How Does Platelet-Rich Plasma Injection in Ovaries of Poor Responders Affect the Retrieved Oocytes, and Anti Mullerian Hormone: A Clinical Trial

Objective: Platelet Rich Plasma (PRP) is proposed to have important role in cell division and proliferation, angiogenesis and health. This study evaluates the effect of a single injection of autologous PRP on ovarian response markers in women with poor ovarian response (POR). Materials and methods: This non-randomized clinical trial was conducted between August 2020 and September 2021. Fifty six women with Bologna criteria for POR willingly chose to participate in one of the following groups: PRP for one cycle in the time of oocyte pickup (OPU) (intervention group, n= 34) or control group (n=22).The primary outcomes were: number and quality of oocytes in coming 2 cycles of ICSI, and Anti Mullerian Hormone (AMH) level two months after PRP injection. The secondary outcomes were the number and quality of embryos and chemical pregnancy rate after embryo transfer. Results: A total of 45 participants continued the study, of which 23 were in the intervention group and 22 in control group. There were no demographic differences between two groups. At a two cycle follow up, PRP group experienced a significant improvement in AMH level and there was no respective change in control group. In one year follow up the overall pregnancy rates were same in both groups (3% Vs. 0, p=.60), while there was no difference in cumulative number and quality of embryos. Conclusion: PRP injection can improve ovarian reserve marker without adverse effects. Further evidence is required to evaluate the impact of PRP on assisted reproduction outcomes

Frequency distribution of pregnancy occurrence in infertile women after diagnostic-surgical hysteroscopy

Background: Mullerian disorders are present in 5-25% of infertile women. Myoma, polyp and endometrial adhesions are among other involved factors in infertility. Objective: The aim of this study was to determine the frequency distribution of pregnancy occurrence in infertile women after the diagnostic-surgical hysteroscopy on selected infertile cases including those with abnormal uterine. Materials and Methods: One hundred and fifteen women with at least 12 months infertility who had abnormal uterine cavity and patients who had at least 4 unsuccessful ART cycles with no confirmed diagnosis of uterine cavity problem, underwent diagnostic hysteroscopy and if required hysteroscopic surgery. Follow up sonography and HSG performed 2-3 months later and all subjects were followed for pregnancy occurrence for 12 months. Results: Mean age of subjects was 32.65 ± 6.2 years and mean of infertility duration was 8.33 ± 5.25 years. Based on the sonography and HSG performed prior to the hysteroscopy, respectively 69.6% and 41.8% of the subjects had abnormality. In 65.2% of the cases, hysteroscopy showed septum, myoma, endometrial adhesion and irregularity and all of them underwent hysteroscopic operation. Among the operated cases, in 27 cases pregnancy occurred during the first 6 postoperative months and in 2 cases during the second 6 postoperative months of whom one case was EP. Conclusion: There was no significant difference in the rate of pregnancy occurrence between those who had abnormal hysteroscopy and those who were normal (p= 0.63). This can show the variation of infertility causes and the fact that infertility is not just due to uterine problems. Therefore, the repetition of therapeutic measures and longer follow up of infertile cases are necessary

Prominent Complaint: a Guide to Medical Therapy of Overactive Bladder Syndrome in Older Women

To evaluate Overactive bladder (OAB) with detrusor overactivity (DOA) following oxybutynin or tolterodine treatment in recommended doses at a four-week course. A total of 100 Iranian women 45 years or older with urgency that also showed idiopathic detrusor overactivity (IDO) in the filling phase of their cystometry were included in the current study. In this double-blinded trial two parallel groups were randomized by using two kinds of the antimuscarinic drugs for a four- week course [oxybutinin 5mg, t.d.s. or Tolterodin 2mg, b.i.d.] in the same  packages. Data were collected from three-day frequency volume chart (FVC) one month before and after the treatment course. The effectiveness of each drug was compared using the paired, samples t-test. Patients' improvement regarding urinary urgency, frequency and urge incontinence after treatment in both groups was seen, but mean improvements in the terms of urgency and urge incontinence were larger in patients who were treated by oxybutynin. Night-time frequency was shown to be improved by a significantly larger score by tolterodine. Discontinuation of treatment due to adverse events had no significant difference in two groups. Four-week treatment with oxybutynin was better than tolterodine IR in improving urgency and urge incontinence, but there were not statistically significant difference between them. In planning a course of treatment especially in the elderly, the difference in the group of symptoms that reduce patients' quality of life should be considered. Physicians should consider the patient's prominent symptom in selection of anti-muscarinic drugs for the treatment of overactive bladder syndrome especially in elderly patients

Effect of Anti Phospholipid Antibodies on in vitro fertilization/intracytoplsmic sperm injection outcome

Objective: The study aimed to determine the relationship between presence of antiphospholipid antibodies (APLs) and clinical pregnancy rate in patients undergoing IVF/ICSI procedures. Materials and methods: This descriptive-analytic study performed on two hundred consecutive women referred for IVF/ICSI in Vali-e-Asr Reproductive Health Research Center. Serum levels of APLs , anticardiolipin [aCL], antiphosphatidic acid [aPA], antiphosphatidyl choline [aPC] and antiphosphatidylserine [aPS] were checked for all patients before starting IVF cycles. APLs  seropositivity and clinical pregnancy rate were determined. T-test and Mann-Whitney were used to compare two groups. P value <0.05 was considered significant. Results: 23 women (11.5%) were APL positive. Twenty nine women of 177 APL seronegative patients (16.4%) became pregnant while only one of 23 seropositive patients (4.3%) was pregnant. Clinical pregnancy rate was not significantly different in two groups. Conclusion: Although APLs were common, these antibodies did not affect the outcome of IVF/ICSI procedures. Thus screening for APLs is not recommended in women undergoing these procedures

Artificial Endometrial Preparation for Frozen-Thawed Embryo Transfer with or without Pretreatment with Depot Gonadotropin Releasing Hormone Agonist in Women with Regular Menses.

