Recurrent implantation success in consecutive embryo transfer cycles: a unique case report.

We describe here a unique case of a woman with an azoospermic male partner conceiving each time during ten consecutive in-vitro fertilization embryo transfer (IVF-ET) cycles. A 27 year old woman reported with primary infertility to our out-patient department at the Institute of Reproductive Medicine, Salt Lake, India in November 2001. Ten consecutive IVF-ET cycles including both, fresh and frozen embryos were performed over a span of ten years. Following each ET, the woman became pregnant; however, viable babies were not achieved. Finally, after the tenth consecutive IVF-ET cycle, a caesarean section (CS) was performed at 30 weeks and twin babies weighing 1.3 kg and 1.25 kg, respectively, were delivered and both the babies survived. It seems unlikely that the woman's conception with each embryo transfer was merely coincidental; a persistently receptive window of implantation with a high embryo implantation rate is evident. This case motivated us to introduce the term, repeated implantation success (RIS). We hypothesize that for successful implantation, expression of various factors during each cycle may be possible only in genetically pre-determined women. Identification of these genetically pre-determined set of marker(s) could help in predicting the chances of a successful pregnancy in women undergoing IVF.

Luteal phase estradiol level: a potential predictive marker for successful pregnancy in in vitro fertilization/intracytoplasmic sperm injection.

OBJECTIVE: To analyze the role of luteal E(2), P, and FSH levels in the prediction of clinical pregnancy in stimulated cycles. DESIGN: Prospective study. SETTING: Institute of Reproductive Medicine, Salt Lake, Kolkata, India. PATIENT(S): A total of 268 women aged <40 years undergoing their first IVF-ET/intracytoplasmic sperm injection cycles. INTERVENTION(S): Estimation of luteal phase serum E(2), P, and FSH levels on days 0, 7, and 14 of ET. MAIN OUTCOME MEASURE(S): Comparison of luteal phase hormonal profile in pregnant and nonpregnant women and interpretation by discriminant analysis. RESULT(S): A total of 113 pregnancies were achieved (42.16%). Age, basal FSH level, peak E(2) level, number of oocytes retrieved, and number of embryos transferred were comparable between pregnant and nonpregnant women. Day-7 and day-14 luteal E(2) levels were significantly different between the two groups. Progesterone levels were comparable in both groups on days 0 and 14. Levels of FSH showed statistically significant differences between the two groups on days 0, 7, and 14. Classification accuracy for E(2), P, and FSH was 82.1%, 60.8%, and 67.51%, respectively. CONCLUSION(S): Luteal E(2) concentration seems to be a promising marker of successful clinical pregnancy.