Do Lunar Cycles Influence In Vitro Fertilization Results?

Purpose : Our objective was to investigate the lunar influence on IVF-ET outcomes. Methods : Between 1992 and 1999 we have completed 7572 preprogrammed IVF-ET treatment cycles with the same stimulation protocol in two outpatient units. (Vienna, Austria and Budapest, Hungary) Multiple regression (SAS; proc Logistic) and two separate analyses were performed on pregnancy rates using a harmonic sinoidal trend based on the synodic and anomalistic lunar cycles respectively. Results : The overall pregnancy rate was 30.9%. The amplitude of harmonic sinoidal, trend for the synodic lunar cycles was x ² = 1.63, 2 d.f., p = 0.44 and x ² = 6.27, 2 d.f., p = 0.044 for the anomalistic moon periods. For the anomalistic lunar months the amplitude of harmonic sinoidal trend was borderline in terms of higher pregnancy rates with the moon in Perigee. Conclusion : The cause of seasonal changes in IVF-ET outcomes is probably very complex. Our results indicate that lunar influence may only be one of the contributing factors. Further studies are needed to clarify unexplained fluctuations of pregnancy outcomes.     

Hysteroscopic Tissue Removal Systems: A Randomized In Vitro Comparison

Study Objective

To compare polyp resection time and myoma resection rate using 2 hysteroscopic tissue removal systems.

Reproductive Outcomes of In Vitro Fertilization–Intracytoplasmic Sperm Injection after Transcervical Resection of Adhesions: A Retrospective Cohort Study

Study ObjectiveTo investigate pregnancy and obstetric outcomes of patients with intrauterine adhesions (IUAs) after treatment with in vitro fertilization–intracytoplasmic sperm injection (IVF-ICSI) and fresh embryo transplantation after transcervical resection of adhesions (TCRA).DesignRetrospective cohort study.SettingUniversity-based reproductive medical center.PatientsA total of 535 patients with IUAs and with a history of TCRA and 1605 matched patients without a history of IUAs underwent IVF-ICSI and received fresh embryo transfers.InterventionsBetween January 2014 and December 2018, all patients underwent IVF-ICSI treatment and received fresh embryo transfers.Measurements and Main ResultsThe patients in the TCRA group were matched with the control group according to strict criteria. Pregnancy and obstetric outcomes were compared. There were no significant differences in clinical pregnancies, ectopic pregnancies, live births, preterm births, and obstetric outcomes between the 2 groups (p >.05). However, the TCRA group had a higher risk of miscarriage than the control group (p = .048).ConclusionTCRA improved the reproductive outcomes of patients with IUAs, but the risk of miscarriage was higher than that in the general population. To avoid miscarriage, careful monitoring is critical for pregnant patients with a history of TCRA who undergo embryo transfers during IVF treatment.     

Involvement of Interleukin-1 and the Interleukin-1 Receptor Antagonist in In Vitro Embryo Development Among Women Undergoing In Vitro Fertilization–Embryo Transfer

PURPOSE: To examine the roles of Interleukin-1 (IL-1) and IL-1 receptor antagonist (IL-1ra), in in vitro embryo development and subsequent pregnancy outcome. METHODS: Maternal serum utilized to supplement embryo growth in IVF cycles was analyzed for the presence of IL-1 cytokines. RESULTS: The maternal serum that was utilized to supplement the embryo media was found to have measurable amounts of IL-1beta and IL-1ra. CONCLUSIONS: Relative antagonism of the IL-1 system was positively associated with embryo development and pregnancy outcome.     

Controlled Ovarian Hyperstimulation Adversely Affects Implantation Following In Vitro Fertilization–Embryo Transfer

Purpose:Our purpose was to determine if controlled ovarian hyperstimulation adversely affects implantation.Methods:A retrospective comparison of pregnancy rates (PRs) and implantation rates was made between oocyte recipients versus their donors, who shared half of the retrieved oocytes, and regular patients undergoing in vitro fertilization–embryo transfer (IVF-ET) who were not sharing eggs.Results:Higher implantation rates (39.0 vs 22.5%; P < 0.05) were found in recipients compared to donors in the stimulated cycle. However, no differences were seen in PRs or implantation rates in frozen ET cycles. The data for standard IVF patients were almost-identical to those for donors.Conclusions:Superior implantation rates and PRs in oocyte recipients versus donors were not related to better oocyte quality for recipients because of egg sharing or to a better uterine environment because of similar results with frozen ET in all three groups. An adverse effect of the hyperstimulation regimen best explains the difference.     

