Gestation sac size in in-vitro fertilization pregnancies

Summary. The gestation sac size in pregnancies resulting from in-vitro fertilization (IVF) and embryo transfer have been compared with those in spontaneous pregnancies. Small-for-dates gestational sac sizes were found in 36% of the IVF pregnancies. This proportion held for both singleton and multiple pregnancies. With increasing gestation beyond 8 weeks the gestation sac volume increasingly approached normal. In contrast to spontaneous conceptions, IVF pregnancies had a low rate of pregnancy loss once fetal heart movements were demonstrated, when the gestation sac size was small-for-dates. Small sac size in an IVF pregnancy may lead to the misdiagnosis of a failed pregnancy.     

Two consecutive ectopic pregnancies after in-vitro fertilization and embryo transfer. Case report

Ectopic pregnancy is a known complication of in vitro fertilization and embryo transfer (IVF/ET). The overall incidence of ectopic pregnancy after IVF is 4.4-5.8% of clinical pregnancies. The risk factors associated with ectopic pregnancies are complex. We present a patient with two consecutive ectopic pregnancies after IVF/ET.     

Conceptual age and ultrasound measurements of gestational sac and crown-rump length in in vitro fertilization pregnancies

The growth of the mean gestational sac diameter and the crown-rump length were evaluated from individual series and found to be linear in singletons, twins, and triplets from an in vitro fertilization program as well as in pregnancies with ovulation determined from serial ultrasound folliculograms. No difference in growth rate between the different groups was observed. The 95% confidence limits were 7.7 days before and 7.5 days after mean for the gestational sac diameter, and 5.2 days before and 5.6 days after mean for the crown-rump length. These limits, used together with new linear equations, create less anxiety and less unnecessary surgical intervention than current nonlinear standards when conceptual age is known and the gestational sac or the crown-rump length are too small to be measured.     

Hormonal profiles in the follicular phase, luteal phase and first trimester of pregnancies arising from in-vitro fertilization

The hormonal profiles for oestradiol-17 beta, progesterone, prolactin and beta-human chorionic gonadotrophin (beta-hCG) are documented for the first 24 pregnancies arising from in-vitro fertilization during a collaborative project between the University of Western Australia and PIVET Laboratory. All patients had ovarian follicle stimulation with clomiphene citrate, sometimes combined with human menopausal gonadotrophin and all had oocyte recovery undertaken 36 h after injection of 5000 i.u. hCG. The follicular phase profile indicated that patients were admitted for the hCG injection when oestradiol-17 beta levels were around 1500 pmol/l per follicle with a dimension of greater than or equal to 1.6 cm on ultrasound. Luteal phase data indicated that oestradiol-17 beta and progesterone levels were two to three times higher than that expected during spontaneous conception cycles and those pregnancies which subsequently aborted had significantly lower levels in the late luteal phase. During pregnancy elevated oestradiol-17 beta and progesterone levels were maintained through the early weeks during organogenesis while the beta-hCG profile was similar to that reported for spontaneous pregnancies arising without ovarian stimulation. Six women aborted and the other 18 pregnancies have generated 22 infants.     

Implantation failure following in-vitro fertilization

PURPOSE OF REVIEW: Embryo implantation remains the rate-limiting step in assisted conception programmes. Factors affecting the interactions between blastocyst and endometrium are subjects of current research and, sadly, have also been the subjects of much confusion. This review aims to present current thinking on factors affecting embryo development, endometrial receptivity during and around the implantation window and the evidence for and against various proposed treatment options RECENT FINDINGS: Age-related aneuploidies of the sex chromosomes and several other autosomes are now thought to adversely affect oocyte and embryo quality, leading to repeat in-vitro fertilization failures. Several small controlled trials have suggested improvements in clinical outcomes following preimplantation screening and blastocyst transfer for aneuploidy in older women. These are, however, very costly, wasteful of embryos and do not appear beneficial after the age of 40 years. Factors influencing endometrial receptivity remain largely unresolved. New technology using microarrays for gene expression profiling and progesterone receptor polymorphism may shed more light in the near future. SUMMARY: Giant strides have been made in studying the causative factors of implantation failure, but these have not been matched by therapeutic solutions. Many proposed interventions are of unproven value, yet can have harmful side-effects.     

Reproductive outcomes after in-vitro fertilization

PURPOSE OF REVIEW: This paper reviews the effect of in-vitro fertilization on maternal and perinatal outcomes of pregnancy. RECENT FINDINGS: Few randomized, controlled trials have been published in this area due to inherent difficulties in studying this population of infertile women who require in-vitro fertilization. Systematic review of the literature identified published studies that consistently highlighted the higher incidence of maternal and perinatal morbidity associated with pregnancies following in-vitro fertilization. SUMMARY: Some prospective observational studies compare maternal and perinatal outcomes in in-vitro fertilization pregnancies. Larger studies show that adverse pregnancy outcomes such as preeclampsia, gestational hypertension, placental abruption, placenta praevia, and preterm delivery increase significantly with in-vitro fertilization. Perinatal adverse outcomes such as prematurity and those related to plurality of the pregnancy also increase. All patients undergoing in-vitro fertilization should have careful counselling regarding these increased risks prior to treatment.     

