Women Undergoing In Vitro Fertilization Cycles Research Articles

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-747 Prevalence of Caesarean scar defect (CSD) and clinical impact on reproductive outcomes in patients undergoing in vitro fertilization (IVF)

Abstract Study question Can sonohysterography-detected CSD have a deleterious effect on reproductive outcomes in women with secondary infertility undergoing IVF? Summary answer A 68% prevalence of CSD has been estimated in the study population. CSD significantly reduces the ongoing pregnancy rates in women undergoing IVF cycles. What is known already here is limited and conflicting evidence about the relation between Caesarean section, CSD and IVF treatment outcomes. Notably, most of the previous studies did not investigate the presence of CSD in infertile women with a history of Caesarian delivery. Furthermore, even if considered, the diagnosis of CSD is commonly based on transvaginal ultrasound assessment. Given the lower sensitivity of this method compared to saline infusion sonohysterography, an underestimation of the real effect is plausible. Study design, size, duration Retrospective cohort study of 122 women with a history of Caesarean delivery and an indication to IVF for secondary infertility referred to an Italian public assisted reproductive centre between 1 January 2016 and 30 April 2021. Participants/materials, setting, methods Women aged 18-43 with secondary infertility and a history of Caesarean delivery, tested for CSD with a saline infusion sonohysterography were included. Women with congenital uterine anomalies, intra-cavitary uterine pathologies, adenomyosis or previous myomectomy were excluded. CSD was defined as an anechoic indentation on the cesarean scar at the midsagittal plane, with a depth ≥ 2 mm. Main results and the role of chance Among the 122 women included, 83 (68%) were diagnosed with CSD by saline infusion sonohysterography. One hundred and fourteen patients underwent at least one IVF cycle: 76 (case group) had a CSD, 38 (control group) had a normal Caesarean scar. Groups were similar in patients and treatment characteristics. Clinical pregnancy rate was 43% in the CSD group and 71% in the control group (odds ratio [OR] 0.31; 95% confidence interval [CI], 0.14-0.72; p = .006). Ongoing pregnancy rates were 33% and 58%, respectively (OR, 0.34; 95% CI, 0.15-0.76; p = .015). Similar results were obtained after adjusting for potential confounders on the regression analysis. Ectopic pregnancy and miscarriage rate along with obstetric and neonatal complications were similar in both groups. In a subgroup-analysis comparing women with CSD who achieved pregnancy and those who did not, pregnant patients had a greater residual myometrial thickness compared to those who did not get pregnant, even if this finding did not reach statistical significance (5.3 mm versus 4.4 mm, p .07). Limitations, reasons for caution Retrospective nature of the study does not permit to infer a causal association between CSD and the reduced chance of pregnancy. Our results are representative of an infertile population but generalization needs further investigation. The sample size was too small to reveal the potential effect on obstetric and neonatal outcomes. Wider implications of the findings In infertile patients with a previous Caesarean section, the presence of CSD is more common than previously thought. The presence of CSD might significantly reduce the IVF success rate. This finding is important in relation to the rising of Caesarean section rates and the possible application of CSD surgical repair. Trial registration number not applicable

Should Intra Cytoplasmic Sperm Injection (ICSI) be the primary insemination method in women undergoing IVF cycles with donor sperm?

To compare efficacy of Intra Cytoplasmic Sperm Injection (ICSI) with conventional in vitro fertilization (IVF) on treatment outcome in women undergoing in vitro fertilization with donor sperm. We examined retrospectively the outcome data from 203 patients undergoing fresh cycles of conventional IVF (cIVF) or ICSI and an additional 77 frozen-thawed embryo transfer (FET) cycles during 2003-2014, all using donor sperm. Fertilization, cleavage, pregnancy and live birth rates and number of high-quality embryos were compared between cIVF and ICSI. Altogether 185 women underwent 479 transfer cycles of fresh embryos (237 cIVF vs. 224 ICSI and 18 "rescue ICSI" cycles). In addition, 77 FET cycles were compared (24 cIVF vs. 53 ICSI cycles). No differences were found between cIVF and ICSI in fertilization, cleavage, pregnancy and live birth rates (92.6% vs 92.2%, 73.4% vs 72.4%, 25.3% vs 27.2% and 13.1% vs 14.7%, respectively). Pregnancy and life birth rates remained similar even when FET cycles were included (25.8% vs 26.2% and 13.1% vs 13.7%, respectively). The use of ICSI was associated with lower rates of high-quality embryos (52.7% vs. 63.3%, P < 0.0001). A multivariate logistic regression analysis found that patients' age, number of transferred embryos and smoking were independently associated with the chance to conceive. Patient age correlated inversely with fertilization rate (r =-0.13, P < 0.006).Non-smokers were more likely to become pregnant (OR = 2.23, P < 0.012). Our results show that ICSI does not bypass the age-related decrease in oocyte quality in patients using donor sperm for IVF. Use of ICSI was associated with lower rates of high-quality embryos. The findings imply that ICSI should not be the primary method of insemination in patients undergoing IVF with donor sperm.

