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Showing 35 results for Insemination

Marzieh Mehrafza, Nadia Nobakhti, Zahra Atrkar Roushan, Havva Dashtdar, Mane Oudi, Ahmad Hosseini,
Volume 1, Issue 1 (1-2003)

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)

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.
Iraj Rashidi, Mansoureh Movahedin, Taki Tiraihi,
Volume 2, Issue 2 (7-2004)

Background: Pentoxifylline (PX) prevents cAMP breakdown by inhibiting the activity of the cAMP-phosphatase and presumably, stimulates sperm motion. Incubation with PX causes hyperactivation of sperm, an important step in achieving fertilization, and leads to changes in membranes associated with sperm capacitation. Objective: The purpose of this study was to examine the effects of pentoxifylline on sperm viability, motility and fertilization rate after mouse sperm preservation. Materials & Methods: Epididymal spermatozoa from adult NMRI mice were collected in T6 medium supplemented with 5% BSA and divided into four control and four experimental groups. The control groups included: (1) Fresh sperm sample (2) Preserved sperm sample at room temperature for 18 hours. (3) Preserved sperm sample at incubator 37°C for 18 hours. (4) Preserved sperm sample at 4°C for 18 hours. Experimental groups were the same groups after treatment with 3mmol/L PX. All the samples were assessed according to World Health Organization Criteria. Oocytes from superovulated NMRI female mice were inseminated in-vitro incubated sperm of all the control and experimental groups. After insemination and washing, the fertilization rate and cleavage rate were assessed by the presence of two pronucleus (2PN) and 2-cell stage embryos. To study the acrosomal reaction of control and treated spermatozoa transmission electron microscopy (TEM) technique was used. Results: The results showed that addition of 3mmol PX to preserved mouse spermatozoa at 4 ºC and 37 ºC could increase the motility rate significantly (P<0.05) and also it could enhance abnormal morphology rate. Significant increase of fertilization rate was seen after preservation of treated sperm at 4 ºC (P<0.05), but there was not seen significant difference regarding cleavage rate comparing treated and non-treated spermatozoa (P>0.05). Studies with electron microscopy showed that addition of PX to the preserved spermatozoa prevent early acrosomal reaction. Conclusion: The results of this study demonstrated that addition of pentoxifylline in mouse sperm samples after short time preservation can enhance the motility and fertilization rate, although it can enhance the abnormal morphology. It also can increase the number of intact sperm after preservation Article
Nourollah Rezaei, Ri-Cheng Chian,
Volume 3, Issue 1 (7-2005)

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.
Robabeh Taheripanah, Maryam Sadat Hosseini, Mohamad Hashemi,
Volume 6, Issue 2 (7-2008)

Background: Ectopic pregnancy is one of the pathologic entities that it destroys the fallopian tube and impairs the future pregnancy. There are different medical and surgical therapies in order the treatment and reserve of fertility. The aim of this report is discuss a case of successful intrauterine after management of ectopic pregnancy with local injection of KCL in an infertile PCOD patient.
Case: The patient was a PCOD woman with gestational age of 8.5 weeks. One gestational sac and alive fetus with normal heart beat was seen in the right adnexa. Hemodynamic situation was stable. 0.5cc KCL 10% was injected to the fetal heart and the extracted tissue sent for pathology. We evaluated the effects of this treatment by measuring serial human chorionic gonadotropin (hCG) titers. Moreover, we used hysterosalpingogrphy to diagnose and to evaluate the patency of the tubes. Induction ovulation and intrauterine insemination was done and pregnancy occurred. Patient passed the pregnancy very good and she delivered by cesarean section due to breech presentation at 39 weeks of gestational age. There was no sign of pathologic finding in the tubes or adhesion or sequel of ectopic pregnancy.
Conclusion: The beneficial outcomes of this kind of treatment suggest that local injection of KCL as a low invasive treatment can be the choice treatment for alive and progressed ectopic pregnancy or heterotopic pregnancy. Because of rarity of this management and successful intrauterine we reported the usefulness of local KCL injection for the successful conservative treatment of alive ectopic pregnancy in Iran.
Sanam Moradan,
Volume 7, Issue 1 (7-2009)

