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Subendometrial contractility is not predictive for in vitro fertilization (IVF) outcome.

OBJECTIVES: The aim of the study was to investigate whether endometrial thickness, endometrial pattern, endometrial movement and serum estradiol and progesterone affect the outcome of in vitro fertilization. METHODS: Prospectively collected data of endometrial thickness, endometrial pattern and subendometrial activity were analyzed in 122 consecutive in vitro fertilization cycles. All measurements were made on the day of hCG administration (day -2), day of embryo transfer (day +2), day +6 and day +12. RESULTS: It would appear that pregnant women tend to have a thicker endometrium on day +12 than non-pregnant women. There appears to be no appreciable difference between pregnant and non-pregnant women in endometrial movement and thickness, nor in serum estradiol and progesterone on day +2 and day +6. In combining three echographic variables (thickness, pattern and movement) and hormone level (estradiol and progesterone), only progesterone on day +12 could be used to predict the outcome. CONCLUSIONS: Subendometrial contractility plays no important role in implantation on the day of embryo transfer or 4 days later.

Adult↗

Human pregnancy by in vitro fertilization (IVF) using sperm aspirated from the epididymis.

Spermatozoa were collected by microaspiration from the corpus epididymidis of a 42-year-old man with secondary obstructive azoospermia and used for in vitro fertilization. At insemination 61% of the spermatozoa were motile, with a motility index of 157. One of five eggs was fertilized and this was subsequently transferred to the patient's wife at the two-cell stage. Ultrasound examination and changing hormone levels confirmed an on-going pregnancy, which is currently at 30 weeks of gestation. This technique will provide a useful alternative for the management of some infertile men with obstructive azoospermia.

Adult↗

[Pregnancy and delivery after in vitro fertilization (IVF) of human ova via intracytoplasmatic sperm injection (ICSI) of testicular sperm (TESE)].

This is a report on a pregnancy achieved by in-vitro fertilisation (IVF) with intracytoplasmatic sperm injection (ICSI) after testicular sperm extraction (TESE). Because of a bilateral absence of the ductus deferens, microsurgical epididymal sperm aspiration (MESA) was not possible. This anatomic situation was probably caused by a bilateral herniotom during childhood. The wife became pregnant in the first treatment cycle and meanwhile gave birth to a healthy boy. This case report demonstrates that the ICSI procedure is successful even with testicular spermia and extremely low sperm counts.

Adult↗

Transient hyperprolactinemia has no effect on endocrine response and outcome in in vitro fertilization (IVF).

Transient rises in plasma prolactin levels can be observed during the late follicular phases of both natural and stimulated cycles. It has been suggested that such a phenomenon might adversely affect the success of in vitro fertilization. This prospective study was designed to assess the effect of transient rises in prolactin levels on the endocrine response to ovarian stimulation and the outcome of in vitro fertilization treatment. A total of 90 treatment cycles in 87 couples was studied. Prolactin was measured in the mid and late follicular phases of the cycles. During the study period, 24 pregnancies occurred. There were no differences in those cycles in which pregnancy did or did not occur in either mid or late follicular prolactin levels. Neither the initial level nor the percentage rise in prolactin during the stimulation had any effect on the peak estradiol level achieved, the numbers of follicles seen, the number of eggs retrieved, or the incidence or outcome of pregnancy. It was concluded that transient hyperprolactinemia is of no significance in ovarian stimulation for in vitro fertilization.

Adult↗

The in vitro maturation (IVM) of human oocytes for in vitro fertilization (IVF): is it time yet to switch to IVM-IVF?

The recent study by Li et al. observed that human oocytes from patients with polycystic ovary syndrome (PCOS) matured in vitro exhibited a higher proportion of abnormal spindle structures and disturbed chromosomal configurations compared with in vivo-matured oocytes from a control group of PCOS patients. This article discusses the obstacles that must be overcome and factors that must be monitored when attempting to optimize conditions for the in vitro maturation of human oocytes, with particular attention to the strengths and weaknesses of the study by Li et al.

Animals↗

The significance of plasma progesterone levels during early pregnancies achieved after in vitro fertilization (IVF) treatment.

