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Polypronuclear embryos after in vitro fertilization
Citations from the Literature estradiol level exceeded 2,700 pg/mL. The clinical pregnancy rate and the on going pregnancy rate were significantly higher using hCG (after the transfer of 3 embryos, 45% and 43% with hCG versus 23% and 17% with P). The same results were noted for the embryo implantation rate per ET (19% of embryos are viable after 6 months of pregnancy after hCG versus 7.5% after P). Adequate luteal support, therefore, significantly improves the results of IVF when LH-RH-a are used. The poor results obtained with P in this study might be related to its poor bioavailability after oral administration. Polypronuclear embryos after in vitro fertilization Dandekar PV; Martin MC; Glass RH Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94143, USA FERTIL STERIL 1990,53/3 (510-514) Triploidy occurs in 1% to 3% of recognized conceptions in vivo. In vitro fertilization (IVF), which places large numbers of sperm in proximity to the oocyte, may increase the risk of triploidy. The risk also could be influenced by stimulation protocols that differentially affect egg quality. We found no significant difference in triploidy when cycles were stimulated with clomiphene citrate/human menopausal gonadotropin (3.2%) compared with gonadotropin releasing hormone analog/human menopausal gonadotropin stimulation (4.40/o). Triploidy was less common with male factor infertility (0.7%) compared with other causes of infertility (3.4% to 3.8%). Triploid embryos can develop to cleavage stages indistinguishable from those generated by diploid embryos. Thus, identifying and discarding embryos with > 2 pronuclei is a vital function of an IVF laboratory.
Luteal rescue in in vitro fertilization-embryo
89
transfer
Hutchinson-Williams KA; DeCherney AH; Lavy G; Diamond MP; Naftolin F; Lunenfeld B Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, PO Box 3333, New Haven, CT 06510, USA FERTIL STERIL 1990,53/3 (495-501) The luteal phase hormone profiles of two groups participating in the Yale in vitro fertilization (IVF) program were compared. A control group (group I) consisted of 28 women (28 cycles) who received our standard ovulation induction regimen (no luteal phase support). The treatment group (group II) consisted of 40 women (42 cycles) who were, prospectively studied after receiving luteal phase support with 0,000 IU human chorionic gonadotropin (hCG) 5 days after the initial hCG dose. The groups were matched for age and cause of infertiity. Estradiol (E,) and progesterone (P) were measured on the day of embryo transfer and every 3 to 4 days thereafter. LuteaI phase hCG support significantly augmented (1) E, and P levels in the conception cycles of group II compared with group I and (2) P levels in the nonconception cycles of group II compared with group I. The midluteal decline in E, that was observed in group I was minimized or prevented in group II. This was not statistically different from the 13% ongoing pregnancy rate noted in separate group of 163 tubal factor couples undergoing IVF after our standard ovulation induction regimen during the period of the study. In summary, the luteal phase hormone profiles of cycles were improved by supplementation with hCG. It is concluded that this type of intervention may serve to rescue potentially failing corpora lutea and thereby optimize the peri-impantation hormonal milieu.
Severe ovarian hyperstimulation syndrome using agonists of gonadotropin-releasing hormone for in vitro fertilization: A European series and a proposal for prevention
Improved pregnancy rates and outcome with gamete intrafallopian transfer when follicular fluid is used as sperm capacitation and gamete transfer medium
Forman RG; Frydman R; Egan D; Ross C; Barlow DH Nuffierd Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, GBR FERTIL STERIL 1990.5313 (502-509) Severe ovarian hyperstimulation syndrome (OH%) was recorded in 8 of 413 patients after the use of gonadotropinreleasing hormone agonists (GnRH-a) associated with gonadotropins for in vitro fertilization. Seven of the 8 patients were pregnant. Common factors associated with the development of OHSS were high serum estradiol values on the day of ovulation induction and many follicles 2 12 mm. Based on this experience, a new therapeutic schedule was used in a group of 10 patients who, after GnRH-a and gonadotropin stimulation, were judged to be at high risk of DHSS on the day of human chronic gonadotropin (hCG). No hCG was administered and gonadotropins were stopped. The administration of GnRH-a was continued and, after a further period of pituitary desensitization, follicular stimulation was recommended with a lower dose of gonadotropins. No cases of OHSS occurred and 3 patients became pregnant.
