Background: Nearly 25-50% of infertile women have endometriosis. There are reports of disorders in the expression of granulocyte colony-stimulating factor (G-CSF) receptors in women with endometriosis. Objective: To examine the effect of intrauterine administration of G-CSF in in vitro fertilization (IVF) cycles on the fertility rate of infertile women with moderate-to-severe endometriosis. Materials and Methods: This clinical trial was conducted on 66 infertile women with moderate-to-severe endometriosis, undergoing IVF and intracytoplasmic sperm injection (ICSI). The participants were allocated into two groups via simple randomization: the G-CSF (n = 27) and control (n = 39) groups. In the G-CSF intervention group, on the oocyte pick-up day, immediately after an ovarian puncture, 300 μg of G-CSF was injected through a transcervical catheter under abdominal ultrasound guide to visualize flushing into the uterine cavity. Women in the control group received no intervention. The two groups were evaluated for clinical pregnancy. Results: No significant difference was noted in the demographic characteristics of the two groups. The rate of clinical pregnancy was 28.2% in the control group and 25.9% in the G-CSF group, indicating no significant difference (p = 0.83). Conclusion: The results showed that the intrauterine injection of G-CSF had no effects on pregnancy in women with stage-3/4 endometriosis undergoing IVF. Key words: G-CSF, In vitro fertilization, Endometriosis, Pregnancy.

Background Determining the initiation day of antagonist administration is an important and challenging issue and different results have been reported in the previous studies. The present study was designed to compare the controlled ovarian hyperstimulation (COH) cycles outcomes of early-onset gonadotropin-releasing hormone antagonist (GnRH-ant) protocol with conventional flexible GnRH-ant protocol in patients with poor ovarian response (POR) diagnosis. This randomized clinical trial was performed on infertile women who were diagnosed as poor responders in in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) cycles at Arash Women’s Hospital affiliated to Tehran University of Medical Sciences. POR was defined according to the Bologna criteria and the eligible women were randomly allocated into an experimental (early-onset GnRH-ant) and control (conventional flexible GnRH-ant) groups. The women in the experimental group received recombinant gonadotropins (150–225 IU) and GnRH-ant (0.25 mg) simultaneously on the second day of the cycle. In the control group, the starting and the dose of gonadotropins were similar but daily administration of GnRH-ant was initiated when the leading follicle diameter was ≥ 13 mm. The COH outcomes were compared between groups (n=58 in each group). Results The analysis showed that the two groups did not have statistically significant differences in terms of the ovarian stimulation duration and the total dose of used gonadotropins. The total number of metaphase II (MII) oocytes in the experimental group was significantly higher than that of in control group (P = 0.04). Moreover, clinical and ongoing pregnancy rates per embryo transfer (ET) in the experimental group were significantly higher than those in the control group (P = 0.02 and P = 0.03, respectively); however, the implantation and miscarriage rates were similar between groups. Conclusions The early-onset GnRH-ant protocol can improve the number of retrieved and MII oocytes and probably the pregnancy outcomes after fresh embryo transfer in POR patients. However, larger randomized clinical trials are required to compare the pregnancy outcomes after this approach with other COH protocols with considering cost-effectiveness issue. Trial registration IRCT20110731007165N9. The name of the registry: Ladan Kashani. The date of trial registration: 8.02.2020.

Context: Preeclampsia is among the major causes of maternal, fetal, and neonatal morbidity and mortality, worldwide. It is characterized by an increase in blood pressure and proteinuria (Systolic BP≥140 or Diastolic BP ≥90 mmHg). The serum level of 25-hydroxy vitamin D deficiency has long been suspected as a risk factor for gestational diabetes mellitus (GDM) and preeclampsia, and perhaps 1, 25-dihydroxy vitamin D has a role in the regulation of the immune system. Inflammatory markers, including cytokines, angiogenic factors, leukocytes, interleukins, and acute phase reactants, are involved in the pathophysiology of preeclampsia and gestational diabetes mellitus. Objective: This review article was performed with the aim to assess the relationship among pathophysiology of gestational diabetes, preeclampsia, vitamin D level, and immunomodulation. Evidence Acquisition: Databases of Cochrane (2000Cochrane ( -2016, Embase (2000Embase ( -2016, Pubmed/Medline (1995-2016, and Google Scholar (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) were searched to find the related references with keywords of gestational diabetes mellitus, preeclampsia, vitamin D, regulation of the immune system. The contents of the articles were exactly and repeatedly studied and analyzed. Results: Vitamin D deficiency is more prevalent in patients with gestational diabetes mellitus and preeclampsia than normal pregnant women are, so vitamin D supplementation may control glucose levels and blood pressure and improve the outcome of pregnancy. Conclusion: Several studies, materials provided in this study, and clinical evidence confirm that both preeclampsia and gestational diabetes unbalance the maternal immune system; in addition, evidence from casecontrol studies show that vitamin D levels are significantly lower in patients with preeclampsia and diabetes than normal people.