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Microdeletions of Yq are associated with azoospermia and severe oligozoospermia. In general, men with deletions are infertile and therefore deletions are not transmitted to sons unless in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are performed. We report an unusual family characterized by multiple members with infertility and Yq microdeletion. Complete reproductive history, semen analyses and blood samples were elicited from relevant family members. DNA preparation and quantification were performed using commercial kits. A total of 27 pairs of sequence tagged sites based primer sets specific for the Y microdeletion region loci were used for screening. Southern blots using deleted in azoospermia (DAZ) and ribosomal binding motif (RBM) cDNAs were then analysed for confirmation. The proband, his three brothers and father were all found to be deleted for DAZ but not RBM. At the time of analysis, the proband's father was azoospermic whereas his four sons were either severely oligozoospermic or azoospermic. Unlike their father, the four sons are infertile and have no offspring, except for one of them who achieved a daughter only after IVF/ICSI treatment for infertility. Microdeletions of Yq involving the DAZ gene are associated with a variable phenotypic expression that can include evidently normal fertility. [ABSTRACT FROM AUTHOR]

Ovarian hyperstimulation syndrome (OHSS) is a serious complication of gonadotrophin usage but it is difficult to accurately predict its occurrence. Previous investigators have identified the combination of high oestradiol concentrations and oocyte number as being predictive in 80% of cases. In this study we sought to identify the incidence of severe OHSS in patients with high oestradiol concentrations and large numbers of oocytes and to evaluate the importance of pregnancy in the development of OHSS. Between 1990 and 1993, we studied 139 cycles using two assisted reproductive techniques [oocyte donor, n = 72; in-vitro fertilization (IVF), n = 67] in which either oestradiol (> 4000 pg/ml), oocyte number (> 25), or both were elevated. OHSS was diagnosed by standard criteria. There were no cases of severe OHSS in the oocyte donor group and six in the IVF group. Among 10 patients with oestradiol concentration > 6000 pg/ml and > 30 oocytes, only one had OHSS (10%). The relative risk of OHSS with pregnancy was 12 (confidence interval 2.18-66.14). We conclude that the risk of OHSS even at high levels of stimulation is lower than previously believed. Secondly, donors have a very low risk of OHSS, probably because of the absence of pregnancy. As such, cryopreservation of all oocytes in IVF cycles is a reasonable alternative to cycle cancellation or use of adjunctive medication. [ABSTRACT FROM AUTHOR]

The isolated finding of polycystic-appearing ovaries on ultrasound examination of normal women is not uncommon. The purpose of this study was to determine the clinical significance of polycystic ovaries in a population of healthy, non-hirsute, fertile women preparing to undergo ovarian stimulation. We evaluated whether the finding of polycystic ovaries in oocyte donors predicts a different response to ovarian stimulation when compared to donors with normal-appearing ovaries. Furthermore, we examined whether oocytes from polycystic ovaries had the same capacity for fertilization and development as those retrieved from normal ovaries. In all, 11 donors with polycystic-appearing ovaries were compared prospectively to 13 donors with normal-appearing ovaries who were undergoing ovarian stimulation during the same time interval. The two groups were similar in age and baseline androgen concentrations. Significantly more oocytes were produced by the polycystic group for the amount of human menopausal gonadotrophin (HMG) administered (P < 0.05). In addition, all previous cycles completed by these 24 donors were compared (polycystic group: total of 31 cycles; normal group: total of 37 cycles). The donors with polycystic ovaries required less HMG to obtain optimal stimulation (P < 0.05), attained a greater peak oestradiol concentration (P < 0.05), produced a greater number of follicles (P < 0.05) and oocytes (P < 0.01) and a higher percentage of mature oocytes (P < 0.05). Furthermore, they achieved a higher peak oestradiol/HMG (P < 0.01) and oocytes/HMG ratio (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]

Clinical impressions suggest the presence of considerable anxiety and depression in infertile couples. We utilized a psychological stress test to assess adaptations to provoked stress to improve the psychological profile of infertile women. A psychological stress test was administered to four groups: normal menstruating females (controls, n = 13); oocyte donors (n = 13); recipients of oocyte donation (n = 7); and women undergoing standard in-vitro fertilization (IVF; mean age 38.0 years; n = 8). The psychological stress test consisted of three active coping tasks: (i) serial subtraction, (ii) Stroop colour test, (iii) speech task and (iv) one passive coping task, the cold-pressor test. Haemodynamic responses (HD) were monitored before, during and after the psychological stress test, and serum samples were drawn for catecholamines and cortisol. Baseline blood pressures were similar among groups. The psychological stress test elicited different biophysical responses in controls compared with the other groups (P < 0.001). Oocyte donors had different speech task responses from baseline, although these and the other parameters of the psychological stress test were not different from either the recipient or IVF groups. Blood pressure responses from baseline were blunted in both recipients and standard IVF patients following provoked stress. Baseline cortisol and norepinephrine were similar among all groups, yet provoked stress elicited a significant increase in controls (142.0 +/- 25.2%, P < 0.001) compared with oocyte donors (17.1 +/- 19.7%), recipients and standard IVF patients (mean -15.5 +/- 17.3% respectively).(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]

