Cumulative Conception Rate Research Articles

Factors influencing the cumulative conception rate and discontinuation of in vitro fertilization treatment for infertility

Objective: To examine the cumulative conception rate and live birth rate in women undergoing IVF and to assess the influence of prognostic factors on cumulative conception rate and discontinuation of treatment. Design: Retrospective analysis of data from couples undergoing IVF. Setting: Assisted conception unit of a university hospital. Patient(s): Two thousand fifty-six patients undergoing 2708 cycles of IVF from April 1992 to March 1999. Main Outcome Measure(s): Cumulative conception rate by age, number of oocytes retrieved, and embryos transferred, and the influence of these factors on dropout rates. Result(s): The cumulative conception rate and cumulative live birth rate after four attempts were 75% and 66%, respectively. The cumulative conception rate differed significantly between women 35 years of age or younger and those older than 35 years who had five or more oocytes retrieved (83% vs. 63%). When fewer than five oocytes were retrieved in women 35 years of age or younger, the cumulative conception rate decreased to 33%. Overall, 36% of patients continued treatment after the first attempt; these patients were more likely to have more than five oocytes retrieved and more than two embryos available for transfer. Conclusions: The cumulative conception rate was greater when the female partner was 35 years of age or younger and had more than five oocytes retrieved and more than two embryos were available for transfer. These factors influenced dropout rates.

Pregnancy rates following fimbriectomy reversal via neosalpingostomy: a 10-year retrospective analysis

Objective: To establish parameters associated with successful fimbriectomy reversal and to estimate monthly fecundability and cumulative pregnancy rates through life-table analysis. Design: Series report. Setting: University-based infertility clinic. Patient(s): Forty-one women undergoing surgery for tubal sterilization reversal. Intervention(s): Surgical fimbriectomy reversal. Main Outcome Measure(s): Time from sterilization to reversal, laparoscopy vs. laparotomy, uni- vs. bilateral fimbriectomy reversal, Bruhat vs. suture, tubal lengths, postsurgical hysterosalpingogram, ovulation induction, incidence of pregnancy and outcome, and life-table analysis to determine pregnancy rate. Result(s): The mean time from sterilization to reversal was 11.5 years. Of the 41 women who underwent fimbriectomy reversal, 6 (14.6%) conceived. Sixteen reversals were performed by laparotomy resulting in 4 (25%) pregnancies, whereas 25 were performed laparoscopically resulting in 2 (8%) pregnancies. Eight had unilateral salpingostomies and 33 bilateral, of which 1 of 8 (12.5%) and 5 of 33 (15.2%) conceived, respectively. Using the Bruhat technique, 1 of 11 (9%) conceived vs. 5 of 30 (16.7%) that underwent reversal using sutures. The mean postoperative tubal length for the 6 women who conceived was 8 cm vs. 6.7 cm in the 35 women who did not conceive. Postoperatively, 26 women received ovulation induction and 1 (3.8%) conceived whereas 5 (33.3%) conceptions occurred in 15 women who did not require ovulation induction. Using life-table analysis with 619 postsurgical cycles, the monthly fecundability was .0097. The cumulative conception rate after 5 years was 31.2%. Conclusion(s): Neosalpingostomy for the reversal of fimbriectomy sterilization represents a viable option for fertility restoration. The best candidates for this procedure are spontaneously ovulatory and have a tubal length of more than 7 cm.

Spontaneous conception after the birth of infants conceived through in vitro fertilization treatment

Objective: To investigate the incidence of spontaneous conception after the birth of infants conceived through IVF in couples with subfertility caused by endometriosis, a mild male factor, or unexplained factors, and to identify clinical conditions related to the occurrence of spontaneous conception. Design: Retrospective analysis. Setting: Department of Obstetrics and Gynecology, Akita University School of Medicine, Akita, Japan. Patient(s): One hundred forty-two women who conceived through IVF and 25 of the 142 women who subsequently conceived spontaneously. Intervention(s): Patient characteristics and IVF data were obtained from hospital records, and follow-up data were collected through telephone interviews. Main Outcome Measure(s): Cumulative conception rate. Result(s): The cumulative conception rate at 60 months after the delivery of infants conceived through IVF was 18%, with most conceptions occurring within 2 years of delivery. Proportional hazard analysis indicated that patient age was the most important clinical variable related to the occurrence of spontaneous conception. Conclusion(s): This study provides information that will be useful in counseling subfertile couples who have conceived through the use of IVF.

