Children: Inteffigence and behaviour in children born after in-vitro fertilization treatment

This study is the first to examine a large group of childrenborn after in-vitro ferlilization (IVF) who were old enoughat the time of the investigation to make it possible to drawconclusions about the outcome. The aim of the study was to assessthe cognitive, behavioural and social development of the children.The study comprised 99 P/F children, 33–85 months of age,from the University Hospitals of Lund and Malmö, Sweden.The children's development was assessed with the Griffiths'scales of mental development. The children's behaviour was delineatedthrough semistructured interviews with their mothers, covering50 different behaviours. The mothers also filled in Achenbach'sChild Behaviour Checklist (CBCL). All children were examinedby a paediatric neurologist. The results were compared to Swedishpopulation groups. Of the children born, 66% were singletons,22% were twins, 12% were triplets and 28% were born prematurelyin gestational weeks 32–36. The cognitive developmentof the IVF children was excellent, and their behaviour was normalwhen compared with two Swedish population groups. Our conclusionwas that the development, behaviour and social adapta tion ofthe children was very satisfactory.     

Risk of cancer in the offspring of women who underwent ovarian stimulation for IVF.

BACKGROUND: Over the past decade attention has been increasingly focused on the long-term health effects of assisted reproductive technologies (ART), such as IVF, in both women and their offspring. To determine the risk of cancer in children conceived by IVF we used a large population-based historical cohort that was initially designed to examine the risk of gynaecological disorders in women who underwent IVF. METHODS: Children were included in the exposed group if they were conceived by IVF or other related fertility techniques (n=9484). The unexposed group consisted of 7532 children whose mothers were diagnosed with subfertility disorders but who were conceived naturally. All cohort members were asked to complete a mailed questionnaire that inquired about reproductive variables and cancer in the offspring (response rate 66.9%). RESULTS: During an average follow-up period of 6.0 years, 16 cancers were observed in the exposed and unexposed group combined, whereas 15.5 were expected [standardized incidence ratio (SIR) = 1.0; 95% confidence interval (95% CI) 0.6-1.7]. A direct comparison between children conceived after ART and naturally conceived children revealed no increased risk for childhood malignancies [risk ratio (RR) = 0.8; 95% CI 0.3-2.3]. CONCLUSIONS: Despite the small numbers of observed cancer cases, these findings demonstrate that children conceived by ART have no greatly increased risk of cancer during childhood compared with the general population and the internal reference group.     

Infertility: Psychological follow-up of children born after in-vitro fertilization

We have studied from birth up to the 3rd year the psychologicalattitude of 33 in-vitro fertilization (IVF) children comparedto two other groups: children born after ovarian stimulationwithout IVF (n = 33) and children conceived naturally (n = 33)during the same period. Fourteen children, born by oocyte donation,were also studied by the same methodology. In the IVF group,we found some feeding difficulties and sleep disorders in theinfants at 9 months and some signs of depression in mothers.All these symptoms disappeared afterwards. The development ofall the children is satisfactory and the relationship with theirmother is excellent. In this preliminary study, we concludethat the method of assisted reproduction has no bad influenceon the psychomotor development of these children.     

