Good oocytes for successful IVF cycles

Human fertility is mainly related to the egg quality both in spontaneous and IVF induced cycles.     

Natural IVF cycles may be desirable for women with repeated failures by stimulated IVF cycles

Purpose Although many reports support stimulated in vitro fertilization, several patients do not respond to it well. Furthermore, stimulated treatment could be associated with reduced ovarian response. We describe three successful cases involving patients of advanced age from whom dominant follicles were retrieved during the natural cycle. Materials and methods All patients had failed to bear children through stimulated in vitro fertilization. In case 1, a follicle was retrieved after a gonadotropin-releasing hormone agonist was used to induce luteinizing hormone surge. In cases 2 and 3, pregnancy was achieved via completely natural cycles. Results One embryo was transferred every 16 cycles. Ongoing pregnancy—defined as pregnancy progressing beyond gestation week 9—was established in three cycles. The patients successfully delivered and had uneventful neonatal courses. Conclusion Mature oocyte retrieval followed by natural rather than stimulated in vitro fertilization might be a potential treatment for patients of advanced age when stimulated in vitro fertilization has been repeatedly unsuccessful. Capsule We describe three successful pregnancies and deliveries achieved via natural IVF cycles: the patients were older than 37 years with repeated failures by stimulated IVF.     

Physical symptoms throughout IVF cycles

The physical impact of in vitro fertilisation (IVF) is not well explored. The aim of this prospective controlled longitudinal study was to examine the impact of 11 symptoms during an entire long down regulation (LDR) cycle and to determine the effect of the mean recombinant follicle stimulating hormone (RecFSH) dose and ovarian responsiveness of patients and outcome had on reported symptoms. The severity of symptoms was measured using a daily questionnaire to determine a total summary score (TSS) for each symptom, a summary symptom score (SSS) based on all TSS and a mean daily severity for each symptom. Outcome was determined by beta human chorionic gonadotrophin (β-hCG) test result. 79.1% of women undertaking LDR IVF cycles had significant physical symptoms. Treatment symptom severity peaked at oocyte retrieval, with prominent symptoms including bloating, abdominal pain/cramps and fatigue. No relationship was found between outcome, RecFSH dose and ovarian responsiveness with reported symptoms. In conclusion, IVF places a real physical burden on women should be encouraged to reduce undertaking LDR cycles. The impact of the symptoms, particularly the increase in severity leading up to day of oocyte retrieval suggests that women may be warned to reduce stress and activities during this time.     

Endometrial receptivity evaluation in IVF cycles

Abstract

Endometrial receptivity formation in in vitro fertilization (IVF) cycles was assessed both on molecular level: leukemia-inhibitory factor (LIF), transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor (VEGF), granulocyte macrophage colony stimulating growth factor (GM-CSF) together with hemodynamic characteristics of uterine (Ua) arteries.

Aim: Aim of study was to working out an endometrial receptivity evaluation-based prognostic model for IVF efficacy in examined patients.

Materials and methods: A total of 97 infertility patients in IVF cycles enrolled in the study. Тwo groups were formed, retrospectively. Group I included 50 women with ultrasound-confirmed pregnancy (51.55%), while the second one embraced 47 women with failed pregnancy. Within the pre-supposed “window of implantation” (WOI) in the preceding IVF cycle, endometrial biopsy was done, succeeded by immunohistochemical assessment of LIF, VEGF and TGF-β1 expression in endometrial samples. The VEGF, GM-CSF and TGF-β1 content in the cervical mucus (CM) was measured by multiplex analysis on transvaginal puncture (TVP) and embryo transfer (ET) day. Hemodynamic characteristics (systolic/diastolic rate, S/D), resistance index (RI) and pulsation index (PI) of Ua arteries on the 2nd–3rd day of menstrual cycle, ovulation triggering (OT) and ET day were assessed.

Results: Based on logistic regression analysis, it was found that LIF expression in endometrial epithelium obtained on WOI period of the preceding IVF cycle; VEGF content in the CM on the TVP day, S/D rate and RI of spiral arteries on the OT day are of significant importance in endometrial receptivity formation. Built math model allows high accuracy (85.6%) prediction for pregnancy achieved through IVF by means of applying the suggested parameters.     

