A prospective, randomized comparison of two commercial media for ICSI and embryo culture

Purpose:The aim of this prospective, randomized study was to compare the results obtained in ICSI with two culture media, P-1 (Irvine Scientific) and IVF-50 (Scandinavian IVF Science). Methods: A total of 182 patients undergoing ICSI treatment were randomly included in this study and divided in two groups: Group I: P-1 medium (n = 91) or Group II: IVF-50 medium (n = 91). All the embryos were transferred on the second day. Results: Patient age did not differ (p = .29) between Group I (34.8 ± 4.8) and Group II (34.0 ± 4.5). The number of oocytes retrieved from Group I (10.6 ± 6.7) was also similar (p = .49) to that retrieved from Group II (11.1 ± 6.4). In addition, there was no difference (p = .25) in the number of oocytes retrieved at metaphase II between Group I (7.9 ± 4.6) and Group II (8.7 ± 4.6). Normal fertilization rates, abnormal fertilization rates, and cleavage rates were similar (p = .62, p = .48, and p = .9, respectively) between Group I (68.4 ± 23.3%, 6.7 ± 10.3%, and 98.7 ±4.6%) and Group II (65.3 ± 26.2%, 9.0 ± 13.8%, and 98.9 ± 3.9%, respectively). The embryo score was also similar (p = .62) for both groups (Group I: 31.9 ± 14.0 and Group II: 33.4 ± 15.8). There was no difference in the number of embryos transferred (p = .69) between Group I (2.8 ± 1.0) and Group II (2.8 ± 1.1). In addition, pregnancy rates/puncture, pregnancy rates/transfer, implantation rates, and abortion rates were also similar for Group I (36.2%, 37.0%, 17.4%, and 12.1%, respectively) and Group II (31.8%, 33.7%, 15.8%, and 10.3%, respectively) (p = .64, p = .75, p = .72, and p = 1.0, respectively). Conclusions: There were no differences in the results obtained with culture media P-1 (Irvine Scientific) and IVF-50 (Scandinavian IVF Science) for ICSI and embryo culture.     

Zona thinning with a noncontact diode laser in ICSI embryos from women of advanced age

Purpose : The objective of this study was to determine if the zona thinning (ZT) technique improved the rates of implantation and clinical pregnancy for patients aged 38 years submitted to an ICSI program. Methods : A total of 100 patients submitted to ICSI and aged 38 years were divided in a prospective and randomized manner into two groups: Group I – patients submitted to ZT (n = 50); a laser diode with 1.48 m wavelength (Fertilaser) was used for the ZT procedure with 1–2 irradiations of 10 ms applied to four different positions on the zona pellucida (ZP) of each embryo to thin 60–90% of the ZP (each point with a 15–20 m length of ZT). Group II – patients with no ZT (n = 50). In both groups, embryo transfer was performed on the second or third day. Results : The age of Group I patients (39.8 ± 1.3) did not differ (p = 0.67) from that of Group II patients (40 ± 1.9). The number of oocytes retrieved at metaphase II from Group I (6.4 ± 4.2) and Group II (6.8 ± 5) was similar (p = 0.94). Normal fertilization rates and cleavage rates were similar (p = 0.78 and p = 0.63, respectively) for Group I (71.5 ± 22% and 96.7 ± 11%) and Group II (73.5 ± 19.7% and 96 ± 11%, respectively). The number of embryos transferred was similar (p = 0.53) for the two groups (Group I = 3.1 ± 1.3; Group II = 2.9 ± 1.1). The thickness of the ZP of Group I embryos (16.9 ± 2.4 m) did not differ (p = 0.97) from that of Group II embryos (16.9 ± 2.3 m). The rates of embryo implantation and clinical pregnancy per embryo transfer were similar (p = 0.67, p = 0.61) for Group I (7 and 16%, respectively) and for Group II (8.2 and 22%, respectively). Conclusions : These results suggest that ZT in the population aged 38 years may have no impact on ICSI success rates. However, this conclusion is limited to a situation in which length of the laser ZT was 20 m and the laser was applied to four different positions.     

Is it worthwhile to operate on subclinical right varicocele in patients with grade II–III varicocele in the left testicle?

