Pregnancy Rates In IVF Cycles Research Articles

Hypoandrogenism in association with diminished functional ovarian reserve

Is diminished functional ovarian reserve (DFOR) associated with low androgen levels? Low androgen levels are associated with DFOR at all ages. Androgen supplementation via dehydroepiandrosterone (DHEA) has been reported to improve functional ovarian reserve (FOR); pregnancy rates in IVF cycles are associated with how well DHEA converts to testosterone (T); and androgen effects through the androgen receptor have been demonstrated in mice to beneficially affect early stages of follicle maturation. In a controlled cohort study we investigated consecutive women presenting to our center with two forms of DFOR, premature ovarian aging/occult primary ovarian insufficiency (POA/OPOI) and physiologic diminished ovarian reserve (DOR). As controls for POA/OPOI patients, infertile women with normal age-specific FOR were recruited. The study involved 140 women with POA/OPOI, defined as age <38 years and abnormally low FOR by age-specific FSH and/or anti-Müllerian hormone (AMH), 166 women with DOR, defined as women age >40 years. Forty-nine control patients <38 years demonstrated normal FOR by FSH and/or AMH. In all three patient groups dehydroepiandrosterone (DHEA), DHEA-sulfate (DHEAS), total testosterone (TT) and free testosterone (FT) at the time of initial presentation to our fertility center were assessed. In a small subgroup of women early morning cortisol levels were also assessed. DHEAS marginally varied between the three groups (P = 0.04), with older women with DOR actually demonstrating higher levels than controls (P = 0.03). TT differed between the three groups more profoundly (P = 0.005), with women with POA/OPOI demonstrating significantly lower levels than controls (P = 0.009). Adjustment for body mass index, age and race in principle maintained observed differences in TT between groups, while adjustment for FMR1 (fragile X mental retardation 1) genotypes/sub-genotypes eliminated all differences. All three patient groups demonstrated low morning cortisol levels. While results support lower androgen levels in women with DOR, and even more so in women with POA/OPOI, presented data should be viewed as preliminary, considering the known variability of androgen levels and the small number of women in whom morning cortisol levels were available. Especially at young ages DFOR appears associated with significant hypoandrogenism (low T) in comparison with young control patients with normal FOR, raising the question whether this hypoandrogenism originates in adrenals or ovaries. POA/OPOI, thus, phenotypically mimics the polycystic ovary syndrome, where similar questions arise, though in regard to hyperandrogenism. This research was supported by the Foundation for Reproductive Medicine, a not-for-profit medical research foundation and intramural funds from the Center for Human Reproduction. N.G. and D.H.B are members of the Board of the Foundation for Reproductive Medicine. N.G., A.W. and D.H.B. received research support, lecture fees and travel support from a variety of pharmaceutical and medical device companies, none in any way related to the issues discussed in this manuscript. N.G. and D.H.B. are listed as co-inventors on two, already granted US user patents, which claim therapeutic benefits from DHEA supplementation in women with DFOR and DOR: both authors are also listed on additional pending patents in regard to DHEA supplementation and on pending patents, claiming diagnostic and therapeutic benefits from the determination of CGG repeats on the FMR1 gene. N.G. is the owner of the Center for Human Reproduction, where this research was performed.

Report of results obtained in 2,934 women using donor sperm: donor insemination versus in vitro fertilization according to indication

To demonstrate that the use of donor sperm leads to varying outcome rates and that its use has evolved. Retrospective observational cohort study. University-affiliated private IVF setting. Women (2,934) undergoing donor insemination (DI) or IVF with donor sperm (IVF-D). None. We evaluated the distribution of the clinical indications for the use of donated sperm, studying the reproductive outcome. A total of 1,663 DI (57%) and 1,271 IVF-D (43%) were performed. There were significant differences in the indications for the use of donated sperm (DI vs. IVF-D). Regarding pregnancy rates (PR), cases of nonobstructive azoospermia presented the highest rate (29.1%), whereas cases of intracytoplasmic sperm injection (ICSI) failures and single women showed rates of 27.6% and 22.6%, respectively. Meanwhile, patients with ICSI failures achieved the highest PRs in IVF cycles (48.7%), whereas nonobstructive azoospermia and single women showed rates of 42.0% and 38.2%, respectively. There have been significant increases in the use of donated sperm in single women. Single women, which also represented the oldest group, show a lower probability of achieving pregnancy, and thus represent a subfertile population. Associated factors could include advanced maternal age.

