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Successful treatment of infertility due to anejaculation with in vitro fertilization and embryo transfer: a report of two cases.

We investigated the efficacy of assisted ejaculation in combination with in vitro fertilization and embryo transfer (IVF-ET) in two couples with infertility due to anejaculation. Case 1 was in an anejaculatory condition associated with a spinal cord-injury. We performed intrauterine insemination (IUI) three times using motile sperm obtained by intrathecal injection of neostigmine, but no pregnancy followed. The couple then entered IVF-ET. The semen volume obtained by assisted ejaculation was 4.5 ml. The sperm count was 33 x 10(6)/ml with 33% motility. At 35 weeks of gestation she delivered three healthy babies by cesarean section. Case 2 was in an unexplained retrograde ejaculatory condition. We performed IUI eight times before changing to IVF-ET. We then used sperm obtained from urine or sperm recovered from the bladder after administration of human tubal fluid, but no pregnancy followed. At the fifth IVF-ET attempt, using sperm obtained from urine, we succeeded. We prepared the sperm by the Percoll gradient method. The sperm count was 36 x 10(6)/ml with 64% motility. At 39 weeks of gestation she delivered a healthy baby. Deficient seminal quality contributes to the decreased fertility potential in patients with anejaculation. With the use of IVF-ET methods, pregnancies can be achieved in these couples.

Adult↗

Magnetic resonance imaging and transvaginal ultrasound of the uterus prior to embryo transfer.

This study was designed to investigate the role of magnetic resonance (MR) imaging in predicting the outcome of in-vitro fertilization (IVF)/embryo transfer treatment by seeking differences in receptive compared to unreceptive endometria. Women about to undergo embryo transfer were submitted to both vaginal ultrasound and MR imaging. Measurements were obtained of the thickness, cross-sectional area and volume of uterine layers and of the MR signal intensity ratios between layers. Measurements were compared with the occurrence of subsequent successful implantation. Although there was no association with either the quantity or the relative signal intensity of the endometrium, an interdependence was demonstrated between both the endometrium/myometrium and myometrium/junctional zone signal intensity ratios and subsequent successful implantation (P < 0.037 and < 0.004 respectively). It is concluded that MR imaging may provide unique information which may help in predicting the outcome of IVF/embryo transfer treatment and in understanding implantation. Significant differences were seen in the relative MR signal intensities of the myometrium.

Adult↗

Bioeconomic evaluation of embryo transfer in beef production systems: I. Description of a biological model for steer production.

Concepts used to derive a deterministic model for evaluating embryo transfer for commercial steer production taking into consideration genetic merit for growth and mature size, herd feed supply, and recipient maternal environment are discussed. Genetic potential of an embryo is used to derive optimal growth rates that can be sustained by available herd feed per animal per day. Equations are provided for various measures of performance as functions of the feed, genotype of the embryo, and recipient maternal contribution. To assess the value of a particular line of embryos, interactions between genotype and nutrient environment are quantified, so that the benefits of embryos of high genetic merit are evaluated objectively. Product quality and weight are predicted from the model to provide a framework that will allow commercial beef producers to determine marketing strategies likely to result in optimal return.

Animal Feed↗

Immunological changes and stress are associated with different implantation rates in patients undergoing in vitro fertilization-embryo transfer.

OBJECTIVE: To evaluate the possible correlation between immunological changes and implantation rates in patients who undergo in vitro fertilization-embryo transfer (IVF-ET). DESIGN: Controlled clinical study. SETTING: University hospital. PATIENT(S): Forty infertile women undergoing IVF-ET. INTERVENTION(S): Stroop Color Word (CW) test, State-Trait Anxiety Inventory (STAI) test, blood sampling. MAIN OUTCOME MEASURE(S): Heart rate and systolic and diastolic blood pressure responses to Stroop CW; circulating T, B, T-helper (CD4), and T-suppressor (CD8) lymphocytes. RESULT(S): The total number of T lymphocytes increased significantly during superovulation, resulting in significantly higher levels in subjects achieving embryo implantation than in those showing a failure of implantation. An opposite trend was observed for the activated T cells. The number of T-helper lymphocytes and the T-helper/T-suppressor ratio showed a significant increase from baseline to the time of pick-up only in patients with implantation. CONCLUSION(S): A prolonged condition of stress, which causes a decreased ability to adapt and a transitory anxious state, is associated with high amounts of activated T cells in the peripheral blood. Such a condition, in turn, is associated with a reduced implantation rate in women undergoing IVF-ET.

