Pregnancy results after ovum donation following one to seven embryo transfers.

OBJECTIVE: To determine whether failure to achieve pregnancy after repeated ET after ovum donation was due to an endometrial defect or to the embryo quality. DESIGN: Retrospective data analysis. SETTING: A private infertility center. PATIENT(S): Four hundred sixty-seven donors (513 cycles) undergoing IVF donating oocytes to 266 recipients (423 cycles). INTERVENTION(S): Hormonal endometrial preparation with increasing dosages of valerate E2 (2,4, and 6 mg) and 100 mg of P. MAIN OUTCOME MEASURE(S): Pregnancy rates (PRs) and abortion rates in patients undergoing one to seven ETs after ovum donation. RESULT(S): Pregnancy rates in recipients that had one or two ETs were significantly higher (34.8%) compared with those of recipients having three or more ETs (15.1%). Abortion rates were significantly higher (54.5%) in recipients repeating more than three ETs than in the recipients having one or two ETs (29.1%). CONCLUSION(S): Recipients that had failed to establish a pregnancy after two ETs had a lower PR in successive attempts, possibly because of a defect of their endometrial lining.

Triplet pregnancy and fetal reduction counselling.

The aim of this study was to compare the fetal loss between triplet pregnancies that underwent fetal reduction to twins and triplets which continued in spite of reduction being suggested to all of them. During a five year period a total of 3,518 cycles underwent ovarian stimulation with GnRH analogues, HMG, pure-FSH and HCG for the purpose of IVF; 2,918 women underwent ovarian aspiration leading to 2,380 embryotransfers. A total of 560 clinical pregnancies were detected with 24 clinical triplet pregnancies. Fourteen women continued their triplet pregnancy while 10 women underwent fetal reduction to twins. From 42 fetuses (14 triplets) starting the third trimester only 29 survived (total fetal loss 30.9%). From 14 fetuses (7 twins) starting the third trimester all survived. Three twins were lost during the second trimester due to cervix incompetence. Fetal reduction to twins must be proposed to each multifetal pregnancy, considering the very serious high mortality rate.

Serum and follicular fluid sex hormone-binding globulin in stimulated and unstimulated cycles.

BACKGROUND: It is well-known that sex hormone-binding globulin (SHBG) concentrations in the follicle are relatively low in comparison with the corresponding estradiol (E2) levels, which are extremely high. A direct comparison of these data in stimulated and unstimulated cycles, as well as the relationship of SHBG with testosterone (T) and E2 in serum and follicular fluid (FF), is assessed. METHODS: SHBG was measured in serum and FF in 42 cycles stimulated by GnRH agonists and gonadotropins and in 15 unstimulated cycles. The levels of SHBG were compared to the corresponding total estradiol and total testosterone concentrations. The analyzed FFs of 42 women, 12 of whom conceived, were randomly selected from 90 patients participating in an in vitro fertilization program. Mature oocytes were retrieved from all follicles from which FFs were analyzed. RESULTS: Markedly elevated SHBG was found in both the serum and the FF of stimulated cycles compared to unstimulated cycles. In contrast, serum T and E2 were significantly higher in induced than in unstimulated cycles, while there was no significant difference in FF T or E2 between the two groups of cycles. No correlation was found between serum and FF SHBG in either stimulated or unstimulated cycles. In stimulated cycles, only in FF, SHBG was significantly correlated with both E2 and T. In unstimulated cycles, no correlation was found between SHBG and either one of the corresponding steroids either in serum or in FF. CONCLUSIONS: The fraction of non-SHBG bound, biologically active sex steroids may be lower in the FF of stimulated than that of unstimulated cycles.

The effect of pentoxifylline on sperm motility, oocyte fertilization, embryo quality, and pregnancy outcome in an in vitro fertilization program.