Monocyte chemotactic protein-1 concentrations and expression of women with endometriosis undergoing IVF cycles

To research the local action of endometriosis on follicular inflammatory microenvironment of patients undergoing in vitro fertilization (IVF) cycles. A prospective case control study was organized at Kamal AL-Samarai IVF center (Baghdad/Iraq), January 2021 - May 2021. The study included (80) infertile women undergoing IVF cycles were split to two groups: Patients with endometriosis group (n = 40) and Patients without endometriosis group (n = 40). Follicular fluid (FF) and blood samples were gathered at the period of oocyte pick-up. Levels of MCP-1 mRNA were investigated with the reverse transcription polymerase chain reaction (RT-PCR) technique. Concentrations of cytokines (monocyte chemo attractant protein-1 (MCP-1), tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10)) were investigated in FF by sandwich enzyme-linked immunosorbent assay (ELISA). The mRNA expression of MCP-1 was significantly (P = 0.00) higher in patients with endometriosis group (1.95 ± 0.69) compared with patients without endometriosis group (0.40 ± 0.15). The studied cytokines concentrations in FF of women with endometriosis group were significantly (P = 0.00) higher than those without endometriosis group: MCP-1 (548.07 ± 199.43 pg/ml vs. 45.98 ± 18.72 pg/ml), TNF-α (912.15 ± 316.12 pg/ml vs. 261.89 ± 90.69 pg/ml), IL-10 (258.94 ± 68.82 pg/ml vs. 52.12 ± 14.46 pg/ml). The immune milieu of FF of patients with endometriosis is modified, which could explain the effect of endometriosis on infertility. Furthermore, elevated MCP-1 expression in endometriosis patients suggesting systemic inflammatory changes.

Predictive value of follicular fluid insulin like growth factor-1 in IVF outcome of normo-ovulatory women

Abstract Introduction Insulin like growth factor-1 (IGF-1) has been found to stimulate follicular development, estrogen and progesterone production and oocyte maturation. This study aims to detect the changes in the follicular fluid IGF-1 levels in normo-ovulatory women undergoing in vitro fertilization (IVF) cycle and evaluate the possibility of IGF-1 to be a predictive marker for IVF outcome in normo-ovulatory women. Materials and methods This prospective cross-sectional study was performed among 88 IVF normo-ovulatory women who were categorized according to IVF pregnancy outcome (clinical pregnancy) into two groups: 55 pregnant women and 33 non-pregnant women. Follicular fluid IGF-1 levels have been measured at the time of oocyte retrieval by utilizing enzyme linked immune-sorbent assay (IGF-1 ELISA kit, Diametra, Inc, Italy). The relationship between follicular fluid IGF-1 (FF IGF-1) levels and the number of oocytes retrieved, number of mature oocytes, number of embryos, fertilization and clinical pregnancy rate were assessed. The demographic data were similar between two groups as regards age and BMI. Results FF IGF-1 levels were significantly higher in pregnant women than in non-pregnant women (90.11 ± 44.31 ng/ml, 69.07 ± 30.55 ng/ml) respectively (p Conclusion Our study demonstrated that higher FF IGF-1 levels predict higher pregnancy rates in normo-ovulatory women undergoing IVF cycles.

