morphology and embryo quality in women with normal ovarian response.

Predictive factors of early moderate/severe ovarian hyperstimulation syndrome in non-polycystic ovarian syndrome patients: a statistical model.

PURPOSE: To evaluate demographic, medical history and clinical cycle characteristics of infertile non-polycystic ovary syndrome (NPCOS) women with the purpose of investigating their associations with the prevalence of moderate-to-severe OHSS. METHODS: In this retrospective study, among 7073 in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) cycles, 86 cases of NPCO patients who developed moderate-to-severe OHSS while being treated with IVF/ICSI cycles were analyzed during the period of January 2008 to December 2010 at Royan Institute. To review the OHSS risk factors, 172 NPCOS patients without developing OHSS, treated at the same period of time, were selected randomly by computer as control group. We used multiple logistic regression in a backward manner to build a prediction model. RESULTS: The regression analysis revealed that the variables, including age [odds ratio (OR) 0.9, confidence interval (CI) 0.81-0.99], antral follicles count (OR 4.3, CI 2.7-6.9), infertility cause (tubal factor, OR 11.5, CI 1.1-51.3), hypothyroidism (OR 3.8, CI 1.5-9.4) and positive history of ovarian surgery (OR 0.2, CI 0.05-0.9) were the most important predictors of OHSS. The regression model had an area under curve of 0.94, presenting an allowable discriminative performance that was equal with two strong predictive variables, including the number of follicles and serum estradiol level on human chorionic gonadotropin day. CONCLUSION(S): The predictive regression model based on primary characteristics of NPCOS patients had equal specificity in comparison with two mentioned strong predictive variables. Therefore, it may be beneficial to apply this model before the beginning of ovarian stimulation protocol.

Comparison of easy and difficult embryo transfer outcomes in in vitro fertilization cycles.

BACKGROUND: The aim of this study was to compare the effects of easy and difficult embryo transfers (ET) on implantation and pregnancy rates. MATERIALS AND METHODS: In this prospective study, we analyzed the results of 706 ET procedures over a 12-month period. An easy ET was defined as a transfer that occurred without the use of force or other instrumentation. A difficult ET was defined as the use of force for catheter placement, and/or the use of additional instruments, and/or manipulation. Pregnancy rate was compared between patients with easy or difficult ETs. RESULTS: There was a significantly higher implantation rate in the easy group (21.7%) compared to the difficult group (12.1%, p<0.05).The easy group had a higher pregnancy rate (38.1%) compared to patients who had difficult ETs (21.4%; p<0.05). CONCLUSION: Any uterine manipulation during ET adversely affects in vitro fertilization (IVF). Precaution should be taken to identify possibly difficult ET cases in advance.

Comparison of cabergoline and intravenous albumin in the prevention of ovarian hyperstimulation syndrome: a randomized clinical trial.

PURPOSE: To compare the efficacy of cabergoline (Cb2) and intravenous human albumin (HA) in the prevention of ovarian hyperstimulation syndrome. METHODS: In this randomized controlled trial study, 138 women who were at high risk for developing OHSS were randomly allocated into two groups. In Group one, 20 gr of HA 20% was infused over 1 h. Group two received 0.5 mg per day of Cb2 orally for 7 days, starting on oocyte pickup day. All patients were visited seven and 14 days after oocyte retrieval to determine early clinical or ultrasound evidence of OHSS. RESULTS: Moderate OHSS was observed in 33 versus 14 cases in the HA and Cb2 groups, respectively, which was significantly different. The number of severe OHSS cases in the HA group was significantly higher than in the Cb2 group (P < 0.001). CONCLUSIONS: Prophylactic oral low dose cabergoline was more effective and less costly than intravenous human albumin in the prevention of OHSS in high-risk patients.

Improvement in pregnancy rate by removal of cervical discharge prior to embryo transfer in ICSI cycles: a randomised clinical trial.

AIMS: The present study aimed to evaluate the effect of removing cervical discharge prior to embryo transfer (ET) on pregnancy rates. METHODS: Five hundred and thirty women who were candidates for fresh ET in intracytoplasmic sperm injection (ICSI) cycles were randomly allocated to intervention or control groups. In the intervention group, the cervical canal was cleansed using sterile cotton swabs prior to ET. The control group had routine ET. Multiple logistic regression analysis was used to estimate the adjusted effect of removing the cervical discharge on pregnancy rates. RESULTS: There was a significant difference in pregnancy rates between the two groups. The clinical pregnancy rate was 104/265 (39.2%) in the intervention group compared with 60/265 (22.6%) in the control group (P<0.001). The intervention group also had a higher implantation rate (20.5%) compared with the control group (12.2%; P<0.001). Additionally, the live birth rate in the intervention group (33.6%) was significantly higher than in the control group (17.4%; P<0.001). The logistic regression analysis indicated that the odds ratio of pregnancy in the intervention group was 2.297 (95% CI, 1.552-3.399) compared with the control group. CONCLUSIONS: Removal of cervical discharge prior to ET may have a significant effect on the rate of implantation, pregnancy and live birth.