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.     

Donor age is paramount to success in oocyte donation.

Several reports suggest increasing age in oocyte donors decreases the chances of in-vitro fertilization (IVF) success, while others describe no effect. The published data concerning gravidity and parity are similarly conflicting. To further address these questions, we retrospectively studied 445 consecutive donor IVF cycles at two large university-based IVF practices. Donor cycles were analysed for the number of oocytes retrieved, gravidity, parity, and age of the donor, and pregnancy outcome in recipients. The previous gravidity and parity of the donor were not associated with successful pregnancy in recipients. The number of oocytes retrieved was positively correlated with pregnancy. However, after adjusting for donor age, neither prior fertility nor the number of oocytes retrieved were significant predictors. In contrast, the donor's age was highly associated with recipient success. We conclude that the age of the oocyte donor is a significant predictor of pregnancy success and should be a major factor in selecting prospective candidates. The gravidity and parity of the donor are insignificant predictors, as are the total number of oocytes retrieved at the time of oocyte harvest.     

Sonohysterography: a valuable tool in evaluating the female pelvis

A number of medical conditions, including abnormal uterine bleeding, endometrial cancer, monitoring tamoxifen therapy, infertility, and recurrent abortion, warrant investigation of the female genital tract. Diagnostic studies including hysterosalpingogram, ultrasound, and sonohysterography have proved useful in the investigation of these gynecologic conditions. This article discusses each of these tests with particular emphasis on sonohysterography and their current and potential contributions in both diagnostic and therapeutic applications. The utility of each as well as their comparative value to each other and existing gold standards is reviewed. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to outline the current screening methods for uterine cavity and pelvic abnormalities, to list the advantages of sonohysterography, and to describe the clinical situations where sonohysterography can be used.     

GnRH antagonists followed by a decline in serum estradiol results in adverse outcomes in donor oocyte cycles

BACKGROUND: The aim of this retrospective study was to assess clinical outcomes using GnRH antagonists in oocyte donation cycles. METHODS: Between July 2000 and June 2001, 40 recipient cycles generated from donor oocytes were evaluated. Controlled ovarian hyperstimulation (COH) was started on cycle day 2 using recombinant gonadotrophins (225 IU daily). GnRH antagonist was started on cycle day 6 of COH. All recipients were synchronized to donors using GnRH agonist followed by estrogen and progesterone supplementation. Main outcome measures were days of stimulation (DOS), number of ampoules used, peak serum estradiol, number of oocytes, fertilization rate, embryo score, clinical on-going pregnancy rate and implantation rate. RESULTS: Thirty-seven donor cycles (93%) underwent oocyte retrieval, resulting in 36 embryo transfers. Fourteen cycles (35%) had decreased serum estradiol after initiation of GnRH antagonist. No differences were seen in numbers of FSH ampoules, DOS, peak serum estradiol, number of retrieved oocytes, fertilization rate and embryo quality. However, clinical pregnancy rate per initiated cycle [14% (2/14) versus 54% (14/26)], ongoing pregnancy rate per initiated cycle [7% (1/14) versus 46% (12/26)] and implantation rate (4 versus 24%) were all significantly less (P <0.05) following a decrease in serum estradiol after initiation of GnRH antagonist. No clinical predictor, including donor age, basal day 2 FSH or estradiol, ovarian morphology or serum estradiol prior to GnRH antagonist, was predictive of a decline in serum estradiol following GnRH antagonist. CONCLUSION: These data demonstrate an adverse effect on clinical outcome in cycles, resulting in a decline in serum estradiol after GnRH antagonist administration. This effect was unpredictable and provided a simplified protocol for oocyte donation cycles; nonetheless, further study is needed to clarify the adverse effects of GnRH antagonists in oocyte donation cycles.