Comparison of EffectiveNESS between Recombinant Follicle Stimulating Hormone and Human Menopausal Gonadotrophin Administration in those with Diminished Ovarian Reserve.

The study was carried out to compare the effectiveness of recombinant follicle stimulating hormone (recombinant FSH) and human menopausal gonadotrophin (HMG) in those with diminished ovarian reserve. A total of 106 ovarian stimulation cycles from 88 poor responders were included in this study. Either recombinant FHS or HMG was administered in order to stimulate the ovary for each cycle. The pregnancy rate of the recombinant FSH group (22.5%) was higher than that of the HMG group (9.1%). The cancellation rate of the recombinant FSH group (10.0%) was lower than that of the HMG group (19.7%). In in vitro fertilisation-embryo transfer (IVF-ET) cycles, the fertilisation rate of the recombinant FSH group (62.8%) was higher than that of the HMG group (51.8%). The pregnancy rate and the implantation rate of the recombinant FSH group (23.0 and 9.1%, respectively) were higher than those of the HMG group (13.6 and 5.9%, respectively). Although this did not achieve statistical significance, only the recombinant FSH group achieved pregnancies using gamete intrafallopian transfer (GIFT). In conclusion, recombinant FSH is probably more effective than HMG in improving the IVF and pregnancy rate in poor responders.

Comparison of sperm motility between the swim-up and swim-down methods.

The objective of this study was to compare two methods for the extraction of high motility sperm; the swim-up and swim-down techniques. The result showed that both methods produced greater sperm motility than the original semen. The motility of the sperm was lower in the swim-down method compared with the swim-up method (65.5+11.2% vs 76.5+10.1%; p<0.01).

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.

Higher pregnancy rate with intrafallopian tubal gamete or zygote transfer (GIFT or ZIFT) than intrauterine embryo transfer (IVF-ET).

From November 1996 to September 1998, we had treated infertile couples who required assisted reproductive conception by allocating to either one of the three treatment methods: IVF-ET for those with bilateral tubal obstruction; ZIFT for those with at least one tubal patency but poor sperm ; and GIFT for those with at least one tubal patency and normal sperm (unexplained infertility). The ovarian stimulation protocol was all the same by using GnRH analogue (Suprefactฎ) for pituitary suppression and daily hMG (Metrodinฎ) injection for ovarian stimulation. The oocyte pick up was due when the leading follicle reach 18 mm. For IVF-ET and ZIFT, the fertilization was obtained by conventional in vitro fertilization or by ICSI depending on the sperm quality. Laparoscopic intrafallopian tubal gamete or zygote transfer was preformed on day 0 ( ovum pick up day) for the GIFT or on day 1 for the ZIFT group. Intrauterine embryo transfer was performed on day 2- 3 for the IVF-ET group. Every treatment cycle was conducted by the investigator group to minimize the variation of technical bias. Of all the 213 treatment cycles, 82 were IVF-ET, 92 were ZIFT, and 39 were GIFT. The average female patient age in each groups was not different. The pregnancy rate achieved in the GIFT and ZIFT groups were significantly higher than the IVF-ET group ( 46.2%, 40.2% and 23.2% respectively , p < 0.05). For the pregnancy outcome, the abortion rate seemed to be highest in the IVF-ET group ( 36.8%) whereas the multiple pregnancy rate seemed to be higher in the fallopian tubal transfer group ( 27% for ZIFT and 38.9% for GIFT), although there were no statistical significance. The benefit of the higher pregnancy rate for the intrafallopian tubal transfer treatment group could be due to the more suitable environment for the early stage embryo and the the more synchronize of the endometrial receptivity and the embryo arrival timing provided by the fallopian tube. In conclusion, until the optimal in vitro embryo culture system can be developed, gamete and zygote intrafallopian tubal transfer should yield higher pregnancy rate than intrauterine embryo transfer.