S.G. Somkuti

Effect of macroscopic or microscopic blood and mucus on the success rates of embryo transfers

OBJECTIVE To assess the effect of microscopic and macroscopic contamination of embryo transfer (ET) catheters with blood or mucus on in vitro fertilization (IVF)-ET success rates. DESIGN Retrospective cohort study. SETTING Infertility practice in teaching community hospital. PATIENT(S) Four hundred seventy patients undergoing IVF-ET. INTERVENTION(S) Controlled ovarian hyperstimulation and IVF-ET. MAIN OUTCOME MEASURE(S) Implantation rate (IR) and clinical pregnancy rate (CPR). RESULT(S) The IR and CPR of IVF-ETs were comparable regardless of the presence (26.59% and 48.78%, respectively) or absence (23.49% and 44.44%, respectively) of any type of contamination. Even when analyzing specific contamination categories (i.e., macroscopic blood, microscopic blood on the outer catheter, microscopic blood on the inner catheter, blood anywhere without mucus, mucus only, or blood and mucus combined), there was no statistical significance in IR (range: 21.17% to 26.69%) or CPR (range: 32.69% to 49.5%). CONCLUSION(S) In general, IR and CPR appear to be unaffected by ET catheter contamination, whether it is macroscopic or microscopic presence of blood or mucus.

Outcomes of day-1, day-3, and blastocyst cryopreserved embryo transfers

The optimal developmental stage for cryopreserving embryos in IVF-ET remains controversial. Our study demonstrates that besides an improvement in postthaw survival rate for day-1 and blastocyst cryopreserved ET over day-3, all three groups attained statistically similar implantation, clinical pregnancy, multiple, twinning, and male gender rates.

46,XY monozygotic twins with discordant sex phenotype

OBJECTIVE To analyze male and female sex differentiation in monozygotic twins. DESIGN Retrospective study. SETTING Multiple academic centers. PATIENT(S) A pair of monozygotic twins. INTERVENTION(S) Skin and blood samples were obtained for DNA analysis and karyotyping. MAIN OUTCOME MEASURE(S) Mutation within the SRY gene was analyzed by the polymerase chain reaction-single-stranded conformation polymorphism test. Monozygosity was ascertained by short tandem repeat analysis. Karyotypes were studied in blood and skin fibroblasts. RESULT(S) SRY was present in both twins, but no mutations were detected in the SRY conserved motif. Monozygosity was confirmed by the use of short tandem repeat analysis in four loci: c-fms, thyroid peroxidase, von Willebrand factor, and tyrosine hydroxylase. The karyotype was 46,XY uniformly in both twins. CONCLUSION(S) Monozygotic twins can develop discordant male and female phenotypes despite the presence of a common karyotype and despite the presence of intact testis-determining genes. In the present case, this could be due to mutation or to mosaicism involving occult 45,X cell lines in the dysgenetic gonads.

Profound hypothyroidism-induced acute menorrhagia resulting in life-threatening anemia.

BACKGROUND: Menorrhagia is a very common gynecologic entity with a broad differential diagnosis which includes both hypothyroidism and hyperthyroidism. CASE: We present the case of a 31-year-old patient with acute menorrhagia causing life-threatening anemia that resulted from profound hypothyroidism. Despite timely institution of thyroid replacement, the patient required emergent embolization of a uterine arteriovenous malformation after dilatation and curettage failed to control her bleeding. She was stabilized and discharged to home on the sixth hospital day. Three years later, she successfully conceived and delivered a healthy infant. CONCLUSION: Our case demonstrates the importance of thyroid evaluation in the patient who presents with menorrhagia. Timely management with medical treatment as well as conservative surgical or radiological interventions can facilitate resolution of symptoms and preserve the patients fertility potential.

Comparison of pregnancy, implantation, and multiple gestation rates for day 3 versus day 5 embryo transfers.

AbstractPurpose: To compare pregnancy, implantation, and multiple gestation rates resulting from day 3 and day 5 embryo transfers after in vitro fertilization emphasizing a subset of patients who met criteria for day 5 transfer but elected to undergo day 3 transfer. Method: A retrospective analysis of day 3 and day 5 embryo transfers from January 2001 to June 2002 were evaluated in a community teaching hospital setting. A total of 331 patients ≤40 years old were included. Using Students t test, χ2test, and Fishers exact test, we compared the pregnancy, implantation, and multiple gestation rates. Results: Pregnancy, implantation, and multiple gestation rates were not significantly different between the subgroup who met criteria for day 5 embryo transfer but elected day 3 transfer. There was no significant difference between similar parameters in the overall comparison of day 3 versus day 5 embryo transfers. Conclusions: Blastocyst transfers have similar multiple gestation rates, pregnancy rates, and implantation rates when compared to day 3 embryo transfers.

Prognosis for clinical pregnancy and birth after transferring embryos derived from a cohort of incompletely mature oocytes at retrieval time

The purpose of this retrospective study was to establish a prognosis for implantation, pregnancy and live birth rates in stimulated IVF cycles after transferring embryos derived from: 1/ retrieved immature oocytes that matured overnight in vitro (late mature group: LM); 2/ retrieved immature oocytes that matured overnight in vitro and were added to the embryos derived from retrieved mature oocytes (mixed embryos group: MX); and 3/ retrieved mature oocytes (mature group: M). The obtained implantation, clinical pregnancy and live birth rates for the LM group were: 5.6%, 11.4%, 11.4%; for the MX group were: 4.2%, 14.6%, 11.6%; and for the M group were: 14.6%, 45.2% and 33.3%, respectively. These measurements were significantly lower p<0.05 for the LM and MX groups in comparison to the M group. The number of oocytes retrieved and the number of embryos transferred were the lowest (p<0.001-0.05) for the LM group. It is concluded, that the retrieved immature oocytes are able to mature during overnight culture in vitro, be fertilized and provide developmentally competent embryos with the prognosis of 11% for the successful delivery.