Risk factors for high-order multiple pregnancy and multiple birth after controlled ovarian hyperstimulation: results of 4,062 intrauterine insemination cycles

OBJECTIVE: To determine factors responsible for high-order multiple pregnancy (HOMP) and high-order multiple births when multiple cycles of controlled ovarian hyperstimulation-IUI (COH-IUI) are performed. DESIGN: Retrospective analysis. SETTING: Private infertility clinic. PATIENT(S): Women (n = 2,272) who underwent 4,067 consecutive COH-IUI cycles. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): High-order multiple pregnancy rate, pregnancy rate (PR), and birth rate (PR) per cycle. RESULT(S): High-order multiple pregnancy was related to number of follicles of diameter > or = 10 mm, age, and treatment cycle. For age <32 years, HOMP was 6% for three to six follicles and 20% for seven or more follicles. For ages 32 to 37 years, HOMP was 5% for three to six follicles and 12% for seven or more follicles. In the first COH-IUI cycle, HOMP was 8% for three to six follicles and 15% for seven or more follicles. In the second cycle, HOMP did not occur unless there were more than six follicles. No HOMP occurred after the second cycle. Pregnancy rate did not increase significantly when there were more than four follicles. Continuing COH-IUI past the third cycle resulted in additional pregnancies in patients with one to eight follicles. CONCLUSION(S): High-order multiple pregnancy can be predicted by age and number of follicles of diameter > or = 10 mm. Controlled ovarian hyperstimulation is not necessary to achieve satisfactory overall pregnancy rates if ovulation induction is continued past the third cycle in low responders.     

Treatment with piroxicam before embryo transfer increases the pregnancy rate after in vitro fertilization and embryo transfer

OBJECTIVE: To examine the effect of beta-cyclodextrin piroxicam treatment for priming of the uterus on the pregnancy outcome of IVF-embryo transfer (ET) programs. DESIGN: Prospective, randomized, double-blinded placebo-controlled clinical study. SETTING: Large urban medical center. PATIENT(S): One hundred eighty-eight consecutive cycles of fresh IVF-ET and 78 cycles of frozen-thawed ET. The patients underwent IVF because of tubal, male infertility, unexplained, or endometriosis factors. They were randomly divided into treatment and control groups. INTERVENTION(S): In the treatment group, 94 cycles in fresh ET and 39 cycles in frozen-thawed ET the patients received an oral dose of 10 mg of piroxicam. In the control group, the same number cycles corresponding to the treatment group were treated with placebo. Both groups started piroxicam or placebo treatment 1-2 hours before ET. Patients and staff were blinded to the treatment. MAIN OUTCOME MEASURE(S): Implantation rate (IR) and pregnancy rate (PR). RESULT(S): Piroxicam increased significantly IR (18.7%) and PR (46.8%) compared to the control group (8.6% and 27.6%, respectively) in fresh cycles. With the exception of an unexplained factor, patients with the tubal, male infertility, or endometriosis factor had significantly higher PR in the treatment group compared to the control group. The beneficial effect of piroxicam was found in patients less than 40 years old, but was not found in patients more than 40 years. In frozen-thawed cycles, there were statistically significant differences between the treatment group and the control group in IR (9.4% vs. 2.3%) and PR (25.6% vs. 7.7%), respectively. CONCLUSION(S): Our study showed that piroxicam increases IR and PR after IVF-ET in both fresh and frozen-thawed ET cycles. The beneficial effect seems to be more remarkable in patients less than 40 years old with tubal, male infertility, or endometriosis factors. These results suggest that piroxicam treatment before ET is very effective in the priming of a uterus suitable for embryo implantation. This is the first study to investigate the possible consequence of piroxicam for improving the PR after IVF-ET.     

