The luteal phase (LP) in the fresh ICSI cycle is insufficient, adequate LP support is one of the approved treatments for improving implantation and pregnancy rates. It is generally known that the LP is inadequate after ovarian stimulation due to negative from supra-physiological blood levels of steroids released by numerous corporal luteal, LH concentrations are low during the luteal phase. In this study, patients were divided into two groups: (40) patients as study group; those who received GnRHa (Decapeptil 0.1 mg), three days after embryo transfer, in addition to conventional luteal phase support (LPS) in the LP to increase the implantation and pregnancy rate in IVF; and their control group (40) received standard LPS only. On the second day of stimulation, blood samples for FSH, LH, TSH, E 2 , and prolactin were taken. On the day of ovulation induction, measure E 2 , progesterone, and LH; and on the day of embryo transfers, measure progesterone and LH. The overall characteristics of the patients in both groups were not significantly different. There was also no significant change in the number of total oocytes, mean of metaphase II oocytes percent, cleavage rate, grade I embryo percent, or serum hormones level between the study and control groups (p > 0.05). GnRH agonist treatment in the luteal phase improves clinical pregnancy and implantation rate in fresh ICSI cycles but is not statistically significant.
Reactive oxygen species (ROS) are believed to play an important role in the function of the male and female reproductive system, as well as in embryonic development. If the balance between production and elimination of ROS is disturbed, pathogenic consequences would happen. Reactive oxygen species can sometimes exert damaging effects when overabundant, oxidative stress is hypothesized to have a negative impact on, for example, folliculogenesis, embryo development, oocyte maturation, oocyte fertilization, endometriosis, polycystic ovary syndrome and unexplained infertility .8-Hydroxy2-desoxy guanosine (8‐OHdG) is a sensitive indicator of DNA damage as a result of oxidative stress. The study aim was to evaluate follicular fluid levels of 8-Hydroxy2-desoxy guanosine in patients undergoing Intracytoplasmic Sperm Injection (ICSI) and compared the results between both pregnant and non-pregnant patients . One hundred and twenty-seven women included in this study, they underwent controlled ovarian hyper stimulation, program followed by ova pick up, at that time follicular fluid were obtained and freezes till the time of analysis for reactive oxygen species (ROS), patient injected oocyte was cultured in CO2 incubator, then embryo grading, embryo transfer, pregnancy rate and reactive oxygen species level were determined. Follicular fluid 8-OHdG was significantly lower in pregnant females (p < 0.001), 8-OHdG had negative correlations with grade 1 and grade 2 embryos and negative correlation with total blastocyst count. Follicular fluid levels of 8-OHdG provides sensitive tool to predict positive pregnancy outcome in women undergoing ICSI.
Glycotoxins termed as advanced glycation endproducts (AGEs) are made endogenously and exogenously. Maillard reaction is a chemical non-enzymatic process, between sugars and a free amino acid group of nucleic acids, proteins, and lipids which happens exogenously when handled with high temperature for a prolonged period and in a dry environment, resulting in glycotoxins (AGEs) formations. This reaction is responsible for the taste, color, and smell of food. Glycotoxins derived from food are absorbed in the intestine and store in cells and tissues. Also, glycotoxins are derived exogenously from smoking. While endogenous glycotoxins are generated by normal body physiology. Obesity and insulin resistance may induce glycotoxins (AGEs) accumulation. The objective of this study was to evaluate the relationship between glycotoxins (AGEs) and obesity. 66 infertile females who were undergoing intracytoplasmic sperm injection ICSI. These females were classified into three groups according to their body mass index. On the day of ova pick up the collect serum and follicular fluid for subsequent measurement of glycotoxins (AGEs) by ELISA kits. there was a significant difference in the concentration of glycotoxins in follicular fluid and serum between the three ICSI groups of patients. As well as there was a significant difference in the concentration of glycotoxins (AGEs) in follicular fluid and serum in the same ICSI groups of patients. there is a significant positive relation between glycotoxins (AGEs) and increase BMI.