In patients with high AMH level, IVF outcome by GnRH agonist protocol is higher than antagonist protocol

Anti-Müllerian hormone (AMH) has been suggested as a marker of ovarian reserved and predictor of ovarian response to controlled ovarian hyperstimulation (COH). The aim of this study was compared IVF outcome of COH protocols using GnRH agonist vs.GnRH antagonist in women according to serum AMH level. Retrospective study. The study included 420 cycles between June 2010 and March 2011 in IVF cycles, except for PCOD patients, controlled ovarian hyperstimularion were per formed with GnRH agonist long protocol(n = 158) and GnRH antagonist short protocol(n = 262). Excessive response to stimulation was defines as requirement for freezing of all embryos (‘Freeze all'). The patients were divided into three groups according to serum AMH level(ng/ml): A(<2, n = 113), B(2≤ <5, n = 173), C(≥5, n = 134). In each group, we compared pregnancy rates in GnRH agonist and GnRH antagonist cycles. The 420 cycles of IVF performed during the study period in 185 pregnancies (44.0%), 16 ‘Freeze all’ (5.9%). The pregnancy rates (23.9%(27/113) vs. 43.5%(73/173) vs. C-64.3%(85/143)) and ‘freeze all’ rates (0%(0/113) vs. 2.9%(5/173)vs. C-7.6%(11/143))were increased according to serum AMH level (P<0.01). In group A and B GnRH antagonist protocol had similar pregnancy rates as compared with GnRH agonist protocol (A: 28.1%(9/32) vs. 22.2%(18/81), B: 44.8%(30/69) vs. 42.6%(43/104)). In group C, pregnancy rates of antagonist protocol were significantly lower than GnRH agonist protocol (51.9%(27/87) vs. 70.4%(50/77), P<0.001). The ‘Freeze all’ rates were similar (A:0% vs. 0%, B:2.9%(2/69) vs. 2.9%(3/104)), C:8.8%(5/57) vs. 7.8%(6/77)). Our results showed that AMH level can be considered as a main predictor of pregnancy rates in IVF cycles. When serum AMH level was above 5 in the patients, long protocol by GnRH agonist showed a much better outcome than GnRH antagonist protocol. And in the patients at risk of OHSS, all embryos were cryopreserved in order to minimize both the incidence and degree of OHSS.

Endometrial receptivity is affected in women with high circulating progesterone levels at the end of the follicular phase: a functional genomics analysis

Elevated serum progesterone levels at the end of the follicular phase in controlled ovarian stimulation (COS) leads to a poorer ongoing pregnancy rate in IVF cycles due to reduced endometrial receptivity. The objective of this study was to use microarray technology to compare endometrial gene expression profiles at the window of implantation according to the levels of circulating progesterone. For this prospective cohort study, microarray data were obtained from endometrial biopsies from 12 young healthy oocyte donors undergoing COS with pituitary suppression by either gonadotrophin-releasing hormone (GnRH) agonists or antagonists, and recombinant FSH. On the day of recombinant chorionic gonadotrophin (rCG) administration, six women had serum progesterone levels (P) >1.5 ng/ml (study group) and six had serum P levels <1.5 ng/ml (control group). Endometrial samples were collected using a Pipelle catheter 7 days after the rCG injection. Using the parametric test, we identified 140 genes significantly dysregulated (64 up- and 76 down-regulated) in the study group endometria compared with the control endometria, regardless of the GnRH analogue employed. These genes are related to cell adhesion, developmental processes, the immune system and others, which are all required for normal endometrial function development. Of the 25 gene targets previously proposed as markers for endometrial receptivity, 13 appeared over-regulated in the study group. Our results reveal that elevated progesterone levels on the day of rCG administration can induce significant alterations in the gene expression profile of the endometrium.

