Cycle Fecundity Rates Research Articles

Fenbendazole treatment is associated with increased cycle fecundity rate in subfertile baboons

Fenbendazole treatment is associated with increased cycle fecundity rate in subfertile baboons

Altered expression of hormone receptor, integrin β3 and pinopode in the endometrium of luteal phase defect women

Objective: To invistigate estrogen receptor (ER), progesterone receptor (PR), integrin β3, and pinopode expression in luteal phase deficiency (LPD) women.Methods: There were 52 nulligravidas consecutive infertile patients undergoing a routine assistant reproduction consultation included in this study. An endometrial biopsy sample was randomly obtained between days 4 and 10 of the luteal phase. Endometrial morphology was examined with scanning electron microscopy. Expressions of ER, PR, integrin β3 were determined in the endometrium of LPD patients with immunohistochemistry.Results: The incidence of LPD was 15.3% (8/52) in this study. On day luteinizing hormone (LH) surge + 9∼LH + 10, noted regressing pinopodes resembling a day LH + 7∼LH + 8 in the endometrium of the control group. The expressions of ER and PR in glandular epithelium were significantly increased in endometrium of LPD than that in the control group (p < 0.05). In contrast, there was a statistically significant decrease expression of the integrin β3 in women from the group of LPD (p < 0.05).Conclusion: The altered expression of ER and PR may be associated with the expression variation of integrin and pinopode formation in endometrium of LPD women. This alteration may imply the association of low rates of cycle fecundity and high rates of embryonic loss in LPD women.

Effects of anti-TNF-mAb treatment on pregnancy in baboons with induced endometriosis

Hormonal suppressive therapy is not effective for endometriosis-associated subfertility and can even prevent conception. Medical inhibition of TNFalpha, which has been shown to improve conception, is effective in the prevention and treatment of endometriosis in baboons. Prospective, placebo-controlled fertility trial. Animal research and laboratory facility. Sixteen adult female baboons with induced endometriosis. All animals received a single IV dose of the anti-TNFalpha monoclonal antibody c5N (n = 9) or placebo (n = 7) at four different time points. The animals were then exposed to timed mating up to nine completed cycles or until pregnancy was achieved. Pregnancy rate (PR), cycle fecundity rate (CFR), time to pregnancy (TTP), and cumulative pregnancy rate (CPR). Inhibition of TNFalpha did not result in a significant improvement in PR (100% c5N vs. 86% placebo), CFR (18% c5N vs. 30% placebo), median TTP (5 cycles c5N vs. 2 cycles placebo), or CPR (100% c5N vs. 80% placebo). The duration of the menstrual cycle was unchanged in both groups before and after the study. Two nonpregnant baboons in the c5N-group died during the study. Medical inhibition of TNFalpha allowed for normal conception but did not improve fecundity in baboons with induced endometriosis when compared with placebo. Larger studies with clinically available TNFalpha blockers in baboons with moderate to severe endometriosis are needed to further test the potential of these agents in the prevention or treatment of endometriosis-associated subfertility.

Laparoscopic surgery for endometriosis: a long-term follow-up.

To investigate if complete resolution of endometriosis by laparoscopic surgery is beneficial to postoperative fecundity, dysmenorrhea and dyspareunia. An observational comparative study on the outcome of laparoscopic surgery. Laparoscopically-treated symptomatic women with endometriosis (total n = 236); complete (n = 185) and incomplete (n = 51) surgery groups. Postoperative fecundity and symptom reduction. With whole populations, no surgical completeness-related difference was observed in cumulative pregnancy rates during the postoperative days 0-400 (cycle fecundity rate = 0.0319). Further accumulation of pregnant cases was followed in the complete surgery group (final cumulative pregnancy rate = 80%), but not in the counterpart group (p = 0.003). The similar result was obtained when only r-AFS classification stages III and IV were compared (p = 0.007). No r-AFS stage-related difference was observed in cumulative pregnancy rates when only patients of complete surgery were selected for comparison. The surgery reduced dysmenorrhea (84.7%) and dyspareunia (80.0%). Laparoscopic conservative surgery for endometriosis, especially when it is complete, increases fecundity and reduces disease-related symptoms, such as dysmenorrhea and dyspareunia.