Fakih H, Vijayakumar R Reproductive Endocrinology and Infertility, Saginaw Cooperative Hospitals, Inc, IO00Houghton, Saginaw, MI 48602, USA FERTIL STERIL 1990,53/3 (515-520) Follicular fluid (FF) is a dynamic medium rich in steroids, polypeptide hormones, and growth factors. Preovulatory FF can stimulate spermatozoa1 acrosome reaction. Moreover, short preincubation of washed sperm with FF improves sperm performance in the hamster egg penetration assay. In the current study, FF was used to capacitate sperm transfer medium in 131 gamete intrafallopian transfer (GIFT) procedures. Ham’s F-10 medium (GIBCO, Grand Island, NY) with 50% maternal serum was used in another 29 GIFT procedures. In the Ham’s F-10 group, 29 GIFT procedures were performed in 25 patients with a pregnancy rate of 21% per laparoscopy and 24% per patient. In the FF group, 131 GIFT procedures were performed in 100 patients with a pregnancy rate of 50% per laparoscopy and 66% per patient, with a 59% ongoing pregnancy rate per patient. The most significant improvement was in the malefactor group with pregnancy rate of 0% in the Ham’s F-10 group Int J Gynecol Obstet 34
Luteal rescue in in vitro fertilization-embryo
89
transfer
Hutchinson-Williams KA; DeCherney AH; Lavy G; Diamond MP; Naftolin F; Lunenfeld B Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, PO Box 3333, New Haven, CT 06510, USA FERTIL STERIL 1990,53/3 (495-501) The luteal phase hormone profiles of two groups participating in the Yale in vitro fertilization (IVF) program were compared. A control group (group I) consisted of 28 women (28 cycles) who received our standard ovulation induction regimen (no luteal phase support). The treatment group (group II) consisted of 40 women (42 cycles) who were, prospectively studied after receiving luteal phase support with 0,000 IU human chorionic gonadotropin (hCG) 5 days after the initial hCG dose. The groups were matched for age and cause of infertiity. Estradiol (E,) and progesterone (P) were measured on the day of embryo transfer and every 3 to 4 days thereafter. LuteaI phase hCG support significantly augmented (1) E, and P levels in the conception cycles of group II compared with group I and (2) P levels in the nonconception cycles of group II compared with group I. The midluteal decline in E, that was observed in group I was minimized or prevented in group II. This was not statistically different from the 13% ongoing pregnancy rate noted in separate group of 163 tubal factor couples undergoing IVF after our standard ovulation induction regimen during the period of the study. In summary, the luteal phase hormone profiles of cycles were improved by supplementation with hCG. It is concluded that this type of intervention may serve to rescue potentially failing corpora lutea and thereby optimize the peri-impantation hormonal milieu.
Severe ovarian hyperstimulation syndrome using agonists of gonadotropin-releasing hormone for in vitro fertilization: A European series and a proposal for prevention
Improved pregnancy rates and outcome with gamete intrafallopian transfer when follicular fluid is used as sperm capacitation and gamete transfer medium
Forman RG; Frydman R; Egan D; Ross C; Barlow DH Nuffierd Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, GBR FERTIL STERIL 1990.5313 (502-509) Severe ovarian hyperstimulation syndrome (OH%) was recorded in 8 of 413 patients after the use of gonadotropinreleasing hormone agonists (GnRH-a) associated with gonadotropins for in vitro fertilization. Seven of the 8 patients were pregnant. Common factors associated with the development of OHSS were high serum estradiol values on the day of ovulation induction and many follicles 2 12 mm. Based on this experience, a new therapeutic schedule was used in a group of 10 patients who, after GnRH-a and gonadotropin stimulation, were judged to be at high risk of DHSS on the day of human chronic gonadotropin (hCG). No hCG was administered and gonadotropins were stopped. The administration of GnRH-a was continued and, after a further period of pituitary desensitization, follicular stimulation was recommended with a lower dose of gonadotropins. No cases of OHSS occurred and 3 patients became pregnant.
Fakih H, Vijayakumar R Reproductive Endocrinology and Infertility, Saginaw Cooperative Hospitals, Inc, IO00Houghton, Saginaw, MI 48602, USA FERTIL STERIL 1990,53/3 (515-520) Follicular fluid (FF) is a dynamic medium rich in steroids, polypeptide hormones, and growth factors. Preovulatory FF can stimulate spermatozoa1 acrosome reaction. Moreover, short preincubation of washed sperm with FF improves sperm performance in the hamster egg penetration assay. In the current study, FF was used to capacitate sperm transfer medium in 131 gamete intrafallopian transfer (GIFT) procedures. Ham’s F-10 medium (GIBCO, Grand Island, NY) with 50% maternal serum was used in another 29 GIFT procedures. In the Ham’s F-10 group, 29 GIFT procedures were performed in 25 patients with a pregnancy rate of 21% per laparoscopy and 24% per patient. In the FF group, 131 GIFT procedures were performed in 100 patients with a pregnancy rate of 50% per laparoscopy and 66% per patient, with a 59% ongoing pregnancy rate per patient. The most significant improvement was in the malefactor group with pregnancy rate of 0% in the Ham’s F-10 group Int J Gynecol Obstet 34