Assisted Reproductive Technique Cycles Research Articles

Hormones in pregnancy

The endocrinology of human pregnancy involves endocrine and metabolic changes that result from physiological alterations at the boundary between mother and fetus. Progesterone and oestrogen have a great role along with other hormones. The controversies of use of progestogen and others are discussed in this chapter. Progesterone has been shown to stimulate the secretion of Th2 and reduces the secretion of Th1 cytokines which maintains pregnancy. Supportive care in early pregnancy is associated with a significant beneficial effect on pregnancy outcome. Prophylactic hormonal supplementation can be recommended for all assisted reproduction techniques cycles. Preterm labor can be prevented by the use of progestogen. The route of administration plays an important role in the drug's safety and efficacy profile in different trimesters of pregnancy. Thyroid disorders have a great impact on pregnancy outcome and needs to be monitored and treated accordingly. Method of locating review: Pubmed, scopus

Low-Molecular-Weight Heparin in Women with Repeated Implantation Failure

Implantation failure is common in assisted reproduction techniques (ART). The role of low-molecular-weight heparin (LMWH) is a matter of debate as a potential factor to improve implantation. To evaluate the pregnancy rate in patients with or without heparin administration. We performed a retrospective observational analysis of patients with at least two IVF/intracytoplasmic sperm injection cycles with implantation failure, screened for inherited thrombophilia and submitted to further ART cycles with or without administration of LMWH. A total of 265 patients fulfilled the enrollment criteria. Of these 149 (56%) were primary infertile and 116 (44%) were secondary infertile. Their mean age was 36.3 ± 3.6 years. We analyzed basal FSH, smoking habit, gene variants for inherited thrombophilia (i.e., MTHFR C677T, prothrombin G202A10G and Factor V Leiden). The patients underwent 569 new ART cycles: 512 (90%) without and 57 (10%) with LMWH. In total 105 clinical pregnancies were observed in 569 cycles (18.8%). The pregnancy rate was 17.19% (88/512) in patients not treated with LMWH and 29.52% (17/57) in the LMWH-treated group (p = 0.006). In women over 36 years of age the pregnancy rate was 15.53% (50/322) in nontreated versus 35.71% (10/28) in treated cycles (p = 0.007), while no difference was found in younger women. No statistical difference was found between the presence of inherited thrombophilia and pregnancy rate in treated and untreated cycles. significantly higher pregnancy rate in patients with previous ART implantation failures was observed with LMWH. Our results confirm no relation among inherited thrombophilia and pregnancy rate in patients with previous IVF implantation failures. These findings should be confirmed by randomized controlled trials before use of LMWH for ART cycles is recommended.

Final ART success rates: a 10 years survey

Cumulative pregnancy rates (CPRs) and live birth rates (CLBRs) are much better indicators of success in IVF programmes than cross-sectional figures per cycle or embryo transfer. They allow a better estimation of patient's chances of having a child and enable comparisons between centres and treatment strategies. A 10 year cohort study of patients undergoing their first assisted reproductive technique cycle was conducted. Patients were followed until live birth or discontinuation of treatment. All IVF and ICSI cycles and cryo-cycles with embryos derived from frozen pronuclear stage oocytes were included. The CPR and CLBR were estimated using the Kaplan-Meier method for both the number of treatment cycles and transferred embryos. The analysis assumed that couples who did not return for subsequent treatment cycles would have had the same chance of success as those who had continued treatment. A total of 3011 women treated between 1998 and 2007 were included, and 2068 children were born; women already with a live birth re-entered the analysis as a 'new patient'. For 3394 'patients under observation' with 8048 cycles, the CLBR was 52% after 3 cycles (the median number of cycles per patient), 72% after 6 cycles and 85% after 12 cycles. A CLBR of ∼ 50% was achieved for patients aged under 40 years, after the cumulative transfer of six embryos. The mean live birth rate from one fresh cycle and its subsequent cryo-cycle(s) was 33%. Our analysis also shows that ART can reach natural fertility rates but not exceed them. Most couples with infertility problems can be treated successfully if they continue treatment. Thereby ART can reach natural fertility rates. Even with the restrictions in place as a result of the German Embryo Protection Law, CLBR reach internationally comparable levels.

