F. Carranza

The endometrial receptivity array for diagnosis and personalized embryo transfer as a treatment for patients with repeated implantation failure

OBJECTIVE To demonstrate the clinical value of the endometrial receptivity array (ERA) in patients with repeated implantation failure (RIF), for guiding their personalized embryo transfer (pET) as a novel therapeutic strategy. DESIGN Prospective interventional multicenter clinical trial. SETTING University-affiliated infertility and private clinics. PATIENT(S) Eighty-five RIF patients and 25 comparison patients. INTERVENTION(S) Endometrial sampling and pET guided by ERA. MAIN OUTCOME MEASURE(S) A receptive (R) or nonreceptive (NR) endometrial status according to ERA. Pregnancy (PR) and implantation (IR) rates after pET. RESULT(S) The ERA test gave an R result of 74.1% in RIF patients versus 88% in control subjects. Clinical follow-up was possible in 29 RIF patients, in whom pET was performed, resulting in 51.7% PR and 33.9% IR. The IRs and PRs in the 6 months after the biopsy showed that pregnancy was not related to the local injury. Twenty-two RIF patients (25.9%) were NR, and in 15 of them a second ERA validated a displacement of the window of implantation (WOI). In eight of them, pET was performed on the day designated by the ERA, resulting in 50.0% PR and 38.5% IR. These results should be considered as preliminary. CONCLUSION(S) There is an increased percentage of WOI displacement in RIF patients compared with comparison group patients, leading to the concept of pET as a therapeutic strategy. Rescue of NR patients by pET in a displaced WOI results in similar PR and IR.

Influence of follicle rupture and uterine contractions on intrauterine insemination outcome: a new predictive model

OBJECTIVE To correlate the detection of follicle rupture and the number of uterine contractions per minute with the outcome of IUI and to build a predictive model for the outcome of IUI including these parameters. DESIGN Retrospective cohort study. SETTING Fertility clinic. PATIENT(S) We analyzed data from 610 women who underwent homologous or donor double IUI from 2005 to 2010 and whose data of uterine contractions or follicle rupture were recorded. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live-birth rate. RESULT(S) Nine hundred seventy-nine IUI cycles were included. The detection of follicle rupture (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.30-3.01) and the number of uterine contractions per minute (OR, 1.67; 95% CI, 1.02-2.74) assessed after the second insemination procedure of a double IUI were positively correlated with the live-birth rate. A multiple logistic regression model showed that sperm origin, maternal age, follicle count at hCG administration day, follicle rupture, and the number of uterine contractions observed after the second insemination procedure were significantly associated with the live-birth rate. CONCLUSION(S) Follicle rupture and uterine contractions are associated with the success of an IUI cycle. This may open new possibilities to improve the methodology of IUI.

How to Perform the Best Intrauterine Insemination? A Review

Intrauterine insemination is a treatment used in couples with mild/moderate male factor, when female partner has at least one tube patent. Numerous studies have attempted to determine for many years which parameters are limiting to ensure pregnancy with this technique of assisted reproduction. This review focus on prognostic factor for a successful outcome, as semen quality, female etiology, synchronization with ovulation, assessment of follicle rupture, number of insemination per cycle and influence of uterine contractions. We conclude with this review that intrauterine insemination is a less invasive and expensive option than other [IVF], with acceptable results when adequately indicated.