Search

Objective To investigate the relationship between the embryo number and morphology in conception cycles and the incidence of multiple pregnancies. Design The study is based on information received from a computerized data base. Setting In Vitro Fertilization Unit, Sapir Medical Center, Kfar Saba, Israel. Patients A total of 117 consecutive pregnancies resulted from replacement of fresh embryos in our IVF-ET program. Main Outcome Measures The impact of embryo quality, as assessed by morphological parameters, on the multiple pregnancy rate (PR). Results Implantation rates positively correlated with the number and the quality of transferred embryos. However, no multiple pregnancies occurred when only two embryos were replaced. There were no multiple pregnancies when only embryos of low quality (grades 1 and 2) were transferred. Furthermore, there was no correlation between the number of replaced embryos of poor quality and the rate of implantation. The multiple PR increased from 10% when a mixture of high and low quality embryos were transferred to 30.76% when only embryos of highest quality were transferred. Conclusion The implantation rate of transferred embryos is directly correlated with the morphological scoring. The results of the study suggest that the number of embryos transferred should be balanced against their morphological quality to reduce the rate of multiple pregnancies.

Objective To provide an up-to-date review of studies that have examined the relative role of endometrial development in in vitro fertilization (IVF) and embryo transfer (ET) treatment in relation to the treatment outcome. Data Identification The most important published studies and personal communications related to this topic have been identified through a computerized bibliographical search (MEDLINE). Study Selection Studies that have evaluated the endometrial maturation in IVF and ET treatment with respect to different treatment protocols of ovarian stimulation. Clinical trials exploring the efficacy of various combinations of hormonal supplementation that aim to improve the endometrial environment and treatment outcome. Publications and personal communications reporting a variety of treatment protocols and drugs utilized for the creation of artificial endometrial cycles in IVF treatment employing donated eggs. Results Ovarian stimulation frequently adversely affects the process of endometrial maturation. Various kinds of hormonal supplementation, used in clomiphene citrate- and/or human menopausal gonadotropin (hMG)-stimulated cycles have not improved treatment outcome. Human chorionic gonadotropin or natural progesterone (P) supplementation administered after controlled ovarian stimulation with gonadotropin-releasing hormone and hMG effectively corrected the luteal phase defect and resulted in an improved conception rate. The endometrium of agonadal women is highly conducive to hormonal manipulation. All estrogen preparations used effectively promoted endometrial growth and proliferation. Natural P is superior to synthetic progestins for induction of receptive secretory endometrium. Conclusion The development of adequately receptive endometrium is a major factor determining the outcome of IVF and ET treatment.

The study investigates the effect of sperm preincubation with FF on the fertilization rate in an IVF program. The oocytes inseminated with FF pretreated semen showed a significantly higher rate of fertilization. The percentage of cleavage and polypronuclear occurrence did not differ from the controls.

Objective: To describe a case of bilateral internal jugular vein thrombosis complicating ovarian hyperstimulation syndrome (OHSS). Design: Case report. Setting: Internal medicine ward in a teaching hospital. Patient: A 28-year-old nulliparous woman undergoing IVF. Intervention(s): Ultrasonographic Doppler of the neck veins was performed because of pain and swelling in the neck, and bilateral jugular vein thromboses were detected. Laboratory evaluation revealed activated protein C resistance caused by factor V Leiden mutation. Low-molecular-weight heparin (enoxaparin) was administered for the remainder of the pregnancy and for 6 weeks after delivery. Main Outcome Measure: Resolution of jugular venous thromboses documented by ultrasonographic Doppler and normal progression of pregnancy. Result(s): The patient delivered healthy twins at term. There were no complications arising from the jugular vein thromboses or the low-molecular-weight heparin treatment. Conclusion(s): Unusually located venous thrombosis should prompt an evaluation for a hypercoagulable state. The high prevalence (4%–7%) of factor V Leiden mutation in most Western populations and the mutation's potential contribution to thrombotic complications in OHSS suggest that screening for this abnormality in women undergoing IVF may be indicated.

