A. Nazari

Increased endometrial thickness on the day of human chorionic gonadotropin injection does not adversely affect pregnancy or implantation rates following in vitro fertilization–embryo transfer

OBJECTIVES To investigate the controversy whether an increased endometrial thickness has an effect on pregnancy, implantation, or abortion rates in in vitro fertilization-embryo transfer (IVF-ET) cycles. DESIGN Retrospective analysis. SETTING A university-based IVF center. PATIENT(S) Five hundred seventy women under the age of 40. INTERVENTION(S) Measurements of endometrial thickness on day of human chorionic gonadotropin (hCG) administration. Cycles were compared by endometrial thickness of </=14 mm in 510 women to a thickness of >14 mm in 60 women. MAIN OUTCOME MEASURE(S) Implantation, pregnancy, and abortion rates. RESULT(S) Implantation, pregnancy, and abortion rates were similar in each group. In cycles where the endometrial thickness was </=14 mm, the rates were 20.9%, 43.1%, and 11.8% compared with 25.5%, 48.3%, and 13.8% in cycles >14 mm. CONCLUSION(S) No adverse effects of a thickened endometrium were demonstrated on implantation, pregnancy, or abortion rates in the first IVF-ET cycle. These findings fail to corroborate with those of Weissman et al. and support those of Yakin et al.

The effect of assisted hatching on pregnancy rates after frozen embryo transfer

OBJECTIVE To compare clinical pregnancy and implantation rates after transfer of frozen-thawed embryos prepared according to an assisted hatching protocol or a nonassisted hatching protocol. DESIGN A historical cohort study in which a cohort of patients who underwent an assisted hatching protocol was matched for clinical parameters to an external historical cohort treated before assisted hatching was available. SETTING In vitro fertilization-ET facility of a university-based practice. PATIENTS Seventy-nine matched pairs. INTERVENTIONS Nonassisted hatching patients: embryos were thawed, cultured in human tubal fluid + 0.5% bovine serum albumin until 48 hours and transferred. Assisted hatching patients: embryos thawed, cultured in human tubal fluid + 10% synthetic serum substitute until 72 hours, had assisted hatching and transferred. MAIN OUTCOME MEASURES Clinical pregnancy (gestational sac) and implantation rates. RESULTS Twelve (15.2%) clinical pregnancies per transfer in nonhatched group versus 24 (30.4%) in hatched group. Nonhatched group: 284 embryos transferred; 15 (5.3%) implanted. Three pregnancies (25.0%) had two sacs. Hatched embryos: 269 were transferred; 37 (13.7%) implanted. Eleven pregnancies (45.8%) were multiple gestations (9 twins, 2 triplets). CONCLUSION Clinical pregnancy and implantation rates were higher for group having assisted hatching protocol. It is not clear whether the improvement is due to the overall methodology change or to assisted hatching. Assisted hatching using the zona-drilling technique is not detrimental to frozen-thawed human embryos and may be beneficial.

A matched study to determine whether low-dose aspirin without heparin improves pregnancy rates following frozen embryo transfer and/or affects endometrial sonographic parameters.

Purpose:The objective of the matched, controlled study was to determine whether low-dose aspirin therapy without heparin improves pregnancy rates following frozen embryo transfer.Methods:Thirty-six women who did not achieve a pregnancy following fresh embryo transfer and who had frozen embryos available for another transfer were included. Eighteen women were treated with 81 mg aspirin from day 2 of the cycle through pregnancy testing. If the β-human chorionic gonadotropin level was positive, aspirin was continued through the pregnancy. Eighteen women were not given aspirin. The mean outcome variables were pregnancy and implantation rates.Results:The clinical pregnancy rate in the aspirin group was 11.1%, compared with 33.3% for the controls, and implantation rates were 2.9 and 10.9%, respectively.Conclusions:No positive effects of low-dose aspirin therapy on pregnancy rates following frozen embryo transfer were observed.

Correlation of Computerized Semen Analysis with Successful Fertilization of Oocytes in an in Vitro Fertilization Program

Sixty-nine couples enrolled in 123 in vitro fertilization-embryo transfer cycles were categorized by percentage fertilization; the results of categorization were compared with those of computerized semen analysis carried out with the CellSoft semen analyzer. Four groups were established: group 1 had 75% fertilization or greater; group 2 had 34% to 74% fertilization; group 3 had 1% to 33% fertilization; and group 4 had 0% fertilization. Statistical differences in certain semen parameters (motility, linearity, and straight-line velocity) were found comparing groups 1 and 3 using the initial ejaculate. A significant number of patients in group 1 had all normal semen parameters, but no statistical difference could be found in group 3 or 4 because of variations in specific abnormal parameters in the groups. When the straight-line velocity-motile density (SLVMD) calculation was used, a significant difference was seen between group 1 and group 3 and between group 1 and group 4 (p less than 0.01); 65% of group 3 and 76% of group 4 had an abnormal SLVMD. SLVMD is a useful calculation to predict fertilization rates in vitro from the initial ejaculate.

