فهرست مطالب parvin hakimi

Despite advancements in the assisted reproduction technology (ART), the proportion of unexplained infertility is 30% among infertile couples. This study aimed to explore the pregnancy proportions in women with primary unexplained infertility who were given follicle-stimulating hormone (FSH) along with the human chorionic gonadotropin (hCG) trigger compared with those who were only given the hCG trigger.

In this randomized controlled trial, the women eligible for intrauterine insemination (IUI) were investigated between April 1, 2022 and April 1, 2023 at Al-Zahra referral academic center. To this end, a total of 130 women were primarily screened and then 50 ones were excluded from the study based on the pre-defined inclusion criteria. Therefore, the final study population consisted of 80 eligible women with primary unexplained infertility, who were randomly assigned to the intervention group (n=40) and control group (n=40). The patients in the intervention group received two ampules (75 IU) of FSH in addition to two ampoules (5000 IU) of hCG, while the patients in the control group only received hCG. Both groups underwent IUI 34-36 hours after the hCG triggering. The biochemical and clinical pregnancy rates were evaluated as primary outcomes.

No significant differences were observed between the baseline and clinical characteristics, including endometrial thickness and the number of follicles before intervention (P>0.05). However, the clinical pregnancy rate was higher in the dual FSH and hCG group (40.0%, 16/40) than that in the hCG group (20.0%, 8/40) (P=0.048). The chemical pregnancy rates were 32.5% (13/40) and 37.5% (15/40) for the hCG and dual FSH and hCG groups, respectively. No significant relationships were detected between the biochemical pregnancy and the number of gestational sacs (P>0.05).

The dual administration of FSH and hCG for oocytes, compared with the injection of hCG alone, improved the clinical pregnancy. The biochemical pregnancy and live birth rates as well as the number of gestational sacs were not improved significantly.

Ovarian hyperstimulation syndrome (OHSS) is a serious life-threatening complication of infertility treatment. Vulvar edema is a disease with various causes and frequent phenomena seen in physiological and pathologic conditions like pregnancy, inflammatory disorders, tumors, idiopathic reasons, and most importantly, in the severe form of OHSS.

Here, we report a 26-yr-old woman with severe OHSS, recombinant follicle-stimulating hormone therapy. 8 days later, we observed a mild and asymmetrical swelling of the vulva with severe edema in the right labia. Due to the worsening of the vulvar edema even after 15 days of conservative treatment, hand massage and compressive bandaging of the vulva were performed, which caused rapid recovery within 20 min of the case.

Treatment with a hand massage with lubricant gel followed by compressive bandaging resolved the vulvar edema immediately; it is an easy procedure without any adverse events.

In this article published in Int J Fertil Steril, Vol 16, No 2, April-June 2022, Pages: 90-94, the authors found that this sentence “Also, AMH level was not statistically significantly different after PRP treatment (0.38 ± 0.039) in comparison with before of treatment (0.39 ± 0.04, Fig.1C)” was incorrect. The corrected one is “Also, AMH level was not significantly different before PRP treatment (0.38 ± 0.039) in comparison with after of treatment (0.39 ± 0.04, Fig.1C)” in the first paragraph of the result section.The authors would like to apologies for any inconvenience caused.

Growth hormone (GH) is a potential treatment in the assisted reproductive technology (ART) to improve endometrial receptivity and thickness. In the current study, we investigated the effect of the intrauterine administration of GH on the endometrial thickness (EMT) and ART outcomes in the patients with refractory thin endometrium.

In this clinical trial study, women with a refractory thin endometrium and a history of one or more frozen embryo transfer (FET) cancellation who were referred to the infertility center of the Tabriz Al-Zahra hospital (Tabriz, Iran) and Milad Infertility Clinic (Tabriz, Iran) received intrauterine injections of GH every other day from day 14 of the menstrual cycle until the EMT reached ≥7 mm in addition to the routine endometrium preparation protocol. EMT was evaluated during the treatment and in the cases with EMT ≥7 mm, biochemical/clinical pregnancy was evaluated after embryo transfer.

Thirty-one women aged 35.29 ± 6.21 years were included in this study. The mean amount of EMT was significantly increased following the GH treatment (7.03 ± 1.23 mm) vs. before treatment (5.14 ± 1.1 mm, P<0.001). The EMT reached ≥7 mm in the 65% patients (20/31). Also, the embryo transfer resulted in pregnancy in the patients, biochemical pregnancy: 9/20 (45%) and clinical pregnancy: 7/20 (35%). There was a positive correlation between EMT on the day 13 of cycle (before the treatment) and the maximum EMT (r=0.577 and P=0.001). The EMT was statistically different on the embryo transfer day between clinically pregnant and non-pregnant women (7.18 ± 0.56 vs. 6.21 ± 0.72 mm, P=0.007).