Successful pregnancies have recently been reported in cycles of unstimulated in-vitro fertilization (IVF) which is a simplification of the standard IVF approach utilizing ovarian stimulation. The purpose of this study was to analyse retrospectively the results of the first 3 years of unstimulated IVF cycles at our institution in order to identify factors which predispose these cycles to success or failure. All patients (n= 57) underwent serial monitoring with transvaginal ultrasound and serum oestradiol determinations. Human chorionic gonadotrophin (HCG) 10 000 IU was administered when follicles were felt to be mature and aspiration undertaken (n= 98) 34–36 h later. Among nine patients aged≥40 years, 13 aspirations resulted in nine embryo transfers and no pregnancies. In one completed cycle in this group, the patient, who was 42 years old had a baseline follicle stimulating hormone(FSH) concentration of 35.3 mIU/ml. The cycle progressed uneventfully and follicle aspiration yielded two oocytes and two morphologically normal embryos which, however, did not implant. In six patients <40 years with male factor, seven aspirations yielded 18 oocytes of which 15 were inseminated and did not fertilize. One of the immature oocytes was allowed to mature in vitro and was fertilized and cryopreserved. Its transfer in a subsequent cycle yielded a live birth. Among 78 cycles in 42 patients aged <40 years without male factor, 63 resulted in embryo transfer with 14% clinical pregnancy rates per aspiration and 17% per embryo transfer. Pregnancy was associated with higher oestradiol concentrations at the time of HCG administration and multiple embryos available for embryo transfer. There was no effect on the pregnancy rate by the day of HCG administration, follicle diameter, number of cycles completed or number of oocytes obtained. We conclude that unstimulated IVF is a clinically viable alternative to stimulated cycles, that patients may be offered up to three cycles without an appreciable decrease in success rates and that success rates which are highest among women < 40 years old and in the absence of male factor may be maximized by the attainment of maximal oestradiol coneetrations prior to HCG administration [ABSTRACT FROM PUBLISHER]

We analysed the results of oocyte donation to women of advanced reproductive age (> or = 45 years old) and followed their pregnancies through to delivery in order to assess obstetrical outcomes. Patients (n = 162) aged 45-59 years (mean +/- SD; 47.3 +/- 3.4 years) underwent 218 consecutive attempts to achieve pregnancy. Oocytes (16.2 +/- 7.2 per retrieval) were provided by donors < or = 35 years old. Cleaving embryos (8.2 +/- 4.8 zygotes/couple) were transferred transcervically (4.5 +/- 1.1 per embryo transfer) to recipients prescribed oral micronized oestradiol and intramuscular progesterone. Following oocyte aspiration there were six instances of non-fertilization (2.8%) and 212 embryo transfers. A total of 103 pregnancies was established for an overall pregnancy rate (PR) of 48.6%, which included 17 preclinical pregnancies, 12 spontaneous abortions, and 74 delivered pregnancies (clinical PR 40.6%; delivered PR 34.9%). Multiple gestations were frequent (n = 29; 39.2% of pregnancies) and included 20 twins, seven triplets, and two quadruplets. Two of the triplet and both of the quadruplet pregnancies underwent selective reduction to twins. Antenatal complications occurred in 28 women (37.8% of deliveries) and included preterm labour (n = 9), gestational hypertension (n = 8), gestational diabetes (n = 6), carpel tunnel syndrome (n = 2), pre-eclampsia (n = 2), HELLP syndrome (n = 2), and fetal growth retardation (n = 2). 48 (64.8%) deliveries were by Caesarean section. The gestational age at delivery for singletons was 38.3 +/- 1.3 weeks (range 35-41 weeks), with birth weight 3218 +/- 513 g (range 1870-4775 g); twins 35.9 +/- 2.0 weeks (range 32-39 weeks), birth weight 2558 +/- 497 g (range 1700-3450 g); and triplets 33.5 +/- 0.7 weeks (range 32-34 weeks), birth weight 1775 +/- 190 g (range 1550-2100 g). Neonatal complications (4.6% of babies born) included growth retardation (n = 2), trisomy 21 (n = 1), ventricular septal defect (n = 1), and small bowel obstruction (n = 1). There were no maternal or neonatal deaths. We conclude that oocyte donation to women of advanced reproductive age is highly successful in establishing pregnancy. However, despite careful antenatal screening, obstetrical complications are common, often secondary to multiple gestation. [ABSTRACT FROM AUTHOR]