The dynamic changes of anti-Mullerian hormone and inhibin B during controlled ovarian hyperstimulation in decreased ovarian reserve women and the effect on clinical outcome

Objective: To investigate the dynamics of anti-Mullerian hormone (AMH) and inhibin B (INHB) levels during controlled ovarian hyperstimulation (COH) in women with decreased ovarian reserve (DOR), and assess the effect of these dynamic changes on the prediction of clinical outcome in in-vitro fertilization (IVF).Methods: A total of 124 women undergoing IVF cycles were divided into normal ovarian reserve (NOR) and DOR groups. AMH and INHB levels were measured in serum on menstrual cycle day 2 or 3 (D2/3), day 5 of stimulation (D5), hCG day (D-hCG) and follicular fluid (FF) on oocyte retrieval day.Results: Serum AMH levels were gradually decreased while INHB levels were gradually increased from D2/3 to D-hCG during the COH in both groups. Serum AMH, INHB levels on D2/3 and FF AMH, INHB levels were highly positively correlated with AFC and oocytes retrieval. Multivariate logistic regression analysis revealed that clinical pregnancy did not directly correlate with serum and FF AMH and INHB levels.Conclusion: Serum AMH and INHB levels were not directly related to clinical pregnancy, dynamic serum AMH and IHNB levels were positively correlated with COH outcomes.

Effect of Intrauterine Instillation of Granulocyte Colony-stimulating Factor on Endometrial Thickness and Clinical Pregnancy Rate in Women undergoing in vitro Fertilization Cycles: An Observational Cohort Study

ABSTRACTIntroductionIn spite of significant advances in the field of reproductive medicine, repeated implantation failure (RIF) is a challenging and extremely disappointing problem. The success ofin vitrofertilization and embryo transfer (IVF-ET) cycles depends mainly on uterine receptivity and embryo quality. Successful evaluation of endometrial receptivity conducive to embryo implantation continues to be a challenge in assisted reproductive technology (ART). Several researcher groups have reported the successful use of granulocyte-colony stimulating factor (G-CSF) during IVF cycles in terms of achieving higher clinical pregnancy rates on account of increased endometrial thickness. Women who fail to achieve adequate endometrial thickness despite conventional treatment with high dose estrogen or those with a history of repeated implantation failures in spite of normal endometrial thickness often do not achieve pregnancy and resort to gestational surrogacy. A new therapeutic approach to achieve successful pregnancy in such patients would be very desirable.Study objectivesTo assess the efficacy of a single dose of intrauterine G-CSF on endometrial thickness, implantation and clinical pregnancy rates in women who either had a thin endometrium after estrogen priming (&lt; 8 mm) or a history of repeated implantation failures at IVF, undergoing embryo transfer after 10 days of priming with oral estradiol and vaginal slidenafil.Materials and methodsTwo hundred and thirty-one women (between 24 and 46 years of age) undergoing IVF-ET were recruited for the study. All cases were prospectively studied at the Mumbai Fertility Clinic and IVF Center (a subdivision of Kamala Polyclinic and Nursing Home) over a period of 6 months from January to June 2014, after their written informed consent. Subgroup I consisted of 117 patients who had a persistently thin endometrium (&lt; 8 mm) in spite of high dose oral estradiol valerate and vaginal sildenafil priming. Subgroup II consisted of 114 patients who had a history of repeated (two or more) implantation failures (RIF) at IVF-ET cycles despite adequate endometrium (≥8 mm). All were infused with a single dose of G-CSF (300 mcg) in the uterine cavity after 10 days of priming with oral estradiol valerate and vaginal sildenafil citrate. Endometrial thickness was reassessed 4 days after G-CSF instillation. This was followed by administration of intramuscular progesterone in oil (100 mg) daily with embryo transfer on day 5 of progesterone for all patients. All embryo transfers for patients undergoing oocyte donation or embryo donation were done at the 4-cell stage on day 2. All Frozen embryo transfers (FET) of vitrified embryos were at 8 cell stage. Estimation of serum beta hCG was at 14 days post-embryo transfer for all patients. Successful implantation and net clinical pregnancy rate was confirmed based on appearance of gestational sac on sonogram after 10 days and observation of fetal cardiac activity after 20 days of positive β-hCG results.ResultsOut of total 231 patients recruited in the study, 95% patients from subgroup I (n = 111) and 94% patients from subgroup II (n = 107) showed mean increase in endometrial thickness by at least 2.5 mm within 4 days of G-CSF single dose instillation. A total of 218 patients from both subgroups underwent S. β-hCG estimation 14 days post IVF-ET. Out of 103 β-hCG positive patients, 83 showed net clinical pregnancy (fetal cardiac activity present) giving a net pregnancy rate of 38.07% for the whole study group with 37% in the subgroup with thin endometrium (&lt; 8 mm) and 39.25% in the subgroup with adequate (≥8 mm) endometrium with history of two or more failed implantation at previous IVF-ET cycles. There were no adverse events for the whole study population.ConclusionThere can be a strong possibility with a single dose of 300 mcg intrauterine infusion of G-CSF to achieve significant increase in the endometrial thickness with higher successful pregnancy rate among infertile women under- going IVF-ET cycles with a history of a persistently thin endometrium or repeated implantation failures (rather difficult to treat patients). G-CSF could be a valuable tool to consider before advising the option of surrogacy. In the absence of a control group, our conclusions warrant conduct of further studies.How to cite this articleShah J, Gangadharan A, Shah V. Effect of Intrauterine Instillation of Granulocyte Colony-stimulating Factor on Endometrial Thickness and Clinical Pregnancy Rate in Women undergoingin vitroFertilization Cycles: An Observational Cohort Study. Int J Infertil Fetal Med 2014;5(3):100-106.

