Background: Prolonged GnRH-a administration in IVF cycles may have some advantages related to the treatment outcomes.Objective: In this study, we aimed to analyse the effect of prolonged gonadotropin releasing hormone agonist (GnRH-a) administration on CONTROLLED OVARIAN HYPERSTIMULATION outcomes of in vitro fertilization (IVF) patients.Materials and Methods: In this retrospective study, 55 patients with a GnRH-a administration period more than 10 days were compared with 55 patients whose same period was £10 days with respect to the demographic characteristics, metaphase II (MII) oocyte ratio, grade I (GI) embryo ratio, blastocyst ratio, fertilization, implantation, and the clinical pregnancy rates.Results: The mean hospital visit count of the prolonged GnRH-a patients was 2.6±0.4. As we expected, total GnRH-a doses used during hypophyseal down regulation were significantly different between the groups (p<0.0001). MII oocyte, G1 embryo and the blastocyst ratios were also significantly different between the groups (p<0.0001; p<0.01 and p<0.05). All the other parameters were insignificant.Conclusion: Prolonged GnRH-a administration during OVARIAN suppression in IVF patients may have positive impacts on the oocytes and the embryos, but this affect may not be observed in the overall pregnancy rates.

BACKGROUND: There are many factors that affect intrauterine insemination (IUI) success rate and identifying those factors can be helpful. This study aimed to investigate the single versus double IUI in CONTROLLED OVARIAN HYPERSTIMULATION cycles.METHODS: This is a randomized clinical trial with equal randomization (1:1) conducted on 580 women who underwent IUI in a private infertility clinic from May 2013 to November 2014 in Rasht, Iran. Women were randomly assigned to single (n=290) or double (n=290) IUI groups. Women in the single group underwent IUI performed 36 h after human chorionic gonadotropin (HCG) administration. Women in the double group underwent two IUIs performed 18 and 40 hours after HCG administration. The main outcome was clinical pregnancy confirmed by evidence of fetal cardiac activity. Data were analyzed by SPSS software. Comparisons of frequencies were done using the Fisher exact test and Chi-square test. For comparing means between the two groups, the independent t-test was used. The P-value < 0.05 was considered to indicate statistical significance.RESULTS: Pregnancy rate was 11.7% (34.290) in the single IUI group and 13.4% (39.249) in the double IUI group. The difference between the two groups was not statistically significant (P=0.617, OR=1.17, 95% CI: 0.72-1.91). Also, we could not show significant difference between single and double IUI groups in different cause of infertility groups regarding the success rate.CONCLUSION: Based on findings, double versus single IUI did not increase the pregnancy rate of IUI and further investigations are recommended.

Infertility is a condition affecting approximately 10-15% of reproductive age couple. Although in 1978 the first baby was born from in vitro fertilization in a normal cycle with developing of IVF procedures, nowadays there are many protocols that we use for CONTROLLED OVARIAN hyper stimulation in order to increase the pregnancy rate. Although these gonadotropins produce many oocytes, but changing of hormonal pattern in these women, alter the endometrial receptivity. On the other hand, there are inadequate researches about it and after 50 years of gonadotropin administration, lack of understanding of consecutive steps leading to embryonic implantation, remains. The endometrial changes that were occurred during CONTROLLED OVARIAN hyper stimulation may compromise implantation, for example supra physiologic level of estradiol, progesterone or increasing of the expression of some apoptosis related genes. As well as many of these protocols produce luteal phase defect that needs support of this phase with some drugs like HCG or progesterone. In this lecture, we will speak about these drugs and things that we should do.

Background: OVARIAN HYPERSTIMULATION syndrome (OHSS) is a rare iatrogenic complication of ovulation stimulation. The pathogenesis of OHSS is uncertain. The crucial event appears to be an increase in capillary permeability by vasoactive mediators such as cytokine and histamine. The aim of this study is to evaluate the role of loratadine (antihistamine) in preventing OVARIAN HYPERSTIMULATION syndrome.Materials and Methods: A total of 226 patients, with a history of severe OHSS undergoing IVF-ICSI cycles were randomly selected to receive loratadine (n=110) or placebo (n=116) daily. This study was conducted at Royan Institute. Patients of each group were subdivided to PCO and normo-ovulatory group. Loratadine (10 mg/ daily) was started from beginning of HMG to 3 days after embryo transfer. The main outcome measures were number of retrieved oocytes, serum E2 level of HCG injection day, cancellation rate, number of transferred embryos, occurrence of OHSS and pregnancy rate.Results: Overall, loratadine caused a nonsignificant decreasing in occurance of OHSS in treated patients (p=0.29). The proportion of treated women who had pregnancy was higher than the corresponding proportion of untreated women but the difference was not significant (p=0.27). In other measures there was no significant difference.Conclusion: The addition of loratadine (10mg/ daily) to the standard long protocol for oocyte retrieval increased pregnancy rates and decreased the occurrence of OHSS but in both of them it was not significant.

Objective: To evaluate the predictive value of basal serum anti-müllerian hormone level and small antral follicle count for high OVARIAN response to CONTROLLED OVARIAN HYPERSTIMULATION.Materials and Methods: A total of 159 patients were prospectively included. Basal serum anti-müllerian hormone and small antral follicle count (2-6 mm) were measured.Results: Small antral follicle count and anti-mullerian hormone have similar predictive accuracy for high OVARIAN response with area under curve of 0.961 and 0.922, respectively. The sensitivity and specificity for prediction of high OVARIAN response were 89% and 92% for small antral follicle count and 93% and 78% for anti-müllerian hormone at the cutoff values of ³ 16 and ³ 34.5 pmol/l, respectively.Conclusion: Small antral follicle count and anti-müllerian hormone are equally accurate predictors of high OVARIAN response and facilitate determination of the optimal strategy for CONTROLLED OVARIAN HYPERSTIMULATION.