Comparison of changes in uterine contraction frequency after ovulation in the menstrual cycle and in in vitro fertilization cycles

OBJECTIVE: To compare changes in uterine contraction (UC) frequency occurring after ovulation in the menstrual cycle and in IVF and to clarify UC anomalies encountered in IVF. DESIGN: Prospective crossover trial. SETTING: University infertility clinic. PATIENT(S): Six women seeking IVF for male factor infertility having regular menstrual cycles were studied during the menstrual cycle and IVF. INTERVENTION(S): Identification of LH surge in the menstrual cycle. Measurement of plasma E(2) and P levels and assessment of UC frequency by direct ultrasound visualization on the day of LH surge in the menstrual cycle and the day of hCG administration in IVF and every 2 days thereafter for 6 days. MAIN OUTCOME MEASURE(S): Uterine contraction (UC) frequency and plasma E(2) and P levels. RESULT(S): UC frequency was similar on the day of LH surge (5/minute) and hCG administration (5.3/minute). Establishment of uteroquiescence was more prompt in the menstrual cycle than in IVF, with lower UC frequency 4 days after LH surge compared with 4 days after hCG, while E(2) and P levels were higher in IVF. Six days after LH surge/hCG administration, UC frequency was low in the menstrual cycle and in IVF. CONCLUSION(S): High UC frequency in IVF at the time of ET results from delayed establishment of uteroquiescence after ovulation in IVF as compared with the menstrual cycle. In IVF, low UC frequency 6 days after hCG may contribute to the higher pregnancy rates observed with blastocyst transfers.     

Effects of Vaginal Progesterone Administration Starting on the Day of Oocyte Retrieval on Pregnancy Rates

PURPOSE: Vaginal progesterone administration starting on the day of oocyte retrieval induced a decrease in uterine contraction frequency on the day of embryo transfer (ET) as compared with preovulatory values. Uterine relaxation before ET is likely to improve outcome by avoiding displacement of the embryo from the uterine cavity (Fanchin, Righini, de Ziegler, Oliviennes, Ledée, Frydman: Fertil Steril 2001;75:1136-1140). The objective of the present study was to determine whether the early use of vaginal progesterone on the day of oocyte retrieval may alter the embryo implantation and pregnancy rates. METHODS: A total of 103 patients were submitted for ovarian stimulation with GnRH-a and recombinant FSH (Puregon, Organon) for the application of invasive assisted reproduction techniques (ICSI). The patients were divided into two groups in a prospective and randomized manner: Group A (n = 51) where application of vaginal progesterone started (Utrogestan, Besins International) at the dose of 400 mg from the evening of the day of oocyte retrieval, and Group B (n = 52) started to apply vaginal progesterone at the same dose but from the evening of embryo transfer (2nd day). RESULTS: The age of Group A patients (34.2 +/- 4.6) was similar (p = 0.50) to that of Group B patients (34.8 +/- 4.9). The number of oocytes retrieved and at metaphase II from Group A patients (10.6 +/- 6.9 and 7.8 +/- 6.0; respectively) did not differ significantly (p = 0.84 and p = 0.49, respectively) from the number of oocytes retrieved and metaphase II from Group B patients (10 +/- 5.6 and 6.7 +/- 4.7, respectively). Also, there was no difference (p = 0.48) in number of embryos transferred to Group A patients (2.7 +/- 0.8) versus Group B patients (2.7 +/- 0.9). Embryo implantation and pregnancy rates for Group A patients (12.6 and 27.4%, respectively) were equal (p = 0.98 and p = 1.0, respectively) to those for Group B patients (13.4 and 28.8%, respectively). CONCLUSION: Vaginal progesterone at the dose of 400 mg started on the day of oocyte retrieval did not increase implantation or pregnancy rates when compared to the same dose started on the day of embryo transfer.     

