Ovum donation by sisters in ovarian failure: Simplified priming and early withdrawal of exogenous support

Two cases of successful pregnancy and delivery by patients with ovarian failure are reported. In both cases ova were donated by the sister of the patient. A high degree of success (two pregnancies in three attempts) is discussed, as is the significance of simplified pretransfer priming and very early withdrawal of exogenous hormonal support.     

Progress we can be proud of: U.S. trends in assisted reproduction over the first 20 years

OBJECTIVE: Documentation of the significant progress of assisted reproductive technology (ART) therapy in the United States. DESIGN: Tabulation of data from the annual published reports of ART activity in the United States for the years 1985 through 1999. SETTING: ART centers in the United States that report their results to the Centers for Disease Control and Prevention (CDC) via the Society for Assisted Reproductive Technology (SART). PATIENT(S): The annual reports included 647,208 cycles of treatment. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The number of clinics and cycles, and the rates of pregnancy, delivery, miscarriage, and multiple pregnancy were examined. Practice trends were also examined. RESULT(S): The number of clinics and cycles has grown steadily. The 155,661 clinical pregnancies led to 128,608 births and 177,745 babies born. The advent of intracytoplasmic sperm injection (ICSI) and the fall of GIFT and zygote intrafallopian transfer (ZIFT) are noted. Pregnancy rates have risen steadily in all therapies, and the number of deliveries of triplets or more has declined dramatically in the most recent reporting years. CONCLUSION(S): Over the years, ART therapies have steadily become more effective, with notable reductions in multiple pregnancies, the ability to avoid laparoscopy (for egg retrieval and in some cases tubal transfers), and effective therapy for serious sperm, egg, and uterine problems, none of which was true in the early years. This has occurred owing to the dedication and ingenuity of practitioners, and, notably, without federal regulation of clinical practice.     

The establishment of an ovum donation program using a simple fixed-dose estrogen-progesterone replacement regimen

Most ovum donation (OD) programs involve cycle synchronization between recipient and donor for normally cycling recipients and a complex estrogen-progesterone replacement regimen for recipients with ovarian failure. In 1987, Serhal and Craft (1) suggested the use of a fixeddose estrogen-progesterone regimen for recipients who were normally ovulatory and to those with ovarian failure. Following this protocol, and simplifying it still, the authors administered 6 mg estradiol valerate (E₂) daily orally starting on day 2–6 of induced withdrawal bleeding, augmented with 100 mg progesterone in ethyl oleate (P) intramuscularly daily, starting any time between 4 days prior to and the day of oocyte pickup. All recipients underwent embryo transfer at a 2-pronuclei (2PN)-10-cell stage. A group of 21 patients underwent 26 treatment cycles, resulting in 16 pregnancies. Twelve of the patients gave birth, one to triplets, two to twins, and nine to singletons. Four patients miscarried in the first trimester of pregnancy.     

CLINICAL ASSISTED REPRODUCTION: Births After Transfer of Zona-Free Blastocysts in Oocyte Donation Cycles

Purpose: Oocyte donation is a well-established method of assisted reproduction for women with irreversible infertility and with previous implantation failures after in vitro fertilization. Although the pregnancy rates are very high, sometimes implantation does not occur even after various attempts. We report the first two cases of transfer of zona-free blastocysts in oocyte donation cycles that developed to normal pregnancies and births.Methods: The patients had undergone three previous standard oocyte donation cycles with failure of implantation. Endometrium preparation was performed after suppression of the pituitary function, with E₂ valerate and Progesterone at the day of oocyte retrieval. Normally fertilized embryos were cultured in Earle's culture medium until Day 3 and in S2 medium until Day 5. For each patient, the zonae of two fully expanded blastocysts were enzymatically removed with 0.5% pronase. Zona-free blastocysts were transferred for the patients 2 h later.Results: On Day 12 after transfer, pregnancies were confirmed with elevated serum levels of hCG. A gestacional sac with a foetal heart beat was seen by ultrasound 15 days later, in each patient. Normal healthy babies were born at 38 and 39 weeks of pregnancy.Conclusions: This is the first report of successful pregnancies and births after oocyte donation and transfer of zona-free blastocysts in human. It not only shows the feasibility of the treatment but also opens a new alternative for the patients with repetitive implantation failure after OD cycles.     

