Prediction of ovarian reserve based on day-3 serum follicle stimulating hormone concentrations during the pituitary suppression cycle using a gonadotropin releasing hormone agonist in patients undergoing in vitro fertilization–embryo transfer

Satisfactory results following in vitro fertilization–embryo transfer (IVF-ET) treatments depend on retrieving an appropriate number of mature oocytes without causing the development of ovarian hyperstimulation syndrome (OHSS). The present study was carried out to investigate whether the ovarian reserve is predictable based on the day-3 serum concentration of follicle stimulating hormone (FSH) during the pituitary suppression cycle using a gonadotropin releasing hormone (GnRH) agonist (defined as day-3 FSH) in patients undergoing IVF-ET treatment. Day-3 FSH before the administration of gonadotropin was assessed in 72 IVF-ET cycles from 59 infertile women. The mean?±?SD of day-3 FSH, the total amount of FSH plus human menopausal gonadotropin (hMG) administered, and the total number of oocytes retrieved was 5.5?±?2.6 mIU/ml, 2834.2?±?1236.5?IU and 7.7?±?5.8, respectively. There were significant correlations between day-3 FSH and the total amount of FSH–hMG administered (p?<?0.001), and day-3 FSH and total number of oocytes retrieved (p?<?0.001). There was a significant difference of day-3 FSH between patients who subsequently conceived (4.4?±?1.3 mIU/ml) and those who did not conceive (6.1?±?2.9 mIU/ml) (p?= 0.001). There was also a significant difference of day-3 FSH between patients who developed moderate or severe OHSS (4.5?±?1.2 mIU/ml) and those who did not (5.9?±?2.8 mIU/ml) (p?=?0.003). Receiver-operator characteristic curve analysis showed that the significant cut-off point for day-3 FSH for predicting ovarian reserve was 5.25?mIU/ml. These findings indicate that day 3-FSH is useful for predicting ovarian reserve during the pituitary suppression cycle using a GnRH agonist in patients undergoing IVF-ET.     

Influence of endometrial thickness and pattern on pregnancy rates inin vitro fertilization-embryo transfer

Aim : Our aim was to investigate the role of endometrial thickness and pattern in the pregnancy rate during an in vitro fertilization-embryo transfer (IVF-ET) cycle.
Methods : Records of patients who underwent IVF-ET at the Jichi Medical School Hospital during May 1995–December 1999 were evaluated retrospectively. Only cycles, in which endometrial thickness and pattern on the day of human chorionic gonadotrophin (HCG) administration were recorded, were analyzed in this study. Endometrial thickness was divided into three categories (A: < 10 mm, B: 10–14 mm, C: > 14 mm), and endometrial pattern was divided into two categories: triple line and non-triple line. A total of 156 IVF-ET cycles from 120 patients was evaluated.
Results : There were no significant differences for both the endometrial thickness and pattern in the pregnancy rate during the IVF-ET cycle ( P  > 0.05). Among the study groups, the triple-line endometrial pattern was found to be 58.7% in group A, 84.0% in group B and 70% in group C. We found that in the triple-line endometrial pattern, there was a significant difference between group A and group B ( P  < 0.01). Triple-line endometrial pattern appeared significantly in younger women (33 ± 5.4 years) than in non-triple-line endometrial pattern (36 ± 5.2 years; P  = 0.047). The minimum and maximum endometrial thickness where pregnancy occurred was 6.5 mm (two pregnancies) and 19 mm (one pregnancy), respectively.
Conclusion : Endometrial thickness and pattern have no influence on the pregnancy rates in an IVF-ET cycle, but patients with triple-line endometrial pattern and group B endometrial thickness showed a better pregnancy outcome in the IVF-ET treatment. (Reprod Med Biol 2002; 1 : 17–21)     

Symphysis-fundus height and weight gain pattern in Japanese women with twin pregnancies

OBJECTIVE: To determine the normogram for symphysis-fundus height and weight gain pattern in Japanese women with twin pregnancies and to examine whether fundus height and weight gain pattern are altered in women who give birth to twin infants complicated by fetal growth restriction (FGR). STUDY DESIGN: A retrospective review of the medical records of 186 twin gestations that had been followed at our institution together with 229 singleton pregnancies as a control. We examined maternal symphysis-fundus height, body weight gain and increase in body mass index (BMI) according to gestational age and compared them between women with and without FGR. RESULTS: As compared to women with singleton pregnancies, those with twins exhibited larger fundus height, larger weight gain and larger increase in BMI, all of which were observed from as early as 16-18 weeks of gestation until delivery. Mothers of twins with at least one FGR infant showed smaller fundus height, smaller weight gain and smaller increase in BMI as compared to those without. CONCLUSION: We constructed the normogram for symphysis-fundus height and weight gain pattern in Japanese twin gestations and determined the characteristic change in these parameters in FGR in women with twins. These results may be of use in identifying mothers of twins with FGR.     

