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Review Article Assisted Reproduction

Factors affecting Embryo Quality and Pregnancy Outcome in Intra-Cytoplasmic Sperm Injection using Decapeptyl and Cetrorelix- A retrospective study

Laiba Masood, Faiza Alam, Nida Zahid, Ahmed Ayaz, Syed Sajjad Hussain, Rehana Rehman

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Objective: To compare embryo quality and pregnancy outcome of patients undergoing Intra-Cytoplasmic Sperm Injection (ICSI) via agonist and antagonist protocol at Australian Concept Infertility Medical Center (ACIMC), Karachi, Pakistan. Method: The ACIMC database extracted information of all adult infertile female patients who were recommended treatment of ICSI between 1st June 2015 till 31st August 2017.They were categorized on the basis of treatment by gonadotropin releasing hormone. One group was treated with the agonist (long term) and the other with the antagonist. The data was analyzed on STATA 12, independent T test/ Mann-Whitney U test, chi-square/ fisher exact test, and linear regression were performed where appropriate. Results: Of the 267, patient, 222 received GnRH agonists, while 45 were given GnRH antagonist. Univariable analysis showed an association of good quality embryos with the GnRH antagonist protocol, age, antral follicles, number of eggs fertilized and levels of; estradiol, follicle stimulating hormone (FSH) and prolactin (p<0.25). On the multivariable analysis, prolactin levels, number of eggs fertilized and inseminated were associated with good quality embryos. There was a significant relationship between estradiol and no of follicles (p value<0.05). Positive pregnancy outcome correlated with age, follicle count, FSH levels and eggs inseminated(p<0.25). Conclusion: Our results show that treatment type doesn’t have an influence on the embryo and pregnancy outcome. However, estradiol levels, prolactin levels, number of follicles and particularly female age are predictors of embryo quality.


intra-cytoplasmic sperm injection, treatment protocols, GnRH agonist, GnRH antagonist and pregnancy outcome


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