Day Of hCG Research Articles

Progesterone-to-follicle index is better correlated with in vitro fertilization cycle outcome than blood progesterone level

To investigate the impact of late follicular phase progesterone (P) elevation in relation to ovarian response on cycle outcome. Cohort study. The progesterone-to-follicle index (PFI) was calculated by dividing the blood P by the number of follicles ≥14 mm. The clinical pregnancy rate was calculated against the range of PFI values and blood P levels. In vitro fertilization unit. A heterogenous population undergoing IVF with pituitary suppression and gonadotropin stimulation resulting in 3-15 follicles ≥14 mm and blood P≤10 nmol/L on hCG day and resulting in fresh embryo transfer. None. Association of blood P and PFI with clinical pregnancy rate. Data were retrieved for 8,649 IVF cycles in normal responders. The (reverse) odd ratios for pregnancy were 1.112 (95% confidence interval [CI], 1.077-1.165) for blood P and 4.104 (95% CI, 3.188-5.284) for the PFI. Elevated P levels were associated with a lower pregnancy rate only when they reached the >93rd percentile. The PFI was inversely and linearly related to the pregnancy rate for the whole range of values. A late increase in P level is detrimental if it is a consequence of increased P production per follicle (high PFI) but not if it is a consequence of additional follicular recruitment. The PFI enables clinicians to differentiate these conditions.

A randomized double blind comparison of atosiban in patients undergoing IVF treatment.

Does atosiban (oxytocin/vasopressin V1A receptor antagonist), given around embryo transfer improve the live birth rate of women undergoing IVF treatment? The use of atosiban around embryo transfer did not improve the live birth rate in a general population of IVF patients. Uterine contractions in IVF cycles were significantly increased following ovarian stimulation and women with frequent uterine contractions had a lower pregnancy rates. A few observational studies suggested that the use of atosiban around embryo transfer resulted in higher pregnancy rates in women with repeated implantation failure (RIF). A non-randomized trial of IVF patients also reported higher implantation and clinical pregnancy rates after the use of atosiban. This multi-centre randomized double blind study recruited 800 general subfertile women undergoing IVF treatment between November 2011 and March 2013. Subjects were randomized into the atosiban (n = 400) and placebo (n = 400) groups according to a computer-generated randomization list. Subjects were recruited and randomized in the three IVF units in Guangzhou, Hong Kong and Ho Chi Minh City. Women in the atosiban group received i.v. atosiban 30 min before embryo transfer with a bolus dose of 6.75 mg, and the infusion was continued at 18 mg/h for ∼1 h. The dose of atosiban was then reduced to 6 mg/h continued for another 2 h. Those in the placebo group received i.v. normal saline only. The primary outcome measure was the live birth rate. There was no significant difference in the live birth rate between the atosiban and placebo groups (39.8 versus 38.0%, P = 0.612, rate ratio 1.051, 95% confidence interval: 0.884-1.251). No significant differences were found between the two groups in the positive pregnancy test, clinical pregnancy, ongoing pregnancy, miscarriage, multiple pregnancy, ectopic pregnancy rates and implantation rate per woman. Similar results were found between the groups at different IVF centres, with a repeated cycle, presence of uterine fibroids or a serum estradiol level on the day of hCG above the median level. Limitations include the transfer of early cleavage embryos, no measurement of uterine contractions, no documentation of adenomyosis and incomplete tracking of congenital abnormalities in newborns. This randomized double blind study demonstrated that the use of atosiban given around embryo transfer did not improve the live birth rate in a general population of IVF patients; therefore atosiban should be given only in the context of clinical research. Centres in Hong Kong and Vietnam received research funding from Ferring, which was not involved in study design, execution, data analysis and manuscript preparation. There are no conflicts of interest. ClinicalTrials.gov Identifier: NCT01501214.

