A Comparison Between the Effect of Vaginal Sildenafil Versus Oral Estradiol Valerate on Ultrasound Parameters of Endometrial Receptivity and Follicular Growth in Iraqi Females Receiving Letrozole for Induction of Ovulation

Endometrial thickness (ET) is one of the best predictors of implantation rate and pregnancy success rate because endometrial growth depends on hormones. Estrogen regulates the proliferative phase, endometrial proliferation induced by estrogen after menstruation is largely dependent on blood flow to the basal endometrium that produces progesterone receptors which are required for progesterone-regulated endometrial growth in the secretory process. To compare the effect of estradiol valerate vs. sildenafil citrate on endometrial receptivity and subsequent pregnancy outcome in unexplained infertility patients receiving letrozole for ovulation induction. Herein, 21 patients with unexplained infertility underwent ovulation induction by letrozole (2.5 mg). Patients were divided into 2 groups; group A (10 patients) were given sildenafil tablets vaginally (25 mg) four times daily and group B (11 patients) were treated with estradiol valerate tablet 2 mg/12 hours. Patients were evaluated by transvaginal ultrasonography (TVS) to determine endometrial thickness, pattern, size, and the number of the dominant follicles, serum assessment of Vascular Endothelial Growth Factor (VEGF) level at trigger day, and chemical pregnancy outcome 14 days later. Results showed that the endometrial thickness, patterns of the endometrium, VEGF, size of the dominant follicle at the trigger day, and pregnancy rates were not significantly different between the two groups. However, the difference in the number of the dominant follicles at trigger day was statistically significant which is more in the sildenafil treated group. The present study confirmed the findings of both Sildenafil and E2 valerate to boost endometrial receptivity and pregnancy rate.

Download Full-text

A Comparative Study to Assess the Efficacy of Two Different Estradiol Formulations during In Vitro Fertilization

International Journal of Reproductive Medicine ◽

10.1155/2021/3153307 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Manish Banker ◽

Parul Arora ◽

Jwal Banker ◽

Sandeep Shah

Keyword(s):

In Vitro Fertilization ◽

Endometrial Thickness ◽

Hormone Replacement ◽

Implantation Rate ◽

Secondary Outcome ◽

Estradiol Valerate ◽

Uterine Receptivity ◽

Clinical Practices ◽

Vitro Fertilization

Improvements in stimulation protocols, introduction of vitrification, and changes in clinical practices have contributed to improved efficacy and safety of assisted reproductive technology (ART) procedures. This has also led to a concomitant increase in number of cycles requiring hormone replacement therapy (HRT) protocol for performing an embryo transfer. Successful implantation is dependent on endometrial thickness which in turn is regulated by temporal regulation of hormones. Careful control of estrogen levels determines uterine receptivity. One of the most used drugs for achieving appropriate endometrial lining of >7 mm in HRT is estradiol valerate. Although different estrogen formulations with varying physicochemical properties exist, there is not enough literature to support if the differences translate into a discernible clinical outcome in an in vitro fertilization (IVF) setting. Objective and Method. In this study, retrospective in nature, we compare the efficacy of oral estradiol hemihydrate with estradiol valerate in HRT cycles in 2,529 Indian women, undergoing treatment at a center in India between Jan 2017 and May 2019. Results. Our results primarily indicate that between the estradiol valerate and estradiol hemihydrate treatment groups, the implantation rate (IR) was 47.42% and 49.07%, respectively ( P value 0.284), and the endometrial thickness ( mean ± SEM in mm) that was achieved was 9.25 ± 0.038 mm and 9.57 ± 0.058 mm ( P value < 0.001), respectively. There were no significant differences observed in the secondary outcome measures including clinical pregnancy rate, abortion rate, ectopic pregnancy, and live birth rate. Conclusions. Hence, this study concludes that oral estradiol hemihydrate and estradiol valerate are therapeutically equivalent and provide similar clinical outcomes in an IVF setting.

