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Robab Davar, Abbas Aflatoonian,
Volume 2, Issue 2 (7-2004)

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. Article
Robab Davar, Sedighe Ghandi, Naeimeh Tayebi,
Volume 5, Issue 4 (7-2007)

Background: Recent reports have suggested that ultrasound-guided embryo transfer (UG-ET) might improve pregnancy rates.
Objective: To determine whether transabdominal UG-ET is a useful tool for increasing pregnancy and implantation rates in patients undergoing IVF or ICSI.
Materials and Methods: A prospective randomized clinical trial was conducted in 180 patients in order to compare embryo transfer under abdominal ultrasound-guidance (n=90) with embryo transfer by clinical touch method (n=90).
Results: The Clinical pregnancy rate was 21.1 % in the ultrasound-guided group and 15.5 % in the clinical touch group (p =0.3). The implantation rate in the ultrasound guided group was 11.1% while this was 7.2% in the clinical touch group (p =0.12). The percentage of difficult transfer was not significantly different in both groups, this was 8.9% in the ultrasound-guided group and 13.3% in the clinical touch group (p =0.47).
Conclusions: Although the clinical pregnancy and implantation rate are higher in UG-ET group than the clinical touch group, but this difference was not statistically significant.
Robab Davar, Mojgan Javedani, Mohammad Hossein Fallahzadeh,
Volume 9, Issue 1 (7-2011)

Background: Polycystic ovary syndrome (PCOS) is associated with approximately 75% of women who suffer from infertility due to anovulation. Additionally, around 20– 25% of anovulatory women with PCOS do not respond at all to clomiphene citrate and are considered to be “clomiphene– resistant”. Aromatase inhibitors have been suggested as an alternative treatment to clomiphene as the discrepancy between ovulation and pregnancy rates with clomiphene citrate has been attributed to its anti-estrogenic action and estrogen receptor depletion.
Objective: The aim of this study is to compare results of Metformin-letrozole with Metformin-clomiphene citrate in clomiphene resistance PCOS patients undergoing IUI.
Materials and Methods: In this single blind randomized trial, ovarian cycles were studied in 100 clomiphene- resistant patients with PCOS. The inclusion criteria were patients who received 150mg clomiphene citrate daily for 3 cycles and failed to become pregnant. The patients were matched for their age, body mass index (BMI), and infertility period. They were randomly allocated to a metformin-letrozole group (n=50) and a metformin-clomiphene citrate group (n=50). Chemical and clinical pregnancies were assessed after IUI. Abortion rates were determined in both groups.
Results: Regarding pregnancy rate, there was no significant difference between the two groups. One miscarriage (2%) occurred in the metformin-clomiphene citrate group, whereas none was seen in the metformin-letrozole group.
Conclusion: There is no significant difference in pregnancy rate between clomiphene citrate and letrozole groups although it has been 2% in the former and 5% in the latter. Article
Tayebe Hemati, Nasrin Moghadami-Tabrizi, Fateme Davari-Tanha, Bahram Salmanian, Pouya Javadian,
Volume 9, Issue 3 (7-2011)

Background: Polycystic ovarian syndrome (PCOS) is a common disease among women in fertility ages and cause severe insulin resistance. Hyperhomocysteinaemia is said to be among the features of PCOS that could influence its outcome.
Objective: This study aimed to investigate whether hyperhomocysteinaemia exists in PCOS and if it is related to insulin resistance in the affected patients.
Materials and Methods: This prospective study was carried out in a university based fertility clinic. Sixty four PCOS patients and 50 normo ovulatory controls were reviewed for fasting glucose, insulin, homocysteine, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) plasma levels in the blood sample of the 3rd day of their menstrual cycle. Insulin resistance was determined with the fasting glucose (mmol/L) to insulin (mIU/L) ratio and HOMA-IR (Homeostasis model assessment-Insulin resistance). Independent-samples T-test and linear regression test were utilized to analyze the obtained data.
Results: Homocysteine levels compared between PCOS patients and control group showed a significant difference. PCOS group was divided into insulin resistant (IR) (LogHOMA-IR?0.57) and non insulin resistant (NIR) patients. The IR group had significantly higher homocysteine (p-value=0.02), fasting insulin and glucose levels (p-value<0.001) rather than NIR group.
Conclusion: PCOS patients have a leaning toward hyperhomocysteinaemia and insulin resistance. Insulin resistant patients are found to have higher homocysteine level.
Razieh Dehghani Firouzabadi, Farnaz Mohammadian, Mehri Mashayekhy, Robab Davar, Maryam Eftekhar,
Volume 10, Issue 5 (10-2012)

