Khaldoun Sharif

Assessment of early cleaving in vitro fertilized human embryos at the 2-cell stage before transfer improves embryo selection.

OBJECTIVE To determine the most viable embryos for transfer. DESIGN Study 1: Preselection of early-cleaving 2-cell embryos for transfer. Study 2: Alternating weeks during which preselection was performed and not performed. SETTING ART program, Birmingham Womens Hospital, Birmingham, United Kingdom. PATIENT(S) Patients undergoing IVF or ICSI cycles with transfer on day 2. INTERVENTION(S) Culture of all fertilized embryos. MAIN OUTCOME MEASURE(S) Number of fertilized embryos cleaving to the 2-cell stage on day 1, embryo quality, implantation rates, and pregnancy rates. RESULT(S) Patients with early-cleaving 2-cell embryos had significantly higher pregnancy and implantation rates (45 of 100 [45.0%] and 58 of 219 [25.5%], respectively) than did patients without early-cleaving 2-cell embryos (31 of 130 [23.8%] and 43 of 290 [14.8%], respectively). In weeks during which preselection was used, the overall pregnancy and implantation rates of the clinic improved. CONCLUSION(S) The presence of early-cleaving 2-cell embryos improves a patients chance of achieving pregnancy. Use of more stringent embryo selection criteria can improve overall pregnancy rates.

Age and basal follicle stimulating hormone as predictors of in vitro fertilisation outcome

Objective To examine the relative effect of basal follicle stimulating hormone (FSH) concentration and the womans age on predicting the ovarian response to gonadotrophin stimulation, normal fertilisation rate and pregnancy rate in in vitro fertilisation (IVF) treatment following pituitary desensitisation.

Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves pregnancy outcome in IVF: a randomized controlled trial

BACKGROUND Hydrosalpinges have adverse effects on IVF outcomes. Salpingectomy is effective in improving outcomes, but it is not always practical or safe. Ultrasound-guided aspiration of hydrosalpinges at oocyte collection is an option for those who develop hydrosalpinges during controlled ovarian stimulation; however, there is no randomized evidence to show whether this practice is effective. METHODS Between October 1999 and June 2003, consenting women of age <or=39 years with an ultrasound diagnosis of hydrosalpinx were randomized before oocyte collection to transvaginal aspiration of hydrosalpinx under antibiotics cover or no aspiration. Third-party randomization was performed using a computer algorithm, and allocation concealment was achieved with opaque sealed envelopes. Outcomes were biochemical and clinical pregnancies, implantation, spontaneous abortion, ectopic pregnancy and pelvic infection rates. Analysis was by intention to treat. RESULTS Sixty-six women were recruited to the trial, 32 to the aspiration group and 34 to the no-aspiration group. Aspiration resulted in a greater biochemical pregnancy rate [14/32 (43.8%) versus 7/34 (20.6%), relative risk (RR) = 2.1 (1.02, 4.6), P = 0.04]. Clinical pregnancy rates for aspiration versus control groups were 31.3% (10/32) and 17.6% (6/34), respectively [RR = 1.8 (0.8, 4.3), P = 0.20]. There were no changes in implantation rate or spontaneous abortion risk with aspiration and no differences between the groups in infection or ectopic pregnancy rates. CONCLUSIONS In women who are identified to have hydrosalpinges during controlled ovarian stimulation during IVF, aspiration of hydrosalpinges during oocyte collection may be effective in improving pregnancy rates (Trial Registration Number: NCT00566956).

Is bed rest following embryo transfer necessary

OBJECTIVE To evaluate the effect of no bed rest following ET on the results of an IVF program. DESIGN Historical cohort-control study. SETTING A University-based assisted conception unit. PATIENT(S) One thousand and nineteen (1019) IVF cycles were performed at our unit from June 1994 to August 1996. The historical control consisted of all the 19,697 IVF cycles reported in the United Kingdom national database from April 1994 to March 1995. INTERVENTION No bed rest following ET in our patients. MAIN OUTCOME MEASURE(S) Pregnancy rate (PR) and clinical PR per cycles started and per ET procedure. RESULT(S) The clinical PR per ET was significantly higher in our patients than in the national data (30% versus 22.9%), as was the clinical PR per cycle (23.5% versus 18.6%). The implantation rate in our patients was 17.2%. CONCLUSION(S) The favorable PR in our patients despite no bed rest following ET suggests the bed rest is not necessary.