Hydrosalpinges have been associated with poor in-vitro fertilization (IVF) outcome in some, but not all, studies, perhaps through endometrial effects. To determine whether hydrosalpinges affect IVF outcome via endometrial factors alone, we analysed the results of recipients of donor oocytes with hydrosalpinges, thereby controlling for confounding variables, while isolating the intrauterine environment. We retrospectively analysed 110 patients who underwent 121 donor oocyte cycles in a university-based assisted reproduction programme. Thirteen cycles involving recipients (n = 10) with hydrosalpinges were compared to 108 cycles involving recipients (n = 100) without hydrosalpinges. Pregnancy, implantation, miscarriage, and ectopic pregnancy rates were compared between women with and without hydrosalpinges. There were no significant differences between the hydrosalpinx and no hydrosalpinx groups with respect to donor age, recipient age, or number or grade of embryos transferred. Patients with a hydrosalpinx had significantly lower embryo implantation rates (7.1 versus 19.3%, P < 0.05) and significantly higher miscarriage (75.0 versus 14.9%, P < 0.05) and ectopic pregnancy rates (33.3 versus 0.0%, P < 0.05) than normal controls. We conclude that the presence of a hydrosalpinx adversely affects early pregnancy events by altering the intrauterine environment. [ABSTRACT FROM AUTHOR]

Oocyte donation has proven to be highly successful in establishing pregnancy in functionally agonadal women. Both implantation and ongoing pregnancy rates in women using this method have surpassed those normally seen in standard in-vitro fertilization (IVF) patients. Over a 5 year period, seven women who had previously conceived using oocyte donation elected to attempt pregnancy and deliver a second child using the same donor. In each case the paramount consideration was to provide a sibling of the same genetic make-up as the child or children previously borne. Of the seven women studied, whose ages ranged from 24 to 44 years, five became pregnant on subsequent cycles. The time to conception varied from one to a maximum of three attempts with three of the five women becoming pregnant on the first cycle and two requiring three cycles to establish the subsequent pregnancy. The overall rate of success in this group was 12 pregnancies in 20 cycles of embryo transfer (60%). An exaggerated implantation rate (25.6%) was also noted (23 individual embryo implantations from 90 embryos transferred). Of the 12 pregnancies established in these seven women, four (33%) were multiple gestations (three triplets, one twin). We conclude that women who have previously experienced pregnancy following oocyte donation are highly likely to conceive in a subsequent trial at a rate that may be higher than that normally seen in the general population of women undergoing oocyte donation. [ABSTRACT FROM AUTHOR]

A summary is presented of 3 years' experience with donors in an oocyte donation programme. During this interval, 50 women participated as gamete donors. All proffered their services without solicitation from the programme. Most were college-educated, working mothers. The majority stated that the primary motivation for participation was concern for others' infertility. Oocytes donors generally found the required use of parenteral medication taxing but tolerable. In most cases, injections were administered to the donor by her husband or by the female recipient. The majority of donations were performed without anonymity (66%). Cycles were performed at approximately 3-month intervals. This approach as well tolerated by donors and allowed predictable scheduling of cases. All women felt their participation was of great significance and each was willing to donate oocytes again if asked. [ABSTRACT FROM AUTHOR]

Ten patients with normal bimanual pelvic examinations were found to have small, non-palpable adnexal cysts by transvaginal ultrasound examination. After failing to respond to a course of observation and suppressive therapy with combination oral contraceptives, surgical evaluation was performed. In each case, histological examination returned a pathological diagnosis (endometrioma, serous cystadenoma, mature cystic teratoma, inflammatory cyst). This series suggests that transvaginal ultrasonography may be used to detect adnexal pathology before it is clinically apparent. A scheme for management of this clinical entity is proposed. [ABSTRACT FROM AUTHOR]

A quadruplet pregnancy occurred in a woman 51 years of age following oocyte donation and embryo transfer. Successful pregnancy occurred following two previously unsuccessful attempts. The patient underwent a selective reduction of her pregnancy to two fetuses at approximately 13 weeks gestational age. Her pregnancy continued uneventfully and she underwent the delivery of two viable infants at 38 weeks gestational age by Caesarean section. This case represents the first quadruplet pregnancy to be established in a woman of 50 years of age or older. It illustrates both the benefits and risks of oocyte donation to women of advanced reproductive age. [ABSTRACT FROM AUTHOR]