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PubMed2006

The obstetrical and neonatal outcome of babies born after single-embryo transfer in IVF/ICSI compares favourably to spontaneously conceived babies.

BACKGROUND: Recently, concern has risen about poor obstetrical and neonatal outcome of singletons after IVF/ICSI. Because the population of patients receiving single-embryo transfer (SET) resulting in singleton pregnancies is different from the one that would have become pregnant (with a singleton) before SET was introduced, we wanted to investigate whether the outcome of singleton pregnancies after SET differed from spontaneously conceived singletons. METHODS: The obstetrical and early neonatal outcome of all pregnancies originating from SET after IVF/ICSI procedures between 1 January 1998 and 31 December 2003, was prospectively collected and analyzed. RESULTS: Data from 251 singleton pregnancies and births after SET were analyzed and compared to data from 59,535 spontaneously conceived singletons retrieved from the Centre for Perinatal Epidemiology. The mean birthweight of the singletons after SET was 3322 g (+/-538 SD) versus 3330 g (+/-531 SD) for the spontaneously conceived singletons (P = 0.82). The mean gestational age was 38.7 weeks (+/-1.9 SD) for SET and 38.9 weeks (+/-1.8 SD) for spontaneously conceived singletons (P = 0.06). The proportion of very preterm birth (<32 weeks) was 0.8% in each group, and the proportion of preterm birth (<37 weeks) was 10.0% for SET singletons and 6.24% for spontaneous singletons (P = 0.03). However, mean birthweight of very preterm, preterm and term SET singleton babies was similar to the mean birthweight in every category of gestational age in the spontaneous conceived control group. Stillbirth was 0.4% for both populations (P = 0.99). CONCLUSIONS: Good prognosis patients, in whom SET is applied, do not only have a higher chance of conception but do not have an unfavourable outcome of their singleton baby when compared to spontaneous singletons.

Adult↗

PubMed1988

The efficiency of human reproduction after in vitro fertilization and embryo transfer.

Two hundred ninety-seven nonpregnant patients were used to study the possibility of early transient implantation as a parameter of the efficiency of in vitro fertilization (IVF) procedures. Ten patients without embryo transfer (ET) were used as controls. The luteal estradiol, progesterone, and human chorionic gonadotropin were measured by radioimmunoassay (RIA). In 31 cases, a transient elevation of hCG occurred after complete serum clearance of exogenous hCG, suggesting that the transient increase in hCG was of embryonic origin. In addition, five patients were found to have prolonged clearance of hCG, which was due not to individual variation in clearance, but to a minimal production of hCG by trophoblastic tissue. These data suggest that implantations occurred in 12.1% of our so-called "nonpregnant" patients.

Chorionic Gonadotropin↗

PubMed1984

[Personal experience with in vitro fertilization and embryo transfer].

The causes of sterility could be better characterized in 49 so called complex laparoscopies with estimation of sperm ascension and extraction of oocytes following hormonal stimulation. Oocytes could be obtained in sterility operations. They have been fertilized and transferred into the tubes, with the result of 2 pregnancies after 49 such procedures. Up to now there is no late pregnancy after 115 in vitro fertilizations and 53 embryo transfer into the uterus.

Embryo Transfer↗

PubMed1994

The poor-responder patient in an in vitro fertilization-embryo transfer (IVF-ET) program.

The purpose of this article is to review the methods and evaluate the 'avenues' that are open to patients and physicians in their search for improvement of in vitro fertilization-embryo transfer (IVF-ET) treatment results. The option of egg donation, although very important and viable in the treatment of poor responders, is not described here.

Embryo Transfer↗

PubMed2003

A case of pregnancy complicated by the development of a tubo-ovarian abscess following in vitro fertilization and embryo transfer.

Tubo-ovarian abscess is an uncommon complication in pregnant women. In this report, we present a patient who developed a tubo-ovarian abscess during pregnancy following in vitro fertilization and embryo transfer (IVF-ET). Despite treatment with intravenous antibiotics she delivered at 22 weeks of gestation. After delivery, she underwent a left salpingo-oophorectomy. Review of the literature revealed only 26 reported cases of tubo-ovarian or pelvic abscess during pregnancy. Pelvic inflammatory disease, previous laparotomy, and structural genital anomalies are known risk factors for pelvic abscess during pregnancy. Pelvic abscess resulting as a complication of vaginal oocyte retrieval has been reported. Therefore, although enabling women with organic pelvic disease such as endometriosis and hydrosalpinx to achieve pregnancy, assisted reproductive techniques may potentially result in pelvic infection during pregnancy. This case suggests that a preconception evaluation and treatment for such conditions should be considered for women undergoing treatment for infertility.

