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Showing 30 results for Female Infertility

Ensieh Shahrokh Tehrani Nejad, Ashraf Moini, Elham Amirchaghmaghi, Batol Hossein Rashidi, Parvin Jaberi Pour, Elham Azimi Neko,
Volume 5, Issue 3 (7-2007)

Background: Although the uterine fibroids are common, their influence on fertility remains controversial. The association of submucosal fibroid with subfertility is well recognized, but debate persists as to whether intramural fibroids can cause infertility and the evidence for its effect on pregnancy in cycles of assisted conception remains unclear.
Objective: The purpose of present study was to determine the effect of intramural fibroids less than 6 cm not compressing uterine cavity on the outcome of ART cycles in patients undergoing IVF/ICSI cycles.
Materials and Methods: In this prospective cohort study, 94 women with uterine intramural fibroids and 184 controls referred to Royan Institute between 2001 and 2002 were enrolled. The intramural fibroids and their location were detected by transvaginal ultrasound performed just before the ART cycle. All patients underwent long standard GnRH agonist protocol. Student t-test and Chi-square test were used for the statistical analysis.
Results: The mean age of patients was 33.9 ±3.37 years in myoma group (n=94) and 33.28 ±3.59 years in control group (n=184). The total dose of gonadotropin used, estradiol level on day of hCG administration, the number of metaphase II oocytes retrieved, fertilization rate, number and quality of embryos developed and transferred, the clinical pregnancy and abortion rates were similar in two groups.
Conclusion: The presence of intramural fibroids less than 6 cm not compressing endometrial cavity does not adversely affect clinical pregnancy rate in patients undergoing IVF or ICSI.
Monir Owj, Moid Mohseni, Elham Amirchaghmaghi, Maria Sadeghi, Babak Eshrati, Fatemeh Shabani,
Volume 5, Issue 5 (7-2007)

Background: Smoking has negative effects on reproductive process. Exposing to cigarette smoking (passive smoking) may exert some effects as the direct smoking.
Objective: The aim of this study was to evaluate the correlation between ovarian response and passive smoking in women who underwent ART cycles.
Materials and Methods: One hundred-sixty patients who underwent ICSI between 2000 and 2001 were studied in a prospective cohort study. The case group included women whose husbands smoked at least 5 cigarettes daily for 1 year or more. The control group included women with nonsmoking husbands. Women with high FSH level (>12 IU/ml) were excluded. Long standard protocol with GnRH agonist and HMG were used in all patients. In vitro fertilization and embryo transfer was carried out in a standard fashion.
Results: Eighty one women were in case group and 82 in control group. Ovarian response variables were not significantly different between two groups but there was a significant relation between passive smoking and fertilization (RR= 1.18, 95% CI: 1.07-1.31). However pregnancy rate was not significantly different between two groups. Moreover there were no significant differences between heavy and light smokers in ovarian response outcomes.
Conclusion: This study showed no correlation between ovarian response parameters and passive smoking in women underwent ART cycles, whereas fertilization rate is significantly lower in this group compared to control group. It may be related to sperm quality than oocytes. Assessment of nicotin in follicular fluid and cytogenetic evaluation of embryo before transfer are recommended for more information and confirmation.
Ensieh Shahrokh Tehrani Nejad, Batool Hosein Rashidi, Atefeh Larti, Zahra Ezabadi, Nadia Jahangiri, Elham Azimi Nekoo,
Volume 7, Issue 2 (7-2009)

Background: Endometriosis is one of the most challenging diseases that constitute 20% - 40% of women searching for their infertility diagnosis. Objective: This study was undertaken in order to compare the outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in women with endometriosis, and tubal factor infertility as controls.
Materials and Methods: From 2005 to 2006 a retrospective study was carried out in patients with endometriosis (n=80) and tubal infertility (n=57) after treatment with IVF/ICSI. The main outcome measures were ovarian responsiveness, quality of oocytes, implantation, pregnancy and ongoing pregnancy rates. Appropriate statistical analysis was performed using χ2 and student t-tests.
Results: No differences were found in mean number of ampoules of hMG, duration of hMG injection, number of MΙΙ oocytes, number of embryo transferred, and rates of implantation, pregnancy, ongoing pregnancy and twin birth between women with endometriosis and tubal infertility and also between women with stages I/II or those with stages III/IV disease with women with tubal factor infertility.
Conclusion: Our results suggest that endometriosis does not seem to have adverse effect on outcome of IVF/ ICSI as compared with tubal infertility.
Mahnaz Ashrafi, Saeed Kazemi Ashtiani, Farideh Malekzadeh, Elham Amirchaghmaghi, Fahimeh Kashfi, Babak Eshrati, Fatemeh Shabani,
Volume 8, Issue 2 (7-2010)

