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Hurricane Katrina was a devastating storm that brought lessons in emergency preparedness. All IVF programs should have a plan to protect fresh and cryopreserved embryos in case of natural or human-made disaster.

Objective: To determine factors responsible for high-order multiple pregnancy (HOMP) and high-order multiple births when multiple cycles of controlled ovarian hyperstimulation-IUI (COH-IUI) are performed., Design: Retrospective analysis., Setting: Private infertility clinic., Patient(s): Women (n = 2,272) who underwent 4,067 consecutive COH-IUI cycles., Intervention(s): None., Main Outcome Measure(s): High-order multiple pregnancy rate, pregnancy rate (PR), and birth rate (PR) per cycle., Result(s): High-order multiple pregnancy was related to number of follicles of diameter > or = 10 mm, age, and treatment cycle. For age <32 years, HOMP was 6% for three to six follicles and 20% for seven or more follicles. For ages 32 to 37 years, HOMP was 5% for three to six follicles and 12% for seven or more follicles. In the first COH-IUI cycle, HOMP was 8% for three to six follicles and 15% for seven or more follicles. In the second cycle, HOMP did not occur unless there were more than six follicles. No HOMP occurred after the second cycle. Pregnancy rate did not increase significantly when there were more than four follicles. Continuing COH-IUI past the third cycle resulted in additional pregnancies in patients with one to eight follicles., Conclusion(s): High-order multiple pregnancy can be predicted by age and number of follicles of diameter > or = 10 mm. Controlled ovarian hyperstimulation is not necessary to achieve satisfactory overall pregnancy rates if ovulation induction is continued past the third cycle in low responders.

The 2002 recommendation of the consensus meeting of the European Society of Human Reproduction and Embryology (ESHRE) that the outcome measure of assisted reproductive technology (ART) and non-ART should be 'singleton live birth rate' could profoundly effect the ability of infertility patients to become pregnant. We reviewed published reports and new data concerning elective single embryo transfer (eSET) vs. double embryo transfer (DET) and the outcome of twin pregnancies in the United States, as well as recommendations of other Societies concerning number of embryos to transfer and methods used to measure ART success. We found that no single outcome measure of ART is ideal. Mandatory eSET would result in 42%-70% fewer births compared to DET. Infertility treatments account for only 12% of all twin pregnancies and 4% of all premature births in the United States. Twin and singleton births due to ART do not occur earlier than spontaneously conceived twins and singletons unless they started as triplet and higher order pregnancies. Multiple outcome measures are necessary when evaluating ART success. Twin as well as singleton births should be counted as ART successes. The essential aim of infertility treatment should be a healthy low order (singleton or twin) birth.

Objective: To determine if previous treatment with clomiphene citrate intrauterine insemination (CC-IUI) affects pregnancy and high-order multiple pregnancy (HOMP) rates in subsequent hMG-IUI or FSH-IUI cycles., Design: Retrospective cohort study., Setting: Private infertility clinic., Patient(s): Five hundred fifty-one patients (age <38 years) without tubal factor infertility, treated with 918 cycles of hMG/FSH-IUI after one or more unsuccessful cycles of CC-IUI; 908 patients treated with 1459 cycles of hMG/FSH-IUI without prior CC-IUI., Intervention(s): CC-IUI, hMG-IUI, FSH-IUI., Main Outcome Measure(s): Pregnancy rate per cycle, HOMP (three or more gestational sacs)., Result(s): Pregnancy rates during the first three hMG-IUI or FSH-IUI cycles averaged 21.8 +/- 1.1% without previous CC-IUI, 19.6 +/- 1.3% after one to four cycles of CC-IUI, and 3.6 +/- 2.6% after >or= five previous CC-IUI cycles. The HOMP rates were 8.8% without previous CC-IUI, 7.5% after one, 5.7% after two and <2.6% (0 out of 38) after >or= three previous CC-IUI cycles., Conclusion(s): Pregnancy rates in hMG/FSH-IUI cycles are significantly reduced after four unsuccessful CC-IUI cycles. High-order multiple pregnancies due to hMG/HMG-IUI are reduced following previous unsuccessful CC-IUI cycles.

