Background: Recently the reproductive hormones, Anti-Mullerian hormone (AMH), activin A, and follistatin (FS) have been found to play an important role in folliculogenesis, oocyte maturation and corpus luteum function by changing the pattern of granulosa cell expression which in turn affects the success of fertilization potential. Objectives: To examine the relation of in vivo concentrations of AMH, activin A, and FS hormones on the ovaries status in the phases of menstrual cycle and to elucidate the relationship of these hormones with pregnancy rate following intrauterine insemination(IUI). Materials and methods: Seventy seven infertile couples were recruited from infertility clinic population at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies through the period from September 2011 to May 2012. Those infertile couples were divided to 3 groups according to the infertility cause (male factors causes, anovulatory causes and unexplained causes of infertility). Measurements of AMH, activin A, and FS hormones levels were done at cycle day (CD25-). Then measurements of activin A, and FS hormones levels were done only at preovulatory cycle(CD1214-) when the size of the Graffian follicle range between 1824-mm and at least one follicle was present and before hCG injection and at day 28 of the cycle (CD28). IUI was performed 3640- hours after hCG injection then measurement of the three hormones was performed after successful IUI. The result of successful pregnancy was recorded and statistical relation with AMH, activin A and FS hormones was assessed. Results: There was a positive significant correlation between endometrial thickness (ET) and pregnancy rate and the best ET to predict pregnancy is more than 7mm. There was no significant relation (P>0.05) between AMH level and pregnancy rate. A significant correlation was found between follistatin levels in preovulatory (CD 1214-) with a cutoff value 0.20ng/ml to predict pregnancy. There was a significant relation between activin-A level and pregnancy rate with a predictive cut off value 397.5 ng/ml on (CD 28) only. Conclusions: Activin-A can be regarded as a biomarker candidate for diagnosing very early pregnancy at luteal phase following IUI. Follistatin preovulatory (average CD13) has the most predictive value for pregnancy following IUI.
Background: The intra uterine insemination (IUI) still an easy, simple and effective method to overcome the infertility that resulted from different causes. Although the equipments and methods of assisted reproductive technologies (ART) were highly developed, the percentage of successful IUI live-birth not exceed 20-30%. Objective: The present study was aimed to elucidated the cut off values of in vitro sperm preparation technique, follicular number and size, endometrial thickness and hormonal profile that lead to successful pregnancy rate (PR)following IUI. Materials and Methods: In retrospective study, one hundred cases of infertile couples were in who were became pregnant following IUI at the Institute of Infertility Diagnosis and Assisted Reproductive Technologies, through the period from January 2007 to January 2010. Depending on the results of retrospective study, IUI was achieved for 100 infertile patients between August 2010and June 2011. The mean of significant prognostic variables were measured in both studies namely: age, type of infertility, type of sperm activation techniques, the protocol of ovulation induction medicine, the mean of hormonal status of Luteinizing Hormone (LH), Estradiol(E2), and number with diameter of follicles, endometrial thickness a cycle day before hCG injection. Results: The protocol of ovulation induction in IUI cycles by using clomiphene citrate(CC) and recombinant gonadotropin (rFSH) was significantly(p<0.05) improve the IUI results compared to CC alone or CC with PergonalS. The mean values obtained by ultrasonography namely; two follicles, and dominant follicle of 19.5mm in size with endometrium thickness of >9.5mm were gave significantly successful IUI outcome compared to other values. In prospective study similar results were obtained, therefore the overall pregnancy rate was 37% per cycle. Conclusion: The calculated data of successful IUI outcome from retrospective study gave a best pregnancy rate in prospective study which was 37%. Consequently, these results can be considered as guideline for physician who interest in assisted reproduction to have a success in IUI.
Background: it is important to study a history of the science to appreciate the past as a motive for hard work in the present for better future. In the other hand, the factors affecting pregnancy rate of frozen embryos are yet to be clarified at different embryonic developmental stages. Objectives: to record a brief history of embryo cryopreservation in Iraq and to study many clinical and embryological factors that might affect the pregnancy rate. Subjects, materials and Method: a cross-sectional study of many clinical and em-bryological variable, where120 frozen-thawed embryo transfer cycles enrolled in the study at the period from January 2017 till July 2018. The variables were sta-tistically analyzed first by one factor analysis comparing between pregnant and non-pregnant cases; then by multivariate logistic regression analysis to illustrate main factors without a possible confounder effect. Results: In one factor analysis, the following variables showed a significantly high effect on pregnancy rate (P value <0.001) which are women’s age, women’s weight, number of retrieved oocytes, mature oocytes and good quality embryos, developmental stage, E2 level, and endometrial thickness. While in multivariate logistic regression analysis the women’s weight, the number of retrieved oocytes and good quality embryos were the main factors. Conclusions: it is judiciously to consider these factors while managing infertile couples with embryo cryopreservation programs especially the modifiable fac-tors.
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
Background : The overall success rate of assisted reproductive techniques is only about 30% due to certain limiting factors. Endometrial scratching could induce inflammatory response which manifested by the up-regulation of different cyto kines and chemokines with subsequent accumulation of immune cells in the in jured site. One of the most important cytokine in this regard is TNF-α which was found to induce tissue remodeling by stimulating the production of many other pro-inflammatory cytokines. Objectives: To investigate the role of endometrial injury during the luteal phase before ICSI cycles in the enhancement of pregnancy outcomes. Materials and Methods: This prospective study was undertaken in the High In stitute of Infertility diagnosis and Assisted Reproductive Techniques / Al-Nahrain University. All women were undergone ICSI cycles. Women in the intervension group underwent endometrial scratching with a Pipelle catheter in luteal phase preceding cycle. Blood sample was taken before scratch. All patients undergo controlled ovarian hyperstimulation, oocyte retrieval and embryo transfer, anoth er blood sample was taken at day of embryo transfer to measure level of TNF-α. Clinical pregnancy rate then evaluation after luteal support of two weeks. Results: The patients in scratch group has higher pregnancy rate (14/23) 60.9% than non intervention group (11/33) 33.3% although not significant (p value 0.057). The results showed that the TNF-α after scratch (54.53±10.2) was significant ly higher than before scratch (39.26±14.74) in the same group, as p value was ( <0.001). In addition the TNF-α was significantly higher in scratch group (54.53±10.2) than control (25.91±9.08) as p value was (< 0.001). Conclusion: Induced endometrial local injury is an easy, simple and cost-effec tive technique that can be used to improve the uterine receptivity and enhance embryo transplantation.