Background: Menopause is a step of a woman’s life when hormonal changes cause menstruation to stop permanently. Menopausal symptoms can affect women's health and differ between different races and societies.
Objective: The aim of this study was to survey the symptoms associated with menopause among Iranian women living in Tehran, Iran.
Materials and Methods: In this cross sectional study which has been done between 2004 and 2005, women aged equal or more than 35 years old living in districts of Tehran were selected by multistage randomized cluster sampling. For each woman a questionnaire was completed. The data gained from each questionnaire was analyzed by using SPSS version 13.
Results: At time of study, 2462 women were naturally menopause. The mean age of natural menopause onset was 47.71 (SE=0.11) years. In 52.9% of cases, the onset of menopause was sudden. The symptoms associated with menopause were night sweats (61.2%), joint and muscle pain (59.9%), hot flashes (53.1%), fatigue (45.6%), decreased libido (33.9%), insomnia (33.7%), weight gain (30.1%), forgetfulness (24.9%) and urinary symptoms (17.4%). 
Conclusion: This study showed that night sweats, joint and muscle pain and hot flashes are the most common symptoms associated with menopause.
Ashraf Moini, Fatemeh Zafarani, Bita Eslami, Maria Sadeghi, Zahra Kamyabi, Nadia Jahangiri,
Volume 9, Issue 2 (7-2011)

Background: Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment.
Objective: The objective of this study was to compare the efficacy of three types of progesterone on biochemical, clinical and ongoing pregnancy rates and abortion and live birth rates.
Materials and Methods: A prospective randomized study was performed at Royan Institute between March 2008 and March 2009 in women under 40 years old, who use GnRH analog down-regulation. One hundred eighty six patients in three groups were received progesterone in oil (100 mg, IM daily), intravaginal progesterone (400 mg, twice daily) and 17-a hydroxyprogestrone caproate (375mg, every three days), respectively.
Results: Final statistical analysis after withdrawal of some patients was performed in 50, 50 and 53 patients in group 1, 2 and 3 respectively. No differences between the groups were found in baseline characteristics. No statistical significance different was discovered for biochemical, clinical and ongoing pregnancies. Although the abortion rate was statistically higher in group 1 (p=0.025) the live birth rate was not statistically significant between the three groups.
Conclusion: The effects of three types of progesterone were similar on pregnancies rate. We suggest the use of intravaginal progesterone during the luteal phase in patients undergoing an IVF-ET program because of the low numbers of abortions, and high ongoing pregnancy rates.
Tohid Najafi, Marefat Ghaffari Novin, Jalil Pakravesh, Khadijeh Foghi, Fatemeh Fadayi, Gelareh Rahimi,
Volume 10, Issue 2 (7-2012)

Background: Nitric oxide (NO) is a molecule that incorporates in many physiological processes of female reproductive system. Recent studies suggested the possible role of endothelial isoform of nitric oxide synthase (eNOS) enzyme in female infertility.
Objective: The aim of this study is to evaluate the expression of endothelial nitric oxide synthase in endometrial tissue of women with unexplained infertility.
Materials and Methods: In this case-control study a total of 18 endometrial tissues obtained from 10 women with unexplained infertility and 8 normal and fertile women by endometrial biopsy, 6 to 10 days after LH surge. Specimens were fixed in 4% paraformaldhyde fixative and frozen sectioned for semi-quantitative immunohistochemical evaluation using monoclonal anti-human eNOS antibody. Hematoxilin and Eosin was used for Histological dating. Results: Localization of endothelial nitric oxide synthase was seen in glandular and luminal epithelium, vascular endothelium and stroma in both fertile women and women with unexplained infertility. Although there were differences in immunoreactivity of glandular epithelium (p=0.44), vascular endothelium (p=0.60) and stroma (p=0.63) but only over-expression of eNOS in luminal epithelium (p=0.045) of women with unexplained infertility compared to fertile women was statistically significant (p<0.05).
Conclusion: This study suggests that changes in luminal expression of eNOS may influence receptivity of endometrium.
Sughra Shahzad,
Volume 10, Issue 6 (4-2012)

