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Zygote intrafallopian transfer as a treatment for nontubal infertility: A 2-year study
282
Citations from the Literature
Does this high rate of failure result from inadequate technique, or does it simply reflect the maximal potential of a cohort of aspirated eggs to produce a pregnancy? And to what extent does cryopreservation affect the capacity for implantation of embryos? Methods. The study was conducted among patients enrolled in an egg-donation program. Aspirated eggs from a given cohort were distributed to the donor herself and a few recipients. The recipients were prepared by a standard protocol of hormone replacement and were assigned at random to the transfer of either fresh or frozen and thawed embryos. The donors received only fresh embryos. Results. Forty cycles of donation were, studied. In 25 cycles (63 percent) pregnancy was established in the donor, in the recipient (or recipients), or in both. Of the fresh embryos that were transferred to the recipients, 24 percent were successfully implanted, as compared with only 7.7 percent of the frozen and thawed embryos (P < 0.01). A pregnancy success rate of 37 percent of recipient cycle was observed in the recipients of fresh embryos, as compared with a rate of only 16 percent in those receiving frozen and thawed embryos (P < 0.05). Conclusions. The majority of egg cohorts evidently possess the potential to produce a pregnancy, but cryopreservation of human embryos significantly reduces their capacity for implantation. Are factors that influence oocyte fertilization also predictive?An assessment of 148 cycles of in vitro fertilization without gonadotropinstimulation Ramsewak SS; Cooke ID; Li T-C; Kumar A; Monks NJ; Lenton EA Department of Obstetrics and Gynaecology, Jessop Hospital for Women, Leavygreave Road, Sheffield S3 7RE; GBR
FERTIL STERIL 1990 54/3 (47-74) Fertilization characteristics of I52 consecutively obtained oocytes in an in vitro fertilization (IVF) program employing only natural and clomiphene citrate-induced cycles were retrospectively analyzed. Fertilization occurred significantly more often (1) in women with tubal infertility, (2) in spontaneous cycles, and (3) in cases of secondary infertility. Grade I sperm motility from the original semen sample and the duration of infertility were also significant influencing factors. A similar sperm correlate was not identified on samples after sperm migration. Preovulatory follicular fluid steroids, progesterone (P), estradiol (Ez), E2:P ratio, and luteinizing hormone (LH), as well as baseline plasma LH and the magnitude of the LH surge did not correlate with fertilization. However, when the identified factors were used to predict fertilization (discriminant analysis), only 58.3% of oocytes were correctly classified. This data supports the concept of performing IVF as a test in its own right. Asymptomatic cervicovaginal leukocytosis in infertile women Wah RM; Anderson DJ; Hill JA Fearing Research Laboratory, Harvard Medical Longwood Avenue, Boston, MA 02115; USA
School,
250
FERTIL STERIL 1990 54/3 (44450) Cervicovaginal cells were obtained from I14 women undergoing intrauterine insemination and 21 women undergoing doInt J Gynecol Obstet 35
nor insemination. Monoclonal antibodies were used to identify leukocyte subpopulations in women with nonepithelial cell counts > 2 x 10’ (termed asymptomatic cervicovaginal leukocytosis). Leukocyte counts exceeding this number were not found in any of the women undergoing donor insemination; however, > 2 x 10’ leukocytes were detected in 22% of the infertile women. Granulocytes predominated; lymphocytes and macrophages were detected in only 8 of I14 samples. Women with cervical factor infertility had a significantly higher incidence of asymptomatic cervicovaginal leukocytosis than women with either male factor or unexplained infertility. These data suggest that cervicovaginal leukocytes may play a role in cervical factor infertility since soluble products of activated leukocytes are known to adversely affect reproduction. Use of buserelin acetate in an in vitro fertilization program: A comparison with classical clomiphene citrate-human menopausal gonadotropintreatment Lejeune B; Barlow P; Puissant F; Delvigne A; Vanrysselberge M; Leroy F Department of Gynecology and Obstetrics, Hospital, 322. rue Haute, 1000. Brussels; BEL
Saint-Pierre