It is well known that oocyte quality is essential in the determination of the developmental potential of the fertilized oocytes. The oocyte developmental potential decreases in all species with increasing age. Use of serum and follicular fluid concentration of GDF9 as biomarkers of oocyte and embryo quality and their relation to pregnancy rate. Eighty-eight women were included in this study are selected from those undergoing intra-cytoplasmic sperm injection. Positive pregnancy was achieved by 14 women. The difference in mean serum and follicular GDF9 between pregnant and non-pregnant women was not significant. MI oocyte count was not significantly correlated to serum and follicular GDF9 (p > 0.05). MII oocyte count showed a non-significant correlation to serum and follicular GDF9 (p > 0.05). Grade 1 embryo count showed a non-significant correlation to serum and follicular GDF9. Grade 2 embryo count showed a non-significant correlation to serum and follicular GDF9. Also, grade 3 embryo count showed a non-significant correlation to serum and follicular GDF9. The current study revealed that serum and follicular GDF9 could not be used as indicators for oocyte maturity, embryo quality, or pregnancy rate.
Background: The evaluation of ovarian reserve has been, and still, the focus of substantial clinical research. The assessment of ovarian reserve is valuable for determining stimulation protocols, and because of limited predictive value of age alone, or other passive hormonal analysis in estimating response to the exogenous stimulation, Dynamic research was done on serum inhibin B. Objective: Measurement of serum inhibin B as a predictive evaluation of early ovarian response following ovulation induction program in intrauterine insemination(IUI). Materials and Methods: Thirty couples were involved in IUI program. They divided into two groups: group (1) 15 women were treated by Gonadotropin(Gn) recombinant follicle -stimulating hormone (rFSH). While group (2), 15 women were treated by Clomiphene citrate (CC). Treatment started at day 3 of the menstrual cycle. Serial hormonal profile tests namely; Inhibin B, Estradiol (E2), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH) were done at days 3, 7 of the menstrual cycle and the day of human chorionic gonadotropin hormone (hCG) injection with recurrent ultrasonography (US) to confirm the number and development of the follicles. Results: There was a significant difference in the level of inhibin B (P< 0.05) between day 3 and 7 of the cycle with the mean of the follicle number 1.67±0.18 in group(1), while in group (2) there was a non significant difference (P>0.05) in the level of inhibin B between day 3 and 7 of the cycle with the mean of the follicle number 2.14±0.17. Percentage of pregnancy rate in IUI in this study was 19.23%. Percentage of pregnancy rate in group (1) was 25%,while in group (2) was 14.28%,but there is a significant difference (P<0.05) in the pregnancy rate between the two groups. Conclusion: It was concluded that serum inhibin B obtained at day 7(day 5 of (Gn) therapy) offers an early and accurate prediction of ovarian response to (Gn) stimulation while there was no significant change in the level of inhibin B between day 3 and 7 of the cycle in patients treated by CC.
Human chorionic gonadotropin is a glycoprotein hormone produced by the placenta. It exists in several isoforms with long half-lives (hours) and angiogenic potential; it maintains the corpus luteum to produce progesterone. This study aimed to evaluate Human chorionic gonadotropin concentration in follicular fluid and its effect on oocyte maturity and pregnancy rate, and whether it can be used as a noninvasive biomarker for predicting oocyte competence and pregnancy rate during intracytoplasmic sperm injection cycles. Infertile women undergoing ICSI treatment were included in the study. An antagonist protocol was used for ovulation induction. Patients were divided into two groups: pregnant women (n=18) and non-pregnant women (n=22). Samples of follicular fluid were collected on the day of oocyte pick-up. Chemiluminescent Immunoassay (CLIA) equipment was used for the quantitative determination of total β-human chorionic gonadotropin in follicular fluid. The mean beta-human chorionic gonadotropin level showed a highly significant increase relative to the mean level of non-pregnant women (110.24 ±20.50) versus (56.195 ±29.45). Moreover, there was no significant relationship between the levels of beta-human chorionic gonadotropin follicular fluid and the total number of oocytes and oocyte quality in the two groups. The Beta Human chorionic gonadotropin concentration in the follicular fluid plays an important and influential role in the prediction of pregnancy rates. Despite this, follicular fluid hCG level showed no relationship with the total number and quality of oocytes in the pregnant and non-pregnant groups.
Human chorionic gonadotropin is a glycoprotein hormone produced by the placenta. It exists in several isoforms with long half-lives (hours) and angiogenic potential; it maintains the corpus luteum to produce progesterone. This study aimed to evaluate Human chorionic gonadotropin concentration in follicular fluid and its effect on oocyte maturity and pregnancy rate, and whether it can be used as a noninvasive biomarker for predicting oocyte competence and pregnancy rate during intracytoplasmic sperm injection cycles. Infertile women undergoing ICSI treatment were included in the study. An antagonist protocol was used for ovulation induction. Patients were divided into two groups: pregnant women (n=18) and non-pregnant women (n=22). Samples of follicular fluid were collected on the day of oocyte pick-up. Chemiluminescent Immunoassay (CLIA) equipment was used for the quantitative determination of total β-human chorionic gonadotropin in follicular fluid. The mean beta-human chorionic gonadotropin level showed a highly significant increase relative to the mean level of non-pregnant women (110.24 ±20.50) versus (56.195 ±29.45). Moreover, there was no significant relationship between the levels of beta-human chorionic gonadotropin follicular fluid and the total number of oocytes and oocyte quality in the two groups. The Beta Human chorionic gonadotropin concentration in the follicular fluid plays an important and influential role in the prediction of pregnancy rates. Despite this, follicular fluid hCG level showed no relationship with the total number and quality of oocytes in the pregnant and non-pregnant groups.
Obesity induces metabolic dysfunctions in bodily systems and is a significant health challenge. Excessive adipose tissue accumulation encompasses dynamic, endocrine, and biologically active processes. The fundamental pathogenic mechanism of obesity is chronic low-grade inflammation exacerbated by pro-inflammatory biomarkers such as free fatty acids, lipopolysaccharides, adipokines, and cytokines. The rising prevalence of obesity over the past forty years has led to an increase in associated comorbidities, including polycystic ovarian syndrome (PCOS). To clarify the impact of increasing body mass index (BMI) in PCOS and non PCOS on the ICSI outcomes of 143 infertile Iraqi females, dividing them into two main groups: PCOS and non PCOS and each group into normal weight and overweight/obese group. Group 1= normal BMI PCOS, group 2= overweight/ obese PCOS, group 3= normal BMI non PCOS, group 4= overweight/obese non PCOS. Significant differences in ICSI outcomes were observed in the PCOS groups compared to the non-PCOS groups concerning the total number of harvested, MI, MII oocytes, GV, abnormal and fertilised oocytes, total and D3 grade I embryos alongside higher number of arrested and transplanted embryos. There are numerically higher number of D3 grade II and III embryos, morula and blastocyst with no significant difference seen. The rates of maturation and fertilisation exhibited no significant disparities. The biochemical pregnancy rate was higher in group 2 compared to group 1, and in group 4 compared to group 3, with a statistically significant difference. A higher BMI among younger PCOS individuals may be associated with better pregnancy outcomes.
