Israel Yovel

Patients with Turner’s syndrome may have an inherent endometrial abnormality affecting receptivity in oocyte donation

OBJECTIVEnTo evaluate whether endometrial receptivity is compromised in patients with premature ovarian failure (POF) due to Turners syndrome who undergo oocyte donation.nnnDESIGNnRetrospective analysis.nnnSETTINGnIn vitro fertilization-ET units, anonymous oocyte donation program.nnnPATIENTSnThe study included 53 patients with POF who underwent oocyte donation. These included 7 patients with Turners syndrome (45,X) who underwent 22 ET cycles, 15 women with Turner variants (mosaics, deletions, or isochromosomes) who underwent 36 ET cycles, and 31 other patients with POF and a normal karyotype who underwent 69 oocyte donation cycles.nnnINTERVENTIONnAll patients on standby for donation were treated with E2 valerate 6 mg/d until oocytes became available; then P 100 mg/d was added. Oocyte donors were healthy women < 34 years who underwent IVF themselves.nnnMAIN OUTCOME MEASURESnClinical pregnancy rates (PRs), biochemical pregnancies, early abortions, and delivery rates were evaluated.nnnRESULTSnTurners syndrome patients had a significantly higher rate of biochemical pregnancies (22.7% versus 4.3%), a lower clinical PR (22.7% versus 33.3%), a significantly higher rate of early abortions (60% versus 8.7%), and a significantly lower rate of deliveries per pregnancy (20.0% versus 73.1%) compared with non-Turner patients.nnnCONCLUSIONSnPatients with a complete or partial deficiency of an X chromosome have reduced PRs and an increase in early implantation failure after oocyte donation. This may indicate an inherent endometrial abnormality, possibly associated with a deficiency of X-linked genes regulating endometrial receptivity.

The Development of an Efficient Ambulatory In Vitro Fertilization (IVF) and Embryo TrAnsfer (ET) Program Using Ultrasonically Guided Oocyte Retrieval

Until recently most of the current in vitro fertilization and embryo transfer (IVF‐ET) programs used laparoscopy for oocyte retrieval and included hospitalization in the treatment. The establishment of a successful ambulatory IVF program that uses ultrasonically guided oocyte aspiration, is described. Between August 1985 and February 1987, 384 percutaneous transvesical ultrasonically and transvaginally guided follicle aspirations were performed on 414 patients, following ovarian stimulation with hMG and hCG. Ninety two clinical pregnancies were confirmed by ultrasound. The clinical pregnancy rate was 26.8% when based on the number of embryo transfers. There were 16 multiple pregnancies (17.4%), 18 miscarriages (19.5%), and two tubal pregnancies (2.1%). The most important factors contributing toward the success of this program were rigid adherence to clinical and laboratory protocols, and the maintenance of a strict quality control. The ambulatory management was very well accepted by the patients, who during the entire period of ovarian stimulation had minimal disruption of their routine activities.

The performance of primary and secondary unexplained infertility in an in vitro fertilization-embryo transfer program

The term unexplained infertility is applied to a couple in whom after an elaborate workup no apparent reason for infertility is found. Between August 1985 and May 1987, 435 patients underwent 720 treatment cycles in an in vitro fertilization-embryo transfer (IVF -ET) unit. Eighty-three of the patients had unexplained infertility as their indication for IVF-ET. Fifty-two (group A) had primary unexplained infertility and 31 (group B) had secondary unexplained infertility. Group A underwent 87 and group B underwent 50 treatment cycles. Forty-six ET were performed in group A and 34 in group B. Clinical pregnancies were achieved in 20 patients of group A (11.5% per treatment cycle) and 13 of group B (26.0%), for a combined rate of 16.8% per cycle. Patients with tubal infertility treated in the program had a pregnancy rate of 18.8% per treatment cycle. The performance of the secondary unexplained infertility group is significantly better than that of the primary unexplained infertility group. However, the overall results with patients with unexplained infertility are similar to those patients treated for tubal infertility.

Intrauterine insemination before transfer of frozen-thawed embryos may improve the pregnancy rate for couples with unexplained infertility: preliminary results of a randomized prospective study

OBJECTIVEnTo evaluate whether a combination of IUI and frozen-thawed embryo transfer (FT-ET) with ovulation induction would improve the PR in couples with unexplained infertility.nnnDESIGNnProspective, randomized study.nnnSETTINGnIn Vitro Fertilization Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.nnnPATIENT(S)nSixty-two patients with unexplained infertility were assigned into two groups. The study group was composed of 32 women (38 cycles) who received ovulation induction followed by IUI and FT-ET. The control group was composed of 30 women (33 cycles) who received ovulation induction followed by FT-ET.nnnINTERVENTION(S)nClomiphene citrate (CC) and hCG, IUI, and FT-ET.nnnMAIN OUTCOME MEASURE(S)nPregnancy rate (PR) per cycle, PR per ET.nnnRESULT(S)nIn the study group, the PR per cycle and per ET were 36.8% (14 of 38) and 40.6% (13 of 32), respectively. In the control group, the PR per cycle and per ET were 12.1% (4 of 33) and 14.3% (4 of 28), respectively. Statistically significant differences were found between the two groups in the PR per cycle (P=.02) and PR per ET (P=.03). No statistically significant difference was found between the groups for the stage in which the embryos were cryopreserved, the survival cleavage rates after thawing, grading of thawed embryos, and number of embryos transferred.nnnCONCLUSION(S)nIn couples with unexplained infertility, the PR may be improved by combining IUI and FT-ET with ovulation induction. Performing IUI before thawing may prevent treatment cancellation in cycles with no surviving embryos.

