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Objective: To compare different methods of ovarian stimulation (OS) for assisted reproductive technology in baboons., Design: Prospective randomized study., Setting: Institute of primate research., Animal(s): Baboons (n = 10) were randomized into two groups (of five animals each) during three different cycles to compare six protocols of OS., Intervention(s): Cycle 1: clomiphene citrate (CC) alone (group CC) versus CC and GnRH agonist (group CC-Ag); cycle 2: recombinant gonadotropins (GON) without GnRH agonist (group GON) versus GON and depot GnRH agonist (group GON-AgDepo-1); cycle 3: GON and depot GnRH agonist (group GON-AgDepo-2) versus GON and daily GnRH agonist in a classic long protocol (group GON-Ag). Oocyte aspiration was performed 34-36 hours after injecting 5,000 IU rhCG, followed by fertilization via intracytoplasmic sperm injection (ICSI)., Main Outcome Measure(s): Number and quality of oocytes retrieved and their fertilization rate., Result(s): More metaphase II (MII) oocytes were retrieved using the GON-AgDepo-1 (n = 12; 64% MII), GON-AgDepo-2 (n = 9; 79% MII), GON-Ag (n = 16; 88% MII), and GON (n = 6; 59% MII) protocols compared with the CC (n = 9; 15% MII) and CC-Ag (n = 14; 20% MII) protocols. Fertilization by ICSI varied between 43% and 71%., Conclusion(s): In baboons, long and depot protocols yield similar numbers of MII oocytes; however, depot protocol may be preferable because only one injection of GnRH agonist is needed., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To test the hypothesis that patients with advanced maternal age (AMA) have a higher implantation rate (IR) after embryo transfer of embryos with a normal chromosomal pattern for the chromosomes studied with preimplantation genetic screening (PGS) compared with patients who had an embryo transfer without PGS., Design: Prospective randomized controlled trial (RCT)., Setting: Academic tertiary setting., Patient(s): Patients with AMA (> or =35 years)., Intervention(s): In an RCT, the clinical IR per embryo transferred was compared after embryo transfer on day 5 or 6 between the PGS group (analysis of chromosomes 13, 16, 18, 21, 22, X, and Y) and the Control group without PGS., Main Outcome Measure(s): No differences were observed between the PGS group and the Control group for the clinical IR (15.1%; 14.9%; rate ratio 1.01; exact confidence interval [CI], 0.25-5.27), the ongoing IR (at 12 weeks) (9.4%; 14.9%), and the live born rate per embryo transferred (9.4%; 14.9%; rate ratio 0.63; exact CI, 0.08-3.37). Fewer embryos were transferred in the PGS group (1.6 +/- 0.6) than in the Control group (2.0 +/- 0.6). A normal diploid status was observed in 30.3% of the embryos screened by PGS., Conclusion(s): In this RCT, the results did not confirm the hypothesis that PGS results in improved reproductive outcome in patients with AMA., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the prevalence of histologically proven endometriosis in a subset of infertile women., Design: Retrospective case series with electronic file search and multivariable logistic regression analysis., Setting: Tertiary academic fertility center., Patient(s): Two hundred twenty-one infertile women without previous surgical diagnosis for infertility with regular cycles (variation, 21-35 days) whose partners have a normal semen analysis., Intervention(s): Diagnostic laparoscopy and, if necessary, operative laparoscopy with CO(2) laser excision., Main Outcome Measurement(s): The prevalence of endometriosis and of fertility-reducing nonendometriotic tubal and/or uterine pathology., Result(s): The prevalence of endometriosis was 47% (104/221), including stage I (39%, 41/104), stage II (24%, 25/104), stage III (14%, 15/104), and stage IV (23%, 23/104) endometriosis, and was comparable in patients with (54%, 61/113) and without (40%, 43/108) pelvic pain. The prevalence of fertility-reducing nonendometriotic tubal and/or uterine pathology was 29% in all patients (15% in women with and 40% in women without endometriosis). A multivariate logistic regression model including pain, ultrasound data, age, duration of infertility, and type of fertility was not or not sufficiently reliable for the prediction of endometriosis according to the revised American Fertility Society (rAFS) classifications I-II and rAFS III-IV, respectively., Conclusion(s): Reproductive surgery is indicated in infertile women belonging to the study population, regardless of pain symptoms or transvaginal ultrasound results, since half of them have endometriosis and 40% of those without endometriosis have fertility-reducing pelvic pathology.

