The point of this consideration is to examine the possible influence of progesterone (P4), estradiol (E2), and testosterone (T) concentrations in follicular fluid (FF) on fertilization, implantation, and biochemical pregnancy rates in patients with polycystic ovary (PCO) and normal women during in vitro fertilization (IVF) treatment. 30 normal-ovulatory women between 24-42 years old and 26 women with the PCO, between 21-37 years old under assisted reproductive therapy were recruited from two university hospital IVF centers during this study. The fluid from more than one preovulatory follicle was obtained on the day of ovulation for hormone measurement using the Elisa method. Association between the mentioned steroid levels and fertilization, implantation, and biochemical pregnancy rates were assessed by using spearman, Mann-Whitney, and regression tests. Among the assessed outcomes, in the PCO group, the FF, E2, and T levels appeared to have a noteworthy reverse relationship with fertilization rate (P= 0.050). In both groups, intrafollicular levels of the E2/T ratio correlated positively with implantation rate (P=0.024 in control vs. P= 0.009 in PCO) and biochemical pregnancy (P= 0.020 in control vs. P= 0.012 in PCO). Furthermore, intrafollicular E2/P4 levels showed a positive relationship with both implantation (P= 0.047) and biochemical pregnancy (P= 0.050) rates in the control group. Our results for the first time suggest that high intrafollicular levels of E2 and T may influence reduced fertilization rate. The E2/T ratio would be a good predictor of successful implantation and pregnancy rates regardless of infertility causes. Moreover, the E2/P4 ratio could be a valuable prescient marker for implantation and biochemical pregnancy rates in normal-ovulatory women. Beyond the mentioned results, the underlying pathological processes, and pathways, including hyperandrogenism and interruptions in the hypothalamic-pituitary-ovarian (HPO) axis could be the potent concepts in polycystic ovary syndrome (PCOS) etiology and an alteration in genetic variants of SHBGs and catalytic enzymes responsible in steroidogenesis pathways. Furthermore, possible correlations between the mentioned steroid hormones and the functions of genes related to gonadotropins and steroid hormones in the pathophysiological pathways involved in PCOS were explored.

Background: One of the most annoying problems in IVF is poor ovarian response. It is anticipated that 5-18% of all IVF cycle are affected by poor response to ovarian hyperstimulation.Poor response to goandotropin may lead to decline in the pool of embryos for transfer or cryoperservation, and decrease pregnancy rates. Different mechanisms explain poor ovarian response for example decreased number of FSH receptors in granulosa cells, anti-FSH IgA and IgG potentially exerting a local FSH antagonizing effect in maturing follicles, the presence of a specific FSH receptor-binding inhibitor in the follicular fluid, the higher FSH threshold to stimulation follicle development.As mentioned above, likely immune system is involved in the mechanism of poor responder and affects the steroidogenesis. First line of immune system is pattern recognition receptors (PRRs) as a compartment of innate immunity. The most important group of PRRs which also identified in female reproductive tract is Toll like receptors (TLRs) family. So far, TLR1-10 are characterized in human. TLR1, 2, 4, 5, 6 and TLR10 are expressed on the cell membrane and they recognize lipid and protein ligands. TLR3, 7, 8 and TLR9 can detect nu cleic acid from pathogens are found in endosomal compartment.In addition these receptors recognize a broad range of endogenous ligands including heat shock proteins, hyaloronan, host RNA, and reactive oxygen species (ROS).So TLRs play abundant immunologic and physiologic roles in reproductive system. Therefore, the aim of this study is to investigate TLR1.2, 3, 5, 7, 8 genes expression in follicular cells obtained from ovarian poor response women in compare to normal women.Materials and Methods: All procedures were approved by the Royan Ethics committee and informed consent was obtained prior to the collection of samples.Forty patients (20 infertile ovarian poor responder patients and 20 normal women with male factor infertility) underwent controlled ovarian stimulation with monitoring E2 levels and pelvic ultrasounds. Gonadotropin doses were then adjusted accordingly and monitoring was continued until patients received 10, 000 IU hCG intramuscular.Oocyte retrieval was performed approximately 36 h after hCG. The follicular fluid was obtained from the largest follicle (>18 mm) visualized on ultrasound before using any flushing medium. This follicle was aspirated with a 17-gauge Cook needle attached to 100 mm Hg pump-operated aspirator. It was the first puncture of the oocyte retrieval. The follicular fluid was transferred to a sterile Petri dish, and the oocytes were then removed. The follicular fluid was placed into a 15- mL conical tube and centrifuged at 300g for 5 min. The supernatant was removed for further proteomic study.Total RNA was extracted separately from cellular pallet in each group using TRI reagent and treated with DNaseI.First strand cDNA synthesis was performed using oligo dT primers and Superscript II reverse transcriptase system. RT-PCR and Quantitative PCR was performed using the prepared cDNA and primer for TLR1-10. Relative TLR expression quantities were compared between two groups. The threshold cycle values were normalized against the threshold value of humanβ-actin. Differences in normalized expression values between samples were tested for significance using ANOVA statistical test. The results were expressed as mean ±SEM. The level of statistical significance was set at p<0.05.Results: TLR1-10 genes were expressed in follicular cell of both, case and control groups. The mean relative expression of TLR1, 2, 4, 6 genes were significantly higher in poor ovarian responder, TLR5 and 8 expressions were higher in poor ovarian responder but not significant. TLR 3, 7, 9 and TLR10 was lower in patients with poor ovarian responder in compare to normal women.Conclusion: Our findings suggested that TLRs are involved in pathophysiology of ovarian poor response. It’s been proposed that inflammatory markers such as IL6, IL8 and TNF-a are vary in poor responders. Since these markers are produced by TLRs signaling, therefore it’s possible that these changes are a result of TLRs activation in poor responders.

