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Elevated day 3 serum follicle stimulating hormone and/or estradiol may predict fetal aneuploidy.

OBJECTIVE: To determine whether baseline serum FSH and/or E2 concentrations can predict the risk for fetal chromosomal abnormalities. DESIGN: Case control study. SETTING: Reproductive technology program at a university hospital. PATIENT(S): Patients who underwent dilation and curettage (D + C), and whose products of conception were karyotyped. INTERVENTION(S): Patients underwent natural conception or controlled ovarian hyperstimulation followed by intrauterine insemination, in vitro fertilization and embryo transfer, gamete intrafallopian transfer, or zygote intrafallopian transfer. MAIN OUTCOME MEASURE(S): Baseline serum FSH and E2 concentrations and fetal karyotype. RESULT(S): Genetic evaluation of 78 D + C specimens revealed 34 normal and 44 abnormal fetal karyotypes. A significantly greater proportion of women with abnormal fetal karyotype had elevated baseline serum FSH (> or =15 mIU/mL [RIA] or 10 mIU/mL [Immulite]) and/or E2 > or = 50 pg/mL [Immulite]) compared with women of normal fetal karyotype. Among karyotypically abnormal abortuses, autosomal trisomy was the most common abnormality noted (79.5%), followed by mosaicism (6.8%), triploidy (6.8%), monosomy XO (4.5%), and balanced translocation (2.3%). CONCLUSION(S): Baseline serum FSH and/or E2 concentrations may be valuable as predictors of fetal aneuploidy.

Abortion, Missed↗

Detection and measurement of thyroid stimulating hormone in human follicular fluid.

The objectives were to measure thyroid stimulating hormone (TSH) levels in human follicular fluid (FF) and compare them with serum levels. Serum and FF samples were obtained from women (n = 41) undergoing in vitro fertilization/embryo transfer, gamete intrafallopian transfer and zygote intrafallopian transfer. Ovulation induction was achieved using human menopausal gonadotropins and human chorionic gonadotropin (hCG) after pituitary suppression with a gonadotropin releasing hormone agonist. Blood samples obtained on the day of hCG injections were assayed for TSH. Follicular fluids were obtained at the time of oocyte retrieval (approximately 34 hours after hCG injection). Serum and FF TSH levels were measured using an enzyme immunoassay. The correlation between serum and FF TSH levels was determined. Comparison between mean serum and FF levels was done using Student's t test after logarithmic transformation of the data. Levels of TSH in FF (1.71 +/- 0.14 microIU/mL, mean +/- SEM) were not different (P > .05) from levels in serum (1.43 +/- 0.10). Serum and FF levels correlated positively (r = .7). TSH appears to be present in human FF, and the levels in FF are similar to those in serum.

Female↗

Comparison of zygote intrafallopian tube transfer and transcervical uterine embryo transfer in patients with repeated implantation failure.

OBJECTIVE: This study was designed to evaluate the role of zygote intrafallopian transfer (ZIFT) procedure in patients with repeated failure of implantation. STUDY DESIGN: A total of 141 ZIFT cycles of 132 women and 145 embryo transfer (ET) cycles of 97 women in whom five or more embryos were transferred were included in this study. Transcervical uterine embryo transfer and ZIFT cycle outcome in patients with five or more previous implantation failure were compared. Embryos were transferred by laparoscopy into the fallopian tube 24-27 h following oocytes retrieval in the ZIFT group. In the ET group, embryos were transferred transcervically on the third day following oocytes retrieval. RESULTS: The mean age was 34+/-4.9 and 34.9+/-5.0 years in ZIFT and ET group, respectively. No difference was determined between the two groups regarding the basal FSH, E2 value on the day of HCG injection and the number of oocytes retrieved or fertilized. The implantation rate was 6.5% versus 7.2%, clinical pregnancy rate was 22.7% versus 24.8% and live birth rate was 21.2% versus 16.5% in ZIFT and ET groups, respectively. CONCLUSIONS: Implementation of ZIFT procedure in patients with repeated implantation failure is not superior to transcervical uterine embryo transfer.

Adult↗

Surgical techniques of oocyte collection and embryo transfer.

