Abraham Kogosowski

Pregnancy and birth after transfer of embryos that developed from single- nucleated zygotes obtained by injection of round spermatids into oocytes

OBJECTIVE To use injection of spermatids into oocytes as a mode of infertility treatment in cases in which spermatozoa are not available. DESIGN Prospective clinical evaluation and case report. SETTING In Vitro Fertilization Unit, Herzliya Medical Centers, Herzliya-on-Sea, Israel. PATIENT(S) Thirteen couples with male factor infertility in which the male partner lacked spermatozoa in the ejaculate or testicular biopsy samples. INTERVENTION(S) Round spermatid injection and elongated spermatid injection into oocytes. MAIN OUTCOME MEASURE(S) Evaluation of the rate of two-pronucleated and single-nucleated zygote development. RESULT(S) The rate of two-pronucleated zygote development after round spermatid injection and elongated spermatid injection was relatively low (27% and 36%, respectively). Single-nucleated zygotes develop more frequently after round spermatid injection and elongated spermatid injection (35% and 17%, respectively) than after intracytoplasmic sperm injection with mature spermatozoa. A normal pregnancy and childbirth resulted from the transfer of 4 cleaving embryos, each of which developed from a single-nucleated zygote in a round spermatid injection treatment cycle with ejaculated spermatids. CONCLUSION(S) Embryos derived from single-nucleated zygotes after spermatid conception can be viable and give rise to an ongoing clinical pregnancy and childbirth.

Patients with Turner’s syndrome may have an inherent endometrial abnormality affecting receptivity in oocyte donation

OBJECTIVE To evaluate whether endometrial receptivity is compromised in patients with premature ovarian failure (POF) due to Turners syndrome who undergo oocyte donation. DESIGN Retrospective analysis. SETTING In vitro fertilization-ET units, anonymous oocyte donation program. PATIENTS The study included 53 patients with POF who underwent oocyte donation. These included 7 patients with Turners syndrome (45,X) who underwent 22 ET cycles, 15 women with Turner variants (mosaics, deletions, or isochromosomes) who underwent 36 ET cycles, and 31 other patients with POF and a normal karyotype who underwent 69 oocyte donation cycles. INTERVENTION All patients on standby for donation were treated with E2 valerate 6 mg/d until oocytes became available; then P 100 mg/d was added. Oocyte donors were healthy women < 34 years who underwent IVF themselves. MAIN OUTCOME MEASURES Clinical pregnancy rates (PRs), biochemical pregnancies, early abortions, and delivery rates were evaluated. RESULTS Turners syndrome patients had a significantly higher rate of biochemical pregnancies (22.7% versus 4.3%), a lower clinical PR (22.7% versus 33.3%), a significantly higher rate of early abortions (60% versus 8.7%), and a significantly lower rate of deliveries per pregnancy (20.0% versus 73.1%) compared with non-Turner patients. CONCLUSIONS Patients with a complete or partial deficiency of an X chromosome have reduced PRs and an increase in early implantation failure after oocyte donation. This may indicate an inherent endometrial abnormality, possibly associated with a deficiency of X-linked genes regulating endometrial receptivity.

The Development of an Efficient Ambulatory In Vitro Fertilization (IVF) and Embryo TrAnsfer (ET) Program Using Ultrasonically Guided Oocyte Retrieval

Until recently most of the current in vitro fertilization and embryo transfer (IVF‐ET) programs used laparoscopy for oocyte retrieval and included hospitalization in the treatment. The establishment of a successful ambulatory IVF program that uses ultrasonically guided oocyte aspiration, is described. Between August 1985 and February 1987, 384 percutaneous transvesical ultrasonically and transvaginally guided follicle aspirations were performed on 414 patients, following ovarian stimulation with hMG and hCG. Ninety two clinical pregnancies were confirmed by ultrasound. The clinical pregnancy rate was 26.8% when based on the number of embryo transfers. There were 16 multiple pregnancies (17.4%), 18 miscarriages (19.5%), and two tubal pregnancies (2.1%). The most important factors contributing toward the success of this program were rigid adherence to clinical and laboratory protocols, and the maintenance of a strict quality control. The ambulatory management was very well accepted by the patients, who during the entire period of ovarian stimulation had minimal disruption of their routine activities.

High initial values of β-subunits of human chorionic gonadotropin in ovum donation pregnancies indicate better implantation

Fifty-five patients were treated by ovum donation, and a control group of 165 patients underwent IVF. The number of pregnancies obtained were 28 and 25, respectively. The initial beta-hCG values, as well as the PRs and implantation rates, in the ovum donation series were significantly higher than those of the IVF series. The clinical significance and potential application of these observations are discussed.

