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Peroxidase-positive round cells and microorganisms in human semen together with antibiotic treatment adversely influence the outcome of in-vitro fertilization and embryo transfer.

Human semen contains not only spermatozoa but also other cells routinely differentiated as being peroxidase-positive (e.g. leucocytes) and peroxidase-negative (e.g. immature germ cells and lymphocytes) cells. Considerable uncertainty exists about their role in male fertility. To assess the clinical value of both parameters, and of microorganisms in semen, 391 treatments with in-vitro fertilization and embryo transfer were analysed retrospectively, and the concentrations of both peroxidase-positive and -negative cells, together with the presence of microorganisms in semen, were compared with both the fertilization and pregnancy rates. The data indicate that the results of treatment were affected only by excessively elevated concentrations of peroxidase-positive cells (> 6 x 10(6)/ml) and only marginally by the presence of microorganisms in the semen. The pregnancy rate after in-vitro fertilization and embryo transfer was not improved by antibiotic treatments preceding gamete recovery by several weeks. The increased presence of peroxidase-negative cells (e.g. germ cells) in semen was not associated with a significant change in the pregnancy rate. However, the concentration of peroxidase-negative cells in semen correlated significantly with sperm numbers (p < 0.01), sperm concentration (p < 0.01), and normal morphology rates (p < 0.01). It is concluded that short-term antibiotic treatment of asymptomatic patients before assisted reproduction should be handled with caution. The widespread view that peroxidase-negative cells in semen are harmful is rejected.

Anti-Bacterial Agents↗

The effect of smoking on oocyte quality and hormonal parameters of patients undergoing in vitro fertilization-embryo transfer.

PURPOSE: The aim of the present study was to investigate the influence of smoking on different parameters such as oocyte count, embryo score, and basal hormone values within the scope of in vitro fertilization-embryo transfer (IVF-ET). METHODS: Eight hundred thirty-four women undergoing IVF-ET treatment were classified as smokers or nonsmokers on the basis of questionnaires. Additionally, we divided them into three groups according to their stimulation protocol--"combined stimulation" [I; clomiphene citrate plus human menopausal gonadotropin (hMG)], "ultrashort" [II; gonadotropin releasing hormone agonist (GnRHa) plus hMG or follicle-stimulating hormone (FSH)], and "long downregulation protocol" (III)--and further classified again as smokers or nonsmokers within the groups. RESULTS: In general, smoking patients were significantly (P = 0.0195) younger than nonsmokers and showed a significantly (P = 0.0379) lower embryo score and a tendency (P = 0.0931) to produce fewer oocytes. There was no significant difference concerning the number of normally or pathologically fertilized and transferred oocytes and embryos suitable for cryopreservation. Women who smoked had significantly (P = 0.0112) higher basal 17-beta-estradiol (E2), luteinizing hormone (LH) (P = 0.0001), and dehydroepian-drosteronesulfate (DHEAS) (P = 0.0039) levels, but their basal human prolactin (HPRL) levels were significantly (P = 0.0033) lower than those of nonsmokers. According to the stimulation protocol used, we found the following results. Smoking patients in group I showed a significantly (P = 0.023) lower embryo score and produced fewer oocytes (P = 0.0113), with fewer of them being fertilized (P = 0.0072) and transferred (P = 0.0067). Women who smoked had significantly (P = 0.0002) higher basal LH levels, but their HPRL levels were significantly (P = 0.031) lower than those of nonsmokers. Furthermore, they had a thinner endometrium on the day of embryo transfer (P = 0.0366). In group II we measured significantly elevated basal E2 levels (P = 0.0089) and higher LH values (P = 0.0092) in smokers. Group III showed a trend (P = 0.0565) toward lower HPRL values in smokers. CONCLUSIONS: Although the fertilization rate of oocytes and the pregnancy rate were not significantly different between smokers and nonsmokers, we found significantly alterated hormonal parameters and negatively influenced oocyte parameters, particularly after clomiphene stimulation. So we might consider using only GnRHa protocols for smoking patients. Additionally, we advise our patients to stop smoking before an IVF-ET treatment because of the complex effects of smoking on the reproductive and hormonal system.

Adult↗

Factors influencing successful in vitro fertilization and embryo transfer: a matched pair study.