Serum leptin concentrations in patients with severe ovarian hyperstimulation syndrome during in vitro fertilization-embryo transfer treatment

OBJECTIVE: To investigate the changes in serum leptin concentration in the conception cycle of severe ovarian hyperstimulation syndrome (OHSS). DESIGN: Prospective longitudinal study of 66 IVF-ET cycles between May 2000 and June 2002. SETTING: Infertility outpatient clinic at a Japanese medical school. PATIENT(S): Infertile patients undergoing IVF-ET cycles at the infertility outpatient clinic were divided into three groups consisting of group 1 (conception-cycle patients with severe OHSS, n = 9), and group 2 (conception cycle, non-OHSS, n = 28), and group 3 (nonconception cycle, non-OHSS, n = 29). INTERVENTION(S): Blood samples were collected at five different periods. Period I, on the first day of ovarian stimulation with FSH; period II, at hCG administration before oocyte retrieval; period III, 7 days after oocyte retrieval; period IV, 14 days after oocyte retrieval; and period V, 21 days after oocyte retrieval. MAIN OUTCOME MEASURE(S): Serum leptin concentration. RESULT(S): The serum leptin concentration was low in the OHSS group compared with that of the non-OHSS groups in all serum samples, with significant levels at periods III (vs. groups 2 and 3; P<.05) and IV (vs. group 3; P<.01). A twofold increase of leptin concentration from period I to period II (P<.05) was observed in all groups. CONCLUSION(S): The change pattern in serum leptin concentration might provide a great contribution to the pathophysiology development of OHSS patients during assisted reproductive treatment.     

Optimal ventricular pacing rate in fetal lambs with complete atrioventricular block

OBJECTIVE: This study was undertaken to determine the optimum ventricular pacing rate at which the optimal cardiac function can be attained in fetal lambs with complete atrioventricular block. STUDY DESIGN: Complete atrioventricular block was created by cryosurgery in 12 fetal lambs, and the ventricle was paced randomly at rates of 60, 90, 120, 150, 180, 210, 240, and 270 beats/min. The aortic pressure, central venous pressure, and right ventricular cardiac output were measured before cryosurgery and during ventricular pacing. RESULTS: Complete atrioventricular block was created in 9 of 12 fetal lambs. Systolic aortic pressure significantly decreased at pacing rates of 60, 90 and 240 beats/min (P <.01), and central venous pressure was increased significantly at a pacing rate of 60 beats/min (P <.01) compared with the control. Right ventricular cardiac output significantly decreased at pacing rates of 60, 90, 120, 180, 210, 240, and 270 beats/min (P <.01), although no significant difference was found at the pacing rate of 150 beats/min compared with control. CONCLUSION: Ventricular pacing at a rate of 150 beats/min gave the highest aortic pressure, the lowest central venous pressure, and the highest right ventricular cardiac output in fetal lambs with complete atrioventricular block.     

Prediction of pregnancy by intrauterine insemination using CASA estimates and strict criteria in patients with male factor infertility

