[Intracytoplasmic sperm injection (ICSI): the Bialystok experience]. / Wyniki leczenia nieplodnosci metoda icsi w osrodku bialostockim.

OBJECTIVE: To present a complete results of Intracytoplasmic Sperm Injection Program (ICSI) performed at IVF Unit in Bialystok, Poland. DESIGN: Retrospective data analysis. MATERIALS AND METHODS: A total of 2593 cycles of ICSI treatment were analyzed. The results of controlled ovarian hyperstimulation (COH), parameters of fertilization, early embryo development and clinical pregnancy rates were compared depending on the type of COH used. RESULTS: Overall, for 16708 MII oocytes microinjected, the 2 pronuclear fertilization rate was 54%. Embryo transfer was performed in 94% of started cycles and 629 clinical pregnancies were recorded, giving a clinical pregnancy rate of 24% per cycle and 26% per transfer. No influence of COH on embryological and clinical results was noted. CONCLUSION: Intracytoplasmic sperm injection can be used successfully to treat couples with male factor infertility and those who have failed standard IVF. Precisely adapted protocol of ovarian hyperstimulation for every patient could diminish the costs of treatment without negative influence on ICSI results.

[Enzymatic assisted hatching in the infertile couple after failed attempts of IVF ET]. / Enzymatyczne usuniecie oslonki przejrzystej blastocysty pronaza u pacjentek po kilkukrotnych niepowodzeniach w programie IVF ET.

The study was conducted on the patients who had attempted and failed previous IVF procedures. The aim of this study was to determinate effectiveness sequential culture of embryos to blastocyst and assisted hatching by zona pellucida digestation by pronase. In this group the pregnancy rate was 24.1% compared to control 17.8%. The implantation rate was higher in study group than control one. It suggests that the culture embryos to balstocyste stage and assisted hatching by digestation by pronase is safe and effective mode of treatment of infertile couple after failed attempts IVF ET.

[Reinsemination of oocytes by intracytoplasmic sperm injection after the failure of conventional fertilization. Early embryonal development]. / Mikroiniekcja plemnika do cytoplazmy (ICSI) oocytów nie zaplodnionych w warunkach IVF. Wczesny rozwój embrionalny zarodkow.

OBJECTIVE: To analyze the influence of intracytoplasmic sperm injection (ICSI) on early embryo development used for reinsemination of unfertilized 1-day-old oocytes. DESIGN: Prospective observational study. MATERIALS AND METHODS: A total of 126 embryos resulted from reinsemination by ICSI were analyzed with regard for the time course of cleavage and the quality of embryos at 48 hours after injection. Results were compared with those obtained in 698 embryos obtained after routine ICSI program. RESULTS: It has been shown that embryos derived from reinsemination developed slower in comparison with those obtained after regular ICSI program. At 48 hours after microinjection 50% of embryos achieved 4 blastomeres stage and 37% remained on 2 cells stage. 71% of regular ICSI embryos at this same time showed 4 blastomere or more, only 16% remained on 2 blastomeres stage. The quality of embryos was similar in two compared groups, however those obtained following reinsemination at 4 blastomere stage were significantly poorer quality. CONCLUSION: Embryos derived from reinsemination of 1-day old oocytes unfertilized after conventional IVF developed slower and the quality of embryos at 4 blastomere stage was poorer comparing to regular ICSI embryos.

[The comparison of efficiency of supplement of the second phase in the program IVF-ET by dydrogesterone and progesterone]. / Porównanie skutecznosci suplementacji drugiej fazy w programie IVF-ET dydrogesteronem i progesteronem.

The retrospective study was carried out to compare effectiveness of progesteron and dydrogesteron luetal phase support following in vitro fertilisation and embryo transfer. Two hundred and fifty eight patients undergoing IVF ET received progesteron in itramuscular injections. Two hundred sixty patients received dydrogesteron three times daily p.o. There were no differences in stimulation protocols, indications for IVF and IVF procedures. Pregnancy rate, implantation rate and spontaneous abortion rate were similar in both groups. The effectiveness of luteal phase support in patients undergoing IVF ET program by dydrogesteron and progesteron is similar with significantly lower costs for the last one.

[Monozygotic pregnancy after the treatment for infertility by transfer of frozen-thawed embryos]. / Ciaza mnoga monozygotyczna po leczeniu nieplodnosci metoda pozustrojowego zaplodnienia.

