Comparison of pulsatility indices on the day of oocyte retrieval and embryo transfer

Transvaginal ultrasonography with colour blood flow imagingand analysis of impedance to uterine arterial blood flow hasbeen used to provide an index of uterine receptivity for implantationafter IVF/embryo transfer. A mean uterine arterial pulsatilityindex (PI) >3.0 at the time of embryo transfer predicted35% of failures to become pregnant. Cryopreserving embryos innon-receptive cycles and transferring them in receptive cycleswould be expected to improve pregnancy rates. Earlier decisionsregarding embryo cryopreservation can be made if receptive cyclescan be predicted at the time of oocyte retrieval rather thanat embryo transfer. To assess differences in uterine arteryimpedance, PI were measured serially in 107 women on both theday of oocyte retrieval and the day of embryo transfer. MeanPI on the day of oocyte retrieval was 2.52 ± 0.59, andon the day of embryo transfer was 2.78 ± 0.45. No significantdifference was observed when PI determined on the day of oocyteretrieval were compared with PI on the day of embryo transfer.These data suggest that the PI measurement done on the day ofoocyte retrieval could substitute for the measurement done onthe day of embryo transfer. This would allow prediction of non-receptiveendometria earlier in the cycle. Further studies are neededto evaluate whether cryopreservation of embryos and transferwhen the uterus is more receptive will increase the implantationrates.     

Controlled ovarian stimulation using highly purified FSH results in a lower serum oestradiol profile in the follicular phase as compared with HMG

We have examined the efficacy of highly purified follicle stimulatinghormone (FSH-HP) for controlled ovarian stimulation in our in-vitrofertilization (IVF) programme, and compared the results obtainedwith this preparation with those using human menopausal gonadotrophin(HMG) in 15 patients who had received treatment with both FSH-HPand HMG in consecutive cycles (n = 39). No differences werefound in the duration of stimulation, which was 13.9 days (HMG)as compared with 143 days (FSH-HP). However, in the FSH-HP-treatedcycles we found a striking difference in the rise of serum oestradiol,which was significantly lower than in HMG-treated cydes (2953± 938 pmol/1 as compared with 6349 ± 3683 pmol/1on the day before ovum retrieval). Number and size of follicleswere similar in the two groups, as were oocyte characteristics.Increase in endometrial thickness at two days prior to ovumretrieval was slightly higher after HMG. The results indicatethat in combination with a long gonadotro-phin-releasing hormoneagonist (GnRHa) protocol, pure FSH is sufficient for adequatefollicle recruitment and growth. However, since FSH-HP resultedin markedly reduced concentrations of serum oestradiol as comparedto HMG cycles, IVF programmes using repeated oestradiol measurementsto decide the day of ovum retrieval must take this into considerationin order not to prolong the stimulation unnecessarily.     

Junctional zone contractions and embryo transfer: is it safe to use a tenaculum?

Applying a tenaculum to the cervix is a common practice when the correction of uterine position prior to embryo transfer is required. Our study was designed to assess junctional zone contractility before and after this procedure in 20 patients at the time of mock embryo transfer (mid-luteal phase, at commencement of down-regulation). Real-time transvaginal ultrasound and computer technology was used to evaluate the contraction pattern and frequency. When a tenaculum was applied, the total number of contractions, the number of cervico-fundal, random and opposing contractions all increased significantly (P values 0.0003, 0.005, 0. 001 and 0.007 respectively). Eleven women displayed cervico-fundal contractions, prominent opposing and random contractions were observed in all 20 patients and four patients generated fundo-cervical waves not seen in any case before stimulation with the instrument. In conclusion, manipulation with a tenaculum in the cervical area stimulates junctional zone contractions and is best avoided at the time of embryo transfer.     