Intravenous calcium infusion as a novel preventive therapy of ovarian hyperstimulation syndrome for patients with polycystic ovarian syndrome

To evaluate the effectiveness of IV calcium infusion on prevention of ovarian hyperstimulation syndrome (OHSS) in patients with polycystic ovary syndrome undergoing assisted reproductive techniques cycles. A retrospective comparative study. Assisted reproduction techniques centre in Turkey. Four hundred fifty-five women with high risk for OHSS. The patients in group I (n = 84) were administered IV calcium gluconate for prevention of OHSS, and the patients in group II (n = 371) comprised the control group, with no manipulation for prevention of OHSS and were age- and body mass index-matched with the study group. Ovarian hyperstimulation syndrome rate, clinical pregnancy rate. Mean (±SD) ages of the women in the calcium infusion group (group I) and the control group (group II) were comparable (30.5 ± 4.3 vs. 31.4 ± 3.9, respectively). Ovarian hyperstimulation syndrome was found in 16.2% (60 patients) in group II, whereas in group I, only 3 patients (3.6%) developed OHSS. Interestingly, all the hyperstimulation cases in group I were mild, and there was no severe effect. Implantation rates were similar in both groups. Furthermore, we obtained clinical pregnancy in nearly 40.5% in group I and 28.8% in group II. The live-birth rate was 38.1% in the calcium infusion group and 24.8% in the control group. Intravenous calcium infusion resulted in a significantly lower rate of development of OHSS for patients with polycystic ovary syndrome and high risk of OHSS. This novel therapy may be used for prevention of OHSS effectively.

Semen cultures analysis: retrospective study during a 6-year period and interest in the management of infertility

In the past decade, the number of couples consulting an assisted reproductive techniques (ART) center for infertility has increased in most European countries. In France, sperm bacterial examination must be performed every 6months in couples undergoing in vitro fertilization (IVF) cycles, according to 2010 French ART Guidelines. The aim of this study was to analyze the results from such samples at Nantes University Hospital and to assess their potential value for infertile couples undergoing ART cycles. Between 2003 and 2008, semen cultures performed were analyzed according to bacterial enumeration, type and number of bacterial species, and their antibiotic resistance profile. A total of 14,119 semen cultures were performed, showing an annual increase of 45% from the start to the end of the study. The proportion of positive semen cultures was stable throughout the study period (40 to 45%). Many bacterial species were considered as contaminants (coagulase-negative staphylococci, alpha-hemolytic streptococci). For pathogen agents (in most cases, Enterobacteriaceae), the antibiotic resistance profile revealed mostly a susceptible phenotype. Finally, every positive bacterial result had direct consequences on the IVF cycle management, with subsequent reinforced advice on the hygiene procedure before sample collection and/or antibiotics prescription.

Low-dose human chorionic gonadotropin versus estradiol/progesterone luteal phase support in gonadotropin-releasing hormone agonist–triggered assisted reproductive technique cycles: understanding a new approach

It remains unclear how GnRH agonist (GnRHa) triggering affects the luteal phase, so we investigated the luteal phase after GnRHa triggering, supported with conventional E(2)/P with or without low-dose hCG. E(2)/P support, compared with low-dose hCG, induced a shorter luteal phase (11.2 ± 1.1 vs. 15.0 ± 1.6 days) and fewer subjective complaints (0 vs. 42%), whereas hCG caused more free fluid accumulation and enlarged ovaries than E(2)/P alone. Steroids and low-dose hCG differentially affected corpus luteum function, ovarian size, free fluid accumulation, and patient comfort.

Outpatient hysteroscopy: a routine investigation before assisted reproductive techniques?

