Comparative Study Between Long Protocol with Antagonist Protocol on IVF Cycle

ObjectiveOvarian stimulation is one of important step in In Vitro Fertilization (IVF) program to produce numbers of good oocyte to achieve better pregnancy rate. Various methods of ovarian stimulation have been tried mostly now are long (agonist) and antagonist protocol. The aim of this study is to compare the efficacy and safety of both protocol.MethodsA retrospective comparative analytical study of all subfertile patients who underwent IVF program from January to December 2011 in Halim Fertility Centre that meets the inclusions and exclusions criteria was done.ResultsNumber of stimulation days in antagonist groups (9.3 + 1.34 days) was similar with agonist group (9.8 + 1.57 days). The total dosage of gonadotropin used in antagonist group (1279 + 805.65) was significantly lower than agonist group (2196.3 + 931.99). Pregnancy rates between both group was similar (34% in antagonist group vs 36% in agonist group). There was no severe Ovarian Hyperstimulation Syndrome (OHSS) case in antagonist group and there were 5 cases of severe OHSS found in agonist group. There was a significant higher severe OHSS cases in agonist group.ConclusionOvarian stimulation with agonist and antagonist protocol have similar efficacy in IVF outcome, but antagonist protocol appears to be safer than agonist protocol in term of incidence of severe OHSS

Human Blastocyst Formation and Development

The preimplantation period of human embryo development is remarkable and characterized by successive changes in terms of genetic control, physiology, and morphology of the embryo. Human preimplantation embryo development is characterized by the initial phase of embryo development, the phase before the embryo implantation process. In normal conditions, after fertilization, the embryo grows until the blastocyst stage. The blastocyst grows as the cells divide and the cavity expands, where it “hatches” from the zona pellucida to implant into the endometrium. Reprogramming and programming are continuous processes in the embryo that encompasses fusion of the egg and sperm pronuclei; epigenetic reprogramming and modification, an extensive wave of degradation of maternal transcripts, and activation of the nascent human embryonic genome and aneuploidy can occur in this stage. The embryo produces cytokines, growth factors, and receptors for endometrial signals in the apposition stage

In Vitro Fertilization Outcome After Intracytoplasmic Sperm Injection with Fresh and with Frozen-Thawed Epididymal Spermatozoa

IntroductionTesticular epididymal sperm aspiration (TESA) is one of the method  to retrieve sperm from the testes in men with azoospermia. The aim of the study is to compare the In vitro fertilization (IVF) outcome of intracytoplasmic sperm injection (ICSI)-ET cycles with fresh testicular epididymal spermatozoa obtained on the same day with  oocyte retrieval and with frozen-thawed testicular epididymal spermatozoa.Material & MethodsA retrospective comparative analysis of  patients who underwent fresh TESA and frozen-thawed TESA in ICSI-ET cycles from January 2012 to December 2014 in Halim Fertility Center was done. Fresh testicular epididymal sperm aspiration (fresh TESA) was performed on the same day with oocyte retrieval in 28 cycles and the frozen-thawed testicular epididymal sperm aspiration (frozen-thawed TESA) was used in 30 cycles.  ResultsThe two groups were comparable in terms of the ages of male and female patients, etiology of infertility and duration of infertility. Fertilization rates in fresh TESA group were 53,5% and in frozen-thawed TESA group, fertilization rates were 50%. There was no statistically significant difference between the groups. Clinical pregnancy rates in fresh TESA group were 35,7%  and in frozen-thawed TESA group, clinical pregnancy rates were 26,7% and statistically there was no significant difference between the groups.ConclusionThere is no significant difference in the in vitro fertilization outcome of intracytoplasmic sperm injection (ICSI)-ET cycles between fresh TESA and frozen-thawed TESA

The Association Between Sperm DNA Fragmentation and Idiopathic Early Recurrent Pregnancy Loss

IntroductionVarious etiologies of recurrent pregnancy loss (RPL) have been extensively studied, but more than half of them still remain unknown. Male factor may play a role in incidence of idiopathic early recurrent pregnancy loss. Sperm DNA fragmentation as one of sperm test for male factor can be measured and expressed by a DNA Fragmentation Index (DFI). The aim of the study is to evaluate the association between sperm DNA fragmentation and the incidence of idiopathic early recurrent pregnancy loss.Material & MethodsA prospective study was done by recruiting 40 cases of  male couple from patients with a history of idiopathic early recurrent pregnancy loss and 40 cases of control from normal fertile population from May 2010 to September 2011 in Halim Fertility Center. Sperm DNA fragmentation was detected by halosperm kit.ResultsBoth of groups were comparable in terms of the age of male patients, body mass index, duration of infertility, history of miscarriage and sperm parameters. Sperm DFI in the case group was 34.12%. and in the control group was 16.02%. There was significantly higher sperm DFI in the case group than in the control group. Sperm DFI <30 was increased in control group (95%) compared with case group (40%). Sperm DFI ≥30 was increased in case group (60%) compared with control group (5%). There was a significant association between sperm DFI ≥30 and idiopathic early recurrent pregnancy loss (p<0,05).ConclusionThere is an association between higher sperm DNA fragmentation and incidence of idiopathic early recurrent pregnancy loss