Factors Affecting the Outcome of Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome in Women With Anovulatory Infertility

Objective To describe and analyse the factors affecting the pregnancy rate of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. Design A retrospective study. Setting A specialist infertility clinic based at a teaching hospital in England. Population One hundred and eighteen women, for whom hospital records and follow up data were available, with polycystic ovarian syndrome who underwent laparoscopic ovarian surgery for anovulatory infertility over a five year period, between January 1991 and December 1995. Main Outcome measures Ovulation and pregnancy rate. Results The cumulative conception rate 12 months after the treatment was 54%. Women who conceived following the surgery had a shorter duration of infertility, were treated with diathermy (rather than laser), had higher pre-operative luteinising hormone levels, were younger and were more likely to have ultrasonographic evidence of polycystic ovarian disease. Logistic multiple regression analysis showed that the duration of infertility, modality used in treatment (laser or diathermy) and the preoperative levels were the main determinants of the outcome. Conclusion Women with polycystic ovarian syndrome respond favourably to laparoscopic ovarian drilling. The success rate in women with infertility duration of less than three years, treated with diathermy, in whom the pre-operative level was more than 10 IU/L reached 79%.

Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility.

To describe and analyse the factors affecting the pregnancy rate of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. A retrospective study. A specialist infertility clinic based at a teaching hospital in England. One hundred and eighteen women, for whom hospital records and follow up data were available, with polycystic ovarian syndrome who underwent laparoscopic ovarian surgery for anovulatory infertility over a five year period, between January 1991 and December 1995. Ovulation and pregnancy rate. The cumulative conception rate 12 months after the treatment was 54%. Women who conceived following the surgery had a shorter duration of infertility, were treated with diathermy (rather than laser), had higher pre-operative luteinising hormone levels, were younger and were more likely to have ultrasonographic evidence of polycystic ovarian disease. Logistic multiple regression analysis showed that the duration of infertility, modality used in treatment (laser or diathermy) and the pre-operative levels were the main determinants of the outcome. Women with polycystic ovarian syndrome respond favourably to laparoscopic ovarian drilling. The success rate in women with infertility duration of less than three years, treated with diathermy, in whom the pre-operative level was more than 10 IU/L reached 79%.

Zygote intrafallopian transfer may improve pregnancy rate in patients with repeated failure of implantation

Objective: To evaluate the efficacy of zygote intrafallopian transfer (ZIFT) on implantation rates and pregnancy rates (PRs) in patients with repeated failure of implantation in IVF-ET cycles. Design: A case-control study. Patient(s): Criteria for patient selection included male factor or unexplained infertility, normal uterine cavity, and at least three failures of implantation in IVF-ET cycles in which at least three embryos were placed per transfer. Data on 70 patients who underwent 92 ZIFT cycles are presented. A control group consisted of patients with the same selection criteria who underwent an additional standard IVF-ET cycle during the same time period. Intervention(s): Ovulation induction consisted of down-regulation with GnRH analogue followed by ovarian stimulation with FSH and hMG. Intracytoplasmic sperm injection was performed on the oocytes of all patients with male factor infertility. Zygotes were transferred by laparoscopy into the fallopian tube 24–26 hours after oocyte retrieval. Main Outcome Measure(s): Implantation rates and PRs in the ZIFT and control groups were compared. Result(s): The PRs and implantation rates were significantly higher in the ZIFT group than in the control group: 34.2% (24/70) and 8.7% (29/333) versus 17.1% (12/70) and 4.4% (13/289), respectively ( P = 0.002 and P = 0.04). The cumulative conception rate for two ZIFT cycles was 59.3%. Conclusion(s): Zygote intrafallopian transfer should be considered a beneficial mode of treatment for patients with repeated failure of implantation in IVF and transcervical ET. More prospective randomized studies are needed to support this observation.

