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Showing 15 results for Assisted Reproductive Technology

Robabeh Taheripanah, Mohammad A Karimzadeh, Mohammad Ghafourzadeh,
Volume 2, Issue 1 (7-2004)

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.
Fatemeh Mostajeran, Hosna Gharavi, Seyed Mehdi Ahmadi,
Volume 4, Issue 2 (7-2006)

Background: Spontaneous occurrences of multifetal pregnancies always have been a medical problem. The risks of perinatal morbidity and mortality and maternal morbidity increase with enhancement of the number of fetuses. In our prospective experimental study, the outcome of twin pregnancy after Assisted Reproductive Technologies (ART) with and without Multifetal Pregnancy Reduction (MFPR) is compared relating to perinatal and maternal complications.
Objective: The aim of this study was to compare the gestational age at delivery, birth weight, and other complications of surviving twins following MFPR to those in a control group of non-reduced twins.
Materials and methods: In this prospective experimental study, from infertile couples who were referred to Isfahan Fertility- Infertility Center (IFIC) and were candidate for ART (Invitro Fertilization or Intra Cytoplasmic Sperm Injection), 30 couples who have had twin (control group) and 35 couples with quadruplet or higher order pregnancies (experimental group) were selected. In cases with experimental group MFPR was done, and pregnancy outcome-miscarriage, premature labor, Premature Preterm Rupture of Membranes (PPROM) and Pregnancy Induced Hypertension (PIH)-were compared between two groups.
Results: Distribution of complications in experimental vs. control groups was as follows: miscarriage: 23.3 vs. 16 .7%, premature labor: 15.7% vs. 13.3 %, pregnancy induced hypertension: 13.3% vs. 16.7%, abruption: 6.7% vs. 6.7%, and premature preterm rupture of membranes: 23.3% vs. 26.7 %. Mean neonatal weight at birth (2239 vs. 2240 gr) and mean gestational age at delivery (33.5 vs. 34.1 w) were similar. The differences between two groups were not statistically significant (P>0.05).
Conclusion: MFPR during early pregnancy is a safe, effective and simple operative for the purpose of reducing perinatal and maternal complications.
Abbas Aflatoonian, Maryam Eftekhar, Farnaz Mohammadian, Fariba Yousefnejad,
Volume 9, Issue 4 (7-2011)

Background: Human fertility has been declined all over the world. Advanced women’s age is one of the most important factors in determining the success of reproduction and ageing has negative impact on ART outcome and advanced female age decreases the chance of live birth rates achieved using ART, especially after 40 years of age.
Objective: To evaluate  ART outcomes regarding to pregnancy, abortion, cycle cancellation and live birth rates in women 40 years and older.
Materials and Methods: A retrospective study was performed on three hundred-thirteen women undergoing ART cycles in the Madar Hospital in Yazd. Women with age ≥ 40 years who indicated for ART enrolled the study regardless of the infertility type or etiology. In this study, we used data from IVF or ICSI cycles using fresh embryo transfer. Follow up was performed in regard to pregnancy, abortion, cycle cancellation and live birth rates.
Results: The mean age of women was 41.87±1.97 years. Chemical pregnancy rate was 8.6% (27/313) per cycle. Clinical pregnancy rate was 3.8% (12/313) per cycle. Spontaneous abortion was observed in 63% (17/27) of patients with positive pregnancy test. The overall cancellation rate was 23.3% per oocytes retrieval. The overall live birth rate per cycle for all women who initiated an ART cycle at age ≥40 years was 3.2% (10/313) that eight of those women were under 42 years old.
Conclusion: Based on our results, we suggest that women with age 42 years and above should be advised to use other options, including oocyte donation or adoption.
Razieh Dehghani Firouzabadi, Farnaz Mohammadian, Mehri Mashayekhy, Robab Davar, Maryam Eftekhar,
Volume 10, Issue 5 (10-2012)

