In vitro fertilization-embryo transfer pregnancy was a risk factor for hemorrhagic shock in women with placental polyp

Objective: The aim of this study was to determine the risk factors for hemorrhagic shock in women with placental polyp.

Materials and methods: Twelve women (group A) developed hemorrhagic shock (shock index?Results: When compared with group B, group A had higher in vitro fertilization-embryo transfer (IVF-ET) pregnancy rate (58.3 versus 12.0%, p?p?p?p?Conclusions: For the first time, IVF-ET pregnancy was found to be a risk factor for the development of hemorrhagic shock in women with placental polyp.     

The influence of thyroid autoimmunity on embryo quality in women undergoing assisted reproductive technology

The influence of thyroid autoimmunity in assisted reproductive technology (ART) outcome in euthyroid women is still controversial. In this study, we retrospectively evaluated embryo quality in 123 euthyroid women undergoing ART with or without thyroid autoantibodies (TAA). Embryo quality was assessed in 119 embryos of 29 infertile patients with TAA and in 394 embryos of 94 infertile patients without TAA. Our results showed not statistically significant differences in age, body mass index, anti-Müllerian hormone, follicle stimulating hormone, free triiodothyronine, and free thyroxine levels between cases and controls. Thyroid stimulating hormone was within the normal range, but significantly higher in TAA patients compared with the controls (2.4?±?0.8 vs. 2?±?0.9?mIU/L, respectively, p?p?相似文献   

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.     

The Effects of Oxidative Stress on Outcomes of Assisted Reproductive Techniques

Purpose : To investigate the impact of oxidative stress on pregnancy success by monitoring malondialdehyde levels in follicular fluid. Methods : Forty five couples were enrolled in this prospective study. Following long protocol of GnRH analogues and r-FSH treatment, oocyte retrieval and intracytoplasmic sperm injection were performed. Malondialdehyde levels were assayed by thiobarbutiric acid reacting substances test. Student's t-test and χ² test were used for statistical analysis. Results : Patients were divided into two groups; group I (pregnancy positive, n = 20), group II (pregnancy negative, n = 25). There was no statistical significant difference in terms of age, infertility period, FSH levels on the third day, number of oocytes retrieved and fertilization rates between the two groups. Pregnancy rates were found to be decreasing in higher malondialdehyde levels. Conclusion : Malondialdehyde can be used as a marker of oxidative stress and a potential marker in predicting assisted reproductive techniques outcome.     

Ultrasound guided embryo transfer significantly improves pregnancy rates in women undergoing oocyte donation.

OBJECTIVES: Recent reports suggest ultrasound (US) guided embryo transfer (ET) improves pregnancy rates. Using the ovum donation model to eliminate confounding variables, we assessed the impact of US guided ET on pregnancy rates, implantation rates, and multiple gestation rates. METHODS: All women who underwent IVF-ET cycles using donated oocytes from November 1997 to September 1998 (n = 137) were evaluated retrospectively. ET from November 1997 to April 1998 were performed without US, while all ET from May 1998 to September 1998 were performed using transvaginal or transabdominal US. ET was further categorized as easy or difficult. Difficult ET was defined as requiring at least two attempts and/or the presence of blood on the catheter and/or > 5 min. RESULTS: Pregnant patients (n = 73) were similar with respect to the number and morphology of the embryos transferred compared to non-pregnant patients (n = 65). US guidance significantly improved implantation and pregnancy rates in cycles with easy transfers [28.8 vs. 18.4% and 63.1 vs. 36.1%, respectively (P < 0.05)] without impacting multiple pregnancy rates. CONCLUSION: US guided ET is simple and reassuring and appears to significantly improve pregnancy outcomes in ovum donation cycles by optimizing the placement of embryos.     