FERTIL STERIL, 1990 54/3 (475-481) A comparison has been established retrospectively between clomiphene citrate-human menopausal gonadotropin (CChMG) and buserelin acetate-hMG treatments in in vitro fertilization trials performed over a 3-year period. The analysis of 466 CC-hMG and 319 buserelin acetate-hMG trials shows that buserelin acetate-hMG stimulation generates a greater ovarian response resulting in higher numbers of oocytes being retrieved (6.2 + 3.8 versus 9.3 f 5.2) and fertilized (2.8 * 2.7 versus 4.3 f 3.8). More embryos are thus obtained, allowing a wider choice for intrauterine replacement and cryopreservation. Mean embryonic vitality scores do not differ (4.33 * 1.51versus 4.44 f 1.54),implying that the embryonic quality remains similar in both treatments. A premature demise of the corpus luteum occurs in a large proportion of buserelin acetate-hMG cycles. However, when suppletive progesterone treatment is given, there is a trend toward a better implantation rate per embryo, and a significantly higher ongoing pregnancy rate is observed in relation to buserelin acetate-hMG treatment (20%) as compared with CC-hMG cycles (14%). Zygote intrafallopian transfer as a treatment for nontubal infertility: A Zyear study Pool TB; Ellsworth LR; Garza JR; Martin JE; Miller SS; Atiee SH 4499 Medical Drive, San Antonio, TX 78229: USA FERTIL STERIL 1990 5413 (482-488) Zygote intrafallopian transfer (ZIFT) was used as a treatment for long-standing non-tubal infertility for a 2-year period. The overall clinical pregnancy rate for 114 tubal transfers was 40.4% with a delivery/ongoing rate of 34.2%. Concurrent use of in vitro fertilization and embryo transfer (IVF-ET) for tubal factor infertility gave significantly lower clinical pregnancy and delivery/ongoing rates (21.1% and 15.8% respectively). The use of gamete intrafallopian transfer (GIFT) for nontubal in-
Citations from
the Literature
283
fertility yielded a 32% clinical pregnancy rate and a 26% delivery rate for 53 transfers. Zygote intrafallopian transfer resulted in an implantation rate per zygote of 17% overall compared with 8.1% per embryo for IVF-ET and I I .2% per oocyte for GIFT. The transfer of three zygotes per patient gave the same clinical pregnancy rate as the transfer of four while reducing the incidence of multiple gestation from l9”/0to 7.8”%per transfer. No significant decline in the clinical pregnancy or delivery rate was seen with GIFT in women aged 25 through 39.
achieved. Fecundability rates were 12.3% for LH-kit cycles and 5.3% for non-LH method cycles. The difference in outcome was not statistically significant. However, when the LH kit plus I insemination was compared with 2 inseminations timed by conventional methods, there appeared to be a distinct monetary and time expenditure advantage. These findings suggest that sufficient advantage may be derived from use of an LH kit to recommend its use on a routine basis for the timing of therapeutic donor insemination.
Effect of naloxone on plasma insulin, insulin-like growth factor I, and its binding protein I in patients with polycystic ovarian disease
The significance of the zona-free hamster oocyte test for the evaluation of male fertility
Laatikainen T, Anttila L; Suikkari A-M; Ruutiainen K, Erkkola R; Seppala M
Section of Reproductive Medicine, Department of Obstetrics and Gynaecology, University Hospital, Oostersingel 59, 9713 EZ Groningen; NLD
Department of Obstetrics, Helsinki University Central Hospital, Haartmaninkatu 2, SF-00290, Helsinki; FIN
FERTIL STERIL 1990 54/3 (43-37) Insulin and insulin-like growth factors (IGFs) stimulate ovarian steroidogenesis, and hyperinsulinemia is often accompanied by hyperandrogenemia in women with polycystic ovarian disease (PCOD). Because opioid peptides are involved in the regulation of insulin secretion, we studied the effect of naloxone-induced opiate receptor blockade on the circulating levels of insulin, IGF-I, and IGF binding protein I (IGFBP-I) in I3 nonobese and 7 obese PCOD patients and in 6 healthy subjects. In obese PCOD patients, the mean basal insulin concentration was significantly higher and the IGFBP-I concentration lower than in nonobese PCOD patients. Plasma IGF-I levels were elevated both in obese and nonobese PCOD patients. After an intravenous bolus of IO mg naloxone, no significant changes were found in the, circulating insulin or IGF-I levels, whereas IGFBP-I levels decreased in nonobese PCOD patients and remained low in obese PCOD patients. No significant decrease was found in healthy subjects. These results suggest that, in addition to insulin, endogenous opioids are involved in the regulation of serum IGFBP-I level.
