Comparison of human menopausal gonadotrophin and recombinant follicle-stimulating hormone in in-vitro fertilisation and pregnancy outcome.

The study was carried out to compare the effectiveness of human menopausal gonadotrophin (HMG) and recombinant follicle-stimulating hormone (recombinant FSH) in term of in vitro fertilisation (IVF) and pregnancy outcome. A total of 238 patients who underwent IVF for infertility treatment were included in the study. The first attempt of controlled ovarian stimulation was recorded and evaluated. A long protocol of ovarian stimulation was performed with gonadotrophin releasing hormone analogue (GnRH-a) administration. Gonadotrophin, which was either HMG (group A) or recombinant FSH (group B), was administrated to each patient for ovarian stimulation. The results of this study showed no difference in the number of stimulation days, fertilised oocytes, transferred embryos and cycles with embryos available for freezing between the two groups. Although the starting doses of both gonadotrophins were similar, the total dosage of HMG was higher than that of recombinant FSH (48.8ฑ20.8 versus 42.9ฑ20.0, p = 0.03). The number of retrieved oocytes in group A was higher than that in group B (9.5ฑ4.4 versus 8.3ฑ4.3, p = 0.04). The differences in cancellation rate, fertilisation rate, pregnancy rate per cycle and per transfer, as well as implantation rate between the two groups was not statistically significant. In conclusion, patients who underwent ovarian stimulation with GnRH-a long down-regulation still benefit for HMG for their treatment. We did not find any difference in fertilisation rate or pregnancy rate as well as implantation rate between HMG and recombinant FSH. A greater number of oocytes were retrieved in patients treated with HMG. However, more ampoules of HMG were administrated to achieve ovarian stimulation, compared with recombinant FSH.

Improving pregnancy rates after intracytoplasmic sperm injection by usng MIFT technique: A new option for embryo transfer.

To evaluate the efficacy of a new technique, micro-injected oocytes intrafallopian transfer (MIFT), involving a same day procedure. 9 patients with at least one patient fallopian tube were offered this procedure. Ovarian induction consisted of down regulation with GnRHa followed by ovarian stimulation with hMG except for one patient who received only hMG due to a poor response. HCG 10,000 IU was administered when at least 2 leading follicles exceeded 18 mm. in diameter and transvaginal oocyte retrieval was performed 34-36 hours thereafter. Intracytoplasmic sperm injection (ICSI) was performed on the oocytes of all patients with male factor infertility. MIFT was performed on the same day after ICSI by transferring 2-5 micro-injected oocytes into the fallopian tube by laparoscopy under general anesthesia. The implantation rate and pregnancy rate were 16.1% (5/31) and 55.6% (5/9) respectively. This study suggests that MIFT is effective, easy and should be considered as a new option which yields a high pregnancy rate.

Comparative study of embryo culture media containing and without containing glucose as energy substrate.

The aim to increase pregnancy rate by in vitro fertilization (IVF-ET) is to improve the embryo culture system, especailly the culture media. Most of the conventional IVF media has been deve-loped from somatic cell culture which contains glucose as the energy substrate. Many recent studies in mammals, including human, reported that glucose was not the preferred nutrient for the zygote and early cleaving embryo, and may stimulate premature glycolysis, which induce the Crabtree effect; thus depressing respiratory rate and energy production. This study was conducted to evaluate the embryo culture outcome that grows in conventional IVF media containing 5 mM of glucose (Medicult media) as compared to the home-made media without glucose (SJ-media). Ten infertile couples were enrolled in the study for eleven treatment cycles. Seventy eight oocytes were retrieved, of which sixty three were fertilized as 2 PN embryo, that were randomly allocated into two culture groups: 32 embryos in group I( Medicult media), and 31 embryos in group II (SJ-media). Twenty eight hours after the culture, the embryos in both groups were compared. There was no statistical difference between the embryos of the two culture groups (p>0.05), but there was a trend in which embryos in group I had more 3-4 blastomere than group II (68.8%vs 51.5%); embryos in group II; however; had less fragmentation (67.7% vs 50% for fragmentation< 5%) and were of better quality than group I (51.6% vs 40.6% for embryo grade A, and 32.2% vs 25% for grade B). In conclusion, this study has confirmed that human embryos can grow in media devoid of glucose ; at least; as well as glucose containing media. A larger sample size study ; however ; need to be carried out.

Fertilization rate during intracytoplasmic sperm injection procedure comparing 6 and 12 O’clock polar body position.

A Prospective study was designed to compare fertilization rate between the . and 12 o’clock position of the polar body during the intracytoplasmic sperm injection (ICSI) procedure. A total of 128 oocytes were injected by placing the first polar body at 6 o’clock and 12 o’clock alternately. Normal fertilization rates were 70.31 and 71.87 percent respectively. There was no statistical significance between the two groups.