Heterotopic pregnancy following in vitro fertilization and embryo transfer: 12 cases report

Objective  To evaluate the incidence, predisposing factors, early diagnosis and treatment options of heterotopic pregnancy (HP) following in vitro fertilization and embryo transfer (IVF-ET) procedure. Methods  A retrospective review study was performed to identify the HP cases after IVF-ET at the Reproductive Centre in Guangdong Women and Children’s Hospital in China between the years of 2002–2007. Results  Twelve out of 1,476 pregnancies (0.81%) were diagnosed for HP, of which nine patients elected for exploratory salpingectomy, two patients received selective fetal reduction by embryo aspiration under ultrasound guidance, and one patient opted for expectant treatment. Postoperatively, four intrauterine pregnancies were continued to develop until term while two were delivered at 35 weeks of gestation. The achievement ratio of continuous pregnancy was 66.7% (6/9). Conclusion  The incidence of HP is increasing due to the widespread use of assisted reproductive technology. An early transvaginal sonography performed by experienced radiologist/radiographer is considered to be essential and beneficial in establishing early diagnosis of HP. Both salpingectomy and selective fetal reduction by embryo aspiration can be administered as one of the effective therapies for HP with the optimal outcome of intrauterine pregnancy.     

The impact of embryo quality on pregnancy outcome in elderly women undergoing in vitro fertilization-embryo transfer (IVF-ET)

Most IVF-ET units limit the procedure to women below age 38. Nevertheless, demands for infertility treatment, including IVF therapy, are more frequent nowadays. We compared 46 cycles for ovulation induction for IVF in 46 women aged 40 or more (Group I) to 51 induced cycles for this procedure in younger women of mean age 30.2 years (Group II). Cancellation rates due to early luteinization or ovulation were significantly higher in group I than in group II (28.2 and 17.6%, respectively) (P<0.001). Also, significantly higher abortion rates were observed in older women (62.5%), in comparison to the younger control group, (25%), (P<0.001). It is suggested that the high abortion rate considered to be due to genetic factors in older women, may possibly also be due to the aging uterine environment. Furthermore, while embryos with fragmentations may often produce clinical pregnancies in the young, the aging uterus in the elderly woman does not encourage the development of clinical pregnancies in such embryos. Consequently the higher abortion rate in the elderly woman.     

Recombinant human albumin supports mouse blastocyst development,suppresses apoptosis in blastocysts and improves fetal development

Aim  Human serum albumin (HSA) is usually added to human in vitro fertilization culture medium to support embryo development, but carries some risk of contamination with various other compounds. Recombinant human albumin (rHA) has been shown to be a chemically defined protein. We evaluated the effect of rHA on mouse embryo development. Methods  B6D2F1 pronuclear oocytes were cultured in protein-free potassium simplex optimized medium with non-essential and essential amino acids supplemented with rHA, HSA (1 mg/mL) or polyvinyl alcohol (PVA; 0.1 mg/mL) for 96 h. The incidence of apoptosis and the generation of nitric oxide (NO) in blastocysts and fetal development after embryo transfer were examined. Results  Blastocyst development was equal in the three supplements. The incidence of apoptosis and the generation of NO in blastocysts developed in rHA was significantly (P < 0.05) lower than in HSA or PVA. After transfer of blastocysts developed in rHA, the percentage of fetal development was significantly (P < 0.05) higher than in HSA or PVA (75.8 ± 2.2% vs 46.8 ± 7.5% or 42.4 ± 3.9%, respectively). Conclusions  Supplementing culture medium with rHA resulted in decreased apoptosis and increased fetal development after embryo transfer. The results show that the presence of rHA in the culture medium is beneficial for producing high-quality blastocysts.     

Expectations for oocyte fertilization and embryo cleavage after whole sperm versus sperm head intracytoplasmic sperm injection