Hormonal profiles in the follicular phase, luteal phase and first trimester of pregnancies arising from in-vitro fertilization

Summary. The hormonal profiles for oestradiol-17β, progesterone, prolactin and β-human chorionic gonadotrophin (β-hCG) are documented for the first 24 pregnancies arising from in-vitro fertilization during a collaborative project between the University of Western Australia and PIVET Laboratory. All patients had ovarian follicle stimulation with clomiphene citrate, sometimes combined with human menopausal gonadotrophin and all had oocyte recovery undertaken 36 h after injection o f 5000 i.u. hCG. The follicular phase profile indicated that patients were admitted for the hCG injection when oestradiol-17β levels were around 1500 pmol/l per follicle with a dimension of 1·6 cm on ultrasound. Luteal phase data indicated that oestradiol-17β and progesterone levels were two to three times higher than that expected during spontaneous conception cycles and those pregnancies which subsequently aborted had significantly lower levels in the late luteal phase. During pregnancy elevated oestradiol-17β and progesterone levels were maintained through the early weeks during organogenesis while the β-hCG profile was similar to that reported for spontaneous pregnancies arising without ovarian stimulation. Six women aborted and the other 18 pregnancies have generated 22 infants.     

Maternal morbidity and mortality in in-vitro fertilization

Pregnancies following in-vitro fertilization (IVF) are known to be at increased risk of a number of pregnancy- and delivery-related complications when compared with non-IVF pregnancies. Most of these complications seem to be due to underlying fertility problems. Ovarian stimulation carries a marked risk for two serious conditions - ovarian torsion and ovarian hyperstimulation syndrome - both of which are relatively rare. Although some common pregnancy complications show an up to five times increased risk over non-IVF pregnancies, the absolute frequencies are still low for most of these conditions. However, an increased risk of placenta praevia might be to some extent due to the IVF procedure. No long-terms effects on cancer risk or mortality can be linked to the IVF procedure, although follow-up time is still relatively short.     

体外受精-胚胎移植后妊娠产科结局分析

目的　研究体外受精 胚胎移植 (IVF ET)术后妊娠的母儿围生期特点。方法　采用病例对照方法 ,选择行IVF ET术后妊娠并于 1993年 1月至 2 0 0 2年 12月分娩的妇女 2 5 5例 ,与同期分娩的自然受孕的妇女17175例对照 ,研究IVF ET术后妊娠的围生期情况。结果　IVF ET单胎妊娠的早产、前置胎盘、糖耐量试验(OGTT)异常、产后出血、剖宫产率高于自然受孕组 ,P <0 0 5。IVF ET双胎妊娠的分娩孕周、新生儿体重低于单胎妊娠 ,P <0 0 5 ;中度及重度妊娠期高血压疾病 (妊高征 )、胎膜早破发生率高于单胎妊娠 ,P <0 0 5。结论　IVF ET妊娠是高危妊娠 ,多胎妊娠率高是导致早产和低体重儿显著增多的主要原因 ,加强孕期保健 ,及时治疗并发症可获得良好的妊娠结局。     

The use of ovulation-inducing agents in in-vitro fertilization

In view of the increasing pregnancy rate associated with increased numbers of embryos transferred to the uterus, it is optimal to transfer more than one embryo to each patient. This requires treatment with ovulation-inducing agents to increase the number of preovulatory follicles developing. However, the degree of ovarian "hyperstimulation" must be limited to prevent subsequent luteal-phase dysfunction. In all probability, the ideal regimen for enhanced follicular recruitment to achieve these goals has not as yet been determined. Up to this time multiple different regimens have been used throughout the world, all of which have achieved an increase in the number of embryos available for uterine replacement. Unfortunately, as the degree of augmented follicular development is increased, there appears to be a progressive shortening of the luteal length. It remains to be determined whether or not this shortening of the luteal length can be overcome by pharmacologic support of the luteal phase. In addition, if all embryos recovered are to be transferred to the uterus in the treatment cycle, there is a substantial risk (ranging from 10% to 35%) that if a woman becomes pregnant, she will have a multiple pregnancy. As ethical constraints challenge the advisability of selecting only some of the available embryos for uterine replacement, the development of cryopreservation for subsequent uterine replacement appears highly desirable.     

Triple-test screening in in vitro fertilization pregnancies.

PURPOSE: To determine whether the results of triple-test analysis differ between spontaneous and IVF pregnancies. METHODS: The study population consisted of 140 women with singleton pregnancies, 70 by IVF, and 70 by spontaneous conception. The groups were matched for maternal age, gestational week, and laboratory batch. The levels of all triple-test markers--alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and unconjugated estriol (u-E3)--were compared between the groups. RESULTS: Significantly higher HCG levels were detected in the patients with IVF pregnancies than in the control group (1.31 +/- 0.8 vs. 0.95 +/- 0.5 multiple of the medians, respectively, (p < 0.006), but there were no significant differences in AFP or u-E3 levels. Overall, 18.5% of the IVF group were found to be screen-positive as compared with 11.4% of the control group (difference not statistically significant). Only 8 IVF pregnancies (11.4%) reached the lowest calculated risk possible (1:9999) compared with 17 (24.2%) in the control group (p < 0.05). CONCLUSIONS: Our findings support previous data demonstrating elevated maternal serum HCG in IVF patients in comparison with spontaneous ones.