Administration of NTG before embryo transfer does not increase pregnancy rate

Farnoush Farzi, Marzieh Mehrafza, Ali Mirmansouri, Mona Oudi, Ahmad Hoseeini
Abstract Background: Recent studies of uterine contractility in IVF–embryo transfer led us to consider an alternative, and possibly complementary, explanation for the high implantation rates of blastocysts. It has been demonstrated that myometrial contractile activity influences embryo implantation, possibly through mechanical displacement of embryos. Objective: The aim of this study was to examine the effect of nitroglycerine (NTG) treatment for priming the uterus on the pregnancy outcome of ICSI-ET programs.  Materials and Methods: This study was a prospective, randomized, double-blinded placebocontrolled clinical trial. One hundred consecutive cycles of ICSI-ET on infertile couples were randomly divided into treatment and control groups. The treatment group (50 cycles) received an oral dose of 0.4 mg of NTG, and the control group (50 cycles) received a placebo, 15 minutes before fresh ET. An informed consent from was obtained form each patients. The main outcomes were implantation rate (IR) and pregnancy rate (PR).  Results: The mean age of females in the control group and in the treatment group were 30.1±5.1 and 31±5.5 years respectively. Data showed that the mean duration of infertility was not significantly different between control and treatment groups (6.6±5.8 versus 7.8±5.1 years, respectively). The mean number of oocyte retrieval (metaphase II), 2pn, embryo cleaved, embryo transferred and PR weren't different between two Groups (p>0.05).  Overall PR was 36%, it was 38% in treatment group and 34% in control group but there wasn’t statistically significant difference between two groups. (p>0.05)  Conclusion: NTG didn't increase PR compared to placebo group. These results suggest that NTG treatment before ET isn't effective in the priming of a uterus.  


Delayed transfer of embryos from two to three or four days after oocyte retrieval and the pregnancy rate in ICSI

Fattaneh Farifteh, Marzieh Mehrafza, Mona Oudi, Azadeh Eftekhari, Maryam Rahnavard, Khatereh Barjasteh, Ahmad Hossieni
Abstract Background: Embryo transfer (ET) has traditionally been performed two days after oocyte retrieval. Delaying transfer from day two to day three or four would allow for further development of the embryo, might therefore optimize the selection of viable and best quality embryos for transfer and may be closer to the physiological time of the entry into the uterus than transfer on day two, and might have a positive effect on pregnancy outcomes. Objective: The study aimed to determine whether delayed transfer of embryos from 2 to 3 or 4 days after oocyte retrieval and the pregnancy rate in ICSI (intra cytoplasmic sperm injection) procedure. Materials and Methods: In this descriptive study we evaluated infertile couples who were referred to the Mehr Infertility Institute between 2006 and 2008 for ICSI, according to the day of embryo transfer. We compared embryo quality, pregnancy rate and implantation rate among day 2, 3 or 4 of transfers.  Pregnancy rate was confirmed by measurement of β-hCG in serum after 14 days. After data collection, analysis was carried out with the t-test and chi squared tests by using the statistical software package, SPSS.16. Results: The overall clinical pregnancy rate (CPR) reported was 46.6%. The mean age of women and duration of infertility didn't differ on the day of embryo transfer (p>0.05). Overall CPRs were not statistically different for day 2 (50.3%), day 3 (46.5%) and day 4 (34.8%) transfers respectively, there were no significant differences in the age of transferred embryos between pregnant and nonpregnant women (p>0.05). Conclusion: From the result of the present study there were no statistically significant differences in pregnancy rates according to the day of embryo transfer.   


Outcome of Intracytoplasmic Injection of Epididymal and Testicular Sperm Obtained from Patients with Obstructive and Nonobstructive Azoospermia

M.Mehrafza, R.Tavakolnia, H.Dashtdar, F.Farzi, M.Oudi, A.Hosseini

Purpose: Fertilization and pregnancy rates in patients with obstructive and nonobstructive azoospermia whom underwent ICSI were assessed.  
Method: From Sep. 2001 to Jun.2003, 50 ICSI procedures with precutaneouse epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE) were carried out in obstructive azoospermia and nonobstructive azoospermia patients.  
Results: 172 and 116 MII oocytes were injected in obstructive azoospermia and nonobstructive azoospermia which 69.2% and 64.6% were fertilized respectively. The clinical pregnancy rates were 23.3 and 25% and ongoing pregnancy were similar in the both groups. (20%)  
Conclusion: The azoospemric patients are potentially fertile and using new technique of sperm retrieval in combination with ICSI, they can achieve fertilization and pregnancy. Moreover, the etiology (obstructive versus nonobstructive) didn’t influence the outcome of treatment significantly in the present study. 