To evaluate the importance of subjecting the patient to an outpatient (office) hysteroscopy (OH) before assisted reproductive techniques (ART) and patient compliance, possible side effects, and complications of the procedure. Comparative observational cross-sectional study. University hospital. One hundred fifty-two patients attending the outpatient infertility clinic for pre-ART (IVF/intracytoplasmic sperm injection [ICSI]-ET) investigations, with normal uterine findings on hysterosalpingography (HSG). Transvaginal sonography (TVS) and OH (using a rigid, 30-degree, 4-mm hysteroscope) by the vaginoscopic "no touch" technique. Diagnostic value and compliance of OH. The procedure was successful in 145 patients (95.4%); 51 of them (35.2%) had previous ART failures. Abnormal hysteroscopic findings were observed in 48 women (33.1%), in which endometrial polyp, submucous myoma, and intrauterine adhesions were the most common findings. The TVS was specific (100%) but not sensitive (41.7%) compared with OH. Abnormal hysteroscopic findings were significantly higher in patients with previous ART failure(s). The procedure was acceptable in almost all patients with no reported complications. The OH should be part of the infertility workup before ART even in patients with normal HSG and/or TVS. This is especially relevant in cases with prior failed ART cycles.

COMPARISON OF ART OUTCOMES BETWEEN TWO COH PROTOCOLS: GONAL-F VERSUS GONAL-F PLUS HMG

Background The purpose of this prospective randomized study was to compare ovarian response as well as oocytes embryo yields and pregnancy rates in women who underwent ovulation induction for intracytoplasmic sperm injection (ICSI) with recombinant human FSH (rFSH) alone or in combination with human menopausal gonadotropin (HMG). Materials and methods Out of 300 patients in assisted reproductive technique (ART) cycles who underwent down regulation with GnRH analogue in a long protocol 64 patients received 150 IU/d r FSH until day six when they were randomly allocated into two study groups: group A who received rFSH alone (n=32) and group B (n= 32) who received rFSH and HMG. Results The total number of ampoules of rFSH the numbers of oocytes retrieved embryos and serum concentrations of luteinizing hormone (LH) on the day of hCG administration were similar in both treatment groups. However the numbers of follicles ≥15mm serum concentrations of progesterone and estradiol on the day of hCG administration were significantly higher in group B when compared to group A. Although the number of high quality embryos (grades A and B) were significantly better in group B the number of pregnancies and live birth rates were similar in both groups. Conclusion The study shows that the addition of LH to rFSH in pituitary – suppressed women undergoing ART improves some parameters of ovarian response but doesn’t improve overall pregnancy rates.

Beneficial effect of autologous endometrial cell coculture in patients with repeated implantation failure

To confirm the beneficial effect of endometrial coculture in patients with repeated failures with assisted reproductive techniques (ART). Patients with previous failures were offered a repetition of ART in conjunction with autologous endometrial coculture. Private fertility center. Sixty-eight couples who had attempted 92 cycles of IVF or intracytoplasmic sperm injection without obtaining an evolutive pregnancy. Patients repeated one cycle of ART with concomitant endometrial coculture of their embryos. Comparative pregnancy and delivery rates in conventional ART cycles vs. cycles with autologous endometrial coculture. In the previous 92 cycles (146 ETs, fresh plus frozen) only 8 pregnancies were initiated, and all ended in spontaneous abortion. Upon repeating 68 cycles (76 ETs) using coculture, 39 pregnancies were obtained, of which 19 resulted in live births, 10 are ongoing evolutive pregnancies, and 10 ended in spontaneous abortions. These results confirm the usefulness of autologous endometrial coculture for the treatment of patients with repeated implantation failure.

Assisted reproductive technologies: how to minimize the risks and complications in developing countries?

In 2% of assisted reproductive techniques (ART) cycles complications occur. Some are preventable, some are not. In this paper, we will discuss risks and complications of the standard ‘Western’ approach in ART today and point to some measures to be taken when implementing ART in developing countries, where resources and access to medical care may be limited. Ovarian hyperstimulation syndrome (OHSS, and its thrombo-embolic complications) is responsible for the majority of cycle-related complications, followed by bleeding and infection at oocyte retrieval. ART pregnancies are complicated by first-trimester bleeding more often than spontaneous pregnancies, they are more often ectopic, but the major complication is the very high incidence of multiple pregnancies, when more than one embryo is transferred. OHSS can be prevented by screening patients at risk and by using mild or no stimulation. Simple measures can minimize the risks of bleeding or infection. Obviously single embryo transfer is the only way to avoid multiple pregnancies, which have a highly increased risk for severe maternal and neonatal morbidity and mortality (mainly due to prematurity). Special attention should be given to pre-existing pathologies. Risk minimization of ART in developing countries is not only mandatory from an economical but also an ethical point of view.