Abscess↗

PubMed1999

Serum progesterone before and after human chorionic gonadotropin injection depends on the estradiol response to ovarian hyperstimulation during in vitro fertilization-embryo transfer cycles.

PURPOSE: Our purpose was to assess if periovulatory serum progesterone is reflective of ovarian responsiveness in controlled ovarian hyperstimulation (COH). METHODS: One-hundred forty-two in vitro fertilization-embryo transfer cycles in women using GnRH-a suppression and human menopausal gonadotropin (hMG) stimulation were evaluated. Responses were studied according to ovarian response to hMG and age. Outcome measures included peak serum estradiol, serum progesterone and estrogen/progesterone ratios on the day of hCG injection, number of harvested oocytes, fertilization rates, and delivered pregnancy rates. RESULTS: A periovulatory rise in serum progesterone (> 0.9 ng/ml) occurred only among younger women (< 40 years old) with a good response (P < 0.05). Though the number of oocytes was greater in good responders, fertilization and pregnancy rates were similar among all women regardless of age and ovarian response. CONCLUSIONS: Periovulatory levels of serum progesterone vary according to ovarian response to COH. Elevations in progesterone do not appear to be a manifestation of poor responders. Reduced periovulatory progesterone may reflect inadequate steroidogenesis.

Adult↗

PubMed1984

Organization and computerized analysis of in vitro fertilization and embryo transfer programs.

The in vitro fertilization experience of one of the earliest successful programs is presented based on three different center types: (I) large hospital-university, (II) private gynecological office, and (III) egg-embryo transfer from and to centralized laboratory. A computerized analysis of systems I and II for 1982 is presented. No statistically different results were found between system I and system II. System III was abandoned because of unsatisfactory results.

Adult↗

PubMed1997

A comparison of early gestational age markers in viable twin pregnancies resulting from in vitro fertilization-embryo transfer versus spontaneous conception with ovarian stimulation.

The objective of this study was to determine whether there were differences in gestational age markers in dizygotic twin pregnancies resulting from in vitro fertilization-embryo transfer (IVF-ET) when compared with dizygotic twin pregnancies spontaneously conceived following ovulation inducing therapy drugs without assisted reproductive techniques (ART). Thirty-one sets of twins conceived by IVF-ET and 33 sets of twins conceived without ART were monitored by serum beta human chorionic gonadotropin (B-hCG) levels and transvaginal sonographic measurements of sac size (SS) and crown-rump length (CRL). Comparison between groups found that SS was significantly smaller in the IVF-ET group as compared to the non-ART group 21-35 days post-ovulation (p < .05). The CRL was similar in both groups as well as the doubling times of B-hCG. These data indicate that in dizygotic twin pregnancies initial development of SS may be slower following IVF-ET than in spontaneously conceived twins.

Adult↗

PubMed1986

The effect of recipient age on the success of embryo transfer in mice.

Eight-hundred-sixteen morulae and blastocysts were transferred to the uteri of 102 recipients of various ages on Day 3 or 4 of pseudopregnancy (Day 1 is the day of the vaginal plug). Day 3 recipients had significantly higher pregnancy rates and embryo survival rates than Day 4 recipients. Recipient age had little effect on pregnancy rates, but had a significant effect on embryo survival in Day 3 recipients. Day 3 recipients of 11-13 weeks of age had the highest pregnancy rate (100%) and embryo survival (75%). The results suggest that recipient age should be considered an important factor in embryo transfer experiments.

Age Factors↗

PubMed1994

Microinjection: choice of embryo transfer technique.

