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Showing 149 results for Ivf

Mir-Mehrdad Farsi,
Volume 1, Issue 1 (1-2003)
Abstract

Background: While traditional semen parameters are of significant clinical value, total fertilization failure in IVF cycles is not uncommon. Sperm function testing such as; Hamster egg penetration test has severed limitations as a clinical test. The aim of this study was to evaluate the predictive value of semen parameters by using of intracellular calcium [Ca2+]I increase in response to progesterone. Materials and Methods: The [Ca2+]i response to progesterone was measured in spermatozoa of 86 patients referring to the Assisted Conception Unit for semen analysis. The patients were divided into 3 groups; according to their semen parameters and measured intracellular [Ca2+]i increasing in response to progesterone . Results: There was no significant correlation between each individual semen parameter and [Ca2+]i elevation in response to the progesterone, but most of the patients in each group had [Ca2+]i increasing as expected based on sperm parameters. However, there were cases in groups 1 and 2 (Normal and IVF) that demonstrated [Ca2+]i increases which were poor or lower than expected. Out of the 22 patients in the normal category, 8 cases had poor response to [Ca2+]I increase and out of the 47 patients in the IVF group, 9 patients were as well. In addition we measured [Ca2+]I increases in 6 fertile donor samples for comparison purposes. Conclusion: [Ca2+]i increase in response to progesterone is related to predicting value of sperm parameters in most cases. However, the response of sperm to progesterone could be different in some cases that are expected in normal or IVF category based on our semen analysis criteria. We suggest that the [Ca2+]i measurements may perfect the sperm fertility potential.
Marzieh Mehrafza, Nadia Nobakhti, Zahra Atrkar Roushan, Havva Dashtdar, Mane Oudi, Ahmad Hosseini,
Volume 1, Issue 1 (1-2003)
Abstract

Backgroud: Intrauterine insemination (IUI) is generally attempted before proceeding to more expensive and invasive assisted reproductive techniques such as invitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This procedure is most commonly performed as a therapeutic method for couples with a wide variety of subfertility etiologies, such as low count or low motility of sperm, or an incompatibility between the sperm and the cervical mucus. The objective of this clinical trial study was to compare the correlation between the semen parameters and pregnancy rates in patients undergoing hyperstimulation and IUI. Materials and Methods: 336 infertile couples that underwent 336 cycles of IUI with washed husband�s semen were included in this study. All patients� charts were reviewed for age, etiology and duration of infertility, semen characteristics and pregnancy rates. The SPSS 9 software and Chi-square tests were applied for statistical analysis. P<0.05 was determined as statistical significance. Results: Total pregnancy rates were18.2% (61 out of 336 cycles). Postwash semen parameters including: sperm count ?10? 106 ,motility ?50% (grade III and IV >20%) had significant effect on pregnancy rates after IUI. The Outcome of this procedure was not significantly affected by female age, duration or etiology of infertility. Conclusion: Postwash semen quality was the most important factor for predication of successful pregnancy in this study.
Seyed M Kalnatar, Ahmad Ebrahimi, Mehrdad Solimani, Hossein Fazli,
Volume 1, Issue 1 (1-2003)
Abstract