Early pituitary desensitization and ovarian suppression with leuprolide acetate is associated with in vitro fertilization-embryo transfer success

OBJECTIVE: To determine if the timing of the onset of pituitary desensitization and ovarian suppression using follicular phase leuprolide acetate (LA) is associated with in vitro fertilization-embryo transfer (IVF-ET) success for pregnancy. DESIGN: Retrospective series of IVF patients undergoing pituitary desensitization and ovarian suppression before beginning controlled ovarian hyperstimulation for IVF-ET. SETTING: Tertiary infertility practice. PATIENTS: Seventy-eight women for 80 cycles began LA on day 1 of their menstrual cycle. After 11 days of LA, 47 (59%) cycles in group I had suppressed serum estradiol (E2) levels less than 40 pg/mL, in contrast to 33 (41%) cycles in group II not adequately suppressed, thereby requiring additional days to achieve suppression. INTERVENTIONS: Controlled ovarian hyperstimulation was started when patients were satisfactorily suppressed, i.e., E2 less than 40 pg/mL. MAIN OUTCOME MEASURE(S): Mean E2 response, ampules of human menopausal gonadotropin, cancellation rates, number of oocytes retrieved, fertilization rates, and pregnancy rates (PRs) per cycle were examined between groups I and II. RESULTS: Group I demonstrated a greater mean E2 response on the day of human chorionic gonadotropin 1,735 pg/mL versus 1,470 pg/mL (P = 0.008), a greater fertilization rate 64% versus 55% (P = 0.02), and a higher PR per cycle 34% versus 12% (P = 0.036) compared with group II. CONCLUSIONS: Women who achieved desensitization-suppression within 11 days of initiating LA demonstrated a more favorable outcome for IVF-ET than those who did not.     

Ovarian cancer risk associated with varying causes of infertility

OBJECTIVE: To evaluate the risk of ovarian cancer as related to underlying causes of infertility. DESIGN: Retrospective observational cohort study. SETTING: Five large reproductive endocrinology practices. PATIENT(S): A total of 12,193 women evaluated for infertility between 1965 and 1988. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Ovarian cancer ascertained through 1999. RESULT(S): With 45 identified ovarian cancers, this cohort of infertility patients demonstrated a significantly higher rate of ovarian cancer than the general female population (standardized incidence ratio [SIR] = 1.98; 95% confidence interval [CI], 1.4-2.6). The risk was higher for patients with primary infertility (SIR = 2.73) than for those with secondary infertility (SIR = 1.44), and it was particularly high for patients who never subsequently conceived (SIR = 3.33). Women with endometriosis had the highest risk (SIR = 2.48; 95% CI, 1.3-4.2), with a further elevated risk among those with primary infertility (4.19, 2.0-7.7). Comparisons among the infertile women, which allowed calculation of rate ratios (RRs) after adjustment for multiple factors, also showed links with endometriosis. Compared with women with secondary infertility without endometriosis, patients with primary infertility and endometriosis had a RR of 2.72 (95% CI, 1.1-6.7). CONCLUSION(S): Determination of ovarian cancer risk should take into account the type of infertility (primary vs. secondary) and underlying causes. Further study of endometriosis may provide insights into ovarian carcinogenesis.     

Laparoscopic management of hydrosalpinges before in vitro fertilization-embryo transfer: salpingectomy versus proximal tubal occlusion

OBJECTIVE: To compare ovarian response and IVF-ET cycle outcome in patients with hydrosalpinges managed by either laparoscopic salpingectomy or proximal tubal occlusion. DESIGN: Retrospective analysis. SETTING: Tertiary-care assisted reproductive technology program. PATIENT(S): One hundred four consecutive fresh IVF-ET cycles in 94 patients with tubal-factor infertility. INTERVENTION(S): Laparoscopic salpingectomy (group 1: 35 cycles) or bipolar proximal tubal occlusion (group 2: 17 cycles), controlled ovarian hyperstimulation, and IVF-ET. Control groups consisted of both tubal-factor patients without hydrosalpinges (group 3: 37 cycles) and those with prior bilateral tubal ligation for sterilization (group 4: 15 cycles). MAIN OUTCOME MEASURE(S): Uterine artery Doppler flow, controlled ovarian hyperstimulation response, and implantation and clinical pregnancy rates. RESULT(S): There were no differences in mean uterine artery pulsatility indices or ovarian response among any of the groups. A trend toward a higher cycle cancellation rate in group 1 did not approach statistical significance. Clinical pregnancy and implantation rates were not significantly different between group 1 (57.1%, 29.2 +/- 5.9%, respectively) and group 2 (46.7%, 19.4 +/- 6.1%, respectively) or compared with those of controls. CONCLUSION(S): [1] Management of hydrosalpinges by laparoscopic salpingectomy or bipolar proximal tubal occlusion yielded statistically similar responses to controlled ovarian hyperstimulation and IVF-ET cycle outcome. [2] The latter approach may be preferable in patients who present with dense pelvic adhesions and easy access only to the proximal fallopian tube.     

