Prognosis of oocyte donation cycles: a prospective comparison of the in vitro fertilization-embryo transfer cycles of recipients who used shared oocytes versus those who used altruistic donors.

OBJECTIVE: To prospectively compare the prognosis of IVF-ET cycles using oocyte sharing vs. cycles using altruistic donors. DESIGN: Prospective cohort prognostic study. SETTING: University teaching hospital. PATIENT(S): A total of 353 consecutive infertile women with premature ovarian failure or diminished ovarian function. INTERVENTION(S): After receipt of institutional ethics approval, IVF-ET was performed with the use of either oocyte sharing (n = 220) or altruistic donors (n = 133). Continuous data (mean + SD [95% confidence interval]) were compared with Student's t test or Mann-Whitney test as appropriate; categoric data were compared with Fisher's exact test, odds ratios (OR), and relative risk (RR). Two-tailed P<.05 was considered significant. Logistic regression was used to adjust for confounding variables. MAIN OUTCOME MEASURE(S): The primary endpoint was clinical pregnancy. The secondary endpoints were E(2) dosage, endometrial thickness, fertilization, embryo quality, and rates of embryo cleavage, transfer, and implantation, positive beta-hCG, and biochemical, ectopic, and multiple pregnancy. RESULT(S): There was no statistically significant difference in clinical pregnancy rates (28.18% vs. 30.08%; OR 0.91 [0.49-1.67]; RR 1.07 [0.69-1.65]; adjusted OR 0.95 [0.51-1.78]). The mean E(2) dosage, endometrial thickness, fertilization rate, embryo score, embryo cleavage, number of embryos transferred, and rates of implantation, positive beta-hCG, and biochemical, ectopic, and multiple pregnancy were similar. CONCLUSION(S): The prognosis with use of shared oocytes is similar to that with altruistic donors.

Ultrasound-guided hydrosalpinx aspiration during oocyte collection improves pregnancy outcome in IVF: a randomized controlled trial.

BACKGROUND: Hydrosalpinges have adverse effects on IVF outcomes. Salpingectomy is effective in improving outcomes, but it is not always practical or safe. Ultrasound-guided aspiration of hydrosalpinges at oocyte collection is an option for those who develop hydrosalpinges during controlled ovarian stimulation; however, there is no randomized evidence to show whether this practice is effective. METHODS: Between October 1999 and June 2003, consenting women of age

Surgical sperm retrieval: what not to do.

Surgical sperm retrieval has revolutionized the treatment of azoospermia. However, the ease with which it could be performed meant that it is perhaps being used where not indicated. Here are the potential pitfalls to be avoided.

The role of selective salpingography and tubal catheterization in the management of the infertile couple.

PURPOSE OF REVIEW: This review is intended to update the reader about recent developments in the field of selective salpingography and tubal catheterization, to offer an interpretation of the information presented and to suggest further research links. RECENT FINDINGS: The measurement of tubal perfusion pressures at selective salpingography and tubal catheterization has offered a new dimension in the evaluation of the fallopian tube. A classification of infertile women based on tubal perfusion pressures is presented, and this is correlated with the possibility of spontaneous fertility, thus giving selective salpingography and tubal catheterization a prognostic profile in addition to diagnostic and therapeutic functions. Experience derived from the use of the technique in unselected infertile women (i.e. not with proximal tubal blockage) is presented. The use of selective tube catheterization for sterilization purposes joins the mainstream with the publication of the encouraging results of a multinational trial. The debate on the validity of the diagnosis of proximal tubal blockage is enriched by the suggestion that simply rotating the patient during hysterosalpingography will resolve most cases of the condition. The fertility gain by single-tube recanalization in women with unilateral proximal tubal blockage is given further support. The use of oil-based media for selective salpingography and tubal catheterization is discussed. A hypothesis on the pathophysiology of proximal tubal blockage is presented. SUMMARY: The evidence clearly supports the use of selective salpingography and tubal catheterization for infertile women with proximal tubal blockage. The potential of the technique to play a wider role in the management of infertility is demonstrated by recent research.