The levels of C-reactive protein in women treated by IVF

BACKGROUND: The complex regulation of endometrial receptivity and embryo implantation involves cytokines, several of which are stimulators of the acute-phase reactant C-reactive protein (CRP). The purpose of this study was to evaluate the concentrations of serum CRP in women treated by IVF. METHODS: Seventy-two women who underwent IVF treatment were prospectively studied. The levels of serum CRP were evaluated on the following days: oocyte retrieval, embryo transfer, 5, 6 or 7 days afterwards and 12 days after embryo transfer. RESULTS: CRP levels increased from 6.8 +/- 9.5 mg/l on oocyte retrieval day to 14.6 +/- 12.5 mg/l on days 5-7 post-transfer (P<0.0001). The ratios of CRP levels for transfer day/pick-up day were 1.2 in women who conceived versus 2.5 in the non-pregnant group (P=0.01). CONCLUSION: In women treated by IVF the concentrations of CRP in blood increase significantly during the first week following oocyte retrieval. Successful outcome is associated with a relative small increment in CRP on the day of embryo transfer.     

Intravenous albumin does not prevent moderate-severe ovarian hyperstimulation syndrome in high-risk IVF patients: a randomized controlled study

BACKGROUND: Intravenous albumin administration has been described for many years as a debatable, but probably useful preventive measure in ovarian hyperstimulation syndrome (OHSS). The present study details the largest randomized controlled trial to date of albumin infusion versus no treatment in IVF patients with a high risk of developing moderate to severe OHSS. METHODS: Between March 1999 and February 2002, women undergoing IVF at the IVI Valencia with >20 retrieved oocytes were included. A total of 988 patients was initially enrolled. Immediately after oocyte retrieval, patients were allocated to two groups based on a computer randomization: the first group received 40 g human albumin; the second group received no treatment. Subjects were weighed and a blood analysis performed immediately after oocyte retrieval and again 7 days later. Women were monitored on an outpatient basis until menstruation, or until fetal heart activity was detected. Twelve subjects were excluded due to follow-up loss, leaving 976 women (377 of them oocyte donors), with 488 in each group. RESULTS: No difference was found between the two groups in terms of patient characteristics and outcome. Moderate-severe and severe-only OHSS rates were similar. The incidence of haemoconcentration and liver and renal dysfunction at 7 days after oocyte retrieval was similar in the two groups. In women who developed moderate/severe (n = 66) or only severe (n = 46) OHSS, there was no difference based on prior albumin administration between blood parameters or body weight on the day of oocyte retrieval, 7 days later, and even when comparing variation between both measurements. Moreover, the number of patients with paracentesis, hospital admissions, complications and days of OHSS until resolution did not differ. CONCLUSIONS: Albumin infusion on the day of oocyte retrieval is not a useful means of preventing the development of moderate-severe OHSS.     

Cetrorelix in an oral contraceptive-pretreated stimulation cycle compared with buserelin in IVF/ICSI patients treated with r-hFSH: a randomized, multicentre, phase IIIb study

BACKGROUND: The aim of this study was to assess the non-inferiorityof an oral contraceptive (OC)-pretreated cetrorelix regimenand a buserelin regimen in IVF/ICSI patients treated with r-hFSHin terms of total number of oocytes retrieved. METHODS: Multicentre,randomized study. One hundred and eighty two patients were randomizedto receive cetrorelix with OC pretreatment (n = 91) or to receivebuserelin (n = 91). The cetrorelix group started with dailyOCs on cycle day 5 and continued for 21–28 days. Cetrorelix(0.25 mg) was given daily from stimulation day 6 up to and includingthe day of r-hCG administration. The buserelin group startedwith buserelin (500 µg/day) for at least 10 days untildown-regulation was achieved, after which the dose was reducedto daily 200 µg up to and including the day of r-hCG administration.r-hFSH was started in both groups on a Friday, in the cetrorelixgroup 5 days after the last OC pill intake. Both regimens werefollowed by a standard IVF or ICSI procedure. The primary efficacyendpoint was the number of oocytes retrieved per patient. RESULTS:Number of oocytes, cancellation rates, r-hFSH requirements,number of oocyte retrievals during the weekend or public holidayand number of pregnancies were similar in both groups. Bothtreatment regimens were well tolerated. CONCLUSIONS: Cetrorelixpretreated with OCs resulted in similar number of oocytes retrievedcompared with a long buserelin protocol. Both regimens werewell tolerated and allowed scheduling of the oocyte retrieval,with only small number of retrievals falling on a weekend orpublic holiday.     

