Cover
Vol. 12 No. 2 (2022)

Published: August 31, 2022

Pages: 62-80

Research Article

The Effect of Magnesium Sulfate Administration at Day of Embryo Transfer on Improving Subendometrial Blood Flow, Endometrial Receptivity, Implantation Rate and Clinical Pregnancy Rate.

Iqbal A. Fahad 1 Lubna A. Al-Anbari Muayad S. Abood
1High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq.
History
  • Received: September 7, 2022
  • Accepted: September 30, 2022
  • Available Online: October 8, 2022
DOI

https://doi.org/10.28969/IJEIR.v12.i2.r5.22

Abstract

For successful implantation, a high-quality embryo, receptive endometrium, and tight communication between the two are required. The lack of uterine contractions during embryo transfer is one of the characteristics that greatly affects endometrial receptivity. This is because it has been observed that ET may cause uterine contractions, which may be harmful to embryonic apposition and endometrial blood flow .The aim of this study was to assess how magnesium sulfate administration on the day of embryo transfer improve sub endometrial blood flow, endometrial receptivity, and increase implantation rate and clinical pregnancy rate . Eighty infertile women undergoing ART cycles participated in this prospective. Recombinant FSH (Gonal-F) was used in a controlled ovarian hyperstimulation technique. The first group A (n=40) got a 4gm infusion of magnesium sulfate, while the second placebo control group B (n=40) received 200ml of 5% glucose water as a placebo, respectively. While there were no significant changes in body mass index (BMI), endometrial thickness, number of transferred embryos, or embryo transfer day, significant variations were seen in patient mean age (p<0.001) and mean number of grades I embryo (P=0.003). It was significantly different after magnesium sulfate administration with the lowest value in magnesium sulfate group (P=0.024; P <0.001 and P <0.001 respectively). Implantation rate and clinical pregnancy rate both increased after drugs administration although it was non-significant (P= 0.106 and P= 0.348 respectively). It appears that magnesium sulfate injection before to embryo transfer can significantly increase sub endometrial vascularity and endometrial receptivity and improving implantation rate and clinical pregnancy rate non significantly in ICSI cycles by lowering uterine muscular

