Andrea Maccolini

Oocyte donation program: pregnancy and implantation rates in women of different ages sharing oocytes from single donor*

OBJECTIVE To investigate the importance of uterus age as regards of pregnancy, implantation, and abortion rates using the oocyte donation model. DESIGN Retrospective data analysis of cases where recipients of different ages shared oocytes from single donor. SETTING A tertiary infertility center. PATIENTS One hundred fourteen women (21 to 49 years of age) undergoing a total of 114 cycles of oocyte donation were divided into two groups according to age (group A < = or 39 years: group B between 40 and 49 years). INTERVENTIONS Hormonal replacement therapy was given using increasing doses of 17 beta-E2 (2, 4, and 6 or 8 mg) and either 100 mg of P in oil or 600 mg of micronized P through the vaginal route. MAIN OUTCOME MEASURES Pregnancy, abortion, and implantation rates. RESULTS Fifty-seven transfer cycles were performed per age group. Twenty-seven clinical pregnancies were achieved in Group A and 14 in group B, with pregnancy rates (PRs) of 47.3% and 24.5%, respectively. There were four abortions in group A and one in group B, resulting in abortion rates of 14.8% and 7%, respectively. Thirty-four of 137 transferred embryos in group A and 20 of 134 in group B implanted, resulting in implantation rates of 24.8% and 14.9%, respectively. CONCLUSION This study seems to suggest that there are differences in pregnancy and implantation rates in recipients of different ages because of uterine receptivity. Fertility therefore does not depend merely on oocyte age and quality but also on uterine age.

Perifollicular vascularity and its relationship with oocyte maturity and IVF outcome.

New markers of embryo ability to implant are pursued continuously. Understanding whether an oocyte is really “mature,” that is, ready to be fertilized, would be of great help in choosing an embryo that will implant. It is usual to pay attention to the phase of meiosis, considering the extrusion of the polar body (metaphase II) to be the only sign of the maturity of the oocytes. Nevertheless, understanding more about how the cytoplasm contributes to an oocytes competency also shows promise as a method of predicting which embryos will implant. Some studies about perifollicular vascularity have demonstrated that embryos originating from oocytes developed in well‐vascularized follicles have a higher implantation rate than those originating from oocytes developed in follicles with poor vascularization. Here, we report our results from a preliminary study in which embryos were transferred according to the degree of vascularization of the follicle. Women who received embryos originating from oocytes developed in well‐vascularized follicles had a statistically higher pregnancy rate than women who received embryos deriving from oocytes grown in more poorly vascularized follicles (34% vs. 13.7%).

Gamete intrafallopian transfer by hysteroscopy as an alternative treatment for infertility

Objective To evaluate efficacy and safety of the hysteroscopic cannulation by flexible catheter of the fallopian tubes for gamete intrafallopian transfer (GIFT). Design We studied the pregnancy rate (PR) and the safety of this new technique. Setting All patients were enlisted for GIFT at our Reproductive Medicine Unit. Patients We treated 26 patients whose infertility causes were terminal tubal damage, male factors, unexplained factors, and endometriosis. Patients with uterine tubal ostia unsuitable for gamete transfer or cervical incontinence were not included in the group. Interventions The patients underwent ovulation induction and oocyte retrieval by transvaginal ultrasonically guided puncture. The gamete transfers were carried out by hysteroscopic procedure using a flexible catheter put through the operating channel. Main Outcome Measure The efficacy was evaluated by the PR (25.9%). Results Seven clinical pregnancies were obtained, but two patients aborted during the first weeks of pregnancy. No ectopic pregnancies were observed. Conclusions Our results indicate that hysteroscopic GIFT is an alternative, safe, effective, and not invasive technique for fertility problems.

Inadvertent recombinant human follicle stimulating hormone bolus instead of human chorionic gonadotrophin leads to the retrieval of competent oocytes in IVF program

OBJECTIVE To present a case where recombinant human FSH (r-hFSH) was accidentally used instead of hCG and resulted in oocyte maturation. DESIGN Case report. SETTING A tertiary infertility center. PATIENT(S) A 36-year-old woman underwent IVF for infertility problems. The couple was unable to obtain a pregnancy during the previous 2 years. INTERVENTION(S) Oocyte retrieval after a r-hFSH bolus (two vials of Gonal-F 1050 IU) instead of the routinely used hCG. MAIN OUTCOME MEASURE(S) Oocyte maturity evaluation, fertilization after intracytoplasmic sperm injection, cleavage stage, and embryo quality. RESULT(S) A total of nine oocytes were retrieved; eight were metaphase II. Three eggs were fertilized by intracytoplasmic sperm injection, and four of the remaining MII oocytes were cryopreserved. All three oocytes fertilized and developed to three good-quality embryos that were transferred on day 2. No pregnancy was obtained from this fresh transfer cycle or from transferred embryos resulting from the thawing cycle. CONCLUSION(S) A massive r-hFSH administration can lead to the retrieval of mature MII oocytes that are able to fertilize and give good-quality embryos to transfer.

