Pregnancy outcome in long- versus short-acting gonadotropin-releasing hormone agonist cycles in participants with normal ovarian reserve: An RCT

Background

There is no agreement on which of the 2 gonadotropin-releasing hormone (GnRH) agonist protocols are the most efficient, neither there is any consensus on which one yields a better clinical pregnancy percentage.

Objective

The present study aims to compare the effectiveness of reduced dosages of long- and short-acting GnRH agonists on pregnancy outcomes.

Materials and Methods

In this randomized controlled clinical trial, 400 women were randomly assigned to 2 groups (n = 200/group): the reduced dosage of long-acting GnRH agonist group (group 1, 1.25 mg Decapeptyl) and the short-acting GnRH agonist group (group 2, 0.5 mg/day Buserelin Acetate). The study was conducted at Mehr Medical Institute, Rasht, Iran between July 2019 and July 2020. Biochemical and clinical pregnancy were compared between groups.

Results

No significant differences were observed in the endometrial lining, the total number of retrieved and metaphase-II oocytes, progesterone, and serum estradiol levels on human chorionic gonadotropin day, fertilization rate, and top-quality embryos between the groups. The duration of induction (10.8 ± 1.7 vs. 10 ± 2.1, p < 0.001) and the total dosage of gonadotropins (2939.4 ± 945.9 vs. 2441 ± 1247.1, p < 0.001) were significantly greater in group 2 than in group 1. No significant differences were observed between the 2 groups in terms of implantation rate, chemical pregnancy rate, and clinical pregnancy rate. A higher percentage of ovarian hyperstimulation syndrome was observed in group 2 (p = 0.005).

Conclusion

Due to a lower percentage of ovarian hyperstimulation syndrome in group 1 and similar assisted reproductive technology outcomes in both groups, the long protocol was found to be superior to the short protocol.

The comparison of pregnancy outcomes in fresh and frozen embryo transfer: A cross-sectional study

Background

The benefits of frozen embryo transfer (FET) vs. fresh embryo transfer for in vitro fertilization (IVF) have been discussed in previous studies.

Objective

To determine and compare the pregnancy outcomes following FET and frozen embryo transfer in women who underwent assisted reproductive techniques.

Materials and Methods

In this cross-sectional study, 233 women candidates for IVF/intra cytoplasmic sperm injection who referred to the Kamali Training Medical Center, Karaj, Iran during 2019-2020 were evaluated in 2 groups of fresh (n = 127) and frozen (n = 106) embryo transfers. The rates of pregnancy outcomes including chemical and clinical pregnancy, live birth, preeclampsia, ectopic pregnancy, still birth, and pregnancy loss were compared between groups in 3 age subgroups (< 25, 25-35, and 35-40 yr old).

Results

No significant difference in terms of chemical and clinical pregnancy and live birth rates were observed between groups in women aged < 25 yr. Chemical and clinical pregnancy and live birth rates were significantly higher in the FET group compared to fresh group in 25-35-yr-old women (p = 0.01, p = 0.03, and p = 0.01, respectively). In 35-40-yr-old women, no significant differences were observed in terms of chemical and clinical pregnancy rates, but live birth rate was found to be significantly higher in the FET group (p = 0.02). The pregnancy loss was lower in the FET group (p = 0.038).

Conclusion

In conclusion, the FET method in women aged 25-35 yr significantly increases the chance of successful IVF/intra cytoplasmic sperm injection.

The effect of Nifedipine on embryo transfer outcomes: A randomized clinical trial

Background

Endometrial receptivity is crucial for embryo implantation, and excessive uterine contraction reduces success. Nifedipine which is a calcium channel blocker, could decrease uterine contraction and improve pregnancy outcomes.

Objective

This study aimed to assess the effect of Nifedipine before embryo transfer on the pregnancy outcome in women undergoing in vitro fertilization (IVF) in a tertiary center in Iran.

Materials and Methods

150 women who were candidates for IVF were randomly assigned into 2 groups: group 1 received 20 mg Nifedipine 30 min before embryo transfer, and group 2 received no intervention. Blood pressure of the participants was monitored every 10 min for 1 hr under the supervision of an anesthesiologist. Finally, implantation rate and chemical and clinical pregnancy rates were compared between groups.

Results

At the end of the study, 140 participants were included in the final analyses. No significant difference was observed in clinical pregnancy rates between groups (20% vs. 22%, p = 0.51).