Brief co-incubation of sperm and oocytes for in vitro fertilization techniques

The in vitro fertilization (IVF) technique is commonly used and is the only treatment option for a proportion of infertile couples. To obtain better outcomes of IVF, it is important to enhance embryo quality by optimizing IVF techniques. In IVF procedures, oocytes and sperm are routinely co-incubated overnight, which may expose oocytes and zygotes to suboptimal culture conditions with increased reactive oxygen species (ROS) produced by sperm in this long term culture. As an attempt to avoid possible detrimental effects on the oocytes from long exposure to sperm, the brief co-incubation insemination protocol was developed. However, despite a number of studies in this area, it is unclear whether brief co-incubation improves the IVF outcomes compared with the standard overnight insemination protocol. This Cochrane review aimed to determine whether brief co-incubation of sperm and oocytes improves outcomes compared with the standard overnight insemination protocol for women undergoing IVF. We searched the Cochrane Menstrual Disorders and Subfertility Group Register (14 June 2012), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, 1st quarter), MEDLINE (1948 to 14 June 2012), EMBASE (1989 to 14 June 2012), PsycINFO (1806 to 14 June 2012) and CINAHL (1980 to 26 July 2012). In addition, we searched trials registers, reference lists of articles, conference proceedings (American Society for Reproductive Medicine (ASRM), European Society of Human Reproduction and Embryology (ESHRE)) and contacted experts in the field. We included randomized controlled trials (RCTs) comparing brief co-incubation of gametes with the standard overnight insemination protocol. Two review authors independently assessed studies for inclusion and trial quality, and extracted data. Disagreements were resolved by discussion with a third author. Statistical analysis was performed using RevMan software. Eight RCTs with 733 women in total that compared brief co-incubation and the standard insemination protocol were included. Live birth was not reported in the included studies. For ongoing pregnancy rate, there were 127 ongoing pregnancies in two trials including 426 women. The low quality evidence showed that brief co-incubation was associated with an increased ongoing pregnancy rate compared to the standard insemination protocol (pooled odds ratio (OR) 2.42, 95% confidence interval (CI) 1.55 to 3.77; P < 0.0001, I(2) = 0%). Measuring clinical pregnancy rate, there were 93 clinical pregnancies in three trials including 372 women. The low quality evidenceshowed that brief co-incubation was associated with a significantly higher clinical pregnancy rate than the overnight insemination protocol (pooled OR 2.36, 95% CI 1.45 to 3.85; P = 0.0006, I(2) = 0%). For the miscarriage rate, there were six miscarriages in one trial including 167 women. This low quality evidence suggested no significant difference in the odds of miscarriage between brief co-incubation and standard insemination (OR 1.98, 95% CI 0.35 to 11.09; P = 0.44). This review has provided evidence that brief co-incubation of sperm and oocytes may improve the ongoing pregnancy and clinical pregnancy rates for infertile women undergoing IVF cycles. More RCTs are required to assess whether brief co-incubation would contribute to a higher live birth rate and a lower miscarriage rate compared to the standard overnight insemination protocol.

Microorganisms within Human Follicular Fluid: Effects on IVF

Our previous study reported microorganisms in human follicular fluid. The objective of this study was to test human follicular fluid for the presence of microorganisms and to correlate these findings with the in vitro fertilization (IVF) outcomes. In this study, 263 paired follicular fluids and vaginal swabs were collected from women undergoing IVF cycles, with various causes for infertility, and were cultured to detect microorganisms. The cause of infertility and the IVF outcomes for each woman were correlated with the microorganisms detected within follicular fluid collected at the time of trans-vaginal oocyte retrieval. Microorganisms isolated from follicular fluids were classified as: (1) ‘colonizers’ if microorganisms were detected within the follicular fluid, but not within the vaginal swab (at the time of oocyte retrieval); or (2) ‘contaminants’ if microorganisms detected in the vagina at the time of oocyte retrieval were also detected within the follicular fluid. The presence of Lactobacillus spp. in ovarian follicular fluids was associated with embryo maturation and transfer. This study revealed microorganisms in follicular fluid itself and that the presence of particular microorganisms has an adverse affect on IVF outcomes as seen by an overall decrease in embryo transfer rates and pregnancy rates in both fertile and infertile women, and live birth rates in women with idiopathic infertility. Follicular fluid microorganisms are a potential cause of adverse pregnancy outcomes in IVF in both infertile women and in fertile women with infertile male partners.