Comparative Study Between Mock Embryo Transfer Prior To The Treatment Cycle and Real Embryo Transfer In In Vitro Fertilization

IntroductionA trial or mock embryo transfer (ET) may influence pregnancy rates and it performed prior to ET allows the clinician to assess the uterine cavity and the utero-cervical angle. The aim of this study is to compare the consistency of the type of ET in mock ET with real ET.Material & MethodsA retrospective comparative analysis of  patients who underwent in vitro fertilization or ICSI cycle from January 2014 to December 2014 in Halim Fertility Center was done. The type of transfer was divided into two groups: ‘easy’ or ‘difficult’. An easy ET was defined as a transfer that occurred without the use of manipulation or other instrumentation and difficult ET was considered when additional instrumentation was required.ResultsFrom the study, 103 patients who underwent Mock-ET, we  found 58 patients (56.3%) with easy ET and 45 patients (43.7%) with difficult ET, which with hard catheter ET in 17 patients (16.5%), with osfander assistance in 20 patients (19.4%) and with stylet in 8 patients (7,8%). 58 patients with Easy Mock ET group were entirely easy real ET (100%) and 45 patients with difficult Mock ET group also entirely were difficult real ET (100%). The Statistical analysis shows no significant difference between the mock ET and real ET groups (p>0,05). In easy real ET, clinical pregnancy rates were 32.8% and in difficult real ET, clinical pregnancy rates were 26.7% with no significant difference between the  groups (p>0,05).Conclusion:Mock ET prior to the treatment cycle is consistent with real ET

Outcome of Intra Uterine Insemination for HIV Serodiscordant Couple

IntroductionHIV serodiscordant couple who wish to have offspring but fear of disease contagious prohibittedthem from concieved naturally. Intrauterine insemination without having direct sexual contact is one of the method to achieve this wish. This study was aimed to evaluate the outcome of intrauterine insemination in HIV serodiscordant couple.Material and methodsRetrospective analytic study was done. HIV serodiscordant couple who have been treated with intrauterine insemination from January 2010 until June 2014 in Halim Fertility Centre Medan was included in this study.ResultsThere were 27 cycles of intrauterine insemination from HIV serodiscordant couple. The clinical pregnancy rate were 33.3%. None of the babies or mother after deliveries have HIV positive.ConclusionIntrauterine insemination in HIV serodiscordant couple appears to be effective and safe method to achieve pregnancy.

Correlation of Paternal Homocysteine Level and Sperm DNA Fragmentation in Couple with Idiopathic Recurrent Early Pregnancy Loss

Background: Recurrent pregnancy loss is the traumatic event for couples in the effort to obtain offsprings. Various female etiologies have been extensively studied, but more than half of remain unknown. As a result of unification of sperm and oocyte, an embryo combined with any defect during spermatogenesis will also affect the quality of embryo consequently determining the pregnancy outcomes. Routine semen analysis failed to support the evidence of influence of defective sperm in recurrent pregnancy loss. Currently, examination of sperm DNA fragmentation has been added to evaluate the quality of sperm beside the routine semen analysis. We hypothesized that high sperm DNA fragmentation plays a role in the incidence of idiopathic recurrent early pregnancy loss. Beside that, the cause of sperm DNA fragmentation are numerous and remain controversial. This study was conducted to determine the impact of paternal hyperhomocysteinemia on high sperm DNA fragmentation and incidence rates of idiophatic recurrent early pregnancy loss. Material and methods: Fourty partners of idiopathic recurrent early pregnancy loss caes and 40 cases of control from normal male fertile population were included in this study. Blood and semen samples were collected for routine semen analysis, sperm DNA fragmentation, serum and seminal homocysteine. The results were then analyzed to determine the association between sperm and DNA fragmentation, serum homocysteine, seminal homocysteine and incidence rates of idiopathic recurrent early pregnancy loss. Results: incidence rates of idiopathic recurrent early pregnancy loss was significantly associated with sperm DNA fragmentation (p<0.05) and serum homocysteine (p<0.05). Idiopathic recurrent pregnancy loss partners had significantly higher DFI (p<0.05). Hyperhomocysteinemia appears to be associated with significantly increase of sperm DNA fragmentation (p<0.05). Conclusion: Paternal serum homcysteine and high sperm DNA fragmentation was significantly correlated with the incidence rates of idiopathic recurrent early pregnancy loss. Key words : hyperhomocysteinemia, DFI, idiopathic recurrent early pregnancy los

