体外受精-胚胎移植周期中注射绒毛膜促性腺激素日性激素水平与妊娠率的关系

目的：探讨在体外受精－胚胎移植（IVF－ET）周期中注射绒毛膜促性腺激素（HCG）日性激素水平与妊娠率的关系。方法：对71个常规IVE－ET和卵母细胞单精子显微注射（ICSI）周期中注射HCG日的性激素水平进行测定。结果：促黄体生成素（LH）普遍受抑制，与临床妊娠无关；孕酮（P）＜2．86nmol/L时妊娠率较高，雌二醇（E2）（每卵子）513．8－770．7pmol/L时妊娠率高于其它两组。结论：在IVF－ET和ICSI周期中，注射HCG日的P值和E2（每卵子）水平是预测妊娠成功率的一个比较好的指标，当两者联合应用时，可提高预测的准确率。     

GnRH拮抗剂配伍HMG方案对卵巢低反应患者IVF—ET治疗结局分析

目的探讨促性腺激素释放激素拮抗剂（GnRH拮抗剂）配伍HMG方案对卵巢低反应患者控制性超排卵的效果，及其对体外受精-胚胎移植结局的影响。方法研究对象为前次IVF—ET治疗失败，证明是卵巢低反应，要求再次IVF—ET治疗的患者，随机分为2组，实验组使用GnRH拮抗剂＋HMG方案，共21个周期，对照组使用GnRH激动剂短方案，共23个周期。将两组患者的年龄、基础FSH水平、Gn使用天数和剂量、hCG日血清E2水平、获卵数、受精率、临床妊娠率、胚胎种植率等进行比较。结果两组患者不孕年限、与前次IVF—ET间隔时间、周期取消率、Gn使用天数、HCG日E2水平、获卵数、受精方式、受精率，胚胎移植数等比较差异均无显著性（P〉0．05）。拮抗剂组与激动剂组的平均年龄分别为：（37．7±3．3）岁和（35．9±4．1）岁；平均基础FSH分别为：（14．21±6．76）μ／L和（10．04±4．60）μ／L。平均Gn使用量：拮抗剂组为（32．3±17．8）支，激动剂组为（39．8±12．2）支。拮抗剂组与激动剂组的临床妊娠和胚胎种植率分别为（42．1％vs10．5％）和（25．7％vs5．0％），两组患者的年龄、基础FSH、平均Gn用量、临床妊娠率、胚胎种植率等比较差异均有显著性（P〈0．05）。结论GnRH拮抗剂与HMG配伍，对卵巢低反应的患者是一种有效的超排卵治疗方案，可以提高IVF—ET的临床妊娠率和胚胎种植率，并且费用低廉。     

血清雌二醇水平和获卵数对体外受精-胚胎移植治疗结局的影响

目的 探讨体外受精与胚胎移植（IVF－ET）程序中注射人绒毛膜促性腺激素（HCG）日血清雌二醇（E2）水平及获卵数目对其治疗结局的影响。方法 回顾分析2000年2月至2001年1月947个IVF－ET周期的资料。结果 注射HCG日血清E2水平过高、获卵过多者，IVF－ET卵母细胞受精率下降，IVF－ET临床妊娠率从单因素分析，有增高趋势，经多因素Logistic回归分析，排除年龄等干扰因素后，血E2水平及获卵数对IVF－ET临床妊娠的影响无统计学意义。血E2水平过高及获卵过多者，伴随重度OHSS发生率的上升。结论 注射HCG日血E2水平过高及获卵数过多不能预测IVF－ET的临床妊娠。     