Background: Pelvic inflammatory disease is one of the most serious infection and one of the important and life threatening complications of it is tubo-ovarian abscess. This infection with intrauterine insemination (IUI) is rare. We report a case of ruptured tubo- ovarian abscess after (IUI).
Case: A 27 years old woman was referred to our center with acute abdominal pain and fever one week after IUI. The diagnosis was PID and after treatment with intravenous antibiotics she was still febrile after 3days and had generalized tenderness in abdominal exam. Therefore, laparatomy was performed and left fallopian tube ruptured abscess was detected. Left salpingectomy was done. The patient developed dyspnea and tachypnea in second day post operation and echocardiography with spiral CT scan was normal. So a mild ARDS was considered .The patient was discharged from hospital 5 days after operation in good condition.
Conclusion: This is a case of PID, tubal abscess and ARDS after IUI and it is necessary to keep in mind this diagnosis after IUI.
Shahdokht Motazedian, Bahareh Hamedi, Jaleh Zolghadri, Khatereh Mojtahedi, Nasrin Asadi,
Volume 8, Issue 1 (7-2010)

Background: Although intrauterine insemination (IUI) is one of the most common methods which is used for male factor and unexplained infertility the relative influence of various semen parameters on the likelihood of a successful outcome is controversial. Several semen parameters have been evaluated as predictors of a successful outcome with intrauterine insemination.
Objective: To evaluate the effects of sperm morphology on the success rate of IUI.
Materials and Methods: This was a prospective study of 200 couples who underwent IUI cycles of ovarian stimulation in Shiraz University of Medical Sciences. The patients were chosen in 2 groups group A: 100 patients with ≤20% normal sperm morphology and group B: 100 patients with >20% normal sperm morphology (unexplained infertility). The other semen parameters were normal in both groups.
Results: Total clinical pregnancies were 10.5% (pregnancy rate / cycle). There was not any difference between two groups in rate of pregnancy and also pregnancy outcome.
Conclusion: Intrauterine insemination used for treating male factor infertility has not shown excessive advantage when normal sperm morphology in semen analysis is more than 20% in comparison with ≤ 20%.
Victoria Habibzadeh, Sayed Noureddin Nematolahi Mahani, Hadiss Kamyab,
Volume 9, Issue 1 (7-2011)

Background: Many studies have been carried out to understand the effect of endometrial thickness on the reproductive outcome while the factors affecting the pattern itself are still unknown.
Objective: To determine the factors such as age and the number of follicles that could affect the endometrial thickness
Materials and Methods: This study was conducted as a retrospective study on 680 infertile women considered for intrauterine insemination (IUI). IUI protocol was sequential regimen of clomid and gonadotropin. Endometrial thickness measurement was done on the day of HCG administration. Correlation between endometrial thickness and factors such as age, total follicle numbers, dominant follicle numbers, gonadotropine ampule numbers and pregnancy rate were assessed.
Results: The mean endometrial thickness was 7.2±1.8 mm. The endometrium was thinner in older patients compared with younger ones. But in all age ranges pregnancy rate was higher in endometrial thickness 6< ET≤10 mm (p<0.05).
Conclusion: We did not find any correlation between age,  number of follicles and gonadotropine ampoules with endometrial thickness but in all age ranges, there is a possibility of higher chance of pregnancy in endometrial thickness 6 < ET≤10 mm. 
Mahbod Ebrahimi , Firoozeh Akbari Asbagh, Azizeh Ghaseminejad,
Volume 9, Issue 1 (7-2011)

 Background: Controlled ovarian hyperstimulation and intrauterine insemination (IUI) cycle is an ideal protocol for some subfertile patients. So, we decided to try this therapeutic protocol for the patients with unilateral tubal blockage diagnosed by hysterosalpingography (HSG).       
Objective: To evaluate the effect of unilateral tubal blockage diagnosed by HSG on cumulative pregnancy rate (CPR) of the stimulated IUI cycles.          
Materials and Methods: A cross-sectional analysis was performed between October 2006 and October 2009 in an academic reproductive endocrinology and infertility center. Two groups of patients undergoing stimulated IUI cycles were compared. Sixty-four infertile couples with unilateral tubal blockage diagnosed by HSG as the sole cause of infertility in the group (І), and two hundred couples with unexplained infertility in the group (II). The patients underwent 3 consecutive ovarian hyperstimulation (Clomiphen citrate and human menopausal gonadotropin) and IUI cycles. The main outcome measurements were the CPRs per patients for 3 consecutive stimulated IUI cycles.                                            
Results: Cycle characteristics were found to be homogenous between the both groups. CPRs were similar in group І (26.6%) and group II (28%) (p=0.87; OR=1.075; 95% CI: 0.57 -2.28).
Conclusion: Unilateral tubal blockage (diagnosed on HSG) has no effect on success rate of stimulated IUI cycles, so COH and IUI could be recommended as the initial therapeutic protocol in these patients.
Viroj Wiwanitkit,
Volume 9, Issue 2 (7-2011)

