Positive Beta-human Chorionic Gonadotropin Research Articles

Delaying Thyroxine Until Positive Beta-Human Chorionic Gonadotropin is Safe for Patients Receiving Fertility Therapy: Applying New ATA Guidelines to Subclinical Hypothyroidism.

This study sought to examine the effect of changing TSH threshold recommendations from 2.5 to 4 mIU/L before fertility therapy on the prevalence of early gestational subclinical hypothyroidism (SCH) (TSH2 >2.5 mIU/L) and to evaluate implications on progression to clinical pregnancy (defined as detection of cardiac activity on ultrasound). A retrospective chart review was performed in an academic fertility clinic on all patients with a measured pre-treatment TSH (TSH1) and positive beta-human chorionic gonadotropin following fertility treatment. The study assessed the effect of TSH2 on ongoing pregnancy, both in patients newly diagnosed with SCH and in patients previously receiving LT4, stratified by initial TSH. Of 482 women included in the study, baseline TSH (TSH1) was <2.5 mIU/L in 333 women (69%) and 2.5-4 mIU/L in 64 women (13.2%). Eighty-five women were taking LT4 at baseline (17.6%). Among women with a TSH1 between 2.5 and 4 mIU/L, the corresponding TSH in early pregnancy (TSH2) was <2.5 mIU/L in 35 women (55%). Overall, there was no difference in progression to clinical pregnancy between women with a TSH2 of 2.5-4 mIU/L compared with women with a TSH2 <2.5 mIU/L (OR 0.70; 95% CI 0.44-1.09). Similarly, when excluding women taking LT4 at baseline, there was no difference in progression to clinical pregnancy (OR 0.90; 95% CI 0.28-2.86). Rate of progression to clinical pregnancy was equivalent between women with an early pregnancy TSH (TSH2) <2.5 and women with a TSH2 of 2.5-4.0 mIU/L. Our findings support initiating LT4 in early pregnancy, as opposed to pre-pregnancy if the TSH remains above cut-off because there does not appear to be a difference in in early pregnancy outcomes if treatment is delayed.

Outpatient endometrial aspiration: an alternative to methotrexate for pregnancy of unknown location

Pregnancies of unknown location with abnormal beta-human chorionic gonadotropin trends are frequently treated as presumed ectopic pregnancies with methotrexate. Preliminary data suggest that outpatient endometrial aspiration may be an effective tool to diagnose pregnancy location, while also sparing women exposure to methotrexate. The purpose of this study was to evaluate the utility of an endometrial sampling protocol for the diagnosis of pregnancies of unknown location after invitro fertilization. A retrospective cohort study of 14,505 autologous fresh and frozen invitro fertilization cycles from October 2007 to September 2015 was performed; 110 patients were diagnosed with pregnancy of unknown location, defined as a positive beta-human chorionic gonadotropin without ultrasound evidence of intrauterine or ectopic pregnancy and an abnormal beta-human chorionic gonadotropin trend (<53% rise or <15% fall in 2 days). These patients underwent outpatient endometrial sampling with Karman cannula aspiration. Patients with a beta-human chorionic gonadotropin decline ≥15% within 24 hours of sampling and/or villi detected on pathologic analysis were diagnosed with failing intrauterine pregnancy and had weekly beta-human chorionic gonadotropin measurements thereafter. Those patients with beta-human chorionic gonadotropin declines <15% and no villi identified were diagnosed with ectopic pregnancy and treated with intramuscular methotrexate (50 mg/m2) or laparoscopy. Across 8 years of follow up, among women with pregnancy of unknown location, failed intrauterine pregnancy was diagnosed in 46 patients (42%), and ectopic pregnancy was diagnosed in 64 patients (58%). Clinical variables that included fresh or frozen embryo transfer, day of embryo transfer, serum beta-human chorionic gonadotropin at the time of sampling, endometrial thickness, and presence of an adnexal mass were not significantly different between patients with failed intrauterine pregnancy or ectopic pregnancy. In patients with failed intrauterine pregnancy, 100% demonstrated adequate postsampling beta-human chorionic gonadotropin declines; villi were identified in just 46% (n=21 patients). Patients with failed intrauterine pregnancy had significantly shorter time to resolution (negative serum beta-human chorionic gonadotropin) after sampling compared with patients with ectopic pregnancy (12.6 vs 26.3 days; P<.001). With the use of this safe and effective protocol of endometrial aspiration with Karman cannula, a large proportion of women with pregnancy of unknown location are spared methotrexate, with a shorter time to pregnancy resolution than those who receive methotrexate.

