Implantation Rates In Women Research Articles

An Approach to Improve Endometrial Receptivity: Is It Beneficial to Flush The Uterine Cavity with Follicular Fluid and Granulosa Cells? A Phase III Randomised Clinical Trial.

The follicular fluid (FF) of mature oocytes contains a high concentration of growth factors and cytokines that have the potential to influence implantation in either a paracrine or autocrine manner. During the physiological processes of ovulation, FF enters the fallopian tubes in conjunction with the oocyte. The purpose of this study is to evaluate implantation and clinical pregnancy rates following uterine flushing with FF and granulosa cells in infertile women with moderate male factor infertility after ovum retrieval for intracytoplasmic sperm injection (ICSI). This phase III randomised clinical trial enrolled 140 women with moderate male factor infertility who intended to undergo ICSI at Royan Infertility Clinic (Tehran, Iran). A computer-generated program and opaque sealed envelopes were used to randomly allocate patients to either an intervention group (n=70) or a control group (n=70). Participants in the intervention group received 2 ml of clear FF (without blood contamination) from 2 to 3 dominant follicles after oocyte retrieval. The control group only underwent uterine cavity catheterisation. The intervention group had a clinical pregnancy rate of 38.5% (25/65) compared to the control group [42.9% (27/63); P=0.719] and an implantation rate of 24.1% compared to the control group (27%; P=0.408). These rates did not differ between the groups. There were no statistically significant differences between the intervention and control groups in terms of pregnancy-related complications-ectopic pregnancy, blighted ovum or anembryonic pregnancy, and abortion. Uterine cavity flushing with FF from mature follicles following oocyte retrieval had no effect, either positively or negatively, on clinical pregnancy or implantation rates in women with moderate male factor infertility (registration number: NCT04077970).

Impact of granulocyte colony stimulating factor infusion on the implantation rate in women with unexplained previous intracytoplasmic sperm injection failure: a case control study

Impact of granulocyte colony stimulating factor infusion on the implantation rate in women with unexplained previous intracytoplasmic sperm injection failure: a case control study

Intrauterine autologous platelet-rich plasma treatment in women with at least two implantation failures: A retrospective cohort study.

Finding the most effective way to improve implantation rate in women who are receiving assisted reproductive technology treatment is still a challenge. This study aimed to assess the pregnancy outcomes of intrauterine platelet-rich plasma (PRP) therapy in women with a history of at least 2 implantation failures. In this retrospective cohort study, data of 852 women who were candidates for frozen-thawed embryo transfer was extracted from their medical records from April 2017 to September 2021 at Yazd Reproductive Sciences Institute, Yazd, Iran. Of these, 432 received intrauterine PRP treatment 48 hr before transfer (PRP group), and the results of the pregnancy outcomes compared with 420 of the control group who did not receive the treatment before transfer. Pregnancy outcomes, including chemical, clinical, ongoing pregnancy, and live birth rate were statistically significant in the PRP group (p 0.001). However, when categorized according to the implantation history, this significant improvement in all 4 was only seen in women with at least 2 prior implantation failures. In women with a history of only one implantation failure, PRP therapy significantly improved the ongoing pregnancy and live birth rate (19.5%, p = 0.04). Also, in women who received donor eggs and had repeated implantation failure, PRP improved pregnancy outcomes clinically but not statistically (p = 0.15). PRP seems to be effective in improving the pregnancy rate in women with a history of 2 or more implantation failures and also shows an increase in the live birth rate in women with only one implantation failure.