试管婴儿(IVF-ET)新生儿期情况分析

目的前瞻性对体外授精-胚胎移植(IVF-ET)技术受孕出生的新生儿进行评估,探讨实施IVF-ET技术出生新生儿的安全性.方法从自2000年10月～2004年12月在本院接受IVF-ET治疗后受孕181例孕妇进行前瞻性追踪观察,将其分娩的新生儿254个作为观察组,本院产科自然妊娠分娩的新生儿1205个作为对照组,对两组单胎和总体新生儿胎龄、出生体重、Apgar评分、高胆红素血症、新生儿窒息、新生儿死亡及新生儿畸形发病率的进行观察比较.结果单胎新生儿的出生体重、Apgar评分、新生儿死亡率及新生儿畸形率与对照组无差异性(P＞0.05);单胎新生儿窒息率观察组低于对照组,两组比较有显著差异性(P＜0.05).两组总体比较新生儿畸形、新生儿窒息率、新生儿死亡率无差异性(P＞0.05),而新生儿低体重出生率、高胆红素血症、住院治疗时间,观察组明显高于对照组,两组比较有极显著差异性(P＜0.01);而Apgar评分观察组低于对照组两者比较有差异性(P＜0.05).结论 IVF-ET技术不增加新生儿畸形和围产期死亡率;多胎是IVF-ET技术主要并发症,是早产和低体重出生儿、高胆红素血症、新生儿窒息等新生儿不良结局的主要原因.     

Developmental outcome at 2 years of age for children born after ICSI compared with children born after IVF

BACKGROUND: Since the introduction of ICSI in 1991, medical outcome studies on ICSI children have been performed, but few have addressed developmental outcome. Hence, this outcome was assessed by performing a standard developmental test on children born after ICSI as compared with children born after IVF, at the age of 2 years. METHODS: In a prospective study, the medical and developmental outcome of 439 children born after ICSI (378 singletons, 61 twins) were compared with those of 207 children born after IVF (138 singletons, 69 twins), at the age of 24-28 months. These children were part of a cohort of children followed since birth. Of children reaching the age of 24-28 months between May 1995 and March 2002, 44.3% (2375/5356) were examined by a paediatrician who was unaware of the type of treatment used for each couple. Of all the children born, 12.2% (439/3618) in the ICSI group and 11.9% (207/1738) in the IVF group underwent a formal developmental assessment using the Bayley Scale of Infant Development (mental scale) by a paediatrician blinded to the type of treatment. RESULTS: There was no significant difference in maternal educational level, maternal age, gestational age, parity, birthweight, neonatal complication rate or malformation rate at 2 years between ICSI and IVF singletons, or between ICSI and IVF twins. No significant difference was observed in the developmental outcome using the Bayley scale at the age of 24-28 months (raw scores or test age) between ICSI children or IVF children. A multivariate regression analysis for the singleton children indicated that parity, sex (boys had lower scores than girls) and age had a significant influence on the test result, but that the fertility procedure (ICSI versus IVF) did not influence the test result. ICSI children from fathers with low sperm concentration, low sperm motility or poor morphology had a similar developmental outcome to that of children from fathers with normal sperm parameters. There were no significant differences between the initial cohort and the group lost to follow-up, nor between the psychologically tested and the non-tested group for a number of variables such as maternal educational level, birthweight in singletons and neonatal malformation rate. Although only some of the cohort of ICSI children were evaluated, a representative sample of both ICSI and IVF children was compared. CONCLUSIONS: There is no indication that ICSI children have a lower psychomotor development than IVF children. Paternal risk factors associated with male-factor infertility were found not to play a role in developmental outcome.     

Comparative follow-up study of 130 children born after intracytoplasmic sperm injection and 130 children born after in-vitro fertilization