Purpose: To determine whether repair of subclinical varicoceles in the right testicle results in significant seminal improvement in patients with clinical left varicocele.Methods: Patients were divided into two groups: Group I (unilateral varicocelectomy) and Group II (bilateral varicocelectomy—subclinical left varicocele). The mean sperm concentration before treatment was higher in Group I (21.01 ± 19.1) compared to Group II (5.7 ± 10.7) (p = 0.04).Results: An increase in volume was detected in the left testicle of patients in Group I (17 ± 7.9 vs. 22.81 ± 8.2; p = 0.04) and in the right testicle of patients in Group II (18.4 ± 6.2 vs. 22.3 ± 6.5; p = 0.04). Although the mean postoperative sperm concentration in Group I increased slightly (25.7 ± 22.8), the mean sperm concentration in Group II increased significantly (30.32 ± 9.8; p = 0.03). Pregnancy rate was higher in Group II (66.7%) compared to Group I (33.3%).Conclusions: Even a small, subclinical unrepaired varicocele continues to have a detrimental effect on bilateral testis function in a patient with grade II–III left varicocele.     

Zona Thinning with Noncontact Diode Laser in Patients Aged ≤37 Years with No Previous Failure of Implantation: A Prospective Randomized Study

Purpose: Zona thinning (ZT) is a technique used to improve pregnancy rates among patients 38 years old and/or patients presenting previous implantation failure. The objective of the study was to determine whether ZT has a beneficial effect on patients younger than 37 years who are undergoing the first ICSI attempt. Methods: A total of 103 patients submitted to ICSI for the first time and those aged 37 years were divided in a prospective and randomized manner into two groups: group I, patients submitted to ZT (n = 51) (a laser diode with 1.48-m wavelength (Fertilaser) was used for the procedure); group II, patients with no ZT (n = 52). In both groups, embryo transfer was performed on the second day. Results: The age of group I patients (31.8 ± 3.6) did not differ (P = 0.53) from that of group II patients (31.4 ± 3.6). The number of metaphase II oocytes was similar(P = 0.76) for the two groups (group I = 9.12 ± 5.27; group II = 8.67 ± 5.02). The average number of embryos available per transfer of group I (6.14 ± 4.02) did not differ (P = 0.69) from that of group II (5.75 ± 3.83). The number of embryos transferred was similar (P = 0.61) for the two groups (group I = 2.76 ± 0.9; group II = 2.87 ± 0.79). The thickness of the zona pellucida of group I embryos (16.6 ± 2.2 m) did not differ (P = 0.08) from that of group II embryos (17.1 ± 1.7 m). The rate of embryo implantation (20.8%) and the rate of clinical pregnancy per embryo transfer (40.3%) were higher for group II than for group I (17.7% and 33.3%, respectively), but the difference was not significant (P = 0.55 and P = 0.54). Conclusions: These results suggest that ZT in the population aged 37 years and with no previous failure of implantation may have no impact on intracytoplasmic sperm injection success rates.     

The choice of a gonadotropin-releasing hormone analog influences outcome of in vitro fertilization treatment

OBJECTIVE: Our purpose was to determine if there is a difference in outcome associated with choice of gonadotropin-releasing hormone analog in in vitro fertilization treatment cycles. STUDY DESIGN: A retrospective analysis of 510 consecutive in vitro fertilization cycles with patient-selected use of either nafarelin (Synarel) or leuprolide (Lupron) was performed. RESULTS: Of 510 consecutive patient cycles, 284 patients (56%) chose nafarelin and 226 (44%) chose leuprolide. In the nafarelin group 64 cycles (34% of retrievals) resulted in deliveries. In the leuprolide group 37 (24%) resulted in delivery (p < 0.05). There were 260 patients in their first cycle of treatment, with 157 (60%) choosing nafarelin, resulting in 33 deliveries (34% per retrieval). Leuprolide, used in 103 (40%) of first cycles, resulted in 12 deliveries (20% per retrieval), (p = 0.052). CONCLUSIONS: In a large population of unselected patients undergoing in vitro fertilization the choice of nafarelin was associated with a significantly better outcome in terms of successful pregnancies achieved. (AM J Obstet Gynecol 1994;170:1629-34.)     