Conclusion

Nifedipine administration before embryo transfer does not improve the implantation and clinical pregnancy rates in women undergoing IVF.

Natural cycle versus modified natural cycle for endometrial preparation in women undergoing frozen-thawed embryo transfer: An RCT

Background

Studies have evaluated different endometrial preparation methods, but the optimal frozen-thawed embryo transfer (FET) cycle strategy in terms of the in-vitro fertilization outcome is still debated.

Objective

To compare the natural versus modified natural cycles for endometrial preparation in women undergoing FET.

Materials and Methods

This study was designed as a randomized clinical trial, and it was performed at the Arash women's hospital between August 2016-2018. Hundred and forty eligible participants were enrolled in this study and were randomly divided into 2 groups by using the block randomization method, including true natural FET (n = 70) and modified natural FET (mNFET) (n = 70) cycles. Both groups were monitored for endometrial thickness and follicular size; simultaneously spontaneous luteinizing hormone surge using urinary luteinizing hormone testing kits. The mNFET group received 5000 IU of human chorionic gonadotropin injection to trigger final follicular maturation. Luteal support by vaginal progesterone (cyclogest 400 mg twice daily) was used in true natural FET from the day of transfer until the 10 th wk of pregnancy. Chemical and clinical pregnancy and abortion rates were considered as the primary outcomes.

Results

There were no differences in the participants' baseline characteristics between groups. There was no difference in clinical pregnancy and abortion rate between groups, while the implantation rate was significantly higher in the mNFET group (29.2% vs. 17.6%; p = 0.036).

Conclusion

The results demonstrated that both types of natural cycles were similar in pregnancy outcomes, while modified cycles might be associated with a higher implantation rate.

The effects of supplemented sericin on in vitro maturation and preimplantation development of mouse embryos: An experimental study

Background

Mouse embryo culture condition is an essential part of transgenic, reproductive and developmental biology laboratories. Mouse embryonic culture media may have a high risk of serum contamination with pathogens.

Objective

To investigate the effect of sericin as an embryo culture medium supplement on in vitro maturation (IVM), in vitro fertilization (IVF), and development of the preimplantation embryo in mice.

Materials and Methods

The effects of sericin at three concentrations (subgroups) of 0.1%, 0.5%, and 1% as a medium supplement on IVM, IVF, and in vitro development of mouse embryos were separately investigated and compared with a sericin-free (control) group. The cumulative effect of the three concentrations was evaluated for IVM + in vitro development and IVF + in vitro development as follow-up groups.

Results

In the IVM group, compared to the control group, the number of oocysts reaching the MII stage was significantly higher when 1% sericin was used (161/208 = 77.4%). No significant results were observed in the IVF and in vitro development groups with different concentrations of sericin compared to the control group. Among the follow-up groups, in the IVM + in vitro development group, the number of oocytes was higher after passing the IVM and IVF and reaching the blastocysts stage when 1% sericin was used, compared with other sericin subgroups. A significant difference was also noted when compared with the control group (p = 0.048). The IVF + in vitro development study group, on the other hand, did not show any significant relationship.

Conclusion

It can be concluded that 1% sericin can be used as a supplement in mouse embryo cultures to improve the IVM rate. Also, based on the findings, sericin appears to be an effective supplement which can have a positive effect on the development of embryos derived from IVM.

The effect of curcumin on embryonic in vitro development in experimental polycystic ovary syndrome: An experimental study

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common disease in women. Some plant compounds which have antioxidant properties, such as curcumin, may be useful for these patients when delivered orally or in vitro.

OBJECTIVE

The aim of this study was to evaluate the impact of PCOS on oocyte quality and the effect of curcumin on in vitro fertilization of oocytes.

MATERIALS AND METHODS

In this experimental study, Naval Medical Research Institute mice aged six to eight wk were used. Mice were divided into five experimental groups (control, experimental PCOS, curcumin 6, 12 and 24 μM). To induce experimental PCOS, estradiol valerate (100 mg/kg, IP) was injected. The total antioxidant capacity and production of malondialdehyde in ovarian tissue and blood serum were evaluated in all groups. Finally, 6, 12 and 24 μM of curcumin were added to the culture medium of the PCOS group oocytes and development in the different groups was evaluated.