Background: Determination of oocyte fertilization and embryo quality are one of the most important purposes in ART cycles. Follicular fluid provides an important microenvironment for development of oocytes and some biochemical characteristics of the follicular fluid, such as pregnancy-associated plasma protein-A (PAPP-A), may play an important role in prediction of success rate of ART.
Objective: This study was performed to evaluate whether there was any difference in follicular fluid PAPP-A, fertilization, and embryo quality between GnRH agonist long protocol and flexible GnRH antagonist multiple-dose protocol in ART cycles.
Materials and Methods: A total of 100 women who were candidates for ART were enrolled the study and were divided into two groups, GnRH agonist (GnRHa) long protocol (n=51) and flexible GnRH antagonist (GnRHant) multiple-dose protocol (n=49). Follicular fluid sample was obtained from a single mature follicle and follicular fluid PAPP-A level, fertilization and embryo quality of the same oocyte were evaluated in both groups.
Results: There was no significant difference in the mean levels of follicular fluid PAPP-A between the GnRHa protocol and GnRHant protocol (3.5±1.4 vs. 3.8±1.9, respectively). The mean levels of follicular fluid PAPP-A in fertilized oocyte and good quality embryo were comparable in GnRHa and GnRHant protocols.
Conclusion: Our data indicated that no differences of follicular fluid PAPP-A levels were observed between cycles using GnRHa long protocol and those of using flexible GnRHant multiple-dose protocol.
Razieh Dehghani Firouzabadi, Robab Davar, Farzaneh Hojjat, Mohamad Mahdavi,
Volume 11, Issue 2 (4-2013)

Background: Sildenafil citrate may increase endometrial thickness and affect the outcome of frozen-thawed embryo transfer cycles.
Objective: The aim of this study was to estimate the effect of sildenafil citrate on ultrasonographic endometrial thickness and pattern and to investigate the estrogen level on the day of progesterone administration, the implantation rate and chemical pregnancy rate in frozen embryo transfer cycles.
Materials and Methods: This randomized controlled trial was conducted on 80 patients who had an antecedent of poor endometrial response and frozen embryos. 40 patients were given estradiol by a step up method with menstruation to prepare the endometrium, and the other 40 were given sildenafil citrate tablets (50 mg) daily in addition to the above treatment protocol from the first day of the cycle until the day progesterone was started. This was discontinued 48-72 hours prior to the embryo transfer.
Results: The endometrial thickness was significantly higher in the sildenafil citrate group (p<0.0001), the triple line patterns of the endometrium were significantly higher in the sildenafil citrate group (p<0.0001), while the intermediate patterns of the endometrium were not significantly different in the two groups. The echogen patterns of the endometrium were significantly higher in control group (p<0.0001). Finally, implantation rate and the chemical pregnancy rates were higher in the sildenafil citrate group but not significantly.
Conclusion: As our study shows, the oral use of sildenafil citrate is a good way to improve the endometrial receptivity. We recommend the routine use of oral sildenafil citrate in patients with a previous failure of assisted reproduction technology cycles due to poor endometrial thickness.
Leili Mosalanejad, Nehle ParanDavar, Morteza Gholami, Sareh Abdolahifard,
Volume 12, Issue 2 (2-2014)

Background: Assisted reproductive technology (ART) provide the hope of pregnancy for infertile women, but do not always turn this hope into reality.
Objective: The purpose of this study was to explore the lived experience of infertile women from increasing and decreasing factors of hope in infertile women with failure in infertility treatment.
Materials and Methods: Using a qualitative research design (Phenomenology study), 23 subjects were selected who had experienced infertility failure visited by gynecologist (Rasekh Infertility center) in 2012. The data were collected through semi structured interviews and analyzed using interpretive research strategies of phenomenology by Collizichr('39')s seven-stage method.
Results: Totally 96 codes were identified. The data arranged in two categories. The factors decreasing and increasing hope in infertility treatments. Totally 5 themes and 20 sub themes were extracted. The increasing factors which emerged from the data contain "spiritual source", "family interaction and support" and "information through the media", and decreasing factors contain "nature of treatments" and "negatively oriented mind".
Abbas Aflatoonian, Robab Davar, Farzaneh Hojjat,
Volume 12, Issue 6 (8-2014)