不孕症合并子宫内膜非典型增生患者助孕治疗的临床分析

目的探讨不孕症合并子宫内膜非典型增生患者经保守治疗后助孕治疗的疗效和安全性。方法回顾性分析8例不孕症合并子宫内膜非典型增生患者，经孕激素或促性腺激素释放激素激动剂（GnRHa）治疗子宫内膜非典型增生缓解后，采用助孕治疗，观察助孕治疗的疗效及其对子宫内膜的影响。结果经孕激素或GnRHa治疗后，8例患者子宫内膜非典型增生全部缓解。共进行单纯促排卵治疗7个周期，促排卵联合人工授精2个周期，体外受精-胚胎移植（IVF—ET）7个周期，冻融胚胎移植2个周期。单纯促排卵周期均未妊娠，人工授精1个周期双胎妊娠；7个IVF—ET周期中，胚胎移植6个周期，3个周期获得临床妊娠；冻融胚胎移植1个周期获得临床妊娠。现足月分娩6活婴。1例未妊娠患者在促排卵后4个月发现子宫内膜癌变。结论不孕症合并子宫内膜非典型增生的患者经孕激素或GnRHa治疗缓解后，及时助孕治疗能提高妊娠率，但需严密观察，注意子宫内膜癌发生的可能。     

抗卵巢抗体对体外受精-胚胎移植过程及结局的影响

目的 :研究抗卵巢抗体对体外受精 胚胎移植 (IVF ET)的影响。方法 :接受IVF ET治疗的患者 80例 ,在施行IVF治疗前抽取静脉血 3ml ,测定血清中抗卵巢抗体(AOAb)阳性率 ,并分别计算阳性组和阴性组患者的取卵数、受精率、卵裂率、优质胚胎率、冷冻胚胎率、临床妊娠率及胚胎种植率。结果 :AOAb的阳性率为 2 8.8% (2 3/ 80 )。AOAb阳性患者中平均取卵数、胚胎种植率和临床妊娠率均低于抗体阴性组。结论 :抗卵巢抗体的存在影响了IVF ET的诸过程 ,降低了临床妊娠率。     

高龄妇女接受体外受精-胚胎移植的结局

目的　探讨高龄妇女接受体外受精 胚胎移植 (IVF ET)治疗后妊娠及围产情况。方法　对 1999年 1月至 1999年 12月 ,139例接受常规IVF ET治疗和 6 9例卵母细胞浆内单精子注射(ICSI)治疗的 2 0 8例高龄 (36～ 4 5岁 )妇女的临床资料进行回顾性分析。结果　 2 0 8例共妊娠 4 8例 ,妊娠率为 2 3 1%。 36、37、38、39及 4 0～ 4 5岁组妇女的不孕原因、不孕年限、治疗次数、卵裂率、移植胚胎情况等比较 ,差异均无显著性 (P >0 0 5 )。随年龄增加 ,卵泡数明显减少 ,各年龄组分别为 (14 7±1 2 )、(13 0± 2 0 )、(11 3± 0 9)、(9 7± 0 9)及 (6 5± 1 9)个 ;妊娠率明显下降 ,分别为 2 4 1、2 0 5、13 2、11 1及 9 8% ;种植率也明显下降 ,分别为 15 6、11 2、10 5、6 5和 2 2 % ;而流产率则明显增高 ,分别为 2 3 0、2 7 2、33 4、4 1 2及 4 3 3% ;多胎妊娠率分别为 31 2、2 7 3、15 4、6 7及 0 0 %。各年龄组上述指标比较 ,差异均有显著性 (P <0 0 5 )。除新生儿体重外 ,各年龄组在产科结局方面差异无显著性。结论　 37岁以上妇女接受IVF ET的妊娠率及种植率明显下降 ,≥ 4 0岁妇女下降明显加快 ;移植3个以上胚胎可能有利于提高妊娠率 ,同时不增加多胎妊娠。     