OBJECTIVE: To compare oocyte fertilization and embryo development after intracytoplasmic sperm injection (ICSI) with a whole sperm vs. a sperm head. DESIGN: Retrospective study. SETTING: Hospital-based IVF practice. PATIENT(S): Fifty-three women undergoing 54 IVF-embryo transfer plus ICSI procedures between January 1999 and June 2002. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Oocyte fertilization, zygote cleavage, and embryo stage after 72 hours of culture. RESULT(S): A significantly higher fertilization rate was observed using whole sperm (72.2%) than when using sperm heads (56.4%). Zygote cleavage rates for whole sperm vs. sperm head ICSI were 96.4% and 92.7%, respectively. Embryo cell stage after 72 hours of culture for whole sperm vs. sperm head ICSI was 6.5 +/- 2.1 cells and 5.6 +/- 1.8 cells, respectively. Embryo grade at this same time point was not different (2.3 +/- 1.0 and 2.5 +/- 0.9, respectively). CONCLUSION(S): The ICSI using whole sperm produces superior fertilization rates compared to ICSI using sperm heads, but once oocytes were fertilized, zygote cleavage rates were not different between the two sperm sources. Oocytes injected with a whole sperm produced embryos of higher cell stage but equivalent quality compared to oocytes injected with sperm heads. Therefore, having only sperm heads for use in ICSI should not be a deterrent to using this procedure.     

Effect of a supplementation with myo-inositol plus melatonin on oocyte quality in women who failed to conceive in previous in vitro fertilization cycles for poor oocyte quality: a prospective,longitudinal, cohort study

Background.?Several factors can affect oocyte quality and therefore pregnancy outcome in assisted reproductive technology (ART) cycles. Recently, a number of studies have shown that the presence of several compounds in the follicular fluid positively correlates with oocyte quality and maturation (i.e., myo-inositol and melatonin).

Aim.?In the present study, we aim to evaluate the pregnancy outcomes after the administration of myo-inositol combined with melatonin in women who failed to conceive in previous in vitro fertilization (IVF) cycles due to poor oocyte quality.

Materials and methods.?Forty-six women were treated with 4 g/day myo-inositol and 3 mg/day melatonin (inofolic® and inofolic® Plus, Lo.Lipharma, Rome) for 3 months and then underwent a new IVF cycle.

Results.?After treatment, the number of mature oocytes, the fertilization rate, the number of both, total and top-quality embryos transferred were statistically higher compared to the previous IVF cycle, while there was no difference in the number of retrieved oocyte. After treatment, a total of 13 pregnancies occurred, 9 of them were confirmed echographically; four evolved in spontaneous abortion.

Conclusion.?The treatment with myo-inositol and melatonin improves ovarian stimulation protocols and pregnancy outcomes in infertile women with poor oocyte quality.     

The influence of oocyte maturity and embryo quality on pregnancy rate in a program for in vitro fertilization-embryo transfer

An important factor influencing the pregnancy rate after in vitro fertilization-embryo transfer (IVF-ET) appears to be the number of embryos transferred to the uterus. In this study, the influence of oocyte maturity and embryo quality on pregnancy rate was assessed in patients undergoing IVF-ET. Ovarian hyperstimulation was performed by human menopausal gonadotropin (hMG [n = 29]), clomiphene citrate (CC)/hMG (n = 81), and hMG/follicle-stimulating hormone (FSH [n = 13]) protocols. Oocyte maturity was graded on a scale from 1 to 5 based on the morphology of the ooplasm, cumulus mass, corona radiata, and membrana granulosa cells. Embryos were graded according to the symmetry of the blastomeres and the presence or absence of fragmentation. Mature preovulatory oocytes yielded the highest fertilization rates. No differences were found among the protocols in terms of fertilization rate, embryo quality, or pregnancy rate. When all protocols were combined, patients who conceived had a significantly higher number of embryos transferred than those who did not conceive (3.6 +/- 0.1 [mean = SEM] versus 2.7 +/- 0.1). When embryo quality was compared, there was no difference in the number of "B" embryos transferred between patients who conceived and those who did not (1.2 +/- 0.2 versus 1.2 +/- 0.1), but the patients who conceived had significantly more "A" embryos transferred (1.6 +/- 0.3 versus 0.8 +/- 0.1). These data suggest that the treatment protocol did not determine embryo quality. Furthermore, the increase in pregnancy rates seen with an increase in embryos transferred is the result of the transfer of more "A" embryos.     

