Evidence-based clinical outcome of oocyte slow cooling.

In the last few years, there has been a significant improvement in oocyte cryopreservation techniques. To investigate the clinical significance of oocyte freezing, an assessment of the cumulative pregnancy rate per started cycle derived from the use of fresh and frozen-thawed oocytes was performed. Between 2004 and 2006, 749 cycles were carried out, in which no more than three fresh oocytes were inseminated either by standard IVF or microinjection. Supernumerary mature oocytes were cryopreserved by slow cooling. Cryopreservation of fresh embryos was performed in rare cases to prevent the risk of ovarian hyperstimulation syndrome using a standard embryo freezing protocol. Fresh embryo transfer cycles totalled 680, 257 of which resulted in pregnancy. The pregnancy rates per patient and per transfer were 34.3% and 37.8% respectively. When frozen-thawed oocytes were used, following 660 thawing cycles, 590 embryo transfers were performed in 510 patients. Eighty-eight pregnancies were achieved with embryos from frozen oocytes, with a success rate of 17.2% per cycle. When fresh and frozen-thawed cycles were combined, the number of pregnancies was 355, giving a cumulative pregnancy rate of 47.4%. Oocyte cryopreservation can contribute considerably to the overall clinical success, ensuring a cumulative rate approaching that achievable with embryo storage.

Effect of reduced dose of triptorelin at the start of ovarian stimulation on the outcome of IVF: a randomized study.

BACKGROUND: Partial pituitary desensitization using gonadotrophin-releasing hormone (GnRH) agonists may be sufficient in women undergoing controlled ovarian hyperstimulation for assisted reproduction. However, the minimal effective agonist dose remains to be determined. The aim of the study was to investigate the effect of a reduced daily dose of triptorelin, administered at the start of ovarian stimulation, on the results of IVF and intracytoplasmic sperm injection. METHODS: A total of 132 patients was randomized in two groups. Pituitary desensitization was obtained in group 1 (66 patients) with a single 3.75 mg injection (i.m.) of triptorelin. In group 2, 66 patients received 100 microg triptorelin daily, which was then reduced to 50 microg at the start of follicle-stimulating hormone (FSH) stimulation. RESULTS: No significant differences were found in terms of pregnancy rate per transfer (38% in group 1 versus 34.9% in group 2), implantation rate (20.2 versus 18%) and abortion rate (8.3 versus 9.1%). The number of FSH ampoules used, as well as the number of days stimulation required, was significantly reduced in group 2 (41 +/- 26 versus 46.6 +/- 25.3, P < 0.03 and 11 +/- 1.3 versus 11.8 +/- 1.5, P < 0.002 respectively). No significant differences were seen in oestradiol concentrations and in follicle number, in the quantity of oocytes collected and fertilized, or in the number of embryos obtained or transferred. CONCLUSION: A reduced dose of triptorelin is enough for pituitary suppression during ovarian stimulation but provides no significant improvement in IVF cycle outcome when compared with depot formulation. The possibility of a shorter treatment protocol requiring lower amounts of gonadotrophins should be considered in view of its economic advantage.

Improvement of pregnancy and implantation rates in cyclic women undergoing oocyte donation after long-term down-regulation.

An oocyte donation programme was carried out in 122 patients aged between 40 and 49 years for a total of 225 replacement cycles. Eggs were donated by 103 women undergoing assisted reproduction technologies in our infertility centre. Recipients were divided into different groups according to whether they were menopausal (group A) or cyclic and treated with short- (group B) or long-term (group C) gonadotrophin-releasing hormone analogues. In group C, the ovarian suppression of the patients was prolonged with the aim of producing a type of artificial menopause. Oocyte donors were aged between 21 and 35 years, and were equally distributed between the different groups. There were significant differences in pregnancy and implantation rates according to ovarian status: 30.8 and 16.1% respectively in group A, 30.6 and 17.7% respectively in group C versus 10.4 and 5.6% respectively in group B. Apart from improved pregnancy and implantation rates in cyclic women aged > 40 years after long-term down-regulation, these data seem to demonstrate an important role for the endometrium in the implantation process.

