Successful use of "Hour 1" transfer of sperm microinjected oocytes in natural cycles of poor responder women: a prospective randomized controlled pilot study.

The aim of the study is to demonstrate the successful use of "Hour 1" transfer of sperm microinjected oocytes in natural cycles of poor responder women. Seventy women were selected from 92 consecutive poor responders undergoing intracytoplasmatic sperm injection (ICSI) in a natural cycle at our Sterility and Assisted Reproduction Unit from September 2009 to July 2013, and randomly distributed in two homogeneous groups: Group A or B. Women in Group A (35) underwent transfer within 1 h after ICSI; Group B (35, control group) underwent transfer 3 days after ICSI. In Group A, seven clinical pregnancy and one miscarriage occurred; in Group B, eight clinical pregnancies and two miscarriages were observed. Pregnancy, miscarriage, term pregnancy and overall live birth rates' difference between the two groups was not statistically significant (p > 0.05). Difference between the two groups in terms of timing, type of delivery and newborn birthweight was not observed. Neither ectopic pregnancy nor multiple pregnancies occurred. "Hour 1" uterine transfer of ICSI oocytes, still to be considered with caution because of the relatively low number of observations of the pilot study, deserves further attention on a larger scale, and might be evaluated for clinical and financial effectiveness in other clinical settings.

Term pregnancy and live birth subsequent to immediate uterine transfer of sperm microinjected oocyte in a natural cycle.

It has been reported that it is possible to achieve a pregnancy after immediate uterine transfer of oocyte and sperm, before fertilization and cleavage were known to have occurred; there is an enormous amount of work about the optimal timing of embryo transfer, with no conclusive evidence of a gold standard satisfying patient age, endometrial receptivity, hormonal levels and embryological parameters. We hereby report a case of one 35-year-old nulligravid woman with longstanding tubal factor infertility and 3 previous failed ICSI cycles, treated with ICSI and immediate transfer of the oocyte microinjected with a spermatozoon in a natural cycle. A single oocyte was retrieved, injected with a spermatozoon and transferred 40 min after injection, resulting in an uneventful pregnancy and delivery of a healthy female infant weighing 3320 g at 40 weeks' estimated gestational age. This case, certainly novel, should be interpreted with caution. Whether confirmed for efficacy and safeness in appropriate controlled clinical trials, our present observation could offer a simple, practical and cost-effective approach in ART programs in selected patients.

Thyroid function in infertile patients undergoing assisted reproduction.

PROBLEM: Thyroid disease is one of the most common endocrine conditions affecting women during reproductive age. A link between thyroid and assisted reproduction outcome is debated. METHOD OF STUDY: Serum TSH levels, number and scoring of oocytes and embryos, and number of clinical pregnancies were retrospectively recorded in 164 women undergoing assisted reproduction technologies (ART) at an University-based fertility center, to evaluate the outcome of the first steps of assisted reproduction (ovarian stimulation, oocyte pickup and fertilization, embryo transfer and implantation) in relation to thyroid function and autoimmunity. RESULTS: No significant relationship was found between TSH and all parameters, except clinical pregnancy rate (22.3% in TSH ≤ 2.5 group versus 8.9% in TSH > 2.5 mUI/L group; P = 0.045). No pregnancy occurred in women with anti-thyroperoxidase autoantibodies, while pregnancy occurred in 23.9% of cycles without autoimmunity (P = 0.02). CONCLUSION: Further studies must be conducted in order to shed light on the link between infertility and thyroid dysfunction.

Perinatal outcomes in oocyte donor pregnancies.

OBJECTIVE: To assess the obstetric outcomes of pregnancy following intracytoplasmic sperm injection (ICSI) using donor oocytes. METHODS: Twenty-six deliveries from oocyte donor ICSI (d-ICSI) were compared to the next two consecutive deliveries from homologous ICSI (h-ICSI group) (n = 52) and with the two consecutive deliveries from women older than 40 years (Advanced Maternal Age: AMA) (n = 52). We evaluated the occurrence of gestational hypertension (GH), preeclampsia (PE), fetal growth restriction (IUGR), gestational diabetes mellitus (GDM), preterm premature rupture of membranes (pPROM), preterm birth, placental anomalies, mode of delivery, hemorrhage, gestational age at birth and birth weight. RESULTS: d-ICSI had significantly more PE (d-ICSI 19.2%, h-ICSI 0%, AMA 0%, p < 0.001); higher rates of IUGR than AMA pregnancies (d-ICSI 19.2%, AMA 3.8%, p < 0.025). Placental accretism was found only in the d-ICSI group (15.4%, p < 0.043). No postpartum bleeding was observed. CONCLUSIONS: This is the first study that compares the obstetric outcomes of donor pregnancies to the outcomes of h-ICSI and AMA. Obstetricians who deal with pregnancies from oocyte donation need to be aware of the more severe obstetric outcomes, especially placenta accreta and preeclampsia. All women who conceive through oocyte donation should be counseled as early as the pre-conception period and referred to specific centers for high-risk pregnancies.

