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PubMed2003

Impact of technical difficulties, choice of catheter, and the presence of blood on the success of embryo transfer--experience from a single provider.

PURPOSE: To investigate the impact of technical difficulties, choice of catheter, and the presence of blood during embryo transfer on the results of in vitro fertilization and ICSI. METHODS: A cohort of 784 consecutive cycles in 655 in vitro fertilization and ICSI patients were studied. RESULTS: Negotiating the cervix, using the volsellum, presence of blood on the catheter wall or on the cervix did not affect the results. Changing the catheter and blood on the catheter tip reduced the pregnancy (P < 0.05 and P < 0.05) and implantation rates (P < 0.001 and P < 0.01). The Ultrasoft catheter produced higher pregnancy (P < 0.0005) and implantation rates (P < 0.01) compared to the more rigid Frydman catheter. CONCLUSIONS: Negotiation of the cervix, the use of a volsellum, and the presence of blood on the catheter wall or on the cervix do not affect the results. Changing the catheter and blood on the catheter tip significantly diminish the pregnancy and implantation rates. Soft catheters perform better.

Blood Loss, Surgical↗

PubMed2005

Lymphocyte immunotherapy can improve pregnancy outcome following embryo transfer (ET) in patients failing to conceive after two previous ET.

PURPOSE: To determine if lymphocyte immunotherapy (LIT) can improve the outcome after embryo transfer (ET) in women failing to have a live delivery after at least two previous attempts. METHODS: Women failing to deliver a live baby despite at least two previous ET cycles at Cooper Center for IVF irrespective of previous failed ET cycles in other centers were offered the option of lymphocyte immunotherapy prior to their next ET. They were subsequently matched to the very next woman having ET but in whom LIT was never offered or was refused. The matching was based on age, number of previous failed ET cycles, type of ET (fresh or frozen), and serum follicle stimulating hormone (FSH) level. RESULTS: The clinical and viable pregnancy rate was 70.3% and 51.3% for the LIT group vs 45.9% and 16.2% for the controls (p < .05). CONCLUSIONS: Lymphocyte immunotherapy may help improve outcome following ET in women with previous failures. The data should encourage a larger multicenter prospective study.

Adult↗

PubMed1993

Heterotopic pregnancies after in-vitro fertilization and embryo transfer--a Danish survey.

Thirteen cases of heterotopic pregnancy were diagnosed among 1171 pregnancies established in Denmark after in-vitro fertilization and embryo transfer (IVF-ET). Thus the frequency of heterotopic pregnancy was 13/1171 or 1.1%. In five cases the diagnosis of heterotopic pregnancy was made by ultrasound at 6-9 weeks of gestation; three of these patients were asymptomatic, while two patients presented with abdominal pain and vaginal bleeding. All these patients had an unruptured ectopic pregnancy. Eight cases were diagnosed at the time of surgery; all these patients presented with abdominal pain. Only two of the 13 patients had vaginal bleeding. In nine of the 13 cases the intra-uterine pregnancy resulted in term delivery, while one pregnancy is ongoing. In pregnancies following IVF-ET, this diagnosis should particularly be considered in cases with abdominal pain; vaginal bleeding may be absent. Ultrasound examination may lead to early diagnosis even in asymptomatic cases. In most cases, removal of the ectopic gestation will allow the intrauterine pregnancy to proceed to term.

Adult↗

PubMed2004

Outcome of in vitro fertilization-embryo transfer according to age in poor responders with elevated baseline serum follicle stimulation hormone using minimal or no gonadotropin stimulation.

PURPOSE: To determine whether decreased ovarian reserve or advancing age are more associated with decreased oocyte quality. METHODS: Women with baseline serum follicle stimulating hormone (FSH) > 12 mIU/ml who demonstrated previous poor response to controlled ovarian hyperstimulation (COH) had oocyte retrieval without gonadotropin stimulation in natural cycles or with minimal stimulation (maximum 75 IU gonadotropins) without agonists or antagonists were evaluated following in vitro fertilization-embryo transfer. RESULTS: The ongoing/delivered pregnancy rates were 27.3%, 30.8%, 21.7%, and 0.0%, respectively, with a mean of 1.06 embryos per transfer. The implantation rates were 33.3%, 28.6%, 14.7%, and 6.0%. Approximately half of the retrievals resulted in failed fertilization. CONCLUSION: Using these minimal or no drug COH regimens in a difficult group of women, age was found to be a more adverse infertility factor than elevated serum FSH.

