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 pretreatment 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 protoco

Vaginal compared oral administration of estradiol in women with thin endometrium: A cross-sectional study

Background: Endometrial thickness is regarded as an indicator of the receptivity of the endometrium. Patients preparing for frozen embryo transfer need some interventions in case their endometrium is thin. Objective: This study aimed to compare the clinical outcomes of oral administration of estradiol valerate with its vaginal type in women with inappropriate endometrial thickness. Materials and Methods: This cross-sectional study comprised of 79 women (cycles) who had undergone frozen-thawed embryo transfer. On the 13th day of the cycle, vaginal sonography was performed in case the thickness of the endometrium was < 7 mm; in the oral group, the patients continued using oral estradiol valerate tablet. However, in the vaginal group, the participants applied estradiol valerate tablet vaginally. Finally, the chemical and clinical pregnancy rate, also, early miscarriage rate were compared between the two groups. Results: The early miscarriage rate was lower in the vaginal group in comparison with the oral group (p = 0.040). Women in the vaginal group showed a lower rate of chemical pregnancy compared to the oral group, but this difference was not statistically significant (25.0 vs. 34.4%, p = 0.440). The rate of clinical pregnancy in the two groups was not statistically significant, although the vaginal group had a higher pregnancy rate (22.5% vs. 15.6%, p = 0.464), especially in women older than 34 years (37.5% vs. 11.1%, p = 0.355). Conclusion: Vaginal administration of estradiol tablet in women with thin endometrium leads to a lower rate of early miscarriage. Key words: Endometrium, Thickness, Frozen, Embryo transfer, Estradiol valerate

Endometrial preparation using gonadotropin-releasing hormone agonist prior to frozen-thawed embryo transfer in women with repeated implantation failure: An RCT

Background: Preparation of endometrial thickness in frozen-thawed embryo transfer (FET) is extremely important, particularly in repeated implantation failure (RIF) patients. Objective: This study aimed to investigate the clinical outcomes of FET cycles among RIF women, based on the effects of administering gonadotropin-releasing hormone (GnRH) agonist prior to estrogen-progesterone preparation of the endometrium. Materials and Methods: In this randomized clinical trial, 67 infertile women who were candidates for FET were divided into two groups: A) case group (n = 34), treated with GnRH agonist prior to endometrial preparation and B) control group (n = 33), which received the routine protocol. (6 mg daily estradiol started from second day) The clinical outcomes) including chemical and clinical pregnancy, in addition to implantation rates, were compared between the two groups. Results: The results showed no significant differences in women’s age (p = 0.558), duration (p = 0.540), type (p = 0.562), and cause of infertility (p = 0.699). Regarding pregnancy and implantation rates, there was a trend toward an increase in the case group; however, differences were not statistically significant. Conclusion: Although our results showed no significant differences between groups. Because there are trends to better results in case group larger sample size may show significant difference. Key words: Implantation failure, Gonadotropin-releasing hormone, Embryo transfer, Pregnancy, Implantation

Insulin-like growth factor-1 on cycle day 2 and assisted reproductive techniques outcome: A cross-sectional study

Background: Individualized assisted reproductive techniques (ART) can improve ART outcomes. Some studies suggested using insulin-like growth factor-1 (IGF-1) level on cycle day 2 for individualized ART. Objectives: To investigate the relationship between the serum levels of IGF-1 on day 2 of the cycle and ART outcomes. Materials and Methods: In this cross-sectional study, cycle day 2 serum levels of IGF- 1 were measured in 175 women aged between 18-44 yr as candidates for in vitro fertilization or intracytoplasmic sperm injection. All participants received antagonist protocol, and the relationship between serum levels of IGF-1 and ART outcomes according to the number of oocytes were investigated; poor responders (oocytes < 5), normal responders (oocytes 5-15), and hyper responders (oocytes > 15). Results: Poor responders had higher serum level of IGF-1 when compared with normal and hyper-responders; however, this difference was not statistically significant (p = 0.41). The serum levels of IGF-1 in women with zero retrieved oocytes and those cycles that were canceled for the inappropriate ovarian response were not significantly different compared to other women in the group of poor responders. An inverse relationship was observed between the serum level of IGF-1 and anti-Mullerian hormone levels. Furthermore, no significant relationship between serum level of IGF-1 with age, body mass index, number of 2 pronucleus, and number of embryos was observed. Conclusions: According to our results, the serum levels of IGF-1 may not be able to predict ART outcomes. It seems necessary to conduct more studies with larger sample size in this field. Key words: Insulin-like growth factor-1, Poor ovarian response, Oocyte retrieval, Assisted reproductive technique outcome

