IVF outcome is optimized when embryos are replaced between 5 and 15 mm from the fundal endometrial surface: a prospective analysis on 1184 IVF cycles.

BACKGROUND: Some data suggest that the results of human in vitro fertilization (IVF) may be affected by the site of the uterine cavity where embryos are released. It is not yet clear if there is an optimal range of embryo-fundus distance (EFD) within which embryos should be transferred to optimize IVF outcome. METHODS: The present study included 1184 patients undergoing a blind, clinical-touch ET of 1-2 fresh embryos loaded in a soft catheter with a low amount of culture medium. We measured the EFD using transvaginal US performed immediately after ET, with the aim to assess (a) if EFD affects pregnancy and implantation rates, and (b) if an optimal EFD range can be identified. RESULTS: Despite comparable patients' clinical characteristics, embryo morphological quality, and endometrial thickness, an EFD between 5 and 15 mm allowed to obtain significantly higher pregnancy and implantation rates than an EFD above 15 mm. The abortion rate was much higher (although not significantly) when EFD was below 5 mm than when it was between 5 and 15 mm. Combined together, these results produced an overall higher ongoing pregnancy rate in the group of patients whose embryos were released between 5 and 15 mm from the fundal endometrial surface. CONCLUSIONS: The site at which embryos are released affects IVF outcome and an optimal EFD range exists; this observations suggest that US-guided ET could be advantageous vs. clinical-touch ET, as it allows to be more accurate in releasing embryos within the optimal EFD range.

Family planning, fertility awareness and knowledge about Italian legislation on assisted reproduction among Italian academic students.

Over the last century, most industrialized countries have experienced a progressive increase in maternal age at first pregnancy and a reduction of fertility rate, with important social and economic consequences. Moreover in Italy a very restrictive law on assisted reproductive technologies was introduced in 2004, limiting its effectiveness and causing a strong public debate that unfortunately focused more on the political and ethical implications of the law than on the medical and technical aspects of assisted reproduction. The present study performed an epidemiological investigation among the students of Turin University in the year 2006/07 in order to assess three aspects: the factors affecting the decision to become parents, their level of consciousness about human reproduction and their level of knowledge about the legal rules that regulate assisted reproduction in Italy. The study also wanted to clarify how the sex (male or female) and the type of education (sciences or humanities) could affect their opinions and knowledge in this area. It was observed that young people consider parenthood an important part of their life, but knowledge about human fertility and legal rules regulating assisted reproduction is rather poor, regardless of sex and type of education.

Superfetation after ovulation induction and intrauterine insemination performed during an unknown ectopic pregnancy.

This report describes the first case of superfetation after ovarian stimulation with gonadotrophins and intrauterine insemination (IUI) that were performed in the presence of an undiagnosed tubal pregnancy. A 32-year-old woman who underwent repeated attempts of ovarian stimulation and IUI was hospitalized for severe pelvic pain and submitted to laparoscopic salpingectomy because of ruptured salpynx containing a 6-week pregnancy. Transvaginal ultrasound examination showed a simultaneous intrauterine 2-week pregnancy that had been conceived by ovarian stimulation and IUI while the tubal pregnancy was already ongoing and still undiagnosed. The intrauterine pregnancy went on until term and ended with the spontaneous delivery of a healthy baby. This report demonstrates that human superfetation may occur after gonadotrophin treatment and IUI in the presence of an ongoing tubal pregnancy. It is recommended to perform a pregnancy test before starting ovulation induction even when an apparently normal blood discharge appeared.

Low-dose acetylsalicylic acid plus prednisolone as an adjuvant treatment in IVF: a prospective, randomized study.

OBJECTIVE: To test whether adjuvant therapy with acetylsalicylic acid (ASA) and prednisolone (ASA+Pred) could improve the outcome of IVF in good-pregnancy prognosis patients. DESIGN: Prospective, randomized study. SETTING: University hospital. PATIENT(S): Three hundred ninety-five infertile couples undergoing IVF. INTERVENTION(S): Patients were randomized to receive ASA+Pred (n = 97) or nothing (n = 298), in addition to the routinely used IVF medications. MAIN OUTCOME MEASURE(S): The primary endpoint was implantation rate (IR). Secondary endpoints were number of retrieved oocytes and pregnancy rate (PR). The blood flow in uterine arteries and subendometrial vessels also was measured. RESULT(S): Patients who received ASA+Pred had significantly more retrieved oocytes. The PR and IR in the study group and in controls were 50.5% and 40.6% and 25.1% and 19.4%, respectively, values that were not significantly different from one another. Uterine blood flows were not significantly different between treated and nontreated patients. A statistically significantly lower incidence of severe ovarian hyperstimulation syndrome was noted among treated patients who were at high risk of developing ovarian hyperstimulation syndrome (1.7% vs. 6.5%). CONCLUSION(S): Adjuvant treatment with ASA+Pred improves ovarian responsiveness but does not significantly improve uterine blood fluxes, PR, and IR. It may be effective in preventing the onset of severe ovarian hyperstimulation syndrome.