Ovary and Ovulation: Contralateral selection of dominant follicle favours pre-embryo development

Ovulation was studied using vaginosonography in a total of 410natural cycles of 123 women undergoing infertility treatment[267 intrauterine insemination (IUI) cycles of 103 women and143 in-vitro fertilization (IVF) cycles of 50 women]. None ofthe women received ovarian stimulation. Each follicle was measureddaily from 14 mm in diameter until formation of corpus luteumor oocyte retrieval. Contralateral ovulation as compared withthe preceding cycle occurred in 57% of the 410 cycles. Contralateralovulations occurred in 72% of cycles with a follicular phase<13 days. In cycles with a follicular phase of >14 days,ovulations occurred at random. The length of follicular phasein contralateral ovulation cycles (15.2 ± 3.2 days) wassignificantly (P < 0.05) shorter than that of ipsilateralovulation cycles (15.8 ± 2.8). During the 57% contralateralovulations in 143 IVF cycles, the rates of oocyte retrieval(89%), fertilization (69%), cleavage (90%) and embryo transfer(56%) were significantly higher than those of ipsilateral ovulations(69, 51, 64 and 23% respectively). The pregnancy rate of contralateralovulations (9%) was also higher, though not significantly, thanthat of ipsilateral ovulations (3%), although the pregnancyrates per transfer were similar (16 and 14% respectively). Thetotal pregnancy rate of both IUI and IVF was higher in contralateralthan in ipsilateral ovulation cycles (8.1 and 4.0% respectively).The dominant follicles in contralateral ovulation cycles showedsignificantly higher oestradiol/androstenedlone ratio (P <0.025) and oestradlol/testosterone + androstenedione ratio (P< 0.025), and lower androstenedione (P < 0.05) than thoseof ipsilateral ovulation cycles. There was no significant differencein oestradiol, progesterone and testosterone. These resultsindicate that the dominant follicles in contralateral ovulationcycles are healthier than those of ipsilateral ones. Local intra-ovarianfactors, e.g. from the corpus luteum, may negatively affectthe health of the dominant follicle and the enclosed oocyte.Therefore contralateral selection of the dominant follicle inthe succeeding cycle may favour pre-embryo development. Thechance of conceiving during a natural cycle may be affectedby the site of ovulation in the preceding cycle.     

Pregnancy and birth after high serum progesterone concentrations during the follicular phase in an in-vitro fertilization cycle with gonadotrophin-releasing hormone agonist suppression

This case illustrates the possibility of achieving a pregnancyand birth when elevated progesterone concentrations (>4 ng/ml)are present during the follicular phase (from 6 days beforehuman chorionic gonadotrophin injection) of a gonadotrophin-releasinghormone agonist/menotrophin cycle for in-vitro fertilization(IVF). The present patient underwent three IVF/embryo transfercycles in which progesterone concentrations were repeatedlyincreased from the mid-follicular phase onwards. A pregnancywas achieved after the first IVF attempt but ended in a miscarriagein the 19th week of gestation. During the second IVF attemptan endometrial biopsy taken on the day of oocyte retrieval revealedan endometrial advancement of 2 days. A successful pregnancyand birth was again achieved after the third IVF attempt althoughprogesterone concentrations were considerably increased from6 days before the ovulatory stimulus.     

