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Objective: To describe outcomes of the first 100 consecutive infertility patients participating in a risk-sharing program with uncomplicated eligibility requirements. The program included the costs of FSH-containing gonadotropin preparations and provided a full payment refund if no birth occurred that resulted in a normal infant surviving to an age of 1 month., Design: Retrospective cohort study., Setting: Private IVF center., Patient(s): Infertility patients<35 years of age, considered to be good autologous oocyte IVF candidates at time of program enrollment., Intervention(s): Retrospective analysis of outcomes of fresh IVF-ET and frozen embryo transfer cycles involving conventional treatment protocols., Main Outcome Measure(s): Cumulative successful pregnancy rate., Result(s): Of the first 100 patients enrolled in the program, 82 have had a delivery of a normal infant surviving to an age of 1 month, and another 6 have undelivered ongoing pregnancies at 20+ weeks. Nine participants completed the program without completing a successful treatment cycle, and another three remain enrolled., Conclusion(s): Infertility patients<35 years of age participating in a risk-sharing program with uncomplicated eligibility requirements are very likely to have a successful pregnancy. Other centers may wish to incorporate some of the described program's features into their own risk-sharing IVF programs., (Copyright © 2011. Published by Elsevier Inc.)

Objective: To report our initial IVF-ET experience combining assisted hatching performed 3 days after oocyte retrieval with day 5 embryo transfer (ET)., Design: Retrospective review of 110 consecutive IVF cycles not involving donor oocytes, including 16 cycles that involved assisted hatching performed 3 days after oocyte retrieval in combination with day 5 ET., Setting: Academic teaching hospital IVF center., Patient(s): Eighty-six consecutive IVF patients undergoing ET., Intervention(s): Assisted hatching using acid Tyrode's solution performed 3 days after oocyte retrieval in selected cases in combination with day 3 or 5 ETs., Main Outcome Measure(s): Clinical pregnancy rate per ET., Result(s): Of the 16 women undergoing day 5 ET following day 3 assisted hatching, 14 had a clinical pregnancy. These included 11 ongoing/delivered singletons and 2 ongoing/delivered twin pregnancies, neither of which was monochorionic. These clinical and ongoing/delivered pregnancy rates compared very favorably with those of 54% and 46%, respectively, for the 35 patients undergoing day 5 ETs without assisted hatching, even though the latter group appeared to be better IVF candidates based on the prognostic factors commonly used to predict success., Conclusion(s): Our experience suggests that day 3 assisted hatching followed by day 5 ET may be a useful combination in selected patients. Although not seen in our small series, an increased risk of monochorionic pregnancies remains a theoretical concern when such a combination is used, since both assisted hatching and blastocyst transfers have been independently linked to an increased risk in some reports.

Objective: To report the successful use of recombinant human FSH in a patient with a history of a severe systemic immunoglobulin E (IgE)-mediated reaction to urofollitropin., Setting: University hospital., Patient: A 38-year-old infertility patient who had experienced a whole-body rash with hives, tachycardia, fever, and other symptoms after urofollitropin administration, with confirmation of IgE-mediated sensitivity to urofollitropin by intradermal skin testing., Intervention: In vitro fertilization-ET after the use of recombinant human FSH to stimulate ovarian follicular development., Results: Establishment of a clinical pregnancy., Conclusions: Our case provides evidence for the involvement of nongonadotropin proteins as the direct cause of some adverse reactions from conventional urine-derived human FSH preparations.

Objective: To compare the efficacy of a globulin-containing protein source, Synthetic Serum Substitute (Irvine Scientific, Santa Ana, CA) and human serum albumin (HSA) in the early culture of human oocytes and embryos., Design: Oocytes from 31 consecutive IVF cycles were assigned alternately to dishes containing human tubal fluid (HTF) and either Synthetic Serum Substitute or HSA as the protein source. Each semen sample was split for processing in Synthetic Serum Substitute or HSA. Sperm processed in Synthetic Serum Substitute was added to oocytes cultured in Synthetic Serum Substitute, and sperm processed in HSA was added to oocytes cultured in HSA. After determination of fertilization, zygotes were placed in HTF containing the same protein supplement. Before transfer, the embryos were graded morphologically., Main Outcome Measures: Occurrence of normal fertilization and embryo quality as assessed by morphological grading., Results: There was no significant difference in the occurrence of fertilization or in embryo morphological quality between oocytes cultured in Synthetic Serum Substitute as compared with HSA., Conclusions: The use of a globulin-containing protein source in culture for IVF-ET did not improve the fertilization rate or embryo quality. Our design did not allow for demonstration of an effect on pregnancy rate.