Comparison of the effectiveness of single intrauterine insemination (IUI) versus double IUI per cycle in infertile patients

OBJECTIVE: To compare a single periovulatory intrauterine insemination (IUI) with a regimen based on double IUI, performed during preovulatory and periovulatory periods, in patients undergoing controlled ovarian hyperstimulation (COH). DESIGN: Prospective, randomized study. SETTING: Infertility and endocrinology units of a medical university. PATIENT(S): One hundred ten patients with male factor, cervical factor, and unexplained infertility who were undergoing 486 cycles of COH with IUI. INTERVENTION(S): The patients were randomly divided into two groups. One group underwent single IUI in the first cycle and double IUI in the second cycle; this alternating pattern was continued up to six cycles unless pregnancy occurred. For patients in the second group, double IUI was performed in the first cycle and single IUI in the second cycle; this pattern was repeated as in the first group. MAIN OUTCOME MEASURE(S): Relationship of single and double IUI to rates of clinical pregnancy and abortion. RESULT(S): Forty-two women became pregnant, with an overall pregnancy rate per cycle of 8.6% and pregnancy rate per couple of 38.2%. Pregnancy rate per cycle was 7.9% in single IUI cycles and was 9.4% in double IUI cycles; these findings were not statistically significant. CONCLUSION(S): Among patients undergoing COH-IUI, results of single and double IUI do not statistically differ.     

Effect of prolonged gonadotropin-releasing hormone agonist therapy on the outcome of in vitro fertilization-embryo transfer in patients with endometriosis

OBJECTIVE: To evaluate the effect of a 3-month course of GnRH agonist administered immediately before IVF-ET in infertile patients with endometriosis. DESIGN: Prospective, randomized trial. SETTING: Three tertiary care assisted reproductive technology programs. PATIENT(S): IVF-ET candidates with surgically confirmed endometriosis. INTERVENTION(S): Twenty-five patients received three courses of a long-acting GnRH agonist, 3.75 mg i.m. every 28 days, followed by standard controlled ovarian hyperstimulation. Twenty-six patients received standard controlled ovarian hyperstimulation with mid-luteal phase GnRH agonist down-regulation or microdose flare regimens. MAIN OUTCOME MEASURE(S): Response to controlled ovarian hyperstimulation, ongoing pregnancy rates per cycle, group implantation rates, and implantation rate per embryo transfer procedure. RESULT(S): The extent of surgically confirmed endometriosis was greater in patients who received the long-acting GnRH regimen for 3 months before IVF-ET. The groups did not differ significantly in terms of dose or duration of gonadotropin stimulation, number of oocytes retrieved, fertilization rate, or number of embryos transferred. Patients who received the long-acting GnRH regimen had significantly higher ongoing pregnancy rates (80% vs. 53.85%) and a trend toward higher implantation rates (42.68% vs. 30.38%). CONCLUSION(S): Prolonged use of GnRH agonist before IVF-ET in patients with endometriosis resulted in significantly higher ongoing pregnancy rates than did standard controlled ovarian hyperstimulation regimens. No deleterious effect on ovarian response was observed.     