Controlled ovarian hyperstimulation in women > or = 40 years old undergoing IVF-ET: mid-luteal versus early follicular (flare-up) GnRH analog regimens.

The aim of this study was to compare results obtained using two different GnRH analogue regimens in women > or = 40 undergoing IVF cycles. Patients using GnRH-a from mid-luteal phase of the previous cycle (group A) needed more days of ovarian stimulation than patients GnRH-a in the follicular phase of the same cycle "flare-up" (group B) (11.7 +/- 1.3 vs 10.8 +/- 2 respectively). Group A patients developed more follicles and obtained more oocytes than group B (9.2 +/- 4.9 vs 6.1 +/- 4.4; And 7.6 +/- 4.7 vs 4.2 +/- 3.2, respectively). The cancellation rate was significantly higher in B than A (20 vs 8.6%, respectively). Pregnancy rates however were significantly lower in "flare-up" than in mid-luteal group (3 vs 14% per cycle, 4.7 vs 17% per patient, 3.8 vs 15.2% per oocyte retrieval and 5.4 vs 18.8% per transfer, respectively). Different results obtained in the two groups suggest that Gn-RH-a long protocol allows better ovarian stimulation and consequently improved pregnancy rate than "flare-up" in women > or = 40 years old.

Hysteroscopic gamete intra-fallopian transfer: a good alternative, in selected cases, to laparoscopic intra-fallopian transfer.

Results obtained in two groups of patients treated with gamete intra-Fallopian transfer (GIFT) are reported. Hysteroscopic GIFT was carried out in some cases where general anaesthesia was not advisable or possible, i.e. difficulties in tubal catheterization due to pelvic adhesions, extended distal tubal damage, patients' intolerance, lack of available operating theatre. Ovarian stimulation was started on 131 patients for a total of 147 cycles. Twenty-five cycles were cancelled because of failure of the ovarian response. Either laparoscopic (group 1; 73 patients) or hysteroscopic GIFT (group 2; 50 patients) was performed. In group 1 a mean of 6.8 +/- 3.4 oocytes per cycle were retrieved and a mean of 4.7 +/- 1.3 mature oocytes were transferred. The pregnancy rate was 30.1% per retrieval (22 clinical pregnancies). In group 2, a mean of 5.0 +/- 3.1 oocytes was harvested and 3.9 +/- 2.0 mature oocytes per cycle were transferred. Thirteen clinical pregnancies were achieved (26.5% per cycle) in group 2. Comparing the two groups, the number of recovered and transferred oocytes was significantly lower in hysteroscopic GIFT (P less than 0.05 and P less than 0.001 respectively).

[Synaptology of the claustrum in the rat]. / Sinaptologia del claustro nel ratto.

A great deal of information is available on the morphology of the claustrum in various animal species, as well as on its neuronal distribution and relationships with the cerebral cortex and other nuclei. However, no research has been performed on synaptic organization. Here we report an ultrastructural study performed on 7 male albino rats of the Wistar strain weighing 270-310 g. Five rats were sacrificed by prolonging general anesthesia with diethyl ether until death. Three of these rats were secured to the stereotaxic atlas coordinates of Paxinos and Watson (1982); the claustrum area was marked by injecting 1 microliter of a 10% Evans Blue solution into the nucleus. The brain was then removed from the skull, cut into 2-3 mm thick coronal sections, and tissue samples taken from the area immediately adjacent to the marked area were immersed in 2% OsO4 buffered with 2% potassium dichromate containing 0.2% CaCl2 at pH 7.7 (Gobel, 1968). After dehydration they were embedded in Durcupan and the ultrafine sections were stained with uranyl acetate and lead citrate and observed with either a Zeiss 9S2 or a Hitachi H 800 electron microscope. The samples from two other rats, taken with the stereotaxic techniques described, were fixed for 12 h in 0.6 potassium permanganate solution buffered with veronal-acetate at pH 7.4 (Luft, 1956). After processing for electron microscopy, a portion of the sections were used without any contrast medium and the remainder were stained with uranyl acetate and lead citrate.(ABSTRACT TRUNCATED AT 250 WORDS)