Tragic outcome of post-menopausal pregnancy: An obstetric commentary

The recent Italian court report regarding the removal and adoption of a 1-year-old child conceived with assisted reproduction treatment from parents deemed to be ‘too old’ at ages 57 and 70 brings to the fore the complex medical and ethical issues that surround assisted reproduction. This obstetric commentary examines the biology of reproductive ageing, current childbearing trends and the outcomes of post-reproductive age pregnancies, particularly focusing on maternal mortality as ‘the tip of the iceberg’ of IVF harms. The case highlights the need for global standards to ensure medical accountability.     

Conventional IVF as a laboratory strategy to rescue fertility potential in severe poor responder patients: the impact of reproductive aging

Abstract

Objective: To investigate whether laboratory strategies can improve in vitro fertilization (IVF) outcome in poor responder patients. We compared the effectiveness of conventional IVF and intra cytoplasmic sperm injection (ICSI) in assisted reproductive technologies cycles in which only one or two oocytes were retrieved at ovarian pick up, in the absence of male infertility.

Design: Retrospective analysis of 425 cycles in 386 poor responder patients.

Intervention(s): Standard stimulation protocol with gonadotropins and gonadotropin releasing hormone (GnRH) antagonist.

Main outcome measure(s): Fertilization rate, cleavage rate, good-quality embryo rate, implantation rate, clinical pregnancy rate (PR) and miscarriage rate.

Results: IVF was found to be more advantageous for implantation and PR, especially in patients under 35 years and in women aged between 35 and 38 years. No differences were noted in the other parameter evaluated. Patients aged over 38 years showed no difference using the two techniques.

Conclusion: The employment of ICSI in the absence of a male factor can reduce reproductive outcome in poor responder. Probably because of aging-related defects overcoming the advantage of sperm selection, the choice of IVF technique is not relevant to reproductive success when oocyte quality is compromised by reproductive aging. Although further randomized trials are needed to confirm our results, we propose that, in absence of male infertility, conventional IVF might be the technique of choice in young patients, especially in those aged below 35 years.     

Outcomes of 1503 cycles of modified natural cycle in vitro fertilization: a single-institution experience

PurposeA retrospective cohort study was conducted in a single academic center to determine if modified natural cycle in vitro fertilization (mnIVF) is an acceptable treatment for the infertile couple.MethodsCycles performed between July 2005 and December 2011 were included. In our center’s mnIVF protocol, a GnRH antagonist, gonadotrophin, as well as Indocid are given on a daily basis from detection of a dominant follicle until ovulation induction. The primary outcomes were clinical pregnancy rates (CPR) per cycle started and per embryo transfer (ET). Outcomes were stratified by female patient age (≤35 years and ≥36 years). They were further stratified in each age group by ovarian response status according to the 2011 Bologna criteria.ResultsA total of 1503 cycles of mnIVF, performed in 782 patients, were analyzed. CPRs were 13.7 % per started cycle and 32.5 % per ET. Stratification by ovarian response status (normal or poor) in each age group showed similar CPRs in patients ≤35 years (p = 0.373), and divergent CPRs per ET in patients ≥36 years old (26.26 vs 6.25 %).ConclusionMnIVF is an acceptable treatment option for patients considering IVF, particularly for women ≤35 years old and for women ≥36 years old with normal ovarian response.     

Looking to Europe: Something's changed in Italy

The new Italian law regulating the use of assisted reproduction technologies (ARTs) prohibits treatment widely practiced in Europe. The new regulations have already given rise to a humiliating form of “reproductive tourism” of Italian subfertile couples.     