Hypothalamic-pituitary suppression with oral contraceptive pills does not improve outcome in poor responder patients undergoing in vitro fertilization-embryo transfer cycles

Purpose: To evaluate and compare the use of OCP with GnRHa for hypothalamic-pituitary suppression in poor responder IVF patients. Methods: Retrospective analysis of IVF-ET cycles of poor responders. Hypothalamic-pituitary suppression with OCP (Group I, n = 29) or GnRHa (Group II, n = 52), followed by stimulation with gonadotropin, oocyte retrieval, and embryo transfer. Baseline characteristics and cycle outcomes were compared. Results: 73 women underwent 81 cycles from 1/1/1999 to 1/1/2000. Baseline characteristics were similar. 31/81 (38%) cycles were cancelled (Group I, 14/29 (48%) vs. Group II, 17/52 (33%), NS). Cycle outcomes including amount of gonadotropin, number of eggs retrieved, number of embryos transferred, and embryo quality were similar. Patients in Group I required fewer days of stimulation to reach oocyte retrieval. Pregnancy outcomes were similar in the two groups. Conclusion: Our retrospective analysis revealed no improvement in IVF cycle outcomes in poor responders who received OCPs to achieve hypothalamic-pituitary suppression instead of GnRHa.     

Ultrasound Guidance Is Not Necessary During Easy Embryo Transfers

Purpose: To determine whether the use of ultrasound (US) to guide embryo transfer (ET) in a population previously defined as likely to have easy transfer would change the implantation and pregnancy rates in an ICSI program.Methods: A total of 100 patients identified as likely to have easy transfer after mock transfer were divided into two groups: Group I, US-guided ET (N=50) and Group II, ET without the aid of US (N=50).Results: Implantation and pregnancy rates were similar (p=0.51, p=0.29) for Group I (19.6%, 42%) and Group II (16.3%, 30%), as also was the abortion rate (p=0.55) (Group I: 1/21; Group II: 2/15).Conclusion: As long as previous mock transfers are routinely performed during a cycle preceding assisted reproduction and the clinician considers transfer to be easy, ultrasound does not benefit the process of embryo transfer.     

Impact of high basal FSH/LH ratio in women with normal FSH levels on in vitro fertilization outcomes

Abstract

Basal luteinizing hormone (LH) levels have also been suggested to impact on ovarian responsiveness as well as basal follicular stimulating hormone (FSH) levels. The aim of this study was to compare the in vitro fertilization (IVF) outcomes according to cycle day 3 FSH/LH ratio and to assess the proper stimulation protocol between gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist protocols. The retrospective cohort study recruited a total of 1211 women having the laboratory values of FSH (<10?IU/L) and LH within 3 months before IVF. Patients were treated with GnRH agonist long or GnRH antagonist protocols and stimulated with recombinant FSH (rFSH). The number of total retrieved oocytes and mature oocytes, implantation rate, clinical pregnancy rate and ongoing pregnancy rate were analyzed between groups: Group I: FSH/LH?<?2 and Group II: FSH/LH?≥?2. The Group II had the small number of retrieved oocytes and mature oocytes compared to the Group I (p?=?0.000). Clinical and ongoing pregnancy rate were lower in Group II (p?=?0.006, 0.006, respectively). In comparison of each protocol within groups, Group II showed significantly low pregnancy rate when GnRH antagonist was administered. In women with normal FSH level, high day 3 FSH/LH ratio can present subclinically low ovarian reserve and be predictive of lower pregnancy outcomes in fresh IVF cycles, and the choice of GnRH agonist can be related to favorable IVF outcomes.     

Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation

Purpose : To compare ovarian response to controlled ovarian hyperstimulation (COH) between normal ovaries and ovaries previously treated surgically for unilateral ovarian endometrioma. Methods : From January 1996 to December 2001, 32 patients with unilateral ovarian endometrioma previously treated surgically underwent 38 cycles of COH. Their records were reviewed retrospectively. The number of dominant follicles observed on the day of hCG injection and the number of eggs retrieved from the diseased and the normal ovaries in each patient were compared. Results : The numbers of dominant follicles from diseased and normal ovaries were 1.9 ±1.5 and 3.3 ± 2.1, respectively (P < 0.001). During ovum pick up, the numbers of eggs retrieved from diseased and normal ovaries were 2.9 ± 2.6 and 6.1 ± 4.1, respectively (P < 0.0001). For diseased ovaries, 21.1% (8/38) had no dominant follicles, while only 7.9% (3/38) of normal ovaries lacked dominant follicles. The clinical pregnancy rate and the implantation rate per embryo transfer were 33.3 and 17.6%. Conclusions : Surgery for ovarian endometrioma may damage ovarian reserve. It potentially results in poor ovarian response to COH, compared to the response of the contralateral normal ovary in the same individual.     