Prognostic factors for patients undergoing vitrified-warmed human embryo transfer cycles: a retrospective cohort study

We examined the prognostic factors for pregnancy in 210 vitrified-warmed embryo transfer (ET) cycles in 121 patients. The univariate analysis showed that age, gravida, the number of cycles associated with infertility caused by endometriosis, the number of previous assisted reproductive technology (ART) treatment cycles, and the number of ICSI procedures were significantly lower in pregnant cycles compared with non-pregnant cycles. The percentages of ET using at least one intact embryo and of ET using at least one embryo that had developed further after warming were significantly higher in pregnant cycles compared with non-pregnant cycles. Multivariate logistic regression analysis showed that previous ART treatment cycles, ET with at least one intact embryo, and ET using at least one embryo that had developed further were independent prognostic factors for pregnancy in vitrified-warmed ET cycles. We conclude that fewer previous ART treatment cycles, ET using at least one intact embryo, and ET with embryos that have developed further after warming might be favourable prognostic factors for pregnancy in vitrified-warmed ET cycles.     

A new method to assess oxidative stress in ART cycles

The role of oxidative stress (OS) in female reproduction is an understudied area for investigation. The aim of the study was to assess reactive oxygen species (ROS) levels both in follicular fluid (FF) and in serum samples of women undergoing IVF and to relate them to clinical outcomes. A total of 56 women were enrolled. From each patient a sample of serum and FF were collected at oocyte retrieval day and analyzed for OS, by measuring a class of reactive oxygen metabolites (ROMs) (dROMs test) and for biological anti-oxidant potential levels (BAP test). The data analyzed in serum and in FF were related to pregnancy outcomes. There was no significant relationship between d-ROMs and BAP levels in serum or FF GROUP A and B and the clinical parameters of prognosis of women: age, number of oocytes retrieved number of oocytes methaphase II, FSH, fertilization rate and cleavage rate, number of embryos transferred and embryo score. There was a positive association between systemic levels of OS measured in serum GROUP A and pregnancy outcomes (p?=?0.007) suggesting that the evaluation of OS in FF needs more investigation about markers in follicular microenvironment in order to predict IVF success.     

Effectiveness of high‐dose transvaginal progesterone supplementation for women who are undergoing a frozen‐thawed embryo transfer

Purpose

To evaluate the effectiveness of high‐dose progesterone supplementation for women who are undergoing a frozen‐thawed embryo transfer (FET).

Methods

Among the 2010 FET cycles that were included in the present study, 1188 were 1200 mg/d of vaginal progesterone, while 822 were 900 mg/d. The dose of progesterone that was used was decided by the treatment period and additional progesterone supplementation was used when the serum progesterone levels were <9 ng/mL on luteal day 5.

Results

The clinical pregnancy rate was higher in the 1200 mg group than in the 900 mg group. The mean serum progesterone level on luteal day 5 in the 1200 mg and 900 mg groups was 12.6 ng/mL and 13.4 ng/mL, respectively. The rate of additional progesterone supplementation was higher in the 1200 mg group. A logistic regression analysis identified a younger age (≤37 years) and the use of 1200 mg progesterone as independent predictive factors for the clinical pregnancy outcome. The analysis of the infant outcomes revealed no significant difference in the distribution of birth ages and weights.

Conclusion

High‐dose transvaginal progesterone of 1200 mg/d as luteal support contributed to good pregnancy outcomes.     

体外受精-胚胎移植女性患者心理韧性及其影响因素研究

目的探讨接受体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)女性患者影响心理韧性的因素。方法采用一般资料调查表、心理韧性量表、一般自我效能感量表、简易应对方式量表、领悟社会支持量表对进行IVF/ICSI-ET的189例女性患者进行问卷调查。结果 IVF/ICSI-ET女性患者的心理韧性总分为(61.4±11.7)分,显著低于国内普通人群[(65.4±13.9)分](P0.05),一般自我效能、积极应对方式、家庭内支持状况、文化程度、不孕类型、治疗周期数及不孕原因是心理韧性的主要影响因素,共同解释了IVF/ICSI-ET女性患者心理韧性63.00%的变异。结论 IVF/ICSI-ET女性患者心理韧性总体水平较差,医护人员应采取针对性的心理干预措施来提高其心理韧性,改善其心理健康状况,提高治疗效果。