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PubMed1991

Assisted reproductive technology.

Several aspects of reproductive technology are discussed. In tubal infertility, the choice between surgery or in vitro fertilization and embryo transfer (IVF-ET) is addressed. In cases with bilateral distal occlusion or otherwise bad prognosis, IVF is probably more successful and less expensive. IVF in unstimulated cycles has given promising results, with pregnancy rates comparable to the results from the National IVF-ET Registry. If these results can be confirmed by more studies they will probably have a great impact on the choice of treatment in tubal infertility. The results obtained with various transfer procedures in nontubal infertility have still to prove tubal transfer to be a more effective procedure than IVF. Finally, studies on microinsemination in male infertility or unexplained infertility with previous fertilization failure in IVF show promising results with the subzonal insemination and partial zona dissection procedures.

Embryo Transfer↗
PubMed1990

[Preovulatory human oocyte and its hormonal microenvironment in stimulated cycles].

The hormonal microenvironment of 213 follicles in 44 stimulated cycles was analysed. Mature and intermediate oocytes were found to be associated with larger follicles which contained significantly higher levels of E2, P, FSH and LH, while smaller follicles containing significantly higher T level usually gave rise to immature oocytes. The fertilization rate was higher in mature and intermediate oocytes than in immature oocytes. In this study there was no significant difference in the cleavage rate of the fertilized eggs in relation to the E2, P, T, FSH and LH concentrations in follicular fluid as well as to the contents of these hormones per follicle.

Adult↗
PubMed1989

[Treatment of endometriosis associated infertility].

During the last 13 years, 2,080 infertile patients were subjected to diagnostic laparoscopy. The mean age was 32.3 and their mean infertility period was 6.0 years. Of these, 1,263(60.7%) patients were diagnosed to have endometriosis: 587(46.5%) were stage I (R-AFS), 348(27.6%) were stage II, 184(14.6%) were stage III and 144(11.4%) were stage IV. The age and the infertility period were almost the same among the stage of the disease. The overall pregnancy rate was 34.6%, after minimum 2 month follow up. The presence of endometriosis did not affect the prognosis of infertility: 34.2% pregnancy rate for patients with endometriosis, and 35.3% for those without endometriosis. There was an inverse relationship between the stage of the disease and the subsequent pregnancy rate: 37.8% for stage I, 34.8% for stage II, 32.1% for stage III and 20.8% for stage IV. But statistical significant difference was observed only between stage I and II, and stage IV. To elucidate the mechanism of endometriosis associated infertility, peritoneal fluid volume, intratubal sperm transport (peritoneal sperm recovery test), and phagocytosis of sperm in the tube and in the peritoneal fluid were examined in more than 1,000 cases. However, no positive relationship was found between the disease and these parameters. Fimbrial microbiopsy also revealed that endometriosis did not affect the ciliation index of the fimbria, nor changed the fine surface structure. Patients with minimal-mild disease were first managed expectantly for one year after laparoscopy: The pregnancy rate was 36.1% for stage I, and 29.7% for stage II. Ninety-eight patients who failed to conceive by expectant management were put on danazol therapy (600 mg/day, for 6 months). However, the results were very disappointing. Of 44 patients with stage I disease, only 3(6.8%) achieved a pregnancy, and none of 54 stage II patients conceived so far. Moreover, second-look laparoscopy revealed that danazol had no effect on the eradication of minimal-mild endometriosis. The patients with stage I-II disease were then treated exclusively by electrocautery at the time of initial laparoscopy: The pregnancy rate was 30.8% (57/185) for stage I, and 23.8% (25/105) for stage II. At second-look laparoscopy, 45.5% (10/22) of stage I and 73.7% (14/19) of stage II were disease free or improved, although the pregnancy rate was not so good as expected.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

[Biological process in patients having been impregnated through GIFT or IVF-ET. Clinical experience].

There were analyzed in a retrospective way the results of pre-retrieval hormonal levels as well as the number of retrieved oocytes, mature oocytes and transferred embryos in three groups of patients (2 GIFT, 1 IVF-ET) which achieved a pregnancy, and were matched with groups with no pregnancy. There were no statistically significant differences in most of the analyzed parameters, by the aforementioned we can suppose that pregnancy depends of endometrial quality and in this moment we are not able to modify it satisfactorily.

Adult↗
PubMed1993

[Assisted reproduction. Alternatives].

From the first publications about fertilization in vitro (FIVTE) Patrick Steptoe and Robert Edwards, added several knowledges and new concepts in modern Gynecology, so starting a new era of Reproductive Medicine, so ideating a series of programs and methodologies to emulate the physiological ovarian cycle; with this concept Ricardo Asch carries the transference of gametes to tubes and calling this procedure GIFT. These methodologies with a high technology have been called Assisted Reproduction, which is reviewed in this paper.

Embryo Transfer↗
PubMed1990

Transfallopian tube embryo transfer: successful pregnancy outcome.