The Utility of Serum Progesterone and Inhibin A for Monitoring Natural-Cycle IVF-ET

Purpose: Our purpose was to assess the value of monitoring serum P and inhibin A to determine how values might improve the clinical monitoring of natural cycle in vitro fertilization (IVF)-embryo transfer (ET) patients. Methods: All patients (n = 26) who underwent natural-cycle IVF-ET (n = 35) were analyzed. Groups were evaluated according to patients who had a spontaneous luteinizing hormone (LH) surge (group I) and women receiving human chorionic gonadotropin (hCG) who underwent subsequent oocyte aspiration (group II). Group II was further evaluated according to women who did (n = 10) and did not (n = 7) have an ET. All cycles were evaluated with serial transvaginal ultrasonography and serum estradiol, progesterone, and inhibin A. When follicle maturity was achieved, hCG, 10,000 IU, was administered intramuscularly if a LH surge was not detected. Transvaginal ultrasound-guided aspiration was performed 34–36 hr after hCG administration followed by a 48-hr transcervical ET. Results: No differences were seen in cycles the day prior to (d-1) and the day of a spontaneous LH surge, (n = 18) or hCG (d-0)(n = 17) in group I or group II with respect to lead follicular diameter (d-1,15.3 ± 0.6 vs. 14.2 ± 0.9 mm; d-0, 17.4 ± 0.8 vs. 17.8 ± 0.6 mm) and serum estradiol (d-l, 148 ± 15 vs. 150 ± 15 pg/ml; d-0, 218 ± 15 vs. 199 ± 16 pg/ml), respectively. However, serum progesterone was significantly elevated in group I compared with group II on d-l (0.82 ± 0.6 vs. 0.48 ± 0.04 ng/ml; P < 0.05) and d-0 (1.1 ± 0.12 vs. 0.63 ± 0.08 ng/ml; P < 0.05). Inhibin A was significantly greater on d-l in group I (24 ± 2.5 vs. 15 ± 2.2 pg/ml; P < 0.05). In group II, cycles that resulted in an ET (n = 10) compared with group II cycles that did not (n = 7) revealed a significant difference in serum progesterone (0.51 ± 0.05 vs. 0.7 ± 0.07 ng/ml; P < 0.05) and inhibin A (15 ± 2.5 vs. 37.3±5 pg/ml; P < 0.05) the day of hCG. Conclusions: The possible application of serum progesterone and inhibin A in managing natural-cycle IVF-ET is suggested. These assays may predict women who should be set up for egg retrieval, while canceling others in spite of the absence of an LH surge.     

Assessment of uterine cavity by hysteroscopy in assisted reproduction programme and its influence on pregnancy outcome

Objective: The aim of the study was to evaluate if the diagnosis and treatment of uterine cavity abnormalities by hysteroscopy in patients undergoing IVF programme is of any value in improving clinical pregnancy outcome. Methods: 520 patients participated in this prospective randomized study and were classified into two groups. Group I (n = 265) without office hysteroscopy. Group II (n = 255) had office hysteroscopy and was sub classified into Group II a and Group II b. Group II a (n = 160) had normal hysteroscopic findings whereas Group II b (n = 95) had abnormal office hysteroscopy findings, which were corrected at the same time. Result: There was no difference in the mean number of oocytes retrieved, fertilization rate, and number of embryos transferred among the patients in different groups. Statistically significant difference was observed in terms of clinical pregnancy rates between Group I and Group II a (26.2 and 44.44%, P < 0.05), and Group I and Group II b (26.2 and 39.55%, P < 0.05), respectively. Conclusion: Patients with recurrent IVF embryo transfer failures after normal hysterosalpingography findings should also be reevaluated using hysteroscopy prior to further commencing IVF-embryo transfer cycles in order to enhance the clinical pregnancy rates.     