Background: Genital tuberculosis is a common entity in gynecological practice particularly among infertile patients. It is rare in developed countries but is an important cause of infertility in developing countries.
Objective: The present study has investigated the prevalence of female genital tract tuberculosis (FGT) among infertile patients, which was conducted at the Obstetrics and Gynecology Unit-I, Allied Hospital, affiliated with Punjab Medical College, Faisalabad, Pakistan.
Materials and Methods: 150 infertile women who were referred to infertility clinic were selected randomly and enrolled in our study. Patients were scanned for possible presence of FGT by examination and relevant investigation. We evaluated various aspects (age, symptoms, signs, and socio-economic factors) of the patients having tuberculosis.
Results: Very high frequency of FGT (20%) was found among infertile patients. While, a total of 25 patients out of 30 (83.33%) showed primary infertility and the remaining 5 cases (16.67%) had secondary infertility. Among secondary infertility patients, the parity ranged between 1 and 2. A total of 40% of patients (12 cases) were asymptomatic but infertile. Evidence of family history was found in 4 out of a total of 30 patients (13.3%), respectively. According to histopathological and bacteriological examination of endometrial biopsy and laparotomy, tuberculous endometritis was found in 20 out of a total of 25 (80%) cases, while tuberculous salpingitis and tuberculous oophoritis were found both in 2 (8%) of the cases, respectively. Only one case (4%) of tuberculosis cervicitis was found in the present study.
Conclusion: Although infertility is not a disease in classical sense, but it is an extremely important personal concern for many couples and a significant health problem for our profession. So, it is worthwhile to identify and evaluate the factors contributing to infertility.
Hossein Pashaiefar, Mohammad Hasan Sheikhha, Seyyed Mehdi Kalantar, Tahereh Jahaninejad, Mohammad Ali Zaimy, Nasrin Ghasemi,
Volume 11, Issue 1 (4-2013)

Background: Meiotic genes are very important candidates for genes contributing to female and male infertility. Mammalian MutL homologues have dual roles in DNA mismatch repair (MMR) after replication errors and meiotic reciprocal recombination. The MutL homologs, MLH1 and MLH3 , are crucial for meiotic reciprocal recombination and human fertility. In this study the functional polymorphisms of MLH3 C2531T was investigated in Iranian women with unexplained infertility.
Objective: Investigating the association between a common SNP (single nucleotide polymorphism) C2531T in the MLH3 gene and female infertility.
Materials and Methods: In total, 105 women with unexplained infertility as case group and 100 women with at least one child and no history of infertility or abortion as controls were recruited for this association study. The MLH3 C2531T polymorphism was tested by tetra-amplification refractory mutation system-PCR (4P-ARMS-PCR) method.
Results: The MLH3 2531C and T alleles frequencies were 43.33% and 56.67% among infertile patients, and 61.5% and 38.5% among normal controls, respectively. In the patient and control subjects the CC (Pro 844 Pro) genotype frequency of MLH3 C2531T was 4.76% and 25%, the CT (Pro 844 Leu) genotype was 77.15% and 73%, and the TT (Leu 844 Leu) genotype was 19% and 2%, respectively (p=0.0001).
Conclusion: The presence of the polymorphic allele T leads to an increased risk of 2.09 times (OR=2.09, 95% CI=1.38-3.16; p=0.0001) for developing infertility in relation to the control group. Therefore, our data suggest that the MLH3 C2531T polymorphism can be associated with the risk of unexplained infertility in Iranian women.
Bibi Shahnaz Aali, Sakineh Ebrahimipour, Siavash Medhdizadeh,
Volume 11, Issue 4 (6-2013)