GnRH agonist plus vaginal progesterone for luteal phase support in ICSI cycles: a randomized study

In this prospective randomized study, the effect of daily gonadotrophin-releasing hormone agonist (GnRHa) in the luteal phase on IVF and intracytoplasmic sperm injection (ICSI) outcomes was assessed. Women (n = 446) were counselled for IVF–ICSI, and randomized on the day of embryo transfer to group 1 (daily 0.1 mg subcutaneous GnRHa until day of beta-HCG) (n = 224) and group 2 (stopped GnRHa on day of HCG injection) (n = 222). Both groups received daily vaginal progesterone suppositories. Primary outcome was clinical pregnancy rate. Secondary outcome was ongoing pregnancy rate beyond 20 weeks. Mean age, oestradiol on day of HCG, number of oocytes retrieved, number of embryos transferred, and clinical and ongoing pregnancy rates were 28.9 ± 4.5 years, 2401 ± 746 pg/mL; 13.5 ± 6.0 oocytes; 2.6 ± 0.6 embryos, and 36.2% and 30.4% consecutively in group 1 compared with 29.7 ± 4.7 years, 2483 ± 867 pg/mL, 13.7 ± 5.5 oocytes, 2.7 ± 0.6 embryos, 30.6% pregnancy rate, and 25.7% ongoing pregnancy rate in group 2. No significant difference was found between the groups. Subcutaneous GnRHa during the luteal phase of long GnRHa protocol cycles does not increase clinical or ongoing pregnancy rates after IVF–ICSI.

Luteal-long GnRH agonist versus flexible-multidose GnRH antagonist protocols for overweight and obese patients who underwent ICSI

A total of 413 consecutive infertile patients (572 cycles) with a body mass index (BMI) of ≥ 25 kg/m2 were enrolled into the study. The luteal-long GnRH agonist group (Group I) constituted 211 patients (300 cycles) and the flexible-multidose GnRH antagonist group (Group II) constituted 202 patients (272 cycles). The duration of stimulation (d) (10.1 ± 2.5 vs 9.2 ± 2.0; p < 0.01); the total dose of gonadotrophin used (IU) (3,099.4 ± 2,885.0 vs 2,684.0 ± 1,046.4; p < 0.05) and the E2 level on the day of hCG (pg/ml) (2,375.8 ± 1,554.6 vs 1,905.6 ± 1,598.8; p < 0.01) were significantly lower in Group II when compared with Group I. However, the ongoing pregnancy per embryo transfer (37.0% vs 25.7%; p < 0.05) and the implantation rate (25.7% vs 15.6%; p < 0.01) were significantly lower in Group II when compared with Group I. In conclusion, we noted that the luteal-long GnRH agonist protocol produced higher implantation rates and higher clinical-ongoing pregnancy rates in overweight and obese patients when compared with the flexible-multidose GnRH antagonist protocol.

Association between the proportion of dominant follicles and oocyte developmental competence

To explore the optimal timing for hCG triggering by investigating the impact of different proportion of dominant follicles on the oocyte developmental competence. One hundred ninety-eight infertile women were divided into three groups according to the proportion of dominant follicles on hCG day: (1) low: <15% (n = 66); (2) middle: 15-27% (n = 66); (3) high: >27% (n = 66). The grouping criteria were the bottom and top tertiles of the proportion of dominant follicles. The gonadotropin dosage, duration and maximum follicle diameter in the low proportion group were lower than those in the middle and high proportion groups. Oocyte maturation and the abnormal fertilization rate in the low proportion group were lower than those in the middle and high proportion groups. The normal fertilization rate did not differ among the three groups. The cleavage rate and number of transferable embryos in the low proportion group were significantly higher than those in the high proportion group. The high-quality embryo rate, implantation rate, and pregnancy rate in the low proportion group were significantly higher than those in the middle and high proportion groups. A high proportion of dominant follicles are closely associated with impaired oocyte developmental competence and low pregnancy rate. These findings suggest that follicular overgrowth induced by delayed hCG triggering may undermine oocyte developmental competence and the proportion of dominant follicles may be a potential parameters for hCG triggering.