The intrauterine administration of GH could be an appropriate therapeutic strategy for patients with refractory thin endometrium. This treatment could significantly increase the EMT as well as implantation and pregnancy rates in these patients (registration number: IRCT20210220050429N1).

Advanced age is associated with a decline in the natural oocytes, low oocyte yield, and also increases the assisted reproductive technology (ART) failure rate, and consequently resulted in a pregnancy rate decrease. Platelet-rich plasma (PRP) is one of the proposed therapeutic strategies for women with poor ovarian response (POR). Because of the autologous source of PRP, the lowest risks of disease transmission, immunogenic and allergic reactions have been expected. This study aimed to evaluate the single-dose intraovarian injection of autologous PRP in poor ovarian reserve. We conducted a clinical trial study in the Al-Zahra hospital and Milad Infertility Clinic, Tabriz, Iran (April and May, 2021). A total of thirty-five women with a POR and mean age 40.68 ± 0.34 enrolled in this study. After injection of autologous PRP into the ovaries, the number of oocytes, antral follicles, and level of estradiol, anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteal hormone (LH), FSH/LH ratio also were evaluated while, these parameters were evaluated before PRP administration.  At the 2-month follow-up, women treated with PRP showed a significant elevation in the number of oocytes (3.68 ± 0.24, P=0.0043) and embryos (3.17 ± 0.14, P=0.0001), as well as in the estradiol levels (404.1 ± 16.76 vs. 237.7 ± 13.14, P=0.0003).  Single PRP injection is effective and might be a promising therapeutic approach in the patients with POR to conceive with their own oocytes, although further evidence is required to assess the influence of PRP on the live birth rate.

Turner's syndrome is one of the relatively common chromosomal disorders characterized by the absence of all or part of one sex chromosome, with a prevalence of near one in 2500 live birth females. Most typical clinical characteristics of this syndrome include primary amenorrhea, hypogonadism, short stature, digital anomalies, and low hair line at the back of the neck. A large number of affected individuals have a 45,X monosomy; nevertheless, other structural abnormalities of X chromosome or 45,X with cell line mosaicism can also fulfill the criteria. In the current study we report two turner affected patients with dicentric X making an attempt to explain their phenotypes associated with deleted areas.

The first case was a 13-year old female who had edema and lymphoma during infancy. As she grew up, other symptoms of Turner’s syndrome such as short stature, broad shoulders, widely spaced nipples, short metacarpals, small womb, premature ovarian, and higher levels of FSH, LH, and prolactin were apparent. The second patient was a 12 year-old girl without obvious Turner’s syndrome in her infancy, but during her puberty, she showed short stature, short neck, broad chest, normal womb, premature ovarian, normal LH, and increased levels of FSH and prolactin.

The results of G-banding karyotyping depicted that the first patient had 46,X,dic(X) and she was monosomy for short arm of X chromosome, while the second patient was mosaic 45,X(60%)/46,X,dicX(40%). Considering the areas which have been deleted and also heterogenic phenotypes of each patient, roles of every involved gene in that regains have been regarded. With this regard for the exact detection of deleted areas, fluorescence in situ hybridization (FISH) is recommended. Also, carrier detection of parents with a history of affected child for assessing chromosomal abnormalities with the aim of preventing further affected child during their conception is suggested.

Oral progesterone is recommended as an alternative to gonadotropin-releasing hormone (GnRH) agonists and antagonists to prevent luteinizing hormone (LH) surge in assisted reproductive technology (ART) cycles. However, there are little data regarding its use.

We aimed to compare the effect of oral Utrogestan and Cetrotide (a GnRH antagonist) on preventing LH surge in ART cycles.

In this randomized clinical trial, 100 infertile women undergoing ART who received recombinant follicle-stimulating hormone (FSH) at 150-225 IU/day were randomly assigned to receive either Utrogestan 100 mg twice a day (case group) or GnRH antagonist protocol (control group) from cycle day 3 until the trigger day. Triggering was performed with 10,000 IU hCG) when there were at least three mature follicles. Viable embryos were cryopreserved for transfer in the next cycle for both groups. The number of oocytes retrieved and transfered embryos were compared between groups.