OBJECTIVE: Corpus luteum steroidogenesis is lower for in vivo ectopic pregnancy than for intrauterine pregnancy. There is a progesterone hallmark level distinguishing between viable intrauterine pregnancy and nonviable or ectopic pregnancy. This study attempts to answer whether this is also true for in vitro fertilization-treated patients. STUDY DESIGN: Using information retrieved from a computerized database, we compared the plasma 17 beta-estradiol (E2) and progesterone during the luteal phase and for every 2 to 3 days for several weeks during early pregnancy between those patients with proven ectopic pregnancies and those with singleton and multiple intrauterine pregnancies. Vaginal ultrasonography to detect an intrauterine gestational sac was performed from day 19. A total of 73 pregnancies resulted from the replacement of fresh embryos in our in vitro fertilization-embryo transfer program. RESULTS: Only at day 10 post embryo transfer did those patients with ectopic pregnancy show statistically lower mean (SD) serum levels of E2 [2257 (SD, 2351) pmol/L] and plasma progesterone [PP; 221 (SD, 283) nmol/L] compared with patients with intrauterine pregnancy, whose mean E2 was 8846 (SD, 5871) pmol/L and mean PP was 805 (SD, 582) nmol/L (P = 0.008). For the rest of the follow-up until surgery was performed in ectopic pregnancy, there were no differences of statistical significance between extrauterine pregnancy and the intrauterine pregnancy groups. Furthermore, only on day 10 post embryo transfer, did we find a discriminatory zone (confidence interval, 95%) for E2 levels (903 to 3502 pmol/L for EP vs 6116 to 9493 pmol/L for a singleton and 4875 to 9493 pmol/L for multiple pregnancies). PP levels were 26 to 283 nmol/L for ectopic pregnancy versus 496 to 1096 nmol/L for both singleton and multiple pregnancies. An intrauterine gestational sac was visualized at a mean of 23.2 (SD, 4) days after embryo transfer. On this day, the mean P levels were 982.6 (SD, 286.2) nmol/L for intrauterine and 804.5 (SD, 502.4) nmol/L for ectopic pregnancies (P = NS). CONCLUSIONS: Except for day 10 post embryo transfer, the steroidogenesis in ectopic pregnancy after in vitro fertilization treatment does not differ from successful intrauterine pregnancy. This observation negates an impaired steroidogenesis for ectopic pregnancy after in vitro fertilization and makes the PP level irrelevant in the diagnosis of pregnancy implantation.

Chorionic Gonadotropin↗

Outcome of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) using human sperm prepared via a new standardized swim-up technique fit for office use.

Objective: Recent developments in the assisted reproductive technology (ART) areas necessitate the use of new and more efficient and acceptable modes of gamete in vitro manipulation techniques. As established via the use of various forms of ART, the natural process of fertilization has been largely bypassed and the gametes are obtained and manipulated outside of the normal means of conception. For the male, improvements in sperm quality have involved the use of various techniques that aim to recover a small percentage of healthy spermatozoa that can be further used for the different ART procedures. Previous IVF results showed no differences in fertilization rates between ZSC and Percoll recovered sperm (Zarmakoupis-Zavos et al. ACOG, 1997). The current study was designed to study the fertilizing capacity of ZSC recovered spermatozoa and subsequent embryonic development and pregnancy rates established via IVF and ICSI procedures.Methods: Sperm specimens (n = 30) were prepared via the use of the standardized ZSC swim-up technique, which was designed to harvest almost all overlayered media at the end of the procedure to maximize the sperm recovery. The ZSC device consists of a column with a conical cavity where the semen is placed, and from where the sperm swim-up into the overlayered media and are subsequently recovered at the end of the procedure. Semen specimens were initially assessed and then prepared (0.5 mL each) via the ZSC swim-up technique. The enhancement of the routine semen parameters was assessed and the recovered specimens were used for either conventional IVF or ICSI.Results: The results of the fertilization and pregnancy via IVF and ICSI are shown below:The generated results point out that ZSC recovered specimens yielded acceptable levels of fertilization and pregnancy rates in our IVF and ICSI program. Furthermore, the IVF inseminations yielded higher fertilization rates with a slight increase in polyspermic oocytes when compared to the ICSI inseminations.Conclusion: The data generated in this study tend to point out that the ZSC, besides being a simple one-step standardized system, can also be effectively employed in an ART program and can generate adequate fertilization and pregnancy rates. We have previously shown that the quality and fertilizing capacity of ZSC recovered sperm is comparable to that recovered via Percoll gradients. However, the ZSC when compared to the Percoll method was less time consuming (5 minutes of actual labor) and less tedious by eliminating the dilution and centrifugation steps of Percoll preparation, since it washes the sperm while simultaneously selecting it. The ZSC is a standardized semen preparation method and could be the method of choice in an ART program.