Background: The high fertilization failure after IVF treatment cycles could be related to chromosomal abnormalities. This study was carried out to assess the frequency of chromosomal abnormality on human oocytes lacking signs of fertilization 18-20 h after insemination . Materials and Methods: On day one, 18-20 h after insemination (IVF), fertilization was confirmed when two pronuclei (normal IVF) or more pronuclei (poly pronucleus FR) were present. Chromosomal analysis of unfertilized oocytes was carried out within 20-24 h of collection. All oocyte did not sign of pronuclei were collected from total fertilization failure, TFF (FR=0) or partial fertilization failure, PFF (FR=10-90%). Chromosomal preparation was carried out as described by Tarkowski�s techniques. The average of finding between two groups was compared by X2 test. Results: Chromosome spreading permitted adequate analyzing in 348 unfertilized oocytes. In 33.6% chromosomal aneulpoidy was observed with the following frequencies; hypo-hyploidy, 22/348 (6.4%), hyper-hyploidy, 42/348 (12.2%) and diploidy, 52/348 (15%). The frequency of aneuoplidy was significantly higher in TFF group 33/80 (41%) than PFF group 83/268 (31%), p<0.01, X2. The most frequent numerical aberration was observed in chromosome group, G of the human karyotyped. Conclusion: Since cytogentic analysis of failed fertilized oocytes and sperm function tests are very helpful for direct information on low success rate of fertilization, further studies analyzing on both gametes function in TFF cycles will be needed.
Robabeh Taheripanah, Mohammad A Karimzadeh, Mohammad Ghafourzadeh,
Volume 2, Issue 1 (7-2004)
Abstract

Background: The retrieval of good quality oocytes that is accomplished with selection of the best induction ovulation protocol on the basis of patients condition, age and cause of infertility, is one of the most important aspects of ART cycles. The objective was to evaluate the efficacy of low dose, long acting GnRH-a (Decapeptyle) for pituitary desensitization and outcome of ART compared to long protocol of short acting GnRH-a (Busereline). Materials and Methods: In this randomized clinical trial that was performed at Yazd IVF Center, 60 patients with 61 cycles of ART were included. Patients with endometriosis or age > 40 were excluded in this study. Using COH-ET, patients were randomly divided into two groups. In group one, 30 patients received a single half dose of Decapeptyle (1.87mg) in mid-luteal phase. In the other group, 31 patients received Buserelin daily (0.5mg), starting from previous mid-luteal phase. This was reduced to 0.25mg from gonadotropin administration day and was continued until the day of hCG injection. In these groups, the number of oocytes, the fertilization, cleavage, pregnancy and cancellation rates were compared. Results: In two groups, there was no case of cancellation due to premature LH surge. In group I, the mean number of gonadotropins was 27.5+4.2 ampoules while in the second group, it was 28.4±2.8 ampoules (P>0.05). 312 oocytes from group I and 294 oocytes from group II were retrieved. Oocyte quality in group II was better than group I (84.3% vs 77.2%, P<0.05). In long-acting GnRH-a group fertilization rate was 81.9% versus 71.1%in group II (P<0.01). However, embryo development in Group I (85.6% vs 94.1%, P<0.05) was lower than group II. Although, pregnancy rate was 20% in Group I which was higher than group II (12.6%) but, there was no significant difference in cancellation, pregnancy rate and gonadotropins dose in two groups. Conclusion: The low dose long acting GnRH-a is a useful method for pituitary suppression. Low dose GnRH-a combined with gonadotropins permitted the retrieval of good quality oocytes and had no effect on oocytes. The fertilization and pregnancy rates with this method are acceptable and its cost and tolerance is valuable for patients.
Razieh Dehghani Firouzabady, Irandokht Mehri Mahani, Mehdi Dehghani Firouzabady,
Volume 2, Issue 2 (7-2004)
Abstract