Progesterone Supplementation for Luteal Support: Efficacy and Patient Experiences With Vaginal Inserts (Endometrin®) Versus Intramuscular Injection

BACKGROUND: Progesterone is administered to counteract luteal phase defects that may occur during stimulated in vitro fertilization (IVF) cycles. Several routes of progesterone administration are available, although no single method is considered the standard of care. Comparative data are needed to establish a preferred mode of progesterone supplementation. OBJECTIVE(S): To evaluate the efficacy, tolerability, and patient experiences with luteal support using progesterone vaginal inserts (PVI; Endometrin ) vs intramuscular injection of progesterone in oil (PIO) for women undergoing IVF cycles. MATERIALS AND METHOD(S): Women (aged 18 to 42 years) with a documented history of infertility who were suitable candidates for IVF were enrolled in 1 of 2 multicenter, open-label, exploratory studies. The 2 study designs were similar, with the exception of gonadotropin-releasing hormone (GnRH) antagonist use in the first study and only women with polycystic ovary syndrome (PCOS) were included in the second study. Participating centers followed standard IVF protocols. Prior to ovarian stimulation with menotropins for injection (Menopur ) or follitropin beta injection (Follistim AQ ), women were randomized to luteal support with either PVI or PIO. Biochemical, clinical, and ongoing pregnancy (defined as a positive human chorionic gonadotropin serum pregnancy test, presence of a gestational sac, and fetal heart movements, respectively) was assessed. Patients’ experiences were evaluated through a questionnaire administered at the time of the first pregnancy test and at the final study visit. RESULT(S): The combined intent-to-treat population (all randomized patients who received at least 1 dose of study medication) included 137 women treated with PVI and 138 women treated with PIO. The mean number of embryos transferred was comparable between treatment groups for each study. Among women with GnRH antagonist IVF cycles, ongoing pregnancy rates were 44.0% and 46.9% in the PVI and PIO treatment groups, respectively. Similar findings were observed in the PCOS study, with ongoing pregnancy rates of 47.2% (PVI) and 49.1% (PIO). Women who were treated with PVI reported greater administration convenience, ease of use, and overall satisfaction than did womenwho received PIO. Studymedications were generally well tolerated; the majority of adverse events that occurred during the luteal support phase were mild to moderate in intensity. CONCLUSION(S): Luteal support via PVI is as effective as PIO yet provides greater convenience and ease of use. Progesterone vaginal inserts are a patient-friendly alternative to PIO for women undergoing IVF cycles. FINANCIAL SUPPORT: This study was supported by Ferring Pharmaceuticals, Inc.

The efficacy of melatonin administration on oocyte quality

The aim of the study was to evaluate the efficacy of melatonin administration on oocyte quality in women underwent in vitro fertilization (IVF) cycles. Eighty-five women undergoing IVF cycles were randomized in two groups during IVF–embryo transfer (ET) procedure, 40 women with melatonin treatment (A) and 45 women without melatonin treatment (B). Primary endpoint was the number of morphologically mature oocytes retrieved (MII oocytes). Secondary endpoints were fertilization rate per number of mature oocytes, embryo quality and pregnancy rate. There were no differences between two groups according to age, and peak estradiol levels. The mean number of oocytes (15.33 vs. 14.27) and the mean number of mature oocytes did not differ between the two groups (12.63 vs. 10.94), whereas the percentage of mature oocytes (M2/oocytes retrieved) was significantly different in melatonin-treated group (p < 0.05). Fertilization rate (72.75 vs. 71.16) did not differ between the two groups. The mean number of class 1 embryos resulted higher in the group A (3.28 vs. 2.53) (p < 0.05). Clinical pregnancy rate was in tendency higher in the group treated with melatonin, although the differences did not reach statistical significance. Melatonin is likely to improve oocyte and embryo quality in women undergoing IVF or intracytoplasmic sperm insemination (ICSI).

