Fertilization of IVF/ICSI Using Sibling Oocytes from Couples with Subfertile Male or Unexplained Infertility

The significance of the performance of conventional in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) using sibling oocytes from couples with subfertile male or unexplained infertility was evaluated. A total of 410 sibling oocyte cumulus-corona complexes (OCCC) from 21 couples with subfertile male (group A) and 11 unexplained infertile couples (group B) were randomly divided, in order of retrieval, into two groups inseminated either by conventional IVF or by ICSI. The treatment outcomes and the influence of infertility factors on fertilization in each group were compared. The results showed that although the two pronuclear (2PN) fertilization rate per injected sibling oocytes was significantly higher after ICSI (group A: 68.2 %±28.8 %; group B: 66.2 %±24.9 %) than after conventional IVF (group A: 41.8 %±32.7 %; group B: 40.1 %±22.1 %), the other variables studied included: the fertilization rates of per allocated sibling oocytes IVF/ICSI, the fertilization rates of sibling oocytes IVF/ICSI after excluding failed IVF fertilization cycles, as well as the cleavage rates of normal fertilization were not statistically significant (P>0.05). Similarly, though the total fertilization failure rate in the IVF group (group A: 42.9 %; group B: 36.4 %) was significantly higher than in the ICSI group (group A: 4.8 %; group B: 0), we did not cancel cycles due to the normal fertilization of sibling oocytes. Embryo transfer was possible in all 32 couples. There were 10 clinical pregnancies in the two groups. We also discovered a possible association between some semen parameters and sperm functions of group A, and women age and duration of infertility of group B and fertilization. It is suggested that adoption of the split IVF/ICSI technology in the above cases may help eliminate fertilization failures. This is also a useful method to investigate the effect of single factor on the employment of assisted reproductive technology.

Leptin levels in women with unexplained infertility:A systematic review and meta-analysis

BACKGROUND Unexplained infertility(UI)is usually used for any heterosexual couple who failed to have a successful clinical pregnancy without identifying clear causes after they undergo all standard fertility tests.Evidence shows that leptin is one of the most accurate biomarkers for UI.Nevertheless,conflicting results regarding leptin levels in women with UI have been reported.AIM To find the serum leptin levels in women with UI.METHODS All studies written in English and conducted before April 30,2021 from PubMed/MEDLINE,Embase,Cochrane Central Register of Controlled Trials,ClinicalTrials.gov,Google Scholar,OpenGrey,OATD,and the infertility conference abstract were included.Studies were found eligible if they provided the mean and standard deviation of leptin for the case group and control group.The quality assessment of individual studies was evaluated using the Joanna Briggs Institute Quality Assessment Tool.Data synthesis and statistical analysis were done using STATA software version 16.RESULTS A total of 378 studies were reviewed,and just six studies that fulfilled the eligibility criteria were included in this meta-analysis.The pooled result showed that leptin levels were significantly higher in women with UI compared to fertile women,with a standardized mean difference of 0.97(95%confidence interval:-0.49-2.43).However,heterogeneity across studies was highly significant(P<0.00001;I2=98.8%).CONCLUSION The results of this study suggest that leptin levels are elevated in women with UI compared with fertile women;hence,leptin could be a potential biomarker for UI in women,and it may be useful for identifying women with a high risk of infertility.

Clinical pregnancy rate of women with unexplained infertility with or without cervical mucus aspiration before intrauterine insemination: A randomized controlled trial