Intrauterine insemination (IUI) comprises the insertion of a high number of washed and processed spermatozoa directly into the cervix to the uterine cavity around the time of ovulation to increase the chances of pregnancy. It is usually used for couples with mild male factor infertility, unexplained infertility, cervical factors, mild endometriosis, and psychological, sexual dysfunction. The endometrium, which lines the uterus, is prepared for the implantation of the embryo; this process starts in the proliferative phase and extends throughout the luteal phase. Implantation, a crucial phase of pregnancy, is a complicated process, and more than half of failures to achieve pregnancy are caused by implantation failure. To assess the influence of endometrial flushing of 1000IU hCG done prior to IUI procedure on pregnancy rate in infertile females undergoing IUI treatment. The present study was applied to 80 infertile subjected to ovarian stimulation protocol using letrozole and hMG in doses adjusted according to their response; triggering was done using subcutaneous HCG. The results of the present study showed no significant difference regarding initial characteristics, indication for IUI, basal menstrual cycle characteristics, ovarian stimulation characteristics, and semen parameters before and after processing, while there was a significant difference between both groups regarding biochemical and clinical pregnancy rates. In IUI cycles, endometrial human chorionic gonadotropin (hCG) flushing done 5-10 minutes prior to IUI can improve biochemical and clinical pregnancy rates.
The selection of protocols in controlled ovarian stimulation during intracytoplasmic sperm injection affect the treatment outcomes. Both GnRH agonist and GnRH antagonist protocols are clinically utilized, therefore comparision of these protocols is important for the evaluation of their laboratory and clinical outcomes.To compares the short GnRH agonist and GnRH antagonist protocols effectiveness in expected normal responder females undergoing intracytoplasmic sperm injection (ICSI). Methods: A retrospective study was involved 60 women aged less than 35 with antimullerian hormone (AMH) more than 2.5 ng/ml. Participants women were assigned to either group1 short GnRH agonist protocol and group2 GnRH antagonist protocol. The outcomes measured including total oocyte, mature and immature oocytes, number and quality of embryo and pregnancy rate.The short GnRH agonist protocol group showed statistical significant benefit in oocyte yield (p- value 0.04), metaphase I (p- value 0.09), metaphase II (p- value 0.03), embryo number (p- value 0.04), embryo quality (p-value 0.01) and pregnancy rate in expected normal responder women compared to GnRHantagonist protocol. The short GnRHagonist protocol reveals favorable ICSI outcomes than antagonist protocol and may be better choice in expected normal responder women.
To explore whether dual triggering for final oocyte maturation using a low dose of recombinant human chorionic gonadotropin (hCG) plus gonadotropin-releasing hormone agonist (GnRH-a) is as effective as the standard dose of recombinant hCG triggering alone in term of a total number of retrieved oocytes, fertilization and pregnancy rate in fresh autologous antagonist intracytoplasmic sperm injection (ICSI) cycles. 80 infertile women undergoing ICSI, aged ˂ 40 years, 18˂ Body mass index ˂30 Kg/m2 included in fresh autologous antagonist ICSI cycles. 40 women received a Standard dose of recombinant hCG (500 µg) alone and 40 women received GnRH-a (0.2 mg triptorelin plus 250 µg recombinant hCG) were used for final oocytes maturation. This study was conducted at the High Institute for Infertility Diagnosis and Assisted Reproductive Techniques, Al Nahrain University. The mean total number of retrieved oocytes, fertilization, and pregnancy rate were measured. The mean total oocyte number being statistically higher in the dual trigger group. The mean number of fertilized oocytes and clinical pregnancy rates was higher in the dual trigger group than in the control group, but the difference showed borderline statistical significance. Furthermore, fertilization rates show no statistical difference between the control group and the dual trigger group. Results of the study confirm that dual triggers show favorable improvement in fresh autologous antagonist ICSI cycles with the use of GnRH agonists plus hCG compared with hCG alone for triggering of final oocyte maturation.
Despite developments in assisted reproductive technology, there is immaterial progress in the implantation and pregnancy rates. Intrauterine infusion (IUIF) of autologous platelet-rich plasma (PRP) might renew implantation rates through its paracrine properties by progression cytokines and growth factors which favor implantation. Here we determine whether the IUIF of autologous PRP had a role in pregnancy outcome through its outcome on epidermal growth factor and endometrial thickness. An overall of 43 patients where prospectively randomly dispersed into two groups subjected to a superovulation program using Letrozole® tablet orally 2.5 mg twice daily 12 hours apart from day 2 for 5 days for one cycle. 20 women were considered as control receiving the conventional intrauterine insemination (IUI) management while 23 of them were given PRP by IUIF on the day of human chorionic gonadotrophin injection. The IUI was done for both groups 36-48 hours after confirming ovulation. The blood samples were collected from both groups on the day of IUI for the valuation of epidermal growth factor and an ultrasound was done on the day of human chorionic gonadotrophin injection and day of IUI for assessment of endometrial thickness. The mean endometrial thickness in the PRP group at the day of IUI was significantly thicker than that of the control group and the difference in percentage change of endometrial thickness between PRP group and controls significantly higher in PRP group. The mean epidermal growth factor and the pregnancy rate were significantly superior in the PRP group than that of controls. In conclusion, autologous PRP IUIF was well-tolerated and resulted in a significant expansion in endometrial thickness, epidermal growth factor Level and, subsequent pregnancy rate in an infertile woman undergoing IUI.
Reactive oxygen species (ROS) are active chemical compounds created by the body's metabolic process and are crucial in human reproduction. Excessive ROS can contribute to oxidative stress, which has been linked to poor fertility. Embryo culture medium plays an essential role in IVF/ICSI cycles. Eighty participants underwent ovarian stimulation and ICSI cycles; ROS levels were measured in blood samples on the ovum pickup (OPU) day and in each embryo culture dish on ET day using enzyme-linked immunosorbent assay (ELISA). These values were associated with the quality of generated embryos. Women were divided into two groups; the first had day three embryo transfers, whereas the second received blastocyst transfers on day 5. Grades I embryo count was shown to be inversely related to the serum and culture medium ROS levels. Pregnant women had significantly greater levels of GI embryos (p=0.011) and lower levels of GIII embryos (p=0.024). Pregnancy rates for the third-and fifth days of the embryo transfers were 24% and 50%, respectively, with (p=0.045). Pregnancy success rates were increased after ET day five and were strongly influenced by transfer day. Blastocyst-stage embryos with high serum ROS levels were found to be underdeveloped. Culture medium ROS levels can be used as an adjuvant criterion for embryo selection and metabolic marker for developing embryos.