Relative efficiency of therapeutic donor insemination using a Iutelnizing hormone monitor
Federman CA; Dumesic DA; Boone WR; Shapiro SS Department of Obstetrics and Gynecology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792:
USA
FERTIL STERIL 1990 54/3 (489-492) A prospective randomized study was performed to evaluate the use of a urinary luteinizing hormone (LH) detection kit with I insemination as compared with 2 alternative day inseminations with timing based on previous cycle length and basal body temperature changes. The study involved 60 patients who underwent a total of 264 therapeutic donor insemination cycles using cryopreserved semen specimens. Patients alternated LH-kit timed cycles with cycles timed by non-LH methods for a total of 6 cycles or until pregnancy was
Kremer J; Jager S
FERTiL STERIL 1990 54/3 (509-512) Results of the zona-free hamster oocyte test were compared with pregnancy rates after coitus and after artificial insemination with donor semen (AID) in 322 primary infertile couples. Artificial donor insemination was offered if in the test the percentage of hamster oocytes with at least one decondensed sperm head (oocyte-sperm interaction rate) was <20. If the rate was < 5, the pregnancy rate after coitus was significantly lower than in the group with a rate of 2 5 to < 20. In the former group, the pregnancy rate by AID was significantly higher than the pregnancy rate by coitus. We conclude that the zona-free hamster oocyte test is useful to predict the chance to achieve pregnancy in couples with unexplained infertility and to determine whether AID can increase this chance.
Mechanisms of filtration of morphologically abnormal human sperm by cervical mucus
Katz DF; Morales P; Samuels SJ; Overstreet JW Division of Reproductive Biology and Medicine, California, Davis. CA 95616: USA
University of
FERTIL STERIL 1990 54/3 (513-516) It is well known that cervical mucus restricts penetration of morphologically abnormal human sperm, both in vitro and in vivo. However, the mechanisms of such restriction are not well understood. Using videomicrography to simultaneously analyze the motions and morphology of individual human sperm, we analyzed differential penetration of normal and abnormal sperm into fresh human cervical mucus. Abnormal sperm swam slower in mucus than the normal sperm, but their flagellar beat parameters were not commensurately different. Multivariate statistical analysis of the relationship between individual sperm velocity and flagellar beat parameters indicated that the heads of the abnormal sperm experienced greater resistance from the mucus than did normal heads. Differential mucus resistance, more than altered motile vigor, appears to be responsible for the restriction of abnormal sperm during migration through mucus. Int J Gynecol Obstet 35
Citations from the Literature
Does this high rate of failure result from inadequate technique, or does it simply reflect the maximal potential of a cohort of aspirated eggs to produce a pregnancy? And to what extent does cryopreservation affect the capacity for implantation of embryos? Methods. The study was conducted among patients enrolled in an egg-donation program. Aspirated eggs from a given cohort were distributed to the donor herself and a few recipients. The recipients were prepared by a standard protocol of hormone replacement and were assigned at random to the transfer of either fresh or frozen and thawed embryos. The donors received only fresh embryos. Results. Forty cycles of donation were, studied. In 25 cycles (63 percent) pregnancy was established in the donor, in the recipient (or recipients), or in both. Of the fresh embryos that were transferred to the recipients, 24 percent were successfully implanted, as compared with only 7.7 percent of the frozen and thawed embryos (P < 0.01). A pregnancy success rate of 37 percent of recipient cycle was observed in the recipients of fresh embryos, as compared with a rate of only 16 percent in those receiving frozen and thawed embryos (P < 0.05). Conclusions. The majority of egg cohorts evidently possess the potential to produce a pregnancy, but cryopreservation of human embryos significantly reduces their capacity for implantation. Are factors that influence oocyte fertilization also predictive?An assessment of 148 cycles of in vitro fertilization without gonadotropinstimulation Ramsewak SS; Cooke ID; Li T-C; Kumar A; Monks NJ; Lenton EA Department of Obstetrics and Gynaecology, Jessop Hospital for Women, Leavygreave Road, Sheffield S3 7RE; GBR