子宫内膜异位症影响体外受精-胚胎移植结局的初步探讨

目的　探讨子宫内膜异位症的严重程度对体外受精 胚胎移植 (IVF ET)各个环节的影响。方法　对1999年 1月至 2 0 0 2年 4月在中山大学附属第一医院 10 7例已明确分期的子宫内膜异位症不育患者共 139周期IVF ET与同期输卵管因素不育患者 139例进行的 139周期IVF ET的控制性超排卵 (COH)治疗、受精率、卵裂率、每周期胚胎植入率和临床妊娠率、流产率等进行回顾性对照分析。结果　中、重度子宫内膜异位症不育患者与对照组相比进行IVF治疗时使用促性腺激素的总量增加而获卵数减少。重度患者雌二醇 (E2 )峰值下降 ,流产率增加 ,差异有统计学意义 (P <0 0 5 )。子宫内膜异位症不育患者IVF ET治疗时随着病情加重 ,卵巢对控制性超排卵的反应性下降 ,重度患者流产率增高。结论　子宫内膜异位症影响了卵子与胚胎的发育。     

Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin?

OBJECTIVE: To evaluate the ovarian response to stimulation conducted for IVF treatment in women who have undergone conservative surgery for endometriomas. DESIGN: Retrospective study with prospective selection of participants and controls. SETTING: University infertility clinic. PATIENT(S): A series of 374 women who underwent in vitro fertilization (IVF). The study group consisted of 85 patients with ovarian endometriomas who had undergone laparoscopic surgery in an attempt to become pregnant, but had failed within a year of surgery. The control group consisted of 289 patients with tubal factor infertility. INTERVENTION(S): IVF-embryo transfer procedures. MAIN OUTCOME MEASURE(S): Stimulation parameters, fertilization, implantation, and pregnancy rates were analyzed in both groups. RESULT(S): There was no significant difference between the two groups in stimulation parameters or IVF outcome. CONCLUSION(S): A total of 820 cycles were analyzed. A similar IVF-ET outcome was observed in patients with endometriosis after ablation of endometriomas compared to women with tubal factors. In conclusion, endometrioma surgery by internal wall vaporization does not impair IVF outcome. The clinical pregnancy rate was respectively 37.4% and 34.6% in the endometriosis group and the control group.     

超排卵对宫腔内人工授精周期妊娠率的影响

目的分析超排卵对人工授精结局的影响，探讨超排卵对不同人群治疗的有效性。方法回顾性分析我院生殖科2000年3月-2007年12月期间女方有自发排卵的739个人工授精周期，比较不孕原因、女方年龄、有无子宫内膜异位症等因素下超排卵与自然周期妊娠率。结果739个人工授精周期中，超排卵周期233个，自然周期506个，妊娠率分别为21．6％和13．5％（P〈0.05），不孕因素中，宫颈因素为378个，男性因素为100个，盆腔输卵管因素44个，子宫内膜异位症85个，不明原因132个，其中宫颈因素和不明原因不孕周期超排卵周期妊娠率明显高于自然周期（22．40％，14．62％；27．03％，12．63％ P〈0.05）；男性因素、输卵管因素、子宫内膜异位症、女方年龄大于37岁周期，超排卵与自然周期妊娠率差异无显著性（P〉0.05）。超排卵周期中，氯米芬与促性腺素周期临床妊娠率无显著差异（P〉0.05）。结论因宫颈因素、不明原因不孕行人工授精夫妇超排卵周期妊娠率高，而男性因素、子宫内膜异位症、盆腔输卵管因素或年龄大于37岁妇女进行人工授精时慎重选择排卵诱导。     

Laparoscopic ovarian cystectomy of endometriomas does not affect the ovarian response to gonadotropin stimulation

OBJECTIVE: To evaluate the ovarian response cycles of IVF-ET in patients who previously underwent laparoscopic cystectomy for endometriomas. DESIGN: Retrospective study with prospective selection of participants and controls. SETTING: Instituto de Ginecología y Fertilidad Buenos Aires, Argentina. PATIENT(S): Thirty-nine patients underwent an operation for ovarian endometriomas by atraumatic removal of the pseudocapsule with minimal bipolar cauterization of small bleeders and an IVF-ET cycle (group A) and 39 control patients of similar age underwent an IVF-ET cycle for tubal factor infertility (group B). INTERVENTION(S): Laparoscopic endometrioma cystectomy, IVF-ET cycle. MAIN OUTCOME MEASURE(S): E(2) levels, number of gonadotropin ampoules, follicles, oocytes retrieved, number and quality of embryos transferred, and clinical pregnancy rate. RESULT(S): There were no differences in all the parameters studied (E(2) levels, number of follicles, oocytes retrieved, number and quality of embryos transferred, and clinical pregnancy rate) except for the number of gonadotropin ampoules needed for ovarian hyperstimulation, which was significantly higher in group A than in group B. CONCLUSION(S): Our results indicate that laparoscopic cystectomy for endometriomas is an appropriate treatment since it did not negatively affect the ovarian response for IVF-ET.     