The Effect of Smoking on Oocyte Quality and Hormonal Parameters of Patients Undergoing In Vitro Fertilization–Embryo Transfer

Purpose: The aim of the present study was to investigate the influence of smoking on different parameters such as oocyte count, embryo score, and basal hormone values within the scope of in vitro fertilization–embryo transfer (IVF-ET). Methods: Eight hundred thirty-four women undergoing IVF-ET treatment were classified as smokers or nonsmokers on the basis of questionnaires. Additionally, we divided them into three groups according to their stimulation protocol—combined stimulation [I; clomiphene citrate plus human menopausal gonadotropin (hMG)], ultrashort [II; gonadotropin releasing hormone agonist (GnRHa) plus hMG or follicle-stimulating hormone (FSH)], and long downregulation protocol (III)—and further classified again as smokers or nonsmokers within the groups. Results: In general, smoking patients were significantly (P = 0.0195) younger than nonsmokers and showed a significantly (P = 0.0379) lower embryo score and a tendency (P = 0.0931) to produce fewer oocytes. There was no significant difference concerning the number of normally or pathologically fertilized and transfered oocytes and embryos suitable for cryopreservation. Women who smoked had significantly (P = 0.0112) higher basal 17--estradiol (E ₂ ), luteinizing hormone (LH) (P = 0.0001), and dehydroepiandrosteronesulfate (DHEAS) (P = 0.0039) levels, but their basal human prolactin (HPRL) levels were significantly (P = 0.0033) lower than those of nonsmokers. According to the stimulation protocol used, we found the following results. Smoking patients in group I showed a significantly (P = 0.023) lower embryo score and produced fewer oocytes (P = 0.0113), with fewer of them being fertilized (P = 0.0072) and transferred (P = 0.0067). Women who smoked had significantly (P = 0.0002) higher basal LH levels, but their HPRL levels were significantly (P = 0.031) lower than those of nonsmokers. Furthermore, they had a thinner endometrium on the day of embryo transfer (P = 0.0366). In group II we measured significantly elevated basal E ₂ levels (P = 0.0089) and higher LH values (P = 0.0092) in smokers. Group III showed a trend (P = 0.0565) toward lower HPRL values in smokers. Conclusions: Although the fertilization rate of oocytes and the pregnancy rate were not significantly different between smokers and nonsmokers, we found significantly alterated hormonal parameters and negatively influenced oocyte parameters, particularly after clomiphene stimulation. So we might consider using only GnRHa protocols for smoking patients. Additionally, we advise our patients to stop smoking before an IVF-ET treatment because of the complex effects of smoking on the reproductive and hormonal system.     

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.     

Crown–Rump Length Dating of Pregnancy: Error Estimates Based on Measurement of Embryos Conceived by In Vitro Fertilization

Biometric measurements of the first trimester embryo are accurate in obtaining gestational age information, providing the obstetrician with important data in pregnancy management. We evaluated 92 embryos conceived following in vitro fertilization and embryo replacement by measurement of fetal crown—rump length. Comparison to standard tables currently available showed that the actual age of these embryos were underestimated by the available information. Our table provides for adjustment of standard measured ages with 95% confidence, allowing an estimate of the youngest as well as the oldest an embryo might actually be. Until new information by endovaginal scanning is available on embryos with known gestational ages by in vitro fertilization, this may be the most practical way of assessing first trimester gestational age.     

Effects of Preservation of Mouse Spermatozoa in Electrolyte-Free Solution at 4°C on the Outcome of Mouse In Vitro Fertilization

Purpose: The aim was to assess the fertilizing capacity ofspermatozoa cool-preserved in electrolyte-free (EF)solution. Methods: Mouse spermatozoa were cool-preserved in EFsolution and the acrosomal status of the spermatozoa wascompared before and after preservation using chlortetracyclinestain. Mouse oocytes were inseminated by spermatozoacool-preserved in EF solution for 2, 4, or 7 days and fertilizationand blastocyst rates were evaluated. Results: Acrosomal status of spermatozoa cool-preservedin EF solution was not different from spermatozoa beforepreservation, but the capacitated and acrosome-reactedspermatozoa significantly increased after reinitiation. Cool-preservationin EF solution for up to 4 days did not affectfertilization rate. Blastocyst rate of embryos derived fromspermatozoa cool-preserved for 4 or 7 days in EF solutionwas significantly lower than that of embryos derived fromfresh spermatozoa. Conclusions: Mouse spermatozoa cool-preserved in EFsolution possesses as much fertilizing capacity as fresh spermatozoa.However, prolonged preservation affects theembryonic development.     

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.     

Serum Prolactin and TSH in an In Vitro Fertilization Population: Is There a Link Between Fertilization and Thyroid Function?