The safety of intracytoplasmic sperm injection (ICSI) as a novelprocedure of assisted fertilization may be assessed by the healthof the children born. In a prospective followup study of childrenborn after assisted procreation, 130 children born consecutivelyafter ICSI were compared with 130 control children born afterin-vitro fertilization (IVF). In both groups, mothers were matchedfor age and had the same standard treatment protocol. Therewere 74 singleton, 50 twin and six triplet children in eachgroup. Prenatal karyotyping and ultrasound screening, physicalexamination at birth and developmental milestones, with a follow-upat 2 months and 1 year, were recorded. Prenatal karyotypes wereobtained in 100 of the 130 children in the ICSI group comparedwith 22 of the 130 children in the matched IVF group. All karyotypeswere normal except for one prenatally detected mosaicism, whichwas not confirmed at birth. Four major malformations were detectedin the ICSI group (holoprosecencephaly, femur fibula ulna syndromeand palatoschisis in two children), compared with six in thematched IVF group (coarctation of the aorta, palatoschisis,hypospadias, unilateral cryptorchidism, soft tissue syndactilyand ll--hydroxylase deficiency). In the ICSI and IVF groups,mean ± SD birth weights were 2.94 ± 0.67 and 2.80± 0.73 kg, lengths were 48.46 ± 3.56) and 47.47± 5.78 cm, and head circumferences were 33.79 ±2.20 and 31.19 ± 8.88 cm respectively. Among the ICSIsingletons, the mean ± SD birth weight was 3.28 ±0.58 kg and among the twins it was 2.60 ± 0.43 kg; forthe IVF singletons and matched twins the mean ± SD birthweights were 3.19 ± 0.56 and 2.36 ± 0.61 kg respectively.In conclusion, there was no difference in the paediatric follow-upof 130 children born after ICSI and 130 children born afterconventional IVF in age-matched control patients.     

Premature chromosome condensation after in-vitro fertilization

During an in-vitro fertilization programme, 320 inseminatedoocytes neither formation of pronucle nor cell cleavage werestudied Cytogentically. Fourteen of 17 oocytes exhibiting noextruction of polar were characterized by an approximately diploidset of metaphase II chromosomes with four of these oocytes alsoshowing an additional set of prematurely condensed sperm chromosomesof the G₁ phase (G₁ -PCC). These chromosomes were single chomatids.Among 211 occytes characterized by polar body extrusion, thesame type of chromosomes were found in 22, along with metaphaseII chromosomes in the haploid range. This phenomenon can beexplained by the permanent arrest of the oocytes at metaphaseII after sperm penetration, which allows the presence of thepermanent arrest of the oocytes at metaphase II after spermpenetration, which allows the presence of cytoplasmic chromosomecondensing factors to remain, leading to the induction of PCCin the sperm. In these cases, PCC resulted either from distinctpronuclear asnchtrony or interchromosomal asynchrony withinthe chromosome set.     

Cytogenetic study of human oocytes uncleaved after in-vitro fertilization

Chromosome analysis of oocytes uncleaved after IVF allows the cause of the failure of cleavage to be determined and shows the incidence of chromosome disorders among human oocytes. A total of 198 uncleaved oocytes fixed 40 h after insemination were successfully analysed according to Tarkowski's air-drying method: 78.3% were unfertilized and arrested in metaphase II. Among them, 70% were normal (23,X) and 30% aneuploid (16% were hypohaploid, 14% were hyperhaploid). The incidence of chromosome breaks was 18%. In 12.1% of the oocytes, sperm chromosome condensation appeared premature usually in the G1 phase. This was especially observed in idiopathic infertility (7% of fertilized oocytes versus 2% in tubal infertility cases). In 8.1% of the cases, chromosome analysis showed diploidy which may be interpreted by either an absence of extrusion or a reintrusion of the polar body or by first cleavage failure during mitosis. In 1% of the cases triploidy was observed. Our results show that the main reason for failure of cleavage is related to failure of fertilization (78.3%). However, premature condensation of sperm chromosomes at the G1 phase appears to be quite frequent. This may be involved in the aetiology of some cases of idiopathic infertility. Finally, the high rate of chromosomal disorders (30%) in human oocytes may explain the high rate of chromosomal abnormalities in preimplantation embryos.     