Objective To establish the predictive role of preovulatory ovarian ultrasonography in the occurrence of multiple pregnancy after hMG and hCG treatment for anovulatory infertility. Design Prospective. Setting Outpatient Infertility Clinic. Patients Ninety-five anovulatory women who conceived after gonadotropin therapy. Intervention Induction of ovulation by hMG and hCG monitored by plasma E 2 measurements and ovarian ultrasonography. Main Outcome Measures All follicles visualized on the day of hCG administration were recorded and divided into the following four groups: group I,10 to 12mm; group II, 13 to 15mm; group III, 16 to 18mm; and group IV, 19mm and larger. The sonographic findings were statistically evaluated to 80 singletons and 45 multiple pregnancies. Results No statistical correlation was found to exist between the number of follicles from the different groups and the number of fetuses. Conclusions The number and sizes of follicles visualized on the day of hCG administration have no predictive value regarding the occurrence of a multiple pregnancy.

A case report is presented in which a tubal pregnancy established after ET of frozen-thawed embryos in an amenorrheic woman had progressed for 3 weeks without ovarian steroid supplementation

Fifty-two women, who had 62 ovum aspiration cycles, received a progesterone (P) supplementation of 100 mg/day that was initiated 10 hours before human chorionic gonadotropin (hCG) administration and was continued over the following 6 days. Forty-eight women who had 74 ovum pick-ups, but did not get P, served as controls. Forty-four (84.6%) women of the treatment group, and 40 (83.3%) of the controls had ovum fertilization and embryo replacement. The fertilization and cleavage rates and the mean number of replaced embryos per embryo transfer (ET) cycle did not differ between the groups. Endometrial biopsies, from treatment group women with no fertilized eggs, which were taken 48 hours after ovum pick-up, mostly revealed an "advanced endometrial dating," in relation to the "day of hCG." Pregnancy rate per ET cycle for the treatment group was significantly higher than that of the controls; 41.2% versus 23.3%, respectively. It is concluded that the higher pregnancy rate resulted from an improvement in uterine receptivity.

The concentrations of luteinizing hormone (LH), pregnanediol-3-glucuronide (PGD), and estriol-16-glucuronide (E 3 G) were measured in daily morning urine specimens from 53 infertile women. In 26 of 29 women with various degrees of proven endometriosis, two distinct midcycle peaks of LH were found 2 or 3 days apart. Patients with LH peaks separated by 3 days had significantly more severe endometriosis than those with a single peak. Maximum concentrations of E 3 G were found to be delayed until after the first LH peak in these patients, and PGD concentrations did not rise until the time of the second LH peak, making actual luteal function of shorter duration than normal. From the data on LH, it appears that an inappropriate hormonal feedback mechanism is operative in endometriosis.

Benign breast disease, aside from fibroadenomas and intraductal papillomas, frequently responds favorably to hormonal therapy. Although the use of estrogen, androgens, and progestogens often proves useful, danazol, in our hands, was found more consistently effective. Danazol, an impeded androgen derived from a progestogen, 17 alpha-ethinyltestosterone, was employed in doses of 100 to 400 mg/day for 3 to 6 months in the treatment of fibrocystic disease. This agent proved efficacious in eliminating nodularity in the majority of cases, with partial resolution in most of the others. Many women to whom surgery had been previously suggested were spared surgical interference because of a satisfactory response to danazol therapy.

A new flexible protocol for the induction of recipient endometrial cycles is presented. For stimulation of endometrial growth, a fixed dose of conjugated estrogens, 3.75 mg/d was employed. The duration of the proliferative phase varied from 9 to 14 days, thus being adjusted to match the length of the follicular phase of the donor. Embryo transfer was performed on the fifth day of progesterone administration. Four term pregnancies resulted from 12 treatment cycles. In the conception cycles, the hormonal support was continued until the luteal placental shift occurred, regardless of gestational age.