Intracytoplasmic sperm injection after total conventional in-vitro fertilization failure.

OBJECTIVE: This study assessed the value of delayed intracytoplasmic sperm injection after failure of initial in-vitro fertilization in patients with normal seminology. METHODS: A case series analysis was conducted on 82 couples who underwent delayed intracytoplasmic sperm injection after failure of initial in-vitro fertilization at Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia between January 1995 and January 2001. RESULTS: Seventy-eight couples had 616 unfertilized metaphase II mature oocytes after initial in-vitro fertilization. Second day "rescue" reinsemination by intracytoplasmic sperm injection (ICSI) resulted in 174 embryos that were suitable for transfer. This resulted in 4 clinical pregnancies (5.1% per started rescue ICSI cycle). CONCLUSION: The limited success rate in this study provides confirmatory data that rescue ICSI is not an efficient adjuvant laboratory procedure.

Luteal phase support in ovarian induction cycles using human chorionic gonadotropin or oral progestagens.

OBJECTIVE: To determine the efficacy of luteal phase support with human chorionic gonadotropin (hCG) or oral progesterone during human menopausal gonadotropin (hMG) ovulation induction. METHODS: Between September 1999 and March 2001, a total of 91 couples with infertility were recruited at Al-Hammadi Hospital, Riyadh, Kingdom of Saudi Arabia and Badeea Hospital, Jordan. In this prospective trial 46 couples were allocated to luteal phase support with hCG injections, while 45 couples were allocated to Duphaston (oral progestogens) as luteal support. RESULTS: In the group of hCG luteal support, 46 patients completed 46 cycles of hMG therapy, and 8 pregnancies (5 ongoing pregnancies) ensued, with a general total pregnancy rate of 17.4%. In the progesterone (Duphaston) luteal support group, 45 patients with the similar indications to the previous group were studied and 8 pregnancies (5 ongoing pregnancies) were reported with a general total pregnancy rate of 17.8%. Only one spontaneous abortion occurred among the patients in a cycle supported with supplemental hCG, while 2 abortions occurred in the Duphaston supported group. CONCLUSION: Despite theoretical reasons to use luteal phase support during hMG-stimulated cycles, our data showed no improvement in pregnancy rates from such treatment.