An observational study of endometrial vascularity in implantation

Background: According to Ayurveda, Ambu is one of the four essential factors of Garbhasambhav Samugri for formation and development of the embryo. The word Ambu means nutrients essential for formation and growth of embryo which it receives from mother. According to modern science, during implantation, embryo receives its nutrients from endometrium. Though some women have normal endometrial thickness, normal endometrial pattern, normal endometrial morphology, still they are unable to get impregnated. During peri-implantation period of menstrual cycle, endometrial vascularity has major role in implantation of fertilised egg and also further growth of foetus. Objectives: The objective of this study is to evaluate implantation rates in women having endometrial vascularity upto V1, V2, V3, V4 zones. Material & Methods: Anonymous data of endometrial vascularity by transvaginal colour doppler ultrasound examination done, on the day of rupture of follicle of menstrual cycle, on 160 women, willing to conceive, has been collected from gynaecologist. And also, her status whether she was implanted or not implanted was collected from the gynaecologist. Data about her pregnancy status upto 20 weeks were collected. From this collected data, results regarding endometrial vascularity were derived. Results: Implantation rate in cases having vascularity upto V1 zone, upto V2 zone, upto V3 zone, upto V4 zone were 0 %, 8.33 %, 25 %, 30.5% respectively. Conclusion: Implantation rate is greater in cases having vascularity upto V3 and V4 zone than V1 & V2 zone. Endometrial vascularity is an important factor for implantation of fertilized egg and also for further growth of embryo.

Endometrial scratch injury in infertile women undergoing in vitro fertilization cycles: a systematic review and meta-analysis.

This study aimed to evaluate the effect of endometrial scratch injury (ESI) in infertile women undergoing in vitro fertilization (IVF). We screened MEDLINE, CENTRAL, EMBASE, Web of Science, and the Cochrane Central Register from inception to April 2023 using keywords related to endometrial scratch, implantation, infertility, and IVF. We included 41 randomized, controlled trials of ESI in IVF cycles (9084 women). The primary outcomes were the clinical pregnancy, ongoing pregnancy, and live birth rates. The clinical pregnancy rate was reported in all 41 studies. The odds ratio (OR) for the clinical pregnancy rate had an effect estimate of 1.34 with a 95% confidence interval (CI) of 1.14 to 1.58. The live birth rate was reported in 32 studies with 8129 participants. The OR for the live birth rate had an effect estimate of 1.30 with a 95% CI of 1.06 to 1.60. The multiple pregnancy rate was reported in 21 studies with 5736 participants. The OR for the multiple pregnancy rate had an effect estimate of 1.35 with a 95% CI of 1.07 to 1.71. ESI increases the clinical pregnancy, ongoing pregnancy, live birth, multiple pregnancy, and implantation rates in women undergoing IVF cycles.

P-328 Endometrial receptivity in women with endometriosis undergoing Assisted Reproductive Technology (ART) after frozen embryo transfer: a matched pair case-control study

Abstract Study question Does endometriosis affect endometrial receptivity in frozen/thawed embryo transfer (FET) cycles? Summary answer Stage III/IV endometriosis-patients undergoing ART submitted to FET cycles have implantation, pregnancy and live-birth rates, as well as pregnancy outcomes, similar to control women. What is known already The increased infertility rate observed in women with endometriosis is supposed to be linked, among other factors, to molecular alterations already documented in the endometrial tissue of these affected women. These alterations might influence the interaction between the embryo and the endometrium, leading to a compromised implantation; however, data from the literature are controversial and do not always corroborate the hypothesis of a lower implantation rate in women with endometriosis. Study design, size, duration This is a retrospective matched case-control study including 101 women diagnosed with stage III/IV endometriosis. They were matched in a 1:1 ratio with patients undergoing frozen embryo transfers after ART treatments for other infertility-related indications at the Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico di Milano, between 2015 and 2022. Participants/materials, setting, methods Patients (n = 202) were submitted to ovarian stimulation according to standard protocols and only single embryo transfer cases and the 1st ART cycle with freeze-all protocol were included. To match, it was considered the women's age ( ± 1 year), and the number ( = ) and quality ( ± 1 top vs low) of blastocysts obtained in each cycle, considering the Istanbul consensus as the embryo standard assessment protocol. The main outcome evaluated in this study was implantation rate. Main results and the role of chance Baseline characteristics did not significantly vary between the two study groups, except for AMH levels, which was considerably lower in the endometriosis group compared to control (4.0 [2.7 - 5.4] vs 4.6 [3.7 - 6.5], respectively; p = 0.03). Considering the treatment outcomes, the number of oocytes inseminated/injected in each cycle was similar between endometriosis and control group (8 [7 - 10] vs 9 [7 - 11], respectively; p = 0.26). In line with the matching performed, the number of blastocysts generated did not differ between women with and without endometriosis (3 [2 - 4] vs 3 [2 - 4], respectively; p = 1.00), as well as the number of top-quality blastocysts (2 [1 - 3] vs 2 [1 - 3], respectively; p = 0.76). In regard to our main outcome evaluated, implantation rate in women with endometriosis and their controls were similar (36% vs 40%, respectively; p = 0.52). There was also no difference between the endometriosis group and controls considering cumulative pregnancy outcomes, such as pregnancy rate (58% vs 65%, respectively; p = 0.39), cumulative live birth rate (51% vs 59%, respectively; p = 0.26), pregnancy complications (6% vs 14%, respectively; p = 0.34), and pregnancy loss (16% vs 19%, respectively; p = 0.70). Limitations, reasons for caution As it is a retrospective study, our reports might be subjected to misclassification bias. Also, some of the women in the control group may have asymptomatic undiagnosed endometriosis; however, considering the incidence of this disease, it should not compromise our evaluation. Wider implications of the findings Our present findings give support to the idea that endometriosis does not influence the implantation rate in women with endometriosis undergoing ART submitted to FET. Considering fertility, this finding raises doubts about the clinical relevance of the molecular aberrations detected in the endometrium of women affected by endometriosis. Trial registration number not applicable

