Time Of Embryo Transfer Research Articles

The oocyte-to-baby rate of day 2, day 3 versus day 5 embryo transfer: a retrospective study

Objectives: To investigate whether the time of embryo transfer (ET) affect the oocyte-to-baby rate. Materials and Methods: The database was retrospectively analyzed including total number of oocytes collected and corresponding oocyte-to-live baby born (LBB) rate. Then the relationship between different time of embryo transfer and oocyte-to-baby rate was compared. In a year period all patients undergoing infertility treatment were included in the study. The outcome parameters were total number of oocytes collected and corresponding oocyte-to-LBB. Results: For patients under the age of 35 years, there was no increase in oocyte-to-LBB regardless of the time of ET. For patients older than 35 years, the oocyte use rate increased significantly when embryo was transferred on day 2. Oocyte-tobaby rates were also analyzed after grouping patients on the number of oocytes retrieved per cycle. For patients 35 years, the oocyte-to-baby rate was best on day 2 when about 15 oocytes were retrieved. Conclusions: This retrospective analysis demonstrated the relationship between the time of ET and ooctye-to-baby rate that is indicative of a more biologically efficient reproductive system.

Superovulatory response to gonadotrophin FSH/LH treatment and effect of progestin supplement to recipients on survival of transferred vitrified embryos in goats

Two experiments were carried out in goats to evaluate the effects of the FSH/LH ratio during treatment on ovarian response and embryo production (experiment 1) and the efficiency of progestin supplementation on pregnancy and the survival of vitrified embryos (experiment 2). In experiment 1, 30 goats were synchronized and allocated to 2 groups (n = 15) corresponding to the following superovulatory treatments with p-FSH (250 IU, over 3 days) having different doses of purified FSH and LH: (group A) control, FSH/LH ratio of 1, kept constant during treatment; (group B) FSH/LH ratio of 2 and daily FSH/LH ratio of 5.0:1.0:0.3 for the first, second, and third days of treatment, respectively. Ovarian response and embryo production were assessed 7.5 days after estrus. In experiment 2, 46 vitrified blastocysts from p-FSH–superovulated donors were transferred to 26 recipients (2 blastocysts per goat) 7.5 days after estrus. The recipients were synchronized with donors and allocated to 2 experimental groups (n = 13). Group C received progestin supplement as fluorgestone acetate (FGA) inserted into the vagina at the time of embryo transfer, replaced with a new one 16 days later, and maintained until the 45th day of pregnancy; group D, no treatment (control). Pregnancy was diagnosed by transrectal ultrasound scanning on Days 30 and 45 after estrus and followed to term. The results indicated that the increase in FSH/LH ratio from 1 to 2 with decreasing daily FSH/LH (treatment B) did not improve the superovulatory response. Superovulatory treatment A (control) advanced (P < 0.05) the onset of estrus and showed a higher ovulation rate compared to group B (14.9 vs. 10.9; P < 0.05). Fertilization rate, embryo yield, and mean number of transferable embryos in group A (7.5) were higher (P < 0.05) than those in group B (3.2). Recipient goats receiving progestin supplementation (group C) showed a higher (P < 0.05) pregnancy rate and embryo survival (kids born per embryos transferred; 69.3% and 73.1%) than the controls (group D; 23.3% and 19.2%). In conclusion, regimen A with FSH/LH ratio of 1 kept constant during the treatment gave the best ovarian response and embryo production. The progestin supplementation as FGA-pessary administered at embryo transfer time to the 45th day of pregnancy improved the pregnancy rate, kidding rate, and embryo survival of transferred vitrified embryos. Intravaginal progestin supplement has the potential to reduce the incidence of pregnancy losses during early pregnancy.