Background: Embryo transfer has received little clinical attention and has been the most inefficient step in in-vitro fertilization (IVF). Recent reports have suggested that an awareness of the position and length of the uterus during embryo transfer might be helpful in improving pregnancy rate. Objectives: The main objective of the present study was to determine the relation between the length and position of the uterus during embryo transfer and pregnancy rate. Materials and Methods: Patients were randomly allocated to two groups. In case group A (n=40) length of uterus was measured at the day of oocytes collection and the position of uterus was determined. In the control group, Group B, (n=40) the length and position of uterus were not investigated. The embryo transfer catheter was advanced to 5 mm from uterine fondues based on the previously determined cavity length in group A. The embryo transfer procedures ( IVF/ICSI) at 48 hours after oocytes collection was done. The outcome of the treatment cycle in two groups was investigated. Data analysis was performed by using chi-square, fisher-exact and ANOVA tests. The statistical significant was defined (P?0.05). Results: There were no significant differences in the mean age (28.5+4.4, 27.8+6.2), and duration of infertility (7+3.4, 8.7+5.4). The pregnancy rate was not significantly different with respect to position and length of uterus. The pregnancy rate in case groups was 25% and in control group was 22.5%, the difference was not significant (P= 0.792). In both groups, there were ectopic peregnancy and in fact he incidence of ectopic pregnancy, per reported clinical pregnancy, was highest in group A (14.9%) in comparison with group B (1.8%). Conclusion: The pregnancy rate was not significantly different in the two groups. Misdirecting the embryo transfer can not be avoided by an accurate knowledge of the position or length of uterine at the time of oocytes retrieval. Further studies are required to evaluate the role of length and position of uterus related to the pregnancy rate. Article
Alireza Vahidi, Seyed Mehdi Kalantar, Mehrdad Soleimani, Mohammad Hossein Amir Arjmand, Abbas Aflatoonian, Mohammad Ali Karimzadeh, Afsaneh Kermaninejhad,
Volume 2, Issue 2 (7-2004)
Abstract

Backgrownd: Studies in regions with seasonal climatic variations have revealed a correlation between human natural conception and birth rates. Holidays and other cultural activities probably have influence on conception, but the ambient temperature and emotional influences on the female hormones related to fertility may play an important part in the seasonal variation in conception. Objectives: The aim of study was to determine the relationship between the success rate of Assisted Reproductive Technique (ART) treatment cycles and temperature in different seasons. Materials and Methods: A retrospective study on all individuals undergoing assisted ART at our institution was performed during June 2000 to June 2001. The study population represented 258 IVF-ET cycles and 821 ICSI treatment cycles. Different variables were analyzed using ?2 test. Results: In IVF treatment cycles, conception was more common from early spring (March to June). This decreased from spring, with the minimum in fall, 22% and 14%, respectably. A significant seasonal variability in the number of eggs, embryo transferred and sperm motility was not demonstrated (p>0.05), but sperm count was significantly higher in spring than any other season (72+4 x106 and 52+7x106, respectively). Conclusion: The seasonal changes should be taken into account together with other factors when evaluating infertility data. Article
Mahnaz Ashrafi, Ashraf Moini, Afsaneh Mohammadzadeh, Zahra Ezabadi, Fatemeh Zafarani, Ahmad Reza Baghestani,
Volume 3, Issue 1 (7-2005)
Abstract

Background: Polycystic ovarian syndrome (PCOS) patients are prone to premature LH surge and ovarian hyperstimulation syndrome (OHSS). Long GnRH analogue protocol and GnRH antagonist protocol are two methods utilized for induction ovulation in patients undergoing IVF/ICSI. Objective: The aim of this study was to compare the effects of GnRH agonists and antagonists in PCOS patients. Materials and Methods: A total of 60 PCOS patients under 35 years old were enrolled in this study. The patients have no history of thyroid disorder and hyperprolactinemia. All patients received OCP (LD) before starting the treatment. Then patients randomly divided into two groups. The agonist group underwent standard long GnRH analogue protocol. In antagonist group, HMG (150 IU/day) was started from third day of cycle. Then GnRH antagonist (0.25mg) was administered from 6th day after HMG initiation (LH?5 IU/ml) to the day of HCG injection. Follicular development monitored by vaginal ultra sonography and serum estradiol measurement. Results: There were no significant differences in age, duration of infertility, BMI, number of HMG ampules, number of follicles?18mm, serum estradiol level on 6th day of HMG initiation and HCG injection time, fertilization and pregnancy rate between two groups. However there were significant differences regarding duration of treatment, duration of HMG usage, LH level at the initiation of HMG, OHSS rate and number of Metaphase II oocytes between two groups (p<0.05). Conclusion: Usage of the GnRH antagonist may have more advantages such as the shorter duration of treatment and less gonadotrophin requirement. Furthermore, the incidence of OHSS can be reduced in GnRH antagonist comparing to agonist. For decreasing the risk of OHSS and abortion rate, we recommend long term use of OCP before starting the treatment
Soheila Arefi, Mahmoud Jeddi Tehrani, Mohammad Mehdi Akhondi, Ali Reza Mousavi, Mahnaz Heidari, Ahmad Ali Bayat, Ali Sadeghpour Tabaei,
Volume 3, Issue 1 (7-2005)
Abstract

