Low-oxygen compared with high-oxygen atmosphere in blastocyst culture, a prospective randomized study.

OBJECTIVE: To investigate birth rates with two oxygen (O(2)) concentrations in blastocyst culture. DESIGN: Randomized trial. SETTING: Private in vitro fertilization (IVF) clinic. PATIENT(S): Six hundred women undergoing IVF. INTERVENTION(S): Blastocyst culture in atmospheres with either 6% carbon dioxide (CO(2)) in air, the equivalent to 19% O(2), a two-gas system; or 5% O(2), 6% CO(2), and 90% nitrogen (N(2)), a three-gas system. MAIN OUTCOME MEASURE(S): Birth rate. RESULT(S): The inclusion criterion for blastocyst culture (at least five fertilized oocytes) was fulfilled in 396 women, randomized to 197 cultures with the three-gas system and 199 cultures with the two-gas system. The outcome with the three-gas system compared with the two-gas system showed a statistically significantly increased blastocyst rate (47.8% vs. 42.1%), mean number of blastocysts (3.8 vs. 3.3), and number of cryopreserved blastocysts (1.7 vs. 1.1). The mean number of transferred blastocysts was 1.2 versus 1.3. Culture with the three-gas system increased the relative birth rate by 10% compared with the two-gas system (42% vs. 32%, respectively), a statistically significant difference. The overall twin rate was 4.8%. CONCLUSION(S): Blastocyst culture with low-oxygen (5%) versus high-oxygen (19%) concentration yielded a better blastocyst outcome and a marked improvement in birth rate. Generation of cytotoxic reactive oxygen species with prolonged embryo culture might deteriorate blastocyst viability.

Single blastocyst transfer after ICSI from ejaculate spermatozoa, percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE).

PURPOSE: To investigate the outcome of IVF following intracytoplasmic sperm injection (ICSI) from ejaculate, percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE), with subsequent blastocyst culture and single blastocyst transfer. METHODS: Single blastocyst transfer was performed after ejaculate ICSI (oligozoospermia) in 587 patients, TESE/PESA (azoospermia) in 31 patients, and standard IVF in 680 women. RESULTS: There were only minor differences in IVF characteristics between the standard IVF and the PESA-TESE couples. Couples where ejaculate ICSI were performed seemed to represent a slightly poorer prognostic group. A viable fetus after the 12th gestational week, i.e. ongoing pregnancy, was present in 41.4% after ICSI/ET, 51.6% after PESA-TESE/ET and in 40.4% after standard IVF/ET (no significant differences). CONCLUSION: Single blastocyst transfer after ejaculate ICSI or after PESA/TESE appears to give similar results as conventional IVF blastocyst culture.

Promising results with 306 single blastocyst transfers.

Single blastocyst transfer was performed in 306 IVF patients during 2002 to August 2003 in women younger than 39 years of age with at least five fertilized oocytes. Viable pregnancy rate per single blastocyst transfer was 40.7% during 2002 and 47.6% during 2003 (amounting to 35% of all IVF cycles), which in our experience are acceptable results.

Low-dose aspirin in a short regimen as standard treatment in in vitro fertilization: a randomized, prospective study.

OBJECTIVE: To determine if treatment with low-dose aspirin in a short regimen improves the outcome in a nonselected IVF population as compared with no treatment. DESIGN: Prospective, randomized study where IVF patients were given aspirin or received no treatment. SETTING: IVF clinic. PATIENT(S): The study included 1380 consecutive IVF cycles. INTERVENTION(S): Women undergoing IVF were randomly assigned to treatment with aspirin 75 mg daily from the day of embryo transfer (ET) until pregnancy test or no treatment in an open study. MAIN OUTCOME MEASURE(S): Birth rate per ET. RESULT(S): Background characteristics were similar in the two groups studied except for a minor difference in number of embryos transferred (2.1 vs. 2.0). Birth rate was 27.2% in the aspirin group as compared with 23.2% in the nontreated group, giving an odds ratio, adjusted for number of embryos transferred, of 1.2 (95% confidence interval, 1.0-1.6). CONCLUSION(S): The increased birth rate with aspirin compared with no treatment was significant. Given the importance of every birth in IVF, especially when taking into account the limited number of IVF cycles that are normally performed in an individual woman, any treatment to improve birth rate is important.

Electro-acupuncture as a peroperative analgesic method and its effects on implantation rate and neuropeptide Y concentrations in follicular fluid.

