[Intracytoplasmic sperm injection for treatment of male infertility].

The results of 84 consecutive couples who underwent 94 cycles of in-vitro fertilization (IVF) augmented with intracytoplasmic sperm injection (ICSI) were analyzed. Inclusion criteria were previous total failed fertilization or unsuitable sperm parameters for conventional IVF. The rate of diploid fertilization was 61,7%; the implantation rate per embryo was 12,0% and the ongoing pregnancy rate per transfer was 30,0%. None of the sperm parameters of the original or processed semen sample were correlated with ICSI outcome. Conversely, female age and basal serum concentrations of follicle stimulating hormone (FSH) had a significant impact on implantation and pregnancy rates. ICSI has become a very successful therapy in overcoming different types of male infertility.

[The role of ultrasound scanning of endometrium in the superovulation stimulation program during in vitro fertilization and embryo transfer].

The intensive introduction of in vitro fertilization and embryo transfer into the clinical practice of sterility treatment has conditioned the necessity of developing reliable methods of control of the response of ovaries to the application of gonadotropic hormones for stimulating superovulation. There is not sufficient data about prognostic value of ultrasound scanning of structure of endometrium before or after the day of HCG administration in IVF cycles. Several authors have revealed differences in endometrial structure between the women with or without pregnancy. According to the results of our studies, the endometrium thickness has a rather positive prognostic index for evaluating the possibility of the occurrence of pregnancy. Therefore, it is a highly informative ultrasound criterion for making a decision of the completion of superovulation induction and introduction of the embryo transfer and, consequently, makes an important contribution to the in vitro fertilization procedure optimization.

[Results of application of high daily doses of recombinant follicle stimulating hormone in different age groups of women in IVF program].

A prospective, randomized, comparative study has been carried out to investigate the effectiveness of administration of recombinant FSH (rFSH, Gonal-F) in doses 150 and 225 IU in different age groups of women. 63 patients started a long gonadotrophin-releasing hormone agonist protocol (GnRHa, Diphereline, 0,1 mg): 31 received rFSH 150 IU/day and 32 - 225 IU/day. The objective was to assess the impact of these dosing regimens in down-regulated women. Duration of treatment for reaching administered criteria for human chorionic gonadotropin (HCG, Profazi) showed that the results in low-dose group and high-dose group were similar (11,8+/-0,2 days versus 11,2+/-0,4 days). Though, the total dose used per cycle of stimulation for group of patients receiving 225 IU was 2493+/-56 IU and 1762+/-37 IU in the 150 IU group (p<0,001). Average number of retrieved oocytes in low-dose group was 7,4+/-0,5 and 8,9+/-0,7 in high-dose group (no significant difference). In the group of women 31-33 years of age receiving 225 IU more oocytes were retrieved (13,1+/-1,1 versus 9,3+/-0,7 in 150 IU treatment group). Thus the patients of the age 37-39 years receiving 150 IU dose a slightly higher number of oocytes were found (6,1+/-0,3 versus 5,3+/-0,4). No significant relationships were found between serum FSH concentrations as obtained in the early follicular phase and the number of oocytes collected, or the total dose. The rates of obtained transferable embryos (1 and 2 degree) were 67% in low-dose group and 54% in high-dose group. There was better quality of retrieved oocytes than in the stimulation protocol with rFSH. According to the clinical pregnancy and delivery rates per cycles (respectively 26 and 23% in 150 IU group, 19 and 16% in the 225 IU group) and embryo transfer per cycle (29 and 25% in 150 IU group, 21 and 18% in 225 IU group) no significant difference has been found. Our study has shown that in women between 31-39 years of age, the decline in number of oocytes retrieved with increasing age cannot be overcome by augmenting the daily dose of recombinant FSH from 150 to 225 IU.

[Role of follicular fluid analysis in assessment of the main criteria of folliculogenesis in IVF program].

A comparative study was carried out to assess the main criteria of folliculogenesis in follicular fluid of aspirated follicles during the induction of super ovarian stimulation using recombinant follicle stimulating hormone (r-FSH; Gonal-F), human menopausal gonadotropin (HMG, Pergonale) and agonist gonadotropin releasing hormone (a-GnRH; Diphereline 3,75 mg). 86 patients were included in the study: 37 were receiving r-FSH and 49 HMG, two ampoules per day during the first 5 days of stimulation. Ultrasound monitoring was used for every individual follicle on the first day of stimulation and starting from the 5th day, daily. Thus, the visualized follicles were identified and measured, photoregistered during the whole period of ultrasound guidance. During the transvaginal puncture of these follicles the aspirated follicular fluid volume, existence of oocytes, and its estradiol hormones were recorded. It was found that the follicles in both groups of patients having larger volume of follicular fluid (3 to 5 or >5mm) reached the preovulational size earlier (diameter 17 mm), and on the day of injection of human chorionic gonadotropin (HCG; 10000 IU) had a large size (20 to 21 mm). The positive statistically significant correlation has been observed between the volume of follicular fluid and existence of oocytes in aspirated follicular fluid, as well as with the intensity of their cleavage. The concentration of testosterone and estradiol in follicular fluid was lower in the patients receiving r-FSH (average 12.4 nmol/l, range 9.3-15.1 and 1897113 pmol/l; range 1609216-2185012) than in the patients receiving HCG (16.0 nmol/l; range 12.1-19.6 and 2233728 pmpl/l; range 2028660-2438718). The concentration of testosterone in non-pregnant patients receiving r-FSH was 13.7-/+1.0 nmol/l, receiving HMG - 16.0-/+0.9 nmol/l, versus 10.3-/+0.8 nmol/l and 14.8-/+0.7 nmol/l, in the patients receiving r-FSH and HMG, respectively, who became pregnant. Thus, the comparative study of main criteria of folliculogenesis in follicular fluid proved to be more preferable and sufficient using FSH in the ovarian stimulation protocol in IVF program.