Fertility Preservation in Female Cancer Patients: Our Center Experiences

Reproductive options are one of the most important issues to cancer survivors, and it is related to quality of life. Although most of young patients are interested in parenthood in future but significantly pretreatment access of patients to fertility preservation (FP) services is low, because of low referral rate and disparity. Data were retrospectively analyzed from 77 cancer patients who were referred to vali-e-asr reproductive center between March 2013 and February 2015. Their ovarian reserve was estimated with AMH test, Antral follicular count and FSH (if they were referred in first days of menstrual cycle). Embryo or oocyte cryopreservation was used based on participants’ marriage status. Of 77(mean age 30, range: 16-45) patients 29(37.2%) were declined fertility preservation and the cost was the most frequent prohibitive cause. 10(12.9%) were excluded of fertility preservation services. Of 38 patients who were recruited for fertility preservation, 28(60.5%) were married, the mean number of embryos cryopreserved were 3.9. and the mean number of oocytes cryopreserved for 10 single participant in this group was 5.7. Our results demonstrate that oncologists have essential role in improving the provision of fertility preservation services. There are different available FP options that they can be use individualize. By assessing patients’ prohibitive factor and making an attempt to diminish them such as cost of FP services, we can improve their quality of life

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

GnRHa stop protocol versus long protocol in poor responder IVF patients

Background: Recently different studies suggested that discontinuation of gonadotrophin releasing hormone analogue (GnRHa) at beginning of ovarian stimulation (improvement of ovarian response to gonadotrophins) may have some benefit to poor responder patients in invitro fertilization (IVF) cycles. Objective: The efficacy of GnRHa stop protocol in poor responder patients in IVF cycles was assessed. Materials and Methods: This study was a prospective, randomized controlled trial that 40 poor responder patients (less than three mature follicles in a previous cycle) with normal basal follicle stimulating hormone (FSH) were randomly allocated into two protocols: 1) Non-stop protocol: long GnRHa suppression, and start gonadotrophins from day 3 of mense. 2) Stop-protocol: GnRHa is stopped with the onset of menses, and gonadotrophin doses remained similar to group 1. Results: A significantly higher number of follicles, oocytes, embryos and fertilization rate also shorter stimulation days and lower human menopausal gonadotropins (HMG) ampoules were recorded in the stop protocol compared to the control group. Both protocols resulted in a similar cancellation rate, pregnancy rate, estradiol level and LH level. Conclusion: Early follicular cessation of GnRHa permitted the retrieval of a significantly higher number of follicles, oocytes and embryos, and can reduce the number of HMG and stimulation days

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

Comparison of pre-treatment with OCPs or estradiol valerate vs. no pre-treatment prior to GnRH antagonist used for IVF cycles: An RCT

Background: Both oral contraceptive pills (OCPs) and estradiol valerate (E2) have been used to schedule a gonadotropin-releasing hormone antagonist in vitro fertilization (IVF) cycles. Since the suppression of follicle-stimulating hormone by OCPs can stay 5-7 days after stopping the pills, it seems that starting the gonadotropin-releasing hormone (GnRH) after 6 days of pre-treatment discontinuation may be important in IVF outcomes. Objective: The aim of the present study was to determine the number of mature oocyte and pregnancy rate of three pretreatment methods for fresh embryo transfer cycles. Materials and Methods: In this randomized controlled trial, two-hundred ten women (18-35 yr and less than 2 previous IVF attempts) undergoing IVF with the GnRH antagonist protocol were randomized to the OCP, E2, and no pretreatment arms. OCP group (n=53) received OCP (ethinyl estradiol30 &mu;g and levonorgestrel150 &mu;g), E2 group (n=63) received 4 mg/day oral E2 (17&beta;‐E2) for 10 days from day 20 of the previous cycle and GnRH antagonist stimulation was started 6 days after the interruption of OCP and E2. The control group (n =70) did not receive any pretreatment. Results: No significant difference was observed in the mean number of the mature oocyte, endometrial thickness, and embryo quality. The pregnancy rate in E2 group was higher than the two other groups (42.9% vs 39.6% and 34.3% in OCP and control group, respectively), but the difference was not statistically significant (p=0.59). Conclusion: It seems OCP or E2 pretreatment could not improve the fresh IVF-embryo transfer outcome

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

Effect of intramural uterine myoma on the outcome of ART cycles

Background: Although the uterine fibroids are common, their influence on fertility remains controversial. The association of submucosal fibroid with subfertility is well recognized, but debate persists as to whether intramural fibroids can cause infertility and the evidence for its effect on pregnancy in cycles of assisted conception remains unclear. Objective: The purpose of present study was to determine the effect of intramural fibroids less than 6 cm not compressing uterine cavity on the outcome of ART cycles in patients undergoing IVF/ICSI cycles. Materials and Methods: In this prospective cohort study, 94 women with uterine intramural fibroids and 184 controls referred to Royan Institute between 2001 and 2002 were enrolled. The intramural fibroids and their location were detected by transvaginal ultrasound performed just before the ART cycle. All patients underwent long standard GnRH agonist protocol. Student t-test and Chi-square test were used for the statistical analysis. Results: The mean age of patients was 33.9 ±3.37 years in myoma group (n=94) and 33.28 ±3.59 years in control group (n=184). The total dose of gonadotropin used, estradiol level on day of hCG administration, the number of metaphase II oocytes retrieved, fertilization rate, number and quality of embryos developed and transferred, the clinical pregnancy and abortion rates were similar in two groups. Conclusion: The presence of intramural fibroids less than 6 cm not compressing endometrial cavity does not adversely affect clinical pregnancy rate in patients undergoing IVF or ICSI