体外受精-胚胎移植与单精子卵胞浆内注射妊娠结局的比较与分析

目的　探讨体外受精 胚胎移植 (IVF ET)和单精子卵胞浆内注射 (ICSI)的妊娠结局及围产儿结局。方法　回顾性分析 1999年 1月至 2 0 0 1年 6月 ,行IVF ET获得妊娠的 14 3例 (IVF ET组 )及行ICSI获得妊娠的 173例 (ICSI组 )的临床资料 ,比较两组的生化妊娠、流产、异位妊娠、多胎分娩发生率及新生儿出生体重、胎儿孕龄、先天性畸形、围产儿死亡率的情况 ;并对两组单胎、双胎妊娠的结局分别进行比较。结果　IVF ET组与ICSI组两组患者的年龄、不孕年限、产次、移植胚胎数、流产率 (16 1%、13 3% )、分娩率 (6 5 7%、74 6 % )、多胎分娩发生率 (2 7 3%、31 8% )比较 ,差异均无显著性 (P >0 0 5 )。单胎妊娠中 ,IVF ET组与ICSI组低体重儿的发生率分别为 1 8%、6 8% ,小于胎龄儿的发生率分别为 7 3%、8 1% ,早产的发生率分别为 5 5 %、14 9% ;双胎妊娠中 ,IVF ET组与ICSI组低体重儿的发生率分别为 34 2 %、4 2 6 % ,小于胎龄儿的发生率分别为 30 3%、38 0 % ,早产的发生率分别为 4 2 1%、4 6 3%。两组间上述各发生率比较 ,差异均无显著性 (P >0 0 5 )。但双胎妊娠中 ,上述各发生率均明显高于单胎妊娠。两者比较 ,差异均有极显著性 (P <0 0 1)。先天性畸形的发生率 ,IVF ET组与ICSI组分别为 2 2 %     

体外受精-胚胎移植重复周期助孕结局的回顾性分析

目的：研究体外受精-胚胎移植（IVF-ET）多次助孕周期妊娠结局的变化趋势,探讨影响重复周期妊娠结局的相关因素。方法：回顾性分析中山大学孙逸仙纪念医院生殖中心2008年1月—2009年10月行IVF/胞浆内单精子注射（ICSI）助孕治疗的患者1314例（1746周期）,其中助孕周期次数≥3的患者128例（191周期）。分析妊娠结局与助孕周期次数的关系,比较第3周期未妊娠者（A组,68例）与妊娠者（B组,37例）既往未妊娠周期中相关指标的差异。结果：临床妊娠率、活产率在第1～4周期间呈现递减趋势（P〈0.001）,第1周期临床妊娠率显著高于第2周期,活产率显著高于第2～4周期,但第2周期及其后周期间临床妊娠率、活产率差异无统计学意义（P〉0.05）。Logistic回归分析第1/2周期中有统计学意义的变量为年龄、不孕类型和优质胚胎个数,其OR值分别为0.757/0.865、12.00/3.376和1.711/1.436。结论：IVF-ET第1周期临床妊娠率和活产率高,其后周期临床妊娠率、活产率与周期次数无明显关系。在第1、2周期未妊娠的患者中,年龄越小、优质胚胎数越多和继发不孕者在第3周期中获得妊娠的可能性越大。     

体外受精-胚胎移植重复周期助孕结局的回顾性分析

目的：研究体外受精-胚胎移植（IVF-ET）多次助孕周期妊娠结局的变化趋势,探讨影响重复周期妊娠结局的相关因素。方法：回顾性分析中山大学孙逸仙纪念医院生殖中心2008年1月—2009年10月行IVF/胞浆内单精子注射 （ICSI）助孕治疗的患者1 314例（1 746周期）,其中助孕周期次数≥3的患者128例（191周期）。分析妊娠结局与助孕周期次数的关系,比较第3周期未妊娠者（A组,68例）与妊娠者（B组,37例）既往未妊娠周期中相关指标的差异。结果：临床妊娠率、活产率在第1～4周期间呈现递减趋势（P＜0.001）,第1周期临床妊娠率显著高于第2周期,活产率显著高于第2～4周期,但第2周期及其后周期间临床妊娠率、活产率差异无统计学意义（P＞0.05）。 Logistic回归分析第1/2周期中有统计学意义的变量为年龄、不孕类型和优质胚胎个数,其OR值分别为0.757/0.865、12.00/3.376和1.711/1.436。结论：IVF-ET第1周期临床妊娠率和活产率高,其后周期临床妊娠率、活产率与周期次数无明显关系。在第1、2周期未妊娠的患者中,年龄越小、优质胚胎数越多和继发不孕者在第3周期中获得妊娠的可能性越大     

