Kamarul Bahyah Mustafa

Higher β-HCG concentrations and higher birthweights ensue from single vitrified embryo transfers

To examine the effect of cryopreservation on developmental potential of human embryos, this study compared quantitative β-HCG concentrations at pregnancy test after IVF-fresh embryo transfer (IVF-ET) with those arising after frozen embryo transfer (FET). It also tracked outcomes of singleton pregnancies resulting from single-embryo transfers that resulted in singleton live births (n = 869; with 417 derived from IVF-ET and 452 from FET). The initial serum β-HCG concentration indicating successful implantation was measured along with the birthweight of the ensuing infants. With testing at equivalent luteal phase lengths, the median pregnancy test β-HCG was significantly higher following FET compared with fresh IVF-ET (844.5 IU/l versus 369 IU/l; P < 0.001). Despite no significant difference in the average period of gestation (38 weeks 5 days for both groups), the mean birthweight of infants born following FET was significantly heavier by 161 g (3370 g versus 3209 g; P < 0.001). Furthermore, more infants exceeded 4000 g (P < 0.001) for FET although there was no significant difference for the macrosomic category (≥4500 g). We concluded that FET programme embryos lead to infants with equivalent (if not better) developmental potential compared with IVF-ET, demonstrated by higher pregnancy β-HCG concentrations and ensuing birthweights.

Heterotopic triplet pregnancy with bilateral tubal ectopic post-IVF-ICSI of two 12-cell embryos

A heterotopic pregnancy is the coexistence of intrauterine and extrauterine pregnancy. It can be as rare as 1:30,000 in spontaneous pregnancies but can be as high as 1:100 following artificial reproductive techniques (ART) [1]. Bilateral tubal ectopic pregnancy is another extremely rare clinical condition, with an estimated prevalence of 1:200,000 in spontaneous pregnancies [2]. It accounts for one in 750 to one in 1580 ectopic pregnancies [3]. Heterotopic triplets are even more uncommon, and cases with bilateral tubal ectopics and coexisting intrauterine pregnancy are limited, if not unheard of. To add to the rarity of these clinical conditions is when there is a heterotopic triplet pregnancy with bilateral tubal ectopics resulting from the transfer of only two embryos as is explained in the case of our patient. Our patient was a 37-year-old woman with unexplained secondary subfertility of 6 years (gravida 2, para 0 þ 1 miscarriage) with a confirmed intrauterine pregnancy after her first attempt of in vitro fertilization (IVF). She had controlled minimal ovarian stimulation for a total of 10 days. Four mature eggs were retrieved on Day 11, and intracytoplasmic sperm injection was performed on all the eggs. Only two embryos at the 12-cell stage were found suitable for transfer. The patient was prescribed with oral dydrogesterone 8 hourly for luteal support. The Day-10 posttransfer serum b hCG level confirmed a successful implantation, and she was scheduled for follow up. Unfortunately, she presented herself

Live birth rates are satisfactory following multiple IVF treatment cycles in poor prognosis patients

This seven-year retrospective study analysed the live birth rate (LBR) for women undergoing IVF treatment with various antral follicle counts (AFC). The LBR decreased with lower AFC ratings, and in 290 treatment cycles for women in the poorest AFC category, ≤4 follicles (group E), the LBR was the lowest at 10.7%. The pregnancy loss rate (PLR) significantly increased with poorer AFC categories, from 21.8% in AFC group A (≥20 follicles), to 54.4% in AFC group E (p<0.0001). This trend was repeated with advancing age, from 21.6% for younger women (<35years), to 32.9, 48.5 and 100% for ages 35-39, 40-44 and ≥45 years, respectively (p<0.0001). However, LBR within the specific AFC group E cohort was also age-dependent and decreased significantly from 30.0% for <35 years old, to 13.3, 3.9 and 0% for patients aged 35-39, 40-44 and ≥45 years, respectively. Most, importantly, LBR rates within these age groups were not dependent on the number of IVF attempts (1st, 2nd, 3rd or ≥4 cycles), which indicated that cycle number should not be the primary deciding factor for cessation of IVF treatment in responding women <45years old.