Estrone-3-glucuronide chemiluminescence immunoassay: an alternative method for monitoring induction of ovulation with human menopausal gonadotropin in an in vitro fertilization program

A simple, rapid, and sensitive solid-phase immunoassay procedure for the determination of estrone-3-glucuronide (E1-3-G), which uses chemiluminescence as the end point in unextracted morning urine, is described. Thirty-one patients undergoing induction of ovulation in an in vitro fertilization (IVF) unit participated in the study. From day 3 of the menstrual cycle until the day of hCG administration, morning blood samples and morning urine specimens were collected for the determination of serum 17 beta-estradiol (E2) and urine E1-3-G, respectively. A good correlation was noted between E2 measured by radioimmunoassay (RIA) and the E1-3-G measured by chemiluminescence immunoassay (CIA), from day 5 up to the day of hCG administration (0.6 less than r less than 0.85, P less than 0.001). It is evident from this study that the CIA measurement of E1-3-G in morning urine is an accurate and rapid (2.5 hours) method and is convenient for monitoring induction of ovulation with human menopausal gonadotropins.

The efficiency of cryopreserved semen versus fresh semen for in vitro fertilization/embryo transfer

The efficiency of cryopreserved donor semen versus fresh donor semen in an in vitro fertilization/embryo transfer programme was evaluated. Thirty-nine in vitro fertilization/embryo transfer cycles were performed using fresh donor semen (group A) and 74 cycles were carried out using cryopreserved semen (group B). All patients anderwent a uniform controlled ovarian hyperstimulation using high doses of human menopausal gonadotropins. Oocytes were retrieved transvaginally under ultrasound imaging. Semen (fresh or frozen-thawed) were prepared for insemination by a washing technique. Each ovum was inseminated with 500,000–600,000 motile spermatozoa. No significant difference was noted between the two groups regarding female age, duration of infertility, and number of ova retrieved per aspiration. Even though the fertilization rate in group B was significantly lower than in group A (55.5±3.8 vs 70.4±3.5,P=0,008); pregnancy rates per embryo transfer were similar-39.3 and 38.5%, respecitively.

The establishment of an ovum donation program using a simple fixed-dose estrogen-progesterone replacement regimen

Most ovum donation (OD) programs involve cycle synchronization between recipient and donor for normally cycling recipients and a complex estrogen-progesterone replacement regimen for recipients with ovarian failure. In 1987, Serhal and Craft (1) suggested the use of a fixeddose estrogen-progesterone regimen for recipients who were normally ovulatory and to those with ovarian failure. Following this protocol, and simplifying it still, the authors administered 6 mg estradiol valerate (E2) daily orally starting on day 2–6 of induced withdrawal bleeding, augmented with 100 mg progesterone in ethyl oleate (P) intramuscularly daily, starting any time between 4 days prior to and the day of oocyte pickup. All recipients underwent embryo transfer at a 2-pronuclei (2PN)-10-cell stage. A group of 21 patients underwent 26 treatment cycles, resulting in 16 pregnancies. Twelve of the patients gave birth, one to triplets, two to twins, and nine to singletons. Four patients miscarried in the first trimester of pregnancy.

In vitro fertilization for women with pure tubal occlusion: the impact of short gonadotropin-releasing hormone agonist treatment

OBJECTIVEnTo evaluate the impact of a short GnRH agonist (GnRH-a) protocol on follicular and luteal characteristics and treatment outcome in women undergoing IVF for isolated pure tubal occlusion.nnnDESIGNnA prospective randomized study.nnnPATIENTSnEighty patients with pure tubal occlusion undergoing IVF for the first time.nnnINTERVENTIONSnPatients in group 1 (control group) were administered hMG from day 3 of the menstrual cycle. Patients in group 2 were administered 900 micrograms/d buserelin acetate intranasally from day 1 of the menstrual cycle, followed by hMG administration from day 3. Buserelin acetate was discontinued on the day of hCG administration.nnnMAIN OUTCOME MEASURESnInformation collected included E2 levels and follicular growth throughout cycle, amount of hMG required for stimulation, number of oocytes retrieved, fertilization, pregnancy, and cancellation rates.nnnRESULTSnThe short GnRH-a protocol resulted in significantly higher E2 levels and required less hMG for stimulation. However, the number of follicles aspirated, number of oocytes retrieved, fertilization rate, number of embryos transferred, pregnancy rate, and cancellation rate in both groups were comparable.nnnCONCLUSIONSnThe findings suggest that administration of a short protocol of GnRH-a to patients with pure tubal occlusion has no obvious superiority in comparison with hMG alone, except for the lower amount of hMG required for ovarian stimulation.

Successful ovarian superovulation for in vitro fertilization in a patient with an undiagnosed intrauterine pregnancy

laparotomy showed distended intestinal loops, many adhesions that were lysing, and a roundish formation, 7 cm in diameter, in the right adnexal site, which was removed. When it was opened, a resorbing fetus was found and diagnostic histology identified it as an extrauterine pregnancy with no evidence of tubal structures. The postsurgical course was regular and the ultrasound controls indicated normal development of the intrauterine pregnancy until 12 days after the operation, at which time the pregnancy ended in abortion (16th week).

Interdepartmental unit for IVF/ET, Serlin-Hakirya Maternity Hospital, Tel Aviv, Israel.

In Vitro Fertilization Department Pavilion Mrre et Enfant Centre Hospitalier Universitaire 44035 Nantes Cedex, France action of the analogue on ovarian GnRH receptors (7) or decreased ovarian androgen production might also be suspected. The use of an analogue also allows for the administration of more hMG without the fear of inducing premature luteinization. (c) No alteration in cleavage or implantation rates occurred. These different changes resulted in a significantly enhanced pregnancy rate and represent an improvement, even though the optimal regimen still remains to be determined.