Effects of a Gonadotropin-Releasing Hormone agonist and Follicle Stimulating Hormone on the incidence of apoptosis in human luteinized granulosa cells

Objective: Previous studies have shown the importance of apoptosis in follicular atresia occurring especially in granulosa cells (GC) and its relation to the outcome of in vitro fertilization (IVF). The aim of this study was to evaluate the effects of a Gonadotropin-Releasing Hormone agonist (GnRHa) and of Follicle-Stimulating Hormone (FSH) on the apoptosis rate of human luteinized GC. Study design: GC were isolated from follicular fluids of 15 women undergoing IVF cycles, cultured for 1 day and then treated for 1 day in serum-free medium with triptorelin at 100 or 1000 pg/ml or with FSH at 100 or 500 ng/ml. GC cultured without any hormone addition were used as controls. Treatment of cultured GC with triptorelin 100 pg/ml and FSH 100 ng/ml was performed five times each. GC were analysed by flow cytometry after propidium iodide staining to measure the percentage of apoptotic GC. Some triptorelin-treated GC were also examined by electron microscopy. Results: Percentages of GC apoptosis were after hormone treatment respectively: FSH: 100 ng/ml, 2.9±0.6%; 500 ng/ml, 2.9%; triptorelin: 100 pg/ml, 18.6±2.8%; 1000 pg/ml, 86.5% versus 9.8±1.8% in GC controls (FSH 100 ng/ml versus control; triptorelin 100 pg/ml versus control: P<10 −6). Electron microscopy confirmed apoptosis of GC incubated with triptorelin. Conclusions: This study demonstrated that FSH decreased apoptosis in human luteinized GC. In contrast, triptorelin was possibly implicated in a dose-dependent increase in the incidence of apoptotic GC. This last result suggests that clinical use of GnRHa should perhaps be reconsidered in the context of its apoptosis-inducing effect.

Association of endometrial blood flow as determined by a modified colour Doppler technique with subsequent outcome of in-vitro fertilization.

An endometrial thickness of 10 mm or more has been reported to be favourable for embryo implantation. Nevertheless, many women participating in in-vitro fertilization (IVF) programmes have adequate endometrial thickness but do not achieve satisfactory implantation. With the aid of power Doppler sonography, we examined the association between intra-endometrial vascularity and reproductive outcome. For this study, we enrolled only women with endometrial thickness >/=ISOdia>/=10 mm and excluded those with apparent endometrial pathologies. Of 95 women undergoing IVF cycles, there resulted 37 intrauterine pregnancies. The women were of similar age, body mass index, peak oestradiol concentration and endometrial thickness, and a similar number of embryos were transferred. Those women with an intra-endometrial power Doppler area (EPDA) <5 mm2 achieved a significantly lower pregnancy rate (23. 5 versus 47.5%, P = 0.021) and implantation rate (8.1 versus 20.2%, P = 0.003) than those with an EPDA >/=ISOdia>/=5 mm2. We conclude that, in addition to endometrial thickness, EPDA may serve as a factor indicative of endometrial receptivity. Women with adequate endometrial thickness but a small EPDA tended to have an unfavourable reproductive outcome.

Correlation between the amount of follicle-stimulating hormone administered and plasma and follicular fluid vascular endothelial growth factor concentrations in women undergoing in vitro fertilization

Vascular endothelial growth factor (VEGF) is a powerful mediator for vessel permeability and it is strongly implicated in angiogenesis, stimulating endothelial cell proliferation as well as capillary permeability. We studied 30 women undergoing in vitro fertilization (IVF) programs and evaluated, on the day of oocyte retrieval, VEGF levels in plasma and follicular fluid and related such concentrations to the amount of follicle-stimulating hormone (FSH) administered. Furthermore, the correlation between the number of oocytes retrieved and the VEGF concentrations both in plasma and in follicular fluid were also investigated.Results indicate that follicular fluid VEGF concentrations and the amount of pure FSH administered were directly proportional (p < 0.05). On the day of oocyte retrieval, the VEGF plasma concentrations and the number of oocytes collected were directly proportional (p < 0.05). VEGF plasma levels increased after human chorionic gonadotropin (hCG) administration (30.37± 18.60 pg/ml up to 52.62 ± 43.63 pg/ml).In conclusion, this study demonstrates that the doses of pure FSH administered to women undergoing IVF cycles have a crucial role in hCG-dependent VEGF production.