Adult↗

PubMed2000

Three-dimensional endometrial volume estimation as a predictor of pituitary down-regulation in an IVF-embryo transfer programme.

To examine the role of three-dimensional (3D) volume estimation in predicting pituitary down-regulation in an IVF-embryo transfer programme, 46 women were treated with buserelin acetate for down-regulation prior to and concomitantly with ovarian stimulation. Receiver operating characteristic (ROC) curve analysis was used for statistics. The area under the curve (AUC) provides a measure to show how good (AUC close to 1) or how poor (AUC close to 0.5) a test is. If down-regulation was defined as oestradiol <40, <60 or <80 pg/ml, the AUC of 3D-ultrasound was 0.57, 0.83 and 0.97 respectively. The highest sensitivity (100%) and specificity (93.2%) of 3D-ultrasound was achieved if down-regulation was defined as oestradiol <80 pg/ml (n = 44), with an endometrial volume of 1.9 ml. If down-regulation was defined as oestradiol <60 pg/ml (n = 42) the best combination of highest sensitivity (95.2%) and specificity (75. 0%) was obtained with an endometrial volume of 1.9 ml. The comparison of 3D volume calculation with endometrial thickness measurement revealed no significant difference in predicting down-regulation. 3D volume estimation provides a new tool for diagnosing relative hypo-oestrogenism or down-regulation, but it was not superior to two-dimensional ultrasound.

Adult↗

PubMed1994

Heterotopic pregnancy obtained after in-vitro fertilization and embryo transfer following bilateral total salpingectomy: case report.

Heterotopic (coexistent ectopic and intra-uterine) pregnancy is common following in-vitro fertilization and multiple embryo transfer. Total bilateral salpingectomy is generally considered to eliminate the risk of ectopic, and hence heterotopic pregnancy. This is, however, not strictly correct as it does not eliminate the risk of interstitial tubal pregnancy. This is the first reported case of a heterotopic pregnancy following total bilateral salpingectomy. The diagnostic pitfalls and a suggested method of avoiding them are discussed.

Adult↗

PubMed2003

A case of body stalk anomaly arising in the second baby of a triplet pregnancy after in-vitro fertilization and embryo transfer.

We report a case of body stalk anomaly arising in the second baby of a triplet pregnancy after in-vitro fertilization and embryo transfer (IVF-ET). Body stalk anomaly or limb-body wall complex is a rare congenital anomaly with a series of similar clinical manifestations and poor prognosis. IVF-ET is an effective treatment for various types of infertility. We summarize and discuss herein the relation with the sequence of genesis for such malformations and multiple pregnancies after IVF-ET.

Abdominal Wall↗

PubMed1989

Recovery of motile sperm using the migration-sedimentation technique in an in-vitro fertilization-embryo transfer programme.

Sperm washing techniques, based on the swim-up principle used before inseminating the human oocyte in in-vitro fertilization and embryo transfer programmes (IVF-ET), usually require prior centrifugation which causes damage to the sperm cell. A technique is described for separating sperm at laboratory temperature based on sperm migration--sedimentation principles, using two concentric tubes and recovering 70-90% forward-moving cells. A group of 17 patients is presented who were managed with this method. The results were 85% fertilization rate, 4% polyspermia and six clinical pregnancies.

Cell Separation↗

PubMed1984

Preovulatory serum estradiol-17 beta values and ultrasound scans in 17 pregnancies which followed in vitro fertilization and embryo transfer after treatment with clomiphene and hCG.

17 patients whom we treated with clomiphene and hCG became pregnant after in vitro fertilization (IVF) and embryo transfer (ET). We now report on our experience with preovulatory estradiol 17 beta values and ultrasonography in determining the time of hCG administration in these patients. The mean estradiol value just before the hCG injection was 329 +/- 75 pg/ml/follicle. The mean follicle diameter on ultrasound was 23.4 +/- 1.5 mm on the same day. In four cases, we only used estradiol values and in one case only ultrasound for the timing of the hCG injection. Both methods of monitoring follicular growth are discussed.

Adult↗

PubMed1998

Lower segment uterine rupture related to early pregnancy by in vitro fertilization and embryo transfer after a previous cesarean delivery.

A 31-year old woman with secondary infertility after a previous Cesarean delivery underwent in vitro fertilization and embryo transfer (IVF-ET). She was pregnant by IVF-ET. In the first trimester, however, she began to have genital bleeding and lower abdominal pain. This led to intrauterine fetal death, which was terminated by curettage of the uterine cavity. Later, magnetic resonance imaging (MRI) showed the uterine pregnancy on the lower segment scar and the rupture, which was abdominally repaired. It is very likely that the uterine rupture was associated with the implantation in the Cesarean section's scar in this case.

