Adjuvant L-arginine treatment for in-vitro fertilization in poor responder patients

Abstract

The objective of the present study was prospectively and randomly to evaluate the role of L-arginine in improving uterine and follicular Doppler flow and in improving ovarian response to gonadotrophin in poor responder women. A total of 34 patients undergoing assisted reproduction was divided in two groups according to different ovarian stimulation protocols: (i) flare-up gonadotrophin-releasing hormone analogue (GnRHa) plus elevated pure follicle stimulating hormone (pFSH) (n = 17); and (ii) flare-up GnRHa plus elevated pFSH plus oral L-arginine (n = 17). During the ovarian stimulation regimen, the patients were submitted to hormonal (oestradiol and growth hormone), ultrasonographic (follicular number and diameter, endometrial thickness) and Doppler (uterine and perifollicular arteries) evaluations. Furthermore, the plasma and follicular fluid concentrations of arginine, citrulline, nitrite/nitrate (NO2-/NO3-), and insulin-like growth factor-1 (IGF-1) were assayed. All 34 patients completed the study. In the L-arginine treated group a lower cancellation rate, an increased number of oocytes collected, and embryos transferred were observed. In the same group, increased plasma and follicular fluid concentrations of arginine, citrulline, NO2-/NO3-, and IGF-1 was observed. Significant Doppler flow improvement was obtained in the L-arginine supplemented group. Three pregnancies were registered in these patients. No pregnancies were observed in the other group. It was concluded that oral L-arginine supplementation in poor responder patients may improve ovarian response, endometrial receptivity and pregnancy rate.

Effect of estrogen priming through luteal phase and stimulation phase in poor responders in in-vitro fertilization

“…Various factors, including aging and previous ovarian surgery, which mainly reflect early depletion of ovarian reserves, have been associated with a poor response; however, mechanisms other than a deficiency in ovarian function can be involved in poor responses, such as alterations in intraovarian factors or gonadotropin receptor regulation [2]. A poor response to ovulation stimulation results in high cancellation rates of up to 76% and extremely low pregnancy rates from 3.2-14% [3][4][5][6][7][8]. Various strategies for poor responders, including flare regimens and agonist and traditional antagonist protocols have been attempted; however, at present, there is no definitive evidence that poor outcomes can be reversed by a specific protocol [6,[9][10][11].…”

Embryonic Production of Nitric Oxide and Its Role in Implantation: A Pilot Study

“…Apart from the above functions, NO may be directly involved in the physiology of reproductive organs. The NO participates in periovulatory modulation of ovarian blood flow (4)(5)(6) and seems to be involved in follicular maturation and ovulation (1,7). However, although the NO local synthesis within the uterus may be important for regulating endometrial, cervical, and myometrial activity (8), its role in embryonic implantation has not been fully explored.…”

Effect of increased protein intake on the risk of female infertility

“…Nitric oxide has vasodilation properties that improve blood circulation and flow in the sex organs, resulting in oocyte development and embryo implantation. 13 In conclusion, our study showed that both the increased protein intake and the proportion of energy obtained from protein were associated with an increased risk of infertility.…”