The frequency of chromosome anomalies in human preimplantation embryos after in-vitro fertilization

Previous studies have reported chromosome aberrations in humanpre-embryos after in-vitro fertilization (IVF). Although thereason for these abnormalities is not clear, there is evidencethat they can arise during gametogenesis, fertilization or cleavage.The present study has examined further the incidence of chromosomeabnormalities in human pre-embryos after IVF, using oocytesrecovered from normal volunteer women and from women undergoinginfertility treatment in an embryo-replacement programme. Chromosomepreparations were performed for 75 pre-embryos. Of these 35(47%) gave at least one metaphase in which analysis was possible.The overall incidence of abnormal pre-embryos was 40% (14/35).The absolute frequency of aberrations was 9% for trisomies,3% for polyploidies, 26% for structural anomalies and 3% forhypodiploidies. Five pre-embryos were found to be mosaics, threeof which had each one trisomic metaphase. In five of the pre-embryosmultiple anomalies were found. In 13 of the 14 abnormal pre-embryosthe aberrations were found in only one metaphase. The presentstudy demonstrates that trisomic mosaicism may not be a rareevent in human pre-embryos. Further evidence is provided thatmitotic non-disjunction is important for the production of aberrationsin human pre-embryos     

Pregnancy: Heterotopic pregnancies after in-vitro fertilization and embryo transfer

A total of 20 cases of heterotopic pregnancy were encounteredamong 2650 clinical pregnancies (0.75%) resulting from in-vitrofertilization/embryo transfer at Bourn Hall Clinic (Cambridge,UK) during the period July 1984-July 1993. The aetiology ofheterotopic pregnancy in the series is multifactorial, withtubal damage as the main factor. Transvaginal ultrasonographyshowed a high sensitivity for making correct diagnoses of heterotopicpregnancies compared with transabdominal ultrasonography (93.3versus 50.0%). The mean plasma human chorionic gonadotrophin(HCG) concentration on day 13 after embryo transfer was similarto those of uncomplicated intrauterine pregnancies and hencewas of no diagnostic value. The serial plasma HCG concentrationsof patients who delivered were significantly higher than forthose who aborted their intrauterine pregnancies (P < 0.01),although the sample of data available was too small to makefirm inferences. It does appear that serial HCG concentrationsmay have a predictive value of fair accuracy regarding the outcomeof the intrauterine pregnancy in heterotopic pregnancies. Theclinical presentations of the 20 cases at first examinationwere quite variable, with 45% (9/20) of patients asymptomatic.Tubal pregnancy in one patient resolved spontaneously, two caseswere treated by an injection of potassium chloride into thegestational sac and the remaining 17 cases were treated by salpingectomy.In 10 patients the intrauterine pregnancy resulted in live birthand the remaining 10 patients aborted spontaneously.     

Preliminary experience of the use of a gonadotrophin-releasing hormone antagonist in ovulation induction/in-vitro fertilization prior to cancer treatment.

Therapeutic regimens for the treatment of malignant disease may compromise future fertility. One approach to circumvent this is the cryopreservation of embryos created before treatment for the malignancy. Conventional regimens using gonadotrophin-releasing hormone (GnRH) agonists are time consuming, requiring pituitary down-regulation before gonadotrophin administration, thus the duration of treatment is approximately 20-30 days. GnRH antagonists, however, do not cause an initial stimulation of gonadotrophin secretion and can thus be administered during the later stages of follicular maturation to prevent premature luteinization and ovulation. The duration of ovulation induction/in-vitro fertilization (IVF) treatment is thus reduced. In this study, case histories are reported of six women with newly diagnosed malignancies who requested ovulation induction/IVF prior to chemotherapy or surgery in which we have used the GnRH antagonist Cetrorelix. Gonadotrophin administration was started in the early follicular phase, and Cetrorelix (0.25 mg s.c. daily) was added from day 6 of treatment. Subsequent to human chorionic gonadotrophin (HCG) administration oocytes were recovered and successful fertilization and embryo cryopreservation was achieved in all cases. The median duration of treatment was 12 days (range 8-13, including induction of luteolysis in two patients). These results illustrate the potential use and advantages of a GnRH antagonist in ovulation induction/IVF when the need for immediate initiation of treatment and its duration are critical factors.     