Adult↗

PubMed1976

Embryo transfer in pigs: a method for introducing genetic material into primary specific-pathogen-free herds.

Fifty-five embryos were transferred from 4 Duroc donor sows into 4 crossbred recipient gilts. The embryo survival rate was 66%; 53% of eggs ovulated by donors were represented by live pigs at term. Three of the litters were obtained by hysterectomy of the recipients and introduced into a primary specific-pathogen-free herd, thereby saving the donor sows for subsequent use. Embryo transfer provided a method for exploiting the genetic potential of superior females.

Animals↗

PubMed2004

Heterotopic pregnancy after in vitro fertilization-embryo transfer.

OBJECTIVE: A ruptured cornual pregnancy is a rare and challenging problem. We present two cases of cornual pregnancies after in vitro fertilization and embryo transfer (IVF-ET) treated by cornual resection, with an excellent perinatal outcome for the intrauterine pregnancy in both cases. A literature review of cornual pregnancy after IVF-ET is also included. CASE REPORTS: Two women had undergone IVF-ET because of tubal problems. Emergent laparotomy was performed because of internal bleeding at 12 weeks of gestation in one case and 17 weeks in the other, and in both cases, ruptured cornual pregnancies were found. Cornual resection and primary repair were performed. The women were discharged on the 6th and 7th postoperative day, respectively, and they underwent an elective cesarean delivery at 37 weeks of pregnancy. They were delivered of healthy babies, one weighing 2700 g and the other 2310 g. CONCLUSION: These cases illustrate that good perinatal outcomes can be achieved by surgical intervention in heterotopic pregnancies, even in the event of a ruptured cornu.

Adult↗

PubMed2003

Endometrial lesions caused by catheters used for embryo transfers: a preliminary report.

OBJECTIVE: To visualize by microhysteroscopy any possible lesions on the endocervix and endometrium made by the catheters commonly used for embryo transfer (ET). DESIGN: Prospective descriptive study. Tertiary fertility center (IFER). PATIENT(S): Twenty-three infertile patients underwent a mock transfer before a microhysteroscopy during the postovulatory phase (days 2-5 after ovulation) of the cycle with a Tomcat catheter (n = 5), Frydman's catheter (n = 5), Frydman's set (n = 3), or Wallace's catheter (n = 10). INTERVENTION(S): Mock ETs and subsequent mycrohysteroscopies.Visualization, description, and documentation of endocervical and endometrial lesions. RESULT(S): The lesions in all 23 patients were described and documented (tunnel-like, groove-like, punch-out, crater-like). The Wallace catheter appears to be less traumatic to the endometrium (but it seems that it is important to take care to not pass the internal os with the outer sheath). The Tomcat catheter and the Frydman's set caused the more significant lesions that were observed. CONCLUSION(S): In this preliminary study, for the first time endometrial lesions caused by the ET catheters were directly visualized and documented. Some of these observed lesions appear to be capable of compromising the success of ET.

Catheterization↗

PubMed1982

Some aspects of equine embryo transfer.

The number of successful embryo recoveries was 56.0% in experimental mares with no history of breeding problems but in barren mares only 34.3% of embryo recovery attempts were successful. When a recovery attempt was successful, the incidence of twin embryos was 10.7% in experimental mares and 16.7% in barren mares. Maintenance of embryos in vitro for greater than 6 h before non-surgical transfer significantly reduced pregnancy rates compared to maintenance for less than 3 h. The pregnancy rate in recipients at 100 days after ovulation was lower (P less than 0.05) than those at 24 and 30 days after ovulation.

Aging↗

PubMed1990

The value of hysteroscopy in elderly women prior to in vitro fertilization-embryo transfer (IVF-ET): a comparative study.

Two hundred eighty-four hysteroscopies were performed in 312 (91%) candidates for in vitro fertilization and embryo transfer (IVF-ET) who were divided into two groups. Group I consisted of elderly women over 40 years, and group II of women below this age. Although visualization revealed uterine abnormalities in 29.9% of all patients, abnormal findings were significantly increased in the former group in comparison to the latter (P less than 0.001). This difference was attributed mainly to uterine rather than cervical pathology. Furthermore, in elderly women age-related uterine pathology such as submucous myomata, endometrial hyperplasia, and polyps were more prominent, while in younger patients other uterine lesions such as adhesions and tubal ostia occlusion were more common. Moreover, treatment prior to IVF-ET resulted in 7 clinical pregnancies (8.9%) in group I and in 41 clinical pregnancies (19.9%) in group II, all of which failed in one to three cycles previously. It seems that hysteroscopic evaluation may reduce the IVF-ET failure rate due to intrauterine abnormalities in elderly as well as young patients, thus it becomes an absolute prerequisite for all patients scheduled for an IVF program.

