Itai Bar-Hava

The role of purified follicle stimulating hormone therapy in the male partner before intracytoplasmic sperm injection

OBJECTIVEnTo evaluate the impact of long-term purified FSH (pFSH) therapy in male partners before intracytoplasmic sperm injection (ICSI).nnnDESIGNnProspective, randomized, controlled study.nnnSETTINGnLarge university-based IVF unit.nnnPATIENT(S)nSeventy-eight patients made up the study and control groups (39 patients each). All patients had severe male factor infertility.nnnINTERVENTION(S)nInduction of ovulation, oocyte retrieval, ICSI, and ET were carried out in both groups. In the study group, male partners received pFSH (75 IU FSH, <1 IU LH) for > or = 50 days before oocyte retrieval.nnnMAIN OUTCOME MEASURE(S)nFertilization rate, embryo quality, implantation and pregnancy rates.nnnRESULT(S)nFertilization and pregnancy rates were higher in the study group (68% and 35.9%, respectively) were higher than in the control group (59% and 17.9%, respectively), although the differences did not reach statistical significance. The implantation rate was significantly higher in the study group (15.5% versus 6.5%). The study group showed a trend toward a higher number of better-quality embryos per transfer (mean +/- SD, 2.2 +/- 1.6 versus 1.6 +/- 1.6).nnnCONCLUSION(S)nPurified FSH therapy in male partners before ICSI improves implantation rate. Improved embryo quality may be a contributory factor.

Early diagnosis and successful nonsurgical treatment of viable combined intrauterine and cervical pregnancy

Cervical pregnancy is a rare form of EP often resulting in an obstetric catastrophe. We report a case of a combined viable IUP and cervical pregnancy resulting from IVF-ET treatment and which was diagnosed during the 7th week of gestation. Nonsurgical treatment consisting of selective intra-arterial catheterization and administration of MTX directly into the uterine arteries was carried out successfully. Complications were avoided, and the patients reproductive capability was preserved.

Morphology and clinical outcomes of embryos after in vitro fertilization are superior to those after intracytoplasmic sperm injection

OBJECTIVEnTo compare embryos obtained after IVF and intracytoplasmic sperm injection (ICSI) regarding morphology and the likelihood of achieving clinical pregnancy.nnnDESIGNnCase-control study.nnnSETTINGnAn IVF unit controlling 1,310 cycles in 1996.nnnPATIENT(S)nWomen having a total of 477 IVF and 475 ICSI consecutive cycles.nnnINTERVENTION(S)nOvarian stimulation, IVF-ET, or ICSI-ET for all couples.nnnMAIN OUTCOME MEASURE(S)nNumber of grade-A embryos transferred, preclinical pregnancy losses, and clinical pregnancy rates in IVF and ICSI cycles.nnnRESULT(S)nIn comparison with the ICSI group, the IVF group showed significantly more grade-A embryos available for transfer (mean, 2 +/- 1.6 versus 1.8 +/- 1.5), significantly fewer preclinical pregnancy losses (1.6% versus 4%), and significantly higher clinical pregnancy rates (25% versus 19.1%).nnnCONCLUSION(S)nEmbryos obtained after IVF are superior to those obtained after ICSI in relation to embryo morphology and the likelihood of achieving clinical pregnancy.

Spectrum of normal intrauterine cavity sonographic findings after first-trimester abortion.

To characterize the sonographic appearance of the uterine cavity after uncomplicated first‐trimester abortion.

Pharmacokinetics of the progesterone-containing vaginal tablet and its use in assisted reproduction

Natural progesterone, which is devoid of androgenic activity, is widely used in assisted reproduction for luteal and pregnancy support. The vaginal route has become the most established way to deliver natural progesterone because it is easily administered, avoids liver first-pass metabolism, and has no systemic side-effects. The vagina has a large potential for absorption, and through the uterine first-pass effect vaginal administration results in higher uterine progesterone concentrations. We have investigated the pharmacokinetics of natural progesterone in the form of a vaginal tablet. A single dose of 100 mg resulted in a mean C(max) of 31.53 +/- 9.15 nmol/l with a T(max) of 6.92 +/- 3.12 h. The terminal half-life was 16.39 +/- 5.25 h. The pharmacokinetic data are discussed in relation to dose, age, and estrogen priming. Single-dose pharmacokinetics of 100 mg of progesterone vaginal tablets and gelatin capsules were evaluated over 24 h. Results indicated a similar mean T(max) of 6.92 +/- 3.12 and 6.23 +/- 6.57 h, respectively. However, a significantly higher C(max) was achieved by the vaginal tablet (31.95 +/- 9.15 and 23.85 +/- 9.57 nmol/l, respectively, P < 0.05). Continuous use of vaginal progesterone did not influence the hormonal, liver, or lipid profiles evaluated. There was no case of endometrial hyperplasia. The vaginal tablet was found to be well-tolerated, safe, and easily administered. In conclusion, progesterone-containing vaginal tablets have good pharmacokinetic properties and should be used for progesterone supplementation in IVF.