In Vitro Fertilization Treatment for Severe Male Factor: A Comparative Study of Intracytoplasmic Sperm Injection with Testicular Sperm Extraction and with Spermatozoa from Ejaculate

Purpose: Our purpose was to evaluate whether the source of spermatozoa influences the results of intracytoplasmic sperm injection (ICSI) treatment in couples with severe malefactor infertility. Methods: A retrospective analysis of 40 cases of ICSI with testicular-retrieved spermatozoa, matched with 40 cases of ICSI with ejaculated spermatozoa, was performed. We included only couples with normoovulatory females younger than 37 years who were matched according to the day of ovum pickup with the patients in the study group. Results: Eighty cycles were analyzed: 40 cycles using testicular spermatozoa and 40 cycles using ejaculated spermatozoa. In 32 (80%) of the 40 ICSI transcutaneous needle aspiration cycles, we obtained enough spermatozoa to inject all the mature oocytes retrieved. In eight (20%) cases there were not enough spermatozoa to inject all the oocytes. Only 76 (54%) of 141 available oocytes were injected in these eight patients. The oocyte fertilization rates were 42% for the study group and 55.5% for the controls (P < 0.005). Thirty-six (90%) patients in the group with nonobstructive a zoospermia (NOA) and 37 (92.5%) patients in the oligoteratoasthenospermia (OTA) group had embryos for replacement. The mean cleavage rates per cycle (96% with tasticular and 93% with ejaculated spermatozoa), the mean number of embryos per transfer (3.72 ± 1.6 in the NOA group and 4.24 ±1.5 in the OTA group), the embryo quality (cumulative embryo scoring = 34.03 ± 22.62 in the testicular sperm group and 36.08 ± 19.28 in the ejaculated sperm group), and the clinical pregnancy rates (22.5% in the NOA patients and 20% in the ejaculate group) were not significantly different between groups. Conclusions: High fertilization, cleavage, and pregnancy rates can be achieved with intracytoplasmic testicular sperm injection from patients with NOA, reaching levels comparable with those of ICSI using ejaculated spermatozoa.     

Autologous Endometrial Co-culture in Patients with Repeated Failures of Implantation After In Vitro Fertilization–Embryo Transfer

Purpose: Our purpose was to evaluate the effect of co-culture on preembryo development and clinical outcome. Methods: Enrolled patients underwent a luteal-phase endometrial biopsy. The tissue was then enzymatically digested (collagenase) and the stromal and glandular cells were separated by differential sedimentation rates. These cells were cultured to confluence, released, and then cryopreserved until the patient's in vitro fertilization (IVF)–embryo transfer (ET) cycle. All normally fertilized oocytes were then placed on the co-cultured cells until transfer on day 3. Preembryo development on co-culture was compared to that in the patient's noncocultured previous cycle. Implantation and clinical pregnancy rates were compared to those in a control group of patients undergoing IVF during the study period who were matched for age, stimulation protocol, number of oocytes retrieved, and preembryos transferred. Results: Twenty-nine women underwent 31 cycles of IVF-ET. On day 3 the overall mean number of blastomeres per preembryo on co-culture compared to that in the patient's previous cycle was 6.3 ± 1.8 vs. 5.6 ± 1.2 (P = 0.04). The average percentage of cytoplasmic fragments on co-culture compared to the previous cycle was 16 ± 9% vs. 19 ± 9% (P = 0.32). At transfer, after preembryo selection, the mean number of blastomeres per preembryo on co-culture compared to that in the patient's previous cycle was 6.8 ± 1.6 vs. 6.6 ± 1.3 (P = 0.5). The implantation and clinical pregnancy rates between co-culture and the matched control group were 15% (14/93) vs. 13% (16/124) (P = 0.79) and 29% (9/31) vs. 25% (10/40) (P = 0.45). Conclusions: There was a significant improvement in the average number of blastomeres per preembryo on co-culture compared to that in the patient's previous noncoculture cycle. The overall implantation and clinical pregnancy rates between co-culture and a matched control group were not significantly different.     

