BackgroundThe overall incidence of poor ovarian response in IVF cycles has been reported to be between 9 and 24 %. The management of these patients remains a significant challenge in assisted reproduction. The aim of the present study was to evaluate the effect of myo-inositol (MI) on ovarian function in poor responders undergoing ICSI.MethodsThe study is a prospective controlled observational trial, that involved 72 poor responders included in an ICSI program and divided into two groups; group A: 38 patients who have been assuming MI (4 g) + folic acid (FA) (400 μg) for the previous 3 months before the enrollment day; group B: 38 patients assuming FA (400 μg) alone for the same period. COH was carried out in the same manner in the two groups. The main goal was the assessment of oocytes retrieved number and quality; secondary endpoints were the Ovarian Sensitivity Index (OSI: n° oocytes retrieved/total Gonadotropins units × 1000), oestradiol levels on the day of hGC, fertilization rate, implantation rate, ongoing pregnancy rate.ResultsThere was no significant difference between the two groups regarding oestradiol level, but total rec-FSH units were significantly lower (p = 0.004) and M2 oocytes rate significantly higer (p = 0.01) in group A. The ovarian sensitivity index was higher, reaching a statistical significance (p < 0.05), in the group of patients pre-treated with MI, showing an improvement in ovarian sensibility to gonadotropin.ConclusionsOur results suggest that MI therapy in poor responders results in an increased of the number of oocytes recovered in MII and of the gonadotropin Ovarian Sensitivity Index (OSI), suggesting a MI role in improving ovarian response to gonadotropins. Therefore MI seems to be helpful in “poor responders” undergoing IVF cycles.
BackgroundThe complex relationship between oocyte morphology, specific follicular fluid metabolites, gene expression in cumulus granulosa cells, and oocyte competence toward fertilization and embryo development still needs further clarification.MethodsForty-six oocytes retrieved from the largest pre-ovulatory follicle of patients undergoing intra-cytoplasmic sperm injection (ICSI) were considered assessing: (a) oocyte morphological characteristics at polarized light microscopy (PLM), (b) specific follicular fluid (FF) metabolites previously suggested to influence oocyte competence (AMH, markers of redox status and of cytotoxicity), (c) transcription of AMH and AMH type II receptor genes in cumulus cells. Data were analyzed using mono-parametric tests and multivariable logistic analysis in order to correlate morphological and biochemical data with fertilization.ResultsComparing normally fertilized oocytes (n = 29, F group) with unfertilized (n = 17, nF group) we observed that: (a) the meiotic spindle area and major axis were significantly higher in nF group and in fertilized oocytes undergoing an early embryo development arrest; (b) AMH level in FF was comparable in F and nF groups; (c) the FF of nF group contained significantly higher levels of cytotoxicity (lactate dehydrogenase) and oxidative stress (Cu,Zn-superoxide dismutase, catalase, 4-hydroxynonenal-protein conjugates) markers; (d) cumulus cells of nF group showed significantly higher AMH receptor type II gene expression.ConclusionsTaken together, these observations suggest that an excessive cytotoxicity level can alter AMH signal transduction within cumulus cells, in turn leading to partial inhibition of aromatase activity, altered cytoplasmic maturation and increased oxidative stress, factors able to impair oocyte fertilization competence and embryo growth.Electronic supplementary materialThe online version of this article (doi:10.1186/s12958-017-0265-2) contains supplementary material, which is available to authorized users.
Infertility treatment is a stressful process and factors like anxiety and preoccupation could affect the success of In Vitro Fertilization (IVF) or other assisted reproductive techniques. Moreover, luteal phase support (LPS) in IVF cycles is recommended. Our aim was to analyze the effects of LPS with intramuscular and subcutaneous progesterone on stress hormones (cortisol and prolactin). We analyzed one hundred-thirty women undergoing their first IVF cycle and then randomized in two groups: group A (65 patients) received 33 mg/day of intramuscular in oil-progesterone from pick-up and 50mg/day from embryo transfer, group B (65 patients), instead, received 25 mg of subcutaneous water soluble-progesterone from pick-up. Cortisol and prolactin serum levels were obtained at day+7 from oocyte retrieval. Our results showed that the values of prolactin and cortisol were statistically significantly higher in group A compared to the group B. Subcutaneous progesterone treatment, in fact, is associated with lower cortisol and prolactin levels, suggesting new therapeutic opportunities in IVF cycles to reduce patients' distress and improve quality of life. SOMMARIOIl trattamento dell'infertilità è un processo stressante e fattori come l'ansia e la preoccupazione potrebbero influenzare il successo della fecondazione in vitro (IVF) o di altre tecniche di riproduzione assistita. Inoltre, il supporto alla fase luteale (LPS) è raccomandato nei cicli di IVF. Il nostro obiettivo è stato quello di analizzare gli effetti sugli ormoni dello stress (cortisolo e prolattina), della LPS con progesterone intramuscolare e sottocutaneo. Abbiamo analizzato centotrenta donne sottoposte al primo ciclo di IVF e le abbiamo randomizzate in due gruppi: il gruppo A (65 pazienti) ha ricevuto 33 mg/die di progesterone intramuscolare dal giorno del pick-up e 50 mg/die dal giorno del trasferimento dell'embrione, il gruppo B (65 pazienti), invece, ha ricevuto 25 mg di progesterone, solubile in acqua, per via sottocutanea dal giorno del pick-up. I livelli sierici di cortisolo e prolattina sono stati valutati dopo sette giorni dal pick-up. I nostri risultati hanno mostrato che i valori di prolattina e cortisolo erano statisticamente più alti nel gruppo A rispetto al gruppo B. Il trattamento sottocutaneo di progesterone, infatti, è associato a livelli più bassi di cortisolo e prolattina, suggerendo nuove opportunità terapeutiche nei cicli di IVF per ridurre lo stress dei pazienti e migliorare la qualità della vita.
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