Modified natural cycle frozen-thawed embryo transfer in patients with repeated implantation failure: An observational study

Background: Natural endometrium in Frozen-thawed Embryo Transfer (FET) may have some benefits upon implantation in patients with Repeated Implantation Failure (RIF). It might be due to possible differences between natural and stimulated endometrial growth factors and cytokins secretions. Objective: The objective of this study was to compare the pregnancy rate of FET on modified natural cycle versus hormone replacement therapy (HRT) cycle endometrium in patients with RIF. Materials and Methods: In this observational study the pregnancy rate of patients with RIF undergoing day 3 FET in natural cycle endometrium (group 1, n=56), were compared with another group of patients with RIF in whom frozen-thawed day 3 embryos were transferred on HRT cycle (group 2, n=52). Results: The pregnancy rate in group 1 was 41.07%, compared with the pregnancy rate of group 2; 36.5% (p=0.63). The abortion rate was not significantly different among the groups. Conclusion: It can be concluded that FET in a modified natural cycle is comparable with HRT cycle in patients with RI

Infertility-related stress and its relationship with emotional divorce among Iranian infertile people

Abstract Background Infertility affects different aspects of couples’ lives, so it may cause problems in couples’ emotional relationships by increasing marital conflicts. This study aimed to determine Infertility-related stress and its relationship with emotional divorce among Iranian infertile people. Methods We conducted a cross-sectional observational study on 200 infertile people. The research environment was one of the well-equipped infertility centers in Tehran, Iran. Continuous sampling was employed. The data collection tools included a general information form, the Fertility Problem Inventory (FPI), and the Emotional Divorce Scale (EDS). Results The findings revealed a significant direct relationship between infertility-related stress and all its subscales with emotional divorce in both infertile women and men. In infertile women, the most concern was the need for parenthood, while the lowest concerns were the relationship and sexual concerns. Multiple linear regression analysis indicated that social and relationship concerns predicted 44% of emotional divorce, with social concern being the more influential factor. In infertile men, the need for parenthood was the most significant concern, while relationship and social concerns were less prominent. Multiple linear regression analysis showed that relationship concern predicted 50% of emotional divorce in infertile men. In both infertile men and women, social and relationship concerns explained 45% of the variance in emotional divorce. Among these two variables, relationship concern had a more impact in predicting emotional divorce. Also, there was no statistically significant difference between women and men regarding infertility-related stress and its subscales, except for sexual concern. Conclusion The study highlights the importance of the need for parenthood as a main concern among infertile individuals. Increased infertility-related stress and its subscales contribute to higher levels of emotional divorce among this population. Additionally, relationship concern was the lowest concern in infertile people. But it significantly predicts emotional divorce among infertile individuals

C-reactive protein level and pregnancy rate in patients undergoing IVF/ICSI

Background: C-reactive protein (CRP) can be increased after hormonal stimulations. The changes of CRP might affect the success of in-vitro fertilization (IVF). Objective: The aim of this study was to determine the possible relationship between the serum CRP level and outcome of controlled ovarian stimulation, and pregnancy rate in patients undergoing IVF or intra cytoplasmic sperm injection (ICSI). Materials and Methods: This prospective cross sectional study was performed in Avicenna Infertility Clinic on 70 consecutive infertile patients (Jan 2008-Aug 2009) who were candidate for IVF/ICSI, using standard long GnRH agonist protocol. Blood was drawn 4 times during the cycle, on first day of stimulation, the day of HCG injection, the day of ovum pick up, and the day of embryo transfer. Results: In 82.2% of cases, the serum CRP level was higher in day of HCG injection than first day of stimulation and also the day of ovum pick up than the day of HCG injection. The ratio of CRP level in the day of transfer to the day of ovum pick up, was significantly higher (ratio ≥1.23) in patients who became pregnant after ICSI (p =0001). All patients with less than this Ratio have not been pregnant. Conclusion: Controlled ovarian hyper stimulation and puncture of ovaries can potentiate systemic stimulation. Increasing serum CRP level in day of embryo transfer rather than ovum pick up can predict the success in patients undergoing IVF/ICSI

Laparoscopic Ovarian Drilling in Metformin and Clomiphene Resistant Women with Polycystic Ovarian Syndrome

