The impact of acupuncture on in vitro fertilization outcome.

OBJECTIVE: To replicate previous research on the efficacy of acupuncture in increasing pregnancy rates (PR) in patients undergoing IVF and to determine whether such an increase was due to a placebo effect. DESIGN: Prospective, randomized, controlled, single blind trial. SETTING: Private, academically affiliated, infertility clinic. PATIENT(S): One hundred fifty patients scheduled to undergo embryo transfer. INTERVENTION(S): Subjects were randomized to either the acupuncture or control group. Acupuncture patients received the protocol, as first described by Paulus and his colleagues, for 25 minutes before and after embryo transfer. Control subjects laid quietly. All subjects then completed questionnaires on anxiety and optimism. The IVF staff remained blind to subject assignment. MAIN OUTCOME MEASURE(S): Clinical PRs, anxiety, optimism. RESULT(S): Before randomization both groups had similar demographic characteristics including age and psychological variables. There were no significant differences in PRs between the two groups. Acupuncture patients reported significantly less anxiety post-transfer and reported feeling more optimistic about their cycle and enjoyed their sessions more than the control subjects. CONCLUSION(S): The use of acupuncture in patients undergoing IVF was not associated with an increase in PRs but they were more relaxed and more optimistic.

Prognosis for clinical pregnancy and delivery after total fertilization failure during conventional in vitro fertilization or intracytoplasmic sperm injection.

OBJECTIVE: To determine the prognosis for clinical pregnancy and delivery after total fertilization failure. DESIGN: Retrospective analysis of patient treatment cycles. SETTING: Private fertility clinic. PATIENT(S): 555 couples who had total fertilization failure during a cycle of conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Delivery rates, peak estradiol level, number of mature follicles, number of oocytes retrieved, number of mature oocytes, sperm concentration, and sperm motility. RESULT(S): Delivery rates for IVF patients who elected to continue treatment after fertilization failure were 44% per patient, 25% per embryo transfer (ET), and 22% per cycle. Delivery rates for ICSI patients were 36% per patient, 23% per ET, and 18% per cycle. The number of mature oocytes was always statistically significantly lower in the total fertilization failure cycle when compared with fertilization cycles that occurred either before or after, whether ICSI or conventional IVF was involved. CONCLUSION(S): The prognosis for pregnancy is encouraging in subsequent cycles after total fertilization failure. Fertilization failure was a result of suboptimal response to ovarian stimulation.

Effects of lifetime exercise on the outcome of in vitro fertilization.

OBJECTIVE: To estimate whether exercise before the first cycle of in vitro fertilization (IVF) affects cycle outcomes. METHODS: A total of 2,232 patients were prospectively enrolled before undergoing their first cycle of IVF for the treatment of infertility from 1994-2003 at three IVF clinics in the greater Boston area. The primary IVF outcomes of interest included successful live birth and four points of cycle failure: cycle cancellation, failed fertilization, implantation failure, and pregnancy loss. Unconditional logistic regression adjusting for observed confounders was used to quantify the relation between self-reported exercise and cycle outcome. RESULTS: In general, women who reported regular exercise were no more likely to have a live birth compared with those women who did not report exercise (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.7-1.0; P = .07). Women who reported exercising 4 hours or more per week for 1-9 years were 40% less likely to have a live birth (OR 0.6, CI 0.4-0.8) and were almost three times more likely to experience cycle cancellation (OR 2.8, CI 1.5-5.3) and twice as likely to have an implantation failure (OR 2.0, CI 1.4-3.1) or pregnancy loss (OR 2.0, CI 1.2-3.4) than women who did not report exercise. In general, women who participated in cardiovascular exercise had a 30% lower chance of successful live birth (OR 0.7, CI 0.6-0.9) than women who reported no exercise. CONCLUSION: Regular exercise before in vitro fertilization may negatively affect outcomes, especially in women who exercised 4 or more hours per week for 1-9 years and those who participated in cardiovascular exercise. LEVEL OF EVIDENCE: II-2.

Gene expression in the preimplantation embryo: in-vitro developmental changes.

The regulation of early embryo development and the mechanism of implantation remains poorly understood, due to the large number of genes and the complexity of the systems involved. The effect of in-vitro culture on embryos also remains unclear, which raises concerns about the safety of assisted reproductive technology. Changes in the expression of several individual genes in cultured embryos have been reported previously, but a large-scale comparison has not yet been performed to investigate the effects of in-vitro culture systems on embryo development. This study investigated established gene expression profiles of more that 20,000 genes from in-vitro cultured mouse embryos at eight different stages (oocytes, zygote, 2-, 4-, 8-cell embryo, compacting embryo, morula and blastocyst) using microarray technology, and compared these profiles with in-vivo embryos. In most stages of development there was little significant difference in overall expression patterns between in-vitro and in-vivo embryos. In addition, the expression patterns of developmentally important genes from several different categories, such as apoptosis, glycolysis, adhesion and methylation, were examined and compared between in-vitro and in-vivo embryos. Among the genes examined, DNA methyltransferase 1 (DNMT1) shows a significantly higher (P < 0.05) expression level in cultured embryos. Cadherin-11 also demonstrates a slightly different pattern, although the difference is not statistically significant. All the other genes have remarkably similar expression patterns between in-vitro and in-vivo embryos throughout preimplantation stages.

Human progesterone receptor polymorphisms and implantation failure during in vitro fertilization.

OBJECTIVE: Polymorphic variants of the human progesterone receptor gene have been described, but their potential influence on in vitro fertilization outcome have not been studied. STUDY DESIGN: DNA was available from 317 women (cases) who had >or=2 embryo transfers without a clinical pregnancy and from 288 women (control subjects) who became pregnant after 1 in vitro fertilization attempt. With protocols that were specific for H770H (C/T genotype) and +331G/A polymorphism, amplification of polymorphism fragments, digestion with restriction enzymes, and gel visualization were performed. RESULTS: Allele frequencies for the 2 variants were 15.5% for H770H T and 4.1% for +331A in cases and 17.9% and 3.6% in control subjects, respectively. Both polymorphisms were rare among non-white subjects. Possession of a H770H T allele was associated with a decreased risk for implantation failure, which was nonsignificant overall but significant in women aged <35 years (adjusted relative risk, 0.52 [95% CI, 0.28, 0.97]). Possession of a +331A allele was associated with an increased risk of implantation failure, which was nonsignificant overall but significant in women who weighed <135 pounds (adjusted relative risk, 3.85 [95% CI, 1.20, 12.30]). The +331G/A polymorphism tended to increase the risk for implantation failure in women with an H770H C/C genotype, but not in women with a C/T or TT genotype (P=.09). Among white women who were H770H C/C, there was a significant trend (P=.03) in the proportion of +331G/A carriers as the number of implantation failures increased, from 8.6% of women with 0 failed attempts to 40% among women with >or=5 failed attempts. CONCLUSION: Although human progesterone receptor polymorphisms do not clearly affect the risk for implantation failure in most women who undergo in vitro fertilization, the likelihood that a woman carries the +331G/A human progesterone receptor polymorphism increases with the number of failed attempts at implantation.