Andreas Obruca

Air in the uterine cavity after embryo transfer

OBJECTIVE To examine the effect on the pregnancy rate (PR) caused by air bubbles loaded into the transfer catheter to bracket the embryo-containing medium. DESIGN Prospective, randomized study. SETTING One hundred ninety-six consecutive ETs in the Institute of Sterility Treatment. INTERVENTIONS Air bubbles were loaded into the transfer catheter concomitantly with the medium in group I (n = 98), whereas in group II (n = 98) no air bubbles were used. RESULTS The PR of group I equals that of group II. CONCLUSIONS Bracketing the embryo-containing medium by air bubbles offers several advantages, especially the possibility of tracking the air on the ultrasound monitor to localize the embryos after the ET. For these reasons we recommend using the proven method.

Relationship of the individual uterine size and the endometrial thickness in stimulated cycles

At present there is no agreement regarding the usefulness of monitoring the endometrial thickness in stimulated cycles. We tested prospectively the hypothesis of a linear relationship of the given individual uterine size and the endometrial thickness in stimulated cycles using a 240 degrees transvaginal sector scanner. There was a strong correlation of the uterine dimension with the endometrial thickness in the midfollicular and the early luteal phase. Our findings suggest that the endometrial thickness is determined by the individual uterine architecture and therefore not predictive of the likelihood of implantation.

Number and Size of Antral Follicles as Predictive Factors in In Vitro Fertilization and Embryo Transfer

AbstractPurpose: The purpose of the study was to evaluate whethernumber and size of antral follicles can predict the outcomeof in vitro fertilization—embryo transfer. Methods: A total of 113 patients were prospectively includedinto this study. After 19 days of down-regulation, numberand size of follicles were determined by using recent three-dimensionaltransvaginal ultrasound technology. Beforeapplication of gonadotropin, all follicles had been definedas antral follicles. According to size, antral follicles werecategorized into four different groups: group I includedantral follicles < 5 mm, group II follicles 5–10 mm; groupIII 11–20 mm; and group IV >20 mm. Pregnant and non-pregnantpatients were compared in terms of their numberof antral follicles of group I–IV. These four groups were thencompared regarding implantation rate, number of retrievedoocytes, endometrium thickness, and age. Results: Pregnant patients showed an significant highernumber of follicles with the size between 5 and 10 mm (P=0.04). A significant correlation was found between numberof retrieved oocytes and antral follicle size of 5–10 mm(P= 0.0001). Antral follicles with a diameter between 5and 10 mm decreased significantly with age (P = 0.008).In groups III and IV, a significant correlation was foundbetween antral follicle size (P = 0.016) and serum estradiollevel after gonadotropin-releasing hormone-agonist down-regulation (P = 0.011). Conclusions: We demonstrated that patients with a highernumber of follicles between 5 and 10 mm showed a significantlyhigher pregnancy rate, whereas patients with a dominantnumber of antral follicles > 11 mm have a highercancellation rate due to ovarian low response.

Vascular endothelial growth factor and its receptors in male fertility

OBJECTIVE To determine the concentration of vascular endothelial growth factor in the seminal fluid, the presence of vascular endothelial growth factor receptors Flt-1 and KDR in spermatozoa, and the predictive value of seminal vascular endothelial growth factor on fertilization and the chance of pregnancy in patients undergoing intracytoplasmic sperm injection (ICSI) or IVF. DESIGN Retrospective analysis. SETTING Private institute (semen collection, IVF/ICSI) and academic research environment (analysis of seminal fluid and spermatozoa). PATIENT(S) Eighty men whose spermatozoa were subsequently used for IVF or ICSI. INTERVENTION(S) Seminal vascular endothelial growth factor was measured by an EIA. Spermatozoa were analyzed by fluorescence-activated cell sorter analysis and by immunocytochemistry. MAIN OUTCOME MEASURE(S) Oocyte fertilization rate, pregnancy rate, and presence of vascular endothelial growth factor receptors on spermatozoa. RESULT(S) Patients with a seminal concentration of vascular endothelial growth factor of 2-100 ng/mL had a sixfold increased chance of pregnancy. Vascular endothelial growth factor concentration and patients age remained the only independent prognostic factors for pregnancy. The concentration of vascular endothelial growth factor did not correlate with indices of male factor infertility or with the oocyte fertilization rate. Expression of vascular endothelial growth factor receptors (Flt-1, KDR) on spermatozoa was demonstrated. CONCLUSION(S) The seminal concentration of vascular endothelial growth factor correlates with the chance of pregnancy in patients undergoing IVF or ICSI. Vascular endothelial growth factor receptors Flt-1 and KDR were detected on spermatozoa for the first time.