Blunted LH surge after HCG administration in cycles superovulated for in-vitro fertilization

The preovulatory pattern of serum luteinizing hormone (LH) was investigated in cycles superovulated for in-vitro fertilization (IVF). The method used was immunoradiometric assay which shows no cross-reactivity with human chorionic gonadotrophin (HCG) at concentrations usually found after HCG administration. Of the 245 cycles stimulated by clomiphene citrate + human menopausal gonadotrophin, an endogenous LH surge was observed in 29.8% of the patients shortly prior to the HCG injection. In the post-HCG period, 49.4% of the cycles exhibited a blunted LH rise, whereas in the remaining 20.8% the LH level did not exceed twice the mean preovulatory value. According to the oestradiol-17 beta (E2) and progesterone concentrations, different hormonal patterns were found in patients with pre-HCG and post-HCG elevation of LH. However, the occurrence of a blunted LH surge following HCG administration cannot be attributed to different, HCG-induced secretory patterns of progesterone. There were no significant differences in clinical parameters, the pregnancy rate was slightly but not significantly higher (19.0%) in the post-HCG LH surge group than in the two other groups (13.7%). It is presumed that various factors may contribute to the suspension of preovulatory LH suppression. The possible beneficial influence of a post-HCG surge of LH requires further investigation.     

Implantation: Low implantation rate after in-vitro fertilization in patients with hydrosalpinges diagnosed by ultrasonography

The purpose of this study was to assess whether patients withtubal infertility and a hydrosalpinx have a reduced implantationrate after in-vitro fertilization. The study included 741 patientswho had 1190 consecutive oocyte aspirations. The presence orabsence of hydrosalpinges was assessed by transvaginal ultrasonographyon day 2 of all cycles. In 62 patients treated in 104 cyclesa hydrosalpinx was diagnosed, whereas 493 patients treated in813 cycles had no hydrosalpinx and eight patients treated in16 cycles had uncertain hydrosalpinx. The results show thatthe presence of a hydrosalpinx is associated with a reducedpregnancy rate per aspiration (19.2 versus 32.6% P < 0.01),reduced implantation rate (2.9 versus 10.3%, P < 0.0005),reduced delivery rate per aspiration (5.8 versus 20.9%, P <0.0005), reduced delivery rate per embryo transfer (6.6 versus22.8%, P < 0.0005) and increased early pregnancy loss (70versus 36%, P < 0.005). Among 178 patients with unexplainedinfertility or other infertility factors treated with 257 aspirationsthe results were similar to those in patients with tubal infertilitywithout a hydrosalpinx. In conclusion, the presence of a hydrosalpinxdoes not impair the number of embryos transferred but seemsto impair the implantation process. We hypothesize that thismay be due to leakage of fluid into the uterine cavity whichmay disturb the receptivity of the endometrium and/or the developingembryos.     

Obstetric and perinatal outcome and preliminary results of development of children born after in vitro maturation of oocytes

BACKGROUND: Careful follow-up of children born after in vitro maturation (IVM) of human oocytes is essential because the technique is still very new. METHODS: Obstetric and perinatal data were collected from all deliveries after IVM treatment during 1999-2004. The growth and development of IVM children was assessed at 6, 12 and 24 months using Muenchener Funktionelle Entwicklungs Diagnostik and Bayley Scales of Infants. RESULTS: In total, 43 women [age 31.2 +/- 3.9 (mean +/- SD) years] gave birth to 40 singleton infants and three sets of twins (multiple rate 7.0%). Obstetric complications occurred in 15 pregnancies (35%). The mean birthweight of singleton infants was 3550 +/- 441 g and that of twins 2622 +/- 194 g. The rate of preterm birth infants was 5% in singletons. No perinatal deaths occurred. At the age of 12 months, eight children (19%) expressed minor developmental problems and one girl was found to have optical glioma. At 2 years of age, neuropsychological development was within the normal range. CONCLUSIONS: The obstetric and perinatal outcome was good, and the mean birthweight of the infants was normal. Minor developmental delay was overexpressed at 12 months, but the development of the children was normal at 2 years.     

