Value of follicular fluid vitamin D in predicting the pregnancy rate in an IVF program.

PURPOSE: This study investigated whether there is a correlation between levels of 25OH-D in the follicular fluid and the serum of infertile women and the results of IVF and rates of pregnancy. The association between the levels of 25OH-D in the follicular fluid and the vitamin D repletion status was also assessed. METHODS: Two hundred and twenty-one infertile women participated in an IVF cycle from 2010 to 2011 in a prospective observational study. Serum and follicular fluid were collected for vitamin D analysis. Deficient, insufficient, and sufficient levels of vitamin D were defined as 10, 10-29, and 30-100 ng/ml, respectively. IVF cycle parameters and clinical pregnancy rates were also compared with the vitamin D level. RESULTS: The levels of vitamin D deficiency, insufficiency, and sufficiency were 22.6, 70.1, and 7.2%, respectively. The fertilization rates associated with these three levels of vitamin D were 43.17, 53.37, and 58.77%, respectively, (P = 0.054), and the implantation rates were 17.33, 15.26, and 18.75%, respectively, (P = 0.579). No significant correlation was seen between the pregnancy rate and the serum vitamin D level (P = 0.094) or the follicular vitamin D level (P = 0.170). The serum and follicular fluid vitamin D levels showed a significant correlation (P = 0.000). CONCLUSION: Although vitamin D is an important hormone in the human body, no correlation was found between the serum and follicular vitamin D level and the pregnancy rate in the IVF cycle.

The effect of ovarian cyst aspiration on IVF treatment with GnRH.

OBJECTIVE: The formation of cysts during IVF treatment may negatively influence the outcome. The aim of this study is to compare conservative management versus aspiration for functional ovarian cysts before ovarian stimulation for ART. MATERIALS AND METHODS: Women who underwent IVF cycle with a long protocol, and developed ovarian cysts, they were randomly divided into a cyst aspiration group (n = 90) in which the cysts were aspirated after diagnosis and a no-intervention group (n = 90) for which the conservative treatment was continued following cyst diagnosis. RESULTS: The FSH level in women with ovarian cysts in the aspiration group was significantly higher than that in the no-intervention group (9.1 +/- 4.5 vs. 6.5 +/- 1.78 mIU/ml, p = 0.001). HMG requirement in that aspiration group was significantly higher than that in the non- intervention group (26.2 +/- 9.7 vs. 21.85 +/- 7.7, p = 0.0001). The embryo score in the no-intervention group was higher than the aspiration group (18 vs. 16, p = 0.0001).The cycle cancellation rate was significantly higher in the aspiration group than the no-intervention group. The pregnancy rate was higher but not significantly in the aspiration group than no-intervention group. CONCLUSION: Cyst aspiration did not promote retrieved oocyte in quality and in number. Because cyst aspiration requires anesthesia and is expensive, conservative management is better and without improving the IVF outcome.

Comparing GnRH agonist long protocol and GnRH antagonist protocol in outcome the first cycle of ART.

PURPOSE: This prospective study evaluated the efficacy of gonadotropin-releasing hormone (GnRH) antagonist protocol in comparison with the GnRH agonist protocol in the first cycle of assisted reproductive technique (ART). METHODS: We randomized 235 patients undergoing ART for the first time. The first group was stimulated with a standard long protocol and the second group stimulated with GnRH antagonis. RESULTS: There was no statistically significant difference in the age, infertility cause, basal FSH, BMI, the number of oocytes retrieved, number of M2 oocytes, embryo obtained and endometrial thickness between the two groups. But Serum estradiol, consumption of gonadotropins and ovarian hyperstimulation syndrome were significantly lower in the antagonist protocol. Cancellation rate of embryo transfer due to poor-quality embryo in the antagonist protocol was higher, but it was not significant. There was no significant difference in the clinical pregnancy and ongoing pregnancy between the two groups. CONCLUSION: GnRH-antagonist is an effective, safe, and well-tolerated alternative to agonist in the first cycle of ART.

Association of p53 polymorphism with ICSI/IVF failure and recurrent pregnancy loss.

BACKGROUND: The p53 tumour suppressor gene is a well-known factor regulating apoptosis in a wide variety of cells. Alterations in the p53 gene are among the most common genetic changes in human cancers. Several polymorphisms of the p53 tumour suppressor gene have been associated with recurrent pregnancy loss (RPL). AIMS: To evaluate the association of polymorphisms p53 codon 72 with the response to in vitro fertilisation (IVF) treatment and occurrence of repeated miscarriages. METHODS: The homozygous and heterozygous genotypes and allelic frequencies of Arg and Pro p53 at codon 72 were identified by using polymerase chain reaction-restriction fragment length polymorphism technique in 70 infertile women with more than two IVF failures. Each comparison was made with 97 women experiencing RPL and 32 fertile women each with at least two healthy children as the control group. RESULTS: The frequency of homozygous Pro/Pro genotypes was found significantly higher among the women with RPL than the other two groups (P = 0.041). Whereas, Arg/Arg genotype was significantly different in the recurrent implantation failure (RIF) group (P = 0.005). CONCLUSION: It is concluded that p53 codon 72 polymorphism may serve as a susceptible factor affecting the chances of RPL and RIF.

