Background: There is conflicting evidence with regards to the impact of supraphysiologic estradiol levels in in-vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI) cycles on pregnancy outcomes such as oocyte quality, implantation, and clinical pregnancy. The objective of our study was to evaluate the effect of serum estradiol levels on the day of ovulation trigger on pregnancy outcomes in IVF-ICSI cycles.Methods: We performed a retrospective cohort study, which included eighty-three women who underwent IVF-ICSI and experienced fresh embryo transfer (ET) over one year period. The women included in the study were divided into four groups according to the serum estradiol level on the day of ovulation trigger; Group I: <2000pg/ml, Group II: 2000-3000pg/ml, Group III: 3000-4000pg/ml and Group IV: >4000pg/ml. The outcome measures including number of oocytes retrieved, MII (metaphase II) oocytes, fertilization rate, embryo quality, overall pregnancy rate, implantation rate and clinical pregnancy rate were compared among these four groups.Results: The total number of oocytes, MII oocytes as well as good quality embryos significantly increased from group 1 to group 4. The implantation rate was lowest in group 4 compared to all other groups, although not statistically significant. There was no significant difference in overall and clinical pregnancy rate between the groups.Conclusions: Serum estradiol level shows a positive correlation with the number of oocytes retrieved and good quality embryos. A higher estradiol level does not have a significant negative impact on the implantation rate, overall or clinical pregnancy rate.

Context: Advanced glycation end-products (AGEs) are toxic metabolic end-products of lipids, nucleic acids, and proteins. Their accumulation in the ovaries can alter the follicular microenvironment and affect stimulation response. Aims: We aimed to study the association of AGEs in follicular fluid (FF AGE) with oocyte response and clinical pregnancy in ART-Assisted Reproductive Technology cycles. Settings and Design: This prospective study involved 84 individuals undergoing ART. Methods and Material: FF was collected during oocyte retrieval, and the level of AGEs was measured by enzyme-linked immunosorbent assay. Oocyte response was grouped as below target (<7 MII oocytes) or above target response (≥7 MII). Statistical Analysis Used: The association of FF AGE with the oocyte response and clinical pregnancy rate was analyzed by Mann–Whitney U-test. The strength of association of FF AGE with the outcome variables was analyzed with receiver operating characteristic (ROC) curve. Results: The median FF AGE was 17.6 (8.5) μg/ml. It was significantly higher in the below target than the normal ovarian response group (18.5 [17.8] vs. 16.3 [7.8] μg/ml, P = 0.046). Similarly, it was significantly higher in those who did not conceive (19.9 [7.3] vs. 13.5 [5.9] μg/ml, P < 0.001). The cutoff of FF AGE obtained by ROC curve analysis was 16.5 μg/ml above which there were significantly lower oocyte response and clinical pregnancy. Conclusions: Elevated FF AGE can be a significant negative predictor of clinical pregnancy and ovarian response to stimulation in ART cycles. The FF AGE level above the cutoff value of 16.5 μg/ml was associated with significantly lower oocyte response and clinical pregnancy.

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Aim:To evaluate the role of hysteroscopic endometrial injury and its timing prior to embryo transfer in patients undergoing IVF (in vitro fertilization) treatment. Materials and methods:A total of 133 patients who underwent hysteroscopy at CIMAR Fertility Centre at Kochi, between January 2013 and December 2014, and had normal hysteroscopic findings were enrolled for the study. These women subsequently underwent IVF treatment and were evaluated in three groups based on the timing of hysteroscopy before embryo transfer: Group I -hysteroscopy performed 50 days or less before embryo transfer (n = 54), group II -hysteroscopy performed between 51 days and 6 months of embryo transfer (n = 45), and group III -hysteroscopy performed more than 6 months before embryo transfer (n = 34). Results:The implantation rates were 21.8, 22.6, and 21.6% in groups I, II, and III respectively. Overall pregnancy rates were 44.4, 48.9, and 44.1%. Clinical pregnancy rates (CPR) were 40.7, 46.7, and 44.1% and live birth rates (LBR) were 30, 29, and 26% in groups I, II, and III respectively. Thus the implantation rate, overall pregnancy rate, and CPR were not significantly different in the three groups. Conclusion:Hysteroscopic endometrial injury prior to IVF does not improve the pregnancy rate in patients with normal hysteroscopic findings.Clinical significance: Due to the lack of definitive evidence regarding the role of hysteroscopic endometrial injury, ideal technique, and its timing prior to embryo transfer, it is necessary to evaluate the role of endometrial injury as a fertility treatment in women undergoing assisted reproductive technology (ART) cycles, as well as to present it in a way that supports clinical practice. At this stage, there is little evidence to support hysteroscopic endometrial injury prior to embryo transfer as a standard of care, and its use should be limited to selected cases after careful deliberation between the medical team and patient. ijifm ORiGiNAL RESEARCH