Increased circulating Th1/Th2 ratios but not other lymphocyte subsets during controlled ovarian stimulation are linked to subsequent implantation failure after transfer of in vitro fertilized embryos.

To investigate alterations of circulating lymphocyte subsets in women undergoing controlled ovarian stimulation (COS) and survey their relations with pregnancy outcome. Fifty-one women were included in this study, of which 24 women were successfully pregnant in the index IVF cycle (the successful pregnancy group, sPG) and 27 women failed to get pregnant (the non-pregnancy group, nPG). Peripheral blood was collected at three time points during COS: on the day before the first GnRHa administration (GnRHa day), on the day before the first Gn administration (Gn day), and on the day before HCG administration (HCG day). The intracellular Th1(IFN-γ and TNF-α)/Th2(IL-10) ratios in circulating Th cells after in vitro phorbol-12-myristate-13-acetate stimulation, the NK cytotoxicity, and the percentage of T, B and NK cell subsets were assessed by flow cytometer. A third group consisting of patients with recurrent implantation failure (RIF group, n=18) was also enrolled, and the intracellular Th1/Th2 ratios were assessed at HCG day. Intergroup comparison: The ratios of IFN-γ/IL-10 and TNF-α/IL-10 at HCG day were significantly higher (P<0.05) in nPG than those in sPG, while no change at GnRHa day or Gn day. Higher (P<0.05) ratios of IFN-γ/IL-10 and TNF-α/IL-10 at HCG day were also observed in RIF group compared to those in sPG. No significant change (P>0.05) was found in other assessed lymphocyte subsets or in the concentrations of progesterone, estradiol, luteinizing hormone, or follicle-stimulating hormone between the sPG and nPG at the three time points. Intragroup comparison: The ratios of IFN-γ/IL-10 and TNF-α/IL-10 at HCG day were significantly (P<0.05) lower than those at GnRHa day in sPG, but not in nPG. No significant (P>0.05) difference was found in other assessed parameters or at other time points. The ratios of Th1/Th2 were fluctuated during COS, and they might affect the pregnancy outcome of IVF. The circulating NK cytotoxicity and percentage of lymphocyte subsets were relatively stable during the COS.

The true impact of elevated progesterone on the day of hCG on pregnancy rates after IVF: a cohort analysis of more than 3,600 cycles

The detrimental role of progesterone elevation (PE) on the day of hCG for pregnancy achievement in fresh IVF cycles has been suggested by many studies, although some clinicians still doubt the presence of such an effect. Most of the studies have assessed the impact of progesterone (P) by univariate analysis of observational data, thus ignoring any potential confounding effect by other known predictors of pregnancy after IVF. The aim of this study is to estimate the true effect of PE on the day of hCG on ongoing pregnancy rates after removing any potential confounding effect.

Three day progesterone area under the curve: a better test than progesterone on the day of hCG?

Elevated progesterone (P) on day of hCG trigger (P–hCG) has been associated with reduced ART pregnancy rates. However, less is known about the effect of persistently elevated P days before trigger. The objective was to compare the effect of P area under the curve (P–AUC) over multiple days to P–hCG.

3-dimensional endometrial volume as a predictor of pregnancy in in-vitro fertilisation cycles over 2-dimensional endometrial thickness

