Abstract
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.
Highlights
Having difficulty conceiving a child after 12 months of regular, unprotected sexual contact is a medical and social problem that can be defined as the inability to achieve a clinical pregnancy
The mean age of all enrolled women was (29.97±5.33) years, that of peripheral blood mononuclear cells (PBMC) group was (29.87±4.19) years and that of NonPBMC group was (30.05±6.16) years; The mean body mass index (BMI) of all enrolled women was (26.72±2.83) Kg/m2, that of PBMC group was (26.70±2.62) Kg/m2 and that of Non-PBMC group was (26.73±3.02) Kg/m2; there was no significant difference in mean BMI between PBMC group and NonPBMC group (p = 0.958)
At day of ovum pickup there was no significant difference between PBMC and Non-PBMC group in the mean endometrial thickness and in the mean resistive index
Summary
Having difficulty conceiving a child after 12 months of regular, unprotected sexual contact is a medical and social problem that can be defined as the inability to achieve a clinical pregnancy. Implantation, despite the medical and clinical progress made in fertility therapy, is a difficult process in which a foreign embryo has to be accepted by the mother's endometrium. Alterations in the hormone, immunology and thrombophilia are diverse maternal variables that cause failure of implantation (Maleki-Hajiagha, et al [3]). According to the available literature, different maternal immune cell subsets contribute significantly to embryo implantation and are involved in all procedures necessary for the maintenance and completion of a successful pregnancy (Ghaebi, et al [4]). It has been speculated that poor uterine and endometrial perfusion may be the fundamental cause of failure. Blood flow resistance in the uterine artery and the endometrial area has been shown to be a predictive indication of implantation in ART cycles (Haouzi, et al [8]). With the use of high-resolution transvaginal probes, because it is non-invasive and accessible, transvaginal sonography made it suitable for serial follow up during the stimulated cycle (Lessey, BA [9])
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