GnRH agonist administration at the time of implantation does not improve pregnancy outcome in intrauterine insemination cycles: a randomized controlled trial.

OBJECTIVE: To assess whether GnRH agonist administration in the luteal phase improves pregnancy outcome in intrauterine insemination (IUI) cycles. DESIGN: Single-center, randomized, single-blind, placebo-controlled trial. SETTING: University-affiliated infertility clinic, between February 2005 and December 2007. PATIENT(S): Three hundred forty-four women undergoing IUI owing to mild to moderate male factor or donor sperm indication. INTERVENTION(S): Random administration to either a single subcutaneous injection of 0.1 mg triptorelin (group A; n=172) 8 days after hCG administration, or solvent only (group B; n=172) at the same time. MAIN OUTCOME MEASURE(S): Pregnancy rate was the primary outcome measure considered for assessing the role of triptorelin administration at the time of implantation. Clinical pregnancy, miscarriage, and ongoing pregnancy rates were the secondary outcome measures. RESULT(S): No differences were detected between the groups regarding clinical, seminal, or ovarian stimulation parameters. Pregnancy rate per randomized patient was similar in both groups (22.7% vs. 22.1%), as were clinical pregnancy, miscarriage, and ongoing pregnancy rates. There was a significant increase in the proportion of multiple pregnancies in the placebo group (10.3% vs. 36.8%). CONCLUSION(S): Administration of GnRH agonist at the time of implantation does not improve the reproductive outcome of IUI cycles.

Obesity and poor reproductive outcome: the potential role of the endometrium.

OBJECTIVE: To analyze the potential role of extraovarian factors such as endometrium in the reproductive outcome of obese patients. DESIGN: Retrospective study. SETTING: University-affiliated infertility clinic, between January 2001 and July 2005. PATIENT(S): Women undergoing a total of 2656 first ovum donation (OD) cycles with good quality embryos. INTERVENTION(S): The oocyte donors underwent controlled ovarian hyperstimulation, and recipients received a well-established hormonal replacement therapy for endometrial preparation. In vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) was performed according to semen characteristics. All first cycles (n = 2656) of ovum donation used good quality embryos and were divided into groups according to body mass index: <20 kg/m(2) (n = 471), 20 to 24.9 kg/m(2) (n = 1613), 25 to 29.9 kg/m(2) (n = 450), and > or =30 kg/m(2) (n = 122). MAIN OUTCOME MEASURE(S): The recipient body mass index groups were compared regarding IVF outcome. RESULT(S): The rates of implantation, pregnancy, miscarriage, and ongoing pregnancy were similar among the body mass index groups, although there was a negative trend when body mass index increased. Ongoing pregnancy rates per cycle were poorer in the overweight and obese groups than in the underweight and normal groups. In addition, women under 25 kg/m(2) presented an ongoing pregnancy rate per cycle of 45.5%, compared with 38.3% for those with > or =25 kg/m(2). CONCLUSION(S): Excess weight exerts an extraovarian detrimental effect. The role of the endometrium or its environment seems to be subtle but should be taken into account.

Ovarian stimulation length, number of follicles higher than 17 mm and estradiol on the day of human chorionic gonadotropin administration are risk factors for multiple pregnancy in intrauterine insemination.

Aim: The aim of the present study was to identify the risk factors, their prognostic value on multiple pregnancies (MP) prediction and their thresholds in women undergoing controlled ovarian hyperstimulation (COH) with follicle stimulating hormone (FSH) and intrauterine insemination (IUI). Methods: A case-control study was carried out by identifying in our database all the pregnancies reached by donor and conjugal IUI (DIUI and CIUI, respectively), and compared cycle features, patients' characteristics and sperm analysis results between women achieving single pregnancy (SP) versus MP. The number of gestational sacs, follicular sizes and estradiol levels on the human chorionic gonadotropin (hCG) administration day, COH length and semen parameters were obtained from each cycle and compared. Student's t-tests for mean comparisons, receiver-operator curve (ROC) analysis to determine the predictive value of each parameter on MP achievement and multiple regression analysis to determine single parameter influence were carried out. Results: Women with MP in IUI stimulated cycles reached the adequate size of the dominant follicle (17 mm) significantly earlier than those achieving SP. Also, the mean follicles number, and estradiol levels on the hCG day were higher in the CIUI and DIUI MP group. Nevertheless, only ROC curve analysis revealed good prognostic value for estradiol and follicles higher than 17 mm. Multiple regression analysis confirmed these results. No feature of the basic sperm analysis, either in the ejaculate or in the prepared sample, was different or predictive of MP. When using donor sperm, different thresholds of follicle number, stimulation length and estradiol in the prediction of MP were noted, in comparison with CIUI. Conclusions: MP in stimulated IUI cycles are closely associated to stimulation length, number of developed follicles higher than 17 mm on the day of hCG administration and estradiol levels. Also, estradiol has a good predictive value over MP in IUI stimulated cycles. The establishment of clinical thresholds will certainly help in the management of these couples to avoid undesired multiple pregnancies by canceling cycles or converting them into in vitro fertilization procedures. (Reprod Med Biol 2007; 6: 19-26).

Implantation in IVF.

The recent advances in assisted reproduction have made it possible to study and interfere in almost every step of the human reproductive process except for implantation. The most complex and important step remains in great part unknown. Implantation in human has proven to be less efficient compared with other species. However, in in vitro fertilization (IVF) patients, it has been evaluated to be even poorer. This paper highlights the factors related to infertile patients and IVF treatments that can affect implantation and implantation's clinical aspects related to these treatments: implantation failure and early pregnancy loss.