Comparing the Impact of Autologous Platelet-rich Plasma and Granulocyte Colony Stimulating Factor on Pregnancy Outcome in Patients with Repeated Implantation Failure

Marzieh Mehrafza*, Roya Kabodmehri, Zahra Nikpouri, Gholamreza Pourseify, Azadeh Raoufi, Azadeh Eftekhari, Sajedeh Samadnia, Ahmad Hosseini
Background: Despite the advancements in assisted reproductive technologies, repeated implantation failure (RIF) still remains a challenging problem for patients and clinicians. The aim of the present study was to compare the impact of intrauterine infusion of autologous platelet-rich plasma (PRP) and systemic administration of granulocyte colony stimulating factor (GCSF) on pregnancy outcome in patients with repeated implantation failure.
Methods: The present retrospective cohort study included 123 patients with history of more than two repeated failed embryo transfers. Cycles were divided into two groups of intrauterine infusion of PRP (n=67) and systemic administration of GCSF (n=56). Pregnancy outcome was compared between two groups. The p-value less than 0.05 was considered statistically significant.
Results:The clinical pregnancy rate was significantly higher in PRP group than GCSF group (40.3% versus 21.4%, p=0.025). The crud and adjusted odds ratios (95% confidence interval (CI)) were 2.5 and 2.6 (p=0.025, CI: 1.11–5.53 and p=0.03, CI: 1.10–6.15), respectively.
Conclusion: It seems that intrauterine infusion of PRP can positively affect pregnancy outcome in RIF patients in comparison with systemic administration of GCSF and more studies need to be designed to conclude the effectiveness of this method.

Hemodynamic parameters and reproductive outcome after intracytoplasmic sperm injection and fresh embryo transfer in patients undergoing oocyte retrieval with general anesthesia using fentanyl, remifentanil or alfentanil – A randomized clinical trial

Farnoush Farzi, Marzieh Mehrafza, Ali Mirmansouria*, Ziba Zahiri Sorouria, Zahra Atrkar Roushana, Azadeh Raoufi, Reyhane Shalkohi, Sajedeh Samadnia, Ahmad Hossein

Objective:Anesthesia for assisted reproductive technology is very important to provide less stressful andpainful environment for patients, with minimal side effects on oocytes. In the present study, we aimed toevaluate hemodynamic parameters, recovery time and intracytoplasmic sperm injection (ICSI) outcomeamong patients underwent anesthesia with fentanyl, remifentanil or alfentanil.Material and methods:This randomized double-blinded clinical trial was conducted in patients under-going anesthesia for transvaginal ultrasound guided oocyte retrieval (TUGOR). Patients were randomlyallocated to alfentanil (A; 15mg/kg), fentanyl (F; 1.5mg/kg) or remifentanil (R; 1.5mg/kg) groups.

Results:Three hundred forty patients were assessed for eligibility and randomized for transvaginaloocyte retrieval following general anesthesia and 105 were lost to follow up. No statistically significantdifferences were noted among groups regarding basic characteristics. Although, time to respond to verbalcommand was significantly different among groups (A: 1.99±1.64, F: 2.56±1.72, R: 1.78±1.34,P¼0.014). There were no significant differences among groups with respect to thefirst and secondpostoperative pain intensity, patient satisfaction, pre-induction and post-induction systolic and diastolicblood pressure (BP). Terminal systolic (A: 101.61±9.15, F: 105.29±12.61, R: 102±12.91, P¼0.01) anddiastolic (A: 59.97±9, F: 65.63±9.13, R: 63.69±11.01, P¼0.003) BP was significantly different amonggroups. The fertilization rate was significantly different among groups (A: 51.6%, F: 54.4%, R: 62.2%,P¼0.018). Implantation rate, biochemical and clinical pregnancy rate was similar among groups.

Conclusions:The results of present study demonstrated that all three opioids have the same efficiency, inregards to patient satisfaction and pregnancy outcome. However, Anesthesia with alfentanil comparedwith fentanyl and remifentanil, seems to be inferior for TUGOR due to higher effect on fertilization rateand less hemodynamic stability.