Objective: The study aimed to evaluate the effectiveness of laparoscopic ovarian drilling (LOD) on ovulation and restoration of menstrual cycles andpregnancy.  Materials and methods: This cross sectional study was conducted on 81 consecutive Polycystic Ovarian Syndrome (PCO) patients whom were referred to  Avesina Infertility clinic during 2003-2006. Exclusion criteria were tubal and male factor infertility, hyperprolactinemia, thyroid disease and diabetes mellitus. Patients with the age range of  20-35, body mass index of less than 35 kg/m2, failure to ovulate during at least three cycles of Clomiphene Citrate (CC)consumption and more than 12 months of ovulatory factor infertility entered the study. Metformin was used for at least 8 weeks in combination with CC. Forty four PCO women who had not ovulated after medical therapy with combination of CC and Metformin were selected for LOD. The data was analyzed with SPSS software using t- test and logistic regression analysis. P<0.05 was considered statistically significant.  Results: Patients aged 28.9±2.3 years with infertility duration of 4.8±2.3years and BMI of 28±3.3 kg/m2. Effectiveness of medical therapy significantly was related to BMI (P<0.001). After LOD, ovulation occurred in 14 cases (31.8%), restoration of menstrual cycle in 18 women (40.9%), and spontaneous pregnancy in 5 cases (11.3%). Conclusion: LOD is a good method for restoration of ovulatory cycles in anovulatory PCOS women who were resistant to the combination of CC and Metformin. LOD may avoid or reduce the need to gonadotropins for ovulation induction

Modified Blalock-Taussig Shunt and Giant Perigraft Reaction

This is a case of a modified Blalock-Taussig shunt, which was complicated by perigraft transudative, fibrinous fluid accumulation and recurrence after surgical intervention. Follow-up and expectant management of the patient was successful. Our experience regarding this complication is presented

Granulocyte-colony stimulating factor may improve pregnancy outcome in patients with history of unexplained recurrent implantation failure: An RCT

Background: Family of colony-stimulating factors (CSF) have an essential role on early cross talk between embryo and uterine endometrium. Objective: The aim of this study was to evaluate the effects of the single dose of Granulocyte-CSF (G-CSF) injection on clinical outcome of assisted reproductive technology cycle in patients with repeated implantation failures. Materials and Methods: This randomized control trial study was performed on 52 infertile women who referred to the clinic with the history of more than three previous In vitro fertilization/Intracytoplasmic sperm injection-embryo transfer failures. All patients were stimulated with standard long protocol. All embryos were transferred on day five in blastocyst stage in both groups. The treated group received 300 &mu;g (0.5 ml) recombinant human G-CSF subcutaneously which was injected 30 min before blastocyst embryo transfer. Results: There was not statistically significant differences in abortion rate in G-CSF and control group (p=0.09). G-CSF treated group showed higher clinical pregnancy rate in comparison with control group (56.2% vs. 40.0%) but it was not statistically significant (p=0.09). Although live birth rate in G-CSF group was higher than control group (53.1% vs. 35.0%) but there wasn&rsquo;t statistically significant difference in the overall live birth rate between the two groups (p=0.10). G-CSF group had a twin pregnancies while in control group there was no twin pregnancy. Conclusion: Our result demonstrates the possibility that pregnancy outcome is better in women with repeated unexplained In vitro fertilization failure who are treated with G-CSF

Is the ovarian reserve influenced by vitamin D deficiency and the dress code in an infertile Iranian population?

Abstract Background In the recent years, vitamin D has become a topical subject and a focus of research not only in reproductive medicine but across many medical disciplines. In reproductive medicine, studies have identified an association between vitamin D status in women and ovarian reserve. In humans, exposure of the skin to sunlight is the main important source of vitamin D. A dress code of wearing concealing clothing is a risk factor for vitamin D deficiency. The objective of this prospective observational study was to evaluate the correlation between vitamin D deficiency and ovarian reserve in a population of infertile women in Iran. As part of the basic fertility assessment of study participants, blood tests were taken to measure vitamin D concentration and transvaginal ultrasound scans were performed on day 2–5 of the cycle to determine antral follicle count (AFC). All study participants were assessed by a reproductive medicine specialist and consultant dermatologist to classify their skin types according to the Fitzpatrick classification. In addition, the dress code of each study participant was recorded noting the percentage of exposed skin not covered by concealing clothing. Results 189 infertility patients were included in this study. The mean concentration of vitamin D in this study population was 15.46 ng/ml, indicating severe vitamin D deficiency. A statistically significant negative correlation between age and vitamin D (p = 0.008) and age and AFC (p = 0.001) was identified. This study revealed a highly significant correlation between vitamin D concentrations and AFC (p < 0.001). Conclusions A concealing dress code is an independent risk factor for vitamin D deficiency due to a lack of skin exposure to sunlight. Our study suggests that the so caused severe vitamin D deficiency may play a crucial role in reduced ovarian reserve in the herein described group of an infertile female Iranian population

Methyltetrahydrofolate vs Folic Acid Supplementation in Idiopathic Recurrent Miscarriage with Respect to Methylenetetrahydrofolate Reductase C677T and A1298C Polymorphisms: A Randomized Controlled Trial.