SPERM EXTRACTED AND CRYOPRESERVED FROM TESTES SEVERAL HOURS AFTER DEATH RESULTS IN PREGNANCY FOLLOWING FROZEN EMBRYO TRANSFER: CASE REPORT

A 38-year-old male died suddenly on his honeymoon. Sperm was extracted from his testes 3 h following his death and cryopreserved. His wife had in vitro fertilization (IVF) and the eggs were inseminated by intracytoplasmic sperm injection (ICSI). None of the sperm were motile. Selection was based on softness and pliability. There were 4 embryos formed that cleaved, but only 2 were transferred on the retrieval cycle. The wife failed to conceive, but then had a second transfer of the 2 cryopreserved embryos. She achieved a chemical pregnancy with the beta-human chorionic gonadotropin level attaining a maximum level of 107 mIU/mL (rising from 19 mIU/mL). Though this retrieval cycle did not result in a successful pregnancy the achievement of a clinical pregnancy following frozen embryo transfer at least provides cautious optimism for other cases with similar conditions.

Comparison of Efficacy of High-Dose Pure Follicle-Stimulating Hormone versus Human Menopausal Gonadotropins for in vitro Fertilization

The advent of recombinant DNA technology will soon produce for the market a product that has pure follicle-stimulating hormone (pFSH) but no luteinizing hormone. A prospective randomized study was performed to see if pFSH (Metrodin) was able to stimulate the same in vitro fertilization parameters as human menopausal gonadotropin when preceded by gonadotropin suppression by leuprolide acetate. The results showed similar parameters between the two drugs, i.e., number of oocytes, number of embryos, endometrial thickness at time of human chorionic gonadotropin, fertilization rates and pregnancy rates in a protocol purposely designed to stimulate as many follicles as safely as possible because of a shared oocyte and successful cryopreservation program.

Pregnancy after zona drilling of cryopreserved thawed embryos: case report

OBJECTIVE To confirm successful implantation of IVF, cryopreserved human embryos after assisted hatching with acidic Tyrodes solution. DESIGN Case report. SETTING In vitro fertilization-ET facility of a university-based practice. PATIENT A 28-year-old female with nonoperable bilateral tubal occlusion and > 1 1/2 years of primary infertility. INTERVENTIONS The patient was stimulated for egg retrieval after an hMG-controlled ovarian hyperstimulation regime. Luteal phase leuprolide acetate (1 mg) was administered SC for 10 days. The dose was then reduced to 0.5 mg, and she was given hMG and FSH IM twice daily until two lead follicles reached 20 mm average diameter. The patient was administered 10,000 IU hCG 36 hours before retrieval. MAIN OUTCOME MEASURES Viable pregnancy documented by ultrasound (US). RESULTS After the transfer of five cryopreserved-thawed human embryos that were subjected to assisted hatching using acidic Tyrodes solution, the patient established a triplet gestation as documented by US. CONCLUSION This case report demonstrates that zona drilling can be successfully applied to frozen-thawed pronuclear stage embryos that were cultured to 72 hours without damaging them, as evidenced by continued cleavage and resulting implantation.

A comparison of pregnancy and implantation rates following embryo transfer (ET) after in vitro fertilization (IVF) with oocytes donated by paid donors versus infertile women sharing their oocytes

Conclusions: A statistically significant difference between the two groups for number of blastocysts formed and the number of embryos cryopreserved would seem to indicate that conventionally inseminated embryos result in more high quality blastocysts (as to meet the standards necessary for cryopreservation). This finding is consistent with the published literature, and is probably an impact of severe male factor cases. However, a statistically significant difference between the two groups for hatching rate seems to indicate that ICSI-inseminated embryos might benefit from customary use of assisted hatching techniques, yet virtually identical pregnancy rates and spontaneous abortion rates between the two groups do not seem to indicate the implementation of this practice. An analysis of the use of AH techniques in these cases may provide a useful complement to this study. Supported by: N/A.

A study to determine if certain sonographic uterine parameters are associated with multiple gestation

The objective was to determine if lower uterine artery vascular impedance is associated with a greater likelihood of multiple gestation. Color Doppler parameters of pulsatility index, resistance index, endometrial thickness and echo patterns were measured in oocyte/retrieval cycles on days of human chorionic gonadotropin injection, oocyte retrieval, and mid-luteal phase in cycles where at least 3 embryos were transferred. Comparisons of these parameters were made in patients with single versus multiple gestations. There was no association between uterine environment as measured by vascular impedance and endometrial thickness and number of embryos implanted. Thus, a more ideal uterine environment, at least as determined by these sonographic parameters, does not seem to facilitate multiple embryo implantations.

Neither sildenafil nor vaginal estradiol improved endometrial thickness in women with thin endometria after taking oral estradiol in graduating dosages

PURPOSE To determine if sildenafil improves endometrial thickness better than vaginal estradiol (E2) in women with a history of thin endometria. METHODS Women failing to attain an 8 mm endometrial thickness on either the oocyte retrieval cycle or their first frozen embryo transfer (ET) despite an oral graduated E2 regimen were treated again with graduated oral E2 and were also randomly assigned to vaginal sildenafil or vaginal E2 therapy. Endometrial thickness was compared between the groups. RESULTS Neither vaginal E2 nor sildenafil significantly improved endometrial thickness or blood flow in the subsequent frozen ET-cycle. CONCLUSIONS These data fail to corroborate previous claims that 25 mg sildenafil four times daily intravaginally can improve endometrial thickness.