VOLUME 10, ISSUE 2, ARTICLE 1

1. Introduction

Infertility is a big issue that many couples confront at some point in their lives. Reproductive medicine faces a difficult task in dealing with infertility issues. Infertility is estimated to affect 10% to 15% of the world's population (Moridi et al., 2019 ‎^[1]). Infertility is defined as "the inability to achieve a clinical pregnancy following 12 months of regular, unprotected sexual intercourse" according to an updated worldwide dictionary on infertility and reproductive treatments (Zegers-Hochschild et al., 2017 ‎^[2]). Fertility counseling, medical and/or surgical therapy of the underlying reason, fertility drugs, and assisted reproductive technologies (ARTs) are all part of infertility management (Nardelli et al., 2014 ‎^[3]). All procedures that entail the in-vitro handling of both human oocytes and sperm or embryos for the aim of reproduction are referred to as assisted reproductive technologies (ART). Despite considerable advances in assisted reproductive technology (ART) that have overcome many of the underlying reasons for infertility, pregnancy rates remain low (Zhang et al., 2013 ^‎[4]). Positive yield in a series of IVF phases, including controlled ovarian stimulation (COS), ovum pick-up (OPU), fertilization, embryo transfer, and implantation, determines IVF success (Tola, EN 2019 ‎^[5]). In ART therapy, successful implantation is a must-have result. Despite considerable efforts to improve, this result remains restricted. In reality, only around a third of instances involving one or more embryos result in a live delivery (ESHRE, 2016 ‎^[6]), (Chambers et al., 2017 ^‎[7]). Because the luteal phase in fresh cycles is deficient, adequate luteal phase support is one of the acceptable methods to increase implantation and pregnancy rates (Humaidan et al., 2015 ^‎[8]), (van der Linden et al., 2015 ‎^[9]). It is generally known that there is an inadequate luteal phase after ovarian stimulation (Chau et al., 2019 ‎^[10]). Because of supra-physiological blood levels of steroids generated by many corpora lutea, LH concentrations are low during the luteal phase due to negative feedback on the pituitary gland (Thomsen et al., 2018 ^‎[11]). LH is an important hormone for maintaining corpus luteum function and enhancing angiogenic factors, growth factors, and cytokines that can help in implantation. LH inhibition causes early luteolysis or a considerable shortening of the luteal phase (Chau et al., 2019 ‎^[10]). As a result, fertility therapy with new cycles necessitates sufficient luteal support. GnRH agonist (GnRHa) has been shown to help with the luteal phase. On the one hand, it is thought that GnRHa, given at the right dose, can maintain its stimulatory action, allowing LH production to continue through the luteal phase (Fusi et al., 2019 ^‎[12]).

2. Materials and Methods

During the period November 2018 to September 2020, this prospective comparative study was conducted on 80 infertile women who were undergoing ICSI at Infertility Center of the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies/ Reproductive Physiology, Al Nahrain University, Baghdad, Iraq. The Local Medical Ethical Committee of Al Nahrain University's High Institute for Infertility Diagnosis and Assisted Reproductive Technologies granted the current study ethical permission. In addition, each participant signed a formal informed consent form. In the ICSI laboratory of the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, the morphological examination of oocytes aspirated from the ovaries of infertile females and their resultant embryos was performed. The serum hormones were measured in a private laboratory using mini VIDAS. The participants in this study were 80 infertile females having ICSI cycles, ranging in age from 23 to 42 years old and infertility length from 4 to 13 years. In this study, women with both primary and secondary infertility were included. Some women have already had IVF/ICSI cycles, while others have not. A proportion of the women that were recruited had polycystic ovarian syndrome (PCOS). The fallopian tube was blocked in certain women. Following comprehensive standard assessment, a specific reason was not established in a proportion of couples, hence they were categorized as having unexplained infertility.

The study was designed to be a comparative prospective study. The selected 80 women are randomly divided into two groups:

A. Study group: In addition to regular luteal phase sport (LPS), 40 women underwent antagonist protocol with human chorionic gonadotrophin (HCG) trigger and got a single dose of GnRHa (Decapeptil 0.1 mg) on day 6 following ova pick-up (OPU).

B. Control group: 40 women undergo antagonist protocol with human chorionic gonadotrophin (HCG) trigger received standard luteal phase support only (LPS)

3. Results

The overall characteristics of the patients in both groups (the research group and the control group) were not significantly different, including age, weight, type of infertility (primary or secondary), reason of infertility, and length of infertility, as shown in Table 1. Follicle stimulating Hormone, Luteinizing Hormone, Estradiol, Thyroid stimulating Hormone; Prolactin and Progesterone levels were measured for both groups with 0.892 p value for the TSH being the highest response as shown in Table 2. Also, additional results were provided for the hormonal levels at the day of trigger of ET, with the highest p value for the Estradiol 0.793 at the day of trigger, these results were shown in Table 3 and Table 4. There was also no significant difference in total oocytes number, mean metaphase II oocytes percent, mean metaphase I percent, mean germinal vesicle oocyte percent, mean cleavage rate, mean grade I embryo percent, mean grade II embryos percent, or mean serum hormones level between the study and control groups (p > 0.05), as shown in Table 5 and Table 6. Although no statistical evidence was found (p> 0.05), the study group that received GnRHa hormone 3 days after the embryo transfer, in addition to the standard luteal phase support (LPS) in the secretory phase of the fresh ICSI cycles, had a higher clinical pregnancy and implantation rate than the control group that received LPS only in the secretory phase. The implantation rate was 0.614 with the study group showing higher percentage of response than the control group, as shown in Figure 1. Pregnancy and twin pregnancy were compared between study groups as shown in Table 7 and Table 8.