Transfer of embryos into the uterus: How much do technical factors affect pregnancy rates?

Objective Our objective was to identify the effect on outcome of (a) ultrasound-assisted embryo transfer, (b) the use of different embryo transfer catheters, and (c) the length of time the patients remain in the supine position after embryo transfer.Setting The setting was a private fertility center.Subjects This was a prospective study of 178 in vitro fertilization and embryo transfers (IVF-ET) and 63 frozen embryo replacements (FER).Results The pregnancy rate was 28.7% following IVF-ET and 31.8% for FER. Ultrasound-assisted transfer did not affect the outcome (29 vs 30.3%). There was no difference in the performance of the Wallace and Frydman catheters with regard to outcome (30.3 vs 30.7%). Although there was an increase in pregnancy rate as the time interval in the supine position after ET increased, this needs a larger study.Conclusion The parameter studies did not affect the outcome of IVF/ET or FER. Some factors encouraged us to recommend ultrasound-assisted transfer in some cases, and the use of a Frydman catheter for transfer and to encourage the supine position after transfer for longer periods.     

Controlled ovarian hyperstimulation for low responders in in vitro fertilization/intracytoplasmic sperm injection: a low-dose flare protocol

In this retrospective study of 652 anticipated low response women, the overall clinical outcomes (live birth rate and clinical pregnancy rate [PR]) of low-dose flare (LDF) protocol appeared lower than those of conventional down-regulation (DR) (LDF: 15.1% vs. DR: 20.6% and LDF: 10.3% vs. DR: 17.4%, respectively). The findings that LDF protocol improved the clinical outcome in older women, or when LDF followed an unsuccessful IVF/intracytoplasmic sperm injection (ICSI) cycle with DR (LDF: 19.4% vs. DR: 9.76% and LDF: 13.9% vs. DR: 4.2% respectively), need further evaluation through randomized trials.     

Fertilization of supernumerary oocytes following gamete intrafallopian transfer (GIFT): Correlation with outcome of GIFT treatment

In the course of 280 consecutive gamete intrafallopian transfer (GIFT) attempts, supernumerary oocytes in excess of those transferred were inseminated in vitro. Pregnancy resulted in 31.1% of patients following the GIFT treatment. The overall in vitro fertilization (IVF) rate of supernumerary oocytes was significantly higher in those who became pregnant (41.2%) than in patients who did not (34.9%). However, the failure to fertilize any supernumerary oocytes was not significantly different between those becoming pregnant (27.6%) and those in whom the treatment failed (37.3%). Failure to fertilize any supernumerary oocytes in vitro was of a higher rate if suboptimal sperm preparation was used or if only one oocyte was left over for in vitro insemination following the GIFT treatment. We concluded that the in vitro fertilization rate was higher in the pregnant group, but the total failure to fertilize or the fertilization of any supernumerary oocytes does not predict the outcome of GIFT. Embryos resulting following fertilization of excess oocytes may be cryopreserved for subsequent use.     

Does impaired glucose tolerance imply a risk in pregnancy?

Of 218 pregnant women with abnormal glucose tolerance by the criteria of the World Health Organization (1985) 81.2% had impaired glucose tolerance and 18.8% gestational diabetes. Gestational diabetic women were of higher parity, more obese, required insulin therapy more often, had more babies weighing greater than 4 kg and had higher fasting plasma glucose than women with impaired glucose tolerance. Women with gestational impaired glucose tolerance were older, of higher parity, more obese and had heavier babies than pregnant women with a normal screening plasma glucose. Compared with women with impaired glucose tolerance, gestational diabetic women were more likely to have abnormality, and more severe impairment of their glucose tolerance test in the puerperium.     

