Histological component quantification for the evaluation of endometrial receptivity in women with natural cycles undergoing in vitro fertilization/intracytoplasmic sperm injection

Objective

Our aim was to evaluate the value of the volumetric fraction of vascular endothelial cells (EnVF) for determining endometrial receptivity in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).

Effect of seminal plasma application to the vaginal vault in in vitro fertilization or intracytoplasmic sperm injection treatment cycles—a double-blind, placebo-controlled, randomized study

Purpose

To study whether intravaginal application of seminal plasma after follicle aspiration has the potential to increase implantation and clinical pregnancy rates after IVF-ET.

Methods

We conducted a prospective, double-blind, placebo-controlled randomized study of 230 patients undergoing IVF-ET cycles. 500 μL of Fresh seminal plasma from the patient’s partner or culture medium (placebo) were injected in the vaginal vault just after follicle aspiration. The main outcome measured was ongoing clinical-pregnancy rate.

Results

After ET cancellation in ten patients due to lack of fertilization or embryo cleavage, 220 embryo transfers (103 and 117 in the study and control groups) resulted in a clinical pregnancy rate of 36.9 % and 29.1 % for the study and control groups, corresponding to a relative increase of 26.8 %. After an early pregnancy loss of 13.1 % (5/38) and 23.5 % (8/34) in the study and control groups respectively an ongoing pregnancy rate of 32.0 % (33/103) and 22.2 % (26/117) was achieved corresponding to a relative increase of 44.1 %. Multivariate logistic regression analysis adjusted for study group, age, infertility, and cycle characteristics did not demonstrate any parameter that could predict occurrence of clinical pregnancy rates after IVF-ET.

Conclusions

Patients who underwent SP intravaginal insemination after oocyte pick-up reached higher implantation and clinical pregnancy rates following ET compared to controls, although the difference did not reach statistical significance. More studies and variable methodologies may clarify the potential clinical effect of SP in improving live birth rates after ART.     

Does addition of low-dose aspirin and/or steroid as a standard treatment in nonselected intracytoplasmic sperm injection cycles improve in vitro fertilization success? A randomized,prospective, placebo-controlled study

Purpose: To investigate the effects of short-term low-dose aspirin and/or steroid use on implantation and pregnancy rates in nonselected intracytoplasmic sperm injection (ICSI) cycles. Methods: Two-hundred patients undergoing ICSI for their first cycle were enrolled in this study. Participants were then randomized into four groups on the embryo transfer day. Aspirin (100 mg/day) in group A, prednisolone (10 mg/day) in group B, aspirin along with prednisolone in group C were given while placebo was administrated to group D. Result: There were no statistically significant differences recorded in the demographic, ovulation induction cycle characteristics between groups. Mean transferred embryo number and mean top quality embryo number were similar among study groups. There were no statistical differences in implantation and pregnancy rates between study groups. Conclusion: Administration of low-dose aspirin and prednisolone alone or concomitant as a standard treatment have no positive effects on implantation and/or pregnancy rates.     

Luteal estrogen supplementation in stimulated cycles may improve the pregnancy rate in patients undergoing in vitro fertilization/intracytoplasmic sperm injection–embryo transfer

Objective. To evaluate the effect of estradiol addition to progesterone supplementation during the luteal phase on pregnancy and implantation rates in patients undergoing in vitro fertilization/intracytoplasmic sperm injection–embryo transfer (IVF/ICSI-ET) cycles.

Methods. In this prospective, randomized study, carried out in an IVF unit of a university hospital, we studied patients who were undergoing IVF/ICSI with controlled ovarian hyperstimulation using a gonadotropin-releasing hormone agonist/human recombinant gonadotropin long protocol. The main outcome measures were the pregnancy and implantation rates measured in the two groups.

Results. Our results suggest higher pregnancy and implantation rates in IVF/ICSI-ET cycles that were supplemented with estradiol in the luteal phase.

Conclusions. Estradiol supplementation during the luteal phase in women undergoing IVF/ICSI-ET has a beneficial effect on the outcome without (at least, as seems from this study) having any adverse effects.     

Standard in vitro fertilization or intracytoplasmic sperm injection in advanced female age--what may be expected?