Effect of embryo transfer depth on IVF/ICSI outcomes: A randomized clinical trial

Background: Although there has been remarkable advancement in the field of assisted reproductive technology, implantation failure remains a significant issue in most infertile couples receiving these treatments. Embryo transfer is important in assisted reproductive technology and directly affects the implantation rates and pregnancy outcomes. Objective: To assess the effect of two different distance embryo transfer sites from fundal endometrial surface on the outcomes of in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Materials and Methods: A total of 180 women who were candidate for IVF/ ICSI/ embryo transfer in Yazd Research and Clinical Center for Infertility were equally assigned to two groups based on the distance between the fundal endometrial surface and catheter tip to investigate implantation, chemical and clinical pregnancy (group A: 15 ± 5 mm and group B: 25 ± 5 mm, respectively). Results: The subjects in the group B showed significantly higher implantation rate, chemical and clinical pregnancy rate compared to the group A (p = 0.03, 0.01, 0.04, respectively). The rate of ongoing pregnancy and miscarriage indicated no significant differences between groups (p = 0.21, 0.27, respectively). Conclusion: In conclusion, our study showed that the depth of embryo replacement inside the uterine cavity at a distance of 25 ± 5 mm beneath fundal endometrial surface have better effects on the pregnancy outcomes of IVF/ICSI cycles and can be considered as an important factor to improve the success of IVF cycles. Key words: Embryo transfer, Endometrium, Pregnancy outcomes, IVF, ICSI

The effect of low-dose aspirin on the pregnancy rate in frozen-thawed embryo transfer cycles: A randomized clinical trial

Background: The results of previous studies on the effect of low-dose aspirin in frozenthawed embryo transfer (FET) cycles are limited and controversial. Objective: To evaluate the effect of low-dose aspirin on the clinical pregnancy in the FET cycles. Materials and Methods: This study was performed as a randomized clinical trial from May 2018 to February 2019; 128 women who were candidates for the FET were randomly assigned to two groups receiving either 80 mg oral aspirin (n = 64) or no treatment. The primary outcome was clinical pregnancy rate and secondary outcome measures were the implantation rate, miscarriage rate, and endometrial thickness. Results: The endometrial thickness was lower in patients who received aspirin in comparison to the control group. There were statistically significant differences between the two groups (p = 0.018). Chemical and clinical pregnancy rates and abortion rate was similar in the two groups and there was no statistically significant difference. Conclusion: The administration of aspirin in FET cycles had no positive effect on the implantation and the chemical and clinical pregnancy rates, which is in accordance with current Cochrane review that does not recommend aspirin administration as a routine in assisted reproductive technology cycles. Key words: Aspirin, Embryo transfer, Pregnancy rates

Genotype-isolate interaction for resistance to Sclerotinia sclerotiorum in sunflower

The sunflower (Helianthus annuus L.) is one of the most important crops grown for edible oil. Sclerotinia sclerotiorum (Lib.) de Bary is a common and widespread pathogen of sunflower. In the present study the reaction of 35 genotypes, including recombinant inbred lines and their parents, M7 mutant lines developed by gamma irradiation, and some genotypes from different geographical origins, were evaluated against eight S. sclerotiorum isolates in controlled conditions. The proportion of the subsequent basal stem lesions was measured 3 days after inoculation. Highly significant differences were observed among sunflower genotypes and S. sclerotiorum isolates, with the isolates interacting differentially with sunflower genotypes. Two genotypes had high partial resistance to all S. sclerotiorum isolates, whereas others were susceptible to all isolates. Isolates of S. sclerotiorum differed in virulence to host genotypes. Some genotypes showed specific interactions with S. sclerotiorum isolates, being resistant to some isolates but susceptible to others. Recom­binant inbred lines used in this study showed different reactions to eight isolates of S. sclerotiorum when compared with their parental lines. The isolate-specific and isolate-nonspecific partial resistant genotypes identified in present experiments should be used in crossing programmes for breeding of durable resistance to Sclerotinia basal stem disease

Addition of intramuscular to vaginal progesterone for luteal phase support in fresh embryo transfer cycles: A cross-sectional study