FERTIL STERIL 1990 54/3 (47-74) Fertilization characteristics of I52 consecutively obtained oocytes in an in vitro fertilization (IVF) program employing only natural and clomiphene citrate-induced cycles were retrospectively analyzed. Fertilization occurred significantly more often (1) in women with tubal infertility, (2) in spontaneous cycles, and (3) in cases of secondary infertility. Grade I sperm motility from the original semen sample and the duration of infertility were also significant influencing factors. A similar sperm correlate was not identified on samples after sperm migration. Preovulatory follicular fluid steroids, progesterone (P), estradiol (Ez), E2:P ratio, and luteinizing hormone (LH), as well as baseline plasma LH and the magnitude of the LH surge did not correlate with fertilization. However, when the identified factors were used to predict fertilization (discriminant analysis), only 58.3% of oocytes were correctly classified. This data supports the concept of performing IVF as a test in its own right. Asymptomatic cervicovaginal leukocytosis in infertile women Wah RM; Anderson DJ; Hill JA Fearing Research Laboratory, Harvard Medical Longwood Avenue, Boston, MA 02115; USA
School,
250
FERTIL STERIL 1990 54/3 (44450) Cervicovaginal cells were obtained from I14 women undergoing intrauterine insemination and 21 women undergoing doInt J Gynecol Obstet 35
nor insemination. Monoclonal antibodies were used to identify leukocyte subpopulations in women with nonepithelial cell counts > 2 x 10’ (termed asymptomatic cervicovaginal leukocytosis). Leukocyte counts exceeding this number were not found in any of the women undergoing donor insemination; however, > 2 x 10’ leukocytes were detected in 22% of the infertile women. Granulocytes predominated; lymphocytes and macrophages were detected in only 8 of I14 samples. Women with cervical factor infertility had a significantly higher incidence of asymptomatic cervicovaginal leukocytosis than women with either male factor or unexplained infertility. These data suggest that cervicovaginal leukocytes may play a role in cervical factor infertility since soluble products of activated leukocytes are known to adversely affect reproduction. Use of buserelin acetate in an in vitro fertilization program: A comparison with classical clomiphene citrate-human menopausal gonadotropintreatment Lejeune B; Barlow P; Puissant F; Delvigne A; Vanrysselberge M; Leroy F Department of Gynecology and Obstetrics, Hospital, 322. rue Haute, 1000. Brussels; BEL
Saint-Pierre
FERTIL STERIL, 1990 54/3 (475-481) A comparison has been established retrospectively between clomiphene citrate-human menopausal gonadotropin (CChMG) and buserelin acetate-hMG treatments in in vitro fertilization trials performed over a 3-year period. The analysis of 466 CC-hMG and 319 buserelin acetate-hMG trials shows that buserelin acetate-hMG stimulation generates a greater ovarian response resulting in higher numbers of oocytes being retrieved (6.2 + 3.8 versus 9.3 f 5.2) and fertilized (2.8 * 2.7 versus 4.3 f 3.8). More embryos are thus obtained, allowing a wider choice for intrauterine replacement and cryopreservation. Mean embryonic vitality scores do not differ (4.33 * 1.51versus 4.44 f 1.54),implying that the embryonic quality remains similar in both treatments. A premature demise of the corpus luteum occurs in a large proportion of buserelin acetate-hMG cycles. However, when suppletive progesterone treatment is given, there is a trend toward a better implantation rate per embryo, and a significantly higher ongoing pregnancy rate is observed in relation to buserelin acetate-hMG treatment (20%) as compared with CC-hMG cycles (14%). Zygote intrafallopian transfer as a treatment for nontubal infertility: A Zyear study Pool TB; Ellsworth LR; Garza JR; Martin JE; Miller SS; Atiee SH 4499 Medical Drive, San Antonio, TX 78229: USA FERTIL STERIL 1990 5413 (482-488) Zygote intrafallopian transfer (ZIFT) was used as a treatment for long-standing non-tubal infertility for a 2-year period. The overall clinical pregnancy rate for 114 tubal transfers was 40.4% with a delivery/ongoing rate of 34.2%. Concurrent use of in vitro fertilization and embryo transfer (IVF-ET) for tubal factor infertility gave significantly lower clinical pregnancy and delivery/ongoing rates (21.1% and 15.8% respectively). The use of gamete intrafallopian transfer (GIFT) for nontubal in-
Citations from
the Literature
283
fertility yielded a 32% clinical pregnancy rate and a 26% delivery rate for 53 transfers. Zygote intrafallopian transfer resulted in an implantation rate per zygote of 17% overall compared with 8.1% per embryo for IVF-ET and I I .2% per oocyte for GIFT. The transfer of three zygotes per patient gave the same clinical pregnancy rate as the transfer of four while reducing the incidence of multiple gestation from l9”/0to 7.8”%per transfer. No significant decline in the clinical pregnancy or delivery rate was seen with GIFT in women aged 25 through 39.
achieved. Fecundability rates were 12.3% for LH-kit cycles and 5.3% for non-LH method cycles. The difference in outcome was not statistically significant. However, when the LH kit plus I insemination was compared with 2 inseminations timed by conventional methods, there appeared to be a distinct monetary and time expenditure advantage. These findings suggest that sufficient advantage may be derived from use of an LH kit to recommend its use on a routine basis for the timing of therapeutic donor insemination.
