Comparison of synthetic serum substitute and fetal cord serum as media supplements for in vitro fertilization: a prospective, randomized study.

OBJECTIVE: To compare the value of synthetic serum substitute and fetal cord serum (FCS) as protein supplements in the media used for IVF. DESIGN: Prospective, randomized study of 45 patients undergoing IVF. SETTING: Private infertility practice. INTERVENTION(S): The protein supplement for use in IVF medium was randomized prospectively to synthetic serum substitute or FCS. MAIN OUTCOME MEASURE(S): Oocyte fertilization rate, incidence of embryo arrest, number of embryos transferred, ongoing pregnancy rate, and implantation rate were assessed. RESULT(S): There was no significant difference in the fertilization rate, incidence of embryo arrest, number of embryos transferred, ongoing pregnancy rate, and implantation rate. CONCLUSION(S): Synthetic serum substitute is a better alternative to FCS as a protein supplement for IVF because of its availability and cost effectiveness. Synthetic serum substitute can be used in culture medium for sperm washing, insemination, culture, and transfer translating to decreased technician time without a significant difference in fertilization, pregnancy, or implantation rate.

The effect of positive semen bacterial and Ureaplasma cultures on in-vitro fertilization success.

A total of 342 couples planning to undergo in-vitro fertilization (IVF) were examined for the presence of bacteria in semen prior to and during the procedure. Pregnancy rates were analysed retrospectively to ascertain any adverse affects if > 10000 colony forming units (CFU)/ml bacteria were detected in the semen sample. The most common bacteria isolated from semen were Enterococcus spp. (73%). The presence of these bacteria did not affect the pregnancy rate of the patients with positive cultures prior to (32%) or during (37%) the IVF procedure compared with those patients in whom no bacteria were detected (32%). Those patients with semen cultures positive for Escherichia coli prior to the IVF procedure, but which cleared after treatment had a higher pregnancy rate (60%) compared with those patients who were positive for E.coli at the time of the attempt. The group of patients with Staphylococcus aureus in the semen at the time of IVF also demonstrated a low pregnancy rate (17%). Of the patients. 36 (11%) had positive Ureaplasma cultures from the screening test carried out on the semen and 22% became pregnant after successful treatment. None of the three patients with persistently positive cultures became pregnant. In conclusion, the presence of Enterococcus in semen does not affect pregnancy rates following IVF. E.coli, S.aureus and Ureaplasma urealyticum may have a negative effect and should be treated.

Use of the flare-up protocol with high dose human follicle stimulating hormone and human menopausal gonadotropins for in vitro fertilization in poor responders.

OBJECTIVE: To analyze the effect of high dose human FSH in combination with hMG with a flare-up leuprolide acetate (LA) protocol in patients undergoing IVF at risk for a poor response. DESIGN: Prospective. SETTING: Free-standing ambulatory IVF center. PATIENTS: Two hundred eighty-four patients underwent a LA screening test for IVF. Patients with a lack of flare response were considered at risk for a poor response and underwent ovarian stimulation with the flare-up LA protocol in combination with high dose human FSH and hMG. RESULTS: The poor responder group was compared with the good responders on the flare-up LA protocol and to patients undergoing ovulation induction with a luteal phase LA protocol. There were 53 poor responder flare-up LA cycles, 177 good responder flare-up LA cycles, and 54 luteal phase LA cycles. The cancellation rate was higher in poor flare-up LA responders (11.3 percent) compared with good flare-up LA responders (1.1 percent) and luteal phase LA cycles (1.8 percent). Peak E2 levels, number of oocytes, and number of embryos were significantly higher in the good flare-up LA responders. Fertilization rate was similar in all groups. Ongoing pregnancy rate per retrieval was 28 percent in good responders, 29 percent in poor responders, and 33 percent in luteal phase LA patients. Only one patient (0.4 percent) was hospitalized for severe ovarian hyperstimulation. CONCLUSION: The flare-up protocol with high-dose human FSH and hMG is a very good alternative for patients who are at high risk for a poor response. Although peak E2 and number of oocytes were significantly lower in this group, the patients who responded had the same fertilization and pregnancy rate as the good responders. Cancellation rate remains high in poor responders.

A Mono-Percoll separation technique improves sperm recovery of normal and male factor specimens when compared with the swim-up technique.

The purpose of this study was to determine the effects of a simplified 80% Mono-Percoll sperm separation procedure on both normal and male factor semen samples compared with the standard swim-up technique. The parameters examined include sperm concentration, motility and morphology, total motile functional spermatozoa and percentage recovery. Normal patients demonstrated enhanced sperm parameters with the Mono-Percoll compared with the swim-up technique for concentration (67 x 10(6) versus 42 x 10(6)/ml, P < 0.001), motility (66 versus 59%, P < 0.001), morphology (56 versus 49%, P < 0.005) and percentage recovery (60 versus 42%, P < 0.005). Male factor patients showed enhanced sperm parameters with the Mono-Percoll procedure compared with the swim-up technique for motility (53 versus 42%, P < 0.05) and percentage recovery (54 versus 29%, P < 0.005), with no significant difference in concentration and morphology. In summary, the Mono-Percoll sperm recovery procedure is significantly better than the swim-up technique for male factor patients and patients with normal sperm parameters.