Efstratios E. Kolibianakis

Spontaneous pregnancies in couples who discontinued intracytoplasmic sperm injection treatment: a 5-year follow-up study

OBJECTIVE To analyze the occurrence of deliveries after spontaneous conception in patients who have discontinued unsuccessful intracytoplasmic sperm injection (ICSI) treatment. DESIGN Cohort follow-up study. SETTING Tertiary referral center. PATIENT(S) Between July 1992 and December 1993, 200 Belgian women younger than 37 years underwent 433 consecutive unsuccessful ICSI cycles with freshly ejaculated sperm and eventually discontinued their treatment. INTERVENTION(S) Ultrasound-guided oocyte retrieval and ICSI. MAIN OUTCOME MEASURE(S) Delivery after 25 weeks following a spontaneous pregnancy. RESULT(S) The mean age at the time of the last oocyte pick-up was 31.0 +/- 3.9 years. The mean time interval between the last ICSI and the end of the follow-up period was 47.7 +/- 12.1 months. Twenty-three spontaneous pregnancies ending in delivery after 25 weeks were observed (11.5%). The cumulative delivery rate reached a plateau of 10% after 36 months of follow-up. The mean time interval (from last oocyte retrieval) for spontaneous pregnancy to occur after discontinuing ICSI treatment was 20.2 +/- 13.7 months. Proportional hazards analysis showed that delivery rate was reduced by 2.0% per year of infertility. CONCLUSION(S) This study suggests that duration of infertility appears to be predictive of the likelihood of live delivery after spontaneous conception following an unsuccessful ICSI treatment.

Hysteroscopic septum resection using the Versapoint system in subfertile women

The aim of the present study was to assess the safety and efficacy of hysteroscopic septum resection by Versapoint. Forty-five subfertile patients who underwent hysteroscopic septum resection using the Versapoint system were analysed. A type Va and a type Vb septate uterus were present in 10 (22.2%) and 35 (77.8%) patients respectively. Complete septum excision was feasible in all patients. No complications occurred during septum resection. Repeat hysteroscopy 2 months after septum excision showed normal endometrial cavity in all patients. Hysteroscopic septum resection by Versapoint system is a safe and efficient method.

Outcome for donors and recipients in two egg-sharing policies

OBJECTIVE To assess the effect of two different donation policies on results of egg-sharing. DESIGN Retrospective analysis. SETTING Tertiary referral center. PATIENT(S) One hundred five donor-recipient pairs participating in an egg-sharing program between 1998 and 2001. INTERVENTION(S) Egg-sharing was performed according to policy A (retrieval of at least 12 oocytes, with more oocytes allocated to the donor) or policy B (retrieval of at least 8 oocytes, with equal distribution of oocytes between donors and recipients). MAIN OUTCOME MEASURE(S) Delivery rate and cycle cancellation rate. RESULT(S) Policy B resulted in a decreased cycle cancellation rate in the recipient group compared with policy A (9.7% vs. 29.7%, respectively; P<or=.01). No significant difference in delivery rate per fresh transfer was observed between policy A and policy B in donors (30.2% vs. 27.8%, respectively) or recipients (28.2% vs. 25.7%, respectively). CONCLUSION(S) Decreasing the number of oocytes required to perform egg sharing from 12 to 8 and dividing the oocytes equally between donors and recipients significantly reduces the cycle cancellation rate while it does not appear to affect adversely the probability of delivery.

Prenatal genetic testing by amniocentesis appears to result in a lower risk of fetal loss than chorionic villus sampling in singleton pregnancies achieved by intracytoplasmic sperm injection

OBJECTIVE To compare pregnancy outcome after prenatal genetic testing by chorionic villus sampling (CVS) or amniocentesis in singleton pregnancies achieved by intracytoplasmic sperm injection (ICSI). DESIGN Retrospective analysis. SETTING Tertiary referral center. PATIENT(S) Eight hundred twenty-eight patients with singleton gestations achieved by ICSI. INTERVENTION(S) Midtrimester amniocentesis (685 patients) and first-trimester CVS (143 patients). MAIN OUTCOME MEASURE(S) Fetal loss rate, preterm delivery rate, and proportion of babies born with low or very low birth weight. RESULT(S) A significant difference was observed in fetal loss rate between CVS and amniocentesis (3.7% vs. 0.9%, respectively). On the other hand, a similar preterm delivery rate was present between the two methods (11.2% vs. 12.4%, respectively). No significant difference was observed between amniocentesis and CVS in the proportion of babies with birth weight of either <1,500 g (1.8% vs. 3.8%, respectively) or between 1,500 and 2,500 g (8.2% vs. 4.6%, respectively). CONCLUSION(S) Amniocentesis appears to result in a lower risk of fetal loss as compared with CVS in patients with a singleton pregnancy achieved by ICSI.