Subclinical pregnancy losses among women undergoing in-vitro fertilization with ICSI.

BACKGROUND: The purpose of this study is to asses the frequency of subclinical pregnancy loss (SPL) among women undergoing controlled ovarian hyperstimulation (COH) and in-vitro fertilization with ICSI. METHODS: The study was retrospectively conducted in a private IVF center. SPL was defined by a temporary rise in serum beta hCG, along with the absence of signs of intra- and extra-uterine pregnancy by transvaginal ultrasonography. Overall 5273 COH and ICSI cycles with embryo transfer (ET) were segregated according to serum E(2) levels percentiles (-24th, 25th, 74th, and 75th), women age and the type of spermatozoa for assisted fertilization (ejaculated and surgically retrieved). Those groups were assessed for SPL rates. RESULTS: Among the 3125 (59.25) conception cycles, 305 (9.7%) were diagnosed as SPL. There was no difference in SPL rate among E(2) percentile groups. Women older than 35 years of age had significantly higher rate of SPL compared to younger women. There was also no difference in SPL rate among pregnancies in whom surgically retrieved spermatozoa used or ejaculated spermatozoa used for assisted fertilization. CONCLUSION: Our results demonstrated that SPL rate was not influenced by the levels of E(2) during COH or the origin of spermatozoa used for assisted fertilization. However, maternal age was found to be detrimental for SPL.

Elevated oestradiol concentrations are not associated with increased first trimester miscarriage rates of singleton gestations conceived by assisted conception treatment.

The study evaluated the impact of elevated oestradiol concentrations on pregnancy loss during the first trimester in singleton gestations conceived via ovarian stimulation and intracytoplasmic sperm injection (ICSI). Following determination of oestradiol concentrations during 6478 ICSI cycles, patients were assorted by oestradiol percentile. Hyper-responders were defined as patients having peak oestradiol concentrations over the 90th percentile (>4200 pg/ml, 685 cycles), moderate responders were defined as patients having peak oestradiol concentrations between the 75th and 90th percentiles (3250-4200 pg/ml, 958 cycles) and normal responders were defined as patients having peak oestradiol concentrations between the 25th and 75th percentiles (1350-3250 pg/ml, 3325 cycles). The relationship between first trimester miscarriage rates and oestradiol percentiles was analysed in 1184 singleton gestations. Pregnancy rate was significantly lower in normal responders (54.4%) than in moderate (58.8%, P = 0.02) and hyper-responders (60.9%, P = 0.003), but there were no intergroup differences in miscarriage rate (19.6%, 17.1%, and 16.8%, respectively). Although women with severe ovarian hyperstimulation syndrome had a miscarriage rate of 40%, this rate did not differ significantly from the miscarriage rates of the other groups. The findings suggest that high oestradiol concentrations during ovarian stimulation do not expose singleton pregnancies to an increased risk of miscarriage during the first trimester.

Successful pregnancy in a liver transplant recipient following controlled ovarian hyperstimulation and intracytoplasmic sperm injection.

As the demand for assisted reproductive technologies (ART) increases, infertility treatments are increasingly being sought by patients with serious health problems that were once regarded as leading to infertility. Moreover, since pregnancy may worsen their underlying health conditions, these women have been advised to remain infertile. We describe here a liver transplant recipient who underwent ART for male factor infertility. Assisted fertilization was achieved using intracytoplasmic sperm injection, and she conceived after embryo transfer. Her pregnancy follow-up was unremarkable until she delivered a healthy boy pretermly at 31 and half weeks.

Prenatal karyotypes of fetuses conceived by intracytoplasmic sperm injection.