Microbiome at the time of embryo transfer: next generation sequencing of the 16S ribosomal subunit

Microbiome at the time of embryo transfer: next generation sequencing of the 16S ribosomal subunit

Follicle and corpus luteum size and vascularity as predictors of fertility at the time of artificial insemination and embryo transfer in beef cattle

Abstract:Two ultrasound based fertility prediction methods were tested prior to embryo transfer (ET) and artificial insemination (AI) in cattle. Female bovines were submitted to estrous synchronization prior to ET and AI. Animals were scanned immediately before ET and AI procedure to target follicle and corpus luteum (CL) size and vascularity. In addition, inseminated animals were also scanned eleven days after insemination to target CL size and vascularity. All data was compared with fertility by using gestational diagnosis 35 days after ovulation. Prior to ET, CL vascularity showed a positive correlation with fertility, and no pregnancy occurred in animals with less than 40% of CL vascularity. Prior to AI and also eleven days after AI, no relationship with fertility was seen in all parameters analyzed (follicle and CL size and vascularity), and contrary, cows with CL vascularity greater than 70% exhibit lower fertility. In inseminated animals, follicle size and vascularity was positive related with CL size and vascularity, as shown by the presence of greater CL size and vascularity originated from follicle with also greater size and vascularity. This is the first time that ultrasound based fertility prediction methods were tested prior to ET and AI and showed an application in ET, but not in AI programs. Further studies are needed including hormone profile evaluation to improve conclusion.

Maternal serum progesterone concentration and early conceptus development of bovine embryos produced in vivo or in vitro

The hormone progesterone is essential for proper embryonic development. The objective of this study was to examine the relationship between recipient serum concentrations of progesterone, at the time of embryo transfer and at conceptus recovery, on conceptus development from in vivo- or in vitro-produced embryos. Embryos were produced in vivo by superovulation of Holstein cows (IVO; n = 17) or in vitro with either serum-containing (IVPS; n = 27) or serum-restricted medium (IVPSR; n = 34). Single grade I blastocysts from each embryo production system were transferred into heifers on day 7 of development. Conceptuses were recovered on day 17 of gestation and classified as complete, degenerated, or no conceptus. Compared with the IVO group, in vitro-produced embryos had more (P = 0.055) degenerated conceptuses (IVO, 0%; IVPS, 18.5%; and IVPSR, 20.6%). There were no differences in progesterone concentrations at the time of transfer when recipients received either male or female embryos (P > 0.05). Progesterone concentrations in recipients receiving in vivo-produced embryos were higher (P < 0.05; 3.74 ± 0.4 ng/mL; least-squares mean ± standard error of the mean) on day 7 compared with those receiving in vitro-produced embryos (IVPS, 2.4 ± 0.2; IVPSR, 2.58 ± 0.3 ng/mL). However, there was no difference in progesterone concentration on day 7 between treatment groups for heifers from which short conceptuses (≤194 mm) were recovered on day 17. In contrast, when longer (>194 mm) conceptuses were recovered on day 17, heifers receiving in vitro-produced embryos had lower (P = 0.05) serum concentrations of progesterone on day 7 compared with those receiving in vivo-produced embryos (IVPS, 2.2 ± 0.5; IVPSR, 2.3 ± 0.5; IVO, 3.9 ± 0.5 ng/mL). In conclusion, differences in autonomy may exist between in vitro- and in vivo-produced embryos during the period of conceptus elongation with in vitro-produced embryos relying more on intrinsic factors to influence elongation.

Administration of the nonsteroidal anti-inflammatory drug tolfenamic acid at embryo transfer improves maintenance of pregnancy and embryo survival in recipient mice.

To evaluate the effect of the nonsteroidal anti-inflammatory drugs tolfenamic acid and flunixin meglumine in pregnancy rate and embryo survival of recipient mice subjected to embryo transfer. A total of 142 recipient females were transferred with 2,931 embryos and treated with a single injection of tolfenamic acid (1 mg/kg; n = 54 females with 1,129 embryos), flunixin meglumine (2.5 mg/kg; n = 46 females with 942 embryos), or bi-distilled water (10 mL/kg) as control group (n = 42 females with 860 embryos). Pregnancy was checked 2 weeks after embryo transfer, delivery was registered on the due date, and litter size was recorded on Day 7 after birth. Pregnancy rate of tolfenamic acid treated females was significantly higher than flunixin group (P < 0.05) and showed a tendency to be higher when compared to the control group (P = 0.06). The number of pups born from transferred embryos in pregnant females was significantly higher for both treatment groups compared to controls (P < 0.05). Number of pups from total transferred embryos was higher for both treatment groups (P < 0.05) when compared to controls. The use of tolfenamic acid at the time of embryo transfer improves both pregnancy rate and number of live pups in recipient mice, with optimal effects observed with flunixin meglumine. We suggest that the use of tolfenamic acid has beneficial effects on the maintenance of pregnancy and embryo survival in recipient mice, which should be taken into account for further studies in other mammalian females.

