Themis Mantzavinos

The importance of the follicular phase to success and failure in in vitro fertilization

One hundred seventy-five cycles in patients with irreparable tubal disease were stimulated by human menopausal gonadotropin/human chorionic gonadotropin for the purpose of in vitro fertilization. As judged by the height of the peripheral estradiol response, the patients were classified as high, intermediate, or low responders. In addition, the estradiol pattern of the response was found to be separable into six categories. The pregnancy rate was found to be related to the height and to the pattern of peripheral response. The overall pregnancy rate in this consecutive series was 19% but varied according to the height and pattern of response from 40% to 0%.

What is a pregnancy? A question for programs of in vitro fertilization

Pregnancy outcome in studies of normal reproduction and in programs of in vitro fertilization (IVF) is usually classified as chemical beta-human chorionic gonadotropin (beta-hCG) abortion, trimester abortion, and term delivery. The distinction between a chemical beta-hCG abortion and a first-trimester abortion is not clearly stated in the literature, although such terms are commonly used. It is proposed that in programs of IVF pregnancy outcome be classified as menstrual abortion, preclinical abortion, clinical abortion, or viable pregnancy. Pregnancy outcome of 190 consecutive cycles induced by human menopausal gonadotropin/human chorionic gonadotropin in the program of IVF at Norfolk is compared with contemporary studies of pregnancy outcome in normal reproduction. The in vitro data indicate that the Norfolk program has recorded no menstrual abortions, a 33% preclinical and clinical abortion rate, and a viable pregnancy rate that approaches but does not equal the term delivery rate of normal reproduction. However, these results have been achieved by the transfer of multiple concepti, whereas normal reproduction depends on the fertilization of a single oocyte.

Ultrasound measurement of ovarian follicles stimulated by human gonadotropins for oocyte recovery and in vitro fertilization

Ultrasonic monitoring of ovarian follicles and estimation of serum estradiol (E2) were performed in 51 patients in whom oocyte aspiration for in vitro fertilization was planned. All patients received human menopausal gonadotropin and human chorionic gonadotropin. The daily growth rates of ovarian follicles were recorded ultrasonically for 6 days prior to aspiration. Serum plasma E2 was determined daily during the same period. Follicular dimensions based on the volume of aspirated fluid correlated very well with the ultrasonic measurements. Follicular growth was correlated with increasing peripheral blood E2 levels. The mean follicular diameter increased from 10.8 mm 6 days before aspiration to a maximum of 16.0 mm on the day of presumptive ovulation in a group of patients characterized as low E2 responders. In normal and high E2 responders, the values were from 9.7 mm and 10.5 mm to 16.9 mm and 17.6 mm, respectively. The mean sizes of the follicles by ultrasound 20 hours before laparoscopy were 16.0 mm for the right ovary, 16.6 mm for the left ovary, and 18.5 mm in patients with only one ovary. At laparoscopy the mean diameters calculated from the volume of the aspirated fluids were 17.5 mm, 17.4 mm, and 19.3 mm, respectively. Multiple follicles developed in all but 2 of the 51 patients.

Correlation of serum and follicular fluid concentrations of placental protein 14 and CA-125 in in vitro fertilization-embryo transfer patients

OBJECTIVEnTo study serum and follicular fluid (FF) concentrations of placental protein 14 (PP14) and CA-125 in patients participating in an IVF-ET program.nnnDESIGNnDetermination in serum and FF on the day of hCG administration, day of oocyte retrieval, and on ET day of PP14 and CA-125.nnnSETTINGnSecond Department of Obstetrics and Gynecology of the University of Athens; Euromedica IVF Unit; and Hellenic Pasteur Institute.nnnPATIENTSnThirty-three patients undergoing IVF-ET divided in three groups: 8 with conception, 18 with fertilized oocytes but no conception, and 7 without fertilized oocytes.nnnINTERVENTIONSnAll patients underwent an ovarian stimulation with a short protocol of GnRH analogue-pure-FSH-hMG. Three blood probes were collected from each patient, on the day of hCG administration, on retrieval day, and on ET day, respectively, whereas FF was collected on retrieval day.nnnMAIN OUTCOME MEASURESnDetermination in serum and FF of CA-125 and PP14.nnnRESULTSnOn the day of oocyte retrieval, both mean values of serum PP14 and CA-125 were significantly higher in conceptional than nonconceptional cycles. On the day of ET, the mean values of serum PP14 increased significantly in conceptional cycles whereas CA-125 showed no difference. The mean concentration of PP14 in FF was significantly higher in conceptional cycles whereas there was no significant change in the mean concentration of FF CA-125.nnnCONCLUSIONSnIn conceptional cycles after IVF, PP14 increases in serum significantly from hCG day to ET day compared with nonconceptional cycles, whereas CA-125 increases from hCG day to oocyte retrieval day and decreases on ET day. In FF, PP14 was increased in conceptional cycles, whereas CA-125 in FF showed no change.