Hyaluronic acid (HA) is an anionic, non-sulfated glycosaminoglycan distributed widely throughout connective, epithelial, and neural tissues. The study included 40 infertile females. A full history taking, complete general examination, complete gynecological examination, and infertility workup including basal hormonal analysis, and uterine cavity assessment by ultrasound and tubal patency evaluation by hysterosalpingogram was done in addition to husband’s seminal fluid analysis. The control group did not receive any ovarian stimulation drugs, while the 2 nd group was treated with letrozole + gonadotropin. The ovarian stimulation protocol was chosen for each patient according to her age, history, and hormonal assay. Evaluation of thickness and pattern of the endometrium, size, and the number of mature follicles was performed by transvaginal ultrasonography on the 2 nd day of the menstrual cycle and cycle day 11-14 before hCG injection. The study showed no correlation between HA and LH at triggering day in women who received letrozole plus Gonadotropin but a positive correlation was documented between HA concentration and E 2 in addition to a positive correlation with progesterone, the number of follicles, and endometrial thickness at the day of triggering of ovulation. The study revealed that mean hyaluronic acid concentration was elevated significantly (P<0.05) in pregnant women after stimulation protocol compared with nonpregnant (164.2 vs. 152.1 pg/ml). HA was significantly higher in women who undergo ovarian stimulation with letrozole which was a good protocol in the treatment of women with ovulatory problems.
Intrauterine insemination has an important role in the treatment of infertile couples. Usage of vaginal misoprostol therapy at the time of intrauterine insemination has been investigated, and its tolerability and effects on clinical pregnancy rates still questionable. To assess the effectiveness of vaginal misoprostol on some demographic characteristics and hormones level with a success rate of Intrauterine Insemination. the period of collection of patients extended from Sep. 2018 until May 2019. Eighty-one infertile couples who attended Al Nahrain University, High Institute for Diagnostic Infertility and Assisted Reproductive Technologies, and private fertility clinics were enrolled through this study. Divided into two groups, the next group received 100 µg vaginal misoprostol immediately after completion of the IUI procedure, while the control group was subjected to ordinary IUI procedure without adjunctive therapy. The mean of demographic data of body mass index, age, and duration of infertility was statistically insignificant in control, Misoprostol post-intrauterine insemination. The percentage of pregnancy rate in the control group 5.0% and it 19.5% in the Misoprostol post-intrauterine insemination group. Moreover, there are significant differences in pregnancy rates among all study groups. According to this study, there is no significant result of pregnancy occurrences correlated with, female age, male age, and body mass index, duration of infertility or type of infertility, hormone levels. Misoprostol use after intrauterine insemination has a positive impact on pregnancy outcome in the control group 5.0% and it 19.5% in Misoprostol post-intrauterine insemination group. Smaller doses (100 µg) of misoprostol can decrease side effects without affecting the outcome.
Gonadotropin-releasing hormone antagonists are one of the GnRH analogs that were used in assisted reproductive technologies to produce prompt downregulation of pituitary gonadotropin secretion. During conventional antagonist protocol (CAP), exposure to high LH and E 2 occur that have the potential to worse clinical reproductive results. So the downregulation of pituitary secretion for short period during early follicular phase will result in synchrony in follicular developments and this will improve mature oocytes and total embryos numbers. 44 women as normal responders undergoing ICSI-ET cycles were randomized into two groups. The conventional group (CG) (n 30), gonadotropin started from menstrual cycle day 2 or 3 and continue until hCG trigger day, flexible protocol in which GnRH antagonists administered with follicular size (13-14 mm). In the sandwich group (SG) (n 14), a GnRH antagonist was administered for three days in which GnRH antagonists administered with follicular size (13-14 mm). Gonadotropin started from menstrual cycle day 3 and continue until hCG trigger day. Retrieved and MII oocyte mean numbers were significantly higher in SG than in CG ( P = 0.006, and 0.025), respectively. Embryos and frozen embryos mean total numbers were significantly higher in SG than in CG ( P = 0.004). SG patients have a higher pregnancy rate of 9/14 (64.3 %) than CG 12/30 (40.0 %) although not significant ( P =0.057). Early and short GnRH antagonists proved improvements in synchronization of follicular development, retrieved mature oocytes numbers, total embryos, frozen embryos, and pregnancy rates.