Keywords

References

  1. Sardana, D., Upadhyay, AJ., Deepika, K., Pranesh, GT., Rao, KA. (2014). Correlation of sub-endometrial-endometrial blood flow assessment by two-dimensional power Doppler with pregnancy outcome in frozen- thawed embryo transfer cycles. J Hum Reprod Sci. 7 (2):130-5. Doi: 10.4103/0974- 1208.138872. PMID: 25191027; PMCID: PMC4150140.
  2. Eftekhar, M., Mehrjardi, S.Z., Molaei, B. (2020). The correlation between endometrial thickness and pregnancy outcomes in fresh ART cycles with different age groups: a retrospective study. Middle East Fertil Soc J. 24 (10). https://doi.org/10.1186/s43043-019- 0013-y
  3. Elnashar, AM., Aboul-Enein, GI. (2004). Endometrial receptivity. Middle East Fertil Soc J. 9:10–24.
  4. Jain, S., Mahey, R., Malhotra, N., Kalaivani, M., Sangeeta, P., Bhatt, A., Singh, N., Kriplani, A. (2018). Effect of Intrauterine Perfusion of Granulocyte Colony-stimulating Factor on Endometrial Parameters and In Vitro Fertilization Outcome in Women Undergoing In Vitro Fertilization/Intracytoplasmic Sperm Injection Cycles: A Randomized Controlled Trial. J Hum Reprod Sci. 11 (3):254-260. Doi: 10.4103/jhrs.JHRS_20_18. PMID: 30568355; PMCID: PMC6262668.
  5. Saravelos, SH. , Wong, AW., Chan, GW., Cheung, LP., Chung, CH. (2016).Assessment of the embryo flash position and migration with 3D ultrasound within 60 min of embryo transfer. Hum Reprod . 31:591-
  6. pmid:26759141
  7. Munro, MG. (2019). Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity. Fertil Steril. 111 (4):629-640. doi: 10.1016/j.fertnstert.2019.02.008. PMID: 30929720.
  8. Prasad, S., Kumar, Y., Singhal, M., Sharma, S. (2014). Estradiol Level on Day 2 and Day of Trigger: A Potential Predictor of the IVF-ET Success. J Obstet Gynaecol India. 64 (3):202-7. doi: 10.1007/s13224-014-0515- 6. Epub 2014 Feb 27. PMID: 24966506; PMCID: PMC4061344.
  9. Altriagey, A., Dawood, AS., Babikir, GS. (2019). Three-dimensional ultrasonography and assisted reproductive technology. MOJ Womens Health. 8 (1):71-76. DOI: 10.15406/mojwh.2019.08.00215
  10. Lv, H., Li, X., Du, J., Ling, X., Diao, F., Lu, Q., Tao, S., Huang, L., Chen, S., Han, X., Zhou, K., Xu, B., Liu, X., Ma, H., Xia, Y., Shen, H., Hu, Z., Jin, G., Guan, Y., Wang, X. (2020). Effect of endometrial thickness and embryo quality on the live-birth rate of fresh IVF/ICSI cycles: a retrospective cohort study. Reprod Biol Endocrinol.18 (1):89. Doi:
  11. 1186/s12958-020-00636-6. PMID: 32825835; PMCID: PMC7441697.
  12. Choudhary, M., Chowdhary, J., Swarankar, ML. (2017). Predictive value of sub endometrial–endometrial blood flow assessment by transvaginal 3D power Doppler on the day of HCG on clinical outcome of IVF cycles. International Journal of Research in Medical Sciences.3 (11):3114– 3118 .
  13. Yuan, C., Song, H., Fan, L. (2019). The Effect of Atosiban on Patients With Difficult Embryo Transfers Undergoing In Vitro Fertilization–Embryo Transfer. Reprod Sci. 26: 1613–1617. https://doi.org/10.1177/1933719119831791.
  14. Di Renzo, GC., Cabero Roura, L., Facchinetti, F., Helmer, H., Hubinont, C., Jacobsson, B., Jørgensen, JS., Lamont, RF., Mikhailov, A., Papantoniou, N., Radzinsky, V., Shennan, A., Ville, Y., Wielgos, M., Visser, GHA. (2017). Preterm Labor and Birth Management: Recommendations from the European Association of Perinatal Medicine. J Matern Fetal Neonatal Med. 30 (17):2011-2030. [PubMed] [Reference 1list]
  15. Kuijsters, NPM., Methorst, WG., Kortenhorst, MSQ., Rabotti, C., Mischi, M., Schoot, BC. (2017). Uterine peristalsis and fertility: current knowledge and future perspectives: a review and meta-analysis. Reprod Biomed Online. 35 (1):50-71. doi: 10.1016/j.rbmo.2017.03.019. Epub 2017 Apr 12. PMID: 28456372.
  16. Pandey, S ., Shetty, A., Hamilton, M ., Bhattacharya, S., Maheshwari, A. (2012). Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Human reproduction update. 18 (5):485-503.
  17. Elnaggar, A., Farag, AH., Gaber, ME., Hafeez, MA., Ali, MS., Atef, AM. (2017). AlphaVBeta3 Integrin expression within uterine endometrium in unexplained infertility: a prospective cohort study. BMC Women’s Health. Springer Science and Business Media LLC. 17 (1). [Online article link]
