[Clinical implication and frequency of the incidental finding of endometriosis during oocyte retrieval]. / Implicación clinica y frecuencia del hallazgo incidental de endometriosis durante la captura ovular.

BACKGROUND: Endometriosis is a clinical disease that is associated with poor outcomes in in vitro fertilization (IVF) programs with a decrease in oocyte retrieval, oocyte quality, implantation and pregnancy rates. When an endometrioma is diagnosed, it is indicated to remove endometrial cysts by laparoscopy or perform an aspiration before the cycle of IVF. OBJECTIVES: To evaluate the effect of endometriosis diagnosed incidentally during oocyte retrieval on the IVF outcome, as well as to establish its frequency. MATERIAL AND METHODS: Retrospective analysis of 1,000 files of patients who underwent to oocyte retrieval between January 2002 and March 2005, in the Centro Especializado para la Atenci6n de la Mujer in Mexico City. Of the total procedures tubal factor was the first indication for IVF and male factor was on second place. Only in seven patients of 1,000 oocyte retrievals was detected the presence of endometriosis fluid instead of folicular fluid. RESULTS: The prevalence of endometriosis diagnosed incidentally during oocyte retrieval was 0.7%, and the oocyte quality was 1.55 (regular). The fertilization rate for patients with endometriomas was 45% and the implantation and pregnancy rates were zero per cent while the patients without endometriomas the fertilization rate was 65% with an implantation rate of 18% and the pregnancy rate was 35%. CONCLUSION: Endometriosis is a disease that must be treated before an IVF cycle in stages III-IV and especially in presence of endometriomas because it could affect negatively IVF outcomes.

[Usefulness of luteinizant hormone levels to determine the oocyte quality]. / Utilidad de las concentraciones de la hormona luteinizante para determinar la calidad ovocitaria.

OBJECTIVE: To evaluate the luteinizing hormone serum preovulatory levels and correlate them with the embryo number and quality, and with the fertilization and clavage rates. STUDY: Prospective, descriptive and observational. MATERIAL AND METHODS: We included 286 patients that underwent to IVF-ET program, we excluded patients with no mesurement of LH preovulatory levels, or patients that in the oocyte retrieval we do not found oocytes. The protocols for pituitary inhibition were: stop Lupron, long luteal phase and GnRH antagonist, the ovarian stimulation was realized with recombinant FSH. The studied variables were: LH preovulatory levels, number and quality of oocytes, fertilization and clevage rates and embryo quality. Statistical analysis was done with p Pearson and ANOVA tests. RESULTS: The mean age for patients was 34 +/- 3.96 years, the principal factor of infertility was tubal and pelvis pathology. The mean LH preovulatory levels were 2.19 +/- 1.83 UI/L by patient, we observed a negative correlation between LH levels and number of oocytes retrieved (p = -0.157, IC 99%), and the correlation between LH levels and number of metaphase 2 oocyte was negative too (p = 0.113, IC 95%). We observed greater levels of LH (3.15 UI/L) in the degenerated oocytes during oocyte retrieval. We did not found a statistical correlation between fertilization and cleavage rates with LH levels. LH preovulatory levels of 0.85 UI/L could predict good quality oocytes with a sensitivity of 72% and specificity of 25%. CONCLUSIONS: Normogonadotrophic patients without deep suppression of gonadotrophins by the use of GnRH analogues, high LH preovulatory levels correlates with a less number of oocytes, and with degenerated oocytes. Preovulatory LH levels of 0.85 UI/L could predict good quality oocytes.

[Analysis of results of intrauterine insemination performed once or twice per stimulated cycle]. / Análisis de los resultados de la inseminación artificial realizada en una o dos ocasiones por ciclo estimulado.