The individualized choice of embryo transfer timing for patients with elevated serum progesterone level on the HCG day in IVF/ICSI cycles: a prospective randomized clinical study

This study analyzed the clinical outcomes of patients with elevated progesterone level on the HCG day in IVF/ICSI cycles, with different timing of embryo transfer. A total of 123 patients were involved in this prospective randomized clinical study. Group 1: blastocyst transfer group, 38 cases; Group 2: frozen–thawed embryo transfer group (first FET cycle), 42 cases; Group 3: fresh embryo transfer group, 43 cases. The basal FSH level was comparable among three groups (6.7 ± 3 versus 7.0 ± 2 versus 6.9 ± 2.4, p = 0.897). The clinical pregnancy rate was highest in group 2, lowest in group 3, with significantly difference (31.6% versus 38.1% versus 13.9%, p = 0.037). The implantation rate and live birth rate were still lowest in group 3 (21.9% versus 19.8% versus 6.7%, p = 0.016 and 18.4% versus 31% versus 11.6%, p = 0.081). In conclusion, the elevated progesterone level will affect clinical pregnancy rate in fresh embryo transfer cycles. We suggest frozen-thawed embryo transfer for these patients. However, for those patients who expressed the wish to have fresh embryo transfer, they should be suggested fresh blastocyst transfer, if they have more than five good quality embryos.

Development of a high-throughput assay for human proprotein convertase 5/6 for detecting uterine receptivity

Embryo implantation requires a healthy embryo and a receptive uterus. In women, the inner lining of the uterus, the endometrium, remains in a hostile state and becomes receptive for embryo implantation for only a short period during each menstrual cycle. Determining endometrial receptivity is vital in in vitro fertilization (IVF) treatment because the timing of embryo transfer needs to be synchronized with endometrial receptivity. We have previously demonstrated that proprotein convertase 5/6A (PC6) is highly expressed in the receptive endometrium and that PC6 is critical for receptivity establishment in women. Furthermore, endometrial PC6 is secreted into the uterine fluid, and levels correlate with receptivity status. Detection of PC6 in uterine fluids, therefore, would provide a nonsurgical assessment of endometrial receptivity. However, to date no assays are available for human PC6. In this study, we produced three PC6 monoclonal antibodies (mAbs) and developed a sandwich enzyme-linked immunosorbent assay (ELISA) for PC6 detection in human uterine fluids. The PC6 mAbs were confirmed to be highly specific to PC6, and the ELISA detected PC6 in human uterine fluids with a significantly higher level during the receptive phase. This newly established PC6 ELISA provides an important tool in the development of noninvasive strategies to detect endometrial receptivity in women.

100 EMBRYO SURVIVAL AND CONCEPTUS ELONGATION FOLLOWING ASYNCHRONOUS EMBRYO TRANSFER IN CATTLE

Maternal progesterone (P4) regulates early conceptus growth and development in ruminants. Early embryo transfer studies in sheep and cattle demonstrated a need for close synchrony between the embryo and the uterine environment of the recipient. However, manipulating P4 may be one way of strategically regulating the temporal changes that normally occur in the uterine environment in order to allow flexibility in the timing of embryo transfer. For example, previous studies have demonstrated that P4 administration during the first few days of the oestrous cycle facilitates pregnancy establishment with older embryos. The aim of this study was to examine the effect of embryo-uterine synchrony on conceptus elongation in cattle. Oestrous cycles of crossbred beef heifers were synchronised using an 8-day P4-Releasing Intravaginal Device (PRID Delta®, CEVA, Mountain View, CA, USA) with administration of a prostaglandin F2α analogue (Enzaprost®, CEVA; 5 mL equivalent to 25 mg of dinoprost) given on the day before PRID removal. Heifers were checked for signs of oestrus 4 times per day commencing 30 h after PRID withdrawal. Only those seen in standing oestrus (n = 50) were randomly assigned to 1 of 5 treatment groups to receive Day 7 in vitro-produced blastocysts (n = 10 per recipient) (1) on Day 5 post-oestrus; (2) on Day 5, with P4 supplementation via PRID from Day 3 to 5 + 750 IU of eCG at PRID insertion; (3) on Day 5, PRID Delta from Day 3 to 5 plus 3000 IU of hCG at PRID insertion; (4) on Day 7, or (5) on Day 9. At embryo age Day 14, all heifers were slaughtered and the uterus was flushed to recover and measure conceptuses. Data are summarised in Table 1. Fewer recipients yielded conceptuses (P &lt; 0.05) and fewer conceptuses overall were recovered (P &lt; 0.05) following transfer on Day 5 compared with Day 7 or Day 9. Supplementation with P4 resulted in short cycles (evidenced by corpus luteum regression and/or a recent ovulation at slaughter) in 33.3 to 54.5% of recipients receiving embryos on Day 5. Mean conceptus length was greater (P &lt; 0.05) following transfer to an advanced uterus. In conclusion, transfer of embryos to a retarded (Day 5) uterine environment results in poor embryo survival. Supplementation with P4 shortened the interoestrous period in a significant number of heifers. Transfer to an advanced uterine environment promotes conceptus elongation, presumably driven by P4. Table 1.Embryo survival and conceptus length data

