1. The Effect of Bromocriptine-Rebound Method on Ongoing Pregnancy and Live Birth after Intracytoplasmic Sperm Injection Cycles: a Randomized Clinical Trial Ashraf Aleyasin, Ramak Esmaeeliazad R, Marzie Aghahosseini, Leili Safdarian, Fatemeh Sarvi Abbas Ali Kokab Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences Objectives: Material $ Method This study was prospective controlled randomized clinical trial involving 117 volunteer patients attended outpatient clinic, infertility centre, Shariati teaching hospital, Tehran, Iran. The patients were recruited between March 2009 and August 2010. Institutional review board ethical approval for this study was obtained from the Tehran University Ethics Committee. The patients received written information about the study and potential complications of assisted reproductive technology (ART), followed by oral discussion and formal consent. All patients underwent intracytoplasmic sperm injection. Ovulatory women with normal serum prolactin levels were assigned to either Bromocriptine rebound method (n=59 cycles) or long protocol (n=58 cycles). Both procedures were carried out in a similar way; however a group of patients have been given Bromocriptine daily from day 4th of the preceding cycle until the 7 days before gonadotropin stimulation (BRM). The outcomes of ICSI and hormonal data were compared between patients on long standard protocol, and patients on the BR method. Assisted reproductive technology (ART) has found a significant role to treat infertility among couples with broad range of causes. Despite advances in ART, the success of individual cycle to a live birth is still low. This can be related to poor response to ovulation induction. Different protocols have been recommended to optimize follicular development; however the best protocol to improve ovarian stimulation has yet to be recognized. To assess whether Bromocriptine rebound method (BRM) can improve pregnancy outcomes after ICSI cycles. Method and long protocol groups with respect to mean age and BMI (body mass index), infertility duration, primary or secondary infertility and basic laboratory tests. There were no significant differences in the numbers of developed follicles, total retrieval oocytes, embryo transfer and embryos with superior morphologic between two groups. The values of chemical, clinical and ongoing pregnancies and live births were not significantly differences between two groups (37%, 35%, 28.1%, 28.1% in group 1 and 44%, 38.6%, 21.1% and 19.3% in group 2 respectively); ongoing pregnancy and live birth were significantly higher in chemical pregnant on BRM. The miscarriage rates were higher in long protocol group. Results References: The results of this prospective study revealed that BRM might lead to higher ongoing pregnancy and live birth rates compared to Long protocol in women undergoing ICSI cycles. Key Words: Bromocriptine, ICSI, Live birth, Prolactin Parameter BR groupLong protocol group P value Number of patients5958 Total dose of gonadotropins ( IU ) a ( NO. of 75 IU ampoules ) 33 ( 3 – 104 )33 ( 16 – 104 ) 0.880 E 2 day of hCG ( pg/ml ) a 1686.5 ( 22-26600 )1844 ( 174-17690 ) 0.477 No. of oocytes retrieved a 11 ( 3-34 )11 ( 2-25 )0.895 No. of metaphase II oocytes a 7 ( 2-18 )7 ( 1-18 )0.986 No. of pronucleus a 6 ( 1 – 14 )5.5 ( 1 – 15 ) 0.621 Fertilization rate ( % )76.779.40.325 Total of embryo transfer3 ( 0-5 )4 ( 0-5 ) 0.233 No. of top-quality embryo transfer4 ( 1-14 )4 ( 1-11 )0.310 Freezed embryo0 ( 0-14 )0 ( 0-8 )0.701 Implantation rates ( % )16.311.50.196 OHSS ( % )73.50.679 a values are mean ± SD Table 2; Cycle characteristics of patients in long protocol and BRM groups BR groupLong protocol groupP value Number of patients5958 Chemical pregnancy rate ( % )21 ( 36.8 )25 ( 43.9 )0.445 Clinical pregnancy rate ( % )20 (35.1 )22 (38.6)0.698 Ongoing pregnancy rate ( % )16 (28.1 )12 (21.1)0.384 Miscarriage ( % )5 (23.8)13 (52.0)0.051 Multiple pregnancy ( % )5 ( 31.3 )2 ( 16.7 )0.661 Live birth rate ( % )16 (28.1)11 (19.3) Pregnancy outcomes of patients in long protocol and BRM groups 1- Masao Jinno, Yuuko Katsumata, Toshihisa Hoshiai, et al: a novel method of ovarian stimulation for in vitro fertilization ( bromocriptine rebound method ) increases developmental potential of oocytes and pregnancy rate : Nippon Sanka Fujinka Gakkai Zasshi 1995 Dec. ;47 (12) : 1337-44 2- Kyorin University, Tokyo, Japan: a novel method of ovarian stimulation for in vitro fertilization: bromocriptine rebound method: Fertil steril. 1996 Aug ; 66 (2) : 271-4 3- Jinno M, Katsumata Y, Hoshiai T, Nakamura : A therapeutic role of prolactin supplementation bromocriptine rebound method : J clin Endocrinol Metab 1997 Nov ; 82 (11) : 3603-11 Conclusion