In the decade since the birth of the first child conceived as a result of in vitro fertilization and embryo transfer much has been achieved in the field of assisted conception. Although in vitro fertilization (IVF) was successful first for the treatment of tubal disease, the indications for its use have now widened to include unexplained infertility, oligozoospermia, endometriosis and infertility due to immunological disorders. Gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT) are now used commonly for the treatment of couples where the woman has patent fallopian tubes. The huge increase in the demand for therapy using these techniques of assisted conception places considerable strain on the finances available for health care, and has led some to question the wisdom of such use of limited resources. To reduce the cost of treatment, and because repeated IVF-ET attempts may be necessary before achieving pregnancy, the initial laparoscopic approach for oocyte recovery has been largely replaced by ultrasound-guided techniques. Non-surgical embryo transfer techniques have changed little since originally described. However, where the tubes are patent, one-cell zygotes or cleavage stage embryos may be transferred into the fallopian tube (ZIFT and tubal embryo stage transfer respectively). On the other hand if the tubes are blocked, surgical embryo transfer (SET) may be performed. Most recently, some success has been achieved following the transfer of embryos into the fallopian tube by the technique of retrograde fallopian tube catheterisation.

Biopsy, Needle↗

Outcome and complications of assisted reproduction.

This review discusses studies documenting an increase in birth rate associated with in vitro fertilization and gamete intrafallopian transfer. The results of zygote intrafallopian transfer are also encouraging. The rates of chromosomal and congenital abnormalities in assisted reproduction are similar to the rates at which these problems occur in normal pregnancies. Multiple pregnancy is the main determinant of outcome. Singleton pregnancies have higher rates of pregnancy complications. Factors affecting outcome of assisted reproduction include age of the mother, level of basal follicle-stimulating hormone, the number of embryos or gametes transferred, response to ovarian stimulation, and the quality of gametes and eventually of the embryo. Complications of these procedures relate to the technique used. Recent reports have highlighted the effects of multiple gestation in terms of perinatal morbidity, the effect on the family, and the demand for neonatal resources, as well as ethical issues surrounding selective reduction. The use of gonadotropin-releasing hormone agonist has led to an increase in the incidence of severe ovarian hyperstimulation. Other reports document the incidence of ectopic pregnancy in in vitro fertilization with embryo transfer.

Birth Rate↗

Assisted reproductive technology in the United States and Canada: 1995 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States and Canada in 1995. DESIGN: Data were collected in the Society for Assisted Reproductive Technology database program and cycle reporting forms and were submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Two hundred eighty-one programs submitted data on procedures performed in 1995. Data were collected after November 1996 so that outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Procedural outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, and congenital abnormality. RESULT(S): Programs reported initiating 59,142 cycles of ART treatment, including frozen embryo and donor oocyte cycles. Of these, 41,087 cycles initiated were IVF (with and without micromanipulation) with 22.5% deliveries per retrieval; 3,741 were cycles of gamete intrafallopian transfer with 27.0% deliveries per retrieval; 1,078 were cycles of zygote intrafallopian transfer with 27.9% deliveries per retrieval. In addition to these cycles initiated in 1995, 8,453 frozen embryo thaw procedures were reported, either as separate procedures or in combination with other ART procedures with 15.2% deliveries per transfer, 3,555 donor oocyte cycles were initiated with an overall success of 36.0% deliveries per transfer, 1,028 cryopreserved embryo thaw procedures from donated oocyte procedures with an overall success of 16.8% deliveries per transfer, and 200 ART treatment cycles in which a host uterus was used were initiated with an overall success of 34.9% deliveries per ET. As a result of all procedures, a total of 11,631 deliveries were reported, resulting in 16,520 neonates. CONCLUSION(S): In 1995, there were more programs reporting ART treatment and a significant (19.3%) increase in reported cycles. In comparable cycle types, overall average success rates (deliveries per transfer) exhibited a 0.6% increase or a 2.5% increase over the rates in the 1994 reported summaries.