Background: Increased serum progesterone on the day of human chorionic gonadotropin administration may affect in vitro fertilization (IVF) outcome. Objective: The aim of this study was to evaluate whether progesterone elevation on the day of human chorionic gonadotropin administration is associated with the IVF outcome. Materials and Methods: To determine the relationship between serum progesterone on the day of HCG and the outcome of IVF-embryo transfer treatment, 378 infertile patients undergoing IVF-embryo transfer at Yazd Research and Clinical Center for Infertility from October 2009 to March 2011 were prospectively studied. Results: In this study, absolute p-value and P/ER2R ratio were not a good predictor outcome of in-vitro fertilization but progesterone per metaphase II were predictive of implantation rate and pregnancy rate with statistically significant results but had no effect on the fertilization rate. Conclusion: We suggest avoided the increased progesterone that the cause of advanced endometrial maturation and impaired endometrial receptivity. If the progesterone is greater than 0.32 per oocyte metaphase II, the embryo transfer can be canceled and freezing all embryos for future transfer must be considered, to increase acceptance of the endometrium and thus increase the success rate.
Robab Davar, Nasim Tabibnejad, Seyed Mehdi Kalantar, Mohammad Hasan Sheikhha,
Volume 12, Issue 10 (11-2014)

Background: Despite extensive progress in IVF techniques, one of the most difficult problems is the variability in the response to controlled ovarian hyperstimulation (COH). Recent studies show the effects of individual genetic variability on COH outcome.
Objective: To evaluate the correlation between LHβ G1502A polymorphisms in exon 3 of the LH gene and ovarian response to COH.
Materials and Methods: A total of 220 women treated with a long protocol for ovarian stimulation were studied. Three genotypes of GG, GA and AA were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis.
Results: In total, 34 (17%) patients were poor responders, 154 (77%) were normal responders and 12 (6%) were hyper responders. The most frequent genotype was GA (55.5%) whereas 44.5% of patients showed GG genotype and there was no patient with AA genotype. In total 54.5% of normal responders, 61.8% of poor responders and 50% of hyper responders showed GA genotype.
Conclusion: Our results did not establish a significant relationship between this polymorphism and the ovarian response. Therefore it is still very difficult to use the genotype of patients for prediction of the ovarian response to stimulation.
Maryam Eftekhar, Farnaz Mohammadian, Robab Davar, Soheila Pourmasumi,
Volume 12, Issue 11 (12-2014)

Background: Poor ovarian response to controlled ovarian stimulation is one of the most important interest points in assisted reproduction. Mild ovarian stimulation seems to be preferable to high dose of FSH regimens in women with a history of poor ovarian response in previous protocol. Clomiphene citrate and letrozole alone or in combination with FSH have been used in mild ovarian stimulation protocol.
Objective: To compare the efficacy of letrozole and clomiphene citrate for mild ovarian stimulation on assisted reproductive technology outcomes in poor responders.
Materials and Methods: In a randomized control study, 184 women aged between 20 and 45 years with the history of poor response to ovarian stimulation who were candidate for ART were randomly subdivided into two groups: group I (n= 80), women who underwent the clomiphene/gonadotropin/antagonist protocol; and group II (n= 87), patients who underwent the letrozole/gonadotropin/antagonist protocol. Groups were compared regarding implantation, chemical and clinical pregnancy rates.
Results: There was a significant difference in the mean endometrial thickness between two groups (9.16±1.2 mm vs. 8.3±0.3 mm). The implantation rate was significantly higher in letrozole group compare to clomiphene group (7.2 vs. 6.6%, p=0.024 respectively). No significant differences were found in chemical and clinical pregnancy rate between two groups.
Conclusion: In mild ovarian stimulation protocol, letrozole and clomiphene have similar value for the poor responder. The optimal treatment strategy for these patients remains debated.
Robab Davar, Maryam Farid Mojtahedi, Sepideh Miraj,
Volume 13, Issue 8 (9-2015)

Background: There is no doubt that luteal phase support is essential to enhance the reproductive outcome in IVF cycles. In addition to progesterone and human chorionic gonadotropin, several studies have described GnRH agonists as luteal phase support to improve implantation rate, pregnancy rate and live birth rate, whereas other studies showed dissimilar conclusions. All of these studies have been done in fresh IVF cycles.
Objective: To determine whether an additional GnRH agonist administered at the time of implantation for luteal phase support in frozen-thawed embryo transfer (FET) improves the embryo developmental potential.
Materials and Methods: This is a prospective controlled trial study in 200 FET cycles, patients were randomized on the day of embryo transfer into group 1 (n=100) to whom a single dose of GnRH agonist (0.1 mg triptorelin) was administered three days after transfer and group 2 (n=100), who did not receive agonist. Both groups received daily vaginal progesterone suppositories plus estradiol valerate 6 mg daily. Primary outcome measure was clinical pregnancy rate. Secondary outcome measures were implantation rate, chemical, ongoing pregnancy rate and abortion rate.
Results: A total of 200 FET cycles were analyzed. Demographic data and embryo quality were comparable between two groups. No statistically significant difference in clinical and ongoing pregnancy rates was observed between the two groups (26% versus 21%, p=0.40 and 21% versus 17%, p=0.37, respectively).
Conclusion: Administration of a subcutaneous GnRH agonist at the time of implantation does not increase clinical or ongoing pregnancy.
Robab Davar, Sepideh Miraj, Maryam Farid Mojtahedi1,
Volume 14, Issue 1 (1-2016)

