Value of follicular fluid vitamin D in predicting the pregnancy rate in an IVF program.

PURPOSE: This study investigated whether there is a correlation between levels of 25OH-D in the follicular fluid and the serum of infertile women and the results of IVF and rates of pregnancy. The association between the levels of 25OH-D in the follicular fluid and the vitamin D repletion status was also assessed. METHODS: Two hundred and twenty-one infertile women participated in an IVF cycle from 2010 to 2011 in a prospective observational study. Serum and follicular fluid were collected for vitamin D analysis. Deficient, insufficient, and sufficient levels of vitamin D were defined as 10, 10-29, and 30-100 ng/ml, respectively. IVF cycle parameters and clinical pregnancy rates were also compared with the vitamin D level. RESULTS: The levels of vitamin D deficiency, insufficiency, and sufficiency were 22.6, 70.1, and 7.2%, respectively. The fertilization rates associated with these three levels of vitamin D were 43.17, 53.37, and 58.77%, respectively, (P = 0.054), and the implantation rates were 17.33, 15.26, and 18.75%, respectively, (P = 0.579). No significant correlation was seen between the pregnancy rate and the serum vitamin D level (P = 0.094) or the follicular vitamin D level (P = 0.170). The serum and follicular fluid vitamin D levels showed a significant correlation (P = 0.000). CONCLUSION: Although vitamin D is an important hormone in the human body, no correlation was found between the serum and follicular vitamin D level and the pregnancy rate in the IVF cycle.

A comparative study of luteal estradiol pre-treatment in GnRH antagonist protocols and in micro dose flare protocols for poor-responding patients.

PURPOSE: This study aims to verify if luteal estradiol pre-treatment improves IVF/ICSI outcomes in a GnRH antagonist protocol as compared with a micro dose GnRH agonist protocol in poor-responding patients. METHODS: A total of 116 IVF/ICSI cycles were included in this prospective randomized single blind clinical trial. The selected women were randomly assigned to receive an estradiol pre-treatment in a GnRH antagonist protocol (daily oral Estradiol Valerate 4 mg preceding the IVF cycle from the 21st day until the first day of the next cycle) or in oral contraceptive pill micro dose GnRH agonist protocol. RESULTS: The patients in the luteal estradiol protocol required more days of stimulation (10.9 ± 1.6 vs. 10.2 ± 1.8) and a greater gonadotropin requirement (3,247.8 ± 634.6 vs. 2,994.8 ± 611 IU), yet similar numbers of oocytes were retrieved and fertilized. There was no significant difference between the two groups in terms of the implantation rates (9.8 vs. 7.9 %) and the clinical pregnancy rates per transfer (16.3 vs. 15.6 %). CONCLUSION: This study demonstrates that the use of estradiol during a preceding luteal phase in a GnRH antagonist protocol can provide similar IVF outcomes when compared to a micro dose GnRH agonist protocol.

Effect of progesterone supplementation on natural frozen-thawed embryo transfer cycles: a randomized controlled trial.

BACKGROUND: The transfer of cryopreserved embryos can be timed with ovulation in a natural cycle or after artificially preparing the endometrium with exogenous hormones. Progesterone is essential for the secretory transformation of the endometrium that permits implantation as well as maintenance of early pregnancy. The purpose of this study is to assess the effect of luteal phase supplementation on pregnancy rates in natural frozen-thawed cycles. MATERIALS AND METHODS: The study was designed as a prospective randomized clinical trial of 102 women who underwent embryo transfers in natural cycles. The women in the interventional group (n=51) received intra muscular (IM) progesterone 50 mg twice a day starting from 36 hours after hCG administration. The control group (n=51) did not receive any progesterone support. RESULTS: There were no significant differences in demographic characteristics between the groups and no statistically significant differences were observed between study and control groups in clinical pregnancy rate (33.3% vs. 27.5%, p=0.66). There were no differences in implantation rate or spontaneous abortion rate. CONCLUSION: Our results suggest that luteal phase support does not affect clinical pregnancy rates in natural frozen-thawed embryo transfer cycles (Registration Number: IRCT201108044339N6).