Journal Article↗

[Developmental arrest of fertilized human oocytes in the pronuclear stage after in vitro fertilization (IVF)].

Developmental arrest of 18 ova (about 5%) of 362 fertilized oocytes showing formation of two pronuclei was observed after in-vitro fertilization. In 7 ova the pronuclei were still visible 40 hrs after insemination. Five ova were degenerated after formation of the pronuclei. Cytological analysis of the ova revealed that the arrest of development had occurred at different stages of the cell cycle (interphase to metaphase of the first mitotic division) with one ovum being characterized by a tetraploid chromosome set. Asynchronous development of the pronuclei, which is obviously a cause of early developmental arrest, was observed in 4 ova. According to our observations we would rather transfer fertilized oocytes after cell cleavage (in the 2- to 6-cell stage) than in the pronuclei stage.

Embryo Transfer↗

Sperm:oocyte ratios in an in vitro fertilization (IVF) program.

PURPOSE: During the past few years, many oocyte insemination techniques, including microinjection, have evolved in the treatment of male-factor infertility. This preliminary study was designed to evaluate whether microdroplet insemination could be considered a reliable technique, especially for semen samples with male-factor defects. The first objective was to assess fertilization rates obtained by inseminating sibling oocytes using both the conventional IVF and the microdroplet method (Group 1). The second objective was to evaluate subsequent embryo development and pregnancy rates resulting from microdroplet insemination, in addition to formulating adequate sperm:oocyte ratios for various semen categories (Group 2). Four semen categories were studied including fresh normal sperm, frozen/thawed normal sperm, and male-factor sperm with one defect and two or three defects. RESULTS: Group 1 consisted of 54 couples; no statistical significance was found in the fertilization rates between test tube and microdroplet insemination in all four semen categories. Based on these results, patients from Group 2 (48 couples) had their oocytes inseminated only in microdroplets with sperm:oocyte ratios ranging from 2000 to 10,000 motile sperm:1 oocyte. The average fertilization rate for male-factor sperm was 55%, with a 91% cleavage rate. CONCLUSION: Higher fertilization rates were observed in the lowest range of sperm:oocyte ratios (2000-4000:1) for male-factor sperm with one defect and in the highest range (8000-10,000:1) for male-factor sperm with two or three defects. Polyspermy occurred in only 0.4% of the oocytes inseminated. Microdroplet insemination is an alternative treatment for moderate to moderately severe male-factor infertility, establishing a bridge between conventional IVF and microinjection. With adequate sperm:oocyte ratios, this technique allows the natural selection process of fertilization in vitro to take place, without the high incidence of polyspermy or mechanical damage frequently observed in assisted fertilization techniques.

Adult↗

Sodium chloride, osmolyte, and osmolarity effects on blastocyst formation in bovine embryos produced by in vitro fertilization (IVF) and cultured in simple serum-free media.

PURPOSE: A simple serum-free medium (KSOM), relatively low in NaCl concentration, has been developed for culturing mouse zygotes produced in vivo. The present studies were designed to test modifications of this medium to establish optimal conditions for culture of bovine embryos produced in vitro. METHODS: Embryos were produced by standard in vitro fertilization procedures. They were cultured for 6 days in media varying in NaCl concentration and osmolarity with and without osmolytes, betaine or inositol. RESULTS: Increasing the NaCl concentration from 95 to 108.5 and 122 mM decreased blastocyst formation (P < 0.05). Partial substitution of NaCl by sorbitol indicated that both NaCl concentration and osmolarity were important. Neither betaine nor inositol protected the embryos against high concentrations of NaCl. CONCLUSIONS: The concentration of NaCl should not be higher than 95 mM and the total osmolarity of the medium should be between 250 and 270 mosmol.

Animals↗