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PubMed2003

Parents of 5-year-old in vitro fertilization children: psychological adjustment, parenting stress, and the influence of subsequent in vitro fertilization treatment.

Sixty-six parents who had conceived by in vitro fertilization (IVF) were compared with 46 matched naturally conceiving control parents regarding psychosocial adjustment and parenting stress 5 years after the birth of their first child. IVF mothers reported a more external locus of control than did control mothers but did not differ on other measures. Within the IVF group, higher levels of treatment predicted lower parenting stress and more defensive responding on the Parenting Stress Index (R. Abidin, 1990). The more positive reporting of high-treatment IVF parents may be attributable to either defensive responding or the fact that they are particularly highly motivated and competent parents. The study findings confirm a growing body of research regarding overall positive adjustment in IVF parents but also highlight the importance of considering individual differences among IVF mothers with respect to treatment experience.

Adaptation, Psychological↗
PubMed1994

Successful implementation of a regional in vitro fertilization program.

In vitro fertilization and other assisted reproductive technologies are becoming widely accepted modalities of treatment for infertile couples. Like other modern technologies, in vitro fertilization requires specially trained physicians and scientists who need specially dedicated equipment and space. In addition, patients having the procedure must undergo timely laboratory tests and sonographic evaluations for monitoring follicular maturation. To make in vitro fertilization available to patients in north central Florida, the Division of Reproductive Endocrinology and Infertility of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Gainesville established a system that utilizes local resources in three distant locations. Patients in an assisted reproductive technologies cycle are monitored at satellite locations but coordinated through the University of Florida in vitro fertilization team. Oocyte retrieval, laboratory handling of gametes and embryo transfer are performed at the Shands Teaching Hospital in Gainesville. Micromanipulation for severe male factor infertility and oocyte donation are available when needed. Preimplantation diagnosis for genetic conditions is under development. The ongoing pregnancy and delivery rate is 21% per cycle initiated from July 1, 1992, to July 3, 1993, 62% above the reported national pregnancy rate for 1991. This program may be a useful model for the development of collaborative efforts in delivering highly complex medical services to large populations.

Academic Medical Centers↗
PubMed1996

Mimicking the high levels of activity of a large in-vitro fertilization unit leads to early success at the commencement of an in-vitro fertilization and embryo transfer programme.

Infertile couples seeking treatment will endeavour to obtain the highest standards of care at a conveniently located centre. The success rated of a centre would also be an important concern. The busier in-vitro fertilization (IVF) units (> 400 cycles per year) have substantially higher pregnancy rates than those carrying out < 300 cycles per year. We report our experiences at the IVF centre, Maternity Hospital, Kuwait of mimicking the high level of activity of a large IVF unit. Infertile couples were treated in groups of 30-35 every 4-6 weeks. Patients in each group had menstrual cycles synchronized to their luteal phase using progestogens. Thereafter they were down-regulated with gonadotrophin-releasing hormone agonist (long protocol). Oocyte retrieval and embryology activities were concentrated and completed in 7-10 days in each group. This episodic high level of activity was aimed at mimicking that of a busy large IVF centre, although continuous in the latter. The overall results in terms of fertilization cleavage, implantation and clinical pregnancy rates were similar to those obtained in large IVF units. The clinical pregnancy rate per cycle was 25.8-39.1% in IVF and 46.1% in intracytoplasmic sperm injection.

Adult↗
PubMed2005

Correlation of reactive oxygen species levels with the fertilization rate after in vitro fertilization: a qualified meta-analysis.

Our meta-analysis analyzed the relationship between levels of reactive oxygen species (ROS) and fertilization rate after in vitro fertilization (IVF), and showed a statistically significant correlation between the ROS levels and the IVF fertilization rate (estimated overall correlation -0.374 [95% CI, -0.520, -0.205]). We conclude that ROS has a statistically significant effect on the fertilization rate after IVF, and that the measurement of ROS levels in semen specimens before IVF may be useful in predicting the IVF outcome and in counseling patients.