Objective:To detect effect of removing cervical mucus before performing intrauterine insemination(IUI)on pregnancy rate in patients with unexplained infertility.Methods:The randomized controlled trial was conducted in Infertility Division of Department of Obstetrics and Gynaecology of a tertiary care hospital.Totally 80 patients of unexplained infertility were recruited.By computer generated block randomization in block size of 4 and 6,patients were randomly allocated at time of starting ovarian stimulation into the cervical mucus removal group or the non-removal of cervical mucus group before IUI,40 in each group.Ovarian stimulation with clomiphene 100 mg from day 2-6 of menstrual cycle along with human menopausal gonadotropin 150 IU was given alternate day starting from day 7.Follicular monitoring was done and further doses given as per response;trigger was planned when 1-3 follicle reach a diameter of>18 mm.IUI was planned after trigger.IUI was done as per the group allocated.Mucus cleaning was done in the cervical mucus removal group by aspirating mucus with IUI syringe and sterile cotton swab before IUI.The primary outcome was clinical pregnancy rate.Number of difficult IUIs and cycle cancellation due to ovarian hyperstimulation were also noted.Results:IUI was not done in 4 patients due to hyperstimulation.Pregnancies per IUI cycle occurred in 7.9%(3/38)in the cervical mucus removal group and 21.1%(8/38)in the non-removal of cervical mucus group.There was no statistically significant difference in clinical pregnancy rate between two groups(P=0.19).Conclusions:There is a trend towards a lower clinical pregnancy rate with removal of cervical mucus before IUI in women of unexplained infertility though the difference is not statistically significant.Further studies with large sample size need to be done on this intervention.

Timed Intercourse versus Intrauterine Insemination with Mild Ovarian Stimulation for Unexplained Infertility

Background: Infertility is unexplained in about 22% - 28% of infertile couples. Spontaneous pregnancy may occur in them. If did not happen, Expectant management will be via clomiphene citrate (CC) administration, intrauterine insemination (IUI), and IVF & ICSI. Aim: to assess the effectiveness of intrauterine insemination with mild controlled ovarian stimulation compared with expectant management in couples with unexplained infertility more than one year. Methods: 160 couples with unexplained infertility were selected, The couples were randomly divided into two groups: Group (A) “80 couples”: Intrauterine insemination (IUI) with mild controlled ovarian stimulation (combination of CC + hMG) using prepared semen and was performed 36 hours after hCG injection, Group (B) “80 couples”: Couples had no ovulation induction. They encouraged for timed intercourse in the most fertile days of female cycle guided by folliculometry for 6 months. Data were collected quantitatively, coded and analyzed using SPSS. The power of study is 80% and 95% confidence interval. Result: The pregnancy rate was calculated in both groups: In group (A) (IUI/COS): OPR (Ongoing pregnancy rates) was 27.5% and PR (pregnancy rates)/cycle was 8.6%. In group (B) (Expectant management): OPR was 25% and PR/cycle was 5.3%. Conclusion: Mild controlled ovarian stimulation CC + hMG with IUI offers no statistical significance in terms of pregnancy outcomes over expectant management in this study however significance in the response to stimulation.

Serum leptin level in Sudanese women with unexplained infertility and its relationship with some reproductive hormones

BACKGROUND The excessive concentration of leptin has negative effects on all aspects of female reproduction.Despite this established relationship,the exact role of leptin in women’s fertility is not clear enough and needs more clarification.AIM To evaluate the serum leptin levels in Sudanese women and to ascertain the relationship between serum leptin levels and unexplained infertility(UI).METHODS A matched(age and body mass index)case-control study was conducted from March 2021 to February 2022.The study samples were 210 women with UI and 190 fertile women of reproductive age who were attending the maternity hospitals and fertility clinics in Khartoum state Sudan.The serum concentration of leptin and other serum biomarkers were determined using enzyme-linked immunosorbent assays.RESULTS The results showed that there was a highly statistically significant difference between the two groups(P<0.001)for all examined eight biomarkers.Whereby,leptin,luteinizing hormone(LH)/follicular stimulating hormone(FSH)ratio,prolactin hormone(PRL)and testosterone(T)were significantly higher in the UI group compared with the control group.In contrast,FSH and estradiol(E2)/T ratio were significantly lower in the UI group than in the control group and the effect size test for the difference between the two groups was very large(effect size>0.80),for leptin level,LH/FSH ratio,PRL level,and E2/T ratio,and large(effect size 0.50-≤0.80)for FSH and T.CONCLUSION This study reveals that leptin could be a potential biomarker for UI in Sudanese women and it may be useful for identifying women with a high risk of infertility.