Fibrin glue improves pregnancy rates in women of advanced reproductive age and in patients in whom in vitro fertilization attempts repeatedly fail

OBJECTIVEnTo evaluate the possible contribution of fibrin sealant to the ET stage of IVF.nnnDESIGNnCase-control study.nnnSETTINGnAn assisted reproductive technology unit that performed 2,535 treatment cycles from 1996-1997.nnnPATIENT(S)nAll consecutively seen patients who underwent ET from January 1996 to September 1997.nnnINTERVENTION(S)nAll women who underwent ET with the aid of fibrin sealant during the study period were compared with those who underwent standard ET (controls). Thereafter, a case-control study was conducted on the first consecutively seen 174 women who underwent ET with fibrin sealant and a control group that was matched for age and number of previous unsuccessful cycles.nnnMAIN OUTCOME MEASURE(S)nPatient age, number of previous unsuccessful IVF attempts, number of embryos transferred, and pregnancy rates.nnnRESULT(S)nDuring the study period, ET was performed with fibrin sealant in 265 women and by the standard procedure in 1,402 women. Women in the fibrin sealant group were significantly older. The pregnancy rate was not significantly different between the groups in the whole-cohort study (20.4% versus 23.1%), but it was significantly higher in the fibrin sealant group in the case-control study (25.3% versus 14.9%). This also was true when the older women (>35 years) and the women with > or =4 previous failed IVF attempts were analyzed separately (23.2% versus 9.8% and 26.1% versus 13.4%, respectively).nnnCONCLUSION(S)nThe use of fibrin sealant in ET appears to be beneficial in women of advanced reproductive age and in patients in whom IVF attempts repeatedly fail.

Subtorsion of the ovary: sonographic features and clinical management.

To define the sonographic imaging criteria of ovarian subtorsion.

Double (consecutive) transfer of early embryos and blastocysts: aims and results

OBJECTIVEnThe aim of this study was to evaluate the consecutive transfer approach of early embryos and blastocyst(s).nnnDESIGNnCase-control study.nnnSETTINGnPublic assisted reproduction technology unit.nnnPATIENT(S)nThe study population consisted of three groups. In Group 1, a double transfer was performed on 136 consecutive women, that is, a standard transfer of embryos on day 2 or 3, and a second transfer of a blastocyst(s). In Group 2, an early transfer of only two embryos and a second transfer of one blastocyst were performed on 29 women from group 1 who had more than three high-quality embryos available for early transfer. In Group 3, a single early transfer was performed on 139 consecutive women who received three high-quality embryos (controls).nnnINTERVENTION(S)nEarly embryo transfer, extended culture of the spare embryos, and a second transfer of a blastocyst(s).nnnMAIN OUTCOME MEASURE(S)nImplantation and pregnancy rates. RESULTSs): No differences were detected among the three groups in either pregnancy or implantation rates (pregnancy: 36.8%, 41.4%, and 37.4%, respectively; implantation: 14.6%, 19.9%, and 19.8%, respectively).nnnCONCLUSION(S)nThe double (consecutive) transfer of early embryos and blastocyst(s) does not offer any advantage over the traditional early transfer. This may be from the adverse effect of the second transfer on the implantation process.

Comparison of embryo quality between intracytoplasmic sperm injection and in vitro fertilization in sibling oocytes

BackgroundThe aim of the present study was to compare the quality of embryos derived from sibling oocytes by in vitro fertilization (IVF) or ICSI.MethodsConsecutive patients with a less than 40% fertilization rate in a previous standard IVF cycle or with relative male factor infertility were recruited for the study. The oocytes retrieved from each patient were divided into two groups for either conventional insemination (group A) or ICSI (group B). Power analysis showed that to detect a 25% difference in the rate of high-quality embryos between the groups with a power of 0.8, at least 1,200 oocytes were needed in each group.ResultsOne hundred seventy-seven patients were included in the study. Group A was comprised of 1,526 oocytes and group B of 1,480 sibling oocytes. As expected, the fertilization rate was significantly higher in group B than group A (67.1 vs. 43.6%, pu2009<u20090.001). No significant between-group differences were observed in cleavage rate (92.7 and 89.7%, respectively) and the rate of either grade A embryos (22.6 and 23.9%, respectively) or grade A1 embryos (37.3 and 33.5%, respectively).However, in the subgroup of patients with relative male-factor infertility (nu2009=u200936), the rate of grade A1 embryos was significantly higher in the IVF than the ICSI group (46.4 vs. 29.0%, respectively, pu2009=u20090.02).ConclusionsEmbryo quality does not seem to be influenced by the mode of fertilization (IVF or ICSI). We assume that embryo quality depends on intrinsic factors of the gametes involved rather than on the fertilization process per se.

Oral sildenafil may reverse secondary ejaculatory dysfunction during infertility treatment

Erectile dysfunction is much more common than generally supposed, with an estimated prevalence of 10% in men of all ages and 1.9% in men