Confidence Intervals↗
PubMed1991

Assessment of the relevance of zona pellucida antibodies in serum and cervical mucus in patients who have fertilization failure during in vitro fertilization.

OBJECTIVE: To assess whether antibodies to the zona pellucida can cause fertilization failure during in vitro fertilization (IVF). DESIGN: Two methods for detecting zona pellucida antibodies were used to assess 20 women undergoing IVF. Nine patients had failed fertilization during the treatment cycle. SETTING: Academic IVF department of a teaching hospital. PATIENTS: Infertile patients previously assessed as requiring IVF. INTERVENTIONS: Gonadotropin-releasing hormone analogue to achieve pituitary down regulation and human menopausal gonadotropin for superovulation. Transvaginal ultrasound directed oocyte recovery. Cervical mucus and serum samples were obtained. MAIN OUTCOME MEASURES: The presence of antizona pellucida antibodies in serum or cervical mucus in relation to fertilization. RESULTS: Seven of 20 patients had antizona antibodies in serum and 7 of 20 patients had antibodies in mucus. Only 1 patient had antibodies in both samples. No correlation between the presence of antibodies in either sample and failure of fertilization was found. CONCLUSION: Detection of antizona pellucida antibodies by the methods described have no role in the prediction of IVF.

Antibodies↗
PubMed1997

The influence of psychological factors on the outcome of the fertilization step of in vitro fertilization.

Our objective was to determine whether psychological factors have an influence on the outcome of the fertilization step of in vitro fertilization (IVF) trials. The design was a prospective cohort study. We studied 48 women and 32 of their spouses. Each subject was assessed psychologically on the day before oocyte retrieval (OR) with the Child Project Questionnaire (CPQ) and the Ways of Coping Checklist. In addition, the State-Trait Anxiety Inventory was filled in by subjects 2 days before OR, and the State form was completed again for 6 additional days. The outcome measure was the success of the fertilization step. Logistic regression analysis was used to test the influence of psychological factors while taking into account the effect of medical and sociodemographic variables. The following variables were found to be statistically significant predictors of fertilization: normal sperm; tubal lesions or occlusion; women's factor II of the CPQ, i.e. Perception of Marital Harmony in the Project to Conceive a Child. We conclude that, even when the influence of biomedical variables is taken into account, the women's Perception of Marital Harmony in the Project to Conceive a Child, is a statistically significant predictor of the success of the fertilization step of IVF.

Adaptation, Psychological↗
PubMed2004

[The applied value of rescue intracytoplasmic sperm injection after complete fertilization failure during in vitro fertilization cycles].

OBJECTIVE: To discuss the applied value of rescue intracytoplasmic sperm injection(ICSI) after complete fertilization failure during in vitro fertilization (IVF) cycles. METHODS: After 16-18 h co-culture with sperm, all the unfertilized oocytes with the first polar body were re-fertilized by ICSI. RESULTS: After rescue ICSI, the abnormal fertilization rate was 17.9% and the normal fertilization rate was 42.7%. Twenty-four hours later, the normal cleavage rate of the normal fertilized oocytes was 79.6%. On the day of embryo transfer, the good-quality rate of embryos was 29.7% (22/74). A mean number of 3.4 (54/16) embryos were transferred to the patient during each cycle. Clinical pregnancy was found in 3 cases out of the 16 (18.8%). CONCLUSION: The applied value of rescue ICSI may be correlated with the number and maturity of oocytes on the retrieval day.

Female↗
PubMed1989

The hemizona assay (HZA): a predictor of human sperm fertilizing potential in in vitro fertilization (IVF) treatment.