Effect of oocyte activation with calcium ionophore on ICSI outcomes in teratospermia: A randomized clinical trial.

BACKGROUND: Chemical activation is the most frequently used method for artificial oocyte activation (AOA), results in high fertilization rate. OBJECTIVE: This prospective, randomized, unblinded, clinical study aimed to evaluate the efficiency of oocyte activation with calcium ionophore on fertilization and pregnancy rate after intracytoplasmic sperm injection (ICSI) in infertile men suffer from teratoospermia. MATERIALS AND METHODS: Thirty eight women with teratoospermic partner underwent ICSI with antagonist protocol. A total of 313 metaphase II (MII) oocytes were randomly divided into two groups: In the oocytes of the control group (n=145), routine ICSI was applied. Oocytes in the AOA group (n=168) immediately after ICSI, were entered in culture medium supplemented with 5 µΜ calcium ionophore (A23187) for 5 minutes and then washed at least five times with MOPS solution. In both groups, the fertilization was evaluated 16-18 hours after ICSI. RESULTS: The number of fertilized oocytes and embryos obtained were significantly different between two groups (p=0.04). There was no significant difference between the two studied groups regarding the fertilization and cleavage rate (95.33% vs. 84.4%, p=0.11; and 89.56% vs. 87.74%, p=0.76, respectively). Implantation rate was higher in AOA group than in control group, but the difference was not significant (17.64% vs. 7.4%, p=0.14). No significant differences were observed in chemical and clinical pregnancy rate between groups (47.1% vs. 16.7%, p=0.07; and 41.2% vs. 16.7%; p=0.14, respectively). CONCLUSION: We didn't find significant difference in the implantation, fertilization, cleavage and pregnancy rates between the two groups but could significantly increase the number of fertilized oocytes and embryos obtained. Finally oocyte activation with calcium ionophore may improve ICSI outcomes in infertile men suffer from teratoospermia. Further study with more cases can provide greater value.

Assessing the efficacy of aspiration and ethanol injection in recurrent endometrioma before IVF cycle: A randomized clinical trial.

BACKGROUND: Endometriosis is a common hormone-dependent gynecologic disease with a high recurrence. Laparotomy or laparoscopy is the standard surgery for the large endometrioma. Also, sclerotherapy is basically used to treat different diseases one of which is endometrioma. OBJECTIVE: The study was designed to assess the value of transvaginal ultrasound-guided ethanol sclerotherapy in patients with a recurrent endometrioma. MATERIALS AND METHODS: In a randomized clinical trial, an interventional group of 20 patients underwent transvaginal ethanol sclerotherapy for recurrent ovarian endometrioma. The patients were followed up first after one and two weeks and then after one, two, and three months. If the patients had no endometrioma, they were treated with in vitro fertilization (IVF) (standard long protocol). A control group of 20 patients with endometrioma were enrolled for an IVF protocol. They had no treatment by ethanol sclerotherapy. IVF parameters, pregnancy rates, and implantation rates were compared in both groups. RESULTS: The demographic data showed no difference between the two groups. The initial mean endometria size was 41.45±15.9 cm, the recurrence rate after 6 months was 4 (20%), FSH before and after sclerotherapy was 6.97±2.25 IU/L and 6.78±1.88 IU/L (p=0.343). The clinical pregnancy rate was 6 (33.3%) vs. 3 (15%), (p=0.616). The fertilization rate emerged 63.06% in study group vs. 60.38%, (p=0.57). The implantation rate turned out 12.9% in study group vs. 7.5%, (p=0.52). None of these results were significant. However, the data pointed to a better trend toward the ethanol sclerotherapy group. CONCLUSION: Ethanol sclerotherapy could be an effective strategy for the treatment of recurrent endometrioma especially before IVF.