P-532 Understanding the utility of hysteroscopic endometrial peeling in women with implantation failure

Abstract Study question Does hysteroscopic endometrial peeling improve reproductive outcomes in women with implantation failure (IF) undergoing a single euploid embryo transfer (SEET)? Summary answer Women with IF may benefit from intraoperative endometrial peeling prior to a SEET. What is known already Preimplantation genetic testing for embryonic aneuploidy (PGT-A) has been suggested as a strategy to improve implantation rates in women with IF. However, after controlling for the genetic status of the embryo, implantation rates still vary from 40-70%, suggesting that other factors aside from the ploidy of the embryo contribute with the cause of IF. We previously demonstrated that hysteroscopic endometrial peeling enhances implantation in women with IF. However, our study was limited by only including frozen embryo transfers of unscreened embryos. We aim to analyze the clinical utility of hysteroscopic endometrial peeling in women who underwent a SEET. Study design, size, duration A retrospective, cohort study included infertile patients with IF diagnosis who underwent endometrial peeling through hysteroscopy and subsequently a SEET from January 2016 to December 2022. Only the first transfer after the hysteroscopic endometrial peeling was included in the analysis. Participants/materials, setting, methods Women <41 years, with IF, normal saline sonogram, and no previous uterine surgeries were segregated into two groups: A) 66 patients underwent hysteroscopic endometrial peeling, which consists of removing the superficial endometrial layer of the whole uterine cavity with hysteroscopic biopsy forceps, and B) 38 controls who did not undergo surgical endometrial peeling. All patients underwent a subsequent SEET. Main results and the role of chance In total 104 women were included in the cohort. No differences were found in age, body mass index, baseline FSH, AMH, baseline antral follicle count, previous number of stimulation/IVF cycles, number of embryos transferred, and, embryonic quality among cohorts. Evaluating the endometrium, no differences were observed in the endometrial pattern, however, the endometrial thickness was thicker in group B (8.4±1.5mm vs 9.2±1.3mm, p = 0.02). When analyzing the subsequent SEET cycle, women in group A had higher implantation (51.8% vs 40.6%, p = 0.001) and clinical pregnancy rates (63.5% vs 31.4%, p = 0.009). No difference was found in clinical loss rates (9.4% vs 10.1%, p = 0.06) among cohorts. Of the patients who underwent surgical endometrial peeling, 18.1% (12/66) had the following incidental intraoperative findings: mild intrauterine and/or cervical adhesions (5/66, 0.07%), endometrial polyps (10/66, 15.1%), polypoid endometrium (8/66, 12.1%). 64.3% of the patients with incidental findings became pregnant. Limitations, reasons for caution This study is limited by its retrospective nature. Additionally, in patients with noted uterine pathology, appropriate surgical management was administered in the same setting, this could have biased the results. Future randomized controlled trials are needed. Wider implications of the findings This study continues to support the possible benefit of mechanically peeling the superficial endometrial layer through hysteroscopy to increase implantation rates in women with IF who undergo a SEET. Trial registration number NA

Can intrauterine infusion of granulocyte colony-stimulating factor or platelet-rich plasma increase implantation rate in women undergoing in vitro fertilization with normal endometrium: boon or bane?

