Results with GnRH antagonist protocols are equivalent to GnRH agonist protocols in comparable patient populations.

OBJECTIVE: To determine whether ovarian stimulation outcome and success rates are equivalent between GnRH agonist and GnRH antagonist regimens when all other variables are held constant. STUDY DESIGN: Retrospective analysis. Infertile patients (n = 1,277) < 35 years of age, with normal ovarian reserve, undergoing their first in vitro fertilization cycle with a GnRH antagonist or agonist were included. Outcome variables were analyzed and compared between both groups. RESULTS: Of the total number of patients included, 21% (n = 268) underwent stimulation with a GnRH antagonist protocol and 79% (n = 1,009) with an agonist protocol. While the mean number of embryos transferred was similar between both groups, as well as the implantation rate for blastocyst embryo transfers, the implantation rate was noted to be slightly higher for the down-regulation group who underwent a Day 3 embryo transfer (p = 0.01). However, the overall clinical pregnancy, loss and high-order multiple pregnancy rates were constant in both groups. CONCLUSION: Although numerous variables were analyzed in our study, the differences noted did not have an impact on our final results as the clinical pregnancy rates were maintained in the antagonist group.

Monozygotic pregnancies conceived by in vitro fertilization: understanding their prognosis.

OBJECTIVE: To analyze the outcomes and particular characteristics of monozygotic (MZ) pregnancies conceived by in vitro fertilization (IVF). DESIGN: Retrospective data analysis. SETTING: Large private-academic fertility center. PATIENT(S): IVF-conceived MZ pregnancies. INTERVENTION(S): Statistical analysis of MZ pregnancy outcomes depending on fetal order and pregnancy reductions status. MAIN OUTCOME MEASURE(S): Spontaneous pregnancy reduction, pregnancy loss, take-home baby rate, perinatal mortality, gestational age at delivery, and birth weight. RESULT(S): A total of 72 of 3,426 pregnancies (2.1%) were MZ, and 70 were included in the study. Of these, 34 cases (48.5%) were high-order multiple pregnancies (HOMP), and 36 (51.5%) were non-HOMP. In the HOMP group, only 2.9% (1 of 34) had a complete pregnancy loss while 38.8% (14 of 36) of the non-HOMP were lost by 20 weeks' gestation. Of the HOMP patients, 73.1% therapeutically reduced the MZ component, and a statistically significant difference in gestational age of delivery (37.8 ± 3.2 vs. 28.1 ± 7.7) and birth weight (2796 ± 865.8 vs. 1110.0 ± 731.6) was seen when compared with nonreduced HOMP. CONCLUSION(S): Twinning with MZ is encountered in a small but important number of pregnancies derived from assisted reproduction. The prognosis for these patients is unfavorable, particularly for single-implantation MZ pregnancies and for nonreduced HOMP. Patients who do not spontaneously reduce a MZ-HOMP by 12 weeks may benefit from therapeutically reducing the MZ component of the pregnancy.

Advances and controversies in assisted reproductive technology.

As the incidence and awareness of infertility have increased in the last decades, reproductive endocrinologists and scientists have striven to improve the therapeutic options being offered to patients. One of the most advanced and efficient technologies currently being offered is assisted reproductive technology. Among the various techniques that are comprised by assisted reproductive technology, in vitro fertilization is the most widely studied and used, being responsible for approximately 1% of all live births in the United States. As this technology has evolved, many controversies have arisen, and it is the purpose of this article to review what in the authors' opinion are the most current and controversial aspects of the whole process of in vitro fertilization and its related techniques.

Cervical pregnancy: the importance of early diagnosis and treatment.

STUDY OBJECTIVE: To report the evolution and outcome of 12 cases of cervical pregnancy. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University teaching hospitals. PATIENTS: Twelve women with cervical pregnancy. INTERVENTIONS: Methotrexate, uterine artery embolization, curettage, ligation of the descending branch of uterine vessels, or hysterectomy. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was success of conservative management. From January 1985 through December 2005, we encountered 12 cases of cervical pregnancy. The final diagnosis was established by ultrasound, operative findings, and histopathology. We obtained information from the medical records of the patients regarding when and how the diagnosis was made, the characteristics of the pregnancy, and treatment modalities. The prevalence of cervical pregnancy was 1:10,000 deliveries. The patients' history revealed previous curettage in 6 (50%) and cesarean delivery in 2 others (16.7%). Four patients (33.3%) initially not diagnosed to have cervical pregnancy required a hysterectomy. Initial diagnosis of cervical pregnancy was correct in 5 patients. They were treated with methotrexate, uterine artery embolization, curettage, or ligation of the descending branch of uterine vessels. None of these patients required blood transfusion or hysterectomy. CONCLUSION: The success of conservative treatment for cervical pregnancy depends on the diagnostic accuracy of the initial ultrasound. Correct diagnosis would reduce the chance of hysterectomy or blood transfusion.