[Pregnancy rate in cryopreserved embryos based on the classical morphologic scoring and the integrity of blastomeres at thawing]. / Tasa de embarazo en embriones criopreservados según la calificación morfológica clásica y la integridad de las blastómeras a la descongelación.

Two different thaw embryo classifications were evaluated, the morphologic classic evaluation (Veeck, 1990) and all blastomeres intact at the time of embryo transfer. We also discuss the clinic parameters and the physiopathological causes implicated in the successful of this treatment. 176 ovarian stimulation cycles and 513 cryopreserved embryos were reviewed. We found better pregnancy rate and delivery rate in embryo transfers were at least one embryo had all blastomeres intact compare with the transfers with good quality embryos (1+, 2+) of the morphologic classic evaluation without statistic significance (p > 0.05). Pregnancy and delivery rate were higher in cases with embryo in pronuclear stage compare with cleavage stage (p < 0.05). The blastomeric harm disturbs the embryo implantation phase and the future is oriented to the microsurgical remove of the damaged blastomeres and the use of assisted hatching.

[Embryonic quality in the use of urofolitropin vs recombinant FSH for in vitro fertilization]. / Calidad embrionaria en la utilización de urofolitropina vs FSH recombinante para fertilización in vitro.

There were no differences in both groups as tho the age of the patients; received doses of both types of FSH, nor HMG; but there was as to the amount of captured ovocytes, amount, and quality, embrionary, in special 1+ 2+ in favor of the group that received urofolitropine, specially under 35 years of age. In this study there was better qualy and amount, embrionary, obtained with the use of urofolitropine, as compared with FSH recombinant for in vitro fertilization.

[Prognostic value of the initial response of serum estradiol levels to stimulation with GnRH analogues in in vitro fertilization]. / Valor pronóstico de la respuesta inicial de los niveles séricos de estradiol al estímulo con análogos de GnRH en fertilización in vitro.

Studying the value prognostic of the answer of the Estradiol (E2) levels to the stimulation with agonists of GnRH (GnRH-a) during early follicular phase. Retrospective, analytic and comparative study. From January 1, 1993 to December 31, 1995 403 IVF cycles were studied. According to E2 levels after stimulation with GnRH-a four Patterns were assembled. Pattern A (n = 115), B (n = 22), C (n = 11), and D (n = 3). Those was included patients managed in short luteal phase in this study, (FLC) (n = 153) and long luteal phase (FLL) (n = 97) were groups control. The rate of oocyte retrieve was greater in the patterns, A, B, FLC and FLL with respect to the patron D (p = 0.001). The pregnancy rate was higher in A, B, FLC and FLL (25%, 19%, 22% and 25% respectively (p = 0.05). The age was old in C and D and luteal phase with an average of 35 +/- 2 (p = 0.001). The patterns had a better answer, represented by the increment of the estradios (E2) levels response to the GnRH-a action of leuprolide acetate during the early follicular phase they went A and B. We conclude that the early E2 response patterns to leuprolide acetate is the best early prognostic indicator of IVF outcome.

Elevated basal estradiol levels have no negative prognosis in young women undergoing ART cycles.

The objective of this study was to determine the relationship between serum estradiol levels on day 2 of an in vitro fertilization and embryo transfer (IVF-ET) cycle and the chance of pregnancy and implantation rates according to age. Two hundred and forty-eight cycles of IVF-ET in patients treated with gonadotropin-releasing hormone analog (GnRHa, follicle-stimulating hormone (FSH) and human menopausal gonadotropin (hMG) were divided into several groups according to the basal serum concentrations of estradiol (E2):A < 25 pg/ml, B 26-50 pg/ml, C 51-75 pg/ml, D 76-100 pg/ml, E > 100 pg/ml. Furthermore, the patients were subdivided into two subgroups according to age: I younger; and II, older than 35 years. Pregnancy and implantation rates were analyzed for each subgroup according to basal E2 level and age. Statistical analysis was performed using analysis of variance, chi2 and Fisher's test. The number(s) of cycles for each subgroup were 164 and 84 for I and II, respectively. Even though there were no significant differences among groups for the pregnancy rates for individual groups, there was a tendency for a decreased rate with increasing levels of E2 only in women older than 35 years of age. When pregnancy rates of all women with E2 levels above 25 pg/ml were calculated, the differences between those observed in subgroup I (< or = 35 years) and II (> 35 years) was significant: p = 0.02 (38.7% vs. 18.7%, respectively). When implantation rates in the same groups and subgroups were analyzed, we found that again the differences were statistically significant: p = 0.001 (13.1%vs, 4.3% for I and II). The results of the present studies reveal that basal levels of E2 are a marker of poor prognosis for implantation and pregnancy in assisted reproduction (ART) cycles only in patients over the age of 35 years. These data cast doubt on the use of basal levels of E2 to screen women below the age of 35 prior to initiating an ART cycle. In addition, high levels of basal E2 per se may not be deleterious for reproductive efficiency in younger women, since pregnancy and implantation rates did not differ among patients younger than 35 years old (IA to E).

Ability of an anti-luteinizing hormone-releasing hormone vaccine to inhibit gonadotropins in postmenopausal women.

