View clinical trials related to Infertility.
Filter by:Investigative trial to evaluate the role of a glial cell lined derived neurotrophic factor (GDNF) in regulation of spermatogonial renewal and testicular function. Goal of the trial is to provide greater information on the mechanisms that effect stem spermatogonial maintenance renewal and proliferation in its relation to male infertility.
This is a pilot study of a novel protocol for preparation of the endometrium for frozen/thawed embryo transfer whereby estrogen is not administered during the proliferative phase and progesterone is administered through vaginal suppositories in accordance with endometrial thickness only, disregarding the day of ovulation. Progesterone supplementation commences once the endometrium is at least 7 mm, a follicle is demonstrated on TVS, and ovulation has not yet taken place. The day of ET is scheduled according to the unit's working days and progesterone suppositories are commenced 48 hours before the scheduled embryo transfer.
IVF is a well-established method to treat various causes of infertility. Some studies have suggested that ethnicity affects the success of IVF. This is a prospective study involving two tertiary IVF units in Hong Kong and Australia. The IVF outcome between Chinese and Caucasians will be compared.
study the effect of aromataze inhibitor induction together with short stimulation protocol by gonadotrphin releasing hormon antagonist in cases that expected to be poor responder before ICSI
The objective of this study was to evaluate the outcome of follicle stimulating hormone (FSH) co-administration with human chorionic gonadotrophins trigger for women with unexplained infertility (UEI) and assigned for letrozole (LTZ) stimulated intrauterine insemination (IUI) cycles .
This is a prospective randomized trial to compare the use of AFC and serum AMH as the basis for gonadotrophin dosing in in-vitro fertilization treatment. The hypothesis is that the use of serum AMH as the criterion for determination of gonadotrophin dosing in IVF treatment results in more optimal ovarian response than AFC.
Serum concentrations of the different hormones involved in follicular steroid genesis during a cycle of controlled ovarian stimulation with recombinant FSH or HMG will be compared in this study. Serum Progesterone (P) levels at the end of Controlled Ovarian Stimulation (i.e. the day of triggering) have been related to cycle outcome, in terms of ongoing pregnancy and live birth rates. Large cohort studies show that P levels above a certain threshold are associated with poorer cycle outcome. The mechanisms behind P elevation are not well understood yet. It has been shown that P levels are positively related to ovarian response and to the dose of FSH given during COS. Furthermore, it has been well documented that P levels at the end of stimulation are significantly higher when recombinant (r) FSH is used for COS when compared to HMG, either in a GnRH agonist long protocol or in a GnRH antagonist protocol. Some authors suggest that this finding is explained by the fact that COS with rFSH provides a higher oocyte yield than when hMG is given, so the higher P levels observed would be explained by the larger number of follicles developed when rFSH is used. On the other hand, other authors explain this event by a different follicular esteroidogenesis when HMG is used for COS compared to rFSH The hypotheisis behind this assumption is that rFSH enhances P synthesis from its precursor pregnenolone in the granulosa cells. This P is unable to be further metabolized into androgens because of the lack of 17-20 lyase in the human granulosa cells, and therefore is delivered into circulation. On the other hand, when HMG is given for COS, the ∆4 pathway is promoted, and pregnenolone will be catabolized in to Dehidroepiandrostenodione (DHEA), in the theca cells, and this one to Androstenodione, which will be finally aromatized in to estrogens. This mechanism will explain the lower P and higher E2 levels observed in HMG cycles in comparison to rFSH cycles.
Traditionally, the use of GnRH-a suppression was considered essential for adequate endometrial hormonal modulation in cryopreserved-thawed embryo transfer cycles. Several studies, however, have questioned its necessity for controlled endometrial preparation. Using a high dose of estradiol from day 1 of the cycle will suppress the gonadotroph, preventing folliculogenesis and excessive secretion of LH, allowing adequate endometrial preparation without GnRH-a.