OBJECTIVE: To compare double homologous versus only one intrauterine insemination (IUI) by stimulated cycle. PATIENTS AND METHOD: In a prospective, comparative study 138 patients were included, who underwent to intrauterine insemination; not inclusion parameters were: patients with cancelled cycles by poor response or by ovarian hyperestimulation syndrome risk. Patients were divided in two groups: Group 1 (N = 69) one insemination at 36 hours after human gonadotrophin chorionic hormone (hCG) and group 2 (N = 69) two inseminations 24 and 48 hours after hCG. Sperm separation was done with swim up, wash and resuspended or isolate techiques, and ovarian stimulation was done with recombinant FSH, menotrophins or clomiphene citrate. Statistical analysis was made by T Student and chi2 tests. RESULTS: The overall pregnancy rate was 13.04% per cycle; and seminal characteristics after seminal preparation were similar. We observed better pregnancy rates in the patients with ovulatory dysfunction and endometriosis (14.9% and 18.2%). No differences were established in pregnancy rates when patients were compared in function to seminal preparation. CONCLUSIONS: Double IUI at 24 and 48 hours after hCG has the same results in pregnancy rates than only one IUI correctly indicated 36 hours after hCG, but the costs increases in double insemination.

[Fertilization rate analysis as a predictive variable for an in-vitro fertilization program success]. / Análisis de la proporción en la tasa de fertilización como una variable predictiva del éxito en un programa de fertilización in vitro.

OBJECTIVE: Determining if fertilization rates can be used as a predictive factor for pregnancy induction in ETIVF-ICSI programs. TYPE OF STUDY: Retrospective, observational and descriptive. MATERIALS AND METHODS: Six hundred and seventy nine cycles of the in vitro fertilization program, using long protocol hypophyseal suppression, stop, or antagonsits, were included. Ovarian stimulation was carried out with menotropines or recombinant FSH. Those patients whose cycle was stopped due to the lack of follicular development were excluded. Variables under study were: age, fertilization percentage, pregnancy rate, pre-ovulatory estradiol levels, number and quality of captured oocytes, transferred embrios and endometrial thickness on the day of transference and the presence of pregnancy. The Pearson P Test with a 95% confidence interval and the Student T Test used to establish differences with a 95% confidence interval statistical analyses were applied. RESULTS: Six hundred and seventy nine cycles were studied, 487 of which used the conventional fertilization method, and 192 used the ICSI method. Mean age among patients was 34 +/- 1.1 years old, with pre-ovulatory estradiol levels of 4,023 +/- 1,134 pg/mL, the average quantity of captured oocytes was 11.7 +/- 3.2 with a capture rate of 69.6%. Mean fertilization rates averaged 54% with a 20.7% pregnancy rates using the transference method. After analyzing the fertilization rate in each group, a statistically significant linear correlation was observed (P = 0.547, CI 95%) with the pregnancy rate. After assigning patients to two different groups: conventional IVF and ICSI, a higher positive correlation was observed (P = 0.827, CI 99%) in the first group. No significant differences were observed in the remaining parameters between both groups, excepting oocyte maturity, where greater prophase I and metaphase II percentages were observed in the ICSI group. When 50% fertilization was taken as the cutting point, a 78.19% negative predictive value was determined, with a 25% positive predictive value, 77.5% sensitivity, and 25.6% specificity. CONCLUSIONS: A fertilization percentage greater than 50% can be used as a pregnancy predicting factor in in vitro fertilization programs.

Resultados iniciales del primer programa ambulatorio de fertilización in vitron en México / \"Initial results of the first ambulatory program of in vitro fertilization in Mexico\"

Las parejas estériles tratadas mediante fertilización in vitro y transferencia de embriones (FIVTE) requieren altos estándares de calidad. Habitualmente los nuevos programas de FIVTE necesitan generar resultados aceptables tan pronto como sea posible. En este trabajo se reporta la experiencia de un nuevo centro de FIVTE que realiza el procedimiento convencional y con donación de óvulos. Las pacientes fueron manejadas en grupos, con sincronización de sus ciclos menstruales con noretisterona. Ambas variantes del procedimieto dieron origen a embarazos clínicos desde el inicio de actividades. Se analizan los aspectos logísticos y metodológicos. En la actualidad, la meta es mejorar la eficacia y eficacia del programa