Endometrial thickness as a predictor of pregnancy after in-vitro fertilization but not after intracytoplasmic sperm injection

An ultrasonographic evaluation of the endometrium was performedin 158 patients undergoing ovarian stimulation for an in-vitroassisted reproduction programme. Endometrial thickness was evaluatedin 109 patients undergoing in-vitro fertilization (IVF) forfemale indications and in 49 patients undergoing intracytoplasmicsperm injection (ICSI) for male indications. The maximal endometrialthickness was measured on the day of human chorionic gonadotrophin(HCG) administration by longitudinal scanning of the uteruson the frozen image using electronic callipers placed at thejunction of the endometrium-myometrium interface at the levelof the fundus. Cases in which the endometrial thickness was10 mm were included in group A; cases in which the endometrialthickness was <10 mm were assigned to group B. The age ofthe patients, serum 17- oestradiol concentrations on the dayof HCG administration, the length of follicular stimulation,the number of follicles, 17- oestradiol concentrations per follicleon the day of HCG and the number of embryos transferred wereanalysed in each case. When comparing endometrial thicknessand results in IVF and ICSI patients, an endometrium <10mm predominated in IVF patients (27.5%) compared with thoseundergoing ICSI (16.7%) (P=0.05); conversely an endometrium10 mm was more frequent in ICSI than in IVF patients. The incidenceof pregnancy was higher in IVF group A patients (32/79; 41%)than in IVF group B patients (5/30; 17%) (P=0.03), whereas nosignificant difference was found between ICSI group A (13/42;31%) and ICSI group B (3/7; 43%) patients. Thus, a higher percentageof IVF patients had thin endometrium when compared with ICSIpatients; thin endometrium was a prognostic indicator of pregnancyonly in the case of a female indication for infertility (IVF).A thin endometrium in cases of female infertility may reflecta previous or present uterine pathology, whereas in indicationsof male infertility (i.e. cases using ICSI), in the absenceof any associated uterine pathology, the presence of a thinendometrium is not predictive.     

Neonatal outcome and congenital malformations in children born after in-vitro fertilization

BACKGROUND: To evaluate the neonatal outcome and the prevalence of congenital malformations in children born after IVF in northern Finland we carried out a population-based study with matched controls. METHODS: Firstly, 304 IVF children born in 1990-1995 were compared with 569 controls, representing the general population in proportion of multiple births, randomly chosen from the Finnish Medical Birth Register (FMBR) and matched for sex, year of birth, area of residence, parity, maternal age and social class. Secondly, plurality matched controls (n = 103) for IVF twins (n =103) were randomly chosen from the FMBR and analysed separately. Additionally, IVF singletons (n = 153) were compared with singleton controls (n = 287). Mortality rates were compared with national figures from FMBR. RESULTS: Most mortality rates were twice as high as national figures in the general population. When compared with the control group representing the general population, the incidences of preterm birth [odds ratio (OR) 5.6, 95% confidence interval (CI) 3.7-8.6], very low birth weight (OR 6.2, 95% CI 2.0-19.0), low birth weight (OR 9.8, 95% CI 5.6-17.3), neonatal morbidity (OR 2.4, 95% CI 1.7-3.4) and hospitalization (OR 3.2, 95% CI 2.2-4.6) were significantly higher in the IVF group. The prevalence of heart malformations was four-fold in the IVF population than in the controls representing the general population (OR 4.0, 95% CI 1.4-11.7). CONCLUSIONS: Neonatal outcome after IVF is worse than in the general population with similar maternal age, parity and social standing, mainly due to the large proportion of multifetal births after IVF. The higher prevalence of heart malformations does not solely arise from multiplicity but from other causes. In order to improve neonatal outcome after IVF, the number of embryos transferred should be limited to a minimum.     