Subzonal sperm microinjection (SUZI) is indicated in severe oligoasthenozoospermia, in which the total count of motile sperm is inadequate for in vitro fertilization (IVF), and in cases with repeated failure of fertilization. Sperm for microinjection are selected following centrifugation on a Percoll gradient and stimulation with pentoxifylline and 2-deoxyadenosine. Motile sperm (2-10 per egg) are injected into the perivitelline space and fertilized oocytes are then cultured for two days prior to transfer into the Fallopian tube (tubal embryo stage transfer, TEST) or uterus. During 1992, SUZI results showed a total fertilization rate of 30% (19% were 2 pronuclear, 11% were polyspermic), a transfer rate of 55% and pregnancy rates of 15.2% per transfer and 8.3% per cycle. Recent pregnancy data in mild-moderate male factor infertility showed that gamete intrafallopian transfer (GIFT) results were consistently superior to TEST or IVF, suggesting a beneficial effect of the tubal environment on fertilization and early embryonic development. Accordingly, the combination of SUZI followed by the immediate transfer of injected oocytes into the Fallopian tube, the MIFT procedure, was explored. An initial study of 21 consecutive microinjection candidates showed a clinical pregnancy rate of 24% per cycle. Information regarding fertilization and polyspermy rates was available from supernumerary oocytes in 90% of patients. A randomized, controlled trial comparing MIFT with SUZI or TEST in severe male factor infertility is required to confirm the improved pregnancy rate in MIFT cycles.

Embryo Transfer↗

PubMed2006

Effect of the time interval between fusion and activation on nuclear state and development in vitro and in vivo of bovine somatic cell nuclear transfer embryos.

This study indicated that prolonged exposure of donor cell nuclei to oocyte cytoplasm before activation results in abnormal chromatin morphology, and reduced development to compacted morula/blastocyst stage in vitro. However, after transfer of embryos to recipients, there was no difference in pregnancy rates throughout gestation. Chromatin morphology was evaluated for embryos held 2, 3, 4 and 5 h between fusion and activation. In embryos held 2 h, 15/17 (88.2%) embryos contained condensed chromosomes, while only 12/24 (50.0%) embryos held 3 h exhibited this characteristic. The proportion of embryos with elongated or fragmented chromosomes tended to increase with increased hold time. While 15/19 (78.9%) of embryos held 2 h developed a single pronucleus 6 h after activation, only 8/22 (36.4%) had one pronucleus after a 4-h hold. Embryos held 1.0, 1.5, 2.0, 2.5, 3.0, 3.5 and 4.0 h cleaved at rates of 207/281 (73.7%), 142/166 (85.5%), 655/912 (71.8%), 212/368 (57.6%), 406/667 (60.9%), 362/644 (56.2%) and 120/228 (52.6%) respectively. Further development to compacted morula/blastocyst stage occurred at rates of 78/281 (27.8%), 42/166 (25.3%), 264/912 (28.9%), 79/368 (21.5%), 99/667 (14.8%), 94/644 (14.6%) and 27/228 (11.8%) respectively. Embryos held less than 2.5 h between fusion and activation established pregnancies in 18/66 (27.3%) of recipients, while embryos held over 2.5 h established pregnancies at a rate of 17/57 (29.8%). This study indicates that holding bovine nuclear transfer embryos less than 2.5 h between fusion and activation results in improved nuclear morphology and increased development to compacted morula/blastocyst stage, and results in pregnancy rates equivalent to embryos held over 2.5 h.

Animals↗

PubMedDate not supplied

First established pregnancy and birth after induction of ovulation with recombinant human follicle stimulating hormone during in vitro fertilization-embryo transfer and intracytoplasmic sperm injection.

This case report describes the first established pregnancy and birth in the Philippines after induction of ovulation with recombinant follicle stimulating hormone (rec FSH) during In Vitro Fertilization-Embryo Transfer (IVF-ET) and Intracytoplasmic Sperm Injection (ICSI) in a Filipino woman with pelvic endometriosis who underwent right oophorectomy for endometrioma 1 year prior to IVF-ET and ICSI. Husband's semenalysis revealed adequate volume with 10% normal forms. Gonadotrophin releasing hormone agonist (Lupron) 375 mg subcutaneous was given for 2 cycles. 100 IU B.I.D. (a total of 2200 IU) of rec FSH was administered intramuscularly daily with single preovulatory follicle seen upon transvaginal ultrasonographic examination of 10,000 IU of human chorionic gonadotrophin, after which a viable singleton pregnancy was revealed at a gestational age of 8 weeks. The course of pregnancy until term was uneventful and ended with abdominal delivery at a gestational age of 37.3 weeks secondary to poor Fetopelvic Index with oligohydramnios. A healthy girl was born and pediatric examination did not demonstrate any abnormality.