In the present matched-pair study successful and unsuccessful IVF-ET trials in patients with similar preconditions were compared. Sixteen consecutive cases of clinical pregnancies after IVF and ET were included. For each pregnant patient the subsequent patient who fulfilled the matching criteria and who did not conceive was chosen as a control subject. The matching criteria were the stimulation regimen and the number of embryos transferred. Pregnant and nonpregnant patients were compared with regard to their age, the total dosage of hMG, the cycle day at oocyte retrieval, the E2 levels 48 and 24 hours before laparoscopy, the E2 rise, the number of retrieved oocytes, and the cleavage rate. In both groups the investigated variables showed no significant difference between pregnant and nonpregnant patients. In patients with the same cycle stimulation and the same number of embryos transferred, successful implantation was not predictable by the evaluated parameters.

Adult↗

History of the international embryo transfer society Part II.

During 1979, service to members, including publication of abstracts of articles pertinent to interests of members, publication of bibliographies covering topics of embryo transfer, publication of the proceedings of the owners-managers workshop, service as a source of information and contacts for members, and updating members through publication of a newsletter, has been maintained and increased in scope. Membership has been growing steadily throughout the year and, at this writing, the membership has exceeded 200 from 22 countries. Thus, as the Society approaches the 1980 decade, it can do so with an optimism of not just survival but of continued growth in size, breadth of service to members, and range of species and topic interests. There is a good mix in the Society between the commercial and university research sectors interested in embryo transfer. Also, there is a good mix between animal scientists, veterinarians, physiologists, and others interested in this specialty interest area. It is expected that these factors will contributeto a healthy future for the Society.

Journal Article↗

Bioeconomic evaluation of embryo transfer in beef production systems: II. Economic evaluation of steer production.

A bioeconomic model was developed and used to evaluate economic implications of embryo transfer for steer production. Sensitivity analysis indicated that the net returns were strongly influenced by pregnancy and growth rates. Matching of recipient and embryo sizes reduced dystocia prevalence and resulted in as much as a $98 saving per transfer in costs associated with dystocia. Optimal weight and age and net returns at slaughter were found to be a function of mature size and growth rate. Varying growth rates resulted in optimal slaughter weight and net present value (NPV) ranging from 403 to 494 kg and $156 to $273, respectively, for medium-sized steer genotypes characterized by a mature size of 600 kg. The optimal slaughter weight ranged from 456 to 607 kg and NPV from $182 to $344 for large-sized steer genotypes characterized by a mature size of 750 kg. The results showed that high pregnancy rates and embryos with high growth rates generated the greatest profitability from investment in embryo transfer. The model has a wide potential application in formulating optimal biological and economic strategies for matching embryo genetic resources to physical and economic environments for commercial beef production.

Age Factors↗

The importance of the zona pellucida for disease control in livestock by embryo transfer.

From the point of view of disease risk, the movement of livestock by embryo transfer is undoubtedly much safer for trading than the movement of live animals or semen. Nevertheless, strict governmental control by veterinary certification of health of embryos is still vital. In cattle, sheep and pigs, unlike laboratory species such as the mouse, infectious agents do not appear to pass through the zona pellucida (ZP) into the embryo proper. Some agents do, however, adhere firmly to the outer surface of the ZP, especially onto those of the pig. Disease risks associated with the inadvertent transmission of infectious agents when embryos are moved are, therefore, intimately connected with the nature and properties of the ZP. This article reviews current knowledge on the physical and adhesive properties of the ZP and discusses how risks associated with the possible presence of infection on its surface can be minimized. Further research is urgently needed so that realistic but safe veterinary certification of the health of embryos for international trade can be devised.

Animals↗

[The obstetric outcome of in vitro fertilization and embryo transfer pregnancy].

OBJECTIVE: To evaluate the obstetric outcome of in vitro fertilization and embryo transfer (IVF-ET) pregnancy. METHOD: This study compared the obstetric outcomes of 20 cases of IVF-ET pregnancy with that of 8210 deliveries at the same period in our hospital. RESULTS: There were 45% (9/ 20) preterm birth, 50% (10/20) multiple pregnancy, 55% (11/20) pregnancy induced hypertension, 30% (6/20) placenta previa and 85% (17/20) cesarean section in group of IVF-ET pregnancy. CONCLUSION: The incidences of preterm birth, multiple pregnancy, pregnancy induced hypertension or placenta previa were significantly higher in IVF-ET pregnancy.