Background: Determination of oocyte fertilization and embryo quality are one of the most important purposes in ART cycles. Follicular fluid provides an important microenvironment for development of oocytes and some biochemical characteristics of the follicular fluid, such as pregnancy-associated plasma protein-A (PAPP-A), may play an important role in prediction of success rate of ART.
Objective: This study was performed to evaluate whether there was any difference in follicular fluid PAPP-A, fertilization, and embryo quality between GnRH agonist long protocol and flexible GnRH antagonist multiple-dose protocol in ART cycles.
Materials and Methods: A total of 100 women who were candidates for ART were enrolled the study and were divided into two groups, GnRH agonist (GnRHa) long protocol (n=51) and flexible GnRH antagonist (GnRHant) multiple-dose protocol (n=49). Follicular fluid sample was obtained from a single mature follicle and follicular fluid PAPP-A level, fertilization and embryo quality of the same oocyte were evaluated in both groups.
Results: There was no significant difference in the mean levels of follicular fluid PAPP-A between the GnRHa protocol and GnRHant protocol (3.5±1.4 vs. 3.8±1.9, respectively). The mean levels of follicular fluid PAPP-A in fertilized oocyte and good quality embryo were comparable in GnRHa and GnRHant protocols.
Conclusion: Our data indicated that no differences of follicular fluid PAPP-A levels were observed between cycles using GnRHa long protocol and those of using flexible GnRHant multiple-dose protocol.
Aalie Torabizadeh, Fatemeh Vahidroodsari, Zakieh Ghorbanpour,
Volume 11, Issue 10 (12-2013)

Background: Ovarian hyperstimulation syndrome (OHSS) is the most serious and potentially life-threatening iatrogenic complication associated with ovarian stimulation during Assisted Reproductive Technology (ART) protocols. OHSS typically is a result of ovarian expression of vascular endothelial growth factor (VEGF) which increases vascular permeability.
Objective: Comparison of albumin and cabergoline in the prevention of OHSS.
Materials and Methods: 95 high risk infertile women for OHSS (more than 20 follicles in both ovaries at day of Human Chorionic Gonadotropin (HCG) injection) were randomly divided into two groups. First group including 48 women received 10 unit intravenous albumin at starting oocyte retrieval, and second group including 47 women received 0.5 mg/day dopamine agonist (Cabergolin) at day of HCG injection till 8 days. The dosage of human Menopausal Gonadotropin (HMG) used, total number of follicles developed, number of oocytes retrieved, serum E2 concentrations during the luteal phase, development of ascites, number of embryos generated, clinical pregnancy rate, results of the in vitro fertilization-embryo transfer (IVF-ET) cycles and incidence and severity of any OHSS were evaluated.
Results: There was evidence of a statistically significant reduction in the incidence of OHSS in the cabergolin group (53.7%) versus albumin group (46.3%) (p=0.04). But there was no significant difference of a reduction in severe OHSS (p=0.62). There was no difference in clinical pregnancy rate too.
Conclusion: Administration of cabergolin can prevent incidence of OHSS and does not appear to effect on its severity. 
Nastaran Aflatoonian, Soheila Pourmasumi, Abbas Aflatoonian, Maryam Eftekhar,
Volume 11, Issue 10 (12-2013)

Background: Cryopreservation of embryos has been an usual component of clinic in assisted reproductive technology (ART) programs. Recently the dramatic increase in cryobiology activity in the clinical centers has enhanced methods of freezing and improved vitrification protocols are being developed.
Objective: The aim of our study was to assess the effect of storage duration of frozen embryo on ART outcome.
Materials and Methods: In this retrospective study the data of 651 frozen-thawed embryo transfer cycles were assessed over a 36-months period. Our patients were categorized according to storage time of freeze. Group I: less than 90 days, Group II: between 90-365 days. Group III: between 365-730 days. Group IV: between 730-1095 days. Group V: more than 1095 days. Clinical pregnancy and implantation rate were defined and statistical analysis was performed using Student t-test and Chi-square.
Results: According to our finding patient’s mean age was 31.05±5.231 years (range, 18-53 years), and 1204 embryos were transferred .The mean storage duration was 296.72±301.82 days. The mean number of embryo transferred per cycle was similar between groups (p=0.224). According to our analysis clinical pregnancy rate per embryo transfer cycle was similar between groups (p=0.563).
Conclusion: Our results showed that duration of storage had no negative effects on implantation of cryopreserved embryos. In our literature review we found a little article In this context. However our study showed duration of freezing don’t have any negative effects on implantation and pregnancy outcome, but more studies are needed to evaluate long term effects of storage duration on babies were born by cryopreserved embryos.
Abbas Aflatoonian, Hoora Amouzegar, Razieh Dehghani Firouzabadi,
Volume 11, Issue 10 (12-2013)

