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This study investigated whether the difference between endometrial thickness in the frozen embryo transfer (FET) cycle and the preceding fresh stimulated cycle predicts clinical pregnancy in women with thin endometrium. A retrospective analysis of 335 cycles in 227 women (age < 43) with endometrium < 8 mm in the FET cycle was conducted. Endometrial thickness was assessed using the ratio (ET frozen/fresh ) and absolute difference (ET fresh-frozen ) between the maximal endometrial thickness measured during the stimulated IVF cycle and that measured in the FET cycle. We hypothesized that a smaller difference and higher ratio during FET will be associated with higher pregnancy rate. No embryo implantation occurred in women with an FET endometrial thickness < 5.9 mm and an ET frozen/fresh < 0.86. Cycles with a positive beta-human chorionic gonadotropin (ß-hCG) showed a significantly lower mean ET fresh-frozen (1.89 ± 1.78 vs 2.30 ± 1.81, p = 0.03), and a significantly higher ET frozen/fresh ratio (0.82 ± 0.17 vs. 0.77 ± 0.15, p = 0.024). Endometrial thickness in the FET cycle normalized to the preceding stimulated cycle is associated with implantation and may constitute a novel predictor of FET success in women with thin endometrium.

Objective: Pre-implantation genetic diagnosis (PGD) is required in order to screen and diagnose embryos of patients at risk of having a genetically affected offspring. A biopsy to diagnose the genetic profile of the embryo may be performed either before or after cryopreservation. The aim of this study was to determine which biopsy timing yields higher embryo survival rates., Study Design: Retrospective cohort study of all PGD patients in a public IVF unit between 2010 and 2013. Inclusion criteria were patients with good-quality embryos available for cryopreservation by the slow freezing method. Embryos were divided into two groups: biopsy before and biopsy after cryopreservation. The primary outcome was embryo survival rates post thawing., Results: Sixty-five patients met inclusion criteria. 145 embryos were biopsied before cryopreservation and 228 embryos were cryopreserved and biopsied after thawing. Embryo survival was significantly greater in the latter group (77% vs. 68%, p < 0.0001)., Conclusion: Cryopreservation preceding biopsy results in better embryo survival compared to biopsy before cryopreservation.

Objective: Our aim was to compare treatment outcome following in vitro maturation (IVM) compared with IVF in patients with polycystic ovarian syndrome (PCOS)., Study Design: Retrospective evaluation of treatment in women with PCOS who underwent IVM (108) and IVF (108)., Results: We found a significant difference in outcome between IVM and IVF, with an increase in the number of mature oocytes derived (10.5 ± 6.5 vs. 15.3 ± 8.8, p<0.0001) and the cleavage rate (92.4 ± 13.0 vs. 95.2 ± 11.7, p=0.03) in IVM cycles. Due to the lower implantation rate (16.1% vs. 21.6%, p=0.07) we tend to transfer more embryos in the IVM group (3.4 ± 0.8 vs. 2.8 ± 1.0, p<0.0001), but the multiple pregnancy rate in that group was not higher. Importantly, the delivery rate was similar in both groups (26.8% vs. 25%). We also report a yearly change in the success rate of IVM during this period., Conclusions: IVM treatment for PCOS patients may be a valid alternative treatment to IVF with the advantage of eliminating the risk of OHSS and reducing the cost of medication, whilst maintaining high clinical pregnancy rate., (Copyright © 2012. Published by Elsevier Ireland Ltd.)

