Follicular phase hormonal profiles during administration of leuprolide for in vitro fertilization.

Hormonal changes induced during short-term administration of leuprolide were evaluated during the follicular phase in 57 patients who completed an IVF cycle. They were compared with those of 14 patients who were placed on long-term suppression. There was an unexpected abnormal increase in serum progesterone during the first week of the cycle in nine of the 57, with no significant change in the fertilization and cleavage rate; however, no pregnancy was achieved in this group. Transient mild elevation of progesterone was also detected in 16 patients with no adverse effect on fertilization and the outcome of the IVF. In the long protocol, the tonic levels of LH, FSH, and progesterone remained low throughout the follicular phase. The total number of pregnancies was higher in the short suppression regimen, but the full-term pregnancy rates were similar in both protocols.

Fertilization of human oocytes in relation to varying delay before insemination.

Fertilization and pregnancy rates in an in vitro fertilization and embryo transfer program were studied after a range of insemination times of between 1 and 26 hours after oocyte recovery. There was no significant variation in fertilization rate across this range. The pregnancy rate showed no significant variation for insemination between 3 and 16 hours after aspiration. However, it was disappointing at 2 hours (3%), and no pregnancies were achieved from the nine patients whose ova were inseminated 20 or more hours after aspiration. It is concluded that mature oocytes can be inseminated in vitro at any time between 3 and 16 hours after aspiration and still retain the same potential to produce a pregnancy.

Tripling of serum progesterone (P4) and embryonic morphological features in conception and nonconception cycles, after human in vitro fertilization.

A series of 26 in vitro fertilization (IVF) cycles was studied for changes of serum progesterone levels before and after injection of human chorionic gonadotropin (hCG) by a comparison of the number of follicles punctured, number of oocytes recovered, morphological features of oocytes, fertilization rate, cleavage rate, and quality of embryos before their transfer. Subjects were further divided into three groups according to their pregnancy outcome. Five pregnancies were generated and reached the stage of clinical confirmation of live baby delivery or live fetus by ultrasound scanning of the uterine contents. Six patient cycles that had a prolonged luteal phase and beta-hCG levels greater than 40 MIU/ml were described as biochemical pregnancies. Fifteen patient cycles showed no sign of pregnancy. The significant finding of this study is related to the serum progesterone level increase from 20 to 34 hr after hCG injection. The nonpregnancy group yielded a 1.2-fold increase compared with the biochemical pregnancy and pregnancy groups, which had a 3-fold increase. The usage of this multiple effect of progesterone may aid in the prediction of the "high-quality embryo" that might result from a given treatment cycle, indicate the completion of luteinization, the proper timing of hCG to induce final oocyte maturation, and the necessary length of preincubation, and aid in the prediction as to whether or not a pregnancy is likely to result.