Chemical removal of zona pellucida versus laser assisted hatching after repeated failures of assisted reproductive technology.

Background and Aims: To evaluate outcomes after zona pellucida removal by pronase or laser assisted hatching in women with repeated assisted reproduction failures. Methods: Of 389 procedures (January 2004 to November 2005), 203 control cycles had an intact zona, 116 cycles had chemical removal of the zona and 70 cycles had laser assisted hatching. Rates of pregnancy, implantation and abortion were compared, and pregnancy rate was secondarily evaluated for fresh or frozen-thawed blastocysts. Results: Pregnancy rates were 33.5% (68/203) for controls, 29.3% (34/116) for chemical removal and 30.0% (21/70) for laser. Implantation rates were 24.8% (68/274) for controls, 21.8% (34/156) for chemical removal and 30.0% (21/105) for laser. There were no significant differences among groups. Abortion rates were 15.6% (10/64) for controls, 13.9% (5/36) for chemical removal and 14.3% (3/21) for laser. No difference was observed by blastocyst type for control or laser assisted hatching cycles. In the chemical removal group, both pregnancy and implantation rates were higher for frozen-thawed blastocysts than for fresh blastocysts. (41.5%vs 13.2% and 30.7%vs 11.1%, respectively). Conclusions: Assisted hatching did not show a significant benefit. Chemical zona pellucida removal might increase pregnancy rates for frozen-thawed blastocysts. (Reprod Med Biol 2006; 5: 263-267).

[Clinical result of testicular sperm extraction (TESE) to male-factor infertility in Toyota Memorial Hospital].

Owing to progress of assisted reproduction technology in recent years, it has become possible for couples with infertility problems to have children. Between March 1998 and May 2003 testicular sperm extraction (TESE) was performed on 30 men with male-factor infertility in our hospital. Consequently, we succeeded in recovering 20 spermatozoa. Intracytoplasmic sperm injection was subsequently performed in 15 couples and resulted in 8 pregnancies. There was a statistically significant difference in follicle-stimulating hormone, luteirizing hormone and Johnsen's score between the non-obstructive groups with successful TESE and those with unsuccessful TESE.

Embryo evaluation by analysing blastomere nuclei.

BACKGROUND: To create a more effective selection standard for early embryos, we developed a new grading system consisting of conventional morphological evaluation in combination with analysis of blastomere nuclei. METHODS: A total of 744 embryos used during 459 cycles of embryo transfer on day 2 and blastocyst transfer were subjected to retrospective analysis. The overall implantation rate was 15.5% (115/744). Morphological evaluation of the embryos was performed on day 2 by referring to both the size of blastomere and fragmentation (conventional method) and the nucleic features of the blastomeres--either multinucleated or anucleic (nuclei counting method). The implantation rate for every transferred embryo and blastocyst was examined. RESULTS: Although a high implantation rate was observed with the highest quality embryos as judged by either the conventional method (24.1%; 57/237) or the nuclei counting method (26.1%; 104/399), the nuclei counting method predicted implantation rate better than the conventional method. The embryos that were considered to be high quality according to the conventional method, but low quality according to the nuclei counting method, had a limited implantation success rate of 6.3% (4/66). Also, after blastocyst transfer, implantation occurred most often when high quality embryos evaluated by the nuclei counting method were used (25.5%; 25/98), while the blastocysts from low quality embryos seldom implanted (3.2%; 2/63). CONCLUSIONS: When choosing which embryo to transfer, the normality of blastomere nuclei may be a more important index of quality than standard fragmentation features and/or blastomere uniformity analysis. When choosing among embryos, if nucleic status is identical, then embryos with the least fragmentation should be chosen. Moreover, in blastocyst transfer, a blastocyst whose nuclei were judged normal on day 2 should be selected on day 5 over any other blastocysts.

Bone mineral density in adult patients with Turner's syndrome: analyses of the effectiveness of GH and ovarian steroid hormone replacement therapies.

To analyze the effects of treatments with GH and cyclic estrogen/progesterone (E/P) replacement on bone mineralization in patients with Turner's syndrome (TS), bone mineral density (BMD) was measured longitudinally. BMDs of the whole body and the lumbar spine in 16 adult female patients with TS (17-38 year old; 0-20 years by length of E/P treatment) were assessed using dual energy X-ray absorptiometry one to 5 times over a treatment period of up to 7 years maximum. GH treatment was performed in 9 cases (GH group), but not in the remaining 7 (non-GH group). E/P replacement therapy was initiated in all patients after they finished GH administration. The BMDs of both the whole body and the lumbar spine in the patients with TS were significantly less than those in age-matched normal subjects, and did not improve with E/P treatment. Although there were no differences in final body height and age at the beginning of E/P administration between the GH and non-GH groups, whole body BMD in the GH group was significantly lower than that in the non-GH group. These results indicate that GH administration in childhood and adolescence and E/P treatment in adulthood did not increase bone mineralization in the TS patients. Therefore, we can conclude that the optimal protocol of hormonal replacement therapy with GH and E/P during childhood and adolescence should be established as soon as possible.

Pretreatment for ovarian endometrial cyst before in vitro fertilization.

Assisted reproductive technology is a widely accepted treatment for infertile women with endometriosis. The presence of an ovarian endometrial cyst reduces the quality of oocytes, while surgical resection of endometrioma may reduce the ovarian reserve for ovarian stimulation by exogenous gonadotropins. To determine what pretreatment should be performed for ovarian endometrial cyst before IVF-ET, we analyzed IVF outcomes with or without pretreatment in patients with endometrioma. Infertile women with endometrioma who underwent IVF-ET were divided into 3 groups, including patients who had received laparotomy or laparoscopy, patients for whom the endometrioma content had been aspirated and treated with or without alcohol fixation, and patients who did not undergo pretreatment. The number of retrieved oocytes, rate of mature oocytes, and fertilization rate were compared among groups. The results showed that pretreatment for endometrioma reduces the number of retrieved oocytes. Although oocyte quality as a rate of mature oocytes was not affected by the presence of an ovarian endometrial cyst, the fertilization rate was improved by cyst aspiration. We propose that surgical pretreatment is not necessary for ovarian endometrial cyst before IVF-ET, but cyst aspiration may be beneficial after several failed attempts of IVF.

Management of missed abortion in a patient with congenital cervical atresia.

OBJECTIVE: To describe a patient with congenital cervical atresia who became pregnant through IVF and thawed transmyometrial ET and then experienced a missed abortion. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A patient with congenital cervical atresia who underwent reconstructive surgery at 23 years of age and underwent IVF twice at 28 and 30 years of age. INTERVENTION(S): Abortion management. MAIN OUTCOME MEASURE(S): Medical follow-up of IVF-ET, resultant pregnancy, and abortion. RESULT(S): After the second cycle of IVF with frozen-thawed transmyometrial ET, the patient became pregnant but then experienced a missed abortion. Serum beta-hCG levels decreased, the two gestational sacs disappeared, and genital bleeding without signs of infection occurred 14 weeks after diagnosis of the abortion. The abortion was managed conservatively. CONCLUSION(S): When assisted reproductive techniques are used in patients with congenital cervical atresia, the risks (including those relating to the management of an abortion) should be explained in detail to the couple and sufficient informed consent should be obtained before starting IVF-ET procedures.