Obtenção de gametas seguros por meio de associação de técnicas de processamento seminal para casais sorodiscordantes para HIV

the propose of this study was to analyze the clinical and laboratorial parameters of patients submitted to human assisted reproduction techniques with association of sperm processing techniques, in order to remove virus particles from semen samples of couples in which men was infected by human immunodeficiency virus (HIV). assessed were 11 intracytoplasmatic sperm injection (ICSI) cycles from couples whose men were HIV seropositive (HIV Group), and 35 cycles in which semen donors' samples were used in ICSI procedures (Control Group). Semen samples from Control Group were submitted to routine semen analysis, sperm wash and cryopreservation. The man from HIV Group received previous antibiotic therapy; the semen samples were analyzed routinely and prepared by sperm wash and density gradient method before cryopreservation. Those samples were evaluated to viral load and ICSI was performed when no HIV was detected. with regards to semen analysis, the groups were similar to sperm concentration and progressive motility. Nevertheless, the percentage of sperm with normal morphology were higher on Control Group (14.3%) than HIV (5.8%; p=0.002). On embryo parameters assessment, the normal fertilization (CT: 74.7% and HIV: 71.7; p=0.838, respectively) and good embryos rate (CT: 42.4% and HIV: 65.1%; p=0.312, respectively) were comparable. On the other hand, the Control Group presented better clinic results than HIV Group (ongoing pregnancy rate: 52.9% versus 12.5%; p=0.054, and implantation rate: 42.6 versus 10.4%; p=0.059, respectively), however the differences were not statistically significant. After delivery, no seroconversion was observed on mother and child. the association of sperm processing techniques in order to remove HIV from semen samples does not influence in laboratorial parameters of assisted reproduction techniques cycles. On the other hand, it has been demonstrated excellent results getting safety gametes to serodiscordant couples.

Sperm chromatin structure assay parameters measured after density gradient centrifugation are not predictive for the outcome of ART

The sperm chromatin structure assay (SCSA) parameter DNA fragmentation index (DFI) has been shown to predict in vivo and in vitro fertility. So far most SCSA studies have been based on SCSA analysis performed on neat semen. The aim of this study is to assess whether SCSA analysis of sperm prepared by density gradient centrifugation (DGC) could add more information in regard to the prediction of treatment outcome. The study included 510 assisted reproductive technique (ART) cycles. SCSA was performed in neat semen and post DGC. SCSA results were expressed in terms of DFI and high DNA stainability (HDS) cell fractions. The outcome parameter was clinical pregnancy (CP). Scatter-plot diagrams demonstrated that for DGC samples, no DFI cut-off values could be set for in vivo or in vitro fertility. In intrauterine insemination, IVF and ICSI groups the mean difference (95% CI) in DFI post DGC between those who achieved CP and those who did not was 0.2% (-1.7 to 2.0%), 0.4% (-1.9 to 2.8%) and 1.3% (-3.1 to 5.9%), respectively, none of these being statistically significant. The corresponding differences for HDS were 0.1% (-1.3 to 1.5%), 0.1% (-0.7 to 0.9%) and 0.6% (-1.6 to 2.7%), respectively (all P-values >0.6). SCSA performed in semen prepared by DGC cannot predict the outcome of ART.

Sperm chromatin structure assay parameters measured after density gradient centrifugation are not predictive of the outcome of ART

BACKGROUND The sperm chromatin structure assay (SCSA) parameter DNA fragmentation index (DFI) has been shown to predict in vivo and in vitro fertility. So far most SCSA studies have been based on SCSA analysis performed on neat semen. The aim of this study is to assess whether SCSA analysis of sperm prepared by density gradient centrifugation (DGC) could add more information in regard to the prediction of treatment outcome. METHODS The study included 510 assisted reproductive technique (ART) cycles. SCSA was performed in neat semen and post DGC. SCSA results were expressed in terms of DFI and high DNA stainability (HDS) cell fractions. The outcome parameter was clinical pregnancy (CP). RESULTS Scatter-plot diagrams demonstrated that for DGC samples, no DFI cut-off values could be set for in vivo or in vitro fertility. In intrauterine insemination, IVF and ICSI groups the mean difference (95% CI) in DFI post DGC between those who achieved CP and those who did not was 0.2% (-1.7 to 2.0%), 0.4% (-1.9 to 2.8%) and 1.3% (-3.1 to 5.9%), respectively, none of these being statistically significant. The corresponding differences for HDS were 0.1% (-1.3 to 1.5%), 0.1% (-0.7 to 0.9%) and 0.6% (-1.6 to 2.7%), respectively (all P-values >0.6). CONCLUSIONS SCSA performed in semen prepared by DGC cannot predict the outcome of ART.