Background: Controlled ovarian stimulation combined with intra uterine insemination (IUI) is a convenient treatment of infertility with a success rate of 11%. The clinical observation and pattern of progesterone secretion in this method is suggestive of luteal phase defect and postulated as an implicating factor of treatment failure.
Objective: To investigate the efficacy of luteal phase support with intravaginal cyclogest in women undergoing controlled ovarian stimulation combined with intrauterine insemination.
Materials and Methods: In this single-blinded clinical trial, 196 consecutively seen women eligible for the study protocol, were randomized to receive either intravaginal progesterone (cyclogest pessary, Actavis) or no medication in luteal phase. Blood samples were collected and serum progesterone level in 7th and 11th day of the cycle, biochemical and clinical pregnancy and luteal phase duration were compared in case and control groups.
Results: The mean age in case and control group was 28 and 27.9 years, respectively and the most frequent cause of infertility was unexplained. Additionally, ovulatory dysfunction was the most common cause of female infertility in both groups. Based on these variables, there was no statistically significant difference between the two groups. Mean serum progesterone level in the case group were 48.34 and 34.24nmol/day on day 7 and 11 after insemination, respectively and both values were significantly higher than the control group. There was no difference between the two groups in terms of biochemical and clinical pregnancy. Luteal phase duration in the case group was significantly longer than the control group.
Conclusion: Luteal phase support by Cyclogest pessary increases progesterone level and prolongs the luteal phase, but does not affect success rate of IUI cycles in terms of achieving pregnancy.
Farnaz Shapouri, Shaghayegh Saeidi, Sara Ashrafi Kakhki, Omid Pouyan, Elham Amirchaghmaghi, Reza Aflatoonian,
Volume 11, Issue 11 (12-2013)

Background: It has been suggested that malfunction of immune system may cause testicular cancer. Recently, our understanding of innate immune system has been expanded, by discovery of “Toll- like receptors” (TLRs). Some studies have shown that polymorphisms of TLR2 and 4 can effect on the risk of cancer. Also, the role of TLRs 3and 9 have been shown in apoptosis of cancer cells and metastasis in animal models.
Objective: Little information is available about the influence of innate immunity on testicular malignancy. Therefore, expression of TLRs 2, 3, 4 and 9 as main components of innate immunity has been investigated in this study.
Materials and Methods: In this case control study, TLRs gene expression was examined by RT-PCR in normal testis and testicular cancer tissues. Real time quantitative PCR (Q-PCR) analysis was used to compare the relative expression of TLRs between the samples.
Results: mRNAs of TLR 2, 3, 4 and 9 were expressed in all normal and cancer samples. Q-PCR reveals that cancer samples had stronger expression of these genes in compared with normal ones.
Conclusion: It seems that the different TLRs expression in testicular cancer cells may contribute to extensive signaling pathways involved in carcinogenesis.
Firoozeh Ahmadi, Zohreh Rashidy, Hadieh Haghighi, Mohamadreza Akhoond, Maryam Niknejadi, Mandana Hemat, Mansour Shamsipour,
Volume 11, Issue 12 (1-2013)

Background: Assessment of uterine abnormalities is a core part in infertility evaluation.
Objective: The aim of this study was to evaluate the sensitivity and specificity of three-dimensional hysterosonography (3-DHS) in the diagnosis of uterine abnormalities in infertile women.
Materials and Methods: The infertile women who visited Royan Institute and referred to 3-DHS consecutively, prior to in vitro fertilization, from 2010-2011 included in this cross-sectional study. For patients who underwent hysteroscopy in addition to 3-DHS (214/977), the verification bias adjusted sensitivity and specificity of 3-DHS which were calculated by global sensitivity analysis method. Hysteroscopy was used as the gold standard for diagnosis of uterine abnormalities. Histological diagnosis of resected endometrial tissues by hysteroscopy was assessed and the adjusted sensitivity and specificity of 3-DHS and hysteroscopy in detection of polyp or hyperplasia were determined. Histopathologic results were considered as the gold standard for diagnosis of polyp or hyperplasia.
Results: The overall sensitivity and specificity for 3-DHS in diagnosis of uterine anomalies considering hysteroscopy as the gold standard were 68.4% and 96.3% respectively. Sensitivity and specificity of hysteroscopy in diagnose of polyp or hyperplasia was calculated at 91.3% and 81.4% respectively. Sensitivity and specificity of 3-DHS in diagnosis polyps or hyperplasia was calculated at 91.4% and 80.2 % respectively.
Conclusion: The results of present study proved that, compared to hysteroscopy; 3-DHS has a reliable specificity for diagnosis of uterine abnormalities. Sensitivity and specificity of 3-DHS and hysteroscopy in detecting polyp or hyperplasia regarding histopathology as the gold standard was the same.
Nasrin Ghasemi, Fatemehsadat Amjadi, Ensieh Salehi, Mojgan Shakeri, Abbas Aflatoonian, Reza Aflatoonian,
Volume 12, Issue 6 (8-2014)

