J. Dor

Cumulative pregnancy rate following in-vitro fertilization: the significance of age and infertility aetiology

During the years 1984-1992, 951 couples completed 2252 in-vitro fertilization (IVF) treatment cycles at the In-Vitro Fertilization Unit of The Chaim Sheba Medical Centre. This study was conducted to evaluate the success of IVF using the cumulative pregnancy rate (CPR), with special emphasis on the optimal number of treatment cycles, the age of the patients and female infertility factors. It was found that the CPR showed a constant rise during the six initial IVF treatments (56% CPR), and plateaued in the subsequent three cycles (63% CPR). Various female infertility factors did not influence this rate. Women > or = 40 years of age have a significantly lower CPR. Thus, it was concluded that the CPR in IVF declined after the sixth initial treatment cycle, and in women > or = 40 years of age. The infertility factor did not significantly influence CPR.

Zygote intrafallopian transfer may improve pregnancy rate in patients with repeated failure of implantation

OBJECTIVEnTo evaluate the efficacy of zygote intrafallopian transfer (ZIFT) on implantation rates and pregnancy rates (PRs) in patients with repeated failure of implantation in IVF-ET cycles.nnnDESIGNnA case-control study.nnnPATIENT(S)nCriteria for patient selection included male factor or unexplained infertility, normal uterine cavity, and at least three failures of implantation in IVF-ET cycles in which at least three embryos were placed per transfer. Data on 70 patients who underwent 92 ZIFT cycles are presented. A control group consisted of patients with the same selection criteria who underwent an additional standard IVF-ET cycle during the same time period.nnnINTERVENTION(S)nOvulation induction consisted of down-regulation with GnRH analogue followed by ovarian stimulation with FSH and hMG. Intracytoplasmic sperm injection was performed on the oocytes of all patients with male factor infertility. Zygotes were transferred by laparoscopy into the fallopian tube 24-26 hours after oocyte retrieval.nnnMAIN OUTCOME MEASURE(S)nImplantation rates and PRs in the ZIFT and control groups were compared.nnnRESULT(S)nThe PRs and implantation rates were significantly higher in the ZIFT group than in the control group: 34.2% (24/70) and 8.7% (29/333) versus 17.1% (12/70) and 4.4% (13/289), respectively (P = 0.002 and P = 0.04). The cumulative conception rate for two ZIFT cycles was 59.3%.nnnCONCLUSION(S)nZygote intrafallopian transfer should be considered a beneficial mode of treatment for patients with repeated failure of implantation in IVF and transcervical ET. More prospective randomized studies are needed to support this observation.

Alginate scaffold for organ culture of cryopreserved-thawed human ovarian cortical follicles

PurposeTo compare macroporous alginate scaffolds with Matrigel for culturing frozen-thawed human primordial follicles in organ culture.MethodsTwelve girls/women donated ovarian tissue. One tissue sample was fixed immediately after thawing (uncultured samples). Slices were cultured for 2xa0weeks on either Matrigel or on alginate scaffolds with a serum-free culture medium. Growth evaluation consisted of follicular counts and classification, immunohistochemistry and measurement of 17β-Estradiol (E2) production.ResultsThe number of developing follicles was significantly higher in alginate scaffold-cultured samples than on Matrigel with a concomitant decrease in the number of primordial follicles in alginate scaffold-cultured samples than uncultured samples. The number of atretic follicles after 1xa0week was significantly higher in the Matrigel-cultured samples than in the alginate scaffold cultured samples. E2 production was similar in both groups.ConclusionsThree dimensional alginate scaffolds are a promising putative in vitro technology for developing human primordial follicles.

Hysteroscopy in a program of in vitro fertilization

Two hundred twenty-four women underwent hysteroscopic evaluation without anesthesia after at least two failed attempts of in vitro fertilization and embryo transfer. One hundred fifty-three (68%) women were diagnosed as having mechanical infertility, and abnormal hysteroscopic findings were observed in 32 (21%). Forty-one women were diagnosed as having unexplained infer-tility (18%) and six (15%) had abnormal findings with hysteroscopy. Of the 30 couples who entered the in vitro fertilization regimen program because of male infertility, 4 (13%) had abnormal findings. The overall rate of abnormal findings was 19%; cervical canal and intrauterine abnormalities were found in 10 and 32 patients, respectively. Ten patients were treated during hysteroscopic evaluation procedure, and four patients subsequently underwent operative hysteroscopy under general anesthesia. We suggest that diagnostic hysteroscopy should be a routine procedure before in vitro fertilization and embryo transfer therapy.

In vitro fertilization in Kock's ileostomy patients: prior evaluation by pelvic ultrasonography

The study describes Kocks continent ileostomy in 2 females, both of whom were suffering from tubal infertility. Appropriate placement of the abdominal pouch, permitting in vitro fertilization embryo transfer treatment, was present in 1 patient. In the other patient, an ultrasonographic examination demonstrated the pouch covering the entire surface area of both ovaries. Oocyte aspiration was thus precluded for fear of penetrating the pouch. Ovum pickup in the presence of a Kock continent ileostomy can be conducted safely and without risk, if the pouch is correctly positioned above the small pelvis. Ultrasonography facilitated the ability to locate the patients ovaries and precise position of the pouch.