OBJECTIVE: To study the effect of pentoxifylline on sperm motility, oocyte fertilization, embryo cleavage, and quality as well as pregnancy outcome on asthenospermic patients participating in an IVF program. DESIGN: Prospective randomized study. SETTING: Private IVF unit. PATIENTS: Ninety-seven couples, 24 of whom were repeating IVF. Two semen specimens were obtained from each patient and each specimen was divided equally into two parts, nontreated (control semen) and pentoxifylline-treated (treated semen). MAIN OUTCOME MEASURE: Sperm progressive motility, oocyte fertilization. RESULTS: Overall and progressive motility did not differ significantly between the two semen specimens. There was a significant increase in the progressive motality of the pentoxifylline-treated semen compared with control semen. No significant difference was noticed between control and treated semen in fertilization rate, cleavage rate, embryo quality, and pregnancy rate. The percentage of patients who fertilized only with control semen (9.3%) was not significantly different from that of patients who fertilized only with treated semen (10.3%). Couples who were repeating IVF did not show significant difference in fertilization between the present study and previous attempts. CONCLUSION: Our results showed that although the sperm progressive motility is improved after pentoxifylline treatment, it is doubtful whether this effect is of any clinical significance.

Tumour-associated antigens, CEA, CA 125 and SCC in serum and follicular fluid of stimulated and unstimulated cycles.

Serum and follicular fluid levels of CEA, CA 125 and SCC of women participating in an IVF program, in 42 cycles stimulated with GnRH-a and gonadotropins and in 26 unstimulated cycles triggered with HCG, were evaluated and compared with (a) steroid and gonadotropin levels, (b) the results of IVF, and (c) serum values in a control group of women with spontaneous normal ovulatory cycles. In the control group, serum antigens did not vary significantly during the 3 phases of the cycle. In stimulated cycles the median values in serum were 0.7 ng/ml (range, 0.0-2.1) for CEA, 14.0 U/ml (3.3-32.4) for CA 125 and 2.05 ng/ml (1.1-17.8) for SCC, whereas the median values in follicular fluid were 0.6 (0.0-27.9), 21.5 (0-670) and 21.4 (1-360), respectively. In unstimulated cycles the median values and ranges in serum were 0.9 (0.4-3.9), 12.1 (4.8-63.4) and 1.85 (0.7-4.4), respectively, whereas in follicular fluid they were 2.9 (0.4-180.7), 32 (1.7-600) and 231 (10.8-904). Different follicles of the same patients in stimulated cycles showed a wide divergence for all three antigens. In unstimulated cycles all three antigens in follicular fluid were strongly-correlated and a significant inverse correlation was observed between LH and both CA 125 and SCC in serum. In either group of cycles, no significant relationship was found between any serum or follicular fluid antigen and estradiol or testosterone, pregnancy rate, or oocyte quality and fertilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunoglobulins IgG, IgA, IgM, complement C3, C4 and ferritin and transferrin levels in serum and follicular fluid in IVF patients.

Serum and follicular fluid immunoglobulin (IgG, IgA, IgM) and complement (C3, C4), as well as transferrin and ferritin concentrations were measured in 82 consecutive IVF patients (Pregnant: Group A, and non pregnant: Group B). Higher serum concentrations were observed in complement in all Immunoglobulins but IgM which was found to be significantly lower in follicular fluid in both groups. Also there were no statistically significant differences observed for transferrin and ferritin levels in either compartment or among the groups. No correlation was found for the above parameters and the in vitro fertilization outcome in terms of oocytes retrieved, fertilized and embryos implanted.

Assessment of autoantibodies to the zona pellucida in serum and follicular fluid in in-vitro fertilization patients.

Eighty two consecutive IVF patients enrolled in our In-Vitro Fertilization program were investigated on the presence of anti-zona pellucida antibodies in the peripheral blood and follicular fluid, using a haemaglutination test (ovarian zona pellucida HAT) and a zona pellucida slide test, respectively. Overall higher proportion of antibody activity was observed in pregnant patients in both compartments (60% and 53%) in serum and follicular fluid, respectively) than the activity observed in non-pregnant (25% and 48%, respectively). There were no statistically significant differences found for the mean number of oocytes retrieved and fertilized irrespective of the presence of antibodies in serum or in follicular fluid, each one being taken into account separately. However, higher fertilization rates were observed in serum or follicular fluid antibody negative patients (68.2% and 71.2%, respectively) than those who were tested positive (36.6% and 65.4%, respectively). The same was true for the presence of anti-zona pellucida antibodies in serum and in follicular fluid, taking into consideration their presence or absence in both compartments simultaneously.

Hormone levels of follicular fluids with and without oocytes in patients who received gonadotropin-releasing hormone analogues and gonadotropins in an in vitro fertilization program.