Embryo Transfer↗

Is what we clearly see really so obvious? Ultrasonography and transcervical embryo transfer--a review.

OBJECTIVE: To critically review the role of ultrasound-guided embryo transfer (ET) and its influence on the outcome of in vitro fertilization (IVF). DESIGN: Medline review of published manuscripts. RESULT(S): Studies evaluating the role of ultrasound-assisted ET have had mixed results, and although meta-analysis of prospective trials suggests an improvement in outcome, limitations in study design may overstate the effect of ultrasonography. Other ET techniques may eliminate the advantages provided by ultrasonography, limiting its benefit to specific clinical scenarios. However, because no trial has demonstrated an adverse effect and because cases that may benefit from its use often cannot be predicted reliably, the routine application of ultrasonography can be justified.

Embryo Transfer↗

Impact of a second insemination on the results of an in vitro fertilization-embryo transfer (IVF-ET) program.

In an attempt to increase the fertilization and pregnancy rates in our program, a second insemination was carried out when the first insemination yielded fewer than two fertilized oocytes. One hundred eighty consecutive patients were studied retrospectively and thirty-four required second insemination, 35% of them by donor semen. Fifty-five and nine-tenths percent of the patients had at least one fertilized oocyte for embryo transfer, but only 21.9% of the oocytes exposed to a second insemination were fertilized. No pregnancy resulted from the transfer of oocytes fertilized by the second insemination. There were no significant correlations between the success of fertilization after a second insemination and the number of oocytes retrieved, the protocol for the induction of superovulation, or the age of the female patient. Considering that the first insemination was done at a variable time after oocyte retrieval to allow oocyte maturation, we expected all oocytes to be mature at the time of first insemination and we considered the possibility of delayed fertilization as negligible since second insemination was done at least 24-30 hr after oocyte retrieval. Even though a second insemination provides further hope for the patient, by yielding additional fertilized oocytes for embryo transfer, its main value is that it may provide additional information about male fertility.

Adult↗

Problems related to the laboratory part of treatment by in vitro fertilization and embryo transfer.

The successive stages leading to fertilization in mammals are reviewed in this article. Methods of human sperm preparation for IVF are described and the "ideal" delay between oocyte pick-up and insemination time is discussed, as well as methods to reduce the incidence of polyspermy. Different culture media and their supplementation are mentioned, as well as a semi-quantitative embryonic scoring system, defined by the IVF team of the Saint-Pierre Hospital in Brussels. Finally the optimal transfer time, and the handling of embryos at replacement are discussed.

Animals↗

[Superovulation-induced transient hyperprolactinemia in human in vitro fertilization and embryo transfer].

To examine the effects of transient hyperprolactinemia on in vitro fertilization and embryo transfer, 61 cycles in 50 euprolactinemic ovulatory women with irreparable tubal diseases were stimulated with clomiphene (CC) alone or CC and human menopausal gonadotropin followed by human chorionic gonadotropin (hCG). Serum prolactin (PRL) increased after hCG administration with peak values of 45.4 +/- 4.2 ng/ml on the day of laparoscopic oocyte aspiration. The highest serum estradiol (E2) concentration was found on the day before PRL peak and serum progesterone (P) began to increase after hCG injection concomitant with the PRL rise. The group having 50 ng/ml or more of PRL (34 cycles) had significantly higher levels of E2 during preovulatory and early luteal phase compared to those of the group having less than 50 ng/ml of PRL (27 cycles) but there was no significant difference between the P levels in the two groups. In the higher PRL group 72 (62.1%) of 116 collected oocytes were fertilized and 6 (20.0%) conceived. In the lower PRL group 45 oocytes (58.4%) of 77 were fertilized and 3 (12.5%) became pregnant. These data suggest that elevated serum PRL concentrations may have no effect on fertilization of oocytes in vitro or embryonic development.

Adult↗

Suppression of natural killer cell activity and interleukin-2 concentration of serum obtained from in vitro fertilization-embryo transfer patients.

