Favorable influence of local injury to the endometrium in intracytoplasmic sperm injection patients with high-order implantation failure

Local injury to the endometrium prior to controlled ovarian stimulation may considerably improve implantation rates and pregnancy outcomes in intracytoplasmic sperm injection patients with high-order implantation failure (> or =4 IVF trials and > or =12 transferred embryos).     

Serial sonography and colour flow Doppler imaging following testicular and epididymal sperm extraction

Percutaneous epididymal sperm aspiration (PESA), percutaneous testicular sperm aspiration (TESA) and testicular sperm extraction (TESE) are invasive procedures and their consequences on the testis have not been clearly defined. In order to relate the sonographic and colour Doppler flow changes to the clinical data, 14 patients with non- obstructive and six with obstructive azoospermia were examined by the same roentgenologist immediately before, at 5 days, 2 weeks, 2 and 6 months after the surgical procedure. Testicular volumes remained unchanged during the follow-up period in both the non-obstructive and obstructive groups. Of the non-obstructive group, focal testicular lesions were seen in 20 of the 26 testes (77%) 5 days after the procedure and in 54% by 6 months. Ten were hypoechoic, of which six converted to echogenic foci, three remained hypoechoic and one disappeared at 6 months. The other 10 were echogenic lesions, three of which were no longer visible at 6 months and the remainder were unchanged. In the obstructive azoospermic group, focal lesions were not found. Extratesticular abnormality consistent with haematoma was demonstrated in four non-obstructive cases, which disappeared at the 6 month examination, and in none of the obstructive azoospermic patients. Whether residual focal lesions in the testes have long-term effects remains to be evaluated. In the obstructive azoospermic group, the aspirations performed did not leave any sonographic abnormalities.      

Hypercoagulable thrombophilic defects and hyperhomocysteinemia in patients with recurrent pregnancy loss

PROBLEM: Placental perfusion may be compromised by increased thrombosis that leads to pregnancy complications and recurrent pregnancy loss (RPL). Since heritable thrombophilic defects and hyperhomocysteinemia are associated with increased thrombosis, their prevalence was evaluated in RPL patients with special emphasis on combinations of the above pathologies. METHODS OF STUDY: Evaluation of the prevalence of heritable thrombophilic defects (protein S, protein C, anti-thrombin III deficiency, and the mutations for factor V Leiden, methylenetetrahydrofolate reductase [MTHFR], and prothrombin gene), hyperhomocysteinemia. and combinations of these pathologies in 36 non-pregnant recurrent aborters compared with 40 parous women. RESULTS: We found a relatively high prevalence of deficiencies of plasma coagulation proteins in RPL patients compared with the controls. A non-significant different increase in factor V Leiden mutation was detected (6/36 [16%] compared with 2/40 [5%] in the control group, P = 0.14]. Hyperhomocysteinemia was found in 31% of the RPL patients. MTHFR mutation homozygosity was found in 6/36 (16%) of the aborting patients. Combinations of hyperhomocysteinemia and MTHFR mutation were found in three patients, with folate deficiency in two patients, and with B12 deficiency in three. CONCLUSIONS: Combinations of gene mutations, plasma protein deficiencies, and hyperhomocysteinemia, which are associated with an increased thrombotic risk, are more common in RPL patients compared with controls. Large-scale prevalence studies are needed in order to draw conclusions as to the causative relation of such a condition and RPL.     

Increased early pregnancy loss in IVF patients with severe ovarian hyperstimulation syndrome.

BACKGROUND: Since severe ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of assisted reproduction, the focus of attention in such cases is placed firmly upon the health of the patient, with the endeavour to achieve a pregnancy being considered of secondary importance. The aim of this study was to focus on the pregnancy rate and pregnancy outcome in IVF patients hospitalized for severe or critical OHSS, in one centre, during a period of 6 years. METHODS: We compared the characteristics of patients with severe OHSS: those who conceived with the ones who did not conceive, and among pregnant IVF patients, those with ongoing pregnancies with those that miscarried. RESULTS: Pregnancy was achieved in 60 of 104 (58%) patients with severe OHSS. Pregnancy continued until delivery in 37 of these 60 patients (62%), whereas the remaining 23 (38%) aborted. The pregnancy and abortion rates in patients with severe OHSS were significantly higher than those of IVF patients without OHSS, during the same time period [23% (1138/4922) and 15% (169/1138) respectively, P < 0.001]. The mean duration of hospitalization for OHSS was significantly shorter in those who delivered compared with those who aborted (5.9 +/- 3.2 versus 10.5 +/- 9.6 days, P < 0.01) and in the non-pregnant patients compared with the pregnant patients (5.2 +/- 3.2 versus 7.6 +/- 6.6 days, P < 0.02). CONCLUSIONS: The clinical pregnancy rate of IVF patients with severe OHSS was significantly higher than that of patients without the syndrome. A longer stay in hospital-reflecting a more severe form of OHSS-was correlated with a higher frequency of abortions. OHSS, necessitating hospitalization, is a detrimental clinical situation not only for the mother but also for the developing pregnancy.     

The effect of two distinct levels of oxygen concentration on embryo development in a sibling oocyte study

Purpose

This prospective randomized study used sibling oocytes of 258 women with ≥8 oocytes to compare the effect of 5 % O₂ versus 20 % O₂ concentrations on embryo development and clinical outcome.

Methods

Oocytes of each case were divided between incubators with either 5 % or 20 % O₂ concentration. Outcome measures were fertilization, cleavage, embryo quality, blastocyst formation, and implantation, pregnancy and live birth rates.

Results

Fertilization and cleavage rates were similar in both groups. The 5 % O₂ group had significantly more blastomeres (P < 0.05) and more top-quality embryos on day 3 (P < 0.02), as well as significantly more available embryos for transfer (31.6 % vs. 23.1 % for the 20 % O₂ group; P < 0.0001). There were significantly more cycles with good embryos in the 5 % group (76/258) than in the 20 % group (38/258) (P < 0.0001). Implantation and pregnancy rates were significantly higher for 5 % O₂ embryos (P < 0.03 and P < 0.05, respectively). Live birth rates per embryo transfer were 34.2 % and 15.8 %, respectively, P < 0.05.

Conclusions

Implantation, pregnancy and live birth rates are higher, and more good quality embryos are available for transfer and freezing with reduced rather than with atmospheric oxygen concentrations during embryo incubation.     

The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer

This experimental prospective quasi-randomized study examining the impact of a medical clowning encounter after embryo transfer (ET) after in vitro fertilization (IVF) found that the pregnancy rate in the intervention group was 36.4%, compared with 20.2% in the control group (adjusted odds ratio, 2.67; 95% confidence interval, 1.36-5.24). Medical clowning as an adjunct to IVF-ET may have a beneficial effect on pregnancy rates and deserves further investigation.     

Nationwide use of postmortem retrieved sperm in Israel: a follow-up report

A follow-up study of the subsequent use of all postmortem frozen sperm samples during 2003-2010 is reported. Only the sister of one of the 10 unmarried deceased men was in contact with the bank. Four widows elected to discard the frozen sperm and all of the remaining spouses were uninterested in its fate. Because none of the samples were requested for use, the need for sperm procurement should be reconsidered.