ABSTRACT
BACKGROUND: Our objective was to evaluate the effect of ovarian endometrioma on ovarian stimulation outcomes in in vitro fertilization cycles (IVF). MATERIALS AND METHODS: In this prospective cohort study, we followed 103 patients who underwent intra-cytoplasmic sperm injection (ICSI) procedures over a 24-months period. The study group consisted of 47 infertile women with either unilateral or bilateral ovarian endometrial cysts of less than 3 cm. The control group consisting of 57 patients with mild male factor infertility was candidate for ICSI treatment during the same time period as the study groups. Both groups were compared for number of oocytes retrieved, grades of oocytes, as well as embryo quantity and quality. RESULTS: Our results showed similar follicle numbers, good embryo grades (A or B) and pregnancy rates in the compared groups. However, patients with endometrioma had higher gonadotropin consumption than the control group. The mean number of retrieved oocytes in patients with endometrioma was significantly lower than control group (6.6 ± 3.74 vs. 10.4 ± 5.25) (p<0.001). In addition, patients with endometrioma had significantly lower numbers of metaphase II (MII) oocytes (5 ± 3.21) than controls (8.2 ± 5.4) (p<0.001). In patients with unilateral endometrioma, there were no significant differences in main outcome measures between normal and involved ovaries in the patients with endometrioma. CONCLUSION: Patients with ovarian endometrioma had poor outcome. They showed poor ovarian response with lower total numbers of retrieved oocytes and lower MII oocytes during the stimulation phase; however, it does not affect the total number of embryos transferred per patient, quality of embryos, and pregnancy rate per patient.
ABSTRACT
BACKGROUND: Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment. OBJECTIVE: The objective of this study was to compare the efficacy of three types of progesterone on biochemical, clinical and ongoing pregnancy rates and abortion and live birth rates. MATERIALS AND METHODS: A prospective randomized study was performed at Royan Institute between March 2008 and March 2009 in women under 40 years old, who use GnRH analog down-regulation. One hundred eighty six patients in three groups were received progesterone in oil (100 mg, IM daily), intravaginal progesterone (400 mg, twice daily) and 17-α hydroxyprogestrone caproate (375mg, every three days), respectively. RESULTS: Final statistical analysis after withdrawal of some patients was performed in 50, 50 and 53 patients in group 1, 2 and 3 respectively. No differences between the groups were found in baseline characteristics. No statistical significance different was discovered for biochemical, clinical and ongoing pregnancies. Although the abortion rate was statistically higher in group 1 (p=0.025) the live birth rate was not statistically significant between the three groups. CONCLUSION: The effects of three types of progesterone were similar on pregnancies rate. We suggest the use of intravaginal progesterone during the luteal phase in patients undergoing an IVF-ET program because of the low numbers of abortions, and high ongoing pregnancy rates.
ABSTRACT
OBJECTIVE: To investigate the usefulness of inhibin B concentrations obtained on the fifth day in predicting ovarian response and assisted reproductive technologies outcome. METHODS: In this prospective multi-center study, infertile women who were candidate for in vitro fertilization or intracytoplasmic sperm injection for the first time were enrolled. These patients were referred to the Royan Institute, Vali-Asr Hospital and Alvand Hospital, Tehran, Iran between 2003 and 2004. The inclusion criteria were female age (20-35 years), body mass index (BMI) of 20-28 Kg/m2, duration of infertility>2 years, a normal menstrual cycle and a normal day 3 follicle stimulating hormone level of <8.5 IU/l. All patients underwent long standard gonadotrophin releasing hormone agonist protocol. Plasma level of inhibin B was checked on the fifth day of menstrual cycle. The diagnostic accuracy of inhibin B, were assessed by the area under the receiver operating characteristic (ROC) curve. RESULTS: In this study, 107 infertile patients were studied. Using the value of 283 pg/ml for inhibin B as the cut-off point, day 5 inhibin B had 77% sensitivity, 30% specificity, 31.2% positive predictive values (PPV) and 76.7% negative predictive values (NPV) for poor ovarian response. There were statistically significant correlation among day 5 inhibin B concentration and BMI, number of mature follicles, retrieved oocytes, developed and transferred embryos, chemical pregnancy, ovarian hyperstimulation syndrome (OHSS) and poor responder. CONCLUSION: Although the chemical pregnancy, number of retrieved oocytes, developed and transferred embryos were higher in patients with higher day 5 inhibin B concentration but considering its sensitivity, specifity, PPV and NPV, it cannot be used as a strong test for prediction of cancellation, pregnancy, poor responses and OHSS.