This study was conducted to evaluate the current results of standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in the elderly (> or = 40 years of age) female population. Oocyte recovery, fertilization, embryo transfer, pregnancy and cumulative pregnancy rates were assessed. The results were analyzed for: the entire elderly population; the standard IVF group (group 1); all those in the ICSI group (group 2); and ICSI for severe male-factor category (group 3). A total of 330 IVF and 158 ICSI treatment cycles were carried out in 249 women. Forty-five (9.2%) clinical pregnancies were achieved. This rate was not statistically different from those achieved for groups 1, 2 and 3 (9.1%, 9.5% and 6.8%, respectively). The cumulative pregnancy rate for a total of five cycles was 19.2% and 26.4% for groups 1 and 2, respectively. For those who started their treatments at > or = 40 years, the cumulative pregnancy rate for three cycles was 26.5% and 36.5% in groups 1 and 2, respectively. These results clearly demonstrate that female age is a major success determinant, with similar influence on both standard IVF and ICSI therapy modalities.     

Total fertilization failure in intra-cytoplasmic sperm injection cycles – classification and management

In this retrospective cohort study we intended to propose a classification and preliminary management strategy for couples exhibiting total fertilization failure (TFF) in intra-cytoplasmic sperm injection (ICSI) cycles. Sixteen couples with a total of 27 cycles exhibiting TFF, age <40 and/or more than four M2 oocytes aspirated were enrolled. While TFF occurred in 4.3% of all 3723 ICSI cycles, in women younger than 40 with at least 5 M2 oocytes the TFF rate was 0.7%. Indications for ICSI were severe male factor and unexplained infertility. Of the 16 couples with TFF, 4 demonstrated a single episode of TFF, with either subsequent or former normal fertilizations, thus implying possible sporadic faulty laboratory conditions. Ten couples demonstrated repeated total or very low fertilization rates, hinting at a gamete defect not overcome by ICSI. Two couples experienced TFF in the first and only cycle performed at our unit. We conclude that initial and repeated TFF hints at severe gamete defects for which only donor gametes may prove successful while sporadic TFF events could simply imply a technical modifiable condition.     

Monitoring stimulated cycles during in vitro fertilization treatment with ultrasound only – preliminary results

Objective: To evaluate if monitoring patients by ultrasound (US) only during in vitro fertilization (IVF) treatment is safe. Design: Randomized prospective study. Intervention: Patients undergoing their first IVF treatment were randomized into two groups. The ultrasound only group (study group) was monitored by US for follicle size and endometrial thickness without blood tests. In this group, only one blood test was taken before human chorionic gonadotropin (hCG) injection, to ensure a safe level of estradiol (E₂) regarding ovarian hyperstimulation syndrome (OHSS) risk. The control group was monitored by ultrasound plus serum estradiol and progesterone concentration at each visit. Main outcome measure: Clinical pregnancy rate. Results: No differences were found between the groups in the parameters of IVF treatment, induction days, number of ampoules, E₂ level of hCG, as well as embryo quality. The clinical pregnancy rate was not statistically different between the groups, 57.5% vs. 40.0%, respectively (p?=?0.25). No OHSS cases were found among the study or control groups. Conclusion: Ultrasound as a single monitoring tool for IVF cycles is reliable, safe, patient friendly, and reduces treatment expenses. In an era of cost effectiveness awareness, this regimen should be considered for routine management in IVF programs.     

Effect of metformin taken in the ‘fresh’ in vitro fertilization/intracytoplasmic sperm injection cycle upon subsequent frozen embryo replacement in women with polycystic ovary syndrome

Objective.?We aimed to determine whether metformin when taken during a fresh in?vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle affects live birth rate (LBR) in subsequent frozen embryo replacement cycles (FERC).

Design. A retrospective database analysis of women with polycystic ovary syndrome (PCOS) undergoing FERC at a university teaching hospital between 2002 and 2007 (n?=?142). The outcome of FERC in women who had taken metformin in the ‘fresh’ IVF/ICSI cycle (group A, n?=?28) and those who had not (group B, n?=?114) were compared.