Objective: To determine how diagnosis, age, sperm quality, and number of preovulatory follicles affect pregnancy rates when multiple cycles of clomiphene citrate (CC)-IUI are performed., Design: Fifteen-year prospective observational study., Setting: Private infertility clinic., Patient(s): Three thousand, three hundred eighty-one cycles of husband or donor IUI., Intervention(s): Ovulation induction with CC and IUI., Main Outcome Measure(s): Per-cycle pregnancy rate (PR), cumulative pregnancy rate (CPR)., Result(s): Pregnancy rates remained constant through four cycles, then fell significantly for diagnoses other than ovulatory dysfunction. Mean PRs for cycles 1-4 were significantly lower for patients with the following characteristics: age >/=43 years, poor semen quality, single preovulatory follicles, and diagnoses other than ovulatory dysfunction. Additional cycles of CC-IUI compensated for low PRs because of age, semen quality, or number of follicles. After four cycles, CPRs were 46% for ovulatory dysfunction; 38% for cervical factor, male factor, and unexplained infertility; 34% for endometriosis; and 26% for tubal factor. After six cycles, CPRs were 65% for ovulation dysfunction, 35% for endometriosis, and unchanged for other diagnoses., Conclusion(s): Clomiphene citrate-intrauterine insemination should be performed for a minimum of four cycles. Additional cycles of CC-IUI can compensate for low pregnancy rates due to age, semen quality, or follicle number in patients with ovulation dysfunction.

Objective: To determine the relationship of follicle numbers and estradiol (E(2)) levels to multiple implantations in human menopausal gonadotropin (hMG) and clomiphene citrate (CC) cycles., Design: Fifteen-year prospective study., Setting: Private infertility clinic., Patient(s): Women who underwent 3608 cycles of husband or donor intrauterine insemination (IUI)., Intervention(s): Ovulation induction (OI) with CC, hMG, or CC+hMG., Main Outcome Measure(s): Pregnancy and multiple implantations., Result(s): Triplet and higher-order implantations-but not twin implantations-were related to age, E(2) levels, and number of follicles > or = 12 mm and > or = 15 mm, but not number of follicles > or = 18 mm, in hMG and CC+hMG cycles. For patients less than 35 years old, three or more implantations tripled when six or more follicles were > or = 12 mm, in CC, hMG, and CC+hMG cycles, and when E(2) was > or = 1000 pg mL in hMG and CC+hMG cycles. For patients 35 or older, pregnancy rates in hMG and CC+hMG cycles doubled when six or more follicles were > or = 12 mm, or E(2) levels were >1000 pg mL, whereas 3 or more implantations were not significantly increased., Conclusions: Withholding hCG or IUI in CC, hMG, and CC+hMG cycles when six or more follicles are > or = 12 mm may reduce triplet and higher-order implantations by 67% without significantly reducing pregnancy rates for patients under 35 years of age.

Objective: To compare World Health Organization threshold values for normal sperm with the initial sperm quality necessary for successful IUI., Design: Retrospective study., Setting: Private fertility clinic., Patient(s): One thousand eight hundred forty-one couples undergoing 4,056 cycles of IUI., Intervention(s): Intrauterine insemination., Main Outcome Measure(s): Relation of initial sperm quality to fecundity., Result(s): Progressive motility and total motile sperm count were the initial sperm characteristics most closely related to pregnancy on discriminant analysis. The per-cycle pregnancy rate averaged 11.1% during the first three IUI cycles. Pregnancy rates were > or = 8.2% per cycle when the initial sperm values were a concentration of > or = 5 X 10(6)/mL, a total count of > or = 10 X 10(6), progressive motility of > or = 30%, or a total motile sperm count of > or = 5 x 10(6). Minimal increases in fecundity occurred when initial values were greater than these threshold levels. The lowest initial values that resulted in pregnancy were a concentration of 2 x 10(6)/mL, a total count of 5 x 10(6). motility of 17%, and a total motile sperm count of 1.6 X 10(6). Pregnancy rates were <3.6% when initial values were between the threshold levels and the lowest levels., Conclusion(s): The sperm quality that is necessary for successful IUI is lower than World Health Organization threshold values for normal sperm. Intrauterine insemination is effective therapy for male factor infertility when initial sperm motility is > or = 30% and the total motile sperm count is > or = 5 X 10(6). When initial values are lower, IUI has little chance of success.