Background: The human female reproductive tract (FRT) is constantly deal with the invading pathogens. Recognition of these pathogens is attributed to the family of Toll like receptors (TLR) as a major part of the innate immune system. We and others have previously revealed that TLRs1-6 express in the female reproductive tract. However, more studies should be done to detect TLRs 7-10 in the female reproductive tract, especially in the fallopian tubes.
Objective: To examine the expression of TLRs7-10 in human fallopian tube tissue.
Materials and Methods: Using immunostaining techniques, distribution of TLR7-10 was studied in surgical sections from the uterine tubes, obtained from patients undergoing tubal ligation and hysterectomy for benign gynecological conditions. RT-PCR was used to show the existence of TLR7-10 genes in fallopian tube tissue.
Results: TLR7-10 proteins were detected in the fallopian tube epithelium, although the intensity of staining was not equal in cases. TLR7-10 genes were expressed in human fallopian tube tissue.
Conclusion: This study indicates that TLR7-10 is expressed in fallopian tubes tissues, and may play an important role in microbial recognition, and in host defense against ascending infection.
Maryam Niknejadi, Farnaz Akhbari, Fatemeh Niknejad, Gholamreza Khalili, Marzieh Shiva,
Volume 12, Issue 8 (8-2014)

Background: Traditionally, septate uterus was diagnosed with invasive method like hysterosalpingography and hysteroscopy. Nowadays transvaginal ultrasonography was reported to be a sensitive tool for detection of septate uterus too.
Objective: The objective of the present study was to evaluate the application of two dimensional ultrasound (2-DUS) and real time three dimensional ultrasound (3-DUS) in differentiating various type of septated uterus. Hysteroscopy confirmation was assigned as the gold standard.
Materials and Methods: This retrospective study was performed among 215 infertile women with suspected septate uterus from October 2008 to July 2012. An inclusion criterion was septated uterus based on HSG or experiencing abortion, preterm labor, or recurrent IVF failure. Fusion anomalies were excluded from the study (unicornuate, bicornuate and didelphys anomalies). The results of 3D and 2D sonographies were compared, while they were confirmed by hysteroscopy result in detection of septated uterus. Kappa index for agreement between 2DUS and hysteroscopy, as well as 3-DUS and hysteroscopy in detection of septate uterus was carried out. By receiver operating characteristic (ROC) curve, cut off points for predicting the kind of anomalies were proposed.
Results: The women were evaluated by 2-DUS (n=89) and (II) 3-DUS (n=126). All women underwent hysteroscopy, following 2-DUS and 3-DUS at the same or subsequent cycle. The results of kappa (K) index were 0.575 and 0.291 for 3-DUS and hysteroscopy, as well as 2-DUS and hysteroscopy, respectively. Also, the cutoff points were 27% for arcuate and subseptate, and 35% for differentiating septate and subseptate.
Conclusion: Real time 3-DUS has better ability for visualization both uterine cavity and the fundal uterine, so it has higher agreement in detection of septate uterus than 2-DUS. 
Seyedeh Zahra Masoumi, Parisa Parsa, Nooshin Darvish, Sahar Mokhtari, Mahnaz Yavangi, Ghodratollah Roshanaei,
Volume 13, Issue 8 (9-2015)

Background: Infertility is considered as a major health care problem of different communities. The high prevalence of this issue doubled its importance. A significant proportion of infertility have been related to environmental conditions and also acquired risk factors. Different environmental conditions emphasized the need to study the different causes of infertility in each area.
Objective: The aim of this study was to determine the frequency causes of infertility in infertile couples.
Materials and Methods: In this cross sectional descriptive study 1200 infertile men and women that were referred to infertility clinic of Fatemieh Hospital during 2010 to 2011, were examined. This center is the only governmental center for infertility in Hamadan. Sampling was based on census method. Information about the patients was obtained from medical examinations and laboratory findings. To analyze the data, descriptive statistics such as frequencies and the mean were used.
Results: The prevalence of primary and secondary infertility was 69.5% and 30.5% respectively. Among the various causes of infertility women factors (88.6%) had the highest regard. In the causes of female infertility, menstrual disorders, diseases (obesity, thyroid diseases, and diabetes), ovulation dysfunction, uterine factor, fallopian tubes and cervical factor had the highest prevalence respectively. The causes of male infertility based on their frequency included semen fluid abnormalities, genetic factors, vascular abnormalities, and anti-spermatogenesis factors, respectively.
Conclusion: Etiology pattern of infertility in our study is similar with the many other patterns that have been reported by the World Health Organization. However, frequency of menstrual disorders is much higher than other studies that require further consideration.
Azadeh-Sadat Nazouri, Mona Khosravifar, Ali-Asghar Akhlaghi, Marzieh Shiva, Parvaneh Afsharian,
Volume 13, Issue 12 (1-2015)