Adult↗

Assisted reproductive technology in the United States: 2000 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of ART initiated in the United States in 2000. DESIGN: Data were collected electronically using the SART Clinical Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/ Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Three hundred eighty-three programs submitted data on procedures performed in 2000. Data were collated after November 2000 so that the outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. RESULT(S): Programs reported initiating 99,989 cycles of ART treatment. Of these, 73,406 cycles involved fresh nondonor IVF (46.6% with intracytoplasmic sperm injection [ICSI]), with a delivery rate per retrieval of 29.9%; 549 were cycles of gamete intrafallopian transfer, with a delivery rate per retrieval of 24.7%; 763 were cycles of zygote intrafallopian transfer, with a delivery rate per retrieval of 29.9%. The following additional ART procedures were also initiated: 7,581 fresh donor oocyte cycles, with a delivery rate per transfer of 43.7%; 13,083 frozen embryo transfer procedures, with a delivery rate per transfer of 20.4%; 2,721 frozen embryo transfers using donated oocytes or embryos, with a delivery rate per transfer of 23.5%, and 1,200 cycles using a host uterus, with a delivery rate per transfer of 35.8%. In addition, 326 cycles were reported as combinations of more than one treatment type, 41 cycles as research, and 319 as embryo banking. As a result of all procedures, 25,394 deliveries were reported, resulting in 35,345 neonates, of which 35,031 were live born and 314 stillborn. CONCLUSION(S): In 2000, there were more programs reporting ART treatment and a significant (13.5%) increase in reported cycles compared to 1999. In comparable cycle types, overall success rate (deliveries per retrieval) exhibited an actual increase of 0.6%, which represents an increase of 2.2% when compared to the success rate for 1999.

Embryo Transfer↗

Assisted reproductive technology in the United States: 1999 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of ART initiated in the United States in 1999. DESIGN: Data were collected electronically by using the SART Clinical Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Three hundred sixty programs submitted data on procedures performed in 1999. Data were collated after November 2000 so that the outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. RESULT(S): Programs reported initiating 88,077 cycles of ART treatment. Of these, 63,639 cycles involved IVF (with and without micromanipulation), with a delivery rate per retrieval of 29.4%; 838 were cycles of gamete intrafallopian transfer, with a delivery rate per retrieval of 27.9%; 945 were cycles of zygote intrafallopian transfer, with a delivery rate per retrieval of 29.8%. The following additional ART procedures were also initiated: 6,509 fresh donor oocyte cycles, with a delivery rate per transfer of 41.8%; 12,005 frozen embryo transfer procedures, with a delivery rate per transfer of 18.6%; 2,488 frozen embryo transfers using donated oocytes or embryos, with a delivery rate per transfer of 23.6%, and 821 cycles using a host uterus, with a delivery rate per transfer of 33.6%. In addition, 398 cycles were reported as combinations of more than one treatment type, 18 cycles as research, and 416 as embryo banking. As a result of all procedures, 21,904 deliveries were reported, resulting in 30,967 neonates. CONCLUSION(S): In 1999, more programs reported ART treatment and reported cycles increased significantly (7.5%) compared to 1998. In comparable cycle types, the overall success rate (deliveries per retrieval) increased by 0.4%, which represents an increase of 1.2% compared to the success rate for 1998.

Adult↗

Pregnancy in women with premature ovarian failure using tubal and intrauterine transfer of cryopreserved zygotes.

Twenty-nine women, mean age 36.3 (SD 5.5) years, with premature ovarian failure received donated ova on an ovum donation programme. Three had Turner's syndrome, four a surgical menopause, one a chemotherapy-induced menopause and 21 had idiopathic premature ovarian failure. All donated oocytes were fertilized with frozen-thawed spermatozoa from the recipient's partner, and the resulting zygotes were frozen until transfer had been arranged. Overall, 19 women had intrauterine embryo transfer (ET) and a mean of 2.7 (SD 0.9) embryos were transferred on 20 occasions; 10 women underwent zygote intrafallopian transfer (ZIFT) and a mean of 3.5 (SD 0.5) zygotes were transferred on 10 occasions. Both groups were matched for age. The pregnancy rate per transfer was 20% in the ET group and 40% in the ZIFT group. After excluding the 10 women in the ET group who had fewer than three embryos transferred, the pregnancy rates were similar in the two groups, 30% in the ET group and 40% in the ZIFT group. Cryopreserved embryos may be used for ovum donation to preserve anonymity and still show a high pregnancy rate of at least 30% per transfer.