OBJECTIVES: It has been suggested that monozygotic pregnancies occur more frequently after in vitro fertilisation. This phenomenon is attributed to a number of factors including in vitro culture conditions, malformation of the zona pellucida due to manipulation on the oocytes and artificial opening of the zona pellucida. DESIGN: Retrospective analysis of monozygotic pregnancies in an IVF-ET procedures and obstetrical these pregnancies outcome. MATERIALS AND METHODS: A total of 2254 IVF-ET procedures were analysed. Three protocols were used for ovarian stimulation: short or long protocols with gonadotropins releasing hormone analogue or clomiphene citrate with hMG. In 811 cases male factor was diagnosed and intracitoplasmatic sperm injections were performed. RESULTS: 549 clinical pregnancies were achieved in analysed group. In six cases ultrasound examination 5 weeks after embryo transfer showed a greater number of foetus than the number of embryo transferred. In three of those cases the embryos were obtained after ICSI. Age and average thickness of zona pellucida were similar in group of patients with monozygotic pregnancies when compared with all pregnant patients after IVF treatment. CONCLUSIONS: The incidence of monozygotic pregnancy is increased in group pregnancies resulting from IVF ET. No single risk factor can explain this phenomena. This type of pregnancy needs special obstetrical attention.

[Pregnancy and delivery after the transfer of one blastocyst with enzymatically removed zona pellucida]. / Ciaza i poród po transferze blastocysty pozbawionej enzymatycznie oslonki przejrzystej.

OBJECTIVES: The embryonic development up to the blastocyst stage and hatching from zona pellucida are prerequisites for implantation and successful pregnancy. It is suggested that one of the possibilities limiting the implantation rate is impaired hatching. To overcome this problem an artificial alteration of the zona pellucida have been carried out in many laboratories. DESIGN: The report of the first pregnancy in Poland obtained after the transfer of enzymatically zona removed blastocyst. MATERIALS AND RESULTS: The patient was previously treated three times in in vitro fertilisation program without success. In the fourth program the embryos were cultured in co-culture of Vero cells to the blastocyst stadium. On the day 5 after insemination the zona of cavitating and expanding blastocyst was removed by pronase. The zona free blastocyst was transferred to the uterus. As a result of implanted blastocyst the ongoing pregnancy developed normally and the patient delivered healthy baby. CONCLUSION: Enzymatic zona pellucida hatching probably increases the rate of implantation. It is simple, safe and economic techniques.

[Cryopreservation of embryos in an in vitro fertilization program(IVN-ET)--preliminary results]. / Mrozenie zarodków w programie pozaustrojowego zaplodnienia (IVF-ET)--wyniki wstepne.

The authors present preliminary results of cryopreservation of embryos in IVF-ET programme in the Institute of Obstetrics and Gynecology in Bialystok. The method of slow cooling embryos with 1, 2 propanediol and saccharose were used. In the group of 136 patients with excess embryos after the transfer of two fresh embryos 29 pregnancies (21.3%) were obtained. After the transfer of frozen/thawed embryos up till now 5 pregnancies have been obtained (one child born, 3 pregnancies ongoing, 1 abortion).

["Long protocol" for ovarian stimulation using D-Trp6 LHRH (Triptorelin Depot) and menopausal gonadotropin in the IVF-ET program]. / "Dlugi protokól"stymulacji jajeczkowania z uzyciem D-Trp6 LHRH (Triptorelina Depot) i gonadotropiny menopauzalnej w programie IVF-ET.

39 patients (age 35-40, anovulation, previous failures in the IVF-ET programme) were superovulated using GnRH analogue (Decapeptyl-Depot) in the long protocol and hMG 97 embryos were transferred and 109 were cryopreserved. The clinical pregnancy and implantation rates were 31.6% and 13.4%. The long protocol gives better results in the IVF-ET programme but increases the costs of treatment.

[Use of an GnRH analogue for induction of gonadotrophin ovulatory surge in cycles stimulated with clomiphene citrate and menopausal gonadotropin in an in vitro fertilization program]. / Zastosowanie analogu GnRH do wywolania szczytu owulacyjnego gonadotropin w cyklach stymulowanych cytrynianem klomifenu i gonadotropina menopauzalna w programie pozaustrojowego zaplodnienia.

In 23 women treated for sterility by the in vitro fertilization method the gonadotropins ovulatory surge was stimulated by applying a GnRH analogue (Buserelin). The authors showed that a single injection of GnRH analogue in the cycles stimulated with clomiphene citrate and menopausal gonadotropin causes pituitary output of both LH and FSH which is sufficient for morphological and functional maturity of the oocytes. After such treatment two patients conceived and delivered healthy babies.

[Use of GnRH analog for induction of gonadotropin ovulatory surge in cycles stimulated by clomiphene citrate and menopausal gonadotropin in an in vitro fertilization program]. / Zastosowanie analogu GnRH do wywolania szczytu owulacyjnego gonadotropin w cyklach stymulowanych cytrynianem klomifenu i gonadotropina menopauzalna w programie pozaustrojowego zaplodnienia.

In 23 women treated for sterility by the in vitro fertilization method the gonadotropins ovulatory surge was stimulated by applying a GnRH analogue (Busereline). The authors showed that a single injection of GnRH analogue in the cycles stimulated with clomiphene citrate and menopausal gonadotropin causes pituitary output of both LH and FSH which is sufficient for morphological and functional maturity of the oocytes. After such treatment two patients conceived and delivered healthy babies.