It was observed that embryos from oocytes resulting from well-vascularized follicles had a higher implantation rate than those from oocytes developed in poorly vascularized follicles. Neovascularization was recognized as primary in terms of ovulatory follicles growth and selection. Vascular endothelial growth factor serum level has a positive correlation with perifollicular blood flow. The 2D Color and Pulsed Doppler ultrasounds that allow visual observation of the flux of the blood in a limited part of the wall of the preovulatory follicles can be easily measured. To study the preovulatory follicle's blood flow parameters in infertile women undergoing different ovulation induction protocols. 50 infertile female patients who had undergone Intrauterine Insemination (IUI) procedures were classified into two groups which were letrozole or clomiphene citrate groups as induction protocol. Another ultrasound was performed on cycle day 11, 12, or 13 to evaluate growth follicles, also a Doppler study was done to measure perifollicular blood flow and endometrial thickness at the same time blood sample to measure vascular endothelial growth factor were taken. Human chorionic gonadotropin was injected and then after 36-40 hrs. IUI Procedure is done and follows up with the patient to do a pregnancy test after 14 days. The number of dominant follicles, endometrial thickness at HCG trigger, Perifollicular doppler blood flow vascular endothelial growth factor level, pregnancy rates were all measured in both groups. There were significant differences in Perifollicular RI (p<0.001) but there were no significant differences in Perifollicular PI (p=0.476). Regarding pregnancy rate, the letrozole group has a higher although not significant pregnancy rate (32%), if compared with those using CC (20%).
Despite many improvements in Assisted reproductive techniques during the last three decades, clinical pregnancy and live-birth rates still nearly 30–40% and 20–30%, respectively. To enhance endometrial receptivity many attempts done one of the endometrial scratching could provoke delay in endometrial maturation reforms asynchrony between endometrium and the concepts and indeed induce wound healing by producing a considerable raise in the local secretion of pro-inflammatory cytokines and growth factors like Heparin Binding Epidermal Growth Factor (HBEGF) and its receptors has role in mediate the receptivity, maturation, and decidualization of endometrium and facilitates the implantation and development of both placenta and embryo. All women were undergone IUI procedure. They divided into two groups. Intervention group who did endometrial scratching by using pipelle catheter in luteal phase of preceding cycle and another blood sample aspirated before scratch. Control group include women without intervention of endometrial scratch. Both groups underwent controlled ovarian stimulation, triggering of ovulation and another blood sample was aspirated at day of IUI to measure level of HBEGF. 14 days later with luteal support, BHCG test underwent in blood to check pregnancy. Higher pregnancy rate among patients with scratch group (5/20) 25% than non-interventional group (3/25)12%. These result showed that HBEGF level in scratch group (386.1±124.7) is significantly higher than control group (279±189.3) as P-value was (0.035). Moreover, the HBEGF level at day of IUI (455.67±157.34) and in pregnant (563.9±163.66) is significantly higher than before scratch in scratch group (279.0±124.67), (406.26±138.89), as P-values were (0.00007, 0.049) respectively. Intentional local damage to the endometrium is a cost–effective procedure can be used to enhance the uterine receptivity that may help to overcome implantation failure problem.
EMMPRIN (Basigin) is a potent inducer of matrix metalloproteinases (MMPs). Expression of EMMPRIN in the uterus has a very important role in implantation of embryo, this study was conducted to evaluate the relationship of pregnancy rates with EMMPRIN levels in follicular fluid and serum of intracytoplasmic sperm injection patients. The study was cross sectional study analyzed the serum and follicular fluid samples of 58 patients undergo ICSI procedure. The serum and follicular fluid samples were collected from infertile women aged 20 to 42 years. However, the levels of EMMPRIN were measured in the serum and follicular fluid samples and these samples were obtained during oocytes retrieval and another serum samples were collected at the day of embryo transfer. All women have ovarian stimulation with recombinant follicle stimulating hormone (FSH) at the second or third day of the cycle. Result: The pregnancy rate was 27.6 %. The present study showed that EMMPRIN in serum and follicular fluid at day of ova pickup and its level at embryo transfer day, are significantly low in pregnant women (p < 0.05) compared to non-pregnant women. The statistical analysis showed no significant correlation between serum and follicular fluid EMMPRIN with endometrial thickness (p > 0.05). EMMPRIN level can be used as a promising parameter for the prediction of pregnancy rate in ICSI cycles.
The aim of any given ICSI cycle is to achieve normal response and avoid poor or hyper response. A part from ovarian hyper stimulation syndrome (OHSS), pregnancy rate in hyper responder females usually low which could be related to the adverse effect of hyper estrogenic state on oocytes, embryos quality and uterine endometrium. To evaluate the effect of hyper response on ICSI outcome represented by oocytes, embryos quality, fertilization and pregnancy rates. Study showed that total number of retrieved oocytes, mature, immature oocytes, total embryos, good quality embryos and blastocyst count were significantly higher in hyper followed by normal and poor responders respectively. Fertilization rate was significantly higher in both hyper and normal responders than poor ones, while pregnancy rate was significantly higher in hyper responders 47.6% followed by normal 40.7% and then poor ones 16.7%. Conclusions: Irrespective of abnormal hormonal milieu, excessive ovarian response and higher number of produced oocytes improve ICSI outcome in hyper responder females by increasing the chance of getting higher number of embryos, good quality embryos and even blastocyst numbers which in turn increase the chance of pregnancy.
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.
Stem cell factor (SCF) is one of the first growth factors derived from granulosa cells in the ovarian follicle plays a critical role in hematopoiesis and the generation of melanocytes and germ cells. SCF also serves an important role in the development of the interstitial cells of Cajal in the intestine and the learning functions in the hippocampal region of the brain. This study aimed to investigate the levels of SCF in follicular fluid (FF) and if it can be used as a potential marker for predicting oocyte, embryo quality, and pregnancy rate. A total of 44 infertile couples involved in the study. All of them underwent controlled ovarian hyperstimulation for the ICSI cycle. Antagonist protocol was used as an ovulation induction protocol. Patients were divided into two groups according to ICSI outcomes as pregnant (23 women) and non-pregnant (21 women) groups. A comparison was done in both groups based on the oocyte, embryo quality, and other ICSI cycle characteristics, and follicular fluid stem cell factor level. SCF level was measured by using an enzyme-linked immunosorbent assay. Our study showed lack of association between patients' characteristics which included (age, BMI, infertility duration, type of infertility, and causes of infertility, basal hormonal, stimulation characteristics levels), FF SCF level and the oocyte characteristics comparison (total number retrieved oocyte, germinal vesicle oocyte (GV), MI oocyte and MII oocytes, and the number of injected oocytes, fertilization rate, and embryo characteristics) between pregnant and non-pregnant groups. The present study showed that Mean follicular fluid SCF was significantly lower in pregnant women in comparison with that of non-pregnant women, 135.92±38.96 pg/ml versus 185.15±63.58 pg/ml, respectively (P=0.003). Raised SCF level in FF harms ICSI outcome.