不同剂量黄体酮在体外受精-胚胎移植中黄体支持的效果

目的:探讨不同剂量黄体支持对IVF-ET周期黄体期雌、孕激素水平及临床结局的影响。方法:回顾分析长方案超促排卵IVF-ET305周期,根据hCG日雌激素水平采取4种不同黄体支持方案;对照组53例,hCG日血清E2值≤8000pmol/L,胚胎移植日开始肌注黄体酮60mg/d到验孕日。实验组:A组43例,hCG日血清E2值≤4000pmol/L,在取卵第2天开始肌注黄体酮20mg/d联合2000IU hCG q3d×4次到验孕日;B组115例,hCG日E24000pmol/L～8000pmol/L,取卵后第2天开始肌注40mg/d黄体酮到验孕日;C组94例,hCG日血清E2值≥8000pmol/L,取卵后第2天开始肌注60mg/d黄体酮到验孕日。结果:4组患者年龄、不孕年限、不孕因素、Gn用药天数、用药量、移植胚胎数均无明显差异(P0.05);4组hCG日雌激素水平、获卵数、ET日和种植窗期雌激素水平均有显著差异(P0.05),但4组ET日及种植窗期的E2/P值无显著差异;4组的种植率和妊娠率分别为27.68%、32.18%、32.54%、29.33%和41.51%、46.51%、50.43%、42.55%,无统计学差异。结论:不同剂量黄体支持有助于维持黄体期雌、孕激素平衡,有利于减少黄体酮剂量而不影响妊娠结局。     

A randomized study comparing Crinone 8% and intramuscular progesterone supplementation in in vitro fertilization-embryo transfer cycles

Objective: To compare the efficacy of Crinone 8% intravaginal progesterone gel vs. IM progesterone for luteal phase and early pregnancy support after IVF-ET.

Design: Randomized, open-label study.

Setting: Academic medical center.

Patient(s): Two hundred and one women undergoing IVF-ET.

Intervention(s): Women were randomized to supplementation with Crinone 8% (90 mg once daily) or IM progesterone (50 mg once daily) beginning the day after oocyte retrieval.

Main Outcome Measure(s): Pregnancy, embryo implantation, and live birth rates.

Result(s): The women randomized to luteal phase supplementation with IM progesterone had significantly higher clinical pregnancy (48.5% vs. 30.4%; odds ratio [OR], 2.16; 95% confidence interval [CI], 1.21, 3.87), embryo implantation (24.1% vs. 17.5%; OR, 1.89; 95% CI, 1.08, 3.30), and live birth rates (39.4% vs. 24.5%; OR, 2.00; 95% CI, 1.10, 3.70) than women randomized to Crinone 8%.

Conclusion(s): In women undergoing IVF-ET, once-a-day progesterone supplementation with Crinone 8%, beginning the day after oocyte retrieval, resulted in significantly lower embryo implantation, clinical pregnancy, and live birth rates compared with women supplemented with IM progesterone.     

Diagnosis of ectopic pregnancy after in vitro fertilization and embryo transfer

Objective: The combination of transvaginal sonography and serum hCG measurement is reliable in the diagnosis of ectopic pregnancy (EP) in spontaneous pregnancies. In patients who became pregnant through IVF-ET, transfer of multiple embryos after IVF could be responsible for the different performance of these tests. We evaluated the discriminative capacity of transvaginal sonography in combination with hCG measurement in the diagnosis of EP after IVF-ET.

Design: Prospective cohort study.

Setting and Patient(s): Consecutive patients, pregnant through IVF-ET, who presented with clinically suspected EP.

Intervention(s): Transvaginal sonography, serum hCG measurement at 6, 9, and 15 days after ET and after a negative transvaginal sonography.

Main Outcome Measure(s): Ectopic pregnancy confirmed at laparoscopy.

Result(s): Between September 1993 and May 1996, 86 women were included in the study, of whom 24 had an EP. Transvaginal sonography identified 46 intrauterine pregnancies and 5 EPs, but serum hCG could not diagnose EPs in patients in whom transvaginal sonography did not show a gestational sac. Serum hCG measurement 9 days after ET could identify pregnancy failure with 100% specificity at a cut-off value of 18 IU/L, but it could not identify patients with EP with enough certainty to justify immediate treatment.

Conclusion(s): We recommend single serum hCG measurement 9 days after ET to discriminate between viable and nonviable pregnancies. Transvaginal sonography can be postponed until 5 weeks after ET, except for patients with abdominal pain and/or vaginal bleeding, or patients with a serum hCG level of <18 IU/L.     

