Aim The aim of the present study is to evaluate the fertility outcomes of intracytoplasmic sperm injection (ICSI) as well as sperm count, motility and morphology in couples with infertile male partners exhibiting idiopathic oligoasthenozoospermia (OA) and treated with tamoxifen citrate and/or L-carnitine. Materials and methods In this randomized controlled trail, couples with female cause of infertility were excluded. Only couples with male cause of infertility with idiopathic OA were admitted to this study and randomly assigned into four different groups of treatments as follow: Group A (n = 45) received an anti-estrogen compound (tamoxifen 20 mg/day), group B (n = 20) received L-carnitine (1000 mg/day), group C (n = 34) received tamoxifen 20 mg/day plus L-carnitine 1000 mg/day, whereas group D (n = 29) received placebo. Treatments were continued for 3 to 6 months. Results Treatment groups of A, B, and C showed an overall improvement in the tested parameters of sperm when compared to the control group that showed an overall reduction in those parameters after termination of the treatment. In this context, sperm count increased from 7.58 ± 2.93 × 106/ml before treatment to 10.81 ± 1.84 × 106/ml after treatment in group A (p = 0.016). Similarly, sperm count increased from 5.32 ± 2.09 × 106/ml to 8.92 ± 2.29 × 106/ml in group C (p = 0.01). Patients from group C did not only have an improved total motility of sperm from 8.03 ± 1.59% to 13.78 ± 3.85% (p = 0.045) but also an improved sperm normal morphology from 0.88 ± 0.45% to 1.99 ± 0.71% (p = 0.026). Patients from group A or C exhibited an improved ICSI outcomes when compared to those in patients from group B or D (48.9 or 48.3 vs 16.6 or 20, respectively, p = 0.46). Conclusion It is concluded that administration of tamoxifen and L-carnitine can improve both sperm parameters of fertility and ICSI outcomes. Combined tamoxifen and L-carnitine treatments result in maximum therapeutic effect in men with idiopathic OA. How to cite this article Haje M, Naoom K. Combined Tamoxifen and L-Carnitine Therapies for the Treatment of Idiopathic Male Infertility Attending Intracytoplasmic Sperm Injection: A Randomized Controlled Trial. Int J Infertil Fetal Med 2015;6(1):20-24.
This study aimed to determine the outcomes of intracytoplasmic sperm injection (ICSI) if oocyte retrieval was done 32–34 hours or 34:05–36 hours after human chorionic gonadotropin (hCG) injection. A randomized sample involving 186 patients with tubal failure was divided into groups A (96 patients) and B (90 patients). Intracytoplasmic sperm injection was performed on all patients according to described protocols. The number of oocytes retrieved, oocyte cumulus complex quality, number of fertilized eggs, and pregnancy rates were compared between groups. The total of oocytes retrieved in group B was significantly higher than in group A but not significant (P=0.068). The oocyte maturation rate was also significantly higher in the long interval group B than in the short interval group A (P=0.039). There was a significant difference between the two groups in terms of fertilization rate (0.040), and the pregnancy rate in group B was higher than that in group A, but it was not significant (P=0.055). The prolonged interval could also increase the pregnancy rate, but it was not significant. It seems that if the interval between hCG priming and oocyte retrieval is prolonged, the percentage of the number of oocytes retrieved, mature oocytes (MII), and fertilized oocytes increases.
Freezing embryos is the best way to increase fertility for women with ovarian hyper-stimulation syndrome and women at risk for ovarian dysfunction. Due to the importance of freezing and pregnancy embryos, the present study was conducted to compare the fertility rate and the affecting factors following fresh embryos and frozen embryos in women treated with assisted reproductive techniques. In this study, 250 infertile women and IVF/ICSI candidates were studied. Embryos were used in fresh or frozen groups for transfer to the uterus. The expression of the caspase-3 gene was also examined for further evaluation. Data analysis was performed using SPSS 16 software, Chi-square, independent t-test, and Kruskal-Wallis tests. Out of 250 infertile women, 96 (38.4%) became pregnant, of which 54 were in the fresh embryo group and 42 were in the frozen embryo group, which was not statistically significant (P=0.32). Infertility causes, number of embryonic cells and grading of transferred embryos, delivery complications, embryo implantation methods, number of produced embryos after delivery, and endometrial thickness were not significantly different between the two groups (P=0.53). The difference between the mean number of transferred embryos in the two groups was significant (P<0.05), which was no longer significant after excluding non-pregnant women, and in comparing with only pregnant women (P=0.36). The result of caspase-3 gene expression showed that there was significant differences between fresh embryos, healthy thawed frozen embryos, and destroyed thawed frozen embryos. But these results were totally different from the results of the Pregnancy rate section. Therefore, it is inferred that although caspase-3 genes are expressed in frozen embryos after thawing and are ready to destroy the embryo, there are probably a number of involved factors that prevent the activity of caspase-3 and do not allow the apoptotic process to occur. What these factors are and how they prevent this process needs further study.
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