Does Subcutaneous Administration of Granulocyte Colony Stimulating Factor Improve Pregnancy Outcome in Patients Undergoing Intracytoplasmic Sperm Injection

Roya Kabodmehri, Marzieh Mehrafza*, Tahereh Zare Yousefi, Sahar Saghati Jalali, Fatemeh Sedaghat, Elmira Hosseinzadeh, Azadeh Raoufi, Sajedeh Samadnia, Zahra Nikpouri

Background:Expression of granulocyte colony stimulating factor (G-CSF) and its receptors in embryo and endometrium implicates the involvement of this glycoprotein on implantation process. In the present study, we aimed to evaluate the impact of routine use of subcutaneous administration of G-CSF on pregnancy outcomes in intracytoplasmic sperm injection (ICSI) patients.
Methods: In this retrospective study, ICSI outcomes were compared between two groups of patients: the first group (n=108) who received subcutaneous G-CSF (300 mcg) two hours before the embryo transfer and the second group (n=110) who did not receive it. Pregnancy outcome was compared between the two groups. P-value<0.05 was considered statistically significant.
Results:There was no significant difference between G-CSF and control groups with respect to the rate of implantation (respectively, 23%vs. 23%, p=0.49), chemical (respectively, 43.5%vs. 50%, p=0.34) and clinical (respectively, 40.7% vs. 46.4%, p=0.23) pregnancy. In logistic regression analyses, subcutaneous G-CSF administration was not associated with clinical pregnancy in both crude and adjusted odds ratios (OR) with 95% confidence interval (CI) (crude OR: 0.8, CI: 0.47-1.36, p=0.4, and adjusted OR: 0.99, CI: 0.48-2.07, p=0.99).
Conclusion:In the present study, subcutaneous G-CSF did not improve pregnancy outcomes in patients undergoing ICSI; therefore, the routine use of this cytokine is not suggested for all patients.

Comparison of pregnancy outcomes of frozen embryo transfers in women undergoing artificial endometrial preparation with and without short and long-acting gonadotropin releasing hormone agonists

Marzieh Mehrafza*, Tahereh Zare Yousefi, Sahar Saghati Jalali, Zahra Nikpouri, Azadeh Raoufi, Elmira Hosseinzadeh, Sajedeh Samadnia, Ahmad Hosseini

Background & aim:There are conflicting results regarding the benefit of gonadotropin releasing hormone (GnRH) agonist treatment on frozen embryo transfer (FET) outcome. No study was found to compare pregnancy outcome between patients undergoing short and long acting types of GnRH agonist for FET cycles. This study aimed to assess the effectiveness of short and long acting GnRH agonist on FET cycle outcomes.Methods:The present retrospective study was conducted on 296 patients who underwent FET cycles between 2016 and 2017 at Mehr Medical Institute, Rasht, Iran. Pregnancy outcome were compared among three groups: Group A (n=103) received artificial hormone-mediatedcycles without GnRH agonists, Group B (n=100) and C (n=93) received artificial hormone-mediated cycles with short and long-acting GnRH agonists, respectively. Also 16, 26, 12 polycystic ovarian syndrome (PCOS) patients (in group A, B and C respectively) were also assessed for ongoing pregnancy rate among three groups. Data were analyzed using analysis of variance, Kruskal-Wallis, Chi-square goodness of fit test and multivariate logistic regression.Results:No statistically significant differences were observed in terms of endometrial thickness (p=0.053), implantation (p=0.94), biochemical (p=0.67), clinical (p=0.82) and ongoing (p=0.96) pregnancy rates in three groups. Also, PCOS patients did not show significant differences in ongoing pregnancy rate amongthree groups (p=0.72).Conclusion: The findings revealed that neither non-PCOS nor PCOS patients undergoing artificial hormone-mediated endometrial preparation benefit from the addition of short or long-acting GnRH agonist to FET cycles.

Evaluation of live birth rate following intrauterine insemination in women with low or very low serum anti-müllerian hormone level

Accepted in Journal of Kerman University of Medical Sciences.2020

Marzieh Mehrafza, Tahereh Zare Yousefi, Sahar Saghati Jalali, Azadeh Raoufi, Elmira Hosseinzadeh, Sajedeh Samadnia, Maliheh Habibdoost, Ahmad Hosseini


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مولف : دکتر مرضیه مهرافزا، دکتر احمد حسینی و حوا دشتدار
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