Different influence of incongruent follicular development on in vitro fertilization–embryo transfer and gamete intrafallopian transfer pregnancy rates

Objective: To compare the influence of incongruent (asymmetric) follicular development on treatment outcome in IVF-ET and GIFT cycles.

Design: A retrospective comparative study.

Setting: Tertiary referral center for infertility.

Patient(s): Five hundred forty-three consecutive assisted reproduction cycles (428 IVF-ET and 115 GIFT) in 422 infertile patients.

Intervention(s): Controlled ovarian hyperstimulation (COH) and IVF-ET or GIFT.

Main Outcome Measure(s): The incongruity ratio as a parameter of the asymmetry in follicular development and pregnancy rate (PR).

Result(s): For GIFT cycles, the PRs were 37.8% and 15.7% in cycles with congruent and incongruent follicular development, respectively. However, for IVF-ET cycles, the PR was not affected by incongruent follicular development: 28.2% and 29.0%, respectively. An inverse relationship was observed between the degree of incongruity and the estimated probability of pregnancy in GIFT cycles but not in IVF-ET cycles. Neither the side of the dominant ovary nor the degree of incongruity were consistent in consecutive cycles.

Conclusion(s): Incongruent follicular development during COH has a significantly negative influence on the outcome of GIFT cycles but not on the outcome of IVF-ET cycles. The reason for this difference is not clear. We recommend considering IVF-ET instead of GIFT if incongruent follicular development occurs.     

IVF-ET in women with refractory polycystic ovarian disease

Polycystic ovarian disease may be a cause of hormonal infertility. This condition is often refractory to therapy. Three groups of randomly chosen women with refractory polycystic ovarian disease (PCOD) were treated by induction of ovulation with pFSH/hCG, pFSH/hMG/hCG or after down-regulation of the ovaries with a GnRH analogue (Decapeptyl). Out of 18 patients six conceived in the first in vitro fertilization-embryo transfer (IVF-ET) cycle, and two further women conceived in a later cycle. It is suggested that patients with refractory PCOD should be referred for IVF-ET therapy, possibly after treatment with a GnRH analogue.     

Controlled ovarian hyperstimulation and intrauterine insemination for treatment of unexplained infertility should be limited to a maximum of three trials

OBJECTIVE: To investigate the optimum number of cycles of controlled ovarian hyperstimulation and intrauterine insemination in the treatment of unexplained infertility. DESIGN: Observational prospective study. SETTING: In vitro fertilization embryo transfer center. PATIENT(S): Five hundred ninety-four couples with unexplained infertility. INTERVENTION(S): Controlled ovarian hyperstimulation (COH), intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S): Cycle fecundity. RESULT(S): One to 3 cycles of COH/IUI were performed in 594 patients (group A) undergoing 1,112 cycles (mean, 1.9 cycles/patient). Up to 3 further trials (cycles 4-6) of COH/IUI were then performed in 91 of these women (group B), a total of 161 cycles (mean, 1.8 cycles/patient). A historical comparison group C consisted of 131 patients with 3 failed cycles of COH/IUI who underwent 1 cycle of IVF and ICSI at our center. In group A, 182 pregnancies occurred, with a cycle fecundity of 16.4% and a cumulative pregnancy rate (PR) of 39.2% after the first 3 cycles. In group B, 9 pregnancies occurred in cycles 4-6, with a cycle fecundity of 5.6%, significantly lower than that of group A (P<.001). The cumulative PR rose to 48.5% by cycle 6, a further increase of only 9.3%. In the women undergoing IVF and ICSI in group C, 48 pregnancies occurred, with a cycle fecundity of 36.6% per cycle, significantly higher than that of group B (P<.001). CONCLUSION(S): In unexplained infertility, the cycle fecundity in the first three trials of COH and IUI was higher than in cycles 4-6, with a statistically significant difference. Patients should be offered IVF or ICSI if they fail to conceive after three trials of COH and IUI.     

