Natural cycle cryo-thaw transfer may improve pregnancy outcome.

OBJECTIVE: To compare natural vs. hormone replacement treatment (HRT) for cryo-thaw embryo transfer cycles in patients with frozen embryos from previous ART. DESIGN AND SETTINGS: Retrospective chart review of 164 patients (242 cycles) who underwent natural or HRT cryo-thaw embryo transfer between January 2002 and April 2005. MAIN OUTCOME MEASURES: Pregnancy rates per transfer in natural and HRT cryo-thaw cycles. RESULTS: The pregnancy rate per transfer was higher with natural cycles (36.76% vs. 22.99%, P = 0.0298). There was no statistical difference in mean age, endometrial thickness, and average embryo quality in successful cycles. Mean endometrial thickness prior to transfer was greater in natural cycles (9.95 vs. 8.89 mm, P < 0.001). Mean serum estradiol levels were higher in the HRT group prior to transfer (526.1 vs. 103.8 pg/ml, P < 0.001), and were found to be lower in women who achieved pregnancy (337.1 vs. 433.3 pg/ml, P = 0.0136). CONCLUSION: Hormone replacement in preparation for cryo-thaw transfer of embryos was found to be associated with decreased pregnancy rates in comparison to natural cycle cryo-thaw transfer. Greater endometrial thickness was achieved with lower serum estradiol levels in patients undergoing natural cycles, suggesting that higher estradiol levels during HRT cycle may interfere with the window of implantation.

Efficacy of luteinizing hormone activity in patients undergoing in vitro fertilization and treated only with low-dose recombinant choriogonadotropin alfa (Ovidrel) in the late follicular phase.

Ten good prognosis patients underwent IVF with a new ovarian stimulation protocol using only 8 microg of recombinant choriogonadotropin and a GnRH antagonist starting at a 14-mm lead follicle. Six of the 10 subjects delivered and all had supernumerary embryos for cryopreservation.

Clomiphene citrate induced ovulation and intrauterine insemination: effect of timing of human chorionic gonadotropin injection in relation to the spontaneous LH surge on pregnancy rates.

PURPOSE: To determine the optimal time for administration of human chorionic gonadotropin in clomiphene citrate induced intrauterine insemination cycles. METHODS: A retrospective analysis of 171 consecutive cycles was performed. An increase in luteinizing hormone level >100% over the mean of the preceding two days was defined as luteinizing hormone surge. Human chorionic gonadotropin was given in preparation for intrauterine insemination based on the follicle size and estradiol level prior to surge in 85 cycles (Group A), with the spontaneous surge in 64 cycles (Group B) and not given in 22 cycles (Group C) due to high luteinizing hormone levels. RESULTS: The overall pregnancy rate per cycle was 18.1% (31/171), 15.2% (Group A), 20.3% (Group B) and 22.7% (Group C), (p > 0.50). CONCLUSION: Although there may be physiological reasons to propose that timing the human chorionic gonadotropin to the luteinizing hormone surge will improve the success rate, they were not demonstrated.