Frozen embryo transfer prevents the detrimental effect of high estrogen on endometrium receptivity.

Objective:To investigate whether serum levels of estradiol affect reproductive outcomes of normoresponder women undergoing fresh embryo transfer (ET) versus frozen-thawed ET (FET).Material and Methods:Two hundred fifty-five normoresponder women underwent fresh ET in their first or second in vitro fertilization cycle. Ninety-two women with negative pregnacy test results underwent FET. Clinical and ongoing pregnancy rates, implantation, and live birth rates of women undergoing fresh ET versus FET were compared.Results:One hundred forty-seven (57.65%) out of the 255 normoresponder women receiving FET had positive beta-human chorionic gonadotrophin (hCG) results. The remaining 108 women had negative beta-hCG results. The clinical pregnancy rates of the fresh ET group were found as 55.69% (n=142). Ninety-two of the 108 women with failed pregnancies underwent FET; 72.83% had positive beta-hCG results (n=67), and 70.65% had clinical pregnancy (n=65). Both biochemical and clinical pregnancy rates of women undergoing FET increased significantly (p<0.012 and p<0.013, respectively). Ongoing pregnancy (60.87% vs. 52.94%) and live birth rates (59.87% vs. 48.63%) were similar in both fresh and FET groups. Serum E2 levels of women who failed to conceive were significantly higher than those women did conceive. Serum progesterone levels of women who conceived versus those that did not were similar.Conclusion:The detrimental effect of high serum estradiol levels on endometrial receptivity could be prevented by FET.

Autologous Intrauterine Platelet-Rich Plasma Instillation for Suboptimal Endometrium in Frozen Embryo Transfer Cycles: A Pilot Study.

Introduction:This pilot study was to evaluate the effectiveness of intrauterine infusion of autologous platelet-rich plasma (PRP) in infertile women undergoing frozen embryo transfer cycles with suboptimal endometrium.Material and Methods:Intrauterine instillation of autologous PRP was done in 68 women between 22 and 40 years, over 8 months, with suboptimal endometrial growth, and patients with repeated cycle cancellations, in addition to Estradiol valerate. Frozen embryo transfer was performed when the endometrium reached an optimal pattern in terms of thickness, appearance, and vascularity.Results:The mean pre-PRP endometrial thickness (ET) was 5 mm which significantly increased to 7.22 mm post-PRP. There was a significant increase in vascularity, seen by the number of vascular signals seen on Power Doppler, reaching the zones 3 and 4 of the endometrium. The positive beta Human Chorionic Gonadotropin (hCG) rate was 60.93% and the clinical pregnancy rate was 45.31%. A total of 13 women are in the second trimester, 13 are in the first trimester with a healthy intrauterine pregnancy, one patient had an ectopic gestation, three had blighted ova, two had missed abortions, and two biochemical pregnancies.Conclusion:This study suggests that the use of autologous PRP holds promise in the treatment of women with suboptimal ET and vascularity for embryo transfer. It would help to reduce the incidence of cycle cancellations and thus even help reduce the financial and psychological burden of repeated cancelled cycles.

Semen residual viral load and reproductive outcomes in HIV-infected men undergoing ICSI after extended semen preparation

The aim of this study was to evaluate the residual presence of the human immunodeficiency virus (HIV) following a triple gradient extended semen wash from ejaculates of serodiscordant couples, and analyse their reproductive outcomes after intracytoplasmic sperm injection (ICSI). For this purpose, a retrospective analysis of our database was performed in serodiscordant couples, with HIV-infected men and non-infected women, using fresh or frozen sperm with ICSI in oocytes from either the patients or donors from January 2006 to September 2013. Overall, the rate of positive HIV test after semen washing was 1.86%. The positive beta human chorionic gonadotrophin, clinical and ongoing pregnancy rates in patients with their own oocytes were 47.1%, 37.5% and 30.8%, respectively, and 58.6%, 50.8% and 39.1%, respectively, in oocyte donation cycles. To summarize, the described method of sperm washing based on triple gradient sperm selection coupled with extensive centrifugations is a highly reliable technique for HIV removal, as it provides lower than reported post-wash positive tests while maintaining high pregnancy rates in assisted reproduction cycles. Despite extensive personnel training and effectiveness of the washing protocol, post-wash HIV test on semen is recommended to identify residual positive samples.