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine women’s disorders in reproductive age. Hyperandrogenism has a critical role in the etiology of PCOS and it can cause fault in Steroidogenesis process. During steroidogenesis, steroidogenic acute regulatory protein (StAR) seems to increase the delivery of cholesterol through mitochondrial membrane. Therefore, polymorphisms of StAR might effect on this protein and play a role in the etiology of PCOS. Objective: The aim of this study was to investigate the association between StAR SNPs with PCOS. Thus, seven polymorphisms in this gene: rs104894086, rs104894089, rs104894090, rs137852689, rs10489487, rs104894085 were detected. Materials and Methods: In this case control study, 45 PCOS women, 40 male factor/unexplained infertile women, and 40 fertile women as two control groups were participated from 2008-2012. Polymorphisms were detected using restriction fragment length polymorphism (PCR-RFLP) method. Results: Heterozygote genotyping for rs137852689 SNP (amino acid 218 C > T) was only seen in seven PCOS patients, one in normal ovulatory women, and five in male factor/unexplained infertile women (15.5%, 2.5%, 12.5%, respectively) (p= 0.12). While, it has shown no association between other SNPS with PCOs. Conclusion: The RFLP results for seven chosen SNPs, which located in exon 5 and 7 showed normal status in three groups, it means no heterozygous or homozygous forms of selected SNPs were observed. So, it seems evaluation of the active amino acid sites should be investigated and also the study population should be increased.
Maryam Eftekhar, Soheila Pourmasumi, Parvin Sabeti, Abbas Aflatoonian, Mohammad Hasan Sheikhha,
Volume 13, Issue 12 (1-2015)

Background: Genital tuberculosis (GTB) is an important cause of female infertility, especially in developing countries. The positive results of polymerase chain reaction (PCR) in endometrial GTB in the absence of tubal damage raise the possibility of the detection of sub-clinical or latent disease, with doubtful benefits of treatment. Objective: To evaluate the mycobacterium tuberculosis infection in endometrial biopsy samples collected from unexplained infertile women attending Yazd Research and Clinical Center for Infertility by using PCR techniques. Materials and Methods: In this cross sectional study, 144 infertile women with unexplained infertility aged 20-35 years old and normal Histro-saplango graphy findings were enrolled. Endometrial biopsy samples from each participant were tested for mycobacterium tuberculosis detecting by PCR. In 93 patients, peritoneal fluid was also taken for culture and PCR. Results: The PCR results of endometrial specimens were negative in all cases, demonstrating that there was no GTB infection among our patients. Conclusion: Our results showed that GTB could not be considered as a major problem in women with unexplained infertility. Although, studies have indicated that PCR is a useful method in diagnosing early GTB disease in infertile women with no demonstrable evidence of tubal or endometrial involvement.
Maryam Eftekhar, Sepideh Miraj, Maryam Farid Mojtahedi, Nosrat Neghab,
Volume 14, Issue 11 (11-2016)

Background: Although pregnancy rate in in vitro fertilization-embryo transfer (IVF-ET) cycles has been increased over the preceding years, but the majority of IVF-ET cycles still fail. Granulocyte colony stimulating factor (GCSF) is a glycoprotein that stimulates cytokine growth factor and induces immune system which may improve pregnancy rate in women with history of implantation failure.
Objective: The aim of this study was to evaluate GCSF ability to improve pregnancy rate in women with history of implantation failure
Materials and Methods: 0.5 ml (300 μg/ml) GCSF was infused intrauterine in intervention group. Pregnancy outcomes were assessed based on clinical pregnancy.
Results: The mean age of participants was 31.95±4.71 years old. There were no significant differences between demographic characteristics in two groups (p>0.05). The pregnancy outcome in GCSF group was improved significantly (p=0.043).
Conclusion: GCSF can improve pregnancy outcome in patients with history of implantation failure.
Fatemeh Nikmard, Behrouz Aflatoonian, Elham Hosseini, Abbas Aflatoonian, Mehrdad Bakhtiyari, Reza Aflatoonian,
Volume 14, Issue 12 (12-2016)