To construct a semen bank, the collection of donated semen has to be done and an important concern is the safety of collected semen. The contamination is a big problem. Basically, the infectious pathogens can exist within donated semen, hence, a good donor screening is very important. Although viruses have an indirect role in sperm quality, but the evidence in banked semen is presently lack. This does not mean that there is no viral contamination but it might imply the inadequate concern on this issue. Contaminated semen usually means poor quality and hazardous to the recipient. The contamination of the virus in banked semen is a common problem in animal semen banking (1). The safety and transmission of each problematic virus is widely studied and well clarified in animal semen banking (2). However, this issue is not widely concerned in human semen banking. For sure, this case is an actual direct contamination and this cannot be detected if there is no specific screening in the banking process. The scenario of important new emerging viral infections will be specifically detailed in this report. West Nile virus is an emerging problematic viral infection that can cause a deadly clinical disorder. Basically, West Nile virus is classified as an arbovirus that is mainly transmitted by mosquito. However, the uncommon modes of transmissions such as transfusion related transmission are reported (3). The contamination of West Nile virus in semen is an important question in andrology. There is no evidence indicating for the presence of West Nile virus in the semen of the patients. However, American Society for Reproductive Medicine/Society for Assisted Reproductive Technology recommended that practitioners defer gamete donors who have confirmed or suspected West Nile virus infections (4). SARS is another deadly emerging viral infection. The new coronavirus infection is transmitted via respiratory route. The serious symptom due to this infection leads to death in almost all cases and brings a great concern to medical scientists around the world. The contamination of SARS in semen is an interesting topic. The possible transmission of SARS virus via germ line is an important question to be investigated in reproductive medicine (5). Luckily, till present, there is no evidence of SARS contamination in semen. Generally, influenza virus is a respiratory virus that causes respiratory tract infection. In the recent few years, an atypical influenza, avian flu, emerged. This infection brought a concern to the medical society. In early of this year, 2009, the newest emerging viral infection caused by a novel influenza virus, swine flu occurred and became pandemic. The topic on the new influenza virus becomes the present hot issue. Focusing on the contamination of classical influenza virus in semen, there are many evidences confirming the existence of virus in semen derived from the infected cases. It is also confirmed that the existence of the influenza virus in semen lead to decreased semen quality and pathological spermatozoa (6, 7). For the case of avian flu and swine flu, there is no report on the existence of virus in the semen of infected cases at present (8). However, a recent report on animal model indicated for the possibility of transmission of swine flu virus via reproductive tract insemination (9). It is suggested that new atypical influenza can result in poor semen quality and might lead to further infertility (8). However, there is no report on contamination of influenza virus in banked semen. A possible explanation might be the fact that although the influenza virus can contaminate in donated semen it leads to poor semen quality but no proof for possible further transmission to the other one. For the case of avian flu and swine flu, there is also no report on the contamination in banked semen.
Soheila Akbari, Maryam Ayazi Roozbahani, Fatemeh Ayazi Roozbahani,
Volume 10, Issue 1 (7-2012)

