The effect of maternal body mass index (BMI) on fertility outcomes in women undergoing in vitro fertilization/intracytoplasmic sperm injection cycles has been extensively evaluated and the results of these studies have shown a lot of controversial issues. Folate is a naturally occurring type of vitamin B9 crucial for reproductive health. 65 infertile couples were subjected to intracytoplasmic sperm injection cycles. Both primary and secondary types of infertility were involved, with different causes. The mean plasma folate of all infertile women was 12.71±6.52, with pregnant 11.60±5.57 and non-pregnant 11.74±8.80; with no significant difference in mean plasma folate between them. Moreover, the means of follicular fluid folate of all infertile women, pregnant women, and non-pregnant women were 8.00±5.39, 7.84±4.68, and 8.39±6.19 respectively. There was no significant statistical difference in mean follicular fluid folate between pregnant and non-pregnant women (p=0.719). Also, both plasma folate and follicular fluid folate were not significantly correlated to oocyte and embryo characteristics. Although plasma folate was higher in obese than normal and overweight women, the difference did not reach statistical significance. It appears that the correlation among maternal BMI, folate level and fertility outcomes in women undergoing intracytoplasmic sperm injection cycles are still controversial and much research work is needed to figure out such complex interaction among these variables.

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Background:The overall success rate of assisted reproductive techniques is only about 30% due to certain limiting factors. Endometrial scratching could induce inflammatory response which manifested by the up-regulation of different cytokines and chemokines with subsequent accumulation of immune cells in the injured site. One of the most important cytokine in this regard is TNF-α which was found to induce tissue remodeling by stimulating the production of many other pro-inflammatory cytokines. Objectives:To investigate the role of endometrial injury during the luteal phase before ICSI cycles in the enhancement of pregnancy outcomes. Materials and Methods:This prospective study was undertaken in the High Institute of Infertility diagnosis and Assisted Reproductive Techniques / Al-Nahrain University. All women were undergone ICSI cycles. Women in the intervension group underwent endometrial scratching with a Pipelle catheter in luteal phase preceding cycle. Blood sample was taken before scratch. All patients undergo controlled ovarian hyperstimulation, oocyte retrieval and embryo transfer, another blood sample was taken at day of embryo transfer to measure level of TNF-α. Clinical pregnancy rate then evaluation after luteal support of two weeks. Results:The patients in scratch group has higher pregnancy rate (14/23) 60.9% than non intervention group (11/33) 33.3% although not significant (p value 0.057). The results showed that the TNF-α after scratch (54.53±10.2) was significantly higher than before scratch (39.26±14.74) in the same group, as p value was (<0.001). In addition the TNF-α was significantly higher in scratch group (54.53±10.2) than control (25.91±9.08) as p value was (< 0.001). Conclusion:Induced endometrial local injury is an easy, simple and cost-effective technique that can be used to improve the uterine receptivity and enhance embryo transplantation.

Despite many improvements in Assisted reproductive techniques during the last three decades, clinical pregnancy and live-birth rates still nearly 30–40% and 20–30%, respectively. To enhance endometrial receptivity many attempts done one of the endometrial scratching could provoke delay in endometrial maturation reforms asynchrony between endometrium and the concepts and indeed induce wound healing by producing a considerable raise in the local secretion of pro-inflammatory cytokines and growth factors like Heparin Binding Epidermal Growth Factor (HBEGF) and its receptors has role in mediate the receptivity, maturation, and decidualization of endometrium and facilitates the implantation and development of both placenta and embryo. All women were undergone IUI procedure. They divided into two groups. Intervention group who did endometrial scratching by using pipelle catheter in luteal phase of preceding cycle and another blood sample aspirated before scratch. Control group include women without intervention of endometrial scratch. Both groups underwent controlled ovarian stimulation, triggering of ovulation and another blood sample was aspirated at day of IUI to measure level of HBEGF. 14 days later with luteal support, BHCG test underwent in blood to check pregnancy. Higher pregnancy rate among patients with scratch group (5/20) 25% than non-interventional group (3/25)12%. These result showed that HBEGF level in scratch group (386.1±124.7) is significantly higher than control group (279±189.3) as P-value was (0.035). Moreover, the HBEGF level at day of IUI (455.67±157.34) and in pregnant (563.9±163.66) is significantly higher than before scratch in scratch group (279.0±124.67), (406.26±138.89), as P-values were (0.00007, 0.049) respectively. Intentional local damage to the endometrium is a cost–effective procedure can be used to enhance the uterine receptivity that may help to overcome implantation failure problem.

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