RESULTS

A high percentage of oocytes for fertilization were not in good condition in terms of number and quality in the group of PCOS. The addition of curcumin to the embryo culture medium was associated with a higher percentage of fertilized oocytes, two-cells and blastocysts. This increase was significant at a concentration of 24 μM (p ≤ 0.01).

CONCLUSION

Given that adding curcumin seemed to improve fetal growth and prevent the harmful effects of oxygen free radicals on the culture medium, it is recommended to add a certain concentration of curcumin under normal conditions without oxidative stress.

Effect of intrauterine granulocyte-colony stimulating factor administration on in vitro fertilization outcome in women with moderate-to-severe endometriosis: An RCT

Background

Nearly 25-50% of infertile women have endometriosis. There are reports of disorders in the expression of granulocyte colony-stimulating factor (G-CSF) receptors in women with endometriosis.

Objective

To examine the effect of intrauterine administration of G-CSF in in vitro fertilization (IVF) cycles on the fertility rate of infertile women with moderate-to-severe endometriosis.

Materials and Methods

This clinical trial was conducted on 66 infertile women with moderate-to-severe endometriosis, undergoing IVF and intracytoplasmic sperm injection (ICSI). The participants were allocated into two groups via simple randomization: the G-CSF (n = 27) and control (n = 39) groups. In the G-CSF intervention group, on the oocyte pick-up day, immediately after an ovarian puncture, 300 μg of G-CSF was injected through a transcervical catheter under abdominal ultrasound guide to visualize flushing into the uterine cavity. Women in the control group received no intervention. The two groups were evaluated for clinical pregnancy.

Results

No significant difference was noted in the demographic characteristics of the two groups. The rate of clinical pregnancy was 28.2% in the control group and 25.9% in the G-CSF group, indicating no significant difference (p = 0.83).

Conclusion

The results showed that the intrauterine injection of G-CSF had no effects on pregnancy in women with stage-3/4 endometriosis undergoing IVF.

Evaluation of the relationship between serum estradiol levels on human chorionic gonadotropin administration day and intracytoplasmic sperm injection outcomes: A retrospective population-based study

Background

The correlation between high estradiol (E2) levels induced by controlled ovarian hyperstimulation (COH) and pregnancy is controversial.

Objective

To assess the effect of serum E2 levels on the day of human chorionic gonadotropin administration on the intracytoplasmic sperm injection (ICSI) outcome.

Materials and Methods

The current study included 551 participants who had undergone ICSI between May 2014 and May 2016. Based on E2 levels, the individuals aged < 37 yr (n = 502) and 37-42 yr (n = 49) were categorized into six and three groups, respectively. ICSI outcomes including the number of retrieved oocytes (NRO), number of embryos (NE), pregnancy rate, and abortion rate were analyzed in both groups.

Results

Among participants aged < 37 yr, the NRO and NE were 8.69 ± 3.82 and 5.24 ± 2.32, respectively and they had a significant correlation with the E2 level on human chorionic gonadotropin administration day (p < 0.001 for both). Among participants aged > 37 yr, NRO and NE were 5.18 ± 3.17 and 3.40 ± 2.23, respectively, and the NRO (p < 0.001), NE (p < 0.001), pregnancy rate (p < 0.001), abortion rate (p = 0.007), and the number of grade A and B embryos (p = 0.003) had a significant association with the E2 level.

Conclusion

COH is a costly procedure that may have negative effects on endometrial receptivity. Thus, in order to prevent these effects and also to reduce the costs of COH, we recommend gaining optimum number of oocytes rather than maximum number during the procedure.

The effect of follicular fluid selenium concentration on oocyte maturation in women with polycystic ovary syndrome undergoing in vitro fertilization/Intracytoplasmic sperm injection: A cross-sectional study

BACKGROUND

A high level of free radicals and oxidative substances in women with polycystic ovary syndrome (PCOS) can affect the ovaries through oxidative stress. Antioxidants such as selenium, a vital trace element in human health, can improve the prognosis of PCOS by reducing oxidative stress.

OBJECTIVE

This study was performed due to the lack of comprehensive information about selenium concentration in follicular fluid and its effect on the oocyte count and quality in infertile women with PCOS.