Comparison of the cryopreservation of human embryos obtained after intracytoplasmic sperm injection with a slow cooling or an ultrarapid cooling procedure

Purpose: Our purpose was to compare an ultrarapid method (URM) modified with dimethyl sulfoxide (Me₂SO) to a slow method (SM) with propanediol (PROH) for the cryopreservation of extra human embryos in a program of intracytoplasmic sperm injection (ICSI).Methods: The extra embryos of 160 patients were cryopreserved in a prospective and randomized manner (drawing lots) by a modified URM (3 M Me₂SO/0.25 M sucrose/thawing in three sucrose gradients) (Group I) or by a SM )1.5 M Propanediol/program 0-Cryologic CL863) (Group II). A total of 103 cycles has been thawed thus far. The number of thawed cycles was 58 for group I and 45 for group II.Results: The mean age (group I, 31.3 ± 4.5; group II, 31.9 ± 4.3) did not differ between the groups (P = 0.38). The number of frozen embryos (group I, 6.6 ± 3.2; group II, 6.5 ± 3.2) was similar (P = 0.49) for the two groups, as was the number of thawed embryos (P = 0.52) (group I, 6.5 ± 2.9; group II, 6.2 ± 3). The survival rate was higher (P < 0.01) for group II (83.3 ± 23%) than for group I (69.2 ± 28.7%). The cleavage rate was also higher (P < 0.01) for group II (56.8 ± 31%) compared with group I (24.2 ± 22.4%). The number of embryos transferred did not differ (P = 0.14) between the groups (group I, 3.16 ± 1.2; group II, 3.5 ± 1.0). The implantation rate (group I, 6.3%; group II, 13.8%) was significantly different between groups (P = 0.034). Pregnancy rates per thawed and transferred cycle were higher for group II (33.3 and 36.6%, respectively) compared with group I (13.8 and 16%, respectively), and these differences were significant (P = 0.03 and P = 0.03, respectively).Conclusion: The data obtained suggest that the SM is superior to the URM for the cryopreservation of extra embryos after ICSI.     

Is Intracytoplasmic Sperm Injection Necessary for Couples Undergoing In Vitro Fertilization–Embryo Transfer with Normal Semen Analyses but Failing Hamster Egg Penetration Assays?

Purpose: Our purpose was to assess whether in vitro fertilization (IVF)–embryo transfer (ET) candidate couples with basically normal semen analyses but failing zona-free hamster egg penetration assay (HEPA) scares benefit from intracytoplasmic sperm injection (ICSI). Methods: Twenty consecutive IVF candidate couples with normal–borderline semen analyses and failing HEPA scores were recruited. Mature oocytes obtained from each woman were randomly divided between ICSI (group I; n = 126 oocytes) and standard insemination techniques (group II; 138 oocytes). Fertilization (two pronuclei) and cleavage (2–4 cells) rates were assessed for both groups. Results: There were no statistically significant differences between the two groups with respect to (mean ± standard error of the mean) fertilization (group I, 63.1 ± 7.75; group II, 77.8 ± 4.7%) or cleavage (group I, 87.3 ± 2.4%; group II, 91.2 ± 3.5%) rates. Conclusions: ICSI is not beneficial for IVF-ET when sperm samples demonstrate a failing HEPA score but have normal or minimally compromised semen analysis parameters.     

Does Pretreatment with Progestogen or Oral Contraceptive Pills in Low Responders Followed by the GnRHa Flare Protocol Improve the Outcome of IVF-ET?

