Poor ovarian responders (PORs) are characterized by decreased the response of the ovaries to stimulation. Nowadays, using soft protocol of low doses of Gn with/without oral compounds such as letrozole was accepted as a good option. The endometrium receptive parameters include sub endometrial resistance, pulsatility index and endometrial thickness. Eighty infertile POR women divided to two equal groups and undergoing IVF/ICSI antagonist protocols. One group underwent soft protocol using letrozole 2.5mg twice daily for 5 days starting from cycle day 2-3 overlapped low-dose Gn (225 IU) from cycle day 4-5. Other group received high dose Gn only (450 IU) from cycle day 2-3. Both groups continued stimulation cycle until the day of trigger using the flexible antagonist protocol. Estimation of values of sub endometrial RI and PI with endometrial thickness by 2 Color Doppler ultrasound was performed at day of trigger, OCP and ET. There was no significant difference for endometrial thickness at day of trigger, OCP and ET. There was significant difference in means of sub endometrial RI and PI at day of trigger, OCP and ET (P>0.05). This study showed evidence in favor of soft protocol for POR regarding pregnancy rates in spite of the statically difference in means of sub endometrial RI and PI associated with much less cost effectiveness.
Inhibition of luteinizing hormone (LH) by gonadotropin releasing hormone (GnRH) antagonist may lead to suboptimal response during ovarian stimulation. In addition, several studies suggest that low level of LH is associated with lowered fertilization and implantation rate and increased early pregnancy loss rate. The aim of this study is to study the effect of adding low dose human chorionic gonadotropin (hCG - 200 IU), as an LH supplement, to recombinant follicle stimulating hormone (rFSH) in a GnRH antagonist cycles in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. Sixty-three infertile women undergoing IVF were randomly divided into two groups. One group was stimulated with the conventional stimulation protocol (rFSH alone), while the second group received 200 IU hCG in addition to rFSH in the late follicular phase (hCG + rFSH). Both groups' results including pregnancy rate, total dose of rFSH required, duration of stimulation, endometrial thickness, oocytes and embryos characteristic, serum hormone levels (Testosterone, Estradiol, Progesterone, and LH) and level of epidermal growth factor (EGF) were compared. The results show that pregnancy rate among the group of women who received the low dose hCG was higher than those who did not receive hCG. However, this difference did not reach statistical significance. Furthermore, other cycle outcomes and hormonal values were comparable between the two stimulation protocols.
Non-steroidal anti-inflammatory medications may interfere with ovulation, implantation, and pregnancy; they are generally avoided during reproductive procedures. The risks of using them during IVF must be carefully weighed against the necessity of pain relief during oocyte retrieval. About 64 women (ages 20–42) undergoing ICSI participated in a single-blind, cross- sectional clinical trial at the High Institute for Infertility at Al-Nahrain University from October 2024 to May 2025. During oocyte retrieval, participants were split into two groups at random and given propofol anesthesia and ketorolac analgesia, respectively. They all adhered to a common protocol for ovarian stimulation. Based on their maturity stage (MII, MI, or GV), oocytes were categorized; those that were aberrant or degenerated were not included in ICSI. ELISA was used to measure the levels of cortisol and serum LH both before and after oocyte retrieval. The mean post -operation LH Marker level were 10.41±8.0, 6.40± 7.48 among GA and analgesia groups respectively, this relation was statistically significant (P value =0.04). The mean Post -operation Cortisol Marker level were 201.13±132.34, 159.13± 78.42 among GA and analgesia groups respectively . The mean number of Oocytes: Similar for both groups (10±5.53 for anesthesia and 10.59±5.44 for analgesia). Abnormalities of Oocytes: slightly lower in the group receiving anesthesia (0.56±1.44 vs. 0.69±1.18). The anesthesia group had fewer ruptured oocytes (0.16±0.45 vs. 0.25±0.57). Fertilized embryos: Grade I: The anesthesia group had slightly fewer (2.75±2.63 vs. 3.13±2.46). Grade II: Groups are comparable (1.41±1.58 vs. 1.31±1.53). Grade III: Lower in the group under anesthesia (0.19±0.54 vs. 0.38±0.83). Similar results were obtained from arrested embryos (anesthesia: 0.63±1.1, analgesia: 0.68±1.64). The analgesia group had a significantly higher number of transferred embryos (anesthesia: 1.84±1.08, analgesia: 2.88±1.62; P = 0.004). The analgesia group showed a significant decrease in post-operation LH marker, Cortisol Marker, and higher mean number of transferred embryos compared to the anesthesia group.