OBJECTIVE: To evaluate the role of endometrial volume as predictor of pregnancy in In Vitro Fertilisation Cycles (IVF) over endometrial thickness. DESIGN: Prospective, non randomised clinical study. MATERIALS AND METHODS: This was a prospective observational study. A total of 100 infertile women were recruited from our IVF-Embryo transfer program from Feb to March 2014. Endometrial volume was measured on the day of hCG using the VOCAL (Virtual Organ Computeraided AnaLysis) imaging program integrated into Volusen E8 ultrasound system. RESULTS: The mean age was 31.5 years and the mean duration of infertility was 6 years. The mean endometrial thickness was 9.7 mm and the mean endometrial volumewas 4.6 cm3. Overall 31(31%) patients conceived and in these women the endometrial volumewas between 3-8 cm3. All patients who conceived had thickness more than 7 mm. 38 (38%) patients had thickness >7 mm but endometrial volume< 4 cm3 and did not conceive. The positive predictive value of endometrial volume for conception was 40% with sensitivity as high as 93.5%. Endometrial thickness had a high negative predictive value of 68.3% with 97% specificity. Among those who conceived 16 (51%) patients had blood flow in Zone 3, 14 (45%) patients had flow in Zone 2 and only one had flow in Zone 1. CONCLUSION: With a thin endometrium and low endometrial volume, the probability of conception is very low in an in-vitro fertilisation/ embryo transfer cycle and cryopreservation should be recommended. Endometrial thickness more than 7 mm and volume more than 3cm3 together increase the probability of pregnancymore than thickness alone as volume is an objective measure of implantation potential of endometrium. However furthur study is needed for definitive conclusion.

The addition of gonadotrophin releasing hormone agonist to routine luteal phase support in intracytoplasmic sperm injection and embryo transfer cycles: a randomized clinical trial

ObjectivesTo determine the effects of addition of different dosages of gonadotrophin releasing hormone agonist (GnRH-a) to routine luteal phase support (LPS) on implantation and pregnancy rates. Study designThree hundred infertile couples who were treated by intracytoplasmic sperm injection and embryo transfer (ICSI-ET) following controlled ovarian stimulation (COS) with long luteal GnRH agonist protocol were enrolled. All women received 600mg/day vaginal micronized progesterone plus 4mg 17β estradiol for LPS starting from the day of oocyte retrieval. Patients (n=300) were randomized into three treatment groups. Group A (n=100) received leuprolide acetate 1mg s.c. injection 3 days after ET in addition to routine LPS. Group B (n=100) received two sequential doses of leuprolide acetate 1mg s.c. injections 3 and 6 days after ET in addition to routine LPS. Control group (n=100) received only the routine LPS. ResultsA total of 279 patients completed the study. The groups were comparable in terms of baseline demographic parameters including age, duration of infertility and day 3 levels of FSH and estradiol. The cycle parameters of the groups were also comparable regarding the E2 level on day of hCG, number of retrieved oocytes, number of day 3 embryos, number of embryos transferred, and endometrial thickness on both days of OPU and ET. The implantation rates were similar in between the Groups A, B, and control group (20.7% and 25.8% vs. 13.3%, respectively; P=.099). The clinical pregnancy rates and miscarriage rates were similar in between the groups. The ongoing pregnancy rates were 27.4% in control group, 36% in Group A and 42.9% in Group B (P=.093). The OHSS rates were comparable in between the groups. The multiple pregnancy rates were significantly higher in Groups A and B than in control group (12% and 17.9% vs. 4.2%, respectively; P=.014). ConclusionsThe implantation, clinical pregnancy and ongoing pregnancy and multiple pregnancy rates seem to be increased with the addition of GnRH-a to routine luteal phase support.

Basal progesterone levels represent the only independent risk factor prior to initiation of stimulation for elevated progesterone on the day of hCG

The detrimental role of progesterone elevation (PE) on the day of human chorionic gonadotrophin (hCG) for pregnancy achievement after a fresh IVF cycle has been confirmed by many studies. The aim of this study is to evaluate whether there are early markers that could identify women at risk for PE prior to the completion of their stimulation.

Ovarian responsiveness in women receiving fertility treatment after methotrexate for ectopic pregnancy: a systematic review and meta-analysis.