OBJECTIVE: To determine the effects of immunization with an anti-LH-releasing hormone (LH-RH) vaccine in postmenopausal women. DESIGN: Pilot clinical study. SETTING: Normal human volunteers in a medical research-training environment. PATIENT(S): Three postmenopausal women with a mean age of 60 years, 5 years of amenorrhea, and severe hypoestrogenism with elevated serum LH and FSH. INTERVENTION(S): Intramuscular immunization with 300 micrograms LH-RH equivalent of the vaccine in two occasions 1 month apart. MAIN OUTCOME MEASURE(S): Patients were followed for clinical assessment and serum LH, FSH, and anti-LH-RH titers at regular monthly intervals for 7 months. RESULTS(S): The injection of the anti-LH-RH vaccine followed by a booster injection 1 month later resulted in a sharp decrease, 60 days after the first injection, of both serum gonadotropins, accompanied by an increase in anti-LH-RH antibody titers, which were reversible after 180 days in the absence of further booster immunization. CONCLUSION(S): Active immunization offer a safe option to induce antibody response, which in the present regime employed was of about 6-months duration. This procedure opens new possibilities for its use as an affordable therapeutic agent in some hormone-dependent clinical conditions.

Frequency of abnormal karyotypes among abortuses from women with and without a history of recurrent spontaneous abortion.

OBJECTIVE: To compare the frequency of chromosomal abnormalities in products of conception from women with and without a history of recurrent spontaneous abortion. DESIGN: Retrospective analysis of prospectively collected material. SETTING: Private practice at the Genetics and IVF Institute, Fairfax, Virginia and Grupo de Reproducción AGY Asociados, México City, México. PATIENTS: Women with (n = 94) and without (n = 130) a history of recurrent spontaneous abortion who had a spontaneous abortion between January 1, 1992 and November 1, 1994. INTERVENTION: Chromosomal analysis performed on products of conception using standard G-banding technique. MAIN OUTCOME MEASURE: The percentage of chromosomal abnormalities among products of conception from women with and without recurrent spontaneous abortion was compared. RESULTS: Among products of conception from women with recurrent spontaneous abortion, 57% (54/94) had abnormal and 43% (40/94) had normal chromosome analyses. Products of conception from women without recurrent spontaneous abortion had abnormal chromosome analyses in 57% (74/130) and normal results in 43% (56/130). CONCLUSIONS: No differences in frequency of abnormal karyotype were observed in products of conception from women with recurrent spontaneous abortion compared with women without recurrent spontaneous abortion.

[Comparison of 2 artificial insemination technics. (Sperm tubal perfusion and intrauterine insemination)]. / Comparación de dos técnicas de inseminación artificial. (Perfusión tubárica de esperma e inseminación intrauterina).

In 1991 Kahn et al, described a method of intrauterine Insemination called Fallopian Tube Sperm Perfusion (FSP) using 4.0 ml for the insemination volume, unlike the classic Intrauterine Insemination (IIU) in which insemination volume is 0.5 ml. The aim of this study is to compare pregnancy rate per cycle in both technics. Between August 1993 and January 1994, 60 couples with infertility were studied, 131 ovarian stimulation cycles were done, 95 with IIU and 36 with PTE. 18 clinical pregnancies occurred, 11 with IIU and 7 with PTE, for a pregnancy rate per cycle of 11.5% for IIU and 19.4% for PTE. This result confirms the reports by Kahn. PTE represents a new possibility for the treatment of different etiology infertility.

Comparación de dos técnicas de inseminación artificial. (Perfusión tubárica de esperma e inseminación intrauterina) / Comparison of two artificial insemination techniques-Sperm tubal perfusion and intrauterine insemination

En 1991 Kahn y col. describieron un método de inseminación intrauterina llamado Perfusión Tubárica de Esperma (PTE) utilizando un volumen inseminado de 4.0 ml, a diferencia de la Inseminación Intrauterina (IIU) clásica en la que el volumen inseminado es de 0.5 ml. El objetivo del estudio es comparar la tasa de embarazos de ambas técnicas. Durante un período comprendido entre agosto de 1993 a enero de 1994 se atendieron 60 pacientes con infertilidad se realizaron 131 ciclos de inducción de ovulación e inseminación intrauterina, 95 fueron con IIU y 36 con PTE. Se obtuvieron 18 embarazos clínicos, 11 con IIU y 7 con PTE, representando una tasa de éxito de 11.5 por ciento para la primera y de 19.4 por ciento para la segunda técnica. Estos resultados confirman los obtenidos por Kahn. La PTE representa una nueva posibilidad para el tratamiento de la infertilidad de diversas etiologías

Presence of corpus luteum as evidence of ovulation in women treated with low doses of chlormadinone acetate.

PIP: 50 women under continuous treatment for 1-31 months with 500 mcg chlormadinone acetate daily were studied. Culdoscopy was performed between Day 14 and 23 of their menstrual cycles. A corpus luteum was thought to be observed in 37 cases. In 18 with suspected corpus luteum a wedge resection of the ovary was done. Examination of patients 10 days after operation revealed no complications. In 4 cases subsequent culdoscopic examinations revealed no traces of biopsy damage. In 5 an endometrial biopsy was obtained the same day as the ovarian one or shortly thereafter. The 18 ovarian biopsies showed recent corpora lutea in 12, old corpus luteum in 1, follicular and theca-lutein cysts in 2, and normal follicles without corpus luteum in 3. Endometrial biopsies revealed 2 instances of normal secretory endometrium and 1 case of irregular endometrium with corpora lutea. Evidence of ovulation occurred in 70%. The reported pregnancy rate with low-dose progestogen therapy has been 3.7/100 years of woman exposure. The exact mechanism of contraception by chlormadinone acetate has not been determined.^ieng