sajedeh samadnia

Repeated implantation failure (RIF) refers to the condition where high quality embryos are unable tosuccessfully implant after multiple cycles of in vitro fertilization (IVF) treatment. The aim of this study is to investigatethe impact of intrauterine granulocyte colony-stimulating factor (G-CSF) and platelet-rich plasma (PRP) onpregnancy rate in patients with RIF. The present randomised clinical trial study was conducted at the IVF Centre of MehrMedical Institute in Rasht, Iran, from 2020 to 2022. The research consisted of 200 individuals who had experiencedmultiple failed cycles. These patients were randomised into two groups: intrauterine infusion of 1 ml of G-CSF andintrauterine infusion of 1 ml autologous PRP at least 48 hours before embryo transfer (ET). The groups were comparedin terms of implantation rate, and chemical, clinical, and ongoing pregnancy. The implantation rate was significantly higher in patients who received PRP (P=0.016). Chemical pregnancy inthe PRP group was significantly higher than G-CSF group (P=0.003). Both clinical pregnancy and ongoing pregnancyrates were significantly higher in the PRP group (P=0.001) compared to the G-CSF group (P=0.02). The utilisation of PRP via intrauterine infusion is considerably more successful than G-CSF in enhancingpregnancy and live birth rates among patients with RIF. (registration number: IRCT20180528039878N3).

Insufficient serum progesterone level in the implantation phase may reduce the rate of pregnancy during freeze embryo transfer (FET) cycles. The present study aimed to evaluate the impact of FET day serum progesterone level on pregnancy outcomes in patients receiving intramuscular plus vaginal progesterone administration for endometrial preparation.

Based on serum progesterone level on FET day, patients were divided into four quartiles: first ( < 25%), second (26–50%), third (51%–75%), and fourth ( > 75%). There was no significant difference among groups in basal characteristics.

No statistically significant difference was seen among groups concerning the mean number of retrieved and mature oocytes, embryos transferred, and endometrial thickness (EnT). The rate of implantation (P = 0.5), biochemical (P = 0.75), clinical (P = 0.54), and ongoing pregnancy (P = 0.5) were not associated with serum progesterone level on embryo transfer day.

We found that there is no association between serum progesterone level on ET day and pregnancy outcome during FET cycles. It seems that combination therapy using intramuscular and vaginal progesterone, keeps the serum progesterone on ET day high enough that eliminates the need for serum progesterone measurement.

The effect of storage time and temperature on the prepared semen sample was evaluated, but the optimal condition is unclear. The aim of this study was to assess the effect of long-term incubation of prepared sperm at testicular temperature versus room temperature on semen parameters and DNA fragmentation index (DFI).

Sperm samples were collected from 40 patients between 2019 and 2020. Each sample was separated into two parts and underwent a non-direct swim-up method. One group was placed in a 35°C incubator, and the other group was kept at room temperature (26°C) in the dark. Both groups were evaluated at intervals of 45 minutes, 24 hours and 48 hours after sampling in terms of sperm concentration, motility, morphology, and DFI. Student t-test and repeated measures analysis of variance were used.

Sperm count (P=0.007) and motility (P<0.001) at 26°C in three-time intervals of 45 minutes, 24 hours and 48 hours were significantly higher than 35°C. The proportion of normal morphology spermatozoa at 26 and 35°C at 45 min, 24 h, and 48 h did not show a significant difference (P=0.08). DFI at 26°C in three-time intervals was significantly lower than 35°C (P=0.008).

 The results of this study indicated that when the prepared sperm samples are incubated for 24 h at 26°C compared to 35°C, they show significantly better quality and good quality of sperm can be retained for several hours if stored at room temperature.

There is conflicting evidence regarding the impact of season on the assisted reproductive technology outcome.

To retrospectively compare three-year outcome of women undergoing their first intracytoplasmic sperm injection cycle, across seasons.

In this descriptive cross-sectional study, 3,670 women who underwent their first intracytoplasmic sperm injection cycle in Mehr Medical Institute, Rasht, Iran between April 2010 and May 2014 were studied. Women were divided into four groups according to the day of oocyte retrival as: spring (n = 808), summer (n = 994), autumn (n = 1066), and winter (n = 802). Basal and stimulation charecteristics were compared among groups.

While sperm concentration and motility were significantly lower during summer, the total number of retrieved and metaphase II oocytes were significantly higher (p = 0.0001, p = 0.0001, p = 0.004, p = 0.02, respectively). Fertilization rate were significantly higher during autumn (p = 0.0001). Also, the number of high- quality transferred embryos were significantly higher during summer and winter (p = 0.03). A similar pattern was observed in implantation rate and pregnancy over the four seasons

Despite the fact that intracytoplasmic sperm injection minimize the seasonal effect on pregnancy outcome, changes in pregnancy rate still occur among different seasons without particular pattern. It seems that performing assisted reproductive technology procedures in a particular season should be considered as an effective factor.