Can intrauterine infusion of granulocyte colony-stimulating factor or platelet-rich plasma increase implantation rate in women undergoing in vitro fertilization with normal endometrium: boon or bane?

Increased amplitude of subendometrial contractions identified by ultrasound speckle tracking in women with a caesarean scar defect

Research questionWhat is the effect of a caesarean scar defect on subendometrial contractions? DesignProspective cohort study in a Dutch medical centre including women with a niche in the uterine caesarean section scar. Data were compared with controls without a caesarean section scar. All women underwent a 5-min recording by transvaginal ultrasound at four phases in the menstrual cycle: during menses; late follicular; early luteal; or late luteal phase. Uterine motion analysis was evaluated by dedicated speckle tracking using two-dimensional optical flow. Main outcome: amplitude of the subendometrial contractions. ResultsThirty-one women with a niche in the uterine scar and 11 controls, matched for menstrual cycle phase, were included. The amplitude of the subendometrial contractions was significantly higher in women with a niche compared with controls during all phases of the menstrual cycle (menses P < 0.001; late follicular P < 0.001; early luteal P = 0.028; late luteal P = 0.003). Velocity was lower in women with a niche during late follicular phase only (P = 0.012). A positive correlation between niche sizes (depth, length) and amplitude of subendometrial contractions was found. ConclusionSubendometrial contractions were affected in women with a niche in the caesarean section scar compared with women who had not undergone a previous caesarean section. Contraction amplitude was higher and independent of the menstrual phase. These findings may cause postmenstrual spotting, dysmenorrhoea and lower implantation rates in women with a niche. Future studies should investigate this association and the underlying pathways.

In silico evidence for prednisone and progesterone efficacy in recurrent implantation failure treatment.

Increased expression and activation of tumor necrosis factor-α (TNF-α) could lead to recurrent implantation failure (RIF). Therefore, TNF-α inhibition may be a strategic way to enhance the implantation rate in women with RIF. Nowadays, monoclonal antibodies are considered an effective therapeutic method for TNF-α inhibition. Unfortunately, monoclonal antibody treatments have several disadvantages. Thus, the design of small molecules capable of inhibiting TNF-α has become critical in recent years. In silico drug repurposing of FDA-approved drugs for TNF-α inhibition was used in this study. PyRx tools were employed for virtual screening. Additionally, the free energy of binding, the number of hydrogen bonds, and the number of drug contacts with the protein were calculated using the molecular dynamics (MD) simulation method. Virtual screening results reveal that 17 of 2471 FDA-approved drugs benefited from favorable binding energy with TNF-α (delta G < − 10 kcal/mol). Two of the 17 drugs, progesterone and prednisone, were the most frequently used without adverse effects during pregnancy. As a result, MD simulation was used to investigate these two drugs further. According to the MD simulation results, prednisone appears to have a higher affinity for TNF-α than progesterone, and consequently, the prednisone complex stability is higher. For the first time, this study examined the possible role of prednisone and progesterone in inhibiting TNF-α using in silico methods.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s00894-022-05093-z.

The number of previous failed embryo transfer cycles is an independent factor affecting implantation rate in women undergoing IVF/ICSI treatment: A retrospective cohort study.

The implantation rate (IR) in assisted reproductive technologies such as in vitro fertilization (IVF) and intracytoplasmic sperm injection is affected by many different factors such as age, quality of embryo, and stage of embryo development. This study aimed to investigate to what extent the number of previous failed embryo transfer cycles is an independent factor affecting IR.This was a single-center, retrospective cohort study of a consecutive series of 6376 day-3 embryo transfer (ET) cycles following IVF between January 2012 and August 2018. None of the subjects underwent endometrial scratch/injury prior to the treatment cycle, or received intravenous immunoglobulin, steroid, dehydroepiandrosterone, intralipid or heparin during the treatment with the aim of improving implantation rates.Multiple regression analysis showed that the 3 most important independent factors affecting the IR, in decreasing of importance: age, frozen or fresh embryo transfer and the number of previous ET cycles. Having controlled for 2 of the more important confounding variables including maternal age and the type of embryo, the IR in women who had 0, 1, 2, and 3 or more previous failed ET cycles were 45.8%, 35.9%, 31.2%, 21.0%, respectively (P < .001).Repeated implantation failure is a significant independent factor affecting the IR. The number of previous failed ET cycles should be considered in counselling women regarding the prognosis of a further IVF-ET treatment cycle.

