Peter Kemeter

Transvaginal sector scan sonography for needle guided transvaginal follicle aspiration and other applications in gynecologic routine and research.

A transvaginal sector scanner probe has been developed for precise needle-guided transvaginal follicle aspiration under sonographic control. The first results of transvaginal needle-guided follicle aspiration are presented. A high recovery rate was obtained (86% /follicle). The pregnancy rate after in vitro fertilization and embryo replacement was remarkably high (21.3%/cycle). Because exceptionally high-quality images of the organs in the pelvis are obtained, there are numerous other potential applications for the trans-vaginal sector scanner.

Could aspiration of the Graafian follicle cause luteal phase deficiency

Luteal phase quality was evaluated in 32 patients wih nonstimulated cycles after laparoscopic oocyte recovery for in vitro fertilization. A luteal phase deficiency occurred in two cases (6.2%), the mean duration of the luteal phase was 13.5 +/- 1.3 days in 30 patients, and two patients developed amenorrhea of 23 and 43 days respectively after laparoscopy in spite of normal progesterone values 7 and 9 days after oocyte recovery. Six embryo transfers were performed after fertilization and regular cleavage of the obtained oocytes. No pregnancy resulted from the embryo transfers, although the patients had apparently normal luteal phases. In one patient there was a transient beta-subunit human chorionic gonadotropin (beta-hCG) elevation in serum. Luteal phase deficiency should not be main cause of a nonsuccessful embryo transfer. However, a prophylactic luteal phase support after oocyte recovery and embryo transfer in nonstimulated cycles is proposed.

Laparoscopic or ultrasonically guided follicle aspiration for in vitro fertilization

Ultrasonically guided follicular aspiration is presented as an alternative method to laparoscopy for oocyte harvesting. The method is described in detail and compared to laparoscopic oocyte pickup. The success rate of this technique reached in 1984 compared to that of laparoscopic oocyte pickup was the same: the oocyte recovery rate was 93%, the fertilization rate was 58%, and the pregnancy rate was 13% (normal ongoing pregnancies per treatment cycle). Ultrasonically guided follicular aspication is shown to be superior to laparoscopic oocyte recovery as far as ovarian accessibility and complication rate are concerned.

Pregnancy following in vitro fertilization and embryo transfer using pure human serum as culture and transfer medium.

Pure heat-inactivated serum of patients adjusted to 280 mOsm was used for preincubation, insemination, and transfer of oocytes in an IVF-ET program. In patients where the oocyte recovery yielded more than two oocytes, two oocytes were chosen randomly for serum cultivation. The 15th patient of that series became pregnant after a transfer of two serum-cultured embryos. The follow-up weekly clinical investigation and ultrasound revealed a normal single pregnancy, now in the 20th week.

The use of synthetic culture medium and patient serum for human in vitro fertilization and embryo replacement.

The use of heat-inactivated patient serum as both fertilization and embryo replacement medium was compared in a prospective randomized study with a fully synthetic culture medium containing human serum albumin without serum addition (B3 INRA Menezo). Another series of the authors IVF program was analyzed retrospectively when a commercially available synthetic medium with bovine serum albumin (B2 INRA Menezo) or B3, as mentioned above, was used without serum addition for fertilization but with 50–100% patient serum as embryo replacement medium. Fertilization rates were significantly higher in the synthetic culture media (70%) than in serum (57%). The rate of polyploid fertilization was significantly lowest in B3 medium. There was a clear trend toward better pregnancy rates when high-percentage or 100% patient serum was used for embryo replacement, no matter if one, two, three, four or more embryos were replaced. We conclude that there should be no need for any kind of serum addition to fertilization media. The present study proves our previous observation that the use of serum seems to be beneficial as embryo replacement medium. This might well be explained by a “protein stick effect” due to the high macromolecular contents of serum rather than by viscosity measurements, since no significant increase in viscosity was observed when a high percentage of serum was added to culture media.

Psychosocial Testing and Pretreatment of Women for in Vitro Fertilization

Thanks to extensive media coverage, both the public, in general, and infertile patients desiring children, in particular, have been alerted to the fascinating prospects of in vitro fertilization (IVF) and embryo transfer (ET). Many infertile couples would do anything to have a child of their own. As a consequence, they have come to attach high hopes to this new method, just as they were hopeful of other methods in the past.

The behavior of LH, FSH, PRL, T, P, estradiol and cortisol under different kinds of general anesthesias during laparoscopic oocyte recovery for in vitro fertilization

Abstract The effects of different anesthetic drugs on LH, FSH, prolactin, progesterone, 17β-estradiol, cortisol and testosterone were tested during and after oocyte recovery for in vitro fertilization. No major changes of LH, FSH, progesterone, 17β-estradiol and testosterone were noted, whereas prolactin levels in all patients and under all anesthesias showed a highly significant increase, followed by a decrease after 2 h. Also distinct changes were observed in cortisol levels. Among the different anesthetic drugs a diminished increase of PRL under thiopental and halothane was observed when compared with the other drugs.

Results of Laparoscopic Recovery of Preovulatory Human Oocytes From Nonstimulated Ovaries in an Ongoing in Vitro Fertilization Program

The technique and results of 50 laparoscopies performed on sterility patients to obtain mature oocytes from Graafian follicles with a view to carrying out in vitro fertilization are described. In 32% of all laparoscopies and in 52% of all punctured follicles it proved possible to obtain a mature oocyte. Different diameters of puncture needles as well as different suction intensities are compared. As a result of increasing experience and improved technique, the exact time for the intervention was correctly determined in 92% of cases. The recovery rate for oocytes was also increased to 58% with respect to laparoscopies carried out.

Organization and computerized analysis of in vitro fertilization and embryo transfer programs.

The in vitro fertilization experience of one of the earliest successful programs is presented based on three different center types: (I) large hospital-university, (II) private gynecological office, and (III) egg-embryo transfer from and to centralized laboratory. A computerized analysis of systems I and II for 1982 is presented. No statistically different results were found between system I and system II. System III was abandoned because of unsatisfactory results.

Preovulatory serum estradiol-17β values and ultrasound scans in 17 pregnancies which followed in vitro fertilization and embryo transfer after treatment with clomiphene and hCG

Summary17 Patients whom we treated with clomiphene and hCG became pregnant after in vitro fertilization (IVF) and embryo transfer (ET). We now report on our experience with preovulatory estradiol 17β values and ultrasonography in determining the time of hCG administration in these patients. The mean estradiol value just before the hCG injection was 329±75 pg/ml/follicle. The mean follicle diameter on ultrasound was 23.4±1.5 mm on the same day. In four cases, we only used estradiol values and in one case only ultrasound for the timing of the hCG injection. Both methods of monitoring follicular growth are discussed.