For couples with a variety of male factor disorders, intracytoplasmic sperm injection has made pregnancy and motherhood possible. Two hundred-one males who had non-obstructive azoospermia or severe oligospermia were included in this study. One hundred forty trials of ICSI were done by using fresh sperms (fresh group n=140), while 61 trials of ICSI were done by using cryopreserved sperms (cryopreserved group n=61) to compare the conception rates between fresh and cryopreserved sperms used in intracytoplasmic sperm injection (ICSI). Twenty-five samples from each group were collected by doing a testicular biopsy. Pregnancy rates were higher using cryopreserved sperms as compared to fresh spermatozoa, 39.3% compared to 24.3% in the fresh group ( P .030), respectively. Binary logistic regression analysis showed that the odds ratio of achieving pregnancy with cryopreserved sperms was 2.022 higher than with fresh ( P .030). Cryopreservation has no negative effect on the pregnancy rate. Instead, it might improve the results of ICSI in comparison with a fresh sperm sample.
The vaginal microbial makeup has a substantial impact on women's health. The typical vaginal microbial profile in healthy women of reproductive age comprises aerobic, facultatively anaerobic, as well as obligately anaerobic organisms. However, the optimal vaginal microbiota is dominated by lactobacilli and is thought to defend against pathogenic microbial colonization and infection by producing lactic acid, antimicrobial metabolites, and lowering immune system activation. Recent research has come up with the term "molecular bacterial vaginosis (BV)" to describe non-optimal vaginal microbiota that is low in Lactobacillus species (spp.) and has a lot of facultative and absolute anaerobic bacteria specifically Gardnerella vaginalis. In the context of IVF, BV has been linked to infertility. The study comprised forty-six women to explore the vaginal and follicular microbiota of asymptomatic infertile Iraqi women starting an ICSI trial. At the time of ova pick-up, a high vaginal swab and follicular fluid were acquired from each instance for DNA extraction to test for the presence of microorganisms by the use of a real-time PCR special commercial kit. In conclusion, molecular technologies have offered a more thorough view into the vaginal microbiota, which may explain why vaginal dysbiosis shifts during the ICSI-ET treatment. Even though the majority of women have no clinically visible infection, the fact is that they have an aberrant vaginal micro-ecology profile. Nevertheless, isolating microorganisms from follicular fluid did not reduce the likelihood of fertilization or the pregnancy rate during ICSI cycles.
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
Infertility is prevalent among couples in our community, and a considerable number of cases of infertility are caused by tubal factors. The hysterosalpingography (HSG) technique is one of the most important tools for determining the patency status of the tubes. Nevertheless, this method has certain drawbacks that can be addressed with a less invasive alternative, such as hysterosalpingo-contrast sonography (HyCoSy) and hysterosalpingo- foam sonography (HyFoSy) .By enrolling subfertile patients undergoing hysterosalpingo- foam sonography (HyFoSy) or hysterosalpingo-contrast sonography (HyCoSy) procedures and subsequently undergoing intrauterine insemination (IUI), this study sought to evaluate the pregnancy rate in a large single center prospectively . Between January 2024 and January 2025, 100 women who underwent IUI as a therapy modality for infertility at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in Kadhimiya city, Baghdad, were involved in this randomized controlled research. Those who underwent hysterosalpingo-contrast sonography with foam (HyFoSy) or HSG evaluation of the fallopian tube were included. The main results were a biochemical pregnancy test (blood test) and clinical pregnancy verified by ultrasonography at 6–8 weeks gestation . When comparing the HyFoSy and HyCoSy groups, the mean serum levels of estradiol, FSH, LH, prolactin, TSH, and testosterone did not differ significantly (p > 0.05). Differences in the mean length of infertility, the mean ova size, the mean ova count, the average endometrial width (ET), the average number of antral follicles (AFC), and the forms of infertility (p > 0.05). Sixty-eight percent of the HyFoSy group and forty percent of the HyCoSy group experienced successful pregnancies, with a significant difference (p = 0.005) . These results imply that HyFoSy might be better than HyCoSy when tubal evaluation is required before IUI, assuming they are validated in bigger multi-center trials. Future studies should investigate long-term results, such as live birth rates, and include a control group (IUI without prior tubal evaluation).
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.
Pro-fusion proteins as mitofusins-1 are required for controlling mitochondrial shape which determined by a dynamic balance between organelle fusion and fission and also supports oocyte development. When compare with somatic cell, mitochondria of oocyte are tiny and circular in presence. The aim is to study the mitofusin-1 in the follicular fluid as a marker for evaluating of oocyte maturation in women undergoing ICSI cycles. Fifty infertile females were included in cross-section study was undergoing ICSI procedure with age 20 to 42 years. After retrieval of oocyte and the number of oocytes was recorded by embryologist and follicular fluid Samples were used for the measurement of Mitofusin 1. Mitofusin 1 levels by ELISA kit (Mybiosource /USA).The results showed considerable higher mitofusin-1levels in patients with good oocytes quality (3.71 ± 1.35 vs. 2.45 ± 1.12 & p=0.001). There were much positive correlations between follicular fluids mitofusin-1 with both total oocytes count (r= 0.374 & p= 0.007) and MII oocytes (r=0.383 & p=0.006); and there was no much correlation between mitofusin-1 levels with MI oocyte (r= - 0.100 & p= 0.490), germinal vesical oocyte (r=0.103 & p= 0.475) and fertilization rate (r= 0.054 & p= 0.711). High follicular fluid levels of Mitofusin 1 may positively impact oocyte development and pregnancy rate.
Background: Azoospermia is defined as the lack of sperm in male ejaculate and is suggested to be present in about 1 % of all males and to account for 10-15% of the causes of infertility in men. The development of intracytoplasmic sperm injection (ICSI) as an effective therapy. Embryo grading has gained special attention in published literature regarding its predictive role in pregnancy outcome following ICSI; however, substantial controversy is present that justified the carrying out of the present study. Objective: To study the association between embryo quality and pregnancy rate in women of males with azoospermia. Patients,Materials and Methods: This prospective cohort study included 60 patients with azoospermia, 15 male with obstructive type and 45 males with non-obstructive type.Those patients were randomly selected form the population of infertile couples who regularly visits the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies and from Kamal Al-Samarrai Hospital -Center for Infertility Treatment and IVF. Results Pregnancy was encountered in 7 patients (23.33%). It was not statistically associated with type of azoospermia (P=0.388), also it was not affected by age and serum hormonal level, but highly determined by good quality of embryo. Quality of embryo was graded from 1 to 4. The lower the grade, the better the quality of the embryo was. Quality of embryo was not significantly correlated with type of azoospermia, age and hormonal levels. Conclusions Good quality of embryo is a significant predictor of positive pregnancy outcome in ICSI and the quality of embryo is not affected by age of male patient or type of azoospermia.
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.
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.