INTRAUTERINE ADMINISTRATION OF PERIPHERAL BLOOD MONONUCLEAR CELLS INCREASES CLINICAL PREGNANCY RATES IN FROZEN-THAWED EMBRYO TRANSFER CYCLES OF PATIENTS WITH IMPLANTATION FAILURE

Intrauterine administration of peripheral blood mononuclear cells (PBMC) has been proposed to improve implantation rates in women with implantation failure. Our aim was to observe the effects of intrauterine administration of maternal and paternal PBMC on clinical pregnancy rate (CPR) of patients who received frozen-thawed embryo transfer (FET).

Effect of High Trace Element Levels in Serum of Women Undergoing Intra-cytoplasmic Sperm Injection (ICSI) on Implantation Rate

Objectives: To assess the effects of trace element concentrations in serum on implantation rate in women undergoing ICSI. Study design: Across-sectional study was conducted between March 2018 to April 2019 in Kamal ALSamarai Hospital, center of fertility and IVF. One hundred and seventeen women underwent ICSI using GnRH-antagonist protocol were recruited. Concentration E2, P4 and two trace elements (Cu, Zn, and Cu/ Zn) were measured in serum specimen. Women’s were evaluated in two groups; the study group consisted of patients with successful implantation (n = 21) and women in the second group (n=96) experienced implantation failure. Results: No significant differences were observed in age or BMI between the groups. Serum copper levels were significantly higher differences (P=0.001) in group of failure (198 ± 107?g/dL) than in group of successful implantation (133 ± 46?g/dL), zinc concentrations in group of successful and failure out of the maximum of normal range (137 ± 40?g/dL versus 135 ± 34?g/ dL respectively) but statistically significant differences were did not observed (P?0.05). When we calculated the copper/zinc ratio (Cu/Zn), it was significantly higher differences (P=0.001) in group of failure (1.59 ± 1) than in group of successful (1.03 ± 0.4). In conclusion, we observed that high serum copper concentrations and (high Cu/Zn ratio) are a risk factor for implantation failure.

Effects of resveratrol, granulocyte-macrophage colony-stimulating factor or dichloroacetic acid in the culture media on embryonic development and pregnancy rates in aged mice.

The success rate of assisted reproductive technology is closely correlated with maternal age. Reproductive aging pathologies are frequently caused by impaired DNA repair, genomic instability, and mitochondrial dysfunction. Several reports have shown that resveratrol can prevent age-related diseases by improving mitochondrial function. Improved blastocyst development and mitochondrial output by dichloroacetic acid (DCA) supplementation were reported in aged mice. Granulocyte-macrophage colony-stimulating factor (GM-CSF) has significant effects on implantation rates in women with previous miscarriages. Therefore, this study was conducted to observe how those compounds influence the developmental and the reproductive potential of aged oocytes. BDF1 female mice at 58–62 weeks old were used for this study. MII oocytes were fertilized and cultured in MRC media supplemented with or without resveratrol (0.5 μM), GM-CSF (2 ng/ml) or DCA (1.0 mM). The addition of resveratrol, GM-CSF or DCA tended to increase blastocyst development and pregnancy rates. Supplementation with resveratrol significantly increased the pregnancy and implantation rates (p < 0.05). Moreover, resveratrol decreased reactive oxygen species production and increased mitochondrial membrane potential. These results suggest that the addition of resveratrol can increase pregnancy outcomes in women of advanced maternal age.