Adult↗

GIFT, ZIFT, and related techniques.

This review focuses on the theoretical backgrounds for tubal gamete and zygote/embryo transfer, as well as the clinical results of gamete intrafallopian transfer (GIFT), which are compared with other non-fertilization procedures in infertile women with patent fallopian tubes. While GIFT and zygote intrafallopian transfer (ZIFT) probably result in a more synchronized entry of embryos into the uterine cavity, prospective, randomized studies have not shown these methods to be preferable to conventional in-vitro fertilization and embryo transfer. Nevertheless, co-culture with various cell types seems to yield more viable embryos with a high rate of implantation. The promising results with co-culture do not seem to be a cell- or species-specific phenomenon. This non-specific positive or negative conditioning effect of co-culture on embryo quality indicates that more optimal culture media for in-vitro fertilization can probably be devised. The requirements of laparoscopy and general anesthesia with GIFT have prompted the development of simpler methods based on fertilization in vivo. Various methods of artificial insemination combined with controlled ovarian hyperstimulation yield comparable results with GIFT in unexplained infertility. In endometriosis, GIFT seems to give better results compared with insemination techniques. Less invasive transcervical gamete and embryo transfer techniques have now been established, obviating the need for operating theater facilities.

Anesthesia, General↗

In vitro fertilization-embryo transfer (IVF-ET) in the United States: 1990 results from the IVF-ET Registry. Medical Research International. Society for Assisted Reproductive Technology (SART), The American Fertility Society.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States in 1990. DESIGN: The registry follows a prospective study format. PARTICIPANTS: One hundred eighty clinics submitted data on their ART treatments to the In Vitro Fertilization (IVF) Registry. MAIN OUTCOME MEASURES: The outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, chromosomal abnormalities, and congenital defects. RESULTS: During 1990, the clinics reported performing 25,744 ovarian stimulation cycles. From all ART treatments there were 5,150 clinical pregnancies and 3,951 live deliveries. The overall live delivery rates were 14% for IVF (based on 16,405 retrievals), 22% for gamete intrafallopian transfer (based on 3,750 retrievals), and 16% for zygote intrafallopian transfer and related practices (based on 1,370 retrievals). The delivery rates for frozen embryo transfer cycles and IVF with donor egg cycles were 9% and 22%, respectively. CONCLUSIONS: The 1990 results indicate an increase in the use of gonadotropin-releasing hormone analogs and an increase in the number of embryos being transferred per cycle, along with no important changes in clinical pregnancy and delivery rates. In addition, there was an increase in both numbers of frozen embryo transfers and IVF cycles with donor oocytes.

Abortion, Spontaneous↗

Assisted reproductive technology in the United States and Canada: 1991 results from the Society for Assisted Reproductive Technology generated from the American Fertility Society Registry.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States in 1991. DESIGN: Data were collected on an annual summary form and submitted to the Society for Assisted Reproductive Technology generated from The American Fertility Society central registry. PARTICIPANTS: Two hundred fifteen programs submitted data on procedures performed in 1991. Data were collected in October of 1992 so that outcome of all pregnancies established would be known. MAIN OUTCOME MEASURES: The outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, and congenital abnormality. RESULTS: In 1991, programs reported initiation of 33,001 cycles of ART treatment, excluding frozen embryo and donor oocyte cycles. Of these, 24,671 cycles initiated were IVF with 15.2% deliveries per retrieval, 5,452 were cycles of GIFT with 26.6% deliveries per retrieval, and 2,104 were cycles of zygote intrafallopian transfer with 19.7% deliveries per retrieval, and 714 were combination cycles, combining IVF and one of the tubal transfer techniques, resulting in 19.3% deliveries per retrieval. In addition to these cycles initiated in 1991, 4,838 frozen embryo procedures were reported, either as separate procedures or in combination with another ART procedure with 11.1% deliveries per procedure, and 1,107 donor oocyte or surrogacy cycles were initiated with an overall success of 25.6% deliveries per retrieval. From all of these procedures, a total of 5,699 deliveries were reported. CONCLUSIONS: In 1991, there were more programs offering more treatment cycles of ART. Average success rates for most ART procedures exhibited a small increase compared with previously reported summaries.