Amphiregulin, a growth factor inspired by LH surge, promotes oocyte maturation and follicular rupture. This study investigated whether amphiregulin growth factor levels in follicular fluid and blood serum can predict oocyte maturation and positive pregnancy rates in ICSI patients . Methods: The study included 50 women and they did ICSI from October 2024 to February 2025. Each woman got antagonist ovarian stimulation and recombinant follicle stimulating hormone. Blood samples were taken on cycle day two for infertility hormone assessment and on oocyte retrieval day for Elisa Amphiregulin growth factor estimate . Follicular fluids amphiregulin growth factor levels were significantly higher among pregnant females; however there was no significant difference of serum amphiregulin growth factor between pregnant and non- pregnant females. Out of 50 females, 11 females were had positive pregnancy test (Pregnancy rate = 22.0 %), there was a solitary positive correlation between follicular fluids amphiregulin growth factor with metaphase II oocytes count (r=0.800& p=0.003); however follicular fluids amphiregulin showed no significant correlations with other ICSI parameters. There were also no significant correlations between serum amphiregulin with all ICSI parameters. The current study found that elevated Amphiregulin (AREG) levels are linked to successful pregnancy outcomes in ICSI cycles
The association between the two hormones (progesterone and Activin A) in infertile women on the day of ova pick up and their relationship with pregnancy status in assisted reproductive programs are both poorly understood. To determine the correlation of progesterone and activin A on the day of ova pick up with pregnancy status of women undergoing IVF/ICSI cycle. The study was conducted on 80 infertile couples. The serum at day of ova pick up was collected. Serum progesterone and activin A analysis were done for all samples for activin A. Out of eighty infertile females twenty-five became pregnant (Pregnancy rate = 31%). Serum progesterone levels at days of oocytes pick up was significantly higher in pregnant females than non-pregnant (9.22 ± 0.54 vs. 4.47 ± 0.44; p < 0.001). There was a significantly higher serum activin levels at day of oocytes pick up in pregnant women compared to non-pregnant (2.19 ± 0.04 vs. 1.52 ± 0.04; p < 0.001). The cut-off value of serum progesterone at day of oocytes picks up was > 7.5 ng/ml and the cut-off value of serum activin A at day of oocytes pick up was > 1.85 ng/ml. Pregnant women had higher levels of the hormone progesterone and Activin A than non-pregnant women, which is significantly correlated. This result can be utilized to predicate the pregnancy status early in IVF Centers.
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.
The research objective was to evaluate the blood vitamin B12 levels in females before and after two months of vitamin B12 supplementation. Additionally, the study intended to investigate the effects of this supplementation on antral follicle count (AFC), the number of dominant follicles (DF), the outcome of intrauterine insemination (IUI), and the effect of the outcome by age, and BMI, cause of infertility and types of infertility . A randomized controlled trial was undertaken, including 100 couples that have provided comprehensive data. Segregated into two equivalent groups based on their vitamin B12 intake. Groups A and B, group. Group A comprises 50 pairs of individuals using B12 supplements for eight weeks, and Group B contains no additional elements. Collect blood and seminal plasma samples from all couples to assess their vitamin B12 levels. The two groups underwent ovulation induction and intrauterine insemination (IUI) concurrently with the medical evaluation. Group A started after two months of supplement, but Group B began immediately. Vitamin B12 increases female blood levels, antral follicle count, and dominant follicles (DF). The pregnancy rate has little effect. The antral follicle count and numbers of dominant follicles did not differ between pregnant and non-pregnant women after vitamin B12 supplementation.
To assess the predictive value of different clinical, laboratory, and ultrasound parameters in Letrozole when used as an ovulation induction in anovulatory infertile PCOS women. The current study was done in the secondary-referral infertility clinic in AL-Yarmouk teaching hospital, and Al-Mustansiriyah medical college. Sixty-seven anovulatory infertile women with the polycystic ovarian syndrome. Letrozole was given orally on day 2 or 3 of the menstrual cycle for five days and repeated for three consecutive cycles. The primary outcome measures were to evaluate the response rate in the form of successful ovulation and clinical pregnancy. The ovulation rate was (64.2%), with clomiphene naïve vs. previous clomiphene use; it was 87.5%, 51.2% respectively, while pregnancy rate was (32.8%), 41.6% with clomiphene naïve vs. 27.9% with previous clomiphene use. Clinical (age, BMI, Waist circumference, cycle length and days between cycle, infertility period and type, previous reproductive outcome, androgen symptom and m-FG score), laboratory (E 2 , FSH, LH, testosterone, FAI, FBS, fasting insulin, HOMA – IR, and AMH) and ultrasound (mean ovarian volume, mean AFC and antral follicular diameter) parameters were founded to affect ovulation and pregnancy in different extent. After putting all variables in a scoring system, it was found that if the patients had > 26 points for the score, it's more likely that the woman becomes pregnant. A predictive pregnancy score was developed from basic clinical, laboratory, and ultrasound parameters. It may help the clinician to individualized ovulation induction protocol in PCOS women; however, external validation of this system is recommended in a more extensive prospective study.
E ndometrial thickness (ET) is one of the best predictors of implantation rate and pregnancy success rate because endometrial growth depends on hormones. Estrogen regulates the proliferative phase, endometrial proliferation induced by estrogen after menstruation is largely dependent on blood flow to the basal endometrium that produces progesterone receptors which are required for progesterone-regulated endometrial growth in the secretory process. To compare the effect of estradiol valerate vs. sildenafil citrate on endometrial receptivity and subsequent pregnancy outcome in unexplained infertility patients receiving letrozole for ovulation induction. Herein, 21 patients with unexplained infertility underwent ovulation induction by letrozole (2.5 mg). Patients were divided into 2 groups; group A (10 patients) were given sildenafil tablets vaginally (25 mg) four times daily and group B (11 patients) were treated with estradiol valerate tablet 2 mg/12 hours. Patients were evaluated by transvaginal ultrasonography (TVS) to determine endometrial thickness, pattern, size, and the number of the dominant follicles, serum assessment of Vascular Endothelial Growth Factor (VEGF) level at trigger day, and chemical pregnancy outcome 14 days later. Results showed that the endometrial thickness, patterns of the endometrium, VEGF, size of the dominant follicle at the trigger day, and pregnancy rates were not significantly different between the two groups. However, the difference in the number of the dominant follicles at trigger day was statistically significant which is more in the sildenafil treated group. The present study confirmed the findings of both Sildenafil and E 2 valerate to boost endometrial receptivity and pregnancy rate.
Cigarette smoke contains a substance which is a toxic mutagenic chemical, and carcinogenic compounds, which have a negative effect on male fertility. Smoking cigarettes is associated with noticeably higher levels of the oxidative stress-causing reactive oxygen species in the seminal fluid. Because of this, smoking may cause changes to the sperm plasma membrane and a significant amount of deoxyribonucleic acid fragmentation. To study the influence of smoking on sperm chromatin immaturity and ICSI outcomes (fertilization rate, embryo grading and pregnancy rate). At the laboratories of the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies and after 1-7 days of sexual abstinence, 92 males’ sperm samples were taken. After liquefaction, macro-and microscopic studies were carried out, criteria applied by the WHO 2021. Masturbation was used to obtain the sample, which was then placed in sterile containers. The relationship between the smoking and chromatin immaturity and ICSI outcomes have been evaluated. A significant positive correlation between smoking status and sperm chromatin immaturity. Furthermore, there was a negative non-significant correlation between smoking status and fertilization rate. Weak and non-significant correlations between smoking status and embryo grade 2 as well as embryo grade 3. There was a positive association between smoking status and embryo grade 1. The sperm chromatin integrity was significantly lower in the non-smoker group compared to the smoker group.