While anti-Müllerian hormone (AMH) level allows quantitative evaluation of ovarian reserve, its predictive value for live births following assisted reproductive technology cycles has remained controversial. The aim of the present study was to assess the importance of AMH in predicting live birth following intrauterine insemination (IUI) in the case of low or very low ovarian reserve.
In this retrospective cohort study, 123 patients with AMH≤1 ng/ml, who underwent a total of 137 IUI cycles were enrolled and evaluated for live birth rate. Patients were divided into two groups based on serum AMH levels: group 1 with low level of AMH (0.4-1 ng/ml, n=83, cycles: 95) and group 2 with very low level of AMH (≤0.4 ng/ml, n=40, cycles: 42). The results were compared between the two groups. Main outcome was the pregnancy rate.
The rates of biochemical pregnancy, clinical pregnancy and live birth in all patients were 11%, 8% and 7.3%, respectively. The two groups showed no significant difference in the rates of biochemical pregnancy (10.4% vs. 14.3%, p=0.3), clinical pregnancy (6.3% vs. 11.9%, p=0.2) and live birth (6.3% vs. 9.8%, p=0.5). In univariate regression analysis, baseline characteristics and ovarian stimulation parameters showed no significant relationship with the rates of pregnancy and live birth.
In women with AMH≤1 ng/ml, serum levels of AMH did not appear to reflect pregnancy outcomes and live births following IUI. It can be concluded that in women with low or very low levels of AMH, there is chance of pregnancy, and live birth following IUI.

There are conflicting results regarding the benefit of gonadotropin releasing hormone (GnRH) agonist treatment on frozen embryo transfer (FET) outcome. No study was found to compare pregnancy outcome between patients undergoing short and long acting types of GnRH agonist for FET cycles. This study aimed to assess the effectiveness of short and long acting GnRH agonist on FET cycle outcomes.

The present retrospective study was conducted on 296 patients who underwent FET cycles between 2016 and 2017 at Mehr Medical Institute, Rasht, Iran. Pregnancy outcome were compared among three groups: Group A (n=103) received artificial hormone-mediated cycles without GnRH agonists, Group B (n=100) and C (n=93) received artificial hormone-mediated cycles with short and long-acting GnRH agonists, respectively. Also 16, 26, 12 polycystic ovarian syndrome (PCOS) patients (in group A, B and C respectively) were also assessed for ongoing pregnancy rate among three groups. Data were analyzed using analysis of variance, Kruskal-Wallis, Chi-square goodness of fit test and multivariate logistic regression.

No statistically significant differences were observed in terms of endometrial thickness (p=0.053), implantation (p=0.94), biochemical (p=0.67), clinical (p=0.82) and ongoing (p=0.96) pregnancy rates in three groups. Also, PCOS patients did not show significant differences in ongoing pregnancy rate among three groups (p=0.72).

The findings revealed that neither non- PCOS nor PCOS patients undergoing artificial hormone-mediated endometrial preparation benefit from the addition of short or long-acting GnRH agonist to FET cycles.

Expression of granulocyte colony stimulating factor (G-CSF) and its receptors in embryo and endometrium implicates the involvement of this glycoprotein on implantation process. In the present study, we aimed to evaluate the impact of routine use of subcutaneous administration of G-CSF on pregnancy outcomes in intracytoplasmic sperm injection (ICSI) patients.

In this retrospective study, ICSI outcomes were compared between two groups of patients: the first group (n=108) who received subcutaneous G-CSF (300 mcg) two hours before the embryo transfer and the second group (n=110) who did not receive it. Pregnancy outcome was compared between the two groups. P-value<0.05 was considered statistically significant.

There was no significant difference between G-CSF and control groups with respect to the rate of implantation (respectively, 23%vs. 23%, p=0.49), chemical (respectively, 43.5%vs. 50%, p=0.34) and clinical (respectively, 40.7% vs. 46.4%, p=0.23) pregnancy. In logistic regression analyses, subcutaneous G-CSF administration was not associated with clinical pregnancy in both crude and adjusted odds ratios (OR) with 95% confidence interval (CI) (crude OR: 0.8, CI: 0.47-1.36, p=0.4, and adjusted OR: 0.99, CI: 0.48-2.07, p=0.99).

In the present study, subcutaneous G-CSF did not improve pregnancy outcomes in patients undergoing ICSI; therefore, the routine use of this cytokine is not suggested for all patients.

Despite the advancements in assisted reproductive technologies, repeated implantation failure (RIF) still remains a challenging problem for patients and clinicians. The aim of the present study was to compare the impact of intrauterine infusion of autologous platelet-rich plasma (PRP) and systemic administration of granulocyte colony stimulating factor (GCSF) on pregnancy outcome in patients with repeated implantation failure. The present retrospective cohort study included 123 patients with history of more than two repeated failed embryo transfers. Cycles were divided into two groups of intrauterine infusion of PRP (n=67) and systemic administration of GCSF (n=56). Pregnancy outcome was compared between two groups. The p-value less than 0.05 was considered statistically significant. The clinical pregnancy rate was significantly higher in PRP group than GCSF group (40.3% versus 21.4%, p=0.025). The crud and adjusted odds ratios (95% confidence interval (CI)) were 2.5 and 2.6 (p=0.025, CI: 1.11-5.53 and p=0.03, CI: 1.10-6.15), respectively. It seems that intrauterine infusion of PRP can positively affect pregnancy outcome in RIF patients in comparison with systemic administration of GCSF and more studies need to be designed to conclude the effectiveness of this method.