This study was performed to predict pregnancy by intrauterine insemination (IUI) using computer-aided sperm analysis (CASA) estimates and strict criteria in patients with male factor infertility. IUI was performed in 682 cycles on 160 male factor infertile patients. Semen examinations were carried out by CASA and strict criteria before and after sperm preparation using continuous-step density gradient centrifugation. Receiver operating characteristics (ROC) curves were constructed for assessment of the effectiveness of each individual parameter in predicting pregnancy by IUI. A clinically acceptable threshold was calculated when sensitivity plus specificity were maximum. The average cycle of IUI performed was 4.3 +/- 2.4. Pregnancy rate per cycle and per patient were 7.2% (49/682) and 28.1% (45/160), respectively. Using ROC curve, it was shown that normal sperm morphology assessed by the strict criteria before sperm separation and five parameters after sperm separation including rapid, progressive motility, average path velocity (VAP), curvilinear velocity (VCL), and straight line velocity (VSL) were able to predict pregnancy by IUI. Correlation between sperm parameters and pregnancy outcome was examined by the logistic regression model. In a multivariate analysis normal morphology before sperm separation >or=15.5% [odds ratio (OR) = 2.2, p = 0.02], rapid after sperm separation >or=25.5% [OR = 3.9, p = 0.029], and VCL after sperm separation >or=102.65 microm/sec [OR = 3.2, p = 0.002] were the parameters of predictive value for pregnancy outcome. Adjustment of the model for female age, female infertility factors, and the methods of ovulation induction did not change this finding, and the final model still had the same covariates. Pregnancy rates per cycle according to the number (0, 1, 2 and 3) of variables satisfied with the three parameters were 0% (0/110), 1.6% (3/183), 9.7% (21/217) and 15.1% (23/151), respectively. Three semen parameters including normal morphology before sperm separation, rapid and VCL after sperm separation were identified as predictors of pregnancy by IUI. These variables would be helpful when counselling patients before they make the decision to proceed with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-ET.     

Clinical significance of the Acridine Orange test performed as a routine examination: comparison with the CASA estimates and strict criteria

The aim of the present study is to clarify the clinical significance of the Acridine Orange (AO) test (a sperm function test) as a routine examination by investigating the relationships between chromatin decondensation assessed by the AO test and routine semen analysis. Totally 543 semen samples were obtained from 286 infertile men. The AO test was performed, and spermatozoa displaying green fluorescence were considered as mature. The threshold of green AO fluorescence as 50% was adopted and the values <50% were considered as positive in the test. Computer-aided sperm analysis (CASA) and strict criteria were used for routine semen analysis. Twenty-two (4.05%) of 543 semen samples were positive in the AO test. In 20 semen samples obtained from men with severe male infertility treated by intracytoplasmic sperm injections (ICSI), the positive rate was 30.0%, which was significantly higher than that (2.63%) treated by conventional in vitro fertilization (IVF) (p=0.01). As for the basic sperm parameters, there were significant correlations between the AO test and sperm motility (p<0.001), and between the AO test and normal sperm morphology (p=0.02). However, there was no relationship between the AO test and sperm concentration (p=0.585). Sperm motion parameters assessed by CASA, including amplitude of lateral head displacement (ALH), curvilinear velocity (VCL) and rapid sperm movement (Rapid), were significantly correlated with the AO test. The information obtained using the AO test was indicated to be useful in planning treatment strategy for infertile couples.     

Hemodynamic effect of the ventricular pacing site in fetal lambs with complete atrioventricular block

Complete atrioventricular (AV) block in hydrops fetalis is associated with high mortality. Fetal ventricular pacing to restore ventricular rate can be an effective procedure, however, no fetal data has shown an appropriate epicardial ventricular pacing site. To evaluate the hemodynamic effect of right and left ventricular pacing in fetal lambs with complete AV block, a fetal complete AV block model was created. Aortic pressure, central venous pressure, and QRS duration were measured, and right and left ventricular output was estimated in seven fetal lambs. The uterus was opened under maternal anesthesia, and under local anesthesia, catheters were inserted into the fetal superior vena cava and ascending aorta through a neck incision. Pacing leads were then sutured onto the fetal right and left ventricular epicardium via a midline thoracotomy. Complete AV block was created by cryoablation of the AV node. Ventricular output was estimated using echocardiography by a transuterine approach. Fetal hemodynamics were observed before AV block creation (control), and after complete AV block creation with the right and left ventricular pacing set at 150/min. The right ventricular output was 320 +/- 66 mL/kg per minute at control, decreased to 243 +/- 65 mL/kg per minute during right ventricular pacing (P < 0.05), and was 254 +/- 61 mL/kg per minute during left ventricular pacing. The left ventricular output was 224 +/- 98 mL/kg per minute at control, 176 +/- 77 mL/kg minute during right ventricular pacing, and 178 +/- 67 mL/kg per minute during left ventricular pacing. Biventricular (combined ventricular) output was 544 +/- 134 mL/kg per minute at control, 419 +/- 114 mL/kg per minute during right ventricular pacing, and 432 +/- 100 mL/kg minute during left ventricular pacing. Systolic aortic pressure was 62.2 +/- 8.7 mmHg at control, 55.2 +/- 9.5 mmHg during right ventricular pacing, and 53.4 +/- 9.1 mmHg during left ventricular pacing. Central venous pressure (CVP) was 2.6 +/- 0.5 mmHg at control, 4.0 +/- 2.7 mmHg during right ventricular pacing, and 4.4 +/- 2.5 mmHg during left ventricular pacing. The QRS duration was 51 +/- 54 ms at control, but lengthened to 87 +/- 19 ms during right ventricular pacing and to 78 +/- 21 ms during left ventricular pacing (P < 0.05). In conclusion, the right ventricular output decreased during right ventricular pacing in fetal lambs with complete AV block, while it was preserved during the left ventricular pacing. Left ventricular pacing might be superior for treating hydropic fetuses with complete AV block.     

