Background: In vitro fertilization is an important therapy for women with polycystic ovarian syndrome (PCOS). The use of new ways of improving clinical results is yet required. Objective: This study was aimed to investigate the efficacy of progesterone primed ovarian stimulation (PPOS) and compare with conventional antagonist protocol in PCOS. Materials and Methods: A total of 120 PCOS women who were candidates for assisted reproductive technology treatment from August to January 2019 were enrolled in this RCT and were placed into two groups, randomly (n = 60/each). The PPOS group received 20 mg/day Dydrogesterone orally since the second day of the cycle and the control group received antagonist protocol. The pregnancy outcomes including the chemical and clinical pregnancy, the miscarriage rate, and the percent of gestational sacs/transferred embryos was compared in two groups. Results: Number of MII oocyte, maturity rate, Number of 2 pronuclei (2PN) and serum estradiol levels on trigger day were statistically lower in PPOS group (p = 0.019, p = 0.035, p = 0.032, p = 0.030), respectively. Serum LH level on trigger day in PPOS group was higher than antagonist group (p = 0.005). Although there wasn’t sever ovarian hyper simulation syndrome in any participants, mild and moderate ovarian hyper simulation syndrome was less in PPOS group (p = 0.001). Also, the chemical and clinical pregnancy rate were higher in the antagonist group, althoughit was not statistically significant (p = 0.136, p = 0.093 respectively). Conclusion: Our study demonstrate that PPOS does not improve chemical and clinical pregnancy rate of the infertile women with PCOS. Key words: Progesterone, Polycystic ovarian syndrome, Controlled ovarian stimulation, Frozen-thawed embryo transfer, Pregnancy rate.
Background: Embryo transfer (ET) is the last and the most clinical process in assisted reproductive technology cycle. It has been suggested that cervical mucus interacts with an adequate embryo transfer in different ways. A few studies showed that catheter rotation could discharge mucus entrapped in the embryo to neutralize embryo displacement. Objective: The aim of this present study was to compare the outcome of frozen embryo transfer (FET) based on catheter rotation during withdrawal. Materials and Methods: In this case-control study, the clinical documents of 240 women who experienced frozen embryo transfer cycles were reviewed. The subjects were divided into two groups (n = 120/each), including A) the rotation treatment group (360°) that underwent ET using catheter rotation and B) the control group including the subjects who experienced ET with no catheter rotation. Clinical and chemical pregnancies and implantation rates were compared between two groups. Results: Results showed that there is no significant difference between the basic clinical and demographic features of both groups (p > 0.05). A significant difference was observed in terms of the rate of chemical pregnancy between groups (21.7% vs 43.3%, p = 0.001 respectively). In addition, the rate of clinical pregnancy was significantly higher in study group than the control (33.35% vs 14.2%, p = 0.002, respectively). Conclusion: Our results demonstrated that catheter rotation during withdrawal increased the implantation rate and clinical pregnancy.
Background: Endometrial thickness is regarded as an indicator of the receptivity of the endometrium. Patients preparing for frozen embryo transfer need some interventions in case their endometrium is thin. Objective: This study aimed to compare the clinical outcomes of oral administration of estradiol valerate with its vaginal type in women with inappropriate endometrial thickness. Materials and Methods: This cross-sectional study comprised of 79 women (cycles) who had undergone frozen-thawed embryo transfer. On the 13th day of the cycle, vaginal sonography was performed in case the thickness of the endometrium was < 7 mm; in the oral group, the patients continued using oral estradiol valerate tablet. However, in the vaginal group, the participants applied estradiol valerate tablet vaginally. Finally, the chemical and clinical pregnancy rate, also, early miscarriage rate were compared between the two groups. Results: The early miscarriage rate was lower in the vaginal group in comparison with the oral group (p = 0.040). Women in the vaginal group showed a lower rate of chemical pregnancy compared to the oral group, but this difference was not statistically significant (25.0 vs. 34.4%, p = 0.440). The rate of clinical pregnancy in the two groups was not statistically significant, although the vaginal group had a higher pregnancy rate (22.5% vs. 15.6%, p = 0.464), especially in women older than 34 years (37.5% vs. 11.1%, p = 0.355). Conclusion: Vaginal administration of estradiol tablet in women with thin endometrium leads to a lower rate of early miscarriage. Key words: Endometrium, Thickness, Frozen, Embryo transfer, Estradiol valerate.