Download Full-text

P–638 Status of insulin resistance in infertile women and its effect on ovulation induction

Human Reproduction ◽

10.1093/humrep/deab130.637 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

A Agarwal ◽

R Karnatak ◽

M Asnani ◽

S Agrawal ◽

R Singh ◽

...

Keyword(s):

Insulin Resistance ◽

Adverse Effect ◽

Ovulation Induction ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Unexplained Infertility ◽

Model Assessment ◽

Fasting Insulin ◽

Infertile Women

Abstract Study question Is insulin resistance ( IR) a confounding variable in infertile women, other than those those having polycystic ovarian syndrome (PCOS) Summary answer IR was identified in 20.5% of infertile women. The presence of IR did not affect response to ovulation induction but reduced chances of conception What is known already Obesity is strongly correlated with insulin resistance. Obesity also has an adverse effect on fertility. In 2008 Steeg et al reported 5% reduction in chances of spontaneous conception with each unit increase in body mass index (BMI). Tetsurou Sakumoto et al (2010) reported hyperinsulinemia to affect granulose cells in small follicles inducing early response to luteinising hormone and anovulation. Adverse effect on endometrial function and implantation was also postulated. Insulin resistance has been studied in cases of PCOS but has not been studied in infertile women not fulfilling criteria for diagnosis of PCOS . So the present study was planned Study design, size, duration A prospective cohort study was conducted in infertility unit, King George Medical University, Lucknow, India over a period of one year from August 2018 to July 2019. Total 102 women with unexplained infertility were enrolled. Ethical clearance was obtained from institutional ethical committee Participants/materials, setting, methods Women with PCOS; diminished ovarian reserve documented by antral follicle count <7 and anti Mullerian hormone < 1.1ng/ml; bilateral tubal block; abnormal semen analysis; untreated hypothyroidism, hyperprolactinaemia; known diabetes were excluded. All women underwent ovulation induction with clomiphene citrate followed by single intrauterine insemination. Homeostasis model assessment insulin resistance index (HOMA IR) was calculated HOMA-IR = Fasting S. Glucose (mg/dl) x Fasting insulin (µlU) / 405. Value ≥ 2 denoted insulin resistance Main results and the role of chance : IR was identified in 21/102 (20.5%) cases. Fasting insulin levels were in the range of 5 – 9.9 mIU/ml in 53/102 women; <5mIU/ml in 29 and >10mIU/ml in 20. Fasting insulin > 9.45mIU/ml was found to have 90.5% sensitivity and 96.3% specificity in predicting insulin resistance. None of the cases had abnormal fasting and post prandial plasma glucose levels. IR was seen to be significantly correlated with BMI > 25kg/m2 (p = 0.0018) and waist hip ratio of > 0.85 (p = 0.0024).All women had follicular development and follicle rupture irrespective of presence of IR. Women with IR were more likely to have monofollicular development (17/21 IR cases). Correlation of endometrial thickness with IR was not seen. Mean endometrial thickness was 8.9mm. There were 6 pregnancies among the 102 women studied. None of the women with IR conceived. So IR was found to be affecting one fifth of women with unexplained infertility. Failure of any woman with IR to conceive was significant but the finding needs to be further studied. Limitations, reasons for caution : It was a small study with only 102 cases and the women were followed for only one cycle of ovulation induction and intrauterine insemination so results need to be validated in a larger study with a longer follow up. Wider implications of the findings: If further larger studies corroborate the role of IR in women with unexplained infertility it could elucidate the possibility of using insulin sensitisers in management of such cases. IR may emerge as an important gamechanger in management of unexplained infertility. Trial registration number Not applicable

Download Full-text

Effect of gonadotropins and endometrial thickness on pregnancy outcome in patients with unexplained infertility or polycystic ovarian syndrome undergoing intrauterine insemination

Journal of International Medical Research ◽

10.1177/0300060520966538 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052096653

Author(s):

Qing Li ◽

Maoling Zhu ◽

Zhuxiu Deng ◽

Lihua Wang ◽

Yi Huang ◽

...