Laser laparoscopic surgery in the treatment of ovarian endometriomas

To assess the efficacy of laser laparoscopic photocoagulation of endometriomas (2-18 cm) in patients with pain, infertility, or a combination of the two. Retrospective review of all patients with endometriomas from June 1, 1983, to December 31, 1993. Department of gynecology and obstetrics at a district general hospital and national training center in minimal access surgery. One hundred sixty-five women with large endometriomas present at the time of laser laparoscopy. Carbon dioxide laser or potassium-titanyl-phosphate laser laparoscopic surgery. Ninety (74%) of 122 patients reported improvement or resolution of pain; and 30 of 66 achieved a pregnancy, for a cumulative conception rate of 45%. Laser laparoscopy is a practical, safe, and effective technique for the management of large ovarian endometriomas.

Reversal of sterilisation vs. IVF: a cost-benefit analysis

A consecutive series of 132 cases of reversal of sterilisation carried out in a teaching hospital in England between 1982 and 1995 was analysed. Follow-up data was obtained on 112 patients. The overall cumulative conception rate was 47% at 12 months and 55% at 24 months. Among the 71 pregnancies there were seven miscarriages (9%) and 11 ectopic pregnancies (15%). Factors affecting the outcome of surgery were examined. The pregnancy rate achieved with microsurgical techniques was significantly higher than the conventional (macrosurgical) techniques (61% v. 40%, = P 0.05). The method of sterilisation also has a significant impact on the outcome; Filshie clips 69%; Fallope ring 46%; Pomeroy technique 31% (P 0.05). Age, associated infertility factors and the interval between sterilisation and reversal operation did not appear to have a significant impact on the outcome. When compared with IVF, reversal of sterilisation is associated with a higher ectopic rate, lower multiple pregnancy rate and a lower miscarriage rate. We conclude that reversal of sterilisation carries a higher overall success rate than IVF and is more cost effective when the method of sterilisation is by the clip or ring and when the reversal operation is carried out with microsurgical techniques.

A comparison of once- and twice-yearly weaning of an extensive herd in northern Australia

Summary. Continuous mating is common in northern Australian beef herds. The resulting calves are born throughout the year making weaning and herd management difficult. Calves born late in the wet season do not reach suitable liveweight for weaning until late in the year. Low liveweight and poor feed conditions make management of these animals for subsequent turnoff or breeding more difficult. We recorded the growth and survival of all progeny and reproductive performance of heifers from 2 groups of 250 Bos indicus-Bos taurus-cross cows grazing native pastures at Kidman Springs, Northern Territory, for 5 years from July 1985. Calves were weaned in June only (W1) or June and October (W2). Unweaned calves remained with their dams until June the following year and heifers entered the breeding herd as 2 year olds. Calves weaned in June (WJ) were heaviest (157.1 kg; P<0.05) but gained least (84.6 kg; P<0.05) over the following year. Unweaned (UW) calves were lighter (51.1 kg; P<0.05) at branding time, in June, than those weaned in October (WO; 66.8 kg). However, they gained more weight (144.5 v. 112.4 kg; P<0.05) over the following year than WO calves because of a superior wet season growth rate, so that WO calves were lightest (P<0.05) at the yearling muster. Mortality rates of all calf groups were low (2.5%). Liveweight at branding and liveweight gain to yearling stage affected whether heifers subsequently joined the breeding herd. More (P<0.05) heifers from WJ joined the herd than from WO and UW groups. Overall, 63.6% of heifers were selected as replacement breeders (no difference between W1 and W2). Bull control was difficult and many heifers (48%) conceived before the planned start of mating. Cumulative conception rate was 91.3% by 30 months post-branding. In the first year, 60% of heifers mated were confirmed pregnant, but reproductive losses of 25.6% from pregnancy diagnosis to branding contributed to a branding rate of 44.9%. The conception rate of heifers when lactating was 18.6%. Mortality during the first year in the herd was 11.7%. In general, WJ heifers had lower mortalities, higher conception, calving and weaning rates, and higher conception rates when lactating than WO or UW heifers. Animals weaned in October were identified as the most difficult group to manage because of lower liveweight as 2 year olds compared with WJ and UW calves. This affected the numbers of heifers suitable for joining. Cost-effective management systems are needed to improve growth rates or delay onset of oestrus in these animals.