Comparison of the efficacy and safety of a highly purified human follicle-stimulating hormone (Bravelle) and recombinant follitropin-beta for in vitro fertilization: a prospective,randomized study

Objective: To compare the efficacy and safety of Bravelle s.c., Bravelle i.m., and Follistim s.c. in patients undergoing controlled ovarian hyperstimulation for IVF-ET.

Design: Open-label, randomized, parallel group, multicenter study.

Setting: Eleven academic and private fertility clinics with experience in IVF-ET.

Patient(s): Infertile premenopausal women with regular ovulatory menstrual cycles undergoing IVF-ET.

Intervention(s): Down-regulation with leuprolide acetate followed by up to 12 days of Bravelle s.c. (n = 60), Bravelle i.m. (n = 59), or Follistim s.c. (n = 58); hCG administration, oocyte retrieval, and ET.

Main Outcome Measure(s): Mean number of oocytes retrieved; patients with ET, chemical, clinical and continuing pregnancies; mean peak serum E₂ levels; adverse events and injection site pain scores.

Result(s): There were no significant differences among treatment groups in mean number of oocytes retrieved, peak serum E₂ levels, patients with ET, continuing pregnancies, or live births. There were no significant differences among the treatment groups in the number, nature, or intensity of adverse events. Patients treated with Bravelle s.c. or Bravelle i.m. experienced significantly less injection site pain than patients treated with Follistim s.c.

Conclusion(s): Bravelle s.c. and Bravelle i.m. are comparable in efficacy and safety to Follistim s.c. in patients undergoing controlled ovarian hyperstimulation for IVF-ET.     

Effects of early luteal-phase vaginal progesterone supplementation on the outcome of in vitro fertilization and embryo transfer

Objective. To determine whether early luteal-phase vaginal progesterone supplementation improves the outcome of in vitro fertilization–embryo transfer (IVF-ET).

Methods. A randomized, controlled trial was conducted on 197 women undergoing IVF-ET cycles with human chorionic gonadotropin (hCG) as the standard luteal-phase support. The participants were randomly assigned to either the study group or the control group. The study group was given 200 mg micronized progesterone vaginally three times per day starting in the afternoon of oocyte retrieval until the morning of embryo transfer, in addition to the standard hCG luteal-phase support. The control group received only the hCG support. The pregnancy rates and the implantation rates were measured.

Results. There were no significant differences in pregnancy rates or implantation rates between groups. However, subgroup analysis revealed significantly higher pregnancy and implantation rates in the study group among those women with fibroids or difficult oocyte retrieval involving uterine puncture (38.7% vs. 15.4% and 26.8% vs. 9.4% respectively, both p = 0.04).

Conclusion. Additional early luteal-phase vaginal progesterone supplementation may improve the outcome of IVF-ET in women with fibroids or difficult oocyte retrieval.     

Correlation of external and internal monitoring of uterine activity in a cohort of term patients.

External tocodynamometry (ET) and intrauterine pressure monitoring (IUPC) are commonly used to assess uterine contractile activity. It is believed that ET does not accurately document contraction amplitude. However, no direct comparison of ET and IUPC has been published in term patients. Our objective was to determine the correlation between frequency, duration, and amplitude as measured by ET and IUPC. Twenty patients between 36 and 41 weeks' gestation were enrolled during active spontaneous labor. Uterine contractions were recorded simultaneously by ET and IUPC for 2 hours. ET and IUPC data were compared using the Spearman correlation coefficient and the Wilcoxon signed-rank test. The median body mass index (BMI) of the patient population was 31.8 kg/m2 (range 22.2 to 42.3). There was good correlation of contraction frequency measured by ET and IUPC (r = 0.75, p = 0.001), but poor correlation of both contraction amplitude (r = 0.26) and duration (r = 0.27). ET and IUPC assessment of uterine contractile activity, specifically contraction amplitude and duration, do not appear to correlate in a population of moderately obese patients. This suggests that ET should not exclusively be relied upon in this population to assess uterine contractile activity during labor.     

Characteristics of uterine contractility during menses in women with mild to moderate endometriosis

Objective: To establish the role of uterine contractions in retrograde menstruation with subsequent abdominal implantation of endometrial tissue.

Design: Controlled prospective study.

Setting: University hospital-based study.

Patient(s): Infertile women with (n = 22) and without (n = 22) endometriosis.