Elevated Seminal (SP) Plasma Lead (Pb2+) Levels Result in Significant Impairment of Human Sperm Function and Reduced Artificial Insemination (AI) Cycle Fecundity Rates ( f)

Objectives: Under an IRB approved protocol, 2-3 blood plasma (BP) and 2-9 SP specimens were collected over a six month period from AI semen donors (n=14) and from an unselected population (n=13) answering an advertisement for research participation. The Pb2+ levels in these specimens had low (<9.5%) intra-male variation but varied between men over a wide range (e.g., <10 μg/L to ∼1200 μg/L). Pb2+ in BP and SP were positively correlated (Spearman correlation [SC], r=0.9, p<0.0001). Comparable BP/SP Pb2+ levels were previously seen in IVF patients, whose increased Pb2+ levels: [1] were negatively correlated with conventional insemination fertilization rates (SC, n=89, r=−0.6, P<0.0001), and [2] were unrelated to serum FSH, LH or testosterone levels. Preliminary findings also suggested that Pb2+ levels and f were negatively related (n=3, SP Pb2+ <250 μg/L, f >16% vs. n=2, SP Pb2+ >700 μg/L, f <6%; t-test, P<0.004). Therefore, the purpose of this study was to determine if increased Pb2+ levels were related to levels of other toxic metals, to decreased expression of sperm biomarkers for high IVF fertilization rates, and to f. Design: A double-blind study of cadmium (Cd2+) levels, sperm function and f (in 341 AI attempts) in specimens previously examined for Pb2+ content. Metal ion effects were modeled in vitro by exposure of fertile donor sperm (n=24) under capacitating conditions to increasing doses of exogenous Pb2+ (0–5180 μg/L). Materials and Methods: Cd2+ in BP and SP was assayed by graphite furnace atomic absorption spectroscopy. WHO (1992) semen parameters were recorded for fresh semen. Motile sperm populations were obtained from frozen/thawed semen by Percoll density gradient centrifugation and were examined for surface expression of mannose (Man) receptors (MR) and non-nuclear progesterone (P) receptors (NNPR), spontaneous and agonist (free Man and P)-stimulated acrosome reactions (AR). Results were compared using SC and repeated measures analysis of variance (RMANOVA) models. Results: BP and SP Cd2+ levels were more tightly clustered than Pb2+ (range, 0.081 μg/L to 0.161 μg/L). Pb2+ and Cd2+ in BP and SP were positively correlated (SC, respectively, n=11, r=0.7, P<0.01 and n=13, r=0.7, P<0.007). SP Pb2+ levels and sperm count, motility, percentage normal morphology and NNPR were not related. In contrast, significant inverse relationships existed between SP Pb2+ levels and MR (SC, n=12, r=−0.5, P<0.007), Man AR (SC, n=15, r=−0.5, P<0.04) and P AR (SC, n=26, r=−0.4, P<0.03). SP Pb2+ and spontaneous AR were positively correlated (SC, n=16, r=0.6, P<0.01). SP Pb2+ levels and f showed a strong inverse relationship (SC, n=24, r=−0.6, P<0.02). In vitro exposure of fertile donor sperm to exogenous Pb2+ resulted in a dose-dependent decrease in MR (RMANOVA, P<0.01), Man AR (RMANOVA, P<0.0008) and a dose-dependent increase in spontaneous AR (RMANOVA, P<0.0007). Conclusions: SP Pb2+ in subjects studied are representative of the general population. Within the AI group, selected for normal WHO semen parameters, donors with high SP Pb2+ had significantly lower fertility. The correlation between Cd2+ and Pb2+ suggests other metal toxicants may play a role. But in vitro modeling shows Pb2+ alone is sufficient to induce the same characteristics (increased spontaneous AR, decreased MR, decreased agonist-induced AR) in fertile sperm as seen in vivo in subjects with high SP Pb2+. We suggest that potential donors be screened for Pb2+ levels and sperm biomarker expression prior to acceptance into an AI program. These methods may also prove useful in directing ART patients to conventional IVF or to ICSI. (Support: NIH Grant No. ES 06100 to S.B.)