PROBLEM: The effect of serum obtained from in vitro fertilization-embryo transfer (IVF-ET) patients on healthy volunteers' natural killer (NK) cell activity was evaluated. We also measured interleukin (IL-2) concentration with IVF-ET patients' serum and clarified the relationship between IL-2 levels and the suppressive effect on NK cell activity. METHOD OF STUDY: A retrospective nonrandomized clinical study was performed. The suppressive effect on NK cell activity and IL-2 concentrations was measured with serum obtained from 30 pregnant and 30 nonpregnant women during an IVF-ET procedure. The suppressive effect of the serum on NK cell activity was evaluated by the formula that we defined in our previous study. RESULTS: The suppression of NK cell activity was significantly higher in the nonpregnant women than in the pregnant women (P < 0.05); however, IL-2 concentration did not differ. There was a positive correlation between the suppression of NK cell activity and IL-2 levels in the pregnant women, but no significant correlation in the nonpregnant women. CONCLUSIONS: These results suggest that the suppression of NK cell activity may be one of the prognostic factors for IVF-ET. In addition, we speculate that an unidentified humoral factor other than IL-2, which could increase NK cell activity, might exist in the serum of the nonpregnant patient.

Adult↗

Comparison of singleton and multiple pregnancies in in vitro fertilization (IVF) and embryo transfer (ET).

The purpose of this study was to analyze factors associated with multiple gestations in IVF-ET. Twenty-seven multiple gestations conceived following IVF-ET resulted in the delivery of 20 sets of twins and three sets of triplets. One quadruplet pregnancy was terminated due to heavy bleeding. There were four "vanishing sacs," two of which resulted in a twin pregnancy and two in singletons. These were compared to 88 singleton IVF-ET gestations. The only significant difference found was the higher numbers of embryos transferred in the multiple gestation group. No difference was found between the two groups in diagnosis, stimulation protocol, estradiol, response, number of eggs, fertilization, and cleavage rate. Maternal age was younger in the multiple-gestation group, though not statistically significant. It is thus suggested that limitation of the number of embryos transferred is the only means to reduce the incidence of multiple gestations in IVF-ET.

Adult↗

The use of transvaginal color flow imaging after in vitro fertilization to identify optimum uterine conditions before embryo transfer.

OBJECTIVE: To assess whether a measure of uterine blood flow impedance (the pulsatility index, PI) as determined by transvaginal ultrasonography with color blood flow imaging, may be used to assess endometrial receptivity immediately before the time of embryo transfer (ET) after assisted conception. DESIGN: A prospective study of infertile women who had undergone treatment to induce multiple follicular development followed by ultrasound-guided oocyte retrieval. The oocytes were fertilized in vitro. SETTING: The Hallam Medical Centre. PATIENTS: Eight-two women (22 to 44 years of age) who all had three or four good quality embryos available for transfer to the uterus. INTERVENTIONS: All women were examined by transvaginal ultrasonography, with color flow imaging and blood flow analysis, immediately before ET. MAIN OUTCOME MEASURES: The mean PI of the left and right uterine arteries, the pregnancy rate (PR) (%), the embryo implantation rate (%), and the multiple PR (%). RESULTS: The patients were grouped according to whether the PI was low (1.00 to 1.99), medium (2.00 to 2.99), or high (3+). There were 27 women in the low PI group, 36 in the medium, and 19 in the high. The PR (%), embryo implantation rate (%), and multiple PR (%) were 41%, 15.3%, and 27.3% for the low PI group and 47%, 22.2%, and 47.1% for the medium PI group. There were no pregnancies in the high PI group. Thus 35% (19/54) of women who failed to become pregnant had a PI value greater than 3.0. CONCLUSIONS: These data suggest that the PI value on the day of ET could be used to: (1) increase the implantation rate by showing which embryos should be cryopreserved until the uterus is more receptive and (2) reduce the multiple PR by indicating that the number of embryos transferred should be limited when the uterus is most receptive.

Embryo Transfer↗

Gonadotropin stimulation following GnRH-a priming for poor responders in in vitro fertilization-embryo transfer programs.

The effect of gonadotropin-releasing hormone agonist (GnRH-a) administration before gonadotropin superovulation on the stimulation characteristics of poor responder patients was assessed in an in vitro fertilization (IVF) program. Thirty consecutive patients who had exhibited low ovarian response (fewer than four retrieved oocytes) in at least two previous IVF cycles (control cycles, n = 60), were eligible for the study. GnRH-a (nafarelin) was administered daily for 7-10 days from the mid-luteal phase of the previous cycle until the first day of menstruation. Menotropin treatment was commenced on cycle day 3 (with no additional GnRH-a) (study cycles, n = 39). A significantly higher number of oocytes was retrieved (p < 0.0002) and a higher number of embryos transferred (p < 0.003) in the study cycles than in the control cycles. No cases of premature luteinizing hormone surge were recorded. Pregnancy rates per embryo transfer and per cycle were 10.4% and 7.7% for the study cycles and 2.8% and 1.6% for the control cycles, respectively. GnRH-a, administered prior to gonadotropin treatment, should be an additional option of ovulation induction protocol for poor responders in IVF programs.