OBJECTIVE: To evaluate the rate of chromosomal abnormalities in babies conceived by intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective case-control analysis. SETTING: Private IVF center. PATIENT(S): One thousand one hundred thirty-six karyotype results obtained from fetuses conceived by ICSI. INTERVENTION(S): Amniocentesis and prenatal karyotyping. MAIN OUTCOME MEASURE(S): Presence of normal and abnormal chromosomal configurations. RESULT(S): Abnormal karyotypes were detected in 17 (1.5%) of 1,136 fetuses. Eight (0.7%) of these were from singleton and nine (0.8%) from twin pregnancies. There was no difference in the autosomal chromosome structure or the number or structure of sex chromosomes in karyotyped fetuses of singleton and twin pregnancies. However, abnormal numbers of autosomal chromosomes were more frequent in singletons (2.3%) than in twins (1.1%). There was also no difference in the frequency of chromosomal aberrations between ICSI groups in which ejaculated spermatozoa (1.9%) and testicular spermatozoa (1.5%) were used. There was no difference in the frequency of chromosomal aberrations between fetuses for whom ICSI was used because of male factors (1.8%) compared with babies for whom ICSI was also the choice of assisted fertilization method for other types of infertility factors (0.9%). CONCLUSION(S): Sperm source does not influence the karyotype of babies conceived by ICSI. By comparing our results with previously reported data from natural pregnancies, we show that ICSI babies carry a significantly increased risk of an abnormal karyotype. However, the increased risk is similar among the different infertility groups.

Monochorionic triplets following intracytoplasmic sperm injection: a report of two consecutive cases.

Monochorionic triplet pregnancies are very rare. Here we report 2 cases of multiple pregnancies with monochorionic triplets following intracytoplasmic sperm injection (ICSI) and day 3 embryo transfer. The 2 women concomitantly underwent controlled ovarian hyperstimulation due to male factor infertility. Following oocyte retrieval, ICSI and assisted hatching (AH) were performed, and the 2 women conceived consecutively. One patient had a quadruplet pregnancy, which included monochorionic triplets, while the other had monochorionic triplets. Selective embryo reduction by intracardiac KCl injection targeted at 2 of the triplets was performed on the patient with the quadruplet pregnancy, but the third triplet also died. The gestation continued as a singleton pregnancy, and the patient gave birth to a healthy female baby at 38 weeks. The other patient gave birth to 3 healthy female babies at 34 weeks. Possible etiologic factors for the formation of monozygotic splitting among women undergoing assisted reproduction treatment are discussed.

Survival rates during the first trimester of multiple gestations achieved by ICSI: a report of 1448 consecutive multiples.

BACKGROUND: The purpose of this study was to determine the rate of spontaneous gestational sac loss during the first trimester in women achieving multiple pregnancies by ICSI. METHODS: A retrospective analysis was performed of 1448 consecutive multiple pregnancies conceived by ICSI. RESULTS: Of the cohort of 1448 pregnancies, twin gestations constituted 59.6% (864), triplets 30.2% (438) and quadruplets 10.0% (146). During the first trimester, 69 (4.7%) patients miscarried, while 179 (12.3%) continued their pregnancies and had fewer gestational sacs at the end of the first trimester than at the beginning. The overall loss rate of any gestational sac during the first trimester in these multiple pregnancies was 10.1%. There was a significant difference in the frequency of spontaneous reduction to twin or singleton pregnancies in the first trimester between women carrying triplets (11.7%) and those carrying quadruplets (3.5%) [P = 0.004; odds ratio (OR) 3.5; 95% confidence interval (CI) 1.3-9.1]. The frequency of gestational sac loss was significantly greater among women >35 years old (20.9%) than in women less than 35 years old (15.9%) (P = 0.03; OR 1.4; 95% CI 1.0-1.9). CONCLUSION: In multiple pregnancies there is a significant risk of spontaneous loss of any embryo during the first trimester. These findings should be considered prior to any decision about selective embryo reduction.

Successful resection of a heterotopic cervical pregnancy resulting from intracytoplasmic sperm injection.

OBJECTIVE: To report a case of cervical heterotopic pregnancy after IVF-ET treatment. DESIGN: Case report. SETTING: Private IVF center. PATIENT(S): A woman who had undergone controlled ovarian hyperstimulation and intracytoplasmic sperm injection-ET for primary male factor infertility. INTERVENTION(S): Resection of cervical heterotopic pregnancy by hysteroscopy. MAIN OUTCOME MEASURE(S): Successful treatment of heterotopic cervical pregnancy. RESULT(S): A successful pregnancy resulting in a term baby. CONCLUSION(S): Hysteroscopic resection can be used to treat a cervical heterotopic pregnancy.