Adult↗

Multiple ovulation and embryo transfer in Indian buffalo (Bubalus buoalis ).

This study was undertaken to identify the most effective dosage level of folltrooin for superovulation in buffalo. In addition, the effect of the day of estrus on superovulation and the use of exogenous GnRH were also studied. Eighty-three buffalo were treated with prostaglandin. A functional Corous luteum (CL) was palpated in only 73 buffalo 1 d before the superovulation treatment was initiated. One of eight treatments was used on the buffalo: Protocol I(n 8) 9 mg folltropin (PPFE) on Days 9 to 12 of the cycle; Protocol II(n 10) 18 mg PPFE on Days 9 to 12 of the cycle; Protocol III(n 9) 18 mg PPFE on Days 13 to 15 of the cycle; Protocol IV(n 9) 21.6 mg PPFE on Days 9 to 12 of the cycle; Protocol V(n 9) 21.6 mg PPFE with GnRH on Days 9 to 12 of the cycle; Protocol-VI(n 10) 25.2 mg PPFE on Days 9 to 12 of the cycle; Protocol VII(n 9) 28.8 mg PPFE on Days 9 to 12 of the cycle; Protocol VIII (n 9) 36 mg PPFE on Days 9 to 12 of the cycle. The highest ovulation rate was observed in Protocol VI (x 5.3+/-0.79) which is significantly higher (P < 0.01) than other Protocols. Maxium embryos (x 3.7) were recovered using Protocol III. Whereas, highest number of transferable embryos (x 2.2) were recovered from Protocol V. Use of GnRH and superovulation treatment on Days 13 to 15 has no advantageous effect on ovulation rate. In all, 41 embryos were transferred to 35 recioients: nine buffalo became pregnant; 59 embryos were frozen; 12 were thawed; nine good frozen-thawed embryos were transferred to eight recidients, three of which were diagnosed pregnant.

Journal Article↗

Pregnancies in humans by fertilization in vitro and embryo transfer in the controlled ovulatory cycle.

Normal pregnancies have been established in four women with tubal infertility by fertilization in vitro, embryo culture, and embryo transfer after stimulation of follicular growth with clomiphene citrate. In three of these women the time of oocyte maturation was controlled by human chorionic gonadotropin. This procedure for the control of ovulatory response has many advantages when compared with the previously successful method of using the natural ovulatory cycle.

Chorionic Gonadotropin↗

Postthaw blastomere survival is predictive of the success of frozen-thawed embryo transfer cycles.

OBJECTIVE: To investigate the predictors of postthaw blastomere survival and the relationship of blastomere survival to the outcome of frozen-thawed embryo transfer (FET) cycles. DESIGN: Retrospective study. SETTING: An IVF unit in a tertiary care facility. PATIENT(S): Infertile women undergoing FET cycles with embryos cryopreserved on day 3 postinsemination. INTERVENTION(S): FET cycles. MAIN OUTCOME MEASURE(S): Embryo survival postthaw, pregnancy (PR), clinical pregnancy, and implantation rates. RESULT(S): A significant impact of postthaw blastomere survival on the outcome of FET cycles was noted. The thawed embryos in the low survival tertile resulted in significantly impaired implantation rate, clinical pregnancy rate, and PR compared to embryos in the high survival tertile. An inverse association was noted between serum P levels on the day of hCG administration and postthaw blastomere survival. CONCLUSION(S): We have demonstrated that postthaw blastomere survival is predictive of success of FET cycles. The relationship of poor postthaw embryo survival in the setting of elevated P is novel and not hitherto described.