Subcutaneous human menopausal gonadotropin administration for controlled ovarian hyperstimulation with intrauterine insemination cycles

Objective: This study was undertaken to determine the feasibility of administering human menopausal gonadotropin subcutaneously for controlled ovarian hyperstimulation with intrauterine insemination. Study Design: This was a prospective nonrandomized matched-group comparison. Study patients (n = 25) undergoing controlled ovarian hyperstimulation with intrauterine insemination infertility treatment between June 1998 and March 1999 self-administered human menopausal gonadotropin subcutaneously for ovulation induction. Cycles (n = 39) were analyzed for duration of human menopausal gonadotropin treatment, total number of ampules of human menopausal gonadotropin used, peak serum estradiol level, number of mature follicles (≥15 mm), cycle fecundity, and acceptability of the subcutaneous route of human menopausal gonadotropin administration. Age-matched historical control subjects who followed the same protocol except for the route of human menopausal gonadotropin administration, which was instead intramuscular, were used for comparison. Results: Study and control cycles did not differ with respect to duration of human menopausal gonadotropin treatment (7.49 vs 8.18 d), total number of ampules of human menopausal gonadotropin used (17.44 vs 19.55), peak serum estradiol level (881 vs 769 pg/mL), number of mature follicles (≥15 mm; 3.39 vs 2.92), or cycle fecundity rate (15.4% vs 17.9%). Two study patients were switched from subcutaneous to intramuscular administration because of minor local injection site reactions. Conclusion: Subcutaneous human menopausal gonadotropin administration for controlled ovarian hyperstimulation with intrauterine insemination treatment cycles was generally well tolerated and yielded stimulation parameters and pregnancy rates similar to those associated with the intramuscular route. Patients subjectively preferred subcutaneous human menopausal gonadotropin administration because of the ability to self-administer the injections, the use of a smaller injection needle, and reduced muscular pain at the injection site. (Am J Obstet Gynecol 2000;182:1421-6.)

A randomized prospective study comparing pregnancy rates after clomiphene citrate and human menopausal gonadotropin before intrauterine insemination

Objective: To determine whether hMG offers an advantage over clomiphene citrate (CC) in achieving pregnancy after IUI with husband’s sperm. Design: Randomized prospective trial. Setting: Infertility patients in a university teaching hospital. Patient(s): Fifty-eight women under 39 years old undergoing ovulation induction before IUI. Intervention(s): The women were assigned randomly to one of two treatment groups. Patients in group I (CCHH) received CC for the first two cycles and hMG for the last two cycles. Patients in group II (HHCC) received hMG for the first two cycles and CC for the last two cycles. Main Outcome Measure(s): Cycle fecundity rates for the two treatment modalities were compared statistically with use of life-table analysis. Result(s): Of the 174 cycles studied, overall cycle fecundity rate was 11.11 (9 of 81 cycles) in the CCHH group and 10.75 (10 of 93 cycles) in the HHCC group. The difference was not statistically significant. The cycle fecundity rate was 14.44% (13 of 90 cycles) for cycles with CC and 7.14% (6 of 84) with hMG. The difference was not statistically significant. Conclusion(s): These data suggest that CC is an effective alternative to hMG in the population examined.

A randomized comparison of the methods of sperm preparation for intrauterine insemination

Objective: To compare the effectiveness of three methods of sperm preparation for IUI during superovulation of infertile women. Design: Randomized assignment of one of three sperm preparation methods. Setting: University infertility practice. Patient(s): Infertile couples undergoing superovulation and IUI. Intervention(s): The method of preparation of sperm for IUI during superovulation was assigned randomly to double centrifugation, multiple-tube swim-up, or Percoll density gradient. Main Outcome Measure(s): Total number and percent recovery of motile sperm, percent of recovered sperm with normal morphology, and cycle fecundity. Result(s): No method of sperm preparation provided better cycle fecundity than the others despite differences in sperm recovery. Conclusion(s): Double centrifugation, multiple-tube swim-up, and Percoll density gradient sperm preparation for IUI yield similar cycle fecundity rates.