Effect of naloxone on plasma insulin, insulin-like growth factor I, and its binding protein I in patients with polycystic ovarian disease
The significance of the zona-free hamster oocyte test for the evaluation of male fertility
Laatikainen T, Anttila L; Suikkari A-M; Ruutiainen K, Erkkola R; Seppala M
Section of Reproductive Medicine, Department of Obstetrics and Gynaecology, University Hospital, Oostersingel 59, 9713 EZ Groningen; NLD
Department of Obstetrics, Helsinki University Central Hospital, Haartmaninkatu 2, SF-00290, Helsinki; FIN
FERTIL STERIL 1990 54/3 (43-37) Insulin and insulin-like growth factors (IGFs) stimulate ovarian steroidogenesis, and hyperinsulinemia is often accompanied by hyperandrogenemia in women with polycystic ovarian disease (PCOD). Because opioid peptides are involved in the regulation of insulin secretion, we studied the effect of naloxone-induced opiate receptor blockade on the circulating levels of insulin, IGF-I, and IGF binding protein I (IGFBP-I) in I3 nonobese and 7 obese PCOD patients and in 6 healthy subjects. In obese PCOD patients, the mean basal insulin concentration was significantly higher and the IGFBP-I concentration lower than in nonobese PCOD patients. Plasma IGF-I levels were elevated both in obese and nonobese PCOD patients. After an intravenous bolus of IO mg naloxone, no significant changes were found in the, circulating insulin or IGF-I levels, whereas IGFBP-I levels decreased in nonobese PCOD patients and remained low in obese PCOD patients. No significant decrease was found in healthy subjects. These results suggest that, in addition to insulin, endogenous opioids are involved in the regulation of serum IGFBP-I level.
Relative efficiency of therapeutic donor insemination using a Iutelnizing hormone monitor
Federman CA; Dumesic DA; Boone WR; Shapiro SS Department of Obstetrics and Gynecology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792:
USA
FERTIL STERIL 1990 54/3 (489-492) A prospective randomized study was performed to evaluate the use of a urinary luteinizing hormone (LH) detection kit with I insemination as compared with 2 alternative day inseminations with timing based on previous cycle length and basal body temperature changes. The study involved 60 patients who underwent a total of 264 therapeutic donor insemination cycles using cryopreserved semen specimens. Patients alternated LH-kit timed cycles with cycles timed by non-LH methods for a total of 6 cycles or until pregnancy was
Kremer J; Jager S
FERTiL STERIL 1990 54/3 (509-512) Results of the zona-free hamster oocyte test were compared with pregnancy rates after coitus and after artificial insemination with donor semen (AID) in 322 primary infertile couples. Artificial donor insemination was offered if in the test the percentage of hamster oocytes with at least one decondensed sperm head (oocyte-sperm interaction rate) was <20. If the rate was < 5, the pregnancy rate after coitus was significantly lower than in the group with a rate of 2 5 to < 20. In the former group, the pregnancy rate by AID was significantly higher than the pregnancy rate by coitus. We conclude that the zona-free hamster oocyte test is useful to predict the chance to achieve pregnancy in couples with unexplained infertility and to determine whether AID can increase this chance.
Mechanisms of filtration of morphologically abnormal human sperm by cervical mucus
Katz DF; Morales P; Samuels SJ; Overstreet JW Division of Reproductive Biology and Medicine, California, Davis. CA 95616: USA
University of
FERTIL STERIL 1990 54/3 (513-516) It is well known that cervical mucus restricts penetration of morphologically abnormal human sperm, both in vitro and in vivo. However, the mechanisms of such restriction are not well understood. Using videomicrography to simultaneously analyze the motions and morphology of individual human sperm, we analyzed differential penetration of normal and abnormal sperm into fresh human cervical mucus. Abnormal sperm swam slower in mucus than the normal sperm, but their flagellar beat parameters were not commensurately different. Multivariate statistical analysis of the relationship between individual sperm velocity and flagellar beat parameters indicated that the heads of the abnormal sperm experienced greater resistance from the mucus than did normal heads. Differential mucus resistance, more than altered motile vigor, appears to be responsible for the restriction of abnormal sperm during migration through mucus. Int J Gynecol Obstet 35