Background: Clomiphene citrate (CC) an agonist and antagonist of estrogen, is the first line treatment in ovarian stimulation. Anti-estrogenic effect of CC in endometrial thickness and cervical mucus has negative effect on pregnancy rate. Letrozole is an Aromatase Inhibitor has been seen that has acceptable pregnancy rate compared to CC.
Objective: The aim of this study was to compare the efficacy of letrozole and clomiphene citrate (CC) with gonadotropins for ovarian stimulation in women candidate for intrauterine insemination (IUI).
Materials and Methods: One hundred sixty patients eligible to IUI therapy enrolled in this study. Patients randomized to two groups: group A (received letrozole-gonadotropin) and group B (received CC-gonadotropin). In group A (n=80) letrozole was given on days 3-7 of the menstrual cycles. In group B clomiphen citrate was given like letrozole combined with human menopausal gonadotropin (hMG) administered every day starting on day 8. Ovulation was triggered with urinary HCG when the leading follicle (s) reached 18 mm in diameter. A single IUI was performed 36-40 hours later. The ovarian stimulation response (E2 levels and number of follicles, clinical pregnancy and endometrial thickness) was primary outcome.
Results: Both groups were similar in demographic characteristics. There was a significantly lower peak serum E2 level in the letrozole group compared with CC. (236±86 Vs. 283±106 pg/mL, respectively; p<0.002). The number of mature (>18 mm) preovulatory follicles was significantly higher in CC group than letrozole group (2.2±.68 Vs. 2.02±0.63 respectively; p=0.025). Endometrial thickness measured at the time of hCG administration was significantly higher in letrozole group. (9.08±1.2 mm Vs. 8.1±1.9 mm; p=0.0001). The clinical pregnancy rate was comparable between two groups.
Conclusion: Letrozole is a good and cost-effective alternative to CC in IUI cycles.
Leili Safdarian, Zahra Khayatzadeh, Ebrahim Djavadi, Atossa Mahdavi, Marzieh Aghahosseini, Ashraf Aleyasin, Parvin Fallahi, Sima Khayatzadeh, Arash Ahmadzadeh, Mohhamad Bagher Larijani,
Volume 10, Issue 3 (7-2012)

Background: Detection of best predictor of ovarian reserve in patients with temporarily or consistently elevated early follicular phase serum levels of FSH is one of the most important goals in assisted reproductive technique (ART).
Objective: To evaluate whether high level of anti-mullerian hormone level is related to success of ART in patients with temporarily or consistently elevated early follicular phase serum levels of FSH.  
Materials and Methods: Sixty three women underwent intracytoplasmic sperm injection (ICSI) with GnRH-agonist long protocol or intrauterine insemination (IUI) in a prospective cohort study. FSH, inhibin B and anti-Mullerian hormone (AMH) levels were measured in these women whom were divided to three groups (persistently elevated FSH, variably elevated FSH and, normal FSH level). Basal characteristics, stimulation parameters, and pregnancy occurrence were evaluated.
Results: AMH was significantly higher in women with persistently elevated early follicular phase FSH achieving pregnancy. Women with normal FSH did not have significant difference in AMH level between conceived and non conceived cycles. Women with only one elevated early follicular phase FSH achieving pregnancy did not have significant difference in AMH level with non pregnant women. Response to gonadotropin stimulation, recommendation to oocyte donation significantly differed between the groups.
Conclusion: This study has demonstrated that relatively young women with persistently or intermittently elevated day 3 FSH levels have diminished ovarian reserve and lower ART success. However, in women whose FSH levels were constantly elevated, AMH (not inhibin B) concentrations were significantly higher in ART cycles resulting in pregnancy. Therefore, AMH level is a good predictor of ART outcome in patients with elevated early follicular phase serum levels of FSH.

Arzu Yavuz, Oya Demirci, Hamdullah Sözen, Mehmet Uludoğan,
Volume 11, Issue 3 (5-2013)

Background: So far, many studies investigated factors that affect pregnancy rates after intrauterine insemination (IUI). Various investigators have not agreed on the nature and ranking of these criteria.
Objective: The aim of this study was to assess the predictive factors for pregnancy rate after controlled ovarian hyperstimulation (COH)/ IUI.
Materials and Methods: Retrospective study of all patients undergoing IUI at Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital from January 2006 to December 2009. In total 980 IUI cycles in 569 couples were analyzed. All women in the study underwent ovarian stimulation using gonadotropin and IUI was performed 36 h after triggering ovulation. The primary outcome measure was clinical pregnancy rates. Predictive factors evaluated were female age, body mass index (BMI), duration of infertility, type of infertility, follicle stimulating hormone (FSH) level and estradiol (E2) on third day of the cycle, number of preovulatory follicles, endometrial thichness, total motil sperm (TMS) count, and ratio of progressive motile sperm.
Results: The overall clinical pregnancy rate was 4.7%. Among the predictive factors after multivariate logistic regression analysis level of BMI (<25 kg/m²), number of preovulatory follicles (≥2), level of FSH (<9.4 IU/L), level of E2 (<80 pg/ml) and the ratio of progressive motile sperm (>50%) significantly influenced the clinical pregnancy rate.
Conclusion: Level of BMI, FSH, estradiol, number of preovulatory follicles and the ratio of progressive motile sperm may determine IUI procedure as optimum treatment model.
Azam Azargoon, Marjan Bahrami, Jafar Alavy Toussy,
Volume 11, Issue 3 (5-2013)