Adult↗

Assisted reproductive technology in the United States and Canada: 1992 results generated from the American Fertility Society/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States in 1992. DESIGN: Data were collected on an annual summary form and submitted to The American Fertility Society/Society for Assisted Reproductive Technology Registry. PARTICIPANTS: Two hundred forty-nine programs submitted data on procedures performed in 1992. Data were collected in October 1993 so that outcome of all pregnancies established would be known. MAIN OUTCOME MEASURES: The outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, and congenital abnormality. RESULTS: Programs reported initiations of 37,955 cycles of ART treatment, excluding frozen embryo and donor oocyte cycles. Of these, 29,404 cycles initiated were IVF with 16.8% deliveries per retrieval, 5,767 were cycles of GIFT with 26.3% deliveries per retrieval, 1,993 cycles of zygote intrafallopian transfer with 22.8% deliveries per retrieval, and 791 were combination cycles, combining IVF and one of the tubal transfer techniques, resulting in 27.9% deliveries per retrieval. In addition to these cycles initiated in 1992, 5,814 frozen ET procedures were reported, either as separate procedures or in combination with another ART procedure, with 13.9% deliveries per procedure, and 2,032 donor oocyte or surrogacy cycles were initiated with an overall success of 31.3% deliveries per retrieval. As a result of all procedures, a total of 7,355 deliveries were reported. CONCLUSIONS: In 1992, there were more programs offering more treatment cycles of ART. Average success rates exhibited only a small increase compared with previously reported summaries.

Adult↗

Sonographic uterine predictors of pregnancy in women undergoing ovulation induction for assisted reproductive treatments.

OBJECTIVE: To determine preovulatory uterine sonographic predictors of pregnancy in women undergoing ovulation induction for assisted reproductive treatments. DESIGN: Prospective evaluation of uterine sonographic and vascular flow profiles in women stimulated with leuprolide acetate and hMG. SETTING: Private fertility center and tertiary-care academic center. PATIENTS: Ninety-six women underwent 102 cycles of ovulation induction for IVF (46), GIFT (20), and zygote intrafallopian transfer (36). MAIN OUTCOME MEASURES: Endometrial texture, thickness, resistance index at the first branch of uterine artery, diastolic blood flow, and pregnancy outcome (no conception, spontaneous abortion, and delivery). RESULTS: Triple-lined pattern was predominant in women who delivered liveborn infants (P < 0.005). Endometrial pattern and diastolic blood flow were the only predictive markers of term pregnancy (P < 0.001 and P < 0.05, respectively). CONCLUSION: Preovulatory triple-lined sonographic endometrial texture and the presence of end diastole blood velocities at the first branch of uterine artery are the most important uterine predictors of conception.

Adult↗

Assisted reproductive technology in the United States: 1996 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States in 1996. DESIGN: Data were collected electronically using the Society for Assisted Reproductive Technology Clinical Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Three hundred programs submitted data on procedures performed in 1996. Data were collected after November 1997 so that the outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Procedural outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, and congenital abnormality. RESULT(S): Programs reported initiating 65,863 cycles of ART treatment, including frozen embryo and donor oocyte cycles. Of these. 44,647 cycles initiated were in vitro fertilization (IVF) (with and without micromanipulation) with 26.0% deliveries per retrieval; 2,879 were cycles of gamete intrafallopian transfer (GIFT) with 29.0% deliveries per retrieval; 1,200 were cycles of zygote intrafallopian transfer (ZIFT) with 30.9% deliveries per retrieval. In addition to these cycles initiated in 1996, 9,610 frozen embryo transfer procedures were initiated with 16.8% deliveries per transfer, 3,768 donor oocyte cycles were initiated with an overall success of 39.1% deliveries per transfer, 1,096 cryopreserved embryo transfers from donated oocytes procedures with an overall success of 20.8% deliveries per transfer, and 688 ART treatment cycles using a host uterus were initiated with an overall success of 31.3% deliveries per embryo transfer. Also, 1,341 cycles were reported as combinations of more than one treatment type, 19 cycles as research, 311 as embryo banking, and 304 as other (unclassified) cycle types. As a result of all procedures, a total of 14,702 deliveries were reported resulting in 21,196 neonates. CONCLUSION(S): In 1996, there were more programs reporting ART treatment and a significant (11.3%) increase in reported cycles. In comparable cycle types, overall average success rates (deliveries per retrieval) exhibited an actual increase of 3.5% (this is an increase of 15.8% when compared to the success rate for 1995).