Adult↗

PubMed2005

Evaluation of closed adult nucleus multiple ovulation and embryo transfer and conventional progeny testing breeding schemes for milk production in tropical crossbred cattle.

The potential benefits of closed adult nucleus multiple ovulation and embryo transfer (MOET) and conventional progeny testing (CNS) schemes, and the logistics of their integration into large-scale continuous production of crossbred cattle were studied by deterministic simulation. The latter was based on F1 (Bos taurus x Bos indicus) production using AI or natural mating and MOET, and continuous F2 production by mating of F1 animals. The gene flow and the cumulative discounted expressions (CDES) were also calculated. Both schemes had 8, 16, 32, or 64 dams with 2, 4, 8, 16, or 32 sires selected. In the MOET nucleus scheme (MNS), the test capacity was 1, 2, 8, or 16 offspring, and the number of matings per dam per year was 1, 2, or 4. A scheme of 8 sires with 64 dams and a test capacity of 4 female offspring per dam per year resulted in an annual genetic gain (in phenotypic standard deviation) of 0.324 and 0.081 for MNS and CNS, respectively. In the MNS, there was substantial genetic gain with a relatively small number of animals compared with a CNS. The F1 had the highest, and the F2 scheme the lowest CDES. However, a very large number of B. indicus females would be required in the F1 scheme. This scheme may not be practical under conditions in developing countries. The F2 scheme was logistically attractive because it produces its own replacements, and the number of B. taurus females required would be easy to attain. Accompanying technical and financial constraints of nucleus schemes should be addressed before applying them.

Animals↗

PubMed2004

Best site for embryo transfer: the upper or lower half of endometrial cavity?

BACKGROUND: The objective of the present study was to determine the importance of the site of embryo transfer (upper or lower half endometrial cavity) on implantation and clinical pregnancy rates. METHODS: A total of 400 transfers guided by ultrasound were randomly assigned to two groups according to the distance between the uterine fundus and the catheter tip at the time of embryo placement. Group I (n = 200) consisted of transfers corresponding to a distance of < 50% of the endometrial cavity length (ECL), i.e. transfer in upper half of the cavity; and group II (n = 200) consisted of transfers corresponding to a distance of > or = 50%, of the ECL, i.e. transfer in lower half of cavity. The Student's t-test, Mann-Whitney test and Fisher's exact test were used where appropriate. RESULTS: The general characteristics of the study population and the main transfer cycle characteristics had an equal distribution (P > 0.05) between groups I and II. No significant difference in implantation or pregnancy rates was observed between groups I and II. CONCLUSION: The implantation or pregnancy rates were similar whether the embryos were deposited in the upper or lower half of the endometrial cavity.

Adult↗

PubMed1996

Microbial contamination in an in vitro fertilization-embryo transfer system.

OBJECTIVE: To determine sources and transmission of microorganisms in IVF-ET and efficacy of in-place controlling systems. DESIGN: Prospective study. SETTING: In Vitro Fertilization-Embryo Transfer Unit at a university teaching hospital. PATIENTS: Twenty-eight couples undergoing 30 completed IVF-ET cycles. INTERVENTIONS: Gamete and embryo processing in a penicillin and streptomycin-rich medium. MAIN OUTCOME MEASURES: Presence of microorganisms at various stages of IVF-ET. Fertilization, cleavage, and pregnancy rates. RESULTS: In 50% of cycles no microorganisms were isolated and in the other 50% microbes were cultured from various loci. Cultures of four preprocessed semen samples were positive and corresponding postprocessed samples negative. Microbes were detected in 27% of needle washes after oocyte collection; in 40% and 32% of follicular fluids from left and right ovaries, respectively; and in two culture media from egg-sperm incubations at 20 hours after insemination. No microorganisms were grown from media from zygote incubations. Fertilization, cleavage, and pregnancy rates were independent of microbial presence. CONCLUSION: Seminal fluid and transvaginally collected oocytes are potential sources of microbial contamination of the IVF-ET culture system. A penicillin- and streptomycin-rich culture medium is effective in removing contaminating microbes. End point measures are not affected by commensal contamination.

Culture Media↗