Comparison of low-technology and high-technology monitoring of clomiphene citrate ovulation induction

Objective: To determine whether newer monitoring techniques, including urinary detection of the LH surge and vaginal ultrasound, offer an advantage over basal body temperature (BBT) charts alone in achieving pregnancy using clomiphene citrate (CC). Design: Randomized clinical trial. Setting: Infertility patients in an academic research environment. Patient(s): Forty-five women undergoing ovulation induction with CC. Intervention(s): The women were assigned randomly to receive either low- or high-technology ovulation monitoring for a total of 3 ovulatory cycles. Both groups were followed with BBT charts. The high-technology group also was monitored with urinary LH kits and vaginal ultrasound. Main Outcome Measure(s): Cycle fecundity rates for each technique were compared statistically with use of life-table analysis. Result(s): Forty-five patients were studied during a total of 134 cycles. The overall cycle fecundity rate was 8%, 10% (8 of 81 cycles) for the low-technology monitoring group and 6% (3 of 53 cycles) for the high-technology monitoring group. These rates were not statistically significant when evaluated by Fisher’s exact test ( P = .53) or when using life-table analysis and a log-rank test ( P = .48). Conclusion(s): These data suggest that, for initial attempts at ovulation induction with CC in unselected patients, high-technology monitoring of ovulation offers no increase in fecundity over low-technology monitoring.

Intrauterine insemination after ovarian stimulation with clomiphene citrate: predictive potential of inseminating motile count and sperm morphology.

This retrospective study aimed to evaluate the prognostic value of the inseminating motile count (IMC) and sperm morphology (using strict criteria) on success rates after homologous intrauterine insemination (IUI) combined with clomiphene citrate (CC) stimulation. A total of 373 couples underwent 792 IUI cycles in a predominantly (87.4%) male subfertility group. The overall cycle fecundity (CF) and baby take-home rate (BTH) was 14.6 and 9.9% respectively. The cumulative CF and BTH (per couple) after three cycles were 30.6 and 21.1% respectively. Overall, sperm morphology and IMC were of no prognostic value using receiver operating characteristic (ROC) curve analysis, but after classifying the study population into different subgroups according to IMC, sperm morphology turned out to be a valuable prognostic parameter in subgroup 1, i.e. IMC <1 x 10(6). In this subgroup, no pregnancies were seen when the morphology score was <4% and the mean value of sperm morphology was significantly different in the pregnant (8.3%) versus non-pregnant group (5.0%; P <0.05). The cumulative CF and BTH after three IUI cycles were comparable for all couples with the exception of those cases in which the IMC was <1 x 10(6) with a morphology score of <4% normal forms. We recorded only two twin pregnancies (2.5%) and no moderate or severe ovarian hyperstimulation syndrome. We conclude that in a selected group of patients without CC resistance and normal ovarian response following CC stimulation [maximum of three follicles with a diameter of >16 mm at the time of administration of human chorionic gonadotrophin (HCG)], IUI combined with CC-HCG can be offered as a very safe and non-expensive first-line treatment, at least with an IMC of >1 x 10(6) spermatozoa. In cases with <1 x 10(6) spermatozoa, CC-IUI remains important as a first-choice therapy provided the morphology score is > or =4%.