Background: Auto antibodies to zona-pellucida (AZA) seem to be important autoantibodies implicated in reproduction, with substantial role in both endocrine and reproductive functions of the human ovary. There are some debates on the relation of AZA with infertility, repeated In Vitro Fertilization (IVF) attempts, and outcome of it. Objective: In this study, we assessed the presence of AZA in the follicular fluids (FFs) of women who underwent intra cytoplasmic sperm injection (ICSI), in relation to etiology of infertility and multiple puncture of ovaries. Materials and Methods: In this prospective study, follicular fluids were evaluated from 96 infertile women, (19-40 years old, 31.5�5.1), who were candidates for ICSI based on the etiology of infertility. From these 80 women had explained infertility whereas 16 had unexplained infertility. All FFs were evaluated for presence of AZA by ELISA test. Results: Twenty patients (20.8%) were positive for AZA in follicular fluid. In patients with unexplained infertility, AZA antibody in follicular fluid, was significantly higher than the group with proven etiology of infertility (p=0.001). In addition, 20.4 % of patients who had been punctured previously showed AZA in their FFs which is statistically similar to the patients who were punctured for the first time. Conclusions: The high incidence of AZA in infertile women, especially women with unexplained infertility has to be considered. Relation of the presence AZA and repeated puncture of ovaries is still debatable. Determinations of AZA are highly recommended in evaluation of infertile couples especially in patient with unexplained infertility
Nourollah Rezaei, Ri-Cheng Chian,
Volume 3, Issue 1 (7-2005)
Abstract

Background: Addition of amino acids to the culture medium is beneficial for embryonic development in many species. Objective: The objective of this study was to investigate the effects of amino acids on the in vitro maturation and embryonic development of the bovine oocyte. Materials and Methods: Bovine ovaries were collected from a local abattoir and brought into laboratory. Cumulus-oocyte complexes (COCs; n=1212) were aspirated from follicles (2-8 mm in diameter) and randomly assigned to four groups for maturation in culture: (1) Basic medium alone as control; (2) Basic medium supplemented with 2% MEM essential amino acids solution; (3) Basic medium supplemented with 1% MEM non-essential amino acids solution; and (4) Basic medium supplemented with 2% MEM essential amino acids solution + 1% MEM non-essential amino acids solution. COCs were incubated in 1 ml maturation medium in an Organ culture dish at 38.5�C in an atmosphere of 5% CO2 with high humidity. After 24 h of culture, 372 oocytes were fixed to determine maturation rate and the remaining oocytes were used for in vitro fertilization (IVF). Following 18 h of insemination, 437 oocytes were fixed and examined for fertilization and 403 oocytes were further cultured. Results: There were no differences in maturation rates and penetration rates among the four groups. Although oocyte cleavage rates were not different in the four groups, embryo development up to the 8-cell stage and blastocyst were significantly higher (p<0.05) in Group (2) and (4) than in the Control and Group (3). Conclusion: These results indicate that the presence of amino acids, especially essential amino acids in the maturation medium is beneficial to oocyte cytoplasmic maturation and subsequent early embryo development in vitro.
Farnoush Farzi, Marzieh Mehrafza, Ali Mirmansouri, Mona Oudi, Ahmad Hoseeini,
Volume 3, Issue 2 (7-2005)
Abstract