Purpose : Measurements of TSH and prolactin are generally included in the evaluation of female infertility, but their value in women coming to in vitro fertilization (IVF) has been questioned. Methods : In this study, we sought to investigate whether prolactin or TSH, measured in 509 specimens collected prior to therapy, predicted outcome in a prospective study of couples undergoing IVF between 1994 and 2001. Results : TSH was higher in women whose fertility problem was attributed to a male factor, and prolactin was lower if the measurement was taken during menses. TSH and prolactin were positively correlated (p < 0.0001). Neither TSH nor prolactin levels correlated with overall IVF outcome; however, TSH levels were significantly higher among women who produced oocytes that failed to be fertilized and this finding persisted after adjustment for several covariates, including sperm motility. Among women who had a least one oocyte inseminated, the likelihood that they would have fewer than 50% of their eggs fertilized was significantly related to higher TSH levels in a multivariate model. Conclusion : We conclude that TSH may predict poor fertilization in IVF and reflect the importance of thyroid hormones in oocyte physiology.     

Effect of a Sonographically Diffusely Enlarged Uterus Without Distinct Uterine Masses on the Outcome of In Vitro Fertilization–Embryo Transfer

Purpose: Our objective was to study the effect of a sonographically diffusely enlarged uterus without distinct uterine masses on the outcome of in vitro fertilization–embryo transfer (IVF-ET). Methods: Nineteen primary infertility patients undergoing IVF-ET who had a sonographically diffusely enlarged uterus without distinct uterine masses were enrolled. An age-controlled group of 144 primary infertility patients undergoing IVF-ET with a normal uterus and no history of uterine surgery was included. Results: The age, day 3 follicle stimulating hormone, antral follicle count, ovarian response, endometrial thickness, number of retrieved and fertilized oocytes, number of transferred embryos, clinical pregnancy rate, and total delivery rate were not statistically different between the two groups (P > 0.05). Patients with a sonographically diffused enlarged uterus without distinct uterine masses had a higher spontaneous abortion rate (66.7%) than controls (P < 0.04; odds ratio = 7.5;95% confidence interval, 1.16–48.56). Conclusions: A high spontaneous abortion rate was found in patients with a sonographically diffusely enlarged uterus without distinct uterine masses undergoing IVF-ET. Enhanced luteal support was required.     

Sexual Experience before Treatment for Vaginal Agenesis: A Retrospective Review of 137 Women

Study ObjectiveTo summarize the self-reported sexual experiences of women with vaginal agenesis before treatment and discuss the clinical implications.DesignA retrospective review of pretreatment baseline sexuality data and medical records of women with vaginal agenesis seeking vaginal construction.SettingA specialist multidisciplinary center for women with genital differences associated with diverse sex development.ParticipantsOne hundred thirty-seven women with untreated vaginal agenesis associated with Mayer-Rokitansky-Küster-Hauser Syndrome and complete androgen insensitivity syndrome aged 15 to 41 years (mean age, 20 years).InterventionsGynecological examination and completion of questionnaires.Main Outcome Measures(1) Sexual Experiences Questionnaire; (2) Multidimensional Sexuality Questionnaire; (3) Vaginal Self-Perceptions; and (4) vaginal length.ResultsA sizable proportion of women reported having had sexually intimate experiences before any medical intervention on the vagina. Vaginal length, which ranged from dimple to 7 cm and averaged 2.7 cm for the cohort, was unrelated to the range of sexual experiences. Most women perceived their vagina as being too small, but less than half believed that a sexual partner would notice this. Two-thirds of the cohort subsequently completed the dilation program, which was not predicted by pretreatment vaginal length or sexual experience.ConclusionContrary to the assumption that a vagina of certain dimensions is a prerequisite for women to “have sex,” many women with Mayer-Rokitansky-Küster-Hauser syndrome and complete androgen insensitivity syndrome reported having experienced genital and nongenital sexual activities with no medical interventions. It is recommended that treatment providers affirm women's capacity for sexual intimacy, relationships, and enjoyment before they introduce the topic of vaginal construction as a non-urgent choice.     