The role of seminal plasma for improved outcomes during in vitro fertilization treatment: review of the literature and meta-analysis.

There is a growing body of evidence surrounding the role played by seminal plasma in human implantation. Seminal fluid contains several proteins that interact with cervical and uterine epithelial cells inducing active immune tolerance. We sought to answer the study question: Does exposure to seminal plasma improve pregnancy outcomes in women undergoing IVF? Randomized controlled trials (RCTs) were searched for via MEDLINE, EMBASE, the Cochrane Library, National Research Register, ISI conference proceedings, ISRCTN register and Meta-register, from 1966 to December 2013. Search terms included: 'seminal plasma', 'seminal fluid', 'sexual intercourse', 'IVF', 'ICSI', 'ART', 'pregnancy rate', 'implantation', 'embryo transfer' and 'live birth'. This analysis included all RCTs comparing the outcome of IVF treatments in patients exposed to seminal plasma near the time of oocyte pickup (OPU) or embryo transfer (ET) with that of placebo controls or controls with no exposure to seminal plasma. The main intervention was exposure to seminal plasma around the time of OPU or embryo transfer during an IVF cycle. The main outcomes were clinical pregnancy and live birth/ongoing pregnancy rates. Data were collected by two independent authors and statistically pooled via meta-analysis following intention to treat and per protocol principles using RevMan (v5.2.10). I(2) statistic, forest plots and chi-squared heterogeneity tests were used. In total 2204 patients were included in seven RCTs. Meta-analysis revealed a statistically significant improvement in clinical pregnancy rate (RR 1.23, 95% CI 1.06-1.42, P = 0.006) by intention to treat. Per protocol analysis also revealed a statistically significant improvement in clinical pregnancy rate (RR 1.24, 95% CI 1.07-1.43, P = 0.003). There was no statistically significant improvement seen for the outcome of ongoing pregnancy/live birth rate, but the available data were very limited. The methodology and quality of the studies were variable. There are significantly improved outcomes when women are exposed to seminal plasma around the time of ovum pick-up or embryo transfer, with statistical significance for clinical pregnancy but not for ongoing pregnancy/live birth rates being achieved. This meta-analysis is limited by the small number of studies of variable methodology. Further research is required to determine the effect on live birth rate; however, this meta-analysis indicates a significantly improved clinical pregnancy rate and a potential method for improving IVF outcomes.

Endometrial infusion of human chorionic gonadotropin at the time of blastocyst embryo transfer does not impact clinical outcomes: a randomized, double-blind, placebo-controlled trial

To determine whether endometrial hCG infusion at the time of human blastocyst transfer impacts implantation rates. Randomized double-blinded placebo-controlled trial. Academic. Infertile couples with the female partner less than 43 years old (n = 300) undergoing fresh or frozen ET of one or two blastocysts. Patients undergoing ET were randomized into either a treatment or a control group. The treatment group received an infusion of 500 IU of hCG diluted in ET media. The control group received a sham infusion of ET media. Infusions were done using a separate catheter less than 3 minutes before actual ET. Sustained implantation rate: ongoing viable gestation (primary outcome) and ongoing pregnancy rate (secondary outcome). A total of 473 blastocysts were transferred into 300 patients. There were no differences between the two groups in sustained implantation rate (48.1% in the hCG group, 44.2% in the control group) or ongoing pregnancy rate (58.8% in the hCG group, 52.0% in the control group). Endometrial infusion of hCG at the time of blastocyst ET does not improve sustained implantation rates. NCT01643993.