Does recombinant LH combined to progesterone for luteal phase interfere in the outcome of assisted reproduction technique cycles?

The aim of this study was to investigate whether recombinant LH combined to vaginal progesterone for luteal phase support improve benefits the pregnancy outcome of patients submitted to infertility treatment with assisted reproduction technique.

Features of follicle-stimulating hormone–stimulated follicles in a sheep model: keys to elucidate embryo failure in assisted reproductive technique cycles

To evaluate the individual functionality of gonadotropin-stimulated preovulatory follicles, for understanding embryo failure in assisted reproductive technique cycles, in a sheep model. Observational, model study. Public research unit. Fifteen adult Manchega ewes. Synchronization of the estrous cycle with intravaginal progestagens and ovarian stimulation with FSH; evaluation of reproductive activity, plasma sampling, ovarian ultrasonography, and ovariectomies. Determination of estrus behavior, plasma and intrafollicular concentrations of E(2) and inhibin A, number and size of ovarian follicles, and developmental competence of oocytes. These results support the usefulness of serial measurements of plasma inhibin A for assessment of follicular growth during the FSH treatment, rather than of E(2) assays commonly used. Functionality of FSH-stimulated preovulatory follicles is clearly disturbed, as confirmed by a negative correlation between follicular size and intrafollicular concentrations of inhibin A and E(2) in preovulatory follicles after individual dissection; moreover, the ability of their oocytes to resume meiosis was diminished. Functionality of follicles in controlled ovarian stimulation (COS), and developmental competence of their oocytes, is disturbed by the high doses of gonadotropin supplied and finally determined by follicular sizes at starting FSH treatment.

Higher C-reactive protein levels during IVF stimulation are associated with ART failure

Background C-reactive protein (CRP) is believed to be a sensitive marker of endothelial activation and inflammation. The association between an inflammatory state and CRP has prompted research on changes in CRP levels in assisted reproductive technique (ART) cycles. IVF success and CRP levels were not correlated previously. The aim of this prospective study was to assess CRP levels during IVF stimulation and correlate them with IVF success. Materials and methods Twenty-eight Women were stimulated using the ‘Flare-up’ protocol with down-regulation of Triprorelin. CRP levels were measured on cycle days 3, 8, ovum pick-up day and 12 days following embryo-transfer (βhCG testing day). Main outcome measures: CRP levels in women who conceived after IVF protocol ( n = 8) were compared to CRP levels in women who failed to conceive ( n = 20). Results The mean age for both groups was similar. CRP levels were significantly different on day 3 ( p < 0.05), but not on day 8, of the cycle. Average CRP levels on ovum pick-up and on βhCG test days were similar, as was the number of oocytes collected or embryos replaced. Patients who failed to conceive had significantly higher levels of CRP on day 3 of the cycle, before commencement of gonadotrophin administration, and the higher levels continued throughout treatment, although not reaching statistical significance. Conclusions An inflammatory state, indicated by high CRP levels during stimulation, may serve as a prognostic indicator of IVF success.

P-54: Predictability of pregnancy viability after assisted reproductive techniques (ART) cycles by CA-125 and progesterone serum levels on the day of β-hCG testing

Ideally a marker of ART success should predict treatment outcome as early as possible. Serum progesterone levels have been found to be defective before an adverse pregnancy outcome. CA-125 is found in endometrial tissue and glands, although it may have an ovarian origin too. Higher levels in conception vs non conception ART cycles have been found, rising the question about a possible serum marker of endometrial receptivity. The objective of this study is to evaluate the prognostic value of pregnancy outcome of serum CA-125 and progesterone levels in ART cycles testing positive for β-hCG, with a fixed progesterone supplementation protocol.