Does previous methotrexate (MTX) treatment for ectopic pregnancy (EP) have an effect on ovarian response in women receiving fertility treatment? MTX treatment for EP does not seem to affect subsequent fertility treatment. MTX is commonly used to treat EPs that are diagnosed early. Previous studies have reported conflicting results about its effect on subsequent fertility treatments. This systematic review and meta-analysis included a total of 329 patients who had participated in 7 observational studies. A search of the MEDLINE, EMBASE and PUBMED databases was conducted to identify studies about fertility treatments after MTX treatment for EP, published in English or French up to December 2013. Studies were eligible for inclusion only if they compared indicators of ovarian responsiveness during ART in the cycles before and after an injection of MTX for EP. The primary outcome measure was the number of oocytes retrieved. Secondary outcomes included the basal serum FSH level, duration of stimulation, total gonadotrophin dose and serum E2 level on the day of hCG triggering. The mean number of oocytes retrieved during the cycles before and after the MTX treatment did not differ significantly (P = 0.4). The comparisons before and after MTX treatment of the basal plasma FSH level, the duration of stimulation, the total gonadotrophin dose used for stimulation and the estradiol level on the day ovulation was triggered did not find any significant differences. The literature on this topic is sparse, with few studies and even fewer of high methodological quality. These results indicate that MTX to treat EP in infertile patients does not have any negative effect on their subsequent fertility treatment, but further studies should be performed before this result can be considered definitive. This work received support from the Department of Gynecology and Obstetrics, La Conception Hospital, Marseille, France. The authors have no competing interests to declare. N/A.

Relationship between ultrasound parameters and intra cytoplasmic sperm injection outcome in polycystic ovarian syndrome treated by non agonist step up stimulation protocol

Abstract Objective To correlate the ultrasound parameters to the intra-cytoplasmic sperm injection outcome in polycystic ovarian syndrome cases treated by non-agonist chronic step up stimulation protocol. Setting Agial and Integrated Fertility Centers, Alexandria, Egypt. Patients Twenty-five cases of polycystic ovarian syndrome fulfilling Rotterdam criteria were enrolled. Materials and methods Patients received a protocol starting with the administration of urinary human menopausal gonadotrophin (hMG) per day, follow up was done by ultrasound and serum estradiol level with increasing dose until the required response was achieved and if ovarian hyperstimulation syndrome (OHSS) occurred, gonadotrophin was withheld till estradiol declined. Human chorionic gonadotrophin (hCG) was given intramuscularly to achieve oocyte maturation. After 34–36 h of hCG administration oocyte retrieval was performed. The patients received luteal phase support in the form of natural progesterone vaginally. Transvaginal ultrasound was performed two weeks after positive pregnancy test to confirm clinical pregnancy. Main outcome measures Number of ampoules, stimulation days, serum estradiol level and progesterone level on day of hCG, number of oocytes retrieved, grading of embryos obtained, endometrial thickness, pregnancy rate, implantation rate, abortion rate, cancellation rate, multiple pregnancy rate and cost. Results Patients with a higher number of basal antral follicles were associated with a lower number of ampoules needed for stimulation (14.63 vs. 21.64 ampoules) and less stimulation days (7.07 vs. 10.73 days). Patients with a higher number of mature follicles were associated with a higher estrogen level (1561.53 vs. 658.14 pg/ml) and a higher progesterone level on day of hCG (1.10 vs. .62 ng/ml), a higher number of oocytes retrieved (7.18 vs. 4.13 oocytes) and a higher number of embryos transferred (3.06 vs. 2 embryos). The number of mature follicles and the endometrial thickness were higher in the pregnant group (19.78 follicles and 12.94 mm, respectively). The pregnancy rate was 36%, the chemical pregnancy rate was 33.3%, the abortion rate was 22.2% and the ongoing pregnancy rate was (44.4%). Conclusions The higher the number of the basal antral follicles, the less the number of the ampoules needed for stimulation and the less the stimulation days. The higher the number of mature follicles, the higher the estrogen level on day of hCG, the greater the number of oocytes retrieved and the greater the number of embryos transferred. The stromal thickness has no effect on the pregnancy outcome but the number of mature follicles and the endometrial thickness have a positive correlation with the pregnancy outcome.

