Improvement In Clinical Pregnancy Rate Research Articles

Effects of Chinese Medicines for Tonifying the Kidney on DNMT1 Protein Expression in Endometrium of Infertile Women During Implantation Period

The purpose of this study was to explore the effects of Erzhi Tiangui Granule (ETG) on DNA methyltransferases (DNMT) 1 protein expression in endometrium of infertile women with Kidney-yin Deficiency syndrome. A randomized, double-blinded, placebo-controlled clinical trial was conducted. Sixty-six (66) infertile patients who had Kidney-yin Deficiency syndrome and who were to undergo in vitro fertilization-embryo transfer (IVF-ET) were randomly assigned to either a treatment group or a control group according to a random table. Besides gonadotropin (Gn) therapy in both groups, the treatment group received ETG for 3 menstrual cycles before IVF, and the control group received placebo granules. The ETG and the placebo granules were made with similar color and shape, as well as in the same packaging. The scores of the Kidney-yin Deficiency syndrome were assessed. Other outcome measures included the dosage and duration of Gn, the number of retrieved oocytes, the rate of high-quality oocytes, the rate of high-quality embryos, the fertilization rate, and the clinical pregnancy rate. DNMT1 protein expression in the endometrium was measured in the midluteal phase. The difference in the syndrome score change before and after treatment between the two groups was statistically significant (p<0.05). The dosage and duration of Gn were significantly lower in the treatment group than those in the control group (p<0.05). The high-quality oocyte and embryo rates, and clinical pregnancy rate were all higher in the treatment group than those in the control group (p<0.05). The fertilization rate was not significant when compared to the placebo group. No difference was found in the number of retrieved oocytes between the two groups. The DNMT1 protein expression in the endometrium was much more abundant in the treatment group than that in the control group (p<0.05). For the infertile patients undergoing IVF, the Chinese recipe for tonifying the Kidney as an adjunct treatment could reduce Gn dosage and treatment duration, alleviate clinical symptoms, and improve the clinical pregnancy rate. The increased level of DNMT1 protein expression after treatment may lead to enhanced endometrial receptivity. This finding may explain the improvement in clinical pregnancy rate.

Effectiveness of GnRH antagonist in intrauterine insemination cycles

To evaluate the effectiveness of GnRH antagonists in women undergoing controlled ovarian stimulation and intrauterine insemination cycles (COS/IUI). Randomized controlled trial. Recruited women were randomized into two groups: GnRH antagonist and control group. The primary outcomes were incidence of premature LH surge and clinical pregnancy rates. One hundred and forty-one consecutive women were included in the study, with 70 in the antagonist group and 71 in the control arm. The baseline clinical characteristics were similar in both groups. The incidence of premature LH surge and premature luteinization was lower in the antagonist group as compared to the control group (5% vs. 10.3%, P=0.45 and 5% vs. 13.8, P=0.31) but not statistically significant. The clinical pregnancy rates were lower in the antagonist group (2.8% vs. 10%, P=0.12), which was also not statistically significant. The addition of GnRH antagonist during controlled ovarian stimulation and intrauterine insemination cycles does not lead to improvement in clinical pregnancy rates.

The role of inositol supplementation in patients with polycystic ovary syndrome, with insulin resistance, undergoing the low-dose gonadotropin ovulation induction regimen

In an attempt to evaluate the role of inositol supplementation in insulin-resistant patients with polycystic ovary syndrome (PCOS), undergoing gonadotropin ovulation induction using the low-dose step-down regimen, we conducted a prospective longitudinal study comparing the stimulation characteristics of 15 patients treated with inositol, to a cohort, matched by age and body mass index (BMI), without inositol. Inositol nutritional supplementation produced very good clinical results with a significant reduction in cancellation rate (0 vs. 40%) and the consequent improvement in clinical pregnancy rate (PR) (33.3% vs. 13.3%).

Ultrashort flare GnRH agonist combined with flexible multidose GnRH antagonist for patients with repeated IVF failures and poor embryo quality

To evaluate the appropriate controlled ovarian hyperstimulation (COH) protocol in patients with repeated IVF failures and poor embryo quality we compared the stimulation characteristics of ten cycles which included ultrashort flare GnRH agonist combined with flexible multidose GnRH antagonist with the patients' earlier failed IVF attempts. The use of ultrashort GnRH agonist/GnRH antagonist COH protocol resulted in a significantly higher number and proportion of top-quality embryos, with a consequent improvement in clinical pregnancy rate (50%).

Ultrasound-guided embryo transfer is superior to clinical touch alone: a single operator randomized controlled trial

Ultrasound-guidance (US) during embryo transfer (ET) has been shown to improve the ease of transfer, and precision in determining the site of transfer when compared to the standard clinical touch (CT) method. Even so, there have been conflicting reports with regards improvement in clinical pregnancy rates following USG vs. CT-ET. This heterogeneity may be a result of individual transfer techniques, role of multiple practitioners performing embryo transfer, or study quality.

Is there a benefit of low-dose aspirin in assisted reproduction?

Assisted reproduction is an effective treatment for infertile women but, despite advances in ovarian stimulation and laboratory techniques, overall pregnancy rates are still relatively low suggesting that methods to improve implantation are required. One strategy is to increase the blood flow to the uterus with low-dose aspirin. The objective of this review is to determine if low-dose aspirin improves clinical pregnancy rates when administered to infertile women undergoing treatment with assisted reproduction. A retrospective review was unable to demonstrate improved pregnancy rates when low-dose aspirin was compared with no treatment. Such studies, however, have limited value in clinical decision-making because of poor methodological quality. A recent high-quality randomized, placebo-controlled trial of low-dose aspirin was also unable to demonstrate any benefit, a finding supported by a meta-analysis of 10 trials that collectively had sufficient power to detect a clinically relevant improvement in clinical pregnancy rate. Evidence also exists that low-dose aspirin is potentially harmful, because of increased bleeding problems, miscarriage and congenital anomalies. Given the lack of efficacy and the potential for harmful effects to both the patient and her offspring, low-dose aspirin should not be administered to infertile women undergoing treatment with assisted reproduction.

Clinical approaches to increasing uterine receptivity during human implantation.

An improvement in clinical pregnancy rate follows a natural or induced period of amenorrhoea. The cause is unknown, but it could be related to the period of uterine 'rest' which may restore full function to the steroid-sensitive systems, such as the pinopodes, after a prolonged period of constant menstrual cycling. This may result in the restoration of uterine capacity for embryo implantation to levels typical of younger women. Some other avenues of research on the unusual aspects of human implantation are worth further study. An impaired uterine blood flow could lower the chances of implantation. Immunological factors may emerge as major elements in the human implantation process, because the neutralization of antiphospholipid antibodies may enhance the activity of early trophoblast.