Main Outcome Measure(s): Frequency, amplitude, and basal pressure tone of uterine contractions; correlation of contractions with retrograde bleeding and presence of viable endometrial cells; and dysmenorrhea before and 3 and 24 months after surgery.

Result(s): Compared with controls, patients with endometriosis had uterine contractions with higher frequency (22.73 ± 5.66 osc/10 min vs. 11.09 ± 3.26 osc/10 min), amplitude (20.83 ± 3.94 mm Hg vs. 6.77 ± 2.83 mm Hg), and basal pressure tone (50.14 ± 16.30 mm Hg vs. 24.68 ± 6.14 mm Hg). Dysmenorrhea was scored as 4.09 ± 1.44 in patients with endometriosis and 0.86 ± 1.42 in controls. Retrograde bleeding was found in 73% of patients with endometriosis vs. 9% of controls, and only 45% of patients with endometriosis had viable endometrial cells in the cul-de-sac.

Conclusion(s): Endometriosis may result from abnormal myometrial contractility through tubal transportation, dissemination, and implantation of endometrial viable cells into the abdomen.     

超促排卵对不孕女性子宫内膜蠕动波的影响

目的:研究不孕女性自然周期与控制性超促排卵(COH)周期子宫内膜蠕动波的特点。方法:64名排卵正常的不孕女性分别于自然周期LH峰日、排卵日、排卵后2 d和COH周期hCG注射后1 d、采卵日、采卵后2 d阴道超声监测子宫内膜蠕动波,且同时测定血清雌、孕激素水平。结果:自然周期子宫内膜蠕动波频率是COH周期的1.31倍;COH周期与自然周期各个观测日的子宫内膜蠕动波类型分布不同;子宫内膜蠕动波频率与生理水平血清雌二醇(E2)呈正相关,与孕酮(P)呈负相关,与超生理剂量的雌、孕激素无相关性。结论:COH治疗显著地改变了子宫内膜蠕动波的自然运动模式,在胚胎移植前仍表现为较强烈的子宫内膜运动。     

Endometrial estrogen and progesterone receptor and pinopode expression in stimulated cycles of oocyte donors

Objective: To study the effect of controlled ovarian hyperstimulation and the ovarian response on several features of endometrial morphology simultaneously.

Design: Prospective controlled study.

Setting: Academic infertility center.

Patient(s): Twenty-five oocyte donors undergoing COH and 10 ovulatory controls.

Intervention(s): Endometrial biopsies during the luteal phase and measurement of serum E₂ and progesterone levels on days 12, 13, and 18–20.

Main Outcome Measure(s): Endometrial morphology as judged by histologic dating, pinopode expression, and estrogen and progesterone receptor content.

Result(s): Controlled ovarian hyperstimulation caused the early expression of endometrial features as judged by histologic dating criteria, estrogen and progesterone receptor expression, and the timing of pinopode expression in many of the subjects. A significant correlation within subjects with regard to their particular result on any one measure (e.g., histologic examination) and the others (e.g., estrogen and progesterone receptors, pinopodes) was observed. Those with higher levels of progesterone the day after hCG administration exhibited the most prematurity of morphologic features.

Conclusion(s): Many controlled ovarian hyperstimulation cycles are associated with synchronous early expression of the expected pattern of histologic features, estrogen and progesterone receptors, and pinopodes. The most predictive feature of this premature expression was the level of progesterone the day after hCG administration.     

Uterine restoration by radiation sequelae regression with combined pentoxifylline-tocopherol: a phase II study

Objective: To determine whether combined pentoxifylline (PTX) and tocopherol (vitamin E) treatment can improve uterine radiation-induced sequelae, resulting in an improved embryo implantation rate.

Design: Retrospective phase II clinical trial.

Setting: Volunteers in an oocyte donation program in a public hospital.

Patient(s): Six women aged 31 ± 4 years, who were irradiated 25 years previously for childhood cancer with 20 to 40 Gy including the pelvic area.

Intervention(s): Four women had taken hormone replacement therapy for primary amenorrhea, and two had retained their natural cycle. Treatment consisted of at least 12 months of pentoxifylline at 800 mg/day combined with 1000 IU/day of tocopherol.

Main Outcome Measure(s): Endometrial thickness, uterine volume, and uterine artery blood flow were assessed by ultrasonography before and after pentoxifylline-tocopherol treatment, under usual estrogen-progesterone (OP) administration.