Failure to conceive may be deeply upsetting and stressful, eventually leading to social, physical, and psychological implications. This study aimed to evaluate the impact of dual trigger on endometrial receptivity and the role of uterine biophysical profile in estimating the conception rate in women with primary or secondary infertility. A comparative prospective randomized clinical study was conducted at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies/ Al-Nahrain University, from October 2019 to April 2020. 90 infertile women who were attending the infertility diagnosis clinic of the institute was included in the study, receiving stimulated intrauterine insemination. Vaginal ultrasound was done for all women at the early and mid-follicular phase. The uterine scoring system for reproduction was assessed and total score of 20 was calculated and subsequently correlated to conception rate. A uterine scoring system for reproduction cut-off of 16 showed a sensitivity of 86.4% and a specificity of 75%. Patients with total score of 18, pulsatility index of lower than 1.79, and three or more endometrial contractions had the highest prevalence of successful pregnancy. Individual variables of endometrium (thickness, pattern, blood flow in zone 3, and myometrium features) had no statistical significance Applebaum's uterine score system for reproduction is a simple and non-invasive ultrasonic assessment. Low pulsatility index, endometrial contraction ≥3, and total score of 18 can point to the appropriate endometrial environment for implantation as well as the rate of conception.
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.
In human-assisted reproduction both partners need to be evaluated during counseling because causes of infertility are due to male factors and female factors. some body hormones play important role in fertile women and cortisol one of these hormones which is essential for normal ovulation, cortisol usually increases during the follicular phase of the menstrual cycle, play a role in the early stages of follicular development by their interaction with aromatase activity and granulose cell functions. To investigate the correlation of cortisol hormonal level in serum and in follicular fluid that relationship with age in women under Intracytoplasmic sperm injection outcome. Its randomized prospective clinical trial study performance conducting in the Higher Institute for Infertility Diagnosis and Assisted Reproductive Technologies / Al-Nahrain University, Baghdad-Iraq, during the period from November2021to June 2022. a total of Sixty-three Infertile Iraqi women, who planned to inter intrasytoplasmic sperm injection program. The blood sample and follicular fluid sample obtained from all infertile women inter intracytoplasmic sperm injection program to measure cortisol hormonal level at specific days of this study. There was increase in cortisol level in women aged between (30-40) years, So there was significant finding between cortisol level and this age group and there was increase in cortisol level in women aged < 30 years at the same day and no significant difference in cortisol level in women age more than 40. Significant differences in cortisol level appear in group of women age between (30-40) years, also the same result appears in group of women age more than > 40 years and no significant differences in cortisol level in women aged < 30. No significant differences in cortisol level in all age women group (30-40) years, <30 years ,and the women age > 40 years.
Resistin and follistatin levels have been found to be high in polycystic ovarian syndrome (PCOS) patients, that play role in pathophysiology of PCOS and pregnancy status of women having ICSI cycle. This study aimed to determine the relationship between the hormone levels and pregnancy outcome in PCOS and non-PCOS women undergoing intracytoplasmic sperm injection (ICSI) program. The study was done at Higher Institute for Infertility Diagnosis and Assisted Reproductive Technologies from 2022 to 2023. Eighty infertile women participating in the IVF/ICSI treatment. They were split to control (40 non-polycystic ovarian syndrome-PCOS women) and 40 women for PCOS group. They were subdividing to subgroups’ according to body max index (BMI; normal and overweight / obese). ELISA method was used to measure hormone level at day 2 and follicular fluid and serum at day of ova pick up. About 38.8% of study participants were got pregnant. Means of serum resistin and follistatin in day 2 and OPU were significantly higher in patients with PCOS and normal BMI level while follistatin at day 2 and in follicular fluid (FF) were significantly higher in participants who got pregnant. Follistatin level at day 2 > 9.89 ng/ml and in FF > 15.06 ng/ml and might be as a predictor for occurrence of pregnancy after ICSI. The cutoff point of follistatin level in the serum at day two and in FF at the day OPU was found to be a predictor of pregnancy following ICSI, while no correlation was found between resistin and pregnancy outcome.
Women who have transvaginal oocyte retrieval feel nervous and have mild to moderate pain because a needle is used to poke holes in the vaginal skin and ovarian capsule to get the oocytes. The aim of this study is compare between general and spinal anesthesia effect on ICSI outcome . A cross-sectional study was conducted in the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies/ Al-Nahrain University, from first April 2021 to the first of February 2022. Patients were randomized blindly at time of oocyte retrieval for types of anesthesia given: (50 women subjected to spinal anesthesia and 50 women subjected to general anesthesia). All females were subjected to flexible antagonist protocol. Also, all of them had the same surgical procedure by the same physicians. ICSI outcome was compared between the groups. The study showed there was non-significant difference (p>0.05) between the two groups regarding pregnancy rate with higher oocyte number in women subjected to spinal anesthesia than those who were under the general anesthesia although the difference was not statistically significant. The fertilized oocyte number was non significantly higher in spinal anesthesia group than the general anesthesia. So; spinal anesthesia and general anesthesia have comparable ICSI outcome.
Background : With the rapid evolution of assisted reproductive technologies, more and more studies are concerned about the possible influential factors on the success rates of these procedures, with the efforts are now mainly directed toward defining these factors in a trial to increase these rates. Of these factors, inflammation is considered among the most remarkable and is in the focus of the updated studies. However, most of these studies are evaluating the role of inflammation in patients with polycystic ovarian syndrome(PCOS) , while the impact of this inflammation in insulin resistant non PCOS patients is underesti mated and not well evaluated . Objectives: This study is a trial to elucidate the importance of one of the inflam matory mediators , Tumor Necrosis Factor-alpha (TNF – α) , in insulin resistant patients undergoing IVF ( ICSI ) cycles . Patients and Methods: A group of 27non-PCOS infertile patients were select ed for this clinical randomized prospective study from patients attending the high institute for infertility diagnosis and assisted reproductive technologies / Al-Nahrain University and subjected to intra-cytoplasmic sperm injection (ICSI) procedure. BMI was measured for all patients and they were classified according to WHO classification into 3 groups : Acceptable , overweight and obese . Fast ing plasma level of glucose and insulin was investigated and insulin resistance index (HOMA) was calculated. Serum TNF-α has been measured using ELISA and the relation with insulin resistance was investigated. Finally, the pregnancy rate, as a primary reproductive endpoint was compared according to TNF -a and insulin resistance levels between different study subjects. Results: Of the 27 infertile patients , 17(63 %) were non obese and 10 (37%) were obese , 15(55.5%) were having HOMA index < 1.6 and 12 (44.5 %) were having HOMA index ≥ 1.6 . BMI was found to be positively correlated with high er HOMA index ( P = 0.01 and R= 0.4 in spearman correlation). Investigating the relation between TNF-α with BMI revealed that TNF-α levels are increasing with the increment in BMI, However , the difference in the mean TNF-α between the three BMI groups failed to achieve statistical significance (P=0.1). In contrast to that, when stratifying for HOMA index , TNF-α was significantly correlated with it ( spearman correlation R= 0.4 , P=0.01 ) , and patients with HOMA index ≥1.6 were found to have higher levels of TNF-α ( P = 0.03) and to be more obese ( P=0.02 ) than those with HOMA index <1.6.