BACKGROUND: In a previous study on the effect of electro-acupuncture (EA) in combination with a paracervical block (PCB) as an analgesic method during oocyte aspiration in IVF treatment, EA appeared to increase the pregnancy rate. This study was designed to test the hypothesis that EA as an analgesic during oocyte aspiration would result in: (i) a better IVF pregnancy rate than with alfentanil; (ii) peroperative analgesia that was as good as that produced by alfentanil; (iii) less postoperative abdominal pain, nausea and stress; and (iv) a reduction in the use of additional analgesics. Neuropeptide Y (NPY) concentrations in follicular fluid (FF) were analysed when possible. METHODS AND RESULTS: In this prospective, randomized, multicentre clinical trial, 286 women undergoing oocyte aspiration were randomly allocated to the EA group (EA plus a PCB) or to the alfentanil group (alfentanil plus a PCB). No significant differences were found between the EA and alfentanil groups in any of the IVF variables. NPY concentrations in FF were significantly higher in the EA group compared with the alfentanil group. No correlation between pregnancy rate and NPY concentrations was found in either analgesic group. Both EA plus a PCB and alfentanil plus a PCB induced adequate peroperative analgesia during oocyte aspiration evaluated using the visual analogue scale. After 2 h, the EA group reported significantly less abdominal pain, other pain, nausea and stress than the alfentanil group. In addition, the EA group received significantly lower amounts of additional alfentanil than the alfentanil group. CONCLUSION: EA does not improve pregnancy rate in the present clinical situation. The observation that NPY concentrations in FF were higher in the EA group may be important for human ovarian steroidogenesis. The analgesic effects produced by EA are as good as those produced by conventional analgesics, and the use of opiate analgesics with EA is lower than when conventional analgesics alone are used.

Steroid-induced polycystic ovaries in rats: effect of electro-acupuncture on concentrations of endothelin-1 and nerve growth factor (NGF), and expression of NGF mRNA in the ovaries, the adrenal glands, and the central nervous system.

Previous studies on the effect of repeated electro-acupuncture (EA) treatments in rats with steriod-induced polycystic ovaries (PCO), EA has been shown to modulate nerve growth factor (NGF) concentration in the ovaries as well as corticotropin releasing factor (CRF) in the median eminence (ME). In the present study we tested the hypothesis that repeated EA treatments modulates sympathetic nerve activity in rats with PCO. This was done by analysing endothelin-1 (ET-1), a potent vasoconstrictor involved in ovarian functions, as well as NGF and NGF mRNA expression involved in the pathophysiological process underlying steroid-induced PCO. The main result in the present study was that concentrations of ET-1 in the ovaries were significantly lower in the PCO group receiving EA compared with the healthy control group (p < 0.05). In the hypothalamus, however, ET-1 concentrations were found to be significantly higher in the PCO group receiving EA than in the healthy control group (p < 0.05). Concentrations of ovarian NGF protein were significantly higher in the PCO control group compared with the healthy control group (p < 0.001), and these concentrations decreased significantly after repeated EA treatments compared with those in the PCO control group (p < 0.05) and were found to be the same as those in the healthy control group. In conclusion, these results indicate that EA modulates the neuroendocrinological state of the ovaries, most likely by modulating the sympathetic nerve activity in the ovaries, which may be a factor in the maintenance of steroid-induced PCO.

Alternative treatments in reproductive medicine: much ado about nothing. Acupuncture-a method of treatment in reproductive medicine: lack of evidence of an effect does not equal evidence of the lack of an effect.

The increasing popularity of alternative treatments-methods of treatment that are not generally established in Western medicine-demands a serious debate about scientific documentation, efficacy and safety. It has been argued that there is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data, and we agree. Different methods of treatment, referred to as alternative treatments, are used by millions of patients every day which generates billions of dollars in health care expenditure each year. Therefore, it is important that physicians become more knowledgeable about different methods of treatment and increase their understanding of the possible benefits and limitations of each therapy. This article is intended to illustrate acupuncture in reproductive medicine today, as an example of a method of treatment that has become more established in Western medicine over the last decade. Discussed are the scientific documentation and aspects of acupuncture research, the physiological basis for the use of acupuncture, and evidence for the use of acupuncture in reproductive medicine. We are well aware that there are few well-designed papers on the effectiveness of different treatments in this field. However, we need to adhere to these principles, as we hope, do the readers of the present debate article.