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Evaluation of Pregnancy Rates After Intrauterine Insemination According to Indication, Age, and Sperm Parameters

Purpose:Our purpose was to evaluate intrauterine insemination results obtained in our clinic and identify prognostic factors for the chance of pregnancy.Methods:A retrospective study of data from 1989 to 1996 was undertaken. Only first attempts were included in this study, except for the part on the cumulative pregnancy rates. Couples with either one-sided tubapathology, hormonal dysfunction, idiopathic infertility, or andrological indication were selected. All women were stimulated with clomiphene citrate. Five hundred sixty-six couples who underwent 1763 cycles were included in the study.Results:The overall pregnancy rate for first pregnancies was 6.9% per cycle and 21.4% per patient. For first intrauterine insemination attempts this was 8.8% per cycle/patient, varying between 5.0% for andrological indication and 10.6% for tubapathology, 10.0% for idiopatic indication, and 10.3% for hormonal indication. These differences were not significant. Age did not have a significant effect either, although there were no pregnancies observed in women 40 years or older. The number of inseminated spermatozoa significantly affected the pregnancy rate: <2 million, 4.6%; ≥2 to <10 million, 3.9%; and ≥10 million, 11.3%.Conclusions:Unless semen characteristics are insufficient, intrauterine insemination is a useful treatment for infertile couples.

Follow-up of 30 pregnancies after embryo cryopreservation

OBJECTIVE In an observational follow-up study, the pregnancy outcome of the first 30 women who conceived after transfer of cryopreserved embryos was evaluated. STUDY DESIGN The main outcome measures were duration and complications of pregnancy, mode of delivery, complications during and after childbirth, birthweight, Apgar score, and congenital anomalies. RESULTS Twenty-six pregnancies ended in birth of one (n = 22) or more (n = 4) infants with a cesarean section rate of 23%. Of the singleton pregnancies 77% were uncomplicated, but there was a high incidence of breech presentation (14%). Infant birthweight tended to be above average with 45% of singletons weighing more than the 75th centile of weight for gestation. There were no major congenital deformations. CONCLUSION The results of our embryo cryopreservation program are encouraging, but sustained follow-up of such pregnancies and infants is needed.

Prostanoid levels in in vitro fertilization culture medium are not related to the likelihood of implantation

OBJECTIVE To determine prostanoid levels (prostaglandin E2, prostaglandin F2 alpha, 6-keto-prostaglandin F1 alpha, and thromboxane B2 [TXB2]) in embryo culture medium containing inactivated maternal serum and their correlation with the clinical outcome of IVF-ET. DESIGN Prostanoid levels were measured in blank control medium and in medium containing an embryo or nonfertilized oocyte with a high-pressure liquid chromatography (HPLC-RIA) method. Comparisons of HPLC-RIA, Seppak C18-RIA, and RIA directly in the medium demonstrated identical results for TXB2, allowing the use of direct RIA in the large investigation of 129 media. SETTING Leiden University Hospital, The Netherlands. PATIENTS Patients with (n = 12) and without (n = 15) an ongoing pregnancy after IVF-ET. MAIN OUTCOME MEASURES Prostanoid levels in embryo culture medium and relationship between prostanoid levels and successful implantation. RESULTS Thromboxane B2 is the only prostanoid consistently found in these media. In both groups there was no difference in TXB2 levels between control media, media containing a nonfertilized oocyte, and media containing an embryo. There was no difference in TXB2 levels between media that had harbored the beginning of a successful pregnancy and those that had not produced a pregnancy. CONCLUSION Thromboxane B2 in the embryo culture medium originates from maternal serum and bears no relationship with the likelihood of fertilization and implantation.

Successful intracytoplasmic sperm injection after failed in vitro fertilization due to multipronuclear oocytes

OBJECTIVE To report a case of IVF with apparently normal female and male gametes that resulted in the development of only multipronuclear oocytes (instead of oocytes containing two pronuclei) and was successfully treated with ICSI. DESIGN Case report. SETTING A university hospital. PATIENT(S) A 35-year-old woman with unexplained infertility and her partner, a 38-year-old man with normozoospermia. INTERVENTION(S) Intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S) Oocyte fertilization and pregnancy. RESULT(S) Normal fertilization and an ongoing pregnancy occurred after transfer of two embryos. CONCLUSION(S) Although the usual indication for ICSI is male subfertility, it can also be used to successfully treat oocyte defects.