Laparoscopically Assisted Vaginal Hysterectomy—A Pilot Project

Endoscopic gynaecologic procedures have undergone a meteoric rise in popularity. This rapid adoption of untested endoscopic surgical procedures has prompted a growing concern among physicians who point to the present Jack of stringent training guidelines and clearly defined indications for laparoscopic surgery.Laparoscopically assisted vaginal hysterectomy (LAVH), first described by Reich et al. in 1989, was developed to convert an inevitable abdominal hysterectomy into a vaginal procedure, thus avoiding the postoperative morbidity and hospital stay associated with laparotomy. Early reports have suggested that LAVH can reduce postoperative morbidity successfully and shorten hospital stay. This pilot project of LAVH was conducted under the auspices of the Provincial Department of Health. The peri-operative outcomes were compared to cohorts of patients who underwent either a vaginal or abdominal hysterectomy performed by the same surgeons.In this study, LAVH resulted in a higher rate of peri-operative complications. Postoperative hospital stay was comparable to patients who underwent vaginal hysterectomy. The reduction in hospital stay compensated for the increased cost of disposable surgical instruments and resulted in a net cost comparable to the abdominal hysterectomy. Larger studies are needed to evaluate the safety of LAVH and to define better the indications for this surgical procedure.     

Smooth Muscle Differentiation of Penile Stem/Progenitor Cells Induced by Microenergy Acoustic Pulses In Vitro

IntroductionModulating tissue-resident stem and progenitor cells with a non-invasive, mechanobiological intervention is an optimal approach for tissue regeneration. Stem cell antigen-1 (Sca-1) has been identified as a stem cell marker within many organs but never within the penis.AimTo localize and isolate penile stem/progenitor cells (PSPCs) and to evaluate cellular differentiation after exposure to induction medium and microenergy acoustic pulse (MAP) therapy.MethodsSix male Sprague-Dawley rats were used to isolate PSPCs. Isolation was followed by stem cell characterization and differentiation assays. The PSPCs were then treated with MAP (0.033 mJ/mm², 1 Hz) at various dosages (25, 50, 100, and 200 pulses) and for different durations (1, 2, 4, 6, or 8 hours) in vitro.Main Outcome MeasureThe PSPCs (Sca-1-positive cells) were isolated using the magnetic-activated cell sorting system. PSPC cellular differentiation was assessed after induction with induction medium and with MAP in vitro. Wnt/β-catenin signaling was also assayed.ResultsThe PSPCs were successfully localized within the penile subtunic and perisinusoidal spaces, and they were successfully isolated using magnetic-activated cell sorting. The stemness of the cells was confirmed by stem cell marker characterization and by multiple differentiation into smooth muscle cells, endothelial cells, adipocytes, and neurons. MAP-induced PSPCs differentiated into smooth muscle cells by activating the Wnt/β-catenin signaling pathway in a time- and dosage-dependent manner.Clinical ImplicationsBy modulating resident PSPCs, MAP may have utility in the treatment of erectile dysfunction (ED).Strengths & LimitationsThis study provides solid evidence in support of microenergy therapies, including both MAP and low-intensity extracorporeal shock wave therapy, for the treatment of ED. Additional studies are needed and should include additional stem cells markers. Furthermore, studies exploring the underling mechanisms for PSPC activation and differentiation are required.ConclusionPSPCs were successfully identified, localized, and isolated. Additionally, MAP provoked PSPCs to differentiate into smooth muscle cells via the Wnt/β-catenin signaling pathway. As such, MAP provides a novel method for activating endogenous tissue-resident stem/progenitor cells and might facilitate stem cell regenerative therapy targeting ED.Peng D, Yuan H, Liu T, et al. Smooth Muscle Differentiation of Penile Stem/Progenitor Cells Induced by Microenergy Acoustic Pulses In Vitro. J Sex Med 2019; 16:1874–1884.     

A Prospective Trial Using Mifepristone and Vaginal Misoprostol in Termination of Pregnancies up to 63 Days of Gestation

Purpose

According to the Consortium on National Consensus for Medical Abortion in India, on average about 11 million abortions take place annually, and around 20,000 women die every year due to abortion-related complications. This study was undertaken to determine the efficacy and the side effect profile of a regime of 200 mg of mifepristone administered orally followed by 800 mcg of vaginal misoprostol after 48 h.

Methods

50 cases of medical abortion meeting the inclusion criteria were included. On day 1, 200 mg of oral mifepristone was given. On day 3, the patient was called back, and 800 mcg of Misoprostol administered per vaginum and was observed for 6 h. The patients were then called back for review after two weeks to make sure that the abortion was complete. Although, in most cases, this was clinically evident, an ultrasonography was repeated to confirm the completion.

Results

Out of the 50 patients, four were lost to follow up, and of the remaining 46 patients, abortions were complete in 44 (95.65 %), while two (4.35 %) patients required surgical intervention.

Conclusions

Medical abortion with 200 mg oral mifepristone and 800 mcg vaginal misoprostol is an effective, safe, reliable, and noninvasive method with a success rate of 95.65 %. The availability of this low-cost medical treatment using agents which do not require special cold storage and transport facilities and negligible operating theater time makes this provision of safe abortion feasible in settings especially of developing countries, like India, where medical facilities are limited.