Ovum donation

Oocyte donation has come of age. It is now an integral part in the management of infertility, providing hope to patients who were previously considered permanently infertile. The procedure is no longer used only to treat patients with premature ovarian failure, but also to treat patients with failed in vitro fertilization procedures and those patients who are carriers of genetic disorders. Recently, very encouraging results in the treatment of women above the age of 40 have been reported; the pregnancy rate of those below and above the age of 40 is almost identical, providing clear evidence that the endometrium retains its ability to nurture developing embryos despite advancing age. The future of oocyte donation will probably lie in the ability to mature pre-antral immature oocytes obtained from ovaries removed during standard surgical procedures and fertilizing them in vitro.     

A simplified approach to religious infertility

Orthodox Jewish women with a prolonged menstrual flow or short follicular phase may be unable to attend the ritual bath early enough in their cycle for conception to take place. Oral estrogen supplementation may effectively delay ovulation beyond the time of the ritual bath, when intimate relations are allowed, thereby restoring the normal (23%) fecundity rate.     

A simplified approach to Shirodkar cerclage procedure

The success of the Shirodkar cerclage procedure described herein lies in the use of the medium curve White tonsil forceps. The use of this curved tonsil clamp allows compression of the vaginal mucosa laterally, thereby making it relatively simple to place the Mersilene band accurately submucosally and avoiding blind advancement of an aneurysm needle.     

A simplified approach to techniques of splenic salvage

Splenic salvage or partial splenectomy may be simplified by following these basic steps. The spleen is completely mobilized from all of its attachments so that it is tethered only by its blood supply. Appropriate hilar and short gastric vessels are ligated, and devitalized splenic tissue is débrided. Parenchymal bleeding is controlled by compression using horizontal mattress sutures placed through pledgets of folded sheets of oxidized cellulose.     

A simplified approach to in vitro fertilization.

A simplified protocol for in vitro fertilization treatment was developed using low-dose clomiphene for ovarian stimulation, timing of human chorionic gonadotropin administration based solely on sonographic criteria, in-office egg retrieval and use of a simplified culture medium for embryo culture. Twenty-six infertile women underwent 39 treatment cycles, with 33 egg retrievals resulting in 29 embryo transfers. Clinical pregnancy was obtained in six patients (20.7% per embryo transfer), for a rate comparable to that achieved with conventional in vitro fertilization treatment in an age-matched control group. This simplification of in vitro fertilization treatment protocols can lead to decreased patient stress and costs without a substantially lower success rate.     

Ovum donation: Ethical and legal aspects

The newer technologies of assisted reproduction offer the infertile couple a wide spectrum of choices according to their specific problem. A relatively newer technique is that of ovum donation, whose technology is now well established. However, as with other newer technologies, it has given rise to new dimensions of ethical and legal issues which have to date not been fully appraised. It is very difficult to find a legal consensus under international umbrella to the specific issues involved in ovum donation. This is due to the different cultural, religious, and time influence atmosphere prevailing in the various parts of the world. Each society should develop its own statutes on ovum donation. A frame of ethical guidelines should be established by international organizations that may help each society issue its own regulations.     

受卵体外受精-胚胎移植治疗结局分析

目的:探讨受卵体外受精-胚胎移植(IVF-ET)治疗结局和疗效。方法:回顾分析2004年9月至2005年11月在本中心接受卵子赠送IVF-ET的患者共21周期的临床资料。赠卵组(20例)均采用长方案控制性超排卵行IVF-ET。受卵组(21例)采用激素替代治疗准备子宫内膜。赠卵者所赠卵子与受卵者丈夫精液行IVF-ET。选择同期常规IVF-ET患者55例做对照。结果:赠卵组种植率和临床妊娠率(7.3%,15.79%)明显低于受卵组(34.9%,52.38%)和同期IVF-ET组(21.19%,34.55%),P<0.05。结论:受卵IVF-ET是治疗卵巢功能不良和遗传原因不能生育健康后代妇女的有效方法;激素替代周期的种植率和临床妊娠率高于控制性超排卵周期。     

Ovum transport after microsurgical anastomosis of the rabbit oviduct

From experimental work in rabbits it is known that pregnancy outcome is influenced unfavorably by tubal resection anastomosis in spite of the preservation of tubal patency. In 104 Dutch belted rabbits the impact of microsurgical resection anastomoses on ovum transport during the first 24 hours after ovulation was examined. In oviducts in which the ampulla had been operated on, ovum transport was delayed. Mucosal irregularities that interfere with normal ampullary transport by cilia activity may account for the delay noted. Alterations in the duration of ovum transport in the oviduct may influence pregnancy outcome by creating an inappropriate tubal environment for the early embryo or by creating asynchrony between the embryo and the endometrium. No changes were observed in transport in oviducts in which the isthmus had been operated on: even a small segment of isthmus seems to act as a physiologic sphincter and to prevent premature ovum entrance into the uterus.