Intrafollicular concentration of adrenomedullin is associated with IVF outcome.

OBJECTIVE: To test the hypothesis that serum or intrafollicular concentrations of adrenomedullin (AM) would correlate with reproductive outcomes in in vitro fertilisation (IVF) cycles. DESIGN: Serum and follicular fluid samples were collected during transvaginal oocyte retrieval. The follicular fluid was individually aspirated, and the presence of oocyte was recorded. AM concentrations were measured using an enzyme-linked immunosorbent assay. SETTING: Department of Gynaecology, Perinatology and Child Health, 'Sapienza' University of Rome, Italy. PATIENTS: Eighty women undergoing IVF for primary infertility aged 18-45 years. MAIN OUTCOME MEASURES: AM concentrations in plasma and follicular fluid were correlated to follicular fluid volume, presence of oocyte, oocyte maturation, embryo grading, fertilisation and pregnancy rates, live-birth rate and plasma estrogen concentration. RESULTS: Monofollicular fluid AM concentrations did not differ between follicles containing oocyte and those without oocyte; however, AM concentrations were lower in follicles that resulted in pregnancy than in those that failed. Serum but not follicular fluid AM concentrations correlated with serum estrogen levels. Follicular fluid AM correlated with plasma AM levels. CONCLUSION: We conclude that higher level of AM in the follicular fluid appears to be associated with a negative outcome in IVF treatment.

The possible role of hyperhomocysteinemia on IVF outcome.

PURPOSE: To evaluate the effect of the hyperhomocysteinemia on pregnancy rate, implantation rate and abortion rate after IVF. METHOD: Data from a total of 48 infertile couples with hyperhomocysteinemia were prospectively collected for this study. All patients underwent a standard down regulation protocol for ovarian stimulation. Oocytes recovery was performed at 36 h after hCG administration. Embryo transfer took place at 48 h after insemination. The patients were matched in two groups that received or did not receive therapy (group A and B respectively) to normalize homocysteine plasma level. RESULTS: Pregnancy rate, implantation rate and abortion rate varied significantly (p

The impact of the depth of embryo replacement on IVF outcome.

PURPOSE: To evaluate the effect of the depth of embryo transfer replacement on clinical pregnancy rate. METHODS: Data from a total of 104 consecutive embryo transfers performed on 104 women aged 26-37 years were prospectively collected for this study. All patients underwent a standard down regulation protocol for ovarian stimulation. Oocytes retrieval were performed at 36 h after hCG administration. Embryo transfer took place at 48 h after insemination. The patients were matched in two groups according to the distance between the tip of the catheter and the uterine fundus at transfer (group A > 10 < 15 mm and group B < or = 10 mm). The same method of loading embryos into the embryo transfer catheter was used. RESULTS: Clinical pregnancy rates varied significantly (p < or = 0.05) between the two groups: 27.7% in group A and 14% in group B. The number and quality of embryos transferred did not differ between the groups. CONCLUSIONS: The results suggest that the depth of embryo replacement may be an important variable in embryo transfer technique.

Urinary follicle-stimulating hormone (FSH) is more effective than recombinant FSH in older women in a controlled randomized study.

OBJECTIVE: The following study was conducted to determine which FSH, recombinant or urinary, works better in older women. DESIGN: We conducted a controlled randomized study in a single university IVF center. SETTING: University IVF center. PATIENT(S): Women (N = 257) over 39 years old undergoing IVF. INTERVENTION(S): The patients were randomized into two study groups at their first IVF cycle: 121 patients were treated with recombinant FSH, and 120 patients were treated with urinary FSH. Both groups were suppressed with a long GnRH analog protocol. MAIN OUTCOME MEASURE(S): Days of stimulation, E2 at the day of hCG, total amount of FSH administered, number of oocytes collected, amount of FSH per oocyte, and number of embryos obtained. RESULT(S): Patients treated with urinary FSH required a significantly lower total amount of FSH, and a lower amount of FSH per oocyte than women treated with recombinant FSH. The other measures evaluated did not show any statistically significant differences. CONCLUSION(S): Our study showed that urinary FSH performed better in older women than recombinant FSH when associated with the long protocol.