L.B. Werlin

Randomized trial to compare the effect of recombinant human FSH (follitropin alfa) with or without recombinant human LH in women undergoing assisted reproduction treatment

Women undergoing intracytoplasmic sperm injection (ICSI) for male factor infertility were randomly assigned to receive ovarian stimulation in a long agonist protocol with a combination of recombinant human FSH (r-hFSH; Gonal-F) and recombinant human LH (r-hLH; Luveris) (n = 212) starting on day 6 of FSH stimulation until human chorionic gonadotrophin (HCG) at a daily fixed dose of 150 IU r-hLH, or with r-hFSH alone (n = 219). There was no significant difference in the number of metaphase II oocytes retrieved (10.3 versus 10.4) in patients treated with r-hFSH and r-hLH versus r-hFSH alone; however, more embryos were transferred in the LH-supplemented group (2.9 versus 2.8, P = 0.037). Overall, the implantation rates were 22.9 versus 27.0% in patients treated with r-hFSH and r-hLH versus with r-hFSH alone respectively (NS). The respective numbers of MII oocytes retrieved in patients <35 or >or=35 years were 11 versus 8.3 (P = 0.010) for patients treated with r-hFSH alone, and 10.7 versus 9.3 (NS) for those given supplemental r-hLH (150 IU) from day 6. Implantation rates in patients <35 years treated with r-hFSH were higher (30.7%) than those receiving r-hFSH and r-hLH, (23.5%) (P = 0.068). In patients >or=35 years, the implantation rates were 21.7% for those patients supplemented with 150 IU r-hLH from day 6 of stimulation versus 15.7% when treated with FSH alone (NS). Younger patients therefore do not seem to benefit from an LH-supplemented ovarian stimulation protocol, but women >or=35 years undergoing assisted reproduction may benefit from using r-hLH in addition to r-hFSH.

Age thresholds for changes in semen parameters in men.

OBJECTIVE To determine whether age thresholds for elements of semen quality exist. DESIGN Retrospective analysis (covariance and point-change analysis) of results of 4,822 semen analyses and 259 fluorescence in situ hybridization (FISH) analyses. SETTING Reference laboratory within an infertility clinic. PATIENT(S) A total of 5,081 men aged 16.5-72.3 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Ejaculate volume, sperm concentration, sperm motility, sperm motion parameters, strict morphology, and results of FISH analysis. RESULT(S) Measured parameters of ejaculates did not change before 34 years of age. Immediately thereafter, total sperm numbers (and total motile) declined. Sperm concentration and the proportion of sperm of normal morphology declined after 40 years. Sperm motility and progressive parameters of motile sperm fell after 43 years and ejaculate volume after 45 years. The ratio of Y:X-bearing sperm in ejaculates decreased only after 55 years. CONCLUSION(S) Our findings project a declining likelihood of pregnancy following intercourse with men >34 years old, independent from the womans age and increasing with advancing age. Age-related mechanisms associated with this oligoasthenoteratozoospermic progression are discussed.

Ultrasound: a technique useful in determining the side of ovulation *

It is often assumed that ovulation commonly occurs from alternating sides each month, but it is unknown whether it can occur repeatedly from the same side. In an effort to answer this question, we selected 39 women from our infertility clinic who had six consecutive courses of ultrasound (US) to monitor ovulation and in whom the side of ovulation was recorded. Nine patients (23.1%) ovulated from the same side for six consecutive cycles, whereas no patient alternated side of ovulation in the same period of time. Stimulation with clomiphene citrate and/or human menopausal gonadotropin that results in single ovulation did not affect this pattern. The data were analyzed statistically with the use of a Markov Chain Model and the chi-square goodness-of-fit; the occurrence of persistent same-side ovulation was significant to P less than or equal to 0.001.

Preimplantation genetic diagnosis (PGD) as both a diagnostic and therapeutic tool in assisted reproductive technology (ART)

Materials/Methods: All patients entered into the study met all inclusion criteria and were then randomized into PGD or control in one of the 3 groups. All stimulation protocols utilized Follistim/Antagon and Pregnyl. Oocyte recovery was performed by ultrasound guided transvaginal approach. On day #3 post oocyte recovery all 6–8 cell embryos in the PGD group underwent blastomere biopsy and fixation. Slides were then federal expressed to St. Barnabas Hospital in Livingston, New Jersey. FISH was performed utilizing the following probes: x, y, 13, 15, 16, 17, 18, 21, 22. On day #5 post oocyte recovery results were obtained and embryo transfer of no more than 3-chromosomally normal embryos was performed. Medications including corticosteroids, antibiotics, low dose aspirin (80–81mg) and progestational supplementation were utilized. Serum B-HCG levels were obtained 12 days post embryo transfer. Results: See table