Edwina Rudak

Ovarian stimulation with gonadotropin-releasing hormone (GnRH) analogue improves the in vitro fertilization (IVF) pregnancy rate with both transvaginal and laparoscopic oocyte recovery

The relative impact of ovarian stimulation protocal and oocyte retrieval technique on success rates of in vitro fertilization program was studied in 200 patients. Sixty-three patients received gonadotropin-releasing hormone analogue (GnRHa) with human menopausal gonadotropin (hMG), and 137 received hMG only. The GnRHa+ hMG protocol resulted in higher pregnancy rates than the hMG-only protocol (19.0 vs 9.5%, respectively; P<0.01) despite a lower cleavage rate. Oocyte retrieval was performed via laparoscopy in 100 patients and transvaginally in 100 patients. The number of oocytes recovered per cycle was 6.1±3.9 with laparoscopy and 7.0±3.1 transvaginally. Pregnancy rates were similar for both retrieval techniques (13 and 12%, respectively). A breakdown of these results showed that the advantage for the GnRHa+hMG protocol was not affected by the oocyte retrieval technique. A comparison of simultaneous blood and follicular fluid pH measured every 10 min during laparoscopy and transvaginal oocyte recovery revealed a constant decline in follicular fluid pH during laparoscopy, while no changes were observed during the vaginal procedure. We conclude that the improvement in in vitro fertilization results during the period of our study is due primarily to the introduction of GnRHa+hMG protocol rather than the method of oocyte retrieval.

Sheba Medical Center in vitro fertilization and embryo transfer program results: February 10–August 14, 1983

conditions for successful IVF-ET. The IVF-ET team is composed of qualified physicians, an embryologist, a psychologist, technicians, and an administrator. As this is a team effort, special care is given, through weekly meetings, to organization and operation of the IVF-ET program. Human IVF-ET will be performed at Columbia Hospital for Women, Washington, D.C. The facility is set up such that access to the laboratory is restricted to persons in surgical attire via the operating room. Care is taken to ensure sterile conditions during ovum retrieval, embryo culture, and embryo transfer. Backup equipment, external alarms, and emergency power are provided to protect against unforeseen problems arising during IVF-ET. A necessary contingent to the human IVF-ET programs is the animal laboratory located at Georgetown University. This laboratory works in close association with the human IVF-ET unit at Columbia Hospital for Women, performing routine testing of culture medium and providing a resource for basic research in animal in vitro fertilization and preimplantation development. Such an arrangement provides for cooperative research between clinical and nonclinical researchers involved in reproductive physiology and establishes a training environment for future clinical researchers in the field of endocrinology and infertility. Couples entering an IVF-ET program represent a unique group of people. The emotional ramifications of IVF-ET have not been examined. For this reason a psychologist is available to help counsel these couples on the emotional and social aspects of successful and unsuccessful IVF-ET. We feel that this is necessary to ensure complete patient care during (and following) participation in this program. We are excited about the publication of a journal dealing with IVF-ET. Such a compendium is both necessary and beneficial to the growth and improvement of IVF-ET throughout the world. We hope to be able to submit a formal report in the near-future involving the progress of the IVFET program at Columbia Hospital for Women.

β-Endorphin Levels in the Follicular Fluid of Human Oocytes Fertilized in vitro

This study was carried out in order to investigate the relationship between beta-endorphin (beta-ep) levels in plasma and follicular fluid and fertilization rates of oocytes from women undergoing treatment in our in vitro fertilization and embryo transfer program. Nine women suffering from severe tubal damage, with regular menstrual cycles, were studied. Follicular growth was induced with clomiphene citrate, combined with human menopausal gonadotropins. Analysis of follicular fluids and plasma showed no significant difference in beta-ep levels. The larger follicles (greater than 2 ml volume) had significantly higher beta-ep levels than smaller follicles (less than 2 ml volume; p less than 0.001); however, there was no significant difference in the fertilization rates of their oocytes.

Programmed Oocyte Retrieval for IVF: Clinical and Biological Effects of Different Protocols of Pituitary Suppression and Follicular Stimulation

The day of oocyte retrieval is the most important day in vitro fertilization (IVF) programs. It involves the coordination of the clinical, surgical and laboratory staff, thereby allowing only a limited number of cases to be performed daily. The day of retrieval depends on the day of menstruation and the individual ovarian response to medication, hence it is variable and can usually be anticipated only in the last few days of treatment. Some of these disadvantages can be overcome by fixing the day of retrieval in advance as in a “programmed cycle”. Programmed IVF cycles include; suppression of the hypothalamic-pituitary-ovarian axis by oral contraceptives or gonadotropin releasing hormone (GnRH) analogues and a predetermined day for ovum pick-up. The method has been shown to be technically feasible and logistically desirable and can result in a clinical pregnancy rate equivalent to the more conventional individualized approaches to ovulation induction [1–6].