Background: Different protocols are used for controlled ovarian hyper stimulation (COH), but the optimal method has not yet been determined.
Objective: The aim of this study was to compare the outcome of controlled ovarian stimulation (COS) using clomiphen citrate (CC) plus HMG versus CC plus rFSH in intra uterine insemination cycles (IUI).
Materials and Methods: 144 women with unexplained or male factor infertility undergoing IUI cycles were randomized (72 patients in CC plus rFSH group and 72 patients in CC plus HMG group) and included in this single blind study from October 2006 to June 2010. The primary outcomes were clinical and ongoing pregnancy rates. The number of dominant follicles, mean of follicular size, endometrial thickness on the day of HCG administration, total dose of gonadotropins and duration of stimulation with gonadotropins were secondary outcomes.
Results: Clinical and ongoing pregnancy rates were not significantly different in the two groups .There was a significant higher multiple pregnancy rate in CC plus rFSH group (33.3%) versus CC plus HMG group (12.5%; p<0.005). There were no statistically significant differences in the secondary outcomes between the two groups.
Conclusion: According to our results it seems that CC plus HMG is a more suitable and cost-effective regimen than CC plus rFSH in IUI cycles in patients with unexplained or male factor infertility.
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.
Ashraf Kazemi, Fatemeh Ramezanzadeh, Mohammad Hosein Nasr-Esfahani, Ali Akbar Saboor Yaraghi, Mehdi Ahmadi,
Volume 11, Issue 12 (1-2013)

Background: Fat-rich diet may alter oocyte development and maturation and embryonic development by inducing oxidative stress (OS) in follicular environment.
Objective: To investigate the relationship between fat intake and oxidative stress with oocyte competence and embryo quality.
Materials and Methods: In observational study follicular fluid was collected from 236 women undergoing assisted reproduction program. Malon-di-aldehyde (MDA) levels and total antioxidant capacity (TAC) levels of follicular fluid were assessed as oxidative stress biomarkers. In assisted reproduction treatment cycle fat consumption and its component were assessed. A percentage of metaphase ΙΙ stage oocytes, fertilization rate were considered as markers of oocyte competence and non-fragmented embryo rate, mean of blastomer and good cleavage (embryos with more than 5 cells on 3 days post insemination) rate were considered as markers of embryo quality.
Results: The MDA level in follicular fluid was positively related to polyunsaturated fatty acids intake level (p=0.02) and negatively associated with good cleavage rate (p=0.045). Also good cleavage rate (p=0.005) and mean of blastomer (p=0.006) was negatively associated with polyunsaturated fatty acids intake levels. The percentage of metaphase ΙΙ stage oocyte was positively related to the TAC levels in follicular fluid (p=0.046). The relationship between the OS biomarkers in FF and the fertilization rate was not significant.
Conclusion: These findings revealed that fat rich diet may induce the OS in oocyte environment and negatively influence embryonic development. This effect can partially be accounted by polyunsaturated fatty acids uptake while oocyte maturation is related to TAC and oocytes with low total antioxidant capacity have lower chance for fertilization and further development.
Mehri Jamilian,
Volume 12, Issue 2 (2-2014)

Background: The incidence of ectopic pregnancy varies between 1.5-2% of all pregnancies. Bilateral tubal ectopic pregnancy is rare. It may occur in 1 per 200 000 pregnancies.
Case: This is a case report of 25 year-old woman who underwent intra uterine insemination (IUI), because of tubal factor infertility (unilateral). On the 30th day after the IUI she complained from pelvic pain and vaginal bleeding. Pelvic ultrasound showed bilateral tubal ectopic pregnancy with fluid in Douglas Pouch and empty uterine cavity. Exploratory laparotomy, left salpingectomy, and right salpingostomy were performed on the same day of admission.
Conclusion: The above case suggests that cases presenting with infertility and ectopic pregnancy should be followed very closely with β-hCG and or Trans Vaginal Sonography (TVS) to exclude double ectopic. So, as in this case, early diagnosis is essential for prevention of maternal morbidity and mortality.

