Search

Objective: To determine the effectiveness of a short protocol (SP) of gonadotropin-releasing hormone agonist (GnRH-a) administration in patients who already had undergone at least one in vitro fertilization (IVF) and embryo transfer (ET) treatment cycle with the long protocol (LP) and had shown poor results., Methods: One hundred and twelve patients were studied. The E2 levels, the number of preovulatory follicles, the number of oocytes retrieved and fertilized, the number of embryos cleaved, the fertilization rate and the number of embryos transferred were calculated., Results: The values for the mentioned parameters were significantly higher in the SP than those in the LP. So were the pregnancy rates per cycle and per ET (23.2% and 24.1%, respectively) in the SP significantly (p < 0.0001) higher than those in the LP (12.5% and 13.5%, respectively)., Conclusion: In cases who showed poor results to the LP, instead of repeating the same protocol the SP may be substituted. This strategy may not only improve the results, but also decrease the total cost of the IVF-ET treatment.

Preventing the occurrence of high-rank multiple pregnancies without reducing the pregnancy rate remains a high priority of in-vitro fertilization and embryo transfer programmes. Our previous study demonstrated that, if there is at least one embryo with a good morphological grade, then the transfer of two (a double embryo transfer) instead of three embryos does not result in a lower pregnancy rate, and that the influence of the number of embryos transferred becomes significant only when poor-quality embryos are transferred. This result allowed us to employ the simple policy of systematically selecting double embryo transfer cycles without affecting the pregnancy rate. Since January 1994, when patients < 37 years of age had more than two embryos available for transfer, only two instead of three embryos were transferred if at least one of the embryos demonstrated a good morphological grade. After a 1 year application of this policy, of the 147 cycles (group A) that fulfilled the above criteria, two embryos were transferred in 92 cycles, while three embryos were transferred in the other 55 cycles. The results of these cycles were compared to those of the control 144 cycles (group B) in which three embryos were transferred, prior to the application of this policy. The on-going pregnancy rates and the incidence of multiple and triplet pregnancies were 24% and 28%, 22% and 23%, and 2% and 9% in groups A and B respectively. The rates were not significantly different. In conclusion, although our prospective trial demonstrated a tendency of decreasing pregnancy rate and an invariable incidence of multiple pregnancies, the very low occurrence of triplets during this period indicated that this policy provided a practical compromise between achieving a high pregnancy rate and an acceptable incidence of triplet pregnancies.

This study was aimed at assessing the outcome of in-vitro fertilization (IVF) and embryo transfer in patients with polycystic ovarian syndrome (PCOS). The results of IVF and embryo transfer in PCOS patients (PCOS group, 78 cycles of 26 patients) were compared with those of a control group (423 cycles in 202 patients without male factor; age and ovarian stimulation protocol were matched). Although the pregnancy rate per transfer was not different in the two groups of patients (25 versus 34%, PCOS versus control group), the PCOS group had a significantly lower pregnancy rate per follicle aspiration (19 versus 31%, P < 0.05). A notable result was a significantly higher incidence of embryo transfer cancellations in the PCOS group (22 versus 8%, P < 0.01), which resulted from unpredictable failure of either oocyte recovery or fertilization. The incidence of unexplained complete failure of fertilization was significantly higher in the PCOS group (18 versus 5%, P < 0.01). These results may reflect a reduced quality of the oocytes in the PCOS group, and there was a subgroup of PCOS patients who repeatedly produced poor results of treatment. Although the ovarian stimulation regimen best suited to PCOS patients remains to be determined, special care should be taken during ovarian stimulation, especially when the PCOS patients had experienced unexplained failure of oocyte recovery or fertilization in the previous treatment cycle(s).

The rational of transferring two instead of three embryos was studied through 468 in-vitro fertilization (IVF) treatment cycles in 287 couples. The quality of 1224 embryos was determined according to the fragmentation rate and the morphology as good (A) and poor (B). The influence of the number of embryos transferred (two or three) on the pregnancy rate when the same quality or combinations of good and poor quality embryos transferred was examined. When only good quality embryos were transferred the pregnancy rates in double (AA) and triple (AAA) embryo transfer were 40.5 (17/42) and 42.9% (30/70) respectively (not significant). When only poor quality embryos were transferred, the pregnancy rates in double (BB) and triple (BBB) embryo transfers were 11.0% (11/100) and 22.9% (16/70) respectively (P < 0.001). On the other hand, when good and poor quality embryos were transferred together as AB in double and as AAB and ABB in triple embryo transfer, the pregnancy rates were 36.8 (14/38) and 39.9% (59/148) respectively (not significant). There was no difference in the miscarriage rate between double and triple embryo transfers; 16.7 and 18.1% respectively. The multiple pregnancy rate was 14.3% for double embryo transfers and 32.4% for triple embryo transfers (P < 0.001). This study demonstrates that if there is at least one good quality embryo available for transfer, then double instead of triple embryo transfer will not yield a significantly lower pregnancy rate. The influence of the number of embryos transferred on the pregnancy rate became significant when only poor quality embryos were transferred.(ABSTRACT TRUNCATED AT 250 WORDS)