Female↗

Successful pregnancy after ZIFT in a patient with congenital cervical atresia.

We report the third patient with a successful pregnancy following operative correction of congenital cervical atresia. The pregnancy was achieved through zygote intrafallopian transfer (ZIFT). Although stenosis of the newly formed cervical canal causes considerable morbidity, therapy should be aimed at the creation of a conduit for menstrual blood and for possible future pregnancy. New techniques in assisted reproduction such as in vitro fertilization-embryo transfer, gamete intrafallopian transfer, and ZIFT increase the chances of pregnancy in patients with congenital cervical atresia. A hysterectomy, as advocated until very recently, should not, in our opinion, be the first treatment of choice.

Adolescent↗

Selective early elimination of luteal support in assisted reproduction cycles using a gonadotropin-releasing hormone agonist during ovarian stimulation.

OBJECTIVE: To determine if women undergoing GnRH agonist-hMG stimulated IVF cycles can undergo successful discontinuation of luteal phase support. DESIGN: A protocol for selective discontinuation of luteal phase support was evaluated prospectively in women undergoing assisted reproduction cycles. SETTING: A tertiary care institutional-based assisted reproduction program. PATIENT(S): One hundred eighty-eight women who conceived after an IVF or zygote intrafallopian transfer cycle including a GnRH agonist between January 1994 and June 1997. INTERVENTION(S): Women with serum progesterone levels of > or = 60 ng/mL at 4 weeks' gestation were selected for discontinuation of their luteal phase support. MAIN OUTCOME MEASURE(S): Delivery rate. RESULT(S): Sixty-three women (62.4%) met the criteria for discontinuation of luteal phase support. There were no differences in the mean age, peak E2 levels, number of follicles, number of embryos transferred, or delivery rates (85.7% versus 78.9%) between the women who did and those who did not have discontinuation of their progesterone supplementation. CONCLUSION(S): These data reveal that luteal phase support can be discontinued successfully for selective women undergoing IVF who are receiving a GnRH agonist.

Adult↗

Assisted reproductive technology in the United States: 1998 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of ART initiated in the United States in 1998. DESIGN: Data were collected electronically by using the SART Clinical Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Three hundred and sixty programs submitted data on procedures performed in 1998. Data were collated after November 1999 so that the outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. RESULTS: Programs reported initiating 81,899 cycles of ART treatment. Of these, 58,937 cycles involved IVF (with and without micromanipulation), with a delivery rate per retrieval of 29.1%; 1,293 were cycles of gamete intrafallopian transfer, with a delivery rate per retrieval of 27.4%; 1,054 were cycles of zygote intrafallopian transfer with a delivery rate per retrieval of 29.6%. The following additional ART procedures were also initiated: 5,273 fresh donor oocyte cycles, with a delivery rate per transfer of 41.2%; 11,228 frozen embryo transfer procedures, with a delivery rate per transfer of 19.3%; 1,913 frozen embryo transfers using donated oocytes or embryos, with a delivery rate per transfer of 23.5%, and 809 cycles using a host uterus, with a delivery rate per transfer of 31.6%. In addition, 969 cycles were reported as combinations or more than one treatment type, 25 cycles as research, and 398 as embryo banking. As a result of all procedures, 20,241 deliveries were reported, resulting in 29,128 neonates. CONCLUSIONS: In 1998, there were more programs reporting ART treatment and a significant (12.1%) increase in reported cycles compared with 1997. In comparable cycle types, the actual increase in overall success rate (deliveries per retrieval) was 1.4%, which represents an increase of 4.7% compared with the success rate in 1997.

Adult↗