ABSTRACT
This prospective case-control study aimed to test the presence of insulin resistance (IR) in men with unexplained infertility. We included two groups: the study group including 160 infertile men with unexplained oligozoospermia (sperm count <10 × 106/ml) and normal hormonal profile, and the control group of 79 men with proven fertility within the preceding year. A fasting blood test measured IR, FSH, LH, total cholesterol, low-density lipoprotein, high-density lipoprotein and triglycerides. Insulin level was significantly higher in the study group (13.67 ± 10.44) compared with the control group (5.46 ± 3.15), P < 0.0001, and IR was significantly higher in the study group, P < 0.0001. FSH was significantly (P < 0.0001) higher in the study group (4.71 ± 2.57) than the control group (3.15 ± 1.92). LH was significantly higher in the study group (4.98 ± 2.41) compared with the control group (3.15 ± 1.12), P < 0.0001. Total cholesterol was significantly higher in the study group (198.29 ± 37.52) than the control group (182.45 ± 35.92), P < 0.05. In conclusion, IR in men with unexplained infertility may be a cause of reproductive and metabolic abnormalities. The benefit of insulin-sensitizing agents for these patients should be tested.
Subject(s)
Infertility, Male/physiopathology , Insulin Resistance , Case-Control Studies , Follicle Stimulating Hormone/blood , Humans , Infertility, Male/blood , Insulin/blood , Lipids/blood , Luteinizing Hormone/blood , Male , Prospective StudiesABSTRACT
OBJECTIVE: To investigate the value of intrauterine injection of human chorionic gonadotropin (hCG) before embryo transfer (ET). DESIGN: Prospective randomized study. SETTING: The Egyptian IVF-ET Center. PATIENT(S): Infertility patients younger than 40 years undergoing their first in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI). INTERVENTION(S): The study group (n = 167) received either 100 IU of hCG (n = 83), or 200 IU of hCG (n = 84) via intrauterine administration before ET. The control group (n = 93) underwent ET without hCG. After the interim analysis, the modified study group (n = 107) received intrauterine injection of 500 IU of hCG, and the control group (n = 105) underwent ET without hCG. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate (PR) and implantation rate (IR). RESULT(S): The IR and PR were statistically significantly higher in the 500 hCG group (41.6% and 75%, respectively) as compared with the control group (29.5% and 60%, respectively). The IR and PR were 26.6% and 54% in the 100 hCG group, 28.3% and 57% in the 200 IU hCG group, and 29.4% and 60% in the control group, respectively, with no statistically significant difference. CONCLUSION(S): Intrauterine injection of 500 IU of hCG before ET statistically significantly improved the implantation and pregnancy rates in IVF/ICSI. CLINICAL TRIALS.GOV NUMBER: NCT 01030393.
Subject(s)
Chorionic Gonadotropin/administration & dosage , Chorionic Gonadotropin/pharmacology , Embryo Implantation/drug effects , Embryo Transfer/methods , Fertilization in Vitro , Pregnancy Rate , Administration, Intravaginal , Adult , Drug Administration Schedule , Female , Fertilization in Vitro/methods , Humans , Injections , Pregnancy , Sperm Injections, Intracytoplasmic , Time Factors , Up-Regulation , Uterus , Young AdultABSTRACT
Vanishing fetal twins occurred in 9% (264 out of 2,829) intracytoplasmic sperm injection pregnancies and are associated with a lower fetal loss rate in the first trimester. The live birth rate was higher in pregnancies associated with vanishing fetuses.
Subject(s)
Aborted Fetus , Pregnancy Outcome , Sperm Injections, Intracytoplasmic , Aborted Fetus/physiology , Adult , Embryo Loss/diagnosis , Embryo Loss/epidemiology , Female , Humans , Incidence , Infertility, Female/diagnosis , Infertility, Female/therapy , Pregnancy , Pregnancy Outcome/epidemiology , Pregnancy, Multiple/physiology , Prognosis , Sperm Injections, Intracytoplasmic/methods , Sperm Injections, Intracytoplasmic/statistics & numerical data , Treatment Outcome , TwinsABSTRACT
OBJECTIVE: To estimate the live-birth and miscarriage rates in 1-year age increments for women aged ≥40 years undergoing in vitro fertilization or intracytoplasmic sperm injection (ICSI-IVF) with autologous oocytes. DESIGN: Retrospective database and chart analysis. SETTING: Egyptian IVF and embryo transfer center. PATIENT(S): One thousand six hundred forty-five women aged ≥40 years undergoing 2004 fresh nondonor IVF-ICSI cycles. INTERVENTION(S): ICSI-IVF using ejaculate or surgically retrieved sperm. MAIN OUTCOME MEASURE(S): Pregnancy and live-birth rates per initiated cycle based on 1-year age increments. RESULT(S): The overall live-birth rate per initiated cycle was 6.7% (range: 10% to 0.5%). The pregnancy loss rate was 44.8% (range: 39.0% to 75.0%). The cutoff age was 43 years, when the pregnancy rate became statistically significantly lower. The live-birth rate per initiated cycle was statistically significantly higher for women <43 years old, 132 out of 1766 (7.4%) compared with women ≥43 years old, 7 out of 620 (1.1%). The miscarriage rate was 127 out of 295 (43.1%) compared with 15 out of 23 (65.2%) for the two age groups, respectively. CONCLUSION(S): The success rate of ICSI-IVF as measured by live-birth rate per initiated cycle was statistically significantly higher for women aged <43 years as compared with women aged ≥43 years. Once women have attained age 43 years, alternative methods such as oocyte donation cycles or previously cryopreserved embryos are likely to be more effective.