Adult↗

In vitro fertilization and embryo transfer--legal and religious aspects in Israel, patient selection, and a modified technique for oocyte collection.

In vitro fertilization (IVF) and embryo transfer (ET) have recently become an accepted treatment modality for patients with mechanically caused infertility. The first series admitted to our program comprised 42 patients with confirmed mechanical infertility. The method of patient selection and the techniques of laparoscopy, follicular aspiration and oocyte recovery are described. From 26 laparoscopies, a total of 39 oocytes was recovered. Normal cleavage of 10 oocytes was obtained; they were transferred into the uterus at the 4- to 16-cell stage. One pregnancy was obtained. An IVF and ET program involves certain ethical, legal and religious questions, which have special implications in Israel: foster mothers and the use of donor sperm are forbidden. Only married couples may enter the program. Indications, methods, success rates and method failure are discussed.

Embryo Transfer↗

High fecundity of amenorrhoeic women in embryo-transfer programmes.

There is uncertainty over whether the steady decline in human fertility with increasing maternal age is due to quality of the oocyte or of the endometrium. To clarify the issue age-related implantation and pregnancy rates in two embryo-transfer programmes were examined in relation to embryo quality and type of menstrual cycle. In both the UK and the US programmes rates were higher in previously amenorrhoeic (acyclic) women than in eugonadal women, irrespective of age and number of embryos replaced. Oocyte quality, as determined by age of oocyte donor, in-vitro growth of embryo, and proportion of defective embryos in culture, did not contribute to the difference, nor did type of cycle during therapy. If a uterus that has not been subjected to regular menstrual cycles is a favourable factor, a period of induced amenorrhoea might be beneficial for infertile women.

Amenorrhea↗

Reduction of ovarian torsion 1 week after embryo transfer in a patient with bilateral hyperstimulated ovaries.

OBJECTIVE: To report a rare case of unilateral ovarian torsion 1 week after embryo transfer in a patient with bilateral hyperstimulated ovaries. DESIGN: Case report and literature review. SETTING: Reproductive Endocrine division in a university teaching hospital. PATIENT(S): Infertility patients undergoing IVF-ET. INTERVENTION(S): Laparoscopic reduction of adnexa 1 week after ET. MAIN OUTCOME MEASURE(S): Successful preservation of the affected adnexa. RESULT(S): Delivery of 3.324 kg male infant with preservation of the affected ovary. CONCLUSION(S): Untwisting of the affected ovary at laparoscopy without aspiration reduction of cystic masses is appropriate. The outcome of the pregnancy (even very early) in patients with torsion of the adnexa may be favorable after a laparoscopic unwinding of the affected adnexa.

Adnexa Uteri↗

Human chorionic gonadotropin levels in conception cycles after uterine and tubal embryo transfer.

OBJECTIVE: To describe the rate of rise of beta-hCG levels in normal single gestations after uterine and tubal embryo transfer. DESIGN: A prospective study from 1991 through 1992 in which infertility patients who conceived after ovulation induction and ET were monitored with serum beta-hCG levels. SETTING: Infertility unit at Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois. PATIENTS: Ninety-eight women conceived after ovarian stimulation and ET. This study included only patients who conceived after uterine ET (n = 12) and tubal ET (n = 25) and had an exponential rise of beta-hCG levels and sonographic evidence of an intrauterine gestation. RESULTS: The rate of rise of mean beta-hCG levels after ET preceded that of tubal ET by 24 hours until day 14 when the two approximate each other. CONCLUSION: There appears to be a unique interaction between the trophoblast and endometrial surface that may account for the early detection of beta-hCG after uterine versus tubal ET.

Adult↗

Relationship between serum antisperm antibodies and anticardiolipin antibodies and clinical pregnancy outcome in an in vitro fertilization and embryo transfer program.