The hemizona assay (HZA) was developed to assess human sperm fertilizing potential. This blinded study investigated the relationship between sperm binding to the hemizona and in vitro fertilization (IVF) success (36 patients). Nonliving human oocytes were recovered from excised ovaries and stored. Each zona pellucida was cut into equal hemispheres by micromanipulation. For the HZA, one droplet exposed a hemizona to abnormal spermatozoa, while the control droplet contained the matching hemizona and spermatozoa from normal semen. After 4 hr, the number of tightly bound spermatozoa was counted. Binding to the hemizona was significantly higher for those having IVF success (mean of 36.1 +/- 7, versus 10.4 +/- 4 from the failure group; P less than 0.05). Fewer sperm from the failure group had a strictly normal morphology (3.2 versus 12.7%; P less than 0.05, Kruger method). Tight zona binding was significantly correlated with the percentage motile sperm, percentage normal morphology, and seminal sperm concentration. These results enhanced our confidence that the HZA is diagnostic for identification of patients at high risk of failing to achieve fertilization in vitro.

Female↗
PubMed1998

Reducing the risk of multiple births by transfer of two embryos after in vitro fertilization.

BACKGROUND: In vitro fertilization is associated with a high risk of multiple births, which is a direct consequence of the number of embryos transferred. However, other factors that contribute to the risk are not well defined. METHODS: Using the data base established by the Human Fertilization and Embryology Authority in the United Kingdom, we studied the factors associated with an increased risk of multiple births in 44,236 cycles in 25,240 women. The factors included the woman's age, the cause and duration of infertility, previous attempts at in vitro fertilization, previous live births, number of eggs fertilized, and number of embryos transferred. RESULTS: Older age, tubal infertility, longer duration of infertility, and a higher number of previous attempts at in vitro fertilization were all associated with a significantly decreased chance of a birth and of multiple births. Previous live birth was associated with an increased chance of a birth but not of multiple births. The higher the number of eggs fertilized, the higher the likelihood of a live birth. When more than four eggs were fertilized, there was no increase in the birth rate for women receiving three transferred embryos as compared with those receiving two, but there was a considerable increase in the rate of multiple births when three were transferred (odds ratio, 1.6; 95 percent confidence interval, 1.5 to 1.8). CONCLUSIONS: Among women undergoing in vitro fertilization, the chances of a live birth are related to the number of eggs fertilized, presumably because of the greater selection of embryos for transfer. When more than four eggs are fertilized and available for transfer, the woman's chance of a birth is not diminished by transferring only two embryos. Transferring more embryos increases the risk of multiple births.

Adult↗
PubMed1997

In vitro fertilization and in vitro culture of bovine embryos in the presence of noncytopathic bovine viral diarrhea virus.

In vitro embryo production has been used extensively in research and is now offered as a commercial service, yet the hazards of introducing specific infectious agents into in vitro embryo production systems have not been completely defined. The introduction of noncytopathic bovine viral diarrhea virus (BVDV) is a special concern. One objective of this study was to determine if noncytopathic BVDV-infected uterine tubal cells in IVF and IVC systems affected the rate of cleavage and development. An additional objective was to determine if either degenerated ova or embryos produced in the presence of the infected cells had virus associated with them after washing. Follicular oocytes (n = 645) collected from slaughterhouse ovaries were matured and fertilized in vitro, and presumptive zygotes were cultured for 7 d. Primary cultures of uterine tubal cells for use during IVF and IVC were divided into 2 groups. One-half of the cultures was infected with noncytopathic BVDV while the other half was not exposed to the virus. Approximately equal groups of mature oocytes were inseminated, and the presumptive zygotes were cultured with infected or noninfected uterine tubal cells. After 7 d in IVC, zona pellucida-intact (ZP-I) morulae and blastocysts and degenerated ova were washed and assayed for the presence of infectious virus. Infections of uterine tubal cells were not apparent and did not reduce rates of cleavage and development (P > 0.05; Chi-square test for heterogeneity). After washing, BVDV was isolated at a significantly higher rate from groups of virus-exposed degenerated ova (79%) than from individual virus-exposed morulae and blastocysts (37%; P = 0.0002; Mantel-Haenszel summary, Chi-square).

Journal Article↗
PubMed2005

[Intracytoplasmic sperm injection can improve the fertilization limitation following in vitro fertilization during previous cycles].