Keyword(s):

Pregnancy Rate ◽

Pregnancy Outcome ◽

Polycystic Ovarian Syndrome ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Unexplained Infertility ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rates ◽

Ovarian Syndrome ◽

Endometrial Proliferation

Objective The purpose of this study was to investigate the effect of gonadotropin dose and endometrial thickness (EMT) on pregnancy outcome in patients undergoing intrauterine insemination (IUI). Methods We retrospectively analyzed data from 361 patients with unexplained infertility or polycystic ovarian syndrome (PCOS) who underwent 930 IUI cycles treated with gonadotropins. Then, we measured the effects of gonadotropins and EMT on the clinical pregnancy rate. Finally, we assessed the association of various doses of gonadotropins on EMT. Results The dose of gonadotropins given and thickness of the endometrium were higher in the pregnancy group than in the nonpregnancy group (636.0 vs. 600.0 IU for gonadotropin dose; 9.15 vs. 8.70 mm for EMT). Clinical pregnancy rates were significantly improved by increasing the dose of gonadotropins (9.1%, <450 IU; 16.2%, 450–599 IU; 18.6%, 600–749 IU, and 17.3%, ≥750 IU), or by increased EMT (0%, <5.0 mm; 12.2%, 5.0–6.9 mm; 15.5%, 7.0–14.0 mm; and 33.3%, >14.0 mm). Conclusion Increasing the dose of gonadotropins to stimulate one follicle to develop may benefit endometrial proliferation and improve IUI outcomes.

Download Full-text

Uterine scoring system for reproduction scoring correlation with pregnancy rate in infertility patients undergoing intracytoplasmic sperm injection and embryo transfer

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193057 ◽

2019 ◽

Vol 8 (7) ◽

pp. 2867

Author(s):

Mamta Vijay Shivtare ◽

Nikita Lad ◽

Pallavi Vishwekar ◽

Pradnya Shetty

Keyword(s):

Pregnancy Rate ◽

Pregnancy Outcome ◽

Embryo Transfer ◽

Intracytoplasmic Sperm Injection ◽

Scoring System ◽

Endometrial Thickness ◽

Estradiol Valerate ◽

Transvaginal Sonography ◽

Optimum Result ◽

Infertility Patients

Background: Infertility is defined as failure to conceive a clinical pregnancy after 12 months or more of regular unprotected intercourse. The birth of Louis Brown opened door to whole new world. Science of reproduction unfolded with better understanding of physiology and pharmacology of gonadotropins. Improved stimulation protocol, and lab facilities are available for IVF and intracytoplasmic sperm injection (ICSI). The objective of this study was to study relation between uterine scoring system for reproduction (USSR) scoring and pregnancy rate in patients undergoing ICSI and embryo transferred.Methods: A prospective observational study was conducted. Study comprised 48 women visiting with infertility for ICSI and embryo transfer. Baseline scan done on day2 of menses. Patients started on estradiol valerate for endometrial preparation. Transvaginal sonography done on 10th day of menstrual cycle for USSR scoring. USSR scoring includes parameters such as endometrial thickness, endometrial layering, myometrial contractions, myometrialechogenecity, uterine artery Doppler flow, endometrial blood flow, myometrial blood flow.Results: Out of total 48 infertility patients for embryo transfer 22 conceived, which gives 45.83% pregnancy rate. No patients had a perfect score of 20. Patients with score of 17-19 had pregnancy rate of 66%. Endometrial thickness of 10-14mm gave optimum result of 52%. Pulsatality index <2.19 was associated with pregnancy rate of 66%.Conclusions: USSR scoring is highly indicative of good pregnancy outcome in patients undergoing ICSI and embryo transfer. Endometrial morphology and thickness was strongly correlated with successful pregnancy outcome.