Late manifestation of pelvic abscess following oocyte retrieval, for in vitro fertilization, in patients with severe endometriosis and ovarian endometriomata

Purpose: Our purpose was to study the unusual and rare late manifestation of severe pelvic abscess, following oocyte pickup (OPU), for in vitro fertilization and embryo transfer (IVF-ET). Patients: The patients were three infertile women with stage IV endometriosis and ovarian endometriomata, as the sole reason for their infertility. Medical and surgical modalities to treat endometriosis and infertility proved to be unsuccessful. Interventions: All patients were prepared for IVF-ET employing a long GnRH-a and hMG protocol. Transvaginal OPU was performed under ultrasound guidance. Intravenous (iv) prophylactic antibiotic was routinely administered. Results: All women underwent ET, and one conceived. Forty, 24, and 22 days after OPU, respectively, these patients presented with acute symptoms of severe pelvic inflammatory disease (PID) and were found to have pelvic abscess. Broad-spectrum iv antibiotics were employed in all cases, however, two patients did not respond and bilateral adnexectomy was eventually performed. Conclusions: Severe endometriosis with ovarian endometriomata seems to be a significant risk factor for pelvic abscess development, following transvaginal OPU for IVF-ET. Prophylactic IV cefazolin does not seem to prevent this complication. Late manifestation of pelvic abscess supports the notion that the presence of old blood in an endometrioma provides a culture medium for bacteria to grow slowly after transvaginal inoculation.     

子宫内膜异位症对体外受精-胚胎移植的影响

目的　探讨子宫内膜异位症 (内异症 )对体外受精 -胚胎移植 (Invitrofertilization -embryotransfer,IVF -ET)的影响。方法　对 2 0 0 1年 1月～ 2 0 0 3年 1 0月 86例内异症合并不育患者超促排卵、体外受精和胚胎移植结局等进行回顾性分析 (共 94个周期 ) ;同期 2 0 0例输卵管因素不育患者作为对照组。结果　内异症组促性腺激素需要量显著高于对照组 (P <0 0 1 )。内异症组的获卵数、受精率、优质胚胎数显著低于对照组 (P<0 0 5 ) ;裂率比较 ,差异无显著性 ;内异症组的胚胎着床率 (1 4 2 1 % )、临床妊娠率 (2 9 5 5 % ) ,低于对照组(1 9 5 2 % ,38 2 6 % ) ,差异无统计学意义。结论　内异症影响卵巢对促超排卵的反应 ,影响卵母细胞的受精。内异症患者着床率和临床妊娠率显示降低的趋势     

Laser vaporization of ovarian endometriomas: the impact on the response to gonadotrophin stimulation

OBJECTIVE: To evaluate the ovarian response to stimulation for IVF in endometriosis patients who have previously undergone laparoscopic treatment of peritoneal and/or ovarian endometriosis (CO2 laser vaporization). PATIENTS AND METHODS: Retrospective study of 455 patients undergoing IVF. The study group, made up of 127 endometriosis patients, was divided into 2 subgroups: Ia: 42 women with peritoneal endometriosis, treated by laparoscopy, who underwent 71 IVF cycles; Ib: 85 women with ovarian endometriomas, treated by vaporization of the internal wall, who underwent 187 IVF cycles. The control group, consisting of 328 women, was also divided into 2 subgroups: IIa: 193 women suffering from tubal infertility who underwent 422 IVF cycles; IIb: 135 women with idiopathic infertility who underwent 275 IVF cycles. RESULTS: The ovarian stimulation parameters (number of gonadotrophin ampoules, number of follicles and mature oocytes, maximum estradiol concentrations) were not significantly different in the various subgroups. The number of embryos obtained and transferred per cycle, the fertilization rates (group Ia: 61.81%; Ib: 60.90%; IIa: 62.48%; IIb: 57.99%), the implantation rates (group Ia: 17.72%; Ib: 15%; IIa: 13.94%; IIb: 18.05%) and the clinical pregnancy rates (group Ia: 32.39%; Ib: 37.40%; IIa: 27.49%; IIb: 30.18%) were not statistically different in the studied subgroups. DISCUSSION AND CONCLUSION: The theoretical risk of loss of ovarian cortex when treating endometriotic cysts can be eliminated by the technique of vaporization of the internal wall of the endometrioma.IVF outcomes are similar in patients treated for endometriosis and those presenting with unexplained or tubal infertility.     