Relationships between Chlamydia trachomatis antibody titers and tubal pathology assessed using transvaginal hydrolaparoscopy in infertile women

PROBLEM: Since transvaginal hydrolaparoscopy (THL) was introduced as the first-line procedure in the early stages of the exploration of the adnexal structures in infertile women, it has been shown that THL is a less traumatic and a more suitable outpatient procedure than diagnostic laparoscopy. This study was performed to investigate the relationships between Chlamydia trachomatis antibody titers and tubal pathology assessed using THL in infertile women. METHODS: The C. trachomatis antibody titers (IgG and IgA) were evaluated by ELISA. The posterior of the uterus and the tubo-ovarian structures were carefully observed, and tubal passage using indigocarmine was confirmed using THL. THL was carried out in 32 infertile women having C. trachomatis antibody in their sera between May 1999 and October 2001. Unilateral salpingectomy had been performed on two of the 32 patients. RESULTS: Tubal occlusion was confirmed in 20 (32.3%) of the 62 tubes, while peritubal adhesion was diagnosed in 37 (59.7%) of the 62 tubes. Using receiver operating characteristics curves, the cut-off value of C. trachomatis IgG antibody titer to predict tubal occlusion was determined to be 3.55. Tubal occlusion was observed in 16 (51.6%) of the 31 tubes in patients with the C. trachomatis IgG antibody titer of more than 3.55, which was significantly higher in four (12.9%) of the 31 tubes having the antibody titer less than 3.55 (P = 0.004). However, there was no correlation between C. trachomatis IgG antibody titer and peritubal adhesion. As for C. trachomatis IgA antibody titer, there was no correlation between antibody titer and tubal occlusion or peritubal adhesion. CONCLUSIONS: These results suggest that C. trachomatis infection is significantly associated with tubal pathology. Although the cut-off value of C. trachomatis IgG antibody titer to predict the existence of tubal occlusion was shown to be 3.55, we would suggest that THL or standard laparoscopy is performed to consider appropriate treatments in patients with past C. trachomatis infection because of the high prevalence of peritubal adhesion.     

Chemokine bioactivity of RANTES is elevated in the sera of infertile women with past Chlamydia trachomatis infection

PROBLEM: It has been shown that Chlamydia trachomatis infection in infertile women is highly associated with tubal pathology. Chlamydia trachomatis antibody testing is a simple screening test for tubal factor subfertility, however, it is based on the detection of previous infection. Recently, association between some inflammatory diseases and chemokines has been investigated. This study was performed to clarify the relationship between chemokines in the sera of infertile women and past C. trachomatis infection. METHOD OF STUDY: Serum samples were collected from 10 infertile women having C. trachomatis antibodies [immunoglobulin (Ig)G and/or IgA] in their sera and 10 infertile women without the antibodies. All patients' tubo-ovarian structures were explored by transvaginal hydrolaparoscopy (THL). A CXC chemokine, interleukin-8, and six CC chemokines including macrophage inflammatory protein-1alpha (MIP-1alpha), MIP-1beta, monocyte chemotactic protein-1 (MCP-1), MCP-3, eotaxin, and regulated on activation, normal T cell expressed and secreted (RANTES) concentrations in their sera were analyzed using enzyme-linked immunosorbent assay. RESULTS: The serum concentration of RANTES was significantly higher in patients with C. trachomatis antibodies than those without the antibodies (P = 0.019). However, there were no significant differences of the concentrations of other chemokines between the sera of infertile women with and without C. trachomatis antibodies. The concentration of RANTES in the sera of infertile women did not correlate with C. trachomatis antibody titers or tubal pathology diagnosed by THL. CONCLUSIONS: These findings might indicate significant roles of some chemokines in the pathogenesis of C. trachomatis infection. Further studies are necessary to study the usefulness of evaluations of chemokines in tubal infertility investigations.