Antioxidant Supplement Improves the Pregnancy Rate in Patients Undergoing in Vitro Fertilization for Unexplained Infertility

Objective: This is a retrospective study to evaluate the effect of using the antioxidants containing coenzyme Q10 (CoQ10) and omega-3 in patients undergoing in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) for unexplained infertility. Materials Methods: A total of 299 patients undergoing IVF-ICSI for unexplained infertility at the IVF center of Ondokuz Mayis University were studied. The subject group consisted of 135 patients who used OMEPA Q10 (Co Q10 100 mg, omega-3 600 mg, eicosapentaenoic acid 300 mg, docosahexaenoic acid 230 mg) for two months before ovarian stimulation. A group of 164 patients who did not use the supplement were evaluated as the control group. Results: The pregnancy rate of patients using antioxidants was statistically higher than that of those who did not use the supplement (p 0.05). The pregnancy rates of patients in the two groups were 32.9% and 49.6% respectively. The pregnancy rate of patients using antioxidants was statistically higher than that of those who did not use the supplement (p 0.05) seemed not enough. Conclusion: We concluded that using antioxidants that contain Co Q10 and omega-3 in patients undergoing IVF-ICSI for unexplained infertility increased the clinical pregnancy rate. We recommend using antioxidants that contain Co Q10 and omega-3 in infertile patients.

Characterization and risk factors for unexplained female infertility in Sudan:A case-control study

BACKGROUND Female infertility with unknown causes(unexplained)remains one of the mysteries in the reproductive health field,where the diagnostic evidence is still weak and the proposed treatments still work with unknown methods.However,several studies have proposed some possible causes and risk factors for unexplained female infertility.AIM To characterize and identify factors associated with unexplained infertility in Sudanese women.METHODS A matched(age and body mass index)case-control study was conducted from March 2021 to February 2022.The study samples were 210 women with unexplained infertility(UI)and 190 fertile women of reproductive age who were attending the maternity hospitals and fertility clinics in Khartoum,Sudan.The risk factors of unexplained infertility were identified using a structured,pretested questionnaire containing information on socio-demographic variables,anthropometrics,clinical diagnosis of infertility,behavioral factors,physical activity assessment,diversity,and consumption of different food groups by the study participants.RESULTS The results showed a higher proportion of women diagnosed with UI were residents of rural areas than controls(21.4%vs 11.1%,P<0.05),and previous miscarriages and/or abortions were more common in fertile women compared with infertile women(13.16%vs 5.71%,P<0.05).Additionally,infertile women had a significantly(P<0.05)higher proportion of family history of infertility(explained and unexplained)compared with controls.Finally,after controlling for the effects of potentially confounding variables using multivariable logistic regression analysis,only marital status,family history of infertility,use of modern contraceptives,smoking,caffeine consumption,physical activity level,meals consumed,other vitamin-A-rich fruits and vegetables,and other vegetables were found to be significant(P<0.05)factors associated with unexplained infertility among Sudanese women.CONCLUSION Married women with a family history of infertility who smoke and consume a high amount of caffeine,who live a sedentary lifestyle,and who consume more than two meals free of vitamin-Arich fruits and/or vegetables and/or other vegetables per day are at the highest risk of developing unexplained infertility.

Methylene Tetra-Hydrofolate Reductase Gene Polymorphism and Endometrial Perfusion in Unexplained Female Infertility

Aim of the study: Examing the role of Methylene tetra-hydrofolate reductase (MTHFR C677T) polymorphisms in unexplained female infertility. Methods: The study was conducted on women with unexplained infertility attending the Infertility Clinic at El-Shatby University Hospital, Alexandria, during the period from October 2020 to October 2021. Uterine artery Doppler assessment and detection of MTHFR C677T gene mutation were done. The frequencies of homozygous and heterozygous gene mutations were determined. Results: In group I, 35 cases had abnormal uterine artery Doppler compared to 22 normal cases in group II. As regards MTHFR C677T gene mutation, 19 cases were positive in group I (7 were homozygous and 12 were heterozygous) and only one case was positive in group II (heterozygous) which was statistically significant. Conclusion: MTHFR C677T gene polymorphisms may play a role in unexplained infertility.