Result(s): This treatment was well tolerated. All six patients improved significantly in endometrial thickness (6.2 ± 0.6 vs. 3.2 ± 1.1 mm), myometrial dimensions (44 [± 5] × 30 [± 3] × 20 [± 2] vs. 30 [± 7] × 22 [± 3] × 16 [± 2] mm), and diastolic uterine artery flow.

Conclusion(s): In young women who want to bear children, the combination of pentoxifylline and vitamin E can reduce fibroatrophic uterine lesions after childhood irradiation.     

The dosage of human chorionic gonadotropins influences the relationship between progesterone and cycle outcome during in vitro fertilization-embryo transfer

OBJECTIVE: To determine if the dose of hCG affects the initial rise in progesterone seen in patients undergoing IVF-ET and therefore affects it usefulness as a predictor of cycle outcome. DESIGN: Comparison of the rise in progesterone with cycle outcomes for IVF patients receiving 5,000 or 10,000 mIU hCG to stimulate oocyte maturation. SETTING: University-based infertility program. Patients-One hundred six patients undergoing IVF-ET on a long protocol of down-regulation with GnRH, hMG stimulation, and hCG to stimulate oocyte maturation. Stimulation protocol varied only in dose of hCG [5,000 mIU (N = 72) vs. 10,000 mIU (N = 34)]. MAIN OUTCOME MEASURE(S): Rise in progesterone from 12 hours before to 12 hours after hCG administration and its relationship with cycle outcome. RESULTS: All 106 women exhibited a rise in progesterone following the administration of hCG. As seen in earlier studies, there appeared to be a relationship between minimal progesterone increases (<3-fold) and cycle failure in patients receiving 5,000 mIU (P < .02). However, using the criteria of the previous study, there appears to be no relationship between progesterone and cycle outcome in patients receiving 10,000 mIU (P = .30). Further, the higher dose of hCG appeared to induce greater increases in progesterone over the 24-hour period examined (P < .02). After readjustment of the critical value to 3.5-fold, there was an increased tendency toward cycle failure in women exhibiting a minimal progesterone increase. Unlike the relationship associated with 5,000 mIU hCG, though, the relationship between 10,000 mIU hCG and progesterone levels was not statistically different (P = .10). CONCLUSIONS: Increasing the dose of hCG used to stimulate oocyte maturity shifts the previously described relationship between progesterone and IVF-ET-cycle outcome. However, while it remains unclear if progesterone can be used as a predictor of outcome at the higher hCG dose, it appears clear that a relationship exists between minimal progesterone response to hCG and cycle failure.     

Young Low Responders Protected from Untoward Effects of Reduced Ovarian Response

Objective(s): To correlate fertilization and clinical pregnancy rates (PRs) in low responders with their E₂ levels (<500, 500–800, >800–1,000 pg/mL), age (20–30, 31–40, >40 years), number of follicles, and number of oocytes retrieved.

Design: A retrospective study.

Setting: The IVF unit of an academic hospital.

Patient(s): One hundred forty-three women who failed to attain E₂ levels of 1,000 pg/mL on the day of hCG administration.

Intervention(s): Controlled ovarian hyperstimulation, blood E₂ and progesterone measurements, ultrasonographic scanning of ovarian follicles, oocyte retrieval after hCG administration, and ET.

Main Outcome Measure: Clinical PR.

Result(s): Although E₂ levels, fertilization rates, age, and number of oocytes did not differ significantly between the three age groups, the PR achieved in the youngest group was approximately three times as high (19.3%) as that achieved in the two older groups.

Conclusion: Young low responders represent a unique subset in that their age protects them from the deleterious effects of poor ovarian response.     