Results.?In the first FERC there was a significantly higher LBR (A?=?28.6%, B?=?12.3%, OR 2.86 95% CI 1.06–7.71). Women who had elective cryopreservation due to ovarian hyperstimulation syndrome risk were found to have significantly higher LBRs if metformin was taken in the fresh IVF/ICSI cycle (A?=?44.4%, B?=?7.9%, OR 9.33 95% CI 1.60–54.58).

Conclusions.?Women with PCOS who take metformin during IVF/ICSI may have a higher LBR in subsequent FERC, especially in those who have elective cryopreservation for OHSS risk. The findings of this study are limited by its retrospective design and small sample size and require confirmation in an adequately powered prospective randomized controlled trial.     

Does the timing of mock embryo transfer trial improve implantation in intracytoplasmic sperm injection cycles?

Aim.?To determine if endometrial trauma during embryo transfer trials (ETTs) improves implantation and clinical pregnancy rates in intracytoplasmic sperm injection treatment cycles.

Patients.?One-hundred fifty women undergoing their first IVF treatment were included in a prospective randomised study in a University hospital clinic. ETTs were performed either on day 21 of the previous cycle, or on day 6 of the controlled ovarian hyperstimulatin (COH) cycle, or conducted at least two cycles before COH cycle. Clinical pregnancy and implantation rates were compared between the groups.

Results.?There was no difference between the groups in terms of clinical pregnancy or implantation rates.

Conclusion.?Endometrial trauma by ETTs performed either during the preceeding cycle or on day 6 of the COH cycle does not improve pregnancy rates.     

Vacuolated oocytes: fertilization and embryonic arrest following intra-cytoplasmic sperm injection in a patient exhibiting persistent oocyte macro vacuolization—Case report

Purpose  

To describe a case of homogeneous macro vacuolar formation in oocytes from a patient undergoing IVF/ICSI over 3 cycles and implications thereof.     

Milk versus TEST-yolk — preincubated sperm; in vitro fertilization outcome

Objective: Preincubation of sperm in TEST-yolk medium enhances in vitro fertilization (IVF) outcome. However preincubation of sperm in milk at 5°C enhances the results of sperm penetration assay and hemizona assay. This study was therefore performed to determine the influence of milk on in vitro fertilization rate of human oocytes, as compared with TEST-yolk medium. Study design: Forty-one consecutive couples undergoing an IVF procedure were randomized. Of these 20 couples were admitted for the milk study (group 1) and 21 couples for the TEST-yolk study (group 2). Each ejaculate was Percoll-processed and the sperm pellet was resuspended in 0.5 ml of culture medium. An equal volume of heat-inactivated homogenized cow's milk (95°C, 10 min) was added to sperm suspension from group 1 and an equal volume of TEST-yolk medium was added to sperm suspension from group 2. After 2 h of incubation at 5°C and washing with culture medium at 37°C, oocytes were inseminated. Oocytes from group 1 couples were inseminated with milk-treated spermatozoa and those from group 2 couples with yolk-treated spermatozoa. Oocytes were evaluated for fertilization after 18 h. Results: Sperm preincubated in milk fertilized 75 out of 100 mature oocytes (75%). TEST-yolk-treated sperm fertilized 45 out of 64 mature oocytes (70%). The difference was not statistically significant. Conclusions: Preincubation of spermatozoa in milk, as compared with preincubation in TEST-yolk medium yields a similar IVF outcome, so milk may be a suitable alternative medium for preincubation of spermatozoa to enhance its fertilizing potential.     

Progesterone/estradiol ratio <0.25 on the day of human chorionic gonadotropin administration is associated with adverse pregnancy outcomes in prolonged protocols for in vitro fertilization/intracytoplasmic sperm injection

Objective

It has been suggested that a progesterone/estradiol ratio (P/E2) ≥ 1.0 on the day of human chorionic gonadotropin (hCG) administration indicates premature luteinization and might be associated with an adverse pregnancy; however, a lower limit of this ratio has not been determined. We aimed to identify a lower limit of P/E2 that correlates significantly with an increase in adverse pregnancies in patients undergoing a prolonged in vitro fertilization/intracytoplasmic sperm injection therapy.