Background: Preterm labor (PTL) is one of the most important causes in neonatal mortality and morbidity. Late preterm labor (34-36w) includes 75% of such birth. Assisted reproductive technology (ART) pregnant women are at increased risk of PTL.
Objective: The study has been undertaken to determine whether beginning and continuing 17-α hydroxy progesterone caproate can reduce risk of PTL or change neonatal mortality.
Materials and Methods: In a double-blind clinical randomized control trial, 106 women were treated by ART technique for their infertility and in gestational age at 16 weeks entered in our study. In one group, 17-α hydroxy progesterone caproate (Femolife) was injected intramuscularly every week until 36 weeks of gestation and in another group; placebo was injected from 16 until 36 weeks of gestetion. Data collected from pregnancy outcomes, infancy, and subsidiary problems were statistically analyzed by a questionnaire.
Results: The risk of PTL in placebo group was 2.48 higher than control group that was not significant (Cl: 0.81-9.94). Femolife side effect in case group was gestational diabetes and local complication was not frequent. NICU admission was not significantly different between groups.
Conclusion: Although it seems that 17-α hydroxy progesterone caproate does not cause significantly decrease in PTL in singleton ART gestations but any reduction of PTL in such high risk pregnancies may improve final gestational outcome. There is critical need for larger clinical trials to better understanding causes of PTL, specifically late preterm labor, to prevent mortality and morbidity in ART gestation.
Mohammad Hossein Jarahzadeh, Reza Jouya, Fatemeh Sadat Mousavi, Mohammad Dehghan-Tezerjani, Shekoofa Behdad, Hamid Reza Soltani,
Volume 12, Issue 1 (2-2014)

Background: Thiopental sodium and Propofol are two widely-used drugs in the induction of anesthesia in assisted reproductive technology (ART). However, the side effects and outcome of recovery from anesthesia of these drugs on ART have not been identified yet.
Objective: This study aimed at investigating the side effects and hemodynamic effects of using thiopental sodium and propofal as well as effects of these drugs on pregnancy outcome in ART cycles.
Materials and Methods: In this double blinded) randomized controlled trial, 90 woman candidate for ART were randomly divided into two groups. 47 patients received Propofol (2.5 mg/kg) and 43 patients received thiopental (5mg/kg) for anesthesia induction. The entry hemodynamic parameters of the patients were documented. During the anesthesia process, hemodynamic parameters were checked at five-minute intervals.
Results: The results of the study showed a statistically significant difference between two groups in terms of their response to verbal stimulation (p<0.001), the normalization time of the rate and quality of breathing (p<0.001), nausea (p<0.001), and vomiting (p<0.001). Also, in comparison with the other group, all these parameters were better in Propofol group. There was found no significant difference between two groups in terms of other variables.
Conclusion: Based on the findings of the study, Propofol has fewer known side effects. Vomiting and nausea as two known side effect of anesthesia are significantly lower in patients receiving Propofol than patients who received thiopental.
Mohammad-Hossein Razi, Fereshteh Mohseni, Razieh Dehghani Firouzabadi, Sima Janati, Nahid Yari, Sahabeh Etebary,
Volume 12, Issue 2 (2-2014)

Background: Based on classical two-cell, two-gonadotropin theory, in the follicle, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) put on their main effects on the granulosa and theca cells. LH is essential for androgens production. Androgens are used for estradiol production by granulosa cells. Profound suppression of LH concentrations in some normogonadotropic patients can cause several adverse effects.
Objective: The main clinical purpose of this study was that normoresponder women treated with controlled ovarian super ovulation for IVF or ICSI may benefit from co-administration of rLH.
Materials and Methods: 40 patients who were candidates for assisted reproductive technology (ART) were randomly selected. In all patients long luteal protocol was used for ovulation induction. Patients were randomly divided into two groups: Group 1 (n=20) with standard long protocol (GnRH agonist) and r-FSH alone, Group 2 (n=20) with standard long protocol (GnRH agonist) and r-FSH with r-LH. Results were statistically analyzed and compared in two groups.
Results: The number of retrieved oocytes, mature oocytes, cleaved embryos, transferred embryos, estradiol levels in Human chorionic gonadotropin (hCG) administration day, implantation rate and clinical pregnancy rate in group 2 were higher but not significantly different.
Conclusion: Administration of rLH in late follicular phase had no beneficial effect on outcomes in young women with mean age of 31 years. Maybe a greater sample size should be used to see the effects more accurately; also it is possible that rLH will be useful in older patients.
Leili Mosalanejad, Nehle Parandavar, Morteza Gholami, Sareh Abdolahifard,
Volume 12, Issue 2 (2-2014)