Administration, Intranasal↗

Is intravenous immunoglobulins (IVIG) efficacious in early pregnancy failure? A critical review and meta-analysis for patients who fail in vitro fertilization and embryo transfer (IVF).

PROBLEM: Intravenous Immunoglobulins (IVIG) are widely used off label in the treatment of early reproductive failure. As IVIG is expensive, and may have side-effects, evidence of efficacy is needed. Previous results have suggested that the pre-conception treatment of primary recurrent abortion patients might be effective, but the data set has been too small for adequate statistical power. More recently it has been suggested that IVIG may improve the success rate of in vitro fertilization and embryo transfer (IVF) in patients with prior IVF failures, but clinical trials have given conflicting results that need explanation. Systematic reviews generating inconclusive results have focused on methodological rigor to the exclusion of biological plausibility. METHODS: Review of current basic science of design, measurement, and evaluation of clinical trials and basic science mechanisms providing a rationale for treatment. Meta-analysis of published randomized controlled and cohort-controlled trials (updated with two unpublished data sets) evaluating IVIG treatment in IVF failure patients. Live birth rate was used as the most relevant endpoint. The ability of different sources of IVIG to suppress natural killer (NK) cell activity was determined using a standard (51)Cr-release assay in vitro. RESULTS AND CONCLUSIONS: Meta-analysis of three published randomized controlled trials (RCTs) of IVIG in IVF failure patients shows a significant increase in the live birth rate per woman (p = 0.012; Number Needed to Treat for 1 additional live birth, NNT = 6.0 women). Using live birth rate per embryo transferred, and adding data from two cohort-controlled trials to the meta-analysis further supports this conclusion (overall p = 0.000015, NNT = 3.7 women). Relevant variables appear to include properties and scheduling of the IVIG, and selection of patients with abnormal immune test results. Different IVIG preparations vary significantly in their ability to suppress NK activity in vitro. A rationale for use of IVIG is provided by a review of mechanisms of IVIG action and mechanisms underlying failure of chromosomally normal embryos.

Adult↗

Antiphospholipid antibodies and the outcome of pregnancy after the first in-vitro fertilization and embryo transfer cycle.

Increased antiphospholipid antibody prevalence has been demonstrated by a number of recent studies in in-vitro fertilization (IVF) patients but the potential effects of antiphospholipid antibodies on the different components of the reproductive process and the consideration of whether to test IVF patients for antiphospholipid antibodies are controversial. The present study was undertaken to investigate the possible association between the presence of circulating antiphospholipid antibodies (namely the lupus anticoagulant and anticardiolipin antibodies), among a series of 21 consecutive IVF patients having a clinical spontaneous abortion after their first embryo transfer. As a control group (n=42), the nearest IVF cycle resulting in an ongoing pregnancy before and after each miscarried IVF cycle (i.e. the closest cycles in temporal relationship to the index cycle) was used. One patient (4.8%) in the study group and two women (4.8%) among controls were seropositive for antiphospholipid antibodies. These low and similar seropositivity rates found in the two groups studied lead us to conclude that antiphospholipid antibodies testing in IVF patients should be considered only in those women having repeated failures of implantation/clinical abortion after embryo transfer but not in an infertile general population reaching an IVF programme.

Abortion, Spontaneous↗

In vitro fertilization and embryo transfer during natural cycles.

OBJECTIVE: To report the results of in vitro fertilization and embryo transfer (IVF/ET) performed during natural cycles. STUDY DESIGN: A prospective clinical study. RESULTS: Thirty-two cycles were started in 19 patients who had regular ovulatory cycles and tubal factors or unexplained infertility only as the cause of infertility. Egg collection was performed in 12 cycles, and four pregnancies resulted from ET in eight cycles. The pregnancy rates were 12.5% per cycle initiated, 33.3% per retrieval cycle and 50% per transfer. CONCLUSION: Natural cycle IVF/ET offers a low-cost alternative to patients with infertility.

Adult↗