OC22.01: Ultrasound endometrial pattern and endometrial gene expression at the time of embryo transfer in oocyte donation program

<scp>OC</scp>22.01: Ultrasound endometrial pattern and endometrial gene expression at the time of embryo transfer in oocyte donation program

Letrozole as an adjunct in GnRH antagonist cycles improves IVF outcome in poor responders

Letrozole as an adjunct in GnRH antagonist cycles improves IVF outcome in poor responders

Effect of overnight culture after frozen-thawed on the day 3 and 5 embryos: culture instruction time for embryo transfer

Effect of overnight culture after frozen-thawed on the day 3 and 5 embryos: culture instruction time for embryo transfer

Does timing of hysteroscopic endometrial biopsy (HEB) in relation to timing of embryo transfer (ET) affect pregnancy outcomes in previous in vitro fertilization (IVF) failures?

To assess the impact of the timing of endometrial local injury by hysteroscopic endometrial biopsy ( HEB) relative to the timing of embryo transfer on outcomes of previous In vitro fertilization ( IVF) failures.

The frozen–thawed embryo transfer timing determined by serum progesterone level: a retrospective follow-up study

ObjectiveTo compare the reproductive outcomes of frozen–thawed embryo transfer (FET) in nature cycle utilizing monitoring ovulation regimen (MOR) and monitoring progesterone (P) level regimen (MPR). Study designA retrospective analysis of records of 224 women who received FET procedures. Result(s)MPR was used in 60.3% (135/224) of cycles and MOR in 39.7% (89/224) of cycles. The clinical pregnancy rate per transfer was 63.0% in the MPR group and 48.3% in the MOR group (p=0.030). The implantation rates were 42.6% and 35.1%, respectively (p=0.001). The ongoing pregnancy rates per transfer (at 12 weeks’ gestation) were 54.1% and 41.6%, respectively (p>0.05). A logistic regression analysis showed that the type of natural cycle regimen was a predictor of clinical pregnancy rate (odds ratio, 1.996; 95% confidence interval, 1.123-3.549; p=0.019). Other significant variables affecting clinical pregnancy rate was number of top-quality embryos transferred. Conclusion(s)Performing FET using MPR could achieve higher clinical pregnancy rate compared with MOR in a group of patients with the comparable demographic and cycle characteristics profile.

Examining the temperature of embryo culture in in vitro fertilization: a randomized controlled trial comparing traditional core temperature (37°C) to a more physiologic, cooler temperature (36°C)☆

To determine whether culture at a more physiologically cooler temperature, as suggested by limited human and animal data, would improve blastulation and pregnancy rates in human clinical IVF. Paired randomized controlled trial. Academic. Infertile couples (n=52) with a female partner less than 42 years old with eight or more mature oocytes retrieved. Mature oocytes obtained from a single cohort of oocytes were randomly divided into two groups; one was cultured at 37°C and the other at 36°C from the time of ICSI to the time of embryo transfer or vitrification. Paired embryo transfers were accomplished by transferring one euploid embryo from each group. DNA fingerprinting was used as needed to determine the outcome for each embryo. Rate of development of expanded blastocysts suitable for transfer or vitrification (primary outcome), fertilization, aneuploidy, and sustained implantation. A total of 805 mature oocytes were cultured; 399 at 36°C and 406 at 37°C. Paired analysis demonstrated a higher rate of usable blastocyst formation per zygote at 37°C (48.4%) vs. at 36°C (41.2%). Rates of fertilization, aneuploidy, and sustained implantation were equivalent. IVF culture at 36°C does not improve clinically relevant parameters of embryo development or sustained implantation rates. NCT01506089.