Endocrinology: The addition of a glucocorticoid to the protocol of programmed oocyte retrieval for in-vitro fertilization--a randomized study

A group of 78 infertile women, diagnosed as having tubal factorinfertility only, was enrolled in a prospective, randomizedstudy conducted to determine whether the addition of differentdoses of glucocorticoids to the protocol of ovulation inductionfor in-vitro fertilization (IVF) would be beneficial. Oocytenumbers, percentage of fertilization, oestradiol, luteinizinghormone and follicle stimulating hormone serum concentrations,number of embryo transfers and pregnancy rate were evaluated.Compared to control cycles (group A; n=24), the addition of0.5 mg (group B; n=27) or 1 mg dexamethasone (group C; n=27),combined with the protocol of programmed oocyte retrieval forIVF patients in the study, demonstrated equivalent results.The mean numbers of oocytes retrieved were 10.8±3.9 inthe control group, compared to 11.2±4.0 in group B and10.5±3.6 in group C. The fertilization rates were 69±21,66±18 and 70±15% respectively. The pregnancy rateswere 20, 16 and 20.8% respectively. The addition of up to 1mg dexamethasone daily to the protocol of ovulation inductionfor oocyte retrieval did not improve the overall IVF-embryotransfer outcome in patients with tubal factor infertility.     

A prospective randomized study: day 2 versus day 5 embryo transfer

BACKGROUND: This randomized controlled study was performed in an unselected IVF/ICSI population to test the hypothesis that blastocyst transfers result in higher clinical pregnancy rates (CPR) per oocyte retrieval when compared with day 2 transfers. METHODS: Blind randomization for transfer on day 2 (group 1) or day 5/6 (group 2) was performed before stimulation. Oocytes and embryos were cultured in sequential media in 5.5% CO(2), 5% O(2), 89.5% N(2) and 90% humidity. A maximum of two embryos was transferred. RESULTS: The two groups were similar for age, IVF indication, number of treatment cycles, rate of ICSI/IVF, number of fertilized oocytes and number of embryos transferred. The CPR/oocyte retrieval was comparable in group 1 (32%) and in group 2 (44%), while the CPR/embryo transfer was significantly higher (P < 0.01) in group 2 (60%) than in group 1 (35%). Similarly, the implantation rate per embryo transferred was significantly higher (P < 0.03) in group 2 (46%) than in group 1 (29%). The cryo-augmented delivery rate/oocyte retrieval was comparable in group 2 (36.3%) and in group 1 (28.6%). CONCLUSION: This randomized study in an unselected population showed a significantly higher CPR/embryo transfer and a tendency toward a higher CPR/oocyte retrieval in patients receiving blastocysts when compared with day 2 transfers.     

Endocrinological and ultrasonographic variations after immature oocyte retrieval in a natural cycle

BACKGROUND: In-vitro oocyte maturation is an appealing alternative in reproductive medicine but the results obtained are still poor. The aim of our prospective and observational investigation was to study the hormonal modifications that immature follicular aspiration might induce in a natural cycle as well as the implications that these alterations may have in the endometrium. METHODS: Eleven patients (13 cycles) were included in our in-vitro oocyte maturation programme. Ovaries were scanned with transvaginal probes every day and follicular aspiration was performed when a follicle of 9 mm was visualized. Blood was also drawn for hormonal analysis. Endometrial thickness was recorded every day after oocyte retrieval. Two endometrial biopsies were taken on days 6 and 8 after oocyte retrieval. RESULTS: We observed a significant drop in serum oestradiol concentrations after immature oocyte retrieval previous to follicle dominance. Immediately after, rises in both FSH and LH were detected. Also, a new dominant follicle started to grow 3-4 days later. Steroid hormones secreted by this newly recruited follicle were significantly lower than in controls, inducing inadequate endometrial thickness. CONCLUSIONS: These studies show that exogenous hormonal administration might be necessary to achieve a correct endometrial growth when in-vitro oocyte maturation is employed in IVF.     

Ratio of oestradiol concentration on the day of human chorionic gonadotrophin administration to mid-luteal oestradiol concentration is predictive of in-vitro fertilization outcome.