OBJECTIVE: To study the influence of maternal immunological factors on clinical pregnancy outcome in an in vitro fertilization and embryo transfer (IVF-ET) program. METHODS: One hundred and fifty IVF-ET treatment cycles from November 1995 to November 1996 were studied. The indication for IVF-ET treatment was bilateral blocked tubes. Serum antisperm antibodies and anticardiolipin antibodies were measured using enzyme-linked immunosorbent assay (ELISA). Cleavage rate and successful pregnancy rate in relation to antibody status of infertile women after IVF-ET treatment were assessed. RESULTS: Lower cleavage rate (64.2% +/- 32.1%) was found in 44 cycles of antisperm antibody seropositive women, compared with 84.8% +/- 18.7% in 106 cycles of seronegative women (P < 0.05). The clinical pregnancy rate was 31.8% in antisperm antibody-positive cycles and 20.8% in negative cycles (P > 0.05). The abortion rates of the two groups were similar (P > 0.05). Lower pregnancy rate (9.5%) was found in 21 cycles of serum anticardiolipin antibody-positive group, compared with 26.3% in 129 cycles of seronegative women (P < 0.05). Of patients with bio-chemical pregnancy and no pregnancy, 20.0% and 16.2%, respectively, had seropositive anticardiolipin antibody, compared with 5.6% of patients with clinical pregnancy (P < 0.05). CONCLUSION: Serum immunological factors may play a part in clinical pregnancy outcome in IVF-ET.

Adult↗

Spontaneous resolution of ectopic pregnancy in a surrogate after oocyte donation and frozen embryo transfer.

A case of tubal pregnancy in a young and healthy woman participating in a programme of in-vitro fertilization (IVF) gestational surrogacy is reported. The gestational surrogate was the 30 year old fertile sister of a 25 year old patient affected by stage 1 ovarian cancer. After mandatory oncological consultation, the donor was recommended to prospectively undergo controlled ovarian hyperstimulation cycles for embryo banking before being treated by total hysterectomy. Available embryos were cryopreserved and after adequate endometrial preparation using artificial cycles of hormone replacement therapy, three thawed frozen embryos were transferred to the surrogate. At 17 days following embryo transfer the surrogate was noted to have a negative beta-human chorionic gonadotrophin (HCG) serum concentration. All medication was suspended and a few days later normal menstrual bleeding occurred. After 2 weeks, the beta-HCG concentrations, performed as part of routine follow-up evaluation, were showing signs of trophoblast activity (236 mIU/ml). Taking into account the stable condition of the patient, a decision was made to undertake expectant management. At 43 days after embryo transfer, a complete tubal abortion was apparently seen in the posterior cul-de-sac by ultrasound associated with a subtle and short lasting pelvic pain. We stress that this ectopic gestation was able to maintain prolonged viability in conditions of absent corpus luteum and exogenous steroid supplementation.

Abortion, Spontaneous↗

Effects of coasting on the outcome of intracytoplasmic sperm injection-embryo transfer cycles.

OBJECTIVES: To determine the effects of 'coasting' on the outcome of controlled ovarian hyperstimulation (COH) and intracytoplasmic sperm injection-embryo transfer (ICSI-ET). DESIGN: Retrospective study. SETTING: IVF Centre, Ozel Ege Tup Bebek Merkezi, Izmir, Turkey. SAMPLE: Twenty-six coasted and 52 non-coasted COH and ICSI-ET patients were enrolled in this retrospective study. METHODS: Coasted patients were enrolled consecutively during the study period, and two non-coasted controls were selected from our database for each coasted patient. Coasting was decided when serum oestradiol level was > or = 4000 pg/mL. Groups were compared using chi2 and Mann-Whitney U-tests for statistical analysis. MAIN OUTCOME MEASURES: Number of oocytes collected, metaphase II (MII) oocytes and cleaving embryos, the fertilisation rate and clinical pregnancy rate were the main outcome measures. RESULTS: Number of oocytes collected, number of MII oocytes, number of cleaving embryos, fertilisation rate and clinical pregnancy rate for the coasted and non-coasted groups were 15.5 +/- 5.2 and 14.0 +/- 7.1, 9.7 +/- 4.8 and 9.3 +/- 3.9, 6.8 +/- 3.9 and 5.8 +/- 3.1, 0.85 +/- 0.18 and 0.78 +/- 0.18, 13/26 and 24/52, respectively; these differences were not statistically significant. None of the patients in the coasted group were hospitalised for signs or findings of severe ovarian hyperstimulation syndrome. CONCLUSIONS: Coasting does not adversely affect the number and the function of mature oocytes and the clinical pregnancy rate.