Asia↗

PubMed1986

Failure of implantation in human in vitro fertilization and embryo transfer patients: the effects of altered progesterone/estrogen ratios in humans and mice.

Daily blood samples were taken for progesterone (P) and estradiol (E2) measurements from women who showed a platelet response consistent with the presence of viable embryos after in vitro fertilization and embryo transfer procedures. A comparison of steroid levels between those women who became pregnant and those who did not revealed the following: at and after the time of transfer, women who failed to become pregnant had significantly higher E2 levels and a lower ratio of P/E2 than women who became pregnant. The P/E2 ratio was a better predictor of implantation failure than was the absolute level of either hormone. Experiments were done in mice to test the hypothesis that P could protect implantation of the embryo against the inhibitory effects of high E2. In mice, implantation was inhibited by relatively high levels of E2. This effect was overcome by concomitant administration of P. There was a significant dose-response-related interaction of P with the E2.

Animals↗

PubMed1983

Evidence for maternal control of blastocyst growth after asynchronous transfer of embryos to the uterus of the ewe.

The fate of embryos transferred asynchronously in the ewe was investigated when the functional life of the corpus luteum was prolonged by both hemi-hysterectomy and by the presence of a second synchronously transferred embryo. The development of asynchronously transferred embryos was assessed at progressively later stages after transfer. Prolongation of luteal function did not enable asynchronously transferred embryos to persist. Embryos from Day 4 donors were found to be retarded in their rate of development when placed in 'younger' Day 1 or 2 uteri and appeared unable to develop beyond the early blastocyst stage. Conversely, embryos from Day 4 donors placed in 'older' Day 6 or 7 uteri showed accelerated growth and development which was maintained until the uterus reached Day 12. Thereafter further growth of the asynchronously transferred embryos was retarded, although synchronously transferred embryos then entered the phase of rapid blastodermic vesicle elongation. Asynchronously transferred embryos disappeared from the uterus when the ewe entered pro-oestrus. The experiments demonstrate the existence of an active relationship between the embryo and the maternal environment during mid-cycle and an apparent lack of association between embryo size, growth rate and physiological maturation.

Animals↗

PubMed1992

The effect of 17 alpha-hydroxyprogesterone caproate/oestradiol valerate on the development and outcome of early pregnancies following in vitro fertilization and embryo transfer: a prospective and randomized controlled trial.

A prospective and randomized study was performed to investigate the effect of supportive hormones on the development and outcome of early pregnancies following in vitro fertilization and embryo transfer. Immediately after pregnancies were confirmed endocrinologically on day 15 after oocyte collection, 17 alpha-hydroxyprogesterone caproate and oestradiol valerate (PC/EV) was administered to half of the patients in a randomly controlled trial. One group received supportive treatment until the twelfth week of gestation, whereas the other group received no treatment at all. Both groups were followed up by measurements of serum levels of human chorionic gonadotrophin (HCG), oestradiol and progesterone every three days until day 35, when a first ultrasound examination was carried out to confirm fetal vitality. Subsequently, pregnancies were monitored sonographically at regular intervals. In cases of miscarriage, dilatation and curettage was performed and histology analysed. A total of 120 pregnant patients entered the study: 55 of them received hormone treatment and 65 patients were controls. Within the treatment group 48 (89%) clinically ongoing pregnancies were observed, five (9%) miscarriages occurred after the seventh week of gestation and one preclinical pregnancy was noted. In the control group, 38 (59%) ongoing pregnancies were observed, nine (14%) miscarriages occurred and 17 (27%) preclinical pregnancies were recorded. Two ectopic pregnancies, one in each group, were excluded from evaluation. A significantly higher percentage of pregnancies were intact at 7 weeks of gestation after treatment with PC/EV (p less than or equal to 0.01).