Our objective was to examine the relationship between patient weight and the dose of clomiphene required for pregnancy so as to assess the validity of recommendations that the dose of clomiphene be limited to 100 mg. We retrospectively analysed the weight-dose relationship in 1681 clomiphene pregnancies and the relationship between dose and pregnancy, births, multiple births, number of pre-ovulatory follicles and endometrial thickness in 2841 cycles of clomiphene treatment, 25-250 mg, for 5 days before intrauterine insemination (IUI). Doses of clomiphene >100 mg/day were used before pregnancies in 27.4% of patients who weighed >90 kg and in 14.7% of all pregnancies. In IUI cycles, pregnancies and births, but not multiple births or abortions, were related to dose. An increase in dose from 25 to 100 mg resulted in higher pregnancy and birth rates, and in an increase in the average number of pre-ovulatory follicles > or =12 mm in diameter, from 2.0 to 2.8, with no additional increase at higher doses. Endometrial thickness and cycle day of insemination were not related to dose. We conclude that doses of clomiphene may safely be increased beyond 100 mg, and that doses > or =100 mg are required in significant numbers of patients.

The purpose of this study was to determine whether the use of clomiphene results in a higher incidence of spontaneous abortion than occurs naturally in subfertile patients. Reproductive outcomes of 1744 clomiphene pregnancies were compared to outcomes of 3245 spontaneous pregnancies in a prospective study. Abortion was classified as clinical if a sac was seen on ultrasound or if it occurred after 6 gestational weeks, and as preclinical if a quantitative human chorionic gonadotrophin (HCG) was > or = 25 mIU and no sac was seen or abortion occurred earlier. The overall incidence of abortion was higher for clomiphene pregnancies (23.7%), compared with spontaneous pregnancies (20.4%) (P < 0.01). Preclinical abortions were increased by clomiphene for all ages (5.8 versus 3.9%, P < 0.01) and for age > or = 30 years (8.0 versus 4.9%, P < 0.001), but not for age < 30 years (3.7 versus 3.0%). Clinical abortions were increased by clomiphene for age < 30 years (15.9 versus 11.2%) (P < 0.01), but not for age > or = 30 years (20.1 versus 22.3%) or all ages (18.0 versus 16.4%). Clinical abortions occurred 22% less often following clomiphene compared with spontaneous pregnancies for patients with luteal insufficiency (18.3 versus 23.6%, P < 0.05). We conclude that the increase in abortion due to clomiphene is small and may be related to different causes for women aged < 30 and > or = 30 years, and also that clomiphene may decrease clinical abortions in patients with luteal insufficiency.

In each of two trials, a 2-by-2 factorial arrangement of treatments was utilized to evaluate the reproductive performance of first-year and recycled turkey hens to intermittent lighting (IL) through an egg-laying period of 20 wk. The IL treatment provided 4 h of light per day given as 2 h light:12 h dark:2 h light:8 h dark (2L:12D:2L:8D). This treatment group was compared to controls maintained on 16L:8D. Data were collected for BW, feed intake, feed efficiency, time to first egg, eggs per hen fertility, hatchability, egg weight, and poult weight. Consistent age effects included greater BW, egg weight, and poult weight from recycled hens compared to first-year hens as well as a delay in the onset of laying and a reduction in egg production by six eggs per hen in the recycled hens. Feed intake and feed efficiency were similar in both age groups, Intermittent lighting delayed the onset of laying but increased the rate of lay by eight eggs per hen. Late-season fertility, feed efficiency, and egg weight were significantly increased by the IL treatment. The conclusion was that, for turkey hens, intermittent lighting can effectively improve reproductive performance.