Background: Recent studies of uterine contractility in IVF�embryo transfer led us to consider an alternative, and possibly complementary, explanation for the high implantation rates of blastocysts. It has been demonstrated that myometrial contractile activity influences embryo implantation, possibly through mechanical displacement of embryos. Objective: The aim of this study was to examine the effect of nitroglycerine (NTG) treatment for priming the uterus on the pregnancy outcome of ICSI-ET programs. Materials and Methods: This study was a prospective, randomized, double-blinded placebo-controlled clinical trial. One hundred consecutive cycles of ICSI-ET on infertile couples were randomly divided into treatment and control groups. The treatment group (50 cycles) received an oral dose of 0.4 mg of NTG, and the control group (50 cycles) received a placebo, 15 minutes before fresh ET. An informed consent from was obtained form each patients. The main outcomes were implantation rate (IR) and pregnancy rate (PR). Results: The mean age of females in the control group and in the treatment group were 30.1�5.1 and 31�5.5 years respectively. Data showed that the mean duration of infertility was not significantly different between control and treatment groups (6.6�5.8 versus 7.8�5.1 years, respectively). The mean number of oocyte retrieval (metaphase II), 2pn, embryo cleaved, embryo transferred and PR weren't different between two Groups (p>0.05). Overall PR was 36%, it was 38% in treatment group and 34% in control group but there wasn�t statistically significant difference between two groups. (p>0.05) Conclusion: NTG didn't increase PR compared to placebo group. These results suggest that NTG treatment before ET isn't effective in the priming of a uterus
Hossein Hadinedoushan, Robert Normann,
Volume 3, Issue 2 (7-2005)
Abstract

Background: Polycystic ovary syndrome (PCOS) is related to obesity and to major metabolic alterations including both insulin resistance and beta-cell dysfunction. Ghrelin was identified as the endogenous ligand for the growth hormone secretagogue (GHS) receptor. The actions of ghrelin are carried out through interaction with specific receptor, named GHS-R. Objective: In a case-control study, we compared the expression of ghrelin and GHS-Rs mRNA by Quantitative Real-time PCR method in studied groups in order to determine the role of ghrelin and GHS-Rs in pathogenesis of PCOS. Materials & Methods: Follicular fluid samples were obtained at oocyte collection from 22 patients undergoing IVF-ET as control and 11 patients were diagnosed as having PCOS. Total RNA was extracted from isolated follicular fluid cells and 2�g RNA was diluted and reverses transcribed using random primers and Superscript II. Specific primers for the ghrelin, GHS-R1a and GHS-R1b were designed. Samples were run in triplicate on an ABI Geneamp 5700 sequence detection system. They were subjected to 40 cycles of amplification under condition 92�C- 20s and 62�C-1min using 3�l diluted cDNA (1:7), 10�l 2X SYBR green, 3�l diluted cDNA. ?-actin mRNA was assayed and then normalized to total RNA measurements for each sample. Results: Age, weight and resulting pregnancies did not vary between PCOS and non-PCOS patients, whereas the BMI and serum testosterone level of PCOS were significantly higher than non-PCOS patients. Quantitative real-time RT-PCR showed that mRNA for ghrelin and GHS-R 1b were detectable in follicular fluid cells from all patients. We failed to find mRNA for GHS-R 1a in any of follicular fluid cells. There were no significant difference in ghrelin and GHS-R1b mRNA expression levels between PCOS and non-PCOS groups. Conclusion: Our findings indicate that ghrelin and ghrelin receptors may not be considered risk factors for pathogenesis of PCOS.
Reza Mahmoudi, Aligholi Subhani, Mozhdeh Salehnia, Farideh Etesam, Parichehr Pasbakhsh, Farid Abolhasani,
Volume 3, Issue 2 (7-2005)
Abstract