OBJECTIVE: To evaluate whether or not intracytoplasmic sperm injection (ICSI) can improve previous fertilization limitation on conventional in vitro fertilization (IVF). METHODS: One hundred and thirty-six completed cycles in 113 patients with ICSI treatment were grouped. Group 1 was 106 cycles perform ICSI because of male factor, and group 2 was other 30 cycles with the history of fertilization failure and fertilization rate < 20% on conventional IVF, also assembling the cycles in group 2 according to the fertilization rate. RESULTS: There was no significant difference between two groups in the rates of normal fertilization(70.49% vs 72.02%), good quality embryos (38.28% vs 38.81%), and clinical pregnancy (40.57% vs 40.00%) (P > 0.05). The fertilization rate of a majority of cycles (70.00%, 21/30) in group 2 was higher than 50%, and the mean of fertilization rates was 79.79%. CONCLUSION: ICSI can improve the fertilization limitation following IVF during previous cycles, and the fertilization rates was similar to those treated ICSI because of male factor.

Female↗
PubMed1989

The influence of transient hyperprolactinemia on hormonal parameters, oocyte recovery, and fertilization rates in in vitro fertilization.

A detrimental effect of transient elevation of plasma prolactin (PRL) during in vitro fertilization (IVF) has not been proven; however, treatment with a dopamine agonist has been suggested. The present study was undertaken to determine if transient, midcycle hyperprolactinemia exerted a deleterious effect on the number of oocytes retrieved or on fertilization of oocytes in vitro. Fifty-three infertile patients with midcycle hyperprolactinemia (PRL greater than 20 micrograms/liter) during ovarian hyperstimulation for IVF were compared with 53 matched controls who remained normoprolactinemic. Mean (+/- SE) serum PRL levels on the day after hCG were significantly higher in the study group (29.5 +/- 1 micrograms/liter) than in the control (13.1 +/- 0.5 microgram/liter) (P less than 0.0005), whereas the mean estradiol (E2) concentrations on the same day were not significantly different (4822 +/- 287 and 4492 +/- 269 pmol/liters, respectively). Fertilization rates (72 +/- 4 and 70 +/- 4%, respectively) and the mean number of oocytes recovered (4.2 +/- 0.3 and 3.7 +/- 0.3, respectively) did not differ between the two groups. No correlation was observed between serum PRL and E2 levels, fertilization rates, or the number of oocytes retrieved in either group. Eleven patients with elevated PRL levels as a result of ovarian hyperstimulation were treated with 2.5 mg bromocriptine daily during the next IVF cycle. Serum PRL levels were significantly lower in the treated (5.6 +/- 1.8 micrograms/liter) than in the untreated cycles (35.6 +/- 3.1 micrograms/liter) (P less than 0.0005), whereas serum E2 concentrations did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)

Bromocriptine↗
PubMed1994

[The rate of polyploid fertilization of ovocytes in in vitro fertilization in patients with an increased ovarian response].

Polyploid fertilization is a common cause of human embryo's early loss in in vivo (1-2%) and in in vitro fertilization (3-5%) as well. Cause of increased rate of polypoid fertilization in in vitro fertilization is multifactorial. The aim of this paper was to establish if high ovarian response to exogenous hormone stimulation of ovaries can be one of the causes of increased incidence of polyploid fertilization. The research included 125 patients from whom 568 ovocytes were obtained by ultrasound aspiratory punction of ovarian follicles. The gathered results point to the fact that exogenous ovarian stimulation and the degree of ovarian response have a significant influence on increase of polyploid fertilization's rate. Thus, in the group of patients from whom 11 or more ovocytes were obtained, the rate of polyploid fertilization amounted to 11.3%, whereas it is statistically significantly higher (p < 0.01) in regard to those in whom less important difference in the rate of polyploid fertilization considering applied schemes of ovulation's stimulation (p > 0.1) was not established nor was it established considering the age of patients (p > 0.05). Despite the fact that the rate of polyploid fertilization in in vitro conditions is higher that in the natural conception, this method of treating marital infertility opens a unique possibility to identify all irregularities considering fertilization and prevent development of such embryos on time as it happens at the very beginning of the preimplantational stage of ovum's fertilization in laboratory conditions.