Induction of ovulation in clomipheneresistant polycystic ovary syndrome with pulsatile GnRH

To determine the efficacy of pulsatile GnRH alone and in combination with clomiphene citrate or gonadotropins in a stepwise approach for inducing ovulation in women with clomiphene-resistant polycystic ovary syndrome (PCOS). Eighty women with clomiphene-resistant anovulatory infertility and PCOS were given subcutaneous pulsatile GnRH (15 micrograms every 90 minutes) using a portable infusion pump. If no follicular development was seen, clomiphene citrate (100 mg/day for 5 days) was given concurrently with the hormone in the next cycle of treatment. Those who still failed to ovulate regularly were treated with combined pulsatile GnRH with intramuscular gonadotropins (one ampule per day for 5-7 days). RESULTS. Sixty-six of 131 (50%) pulsatile GnRH cycles, 94 of 142 (66%) pulsatile GnRH with clomiphene cycles, and 48 of 69 (70%) pulsatile GnRH with gonadotropin cycles were ovulatory. Monofollicular response (one follicle at least 14 mm on the day of ovulation) occurred in 80.6, 83.9, and 53.6% of cycles, and multifollicular response occurred in 4.8, 3.1, and 21.6% of cycles in the three groups, respectively. Mild ovarian hyperstimulation occurred in one of the 342 cycles. The cumulative conception rate was 30% after three cycles, 60% after six cycles, and 73% after nine cycles. The miscarriage rate was 22% (ten of 45 pregnancies), and 35 women (78%) had live births (33 singletons and two sets of twins). The use of subcutaneous pulsatile GnRH alone and in combination with clomiphene citrate or gonadotropins for induction of ovulation in clomiphene-resistant PCOS in a stepwise approach produces a high cumulative conception rate associated with a low rate of multiple pregnancy and ovarian hyperstimulation syndrome.

Cumulative conception rate following intrauterine artificial insemination with husband's spermatozoa: influence of husband's age.

This paper presents the analysis of 901 cycles of intrauterine artificial insemination with the husband's spermatozoa (AIHIU) in 274 couples who obtained 80 pregnancies. The cumulative pregnancy rate after three cycles of AIHIU was 22% and reached 39% after six cycles. Univariate analysis disclosed two factors of poor prognosis: duration of infertility > 3 years (P = 0.01) and husband's age (P = 0.03). Multivariate analysis revealed that the most significant factor contributing to a decreased likelihood of pregnancy was the age of the husband (P = 0.01), then duration of infertility and dysovulation. The wife's age > or = 35 years did not appear to be of poor prognostic value when taking into consideration the three other factors.

Oral steroid therapy for subfertile males with antisperm antibodies in the semen: prediction of the responders

This study was performed to examine the effectiveness of steroid therapy in subfertile men with antisperm antibodies and infertility lasting > 1 year, to predict those who would respond positively, and to evaluate the effect of the therapy on semen parameters and antisperm antibodies. The patients included 48 subfertile couples in whom the male partner had > or = 20% motile spermatozoa with bound antibodies of immunoglobulin (Ig)G, IgA or a combination of both, and were treated with prednisolone, 40 mg a day, for the first 10 days, then 5 mg on days 11 and 12 of the partner's cycle for 9 months. Twelve couples became pregnant; a cumulative conception rate of 30.2% was achieved at 9 months. The pregnant group started with significantly higher concentrations of IgG (tail) and grade I motility (P = 0.03 and P = 0.02 respectively). Multi-covariate discrete logistic regression analysis on the initial screening semen samples predicted a higher chance of conception for those with high levels of IgG (tail) (P = 0.006, sensitivity = 33%, specificity = 93%, correct = 75%, false positive = 33% and false negative = 24%). In the pregnant group, prednisolone caused a significant increase in grade I motility (P = 0.03). In the non-pregnant group, there was a significant increase in grade I motility (P = 0.0002), amplitude of lateral head displacement (P = 0.03), curvilinear velocity (P = 0.02) and decrease in grade IV motility (P = 0.03) following prednisolone treatment. In both groups there was suppression of the total antisperm antibody concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Infertility: Spontaneous ovulatory cycle donor insemination programme: prognostic indicators of a successful pregnancy

