Isabelle Govaerts

Short-term medical complications of 1500 oocyte retrievals for in vitro fertilization and embryo transfer

OBJECTIVE To evaluate the different short-term complications after in vitro fertilization and embryo transfer. DESIGN a retrospective study on 7 years in the fertility clinic of an university hospital. MATERIALS AND METHODS Short-term medical complications were analysed after 1500 transvaginal ultrasonographically guided oocyte retrievals. RESULTS Ovarian hyperstimulation syndrome (1.8%), pelvic infections (0.4%), intraperitoneal bleeding (0.2%) and adnexal torsions (0.13%) were observed. One case of adnexal torsion occurred during pregnancy (0.18%). Two unusual case of bowel endometriosis were encountered (0.13%). CONCLUSIONS Short-term medical complications after in vitro fertilization and embryo transfer are rare (2.8%). This contrast with the high rate of multifetal pregnancies which increases maternal and perinatal morbidity and mortality and must be considered as the major complication of in vitro fertilization treatment.

The long-acting gonadotropin-releasing hormone analogues impaired the implantation rate.

OBJECTIVES To determine the efficacy and innocuousness of long-acting versus short-acting GnRH analogues (GnRH-a) in long protocol for in IVF-ET. DESIGN Prospective randomized study. SETTING The IVF unit at an academic hospital. PATIENTS One hundred couples admitted for their first IVF-ET attempt. MAIN OUTCOME MEASURES Serum concentrations of LH, E2, and P during the all cycles and duration of pituitary desensitization were assessed, as well as fertilization rate, embryo quality, and implantation and pregnancy rates. RESULTS Significantly more days (10.8 +/- 1.8 versus 9.2 +/- 1.7 days) of stimulation and more ampules of hMG (47 +/- 22 versus 33 +/- 16) were necessary to obtain similar numbers of embryos of quality with the long-acting GnRH-a. Implantation and delivery rates were significantly lower with the long-acting GnRH-a (32.8% versus 21.1%; 48.9% versus 29.1%, respectively). CONCLUSIONS As the long-acting GnRH-a might interfere with the luteal phase and embryo development, short-acting GnRH-a should be preferred for ovarian hyperstimulation in IVF-ET.

Is intracytoplasmic sperm injection (ICSI) a safe procedure? What do we learn from early pregnancy data about ICSI?

The aim of this study was to evaluate the safety of the intracytoplasmic sperm injection (ICSI) procedure by analysing early pregnancy data from ICSI and in-vitro fertilization (IVF) patients. In all, 50 ICSI pregnancies were compared with 226 IVF pregnancies. Comparisons were made during the first 9 weeks after the theoretical last menstrual period (7 weeks after oocyte retrieval) with regard to epidemiological data, plasma hormonal concentrations and transvaginal ultrasonographical findings. Although patients were significantly (P < 0.001) younger in ICSI (31 years) than in IVF pregnancies (33 years), their duration of infertility was similar. Miscarriage and multiple gestation rates were not significantly different in ICSI pregnancies (respectively 24 and 24%) from those found after IVF (32 and 29%). The probability of developmental arrest of the intrauterine sac (miscarriages and vanishing twins) was similar in both ICSI (16%) and IVF (25%) cases. The mean plasma hormonal concentrations starting from day 11 after oocyte retrieval were similar in both groups. Every ICSI and IVF pregnancy showed an embryo with cardiac activity at 7 weeks. Early pregnancy data did not show any abnormal findings for pregnancies achieved using ICSI compared to those achieved by IVF.