Background: Assisted reproductive technology (ART) provide the hope of pregnancy for infertile women, but do not always turn this hope into reality.
Objective: The purpose of this study was to explore the lived experience of infertile women from increasing and decreasing factors of hope in infertile women with failure in infertility treatment.
Materials and Methods: Using a qualitative research design (Phenomenology study), 23 subjects were selected who had experienced infertility failure visited by gynecologist (Rasekh Infertility center) in 2012. The data were collected through semi structured interviews and analyzed using interpretive research strategies of phenomenology by Collizichr('39')s seven-stage method.
Results: Totally 96 codes were identified. The data arranged in two categories. The factors decreasing and increasing hope in infertility treatments. Totally 5 themes and 20 sub themes were extracted. The increasing factors which emerged from the data contain "spiritual source", "family interaction and support" and "information through the media", and decreasing factors contain "nature of treatments" and "negatively oriented mind".
Azita Faramarzi, Mohammad Ali Khalili, Giulietta Micara, Azam Agha- Rahimi,
Volume 15, Issue 5 (6-2017)

High implantation success following in vitro fertilization cycles are achieved via thetransfer of embryos with the highest developmental competence. Multiplepregnancies as a result of the transfer of several embryos per cycle accompany withvarious complication. Thus, single-embryo transfer (SET) is the preferred practice inassisted reproductive technique (ART) treatment. In order to improve the pregnancyrate for SET, embryologists need reliable biomarkers to aid their selection ofembryos with the highest developmental potential. Time-lapse technology is anoninvasive alternative conventional microscopic assessment. It providesuninterrupted and continues the survey of embryo development to transfer day.Today, there are four time-lapse systems that are commercially available for ARTcenters. In world and Iran, the first time lapse babies were born in 2010 and 2015,respectively, conceived by SET. Here, we review the use of time-lapse monitoring inthe observation of embryogenesis as well as its role in SET. Although, the findingsfrom our review support common use of time-lapse monitoring in ART centers; but,future large studies assessing this system in well-designed trials are necessary
Marzieh Aghahosseini, Ashraf Aleyasin, Venus Chegini, Victoria Chegini,
Volume 15, Issue 11 (11-2017)

Background: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication, which can cause high morbidity and mortality. Use of gonadotropin releasing hormone (GnRH) agonist instead of human chorionic gonadotropin (hCG) in GnRH antagonist cycles causes luteinizing hormone surge by GnRH stimulation which reduces the risk of OHSS by reducing the total amount of gonadotropin; however, there is no possibility of transferring fresh embryos.
Objective: The current study aimed to evaluate the effect of hCG along with GnRH agonist administration in the occurrence of OHSS and pregnancy rate in females undergoing in vitro fertilization.
Materials and Methods: The current randomized clinical trial was conducted on 80 cases in 2 groups. Gonal-F was used to stimulate the oocyte from the second day of menstruation. When follicle size was 12-14 mm, GnRH antagonist was added to the protocol till the detection of more than two follicles greater than 18 mm. Then, GnRH agonist was added to the protocol as a trigger. In group A, 35 hr after the administration of GnRH agonist, the low-dose human hCG, 1500 IU, was used. In group B, low-dose hCG, 1500 IU, was used at the same time by GnRH agonist administration. The rate of pregnancy, OHSS, and its severity were compared between 2 groups within 2 wk.
Results: There was no significant difference regarding chemical and clinical pregnancies between the 2 groups. Severe OHSS was significantly higher in group B (p= 0.03).
Conclusion: Administration of hCG 35 hr after GnRH agonist administration results in lower rate of severe OHSS.
Marzie Farimani, Jalal Poorolajal, Soghra Rabiee, Maryam Bahmanzadeh,
Volume 15, Issue 12 (12-2017)

