L. Van Waesberghe

An 18-month survey of infertility treatment by in vitro fertilization, gamete and zygote intrafallopian transfer, and replacement of frozen-thawed embryos

An 18-month survey of infertility treatment by in vitro fertilization (IVF) and related procedures at the Centre for Reproductive Medicine of the Vrije Universiteit Brussel is described. During this period, 1326 treatment cycles were started in patients with long-standing infertility and 1135 oocyte retrievals were performed in 771 different patients. IVF and embryo transfer (ET) after laparoscopic (N=793) or ultrasonically guided (N=342) ovum pickup, gamete intrafallopian transfer (GIFT;N=284), or zygote intrafallopian transfer (ZIFT;N=15) combined with IVF as well as the replacement of cryopreserved embryos yielded an overall pregnancy rate of 21.8% per started cycle. Echographic and laparoscopic oocyte retrieval gave similar results except for a higher fertilization rate after echographic-guided retrieval. For in vitro fertilization and embryo transfer an overall pregnancy rate of 26% per transfer was obtained. For GIFT and ZIFT the pregnancy rates were, respectively, 27.8 and 46.7% per replacement. For each procedure onethird of the pregnancies aborted. After the replacement of frozen and thawed embryos, during a natural cycle, a significantly lower fetal loss was observed.

Chromosome studies and fertility treatment in women with ovarian failure

In vitro fertilization and embryo transfer or gamete (or zygote) intra‐Fallopian transfer after ovum donation were performed in 16 patients with primary or secondary amenorrhea, associated with chromosome abnormalities. The patients showed the wide range of (mostly X) chromosome abnormalities characteristic for women with primary or premature ovarian failure. Four of these patients became pregnant and three of them have delivered healthy infants with a normal karyotype. This pregnancy rate is far superior to the accepted fertility figure in these patients. When these results were compared with the fertility treatment results of three other groups of women with absent ovarian function (1. ovarian dysgenesis; 2. surgical castration; 3. premature menopause) but with a normal 46.XX karyotype, no difference in treatment efficiency could be detected. These results offer a promising approach for the treatment of infertility in agonadal patients with chromosome aberrations.

Establishment of 22 pregnancies after oocyte and embryo donation

Summary. Donated oocytes inseminated with partners semen or donated embryos were transferred on 95 occasions in 28 women without ovarian function and in 21 with functional ovaries. Overall, 22 pregnancies were established, 13 alter the transfer of fresh embryos and nine after the transfer of frozen‐thawed embryos. Eleven of the pregnancies were established in women without ovarian function and 11 in women with functional ovaries. Nine of the pregnancies were established with donated oocytes inseminated with partners semen and 13 with donated embryos. Fifteen healthy infants were born including one set of twins; three pregnancies arc progressing normally and five miscarried.

Perurethral ultrasound-guided ovum pickup

Either a percutaneous-transvesical, a transvaginal, or a perurethral-transvesical approach can be used for oocyte recovery under ultrasound guidance in an in vitro fertilization and embryo transfer program. After having experienced these three different approaches in our program, we preferentially used the perurethral-transvesical approach as our routine technique for oocyte recovery under ultrasound guidance. We feel that this method is easier to perform and also carrier less risk for contamination. From January to December 1986, 186 oocyte retrievals under ultrasound guidance were performed. In 7 cases no oocytes were found despite normal ovarian stimulation. A total of 767 oocytes was collected; the fertilization rate was 71.8%. Forty pregnancies were achieved (21.5% per attempt or 27.7% per embryo replacement). Except for transient hematuria, no complications were observed.

Synchronization in Ovum Donation

The establishment of the first pregnancy after embryo donation was reported in a patient with functional ovaries.1 In 1984 the first birth after embryo donation was reported in a patient with absent ovaries.2 Synchrony between the embryo stage and endometrial maturity is mandatory. Several possibilities exist to synchronize i.e. cryopreservation of the concepti and transfer after thawing at the appropriate moment in the recipient’s cycle. Donor’s and recipient’s cycles can also be synchronized, using LHRH analogues. In this report we analyze the efficiency of LHRH analogues in a donor egg programme.

The Use of GnRH Analogues for Synchronization of Oocyte Donation

Since the first pregnancy and delivery in a patient with absent ovaries [1] more pregnancies have been reported after oocyte donation. Synchrony of the donor’s and recipient’s cycles is mandatory. We here report the synchronization of the donor’s cycle to the recipient’s substituted cycle using a long and short protocol of GnRH analogues in combination with hMG and HCG.

Primary Ovarian Failure

Primary ovarian failure occurs under different circumstances as ovarian dysgenesis, premature menopause, and surgical menopause.’ The first pregnancy and birth after steroid-substitution therapy and in vitro fertilization (IVF) and embryo transfer (ET) in a patient with primary ovarian failure was reported in 1984: The transfer can be done with fresh embryos, if the ovarian cycles from donor and recipient are s y n c h r o n o u ~ ~ ~ ~ ; if their cycles are asynchronous, pregnancy can be obtained by replacing frozen-thawed embryos.’ The results of oocyte and embryo donation at the Centre for Reproductive Medicine of the Medical Campus of the Vrije Universiteit Brussel are reported.