Liana Bianchi

Oocyte donation program: pregnancy and implantation rates in women of different ages sharing oocytes from single donor*

OBJECTIVE To investigate the importance of uterus age as regards of pregnancy, implantation, and abortion rates using the oocyte donation model. DESIGN Retrospective data analysis of cases where recipients of different ages shared oocytes from single donor. SETTING A tertiary infertility center. PATIENTS One hundred fourteen women (21 to 49 years of age) undergoing a total of 114 cycles of oocyte donation were divided into two groups according to age (group A < = or 39 years: group B between 40 and 49 years). INTERVENTIONS Hormonal replacement therapy was given using increasing doses of 17 beta-E2 (2, 4, and 6 or 8 mg) and either 100 mg of P in oil or 600 mg of micronized P through the vaginal route. MAIN OUTCOME MEASURES Pregnancy, abortion, and implantation rates. RESULTS Fifty-seven transfer cycles were performed per age group. Twenty-seven clinical pregnancies were achieved in Group A and 14 in group B, with pregnancy rates (PRs) of 47.3% and 24.5%, respectively. There were four abortions in group A and one in group B, resulting in abortion rates of 14.8% and 7%, respectively. Thirty-four of 137 transferred embryos in group A and 20 of 134 in group B implanted, resulting in implantation rates of 24.8% and 14.9%, respectively. CONCLUSION This study seems to suggest that there are differences in pregnancy and implantation rates in recipients of different ages because of uterine receptivity. Fertility therefore does not depend merely on oocyte age and quality but also on uterine age.

Pregnancies in postmenopausal women over 50 years old in an oocyte donation program

OBJECTIVE To determine the potential of the aging uterus in terms of pregnancy, implantation, and abortion rates, and obstetric complications in postmenopausal women age 50 and over, receiving oocyte donation. DESIGN Retrospective data analysis. SETTING A tertiary infertility center. PATIENTS Thirty-four postmenopausal women (50 to 62 years of age) undergoing a total of 61 cycles of oocyte donation. INTERVENTIONS Hormone replacement therapy (HRT) was given using increasing doses of 17 beta-E2 (2, 4, and 6 mg) and 100 mg of P in oil. MAIN OUTCOME MEASURES Pregnancy, abortion, and implantation rates, and pregnancy outcome. RESULTS There were 34 patients treated through 61 cycles. Fifty-five transfer cycles were performed. A total of 18 clinical pregnancies were achieved with a pregnancy rate per transfer of 32.7% and per patient of 52.9%. There was one abortion, resulting in an abortion rate of 5.5%. Twenty-one of the 116 transferred embryos implanted, resulting in an implantation rate of 18%. No statistically different rates were found in oocytes donors. CONCLUSION Women over the age of 50 and up to 62 can become pregnant using donated oocytes. The aging uterus after HRT allows implantation as well as in young women, and it is able to carry pregnancy to term apparently without any problems.

Oocyte donation programme: results obtained with intracytoplasmic sperm injection in cases of severe male factor infertility or previous failed fertilization

Intracytoplasmic sperm injection was carried out in 15 oocyte donation cycles of 15 infertile couples where oocytes had failed to fertilize after in-vitro fertilization (IVF) procedures or where the male partner had severe male factor infertility. A total of 62 oocytes were donated, but only 46 of these, in metaphase II, were injected. Of the injected oocytes, 31 (67.3%) had two pronuclei the morning after the injection procedure. On the following day, 29 embryos were obtained (93% of the fertilized oocytes) and 25 were transferred. Two patients were not successful and consequently did not undergo embryo transfer. A total of five clinical pregnancies were obtained, giving pregnancy rates of 33.3 and 38.4% per started cycle and embryo transfer respectively.