Background: Embryo implantation process is a complex phenomenon and depends on fetal and maternal factors interaction. Endometrial thickness is needed for successful implantation.
Objective: We designed this study in order to assess adding human chorionic gonadotropin (HCG) to the conventional protocol in endometrial preparation in women with thin endometrium and a history of in vitro fertilization–embryo transfer (IVF-ET) failure.
Materials and Methods: The non-randomized clinical trial study (quasi experimental design) was performed on 28 patients. Participants were women who were candidate for frozen-thawed (ET) and had two previous failed ET cycles because of thin endometrial. HCG was administrated (150 IU, intramuscular) from the 8th day of cycle and when endometrial thickness reached at least 7mm HCG was discontinued and frozen thawed ET was done.
Results: Totally 28 patients were included. The mean ± SD age of participants was 30.39±4.7. The mean of endometrium thickness before and after HCG were 5.07±0.43 and 7.85±0.52, respectively p<0.001. Also, there were five clinically and chemically pregnant women.
Conclusion: The findings of the study suggested that adding HCG to the conventional preparation method was an effective protocol and significantly improved endometrial thickness and pregnancy outcomes in women with previous embryo transfer failure because of thin endometrium.
Fatemeh Davari-Tanha, Ensieh Shahrokh Tehraninejad, Mohadese Ghazi, Zahra Shahraki,
Volume 14, Issue 12 (12-2016)

Background: Recurrent implantation failure (RIF) is the absence of implantationafter three consecutive In Vitro Fertilization (IVF) cycles with transferring at leastfour good quality embryos in a minimum of three fresh or frozen cycles in a womanunder 40 years. The definition and management of RIF is under constant scrutiny.
Objective: To investigate the effects of Granulocyte colony stimulating factor (GCSF)on RIF, pregnancy rate, abortion rate and implantation rates.
Materials and Methods: A double blind placebo controlled randomized trial wasconducted at two tertiary university based hospitals. One hundred patients with thehistory of RIF from December 2011 until January 2014 were recruited in the study.G-CSF 300μg/1ml was administered at the day of oocyte puncture or day ofprogesterone administration of FET cycle. Forty patients were recruited at G-CSFgroup, 40 in saline and 20 in placebo group.
Results: The mean age for whole study group was 35.3±4.2 yrs (G-CSF 35.5±4.32,saline 35.3±3.98, placebo 35.4±4.01, respectively). Seventeen patients had a positivepregnancy test after embryo transfer [10 (25%) in G-CSF; 5 (12.5%) in saline; and 2(10%) in placebo group]. The mean of abortion rates was 17.6% (3), two of them inG-CSF, one in saline group. The implantation rate was 12.3% in G-CSF, 6.1% insaline and 4.7% in placebo group.
Conclusion: G-CSF may increase chemical pregnancy and implantation rate inpatients with recurrent implantation failure but clinical pregnancy rate and abortionrate was unaffected.
Robab Davar, Elham Naghshineh, Nosrat Neghab,
Volume 15, Issue 7 (8-2017)

Background: The best time of final oocyte maturation triggering in assisted reproduction technology protocols is unknown. This time always estimated by combined follicular size and blood progesterone level.
Objective: The aim of this study was evaluation of the effect of delaying oocyte maturation triggering by 24 hr on the number of mature oocytes (MII) and other in vitro fertilization cycle characteristics in antagonist protocols with not-elevated progesterone (p ≤1 ng/ml).
Materials and Methods: All patientschr('39') candidate for assisted reproduction technology underwent controlled ovarian hyperstimulation by antagonist protocol. When at least 3 follicles with ≥18 mm diameters were seen by vaginal ultrasonography; blood progesterone level was measured. The patients who had progesterone level ≤1 ng/dl entered the study. The participantschr('39') randomizations were done and patients were divided into two groups. In the first group, final oocyte maturation was done by human chorionic gonadotropin at the same day, but in the second group, this was performed 24 hr later. Oocytes retrieval was done 36 hr after human chorionic gonadotropin trigger by transvaginal ultrasound guide.
Results: Number of retrieved oocytes, mature oocytes (MII), fertilized oocytes (2PN), embryos formation, number of transferred embryos and embryos quality has not significant differences between two groups. Also, fertilization and implantation rate, chemical and clinical pregnancy did not differ between groups.
Conclusion: Delaying of triggering oocyte maturation by 24 hr in antagonist protocol with not-elevated progesterone (progesterone ≤1 ng/ml) have not beneficial nor harmful effect on the number of mature oocytes (MII) and other in vitro fertilization cycle characteristics.
Robab Davar, Nosrat Neghab, Elham Naghshineh,
Volume 16, Issue 4 (April 2018)