Download Full-text

Pregnancy outcome after ovulation induction with aromatase inhibitors or clomiphene citrate in unexplained infertility

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1080/00016340802638199 ◽

2009 ◽

Vol 88 (2) ◽

pp. 187-191 ◽

Cited By ~ 57

Author(s):

Ahmed Badawy ◽

Tarek Shokeir ◽

Abdel Fattah Allam ◽

Hesham Abdelhady

Keyword(s):

Pregnancy Outcome ◽

Aromatase Inhibitors ◽

Ovulation Induction ◽

Clomiphene Citrate ◽

Unexplained Infertility

Download Full-text

Editor’s Note: Badawy A, Shokeir T, Allam AF and Abdelhady H. Pregnancy outcome after ovulation induction with aromatase inhibitors or clomiphene citrate in unexplained infertility. Acta Obstetricia et Gynecologica Scandinavica , 2009; 88:187–191

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1111/aogs.14195 ◽

2021 ◽

Keyword(s):

Pregnancy Outcome ◽

Aromatase Inhibitors ◽

Ovulation Induction ◽

Clomiphene Citrate ◽

Unexplained Infertility

Download Full-text

EFFECT OF AROMATASE INIBITOR IN OVULATION INDUCTION IN FETILE WOMEN WITH POLYCYSTIC OVARY SYNDROME

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2014.3.12 ◽

2014 ◽

pp. 86-93

Author(s):

Minh Tam Le

Keyword(s):

Polycystic Ovary Syndrome ◽

Ovulation Induction ◽

Polycystic Ovary ◽

Endometrial Thickness ◽

Statistical Significance ◽

Ovulation Rate ◽

Normal Body Mass Index ◽

Ovary Syndrome ◽

Group I ◽

First Choice

Backgrounds: Polycystic Ovary Syndrome (PCOS) is one of the most common causes of female infertility due to ovulation disorders. Clomiphene citrate (CC) is a first choice to restore ovulation but it has some side effects by estrogen receptor down-regulation. Aromatase inhibitor (AI) is a newer class of drugs which increases the production of endogenous FSH to stimulate ovulation. Subjects and methods: randomized control trial to compare 64 cases of infertile women with PCOS examined at the Hue University Hospital, alternately used AI (group I) or CC (group II) for ovulation induction from day 2 cycle. Follow-up follicle growth, endometrium and ovulation via ultrasound. Evaluation were done on 10th day cycle, day of hCG trigger and after administration of hCG. Results: Total of 64 PCOS cases distributed into 2 groups using alternatively AI and CC had similar characteristics with average age of 28.8 ± 4.6, the majority were primary infertility (84.4%), infertility duration was 2.6 ± 2.4 years, 85.9% had oligomenorrhrea or amenorrhea, normal body mass index accounts for 60.9% and 21.9% was lean. Evaluation of both groups on day 10 revealed no differences in the dominant follicle and endometrial thickness. Number of days until the follicle mature appears to be shorter in AI group (15.1 ± 2.9) compared to the CC group (16.5 ± 2.8) with statistical significance. The number of mature follicles in 2 groups were not different at a rate of 81.3% (AI) and 84.4% (CC) but a higher proportion of single mature follicle in the AI group (71.9%) compared with the CC group (65.7%) and There is no case with 3-4 mature follicles in the AI group. The rate of thin endometrium (<8 mm) in the AI group (25%) was lower than the CC group (53.1%) with statistically significance and higher ovulation rate (68.8%) compared with the CC group (56.3%) but have not found statistically significant. Conclusion: Two drugs AI and CC potentially induce follicle development and ovulation similarly, but AI has the potential to be more effective than CC on factors such as the shorter stimulation duration, increasing rate of single follicle, limiting multiple pregnancies, improve endometrial thickness and higher ovulation rate. More researches are needed with a larger sample size to clarify the statistical significance of differences.

Download Full-text