Paternal thrombophilia and recurrent implantation failure: an exploratory case-control study.

OBJECTIVE: Many pieces of literature have reported that inherited and acquired thrombophilia might be a risk factor for recurrent implantation failure (RIF), however, most studies have only focused on RIF patients and not their male partners. We studied the possible association of paternal thrombophilia with RIF risk. METHODS: Forty-two male partners aged 20-45 suffered from RIF compared with 42 males from couples with at least one successful pregnancy. All participants were investigated for thrombophilia markers. RESULTS: The prevalence of coagulation Factor V activity was significantly higher in the case group (42.9%) than in the control group (16.7%) (p=0.008) (OR=3.75; 95% CI, 1.38, 10.12). The prevalence of protein C and protein S deficiencies in RIF patients were 4.8% and 2.4%, respectively, and 0% in the controls. The prevalence of antithrombin III (ATIII) deficiency was significantly higher in the case group (19%) than in the control group (2.4%) (p=0.01). None of MTHFR C677T and MTHFR A1298C were statistically significant between the two groups. Combined thrombophilia was 45.2% in the men of the RIF group when compared with the control, 14.2% (p=0.001) (OR = 4.95; 95% CI, 1.75-13.86). CONCLUSIONS: Paternal thrombophilia may be related to recurrent implantation failure, so evaluation of this factor in RIF patients could be used to identify relevant risk groups and may help in the proper management of these cases to enhance the chance of implantation.

Using autologous intrauterine platelet-rich plasma to improve the reproductive outcomes of women with recurrent implantation failure.

OBJECTIVE: Reproductive clinics are often faced with cases of repeated implantation failure (RIF). This study evaluated whether platelet-rich plasma (PRP) might improve the implantation outcomes of patients suffering from RIF. METHODS: Thirty women with RIF submitted to frozen-thawed embryo transfers were included in the study. Intrauterine infusions of autologous purified platelet preparations were administered 48 hours prior to embryo transfer. Differences in implantation, clinical pregnancy, and miscarriage rates of cycles with and without PRP infusions were analyzed. RESULTS: The implantation rate seen in the PRP group was 6.7%. No significant difference was found the between the implantation, clinical pregnancy, ongoing pregnancy, and miscarriage rates of frozen-thawed embryo transfers with and without PRP infusion. However, the effect size of PRP infusion (Cohen's d=0.39) on implantation rates revealed a relationship in medium strength. CONCLUSION: Platelet-rich plasma might potentially yield beneficial effects as a safe therapeutic option offered alongside other treatments designed to improve the reproductive outcomes of women with repeated implantation failure.

Factors associated with spontaneous abortion following intracytoplasmic sperm injection (ICSI).

OBJECTIVE: The aim of this study was to describe the miscarriage rates and the factors associated with cases of spontaneous abortion observed in women offered intracytoplasmic sperm injection (ICSI). METHODS: This cross-sectional study enrolled women who became pregnant with the aid of ICSI treated at the Babol Infertility Center (Iran) within a period of five years (2010-2015). Data were collected from patient charts and, in some cases, through phone calls. The study looked into the incidence of spontaneous abortion in women offered ICSI and the factors associated with miscarriage. The chi-square test, Fisher's exact test, and the t-test were used to analyze the data. RESULTS: From a total of 145 pregnant women, 120 were included in our study. The prevalence of miscarriage was 20%. Galactorrhea was significantly more present in patients who had miscarriages (25% vs. 9.37%, p=0.04). There was a marked difference in the duration of infertility of miscarriage and non-miscarriage patients offered ICSI (6.6±8.3 vs. 4.9±7.3 years, p=0.05). No association was found between maternal age, BMI, cause of infertility, hormonal pattern, type of infertility, history of surgery, polycystic ovary syndrome, number of oocytes, or day of retrieval with miscarriage.

Prolactin concentration in various stages of endometriosis in infertile women.

OBJECTIVE: The relation between excessive prolactin and endometriosis-related infertility is debatable. Anovulation or defective luteal phase occurs frequently due to hyperprolactinemia in subfertile women. In this investigation, we evaluated the association between serum prolactin levels and the severity of endometriosis. METHODS: This retrospective cohort study carried out at the Babol Infertility Research Center looked into the baseline serum prolactin levels of 114 infertile women with endometriosis and compared them to the levels seen in 101 infertile women without endometriosis (controls). Statistical analysis included independent t-test, chi-square, Welch test and ROC curve analysis. RESULTS: Infertile women with endometriosis had significantly higher serum prolactin levels than infertile women without endometriosis (p=0.003). A significant difference was detected between controls and individuals with endometriosis stages III/IV (p-value=0.009). Prolactin was found to have diagnostic value to detect endometriosis stages III/IV vs. stages I/II in AUC=0.65, 95% CI (0.55, 0.76). Prolactin values with a cut off set at 20.08 ng/mL had a sensitivity of 0.74 and specificity of 0.54 in detecting disease stages III/IV vs. I/II. The prognostic capability of prolactin in detecting endometriosis in cases vs. controls by ROC curve analysis had an AUC=+0.67, 95% CI (0.60, 0.74). Prolactin values with a cut off set at 17.5 ng/mL had a sensitivity of 0.64 and specificity of 0.63 in segregating subjects with and without endometriosis. CONCLUSION: Higher prolactin levels were observed in infertile women with more severe endometriosis when compared to infertile women without endometriosis. Prolactin levels act as a probable prognostic biomarker to detect endometriosis stages III/IV vs. I/II and segregate infertile women with endometriosis from subjects without endometriosis.

Reproductive outcomes of vitrified blastocyst transfer in modified natural cycle versus mild hormonally stimulated and artificial protocols: A randomized control trial.

OBJECTIVE: This study set out to investigate the pregnancy outcome of natural cycle regimen versus other endometrial preparation protocols with vitrification thawed blastocyst transfer (VTBT) cycles. METHODS: This control trial study was carried out on 123 women undergoing VTBT. The women were randomly divided into three groups of endometrial preparation before VTBT; 1. Modified natural ovulation cycle with using HCG (n=32) 2. Mild hormonally stimulated cycle by low dose Clomiphene Citrate (n=30) and 3. Artificial cycle induced with estradiol and progesterone supplementation (n=61). Following endometrial preparation, the thawed blastocyst was vitrified and transferred. Reproductive outcome and endometrium characteristic were evaluated in the three groups. RESULTS: The three above-mentioned protocols resulted in clinical pregnancy rates of 21.43% vs. 13.79% vs. 15.25%, respectively; without statistical differences. The ongoing pregnancy rates did not show any significant differences among the three groups (21.43% vs. 13.79% vs. 13.56%), respectively. In addition, the miscarriage rates were compared in the three groups. The endometrial thickness on the day of progesterone or human chorionic gonadotropin administration were more frequently observed in the artificial and modified natural cycle versus hormonally stimulated groups (8.34±0.89 vs. 7.3±1.4, p<0.001; 8.13±0.95 vs. 7.3±1.4, p<0.001). There was no significant difference regarding triple-line endometrial patterns in the three groups. CONCLUSION: The natural cycle with HCG trigger could be considered as an alternative protocol to mild hormonally or artificial cycle regimens in vitrification thawed blastocyst transfers.