提高体外受精-胚胎移植妊娠率的临床策略探讨

目的 探讨提高体外受精-胚胎移植（IVF-ET）妊娠率的有效方法与策略。方法 2003-05—2005-06上海交通大学医学院附属瑞金医院生殖医学中心对进行IVF-ET的患者固定相关条件，采用超声下胚胎移植、雌二醇（E2）／孕酮（P）监测调控注射人绒毛膜促性腺激素（HCG）的时机及助孕术前行子宫内膜搔刮术，观察其对妊娠结局的影响。结果 超声下发现胚胎移植（ET）日子宫位置较预探有变化者占45．69％，其中深度增减超过5mm者达23．28％，其单胚种植率升高，两者比较差异有显著性意义。HCG日E2／P比值在3．01～4．00者妊娠率最高，〈1者无妊娠。超声观察子宫内膜形态不良者经搔刮术转为规则三线征者占63．64％，获得了与内膜形态良好患者相近的临床结局；经上述措施，临床妊娠率及单胚种植率逐年提高，最高达到53．85％和31．88％。结论 超声下ET和助孕术前子宫内膜搔刮术，对提高IVF—ET妊娠率显示了有效的价值，E2／P监测调控注射HCG时机的效果有待样本积累。     

Results of prednisolone given to improve the outcome of in vitro fertilization-embryo transfer in women with antinuclear antibodies

OBJECTIVE: To evaluate the association of antinuclear antibodies (ANA) with outcome of in vitro fertilization-embryo transfer (IVF-ET) as well as the effect of short-term immunosuppression with prednisolone on implantation, clinical pregnancy and live birth rates following IVF-ET. STUDY DESIGN: The study group consisted of 120 women, 22-42 years old, in whom IVF-ET was performed and whose ANA could be measured. Prednisolone (15-60 mg/d for 5 days) was administered starting 1 day after oocyte retrieval to some women with or without ANA, without randomization. The 223 IVF-ET cycles were divided into prednisolone-nontreated ANA-negative cycles, prednisolone-treated ANA-negative cycles, prednisolone-nontreated ANA-positive cycles and prednisolone-treated ANA-positive cycles. Retrospective analysis of rates of implantation, clinical pregnancy, and live birth were evaluated in the four groups. RESULTS: Overall, ANA positivity was noted in 20.0% of subjects (24/120) and 25.1% of cycles (56/223). Implantation and clinical pregnancy rates in the prednisolone-nontreated ANA-positive group were 0% (0/41 transplanted embryos) and 0% (0/15 cycles), significantly lower than in the other groups. The live birth rate in this group was significantly lower than in the prednisolone-nontreated ANA-negative group and non-significantly tended to be lower than in the other 2 CONCLUSION: Implantation, clinical pregnancy and live birth rates following IVF-ET were low when ANA was detected. Implantation and clinical pregnancy rates were improved significantly by prednisolone, but the live birth rate was not.     