Objective: To investigate the reproductive outcome of artificial endometrial preparation with exogenous steroids for frozen-thawed embryo transfer with and without pre-treatment with depot gonadotropin releasing hormone agonist (GnRH-a) in women with regular menses. AMaterials and methods:This is a prospective randomized clinical trial conducted in two RT centers on 176 women undergoing frozen-thawed embryo transfer. All patients received oral estradiol valerate 4 mg daily from day 2 to day 5 and 6 mg per day from day 6 to the day of the pregnancy test. In day 13 of cycle, an ultrasound examination was performed. After ultrasound confirmation of endometrial thickness (≥8 mm) and no ovarian activity, progesterone in cyclogest supp (800 mg daily) was added. The dose of estradiol would be increased to 8 mg per day if the endometrial thickness was less than 8mm. Two or 3 embryos were transferred via transcervical route 48 hours after the beginning of progesterone administration. In group A (93 patients), Difereline (3.75 mg Im), as a depot GnRH agonist was administered in the midluteal phase (day 21) of previous cycle. In the other group B (n = 83) steroid supplementation was commenced without prior pituitary suppression. Chemical and clinical pregnancy rates were compared in two groups. Results:No significant differences were seen between two groups in terms of chemical pregnancy and clinical pregnancy rates. Conclusion:The findings support the artificial protocol without any pretreatment suppressive drugs to reduce the adverse side effects of GnRH agonists also to minimize the costs

A Randomized Trial to Evaluate the Effect of Local Endometrial Injury on the Clinical Pregnancy Rate of Frozen Embryo Transfer Cycles in Patients With Repeated Implantation Failure

Objective: Repeated implantation failure (RIF) is a condition in which the embryos implantation decreases in the endometrium. So, our aim was to evaluate the effect of local endometrial injury on embryo transfer results. Materials and methods: In this simple randomized clinical trial (RCT), a total of 120 patients were selected. The participants were less than 40 years old, and they are in their minimum two cycles of vitro fertilization (IVF). Patients were divided randomly into two groups of LEI (Local endometrial injury) and a control group (n = 60 in each group). The first group had four small endometrial injuries from anterior, posterior, and lateral uterus walls which were obtained from people who were in 21th day of their previous IVF cycle. The second group was the patients who have not received any intervention. Results: The experimental and control patients were matched in the following factors. Regarding the clinical pregnancy rate, there was no significant difference noted between the experimental and the control group. Conclusion: Local endometrial injury in a preceding cycle does not increase the clinical pregnancy rate in the subsequent FET cycle of patients with repeated implantation failure

The outcome of in vitro fertilization / intracytoplasmic sperm injection in endometriosis–associated and tubal factor infertility

Background: Endometriosis is one of the most challenging diseases that constitute 20% - 40% of women searching for their infertility diagnosis. Objective: This study was undertaken in order to compare the outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in women with endometriosis, and tubal factor infertility as controls. Materials and Methods: From 2005 to 2006 a retrospective study was carried out in patients with endometriosis (n=80) and tubal infertility (n=57) after treatment with IVF/ICSI. The main outcome measures were ovarian responsiveness, quality of oocytes, implantation, pregnancy and ongoing pregnancy rates. Appropriate statistical analysis was performed using χ2 and student t-tests. Results: No differences were found in mean number of ampoules of hMG, duration of hMG injection, number of MΙΙ oocytes, number of embryo transferred, and rates of implantation, pregnancy, ongoing pregnancy and twin birth between women with endometriosis and tubal infertility and also between women with stages I/II or those with stages III/IV disease with women with tubal factor infertility. Conclusion: Our results suggest that endometriosis does not seem to have adverse effect on outcome of IVF/ ICSI as compared with tubal infertility

GnRH antagonist versus agonist in normoresponders undergoing ICSI: a randomized clinical trial in Iran

Background: General concern is that the pregnancy rate is higher with GnRH-agonist as a protocol of pituitary suppression. GnRH-antagonist protocol provides a shorter period of administration and an easy flexible protocol. Objective: In this study, the outcomes of GnRH agonist and antagonist in ICSI cycles are compared in normo responder patients. Materials and Methods: In this randomized clinical trial, 300 normoresponders undergoing ICSI were randomly divided to GnRh agonist (n=150) and GnRh antagonist (n=150) groups. The main outcome measurements were chemical, clinical and ongoing pregnancy rates (PR). Results: The mean duration of stimulation were 9.6±1.6 and 8.2±1.6 days in agonist and antagonist groups respectively (p=0.001). The mean number of MII oocyte retrieved in agonist and antagonist groups were 7.7±4.0 and 6.9±4.3 respectively (p=0.03). There was no significant difference between two groups regarding mean number of gonadotrophin ampoules, follicles, occytes, total embryos and good quality embryos, OHSS incidence, and abortion rate. Chemical pregnancy rate was 35.3% in agonist and 39.3% in antagonist group. Clinical pregnancy rate was 35.3% in agonist and 34% in antagonist group. Ongoing pregnancy rate was 45 (31.3%) in agonist and 44 (29.3%) in antagonist group. There was no significant difference between two groups in pregnancy rates. Conclusion: In this study antagonist protocol was shown to be an easy, safe and friendly protocol in Iranian normoresponder patients, having similar outcomes with standard agonist protocol but shorter period of stimulation