BACKGROUND: Are follicles where no oocytes are retrieved "empty follicles"? METHODS: The levels of estradiol (E2), progesterone (P), testosterone (T), cortisol (F), and prolactin (PRL) of follicular fluids (FF) aspirated individually from 34 randomly selected IVF patients in whom no oocytes were recovered were compared with the respective hormone levels of FF obtained from the same patients when oocytes were retrieved. Two FF without oocytes of a 35th patient in whom no oocytes were retrieved were analyzed. RESULTS: Hormones did not differ significantly in the paired samples, while in the two FF of the 35th woman they were in agreement with cystic follicles. CONCLUSIONS: It is necessary to differentiate aspirated follicles where no oocytes are retrieved from the "empty follicle syndrome," which was not observed in the IVF series studied and should be rare in IVF patients.

Secretion of alpha-immunoreactive inhibin by human pre-embryos cultured in vitro.

alpha-Immunoreactive inhibin was measured using an enzyme immunoassay kit in the culture medium (Ham's F-10 medium supplemented with 14% heat-inactivated human serum) from day 3 or 4 to day 14 post-fertilization of 31 surplus pre-embryos from eight women participating in an in-vitro fertilization programme. Inhibition secretion was demonstrated in all of them from the fourth day after fertilization (mean +/- SEM: 3.0 +/- 0.7 U) and was independent of the morphological development of pre-embryos (2-4 cells, n = 4; 6-8 cells, n = 4; 8-10 cells, n = 9; 10-12 cells, n = 4; morulae, n = 5 and blastocysts, n = 4). On days 7, 10, 13 and 14 post-fertilization, mean inhibin values +/- SEM for non-disintegrated pre-embryos were respectively: 6.5 +/- 0.9 U, 12.3 +/- 2.0 U, 16.8 +/- 3.2 U and 20.2 +/- 3.7 U; however, when disintegration was noted on days 10 and 13 after fertilization, inhibin mean values were 9.0 +/- 1.4 U and 8.4 +/- 1.7 U respectively. Inhibin levels were significantly correlated with human chorionic gonadotrophin levels in the same culture media only on day 13, while correlation with pregnancy specific beta 1-glycoprotein occurred on day 7 post-fertilization. In conclusion, early human pre-embryos secrete alpha-immunoreactive inhibin before the cytotrophoblast is formed. This secretion increases significantly with time when development is continued, while disintegration is followed by a net decline in the rate of inhibin release.

Discordant secretion of pregnancy specific beta 1-glycoprotein and human chorionic gonadotropin by human pre-embryos cultured in vitro.

OBJECTIVE: To study and compare the secretion of pregnancy specific beta 1-glycoprotein (SP1) and human chorionic gonadotropin (hCG) by human pre-embryos, cultured in vitro, with their respective morphological development. DESIGN: Spare human pre-embryos from randomly selected women participating in a program of in vitro fertilization (IVF) were studied prospectively. SETTING: Pre-embryos were cultured, and hormone release was determined in academic research laboratories. PATIENTS, PARTICIPANTS: Pre-embryos (n = 108) cultured for 14 days after fertilization in Ham's F-10 medium (GIBCO Ltd., Paisley, Scotland) were observed, and hCG and SP1 were measured in the culture media at regular intervals. MAIN OUTCOME MEASURES: Discordant secretion of SP1 and hCG. RESULTS: Of the 98 bipronucleate pre-embryos, 53.6% formed blastocysts, 17.3% of which hatched. Human chorionic gonadotropin was detected from day 7 after fertilization concomitantly with blastocyst formation, thereafter showing a logarithmic increase (maximum 10,650 mIU) until the first signs of embryonic disintegration. Pregnancy-specific beta 1-glycoprotein release started 3 to 4 days after fertilization independently of the morphological development and the future production of hCG, thereafter displaying a nonlogarithmic increase (maximum 41 ng). CONCLUSIONS: Hormone secretion and morphological development are unique for each pre-embryo. Human chorionic gonadotropin and SP1 seem to have different biochemical and physiological regulation.

Pregnancy after in vitro fertilization in a patient with borderline tumor of the ovary.

A 36 year old woman with unilateral tubal disease was found, during infertility evaluation, to have epithelial tumor of borderline malignancy in one ovary. She was treated with salpingo-oophorectomy and three months later she asked to participate in our IVF program. High doses of gonadotropins were given for controlled hyperstimulation and a successful pregnancy and live birth was achieved.