A Study of low-dose Aspirin on endometrial and subendometrial blood flows in ovulation induction

Objective To investigate Low-dose Aspirin Effects on Endometrial and subendometrial blood flows in ovulation induction.Metbods A prospective study on the women(254cycles)who received ovulation induction in our hospital were randomly allocated into two groups:A group (Aspirin group,136 cycles)with Low dose aspirin (50 mg/d) and clomiphene citrate(100 mg/d on cycle days 5 to 9)in ovulation induction; B group (CC group,118 cycles) only with clomiphene citrate(100 mg/d on cycle days 5 to 9).Transvaginal color Doppler ultrasound examination was performed to determine the blood flow distribution patterns,pulsatility index (PI),resistance index(RI),systolic/diastolic ratio(S/D) of endometrial and subendometrial blood flows on the day of HCG injection.Results Grades of visible blood flow of the endometrial detected by Transvaginal color Doppler ultrasound was significantly different between the two groups(P＜0.01).Aspirin group had lower PI,RT,and S/D of endometrial and subendometrial blood flows than those in the B group (P＜0.01).Conclusion Low dose aspirin therapy in ovulation induction combined with CC can promotes endometrial and subendometrial blood flows. Key words: Aspirin; Ovulation induction; Endometrial and subendometrial blood flows

Is there a Need for Luteinizing Hormone (LH) Estimation in Patients Undergoing Ovarian Stimulation with Gonadotropin-Releasing Hormone Antagonists and Recombinant Follicle-Stimulating Hormone?

To find out effect of serum luteinizing hormone (LH) levels on Day 1 (Day 2 of cycle) and Day 5 of stimulation and Day of trigger hCG in controlled ovulation stimulation with antagonist protocol of IVF-ICSI cycle on cycle outcome. This retrospective study was conducted in a University Hospital setting. One hundred and 62 patients underwent 165 cycles of controlled ovarian stimulation (COS) with recombinant Follicle stimulating hormone (rFSH) and Gonadotropin releasing hormone (GnRH) antagonist protocol in one year were included. Serum LH levels estimated on Day 1, Day 5 and the day of trigger hCG injections were divided into three groups based on the percentile and outcome measured. The average number of follicles >18 mm in size were significant in the patients with LH levels between 25th to 75th percentile group on Day 1, Day 5 and Day of trigger hCG. The fertilization rate was significant (p= 0.04) in the patients with LH levels < 25thpercentile on the day of trigger hCG. Oocyte recovery rate, oocyte maturation rate and average number of best quality embryos (Grade 1) were not affected significantly in all three groups. In GnRH antagonist and rFSH protocols, low serum LH concentrations on the day of trigger hCG has better fertilization rate. LH levels between 25th and 75th percentile have an influence on the average number of > 18 mm size follicles. However, the LH level on Day 1, Day 5 and Day of hCG does not affect the cycle outcome in COS with antagonist protocol of IVF cycle. Hence, LH estimation is not mandatory in ART cycles with GnRH antagonist protocol.

In high responding patients undergoing an initial IVF cycle, elevated estradiol on the day of hCG has no effect on live birth rate.

BackgroundThe impact of elevated estradiol on the day of human chorionic gonadotropin (hCG) administration on in vitro fertilization (IVF) outcomes has been debated for over 25 years. Some investigators have shown a positive effect, others a negative effect; while most have shown no effect. Few studies have expressed their findings based on live birth. This study examined the relationship between estradiol level and other IVF cycle response parameters in relation to pregnancy, with a focus on live births after controlling for embryo quality.MethodsWe performed a retrospective cohort study on 489 patients <40 years old that underwent an initial IVF cycle. Estradiol concentration on the day of hCG was categorized as; low <2000 pg/ml), mid (2001-4000 pg/ml) and high (>4000 pg/ml) to determine how estradiol level on the day of hCG affected response variables during the IVF cycle. We performed a subgroup analysis restricted to patients with good/fair quality embryos transferred (n = 428), to control for embryo quality and assessed pregnancy outcome. The association between estradiol and live birth (LB) was then evaluated after identifying and controlling for confounding factors. Multivariate analysis was used to identify significant main effects and interactions in the model. Estradiol levels were also compared in patients having a LB or not (NLB) in both populations.ResultsWe found that estradiol was significantly related to + hCG, clinical pregnancy rate, age, and most other IVF cycle response variables. After performing the subgroup analysis controlling for embryo quality, we found that LB rates were not different. Only the main effects of average embryo quality at transfer (AEQS), age and transferring two embryos influenced LB. Estradiol levels were also compared in patients having a LB or NLB in both populations and was found to be higher/not different in LB patients. LB rates and AEQS were also not different in a subgroup of patients having an elevated level of estradiol (>4200 pg/ml) on the day of hCG in patients having embryo transfer on day 3 or day 5.ConclusionsAfter controlling for embryo quality, elevated estradiol on the day of hCG had no effect on LB.