17 alpha-Hydroxyprogesterone Caproate↗

PubMed2005

T-helper 2 and 3 type immunity to trophoblast in successful in vitro fertilization-embryo transfer.

OBJECTIVE: To determine whether peripheral blood mononuclear cell (PBMC) secretion of T-helper (Th)-1 type cytokines and Th-2 and Th-3 type cytokines in women undergoing in vitro fertilization-embryo transfer (IVF-ET) is associated with therapeutic failure and success, respectively. DESIGN: Cohort study. SETTING: Academic medical center. PATIENT(S): One hundred one women undergoing IVF-ET and 19 fertile controls. INTERVENTION(S): Peripheral blood was obtained from women undergoing IVF-ET before oocyte retrieval and from 19 nonpregnant fertile controls. The PBMCs were cultured in the presence or absence of a protein extract from either a trophoblast cell line or sperm membrane. MAIN OUTCOME MEASURE(S): Supernatants from PBMC cultures were tested by enzyme-linked immunoabsorbent assay (ELISA) for the Th-1 type cytokines tumor necrosis factor-alpha (TNF)-alpha) and interferon-gamma (IFN)-gamma), the Th-2 type cytokines interleukin (IL)-6 and IL-10, and the Th-3 type cytokine transforming growth factor (TGF)-beta1. RESULT(S): Levels of IL-6 and IL-10 were significantly higher in controls than in infertile women with endometriosis, and levels of IL-10 were higher in controls than in women with unexplained infertility. No differences were found in unstimulated levels of TNF-alpha, IFN-gamma, or TGF-beta1 between infertile patients and controls. In trophoblast-stimulated PBMC cultures, levels of TGF-beta1 were significantly lower in subjects who experienced failed compared with ongoing pregnancies. CONCLUSION(S): Baseline PBMC secretion of IL-6 and IL-10 is higher in fertile controls than in women with endometriosis, and IL-10 secretion is also higher than in women with unexplained infertility. Trophoblast-stimulated PBMC secretion of TGF-beta1 is positively associated with the establishment of successful pregnancy in women undergoing IVF-ET. Our study provides novel evidence to support a faciliatory role of Th-2 and Th-3 type responses to trophoblast in early pregnancy.

Analysis of Variance↗

PubMed1987

Transvaginal and transabdominal ultrasound for monitoring of follicular development in an in vitro fertilization and embryo transfer program: patient response.

Patients' response to daily ultrasound scanning by either a transvaginal or a transabdominal method for the purpose of monitoring the ovarian response to gonadotropin therapy in an in vitro fertilization and embryo transfer program has been evaluated. A questionnaire was used to determine various aspects of these two procedures, sources of discontent, and the patients' preference. The vast majority of patients reported less discomfort and generally preferred the transvaginal over the transabdominal scanning method. The transvaginal method is easy to perform, affords excellent visualization of the pelvic organs, and in addition, is clearly preferred by patients over the transabdominal technique. We recommend its use in patients monitored for IVF-ET and for a variety of other clinical conditions requiring detailed evaluation of the pelvic organs.

Abdomen↗

PubMed2001

Fresh embryo transfer is more effective than frozen for donor oocyte recipients but not for donors.

BACKGROUND: Recipients of donor oocytes need to be synchronized to the donor's cycle if fresh embryos are to be transferred on the cycle of oocyte retrieval. It would be much easier to merely retrieve the oocytes from the donor, fertilize the oocytes with the recipient's male partner's spermatozoa, cryopreserve the embryos, then transfer on an oestrogen/progesterone treatment programme. METHODS: The IVF outcomes of all patients enrolled in a shared oocyte programme from January 1997 to June 1999 were reviewed. Pregnancy and implantation rates were computed and statistically analysed. RESULTS: There was a significantly higher clinical pregnancy rate for recipients who had a fresh embryo transfer compared with recipients whose first embryo transfer consisted of frozen/thawed embryos (63.4 versus 43.6%). CONCLUSIONS: Conception is more likely after fresh than frozen embryo transfer with recipients but is similar to donor conception rates. If a uterine defect, per se, even without the use of the controlled ovarian stimulation regimen, could explain the difference between fresh pregnancy and implantation rates in donors versus recipients, then these same differences would have been seen when comparing frozen transfers, but they were, in fact, similar.

Adult↗