Ryszard J. Chetkowski

In premature luteinization, progesterone induces secretory transformation of the endometrium without impairment of embryo viability.

OBJECTIVE To determine the effect of serum P on endometrial histology in stimulated cycles. DESIGN Prospective clinical study. SETTING Community hospital-based donor oocyte program. PATIENT(S) Fertile young oocyte donors and infertile donor oocyte recipients. INTERVENTION(S) Oocyte donors underwent gonadotropin stimulation after midluteal pituitary suppression. Endometrial biopsies were obtained at the time of oocyte retrieval. MAIN OUTCOME MEASURE(S) Endometrial histology and serum P levels in oocyte donors. Pregnancy and implantation rates in oocyte recipients. RESULT(S) Thirteen biopsy specimens (52.0%) showed in-phase mixed proliferative pattern (days 14 to 15), whereas 12 (48.0%) were secretory (days 16 to 17). On the day of hCG, subjects with secretory endometrium had higher P of 1.7 ng/mL (5.4 nmol/L) than women with the mixed pattern (0.8 ng/mL [2.5 nmol/L]). Progesterone > or = 0.9 ng/mL had a 78.6% positive predictive value for secretory transformation. In 75.0% of cycles with secretory endometrium, P was > or = 0.9 ng/mL, (2.9 nmol/L) as early as 2 days before hCG. Both mixed and secretory patterns were associated with similar clinical pregnancy rates (57.1% and 60.0%, respectively) and delivery rates (38.1% and 50.0%, respectively) in recipients. CONCLUSION(S) Subtle elevation of P induced secretory endometrial transformation without reduction in embryo viability.

Donation of frozen embryos after in vitro fertilization is uncommon

OBJECTIVE To determine the availability of donated cryopreserved embryos. DESIGN Retrospective review. SETTING Community hospital-based IVF-ET program. PATIENTS Eighty-three consecutive infertile couples who had 98 sets of embryos cryopreserved after IVF-ET and GIFT between January 1, 1989 and December 31, 1991. INTERVENTION(S) Cryopreservation of fertilized oocytes or cleaving embryos after IVF-ET and GIFT. MAIN OUTCOME MEASURE(S) Disposition of frozen embryos as of December 31, 1995. RESULT(S) Of 98 sets of frozen embryos, 71 (72.4%) were thawed for transfer into the infertile woman. At an average of 6 years since the treatment cycle, six sets of embryos (6.1%) remain in storage. Of 21 sets of embryos not thawed for autologous transfer, the majority (17.4%) were discarded, leaving only four clutches (4.1%) available for donation. CONCLUSION(S) Couples who did not use their frozen embryos after IVF-ET and GIFT were four times more likely to destroy them than to donate them.

The effect of pituitary suppression and the women's age on embryo viability and uterine receptivity

OBJECTIVE To examine the effect of pituitary suppression and the womens age on embryo viability and uterine receptivity. DESIGN Retrospective analysis of 394 embryo transfers (ET) after in vitro fertilization (IVF). SETTING Community hospital IVF program from 1986 to 1990. PATIENTS Three groups were studied: women less than 40 years with pituitary suppression (group 1) and without pituitary suppression (group 2); women 40 years of age and older with pituitary suppression (group 3). INTERVENTIONS Pituitary suppression was achieved in groups 1 and 3 with daily leuprolide acetate starting in the luteal phase; human menopausal gonadotropin and progesterone were given intramuscularly. MAIN OUTCOME MEASURES Ongoing and multiple ongoing pregnancy rates (PRs) were compared in the three groups. A mathematical model of implantation was used to estimate embryo viability and uterine receptivity. RESULTS Ongoing and multiple ongoing PRs per ET in group 1 (28.6% and 12.3%) were significantly higher than the corresponding rates in group 2 (16.9% and 2.4%) and in group 3 (16.9% and 3.4%). Implantation analysis revealed higher embryo viability without change in uterine receptivity with pituitary suppression (group 1 versus 2). Decrease in both embryo viability and uterine receptivity was noted in women greater than 40 (group 1 versus 3). CONCLUSIONS (1) Pituitary suppression improved implantation outcome by increasing embryo viability with no change in uterine receptivity and was associated with a high multiple PR in women less than 40; (2) in women greater than 40 both embryo viability and, to a lesser extent, uterine receptivity were decreased; (3) transfer of a larger number of embryos in older patients may improve IVF outcome without excessive risk of multiple pregnancy.

Isofluorane inhibits early mouse embryo development in vitro.

In vitro development of 2-cell mouse embryos to the blastocyst stage was used to assess the toxicity of isofluorane, nitrous oxide, fentanyl, and meperidine. Isofluorane at concentrations similar to those employed during human oocyte recovery for IVF significantly inhibited mouse embryo development. Since the other agents were without effect, balanced anesthesia with nitrous oxide and narcotics may be preferable to isofluorane for IVF and GIFT.

Secondary donation of frozen embryos is more common after pregnancy initiation with donated eggs than after in vitro fertilization-embryo transfer and gamete intrafallopian transfer

OBJECTIVE To determine the availability of donated cryopreserved embryos. DESIGN Retrospective review. SETTING Community hospital-based donor oocyte program. PATIENT(S) Eighty-nine consecutive infertile couples and women who had 94 sets of embryos cryopreserved after pregnancy initiation with unfertilized donated eggs between January 1, 1991 and December 31, 1996. INTERVENTION(S) Cryopreservation of fertilized ova or cleaving embryos. MAIN OUTCOME MEASURE(S) Disposition of frozen embryos as of June 1, 1997. RESULT(S) Of the 94 sets of frozen embryos, 52 (55.3%) were thawed into the original recipient. At an average of 30 months since the treatment cycle, 26 (27.7%) sets of embryos remain in storage. Of the 16 sets of embryos not thawed for transfer, 11 sets (11.7%) were donated and 5 sets (5.3%) were destroyed. The fraction of spare embryos donated was much higher after pregnancy initiation with unfertilized donated eggs than after IVF-ET and GIFT (68.8% versus 19.1%, respectively). CONCLUSION(S) Couples and women who did not use their frozen embryos after pregnancy initiation with unfertilized donated eggs were twice as likely to donate them as to have them destroyed. Secondary donation of cryopreserved embryos was much more common after pregnancy initiation with unfertilized donated eggs than after standard IVF-ET and GIFT.