The role of gamete intrafallopian transfer (GIFT) and tubal embryo transfer (TET) in the treatment of patients with patent tubes associated with male infertility factor

PurposeThe relative effectiveness of gamete intrafallopian transfer (GIFT) and tubal embryo transfer (TET) combined with superovulation in the treatment of infertile patients with patent tubes were compared. Four hundred fifty consecutive cycles were divided into two periods. During the first period (216 cycles), the only technique employed was GIFT, couples being divided into two groups: group A, couples with normospermic partners (118 cycles); and group B, couples with male infertility factor (98 cycles). During the second period (234 cycles), 140 cycles of GIFT were performed in couples with normospermic partners (group C). TET was utilized in 94 cycles (group D), in the case of couples with male infertility factor.ResultsResults demonstrate that the pregnancy rate with GIFT in the case of oligoasthenospermic partners (group B) is significantly lower than that of normospermic partners (groups A and C) (P = 0.0001) and than that with TET in the case of oligoasthenospermic partners (group D) (P = 0.0001).ConclusionThe implantation rate is also significantly different between these groups (B vs A, P =0.0001; B vs C, P =0.0001; B vs D, P =0.01).

Andrology: Influence of spermatozoa characteristics on gamete intra-Fallopian transfer procedures: analysis of results obtained utilizing normozoospermic, oligoasthenozoospermic and donor spermatozoa

The objective of this study was to analyze the efficacy of the gamete intra-Fallopian transfer (GIFT) procedure in relation to spermatozoa characteristics. A total of 268 infertile couples enlisted for GIFT were categorized into three groups on the basis of semen characteristics in the husband. These included oligoasthenozoospermic men in 88 retrieval cycles (group 1), normozoospermic men in 116 cycles (group 2) and azoospermic partners who needed donor semen in 86 cycles (group 3). All female patients had ovarian stimulation and laparoscopic GIFT. Pregnancy rates were significantly higher with donor spermatozoa than with oligoasthenozoospermic or normozoospermic spermatozoa, i.e. 51.1% versus 15.9% (P < 0.001), and 32.7% (P < 0.005). Implantation rates were significantly higher with donor spermatozoa than with normo- or oligoasthenozoospermic spermatozoa (P < 0.01). These data suggest that GIFT does not give good results with male factor infertility. Donor cryopreserved semen gives higher pregnancy and implantation rates than normozoospermic semen, and GIFT with donor spermatozoa gives a good chance of pregnancy to couples previously treated with artificial insemination using donor semen.

Gamete Intrafallopian Transfer by Hysteroscopy as an Alternative Treatment for Infertility

OBJECTIVE To evaluate efficacy and safety of the hysteroscopic cannulation by flexible catheter of the fallopian tubes for gamete intrafallopian transfer (GIFT). DESIGN We studied the pregnancy rate (PR) and the safety of this new technique. SETTING All patients were enlisted for GIFT at our Reproductive Medicine Unit. PATIENTS We treated 26 patients whose infertility causes were terminal tubal damage, male factors, unexplained factors, and endometriosis. Patients with uterine tubal ostia unsuitable for gamete transfer or cervical incontinence were not included in the group. INTERVENTIONS The patients underwent ovulation induction and oocyte retrieval by transvaginal ultrasonically guided puncture. The gamete transfers were carried out by hysteroscopic procedure using a flexible catheter put through the operating channel. MAIN OUTCOME MEASURE The efficacy was evaluated by the PR (25.9%). RESULTS Seven clinical pregnancies were obtained, but two patients aborted during the first weeks of pregnancy. No ectopic pregnancies were observed. CONCLUSIONS Our results indicate that hysteroscopic GIFT is an alternative, safe, effective, and not invasive technique for fertility problems.