Clinical study on embryo transfer after human in vitro fertilization

One hundred forty-six embryo transfers were carried out in the In Vitro Fertilization (IVF) Clinic at St. Pierre Hospital, Brussels, between November 1983 and February 1985. In each of these cases a series of characteristics of the replacement procedure was systematically rates indicated that (i) no significant differences appeared among three different operators, (ii) the absence or occurrence of cervical bleeding and subjective evaluation of the procedure were related to the chances of establishing a pregnancy, and (iii) the duration of replacement had no influence on the outcome of trials. A prospeative randomized study of 100 replacements showed that (i) no better pregnancy rate was obtained by placing patients in the knee-to-chest rather than the dorsal position and (ii) the addition of a rigid external sleeve to the catheter did not provide any advantage. A simplified method of replacement is thus advocated.     

Heterotopic pregnancy after in vitro fertilization and embryo transfer

We have presented a second case of heterotopic pregnancy after IVF-ET. The most likely cause is direct extrusion of embryos through the tubal ostia by the hydrostatic pressure associated with ET. The diagnosis of ectopic pregnancy must be suspected clinically and not ruled out on the sonographic demonstration of an intrauterine pregnancy. Early diagnosis is essential for the prevention of significant maternal morbidity and mortality after IVF-ET.     

Ectopic pregnancies after in vitro fertilization and embryo transfer

Objective Our objective was to analyze the risk factors, stimulation characteristics, and future fecundity of patients with ectopic pregnancies after in vitro fertilization (IVF).Methods We retrospectively evaluated all cases of ectopic pregnancy occurring between January 1989 and March 1993 (Cornell series 1 to 17). A case-control group of intrauterine pregnancies was used for comparison of the stimulation and transfer characteristics.Results Twenty-seven of 1123 pregnancies (2.4%) were ectopic, following 2812 fresh IVF embryo transfers, while 8 of 105 pregnancies (7.6%) were ectopic, following 405 frozen-thawed embryo transfers. Tubal factor was the cause of infertility in the majority (85.7%) of ectopic pregnancies. No difference was found between the ectopics and the matched controls in stimulation and transfer characteristics. Thirty ectopic pregnancies were ampullary, two were interstitial, two were cervical, and one was heterotopic. Twenty of the patients subsequently underwent 29 IVF attempts, with a pregnancy rate of 41.4% per transfer.Conclusions Ectopic pregnancy after IVF appears to be related to preexisting tubal pathology; embryo transfer of cryopreserved thawed embryos in a natural cycle may result in a higher ectopic rate in these patients; in subsequent IVF cycles the intrauterine pregnancy rate of these patients is not decreased.     

Cervical pregnancy after in vitro fertilization and embryo transfer

A case of cervical pregnancy after in vitro fertilization and embryo transfer is described. This unusual pregnancy ended at 26 weeks' gestation after hysterotomy and delivery of an 830 gm boy. We suggest that the in vitro fertilization procedure is one of the possible risk factors of cervical pregnancy.     

Serum prolactin response to embryo transfer during human in vitro fertilization and embryo transfer

Serum prolactin (PRL) concentrations around the time of embryo transfer (ET) have not been studied, despite the fact that transient hyperprolactinemia regularly occurs in response to laparoscopy for oocyte recovery and ET itself may be stressful enough to induce a PRL rise. Hyperprolactinemia might compromise luteal support for implantation and contribute to the limited success of ET. We measured serum PRL concentrations in 10 normoprolactinemic women immediately before, during, and after ET and compared the PRL response around ET to that induced by laparoscopy as a measure of the competency of the stress-prolactin axis. Nine of ten patients demonstrated a significant PRL response to surgery. The mean (±SEM) intraoperative PRL concentration (124.0±19.6 ng/ml) was significantly higher than the preoperative level (12.3±2.4 ng/ml) (P<0.01). Three hours after surgery PRL levels had decreased (44.8±11.5 ng/ml) but remained above baseline. All subjects were normoprolactinemic 48 hr after laparoscopy. Serum PRL concentration did not change significantly in response to ET, with levels of 10.4±1.7, 12.4±1.1, and 10.6±1.8 ng/ml immediately before, during, and 3 hr after ET, respectively. While laparoscopy for in vitro fertilizationembryo transfer commonly induces hyperprolactinemia, the PRL rise is transient, with no carryover to the time of ET. Embryo transfer itself does not induce a significant PRL rise.     

Treatment-independent pregnancy after in vitro fertilization and embryo transfer trial

This study indicates that SP occur in a higher percentage than theoretically expected after IVE-ET treatment, but it is not conclusive as to whether the SP is independent or a result of the treatment or operative laparoscopy. Our results are in agreement with those of previous studies that have shown that SP occur with almost all kinds of infertility. We therefore reject the previous suggestion of Steptoe, who argued that to prevent ectopic pregnancy from complicating embryo replacement, preparatory electrocauterization of diseased tube should be performed. We also suggest that as long as the results of treatment are below the normal monthly spontaneous conception rate, there is justification for a prospective random study that includes all diagnoses other than BTB. Such a study might help make any future selection of patients for treatment more appropriate.     

Hypersensitivity to progesterone-in-oil after in vitro fertilization and embryo transfer

OBJECTIVE: To report the occurrence and management of pulmonary compromise, marked leukocytosis, and eosinophilia in a patient receiving P-in-oil after IVF and embryo transfer. DESIGN: Case report.A tertiary referral reproductive medicine unit. PATIENT(S): A 29-year-old patient receiving P-in-oil supplementation after IVF embryo transfer. INTERVENTION(S): Extensive diagnostic testing and surveillance for hypersensitivity to P in sesame oil; development of an alternative oil-based P-in-oil suspension. MAIN OUTCOME MEASURE(S): Tolerance of alternative P vehicle; clinical pregnancy. RESULT(S): The patient tolerated an alternative P oil vehicle and successfully achieved a clinical pregnancy after frozen embryo transfer. CONCLUSION(S): Although rare, hypersensitivity reactions may occur in patients receiving P-in-oil supplementation after IVF embryo transfer. Testing for tolerance and subsequent use of alternative P vehicles may be an effective strategy in managing patients with sensitivity to P-in-oil.     