This review addresses the current understanding of In Vitro Maturation (IVM) treatment, including indications and effective treatment protocols influencing oocyte developmental competence. A comprehensive literature search was performed to gather relevant studies, clinical trials, and reviews related to IVM. Databases such as PubMed, MEDLINE, and pertinent medical journals were searched. The selected literature was analyzed and synthesized to offer a comprehensive overview. IVM has emerged as a promising technique for inducing maturation in immature oocytes across various developmental stages. Its applications extend to areas utilizing In Vitro Fertilization (IVF), gaining traction as a treatment option for Polycystic Ovary Syndrome (PCOS) and fertility preservation in cancer patients. Recent advancements have led to improved global pregnancy rates, resulting in successful births. IVM also holds potential in reducing risks associated with conventional IVF, including ovarian hyperstimulation syndrome and multiple pregnancies. Despite these advantages, IVM adoption in clinical practice remains limited. Ongoing research aims to refine therapeutic protocols and expand clinical indications. IVM holds promise in assisted reproductive technology, spanning applications from cancer patient fertility preservation to addressing PCOS. Enhanced pregnancy rates highlight efficacy, while risk reduction compared to IVF underscores its importance. Further research is needed for optimal use across patient groups, emphasizing protocol refinement and expanded applications.

Background: The benefits of frozen embryo transfer (FET) vs. fresh embryo transfer for in vitro fertilization (IVF) have been discussed in previous studies. Objective: To determine and compare the pregnancy outcomes following FET and frozen embryos transfer in women who underwent assisted reproductive techniques. Materials and Methods: In this cross-sectional study, 233 women candidates for IVF/intra cytoplasmic sperm injection who referred to the Kamali Training Medical Center, Karaj, Iran during 2019-2020 were evaluated in 2 groups of fresh (n = 127) and frozen (n = 106) embryo transfers. The rates of pregnancy outcomes including chemical and clinical pregnancy, live birth, preeclampsia, ectopic pregnancy, still birth, and pregnancy loss were compared between groups in 3 age subgroups (< 25, 25-35, and 35-40 yr old). Results: No significant difference in terms of chemical and clinical pregnancy and live birth rates were observed between groups in women aged < 25 yr. Chemical and clinical pregnancy and live birth rates were significantly higher in the FET group compared to fresh group in 25-35-yr-old women (p = 0.01, p = 0.03, and p = 0.01, respectively). In 35-40-yr-old women, no significant differences were observed in terms of chemical and clinical pregnancy rates, but live birth rate was found to be significantly higher in the FET group (p = 0.02). The pregnancy loss was lower in the FET group (p = 0.038). Conclusion: In conclusion, the FET method in women aged 25-35 yr significantly increases the chance of successful IVF/intra cytoplasmic sperm injection.

Aim: Evaluation of Primary post partum hemorrhage as a predictor of von Willebrand disease.Case: A 39 years woman with the history of 15 years primary infertility was referred to shahid sadoughi hospital for termination of pregnancy. Due to the history of IVF (Invitro fertilization) golden baby, she was underwent csesarean section. 2 days after this surgery, she had severed vaginal bleeding that could not be controlled by transfusion, prostaglandines, ligation of uterine artry and internal iliac artry and hysterectomy. On evaluation, we had resulted she had a sub normal von willebrand factor and was diagnosed von Willebrand disease.Result and conclusion: In the patients with primary postpartum hemmorrhage whish unanwered to rutine treatments, we must think about inherited bleeding disorders such as von Willebrand disease.