GnRH agonist as luteal phase support in assisted reproduction technique cycles: results of a pilot study

The aim of the study was to investigate whether intranasal (IN) administration of a GnRH agonist could provide luteal support in IVF/ICSI patients. Controlled ovarian hyperstimulation (COH) was performed using hMG/FSH and a GnRH antagonist. Patients were then randomly allocated to either 10,000 IU hCG, followed by vaginal administration of micronized progesterone (3x 200 mg/day) (group A), or 200 microg IN buserelin followed by either 100 microg every 2 days (group B), or 100 microg every day (group C), or 100 microg twice a day (group D), or 100 microg three times a day (group E). Luteal support was continued for 15 days. Twenty-three patients were randomized. Groups B and C were discontinued prematurely in view of the short luteal phase. The luteal phase was significantly shorter in groups B, C and D, whereas group E was comparable with group A, 13.5 and 13.0 days, respectively. In the mid-luteal phase, median progesterone levels were significantly lower in groups B, C and D, whereas group E was comparable with group A, 68.9 and 98.0 ng/ml, respectively. Estradiol (E2) was significantly reduced in groups B and D but sustained in group E. In the hCG group, LH levels were undetectable (<0.1 IU/l), whereas LH was detectable and significantly higher in groups C, D and E. Two pregnancies were obtained in the hCG group (two of five), one ectopic and one ongoing. Three pregnancies were obtained in group E, one miscarriage and two ongoing twin pregnancies (three of five). IN administration of buserelin may be effective in triggering follicular maturation and providing luteal phase support in patients undergoing assisted reproduction techniques (ART).

Assisted Reproduction Techniques for HIV_HCV_HBV Serodiscordant Couples: 4 Years of Experience

ObjectiveOur aim was to evaluate the results of our assisted reproduction programme for these couples and to develop adequate strategies for their management. Human Inmunodeficiency Virus (HIV) and Hepatitis C and B virus (HCV, HBV) serodiscordant couples with the male infected can be helped to have children minimizing the transmission risk.DesignRetrospective review in private setting.Materials and methodsMembers of serodiscordant couples: a. HIV positives males attending our Centre for sperm wash and assisted reproduction, b.HCV positive and HBV positive males needing assisted reproduction for infertility provided 256 semen samples for sperm wash. Before artificial insemination (AI) or Intracitoplasmatic Sperms Injection (ICSI) treatment, semen was confirmed to be negative for viral presence by Polimerase Chain Reaction (PCR) after the sperm wash (Limit 50 cop/ml).ResultsA total number of 149 cycles were carried out, 53 ICSIs and 96 AIs. Thirty-one pregnancies were obtained. The pregnancy rates of ICSI were 26.6% in HBV, 21.42% in HCV and 20% in HIV. For IA, the pregnancy rates obtained were as follow: 18.18% in HBV, 14.58% in HCV and 27,02% in HIV. Regardless of the type of infection, no differences were found in semen quality and embryos obtained. No seroconversion was detected in the patient’s follow-up.ConclusionsTo date, sperm wash, PCR and AI or ICSI are an effective procedures that avoid HIV, HBV and HCV transmission with reasonable pregnancy rates. Although a few assisted reproductive technique cycles were performed for this indication without contamination, it is still too early to demonstrate that this technology is fully safe. Many questions remain unresolved. ObjectiveOur aim was to evaluate the results of our assisted reproduction programme for these couples and to develop adequate strategies for their management. Human Inmunodeficiency Virus (HIV) and Hepatitis C and B virus (HCV, HBV) serodiscordant couples with the male infected can be helped to have children minimizing the transmission risk. Our aim was to evaluate the results of our assisted reproduction programme for these couples and to develop adequate strategies for their management. Human Inmunodeficiency Virus (HIV) and Hepatitis C and B virus (HCV, HBV) serodiscordant couples with the male infected can be helped to have children minimizing the transmission risk. DesignRetrospective review in private setting. Retrospective review in private setting. Materials and methodsMembers of serodiscordant couples: a. HIV positives males attending our Centre for sperm wash and assisted reproduction, b.HCV positive and HBV positive males needing assisted reproduction for infertility provided 256 semen samples for sperm wash. Before artificial insemination (AI) or Intracitoplasmatic Sperms Injection (ICSI) treatment, semen was confirmed to be negative for viral presence by Polimerase Chain Reaction (PCR) after the sperm wash (Limit 50 cop/ml). Members of serodiscordant couples: a. HIV positives males attending our Centre for sperm wash and assisted reproduction, b.HCV positive and HBV positive males needing assisted reproduction for infertility provided 256 semen samples for sperm wash. Before artificial insemination (AI) or Intracitoplasmatic Sperms Injection (ICSI) treatment, semen was confirmed to be negative for viral presence by Polimerase Chain Reaction (PCR) after the sperm wash (Limit 50 cop/ml). ResultsA total number of 149 cycles were carried out, 53 ICSIs and 96 AIs. Thirty-one pregnancies were obtained. The pregnancy rates of ICSI were 26.6% in HBV, 21.42% in HCV and 20% in HIV. For IA, the pregnancy rates obtained were as follow: 18.18% in HBV, 14.58% in HCV and 27,02% in HIV. Regardless of the type of infection, no differences were found in semen quality and embryos obtained. No seroconversion was detected in the patient’s follow-up. A total number of 149 cycles were carried out, 53 ICSIs and 96 AIs. Thirty-one pregnancies were obtained. The pregnancy rates of ICSI were 26.6% in HBV, 21.42% in HCV and 20% in HIV. For IA, the pregnancy rates obtained were as follow: 18.18% in HBV, 14.58% in HCV and 27,02% in HIV. Regardless of the type of infection, no differences were found in semen quality and embryos obtained. No seroconversion was detected in the patient’s follow-up. ConclusionsTo date, sperm wash, PCR and AI or ICSI are an effective procedures that avoid HIV, HBV and HCV transmission with reasonable pregnancy rates. Although a few assisted reproductive technique cycles were performed for this indication without contamination, it is still too early to demonstrate that this technology is fully safe. Many questions remain unresolved. To date, sperm wash, PCR and AI or ICSI are an effective procedures that avoid HIV, HBV and HCV transmission with reasonable pregnancy rates. Although a few assisted reproductive technique cycles were performed for this indication without contamination, it is still too early to demonstrate that this technology is fully safe. Many questions remain unresolved.