Embryo Transfer↗

Effect of Gutai Decoction on the abortion rate of in vitro fertilization and embryo transfer.

OBJECTIVE: To study the effect of Chinese herbal medicine Gutai Decoction (GTD) on the abortion rate of in vitro fertilization and embryo transfer (IVF-ET). METHODS: Observed were two hundred and forty-seven women having received IVF-ET and with beta-human chorionic gonadotropin (beta-HCG) > 25 IU/L on the 14th day after transferring. All were treated conventionally with progesterone 20 - 80 mg per day after transferring and if necessary the treatment was supplemented with Progynova 2 - 4 mg per day, with the medication withdrawn gradually from the 9th week of pregnancy till stopped completely. Among them 131 cases received GTD medication additionally, for 109 cases of whom the medication started from the 2nd day of transferring (taken as Group A) and for the other 22 cases from the 14th day after transferring (taken as Group B), the other 116 cases with no additional GTD treatment given were taken as the control group, with the medication lasting to the 12th week. The abortion rate in them was observed. RESULTS: The abortion rate in Group A, Group B and the control group was 12.84%, 13.64% and 23.28%, respectively, the difference between the GTD treated groups and the control group was significant (P < 0.05). CONCLUSION: Chinese medicine GTD could reduce abortion rate in women receiving IVF-ET.

Abortion, Induced↗

Results of prednisolone given to improve the outcome of in vitro fertilization-embryo transfer in women with antinuclear antibodies.

OBJECTIVE: To evaluate the association of antinuclear antibodies (ANA) with outcome of in vitro fertilization-embryo transfer (IVF-ET) as well as the effect of short-term immunosuppression with prednisolone on implantation, clinical pregnancy and live birth rates following IVF-ET. STUDY DESIGN: The study group consisted of 120 women, 22-42 years old, in whom IVF-ET was performed and whose ANA could be measured. Prednisolone (15-60 mg/d for 5 days) was administered starting 1 day after oocyte retrieval to some women with or without ANA, without randomization. The 223 IVF-ET cycles were divided into prednisolone-nontreated ANA-negative cycles, prednisolone-treated ANA-negative cycles, prednisolone-nontreated ANA-positive cycles and prednisolone-treated ANA-positive cycles. Retrospective analysis of rates of implantation, clinical pregnancy, and live birth were evaluated in the four groups. RESULTS: Overall, ANA positivity was noted in 20.0% of subjects (24/120) and 25.1% of cycles (56/223). Implantation and clinical pregnancy rates in the prednisolone-nontreated ANA-positive group were 0% (0/41 transplanted embryos) and 0% (0/15 cycles), significantly lower than in the other groups. The live birth rate in this group was significantly lower than in the prednisolone-nontreated ANA-negative group and non-significantly tended to be lower than in the other 2 CONCLUSION: Implantation, clinical pregnancy and live birth rates following IVF-ET were low when ANA was detected. Implantation and clinical pregnancy rates were improved significantly by prednisolone, but the live birth rate was not.

Adult↗

Serum PP14 levels in a patient with Turner's syndrome pregnant after frozen embryo transfer.

Data are presented on serum levels of the pregnancy-associated placental protein (PP14) in an XO mother, pregnant after frozen embryo transfer. Steroid replacement before and during early pregnancy was provided with transdermal oestradiol and vaginal micronized progesterone. Characterization of a pre-treatment cycle indicated a physiological response by the endometrium. The pregnancy was associated with normal maternal blood levels of all hormones considered responsible for maintenance of early gestation but with consistently subnormal serum levels of PP14. Hitherto, PP14 has been believed to be an endometrial protein arising from the decidua during pregnancy, under the influence of ovarian steroids. The findings in this case suggest that other factors are involved in its production, possibly under the control of, or originating from, the maternal ovary.

Adult↗