Background: In vitro maturation (IVM) of oocytes is a promising technique to reduce the costs and avert the side-effects of gonadotropin stimulation for in vitro fertilization (IVF). The pregnancy rates from oocytes matured in vitro are much lower than those of in vivo stimulation cycles, indicating that optimization of IVM remains a challenge. Objective: In this study, we investigated the effect of cumulus cells on maturation and fertilization rate of immature oocytes (Germinal vesicle). Materials and Methods: Germinal vesicle (GV) oocytes were recovered from 6-8 weeks old Balb C female mice 48hr after injection of 10 IU pregnant mare serum gonadotropin (PMSG). Collected oocytes were divided into two groups. Group A: GV oocytes without cumulus (denuded oocyte). Group B: GV oocytes with cumulus cells (cumulus-oocyte complex). The oocytes in both groups were cultured in TCM-199 medium in a humidified atmosphere of 5% CO2 in air at 37�C. The maturation, fertilization and developmental rates were recorded after 24hr. Results: Maturation, fertilization and developmental rates in denuded oocytes (DO) were 65.1%, 68.02%, 78.63% respectively, and in cumulus-oocyte complex (COC) were 78.20%, 85.57% and 85.05%, respectively. The maturation, fertilization and developmental rates of COC were significantly higher than those of DO (p<0.05). Conclusion: The results show that cumulus cells have beneficial effects on maturation, fertilization and cleavage rates of mice oocytes.
Abbas Aflatoonian, Tahereh K Bidgoli,
Volume 3, Issue 2 (7-2005)
Abstract

Ovarian hyperstimulation syndrome (OHSS) is a unique iatrogenic complication of controlled ovarian stimulation (COH)/in vitro fertilization (IVF) in reproductive endocrinology occurring during the luteal phase or early pregnancy. It can have a serious impact on the patient�s health. With the expansion of the assisted reproductive techniques (ART) from 1978, the incidence of OHSS is increasing worldwide.OHSS is characterized by gastrointestinal symptoms, ovarian enlargement, fluid shift to the third space, and hemoconcentration. Severe cases are associated with thromboembolic phenomena, respiratory distress, liver dysfunction and renal failure. OHSS is more common among woman who are young, thin and have PCOS or multiple allergies. Vascular endothelial growth factor (VEGF) and other cytokines are pivotal in the pathogenesis of OHSS. In the prevention of any disease, it should be emphasized that the possibility of primary prevention depends on two main requirements, first, the etiology of the disease and predisposing factors; and second, it must be feasible to avoid or manipulate such factors as paint of a prevention strategy. This strategy for preventing OHSS and its severity have included prediction of women at risk; the first step in prevention is identification of patients at risk by the recognition of risk factors. As this is not always possible, there are several ways of avoiding developing of the syndrome. The stimulation phase has to be carefully monitored (regular ultrasound and estradiol measurements), and further interventions need to be implemented if signs of hyper-response are present. The aim of this systemic review of the literature is to answer this question: �can we prevent severe OHSS�. Canceling the cycle, modification of method to trigger ovulation administration of macromolecules, coasting approach, timed unilateral or bilateral aspiration of one or two ovaries performed before or after hCG administration, In vitro maturation (IVM), elective cryopreservation of all embryos, and laser or electrocautery of one or both ovaries, have been showed to be associated with a reduced risk of OHSS by some research groups. The effect of combined method should be assessed. Finally, apart from canceling, none of these approaches was totally efficient, although most of the above-mentioned methods decrease the incidence in patients at high risk of OHSS, but overall �prevention is the ideal treatment of OHSS�.
Nezhat Moossavifar, Nayereh Khadem, Alieh Torabizadeh,
Volume 4, Issue 1 (7-2006)
Abstract