Intracytoplasmic sperm injection improving embryo quality: Comparison of the sibling oocytes of Non-Male-Factor couples

Objective: Our objective was to investigate whether the quality of embryos developed after intracytoplasmic sperm injection (ICSI) is better than that of conventional IVF embryos. Methods: Nine couples who previously achieved a normal rate of fertilization following IVF and four couples whose normal rate of fertilization was expected were involved in this study. The oocytes from those couples were randomly divided into two groups, group A by conventional insemination and group B by ICSI. The fertilization rate and quality of embryos were compared. Results: Normal fertilization was achieved in 61% of the oocytes (83/136) after conventional insemination. In group B, 69% of the oocytes (99/144) achieved normal fertilization, although only 127 metaphase II oocytes were injected using the ICSI technique. More grade A embryos were obtained when the ICSI technique was used for fertilization than by conventional IVF (35.4 and 24.3%, respectively;P=0.028). Conclusions: A similar fertilization rate can be achieved by ICSI in comparison with conventional IVF, when male factor is not involved. Embryos after ICSI have an improved quality.     

Clinical evaluation of three different gonadotrophin-releasing hormone analogues in an IVF programme: a prospective study

The efficacy and safety of short acting buserelin and nafarelin intranasal spray were compared to long acting leuprorelin depot intramuscular or subcutaneous injection in this prospective study of 157 women undergoing controlled ovarian hyperstimulation (COH) for in-vitro fertilisation (IVF). Patients were allocated to three groups to receive buserelin 150 microg nasal spray three times daily (Group B), nafarelin nasal spray 400 microg twice daily (Group N), or leuprorelin depot 3.75 mg once by intramuscular or subcutaneous injection (Group L) for pituitary desensitisation prior to commencing COH with human menopausal gonadotrophins (hMG) according to the Centre's protocol.The mean (+/-S.D.) age (years) (32.6+/-3.8: Group B, 32.1+/-3.3: Group N versus 32.1+/-3.3: Group L); mean (+/-S.D.) total dosage of hMG (ampoules) (37.5+/-16.1: Group B, 39.8+/-14.2: Group N versus 41.9+/-12.6: Group L) and mean daily dosage of hMG (ampoules) (3.1: Group B, 2.8: Group N versus 3.0: Group L) seen were not statistically significantly different.The duration between starting the different gonadotrophin-releasing hormone (GnRHa) and the beginning of the next menstrual period was also not seen to be statistically significantly different between the three groups (Group B: 10+/-5.5, Group N: 9.1+/-4.1 versus Group L: 8.2+/-3, days). The number of abandoned cycles was higher in Group L (17% versus 11.8%: Group B and 11.3%: Group N) but this difference did not reach statistical significance. The clinical pregnancy rates per oocyte retrieval and per embryo transfer procedure were respectively, 31.1, 35% in Group B, 12.8, 14% in Group N versus 20.5, 23.7 in Group L and were not seen to be statistically significantly different even when ongoing pregnancy rates were compared.Apart from a statistically significantly greater incidence of allergic nasal reactions in the nafarelin group (P=0.001), all other side-effects were not shown to be statistically significantly different between the three groups. We conclude that a single dose of leuprorelin depot can be considered to be as an equally effective alternative to multiple doses of buserelin or nafarelin for pituitary desensitisation in women undergoing COH for IVF.     

Cone-beam computed tomography findings of temporomandibular joints with osseous abnormalities

Objective

To evaluate the cone-beam computed tomography (CBCT) findings of temporomandibular joints (TMJs) with osseous abnormalities.

Methods

CBCT images of 88 TMJs in 44 patients with arthrogenic TMJ disorder and 40 normal TMJs of 20 asymptomatic patients were selected for the study. All images were used for evaluation of the condyles (position and width), glenoid fossae (width and depth), and joint spaces (anterior, posterior, and maximum superior). The frequencies of the condylar positions were compared between the two groups using the Chi-square test. The mean values of the remaining CBCT findings were compared between the two groups using the Mann?CWhitney U test.

Results

In the 88 TMJs with osseous abnormalities, a dorsal position of the condyle was most frequently seen (62/88), whereas central and ventral positions of the condyle were seen in two and 24 joints, respectively. The TMJs with osseous abnormalities exhibited a significantly lower mean value for the condyle width and a significantly higher mean value for the anterior joint space than the TMJs without such abnormalities.

Conclusions

Small and dorsally positioned condyles are characteristic CBCT findings of TMJs with osseous abnormalities.