In vitro fertilization in Norfolk, Virginia, 1980-1983

Three years of progress of the Vital Initiation of Pregnancy (VIP) Program in Norfolk is reported. No conception resulted from 41 oocyte aspirations during spontaneous menstrual cycles in 1980. An average of 3.7 oocytes per cycle, or a 73.5% recovery rate, resulted in 362 human menopausal gonadotropin/human chorionic gonadotropin-induced cycles from January 1981 to March 1983. Forty pecent of the oocytes recovered from these cycles were preovulatory, 35% atretic, and 25% immature. Immature oocytes were often matured in vitro, fertilized, and found to produce pregnancies. A total of 62 pregnancies occurred, which represents a 17 or 23% pregnancy rate, based on laporoscopies or embryo transfers, respectively. There were 11 preclinical and 7 clinical miscarriages. Twenty-nine normal babies have been delivered, including a set of twins. The remainder appears to be normally progressing pregnancies. Polyspermia was observed in 8.8% of the fertilizable oocytes.

Fertility drugs and gynecologic cancer.

Abstract:u2002 Fertility drugs (FD) are spreading worldwide fast and therefore many studies have reviewed the possible association between the use of these drugs and cancer. Since the drugs used for ovulation induction during in vitro fertilization (IVF) like hCG, hMG, rFSH increase the levels of gonadal hormones, concerns have grown regarding the risk of developing cancer in breast, ovary, endometrium, and other target organs. In this review, we discuss a number of different studies published in recent years that show no association between the use of these drugs and most cancers.

The Effect of Valacyclovir Treatment on Natural Killer Cells of Infertile Women

Problem:u2002 The aim of this study was to investigate the effect of valacyclovir treatment on natural killer (NK) cell concentration in the peripheral blood of infertile women.

Pregnancies in Primary Amenorrhea With Normally Developed Secondary Sex Characteristics

We report herein 11 pregnancies in patients with primary amenorrhea and normally developed secondary sex characteristics. All patients were fully investigated, and their ovaries as visualized by laparotomy or laparoscopy were found to be small. Ovarian biopsy revealed numerous unstimulated primordial follicles. The hormonal profiles showed hypoestrogenism with atrophic endometrium. Human gonadotropins were used in large amounts in order to achieve pregnancy. Two patients responded in all treatment cycles with menses. The remainder failed to respond to all treatment cycles. All patients became pregnant and carried their pregnancies normally to term. There were four sets of twins and seven single births. Of fifteen newborns, one died of congenital heart disease.

The effect of pentoxifylline on sperm motility, oocyte fertilization, embryo quality, and pregnancy outcome in an in vitro fertilization program**Presented in part at the 8th World Congress on In Vitro Fertilization and Alternate Assisted Reproduction, Kyoto, Japan, September 12 to 15, 1993.

OBJECTIVEnTo study the effect of pentoxifylline on sperm motility, oocyte fertilization, embryo cleavage, and quality as well as pregnancy outcome on asthenospermic patients participating in an IVF program.nnnDESIGNnProspective randomized study.nnnSETTINGnPrivate IVF unit.nnnPATIENTSnNinety-seven couples, 24 of whom were repeating IVF. Two semen specimens were obtained from each patient and each specimen was divided equally into two parts, nontreated (control semen) and pentoxifylline-treated (treated semen).nnnMAIN OUTCOME MEASUREnSperm progressive motility, oocyte fertilization.nnnRESULTSnOverall and progressive motility did not differ significantly between the two semen specimens. There was a significant increase in the progressive motality of the pentoxifylline-treated semen compared with control semen. No significant difference was noticed between control and treated semen in fertilization rate, cleavage rate, embryo quality, and pregnancy rate. The percentage of patients who fertilized only with control semen (9.3%) was not significantly different from that of patients who fertilized only with treated semen (10.3%). Couples who were repeating IVF did not show significant difference in fertilization between the present study and previous attempts.nnnCONCLUSIONnOur results showed that although the sperm progressive motility is improved after pentoxifylline treatment, it is doubtful whether this effect is of any clinical significance.