Background: It has been demonstrated that performing a mock embryo transfer (ET) significantly improves the pregnancy rate in IVF cycles. The mock ET could be performed prior to the stimulation cycle or immediately before real ET. The problem of the first procedure is the possibility of variation in the uterine position and or cervico–uterine angle.
Objective: The purpose of this study was to determine the consistency of the type of ET in mock ET prior to the treatment cycle with real ET.
Materials and Methods: A prospective comparison between the technique of mock embryo transfer and real embryo transfer. One hundred and sixty treatment cycles on 141 patients between January 2003 and September 2004 ended to ET and they were analyzed prospectively. In each cycle, patients underwent a mock ET in mid luteal phase prior to treatment cycle (the date when patients referred to have consultation about down regulation regimen).
Results: Of 160 mock ET the Wallace catheter passed easily in 144 (90%) of them. In the remaining 16 cycles (10%) a tenaculum and or a rigid cannula had to be used. From 144 cases of easy mock ET, real ET was easy in 121 (84%) cases while 23 (16%) cases had difficultly during real ET. In the 16 cases of difficult mock ET, there was 8 cases (50%) of difficult real ET and 8 cases (50%) of easy real ET (p=0.001, χ2=10.67). The overall clinical pregnancy rate for both difficult and easy transfer was 35%. The pregnancy rate for easy real ET was  37.2% and for difficult real ET was 25.87%. Despite of the difference, the statistical analysis shows no significance difference (χ2=1.21). The difference between mean age for both difficult and easy real transfer was not significant.
Conclusion: Mock ET before beginning of the treatment cycle is highly consistent with real ET.
 
Marzieh Farimani, Iraj Amiri, Sedigheh Hoseini,
Volume 4, Issue 1 (7-2006)
Abstract

Background: The ability of the ovary to respond to exogenous gonadotrophin stimulation and development of several follicles is essential in assisted reproductive technology. Neither age and regularity of menses nor follicular phase FSH and estradiol concentrations are reliable predictors of ovarian response. Day 3 serum inhibin-B level, during induction ovulation, has been proposed as a predictor of ovarian response.
Objective: To determine day 3 serum inhibin-B as a predictor of ovarian response to induction ovulation in IVF/ ICSI cycles.
Materials and Methods: Seventy one infertile patients under 40 years old were enrolled in this study. All women have both ovaries, basal FSH level under 15 mIU/ml, and no evidence of endocrine disorders. Day 3 FSH, estradiol, inbibin-B concentrations and ovarian volume were measured before treatment. All patients underwent standard long GnRH agonist protocol. The number of oocytes retrieved, fertilization rate, clinical pregnancy rate, days of stimulation and number of HMG ampoules were determined. The patients were divided into two groups, normal responders and poor responders (number of oocytes retrived <4).
Results: The mean inhibin-B level in normal responders was 166.9 141 pg/ ml versus 115.8 87 pg/ml in poor responders, which the difference was not statistically significant (p=0.24). We could not find a cut off between normal and poor responders.
Conclusion: The use of day 3 inhibin-B level as a predictive marker of ovarian response in IVF/ICSI cycles is not reliable.
Simin Atashkhoii, Sedige Abdollahi, Aliye Ghasemzad Dejani, Laya Farzadi,
Volume 4, Issue 2 (7-2006)
Abstract

Background: The quality of intraoperative analgesia with paracervical block (PCB) during egg collection in in-vitro fertilization (IVF) is still unclear. Objective: This study performed to compare the pain levels during egg collection and the subsequent intra and postoperative side effects in patients receiving a conscious sedation with and without paracervical block. Materials and methods: In this prospective, double-blind, and placebo–controlled study, 60 patients undergoing egg collection in their first IVF cycle were randomized to receive conscious sedation in conjunction with paracervical block with 10 ml lidocaine 1.5% (sedation + PCB patients or study group) or with 10 ml normal saline (sedation patients or placebo group). Results: Patients in study group experienced significantly less vaginal (10.40±8.40 mm vs 20.77±4.60 mm respectively; p&amp;lt;0.0005) and abdominal pain (10.87±5.08 mm vs 35.33±4.27 mm respectively; p&amp;lt;0.0005) during egg collection, compared with those in placebo group. Propofol requirements was 8.67±2.42 mg in PCB patients vs 25.60±5.29 mg in placebo group (p&amp;lt;0.0005). Incidence of intraoperative (9.90% vs 50% respectively; p=0.002) and postoperative (3.33% vs 56.66% respectively; p&amp;lt;0.0005) side effects were significantly less in study patients compared with placebo group. Conclusion: Conscious sedation with PCB appears to be an effective and safe method of providing analgesia and anesthesia for transvaginal retrieval of oocyte.
Abbas Aflatoonian, Maryam Asgharnia,
Volume 4, Issue 2 (7-2006)
Abstract