This study is a prospective before & after clinical trial to investigate the efficacy of double stimulations during both the follicular and luteal phases in patients with poor ovarian response undergoing IVF and intracytoplasmic sperm injection (ICSI) cycles. The study protocol is approved by the Ethics Committee (Institutional Review Board) of Royan institute. The study is conducted according to the Declaration of Helsinki for medical research. All participants provide informed consent after counseling for infertility treatments and routine IVF/ICSI programs. All the patients who diagnosed as poor ovarian responders (POR) based on the Bologna criteria are eligible for participation in this study. In order to define the poor response in IVF, at least two of the following three features must be present: (i) advanced maternal age or any other risk factor for POR; (ii) a previous POR; and (iii) an abnormal ovarian reserve test (ORT). Two episodes of POR after maximal stimulation are sufficient to define a patient as poor responder in the absence of advanced maternal age or abnormal ORT. Stage one of treatment protocol First stimulation performs by Clomiphene citrate (Ovumid®, Iran Hormones Company) 25 mg/day with co-treatment of Letrozole (Letrofem®, Iran Hormones Company) 2.5 mg/day are given from cycle day 3 onwards. Letrozole is only given for 4 days and clomiphene citrate is continuously used before the trigger day. Patients start to inject human menopausal gonadotrophin (HMG) (Menopur®, Ferring, Switzerland) 150 IU every other day beginning on cycle day 6. When one or two dominant follicles (18 mm in diameter) observed, the final stage of oocyte maturation will be induced with triptorelin 100 μg (Decapeptyl®; Ferring GmbH, Germany) follows by ibuprofen 600 mg (Ibuprofen-Najo® , Coated Tablets, Najo Company, Iran) is used on the day of oocyte maturation triggering and the day after. After the first oocyte retrieval, human menopausal gonadotrophin and letrozole are administrated to stimulate follicle development, and oocyte retrieval will be carried out a second time when dominant follicles have matured. All highest-quality embryos (including grade 1 and grade 2, eight-cell blastomere embryos) will be cryopreserved by vitrification method on the third day after oocyte retrieval. Stage two of treatment protocol: Transvaginal ultrasound evaluation performs after oocyte retrieval to determine whether to continue the second ovarian stimulation. The criterion for continued stimulation is the presence of at least two antral follicles 2-8 mm in diameter. A total of 225 IU HMG (Menopur®, Ferring, Switzerland) and letrozole 2.5 mg (Letrofem®, Iran Hormones Company) is administered daily from the day of, or the day after, oocyte retrieval. The initial second stage follicular monitoring is conducted 5-7 days later, and then for follow up every 2-4 days, by using a transvaginal ultrasound evaluation, to record the number of developing follicles. Letrozole administration is discontinued when the dominant follicles reached diameters of 12 mm, given that large follicles have redundant LH and FSH receptors, and good response to exogenous hormone stimulations. Daily administration of medroxyprogesterone acetate 10 mg (Progestrone®, 5mg bid; Aboureihan, Iran) is added beginning on stimulation day 12 for cases in which post-ovulation follicle size is smaller than 14 mm in diameter and stimulation needed to continue for several more days. This performs to postpone menstruation and avoid oocyte retrieval during menstruation, to prevent the risk of infection from the procedure. When three dominant follicles reached diameters of 18 mm or one mature dominant follicle exceeded 20 mm, the final stage of oocyte maturation is induced again with triptorelin 100 μg (Decapeptyl®; Ferring GmbH, Germany) by injection. Again, ibuprofen 600 mg (Ibuprofen-Najo® , Coated Tablets, Najo Company, Iran) is used on the day of oocyte maturation triggering and the day after. Transvaginal ultrasound-guided oocyte retrieval was conducted 32-36 h after GnRH agonist administration. All retrieved oocytes were treated same as in the study stage one.
Oocyte maturation requires a lot of energy, which is provided by the mitochondria via the synthesis of ATP. The majority of patients with advanced maternal age (AMA) have poor egg quality. One of the reasons depends on oxidative phosphorylation of Pyruvate to undergo maturation; on the contrary, the cells of the cumulus (CC) show great activity glycolytic so that these cells are able to provide ATP(adenosine triphosphate and energy substrates to the oocyte. The goal of this work is to analyze the mitochondrial function and energy production in oocyte donors compared with a group of women of advanced maternal age subject to a same ovarian stimulation Protocol