The relevance of endometrial thickness and echo patterns for the success of in vitro fertilization evaluated in 148 patients

1. Asch RH, Balmaceda JP, Ellsworth LR, Wong PC: Preliminary experience with gamete intrafallopian transfer (GIFT). Fertil Steril 1986;45:366-371 2. Guastella G, Comparetto G, Palermo R, Cefalu E, Ciriminna R, Cittadini E: Gamete intrafallopian transfer in the treatment of infertility: The first series at the University of Palermo. Fertil Steril 1986;46:417-423 3. Matson PL, Yovich J, Spittle J, Yovich J: The in vitro fertilization of supernumerary oocytes in a gamete intrafallopian transfer program. Fertil Steril 1987;47:802-811 4. McKenna KM, McBain JC, Speirs AL, Jones G, Du Plessis Y, Johnston WIH: The fate of supernumerary oocytes in a gamete intrafallopian transfer (GIFT) is not predictive of a poor outcome: The effect of oocyte selection. J Vitro Fert Embryo Transfer 1988;5(5):261-264 5. Guzick DS, Balmaceda JP, Ord T, Asch RH: The importance of egg and sperm factors in predicting the likelihood of pregnancy from gamete intrafallopian transfer. Fertil Steril 1989;52:795 6. Dodson WC, Walmer DK, Hughes CL, Yancy SE, Haney F: Adjunctive leuprolide therapy does not improve cycle fecundity in controlled ovarian hyperstimulation and intrauterine insemination of subfertile women. Obstet Gynecol 1991;78: 187 7. Smitz J, Devroey P, Braeckmans P, Camus M, Khan I, Staessan C, Van Waesberghe L, Wisanto A, Van Steirteghem AC: Management of trial cycles in an IVF/GIFT programme with the combination of a GnRH analogue and hMG. Hum Reprod 1987;2:309-314 8. Pouly JL, Janny L, Canis M, Vye P, Boyer C: Gamete intrafallopian transfer: Benefits of programmed stimulation. Fertil Steril 1989;52:1012-1017 9. Kaplan CR, Olive D, Sabella V, Asch R, Balmaceda JP, Riehl RM, Groff TR, Burns WN, Schenken RS: Gamete intrafallopian transfer vs superovulation with intrauterine insemination for the treatment of infertility. J Vitro Fert Embryo Transfer 1989;6:298-304 10. Adams J, Polson DW, Franks S: Prevalence of polycystic ovaries in women with anovulation or idiopathic hirsutism. Br Meal J 1986;293:355-359 11. Gonen Y, Blankier J, CasperRF: Transvaginal ultrasound in selective embryo reduction for multiple pregnancy. Obstet Gynecol 1990;75:720-722 12. Schencker JC, Yarkoni S, Granat M: Multiple pregnancies following induction of ovulation. Fertil Steril 198l;35:105123 13. Uribarren A, Aranguren G, Rodriguez-Escudero FJ, Martinez A, Neyro JL: Selective embryo reduction in a sextuplet pregnancy. Fertil Steril 1990;53:1102-1103 14. Dommergues M, Nisand I, Mandelbrot L, Isfer E, Radunovic N, Dumez Y: Embryo reduction in multifetal pregnancies after infertility therapy: Obstetrical risks and perinatal benefits are related to operative strategy. Fertil Steril 1991 ;55:805-811 15. Aboulgbar MA, Mansour RT, Serour GI: Ovarian superstimulation in the treatment of infertility due to peritubal and periovarian adhesions. Fertil Steril 1989;51:834--837 Gin-den Chen 1 Ming Te Lin Maw Sheng Lee Department of OB/GYN Chun Shang Medical College Hospital Taichung, Taiwan, R.O.C.

Fertilization and pregnancies following intracytoplasmic injection of testicular spermatozoa

PurposeIntracytoplasmic injection (ICSI) with testicular sperm was performed in 16 couples. All men had ductal obstruction and failed previous attempts of epididymal sperm microaspiration.MethodsTestis tissue was obtained by excisional biopsies and incubated in HEPES buffered EBSS medium over 24 h at 37‡C. Motile sperm (Grade 1 to 2) were recovered in 13 patients and fertilized a total of 62 oozytes. Four pregnancies were achieved.ResultsOne healthy boy and two girls (twin pregnancy) were born.ConclusionsThe ongoing pregnancies revealed no fetal abnormalities on ultrasound scanning.