A rare case of 46XX,t(X;11)(q24;q23.3) with premature ovarian insufficiency

Here, we report a rare case of chromosomal abnormality with translocation between bands Xq24 and 11q23.3 leading to premature ovarian insufficiency (POI). POI can occur due to various causes. Studies have shown that 10%–12% of women with POI have chromosomal abnormalities. This patient presented to us with secondary amenorrhea for the past 3 years. She had attained menarche at 13 years and had regular menstrual cycles for 9 years before suffering from secondary amenorrhea. She had no family history of POI. Her karyotype revealed 46XX,t(X;11)(q24;q23.3). Other investigations showed hypoestrogenism, raised follicle-stimulating hormone, low volume ovaries, small sized uterus, and cholelithiasis. Laparoscopic cholecystectomy was done along with pelvic laparoscopy and hysteroscopy. Sequential estrogen and progesterone was given to the patient for 3 months. Following that, in vitro fertilization with oocyte donation was done which resulted into positive beta-human chorionic gonadotropin.

Clomiphene based ovarian stimulation in a commercial donor program.

OBJECTIVE:This study was conducted to compare an extended clomiphene-based ovarian stimulation regimen with the conventional antagonist protocol in donor-recipient cycles.MATERIALS AND METHODS:A total of 170 (N) donors were stimulated between January 2013 and December 2013. Conventional antagonist protocol (group I) was employed in (n1 = 31) cycles, and clomiphene was used in (n2 = 139) donor cycles (group II). 50 mg clomiphene was given simultaneously with gonadotropins from day 2 of the cycle until the day of trigger. The analysis was performed retrospectively for oocytes retrieved, fertilization rates, cycle cancelation, blastocyst formation, and pregnancy rates. The dosages, cost, and terminal E2 (estradiol) were also compared between the two groups.RESULTS:The donor age groups were comparable in both the groups. There were no unsuccessful egg retrievals with clomiphene. The pregnancy rate (positive beta human chorionic gonadotropin) was significantly higher in the clomiphene group (odds ratio: 2.453; P = 0.02). Similarly, fertilization rate was significantly higher in the clomiphene group (59.5/50.5, P = 0.04). Eggs retrieved were similar in both groups, but the terminal E2 was significantly higher in the clomiphene group (P = 0.001). Average gonadotropin used was also significantly lower in clomiphene group (P < 0.001).CONCLUSION:Clomiphene can effectively prevent luteinizing hormone surge and limit the dose of gonadotropins thus bringing down the costs and its negative impact on the endometrium and oocyte quality.

The Role of Serum Testosterone in Early Pregnancy Outcome: A Comparison in Women With and Without Polycystic Ovary Syndrome

ObjectiveHyperandrogenic conditions in women are associated with increased rates of miscarriage. However, the specific role of maternal testosterone in early pregnancy and its association with pregnancy outcome is unknown. The purpose of this study was to compare serum testosterone levels during early pregnancy in women with and without polycystic ovary syndrome (PCOS) who either had successful pregnancies or miscarried. MethodWe collected serum samples from women attending a university-based fertility centre at the time of their first positive serum beta human chorionic gonadotropin pregnancy test. The samples were subsequently assayed for total testosterone level. We used logistical regression modelling to control for PCOS diagnosis, BMI, and age. ResultsTotal testosterone levels were available for 346 pregnancies, including 286 successful pregnancies and 78 first trimester miscarriages. We found no difference in total testosterone levels between women who subsequently had an ongoing pregnancy (mean concentration 3.6±2.6nmol/L) and women with a miscarriage (mean 3.6±2.4nmol/L). Using the Rotterdam criteria to identify women with PCOS, we also found no differences in serum testosterone between women who had ongoing pregnancies or miscarriages, either with PCOS (P=0.176) or without PCOS (P=0.561). ConclusionsOur findings show that early pregnancy testosterone levels do not predict pregnancy outcome, and they call into question the role of testosterone in causing miscarriage in populations of women with PCOS. Further research is needed to elucidate the normal progression of testosterone levels during pregnancy and to investigate further the relationship between PCOS and miscarriage.

Laparoscopic Surgery for Ovarian Pregnancy using Diathermy Hook with Conservation of Ovary: A Case Report and Literature Review.