The effects of female and male infertility factors as well as the insemination regime on the outcome of donor insemination (DI) during 1001 spontaneous ovulatory cycles were assessed. Overall, the average monthly fecundability was 4.4% and the cumulative conception rate after nine cycles was 45%. Female DI recipients' age, nulligravidity or the presence of other infertility factors were associated with a significantly lower pregnancy rate. DI recipients of azoospermic partners had a significantly higher pregnancy rate. The likelihood of a successful pregnancy was higher when more frequent (> or = 1) inseminations were used or in association with higher cervical score and larger follicle diameter at the time of insemination. We suggest that female recipients of DI should be fully investigated before commencing DI treatment. Early resort to other methods of assisted reproduction should be considered in DI recipients aged > or = 35 years, or in younger women if they fail to conceive after nine cycles of DI. More frequent and better timing of inseminations is expected to improve the fecundability rate during spontaneous ovulatory DI cycles.

Cumulative conception and live-birth rates after in vitro fertilization with and without the use of long, short, and ultrashort regimens of the gonadotropin-releasing hormone agonist buserelin

Our purpose was to compare cumulative conception and live-birth rates after in vitro fertilization with and without the use of the long, short, and ultrashort regimens of the gonadotropin-releasing hormone agonist buserelin. Life-table analysis of conception and live-birth rates in relation to ovarian stimulation regimen used in 2893 women who had one of five stimulation regimens exclusively throughout all treatment cycles, namely, human menopausal gonadotropin with or without clomiphene citrate; follicle-stimulating hormone with or without clomiphene citrate; and long, short, and ultrashort protocols of buserelin, plus follicle-stimulating hormone or human menopausal gonadotropin; and in an additional 347 women who had been administered both human menopausal gonadotropin and follicle-stimulating hormone with or without clomiphene citrate. The cumulative conception rate and cumulative live-birth rate were significantly higher in those women treated exclusively with the long buserelin regimen (59% and 55%, respectively, after three cycles) compared with those who only had human menopausal gonadotropin or follicle-stimulating hormone with or without clomiphene citrate (39% and 29%, respectively, after three cycles) (p = 0.001 and p = 0.0001) or compared with those who had only short or ultrashort buserelin regimens (22% and 17% after two cycles) (p = 0.0001 and p = 0.005). The pregnancy failure rate in patients on the long buserelin regimen was 22.4% (95% confidence interval 14.8% to 30.0%) compared with 33.3% (95% confidence interval 29.6% to 37.0%) in those who had human menopausal gonadotropin or follicle-stimulating hormone with or without clomiphene citrate (p = 0.03). When the probabilities of first conception and first live birth were examined by treatment regimen, after we allowed for the effects of age, cause of infertility, calendar year of treatment, and treatment cycle number (with a multiple logistic regression model), it was found that, relative to human menopausal gonadotropin or follicle-stimulating hormone with or without clomiphene citrate, the odds of conceiving with the long buserelin regimen was 1.63 (95% confidence interval 1.31 to 2.03) (p < 0.001) and the odds of a live birth was 1.97 (95% confidence interval 1.53 to 2.54) (p < 0.001). Similarly, relative to short or ultrashort buserelin the odds of conceiving with long bureselin was 1.88 (95% confidence interval 1.39 to 2.55) (p < 0.001) and the odds of a live birth was 1.79 (95% confidence interval 1.25 to 2.56) (p = 0.001). Pituitary desensitization with the long protocol of buserelin significantly increases the probabilities of conception and live birth after in vitro fertilization.

