Probability of success of conservative treatment of infertility: exact timing as an important prognostic factor.

OBJECTIVE: To find out which forms of conservative infertility therapy led to the highest pregnancy rate and which factors influence the occurrence of a pregnancy. STUDY DESIGN: A total of 433 conservative treatment cycles were retrospectively evaluated. Ovarian stimulation was performed with clomiphene citrate (CC) or gonadotropins (follicle stimulating hormone [FSH] or human menopausal gonadotropin) with ovulation induction and luteal phase support in some cases. Patients then received intrauterine insemination (IUI) or had timed intercourse (TI). RESULTS: The pregnancy rates were 2.7% in CC/TI cycles, 8.2% in FSH/TI cycles, 10.3% in CC/IUI cycles, and 15.5% in FSH/IUI cycles. A cycle regulation by means of an ovulation induction and a luteal phase-supporting medication resulted in significantly higher pregnancy rates. When the TI and/or the IUI were carried out postovulatorily and in the case of already beginning endogenous ovulation (increase of the luteinizing hormone value shown in the last control), the success rate was significantly lower. CONCLUSION: Not only the choice of the optimal form of treatment but also a sufficient supportive medication in terms of an ovulation induction and a luteal phase support as well as exact timing are vital for the treatment success in conservative infertility treatment.

Good fertilization results associated with high IL-1beta concentrations in follicular fluid of IVF patients.

OBJECTIVE: To determine the levels of interleukin-1 beta (IL-1beta) in follicular fluid and embryo culture fluid after controlled ovarian hyperstimulation and to assess the association of this cytokine with the outcome of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment and embryo transfer. STUDY DESIGN: A total of 256 couples undergoing the IVF/ICSI program were included in this prospective study. Zygote quality, embryo and blastocyst morphology were evaluated, and embryo transfer was performed 5 days after oocyte recovery. IL-1beta concentrations were measured in follicular fluid and embryo culture fluid of the third and fifth culture days. RESULTS: Embryo replacement was performed with a median of 2 embryos per cycle. In all, 44 clinical pregnancies were achieved in 256 assisted reproductive technology (ART) cycles (pregnancy rate: 19.8% per transfer). Follicular fluid concentrations of IL-1P were not significantly different in pregnant (2.1 pg/mL) and nonpregnant women (2.7 pg/mL). Follicular fluid of lVF, but not ICSI, patients with good fertilization rates (> 90%) contained significantly higher levels of IL-1beta (3.3 pg/ mL) than did follicular fluid of women with fertilization rates < or = 90% (2.0 pg/mL, p < 0.05). No correlation was found between intrafollicular IL-1beta and zygote morphology, day 3 and day 5 embryo morphology. There was no relationship between IL-1beta in culture fluid supernatants and embryonic development. CONCLUSION: In IVF patients high levels of intrafollicular IL-1beta were associated with good fertilization rates. There seems to be no correlation between IL-1beta concentrations in follicular fluid or embryo culture fluid and embryo morphology or pregnancy outcome of ART cycles.

3D-Endometrial volume and outcome of cryopreserved embryo replacement cycles.

PURPOSE: The success of artificial reproductive techniques not only depends on the quality of oocytes and spermatozoa but also on the receptivity of the endometrium. The aim of this study was to assess the value of measurement of endometrial volume by three-dimensional (3D) in comparison to 2D-ultrasound in the prediction of implantation in women having transfer of cryopreserved embryos. METHODS: One hundred and eight couples were included in this prospective study. All patients underwent the IVF or ICSI program and had transfer of cryopreserved embryos. Sixty-eight transfers were done in a spontaneous cycle and 40 in an artificial cycle. Endometrial thickness, pattern and three-dimensional volume were measured immediately before embryo transfer. RESULTS: Twenty clinical pregnancies were achieved (PR 18.5 % per transfer), the PR being similar in spontaneous (22.1 %) and artificial (12.5 %, ns) cycles. Three to five days after ovulation (spontaneous cycles) or after the endometrium reached a thickness of at least 8 mm (artificial cycles), a median of three embryos were replaced. In spontaneous cycles, there were no significant differences in endometrial thickness or volume between pregnant (11.9 mm, 2.9 ml) and non-pregnant women (10.7 mm, 3.4 ml). In artificial cycles, the endometrial volume (3.9 vs. 2.5 ml, p < 0.05), but not endometrial thickness (10.7 vs. 10.2 mm, ns) was significantly higher in pregnant than in non-pregnant women. CONCLUSIONS: In artificial cycles, a low endometrial volume is associated with a poor likelihood of implantation. Endometrial volume measured by 3D-ultrasound is an objective parameter to predict endometrial receptivity.

Comparison of two media for sequential culture after IVF and ICSI shows no differences in pregnancy rates: a randomized trial.

BACKGROUND: Optimal culture conditions are crucial for embryonic development and blastocyst formation after in vitro fertilization (IVF) or Intracytoplasmic sperm injection (ICSI). A prospective randomized trial was carried out to compare the effects of two different sequential media (Vitrolife and MediCult) on embryo development and implantation. MATERIAL/METHODS: 176 couples were included in this prospective randomized study. All couples undergoing the IVF (n=84) or ICSI (n=92) program at the University of Würzburg were randomly assigned to either Vitrolife (n=87) or MediCult (n=89) sequential culture media. RESULTS: The overall median fertilization rate (FR) was 84.0% and was similar in the Vitrolife (FR=87.5%) and MediCult group (FR=80.0%). A mean of 2.7 embryos were replaced into the uterus, not significantly different between both groups. The pronuclear development was significantly enhanced in embryos cultured in Vitrolife than in those cultured in MediCult media (p=0.035). The embryonic development on day 3 was also superior in the Vitrolife group, but only in ICSI cycles (p<0.01). After 5 days of culturing, the blastocyst development was equivalent in both groups. The clinical pregnancy rate was 31.0% per transfer in the Vitrolife group and 28.1% in the MediCult group (not significant). CONCLUSIONS: The results demonstrate that implantation and clinical pregnancy rates with both media are comparable. Embryonic development until day three seemed to be enhanced when the embryos were cultured in Vitrolife media.

Pronuclear scoring. Time for international standardization.

Zygote scoring is an efficient tool for embryo selection not only in countries where embryo selection is not permitted. Several different scoring systems have been published so far, making comparisons of assessments between investigators and laboratories extremely difficult. Pronuclear evaluation should be standardized in a manner analogous to the standardization of cleavage stage embryo scoring or of semen evaluation by the World Health Organization. The ideal score should be clear and easily applicable. The items that have the greatest influence on embryonic development seem to be alignment and size of pronuclei, alignment and number of nucleoli, halo effect and appearance of vacuoles. These morphologic parameters can be observed in different features and can be summarized as a zygote score.