Transmyometrial embryo transfer after difficult immediate mock transcervical transfer

OBJECTIVE To evaluate the place of ultrasound-directed transvaginal transmyometrial ET in a protocol using both the transcervical and transmyometrial routes in a step-wise fashion. DESIGN A prospective descriptive clinical study. SETTING A university-based assisted conception unit. PATIENTS Thirteen patients who had difficult or impossible mock transcervical ET immediately before the real transfer. INTERVENTION Ultrasound-directed transvaginal transmyometrial ET. MAIN OUTCOME MEASURES Pregnancy and clinical pregnancy. RESULTS Four patients became pregnant, including three with clinical pregnancies. CONCLUSIONS In cases in which transcervical ET isd difficult or impossible, transvaginal transmyometrial ET is a viable option. The use of mock transcervical ET immediately before the real transfer would identify patients needing transmyometrial ET.

Do patients need to remain in bed following embryo transfer? The Birmingham experience of 103 in-vitro fertilization cycles with no bed rest following embryo transfer

Since the early days of human in-vitro fertilization and embryo transfer, rest in bed for hours immediately following the transfer has been advocated and widely practised. However, there is no scientific validation for this practice which is both time-consuming for the patient and increases space occupancy in the hospital or clinic. We report here on a study of 103 in-vitro fertilization cycles with no bed rest in hospital following the embryo transfer. The mean number of embryos transferred was 2.7 (range 1-3) and the clinical pregnancy rate per embryo transfer procedure was 40%. These results suggest that bed rest is not necessary following embryo transfer.

A controlled comparison of ovarian response to controlled stimulation in first generation Asian women compared with white Caucasians undergoing in vitro fertilisation.

Objective To compare ovarian response to controlled stimulation among Asian women from the Indian sub‐continent and white Caucasian women undergoing in vitro fertilisation (IVF).

Prognosis of oocyte donation cycles: a prospective comparison of the in vitro fertilization–embryo transfer cycles of recipients who used shared oocytes versus those who used altruistic donors

OBJECTIVE To prospectively compare the prognosis of IVF-ET cycles using oocyte sharing vs. cycles using altruistic donors. DESIGN Prospective cohort prognostic study. SETTING University teaching hospital. PATIENT(S) A total of 353 consecutive infertile women with premature ovarian failure or diminished ovarian function. INTERVENTION(S) After receipt of institutional ethics approval, IVF-ET was performed with the use of either oocyte sharing (n = 220) or altruistic donors (n = 133). Continuous data (mean + SD [95% confidence interval]) were compared with Students t test or Mann-Whitney test as appropriate; categoric data were compared with Fishers exact test, odds ratios (OR), and relative risk (RR). Two-tailed P<.05 was considered significant. Logistic regression was used to adjust for confounding variables. MAIN OUTCOME MEASURE(S) The primary endpoint was clinical pregnancy. The secondary endpoints were E(2) dosage, endometrial thickness, fertilization, embryo quality, and rates of embryo cleavage, transfer, and implantation, positive beta-hCG, and biochemical, ectopic, and multiple pregnancy. RESULT(S) There was no statistically significant difference in clinical pregnancy rates (28.18% vs. 30.08%; OR 0.91 [0.49-1.67]; RR 1.07 [0.69-1.65]; adjusted OR 0.95 [0.51-1.78]). The mean E(2) dosage, endometrial thickness, fertilization rate, embryo score, embryo cleavage, number of embryos transferred, and rates of implantation, positive beta-hCG, and biochemical, ectopic, and multiple pregnancy were similar. CONCLUSION(S) The prognosis with use of shared oocytes is similar to that with altruistic donors.

The role of selective salpingography and tubal catheterization in the management of the infertile couple.

Purpose of review This review is intended to update the reader about recent developments in the field of selective salpingography and tubal catheterization, to offer an interpretation of the information presented and to suggest further research links. Recent findings The measurement of tubal perfusion pressures at selective salpingography and tubal catheterization has offered a new dimension in the evaluation of the fallopian tube. A classification of infertile women based on tubal perfusion pressures is presented, and this is correlated with the possibility of spontaneous fertility, thus giving selective salpingography and tubal catheterization a prognostic profile in addition to diagnostic and therapeutic functions. Experience derived from the use of the technique in unselected infertile women (i.e. not with proximal tubal blockage) is presented. The use of selective tube catheterization for sterilization purposes joins the mainstream with the publication of the encouraging results of a multinational trial. The debate on the validity of the diagnosis of proximal tubal blockage is enriched by the suggestion that simply rotating the patient during hysterosalpingography will resolve most cases of the condition. The fertility gain by single-tube recanalization in women with unilateral proximal tubal blockage is given further support. The use of oil-based media for selective salpingography and tubal catheterization is discussed. A hypothesis on the pathophysiology of proximal tubal blockage is presented. Summary The evidence clearly supports the use of selective salpingography and tubal catheterization for infertile women with proximal tubal blockage. The potential of the technique to play a wider role in the management of infertility is demonstrated by recent research.

Surgical sperm retrieval: what not to do

Surgical sperm retrieval has revolutionized the treatment of azoospermia. However, the ease with which it could be performed meant that it is perhaps being used where not indicated. Here are the potential pitfalls to be avoided.