Laparoscopic management of hydrosalpinges before in vitro fertilization-embryo transfer: salpingectomy versus proximal tubal occlusion

OBJECTIVE: To compare ovarian response and IVF-ET cycle outcome in patients with hydrosalpinges managed by either laparoscopic salpingectomy or proximal tubal occlusion. DESIGN: Retrospective analysis. SETTING: Tertiary-care assisted reproductive technology program. PATIENT(S): One hundred four consecutive fresh IVF-ET cycles in 94 patients with tubal-factor infertility. INTERVENTION(S): Laparoscopic salpingectomy (group 1: 35 cycles) or bipolar proximal tubal occlusion (group 2: 17 cycles), controlled ovarian hyperstimulation, and IVF-ET. Control groups consisted of both tubal-factor patients without hydrosalpinges (group 3: 37 cycles) and those with prior bilateral tubal ligation for sterilization (group 4: 15 cycles). MAIN OUTCOME MEASURE(S): Uterine artery Doppler flow, controlled ovarian hyperstimulation response, and implantation and clinical pregnancy rates. RESULT(S): There were no differences in mean uterine artery pulsatility indices or ovarian response among any of the groups. A trend toward a higher cycle cancellation rate in group 1 did not approach statistical significance. Clinical pregnancy and implantation rates were not significantly different between group 1 (57.1%, 29.2 +/- 5.9%, respectively) and group 2 (46.7%, 19.4 +/- 6.1%, respectively) or compared with those of controls. CONCLUSION(S): [1] Management of hydrosalpinges by laparoscopic salpingectomy or bipolar proximal tubal occlusion yielded statistically similar responses to controlled ovarian hyperstimulation and IVF-ET cycle outcome. [2] The latter approach may be preferable in patients who present with dense pelvic adhesions and easy access only to the proximal fallopian tube.     

Relationship between the day of embryo transfer and the outcome in human in vitro fertilization and embryo transfer

Purpose To clarify the optimal date of embryo transfer (ET), we retrospectively analyzed the relationship between the day of ET and the outcome in human in vitro fertilization and embryo transfer (IVF-ET).Method Of a total of 307 human IVF-ET cycles performed at Kyoto University Hospital between January 1990 and March 1994, we focused on 207 cases of IVF-ET cycles in which two or three good-quality embryos were transferred. These 207 IVF-ET cycles consisted of 54 Day 2 ET cycles, 79 Day 3 ET cycles, 46 Day 4 ET cycles, and 28 Day 5 ET cycles. We compared the pregnancy and live-birth (plus ongoing pregnancy) rates among these four ET groups.Results The pregnancy rates of ET on Days 2 to 4 were not significantly different, whereas Day 5 ET produced a significantly lower pregnancy rate (Day 2, 29.6%; Day 3, 32.9%; Day 4, 30.4%; Day 5, 10.7%). Similar results were obtained for the live-birth (plus ongoing pregnancy) rates (Day 2, 20.3%; Day 3, 18.9%; Day 4, 17.9%; Day 5, 7.1%).Conclusions These results suggest that the day of ET does not fundamentally affect the pregnancy rate in human IVF-ET provided that transfer is made before Day 5.     

Controlled ovarian hyperstimulation does not adversely affect endometrial receptivity in in vitro fertilization cycles

OBJECTIVE: To determine whether exposure of developing endometrium to supraphysiologic E2 levels during controlled ovarian hyperstimulation (COH) in IVF cycles inhibits endometrial receptivity. DESIGN: Retrospective analysis of IVF-ET and ovum donation data. SETTING: Tertiary-care teaching hospital. PATIENT(S): Four hundred ten patients <33 years of age undergoing IVF-ET and 181 anonymous ovum donors (<33 years of age) and their associated ovum recipients. MAIN OUTCOME MEASURE(S): Implantation, pregnancy, and delivery rates. RESULT(S): Ovarian response to COH (duration of stimulation, peak E2 level, area under the curve for E2 exposure, and number of oocytes retrieved) was similar for IVF-ET patients and ovum donors. Donors were younger than IVF-ET patients (mean age, 27.5 +/- 0.2 years vs. 30.4 +/- 0.1 years). A similar number of embryos with similar number of blastomeres were transferred in IVF-ET patients and ovum recipients. The fragmentation rate at time of transfer differed slightly between groups (5.2 +/- 0.2% vs. 4.3 +/- 0.3%). Implantation, pregnancy, and delivery rates did not differ between IVF-ET patients and recipients of donor oocytes. CONCLUSION(S): Exposure of the developing endometrium to controlled ovarian hyperstimulation during IVF cycles does not inhibit embryo implantation or affect pregnancy and delivery rates.     