Japanese quail genetically selected on the basis of atherosclerosis susceptibility were tested for infection by Marek's disease herpesvirus (MDV). Viral DNA was detected in the atherosclerotic aortas of susceptible (SUS) quail by the technique of DNA hybridization. Southern blot analysis demonstrated that restriction mapping of aortic DNA was specific and different from that of MDV. Screening of quail embryos by dot-blot hybridization detected that MDV DNA existed in 100% of SUS quail tested. Resistant (RES) quail were a mixed population, with 16% of embryos resembling the SUS group. Functional MDV was not found by a number of methods including virus isolation, serological test, and exposure of sentinel chicks to SUS quail. These results suggest that the SUS quail possess a portion of the MDV genome in the germline, and the viral genes have been coselected by their susceptibility to cholesterol-induced atherosclerosis.

1. Characteristics of individual oviposition patterns of turkey breeder hens were determined for 160 d of photostimulation with fluorescent blue, green or red light and with incandescent light. 2. In all treatments most eggs were laid during the afternoon and evening. The maximum frequency occurred at 14.00 to 15.00 h (8 to 9 h after light onset); about 15% of all eggs were laid in the dark period. 3. The hourly oviposition distribution remained unchanged and was specific to individual hens throughout the study period. However, it was highly variable between hens, ranging from highly dispersed to tightly clustered. 4. The total number of clutches per hen did not differ between treatments and eggs were laid in relatively short clutches; 65% were of two eggs or fewer, 30% of three to 5 eggs and only 5% of 6 eggs or more. 5. The oviposition time of the first egg in a clutch was very variable; however, oviposition time became more clustered and uniform as the position of the egg in a clutch increased. 6. Mean time of lay, mean interval between eggs and total lag time were not influenced by light treatment. Mean interval was about 27 h for all eggs and was not influenced by clutch size. 7. Light quality at the intensity used in this study did not appear to play an important role in oviposition patterns of turkey hens.

Three light sources: Cool-White (C), Vita-Lite (V), and tungsten (T), each at two intensities (20 or 50 lx), were used to supplement light to 16 hr in a 24-hr cycle for geese maintained in open-shed pens. Two lines of mixed breeds of geese, white and grey, were used and egg production was followed from the 27th week of age through 6 months of the laying period. A significant increase in egg production was found under the C light illumination. At 20 lx, egg production was significantly higher than at 50 lx. No difference in egg production was found between the two lines of geese; however, significant interactions were found between light sources, intensities, and geese lines, as exhibited by different patterns of egg production. Light intensity had the greatest effect until peak egg production had been reached; thereafter, egg production was influenced mainly by the light source.

Genetically selected lines of Japanese quail, highly susceptible (SUS) and resistant (RES) to atherosclerosis, were used to study the possible involvement of Marek's disease herpes virus (MDV). An EcoRI gene library of MDV cloned in pBR328 was used to prepare the 32P-DNA probe in dot-blot and Southern blot hybridizations to detect the presence of MDV DNA sequence in the aorta, embryo and other tissue specimens. The viral DNA was found present in the aorta of SUS quail and it increased with the severity of the aortic lesion. For the DNA isolated from the atherosclerotic aorta, the endonuclease restriction map is specific but not identical to MDV genome. When screening the embryos of SUS and RES quail, it was found that all the SUS were positive with approximately 10 or more viral genome equivalents or virus copies per cell. The RES embryos were heterogeneous, 41% negative (less than 0.1 copy per cell), 43% intermediate (1-10 copies per cell) and 16% positive (10 or more copies per cell). The vaccination of SUS quail with the herpes virus of turkey vaccine did not prevent the disease. These results indicated that a part of MDV genome or another related herpes virus genome was integrated into the host DNA of SUS quail. The integrated viral gene or genes are believed to be important in atherogenesis, because they are genetically co-selected with the atherosclerosis-susceptibility.