Long-term follow-up of children born after amniocentesis

Paediatric and neurodevelopmental examinations were made of 122 children between the ages of 5 and 7 years. The mothers of 62 of these children had undergone amniocentesis for prenatal chromosome determination. The other 60 children were controls, matched for time of birth and maternal age. The fact that no difference between the groups was revealed in respect of paediatric and neurodevelopmental disorders, orthopaedic abnormalities, or respiratory problems during the neonatal period indicates that the risk for developmental complications is not increased in children born after amniocentesis in the second trimester.     

Antiphospholipid antibodies in women having in-vitro fertilization

Antiphospholipid antibodies have an established associationwith pregnancy complications such as recurrent miscarriage,growth retardation, placental abruption and stillbirth but theirmechanism of action is unclear. We have investigated whetherantiphospholipid antibodies occur more frequently in women havingin-vitro fertilization (IVF) and whether their presence is associatedwith the likelihood of failed implantation. We studied 240 womenundergoing IVF treatment who were <38 years and had attemptedfewer than three previous IVF cycles. Antiphos-pholipid antibodies(anticardiolipin and antiphosphatidyl serine immunoglobulinG and immunoglobulin M) were present in 36 out of 240 (15%)of the study population and were not associated with a failedIVF cycle or miscarriage. There was no association between thecause of infertility and the presence of antiphospholipid antibodies.Antiphos-pholipid antibodies were not detected more frequentlyin women with previous attempts at IVF compared with women havingtheir first cycle, indicating that the high incidence of theseantibodies is not due to the IVF treatment. There was a strongassociation between the presence of antiphospholipid antibodiesand intrauterine growth retardation in singleton pregnancies(P<0.005). We recommend routine screening for the presenceof antiphos-pholipid antibodies in women having IVF in orderto identify those pregnancies at increased risk of intrauterinegrowth retardation.     

Analysis of the fourth to eighth in-vitro fertilization treatments after three previously failed attempts

The fourth to eighth in-vitro fertilization cycles of patientswho had previously reached the stage of embryo transfer withoutconceiving were evaluated. A total of 426 cycles were reviewedin women ranging in age from 25 to 46 years. The patients underwentfrom four (169 women) to eight (27 women) treatment cycles,using four established protocols for induction of ovulation.There was no statistical difference in the age, aetiology, durationof infertility and distribution of the various protocols amongthe analysed groups. The pregnancy rates in cycles 4–8were 19.5, 15.4, 10.8, 16.7 and 11.8% respectively (mean 16.2%per cycle) and were not statistically different. There was notrend of reduced success when the number of attempts increased.The overall live birth rate was 12.4%. The pregnancy rate wascomparable between age groups. No protocol proved to be significantlysuperior to others when pregnancy rate per embryo transfer wasassessed. We concluded that the pregnancy rate in cycles 4–8was stable, including those of patients up to 42 years of age.Continuous efforts are therefore advised for at least up tothis age and number of attempts. A change of an induction protocolin subsequent cycles, after repeated failure, is not statisticallyjustified     

Embryo transfer under ultrasound guidance improves pregnancy rates after in-vitro fertilization

Between October 1998 and January 1999, we examined the influence of ultrasound guidance in embryo transfer on pregnancy rate in 362 patients from our in-vitro fertilization (IVF)-embryo transfer programme. These patients were prospectively randomized into two groups: 182 had ultrasound-guided embryo replacement, and 180 had clinical touch embryo transfer. There were no statistically significant differences between the two groups with respect to age, cause of infertility and in the characteristics of the IVF cycle. The pregnancy rate was significantly higher among the ultrasound-guided embryo transfer group (50%) compared with the clinical touch group (33.7%) (P < 0.002). Furthermore, there was also a significant increase in the implantation rate: 25.3% in the ultrasound group compared with 18.1% in the clinical touch group (P < 0.05). In conclusion, ultrasound assistance in embryo transfer significantly improved pregnancy and implantation rates in IVF.