Objective: To assess the endometrial thickness, hormonal status and pregnancy rates with clomiphene citrate (CC) vs. letrozole in frozen-thawed embryo transfer protocols., Study Design: Nineteen patients who had previously undergone in vitro fertilization (IVF) with embryo cryopreservation were prospectively and randomly enrolled in a randomized, controlled trial. Nine patients were treated with CC, 100 mg per day, from day 3 to day 7 of the cycle, and 10 patients were treated with letrozole, 2.5 mg per day, on the same cycle days. beta-Human chorionic gonadotropin (beta-hCG) was administrated when the leading follicular size was > or = 18 mm. Endometrial thickness was measured on cycle day 8, beta-hCG day, transfer day and 7 days after embryo transfer. Estradiol levels were determined on the day of beta-hCG administration., Results: Patients' ages and number of previous unsuccessful IVF cycles were similar between the 2 groups. Endometrial thickness was significantly higher in the letrozole group as compared to the CC group on the day of beta-hCG administration (9.1 +/- 3.6 vs. 6.9 +/- 1.2 mm, p<0.05), on the day of embryo transfer (10 +/- 1.7 vs. 7.6 +/- 1.4 mm, p<0.05) and 7 days after embryo transfer (12.2 +/- 0.4 vs. 9.0 +/- 3.0 mm, p<0.05). Estradiol levels in the letrozole group were significantly lower than in the CC group on the beta-hCG day (231 +/- 132 vs. 515 +/- 363 pg/L, p<0.05). Pregnancy was not achieved in either group., Conclusion: Endometrial thickness is improved by letrozole as compared to CC in frozen-thawed embryo transfer cycles. Further investigation is needed to assess pregnancy and implantation rates.

Several case reports have shown that some patients may develop ovarian cysts or ovarian hyperstimulation syndrome following the administration of gonadotrophin-releasing hormone agonist (GnRHa). This is the first report of a live birth following ovarian stimulation and IVF-embryo transfer using sole administration of GnRHa as part of the short protocol. The 31-year-old woman was referred to IVF because of severe male factor. Following spontaneous menses, ovulation induction was started by administering a conventional flare-up regimen (triptorelin 0.1 mg) on day 1 of the cycle. On day 3, the oestradiol concentration was 444 pg/ml and the progesterone concentration was 0.3 ng/ml. On day 4, about 10 follicles, 8-10 mm in size, were detected in each ovary, and the oestradiol concentration rose to 704 pg/ml (progesterone was unchanged). Surprisingly, on day 9, the follicles were 18-19 mm in diameter, oestradiol had increased to 3678 pg/ml and progesterone was now 2.88 ng/ml. Informed consent was obtained for administering human chorionic gonadotrophin and for performing ovum retrieval 36 h later. Nineteen MII oocytes were retrieved, and all were fertilized, yielding high-quality embryos. Two embryos were transferred, and the patient conceived and recently gave birth to a healthy singleton.

Purpose: To examine whether double transfer of embryos on day 2-3 and on day 5 after ovum pick-up (OPU) improves IVF/ET success rates in patients with multiple consecutive IVF failures, Methods: Consecutive IVF failures patients (7.6 +/- 0.5) undergoing IVF/ET cycles were treated with interval double transfer on day 2-3 and on day 5 after OPU. Matched patients, that had embryos transferred only once on day 2 or 3 served as controls., Results: Baseline and cycle characteristics were similar in the study group and controls. The total pregnancy rate was 44.6% in the study group and 24.2% in the controls (p = 0.001), and the clinical pregnancy rates were 38.5% and 19.6%, respectively (p = 0.001)., Conclusions: Patients with multiple consecutive IVF/ET failures, treated with the interval double transfer approach had significantly improved cycle success rates compared with regular day 2 or 3 embryo transfer protocol.

Objective: The present study was conducted to evaluate the effect of serum progesterone (P) levels on the day of human chorionic gonadotropin (hCG) administration on embryo quality and pregnancy rate in intracytoplasmic sperm injection (ICSI) cycles., Design and Setting: This was a retrospective analysis conducted in the in vitro fertilization (IVF) unit of a tertiary hospital., Patients: Two hundred and one patients who underwent a total of 280 IVF treatment cycles allocated to ICSI during routine IVF/embryo transfer treatment. Results. In cycles with elevated serum P, higher estradiol levels were noted (1915 pg/ml vs. 1256 pg/ml; p<0.05), more oocytes were retrieved and manipulated, and more embryos were available for transfer. Embryo grading was comparable between the two groups. The average age was lower in the group with elevated P; but the pregnancy rate was significantly lower (16.4% vs. 27.6%, p = 0.03)., Conclusions: Our data demonstrate no deleterious effect of elevated P on embryo quality. However, high serum P adversely affects implantation and pregnancy rates.