Infertility Treatment

Analysis of proteins from cervical mucus will be done in patients undergoing infertility treatment (fresh or frozen embryo transfer). Cervical mucus will be analysed for potential new biomarkers of endometrium receptivity. Comparison of the peptide spectrum will be done for the pregnant and not pregnant patients.

Women who meet the study requirements will be enrolled and randomly assigned by a computer system to receive either pioglitazone 30 mg daily or a placebo starting from the second day of their menstrual period for the same duration. All participants will also take clomiphene citrate 150 mg daily from day 3 to day 7 of the menstrual cycle. A transvaginal ultrasound will be performed on day 10 of the menstrual cycle to assess the growth of ovarian follicles, and the number of mature follicles (16-24 mm) will be recorded. If at least one mature follicle measuring 16-24 mm is present and the endometrial thickness is at least 7 mm, an injection of human chorionic gonadotropin (hCG) will be given to trigger ovulation, followed by an intrauterine insemination (IUI) procedure. Participants will be followed until the end of the menstrual cycle, and if the menstrual period is delayed by 5 days, a blood test for β-hCG will be performed to confirm pregnancy. Any side effects during the treatment period, such as swelling, fluid retention, blurred vision, or weight gain, will be recorded.

Ketorolac is a medication often used to relieve pain after surgery. In the past, infertility doctors have been cautious about using ketorolac after egg retrieval for patients planning a fresh embryo transfer (usually done 5 days later). The concern was that ketorolac might increase the risk of bleeding or reduce the chances of the embryo implanting in the uterus. This concern comes from how ketorolac works-it blocks certain chemicals in the body (like prostaglandins and thromboxane) that help with blood clotting and play a role in early pregnancy. However, a large review of past studies found no real evidence that ketorolac increases bleeding risk. In fact, ketorolac is now routinely used for pain relief in IVF cycles where embryos are frozen and not transferred right away. More recent studies from Boston and Chapel Hill have shown that ketorolac provides better pain control and does not appear to harm IVF outcomes, even when embryos are transferred fresh (within the same cycle). Despite these encouraging findings, many IVF clinics still avoid using ketorolac during fresh cycles because of the theoretical concerns. That's why we need stronger, higher-quality research. This study aims to fill that gap by conducting a double-blind randomized controlled trial to find out whether giving ketorolac through an IV after egg retrieval affects important IVF outcomes-especially the chance of implantation and live birth-in patients undergoing fresh embryo transfers. Patients who choose to join the study will randomly be placed into one of two groups. One group will get ketorolac (a pain medicine) after an IVF egg retrieval. The other group will not get ketorolac after egg retrieval. Everything else in their IVF care will stay the same as it normally would. Primary outcome will be implantation rate following fresh embryo transfers in patients receiving ketorolac (30mg IV) vs no ketorolac for post-retrieval analgesia. Secondary outcomes will include pain scale, narcotics required, time to discharge, need for evaluation w/in 24 hours for pain/bleeding, clinical pregnancy rates, miscarriage rates, and live birth rates following fresh embryo transfers in patients receiving ketorolac vs no ketorolac for post-retrieval analgesia.

Infertility is a major health concern with a great psychosocial impact. It's defined as the inability to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse\[1\] affecting about 12%-25% of couples in Egypt\[2, 3\]. People in Egypt prefer extended families to guarantee maintained family line. Therefore, infertility leads to great negative attitudes and extreme pressures on women\[4\]. Besides the medical advances in the treatment of infertility as a pathological condition, concerted actions should be taken to address the consequences of infertility on other aspects of human wellbeing including violence against infertile women\[1\]. Infertile women are more vulnerable to depression and stress which are the underlying factors for domestic violence, as they are commonly blamed for this issue. Domestic violence against women is a global public health problem and human rights crime\[5\]. In 2013, the World Health Organization (WHO) released a report providing global and regional estimates of violence against women, which documented the broad and invasive global prevalence of this problem and its impact on many aspects of women's health\[6\]. Intimate partner violence is the most common form of violence against women, defined as any form of violence by a current or former male intimate partner that can include emotional/psychological and economic elements in addition to physical and sexual components. In the most recent WHO report on IPV and its consequences for health, The baseline quality of life of the victims of intimate partner violence is significantly impaired when compared with the non-abused controls \[7\]. the analysis was limited to physical and/or sexual violence because these are the most widely documented manifestations of IPV across studies\[8\]. This study will be conducted in collaboration with National Women's council and UNFPA Egypt .We are already running a safe women clinic at Women Health Hospital Assiut university since March 2021 aiming to keep women safe and guarding against any type of violence We will conduct this study to evaluate the relation between infertility and violence against Egyptian women. We hypothesized that infertile women would suffer more violance than fertile ones.