Use of the egg-share model to investigate the paternal influence on fertilization and embryo development after in vitro fertilization and intracytoplasmic sperm injection.

OBJECTIVE: To investigate whether sperm from different males can influence fertilization and embryo development. DESIGN: To use an egg-sharing model, in which the eggs from one woman are shared between herself and a recipient, and different spermatozoa are used to fertilize the eggs. SETTING: Assisted Conception Unit, Birmingham Women's Hospital, Edgbaston, United Kingdom. PATIENT(S): Infertile women undergoing egg sharing. INTERVENTION(S): In vitro fertilization (IVF). MAIN OUTCOME MEASURE(S): Fertilization rates and the mean day 2 or 3 embryo score (cell number X grade) were examined for egg-sharing pairs. A comparison was also made for pairs in which intracytoplasmic sperm injection (ICSI) and IVF was used as the insemination method. A paired samples t-test was used to compare the sharer and recipient results. RESULT(S): Pregnancy rates did not differ between sharer and recipient couples. Interestingly, when comparing fertilization, there was a significant difference (P<.05) in favor of IVF over ICSI. When comparing embryo development between egg-sharing pairs, we found that approximately 30% of patients showed a difference in mean embryo score of >or= 5 in all embryo development and 14% in the quality of embryos available for transfer. CONCLUSION(S): We showed that the egg-sharing model is a successful alternative for the treatment of women who required donated eggs. More important, the egg-sharing model shows that, in a certain percentage of couples, differences in early embryo development are paternally influenced.

Modification of the coaxial technique for selective salpingography with measurement of tubal perfusion pressures.

This article describes the use of the fallopotorque catheter system for transcervical selective salpingography and tubal catheterization under fluoroscopic guidance for the diagnosis and treatment of obstruction of the proximal Fallopian tube. The technique of tubal perfusion pressure assessment during the procedure, using the same catheter system, is also described. The relative advantages of this method of selective salpingography and tubal catheterization are then discussed in the background of previously described techniques.

Accuracy of sperm-cervical mucus penetration tests in evaluating sperm motility in semen: a systematic quantitative review.

BACKGROUND: Our objective was to determine the accuracy of in-vitro sperm penetration into cervical mucus or substitutes in evaluating sperm motility in semen. METHODS: This was a systematic quantitative review of test accuracy studies. The Cochrane library (2000:4), Medline (1966-2001), Embase (1988-2001) and SciSearch (1981-2001) were searched, in addition to manual searches of conference papers and bibliographies of known primary and review articles. Primary studies measuring in-vitro sperm penetration into cervical mucus, or substitutes (i.e. sperm-mucus penetration test, SMPT) and comparing results with sperm motility in semen were included. RESULTS: There were 18 primary diagnostic studies published in 17 papers, involving a total of 2580 samples. Fourteen primary diagnostic tests used vanguard distance as diagnostic criteria (SMPT(vd)) and the pooled likelihood ratio (LR) for positive (LR+) and negative (LR-) tests were 2.29 (1.82-2.87) and 0.52 (0.44-0.63) respectively. Four studies used diagnostic criteria based directly or indirectly on swim-up sperm count per high power field (SMPT(sc)) instead. Their pooled LR+ and LR- were 5.24 (3.36-8.18) and 0.15 (0.06-0.39) respectively. CONCLUSIONS: SMPT(vd) has a low accuracy in the evaluation of sperm motility in semen. However, SMPT(sc) was found to be more accurate. This method of using sperm concentration, instead of vanguard distance, as diagnostic criteria of in-vitro SMPT has potential as a useful laboratory-based sperm function test.

The IVF league tables: time for a reality check.

In many countries the reported results of the different IVF clinics are published nationally by the relevant regulatory bodies, such as the Human Fertilisation and Embryology Authority in the UK. The published format suggests that clinics are being compared on a valid basis, and the involvement of the regulatory bodies apparently gives this comparison the official seal of authenticity. However, clinics can control many factors in patient selection, management and reporting, and these can inflate the reported results. Consequently, patients, instead of being appropriately guided, can be misled by these so-called "IVF league tables". The IVF community, including users, providers and regulatory bodies, need to recognize these factors and to develop a way forward for comparing clinics results on an equal and a valid basis. In this paper we discuss the factors that could affect the reported IVF results, and suggest possible options for valid comparison.