Management for Controlled Ovarian Hyperstimulation for an Unusual “Hyporesponsiveness” to FSH and Clomiphene in Patients With Polycystic Ovarian Disease

To evaluate the outcome of assisted reproduction techniques (ART) for delayed response to FSH and clomiphene during ovulatory induction in patients with PCOD. Retrospective study. We reviewed 218 ART cycles with PCOD as an only cause of infertility. These cycles were allocated into two groups according to the response to FSH and clomiphene administration during controlled ovarian hyperstimulation (COH). In group A (n = 199) had a normal initial follicular response (> 10 antral follicles > 10 mm in diameter by vaginal sonography and serum E2 ≥100 pg/mL on day 12) after FSH and clomiphene were given. In group B (n = 19) had a delayed initial follicular response and needed an increased and/or prolonged FSH stimulation to reach initial follicular response. Human chorionic gonadotropin was administered to both groups 36 hours before artificial insemination when serum E2 around 1000-1500 pg/mL and/or > 3 preovulatory follicles > 16-18 mm were noted. The mean age was 31.7 and 29.4 years old in group A and group B, respectively. The total amount of FSH given was significantly higher in group B (25amples vs 10amples). The serum E2 levels on the day of hCG administration was no difference in both groups (1506.20 ±118.16 vs 1131.10±79.06). No statistical difference was found in both groups about pregnancy rate (30.7%, 61/199 in group A; 26.3%, 5/19 in group B). But, the live birth rate was 22.6% (45/199) and 10.5% (2/19) in group A and group B, respectively statistical difference was found in both groups. This is an uncommon condition of delayed response to FSH and clomiphene during ovulatory induction in infertility women with PCOD. Whether the present of a high antimullerian hormone (AMH) level is correlated with a delayed response, we need to confirm by another prospective study. However it should be considered continuing rather than abandoning COH and ART because it will rescue more than 1/4 “ hyporesponsive” women getting pregnancy.