Objective: To evaluate the potential link between serum LH concentrations on the day of oocyte triggering and pregnancy outcome during controlled ovarian hyperstimulation. Materials and Methods: In this retrospective cross-sectional study, data of women ≤42 years undergoing fresh embryo transfer cycles and who had downregulated with GnRH antagonist protocol in a 12-month period was reviewed. Patients with incomplete hospital records were excluded. Women were divided into four groups based on the percentiles of the serum LH level on the day of oocyte triggering: <1.49 (<25 th percentile), 1.49–2.59 (25–50 th percentile), 2.60–4.60 (50–75 th percentile), and >4.60 IU/L (>75 th percentile). Clinical pregnancy was considered the primary outcome, while chemical pregnancy and implantation rate were the most important secondary outcomes which were compared between the four groups. Results: Four hundred and nighty-three women of 1003 infertile women, who were initially assessed for eligibility, met the inclusion criteria. Finally, 426 women were analyzed. Levels of progesterone were significantly correlated with the level of LH on the day of trigger in the >4.60 IU/L group ( r = 0.20, P = 0.034). Furthermore, the levels of estradiol were significantly correlated with the level of LH on the day of trigger in the <1.49 IU/L ( r = 0.21, P = 0.026). The number of retrieved oocytes, 2PNs (two pronucleis), number, and quality of total embryos were similar between groups ( P > 0.05). With regard to oocyte maturity rate, fertilization proportion, fertilization rate, chemical pregnancy rate, and clinical pregnancy rate, there was no difference between varied LH levels in the four groups ( P > 0.05). The only observed difference was the implantation rate that was significantly higher in the 2.60–4.60 IU/L group than the <1.49 IU/L group ( P < 0.05). Conclusions: Our result could not show the potential link between LH concentrations during GnRH antagonist cycles and pregnancy outcomes. However, very low LH levels during ovarian stimulation period may negatively affect the implantation rate.
Background: A repeat dose of Gonadotropin-releasing Hormone (GnRH) agonist could provide long duration of luteinizing hormone (LH) surge and amplitude appropriately. Objective: Improvement in oocyte maturity could be obtained by a repeat dose of GnRH agonist. Materials and Methods: In this randomized double-blinded study, 120 women with polycystic ovarian syndrome and serum estradiol level (E2) > 3000 who were candidate for in vitro fertilization with Antagonist protocol were enrolled between July 2018 and July 2019. Participants were randomized in two groups - and final oocyte maturation was triggered with two doses: In group A, a repeat dose of 0.1 mg, 12 hr. after the first dose and in group B, 0.2 mg SC triptorelin (decapeptyl) 35 hr. prior to oocyte retrieval. Serum Estradiol, LH, and progesterone concentration were measured on the trigger day. Serum LH measurement was done three times in both groups. The outcomes were oocyte yield, meiosis (M) I, MII, Maturity rate, germinal vesicle (GV) rate, 2 pronuclear, embryo yield, ovarian hyper stimulation syndrome rates. Results: Maturity rate (p = 0.89), MI (p = 0.38), MII (p = 0.89), and GV oocytes (p = 0.38) were not statistically different between the two study groups. LH levels measured at 12 hr post-trigger did not relate statistically significant with maturity rate in our participants (p = 0.96). No empty follicular syndrome was reported. Conclusion: Although the second dose of GnRH agonist after 12 hr since the first dose could provide duration of LH surge and amplitude and as a result no empty follicular syndrome was seen, the maturity rate, MI, MII, and GV oocytes were not different between the two study groups. Key words: Polycystic ovarian syndrome, Treatment, In vitro fertilization, Gonadotropin-Releasing hormone.
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