Does isolated teratozoospermia affect performance in in-vitro fertilization and embryo transfer?

The effect of the strict classification of spermatozoal morphology on the outcome of in-vitro fertilization and embryo transfer treatment cycles has been assessed in a retrospective analysis of 2144 consecutive cycles. The patients all had a standardized long protocol gonadotrophin-releasing hormone analogue cycle, with luteal phase start, to achieve down-regulation. All treatment cycles where the sperm density was abnormal (< 20 x 10(6)/ml), or where progressive motility was abnormal (< 40%), were excluded. The study excluded treatment cycles where the oocytes inseminated did not include at least one grade 1 or grade 2 oocyte. The percentage of couples achieving the normalized results of the clinic, including median fertilization rate per patient, insemination rates, numbers of embryos transferred, rates of 'spare embryo' blastocyst formation, cumulative pregnancy rates and pregnancy outcome, were calculated. No statistically significant difference arose between the two groups of patients with regard to the percentage of patients achieving the normalized median fertilization rate or higher (group 1 with > 14% normal forms, and group 2 with > or = 4%, < or = 14% normal forms). There was a statistically significantly lower chance of achieving this rate in patients of group 3 (< 4% normal forms) (P < 0.005), but 68.6% did achieve that fertilization rate or higher. There was no statistically significant difference in any of the other end points. In conclusion, a morphological classification may be appropriate as an indicator for counselling patients with regard to treatment expectations, but its use would be seem inappropriate as an index of fertilizing potential in clinical management.(ABSTRACT TRUNCATED AT 250 WORDS)

A controlled study to assess the use of in vitro fertilization with donor semen after failed therapeutic donor insemination.

OBJECTIVE: To assess the outcome of in vitro fertilization and embryo transfer (IVF-ET) with donor semen in patients who have failed to achieve conception with therapeutic donor insemination (TDI). DESIGN: Retrospective, controlled study. SETTING: All patients were managed and treated at the in vitro fertilization unit, John Radcliffe Hospital, Oxford, United Kingdom. PATIENTS, PARTICIPANTS: Thirty-eight patients undergoing 63 cycles of IVF with donor semen were compared with a control group of patients undergoing the same treatment during the same time period for tubal disease (the subgroup with the best success rates in our program), matched for age, type of infertility (primary or secondary), and number of attempts at treatment. MAIN OUTCOME MEASURES: We compared number of follicles produced, number of oocytes retrieved, fertilization rates, number of embryos obtained, number of embryos transferred, quality of embryos transferred, blastocyst formation in sibling embryos produced, clinical pregnancy rates (PRs), pregnancy loss, and pregnancy outcome. STATISTICS: Chi-squared test statistic with Yates' correction for continuity. RESULTS: There was a statistically significant difference between the number of livebirths in the donor IVF-ET group (37) and the control group (18). The cumulative PR after four cycles for the donor IVF-ET group (83%) was statistically greater than that of the control group (59%). There was no significant difference in all other parameters compared. CONCLUSION: Patients undergoing IVF-ET with donor semen have an excellent outcome. With the decline in PR after six cycles of TDI, early recourse to IVF-ET should be considered in this group of patients.

Attitudes of donors and recipients to gamete donation.

An anonymous questionnaire was circulated at two gamete donation clinics to survey the attitudes of donor insemination patients (n = 71; 89% response rate), sperm donors (n = 52; 85% response rate) and ovum donors (n = 5; 63% response rate) to the release of medical records with non-identifying information, or with identifying information of the donor involved. The majority of established sperm donors agreed to the release of medical records with or without identifying information. In the subset of potential sperm donors 85% would not enter a sperm donation programme unless anonymity was maintained, but 60% would agree to the release of non-identifying medical records. Sixty per cent of recipients of donated spermatozoa would agree to the release of medical records with identifying information of the donor, but 85% stated that they would not tell their children of their genetic origin. There is a significant difference between the attitudes of potential sperm donor recruits to these questions and those of established donors and recipients of donated spermatozoa. In conclusion, the results of this survey show that although established sperm donors would continue to donate spermatozoa if their status of anonymity was withdrawn, recruitment of new donors would be significantly reduced. This would be to the detriment of gamete donation programmes and to the subfertile couples who request this form of treatment.

Obstetric outcome in first-time mothers aged 40 years and over.

This retrospective study examines the outcome of pregnancy after 28 weeks gestation in 100 consecutive, unselected primiparae who were aged 40 years or more. Antenatally, the incidence of hypertension was increased. There was an increased incidence of induction of labour and caesarean section. There were no maternal deaths and no evidence of an increase in maternal morbidity. After correction for congenital malformations, the perinatal mortality rate was not increased in these mothers. The incidence of Down's Syndrome was 4%, as expected. In general, the outcome of the pregnancy for the mother and her baby was satisfactory. Contrary to popular opinion, the results justify an optimistic approach to women about to become mothers for the first time in their forties, and the traditional high intervention rates may not be justified.

Training needs for providers of adolescent health care: results of a survey.

A survey of the training needs of professionals who work with the adolescent population was undertaken in the state of Colorado in December 1980. Over 550 questionnaires were sent to nurses, social workers, mental health personnel and others in rural and urban areas, and 46% of these forms were returned. The eight highest ranked topics were: depression and suicide, family disruption, sexuality, psychosocial growth and development, interviewing, incest, emotional problems, and substance abuse. There was remarkable concurrence in rating these subjects by frequency of choice, by priority, by discipline, and by geographic area. This survey clearly delineates specific topics relevant for continuing education programs for adolescent health care providers.