Patients with stages III and IV endometriosis have a poorer outcome of in vitro fertilization-embryo transfer than patients with tubal infertility

Objective: To evaluate the outcome of IVF in patients with stages III and IV endometriosis.

Design: Retrospective study.

Setting: The Sara Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Israel.

Patient(s): Fifty-eight patients with stages III and IV endometriosis and 60 patients with tubal infertility.

Intervention(s): IVF-ET for all couples.

Main Outcome Measure(s): Fertilization, pregnancy, and birth rates.

Result(s): The comparison between patients with endometriosis and those with tubal infertility indicated that the former had a poor IVF outcome in terms of reduced fertilization rate (40% vs. 70%), reduced pregnancy rate per cycle (10.6% vs. 22.4%), and reduced birth rate per cycle (6.7% vs. 16.6%). The differences were statistically significant.

Conclusion(s): The results show an unfavorable outcome of IVF-ET in patients with endometriosis when compared with those who have tubal infertility.     

子宫内膜异位症对体外受精-胚胎移植影响的临床研究

目的:评估子宫内膜异位症对体外受精-胚胎移植(IVF-ET)结局的影响。方法:回顾分析内异症患者70例行IVF-ET的结局,以输卵管因素IVF患者70例作为对照,统计两组患者促排卵反应、体外受精结果及妊娠结局。结果:与输卵管组相比,内异症组不孕年限及促排卵用药时间明显延长、Gn平均用量明显增多、hCG日内膜明显增厚(P<0.05),且形态不佳;内异症组平均获卵数、受精率、移植周期临床妊娠率、单胚着床率显著低于输卵管组(P<0.05);但是两组的卵裂率以及优质胚胎率无显著差异(P>0.05)。结论:内异症患者明显较差的卵巢反应性和子宫内膜状态影响IVF-ET结局。     

Avoidance of oocyte retrieval on the weekend through the use of scheduled ovarian hyperstimulation for in vitro fertilization and embryo transfer

Objective: To avoid oocyte retrieval for IVF-ET during the weekend, the scheduled method of ovarian hyperstimulation, in which oocyte retrieval is planned in advance for Monday through Wednesday, was evaluated.Design: A retrospective study.Setting: The IVF-ET unit of the Department of Obstetrics and Gynecology at Tokushima University Hospital.Patient(s): One hundred seventy-eight cycles in patients undergoing ovarian hyperstimulation for IVF-ET were stimulated according to the scheduled method of ovarian hyperstimulation (scheduled group). One hundred seventy-one cycles in patients of similar age and with comparable causes of infertility were stimulated according to the conventional method of ovarian hyperstimulation for IVF-ET (conventional group).Intervention(s): In the scheduled method, under GnRH-a, the day of oocyte retrieval was determined in advance for IVF-ET. Ovarian stimulation with FSH and hMG was started 12 days before oocyte retrieval.Main Outcome Measure(s): The cancellation and clinical pregnancy rates (PRs), the days of oocyte retrieval, and other clinical parameters were evaluated in the two groups.Result(s): The cancellation rates in the scheduled and conventional groups were 9.6% and 4.7%, respectively. In about 75% of cycles in the scheduled group, oocyte retrieval was conducted on the scheduled day. When oocyte retrieval was scheduled for Monday through Wednesday, overtime work on the weekend could be avoided in 91% of the cycles without cancellation. The clinical PR was comparable between the two groups.Conclusion(s): The scheduled method of ovarian hyperstimulation for IVF-ET was useful for avoiding oocyte retrieval on the weekend.