Spermatocyte antibodies in serum and follicular fluid of IVF and GIFT patients

With a new SPAK-ELISA test system (Seratec GmbH) we determined sperm antibodies in sera of 60 IVF, 11 GIFT patients and their husbands. We evaluated sperm antibodies in sera of 12 IVF (20.0%), 3 GIFT (27%) and 3 males with normozoospermia parameters (4.2%). Compared to seronegative patients either the number of oocytes and their quality as the fertilization- and embryo transfer rate during the IVF/GIFT procedure were not affected. No intact pregnancy occurred in cases of sperm antibodies in sera. In 16.6% of all seropositive IVF patients the detection of sperm antibodies in the follicular fluids correspond to sera. We recommend to remove autologous serum for the oocyte culture in cases of sperm antibodies in serum of IVF patients.     

In-vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT)

In the past decade, the use of in-vitro fertilization and embryo transfer (IVF-ET) procedures as a means of treatment of infertility has become a clinical reality. More recently, similar yet differing techniques have been described that further expand options of treatment of infertile couples. This article summarizes recent advances in IVF and compares it with the most widely recognized of these alternatives, gamete intrafallopian transfer (GIFT). In addition to comparing and contrasting these new technologies, the authors attempt to highlight unresolved questions about their use.     

Characterization of a suboptimal IVF population and clinical outcome after two IVF cycles

The number of oocytes retrieved in in vitro fertilization (IVF) cycles is an independent factor influencing pregnancy rate (PR), and optimal number of oocytes would be between 10 and 15. This has led to the hypothesis that the identification of a suboptimal group of responders beforehand (4–9 oocytes retrieved) would allow physicians to optimize their PR. A retrospective observational study counting on 735 women doing an IVF treatment in our center was performed. Multivariable logistic regression was used to analyze the relationship between anti-Mullerian hormone (AMH) and antral follicle count (AFC), within suboptimal and optimal responders. We also analyzed the outcome of those patients with an estimated high probability of having an optimal response and the second cycles of those who did not get pregnant in the first cycle to observe the main significant traits that made them change from one group of responders to the other. Main results are that suboptimal responders account for almost half of our patients. Ovarian reserve markers (AMH and AFC) are significantly different in optimal and suboptimal responders, even when adjusted by age. There is a significant difference in the cumulative PR between both groups. Interestingly, 18.9% shifted from suboptimal to optimal response, and 36.9% from optimal to suboptimal.     

Asymptomatic adenomyosis and embryo implantation in IVF cycles

Research on the effect of adenomyosis on the rate of success of IVF is controversial. Differences in study design, study power, criteria and instrument used to diagnose adenomyosis and choice of controls may explain these discrepancies. To establish whether embryo implantation is impaired in women with adenomyosis, women scheduled for IVF were prospectively evaluated for the presence of adenomyosis and whether this condition affected embryo implantation. Forty-nine women with adenomyosis diagnosed at transvaginal ultrasound with no abnormal uterine bleeding were recruited. They were matched for study period, age, day of embryo transfer and number of transferred embryos to 49 controls without the disease. In women with adenomyosis, 24 out of 76 embryos transferred implanted (32%); this occurred in 16 out of 76 (21%) in unaffected controls. The crude odds ratio of implantation in affected women was 1.73 (95% CI 0.83 to 3.60). The odds ratio adjusted for body mass index (the unique variable found to differ at univariate analysis) was 1.78 (95% CI 0.85 to 3.77). In conclusion, implantation rate is not impaired in asymptomatic women who are diagnosed with adenomyosis at transvaginal sonography. Affected women can be reassured about the effect of this condition on their chances of success.     

Psychosocial evaluation in an IVF/GIFT program in Hong Kong

Abstract

This report describes the psychosocial evaluation of 112 couples consecutively enrolled in the IVF/GIFT program in Hong Kong. The psychological profile of the women was similar to that of normal Chinese pregnant women. There were significantly higher scores for measures of anxiety in women than in men. Chinese traditional belief influenced most of the couples in their attitude towards infertility. Most couples could accept IVF/GIFT treatment as a means to conceive a baby, but nearly half were unwilling to disclose their treatment to other people. Only half of the couples had social support. It is speculated that the couples will face psychological stress during treatment.