The role of luteal oestradiol for successful implantation in humans seems to be permissive rather than obligatory. Few studies have attempted to clarify the role of early luteal oestradiol in in-vitro fertilization (IVF) outcome, whether peri-implantation oestradiol is predictive of successful IVF outcome. We retrospectively analysed 106 women undergoing 106 IVF/embryo transfer cycles. Only the first treatment cycle per patient was analysed. Peak oestradiol denoted the concentration on the day of human chorionic gonadotrophin (HCG) administration. Mid-luteal oestradiol was obtained 3 days after embryo transfer (8 days after HCG administration). A total of 44 pregnancies were noted (41.51%). There were no differences in age, cycle day 3 follicle stimulating hormone (FSH), peak oestradiol, number of retrieved oocytes, number of embryo transfers, and mid-luteal oestradiol between pregnant and non-pregnant women. However, the ratio of day of HCG oestradiol to mid-luteal oestradiol was highly predictive of successful outcome: the ongoing pregnancy rate and implantation rate (sacs with fetal heart beat/embryo transfer) were 15.8 and 5.7% respectively if the above ratio exceeded 5.0 (n = 19), compared to 42.1 and 16.3%, and 53.3 and 26. 5% if the ratio was between 0.4 and 2.5 (n = 57), and between 2.5 and 5.0 (n = 30) respectively. Our study suggests that the magnitude of decline in oestradiol concentrations after oocyte retrieval may be important in predicting IVF success. We postulate that endometrial integrity may become compromised when a dramatic drop in oestradiol occurs by the mid-luteal period. Whether these women benefit from oestradiol supplementation after oocyte retrieval remains to be investigated.     

Ejaculation failure on the day of oocyte retrieval for IVF: case report

Unexpected ejaculation failure on the day of oocyte retrieval for IVF occurs once or twice a year in our Reproductive Medicine Unit, where approximately 500 oocyte retrievals are performed each year. Two clinical situations which occurred in 2001 are presented. In the first case, sperm were finally obtained by epididymal aspiration and resulted in the fertilization of five oocytes by ICSI. The transfer of two fresh embryos did not result in a pregnancy and the three supernumerary zygotes were cryopreserved. The male patient presented an anxio-depressive episode necessitating psychiatric hospitalization 1 week after the oocyte retrieval. In the second case, no sperm were obtained and the four oocytes were therefore lost. The couple went through a crisis in their relationship and tried another cycle of IVF 10 months later, after the preventive cryopreservation of a sperm sample. On the day of oocyte retrieval the patient was unable to produce a fresh sample but three zygotes were obtained through ICSI using the back-up cryopreserved sperm. Two embryos were transferred but no pregnancy ensued. The clinical decision-making processes for these two cases are described, as well as the measures employed to help prevent these unfortunate situations.     

The luteal phase after in-vitro fertilization and related procedures

To evaluate any beneficial effect of progesterone supplemen–tationduring the luteal phase of GIFT or IVF cycles stimulated byclomiphene citrate and HMG, two random prospective studies wereperformed. In the first study, a group of patients receiveda luteal phase supplement of 50 mg natural progesterone i.m.daily from the day of oocyte retrieval onwards. Initial resultson 168 patients indicated that the pregnancy rate was similarin patients with or without progesterone supplements. No differenceswere found between the two groups in an analysis of pregnantand failed cycles. In a second study two different protocolsof luteal phase sup–plementation after Buserelin–HMGstimulation were com–pared: natural progesterone in combinationwith oestradiol valerate (50 patients) or HCG supplements (41patients). A 32% pregnancy rate per cycle was encountered inboth groups. Endometrial biopsies, taken during the luteal phasefrom patients who did not undergo embryo replacement, revealedretarded endometrial development in most of the biopsies.     

Serum levels of free androstenedione, testosterone and oestradiol are lower in the follicular phase of conceptional than of non-conceptional cycles after ovarian stimulation with a gonadotrophin-releasing hormone agonist protocol.