Objective: To synchronize the baboon menstrual cycle and to compare different methods of ovarian stimulation for IVF in baboons., Design: Prospective randomized study., Setting: Institute of Primate Research, Nairobi, Kenya., Animal(s): Ten female baboons were treated with an oral contraceptive (33 +/- 8 days) and randomized for ovarian stimulation in two cycles., Intervention(s): In cycle 1 (C1), baboons were stimulated as follows: clomiphene citrate (CC) for 5 days followed by antagonist (group CC-1, n = 3); recombinant gonadotropins (rGn: rFSH and rLH) with antagonist (group antagon-1, n = 3); and long GnRH agonist protocol (group LP-1, n = 4). After 1- month rest, in cycle 2 (C2), the baboons were stimulated as follows: CC for 8 days without antagonist (group CC-2, n = 2); short GnRH agonist protocol (group SP-2, n = 4); long GnRH agonist protocol (group LP-2, n = 4). Oocyte aspiration was performed 34-36 hours after injecting 5000 IU recombinant hCG; the oocytes were then fertilized., Main Outcome Measure(s): Oocytes retrieved and fertilization rate., Result(s): Withdrawal bleeding occurred 4 +/- 1 days after the cessation of the contraceptive. Ovarian stimulation using the different protocols resulted in the following mean numbers of retrieved oocytes: LP-1, n = 19; LP-2, n = 19; CC-1, n = 4; CC-2, n = 4; antagon-1, n = 9; and SP-2, n = 14. Fertilization by intracytoplasmic sperm injection varied (23%-54%)., Conclusion(s): The baboon menstrual cycle can be synchronized using an oral contraceptive. A long GnRH agonist protocol for ovarian stimulation may be suitable for ovarian stimulation in baboons.

Objective: The association between infertility and minimal to mild endometriosis is controversial and poorly understood. The clinical pregnancy rate (PR) per cycle after controlled ovarian hyperstimulation (COH) with or without intrauterine insemination (IUI) is reportedly lower in women with surgically untreated minimal to mild endometriosis than in women with unexplained infertility. It is possible that prior laparoscopic removal of endometriosis has a positive effect on the clinical PR after COH and IUI. Therefore, we tested the hypothesis that after COH and IUI the PR per cycle and the cumulative live-birth rate (CLBR) are equal or higher in women with recently surgically treated minimal to mild endometriosis when compared with women with unexplained infertility., Design: A retrospective, controlled cohort study., Setting: Leuven University Fertility Centre, a tertiary academic referral center., Patient(s): One hundred seven women treated during 259 cycles with COH and IUI including patients with endometriosis (n = 58, 137 cycles) and unexplained infertility (n = 49, 122 cycles). All patients with endometriosis had minimal (n = 41, 100 cycles) or mild (n = 17, 37 cycles) disease that had been laparoscopically removed within 7 months before the onset of treatment with COH and IUI., Intervention(s): Controlled ovarian hyperstimulation using clomiphene citrate (23 cycles) or gonadotrophins (236 cycles) in combination with IUI., Main Outcome Measure(s): Clinical PR per cycle and CLBR within four cycles of treatment with COH and IUI., Result(s): The clinical PR per cycle was comparable in women with minimal or mild endometriosis (21% or 18.9%, respectively) and in women with unexplained infertility (20.5%). The CLBR within four cycles of COH and IUI was also comparable in women with minimal endometriosis, mild endometriosis, and unexplained infertility (70.2%, 68.2 %, 66.5%, respectively)., Conclusion(s): The data from our study suggest that COH and IUI shortly after laparoscopic excision of endometriosis is as effective as COH and IUI in patients with unexplained subfertility.

Objective: To test the hypothesis that the cumulative endometriosis recurrence rate (CERR) after fertility surgery for endometriosis stage III or IV is increased in women exposed to very high E(2) levels during ovarian hyperstimulation (OH) for IVF when compared with women exposed to less high E(2) levels during OH for intrauterine insemination (IUI)., Design: Retrospective cohort study including infertility patients with endometriosis stage III or IV., Setting: Leuven University Fertility Center, between 1990 and 2001., Patient(s): Patients (n = 67) with endometriosis stage III (n = 45) or IV (n = 22) who underwent pelvic reconstructive surgery and subsequently started fertility treatment with either IVF only (n = 39), both IVF and IUI in different cycles (n = 11), or IUI only (n = 17)., Intervention(s): Life table analysis was used to calculate the CERR., Main Outcome Measure(s): The CERR based on histologic or cytologic proof of disease recurrence., Result(s): At 21 months after the start of OH the overall CERR was 31% and was significantly lower in patients treated with IVF only (7%) or women treated with both IVF and IUI in different cycles (43 %) than in those treated with IUI only (70%). At 36 months after the start of OH, the overall CERR was 63%., Conclusion(s): In contrast to our hypothesis, the results from this study showed that the CERR is lower after ovarian hyperstimulation for IVF than after lower-dose ovarian stimulation for IUI, suggesting that temporary exposure to very high E(2) levels in women during OH for IVF is not a major risk factor for endometriosis recurrence in women treated with assisted reproductive technology.

