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Background: Repeated implantation failure (RIF) refers to the condition where high quality embryos are unable tosuccessfully implant after multiple cycles of in vitro fertilization (IVF) treatment. The aim of this study is to investigatethe impact of intrauterine granulocyte colony-stimulating factor (G-CSF) and platelet-rich plasma (PRP) onpregnancy rate in patients with RIF.Materials and Methods: The present randomised clinical trial study was conducted at the IVF Centre of MehrMedical Institute in Rasht, Iran, from 2020 to 2022. The research consisted of 200 individuals who had experiencedmultiple failed cycles. These patients were randomised into two groups: intrauterine infusion of 1 ml of G-CSF andintrauterine infusion of 1 ml autologous PRP at least 48 hours before embryo transfer (ET). The groups were comparedin terms of implantation rate, and chemical, clinical, and ongoing pregnancy.Results: The implantation rate was significantly higher in patients who received PRP (P=0.016). Chemical pregnancy inthe PRP group was significantly higher than G-CSF group (P=0.003). Both clinical pregnancy and ongoing pregnancyrates were significantly higher in the PRP group (P=0.001) compared to the G-CSF group (P=0.02).Conclusion: The utilisation of PRP via intrauterine infusion is considerably more successful than G-CSF in enhancingpregnancy and live birth rates among patients with RIF.

Background: Repeated implantation failure (RIF) refers to the condition where high quality embryos are unable to successfully implant after multiple cycles of in vitro fertilization (IVF) treatment. The aim of this study is to investigate the impact of intrauterine granulocyte colony-stimulating factor (G-CSF) and platelet-rich plasma (PRP) on pregnancy rate in patients with RIF. Materials and Methods: The present randomised clinical trial study was conducted at the IVF Centre of Mehr Medical Institute in Rasht, Iran, from 2020 to 2022. The research consisted of 200 individuals who had experienced multiple failed cycles. These patients were randomised into two groups: intrauterine infusion of 1 ml of G-CSF and intrauterine infusion of 1 ml autologous PRP at least 48 hours before embryo transfer (ET). The groups were compared in terms of implantation rate, and chemical, clinical, and ongoing pregnancy. Results: The implantation rate was significantly higher in patients who received PRP (P=0.016). Chemical pregnancy in the PRP group was significantly higher than G-CSF group (P=0.003). Both clinical pregnancy and ongoing pregnancy rates were significantly higher in the PRP group (P=0.001) compared to the G-CSF group (P=0.02). Conclusion: The utilisation of PRP via intrauterine infusion is considerably more successful than G-CSF in enhancing pregnancy and live birth rates among patients with RIF. [ABSTRACT FROM AUTHOR]

Background: While anti-Müllerian hormone (AMH) level allows quantitative evaluation of ovarian reserve, its predictive value for live births following assisted reproductive technology cycles has remained controversial. The aim of the present study was to assess the importance of AMH in predicting live birth following intrauterine insemination (IUI) in the case of low or very low ovarian reserve. Methods: In this retrospective cohort study, 123 patients with AMH≤1 ng/ml, who underwent a total of 137 IUI cycles were enrolled and evaluated for live birth rate. Patients were divided into two groups based on serum AMH levels: group 1 with low level of AMH (0.4-1 ng/ml, n=83, cycles: 95) and group 2 with very low level of AMH (≤0.4 ng/ml, n=40, cycles: 42). The results were compared between the two groups. Main outcome was the pregnancy rate. Results: The rates of biochemical pregnancy, clinical pregnancy and live birth in all patients were 11%, 8% and 7.3%, respectively. The two groups showed no significant difference in the rates of biochemical pregnancy (10.4% vs. 14.3%, p=0.3), clinical pregnancy (6.3% vs. 11.9%, p=0.2) and live birth (6.3% vs. 9.8%, p=0.5). In univariate regression analysis, baseline characteristics and ovarian stimulation parameters showed no significant relationship with the rates of pregnancy and live birth. Conclusion: In women with AMH≤1 ng/ml, serum levels of AMH did not appear to reflect pregnancy outcomes and live births following IUI. It can be concluded that in women with low or very low levels of AMH, there is chance of pregnancy, and live birth following IUI. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: There is no agreement on which of the 2 gonadotropin-releasing hormone (GnRH) agonist protocols are the most efficient, neither there is any consensus on which one yields a better clinical pregnancy percentage. Objective: The present study aims to compare the effectiveness of reduced dosages of long- and short-acting GnRH agonists on pregnancy outcomes. Materials and Methods: In this randomized controlled clinical trial, 400 women were randomly assigned to 2 groups (n = 200/group): the reduced dosage of long-acting GnRH agonist group (group 1, 1.25 mg Decapeptyl) and the short-acting GnRH agonist group (group 2, 0.5 mg/day Buserelin Acetate). The study was conducted at Mehr Medical Institute, Rasht, Iran between July 2019 and July 2020. Biochemical and clinical pregnancy were compared between groups. Results: No significant differences were observed in the endometrial lining, the total number of retrieved and metaphase-II oocytes, progesterone, and serum estradiol levels on human chorionic gonadotropin day, fertilization rate, and top-quality embryos between the groups. The duration of induction (10.8 ± 1.7 vs. 10 ± 2.1, p < 0.001) and the total dosage of gonadotropins (2939.4 ±945.9 vs. 2441 ±1247.1, p <0.001) were significantly greater in group 2 than in group 1. No significant differences were observed between the 2 groups in terms of implantation rate, chemical pregnancy rate, and clinical pregnancy rate. A higher percentage of ovarian hyperstimulation syndrome was observed in group 2 (p = 0.005). Conclusion: Due to a lower percentage of ovarian hyperstimulation syndrome in group 1 and similar assisted reproductive technology outcomes in both groups, the long protocol was found to be superior to the short protocol. [ABSTRACT FROM AUTHOR]

Background: With introduction of intracytoplasmic sperm injection with testicular sperm extraction or precutaneouse epididymal sperm aspiration, effective treatment was provided for azoospermic men. The aim of present study was to compare clinical outcome following intracytoplasmic sperm injection using extracted testicular/epididymal sperm or ejaculated severe oligoasthenoteratozoospermic sperm. Methods: After retrospective evaluation of more than four hundred medical records of patients undergoing intracytoplasmic sperm injection Mehr medical institute (between 2011-2012), 45 cycles with severe eligoasthenoteratozoospermia and 34 cycles with azoospermia were included. Patients were treated with gonadotropin releasing hormone agonist. The clinical characteristics and intracytoplasmic sperm injection outcome such as the rate of fertilization, implantation and clinical pregnancy were compared between the two groups. Results were presented as mean±standard deviation and number (percent). Differences between variables were analyzed using student's t test and the chi-square test was used to examine differences between categorical variables. P value less than 0.05 were considered as statistically significant. Results: Mean of female age (29±4.9 vs. 30.2±5.8), body mass index (26.9±5.3 vs. 26.9±3.8), estradiol level on human chorionic gonadotropin administration day (1375.6±843.9 vs. 1181.8±673.1), total number of retrieved oocytes (9.7±5.3 vs. 9.2±5.9) and metaphase II oocytes (7.7±5.1 vs. 7.5±5.4) were similar between the two groups. Of 436 and 313 retrieved oocytes, respectively 232 and 163 oocytes were fertilized in oligoasthenoteratozoospermic and azoospermic groups (53.2% vs. 52.1%, P=0.214). There were not statistical differences between groups in number of transferred top quality embryos (1.5±1.2 vs. 1±1.2, P=0.09), implantation rate (22.7% vs. 16.9%, P=0.238) and clinical pregnancy rate (21 (47.7%) vs. 11 (35.4%), P=0.199). Conclusion: Intracytoplasmic sperm injection with precutaneouse epididymal sperm aspiration and testicular sperm extraction are effective methods to treat azoospermic men and its clinical outcome were comparable to ejaculated sever oligoasthenoteratozoospermic cycles. It can be concluded that the influence of sperm quality and origin on intracytoplasmic sperm injection outcome are the same. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrinological disorders that affect approximately 5-7% of women in reproductive age. There is not any consensus about the efficient in vitro fertilization (IVF) protocol for patients with PCOS. The aim of the present study was to compare the half and one-third dose depot gonadotropin-releasing hormone (GnRH) agonist protocols versus the GnRH antagonist protocol in PCOS patients. Methods: In the present study, we retrospectively evaluated 119 infertile women with PCOS. The patients entered in the study in accordance with Rotterdam criteria. According to GnRH analogue used for pituitary suppression, patients were divided into three groups: half and one-third dose depot GnRH agonist protocols and GnRH antagonist protocol. In GnRH agonist protocol, half or one-third dose depot Decapeptyl (1.875 mg, 1.25 mg) was injected on 21st day of previous cycle. In GnRH antagonist cycles, cetrotide 0.25 mg were administered daily when the leading follicles reached 14 mm. All basal and controlled ovarian hyperstimulation (COH) characteristics were analyzed. Results: Basal characteristics including: age, FBS, prolactin, hirsutism, length of menstrual cycle were similar between 3 groups. Statically significant decreases in days of stimulation, number of gonadotrophin ampoules and metaphase II (MII) oocytes were found in GnRH antagonist protocol (P<0.001, P<0.001 and P=0.045), while the decrease in biochemical pregnancy (P=0.083) and live birth rate (P=0.169) wasn't significant. Number of embryos transferred were similar in the half and one-third dose depot GnRH agonist and GnRH antagonist cycles (P=0.881). The incidence of OHSS weren't significantly different between 3 groups (5%, 4.9% and 12.8%, P=0.308). Conclusion: Our study suggest that one-third dose depot GnRH agonist protocol could be a suitable choice for treatment of PCOS because of lower incidence of ovarian hyperstimulation syndrome (OHSS) as compared with half dose depot GnRH agonist and higher pregnancy rate as compared with GnRH antagonisten. [ABSTRACT FROM AUTHOR]

Background: Anti-Müllerian Hormone (AMH) is secreted from granulosa cells of growing follicles and is a useful marker of ovarian reserve. Fertility in women is determined by the quality and quantity of follicle pool and ovarian follicular reserve positively correlates with AMH. In this study we aimed to determine if AMH can predict ovarian response in IVF treatments. Methods: In this retrospective observational study undertaken in Mehr Institute during 2010 to 2011, we studied the medical records of 101 patients and recorded the concentrations of AMH, day two or three FSH, LH, basal estradiol (E2), E2 on day of HCG administration and the number of metaphase II oocytes. Having undergone ovarian hyperstimulation, the women were divided into three groups: poor responders (retrieved oocytes ⩽3), normal responders (retrieved oocytes 4 to 15) and high responders (retrieved oocytes ⩾16). Results: Overall, 20% of patients were defined as poor responders, 71% as average responders and 10% as high responders. There were significant differences in the concentration of AMH, E2 on day of HCG administration, FSH, the number of metaphase II oocytes and age between the three groups. MII oocyte count correlated positively with AMH (r=0.487), basal E2 (r=0.275) and LH (r=0.07) but it did negatively with FSH (r=-0.26) and age (r=-0.04). The areas under curve for AMH, FSH, LH, E2 and age were 0.799, 0.32, 0.429, 0.558 and 0.304, respectively. We determined the 0.85 ng/ml AMH concentration as the cut-off point with 71% specificity and 79% sensitivity for the prediction of poor responders. Conclusion: anti-müllerian hormone is an appropriate predicator of ovarian response following induction of ovulation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]