The crosstalk between a receptive endometrium and a functional blastocyst during human embryo implantation is crucial for conception. Because platelets rich plasma (PRP) with concentrated platelets 4-5 times higher than normal, when release of granules containing growth factors including VEGF, TGF, PDGF, IGF, and EGF, these factors involved for sub endometrial angiogenesis and endometrial receptivity. 44 women under the age of 40 were given antagonist ovarian stimulation treatments, the oocytes were harvested utilizing 2-D power doppler ultrasound guidance, then ICSI done for them. On the hCG day all had an intrauterine autologous PRP infusion. Power Doppler is utilized to measure endometrial thickness (EnT), pulsatility index (PI), and resistance index (RI) of sub endometrial arteries, as well as serum levels of VEGF and EGF were measured on the hCG day and ovum pickup (OPU). The ultrasound findings, on the hCG day compared to those of OPU in all women with intrauterine infused autologous PRP were highly significant (HS). The mean EnT, RI, PI, VEGF and EGF at OPU day was lower than that on hCG day in a HS manner, with (p < 0.001), (p < 0.001), (p=0.047), (p < 0.001), and (p<0.001) respectively. These characteristics were shown to be significantly and independently associated to intrauterine PRP infusion. After PRP injection, both growth factors serum levels (VEGF and EGF) increased, and ultrasonography sub-endometrial metrics such as EnT, RI, and PI changed as the thickness grew while vascular resistance decreased, and all considered as predictors of endometrial receptivity.
In recent years increasing evidence proposed that local immune cells at implantation site have largely contributed to embryo implantation. The intrauterine infusion of activated peripheral blood mononuclear cells culture 2 days before embryo transfer can enhance the implantation. One of the methods used to evaluate the endometrial receptivity is by assessing the sub endometrial blood flow. A total of 67 infertile women (30) women receives intrauterine non-invasive insemination of peripheral blood mononuclear cells (PBMC) culture 2 days before embryo transfer representing the PBMC test group, and (37) women without receiving any cell as Non-PBMC group. The cultured PBMC are administered into the uterine cavity of the patients. 2 days later, embryos are transferred into the uterine cavity. Endometrial thickness and sub-endometrial blood flow measurements are taken for all cases on trigger and embryo transfer days. On embryo transfer day there was no significant difference (p = 0.770) in mean endometrial thickness between the PBMC group and Non-PBMC group. There was a significant difference (p< 0.001) in the mean resistive index; the level being lower in the PBMC group. Moreover, there was a significant difference (p< 0.001) in the mean pulsatility index. Regarding all enrolled women, the pregnancy rate of 25.4 %, the rate was higher in the PBMC group in comparison with the Non-PBMC group, 43.3 % versus 10.8 %, respectively and the difference was significant (p = 0.002). The use of PBMC culture can improve sub-endometrial. Endometrial Receptivity, ICSI, Fresh Embryo Transfer, Peripheral
Fertility is a fundamental function of reproductive health that is under the control of different hormones, cytokines, and growth factors. Transforming growth factor superfamily is a group of cytokines necessary for blastocyst implantation as they regulate endometrial stromal cell proliferation, and promote embryonic adherence to the receptive endometrium. Hyaluronic acid molecule (HA) is a long, unbranched polysaccharide that plays a delicate function in reproduction. Hyaluronic acid regulates gametogenesis, folliculogenesisi, and implantation, thereby was oroposed to improve the rate of successful pregnancy.This study is a prospective clinical trial that includes 80 infertile Iraqi women aged (18-40 years) scheduled for fresh ICSI program. The study sample had been divided into 2 groups based on the type of intervention performed on the day of oocytes retrieval. The Hyaluronic acid group and the control group. For each participant, twice measurement of the serum level of transforming growth factor were done , the first measure was done on day of oocytes retrieval, while the second measure was performed on day of embryo transfer. A comparative statistic was made to examine the effect of hyaluronic acid intrauterine wash on the serum level of transforming growth factor and pregnancy rate.Hyaluronic acid intrauterine wash exerts a significant reduction in transforming growth factor serum level, and a significant improvement in the pregnancy outcome compared to the control group.