A 31-year-old woman presented with a 7-week history of irregular vaginal bleeding without abdominal pain. She had been using the intrauterine contraceptive device (IUD) for the last 3 years. A pregnancy test was positive and subsequent serum beta human chorionic gonadotropin (β-HCG) was 4992 mIU/mL. A transvaginal ultrasound scan demonstrated an empty uterus with an associated adnexal mass but no free fluid. A right primary ovarian ectopic pregnancy was diagnosed a laparoscopy. This was managed laparoscopically using monopolar diathermy hook with conservation of the ovary and minimal blood loss. Ovarian pregnancy is rare, especially in women without the classical risk factors for tubal pregnancy, and efforts should be made to exclude ectopic pregnancy in the absence of abdominal pain in a woman of reproductive age presenting with prolonged and irregular vaginal bleeding. Methods to conserve the ovary are also encouraged in cases of ovarian pregnancy.

True Mirena failure: Twin pregnancy with Mirena in situ

Mirena levonorgestrel intrauterine system (LNG-IUS) is a very reliable method of contraception with the failure rate comparable to sterilization. We present a case of failure of the Mirena intrauterine device in situ in a woman with twin gestational sac with positive Beta Human Chorionic Gonadotropin (β HCG) within 2 years of insertion. Although LNG-IUS is one of the most effective methods of contraception, the risks of failure should always be kept in mind and the women be appropriately counseled before its use.

Effect of piroxicam administration before embryo transfer on IVF outcome: a randomized controlled trial

Two hundred women aged between 28 and 43 years, with infertility from tubal, male, endometriosis or unexplained factor were randomly allocated into treatment (100 patients) and control (100 patients) groups. On the day after oocyte retrieval, each patient began supplementation with progesterone 8% vaginal gel, once daily. The patients in the treatment group received a single oral dose of 10 mg of the non-steroidal anti-inflammatory drug piroxicam 1-2 h before embryo transfer. No statistically significant difference was found between the two groups in any of the analysed endpoints. The rate of positive beta-human chorionic gonadotrophin test per transfer was 37% in the women treated with piroxicam and 47% in controls. The clinical pregnancy rate per transfer and implantation rate were 34% and 19.2% with piroxicam, 38% and 21.9% in controls. The miscarriage rate was 11.8% and 13.2%. No beneficial effect of piroxicam on pregnancy rates was found evaluating either different infertility causes or different ages. This study shows that the administration of a single dose of piroxicam before embryo transfer has no additional effect on pregnancy outcome in patients receiving adequate doses of progesterone for luteal phase supplementation after IVF or ICSI.

P-434: Is serum progesterone post embryo transfer predictive of successful pregancy outcome?

To determine if there is a minimal progesterone value post embryo transfer that predicts successful pregnancy outcome A retrospective Study. Forty-three cycles were reviewed and data stratified by age, diagnosis, total ampules, maximum estrogen, estrogen value on HCG day, estrogen value post embryo transfer, progesterone value post embryo transfer, number of oocytes retrieved, number of embryo transfer, positive or negative serum Beta Human Chorionic Gonadotropin, and Intracytosplasmic Sperm Injection. Positive pregnancy was reported in 22 of 43 cycles with progesterone range of 7.5 to 40. With progesterone level >/= 40, positive pregnancy was seen in 62% of patients in positive pregnancy group compared to 67% of negative pregancy in the negative pregnancy group. When the progesterone value was lowered to 30, the positive pregnancy group rate increased to 82% versus 81% for negative pregancy group. There was no significant difference in post transfer progesterone level in either positive or negative pregancy group. There was no correlation of progesterone level and successful pregnancy (p > 0.05). The mean age was 36.65 and older group of recipients had significantly less chance of successful pregnancy outcome (p <0.01). No correlation seen between number of embryo transter and progesterone levels (p > 0.01). It is concluded that successful pregnancy outcome cannot be determine when using progesterone alone as a single parameter .