The Utility of Serum Progesterone and Inhibin A for Monitoring Natural-Cycle IVF-ET

Purpose: Our purpose was to assess the value of monitoring serum P and inhibin A to determine how values might improve the clinical monitoring of natural cycle in vitro fertilization (IVF)-embryo transfer (ET) patients. Methods: All patients (n = 26) who underwent natural-cycle IVF-ET (n = 35) were analyzed. Groups were evaluated according to patients who had a spontaneous luteinizing hormone (LH) surge (group I) and women receiving human chorionic gonadotropin (hCG) who underwent subsequent oocyte aspiration (group II). Group II was further evaluated according to women who did (n = 10) and did not (n = 7) have an ET. All cycles were evaluated with serial transvaginal ultrasonography and serum estradiol, progesterone, and inhibin A. When follicle maturity was achieved, hCG, 10,000 IU, was administered intramuscularly if a LH surge was not detected. Transvaginal ultrasound-guided aspiration was performed 34–36 hr after hCG administration followed by a 48-hr transcervical ET. Results: No differences were seen in cycles the day prior to (d-1) and the day of a spontaneous LH surge, (n = 18) or hCG (d-0)(n = 17) in group I or group II with respect to lead follicular diameter (d-1,15.3 ± 0.6 vs. 14.2 ± 0.9 mm; d-0, 17.4 ± 0.8 vs. 17.8 ± 0.6 mm) and serum estradiol (d-l, 148 ± 15 vs. 150 ± 15 pg/ml; d-0, 218 ± 15 vs. 199 ± 16 pg/ml), respectively. However, serum progesterone was significantly elevated in group I compared with group II on d-l (0.82 ± 0.6 vs. 0.48 ± 0.04 ng/ml; P < 0.05) and d-0 (1.1 ± 0.12 vs. 0.63 ± 0.08 ng/ml; P < 0.05). Inhibin A was significantly greater on d-l in group I (24 ± 2.5 vs. 15 ± 2.2 pg/ml; P < 0.05). In group II, cycles that resulted in an ET (n = 10) compared with group II cycles that did not (n = 7) revealed a significant difference in serum progesterone (0.51 ± 0.05 vs. 0.7 ± 0.07 ng/ml; P < 0.05) and inhibin A (15 ± 2.5 vs. 37.3±5 pg/ml; P < 0.05) the day of hCG. Conclusions: The possible application of serum progesterone and inhibin A in managing natural-cycle IVF-ET is suggested. These assays may predict women who should be set up for egg retrieval, while canceling others in spite of the absence of an LH surge.     

Human preembryo development on autologous endometrial coculture versus conventional medium

Objective: To evaluate the effect of autologous endometrial coculture versus conventional medium on preembryo development.

Design: Controlled systematic clinical study.

Setting: University-based IVF center.

Patient(s): Women with a history of failed IVF-ET with poor preembryo quality.

Intervention(s): Patients underwent a luteal phase endometrial biopsy. The tissue then was digested enzymatically, and the stromal and glandular cells were separated by differential sedimentation rates. These cells were cultured to confluence, released, and then cryopreserved until the patient’s IVF-ET cycle. All normally fertilized oocytes then were allocated systematically to growth on autologous endometrial coculture or conventional medium until transfer on day 3.

Main Outcome Measure(s): Preembryo blastomere numbers and cytoplasmic fragmentation rates were measured.

Result(s): Forty-two women underwent 44 cycles of IVF-ET. In the morning on day 3, the mean (±SD) number of blastomeres and cytoplasmic fragments per preembryo on coculture compared with conventional medium was 5.9 ± 1.5 versus 5.5 ± 1.4 and 21% ± 13% versus 24% ± 11. At transfer the mean (±SD) number of blastomeres per preembryo on coculture was 7.4 ± 1.3 versus 6.7 ± 1.9 on conventional medium.

Conclusion(s): There was a significant improvement in the mean (±SD) number of blastomeres per preembryo and decrease in the fragmentation rate for preembryos on autologous endometrial coculture compared with noncocultured preembryos from the same patient.     

Quality of endometrial preparation

The gold standard in endometrial preparation remains what has been established for oocyte donation receivers. This preparation requires E2 for 14 days and then P4 in isolation. Endometrial thickness can now be evaluated with three-dimensional ultrasound or with the VOCAL system, which can evaluate endometrial volume: however, the mean thickness of the endometrium only has a predictive value for pregnancy at 6 mm, on day 6 or on the day that hCG is triggered. Despite the technical progress made, Doppler ultrasound, which can evaluate endometrial and subendometrial blood flow, does not contribute valid responses as to uterine receptivity and the chances for pregnancy. However, the level of uterine contractions at embryo transfer is recognized as a major factor of implantation and, to obtain faster uterine quiescence, it is recommended to begin progesterone before the transfer. The need for prolonged progesterone maintenance in case of pregnancy continues to be debated.     

