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Elgindy E.A.,Al Banoon Fertility Center | Elgindy E.A.,Zagazig University | Abou-Setta A.M.,University of Alberta | Mostafa M.I.,Cairo University
Reproductive BioMedicine Online | Year: 2011

This prospective, randomized, controlled trial tested the hypothesis that delaying embryo transfer to the blastocyst stage can increase the probability of clinical pregnancy and live birth in women with high oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) undergoing intracytoplasmic sperm injection using the long protocol. A total of 200 women with oestradiol >3000 pg/ml on the HCG day with four or more good-quality, day-3 embryos were randomized in a 1:1 ratio to undergo day-3 or day-5 embryo transfer. Clinical pregnancy rates (CPR; 41% versus 59%; relative risk 0.70, 95% CI 0.52-0.93) and ongoing pregnancy/live-birth rates (35% versus 52%; relative risk 0.67, 95% CI 0.46-0.93) were lower in women undergoing cleavage-stage than blastocyst-stage embryo transfer. Using receiver operating characteristic curves, among women undergoing cleavage-stage embryo transfer, a detrimental cut-off value for not achieving pregnancy for oestradiol was 4200 pg/ml, with lower CPR and ongoing pregnancy/live-birth rates (P = 0.006 and 0.02, respectively). No detrimental cut-off value for oestradiol was identified among women undergoing blastocyst-stage embryo transfer. Delaying embryo transfer to the blastocyst stage can increase the probability of pregnancy in women with high oestradiol on the HCG day. This prospective, randomized, controlled, clinical trial tested the hypothesis that delaying embryo transfer to the blastocyst stage can increase the chances of pregnancy in women whose ovaries respond better than normal during ovulation induction and are undergoing their first IVF cycle with intracytoplasmic sperm injection (ICSI) using the long agonist protocol. A total of 200 women with high serum oestradiol concentrations (i.e. oestradiol >3000 pg/ml on the day of human chorionic gonadotrophin (HCG) injection) and four or more good-quality day-3 embryos were randomized equally into two groups to undergo day-3 or day-5 embryo transfer. Clinical pregnancy rate (CPR) was significantly lower in women with high oestradiol undergoing cleavage-stage embryo transfer than those undergoing blastocyst-stage embryo transfer (41% versus 59%). Similarly, ongoing pregnancy/live-birth rates were significantly lower in cleavage-stage embryo transfer (35% versus 52%). Further, using receiver operator characteristic (ROC) curves, among cleavage-stage embryo transfer a detrimental cut-off value for oestradiol for not achieving pregnancy was 4200 pg/ml; no cut-off was identified among women undergoing blastocyst-stage embryo transfer. Women with oestradiol ≥4200 pg/ml undergoing cleavage-stage embryo transfer had significantly lower CPR and ongoing pregnancy/live-birth rates. Delaying embryo transfer to the blastocyst stage can increase the probability of pregnancy in women with high oestradiol concentrations on HCG day undergoing ICSI cycles using the long agonist protocol. © 2011 Elsevier Inc. All rights reserved. Source


Elgindy E.,Zagazig University | Elgindy E.,Al Banoon Fertility Center | Elsedeek M.S.-E.-A.,Alexandria University
Journal of Assisted Reproduction and Genetics | Year: 2012

Objective: To study the outcome of blastocysts showing expansion on day 5 and transferred on day 5 or 6, in comparison with those unexpanded and transferred on day 6. Study Design: Prospective cohort of 221 women prepared for BET classified into three groups according to timing of blastocyst expansion and day of embryo transfer. Group I; with expanded blastocysts on day 5 having day 5 transfer, group II; with expanded blastocysts on day 5 having day 6 transfer and group III ; with delayed expansion undergoing day 6 BET. Results: Implantation rates, pregnancy rates, ongoing pregnancy rates, and live birth rates in the first 2 groups were almost double the rates in the third group. The figures for implantation rates were 40 % in the first two groups vs. 19 % in the third group (P<0.05). Pregnancy rates were 60.9 % and 64 % vs. 31.8 % (P<0.05) and ongoing pregnancy/live-birth rates were 52.3 % & 56 % vs. 27.3 %. Conclusion: The current study reports better implantation and pregnancy rates with earlier expanding blastocysts regardless of the time of transfer. © Springer Science+Business Media, LLC 2012. Source


Elgindy E.A.,Al Banoon Fertility Center | Elgindy E.A.,Zagazig University | El-Huseiny A.M.,Al Banoon Fertility Center | El-Huseiny A.M.,Zagazig University | And 4 more authors.
Reproductive BioMedicine Online | Year: 2010

This randomized controlled trial tested the hypothesis that addition of N-acetyl cysteine (NAC) can increase the probability of pregnancy in intracytoplasmic sperm injection (ICSI) cycles using the long agonist protocol. Women undergoing ICSI cycles due to male factor were randomly assigned to receive either long protocol (group A, 38 women) or long protocol plus NAC (group B, 38 women). Clinical pregnancy was the primary outcome. Granulosa cell apoptosis, fertilization rate, number of grade-one embryos and ongoing pregnancy were the secondary outcomes. Clinical pregnancy rate was insignificantly higher in NAC group (52.6%) than control (47.4%). Early and late apoptosis were also insignificantly lower in group B than in group A. Irrespective of the used protocol, there was significant negative correlation between both early and late apoptosis and fertilization rate (both P < 0.001) and the number of good-quality embryos (P = 0.007 and P < 0.001, respectively). Pregnant patients had significantly lower early and late apoptosis than those who didn't achieve pregnancy (P < 0.001). In conclusion, NAC supplementation did not significantly increase the probability of pregnancy in ICSI cycles using long agonist protocol. It appears that granulosa cell apoptosis may be an important prognosticator for ICSI cycle outcome. © 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved. Source

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