Advancing or postponing the day of human chorionic gonadotropin does not matter for the outcome in assisted reproductive technology.

CONTEXT:The primary outcome is to remove the worry of getting immature oocytes with early administration of human chorionic gonadotropin (hCG).AIM:The aim was to find out the association between the day of hCG administration and follicular response in relation to the number and maturity of oocytes, and fertilization rate in assisted reproduction to avoid weekend oocyte recovery (OR).SETTINGS AND DESIGN:Retrospective study was carried out in the university infertility clinic.MATERIALS AND METHOD:Controlled ovarian hyperstimulation (COH) in 94 patients undergoing assisted reproductive technology (2010-2011) with recombinant follicle stimulating hormone and timely gonadotropin-releasing hormone antagonist were analyzed regarding day of hCG from day 8-11. Oocyte maturity and fertilization was analyzed and correlated with the day of hCG administration.STATISTICAL ANALYSIS:Kruskal–Wallis test.RESULTS:The average number of >18 mm follicles observed from day 8-11 of hCG administration was not statistically different. However, the OR rate (54.2%), number of mature oocytes (92.5%), and fertilization rate (78.5%) was maximum in the patients where hCG was administered on day 8 of COH.CONCLUSIONS:The day of hCG administration between 8 and 11 does not affect the OR rate significantly although the number of oocytes recovered on day 8 are marginally higher compared with day 9-11. Hence, it is possible to safely avoid weekend oocyte retrieval, by delaying or advancing hCG administration without compromising the outcome.

Letrozole versus Gonadotropin in Unexplained Infertile Couples Failed to Conceive with Clomiphene Citrate

Background: Unexplained infertility represents about 15% - 20% of infertile couples. Usually, these cases need assistance. Clomiphene citrate is the most used drug for this problem but sometimes pregnancy failed to achieve it, so other options for assistance are gonadotrophin or letrezole. The objective of our study was to compare the pregnancy rate for letrezole and gonadotropin inunexplained infertile women’s who failed to conceive with clomiphene citrate. Methods: This prospective quasi-randomized trial was carried out in cytogenetic unite at obstetrics and gynecology department, Zagazig University Hospital. 140 infertile females were included, induction of ovulation by letrozole for half of them and by gonadotrophin for the other half. Results: There was statistically highly significant decrease in duration of stimulation, E2 levels and endometrial thickness at day of HCG in letrezole group, no significant difference between two groups as regard number of follicles and pregnancy rate per cycle, while the cumulative pregnancy rate and the cost of stimulation are significantly higher in gonadotrophin group. Conclusion: In patient with unexplained infertility who failed to conceive with clomiphene citrate, gonadotrophins have a higher pregnancy rate than letrezole. However, pregnancy rate was high enough with lower cost with letrezole to be acceptable and justified its use in this group of patients.

Periodicity in the levels of serum plasminogen activator inhibitor-1 is a robust prognostic factor for embryo implantation and clinical pregnancy in ongoing IVF cycles.