The main factors affecting pregnancy and implantation rates are uterine receptivity, embryo quality, and transfer efficiency. Embryo transfer (ET) is the last step of critically important procedure of in vitro fertilization (IVF) and probably the least successful step in Assisted Reproductive Technology (ART) treatment cascade; though simple in most of the cases, it may pose to be the most difficult in some. No matter how good the IVF laboratory culture environment is, the physician can ruin everything with a carelessly performed embryo transfer. The entire IVF cycle depends on delicate placement of the embryos at the proper location near the middle of the endometrial cavity. Pregnancy rates will be significantly increased with the following procedures: 1. Trial transfer 2. Avoiding the initiation of uterine contractility by using soft catheters, gentle manipulation and by avoiding touching the fundus. 3. Removal of cervical mucus, wash and lavage of cervix with culture media. 4. Ultrasound-guided ET with full bladder. 5. Deposition of the embryo 2 cm below the uterine fundus. 6. Examination of catheter following transfer for retained embryos, blood and mucus. Slow withdrawal of the embryo transfer catheter, the use of a fibrin sealant, bed rest after embryo transfer, sexual intercourse and routine administration of antibiotics following embryo transfer remained to be studied by randomized clinical trials (RCTs).
Ensieh Shahrokh Tehrani Nejad, Ashraf Moini, Elham Amirchaghmaghi, Batol Hossein Rashidi, Parvin Jaberi Pour, Elham Azimi Neko,
Volume 5, Issue 3 (7-2007)
Abstract

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.
Mitra Bakhtiari, Aligholi Sobhani, Mohammad Akbari, Parichehr Pasbakhsh, Mehdi Abbasi, Azim Hedayatpoor, Fardin Amidi , Feridoon Sargolzaei,
Volume 5, Issue 3 (7-2007)
Abstract

Background: Various approaches have been used in the attempts to improve the quality of frozen–thawed mouse sperms. According to literatures, it seems that hyaluronic acid (HA) has an important role on the permeability and motility of sperms and their interaction with gametes.
Objective: For evaluation of HA supplementation on sperm characteristics and fertilization capability, we investigated the effect of different doses of HA on mouse sperm morphology, motility, vitality and fertilization capability after freezing and thawing.
Materials and Methods: The cauda epididymes was removed from 6 male mice with aseptic method. The sperm samples were frozen in 1.8 ml cryotubes with 18% raffinose and 3% skimmed milk containing cryo-protectant solution. HA at the concentration of 750, 1000 or 1250 µg/ml was supplemented to frozen-thawed sperms. Sperm motility was measured with microscope, and fertilization rate was evaluated after routine IVF by counting the fertilized oocytes. For sperm morphology, papaniclau staining was used while; Eosin B was used for the assessment of sperm viability rate.
Results: HA supplementation (750 µg/ml) improved motility parameters (p < 0.05) and increased the fertility rate (p < 0.05). The effect of 1,000 µg/ml HA was also positive on the sperms. But 1,250 µg/ml HA had negative effect on above mentioned characteristic. On the other hand, none of these doses had any effect on sperm morphology.
Conclusion: The dose of 750 µg/ml of HA has the greatest effect on the motility, vitality and fertility rate of sperms after cryopreservation.

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

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.

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