Serum concentrations of total and free androstenedione, testosterone and oestradiol were followed during the follicular phase in women undergoing ovarian stimulation for treatment by in-vitro fertilization and embryo transfer (IVF-ET) and compared to those in natural unstimulated cycles. In addition, 10 conceptional and 18 non-conceptional cycles were compared in an attempt to understand the background for successful IVF cycles. The ultra-short gonadotrophin-releasing hormone agonist protocol was used for ovarian stimulation. Throughout the follicular phase, levels of total and free androstenedione and oestradiol were significantly lower in conceptional than in non-conceptional IVF cycles. In addition, levels of free testosterone during the follicular phase were significantly lower in women who conceived compared to non-conceptional IVF cycles, whereas levels of total testosterone were similar. Levels of both free and total androstenedione increased significantly from the second day of the menstrual cycle until oocyte retrieval in non-conceptional IVF cycles, whereas levels in conceptional IVF cycles and unstimulated cycles showed no increase. On the day of oocyte retrieval levels of free and total androstenedione were significantly higher in non-conceptional IVF cycles than in conceptional IVF cycles and unstimulated cycles, which were similar. This study suggests that appropriate levels of free biologically active androgens and oestradiol are important parameters for successful conception.(ABSTRACT TRUNCATED AT 250 WORDS)     

Randomized controlled trial of follicle stimulating hormone versus human menopausal gonadotrophin in in-vitro fertilization*

The adverse effect of raised luteinizing hormone (LH) concentrationson reproductive outcome suggests that exogenous LH administrationfor ovarian stimulation may not be desirable. The aim of thisstudy was to compare the clinical pregnancy rates between folliclestimulating hormone (FSH) and human menopausal gonadotrophin(HMG) used in in-vitro fertilization (IVF) cycles. A total of232 infertile patients, with a mean duration of infertilityof 67.1 ± 32.9 months, were selected for IVF (femaleage <38 years, FSH <15 IU/1, and total motile sperm count>5x10⁶). A short (flare-up) protocol with daily leuprolideacetate was followed randomly from day 3 with FSH (n = 115)or human menopausal gonadotrophin (HMG; n = 117), at an initialdose of two ampoules per day. A maximum of three embryos wastransferred, and the luteal phase was supported with four dosesof HCG (2500 IU). No differences were observed between the twogroups in any of the cycle response variables except fertilizationrates per oocyte and per patient, both of which were significantlyhigher with FSH. Clinical pregnancy rates per cycle initiated,per oocyte retrieval and per embryo transfer were 19.1, 21.0and 22.7% respectively for FSH, and 12.0, 12.8 and 15.4% respectivelyfor HMG. Whilst these differences were not statistically significant,the results of this interim analysis suggest that HMG may beassociated with a lower clinical pregnancy rate than FSH.     

Pregnancy: Endometrial ultrasonography as a predictor of pregnancy in an in-vitro fertilization programme

The endometrial pattern and thickness were analysed by ultrasonographyin 139 cycles stimulated for in-vitro fertilization (IVF) onthe day of administration of human chorionic gonadotrophin (HCG).A semi-programmed schedule based on the pill + clomiphene citrate+ human menopausal gonadotrophin (HMG) was used in all cycles.On the day of HCG administration, endometrial pattern and thicknesswere assessed with an Ultramark 4 (ATL) ultrasound equippedwith a 5 MHz vaginal probe. Endometrial pattern I (a ‘tripleline’multilayer) was observed in a total of 105 cycles (76%), andpattern II (fully homogeneous and hyperechogenic in relationto myometrial tissue) in 34 (24%). The incidence of clinicalpregnancy did not differ (P = 0.52) between the groups withendometrial patterns I (23.8%) and II (29.4%). Endometrial thicknesson the day of HCG administration in the group with pattern I(8.4 ± 1.9 mm) was similar (P = 0.96) to that observedin the group with pattern II (8.4 ± 2.0 mm). In addition,the endometrial thickness of the patients who became pregnant(8.0 ± 1.7 mm) did not differ (P = 0.15) from that ofwomen who did not achieve pregnancy (8.6 ± 2.0 mm). Theconclusion from the present data is that ultrasonographic analysisof endometrial thickness and refringency on the day of HCG administrationhad no predictive value for conception in IVF cycles.     