CONTEXT:Plasminogen activator inhibitor-1 (PAI-1) has been inversely correlated to proteolytic extracellular-matrix degradation exerted by urokinase-type (u-PA) and tissue-type plasminogen activators (t-PA). Any pathological disturbance in PAI-1 levels may lead to several pregnancy complications.AIMS:To assess the influence of periodicity in serum PAI-1 levels on embryo implantation and clinical pregnancy outcome in IVF cyclesSETTINGS AND DESIGN:Prospective study of 120 IVF cycles at private infertility centre.MATERIAL AND METHODS:Endometrial response (ER) assessment by measuring Endometrial thickness (cm) and echopattern (grade). Serum PAI-1(ng/ml) measurement by ELISA method on day of hCG, day of ET and days 7 and 14 of ET. Main outcome measure was clinical pregnancy.STATISTICAL ANALYSIS:Student “t” test, ANOVA, Post-test for linear trend, Pearson Correlation.RESULTS:PAI-1 levels declined from dhCG to dET (318.8 ± 36.1 to 176.1 ± 28.4) whereas they increased steadily from dET to d7 to d14ET (176.1 ± 28.4 to 285.2 ± 30.4 to 353.5 ± 150.4; P = 0.0004) in pregnant group (n = 31). Conversely, dhCG to dET levels increased in both nonpregnant (n = 75; 173.8 ± 18.3 to 280.8 ± 26.1) and biochemical pregnancy BCP (n = 14; 172.7 ± 31.1 to 216 ± 30.1) groups. The rising pattern from dET to d7 to d14ET was not observed in non-pregnant and BCP groups. ER thickness and grade shared significant correlation with serum PAI-1 on dET (Pearson r: ER = 0.28, Grade = 0.29) and d7ET (Pearson r: ER = 0.40, Grade = 0.23).CONCLUSIONS:Periodicity in serum PAI-1 levels offers a robust prognostic factor for predicting clinical pregnancy outcome. The dhCG to dET PAI-1 transition is a decisive factor for either transferring embryos in same/ongoing cycle or cryopreserving them and postponing ET to subsequent natural cycle.

Follicular fluid placental growth factor is increased in polycystic ovarian syndrome: correlation with ovarian stimulation.

BackgroundPolycystic ovarian syndrome (PCOS) is characterized by increased ovarian angiogenesis and vascularity. Accumulating evidence indicates that vascular endothelial growth factor (VEGF) is increased in PCOS and may play an important role in these vascular changes and the pathogenesis of this disease. Placental growth factor (PlGF), a VEGF family member, has not been previously characterized in PCOS women. We investigated levels and temporal expression patterns of PlGF and its soluble receptor sFlt-1 (soluble Fms-like tyrosine kinase) in serum and follicular fluid (FF) of women with PCOS during controlled ovarian stimulation.MethodsThis was a prospective cohort study of 14 PCOS women (Rotterdam criteria) and 14 matched controls undergoing controlled ovarian stimulation. Serum was collected on day 3, day of hCG and day of oocyte retrieval. FF was collected on retrieval day. PlGF, sFlt-1 and anti-mullerian hormone (AMH) protein concentrations were measured using ELISA. Since sFlt-1 binds free PlGF, preventing its signal transduction, we calculated PlGF bioavailability as PlGF/sFlt-1 ratio.ResultsSerum PlGF and sFlt-1 levels were constant throughout controlled ovarian stimulation, and no significant differences were observed in either factor in PCOS women compared with non-PCOS controls at all three measured time points. However, FF PlGF levels were increased 1.5-fold in PCOS women compared with controls (p < 0.01). Moreover, FF PlGF correlated positively with number of oocytes retrieved and the ovarian reserve marker anti-mullerian hormone (AMH) and negatively with age. In addition, FF sFlt-1 levels were decreased 1.4-fold in PCOS women compared to controls (p = 0.04). PlGF bioavailability in FF was significantly greater (2-fold) in PCOS women compared with non-PCOS controls (p < 0.01).ConclusionsThese data provide evidence that FF PlGF correlates with ovarian stimulation and that its bioavailability is increased in women with PCOS undergoing controlled ovarian stimulation. This suggests that PlGF may play a role in PCOS pathogenesis and its angiogenic dysregulation.