Ahmed M. Isa, Basim Abu-Rafea, Sahel Al-Asiri, Johara Al-Motawa,
Volume 12, Issue 7 (8-2014)

Background: Intrauterine Insemination (IUI) remains the first thought of infertility treatment.
Objective: To compare the stimulation effects and Pregnancy rate (PR) outcomes of two ovulation induction (OI) medications, human-derived menopausal gonadotrophins (hMGH), Merional (MER), and recombinant follicular stimulating hormone (rFSH), Puregon (PUR), in a cohort of Saudi infertile patients, for better predictability of treatment results.
Materials and Methods: During a 24-month period, 296 women underwent IUI single treatments. PR’s were correlated with the type of stimulation medication that were prospectively and randomly assigned to each patient, and with the number and size of maturing follicles detected on the hCG injection day.
Results: MER and PUR needed comparable number of days (9.26±4.74 and 9.73±6.27 respectively) before follicles were ready for IUI, although the average amount used from MER, 1199.90 IU, was about double that was used from PUR, 621.08 IU. The overall PR in case of PUR however was nearly double that of MER, 13.28% and 7.14% respectively. The best PR, 16.22%, occurred when the follicles matured within 12-13 days. Three follicles of at least 15-mm diameter on the hCG day had better PR’s than one or two, however when the follicles’ diameters were at least 18-mm, PR was significantly higher, (p=0.013).
Conclusion: MER and PUR had comparable stimulation effects; however PUR had noticeably higher PR. The best PR occurred when the follicles matured within 12-13 days. PR in case of three maturing follicles on the hCG day was better than only one or two, and significantly better when their diameters were at least 18 mm.
Afsoon Zarei, Saeed Alborzi, Nasrin Dadras, Ghazal Azadi,
Volume 12, Issue 9 (10-2014)

Background: Implantation is considered as the rate-limiting step in success of assisted reproduction techniques, and intrauterine insemination cycles. It might be affected by ovarian superovulation and endometrial local scratching.
Objective: This study aims to investigate the effect of local endometrial injury on the outcome of IUI cycles.
Materials and Methods: In this randomized clinical trial 144 women with unexplained infertility, mild male factor, and mild endometriosis randomly divided into two study groups through block randomization. The patients were randomly assigned to undergo endometrial biopsy between days 6-8 of the previous menstrual cycle before IUI (n=72, IUI cycles =126) or receive no interventions (n=72, IUI cycles=105).
Results: The pregnancy rate per patient was 17 (23.6%) and 14 (19.4%) in endometrial biopsy and control groups, respectively (p=0.686). The pregnancy rate per cycle was 17/126 (13.5%) and 14/105 (13.3%) in endometrial biopsy and control groups, respectively (p=0.389). The abortion rate was comparable between the two groups (6.9% vs. 9.7%; p=0.764). The ongoing pregnancy rate was found to be comparable between the two study groups, as well (16.7% vs. 9.7%; p=0.325). Endometrial thickness (p=0.609) was comparable between the groups; however ER2R was significantly lower in the endometrial biopsy group (p<0.001).
Conclusion: Application of local endometrial injury in the cycle before the IUI cycles is not associated with increased pregnancy rate per patient and per cycle, decreased abortion, and increased endometrial thickness.
Ziba Zahiri Sorouri, Maryan Asgharnia, Ameneh Gholampoor,
Volume 13, Issue 1 (1-2015)

Background: Intrauterine insemination (IUI) is one of the most appropriate and cost-effective methods in infertility treatment.
Objective: We aimed to investigate effect of vaginal misoprostol on pregnancy rate after IUI.
Materials and Methods: Two hundred and ten infertile women who were referred to Infertility Clinic of Alzahra Hospital by an indication of IUI during 2012-2013 were randomly assigned to receive 200 μg vaginal misoprostol (n=105) or vaginal placebo (n=105) after IUI. For detecting pregnancy, past 2 weeks, beta human chorionic gonadotropin evaluation was made and if positive, transvaginal sonography was done for evaluation of pregnancy 2-3 weeks later and clinical pregnancy was recorded.
Results: Pregnancy had been noted in 24 patients in misoprotol (22.9%) and 27 patients in placebo (25.7%) groups that this difference was not significant (p=0.748). In misoprostol group, 3 case of nausea and vomiting (2.9%) had been observed.
Conclusion: According to the results, administering 200 μg vaginal misoprostol after IUI doesn’t have significant effect on the success rate of IUI.

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