Successful pregnancy following transfer of embryos from oocytes with abnormal zona pellucida and cytoplasm morphology

The failed or impaired fertilization in an IVF cycle may be a result of undetected abnormalities in sperm function, poor oocyte quality, or impaired spermatozoon–oocyte interaction. Whether oocyte dysmorphisms have an impact on intracytoplasmic sperm injection (ICSI) outcome, fertilization, and implantation is controversial. A 33-year-old nulligravida female with a 2-year history of primary infertility was referred to the Toronto Centre for Advanced Reproductive Technology for infertility management. The patient underwent several cycles of ovulation induction followed by timed intercourse or intrauterine insemination without a resulting pregnancy. Following the failed insemination cycles, she proceeded to IVF. Six morphologically abnormal oocytes (including three that were cucumber-shaped) were retrieved and all injected with a single spermatozoon. Four oocytes showed normal fertilization and developed to day-3 embryos with abnormal morphology and were transferred. Two weeks after the embryo transfer, the patient had a positive beta-human chorionic gonadotrophin (β-HCG). The pregnancy was uneventful, and a healthy baby boy was delivered at 41 weeks of age by Caesarean section. Since fertilization, embryo development, and successful pregnancy was achieved in this case, it is recommend that oocytes with extreme morphological abnormalities should not be discarded as ICSI may overcome the barriers to fertilization and cleavage.

Implementing a smallpox vaccination program aboard an aircraft carrier.

To determine the feasibility of implementing a smallpox vaccination program aboard an aircraft carrier in conjunction with anthrax vaccination. Retrospective review of smallpox vaccination program conducted from January 17, 2003 to February 19, 2003. Morbidity and loss of manpower were the major endpoints. There were 5,204 sailors available for vaccination. There were 243 (4.7%) medical exemptions and 24 administrative exemptions. During the program, 4,931 sailors were vaccinated. There were five reportable complications. Three sailors had autoinoculation, one sailor had localized cellulitis, and one patient had a positive beta human chorionic gonadotropin during vaccination. None of the complications required medical evacuation. Only two sailors required time off from duty. Smallpox vaccination can be accomplished rapidly and safely aboard an aircraft carrier. There was not an increase in adverse events compared to historical data despite the close-quarter conditions. Smallpox and anthrax vaccinations can be completed simultaneously with minimal morbidity.

Stress and Anxiety Do Not Result in Pregnancy Wastage

Milad, Magdy P.; Klock, Susan C.; Moses, Scott; Chatterton, Robert Author Information

Stress and anxiety do not result in pregnancy wastage.

The association between stress and reproductive outcome is unclear. In-vitro fertilization (IVF) is psychologically stressful and has been shown to alter psychological markers such as cortisol, prolactin and progesterone. This study was designed to assess prospectively psychological and physiological markers of stress and to determine if they are related to pregnancy outcome. Forty patients were recruited from Northwestern Medical Faculty Foundation (Chicago, Illinois, USA) having obtained an initial positive beta-human chorionic gonadotrophin (HCG) concentration 13 days after IVF with uterine embryo transfer. Patients underwent psychological and hormonal testing on three separate occasions (13, 20 and 27 days after embryo transfer) early in pregnancy. All subjects were followed to delivery. An adverse outcome was defined as a miscarriage before or after cardiac activity (including vanishing twin) or a loss before 20 weeks gestation. There was no difference in age, duration of infertility, diagnosis between patients experiencing an adverse pregnancy outcome (n = 18) and those that did not (n = 22). All patients were found to have high stress levels although this did not differentiate between groups of patients. There was no difference in hormonal markers of stress between patients. In conclusion, there is little association between psychological scores and physiological stress hormone concentrations. Also, it does not appear that high levels of anxiety and stress result in an adverse pregnancy outcome.

Evidence for a Leukocyte Adhesion Factor Produced by the Early Embryo

To determine if the embryo may induce adhesive molecules needed for implantation. Determination of whether platelet rosetting around lymphocytes might occur when exposed to sera from pregnant, but not nonpregnant patients and from culture fluid from embryos but not oocytes. 90.2% of women with positive sera beta human chorionic gonadotropin (beta-hCG) levels taken at least 12 days postovulation demonstrated platelet rosette factor (PRF) vs only 18.7% when beta-hCG was negative. Using mid-luteal phase sera in women receiving hCG injection 1 wk before, 64.7% had positive PRF when serial beta-hCG levels were positive as did 100% of samples taken from in vitro fertilization (IVF) patients; however, only 15.3% were positive with negative serial hCG levels. Culture media from fertilized oocytes and embryos tested positive for PRF, but follicular fluid and media from unfertilized oocytes were negative. The early embryo secretes a factor(s) that gains access to maternal serum and promotes increased lymphocyte/platelet adhesiveness.