Estrone-3-glucuronide chemiluminescence immunoassay: an alternative method for monitoring induction of ovulation with human menopausal gonadotropin in an in vitro fertilization program

A simple, rapid, and sensitive solid-phase immunoassay procedure for the determination of estrone-3-glucuronide (E1-3-G), which uses chemiluminescence as the end point in unextracted morning urine, is described. Thirty-one patients undergoing induction of ovulation in an in vitro fertilization (IVF) unit participated in the study. From day 3 of the menstrual cycle until the day of hCG administration, morning blood samples and morning urine specimens were collected for the determination of serum 17 beta-estradiol (E2) and urine E1-3-G, respectively. A good correlation was noted between E2 measured by radioimmunoassay (RIA) and the E1-3-G measured by chemiluminescence immunoassay (CIA), from day 5 up to the day of hCG administration (0.6 less than r less than 0.85, P less than 0.001). It is evident from this study that the CIA measurement of E1-3-G in morning urine is an accurate and rapid (2.5 hours) method and is convenient for monitoring induction of ovulation with human menopausal gonadotropins.

The establishment of an ovum donation program using a simple fixed-dose estrogen-progesterone replacement regimen

Most ovum donation (OD) programs involve cycle synchronization between recipient and donor for normally cycling recipients and a complex estrogen-progesterone replacement regimen for recipients with ovarian failure. In 1987, Serhal and Craft (1) suggested the use of a fixeddose estrogen-progesterone regimen for recipients who were normally ovulatory and to those with ovarian failure. Following this protocol, and simplifying it still, the authors administered 6 mg estradiol valerate (E2) daily orally starting on day 2–6 of induced withdrawal bleeding, augmented with 100 mg progesterone in ethyl oleate (P) intramuscularly daily, starting any time between 4 days prior to and the day of oocyte pickup. All recipients underwent embryo transfer at a 2-pronuclei (2PN)-10-cell stage. A group of 21 patients underwent 26 treatment cycles, resulting in 16 pregnancies. Twelve of the patients gave birth, one to triplets, two to twins, and nine to singletons. Four patients miscarried in the first trimester of pregnancy.

Successful ovarian superovulation for in vitro fertilization in a patient with an undiagnosed intrauterine pregnancy

laparotomy showed distended intestinal loops, many adhesions that were lysing, and a roundish formation, 7 cm in diameter, in the right adnexal site, which was removed. When it was opened, a resorbing fetus was found and diagnostic histology identified it as an extrauterine pregnancy with no evidence of tubal structures. The postsurgical course was regular and the ultrasound controls indicated normal development of the intrauterine pregnancy until 12 days after the operation, at which time the pregnancy ended in abortion (16th week).

Interdepartmental unit for IVF/ET, Serlin-Hakirya Maternity Hospital, Tel Aviv, Israel.

In Vitro Fertilization Department Pavilion Mrre et Enfant Centre Hospitalier Universitaire 44035 Nantes Cedex, France action of the analogue on ovarian GnRH receptors (7) or decreased ovarian androgen production might also be suspected. The use of an analogue also allows for the administration of more hMG without the fear of inducing premature luteinization. (c) No alteration in cleavage or implantation rates occurred. These different changes resulted in a significantly enhanced pregnancy rate and represent an improvement, even though the optimal regimen still remains to be determined.

Relationship between anticomplement in seminal plasma and complement in follicular fluid associated with outcome in an in vitro fertilization program

AbstractPurpose: The study was conducted to evaluate levels of anticomplement in seminal plasma and levels of complement in follicular fluid, in correlation with fertilization and pregnancy rate after in vitro fertilization and intracytoplasmic sperm injection programs. Materials and Methods: Anticomplement levels were determined in 70 couples undergoing in vitro fertilization therapy. In 15 of these couples, complement levels were measured. Anticomplement and complement levels were also determined in an additional 21 couples (apart from the 70 couples) undergoing intracytoplasmic sperm injection treatment. Results: A correlation was found between fertilization rate and anticomplement levels in the seminal plasma (r=0.4,P<0.01) after standard in vitro fertilization. No correlation was found in the intracytoplasmic sperm injection group, or observed between complement levels and any parameter examined in both groups. Pregnancy occurred only in those couples with an anticomplement: complement ratio below 0.49. Conclusions: Determination of anticomplement and complement levels may contribute to the assessment of a successful outcome of in vitro fertilization/intracytoplasmic sperm injection.