Empty follicle syndrome due to human errors: its occurrence in an in-vitro fertilization programme

We report five cases in which no oocytes were retrieved afterstandard ovarian stimulation for in-vitro fertilization (IVF),and in which it was found that mistakes had been made at thetime of human chorionic gonadotrophin (HCG) administration.In all five cases, oocyte retrieval was achieved after injectingHCG, when necessary, and reprogramming aspiration 24–36h later. A mean of 7 ± 3.2 MII oocytes were recoveredper patient and 3.2 ± 0.8 embryos were transferred. Threeclinical pregnancies were obtained, and four healthy infantswere born. In our programme, these were the only cases of emptyfollicle syndrome (EFS) that appeared over a total of 1118 cycles,and were all explained by human error in the administrationof HCG. Our experience shows that human error could be considereda significant factor in the aetiology of empty follicle syndrome,and that EFS may be in part avoided by taking simple preventivemeasures.     

Is intracytoplasmic sperm injection (ICSI) a safe procedure? What do we learn from early pregnancy data about ICSI?

The aim of this study was to evaluate the safety of the intracytoplasmicsperm injection (ICSI) procedure by analysing early pregnancydata from ICSI and in-vitro fertilization (IVF) patients. Inall, 50 ICSI pregnancies were compared with 226 FVF pregnancies.Comparisons were made during the first 9 weeks after the theoreticallast menstrual period (7 weeks after oocyte retrieval) withregard to epidemiological data, plasma hormonal concentrationsand transvaginal ultrasonographical findings. Although patientswere significantly (P < 0.001) younger in ICSI (31 years)than in IVF pregnancies (33 years), their duration of infertilitywas similar. Miscarriage and multiple gestation rates were notsignificantly different in ICSI pregnancies (respectively 24and 24%) from those found after IVF (32 and 29%). The probabilityof developmental arrest of the intrauterine sac (miscarriagesand vanishing twins) was similar in both ICSI (16%) and IVF(25%) cases. The mean plasma hormonal concentrations startingfrom day 11 after oocyte retrieval were similar in both groups.Every ICSI and IVF pregnancy showed an embryo with cardiac activityat 7 weeks. Early pregnancy data did not show any abnormal findingsfor pregnancies achieved using ICSI compared to those achievedby FVF.     

Pregnancy: Supraphysiological serum relaxin concentration during pregnancy achieved by in-vitro fertilization is strongly correlated to the number of growing follicles in the treatment cycle

In order to analyse the relationship between the ovarian responseto stimulation in in-vitro fertilization (IVF) treatment cyclesand relaxin concentrations during subsequent pregnancies, 31healthy women pregnant after IVF treat ment were studied prospectively.The maximum number of follicles observed from day –4 today –2 in relation to ovum retrieval and the number ofoocytes recovered were recorded. In addition, blood sampleswere drawn in the follicular phase, the luteal phase, earlypregnancy and at gestational weeks 12, 16, 20, 27 and 35 toassess oestradiol, progesterone, human choriomc gonadotrophinand relaxin. The maximum numbers (mean±SEM) of folliclesobserved and oocytes recovered were 9.0±0.6 and 6.1±0.5respectively. The supraphyslological mean relaxin values werestrongly correlated to the maximum number of follicles observed(r=0.72, P <0.0001) and the number of oocytes recovered (r=0.64,P <0.0001), indicating that the source of increased relaxinproduction during IVF pregnancy might be the ovary. These resultsare supported by experimental data. In the present study, theoccurrence of multiple pregnancy was not associated with higherrelaxin concentrations, which is further support for the hypothesisthat the ovary is the main source of serum relaxin.