Vaginal gel versus intramuscular progesterone for luteal phase supplementation: a prospective randomized trial

The aim of this randomized study was to compare the efficacy of intramuscular progesterone (IMP) and progesterone in vaginal gel (VGP) at two different doses for luteal support in IVF. A total of 412 patients, aged between 28 and 37 years, were randomized into three groups. The day after oocyte retrieval each patient began supplementation with one of the following: IMP 50 mg daily (150 patients), VGP 90 mg once daily (143 patients), or VPG 90 mg twice daily (148 patients). No significant difference was found between the three groups in any of the endpoints. The rate of positive beta-human chorionic gonadotrophin per transfer was 38.4% with IMP, 35.0% with VPG once daily and 43.1% with VPG twice daily. Clinical pregnancy rate per transfer and implantation rate were 32.6% and 19.6% with IMP, 26.3% and 16.4% with one dose of VGP, and 37.2% and 21.1% with two doses of VGP. Live birth rate per transfer was 26.1%, 23.4% and 29.9%, respectively. Progesterone vaginal gel can be successfully used as an alternative to intramuscular progesterone for luteal support in IVF. One daily dose appears sufficient to induce clinical pregnancies and live births at a rate comparable to intramuscular supplementation.

CLINICAL ASSISTED REPRODUCTION: Effect of Duration of Estradiol Replacement on the Outcome of Oocyte Donation

Purpose: To investigate if duration of estrogenic endometrial stimulation can affect recipient pregnancy rate in an ovum donation program.Methods: Each recipient received micronized 17 β-estradiol orally in a steadily increasing dosage from 2 to 6 mg daily over a period of time varying from 5 to 76 days until oocyte were available for donation. Recipients (520 patients for a total of 835 transfer cycles) were retrospectively divided into five groups depending on the duration of E2 administration.Results: No significant difference was seen in pregnancy and implantation rates between groups. There was a higher number of miscarriages in Group A (41%), p < 0.05 vs. Group B (15%), and vs. Group E (1%). Age, number of pregnancies and miscarriages, or implantation rate in donors (327 women aged <35 years) were similar in all the five groups.Conclusions: Endometrial receptivity is tolerant to a wide duration of E2 treatment (until 2 months), while waiting for oocytes available for donation, but best results are achieved with a treatment range of 11 to about 40 days.

Comparison of IVF and ICSI when only few oocytes are available for insemination

The aim of this work was to evaluate the efficiency of IVF and intracytoplasmic sperm injection (ICSI) when few eggs available for insemination. A total of 601 women (group A, mean age 31.2 +/- 2.8 years) who were undergoing a total of 671 assisted reproduction cycles donated their excess oocytes to 694 patients (group B, mean age 41.0 +/- 0.2) for 1606 replacement cycles. Each recipient received three to five eggs. The recipients were divided into two groups depending on the insemination method used (IVF, group B1; or ICSI, group B2); ICSI patients were then subdivided into two further groups based on the semen parameters: B2A adequate for IVF and B2B only suitable for ICSI. The results showed that, when comparing A versus B and B1 versus B2, no significant differences were found in terms of pregnancy (28.0 versus 24.1% and 25.5 versus 21.4%), implantation (15.6 versus 14.9% and 15.9 versus 13.1%) and miscarriage (15.4 versus 20.5% and 17.9 versus 26.3) rates respectively. Comparing subgroups B2A and B2B, no significant differences were found in terms of pregnancy (20.0 versus 21.9%), implantation (14.4 versus 12.7%) and miscarriage rates (18.2 versus 28.6%) respectively. In conclusion, ICSI does not seem to yield better outcomes.

Andrology: Influence of spermatozoa characteristics on gamete intra-Fallopian transfer procedures: analysis of results obtained utilizing normozoospermic, oligoasthenozoospermic and donor spermatozoa

The objective of this study was to analyze the efficacy of the gamete intra-Fallopian transfer (GIFT) procedure in relation to spermatozoa characteristics. A total of 268 infertile couples enlisted for GIFT were categorized into three groups on the basis of semen characteristics in the husband. These included oligoasthenozoospermic men in 88 retrieval cycles (group 1), normozoospermic men in 116 cycles (group 2) and azoospermic partners who needed donor semen in 86 cycles (group 3). All female patients had ovarian stimulation and laparoscopic GIFT. Pregnancy rates were significantly higher with donor spermatozoa than with oligoasthenozoospermic or normozoospermic spermatozoa, i.e. 51.1% versus 15.9% (P < 0.001), and 32.7% (P < 0.005). Implantation rates were significantly higher with donor spermatozoa than with normo- or oligoasthenozoospermic spermatozoa (P < 0.01). These data suggest that GIFT does not give good results with male factor infertility. Donor cryopreserved semen gives higher pregnancy and implantation rates than normozoospermic semen, and GIFT with donor spermatozoa gives a good chance of pregnancy to couples previously treated with artificial insemination using donor semen.