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Gonadotropin-releasing hormone antagonists are one of the GnRH analogs that were used in assisted reproductive technologies to produce prompt downregulation of pituitary gonadotropin secretion. During conventional antagonist protocol (CAP), exposure to high LH and E 2 occur that have the potential to worse clinical reproductive results. So the downregulation of pituitary secretion for short period during early follicular phase will result in synchrony in follicular developments and this will improve mature oocytes and total embryos numbers. 44 women as normal responders undergoing ICSI-ET cycles were randomized into two groups. The conventional group (CG) (n 30), gonadotropin started from menstrual cycle day 2 or 3 and continue until hCG trigger day, flexible protocol in which GnRH antagonists administered with follicular size (13-14 mm). In the sandwich group (SG) (n 14), a GnRH antagonist was administered for three days in which GnRH antagonists administered with follicular size (13-14 mm). Gonadotropin started from menstrual cycle day 3 and continue until hCG trigger day. Retrieved and MII oocyte mean numbers were significantly higher in SG than in CG (P = 0.006, and 0.025), respectively. Embryos and frozen embryos mean total numbers were significantly higher in SG than in CG (P = 0.004). SG patients have a higher pregnancy rate of 9/14 (64.3 %) than CG 12/30 (40.0 %) although not significant (P =0.057). Early and short GnRH antagonists proved improvements in synchronization of follicular development, retrieved mature oocytes numbers, total embryos, frozen embryos, and pregnancy rates.

The luteal phase (LP) in the fresh ICSI cycle is insufficient, adequate LP support is one of the approved treatments for improving implantation and pregnancy rates. It is generally known that the LP is inadequate after ovarian stimulation due to negative from supra-physiological blood levels of steroids released by numerous corporal luteal, LH concentrations are low during the luteal phase. In this study, patients were divided into two groups: (40) patients as study group; those who received GnRHa (Decapeptil 0.1 mg), three days after embryo transfer, in addition to conventional luteal phase support (LPS) in the LP to increase the implantation and pregnancy rate in IVF; and their control group (40) received standard LPS only. On the second day of stimulation, blood samples for FSH, LH, TSH, E2, and prolactin were taken. On the day of ovulation induction, measure E2, progesterone, and LH; and on the day of embryo transfers, measure progesterone and LH. The overall characteristics of the patients in both groups were not significantly different. There was also no significant change in the number of total oocytes, mean of metaphase II oocytes percent, cleavage rate, grade I embryo percent, or serum hormones level between the study and control groups (p > 0.05). GnRH agonist treatment in the luteal phase improves clinical pregnancy and implantation rate in fresh ICSI cycles but is not statistically significant.

Background: Recurrent miscarriage has been investigated for a long time with different types of therapeutic trials for those with unknown cause. Prednisolone as an immune modulator agent can have beneficial effect in improving pregnancy outcome in those patients. Objective: The aim of this study was to investigate the role prednisolone in preventing miscarriage in patients with recurrent pregnancy loss. Methods: Sixty two patients enrolled in this study, all of them have recurrent miscarriage, after investigations and exclusion of those with antiphspholipid syndrome, medical disease, endocrine disorder and uterine pathology. Patients divided randomly and equally into two groups. Study group give prednisolone therapy 5 mg orally for two months prior to conception & continue during pregnancy till 13 weeks of gestation, while the second group received folic acid 5mg orally before conception and continue till the end of first trimester. Patients were followed up throughout pregnancy till delivery.Results: There was significant association between pregnancy outcome and type of treatment majority (90.3%, n=28) of patients using prednisolone continue treatment, while only (38.7%, n=12) of control group continue their pregnancy. (X 2 =18.03, P=<0.001). Conclusion: Periconseptual prednisolone therapy can have dramatic improvement in the outcome of pregnancy in those who suffer from recurrent miscarriage