Purpose: Women undergoing in vitro fertilization with lowovarian reserve and poor response to controlled ovarianhyperstimulation (COH) present a management dilemma.In a retrospective observational study, we compared thepretreatment use of the gestogen medroxyprogesterone acetate(10 mg twice daily from day 15 of the cycle for aminimum of 2 weeks) with an oral contraceptive pill (onetablet daily from day 4 of the cycle for a minimum of 3 weeks). Methods: The criteria for inclusion in the study includedone or more of the following: abandoned cycles due topoor response, fewer than four oocytes retrieved followinga standard COH protocol, age >39 years, and elevatedbasal serum follicle-stimulating hormone (FSH).Thirty-eight women received pretreatment with gestogen, and asimilar number of women received pretreatment with thepill. The flare protocol was used in all treatment cyclescombined with an individualized dose of human menopausalgonadotropin (hMG) (4–8 ampoules/day of 75 units FSH/ampoule) depending on previous response, age, and earlyfollicular serum FSH level. Both groups were similar inmean age, duration of infertility, early follicular FSH levels,and the distribution of various aetiologies. Results: Twenty-nine cycles were abandoned before oocyteretrieval, 15 (39.5%) in the pill group and 14 (36.8%) inthe gestogen group, because of an inadequate ovarianresponse. The mean (±SD) number of ampoules (75 IUFSH/ampoule) of hMG used per cycle was similar in thepill and gestogen groups (59.7 ± 19.3 vs. 70.2 ± 29.4,respectively). There also was no difference seen in the numbersof oocytes retrieved (4.4 ± 2.3 vs. 4.2 ± 2.5), totalnumber of embryos (2.5 ± 2.4 vs. 2.2 ± 1.1), or the numberof embryos transferred (1.8 ± 1.2 vs. 2.1 ± 1.0) in the pilland gestogen groups, respectively. One pregnancy in eachgroup resulted following embryo transfer in 22 women inthe pill group and in 24 women in the gestogen group. Conclusions: We conclude that pre-IVF treatment with oralcontraceptive pill or gestogen combined with the flare protocolin women at high risk of or with a history of poor ovarianresponse, as defined in this study, did not appear to resultin an improvement in outcome of IVF-embryo transfer.     

Does Surgical Management of Endometriosis Within 6 Months of an In Vitro Fertilization–Embryo Transfer Cycle Improve Outcome?

Purpose : To assess the effect on cycle outcome of surgery for endometriosis performed in the 6 months prior to in vitro fertilization–embryo transfer (IVF-ET). Methods : Retrospective analysis of all patients with a primary diagnosis of endometriosis undergoing IVF-ET during 12 consecutive months. The setting included tertiary care assisted reproductive technology program. Ninety-five consecutive cycles in candidates for autologous IVF-ET who had undergone surgical resection of endometriosis within 60 months of oocyte retrieval were evaluated. Five patients with persistent or recurrent endometriomas >3 cm at the time of IVF-ET were excluded. Patients were divided into two groups based on the interval between the most recent surgical intervention and oocyte aspiration—Group I: 6 months' interval (19 cycles); Group II: >6 months' interval (76 cycles). Results : Mean intervals between surgery and oocyte aspiration were significantly different between the groups (Gr I: 3.7 ± 0.3 months; Gr II: 21.8 ± 1.6 months; p < 0.001). There were no significant differences between groups with regards to age, extent of endometriosis, or results of ovarian stimulation and oocyte aspiration. Ongoing pregnancy rates (Gr I: 63.2%; Gr. II: 60.5%) were similar. Regression analyses revealed no correlation between implantation rates and either endometriosis score (r = –0.09) or surgery–oocyte aspiration interval (r = –0.13). Conclusions : The interval between surgical management of endometriosis and oocyte aspiration did not have an impact on IVF-ET cycle outcome in the absence of significant persistent or recurrent ovarian disease. Any effect of surgery on enhancing spontaneous conception may be overcome by the inherently greater impact of IVF-ET on implantation and pregnancy.     

Blastomere cytoplasmic granularity is unrelated to developmental potential of day 3 human embryos

Purpose : To examine whether the increase in cytoplasmic granularity observed in some human embryos on day 3 of development is of any predictive value as to embryo developmental potential. Methods : Retrospective study comparing outcomes of treatment attempts in three groups of patients after day 3 embryo transfer. Attempts in which only embryos with clear cytoplasm were transferred form Group I, those in which only embryos with granulated cytoplasm were transferred constitute Group II, and Group III consists of cases with mixed transfer combining both types of embryos. Each group was further divided according to the female age. Results : Clinical pregnancy rates in Groups I (314 attempts), II (173 attempts), and III (323 attempts) were 33.8, 36.4, and 31.3%, respectively. Implantations rates for Groups I–III were 17.0, 17.3, and 14.8%, respectively. No significant differences between groups concerning these and other values, including the number of oocytes and of metaphase II oocytes recovered, fertilization and cleavage rates were found. The proportion of good-morphology embryos was also similar between the different groups (74.3, 72.7, and 70.2% respectively). The representation of women of advanced age (>36 years) was also similar in each group, and intergoup differences remained insignificant were only younger or only older women were taken into account. Conclusion(s) : These data show that the appearance of cytoplasmic granulation in blastomeres of day 3 human embryos is of no prognostic value as to embryo quality and appears to be unrelated to the female age.     