Diagnosis of ectopic pregnancy after in vitro fertilization and embryo transfer

Objective: The combination of transvaginal sonography and serum hCG measurement is reliable in the diagnosis of ectopic pregnancy (EP) in spontaneous pregnancies. In patients who became pregnant through IVF-ET, transfer of multiple embryos after IVF could be responsible for the different performance of these tests. We evaluated the discriminative capacity of transvaginal sonography in combination with hCG measurement in the diagnosis of EP after IVF-ET.

Design: Prospective cohort study.

Setting and Patient(s): Consecutive patients, pregnant through IVF-ET, who presented with clinically suspected EP.

Intervention(s): Transvaginal sonography, serum hCG measurement at 6, 9, and 15 days after ET and after a negative transvaginal sonography.

Main Outcome Measure(s): Ectopic pregnancy confirmed at laparoscopy.

Result(s): Between September 1993 and May 1996, 86 women were included in the study, of whom 24 had an EP. Transvaginal sonography identified 46 intrauterine pregnancies and 5 EPs, but serum hCG could not diagnose EPs in patients in whom transvaginal sonography did not show a gestational sac. Serum hCG measurement 9 days after ET could identify pregnancy failure with 100% specificity at a cut-off value of 18 IU/L, but it could not identify patients with EP with enough certainty to justify immediate treatment.

Conclusion(s): We recommend single serum hCG measurement 9 days after ET to discriminate between viable and nonviable pregnancies. Transvaginal sonography can be postponed until 5 weeks after ET, except for patients with abdominal pain and/or vaginal bleeding, or patients with a serum hCG level of <18 IU/L.     

In vitro fertilization and embryo transfer

In vitro fertilization is one of the newest approaches to infertility. Opportunities for nurses in IVF involve teaching couples about physiology, providing technical assistance and care, and counseling about the medical and emotional aspects of the program. Many times the nurse serves as the primary support person for couples and as their advocate with other team members.     

Superovulation-induced transient hyperprolactinemia in human in vitro fertilization and embryo transfer

To examine the effects of transient hyperprolactinemia on in vitro fertilization and embryo transfer, 61 cycles in 50 euprolactinemic ovulatory women with irreparable tubal diseases were stimulated with clomiphene (CC) alone or CC and human menopausal gonadotropin followed by human chorionic gonadotropin (hCG). Serum prolactin (PRL) increased after hCG administration with peak values of 45.4 +/- 4.2 ng/ml on the day of laparoscopic oocyte aspiration. The highest serum estradiol (E2) concentration was found on the day before PRL peak and serum progesterone (P) began to increase after hCG injection concomitant with the PRL rise. The group having 50 ng/ml or more of PRL (34 cycles) had significantly higher levels of E2 during preovulatory and early luteal phase compared to those of the group having less than 50 ng/ml of PRL (27 cycles) but there was no significant difference between the P levels in the two groups. In the higher PRL group 72 (62.1%) of 116 collected oocytes were fertilized and 6 (20.0%) conceived. In the lower PRL group 45 oocytes (58.4%) of 77 were fertilized and 3 (12.5%) became pregnant. These data suggest that elevated serum PRL concentrations may have no effect on fertilization of oocytes in vitro or embryonic development.     

Clomiphene-HMG ovarian stimulation in human in vitro fertilization and embryo transfer

In a program for in vitro fertilization and embryo transfer, laparoscopies for oocyte aspiration were performed in 40 cycles in 36 normally menstruating women with irreparable tubal diseases (IVF patients) who received clomiphene citrate (CC) and human menopausal gonadotropin (hMG). An intramuscular injection of human chorionic gonadotropin (hCG) was given to all patients after completion of follicular maturation. Fourteen cycles in 13 spontaneously ovulating women (control patients), also stimulated with CC and hMG, were adequately monitored to identify the appearance of the spontaneous luteinizing hormone (LH) surge. The follicular maturation was followed by daily ovarian ultrasonographic examination and serum estradiol estimations. Just before the LH surge the diameter of the leading follicle was 20.2 +/- 0.7 (mean +/- S.E.) mm and the serum estradiol concentration per follicle was 384.1 +/- 16.3pg/ml in the control patients. In the IVF patients the former was 20.6 +/- 0.3mm and the latter was 305.8 +/- 13.3pg/ml prior to hCG administration. When the relationship of follicular size to the rates of oocytes recovery, maturation, fertilization and cleavage was examined, larger follicles (3ml less than or equal to follicular fluid volume) showed good results. Of the 152 oocytes that were recovered from these IVF patients, 96 (63.2%) were fertilized and 79 (52.0%) cleaved. Three pregnancies resulted from 35 embryo transfers.     

Pregnancy after in vitro fertilization,cryopreservation, and embryo transfer

Summary We reported on the first pregnancy achieved in the Erlangen IVF program after cryopreservation and embryo transfer. After hMG stimulation in the first treatment cycle, nine oocytes were retrieved by laparoscopy from a 31-year-old woman and three embryos transferred. Fived other oocytes were fertilized and developed to four- to eight-cell embryos, which were subsequently cryopreserved. Transfer of these embryos two cycles later resulted in a singleton pregnancy and the birth of a healthy girl.