Developmental competence and apoptotic gene expression patterns of mature and immature human oocytes retrieved from controlled ovarian stimulation cycles.

The purpose was to assess the developmental competence of the in vitro or in vivo matured human oocytes as well as the apoptotic genes expression of cumulus cells (CCs) regarding nuclear maturity status of associated oocytes retrieved from stimulated ICSI cycles. A total of 590 oocytes and the associated CCs were retrieved and divided into groups of test and control according to the nuclear maturity status in order to the developmental evaluation as well as expression patterns of apoptosis-related genes using real time PCR. The fertilization and embryo formation rates were 60.3% and 87.5% vs.69.1% and 92.8% in test and control groups, respectively. Good quality embryos on day 3 were 62.2% in test and 69.1% in control groups. There were significant differences in the rates of normal fertilized as well as unfertilized oocytes between the groups. Also, mRNA levels of some apoptotic genes were significantly higher in the CCs obtained from immature oocytes among patients with premature ovarian factors (POF) rather than other infertility etiologies (p < 0.001). The data demonstrated the developmental competence of in vitro matured oocytes -even to good quality cleavage embryos- is not completely consistent with molecular integrity and well-mannered gene expression patterns resulting to ICSI success. It seems that using immature oocytes could be helpful for patients at risk of ovarian hyperstimulation syndrome (OHSS) as the same as patients with diminished ovarian reserve.

Developmental and cytogenetic assessments of preimplantation embryos derived from in-vivo or in-vitro matured human oocytes.

Aneuploidy is of great relevance to embryo selection, as it represents one of the important causes of implantation failure. Furthermore, immature oocytes, retrieved during gonadotrophin-stimulated IVF cycles, are generally discarded in clinics; whereas, there was no detectable comprehensive evidence on higher rates of aneuploidy based on maturity status on the day of oocyte retrieval. As well, the correlation between embryo morphology on aneuploidy remains unclear. The aim was to evaluate the developmental and genetic integrity of human preimplantation embryos from rescue in-vitro matured MII stage oocytes as well as in vivo matured oocytes. 541 rescue in-vitro matured oocytes as case as well as 659 in-vivo matured oocytes as control were used for the developmental assay. Finally, 121 cleaved embryos with good quality were analyzed by FISH technique for the detection of chromosomes X, Y, 13, 15, 16, 18, 21 and 22. The fertilization rates were 61.62% and 61.76% in case and control groups, respectively. Also, embryo formation rates of 89.1% vs. 92.2% were recorded for case and control groups, respectively. Good quality embryos on day 3 were 62.54% in case and 68.36% in control groups. There were insignificant differences in fertilization, embryo formation and quality between the groups. Total abnormality in 35 of the 60 embryos was 58.5% in case and 62.3% in control (p < 0.05). There were significant differences between aneuploidy rates of embryos using only sex chromosome preimplantation genetic screening (PGS) and sex chromosome in combination with autosomal chromosomes PGS in case (58.5% vs 28.3%, p = 0.000) and control groups (62.3% vs 21.3%; p = 0.000). The results demonstrated that a high proportion of good quality embryos were aneuploid in both patient groups with no obvious increase in aneuploidies as a result of rescue IVM application. Furthermore, the morphological characteristics of embryos do not completely consistent with chromosomal content. Despite the Rescue IVM is currently not a routine procedure in association with IVF, our finding suggested a viable option for young infertile women facing cancellation of their IVF treatment due to ovarian over-response or resistance factors as well as patients with low functional ovarian reserve considering good quality of embryos from rescue IVM-MII oocytes.

GnRH antagonist/letrozole versus microdose GnRH agonist flare protocol in poor responders undergoing in vitro fertilization.

OBJECTIVE: To evaluate and compare the efficacy of microdose gonadotropin-releasing hormone (GnRH) agonist flare (MF) and GnRH antagonist/letrozole protocols in poor responders undergoing in vitro fertilization. MATERIALS AND METHODS: A total of 94 poorly responding patients were randomized in an ovarian stimulation protocol with a MF, or a letrozole and high dose follicle-stimulating hormone/human menopausal gonadotropin and flexible GnRH antagonist protocol. RESULTS: There was no significant difference in mean age, body mass index, basal serum follicle stimulating hormone and estradiol levels, duration of infertility, distribution of etiology of infertility, and the number of previously failed in vitro fertilization cycles. The days of stimulation, mean gonadotropin dose, the number of mature follicles, and oocytes retrieved and metaphase II oocytes retrieved, serum estradiol level on the day of human chorionic gonadotropin administration, and the percentage of top and good quality embryos were significantly higher in the MF group. The endometrial thickness, fertilization rate, and the number of embryos transferred were similar in both groups. The implantation and clinical pregnancy rates were higher in the MF group and the total cancellation rate was higher in the GnRH antagonist/letrozole group, but these findings were not statistically significant. CONCLUSION: The addition of letrozole to the GnRH antagonist for poor responders does not improve the outcome of assisted reproductive technology cycles. The MF protocol remains the most appropriate protocol in poor responders.