Implantation failure and disorders of endometrial receptivity represent an essential cause of infertility; multiple parameters were needed to predict the uterine receptivity understanding that no sole parameter could predict the same. A score was termed as (Uterine Biophysical Profile) could be utilized as a predictor of endometrial receptivity. To evaluate the predictive potential of Uterine biophysical profile of both endometrial receptivity and pregnancy outcome in infertile women undergoing Intrauterine Insemination (IUI). The current cross-sectional study was conducted in the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in Al Nahrain University, Baghdad, Iraq from the 1 st of Oct. 2018 till 1 st of May 2019 involving seventy women of infertile couples with the same inclusion and exclusion criteria. Uterine biophysical profile was evaluated using a doppler ultrasound examination and then a score was calculated and correlated to pregnancy outcome. The mean Uterine Artery Pulsatility Index (UAPI) was significantly lower in women with positive pregnancy in comparison to women with negative pregnancy, 2.10±0.19 versus 2.47±0.65, respectively (P=0.032). Moreover, no women with Pulsatility Index (PI) score (0) succeeded to get pregnant and the higher the score, the higher the rate of pregnancy (P=0.006). Furthermore, Spearman correlation showed significant positive correlation between positive pregnancy outcome and UAPI (r=0.365; P= 0.002). The mean total score was significantly higher for pregnant women than in women with negative pregnancy, 18.27±1.33 versus 16.35±2.47, respectively (P= 0.005). The cutoff value was >17 with an acceptable accuracy level of 74.2. The sensitivity of that cutoff vale was 80 % and the specificity was 65.5%. Uterine artery pulsatility index and total uterine biophysical score are the principal predictors of positive pregnancy outcomes in infertile women undergoing IUI.
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.
Pregnancy cannot develop without a coordinated stability between an invading trophoblast and a receptive maternal decidua. Both the maternal decidua and the trophoblast, which is embryonic, must incessantly regulate and change one another during the processes of implantation, trophoblast invasion, and placentation. The goal of this study was to determine whether intrauterine infusion of hCG at various doses on the day of ovum pick-up would affect endometrial receptivity markers, biochemical markers, and ICSI outcome. To this end, measurements of serum levels of TNF and IL-10, endometrial thickness using ultrasound, and sub-endometrial blood flow indices using Doppler ultrasound were used.Ninety infertile women were randomly assigned to one of three groups: the research group (n = 60) was given intrauterine administration of either 700 IU or 500 IU of hCG on the day of ova pickup. The control group (n = 30) without hCG. On cycle days 2- 3, a plasma hormone level assessment was performed on each patient.In the 700 hCG group, the pregnancy rate was statistically higher (53.3% and 40%in the 500IU group respectively) as compared with the control group C (26.7%), no significant difference in ICSI outcome between group A &B. The RI and PI were significantly lower in group A (700IU) compared to group B and C. The biochemical marker TNA and ratio of TNF/IL-10 also lower in group A confirming role of Hcg in enhancement of implantation. Intrauterine injection of hCG at day of ova pickup significantly improved the endometrial receptivity marker and this effect occur in dose dependent manner
Plasminogen Activator Inhibitor-1 expression in serum and follicular fluid plays a crucial role in regulating fibrinolysis during the pregnancy period by blocking the action of other proteins called plasminogen activators. The aim is to assess the Plasminogen Activator Inhibitor-1 level in blood serum and follicular fluid as a predictive marker of pregnancy. This study included Sixty-nine infertile females undergone ovarian stimulation with antagonist protocol and received recombinant follicle-stimulating hormone, at the cycle day two. The serum and follicular fluid were collected from each female on the day of oocyte retrieval, for PAI estimation using the Elisa kit. The data were analyzed using version 23.0 SPSS and Microsoft Office 2010. The serum PAI-1 levels at the day of oocyte retrievals were significantly lower in positive pregnancy women in comparison with non-pregnant women (p < 0.05), Yet no significant follicular fluid PAI-1 levels were noted in comparison with non-pregnant women. There was a negative significant correlation (p > 0.05) between serum and follicular fluid PAI-1 levels on the day of oocyte retrieval according to oocyte ICSI outcome. The evaluation of serum PAI-1 levels can be used as a promising parameter for the prediction of pregnancy outcomes of ICSI patients. It is assumed that the pregnancy rate was affected by PAI-1 level during ICSI cycles. The concentration of PAI-1 in serum and follicular fluid at the retrieval day is not correlated with the oocyte's maturity.
Endometriosis is a chronic inflammatory gynecological disease and a leading cause of female infertility, characterized by Th1/Th2 cytokine imbalance. Interleukin-13 (IL-13) and Interferon-gamma (IFN-gamma) are cytokines mediating anti-inflammatory and pro- inflammatory pathways, respectively, and were investigated in this study in infertile women with endometriosis undergoing Intracytoplasmic Sperm Injection (ICSI).To explore the potential impact and prognostic value of Interleukin-13 (IL-13) and Interferon- gamma (IFN-gamma) on ICSI outcome and to confirm their role in endometriosis-related infertility .A prospective case-control study was conducted involving 80 infertile women aged 18-40 years, including (n=40) women laparoscopically confirmed with endometriosis and (n=40) infertile women without endometriosis serving as controls. Both groups enrolled in ICSI cycles, and on the day of oocyte retrieval, serum and follicular fluid were collected; then concentrations of IFN-γ and IL-13 were quantified using enzyme-linked immunosorbent assay (ELISA). Ovarian stimulation characteristics, oocyte maturity, embryo quality, maturation rate, fertilization rate, and pregnancy rate were compared between groups using appropriate statistical analyses to investigate their association with endometriosis and their impact on ICSI outcomes. Elevated IFN-γ and IL-13 levels in both serum and follicular fluid are strongly associated with impaired ovarian response and poor ICSI outcomes in women with endometriosis. These findings suggest that inflammatory cytokine imbalance contributes to reduced oocyte developmental competence and embryo quality. Assessment of IFN-γ and IL-13 may provide clinically valuable biomarkers for predicting ART outcomes and could facilitate individualized therapeutic strategies targeting immune-mediated reproductive dysfunction.