Results and complications of IVF therapy

This review attempts to discuss the current efficacy of in-vitro fertilization (IVF) treatment, factors influencing IVF success rates, and complications of IVF therapy. The livebirth rate per oocyte retrieval and per embryo transfer (ET) have been among the most widely used indices of success. To determine true efficacy, success rates have to be related to patient characteristics, such as age and cause of infertility. The cumulative conception rate after specified periods of treatment provides the most useful estimate of success rate after IVF. Approaches to further improving IVF treatment in the future are discussed. Considering the ongoing scientific research in the field of assisted reproduction, it should be the challenge of the nineties to further improve IVF success rates per treatment cycle by 50-100%.

Pregnancy and birth rates of live infants after in vitro fertilization in women with and without previous in vitro fertilization pregnancies: A study of eight thousand cycles at one center

OBJECTIVE: Our aim was to compare the cumulative conception and live-birth rates after in vitro fertilization in women undergoing their first course of in vitro fertilization treatment with those in women undergoing their second course of treatment, having previously achieved an in vitro fertilization pregnancy. This study occurred in a tertiary referral-assisted conception unit. STUDY DESIGN: The cumulative conception rates obtained by life-table analysis in 4115 women having their first course of in vitro fertilization therapy (7327 treatment cycles leading to 1123 pregnancies) were compared by means of the log-rank test with those of 331 women in their second course of treatment, having previously achieved an in vitro fertilization pregnancy (561 treatment cycles leading to 138 second in vitro fertilization pregnancies). Similarly, the cumulative live birth rates of 3824 women in their first course of treatment (7136 treatment cycles leading to 732 live births) were compared with those of 105 women in their second course of treatment, having previously achieved an in vitro fertilization live birth (205 treatment cycles leading to 33 second in vitro fertilization live births). RESULTS: The cumulative conception rates and cumulative live birth rates were significantly higher in women having their second course of in vitro fertilization treatment than in those having their first course (cumulative conception rate: p = 0.0001; cumulative live birth rate, p = 0.007). After five cycles of in vitro fertilization, the cumulative conception rates and cumulative live birth rates were 49.8% (95% confidence interval, 46.3% to 53.5%) and 39.0% (95% confidence interval, 35.4% to 42.9%), respectively, in those having their first course of treatment compared with 69.9% (95% confidence interval, 57.6% to 81.3%) and 68.6% (95% confidence interval, 46.1% to 88.5%), respectively, in those having their second course. The estimated median numbers of cycles taken to achieve a pregnancy and live birth (assuming all women could potentially undergo the same number of cycles) were six and eight, respectively, in the first course of treatment compared with only three and five in the second course. CONCLUSION: Women who have achieved a previous in vitro fertilization pregnancy have significantly higher cumulative conception rate and cumulative live birth rates compared with those of women having their first course of treatment. (AM J OBSTET GYNECOL 1994;170:34-40.)

In vitro fertilization and embryo transfer for the treatment of infertility associated with polycystic ovary syndrome