Adult↗
PubMed1998

Low pregnancy rate is achieved in patients treated with intracytoplasmic sperm injection due to previous low or failed fertilization in in-vitro fertilization.

The main indications for intracytoplasmic sperm injection (ICSI) are severe male factor and fertilization failure or a low fertilization rate in previous in-vitro fertilization (IVF) treatments. The fertilization and pregnancy rates after ICSI, however, are seldom reported separately for these two different indications. The aim of this study was to compare the treatment outcome and pregnancy rate after ICSI between 65 patients with previous failed fertilization or a low fertilization rate without male factor, and 219 patients with a primary male factor. From the 2726 oocytes collected, 2087 (77%) were micro-injected and 1355 (65%) achieved normal fertilization. The oocyte fertilization rate was similar in the group with previous failed fertilization or a low fertilization rate and the group with a male factor (65 and 65% respectively), as was the cleavage rate of normally fertilized oocytes (92 and 94% respectively). Despite the similar fertilization and cleavage rates and the similar number and morphological quality of embryos transferred in both groups, the pregnancy rate was significantly lower (P < 0.05) in the group with previous failed fertilization or a low fertilization rate than in the group with a male factor (19.6 versus 33.5% respectively; 95% confidence intervals for the difference, 2-26%). The implantation rate was also lower (P = 0.01) in patients with previous failed fertilization or a low fertilization rate (9.6%) than in the group with a male factor (19.5%). We conclude that patients with previous failed fertilization or a low fertilization rate in standard IVF without male factor have a significantly smaller chance of becoming pregnant after subsequent ICSI than patients with a primary male factor. This poor outcome probably reflects intrinsic oocyte defects not bypassed by ICSI.

Adult↗
PubMed1996

In vitro fertilization of in vitro matured oocytes obtained from the follicles without hCG exposure for prevention of severe ovarian hyperstimulation syndrome: a case report.

We aspirated ovarian follicles of an infertile patient who encountered a great risk of ovarian hyperstimulation (OHSS) during her ovulation-induction cycle, which had been stimulated with gonadotropins, in order to avoid OHSS without interrupting the treatment. If this action were to yield a considerable number of immature oocytes, some of which were to achieve in vitro maturation and subsequent fertilization, this method could be an alternative to conventional ovulation-induction methods for patients who repeatedly present imminent signs of hyperstimulation. However, the number of oocytes collected from the patient was disappointingly low, even though a large number of follicles were thoroughly aspirated. One of these oocytes was matured in vitro in a medium containing 30% follicular fluid and granulosa cells of mature follicles, fertilized, cryopreserved, and transferred in a later artificial cycle; but pregnancy was not achieved. A low number of recovered oocytes from patients in this situation might be a factor that greatly limits the clinical applications of this method.

Adult↗
PubMed1991

The predictive value of idiopathic failure to fertilize on the first in vitro fertilization attempt.

OBJECTIVE: To investigate the subsequent performance of patients with idiopathic fertilization failure on the first in vitro fertilization (IVF) cycle. DESIGN: A retrospective study of 2,322 consecutive patients undergoing their initial IVF cycle. SETTING: Advanced infertility treatment in an IVF/general infertility clinic. PATIENTS: In 5 years, 94 couples with unexplained failed oocyte fertilization had 270 cycles of treatment. Each couple's performance was tracked through subsequent cycles of treatment. INTERVENTIONS: In vitro fertilization with husband and donor sperm. MAIN OUTCOME MEASURE(S): Investigated retrospectively after 5 years of data collection. RESULTS: Sixty-five couples of the original 94 had a second IVF attempt. Fifty of these successfully fertilized oocytes with husband's sperm and 4 with donor sperm. Nineteen of the 65 couples who continued treatment achieved a pregnancy, and only one couple had continuing fertilization failure. CONCLUSIONS: The prognosis in the study group was surprisingly favorable despite the initial failed IVF treatment cycle.

Adult↗