Effects of different stages of endometriosis on the outcome of in vitro fertilization.

OBJECTIVE: This study was undertaken to evaluate the effects of different stages of endometriosis on the outcome of treatment in an in vitro fertilization (IVF) program. METHODS: This was a retrospective, matched case-control study in an academic tertiary referral centre. The study group consisted of 87 women with laparoscopically diagnosed endometriosis, and the control group consisted of 87 age-matched women undergoing IVF for different reasons. The primary outcomes were duration of stimulation, total gonadotropin dose requirement, peak serum estradiol level, total number of oocytes retrieved, fertilization rate, embryo quality, implantation rate, and clinical pregnancy rate. The effect of obliteration of the cul-de-sac by endometriosis was also evaluated. RESULTS: Women with endometriosis required significantly higher gonadotropin doses than women in the control group (P < 0.01). The fertilization rate was significantly lower for women with endometriosis (P < 0.05), although there was no difference in embryo quality or in the number of embryos transferred. In patients with an obliterated cul-de-sac, fewer oocytes were retrieved than in patients in the control group (P < 0.01). CONCLUSION: The presence of endometriosis, including stages III and IV, does not affect IVF outcome. However, women with endometriosis require more gonadotropin stimulation than those with no endometriosis. Women with an obliterated cul-de-sac have fewer oocytes retrieved than women without obliteration.

Effects of repeated treatment failure on the quality of life of couples with infertility.

OBJECTIVE: To determine the impact of repeated treatment failure of clomiphene and intrauterine insemination on the quality of life of couples with infertility. METHODS: A prospective comparative study involving 3 groups of 50 couples each. The first group consisted of infertile couples with repeated treatment failure (group FT), the second group consisted of infertile couples who had never attempted any medical treatment (group NT), and the third was a control group of couples with at least 1 child and no history of infertility. Participants completed a comprehensive questionnaire to assess 16 areas of quality of life. RESULTS: The quality of life score of the control group was higher than the scores reported by groups NT and FT (P <.001). There was no significant difference in the quality of life score reported by group NT and group FT or between male and female partners. Among the women, a high quality of life was reported by 22% in group FT, 14% in group NT, and 54% in the control group. Among the men, a high quality of life was reported by 14% in group FT, 12% in group NT, and 60% in the control group. In contrast to their male partners, the women with repeated treatment failure placed higher importance on children and home than their counterparts who had not started the treatment (P <.05). CONCLUSION: Although couples with repeated treatment failure of clomiphene and intrauterine insemination do not demonstrate a lower overall quality of life than other infertile couples beginning baseline assessment, the quality of life of infertile couples is lower than that of fertile couples.

Fertility after intact ovary transplantation.

Transplantation surgery, which is limited by the supply and short-term viability of fresh donor organs, would be revolutionized if these could survive freezing, but early claims of cryopreservation were never realized. Here we describe the successful transplantation in rats of ovaries, fallopian tubes and the upper segment of the uterus en bloc after storage in liquid nitrogen.