Preliminary report of a low-dose step-up regimen of recombinant human FSH for young women undergoing ovulation induction with IUI

Background: The aim of this study was to evaluate the efficacy and safety of a recombinant human follicle stimulating hormone [r-FSH] low-dose step-up regimen for controlled ovarian hyperstimulation in patients undergoing ovulation induction [OI] with intrauterine insemination [IUI]

Materials and Methods: The study was conducted in the Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan. In this prospective, observational study, consecutive infertile women [20-35 years] with regular menstrual cycles and a normal baseline FSH level were prospectively enrolled between January 2010 and September 2010. A starting dose of 112.5 IU/day r-FSH was administered on day 3 and increased by 37.5 IU/day every 2 days until a follicle >/= 11 mm in diameter was present. Recombinant human chorionic gonadotropin [r-hCG] was administered when a follicle >/= 18 mm was noted. Monifollicular development was defined as only one follicle with a diameter >/= 16 mm. Clinical pregnancy was defined as a pregnancy diagnosed by ultrasonographic visualization of one or more gestational sacs

Results: A total of 29 women and 30 cycles were included. The mean daily dose of r-FSH to achieve a follicle of >/= 11 mm in diameter was 131.3 +/- 23.6 IU and the mean total dose was 1030.0 +/- 383.2 IU. Approximately 41% of the cycles were monofollicular. Clinical pregnancy was observed in 9 [30.0%] cycles, and a fetal heart beat was observed in 7 [23.3%]. There were no multiple pregnancies. Mild ovarian hyperstimulation syndrome, which was resolved with conservative management, was observed in 3 [10.0%] cycles

Conclusion: This r-FSH low-dose step-up regimen seems to be a feasible and practical method for OI in younger infertile women undergoing IUI

outcomes of intracytoplasmic sperm injection and laser assisted hatching in women undergoing in vitro fertilization are affected by the cause of infertility

We sought to determine the association between factors that affected clinical pregnancy and live birth rates in patients who underwent in vitro fertilization [IVF] and received intracytoplasmic sperm injection [ICSI] and/or laser assisted hatching [LAH], or neither. In this retrospective cohort study, the records of women who underwent IVF with or without ICSI and/or LAH at the Far Eastern Memorial Hospital, Taipei, Taiwan between January 2007 and December 2010 were reviewed. We divided patients into four groups: 1. those that did not receive ICSI or LAH, 2. those that received ICSI only, 3. those that received LAH only and 4. those that received both ICSI and LAH. Univariate and multivariate analyses were performed to determine factors associated with clinical pregnancy rate and live birth rate in each group. A total of 375 women were included in the analysis. Oocyte number [OR=1.07] affected the live birth rate in patients that did not receive either ICSI or LAH. Maternal age [OR=0.89] and embryo transfer [ET] number [OR=1.59] affected the rate in those that received ICSI only. Female infertility factors other than tubal affected the rate [OR=5.92] in patients that received both ICSI and LAH. No factors were found to affect the live birth rate in patients that received LAH only. Oocyte number, maternal age and ET number and female infertility factors other than tubal affected the live birth rate in patients that did not receive ICSI or LAH, those that received ICSI only, and those that received both ICSI and LAH, respectively. No factors affected the live birth rate in patients that received LAH only. These data might assist in advising patients on the appropriateness of ICSI and LAH after failed IVF

An update of preimplantation genetic diagnosis in gene diseases, chromosomal translocation, and aneuploidy screening / 대한생식의학회지

Preimplantation genetic diagnosis (PGD) is gradually widely used in prevention of gene diseases and chromosomal abnormalities. Much improvement has been achieved in biopsy technique and molecular diagnosis. Blastocyst biopsy can increase diagnostic accuracy and reduce allele dropout. It is cost-effective and currently plays an important role. Whole genome amplification permits subsequent individual detection of multiple gene loci and screening all 23 pairs of chromosomes. For PGD of chromosomal translocation, fluorescence in-situ hybridization (FISH) is traditionally used, but with technical difficulty. Array comparative genomic hybridization (CGH) can detect translocation and 23 pairs of chromosomes that may replace FISH. Single nucleotide polymorphisms array with haplotyping can further distinguish between normal chromosomes and balanced translocation. PGD may shorten time to conceive and reduce miscarriage for patients with chromosomal translocation. PGD has a potential value for mitochondrial diseases. Preimplantation genetic haplotyping has been applied for unknown mutation sites of single gene disease. Preimplantation genetic screening (PGS) using limited FISH probes in the cleavage-stage embryo did not increase live birth rates for patients with advanced maternal age, unexplained recurrent abortions, and repeated implantation failure. Polar body and blastocyst biopsy may circumvent the problem of mosaicism. PGS using blastocyst biopsy and array CGH is encouraging and merit further studies. Cryopreservation of biopsied blastocysts instead of fresh transfer permits sufficient time for transportation and genetic analysis. Cryopreservation of embryos may avoid ovarian hyperstimulation syndrome and possible suboptimal endometrium.