Elevated serum progesterone values at the time of ovulation induction in luteal leuprolide acetate-down-regulated GIFT cycles are associated with decreased clinical pregnancy rates

Purpose: The effects of premature luteinization of ovarian follicles as detected by elevated progesterone values on the day of human chorionic gonadotropin induction of ovulation were evaluated in 38 consecutive gamete intrafallopian transfer (GIFT) retrieval cycles. Materials and Methods: All patients received leuprolide acetate beginning in the midluteal phase of their prior menstrual cycle, followed by gonadotropin stimulation of folliculogenesis. At least four oocytes were transferred in each cycle. Results: No significant differences in gonadotropin dosage, total number of days of gonadotropins, age, number of prior pregnancies, years of infertility since last pregnancy, total number of eggs retrieved, mature residual oocytes, fertilization of mature residual oocytes, or primary etiology of infertility were observed between groups; however, estradiol concentrations were significantly higher in the group with elevated progesterone values (2573±216 pg/ml) compared to the lower progesterone group (1925±202 pg/ml,P=0.035) and the total number of oocytes transferred was greater in the high progesterone group (7.5±0.5) vs the low progesterone group (6.3±0.3,P<0.038).P ₄ concentrations 0.8 ng/ml were associated with significantly higher pregnancy rates (11/19; 57.9%) compared to progesterone concentrations >0.8 ng/ml (5/19, 26.3%;P=0.050). Conclusions: Premature luteinization may occur in luteal leuprolide acetate-down-regulated patients and progesterone values >0.8 ng/ml are associated with significantly lower pregnancy rates in GIFT cycles.     

A uterine ultrasonographic scoring system as a method for the prognosis of embryo implantation

Purpose : The objective of the present study was to evaluate an ultrasonographic uterine scoring system as a method for the prognosis of embryo implantation in patients submitted to ICSI. Methods : A total of 562 patients submitted to an ICSI program were prospectively evaluated on the day of hCG administration in terms of the following ultrasonographic uterine parameters: A. Endometrial thickness (<7.0 mm = 0; 7 a 14 mm = 3; 14 mm = 1); B. Endometrial layering (three lines = 2; absence of three lines = 0); C. Myometrial contractions in 2 min (<3 = 0; 3 = 3); D. Uterine artery Doppler flow (>3 = 0; 2.2 a 3 = 2; 2.19 = 3); E. Endometrial power Doppler (The endometrium was divided into four equal quadrants and classified as grade I = 1; II = 2; III = 3; IV = 4, according to the visualization of the power Doppler in the quadrants). The colour Doppler signal was considered to be positive when it reached at least the basal layer of the endometrium; F. Myometrial power Doppler (absent = 0; weakly present = 2; strongly present = 3); G. Myometrial echogenicity (homogeneous = 2; inhomogeneous = 0). The patients were divided into 4 groups according to total score: Group I, score <10; Group II, score 10–14, Group III, score 15–17 and Group IV, score 18–20. Results : The uterine parameters using an ultrasonographic scoring system are inversely correlated with patient age (p < 0.0001). The number of days of stimulation with FSH did not differ (p = 0.10) between groups. The number of follicles measuring 16 mm was different (p = 0.01) between groups. The number of metaphase II oocytes also did not differ significantly between groups (p = 0.45). The fertilization rate was also similar (p = 0.10) for all groups. The number of transferred embryos was different between groups (p = 0.02). The rate of embryo implantation did not differ (p = 0.60) between groups. Finally, the pregnancy rates did not differ significantly (p = 0.93) between groups. Conclusions : The ultrasonographic evaluation of uterine parameters on the day of hCG administration using a scoring system is inversely correlated with patient age. In the present study, the use of this ultrasonographic score method could not identify a population with greater uterine receptivity.