Vitamin D Levels in Women with Polycystic Ovary Syndrome

INTRODUCTION: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. There is some evidence suggested that vitamin D played a role in the incidence of PCOS. Previous research has found vitamin D deficiency in the pathogenesis of PCOS and cohort studies showing the relationship of obesity with decreased levels of 25-hydroxy vitamin D. Therefore, we aim to conduct a study on vitamin D levels in women with polycystic ovary syndrome.OBJECTIVE: To determine the difference of the levels of vitamin D in women with and without polycystic ovary syndrome.METHODS: This study is a comparative analytical study on two unpaired population by using cross-sectional study design. The study was conducted in Halim Fertility Clinic Medan starting in November 2014 through April 2015. Blood samples were taken from 23 women PCOS and 23 non-PCOS women. Further data were tabulated and analyzed.RESULTS: Vitamin D levels are lower in women with PCOS compared to controls. In the PCOS group, the levels of vitamin D were lower in obese women. Vitamin D levels were also lower in PCOS women with WHR> 0.85.CONCLUSION: This study showed a significant lower level of vitamin D in PCOS patient

The impact of late follicular progesterone level on in vitro fertilization-intracytoplasmic sperm injection outcome: Case-control study

Background: Studies have been conducted to improve the pregnancy rate through the in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) program. In recent years, researchers have been focusing on finding impact of high progesterone level on endometrial receptivity. However, data on whether progesterone level also affects the quality of the embryo is still limited. Objective: The aim is to assess the effect of late follicular progesterone level on the outcome of in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI). Materials and Methods: This was a case-control of 245 women who underwent in vitro fertilization cycle at Halim Fertility Center, Indonesia. The outcomes assessed were number of oocytes retrieved (OR), maturation rate (MR), fertilization rate (FR), number of good embryos (GE), number of fair embryos (FE), and number of poor embryos (PE). The progesterone (P4) and estradiol (E2) levels were analyzed on the day of human chorionic gonadotropin injection. Serum progesterone level was divided into three groups: 1. low progesterone (≤ 0.50 ng/ml), 2. normal progesterone (0.51-1.50 ng/ml), and 3. high progesterone (> 1.50 ng/ml). All outcomes were compared amongst the groups. Results: Significant differences occurred between progesterone level on the day of human chorionic gonadotropin administration. The number of OR in group 1, 2, and 3 were 8.41 ± 5.88 vs. 12.99 ± 8.51 vs. 17.58 ± 9.52, respectively. Conclusion: Progesterone level on the day of human chorionic gonadotropin injection may have an impact on the outcome of IVF-ICSI. Key words: Intracytoplasmic sperm injection, Embryo, Progesterone, In vitro fertilization

Association between Luteinizing Hormone/Choriogonadotropin Receptor Ins18LQ Gene Polymorphism and Polycystic Ovary Syndrome

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of women in the childbearing period. However, its pathophysiology is still unclear. Certain polymorphisms of the luteinizing hormone/choriogonadotropin receptor (LHCGR) genes may lead to changes in the bioactivity of this hormone. The important functional role of LHCGR in the metabolism of androgen and ovulation, the LHCGR gene variant, may be related to the risk of PCOS. AIM: The aim of this study was to evaluate the association between LHCGR Ins18LQ gene polymorphism and PCOS. METHODS: A case–control study was performed in women with PCOS and non-PCOS from May 2019 to October 2019 in HFC IVF Center. We included 50 women with PCOS and 50 healthy controls. Polymorphism of the LHCGR (ins18LQ) gene was genotyped using polymerase chain reaction-restriction fragment length polymorphism. RESULTS: From this study, we found that there was no significant difference in the proportion of ages between the groups (p > 0.05). There were significant differences in the characteristics of body mass index, FSH level, LH level, and LH/FSH ratio between the PCOS and control groups (p < 0.05). We also found that the proportion of heterozygote variant non-ins/ins was higher in the PCOS group compared to the control group, but there was no significant difference between the polymorphisms of the non-ins and non-nonins variants between the PCOS and control groups (p = 0.269). The frequency of ins alleles was higher in the PCOS group compared to the control group. CONCLUSION: There was no significant association between LHCGR ins18LQ gene polymorphism and PCOS