The case group had significantly higher progesterone levels on triggering day, more follicles of >14 mm with higher maturity, and more oocytes retrieved with a higher rate of embryos transferred. A small increase in the pregnancy rate was observed in the case group, with no significant between-group differences. The most important result was the lack of premature LH surge in either group upon serum LH assessment on the triggering day.

Utrogestan is an alternative treatment that could reduce the LH surge rate and increase the ART outcomes including number of oocytes retrieved and transfered embryos compared with GnRH agonists and antagonists.

  Infertility is considered as a major issue all over the world. All the studies in this field focus on how to develop successful methods of turning infertile couples into fertile ones. Endometrial mechanical injury in order to augment the probability of implantation of embryo and pregnancy rate has been particularly noted in recent years. Considering the controversies in the use of methods and results of the previous studies, we decided to compare the pregnancy and abortion rates in the intrauterine insemination (IUI) cycles with and without intervention, by employing a new method. This interventional study was performed on 150 infertile couples who referred to the infertility treatment clinic of Al-Zahra hospital, Tabriz (from April 2016 to March 2017) and were randomly divided into two groups. The IUI procedure was carried out in the first group after the endometrial scratch on the first to fifth days of the menstrual cycle, while the control group underwent only IUI without any intervention. The pregnancy and abortion rates were compared in study groups. Pregnancy rate in the intervention group was significantly higher compared to the control group. No relationship was observed between the abortion rate and the intervention. There was no statistically significant difference between type and cause of infertility, maternal age and body mass index (BMI), duration of infertility, number of dominant follicles and pregnancy or abortion rates. The endometrial scratching performed on the first to fifth days of the menstrual cycle, preceding IUI procedure, leads to a significant increase in pregnancy rate. On the other hand, this method can be employed with lower costs in comparison to other fertilization methods.

Assisted reproductive treatment (ART) cycle like in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) is an expensive procedure with low implantation and pregnancy rate. Endometrial pattern and thickness are suggested as the factors of endometrial receptivity and predictors of IVF-ICSI success. The correlation between endometrial pattern and thickness with pregnancy rate in IVF-ICSI cycles was evaluated in this study.
In this study, 150 patients with 150 cycles were included. Ovulation induction was performed by antagonist protocol and in the day of human chorionic gonadotropin (HCG) administration, thickness and pattern of endometrium were measured by transvaginal sonography. Two weeks after embryo transfer, pregnancy rate was defined by blood HCG and the correlation between pregnancy rate with thickness and pattern of endometrium in the day of HCG administration was evaluated.
Pregnancy rate in triple line pattern (TLP) was significantly higher than homogenous hypoechoic pattern (P = 0.006). Endometrium thickness was significantly higher in cases of pregnancy (P 9.5 mm in predicting pregnancy rate was 77.50% and 77.50%, respectively. In addition, the sensitivity and specificity of TLP alone or combined with endometrium thickness were 87.50%, 35.45%, 67.50% and 80.90%, respectively.
Thickness and pattern of endometrium both could predict pregnancy occurrence. Having TLP along with endometrium thickness > 9.5 mm, the possibility of pregnancy following IVF-ICSI increases.

The aim of the study was to investigate the role of medroxyprogesterone acetate (MPA) in the prevention of luteinizing hormone (LH) surge during controlled ovarian hyperstimulation (COH). Characteristics of cycle and pregnancy outcomes were compared in subsequent frozen-thawed embryo transfer (FET) cycles.
In a prospective controlled study, In vitro fertilization (IVF)/intracytoplasmic sperm injection treatment was done in 99 patients. In the case group, hMG and MPA were administered from third day of the cycle, simultaneously. As dominant follicles matured, ovulation was induced by hCG or GnRH agonist. hMG and GnRH were administrated to the control group. For later transfer in both protocols, viable embryos were cryopreserved. The primary outcome measured was the incidence of premature LH surge and a number of oocytes retrieved. Clinical pregnancy outcomes from FETs were secondary outcomes.
The number of oocytes retrieved in both case and control groups were equal. LH suppression persisted during ovarian stimulation in the case group, and there was no incidence of premature LH surge. There was no significant difference between amounts of follicles, mature follicles, oocytes resumed and obtained embryos between 2 groups (P > 0.05).
The results showed that in a woman undergoing COH, MPA as an oral drug was effective in the prevention of premature LH surge. The results would help to establish a new method for ovarian stimulation in combination with embryo cryopreservation.