Simultaneous evaluation of basal FSH and oestradiol response to GnRH analogue (F-G-test) allows effective drug regimen selection for IVF.

To determine whether preliminary assessment of ovarian reserve by simultaneous evaluation of basal follicle-stimulating hormone (FSH) and oestradiol response to gonadotrophin releasing hormone (GnRH) analogue (F-G-test) can be used to tailor individually the drug regimen for ovarian stimulation, the in-vitro fertilization (IVF) results of 238 patients were retrospectively analysed. Sixty-two women with abnormal response to the test (DeltaE2 <180 pmol/l and/or FSH >9.5 mIU/ml) had commenced buserelin nasal spray in the mid-luteal phase and discontinued it on cycle day 1. Ovarian stimulation was started on cycle day 3 with 375 IU/day of gonadotrophin. Fifty-three patients completed the treatment cycle (group A). A total of 176 women with normal response to the test (DeltaE2 >180 pmol/l and FSH <9.5 mIU/ml) had continued the GnRH analogue throughout the stimulation cycle and a starting dose of 225 IU/day of gonadotrophin was used from cycle day 3. A total of 158 patients completed the treatment cycle (group B). Group A had significantly higher age (34.9 +/- 4.2 versus 33.2 +/- 4.2) (P < 0.05) and basal FSH (9.2 +/- 3.8 versus 7.0 +/- 2.2) (P < 0.05) and required a higher total dose of gonadotrophin. The numbers of oocytes retrieved and embryos transferred were significantly lower. However, fertilization, clinical pregnancies, and implantation rates were similar in both groups. It was concluded that simultaneous evaluation of basal FSH and oestradiol response to GnRH analogue can be useful in identifying subcategories of women with reduced ovarian reserve who may benefit from reduced GnRH analogue administration and a higher starting dose of gonadotrophin.

Comparison of embryonic development in cleavage stage mouse embryo biopsy between acid Tyrode's solution and laser assisted techniques.

The study was carried out to determine the effectiveness and safety of the infrared 1.48 microm laser in cleavage stage mouse embryo biopsy, compared to the conventional acid Tyrode's solution. One hundred and thirty cryopreserved cleavage stage mouse embryos were included in the study. Fifty embryos were biopsied by acid Tyrode's solution. Forty-seven embryos were biopsied by the infrared 1.48 microm laser. Thirty-three embryos were incubated without biopsy as the control group. Thirteen of 50 embryos in the acid Tyrode's group and 16 of 47 in the laser assisted group became cavitating morulae on day 4, meanwhile 23 of 33 in the control group reached this stage. The blastocyst formation of acid Tyrode's, laser assisted and control group were 94.0, 97.8 and 100.0 per cent, respectively. The hatching rate of acid Tyrode's solution, laser assisted and control group were 78.7, 84.7 and 63.6 per cent, respectively. No significant difference in blastocyst formation and hatching rate was found. The percentage of grade I blastocysts in control group (96.9%) was significantly higher than those in acid Tyrode's solution (68.0%) and the laser assisted group (76.0%). There was no significant difference in the percentage of grade 1 blastocysts between the acid Tyrode's solution and the laser assisted group. In conclusion, the infrared 1.48 microm wavelength laser may be an alternative to acid Tyrode's solution in embryo biopsy.

Basal 17beta-estradiol did not correlate with ovarian response and in vitro fertilization treatment outcome.

OBJECTIVE: To verify the correlation of basal 17beta-E(2) with ovarian response to stimulation and outcome of in vitro fertilization (IVF). DESIGN: Retrospective observational study. SETTING: The Assisted Conception Unit, University College London Hospitals. PATIENT(S): Three hundred five women undergoing IVF and IVF with intracytoplasmic sperm injection. INTERVENTION(S): Basal follicle-stimulating hormone (FSH) and 17beta-E(2) were assessed. The cutoff level for day 2 E(2) established was 250 pmol/L. Each patient was noted for below (group A) or above (group B) the cutoff point according to her basal E(2) level. MAIN OUTCOME MEASURE(S): Basal E(2), age, duration of infertility, cycle day 2 FSH, number of ampules of gonadotropin used, number of days of stimulation, number of retrieved oocytes, fertilization rate, number of embryos transferred, number of cycles with embryo freezing, cancellation rate, clinical pregnancy rate, and implantation rate were compared between the two groups. RESULT(S): No differences were found between group A and group B in the number of oocytes retrieved (8.8 +/- 4.2 vs. 9.3 +/- 4.8), embryos transferred (2.5 +/- 0.8 vs. 2.7 +/- 0.7), cancellation (9.1% vs. 6.9%), pregnancy (24.8% vs. 30%), and implantation rate (12.3% vs. 15.6%). Correlation coefficient and coefficient of determination showed no significant correlation between basal E(2) and the number of oocytes retrieved, age, and basal FSH. CONCLUSION(S): In our study population, basal E(2) was not a sensitive predictor of ovarian response to stimulation and did not correlate with IVF outcome.

Embryonic testicular regression syndrome: a case report.

