Frozen embryo transfer: the present practice and beyond.

BACKGROUND: With the success of oocyte donation in vitro fertilization (IVF) in postmenopausal women, the importance of endometrial preparation became obvious. This appears also very crucial for achieving pregnancy after frozen embryo transfer (FET) after failed fresh IVF cycles and FET in subsequent natural cycles. Although there are different methods of preparing endometrium, in this study, another method of preparing the implantation bed using letrozole was scrutinized for its usefulness. METHODS: Two hundred and seventy patients between 28 and 40 years of age undergoing IVF due to bilateral tubal blocks were chosen for FET. They had a previous unsuccessful single IVF attempt or had postponed embryo transfer due to the threat of ovarian hyperstimulation syndrome or poor endometrial development. Informed consents were obtained from the participants. One hundred patients had endometrial preparation by gonadotrophin-releasing hormone agonist down-regulation and with hormone replacement therapy, 55 had natural cycle FET, and the remaining 115 patients had letrozole-induced ovulation induction (OI) for endometrial preparation. RESULTS: The clinical and biochemical pregnancy rate or live birth rate was higher in the letrozole OI group than in the other two groups. CONCLUSIONS: OI by letrozole and subsequent endometrial preparation as a result of it may be utilized for FET, and this will be cheap and easy to administer, giving better success rates in FET cycles.

Postcoital intra-uterine aspirate--a unique criterion for selecting patients for natural or assisted conception.

The success of any infertility management programme is reflected in its efficacy to achieve a pregnancy either spontaneously or through assistance. For this purpose some routine investigations are carried out to pinpoint the nature of problem(s) which an infertile couple is troubled with. As the basic requisite for conception to occur is the accumulation of motile spermatozoa around the egg at the site of fertilisation, proper assessment of sperm transit from the vagina to the tubal ampulla becomes a very important criterion to predict the possibility of spontaneous pregnancy. Till date postcoital test was the sole investigative tool available to serve this purpose but unfortunately it fails to furnish any information about the concentration and nature of quality of spermatozoa beyond the cervix. This results in the disparity between postcoital test results and pregnancy outcome. In the present study intra-uterine fluid was examined along with cervical mucus 4-6 hours postcoitus in the pre-ovulatory period. The objective was to gather information about the fate of spermatozoa subjected to the uterine environment after being vaginally deposited during coitus. The result of this combined test has been found to be very much informative and helpful for the fertility physician to set the criteria for timed intercourse and / or intra-uterine insemination. This simple test thus appears to play a leading role in infertility management in near feature.