[Apropos of some psychological factors in certain refractory asthmas].
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Biomedical subjects
Publications and source records attributed to C Righini.
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OBJECTIVES: To investigate the hormonal control and the possible consequences of uterine contractions (UC) on IVF-ET outcome. MATERIALS AND METHODS: We studied prospectively 220 controlled ovarian hyperstimulation (COH) cycles for IVF-ET. Just before ET, women underwent 5-minute digital recordings of the uterus using US image analysis software for UC assessment. Plasma progesterone (P) and estradiol were measured. Four groups were defined according to UC frequency: < or = 3.0 (n = 53), 3.1 to 4.0 (n = 50), 4.1 to 5.0 (n = 43), and > 5.0 (n = 74) UC/minute, respectively. RESULTS: Patients, COH and embryology characteristics were comparable in all groups. Notwithstanding estradiol levels were not associated with UC characteristics, plasma P and UC frequency were negatively correlated (r = -0.34, P < 0.001). A stepwise decrease in clinical and ongoing pregnancy as well as implantation rates occurred from the lowest to the highest UC frequency groups (53%, 36%, 21%; 46%, 32%, 20%; 23%, 19%, 10%; and 14%, 11%, 4%; P < 0.001). Direction of UC did not affect ET outcome. CONCLUSIONS: The negative correlation between UC frequency and P levels supports the utero-relaxing properties of P. High frequency UC on the day of ET hinder IVF-ET outcome, possibly by expelling embryos out of the uterine cavity.
The decline of female fertility with increasing age is due to a physiological diminution of the ovarian reserve of follicles. Hence, a reliable evaluation of the ovarian reserve before performing assisted reproductive technology in aged women provides them and the physician with information about the actual probabilities of pregnancy. Patients aged over 38 years should be accepted in assisted reproduction programs only after confirmation of a healthy ovarian reserve. Patients aged more than 42 years, even in case of a normal ovarian reserve assessment, should be only accepted in selected cases. After 42 years until 46 of age, techniques of in vitro fertilization with oocyte donation may represent an alternative chance of pregnancy to aged women.