MATERIALS AND METHODS

In this cross-sectional study, 78 women with PCOS referred to Umm-al-Banin Infertility Clinic Center, Ganjavian Hospital, Dezful, Iran for in-vitro fertilization from March to November 2019 were enrolled. After ovarian stimulation with the antagonist protocol, the oocytes were retrieved under transvaginal ultrasound in in-vitro fertilization/intracytoplasmic sperm injection cycles, and selenium concentrations were measured in the follicular fluid using an atomic absorption method by spectrophotometer device. Oocyte count and morphology were evaluated using inverted optical microscopy.

RESULTS

There were no significant differences between follicular fluid selenium concentrations in terms of the total number of oocytes and immature oocytes in the metaphase I and germinal vesicle stages. However, a significantly reduced number of metaphase II oocytes was observed at selenium levels < 40 μg/dL (p = 0.001).

CONCLUSION

Based on our results, low levels of follicular selenium concentration in infertile women with PCOS can reduce the quality and potency of oocyte maturation.

The effect of the human cumulus cells-conditioned medium on in vitro maturation of mouse oocyte: An experimental study

BACKGROUND

To increase the results of infertility treatment, many efforts have been made to improve the treatment methods. As assisted reproductive technology is mainly using cell culture methods, one of the approaches to improve this technology is conditioned medium from different sources. It is desirable to apply in vitro maturation (IVM) and use oocytes from normal cycles instead of stimulating ovulation.

OBJECTIVE

To investigate the effect of human cumulus cell condition medium (hCCCM) on the IVM of immature mouse oocytes and morphology.

MATERIALS AND METHODS

In this experimental study, 240 germinal vesile oocytes were collected from four-six wk-old mice after 48 hr of 5IU pregnant mare serum gonadotropin (PMSG) injection and cultured in hCCCM (test group, n = 120) and DMEM + 20% FBS (control group, n = 120). The IVM rates and changes in perivitelline space (PVS) and shape were investigated at 8, 16, and 24 hr following the culture. The mature (MII) oocytes were subjected to in vitro fertilization (IVF) and the fertilization rate was assessed in three days.

RESULTS

A significant difference was observed between the maturation rates in the hCCCM and control groups (24.16% vs 0%; p = 0.001), as well as morphologic changes between the two groups (p = 0.04, p = 0.05). The development rate for MII oocytes attained from IVM in the hCCCM group was 27.58% (2-cell) and 6.89% (4-cell). Data displayed that hCCCM is an effective medium for oocytes maturation compared to the control medium.

CONCLUSION

hCCCM supports oocyte in vitro growth and maturation. Moreover, hCCCM changes the oocyte shape and size of perivitelline space.

Does the repeat dose of gonadotropin-releasing hormone agonist trigger in polycystic ovarian syndrome improve in vitro fertilization cycles outcome? A clinical trial study

BACKGROUND

A repeat dose of Gonadotropin-releasing Hormone (GnRH) agonist could provide long duration of luteinizing hormone (LH) surge and amplitude appropriately.

OBJECTIVE

Improvement in oocyte maturity could be obtained by a repeat dose of GnRH agonist.

MATERIALS AND METHODS

In this randomized double-blinded study, 120 women with polycystic ovarian syndrome and serum estradiol level (E2) > 3000 who were candidate for in vitro fertilization with Antagonist protocol were enrolled between July 2018 and July 2019. Participants were randomized in two groups - and final oocyte maturation was triggered with two doses: In group A, a repeat dose of 0.1 mg, 12 hr. after the first dose and in group B, 0.2 mg SC triptorelin (decapeptyl) 35 hr. prior to oocyte retrieval. Serum Estradiol, LH, and progesterone concentration were measured on the trigger day. Serum LH measurement was done three times in both groups. The outcomes were oocyte yield, meiosis (M) I, MII, Maturity rate, germinal vesicle (GV) rate, 2 pronuclear, embryo yield, ovarian hyper stimulation syndrome rates.

RESULTS

Maturity rate (p = 0.89), MI (p = 0.38), MII (p = 0.89), and GV oocytes (p = 0.38) were not statistically different between the two study groups. LH levels measured at 12 hr post-trigger did not relate statistically significant with maturity rate in our participants (p = 0.96). No empty follicular syndrome was reported.

CONCLUSION

Although, the second dose of GnRH agonist after 12 hr since the first dose could provide duration of LH surge and amplitude and as a result no empty follicular syndrome was seen, the maturity rate, MI, MII, and GV oocytes were not different between the two study groups.