Implantation failures in women with infertility associated endometriosis

Endometriosis is currently considered as one of the most common diseases associated with infertility. A controversial issue is whether endometriosis per se exerts a detrimental effect on IVF outcomes. Failure of implantation due to endometriosis-associated infertility is a contradictory and widely discussed burden nowadays. The purpose of the study is to assess the quality of embryos and implantation rate in women with infertility associated with endometriosis. The study included infertile reproductive aged women, between 26 and 40 years who underwent IVF and ICSI procedures. The patients were divided into two groups: group I (n = 70) involved 70 patients with recurrent unilateral endometriomas, II control group (n = 50) with tubal factor infertility. The quality of the retrieved embryos was assessed according to the generally accepted classification of Gardner, indicating the rate of implantation in each group. Embryo transfer was performed in case of high quality embryos. Assessing the ovarian reserve indicators, in the group I patients with recurrent unilateral endometriomas the serum level of AMH was significantly lower (2.1 ± 1.75 vs. 3.2 ± 1.4, p < .005), as well as the number of retrieved oocytes (8.1 ± 3.9 and 10.1 ± 6.8, p < .005). The analysis of the results demonstrated that the duration of stimulation in the group patients with recurrent unilateral endometriomas was significantly higher in comparison with the group II (12.2 ± 1.8 and 10.2 ± 1.6 days, p < .001). Nevertheless, the number of good quality embryos retrieved was comparable in both groups (2.2 ± 1.5 and 2.8 ± 1.8). In the group I patients with recurrent unilateral endometriomas, there was a statistically significant decrease of implantation rate (17.1% vs. 24% p < .005). The results of the study revealed no statistical difference in embryo quality in the study cohort. However, it is important to note that a statistically significant difference in implantation rate in the group of endometriosis-associated infertility compared was obtained 1.5 times lower than in the control group (15.8% vs. 24.0% p < .005). The achieved results demonstrated an adverse IVF outcome in infertile women with recurrent endometrioma compared to the control group.

Effect of Intrauterine Perfusion of Granulocyte Colony-stimulating Factor on Endometrial parameters and In Vitro Fertilization Outcome in Women Undergoing In Vitro Fertilization/Intracytoplasmic Sperm Injection Cycles: A Randomized Controlled Trial.

Context:Studies have found intrauterine perfusion of granulocyte colony-stimulating factor (G-CSF) to improve endometrial thickness and implantation rates in women undergoing in vitro fertilization (IVF).Aims:To study the effect of intrauterine perfusion of G-CSF on endometrial parameters and IVF outcomes in patients undergoing fresh embryo transfers.Settings and Design:This was a randomized double-blinded placebo-controlled trial conducted at assisted reproduction unit of a tertiary care center.Subjects and Methods:One hundred and fifty patients undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment and fresh embryo transfers were randomized to intervention and placebo groups. Patients in the intervention group received intrauterine perfusion of 300 μg (0.5 ml) of G-CSF on the day of ovulation trigger. Patients in placebo group received intrauterine perfusion of 0.5 ml normal saline on the day of ovulation trigger. The primary outcome measure was clinical pregnancy rate. The secondary outcome measures were change in endometrial thickness, volume, and vascularity on the day of embryo transfer; biochemical pregnancy rate, implantation rate, ongoing pregnancy rate, and live birth rate. Statistical analysis was carried out using STATA 12.0 (StataCorp LP, College Station, Texas, USA).Results:Endometrial vascularity in the intervention group was significantly higher on the day of embryo transfer compared to the placebo group. Clinical pregnancy rate was 27.6% in the intervention group compared to 18.9% in the placebo group and the difference was not statistically significant (P = 0.207). There was no statistically significant difference between biochemical pregnancy rate, implantation rate, ongoing pregnancy rate, live birth rate and endometrial parameters between the two groups.Conclusions:Routine use of G-CSF in unselected IVF cycles may not lead to increase in positive IVF outcomes. More trials with larger sample sizes are required before approving or refuting the role of routine G-CSF in increasing IVF success rates. (CTRI/2017/10/010310).

Endometrium or embryo quality in minimal or mild endometriosis - related infertility

