Vitamin D and follicular recruitment in the in vitro fertilization cycle.

OBJECTIVE: Vitamin D (VD) is a fat-soluble steroid hormone, synthesized by the skin, most known for its role in bone mineral balance. Vitamin D receptors (VDR) are also found in the female reproductive system, but their role remains unclear. The objective of this study was to analyze the relationship between serum vitamin D levels and the number of oocytes retrieved after ovarian stimulation. METHODS: This is a retrospective study involving 267 patients undergoing in vitro fertilization (IVF) carried out in the Fertipraxis clinic, a private practice facility. The patients were initially divided into two groups according to their VD levels. Group 1 included 152 patients with VD levels < 30 ng/mL and group 2 had 115 patients with VD levels > 30 ng/mL. They were further analyzed and separated considering their age, anthropometric data, ovarian reserve, amount of gonadotropin used, and follicles obtained until trigger day. RESULTS: In our analysis, there were no difference in the number of follicles and oocytes retrieved, nor in the number of mature oocytes obtained from patients with both vitamin D deficiency and sufficiency. CONCLUSIONS: The results of our study show no difference among number of follicles, oocytes retrieved and mature oocytes obtained after ovarian stimulation according to their vitamin D serum levels. Further higher-quality studies are needed to evaluate the possible roles of serum vitamin D levels in other stages of human fertilization process.

Estradiol and Progesterone Levels are Related to Redox Status in the Follicular Fluid During in vitro Fertilization.

Studies have reported a possible association between the levels of oxidative stress biomarkers in follicular fluid (FF) and infertility treatment outcomes. FF analysis can provide important information about oocyte quality. This study aimed to evaluate the possible correlation between oxidative stress biomarker and intrafollicular hormone levels and clinical and laboratory parameters in women during controlled ovarian stimulation. These women were undergoing in vitro fertilization with intracytoplasmic sperm injection (ICSI).The FF samples were acquired from September 2012 to February 2014 from women undergoing private fertility treatment in Rio de Janeiro, Brazil. A total of 196 women who were undergoing ICSI and had different infertility diagnoses were recruited. The FF from each patient (average patient age of 36.3 ± 4.3 years) was collected following puncture of just one follicle with the largest diameter. After ruling out blood contamination by spectrophotometry, 163 patient samples were utilized in the study. In the FF, the progesterone levels were negatively correlated with (a) hydrogen peroxide scavenging capacity (HPSC) (r = -0.294, P < 0.0001), (b) total number of follicles (r = -0.246, P < 0.001) and (c) total number of oocytes punctured (r = -0.268, P = 0.0001). The concentration of serum estradiol exhibited a positive correlation with intrafollicular HPSC (r = 0.165, P = 0.037). Our data indicate that the FF levels of estradiol and progesterone are related to the FF redox status, which is closely associated with the number of oocytes obtained during ICSI procedures.

High Progesterone levels in the beginning of ICSI antagonist cycles and clinical pregnancy: still a concern?

OBJECTIVE: In controlled ovarian hyperstimulation (COH) using antagonist cycles, an incomplete luteolysis could happen after an inefficient previous luteolysis. Since antagonist cycles are frequent today, this study aims to access the impact of serum progesterone in the beginning and at the end of stimulation, and pregnancy outcomes. METHODS: single-center cohort study, 461 fresh embryo transfers in ICSI antagonist cycles. Serum progesterone levels was measured in the beginning of COH (P4i) and on hCG day (P4f) using threshold values of 1.5ng/mL. Four groups were created: Group 1, P4i and P4f ≤ 1.5; Group 2, P4i ≤ 1.5 and P4f > 1.5; Group 3, P4i > 1.5 and P4f ≤ 1.5 and Group 4, P4i and P4f > 1.5. The clinical pregnancy rate (CPR) and live birth rates (LBR) were the primary outcomes. RESULTS: The number of cycles per group was: 393, 51, 6 and 11, respectively. Group 1 was considered the expected normal, while group 4 represented the persistence of higher levels. There was no difference in age, basal FSH and Estradiol, days of stimulation endometrium thickness and total amount of gonadotropins between group 1 versus group 4. However, significant differences occurred in embryological and clinical outcomes between these 2 groups. CONCLUSION: The impact of serum progesterone in the beginning of stimulation and pregnancy outcomes is a matter of concern. Basal elevated levels could help identify patients that will repeat it on hCG day, being probably a marker to define a freeze-all strategy to these cycles.

Evaluation of two incubation environments--ISO class 8 versus ISO class 5--on intracytoplasmic sperm injection cycle outcome.

OBJECTIVE: To evaluate the impact of two different incubation environments-class 8 versus class 5-on embryo quality and pregnancy rate. DESIGN: Retrospective comparative study. SETTING: Private fertility and gynecology clinic. PATIENT(S): 123 consecutive intracytoplasmic sperm injection (ICSI) cycles were analyzed from January 2002 to February 2005. Cycles were divided into two groups: in group I (n = 60), the embryo culture was performed in class 8 air quality; in group II (n = 63), the embryo culture was performed in class 5 air quality. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Number of embryos available for transfer, number of good quality embryos transferred, implantation rate, and clinical pregnancy. RESULT(S): Age of women, duration of stimulation, total doses of gonadotropins, endometrial thickness on the day of human chorionic gonadotropin (hCG) administration, number of oocytes metaphase II retrieved, number of embryos available, number of good quality embryos transferred, fertilization and cleavage rates, implantation rate, and clinical pregnancy were not statistically different between the groups. CONCLUSION(S): Our study demonstrated that incubation environment class 8 is as good as incubation environment class 5 when compared in relation to the parameters analyzed. We believe that there is still room for improvement in the overall outcome of ICSI embryos.