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PubMed1994

[The evaluation of the usefulness of ultrasound independent of estradiol as a prognostic criterion for ovular capture and maturity. A comparative double-blind study].

One hundred and twenty women were studied which had primary or secondary sterility, and underwent into the GIFT or IVF-ET program at the INPer. They were divided in two groups. Group I had 96 women in which only was taken in account the follicular development measured by vaginal ultrasound to decide continuation or cancellation, in this group estradiol serum levels determination was done, but it was not used for decision making; group II had 24 women in which estradiol was taken in account in addition with ultrasound. There were no differences in the number of follicles seen by ultrasound neither in the estradiol serum levels between the groups. Correlation coefficients between follicles seen by ultrasound and retrieved oocytes and mature oocytes, thus partial correlation coefficients for follicles seen by ultrasound plus estradiol serum levels and retrieved oocytes and captured oocytes were higher in group I in all days with the exception of day 10 in which they were similar. By the aforementioned in can be concluded that in this group of patients the ultrasound was the most reliable variable to give a quantitative and qualitative prognostic of oocyte retrieval.

Adolescent↗
PubMed1994

[Correlation between the time of application of chorionic gonadotropins and biological variables in the gametes].

The scheduled administration of human chorionic gonadotropin in the ovarian stimulation schemes used in Assisted reproduction has made possible to control the ovulatory phenomenon. In order to know the biological repercussion upon the ovule as to elapsed time from HCG and the time of capture, the protocols of Gametes Laboratory, were reviewed; there were 277 cases with this factor. The capture moment was from 32.88 to 41.06 hours from HCG administration, with an average of 36.8 +/- 1.01 hours. There was no significant statistical correlation with the total amount of captured oocytes, useful oocytes, defective oocytes (atresic, broken, degenerated) segmentation rate and embryonary quality. There was a positive, lineal, statistical correlation with the amount of post-mature oocytes (r = 0.35, p = 0.019) and negative with fertilization rate (r = -0.30, p = < 0.0001), both without a correlation among themselves. It was concluded that prolonged time between HCG exposition more than difficulting oocyte capture, negatively affects oocyte quality with a diminution in its possibility of being fertilized. It must be found the optimal window that permits easily obtaining the larger amount of oocytes with the best possibilities of originating healthy pre-embryos.

Chorionic Gonadotropin↗
PubMed1994

[Obstetrical analysis of pregnancies obtained by GIFT or FIV at the National Institute of Perinatology].

The obstetrical outcome of 47 pregnancies which was achieved by assisted reproduction techniques was analyzed. 38 were achieved by GIFT and 9 by IVF-ET. In both series we found that the analyzed parameters are similar to those described by other groups. But in discordance with Angle-Saxon groups, in Latino-American series the principal delivery way was by cesarean section.

Apgar Score↗
PubMed1994

[Functioning conditions of laboratories dealing with cryopreservation of human pre-embryos].

The authors discuss about the functional conditions of the Human Reproductive Laboratories dealing with the cryopreservation of the human preembryos. They determine the safety specifications and recommend documentation of the cryopreservation based on their own practice. Finally they suggest the licensing-controlling system of the Human Reproductive Laboratories concerning cryopreservation of the human preembryos.

Cryopreservation↗
PubMed1993

The effect of coculture on human zygote development.

It is well over a decade since the birth of the first test-tube baby and still the in-vitro conditions for early embryonic development remain suboptimal. The ideal culture medium to increase longevity and improve viability of human embryos is not available. Since the metabolic requirements of the human embryo changes from one cleavage stage to another, the development of a single culture medium for all stages could not be expected. The use of helper cells (coculture) in vitro offers much promise as there are numerous documentations in both man and animals describing their ability to increase blastulation rates and improve embryo viability. This paper reviews the effect of coculture on human zygote development. The selection and establishment of cell-lines, biologic actions of coculture of gametes and zygotes, the outcome, and future prospects are discussed.

Cell Line↗
PubMed1993

Delayed birth intervals of immature fraternal triplets in preterm labor. A case report.

The preterm birth of immature triplets before 28 weeks is associated with excess morbidity and mortality risks attributable to extreme immaturity. We report a case of fraternal triplets in preterm labor in which the second and third triplet births were delayed 11 days after the first birth, at 26 4/7 weeks' gestation. The later-born sibs were heavier at birth and throughout their neonatal course in the hospital and suffered less severe complications as compared to the first-born triplet. Delayed birth intervals of triplets in preterm labor should be considered to improve perinatal salvage of immature triplets, although a successful outcome is rare and unexpected.

Adult↗
PubMed1993

[The functional ovarian reserve in assisted reproduction. A clinical dilemma].

The response to supraphysiological ovarian stimulation in Assisted Reproduction (particularly FIV-TE and GIFT) may be very heterogeneous, despite the fact that selected patients have clinical and paraclinical characteristics very homogeneous. Highly significant differences, were found, in two groups of patients with similar clinical characteristics, who were stimulated with the same scheme. Group I (Adequate response = 22 patients) and Group II (Inadequate response = 13 patients), regarding to basal seric levels of FSH (P = 0.007) and to quality of follicular response (P = 0.000). These results suggest that quality of response to supraphysiological ovarian stimulation, may reflect a "Functional ovarian reserve" and that this can be predicted (partially) with basal seric levels of FSH; but, may be, the inadequate response, paradoxical to certain point, would not represent an ovarian failure or a resistant ovarian syndrome, incipient or transitory during the reproductive age?