The use of gamete intra-Fallopian transfer with donor spennatozoa after failed donor insemination

The objective of this study was to assess the efficacy of gamete intra-Fallopian transfer (GIFT) in couples who had failed to conceive by donor insemination. The study was designed as a retrospective analysis of couples who entered the GIFT programme after 12 failed cycles of donor insemination. It took place in a comprehensive reproductive clinic with large donor insemination and in-vitro fertilization/GIFT programmes. A total of 197 patients received a total of 350 treatments from 1985 until 1992. Couples entered the GIFT programme with the routine stimulation and monitoring. The only difference was that frozen spermatozoa were used for the insemination. The main outcome measure was pregnancy, defined as a positive beta-human chorionic gonadotrophin (> 30 IU/l) at 16 days after replacement of gametes. The overall pregnancy rate achieved was 31% per cycle. Life table analysis showed a cumulative pregnancy rate of 75.4 +/- 5.7% after four cycles and 96.0 +/- 2.7% after eight cycles. It was concluded that the use of GIFT with donor spermatozoa is a highly effective treatment and should be offered to all couples who fail to conceive with donor insemination.

Low Periconceptional Maternal Serum Thymosin α1 Levels Are Associated With Blighted Pregnancies

The thymus-derived peptides, thymosin alpha 1 and thymosin beta 4, are believed to contribute to the maintenance of immune homeostasis. They are also associated with the hypothalamic-pituitary-adrenal-gonadal axis and may play a role in reproduction. Patients were recruited from a university hospital setting. Eligible candidates were 24 to 38 years old who were being seen in an ovulation induction and in vitro fertilization program. Serial maternal serum thymosin alpha 1 and beta 4 levels were assayed preconceptual and then twice in the first trimester by ELISA in 28 women with known ovulation dates who successfully conceived as demonstrated by positive serum beta human chorionic gonadotropin (hCG). Thymosin alpha 1 and beta 4 serum levels for viable pregnancies (group I; N = 19) were compared to pregnancies that aborted (group II; N = 9) using repeated measures of multivariate analysis of variance (MANOVA). Periconceptional (preovulatory and early pregnancy) thymosin alpha 1 and beta 4 values between groups I and II were compared using repeated measure one-way ANOVA. Thymosin alpha 1 levels from pregnancies that remained viable were significantly higher than those from pregnancies that spontaneously aborted. Preovulation thymosin alpha 1 levels also tended to be lower in pregnancies that subsequently aborted. Thymosin beta 4 levels were similar between the two groups. Decreased maternal serum thymosin alpha 1 levels may be associated with periconceptional endocrine and/or immune disturbances preceding miscarriage.

Controlled preparation of the endometrium with exogenous oestradiol and progesterone: a novel regimen not using a gonadotrophin-releasing hormone agonist.

In women having inactive ovaries, controlled preparation of the endometrium has been achieved with exogenous oestradiol and progesterone. We report on the feasibility and practicality of using a similar regimen for timing transfers of cryopreserved embryos in women whose ovaries have not been suppressed. A total of 91 women having cryopreserved embryos from previous in-vitro fertilization (IVF) attempts received 4 mg/day of oestradiol valerate, starting on cycle day 1 of spontaneous (n = 85) or induced (n = 6) menstruation. A single blood sample was obtained on cycle day 14 for the measurement of plasma progesterone, oestradiol and luteinizing hormone (LH). Vaginal administration of micronized progesterone (300 mg/day) was started on day 15. Cryopreserved embryos were transferred on day 17 or 18 provided that day 14 plasma progesterone remained < or = 0.5 ng/ml, thereby confirming the absence of spontaneous ovulation prior to the administration of exogenous progesterone. Out of 91 cycles studied, plasma progesterone was found to be elevated (> 1 ng/ml) in only three (3.2%). Of the 88 scheduled transfers, 31 did not take place because no embryo survived thawing. In the remaining 57 cycles, 116 embryos were transferred resulting in 10 pregnancies, giving pregnancy and embryo implantation rates of 17.5 and 8.6% respectively. When a positive beta human chorionic gonadotrophin (HCG) titre was obtained, supplementation with oral oestradiol and vaginal progesterone was continued until placental autonomy was achieved. Of the 10 pregnancies, five (50%) were lost during the first trimester (biochemical, n = 1; miscarriage, n = 3; ectopic, n = 1).(ABSTRACT TRUNCATED AT 250 WORDS)