Pregnancy and birth rates after oocyte donation

Objective: To determine accumulated conception and live birth rates in ovum donation. Design: Retrospective study from a computer database. Pregnancies with one gestational sac observed by ultrasound have been included as conceptional cycles and pregnancies that resulted in one live child were recorded for the analysis of the live birth rates. Life table analysis was applied. Setting: Oocyte donation program at the Instituto Valenciano de Infertilidad. Patient(s): Three hundred ninety-seven recipients undergoing a total of 627 ETs were analyzed. Intervention(s): Ovarian stimulation and ovum pick-up in donors. Uterine ET in recipients after appropriate exogenous steroid replacement. Main Outcome Measurement(s): Accumulated and estimated (95% confidence intervals [CI]) conception and live birth rates in the oocyte donation program as well as considering age and cause of infertility of the recipients. Result(s): Pregnancy rate after one cycle was 53.4% (CI 50.9% to 55.9%), with a delivery rate of 42.6% (CI 40.1% to 45.1%). Accumulated pregnancy rate increased up to 94.8% (CI 90.6% to 99.0%) after four transfers. Similarly, live birth rates reached 88.7% (CI 88.1% to 89.3%) after four attempts of ET by ovum donation. Cycle fecundity rates were maintained at approximately 50% after each attempt. Implantation rate was 18.3% (430/2,340 replaced embryos). Age and cause of entering the program did not influence the overall results of ovum donation. Conclusion(s): Oocyte donation is a successful treatment modality for infertile couples that offers even higher success rates than natural conception. No difference in cumulative pregnancy rate was observed regardless of recipient age, indication for oocyte donation, or number of cycles attempted.

Ovulation induction combined with intrauterine insemination in women 40 years of age and older: is it worthwhile?

The use of ovulation induction combined with intrauterine insemination (IUI) as a treatment for subfertility in women with patent Fallopian tubes has increased in recent years. Little is known regarding the efficacy of this treatment in women aged >/=40 years. We reviewed our data in our ovulation induction with IUI programme for 168 consecutive patients aged >/=40 years undergoing a total of 469 cycles of treatment. Either sequential clomiphene citrate and human menopausal gonadotrophins or daily gonadotrophins were utilized along with timed IUI insemination. In 402 completed cycles, 28 clinical pregnancies occurred. The pregnancy loss rate was 34.4%. The overall ongoing/viable pregnancy rates per initiated and completed cycles were 4.47 and 5.22% respectively. No viable pregnancies occurred in 136 cycles in women aged >/=43 years. The ongoing/variable cycle fecundity rates for women aged 40, 41, and 42 years were 9.6, 5.2, and 2.4% per cycle respectively. When utilized in women aged >=40 years, ovulation induction with IUI is most likely to result in successful pregnancy in women 40-42 years of age. Women >/=43 years should consider other alternatives such as adoption or egg donation.

Success of intrauterine insemination using cryopreserved donor sperm is related to the age of the woman and the number of preovulatory follicles.

Our objective was to assess parameters associated with a successful outcome of intrauterine insemination (IUI) using cryopreserved donor sperm. We analyzed 750 consecutive donor IUI cycles undertaken by 363 women in an assisted conception clinic. The main outcome measure was clinical pregnancy. IUI was performed in 94.7% of the 750 IUI treatment cycles commenced and 180 clinical pregnancies occurred. The clinical pregnancy rate per cycle was 26.4%. The rate was significantly related to the patient's age (30.5% for age < or = 35 years and 18.1% for age > 35 years; P < 0.006) and whether there was one or more than one preovulatory follicles [20.9, 34.4, and 31.5% for one, two, and three or four follicles with a mean diameter of 14 or more mm at the time of human chorionic gonadotropin (hCG) administration; P = 0.006]. Two to four preovulatory follicles were present in 12.6% of the natural cycles, 43.6% of clomiphene citrate or tamoxifen, and 59.9% of gonadotropin stimulated cycles. The difference in the number of preovulatory follicles between stimulated and unstimulated cycles was highly significant (P < 0.0001). Pregnancy rates were 29.9% in gonadotropin-stimulated cycles, 23.6% in clomiphene citrate- or tamoxifen-stimulated cycles, 23.6% in clomiphene and 20.1% in unstimulated cycles. The difference in pregnancy rates between gonadotropin-stimulated and natural cycles was significant (P = 0.038). Cycle fecundity rates were not significantly affected by the number of previous treatment cycles, duration of infertility, gravidity and parity of the patient, presence of a spontaneous luteinizing hormone (LH) surge before the administration of hCG, or number of motile sperm in the insemination specimen. Success of IUI using cryopreserved donor sperm is related to the age of the women and whether there is one or more than one preovulatory follicles.