A case of testicular regression syndrome was reported. The patient was an 18 year old girl presenting with primary amenorrhoea. Physical examination revealed normal female external genitalia and underdeveloped secondary sexual characteristics. Hormonal profile indicated gonadal failure. Chromosome analysis revealed 46,XY karyotype. Diagnostic laparoscopy demonstrated undeveloped internal genital organs. Remnants of epididymis, vas deferens and seminiferous tubule were uncovered during exploratory laparotomy. Ontogeny of sexual differentiation and pathogenesis of testicular regression syndrome were reviewed and discussed.

Comparison of pronuclear stage embryo transfer and in vitro fertilization-embryo transfer following intracytoplasmic sperm injection.

To determine whether the mode of embryo transfer (PROST vs IVF) affected the outcome in intracytoplasmic sperm injection (ICSI) cycles, 237 ICSI cycles (106 PROST and 131 IVF) were analyzed. Several parameters, including patient age, duration of infertility, amounts of hMG used, number of mature eggs retrieved and injected, fertilization rate, number of embryos transferred, and clinical pregnancy rate, were compared. Most of the variable factors were not significantly different, except the mean numbers of transferred embryos which were significantly higher in the PROST group. The clinical pregnancy rate showed no statistical difference between PROST and IVF cycles (25.5 and 16.8%; p = 0.139). This study suggests that even the pregnancy rate in PROST cycles was slightly higher than IVF cycles, but there was no statistically significant difference between the two groups.

Differences in sexual behaviour between HIV-infected pregnant women and their husbands in Bangkok, Thailand.

In a Bangkok antenatal clinic, we interviewed 102 HIV-infected pregnant women and their husbands, 30% of whom were HIV-negative. We evaluated these data by matched and unmatched analysis, compared men and women in stable couple relationships on a number of sociodemographic and risk factor indicators and investigated further whether there were any differences in sociodemographic or risk factor profiles between HIV-serodiscordant couples and seroconcordant couples. When compared to wives, more of the husbands were working (p = 0.001), earning more money (p = 0.001), had had more than two sex partners (p = 0.001) and had had syphilis (p = 0.001). Serodiscordant couples did not differ greatly from seroconcordant couples except that women married to HIV-negative men were more likely to have been divorced or separated than their husbands which was not the case for women married to HIV-positive men (p = 0.02). There was poor agreement between husband and wife reports of husband risk behaviour and this did not differ between concordant and discordant couples. These findings suggest that assessment of risk and counselling of Thai women is incomplete without information on the HIV status and risk behaviour of her partner. Prevention strategies to decrease heterosexual transmission among couples need to target both the man and the woman.

PIP: This study compared the sexual behaviors of HIV-infected pregnant women and their husbands in Bangkok, Thailand. Researchers interviewed a total of 102 HIV-infected pregnant women and their husbands (30% of whom were HIV-negative). Using matched and unmatched analysis, sociodemographic and risk factor indicators among men and women in stable couple relationships were compared. Differences in sociodemographic or risk factor profiles between HIV-serodiscordant couples and seroconcordant couples were also investigated. Results revealed that income discrepancy between husbands and wives was smaller in discordant than in concordant couples, but the difference did not reach significance. Variables such as jobs, income, number of sexual partners, and presence of syphilis were noted to be much higher among husbands than wives. Men, regardless of HIV status, had consistently higher levels of risk behavior than their female partners. Moreover, women partnered with HIV-negative men, unlike women partnered with HIV-positive men, were infected outside the current relationship. Divorce or separation from a previous husband, younger age at first sex, and a higher number of sexual partners on the part of the wife were predictive of her husband being seronegative. The findings confirm the existence of a gender dichotomy in sexual behavior in Thailand, which is characterized by frequent partner change in males and female monogamy.

Comparison of two-layer Percoll gradient and mini-Percoll methods for sperm preparation.

To compare the efficiency of sperm preparation between the two-layer Percoll gradient and mini-Percoll methods, 50 normal and 33 abnormal semen samples from male partners of infertile couples were studied. The number of recovered spermatozoa, percentage of motility, percentage of normal morphology, and their survival at 24 and 48 hours were assessed. Both Percoll gradient techniques resulted in a significantly higher percentage of motility and percentage of normal morphology compared with the original semen samples (p < 0.0001). The two-layer Percoll gradient showed a higher sperm recovery than the mini-Percoll method (p < 0.001), but the latter resulted in a higher percentage of motility (p > 0.001) and a higher sperm survival rate at 24 hours (p < 0.05) than the former, regarding normal semen samples. These differences did not appear with abnormal semen samples when analyzed as a group. Considering each of the abnormal parameters separately, sperm recovery was significantly higher after the two-layer Percoll gradient in the case of astheno- and teratozoospermia (p < 0.05), but sperm survival at 48 hours was higher after the mini-Percoll gradient in the case of teratozoospermia (p < 0.05). It is concluded that both the two-layer Percoll gradient and mini-Percoll method can be used effectively for sperm preparation. The former yields a higher sperm recovery, but the latter should be considered regarding teratozoospermic samples and semen samples of very low volume.