Background: Serum concentrations of antimullerian hormone (AMH) correlate with ovarian response during assisted reproduction treatment (ART) cycles.
Objective: This retrospective study attempted to evaluate the selection of ovarian stimulation protocols based on serum AMH levels in patients and its impact on the results of ART.
Materials and Methods: Based on AMH levels, the patients with tubal factor infertility were divided in three groups of normal, low and high AMH levels. Oocyte, good embryo number and pregnancy rate in each group were analyzed.
Results: Using agonist and antagonist protocols, an increase in serum AMH led to higher number of oocytes and better quality embryos. At all low, normal and high AMH levels, the agonist protocol led to a more significant increase in the number of oocytes than the antagonist protocol (p<0.05). The number of high quality embryos significantly increased by the agonist protocol than antagonist protocol in women with normal AMH levels of 1.3-2.6 ng/ml (p=0.00). Moreover, the results for the number of high quality embryos at AMH ˃2.6 ng/ml was in favor of the antagonist protocol (p=0.00). The results showed the lowest pregnancy rate at AMH ˂1.3 ng/ml. At AMH ˃2.6 ng/ml, there was a significant increase in pregnancy rate through the antagonist protocol (p=0.04).
Conclusion: Findings of this study suggested that the ART results are predictable, taking into account the AMH levels. The protocol specific to each patient can be used given the AMH level in each individual. This is because the results of each protocol depend on individual conditions
Abbas Aflatoonian, Robabe Hosseinisadat, Ramesh Baradaran, Maryam Farid Mojtahedi,
Volume 15, Issue 4 (6-2017)

Background: Management of poor-responding patients is still major challenge inassisted reproductive techniques (ART). Delayed-start GnRH antagonist protocol isrecommended to these patients, but little is known in this regards.
Objective: The goal of this study was assessment of delayed-start GnRH antagonistprotocol in poor responders, and in vitro fertilization (IVF) outcomes.
Materials and Methods: This randomized clinical trial included sixty infertilewomen with Bologna criteria for ovarian poor responders who were candidate forIVF. In case group (n=30), delayed-start GnRH antagonist protocol administeredestrogen priming followed by early follicular-phase GnRH antagonist treatment for7 days before ovarian stimulation with gonadotropin. Control group (n=30) treatedwith estrogen priming antagonist protocol. Finally, endometrial thickness, the ratesof oocytes maturation, , embryo formation, and pregnancy were compared betweentwo groups.
Results: Rates of implantation, chemical, clinical, and ongoing pregnancy indelayed-start cycles were higher although was not statistically significant.Endometrial thickness was significantly higher in case group. There were nostatistically significant differences in the rates of oocyte maturation, embryoformation, and IVF outcomes between two groups.
Conclusion: Delayed-start GnRH antagonist protocol can be a new hope method totreatment poor ovarian responders.
Maryam Eftekhar, Maryam Farid Mojtahedi, Sepideh Miraj, Malihe Omid,
Volume 15, Issue 7 (8-2017)

Background: Gonadotropin-releasing hormone agonists (GnRH-a) was increasingly used for triggering oocyte maturationfor the prevention of ovarian hyperstimulation syndrome. Studies suggest that GnRH-a might be used as a better trigger agent since it causes both Luteinizing hormone and follicle stimulating hormone release from a physiologic natural cycle.
Objective: The aim of this study was to evaluate the effect of dual-triggering in assisted reproductive technology outcomes.
Materials and Methods: 192 normal responder women aged ≤42 years and 18< Body Mass Index <30 kg/m2 enrolled in this single-blind randomized controlled trial. All participants received antagonist protocol. For final triggering, women randomly were divided into two groups. Group, I was triggered by 6500 IU human chorionic gonadotropin (hCG) alone, and group II by 6500 IU hCG plus 0.2 mg of triptorelin. The implantation, chemical, clinical and ongoing pregnancy, and abortion rates were measured.
Results: The mean of retrieved oocytes and obtained embryos were statistically higher in the dual-trigger group (group I), but the implantation and pregnancy rates were similar in two groups.
Conclusion: The results of our study did not confirm the favorable effect of dual-triggered oocyte maturation with a GnRH-a and a standard dosage of hCG as an effective strategy to optimize pregnancy outcome for normal responders in GnRH-antagonist cycles. We think that this new concept requires more studies before becoming a universal controlled ovarian hyperstimulation protocol in in vitro fertilization practice.

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