The potential value of tubal perfusion pressures measured during selective salpingography in predicting fertility.

BACKGROUND: The value of tubal perfusion pressures assessed during selective salpingography and tubal catheterization in predicting fertility has not been investigated. METHODS: A total of 325 infertile women underwent selective salpingography and tubal catheterization. Pregnancy information was collected in 256 (78.7%). The 50th (300 mmHg) and 90th (500 mmHg) centiles of the tubal perfusion pressure distribution in women with normal tubes on selective salpingography were used as thresholds. Women were divided into three tubal perfusion pressure groups: good (both tubes <300, or one tube <300 and the other 300-500 mmHg), mediocre (both tubes 300-500, or one tube <300 and the other >500 mmHg) and poor (both tubes >500, or one tube > 500 and the other 300-500 mmHg). RESULTS: The pregnancy rate in the good perfusion pressure group was significantly higher than that in the poor perfusion pressure group, both when all non-IVF/ICSI first conceptions (P = 0.001) as well as when spontaneous first conceptions only were considered (P = 0.010). The pregnancy rate in the mediocre group lay between the good and the poor groups, though none of the comparisons reached statistical significance. CONCLUSIONS: Selective salpingography can provide additional diagnostic information in comparison with other tubal assessment tests. Tubal perfusion pressures may be predictive of future fertility.

Long-term fertility prognosis following selective salpingography and tubal catheterization in women with proximal tubal blockage.

BACKGROUND: The possibility of conception following selective salpingography and tubal catheterization is believed to decline sharply a few months after the procedure. This observation may be due to the relatively small number of patients and short follow-up of previous studies. Furthermore, couples with other causes of infertility apart from proximal tubal blockage have usually been excluded. METHODS: Survival analysis of conceptions of 218 consecutive infertile women with proximal tubal blockage who underwent selective salpingography and tubal catheterization was performed. There were no exclusion criteria. Follow-up ranged from 16 to 56 months. RESULTS: A total of 47.2% of spontaneous conceptions and 43.2% of all conceptions, apart from those achieved by IVF or ICSI treatments, occurred after the first 12 months following selective salpingography and tubal catheterization. The decline in the possibility of pregnancy during the study period (conception hazard rate) was only minimal. CONCLUSIONS: In a population of infertile women with proximal tubal blockage, a significant proportion of conceptions occur after the first 12 months following selective salpingography and tubal catheterization. The presence of any additional causes of infertility in the couple should not be regarded as an absolute contraindication to the procedure.

The effect on pregnancy rates of tubal perfusion pressure reductions achieved by guide-wire tubal catheterization.

BACKGROUND: Selective salpingography enables us to measure the Fallopian tube perfusion pressure which, when high, can be effectively reduced with the use of transcervical guide-wire tubal catheterization. Whether fertility prognosis improves as a result is currently unknown. Our objective was to clarify the issue. METHODS: Infertile women undergoing selective salpingography were classified into poor, mediocre and good tubal perfusion pressure groups, based on the distribution of tubal perfusion pressures in an unselected infertile population. Of 325 women, 150 (46.1%) were classified in the poor group and underwent guide-wire tubal catheterization. RESULTS: Complete pregnancy and tubal perfusion pressure data were available for 104 (69.4%) subjects. Following tubal catheterization, 29 women (group A) could be classified in the good, 25 (group B) in the mediocre, while 50 women (group C) remained in the poor tubal perfusion pressure group. Survival analysis showed that the pregnancy rate in group A was significantly higher than the rates in groups B and C (P = 0.036 and 0.005 respectively). CONCLUSIONS: Reductions of tubal perfusion pressures achieved with transcervical guide-wire tubal catheterization resulted in an improved fertility prognosis for women. Selective salpingography and tubal catheterization might have a wider role in the management of the infertile couple than currently believed.