Background : There is controversy related to pathogenesis and mechanism by which minimal or mild endometriosis affects fertility in women. It is accepted that moderate-severe endometriosis disrupt the anatomical relationships between fallopian tube and ovary. Some researchers found impaired implantation in patients with endometriosis, but such defects in implantation may be caused by either embryos or altered endometrium. Further investigations on follicular fluids have also found differences between women with endometriosis and women without the disease. In addition, recent advances on implantation research, show features in the eutopic endometrium of women with endometriosis that are not found in endometrium of women without the disease, although it is controversial. The review aims at describing the available information from the eutopic endometrium or embryo standpoint infertility related to endometriosis. Objective : To explore the interrelation of the eutopic endometrium or embryo in women with infertility and the endometriosis. Methods : Retrospective review of literature using all the available English databases, Cochrane register and articles which addressed the question “Whether the endometrium or embryo quality is different in women with endometriosis associated infertility?“ Conclusion : Although contradictory results have been reported, different clinical studies have demonstrated worse success rates for pregnancy in women with endometriosis compared with healthy women or with tubal factor among those that found lower pregnancy rates in women with endometriosis compared with controls without the disease, some found alterations in implantation rates in women with endometriosis when they were compared with controls. The debate continues, and other approaches should be developed before we can determine the authentic origin of the defects that make conception more difficult in these patients. These new studies must include an adequate design and controls, in order to avoid misleading data that can complicate the interpretation of the pathophysiology of this enigmatic disease.

Intrauterine instillation of cumulus cells enhances implantation rates in women with previous failed implantation following embryo transfer

Intrauterine instillation of cumulus cells enhances implantation rates in women with previous failed implantation following embryo transfer

Mice endometrium receptivity in early pregnancy is impaired by maternal hyperinsulinemia.

Previous studies have investigated the lower embryo implantation rates in women with polycystic ovary syndrome, obesity and type 2 diabetes, and specifically the association between the abnormal oocyte and embryo and hyperinsulinemia. The importance of hyperinsulinemia on maternal endometrium receptivity remains to be elucidated. The present study used a hyperinsulinemic mouse model to determine whether hyperinsulinemia may affect endometrial receptivity. An insulin intervention mouse model was first established. The serum levels of insulin, progesterone and estradiol were subsequently detected by ELISA assay analysis. The number of implantation sites was recorded using Trypan blue dye and the morphology of mice uteri was investigated using hematoxylin and eosin staining. The expression levels of molecular markers associated with endometrial receptivity were detected by reverse transcription-quantitative polymerase chain reaction, western blotting and immunohistochemistry analyses. Finally, the importance of mechanistic target of rapamycin (mTOR) expression following insulin treatment was determined. Mice treated with insulin developed insulin resistance and hyperinsulinemia. The number of implantation sites following insulin treatment did not differ between the control and insulin-treated groups. Additionally, no significant morphological alterations in mice uteri between control and insulin-treated groups were observed. However, the expression levels of estrogen receptor (Esr) 1, Esr2, progesterone receptor and homeobox A10 associated with endometrial receptivity, were imbalanced during endometrium receptivity when maternal hyperinsulinemia was induced. Western blot analysis revealed that expression levels of endometrial phosphorylated (p)-mTOR and p-ribosomal protein S6 kinase β-1 were significantly greater in the insulin-treated group. These results demonstrated that although an embryo may implant into endometrium, mice endometrium receptivity in early pregnancy may be impaired by maternal hyperinsulinemia. In addition, mTOR signaling may be involved in this process. The present study provides preliminary results demonstrating that female reproduction may be compromised during hyperinsulinemia, which requires further investigation in future studies.

The Effect of Preimplantation Genetic Screening on Implantation Rate in Women over 35 Years of Age.

Advanced maternal age (AMA) is an important factor in decreasing success of assisted reproductive technology by having a negative effect on the success rate of intra-cytoplasmic sperm injection (ICSI), particularly by increasing the rate of embryo aneuploidy. It has been suggested that the transfer of euploid embryos increases the implantation and pregnancy rates, and decreases the abortion rate. Preimplantation genetic screening (PGS) is a method for selection of euploid embryos. Past studies, however, have reported different results on the success of pregnancy after PGS in AMA. Investigating the pregnancy rate of ICSI with and without PGS in female partners over 35 years of age referred to infertility centers in Tehran. In this randomized controlled trial, 150 couples with the female partner over age of 35 were included. Fifty couples underwent PGS and the remaining were used as the control group. PGS was carried out using fluorescent in situ hybridization (FISH) for chromosomes 13, 18, 21, X and Y. Results of embryo transfer following PGS were evaluated and compared with those in the control group. Implantation rates obtained in the PGS and control groups were 30 and 32% respectively and not significantly different (P>0.05). PGS for chromosomes 13, 18, 21, X and Y does not increase implantation rate in women over 35 years of age and therefore the regular use of PGS in AMA is not recommended.