Objective To study the effect of GnRh agonist administration prior to estrogen-progesterone preparation of the endometrium on the implantation rate in frozen-thawed embryo transfer (FET) cycles in infertile patients treated with IVF/ICSI.Design Prospective controlled study. Setting Private center in Alexandria, Egypt. Patients Patients undergoing frozen-thawed embryo transfer FET. Intervention(s) Patients were divided into two groups, A and B. Group A patients consisted of 110 patients (110 cycles) who received daily subcutaneous injections of 0.1 mg of the GnRh agonist triptorelin starting from the mid-luteal phase of the cycle preceding the actual FET cycle. The dose was reduced to 0.05 mg from the second day of the cycle when daily oral estradiol valerate 6 mg was also started. Daily vaginal supplementation of micronized progesterone 400 mg b.d. was started after 12 days when the GnRh agonist was also stopped. Frozen-thawed embryos were transferred on day ? 1 of their chronological age and when the endometrium reached 12 mm in thickness. Group B consisted of 100 patients (100 cycles) 123 who started daily estradiol valerate 6 mg administration from the second day of the FET cycle and followed the same regimen but without prior treatment with triptorelin. Main Outcome Measures Implantation and pregnancy rates were compared among the two groups.Results There was a significant increase in implantation rate in the GnRh agonist group (group A) compared to the estrogen and progesterone only group (group B) (44.1 vs. 21.1 %; P = 0.002*). The pregnancy rate was also significantly higher in group A compared to group B (65.5 vs. 42 %, P = 0.013*).Conclusions GnRh agonist administration during endometrial preparation for FET increases the implantation and pregnancy rates.
GnRH antagonist administration on the day of hCG in cases undergoing IVF/ICSI with long agonist protocol is effective in protection of OHSS and does not affect the clinical pregnancy rate nor live birth rate.
Background: Chemical activation is the most frequently used method for artificial oocyte activation (AOA), results in high fertilization rate. Objective: To evaluate the efficiency of oocyte activation with calcium ionophore on fertilization and pregnancy outcomes after intracytoplasmic sperm injection (ICSI) in patients with previous fertilization failure. Design: prospective controlled study Materials and methods: One hundred and eight patients with history of previous fertilization failure undergoing IVF/ICSI treatment with long agonist protocol were randomly divided into two groups: group A (n=54) and group B (n=54) ; a total of 756 metaphase II (MII) oocytes were retrieved . In the oocytes of group A(n=350 oocyte), routine ICSI was applied; while in oocytes in group B (n=406 oocyte) immediately after ICSI, were entered in culture medium supplemented with 5 µΜ calcium ionophore (A23187) for 10 minutes and then washed at least five times with MOPS solution. Main outcome measures: In both groups, the fertilization was evaluated after 16-18 hours. Results: The number of fertilized oocytes and embryos obtained were significantly different between two groups (p=<0.001*). Fertilization rate was significantly higher in group B -where calcium ionophore was applied-compared to group A(control group) (32.2% vs. 9.1%, respectively ,p=0.01*); and Cleavage rate also was significantly higher in group B compared to group A (27.4% vs 12.5% respectively, p=0.028*). Implantation rate was significantly higher in group B than in group A (18.32% vs. 3.12 % respectively, p=0.035*) Pregnancy rate also was significantly higher in group B than in group A (22.2% vs. 1.85% respectively, p=0.042*). Conclusion: Chemical oocyte activation with calcium ionophore resulted in a significant improvement in fertilization, cleavage, implantation and pregnancy rates after ICSI in infertile patients with previous fertilization failure.
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