A reassessment of comparative pregnancy and implantation rates following embryo transfer in recipients vs their infertile donors also trying to conceive in the background of performing salpingectomy for hydrosalpinx

PURPOSE: To compare pregnancy and implantation rates in egg donors trying to conceive vs their recipients in the background of salpingectomy for hydrosalpinx prior to IVF-ET. METHODS: A retrospective six-year review of all donor egg cycles where the eggs are supplied by an infertile donor trying to conceive herself was carried out. Salpingectomy for hydrosalpinx was performed prior to IVF-ET. RESULTS: Clinical and delivered pregnancy rates (PRs) following fresh ET were not significantly different in donors vs recipients (60.0%, 45.8% vs 56.8%, 50.8%). Implantation rates were 27.3% vs 32.6%. The respective implantation rates following frozen ET were 13.8% and 14.4%. CONCLUSIONS: In the background of salpingectomy for hydrosalpinges the much higher PRs in recipients vs donors is no longer seen. The trend for higher implantation rates in recipients (about 20%) following fresh but not frozen transfer could still reflect some adverse effect of the controlled ovarian hyperstimulation regimen in a minority of women.     

Prediction of the rates of fertilization, cleavage, and pregnancy success by cumulus-coronal morphology in an in vitro fertilization program.

OBJECTIVE: To examine the relation between the grading of cumulus-coronal morphology at oocyte retrieval and the rates of fertilization, cleavage, and pregnancy success in IVF-ET cycles. DESIGN: Retrospective study. SETTING: University-affiliated medical center. PATIENT(S): Infertile women who underwent IVF-ET treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Fertilization and cleavage of the oocytes and the pregnancy outcome. RESULT(S): Mature grade 3 cumulus-oocyte complexes (COCs) constituted the highest percentage among all grades and had a higher fertilization rate than COCs of other grades (77% versus 65%, 43%, and 28% for grades 2, 1, and 4, respectively). The cleavage and polyspermy rates did not correlate with cumulus-coronal morphology grading. The pregnancy rate was higher in cycles with >50% grade 3 COCs than in cycles with < or =50% grade 3 COCs (32% versus 16%). In cycles with >80% grade 3 COCs, the pregnancy rate was 57%. The correlation between the percentage of grade 3 COCs and the pregnancy rate was independent of patient age and the number of COCs retrieved. CONCLUSION(S): The cumulus-coronal morphology grade correlates with the fertilization rate but not with the cleavage or polyspermy rate. In vitro fertilization cycles that have a greater percentage of grade 3 COCs have an increased chance of resulting in pregnancy. The cumulus-coronal morphology grade predicts pregnancy success in IVF-ET cycles.     

Zygote intrafallopian transfer in patients with tubal factor infertility after repeated failure of implantation with in vitro fertilization-embryo transfer

OBJECTIVE: To evaluate the efficacy of zygote intrafallopian transfer (ZIFT) in terms of implantation and pregnancy rates in patients with tubal factor infertility and repeated implantation failure in IVF-ET cycles. DESIGN: Retrospective analysis of ZIFT cycles. SETTING: An IVF unit in a university hospital. PATIENT(S): Criteria for patient selection for ZIFT included at least four failures of implantation in IVF-ET cycles in which at least 3 embryos were replaced per transfer and a cause of infertility diagnosed as male, unexplained, or tubal factor with proof of one patient tube. INTERVENTION(S): Four to six zygotes were transferred by laparoscopy into the fallopian tube 24-26 hours after oocyte retrieval. MAIN OUTCOME MEASURE(S): Implantation and pregnancy rates were determined in 112 ZIFT cycles performed in 81 patients with repeated failure of implantation. Results were further stratified for patients with tubal factor (n = 15) and patients without tubal factor (n = 66). RESULT(S): The pregnancy and implantation rates for all ZIFT cycles were 35.1% and 11.1%, respectively. Pregnancy and implantation rates per cycle in patients with tubal factor versus patients without tubal factor were 26.6% versus 37.1% and 9.4% versus 11.4%, respectively. CONCLUSION(S): ZIFT can be considered as a mode of treatment for patients with repeated failure of implantation in IVF-ET and with tubal factor with proved patency of one tube.     