A case of partial Asherman syndrome and blocked fallopian tube following complication of cesarean section is presented. Two IVF-ET attempts failed where difficulty at uterine embryo transfer was encountered. Transtubal embryos transferred 48 hr after transvaginal oocyte collection and in vitro fertilization resulted in an in utero pregnancy and delivery.

Adult↗
PubMed1992

Effect of the number and depth of embryos transferred and unilateral or bilateral transfer in tubal embryo transfer (TET).

PURPOSE: Our purpose was to evaluate the possible effects of the number of embryos transferred, the depth of embryos placed within the tube(s), and unilateral or bilateral tubal transfer on pregnancy initiation in tubal embryo transfer (TET). METHODS: One hundred eight consecutive TET cycles were analyzed. Oocyte retrievals were carried out by transvaginal ultrasound-guided aspiration of follicles. Forty-eight hours after oocyte retrieval, the developing embryos at the stage of two to four cells were transferred into the fallopian tube(s) by laparoscopy. A maximum of four embryos was transferred to each patient. RESULTS: The pregnancy rates were similar among the cycles in which two, three, or four embryos were transferred. In addition, there was no significant difference in the pregnancy rate whether the embryos were deposited > 4 cm or between 3 and 4 cm into the tube(s). Although the pregnancy rate was greater in cycles of bilateral tubal transfer, the difference from that of unilateral transfers was not significant. CONCLUSION: Our data indicate that when two to four embryos were transferred and the embryos were placed > or = 3 cm within the tube(s), unilateral or bilateral tubal transfer had little influence on the ultimate success of TET.

Embryo Transfer↗
PubMed1996

Effect of a programmed short-term stimulation protocol on the replacement of cryopreserved embryos.

PURPOSE: Through problems in the management of embryo thawings and transfers, we investigated in a comparative study the use of the natural cycle and of a programmed short-term stimulation protocol as preparation method for the replacement of cryopreserved embryos. To date, 117 embryos have been thawed, and 60 (51%) survived with > or = 50% intact blastomeres. METHODS: In 31 cases, replacement of the frozen-thawed embryos was planned in the natural cycle (group A) and in nine cases in the stimulated cycle (group B). In group A, 16 replacements could be performed (cancellation rate 48%). Six transfers took place on weekends (37%). Two clinical pregnancies could be established (13% per replacement). In group B, there were no canceled cycles (p < 0.025). All thawings and transfers could be conducted between Monday and Friday. In one case, the single one frozen embryo was degenerated after thawing. RESULTS: Thus, eight replacements could be performed which resulted in three clinical pregnancies (38% per replacement, n.s.) and one biochemical pregnancy. CONCLUSIONS: Based on our results, we conclude that a programmed short-term protocol not only provides viable embryos with a good cryopreservation potential, but it is also a reliable preparation method for the replacement of frozen-thawed embryos.

Adult↗
PubMed1992

Nonhysteroscopic falloposcopy: a proposed method for visual guidance and verification of tubal cannula placement for endotuboplasty, gamete and embryo transfer procedures.

A simplified method for visualization of the uterotubal ostium using a nonhysteroscopic falloposcopic technique has been described. This transvaginal microendoscopic technique is proposed as a realistic method for the visual monitoring of tubal cannula placement for facilitating endotuboplasty, gamete and embryo transfer procedures.

Adult↗
PubMed1992

Health policy dilemmas related to high technology infertility services.

As cost containment in health care becomes an important concern, the costs and benefits of specific health care services will be more closely examined. The costs and benefits of one type of health care, high technology infertility services, are explored in this paper. These services may be particularly susceptible to cost containment since they are costly, raise ethical issues, and because they currently are provided to healthy individuals not experiencing life-threatening illness who can afford them.

Adult↗
PubMed1990

Current trends in human IVF and other assisted reproductive technologies.

The new reproductive technologies such as IVF, GIFT, ZIFT, and micromanipulation have had a profound influence on the therapeutic and diagnostic management of infertility, and in turn have resulted in better understanding of human fertilization and embryo development. While the clinical pregnancy rates in GIFT and ZIFT procedures are comparable to the natural fecundity in the population at large, pregnancy rates in IVF have been generally lower. Further investigations should be directed to improve the implantation rates, and to develop better controlled methods of multiple follicle development. Although more studies are needed, a recent report of potential utilization of nonstimulated oocytes for donor programs as well as IVF-cryopreservation was a promising new development (Cha et al. 1989). Other exciting prospects on the horizon are the possibilities of gene transfer for the treatment of certain genetic diseases and diagnostic applications of embryonal biopsy. These new technologies have also generated serious ethical and legal issues. Any ethical or legal guidelines affecting new reproductive technologies should be developed to protect all participants only when the need for regulation is clear. Ethical guidelines and appropriate legislations with contributions from the medical and scientific community are gradually being established worldwide.

Cryopreservation↗