Background: Over the years, many article on different aspects of pathogenesis and management of poor ovarian responders have been published but there is no clear guideline for treating themyet.
Objective: This study was designated to compare the effectiveness of a delayed start protocol with gonadotropin-releasing hormone (GnRH) antagonist and microdose flare-up GnRH agonist protocol in poor ovarian responders.
Materials and Methods: This randomized clinical trial consisted of 100 poor ovarian responder women in assisted reproductive technologies cycles. They were divided randomly in delayed-start antagonist protocol (with estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation) and microdose flare-up GnRH agonist protocol. The main outcome was clinical pregnancy rate and second outcome was the number of retrieved oocytes, mature oocytes, 2PN number, fertilization rate, and implantation rate.
Results: Fertilization rate, clinical pregnancy rate, and ongoing pregnancy rates were not significantly different between the two studied protocols. Number of retrieved oocytes (5.10±3.41 vs. 3.08±2.51) with p=0.002, mature oocytes (4.32±2.69 vs. 2.34±1.80) with p=0.003, number of 2PN (3.94±1.80 vs. 2.20±1.01) with p=0.001 and implantation rate (19.40% vs. 10.30%) with p=0.022 were significantly higher in delayed antagonist group.
Conclusion: The delayed-start protocol can improve ovarian response in poor responders by stimulating and synchronizing follicle development.
Robab Davar, Saeideh Dashti, Marjan Omidi,
Volume 18, Issue 5 (May 2020)

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.
Fatemeh Zal, Pardis Ahmadi, Maryam Davari, Fatemeh Khademi, Mojgan Akbarzadeh Jahromi, Zahra Anvar, Bahia Namavar Jahromi,
Volume 18, Issue 6 (June 2020)

Background: Oxidative stress and GSH-dependent antioxidant system plays a key role in the pathogenesis of polycystic ovary syndrome (PCOS).
Objective: We compared glutathione peroxidase (GPx) and glutathione reductase activities and reduced glutathione (GSH) levels in serum and follicular fluid (FF) of the first-retrieved follicle and their impact on quality of oocyte and embryo in PCOS women undergoing IVF.
Materials and Methods: This cross sectional study was conducted on 80 pairs of blood samples and FF of the first-retrieved follicle from PCOS women, at the Infertility center of Ghadir Mother and Child Hospital. The mean activity of GPx and GR, also GSH levels in the serum and FF were compared to the quality of the first follicle and resultant embryo.   
Results: Retrieved oocytes included 53 (66.25%) MII, 17 (21.25%) MI, and 10 (12.5%) germinal vesicles; after IVF 42 (52.50%) embryos with grade I and 11 (13.75%) with grade II were produced. The mean values for all three antioxidants were higher in the FF compared to serum (p < 0.001). Also all of the mean measured levels were significantly higher in the FF of the MII oocytes compared to that of oocytes with lower grades (p = 0.012, 0.006 and 0.012, respectively). The mean GPX activity and GSH levels were significantly higher in the serum (p = 0.016 and 0.012, respectively) and FF (p = 0.001 for both) of the high-quality grade I embryos.
Conclusion: GSH-dependent antioxidant system functions more efficiently in the FF of oocytes and embryos with higher quality.
Robab Davar, Masrooreh Hoseini, Lida Saeed,
Volume 18, Issue 8 (August 2020)

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.
Robab Davar, Seyedeh Mahsa Poormoosavi, Fereshteh Mohseni, Sima Janati,
Volume 18, Issue 9 (September 2020)

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.
Robab Davar, Soheila Pourmasumi, Banafsheh Mohammadi, Maryam Mortazavi Lahijani,
Volume 18, Issue 9 (September 2020)

Background: The results of previous studies on the effect of low-dose aspirin in frozen-thawed 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.

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