Impact of intramural leiomyomata in patients with a normal endometrial cavity on in vitro fertilization-embryo transfer cycle outcome

OBJECTIVE: Assess the impact of intramural uterine leiomyomata and a normal endometrial cavity on IVF-ET cycle outcome. DESIGN: Retrospective case-controlled analysis. SETTING: Tertiary-care-assisted reproductive technology program. PATIENT(S): Three hundred ninety-nine consecutive fresh IVF-ET cycles were performed in patients with a normal precycle diagnostic hysteroscopy; patients were divided into four groups. Group 1: positive leiomyomata, age <40 years (n = 51 cycles); group 2: negative leiomyomata, age <40 years (n = 57 cycles); group 3: positive leiomyomata, age > or =40 years (n = 22 cycles); group 4: negative leiomyomata, age > or =40 years (n = 59 cycles). A subgroup of all group 2 patients aged 35-39 (group 2A, n = 113 cycles) was also evaluated as an additional control. INTERVENTION(S): Controlled ovarian hyperstimulation, IVF-ET. MAIN OUTCOME MEASURE(S): Implantation (IR), live birth (LBR) rates. RESULT(S): There were no significant differences in LBR among age-matched controls: group 1 (49%) versus 2 (57.5%) or 2A (57%) and group 3 (40.9%) versus 4 (32.2%). IR was significantly lower in group 1 (21.4%) versus 2 (33.3%) or 2A (33.9%) but not in group 3 (17.5%) versus 4 (11.6%). Implantation did not correlate with either mean leiomyoma diameter or volume. CONCLUSION(S): [1] LBR was not affected by the presence of intramural leiomyoma in IVF-ET patients with hysteroscopically normal endometrial cavities. [2] A significant decrease in IR was only noted in patients <40 years old. [3] Given the relatively high LBR in all groups, prophylactic surgical intervention cannot be justified, but precycle hysteroscopy evaluation is recommended.     

Luteal phase support with estradiol and progesterone versus progesterone alone in GnRH antagonist ICSI cycles: a randomized controlled study

In vitro fertilization (IVF) cycles are associated with a defective luteal phase. Although progesterone supplementation to treat this problem is standard practice, estrogen addition is debatable. Our aim was to compare pregnancy outcomes in 220 patients undergoing antagonist intracytoplasmic sperm injection (ICSI) cycles protocol. The patients were randomly assigned into two equal groups to receive either vaginal progesterone alone (90?mg once daily) starting on the day of oocyte retrieval for up to 12 weeks if pregnancy occurred or estradiol addition (2?mg twice daily) starting on the same day and continuing up to seven weeks (foetal viability scan). Primary outcomes were pregnancy and ongoing pregnancy rates per embryo transfer. Secondary outcomes were implantation and early pregnancy loss rates. Pregnancy rates showed no significant difference between group 1 (39.09%) and 2 (43.63%) (p value?=?0.3). Similarly, both groups were comparable regarding ongoing pregnancy rate (32.7% group 1 and 36.3% group 2, p value?=?0.1). Implantation rates showed no difference between group 1 (19.25%) and group 2 (23.44%) (p value?=?0.2). Early pregnancy loss rates were comparable, with 6.3% and 7.2% in groups 1 and 2, respectively, (p value?=?0.4). In conclusion, the addition of 4?mg estrogen daily to progesterone for luteal support in antagonist ICSI cycles is not beneficial for pregnancy outcome.