Recurrent IVF failure is associated with elevated progesterone on the day of hCG administration

Objective

During in vitro fertilization (IVF) treatment, elevated progesterone on the day of human chorionic gonadotrophin (hCG) administration has been reported to be associated with a reduced chance of live birth. It is not known, however, if the relationship is casual or causal. In the latter situation, one would expect the incidence of elevated progesterone on the day of hCG administration to increase with the number of IVF/embryo transfer (ET) failures. The aim of this study was to investigate if the frequency of elevated progesterone on the day of hCG administration is related to the number of IVF failures.

Study design

This retrospective, observational, cohort study included a consecutive series of 6673 IVF cycles. Subjects were categorized into one of three groups: Group I, no previous IVF/ET treatment; Group II, one previous IVF/ET treatment failure; or Group III, two or more previous IVF/ET treatment failures. The main outcome measure was the proportion of cycles with elevated progesterone (>6 nmol/l) on the day of hCG administration.

Results

After adjusting for age, oestradiol level on the day of hCG administration and number of oocytes retrieved, the proportion of women with elevated progesterone on the day of hCG administration remained significantly different between the three groups: Group I, 16.8%; Group II, 31.7%; and Group III, 39.7% (p < 0.001).

Conclusion

Elevated progesterone on the day of hCG administration is more likely in women with recurrent IVF failure. Women with two or more IVF failures are twice as likely to have elevated progesterone on the day of hCG administration as women undergoing their first IVF cycle.     

Pregnancies and deliveries after in vitro maturation culture followed by in vitro fertilization and embryo transfer without stimulation in women with polycystic ovary syndrome

OBJECTIVE: To improve the efficacy of an IVF-ET program for unstimulated patients with polycystic ovary syndrome (PCOS) with the use of culture for oocyte maturation. DESIGN: Prospective studies with the comparison of different ET procedures from March 1995 through February 1998. SETTING: University-affiliated hospital. PATIENT(s): Ninety-four cycles in 64 consenting patients with PCOS. INTERVENTION(s): Immature oocytes were retrieved from unstimulated patients with PCOS and subsequently cultured and fertilized in vitro. Zygote intrafallopian transfer (ZIFT), uterine ET, or a combined approach of ZIFT + uterine ET was subsequently performed. MAIN OUTCOME MEASURE(s): Laboratory and clinical data. RESULT(s): Among 1, 280 immature oocytes (13.6 +/- 7.5 oocytes per patient) retrieved, 89% (1,139) were morphologically normal, and 62.2% (708/1,139) of the normal oocytes matured in vitro after culture for 48 hours. When intracytoplasmic sperm injection was performed, 68% (481/708) developed to the normal pronuclear stage, and 88.1% of the embryos cocultured with Vero cells (266/302) cleaved. Eighty-five ET cycles were conducted and pregnancy was established in 23 cycles (27.1%), which consisted of 8 after uterine ET and 15 after a combined approach. Seventeen patients delivered 20 normal infants. CONCLUSION(s): The IVF-ET method using no ovarian stimulation followed by in vitro maturation culture can be a feasible assisted reproductive technology for treatment of PCOS with various complications.     

Comparison of transmyometrial and transcervical embryo transfer in patients with previously failed in vitro fertilization-embryo transfer cycles and/or cervical stenosis

Objective: To compare ultrasound-guided transmyometrial and transcervical ET in patients with cervical stenosis or in patients who failed to conceive after at least three previous IVF-ET cycles.

Design: A prospective, randomized study.

Setting: The IVF-ET Unit at Serlin Maternity Hospital.

Patient(s): Forty patients undergoing IVF-ET.

Intervention(s): Ultrasound-guided transvaginal, transmyometrial, versus transcervical ET.

Main Outcome Measure(s): Clinical pregnancy rate.

Result(s): Transmyometrial ET was performed in 20 patients and resulted in one clinical pregnancy. Transcervical ET, performed in another 20 similar patients, resulted in three clinical pregnancies.

Conclusion(s): No benefit was derived by electing transmyometrial ET in preference to transcervical ET in patients who had failed to conceive in previous cycles.