Background: Luteal phase deficiency is common in assisted reproductive technology and is characterized by inadequate progesterone production. Various studies have shown that administration of progesterone in fresh embryo transfer cycles increases the rate of clinical pregnancy and live birth rate. Progesterone administration has variable types: oral, vaginal, oil-based intramuscular, and subcutaneous. Objective: This study aims to compare the effect of adding intramuscular progesterone to the vaginal progesterone for luteal phase support in the fresh embryo transfer cycle. Materials and Methods: This study reviewed the information related to 355 women who had a fresh embryo transfer between March 2020 and February 2021 at the Yazd Reproductive Sciences Institute, Yazd, Iran. The participants population were divided into 2 groups based on the type of luteal phase support regime: group I (n = 173) received 400 mg vaginal progesterone alone twice a day from the day of ovum pick up; and group II (n = 182) received 50 mg IM of progesterone in addition to vaginal progesterone 400 mg twice a day from the day of ovum pick up. Chemical and clinical pregnancy rates were compared between groups. Results: The basic characteristics of groups were statistically similar. The rates of chemical and clinical pregnancy were higher in the vaginal plus IM progesterone group than in the vaginal progesterone group. Moreover, chemical pregnancy showed a significant difference between the groups (p = 0.011). Conclusion: Our findings demonstrated that the addition of IM progesterone to the vaginal progesterone improves the chemical pregnancy rate in fresh embryo transfer. Key words: Luteal phase, Progesterone, Assisted reproductive technology, Embryo transfer

QTL mapping of partial resistance to basal stem rot in sunflower using recombinant inbred lines

Basal stem rot, caused by Sclerotinia sclerotiorum (Lib.) de Bary, is an important cause of yield loss in sunflower (Helianthus annuus L.). Quantitative trait loci (QTLs) implicated in partial resistance to basal stem rot disease was identified using the 116 recombinant inbred lines (RILs) from the cross between the sunflower parental lines PAC2 and RHA266. RILs and their parents were arranged in a completely randomized design with six replications and inoculated with a moderately aggressive isolate (SSU107) of S. sclerotiorum under controlled conditions. QTLs were mapped using a recently developed high-density single sequence repeat/ amplified fragment length polymorphism (SSR/AFLP) sunflower linkage map. Analysis of variance showed highly significant differences among the sunflower genotypes for susceptibility to basal stem rot. The frequency distribution of genotypes for susceptibility to disease showed continuous patterns, suggesting that resistance is controlled by a polygenic system. Transgressive segregation for resistance occurred in this cross. Composite interval mapping analysis revealed 7 QTLs for percentage necrotic area, localized on 7 linkage groups. The effects of QTLs were small to moderate indicating a polygenic control of the studied character. However, like any other quantitative trait, it is necessary to confirm the position of the QTLs and carry out fine-scale mapping before marker assisted selection (MAS). LG8 and LG16 are good candidates for further analysis to develop molecular markers for resistance to Sclerotinia disease

The Effect of Letrozole in Induction of Ovulation in Clomiphene Resistant Patients

Background: In patients with anovulatory infertility the first choice of treatment for ovulation induction is an antiestrogen, most commonly clomiphene citrate (CC). However, 20-25% of the women are resistant to CC and do not ovulate perhaps due to antiestrogenic mechanism of the CC action, which involves long-lasting estrogen receptor (ER) depletion. Objective: The objective of the study was to mimic the action of CC without depletion of ERs by the administration of an aromatase inhibitor letrozole in a selected group of Poly Cystic Ovary (PCO) patients who demonstrated failure to ovulate after treatment with CC. Materials and Methods: 20 patients with anovulation due to polycystic ovary syndrome (PCOS), who had previously inadequately responded to CC were selected for study. The aromatase inhibitor letrozole was administered orally in a dose of 2.5 mg on days 3-7 of the menstrual cycle. Then, occurrence of ovulation, endometrial thickness, and pregnancy rates were determined. Result(s): Only one patient had one dominant follicle (1.8 cm diameter) on day 14 of the cycle (estradiol = 200 pg/ml). IUI was done; however, no pregnancy took place. In the remaining cases, several sonographies were done between days 9 to 15 of the cycle; however, all cycles were cancelled due to absence of a dominant follicle (>1.4 cm). Conclusion(s): Our study did not confirm the favorable effect of letrozole for induction of ovulation in patients with clomiphene resistant PCO