  18. Sharma, N., Saravanan, M, Saravanan Mbbs, L., Narayanan, S. (2019). The role of color Doppler in assisted reproduction: A narrative review. Int J Reprod Biomed. 17 (11):779-788. doi: 10.18502/ijrm.v17i10.5484. PMID: 31911960; PMCID: PMC6906874 .
  19. Robert, CA., Abbas, MK., Zaidi, ARZ., Thiha, S., Malik, BH. (2019). Mediator in the Embryo-endometrium Cross-talk: Granulocyte Colony-stimulating Factor in Infertility. Cureus. 11 (8):e5390. doi: 10.7759/cureus.5390. PMID: 31428551; PMCID: PMC6695290.
  20. Chen, X., Man, GCW., Liu, Y., Wu, F., Huang, J., Li, TC., Wang, CC. (2017). Physiological and pathological angiogenesis in the endometrium at the time of embryo implantation. Am J Reprod Immunol. 78 (2):e12693.
  21. Osaghae, BE., Arrowsmith, S., Wray, S. (2020). Gestational and Hormonal Effects on Magnesium Sulfate’s Ability to Inhibit Mouse Uterine Contractility. Reprod. Sci. 27: 1570– 1579. https://doi.org/10.1007/s43032-020- 00185-8
  22. Catterall, WA. (2011). Voltage-gated calcium channels. Cold Spring Harb Perspect Biol. 3 (8):a003947. Doi: 10.1101/cshperspect.a003947. PMID: 21746798; PMCID: PMC3140680.
  23. Pierzynski, P. (2011). Oxytocin and vasopressin V (1A) receptors as new therapeutic targets in assisted reproduction. Reprod Biomed Online. 22: 9–16
  24. Lan, VT., Khang, VN., Nhu, GH., Tuong, HM. (2012). Atosiban improves implantation and pregnancy rates in patients with repeated implantation failure. Reprod Biomed Online. 25 (3):254-60. doi: 10.1016/j.rbmo.2012.05.014. Epub 2012 Jun 16. PMID: 22818095.
  25. Schwarze, JE., Crosby, J., Mackenna, A. (2020). Atosiban improves the outcome of embryo transfer. A systematic review and meta-analysis of randomized and non- randomized trials. JBRA Assist Reprod. 24 (4):421-427. Doi: 10.5935/1518- 0557.20200016. PMID: 32401462; PMCID: PMC7558905.
  26. Moraloglu, O., Tonguc, E., Var, T., Zeyrek, T., Batioglu, S. (2010). Treatment with oxytocin antagonists before embryo transfer may increase implantation rates after IVF. Reprod Biomed Online. 21 (3):338-43. doi: 10.1016/j.rbmo.2010.04.009. Epub 2010 Apr 18. PMID: 20638340
  27. Kim, A., Jung, H., Choi, WJ., Hong, SN., Kim, HY. (2014). Detection of endometrial and sub-endometrial vasculature on the day of embryo transfer and prediction of pregnancy during fresh in vitro fertilization cycles. Taiwan J Obstet. Gynecol. 53: 360– 365
  28. Pierce, N., Mocanu, E . (2018). Female age and assisted reproductive technology. Global Reproductive Health. 3 (2):e9 doi: 10.1097/GRH.0000000000000009
  29. Sivrikoz, Ts., Özgör, By., Bilgiç, Be., Kutlu, Ht. (2021). Investigation of factors affecting the success rates of in vitro fertilization followed by a failed cycle. Journal of Istanbul faculty of medicine.84 (1): 20–26.
  30. Fanchin, R., Righini, C., Olivennes, F., Taylor, S., de Ziegler, D., Frydman, R. Uterine contractions at the time of embryo transfer alter pregnancy rates after in-vitro fertilization. Hum. Reprod. 1998; 13: 1968– 1974.
  31. Mackens, S., Santos-Ribeiro, S., Orinx, E., De Munck, N., Racca, A., Roelens, C., Popovic-Todorovic, B., De Vos, M., Tournaye, H., Blockeel, C. (2020). Impact of Serum Estradiol Levels Prior to Progesterone Administration in Artificially Prepared Frozen Embryo Transfer Cycles. Front Endocrinol (Lausanne). 11:255. doi: 10.3389/fendo.2020.00255. PMID: 32425886; PMCID: PMC7204383.
  32. Li, Q., Ruan, L., Zhu, L. (2022). Elevated estradiol levels in frozen embryo transfer have different effects on pregnancy outcomes depending on the stage of transferred embryos. Sci Rep .12: 5592. https://doi.org/10.1038/s41598-022-09545-7
  33. Labarta, E., Mariani, G., Holtmann, N., Celada, P., Remoh, J., Bosch, E. (2017). Low serum progesterone on the day of embryo transfer is associated with a diminished ongoing pregnancy rate in oocyte donation cycles after artificial endometrial preparation: a prospective study. Hum Reprod .32:2437– 2442.