After the introduction of new Belgian legislation limiting the number of transferable embryos to prevent multiple pregnancies after assisted reproductive technology, the implantation rate per embryo remained stable at 26% and the clinical pregnancy rate per embryo transfer did not change significantly (37.5% before and 32.5% after legislation), whereas the multiple pregnancy rate per clinical pregnancy decreased threefold from 25.9% to 8.0%) in the Leuven University Fertility Center.

Objective: This study tests the hypothesis that IUI treatment in cases with isolated teratozoospermia (<10% normal forms using strict criteria, normal motility and normal count), results in a lower cumulative live birth rate compared to cases with normozoospermia., Design: A retrospective cohort study., Setting: An academic fertility center., Patient(s): Eight hundred seventy-two IUI cycles in 440 couples were analyzed., Intervention(s): Couples (n = 440) were classified in three groups: normozoospermia (n = 213), isolated teratozoospermia (n = 104), and male factor infertility (n = 123)., Main Outcome Measure(s): Live birth rate per cycle and cumulative live birth rate (CLBR)., Result(s): The three groups were similar with regard to female age, female infertility factors, and ovarian response after hormonal stimulation. The overall CLBR after four cycles was 41.5%, and was significantly increased in the normozoospermic group (52.8%) when compared to the isolated teratozoospermia group (33.4%) and the male factor infertility group (31.4%)., Conclusion(s): This study documents for the first time that the CLBR after four IUI cycles is significantly and similarly reduced in couples with isolated teratozoospermia as in couples with other sperm defects, when compared to couples with normozoospermia. As with couples with male factor infertility, couples with isolated teratozoospermia should be counseled about other treatment options such as IVF, as the CLBR after three IVF cycles is 70%-80% in our program.

Objective: To test the hypothesis that alpha-glycosidase activity in seminal plasma can predict the outcome of both IUI and IVF., Design: A retrospective cohort study., Setting: Tertiary fertility center in a university hospital., Patient(s): Eighty-three subfertile couples who underwent IUI and 125 subfertile couples who underwent IVF., Intervention: None., Main Outcome Measure(s): Determination of the alpha-glycosidase activity in seminal plasma before an IUI or IVF attempt, correlation of alpha-glycosidase activity and other semen parameters, and prediction of pregnancy using alpha-glycosidase activity in seminal plasma., Result(s): Alpha-glycosidase activity correlated with sperm count. In the IUI group, alpha-glycosidase activity of >23.9 mU/mL predicted pregnancy with a sensitivity of 100% and a specificity of 55.2%. In the IVF group, the outcome could not be predicted with use of any of the semen parameters., Conclusion(s): Alpha-glycosidase activity measured in mU/mL probably can be used as a predictor for IVF and pregnancy in an IUI program but has no predictive value with regard to pregnancy rate in an IVF program.

Objective: To prove the presence of interleukin-11 (IL-11) in the follicular fluid (FF), to determine its source and the correlation between IL-11 and fertilization outcome, follicular size, number of follicles per patient, steroids, and insulin-like growth factor-1 (IGF-I) levels., Design: Interleukin-11 levels were measured in FFs, aspirated during oocyte pickup for IVF., Setting: Academic hospital and research environment., Patient(s): Follicular fluid and serum were obtained with informed consent from 44 patients undergoing IVF-ET. Granulosa cells were isolated from 17 patients., Main Outcome Measure(s): We hypothesized that IL-11 might play a role in follicular development, as do other related cytokines present in FF. Interleukin-11 was measured with ELISA., Result(s): Interleukin-11 was absent in the serum but present in FF and in conditioned medium from granulosa cells. Atretic follicles had higher concentrations of IL-11. No correlation was found between IL-11 and fertilization outcome, follicular size, steroid, IGF-I, and total protein concentrations., Conclusion(s): We conclude that IL-11 is present in FF. The role of IL-11 in follicular development should be the object of further investigations.

Objective: To assess the possibility of achieving a pregnancy in the wife of a patient suffering from idiopathic anejaculation who failed to respond to therapeutical modalities such as psychotherapy, sex therapy, and vibrostimulation., Design: Case report., Setting: The IVF program at the Leuven University Fertility Centre., Patient(s): A patient suffering from idiopathic anejaculation., Intervention(s): Intracytoplasmic sperm injection (ICSI) in combination with electroejaculation., Mean Outcome Measure(s): Fertility rate, cleavage rate, clinical pregnancy., Result(s): Two IVF procedures were performed of which the second resulted in an ongoing pregnancy and the delivery of a healthy boy., Conclusion(s): Electroejaculation may offer fertility chances in a patient suffering from idiopathic anejaculation resistant to conventional treatment modalities. When sperm quality shows very low motility, ICSI should be offered to improve pregnancy chances.