A comparative prospective study of conventional regimen with chronic low-dose administration of follicle-stimulating hormone for anovulation associated with polycystic ovary syndrome

To compare efficiency of conventional and chronic low-dose regimens for treatment of anovulation associated with polycystic ovary syndrome (PCOS). Fifty participants divided into two equal groups. The first group was treated with urinary human FSH using a conventional stepwise protocol and the second group was treated with a regimen of chronic low-dose and small incremental rises with urinary human FSH or with recombinant human FSH for a maximum of three cycles. Tertiary referral university hospital fertility unit. Fifty infertile women with clomiphene citrate-resistant anovulation associated with PCOS. Pattern of follicular development, amount of FSH required, serum E2 concentrations, cycle fecundity, cumulative conception, and live birth rates. Multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) rates. Compared with the conventional dose protocol, the chronic low-dose regimen yielded slightly improved pregnancy rates (40% versus 24%) while completely avoiding OHSS and multiple pregnancies, which were prevalent (11% and 33%, respectively) with conventional therapy. Monofollicular development was induced in 74% versus 27% of cycles, and the total number of follicles > 16 mm and E2 concentrations were half those observed on conventional therapy. For women with PCOS, a chronic low-dose regimen of FSH eliminated complications of OHSS and multiple pregnancies while maintaining a satisfactory pregnancy rate. This modality, thus, has distinct advantages and could well replace conventional gonadotropin therapy for these patients.

Donor insemination and human immunodeficiency virus: A risk/benefit analysis

In 1988 the American Fertility Society revised its guidelines for the use of semen in donor insemination by stating that “the use of fresh semen for donor insemination is no longer warranted.” Although the consequences of this recommendation include an approximate doubling of the patient's cost of treatment, a 50% reduction in both cycle fecundity and 3-month life-table pregnancy rates, a reduction in the number of pregnancies because of patient dropout, and an ethically troubling increase in phyisican income as a direct result of the diminished efficacy of treatment, an analysis of the risk of transmission of human immunodeficiency virus through donor insemination has not been presented. All available data suggest that neither safety nor efficacy need be sacrificed in the current practice of donor insemination by offering patients the choice of appropriately screened fresh or frozen sperm. (AM J Obstet Gynecol 1994;170:1692-8.)

Donor insemination and human immunodeficiency virus: A risk/benefit analysis

In 1988 the American Fertility Society revised its guidelines for the use of semen in donor insemination by stating that “the use of fresh semen for donor insemination is no longer warranted.” Although the consequences of this recommendation include an approximate doubling of the patient's cost of treatment, a 50% reduction in both cycle fecundity and 3-month life-table pregnancy rates, a reduction in the number of pregnancies because of patient dropout, and an ethically troubling increase in phyisican income as a direct result of the diminished efficacy of treatment, an analysis of the risk of transmission of human immunodeficiency virus through donor insemination has not been presented. All available data suggest that neither safety nor efficacy need be sacrificed in the current practice of donor insemination by offering patients the choice of appropriately screened fresh or frozen sperm. In 1988 the American Fertility Society revised its guidelines for the use of semen in donor insemination by stating that “the use of fresh semen for donor insemination is no longer warranted.” Although the consequences of this recommendation include an approximate doubling of the patient's cost of treatment, a 50% reduction in both cycle fecundity and 3-month life-table pregnancy rates, a reduction in the number of pregnancies because of patient dropout, and an ethically troubling increase in phyisican income as a direct result of the diminished efficacy of treatment, an analysis of the risk of transmission of human immunodeficiency virus through donor insemination has not been presented. All available data suggest that neither safety nor efficacy need be sacrificed in the current practice of donor insemination by offering patients the choice of appropriately screened fresh or frozen sperm.

