Is there a uniform basal endometrial gene expression profile during the implantation window in women who became pregnant in a subsequent ICSI cycle?

BACKGROUND: To understand which genes are really involved in the implantation process, we planned to study the gene basal expression profile during the window of implantation (WOI) of patients who became pregnant in a subsequent ICSI cycle. METHODS: Women attending their first ICSI cycle at ANDROS Day Surgery for severe male factor infertility were included in the study. An endometrial biopsy was performed during the WOI, in one of the last two cycles before the ICSI cycle. Forty-seven selected gene profiles were analyzed using Low Density Array technology. Only biopsies from women who subsequently became pregnant were evaluated, to exclude any bias regarding embryo viability and embryo transfer difficulties. RESULTS: Fifteen patients were included in the analysis as they became pregnant after ICSI procedure. Four of 47 selected genes were excluded from the analysis. Of the 43 genes analyzed, only 6 genes (VEGFA, PLA2G2A, ALPL, LIF, NNMT and STC1) showed a statistically uniform expression among patients who subsequently became pregnant. For all the other genes analyzed there were considerable differences in their expression levels amongst women who subsequently became pregnant. CONCLUSIONS: Our data suggest that very few genes, which change their expression level during the WOI, show a quantitative homogeneous expression in endometrially-receptive patients. In conclusion, in this study only six genes showed a homogeneous expression, and are probably involved in embryo implantation mechanisms.

GnRH antagonist-induced inhibition of the premature LH surge increases pregnancy rates in IUI-stimulated cycles. A prospective randomized trial.

BACKGROUND: Our prospective randomized controlled trial was designed to assess whether the use of GnRH antagonists can improve the success rate of controlled ovarian stimulation (COS)/intrauterine insemination (IUI) treatments, via inhibition of the premature LH rise. METHODS: A total of 104 patients were randomly divided, using a randomization list, into two groups: in group A (n = 52), recombinant FSH (rFSH) was given with GnRH antagonist Cetrorelix, and in group B (n = 52), the patients received rFSH alone in a manner similar to that of group A. The primary outcome measure was clinical pregnancy rate per couple. RESULTS: The pregnancy rate per patient was 53.8% in group A and 30.8% in group B (P = 0.017). The rate of premature LH surge was 7% in group A and 35% in group B (P < 0.0001). A premature luteinization was observed in two cycles of 144 in group A (1.4%) and in 16 cycles of 154 in group B (10.4%) (P = 0.001). The mean values of LH and progesterone were significantly lower in patients receiving GnRH antagonist than in those who did not (3.3 +/- 3.3 mIU/ml in group A versus 9.9 +/- 7.9 mIU/ml in group B, P < 0.0001, for LH; 1.3 +/- 1.1 ng/ml versus 2.1 +/- 1.9 ng/ml for group A and B, respectively, P < 0.0001, for progesterone). CONCLUSION: The use of GnRH antagonist in COS/IUI cycles improves pregnancy rate, preventing the premature LH rise and luteinization.

Monozygotic bichorionic twinning after transfer of a single frozen/thawed embryo that has undergone quarter laser-assisted zona thinning: a case report.

PURPOSE: To present the occurrence of a monozygotic bichorionic twinning after the transfer of a single frozen/thawed embryo has undergone assisted zona hatching (AZH), using a non contact laser. METHODS: A 33-year-old woman who underwent single frozen embryo replacement (FER). Before transfer, the patient was treated with GnRH agonist and with substitutive therapy (estrogens and progesterone). CONCLUSIONS: We are absolutely certain that we are reporting a monozygotic bichorionic pregnancy: a single frozen/thawed embryo was transferred and no concomitant spontaneous conception was possible. Moreover, molecular biology assessment for polymorphisms confirmed clinical findings. The possibility of the occurrence of a monozygotic bichorionic twinning after the transfer of a single frozen/thawed embryo should be borne in mind and its incidence will have to be studied further.

Is it possible to use the hypoosmotic swelling test as criteria for "freezeability" of human semen in an AID program?

The aim of this study was to determine the possibility of the introduction of another parameter--the hypoosmotic swelling test--in the evaluation of the freezing potentially of anonymous donor's semen sample to be utilized in an AID program. 154 donor semen samples were frozen using classic seminal parameters: HOS tests were performed but not utilized as criteria for freezeability. All specimens were thawed and another HOS test was performed. All specimens were divided into two groups on the basis of the pre freezing HOS test value--HOS tests positive (> or = 55%) and HOS test negative (< 55%)--to verify if it's possible to correlate this value to the recovery of a good motility after thawing. A further division was performed: HOS tests highly positive (> or = 70%), HOS positive (60-55%) and HOS tests negative (< 55%) but the authors did not find any statistical difference. As concerns the clinical evaluation, were considered the last 15 pregnancies achieved with 11 samples out of 22 utilized. There was not any statistical difference. The data could seem to confirm the hypothesis that it is not possible to utilize the HOS test as a predictive value of "freezeability" of human semen sample.

Superovulation with buserelin and gonadotropins dramatically improves the success rate of intrauterine insemination with husband's washed semen.

The purpose of this study was to determine the effectiveness of intrauterine insemination with husband's washed semen during stimulated cycles using a combined treatment of GnRH agonist (buserelin) and gonadotropins. 47 infertile couples were studied; 25 couples were treated with buserelin and gonadotropins (study group) and 22 (control group) received clomiphene citrate alone. Indications for treatment, in both groups, were male subfertility, cervical factor or unexplained infertility. For sperm preparation, the same swim up technique in both groups was used. In the study group, 15 pregnancies were achieved (pregnancy rate: 60%) whereas only 5 pregnancies were achieved in the control group (pregnancy rate: 22.7%) (p less than 0.01). The pregnancy rate per cycle was 17.6 and 4.8 respectively (p less than 0.01). The mean number of follicles per cycle (+/- SEM) was 3.6 +/- 0.2 and 1.7 +/- 0.07, respectively (p less than 0.0005). Comparing successful and unsuccessful cycles a difference was observed only among the levels of 17 beta E2, both per cycle and per follicle/cycle (1075 +/- 165.4 vs 721 +/- 57.6 and 319.8 +/- 42.6 vs 219.9 +/- 17.8; p less than 0.01 and p less than 0.0005 respectively). The authors conclude that intrauterine insemination with washed sperm during stimulated superovulatory cycles is a successful mode of therapy in all couples with infertility not associated with anatomic damage of the adnexa or with chronic anovulation.