Adult↗
PubMed1993

Why are couples satisfied with infertility treatment?

OBJECTIVE: To determine which factors relate to satisfaction with infertility treatment. DESIGN: A prospective structured interview research design was used. SETTING: In-person and telephone interviews were conducted. PARTICIPANTS: Wives and husbands from 185 couples in southeastern Michigan with primary infertility were studied. MAIN OUTCOME MEASURES: There were two main outcome measures: how satisfied people were with the infertility treatment they received and why they were satisfied. RESULTS: Both men and women were satisfied with the infertility treatment they had received. The most frequently mentioned reasons for satisfaction were the technical skills and the emotional support of infertility specialists. Both men and women advised infertility specialists to be compassionate and share information with their patients. Spouses' satisfaction with treatment was the greatest predictor for both men and women. For men, using escape as a coping skill was a negative predictor for treatment satisfaction. For women, personal control and the number of infertility treatments received were other predictors for treatment satisfaction. CONCLUSIONS: As hypothesized, a variety of psychosocial factors were related to treatment satisfaction. Contrary to expectation, treatment costs and how long respondents had been trying to have a child were not related to treatment satisfaction. This study's results suggest that physicians and their staff should pay particular attention to their patients' emotional needs, to their patients' understanding of procedures explained to them, to discussing adoption with their patients, to involving men more in the infertility treatment, and to assisting women to have more control over their course of treatment.

Adaptation, Psychological↗
PubMed1996

[Surgical therapy of obstructive azoospermia: microsurgery].

Microscopic procedures for therapy of obstructive azoospermia or of vasectomy reversals have resulted in accurate reapproximation of ductal structures. The success of vasovasostomy appears to be influenced by the length of time that has passed since the vasectomy was performed or the obstruction become. Failures of vasovasostomy may be attributed to anastomotic stenosis, sperm antibodies, epididymal dysfunction, or an unrecognized epididymal tubule blowout with subsequent obstruction. The latter condition should by suspected when, at the time of the initial vasovasostomy, there is lack of fluid containing spermatozoa in the cut end of the testicular portion of the vas. Chronic intratubular pressure may cause an epididymal blowout, with subsequent spermatic granuloma and obstruction in the epididymal tubule, that may also be related to a congenital disorder or a postinflammatory condition. Spermatozoa gain maturation and the capacity for motility as they move from the caput to the cauda of the epididymis as possible. Microsurgery allows direct microtubular anastomosis between the epididymal tubule and the cut end of the vas. Some conditions are not amenable to conventional surgical techniques, such obstructed azoospermia due to congenital bilateral absence of the vas deferens or to severe damage to the reproductive ducts. To treat these patients surgeons have devised reservoirs (artificial spermatoceles) to collect spermatozoa to be used for artificial insemination. An alternative treatment method for obstructed azoospermia is to obtain sperm from the epididymis with the use of an operating microscope. Although sperm have been obtained the poor sperm motility requires either in vitro fertilization or GIFT. The technique looks promising, although improved techniques to enhance the motility of the collected sperm will ultimately yield better results.

Epididymis↗
PubMed1994

Transvaginal embryo transfer during the zygote intrafallopian tube transfer procedure.

OBJECTIVE: Our purpose was to evaluate a tactile non-ultrasonographically directed approach to transvaginal tubal cannulation and embryo transfer during the zygote intrafallopian tube transfer procedure. STUDY DESIGN: We studied the application of the tactile approach to transvaginal tubal cannulation and embryo transfer in 68 consecutive zygote intrafallopian tube transfer cycles. RESULTS: The tactile approach to transvaginal tubal cannulation and subsequent embryo transfer was successful in 93% of couples. Pregnancy occurred in 16 of the 63 (25%) women undergoing a successful transvaginal embryo transfer. CONCLUSION: The tactile approach to transvaginal tubal cannulation was found to be easily learned and provided a safe and convenient method of tubal embryo transfer. This low-cost approach, which has application to transfer of both embryos and gametes, deserves further study.

Catheterization↗
PubMed2004

Number of transferred embryos: how to reduce multiple pregnancies.

Because the diagnostic tools for predicting whether an early cleavage stage embryo can lead to a viable pregnancy are still elusive, transfer of more than one embryo remains quite common. However, the only way to reduce multiple pregnancies, considered as the main adverse effect of assisted reproductive technology, is to transfer a single embryo. In countries such as Switzerland and Germany, the law allows cryopreservation only at the 2-pronuclear stage. This restricts considerably the possibility of selecting the embryos to be transferred. Therefore, a good cryopreservation program at the 2-pronuclear stage is an essential tool to optimize the efficiency of in vitro fertilization (IVF). We therefore recommend the Cumulated Singleton Delivery Rate (CUSIDERA) as a measure of standard IVF efficiency. This rate averages approximately 23.5% when calculated over the last 10 years in our unit and reaches a value above 35% for patients with more than 10 zygotes. Elective single-embryo transfers and the decrease of iatrogenic multiple pregnancies in IVF remain dependent on better prognostic tools for the appropriate selection of patients, gametes, and zygotes.

Cryopreservation↗