Acupuncture as an adjunct treatment to increase the success rate of vitro in fertilisation: an overview of systematic reviews and meta-analyses

Objectives: To evaluate the effect of acupuncture as an adjunct treatment to increase the success rate of in vitro fertilisation (IVF). Methods: A review of the English and Korean literature was conducted to identify studies on acupuncture as an adjunct treatment to IVF. The main outcome measures were the biochemical pregnancy rate (BPR), the implantation rate (IR), the clinical pregnancy rate (CPR), the miscarriage rate (MR), the on-going pregnancy rate (OPR) and the live birth rate (LBR). Results: Nine meta-analyses of 11 systematic reviews (SRs) were included in this review. In four SRs, the overall IVF outcomes regardless of the procedural steps were documented; two of these SRs reported a significant effect on the CPR. One SR reported that acupuncture at the time of controlled ovarian hyperstimulation had a significant effect on the BPR. Seven SRs reported that acupuncture had no significant impact on transvaginal oocyte retrieval (TVOR). In eight SRs, significant impacts on the CPR, LIBR and OPR were reported when acupuncture was performed around the time of embryo transfer (ET). The results of repeated acupuncture after ET were included in two SRs, which included the same primary studies. The results of the SRs showed that acupuncture had a positive effect on the CPR. Conclusions: When the complete IVF procedure is analysed, there is conflicting evidence in that some reviews have found that acupuncture leads to an increased CPR but others have not. In addition, the reviews presented no evidence to suggest that acupuncture has any specific risks.

The Role of Acupuncture in in vitro Fertilization: A Systematic Review and Meta-Analysis

Background/Aims: In recent years, acupuncture has become more and more popular in the management of subfertility. The aim of this study was to evaluate the impact of acupuncture during in vitro fertilization (IVF) treatment on the outcomes of clinical pregnancy in published randomized studies. Methods: This is a systematic review and meta-analysis. Data sources used were MEDLINE, Embase, Web of Knowledge and the Chinese Biomedical Database. Results: There was no statistically significant difference between the acupuncture group and no acupuncture (intervention) controls around the time of embryo transfer (ET; risk ratio, RR, 1.24, 95% confidence interval, CI, 1.02-1.50) or in unblinded trials, trials blinded to physicians and double-blind trials (95% CI 1.26-1.88, 0.82-1.33 and 0.89-1.25, respectively). This was also the case when comparing acupuncture with sham acupuncture controls around the time of ET (RR, 1.03, 95% CI 0.87-1.22) or when restricting to unblinded trials, trials blinded to physicians and double-blind trials (95% CI 0.80-2.02, 0.82-1.18 and 0.77-1.17, respectively). There was a statistically significant difference when performed at 30 min after ET and implantation phase (RR 1.76, 95% CI 1.22-2.55). There was also a statistically significant difference when performed at follicle phase and 25 min before and after ET (RR 1.56, 95% CI 1.04-2.33). Conclusion: Our study showed that acupuncture did not significantly improve the IVF clinical pregnancy rate when performed only at the time of ET, while we found pooled benefit of acupuncture for IVF when performed at follicle phase and 25 min before and after ET, as well as 30 min after ET and implantation phase.

Evaluation of the effect of bacterial colonization in cervical mucus on the outcome of intracytoplasmic sperm injection cycles

Objective The aim of this study was to evaluate the effect of chlamydial infection and microbial flora in cervical mucus at the time of embryo transfer (ET) on fertilization and implantation in women undergoing intracytoplasmic sperm injection procedures. Participants and methods A total of 500 infertile women were enrolled in this study. All were recruited from the outpatient clinic of the Assisted Reproduction Unit in International Islamic Centre for Population Studies and Researches, Al Azhar University. All participants underwent pituitary downregulation using either a long or a short protocol, followed by ovarian stimulation, oocytes retrieval, fertilization, and embryos transfer. In the study group, cervical swabs were taken with the first folliculometry and screened for chlamydia and other bacterial growth; antibiotics were administered accordingly for positive cases. During ET, cervical swabs were taken from the control group and tested for chlamydia and other bacterial infections, but with no use of any antimicrobials; pregnancy tests were performed two weeks after ET and the participants were accordingly divided into two subgroups: a pregnant group and a nonpregnant group. Results The overall incidence of pregnancy was 193/500 (38.6%), and for those who were pregnant, the incidence of chlamydia alone (in the study group) was 8.89% compared with 8.74% (in the control group). The incidence of other bacterial growth (in the study group) was 35.56% compared with 30.1% (in the control group). The incidence of associated chlamydia and other bacterial growth (in the study group) was 8.89% compared with 5.83% (in the control group). Conclusion Chlamydial infection and microbial flora of the cervix detected during ET play no role in the implantation process and do not affect pregnancy rates significantly in women undergoing intracytoplasmic sperm injection, and antimicrobial plays no significant role in improving the outcome of the rate of pregnancy.