To examine the outcome of treatment with IVF-ET of women with polycystic ovarian syndrome (PCOS) who failed to conceive on conventional treatment. Retrospective analysis with an age-matched control group. University hospital infertility clinic and IVF unit. PATIENTS. Sixty-eight women with PCOS who had failed to conceive on treatment with clomiphene citrate and during six ovulatory cycles on gonadotropins underwent 208 cycles of IVF-ET. An age-matched group of 68 women with a tubal mechanical factor who received 143 treatment cycles during the same period served as controls. Cumulative conception rates, the cumulative livebirth rates, and IVF-ET data were compared between the two groups. Results of treatment with and without GnRH agonist (GnRH-a) within the groups were also compared. A comparison of PCOS and mechanical factor (control) groups showed almost identical results at 6 months for cumulative conception rate (82% versus 85%) and cumulative livebirth rate (69% versus 65%). Significantly more oocytes were retrieved but a smaller percentage fertilized in PCOS, and the pregnancy rate per ET did not differ between the two groups (23% versus 26%). Treatment with GnRH-a and gonadotropins as opposed to gonadotropins alone improved the cumulative conception rate, miscarriage rate, and cumulative livebirth rate in the PCOS but not in the control group and improved fertilization rates in both groups. For patients with PCOS who fail to conceive with gonadotropin treatment, IVF-ET is a successful treatment alternative, producing results equal to those for women with a mechanical tubal factor. Better results were achieved with GnRH-a in women with PCOS but made no difference to those with a mechanical tubal factor compared with treatment with gonadotropins alone.

Ectopic pregnancy among past IUD users

The relationship between return to fertility and pregnancy outcome in women with IUD removal for planned pregnancy as well as the frequency of ectopic pregnancy among all former IUD users in comparison with the general population was studied. The cumulative conception rate in the group of women with IUD removal for planned pregnancy (n = 748) was 93.7% after 5 years, 93.4% being intrauterine and 0.3% ectopic. Rates of ectopic pregnancy in women with IUD removed for planned pregnancy were 2.7/1000 women, 3.6/1000 deliveries and 2.9/1000 pregnancies vs. 3.9, 13.4 and 5.6 in the general population. Only when the number of deliveries is used as denominator, have these differences reached statistical significance (P < 0.05). Except for bleeding/pain and PID removals (6.0 vs. 3.9), in all other groups of former IUD users the incidence of ectopic pregnancy was also lower than in the control group. From the results of this study it was concluded that former IUD users are not at an increased risk for ectopic pregnancy.

Effect of progesterone supplementation in repeat-breeder cattle on conception and plasma progesterone.

Reposital-type progesterone (75 mg/d for cows, 40 mg/d for heifers) or saline were administered to 24 Holstein cattle to assess the effects of exogenous progesterone (P) on fertility in repeat-breeders. Treatments were administered daily from day 6 to 10 after fourth, fifth and sixth insemination. Cumulative conception rate (57.1%) for the fourth through sixth insemination was affected by lactation number, service number, plasma P (4.67 ng/ml for pregnant cows vs 4.06 ng/ml for nonpregnant cows) and corpus luteum size on days 5 and 15. Plasma P concentrations were affected by day of cycle and size of corpus luteum on both ovaries on day 15. A treatment by day interaction accounted for higher plasma P in P-treated cattle than saline-treated cattle from day 5 through 15. Administration of exogenous P during early life of the corpus luteum in the repeat-breeder increased plasma P. Higher plasma P was associated with insemination success.

Low-dose gonadotrophin therapy for induction of ovulation in 100 women with polycystic ovary syndrome

Women with anovulation due to polycystic ovary syndrome are likely to develop multiple follicles during gonadotrophin therapy and therefore have a high risk of multiple pregnancy. We have developed a low-dose regimen for use in these women; 100 women with clomiphene-resistant polycystic ovary syndrome were treated. Ninety-five of the women ovulated at least once, 72% of the 401 cycles induced were ovulatory and the majority (73%) of these were uni-ovulatory. The overall cumulative conception rate was 55% at 6 months with only two multiple pregnancies. The rate of early pregnancy loss was 32%, which is similar to that reported by other groups. The prevalence of complications was low with no cases of severe hyperstimulation and less than 5% of cycles were abandoned because of development of multiple follicles. Analysis of baseline and mid-follicular luteinizing hormone levels showed that a raised baseline and/or mid-follicular luteinizing hormone level was associated with a poor response to treatment, i.e. anovulation, ovulation but no conception, or early pregnancy loss. There were no successful pregnancies in the women whose luteinizing hormone levels were persistently raised during ovulatory cycles. Low-dose gonadotrophin therapy is a safe and effective method of inducing ovulation; it is associated with a high incidence of single follicular development and a very low multiple pregnancy rate.