To determine whether 5-methylenetetrahydrofolate (MTHF) is more effective than folic acid supplementation in treatment of recurrent abortion in different MTHFR gene C677T and A1298C polymorphisms.A randomized, double blind, placebo-controlled trial conducted April 2011-September 2014 in recurrent abortion clinics in Tehran, Iran. The participants were women with three or more idiopathic recurrent abortion, aged 20 to 45 years. Two hundred and twenty eligible women who consented to participate were randomly assigned to receive either folic acid or 5-MTHF according to the stratified blocked randomization by age and the number of previous abortions. Participants took daily 1 mg 5-methylentetrahydrofolate or 1 mg folic acid from at least 8 weeks before conception to the 20th week of the pregnancy. The primary outcome was ongoing pregnancy rate at 20th week of pregnancy, and the secondary outcomes were serum folate and homocysteine at the baseline, after 8 weeks, and at the gestational age of 4, 8, 12, and 20 weeks, MTHFR gene C677T and A1298C polymorphisms.There was no significant difference in abortion rate between two groups. Serum folate increased significantly in both groups over time; these changes were significantly higher in the group receiving 5-MTHF than the group receiving folic acid (value = 2.39, p<00.1) and the result was the same by considering the time (value = 1.24, p<0.01). Plasma tHcys decreased significantly in both groups over time; however these changes were not significantly different between the groups (value = 0.01, p = 0.47).The results do not support any beneficial effect of 5-MTHF vs. folate supplementation in women with recurrent abortion with any MTHFR C677T and/or A1298C polymorphism.ClinicalTrials.gov NCT01976676

Thyroid autoantibodies in euthyroid women with recurrent abortions and infertility

Background: Evidences suggest an association between the prevalence of thyroid peroxidase (anti-TPO) and anti thyroglobulin (anti-Tg) with recurrent abortions and infertility. Iodine deficiency was once endemic in Iran and little data is available about the prevalence of these antibodies in different groups of fertile or infertile individuals. Objective: This case control study was designed to compare the presence of anti-TPO and anti-Tg in four groups of women to reveal their role in the etiology of recurrent abortion and infertility. Materials and Methods: Four groups of euthyroid women referring to Avicenna Infertility Clinic in Tehran were selected; 95 cases as fertile controls and 70, 78 and 137 cases with male and female factor infertility and recurrent abortion respectively. TSH, anti-TPO and anti-Tg were evaluated by chemiluminescent immunoassay. Results: The prevalence of the above mentioned autoantibodies in euthyroid controls was about 25% and the percentage of people with an anti-Tg >500 was two times bigger in the abortion group compared to the control group (p500 in younger cases in the abortion group was significantly higher than the rest of the cases (p<0.05). Anti-TPO distribution had no significant differences. Conclusion: There were no statistically significant differences among four groups. It seems that more comprehensive studies are needed to reach a common conclusion about thyroid autoantibodies in women with recurrent abortions in different groups and different parts of Iran. In addition, dividing the recurrent abortion and infertility groups on the basis of their etiologies could be effective

Repeated IVF/ICSI-ETs failures and impact of hysteroscopy

Background: Despite numerous developments in the field of assisted reproduction, the implantation rate remains low. Among the various reasons of implantation failure, endometrial regularity has an important role. Hysteroscopy is an accurate method for evaluating the endometrial characteristics, with the ability to treat uterine pathology. Objective: The aim of the present study was to evaluate the findings on hysteroscopy and thereafter the result of subsequent IVF/ICSI in infertile women with the history of frequent unexplained and unsuccessful IVF/ICSI attempts. Materials and Methods: In this observational study, the hysteroscopy findings and the outcomes of subsequent IVF/ICSI were evaluated in 89 infertile women admitted in Avicenna Infertility Clinic, with previous repeated (more than two) failed IVF/ICSIETs, including the patients with normal Hysterosalpinography (HSG) and excluding severe male factor infertility and also thrombophilia, genetic and immunologic problems. The data were analyzed with SPSS software and Fisher exact, chi-square, and MC-Nemar tests. Results: In 53 (59.5%) cases, hysteroscopy revealed abnormal intrauterine findings including adhesions 7 (13.7%), single polyp 11 (20.7%), endometrial polyposis 10 (18.8%), endometrial hyperplasia 10 (18.8%), uterine cavity hypoplasia 4 (7.8%) and myoma 5 (9.8%). These abnormalities were significantly higher in women with more than 8 years of infertility (chi-square=4.7, p-value=0.03). After hysteroscopy and subsequent IVF/ICSI-ET attempt using standard long protocol, pregnancy rate were significantly higher compared with the previous repeated IVF/ICSI attempts (35.8% versus 0%). Conclusion: According to this study, we strongly suggest evaluation of endometrial integrity by hysteroscopy in patients with repeated IVF/ICSI-ETs failure, before entering any other fertilization procedures