Bilateral ovarian abscesses following transvaginal oocyte retrieval for IVF: a case report and review of literature

Ultrasound-guided transvaginal oocyte retrieval (TVOR) is a relatively simple and atraumatic method with rare complications as well as the possibility of doing it under sedation. It has become the method of choice in most IVF centres, because it results in excellent oocyte yields, with increased speed and excellent follicle and major pelvic vessel visualization, thereby decreasing the probability of vessel puncture [1]. However, the technique is not without risk such as pelvic infection, bleeding secondary a blood vessel puncture or pelvic visceral trauma. Consumption coagulopathy is a serious complication of pelvic infection and sepsis which can be life threatening if not diagnosed and corrected early, especially if surgical intervention is required. We present a case of bilateral ovarian abscesses following transvaginal oocyte retrieval showing early signs of consumption coagulopathy.     

Air quality in the assisted reproduction laboratory: a mini-review

Quality of air in the clinical embryology laboratory is considered critical for high in vitro fertilization (IVF) success rates, yet evidence for best practices is lacking. Predominantly anecdotal reports on relationships between air quality and IVF success rates have resulted in minimal authentic clinical laboratory guidelines or in recommendations that are based on industrial cleanroom particulate standards with little attention to chemical air filtration. As a result, a nascent industry of costly, specialized air handling equipment for IVF laboratories has emerged to provide air quality solutions that have not been clearly assessed or verified. Clinics are embracing such technology because their embryology laboratories have become epicenters of assisted reproductive technology as the practice of IVF has moved to blastocyst transfers and utilization of trophectoderm biopsy for preimplantation genetic testing (PGT). Thus, a laboratory’s ability to culture, biopsy, and freeze blastocysts is a rate-limiting step that depends on technical proficiency and a supportive and stable culture environment based on a foundation of high-quality ambient air. This review aims to describe how evidence for the importance of air quality, in particular the role of volatile organic compounds (VOC), has resulted in an evolution of clinical practice that has arguably contributed to improved outcomes.     

Evaluating the benefit of measuring serum progesterone prior to the administration of HCG: effect of the duration of late-follicular elevated progesterone following ovarian stimulation on fresh embryo transfer live birth rates

Research question

Progesterone overproduction during ovarian stimulation is associated with lower live birth rates (LBR) after fresh embryo transfer. Therefore, circulating P concentrations on the day of HCG administration are frequently measured in clinical practice and followed by an elective cryopreservation strategy whenever late-follicular elevated P (LFEP) occurs. A recent study concluded that the duration of LFEP >1.00 ng/mL prior to HCG administration may also affect clinical pregnancy rates. The objective of this current study was to assess whether this hypothesis was reproducible using LBR as the primary outcome.

CLINICAL ASSISTED REPRODUCTION: Haemodynamic Evaluation of Tubal and Male Factors of Infertility in Natural and Ovarian Stimulation Cycles

Purpose: To determine the haemodynamic parameters in women with tubal and male factors of infertility and to investigate the effect of ovarian stimulation on the blood flow indices of the uterine and ovarian arteries.Methods: Prospective evaluation of the pulsitility index (PI) and resistance index (RI) of the uterine and ovarian arteries in the tubal and male factors of infertility was done. Comparisons were made between the natural and ovarian stimulation cycles.Results: In natural cycles, uterine PI was 3.55 ± 1.39 and RI was 0.95 ± 0.05 in tubal infertility. These were significantly lower (uterine PI = 4.13 ± 0.08; uterine RI = 0.99 ± 0.06) than the corresponding indices in patients with male factor infertility. After ovarian stimulation in tubal factor, uterine PI and RI were 2.62 ± 0.73 and 0.88 ± 0.08 and were similar (PI = 2.55 ± 0.62, RI = 0.87 ± 0.06) to male factor infertility.Conclusions: The data points to measurable differences in the uterine PI and RI between the tubal infertility and male infertility in the natural cycles. These differences were abolished after ovarian stimulation.