Effects of piroxicam administration on pregnancy outcome in intrauterine insemination (IUI) cycles: a randomized clinical trial.

BACKGROUND: Uterus contractibility is considered a powerful prognostic factor in predicting the embryo transfer outcome. Moreover, uterine contractions are known to be stimulated by prostaglandins which are produced by cyclooxygenase from arachidonic acid. As such, suppressing the inflammatory response and contractions using anti-inflammatory and relaxant agents is expected to result in increased success rate of embryo transfer and artificial insemination. OBJECTIVE: To investigate the effect of piroxicam administration on the success rate in intrauterine insemination (IU) cycles in patients presenting with unexplained infertility. MATERIALS AND METHODS: This randomized, placebo-controlled clinical trial included 260 women with unexplained infertility undergoing IUI cycles. Patients were randomly assigned to receive either piroxicam ten mg/day on days 4-6 after IUI or placebo (control group). The main outcome measures were number of IUI cycles, pregnancy, abortion, and multiple pregnancy rates. RESULTS: The pregnancy rate was found to be 25 (19.2%) and 16 (12.3%) in piroxicam and control groups, respectively (p = 0.039). Five patients (3.8%) in piroxicam group experienced twin pregnancy whereas only three patients (2.3%) in control group had twin pregnancy (p = 0.361). The pregnancy rate per cycle was also significantly higher in those who received piroxicam as compared to controls (11.16 vs. 6.66; p = 0.021). CONCLUSION: Administration of piroxicam after IUI is associated with decreased number of cycles, as well as increased pregnancy rate and pregnancy rate per cycle in IUI cycles. However, piroxicam did not have any effect on abortion, multiple pregnancy, and ongoing pregnancy rates.

Decreased ovarian reserve: any new hope?

While diminished ovarian reserve (DOR) predicts decreased ovarian response to stimulation, it does not necessarily foretell about the fecundity cycle. According to Bologna's criteria laid down by the European Society of Human Reproduction and Embryology, old age, abnormal ovarian reserve tests such as antral follicle count (AFC) and anti-mullerian hormone (AMH) as well as prior suboptimal response to stimulation are the main factors representing DOR. Unfavorable response to maximal stimulation on two previous occasions may also represent DOR. Among the ovarian reserve tests, AMH and AFC are the most predictive values for DOR. Factors which may give rise to DOR include environmental factors, autoimmune or metabolic disorders, infections, genetic abnormalities, and iatrogenic causes (such as smoking, chemotherapy, radiation and gynecologic surgeries). Besides, studies have proposed endometriosis as a key contributor to DOR and hence emphasized on its proper management to prevent additional damages leading to compromised fertility. In summary, DOR is found to be a clinical challenge in the practice of fertility care with controversial countermeasures to prevent or treat the condition. Nevertheless, some promising measure such as: oocyte, embryo and tissue cryopreservation, ovarian transplantation, dietary supplementation and the transfer of mitochondria have offered hopes towards ameliorating the burden of DOR. This review attempts to discuss DOR from different perspectives and summarize some existing hopes in clinical practice.