Comparison of intracervical, intrauterine, and intratubal techniques for donor insemination

To compare the efficacy of intracervical insemination (ICI), intrauterine insemination (IUI), and a combination of intratubal and intrauterine insemination (ITI/IUI) for donor insemination. Prospective randomized clinical trial. The University of Michigan donor insemination program. Forty-one women undergoing donor insemination with cryopreserved sperm for either isolated male factor or male factor plus ovulatory dysfunction corrected by clomiphene citrate. Each patient was randomly assigned to receive each of the three insemination techniques in consecutive cycles until pregnancy occurred or the patient dropped from the study. Cycle fecundity rates were compared using the chi 2 test, and cumulative pregnancy rates (PRs) determined by life table analysis were compared using a log-rank test. Cycle fecundity rate was significantly higher for IUI (18.3%) than for ICI (3.9%) or ITI/IUI (7.3%). By life table analysis, the cumulative PR for IUI was significantly higher than for ICI, but the PR for ITI/IUI was not. For donor insemination with cryopreserved sperm, IUI increases cycle fecundity compared with ICI. The addition of ITI to IUI, however, interferes with the apparent beneficial effect of IUI alone.

The effects of spontaneous luteinizing hormone surges on superovulatory cycles

To determine the effect of a spontaneous luteinizing hormone (LH) surge on the cycle fecundity during superovulation induction. Superovulatory cycles of patients with various diagnoses are retrospectively compared. Reproductive Endocrinology Outpatient Clinic. A total of 1,185 superovulatory cycles from July 1, 1982 until November 1, 1991 are compared. The probability of achieving a pregnancy per treatment cycle. Patients with unexplained infertility and hyperprolactinemia were more likely to have a spontaneous LH surge during superovulation than patients with either endometriosis or polycystic ovarian disease. However, the cycle fecundity rate did not differ whether or not an LH surge occurred, regardless of the diagnosis. Spontaneous onset of an LH surge during superovulation induction does not influence the chances for pregnancy.

Superovulation with human menopausal gonadotropins in the treatment of infertility associated with minimal or mild endometriosis: a controlled randomized study

To determine the efficacy of superovulation with buserelin acetate, human menopausal gonadotropins (hMG), and human chorionic gonadotropin (hCG) in the treatment of infertility associated with minimal or mild endometriosis. Prospective, randomized, controlled study. Forty-nine infertile women with a laparoscopic diagnosis of endometriosis stage I (n = 29) or II (n = 20) according to the revised American Fertility Society classification, randomly assigned to three superovulation cycles (n = 24) or 6 months' expectant management (n = 25). Cycle fecundity rates and cumulative pregnancy rates (CPR) in the two groups. Nine pregnancies were obtained in the superovulation-treated patients and six in the nontreated ones. The cycle fecundity rates and CPR were 0.15% and 37.4% after three superovulation cycles and 0.045% and 24% after 6 months of expectant management (P less than 0.05 and P = not significant, respectively). The women who did not achieve a pregnancy after three cycles of superovulation were followed for a total of 50 months during which no therapy was given. One pregnancy started in this period (cycle fecundity rate = 0.020). One spontaneous abortion occurred in each group. Three treated patients had multiple pregnancies, and four had ovarian hyperstimulation syndrome. Superovulation seems to be associated with a better cycle fecundity rate but not a better CPR than expectant management in infertile women with endometriosis stages I and II. The efficacy and side effects of this therapeutic approach should be evaluated in larger series.

Intrauterine insemination outperforms intracervical insemination in a randomized, controlled study with frozen, donor semen

To assess the efficacy of intrauterine insemination (IUI) in a donor insemination program. Prospective randomized clinical trial. Donor insemination program. Women undergoing insemination were randomly assigned to receive either IUI or intracervical insemination for a maximum of six cycles. None. Cycle fecundity rates between the two routes were compared. The monthly fecundity rate for intracervical insemination was 5.1% compared with 23% by IUI. By life table analysis, pregnancy rates for IUI were significantly higher than intracervical insemination (P = 0.02). Intrauterine insemination with quarantined donor sperm is superior to intracervical insemination.