Background: Platelets contain a significant amount of growth factors that have positive effects on local tissue repair and endometrial receptivity.
Case: Here we present a 45-yr-old woman with primary infertility and two failed in vitro fertilization (IVF) cycles who was candidate to receive donor eggs. Five consecutive frozen-thawed embryo transfer cycles with good quality embryos were performed within 2 yr. With the diagnosis of recurrent implantation failure (RIF), the patient was treated for improving endometrial receptivity with intrauterine administration of autologous platelet-rich plasma (PRP), 24 hr before embryo transfer. The patient gave birth to a healthy baby boy weighing 2350 gr in the cesarean section.
Conclusion: Extensive literature search suggests that this is the first successful pregnancy after administration of PRP in a woman with RIF. Local administration of PRP before embryo transfer may play a vital role in successful implantation
Robab Davar, Nosrat Neghab, Elham Naghshineh,
Volume 16, Issue 4 (4-2018)

Background: Over the years, many article on different aspects of pathogenesis and management of poor ovarian responders have been published but there is no clear guideline for treating themyet.
Objective: This study was designated to compare the effectiveness of a delayed start protocol with gonadotropin-releasing hormone (GnRH) antagonist and microdose flare-up GnRH agonist protocol in poor ovarian responders.
Materials and Methods: This randomized clinical trial consisted of 100 poor ovarian responder women in assisted reproductive technologies cycles. They were divided randomly in delayed-start antagonist protocol (with estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation) and microdose flare-up GnRH agonist protocol. The main outcome was clinical pregnancy rate and second outcome was the number of retrieved oocytes, mature oocytes, 2PN number, fertilization rate, and implantation rate.
Results: Fertilization rate, clinical pregnancy rate, and ongoing pregnancy rates were not significantly different between the two studied protocols. Number of retrieved oocytes (5.10±3.41 vs. 3.08±2.51) with p=0.002, mature oocytes (4.32±2.69 vs. 2.34±1.80) with p=0.003, number of 2PN (3.94±1.80 vs. 2.20±1.01) with p=0.001 and implantation rate (19.40% vs. 10.30%) with p=0.022 were significantly higher in delayed antagonist group.
Conclusion: The delayed-start protocol can improve ovarian response in poor responders by stimulating and synchronizing follicle development.
Soheila Arefi, Elham Fazeli, Manijeh Esfahani, Nasim Borhani, Nazila Yamini, Ahmad Hosseini, Fattaneh Farifteh,
Volume 16, Issue 5 (5-2018)

Background: Family of colony-stimulating factors (CSF) have an essential role on early cross talk between embryo and uterine endometrium.
Objective: The aim of this study was to evaluate the effects of the single dose of Granulocyte-CSF (G-CSF) injection on clinical outcome of assisted reproductive technology cycle in patients with repeated implantation failures.
Materials and Methods: This randomized control trial study was performed on 52 infertile women who referred to the clinic with the history of more than three previous In vitro fertilization/Intracytoplasmic sperm injection-embryo transfer failures. All patients were stimulated with standard long protocol. All embryos were transferred on day five in blastocyst stage in both groups. The treated group received 300 μg (0.5 ml) recombinant human G-CSF subcutaneously which was injected 30 min before blastocyst embryo transfer.
Results: There was not statistically significant differences in abortion rate in G-CSF and control group (p=0.09). G-CSF treated group showed higher clinical pregnancy rate in comparison with control group (56.2% vs. 40.0%) but it was not statistically significant (p=0.09). Although live birth rate in G-CSF group was higher than control group (53.1% vs. 35.0%) but there wasn’t statistically significant difference in the overall live birth rate between the two groups (p=0.10). G-CSF group had a twin pregnancies while in control group there was no twin pregnancy.
Conclusion: Our result demonstrates the possibility that pregnancy outcome is better in women with repeated unexplained In vitro fertilization failure who are treated with G-CSF.

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