IVF-ICSI Split Insemination Reveals those Cases of Unexplained InfertilityBenefitting from ICSI Even when the DNA Fragmentation Index is Reduced to 15% or Even 5%

IVF-ICSI Split Insemination Reveals those Cases of Unexplained Infertility Benefitting from ICSI Even when the DNA Fragmentation Index is Reduced to 15% or Even 5% Purpose The aim of the study was to assess the fertilization rate (FR) of randomized sibling oocytes inseminated by conventional IVF or ICSI in couples with unexplained infertility. Methods The 16-month study was conducted at an established private IVF facility. Oocytes recovered from couples with normal semen parameters and normal DNA fragmentation index (DFI; <30%), were randomly allocated to IVF or ICSI and the FR (2PN/MII) was assessed. Pregnancy outcome following embryo transfers were analyzed with regards to either IVF-embryo vs. ICSI-embryo, and in relation to DFI levels. Results Of 585 oocytes retrieved from 38 patients, 463 were mature (MII). The ICSI group generated a significantly higher number of 2PN embryos with a mean FR of 83.4% vs. 67.6% (p<0.05). There were no cases of complete fertilization failure (CFF) in the ICSI group, but there were 7.9% in the IVF group. The significant difference of FR was observed only when the DFI level was ≥ 15% and if such cutoff was applied, the CFF cases would be reduced to 2.6%. Of the 30 patients who had fresh embryo transfers performed, the ICSI group showed a higher pregnancy rate (69.2% vs. 58.8%; N.S.) with a significantly higher mean DFI value in the non-pregnant group (p<0.05). Conclusions IVF-ICSI split insemination can reveal those cases which will benefit from ICSI even where semen parameters and DFI are normal; however if the DFI is reduced to a 15% cut-off level, the rate of CFF will be minimized, but not completely excluded, even at 5%..

Acupressure only as pain relief for patient with multiple drug allergies undergoing oocyte retrieval

In vitro fertilization (IVF) is associated with significant stress, which can affect the general wellbeing of the couple as well as the outcome of treatment. Oocyte retrieval (OR) is the fundamental step in the IVF/intracytoplasmic sperm injection (ICSI) cycle. Transvaginal ultrasound-guided OR (TVOR) is the most common method used in assisted reproductive technology (ART). However, even though TVOR is a short and minimally invasive procedure, it is stressful and undoubtedly painful [1]. Such pain is due to the passage of a double-bore needle through the vaginal wall and ovarian capsule followed by mechanical stimulation within the ovary during the procedure.

A clinical evaluation of bleeding patterns, adverse effects, and satisfaction with the subdermal etonogestrel implant among postpartum and non-postpartum users

The etonogestrel implant (Implanon; Merck Sharp and Dohme, Kenilworth, NJ, USA) is an effective contraceptive with a good safety profile for up to 3 years [1]. However, its adverse effects include irregular vaginal bleeding (affecting 68.0% of users), weight gain (20.7%), acne (15.3%), breast pain (9.1%), and headache (8.5%) [2]. To provide further information about contraception options for women in the postpartum period, the aim of the present study was to investigate the bleeding patterns and adverse effects reported by women who underwent Implanon insertion within 8 weeks of delivery and compare them with those experienced by non-postpartum women. A prospective study was undertaken at Hospital Tengku Ampuan Afzan, Pahang, Malaysia, between July 1, 2010, and June 30, 2012. Women attending the postnatal clinic or family planning/gynecology clinic who met WHO medical eligibility criteria 1 and 2 (no medical restriction for use of contraception or advantages of using contraception outweigh the risks) [3] were enrolled. Nulliparous women and women who had last delivered 8 weeks to 6 months previously were excluded. The institutional ethical committee approved the study and informed consent was obtained from participants. Participants were divided into two groups. Women in the postpartum group had delivered up to 8 weeks previously and underwent Implanon insertion 4–8 weeks after delivery. Women in the non-postpartum group had last delivered at least 6 months previously and underwent Implanon insertion between day 1 and day 5 of menses. Baseline body weight was recorded for each participant. Follow-up visits were scheduled at 3 and 6 months. Bleeding patterns were categorized using the WHO 90-day reference period [4]. Non-menstrual adverse effects and satisfaction were recorded at 6 months. Data were analyzed using SPSS version 20.0 (IBM, Armonk, NY, USA). The Student t test and Fisher exact test were used to compare variables. P < 0.05 was considered statistically significant. A total of 110 women were included in the study, 60 in the postpartum group and 50 in the non-postpartum group. There were no differences in bleeding patterns between the groups at 3 months (Table 1). However, at 6 months, amenorrhea was significantly more common in the postpartum group than in the non-postpartum group (P = 0.005), and infrequent bleeding was more common in the non-postpartum group (P = 0.024) (Table 1). With regard to non-menstrual adverse effects, headache and acne were significantly more common in the non-postpartum group than in the postpartum group (P = 0.001 and P = 0.040, respectively) (Table 1). There were no significant differences for other adverse effects. Weight gain was the most frequent adverse effect, but there was no significant difference between groups (Table 1). Most users from both groups were satisfied with Implanon, with no difference in terms of satisfaction between groups ( Table 1). This finding implies that most women who experienced adverse effects were able to tolerate them. In conclusion, the present study has shown that bleeding patterns and non-menstrual adverse effects can differ according to timing of Implanon insertion after delivery. However, despite menstrual irregularities and other adverse effects, Implanon was well accepted in both groups.