The effect of air bubble position after blastocyst transfer on pregnancy rates in IVF cycles

To investigate the relationship between air bubble position after blastocyst transfer (BT) and pregnancy rates (PRs). Retrospective cohort study. University-based infertility center. Three hundred fifteen consecutive nondonor BTs by a single provider. Catheters were loaded with 25 μL of culture media, 20 μL of air, 25 μL of media containing the blastocysts, 20 μL of air, and a small amount of additional media. The distance from the air bubble to the fundus, as seen on abdominal ultrasound examination, was measured at the time of transfer. Air bubble location was categorized as <10 mm, 10-20 mm, and >20 mm from the fundus. Clinical pregnancy rate. After controlling for age, parity, FSH and frozen transfers, and accounting for repeated cycles per patient, the PRs for both the >20-mm (38.3%) and the 10-20-mm (42.0%) from the fundus group were significantly reduced compared with the group in which the bubble was <10 mm from the fundus (62.5%). This study is the first to suggest that BT closer to the fundus is associated with higher PR. Although no ectopic pregnancies occurred in the <10-mm group, this outcome should be monitored closely in larger studies.

Clinical analysis of pregnancy rate and multiple-pregnancy rate in case of single embryo transfer by vitrification method

OBJECTIVE: To relieve the burden during the neonatal period, the multiple pregnancy rates in IVF cycles must be controlled to level with natural pregnancy. Single embryo transfer (SET) may be the most effective solution for preventing multiple pregnancies. In our facility, all blastocysts are cryopreserved using vitrification methods which enable to improve high post-thawing survival rates.

¿Es la temperatura ambiente un factor condicionante del resultado en ciclos de inyección intracitoplasmática de espermatozoides?

Objectives The results of in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles in assisted reproduction clinics show distinct degrees of variability. The sensitivity of spermatogenesis to various types of stress results in distinct spermatic populations. Since the male factor (pure or mixed male factor) plays an important role in about 50% of IVF-ICSI cycles, identifying how temporary environmental stress might affect the final ejaculation is important. Observation of temporal patterns of pregnancy rates in our center prompted us to investigate the possible relationship between these rates and the temperature in the city. Material and methods We performed a retrospective, randomized study of the pregnancy rates in our center in 3 consecutive years. Patients undergoing ICSI cycles, aged less than 38 years old, and with no ovarian failure were included. Patients whose eggs had been microinjected with donor sperm were excluded. Results Analysis of the data revealed an association between decreases in pregnancy rates in IVF cycles and the high temperatures registered in Seville during summer.

Appropriate timing of uterine cavity length measurement positively affects assisted reproduction cycle outcome

An appropriate and easy embryo transfer has a direct impact on pregnancy rates. Proper evaluation of the uterocervical axis and uterine depth are necessary for suitable embryo transfer. The aim of this study was to assess the appropriate time for cervical axis evaluation and uterine measurement. A total of 124 patients undergoing IVF treatment were included in the study. They were divided equally into two groups. In group I (62 women), uterine cavity depth was measured and the uterocervical axis was determined on day 2 or 3 of the menstrual cycle, and in group II (62 women) at the time of oocyte retrieval. There was a statistically significant difference in clinical pregnancy rates between the two groups (P = 0.006). Thirty-four women became pregnant in group I (64.2%) versus 19 women in group II (35.8%). In conclusion, uterine cavity measurement is necessary for suitable embryo transfer. It seems that the time of measurement significantly affects clinical pregnancy rate in IVF cycles. The best time for uterine measurement is on day 2 or 3 of menstruation.

Orientation of pronuclei relative to the polar bodies is related to IVF outcome: a 6 year experience with homologous embryo transfers

OBJECTIVE: Previous studies have shown that the orientation of the polar bodies to each other and to the pronuclei is predictive of embryo quality. The most significant indicator of quality was the angle between the pronuclear axis and the farthest polar body (beta angle). The objective of this study was to determine if the beta angle affects implantation and clinical pregnancy rates in IVF cycles where zygotes with homologous beta angles were transferred.

The effect of air bubble position after blastocyst transfer on pregnancy rates in IVF cycles

OBJECTIVE: Studies examining the relationship of air bubble position to IVF cycle outcome have focused primarily on Day 3 embryo transfer, with little data existing on the optimal location for blastocyst transfer (BT). Therefore, the objective of this study was to investigate the relationship between air bubble position after BT and pregnancy rates (PR).DESIGN: Retrospective cohort study.MATERIALS AND METHODS: All non-donor BTs by a single provider at a University center were analyzed from January 2006 through March 2008. All transfers were performed with the Tefcat catheter (Cook IVF), loaded via the “three drop procedure,” with air bubbles separating the drop of medium containing the embryos from two drops of culture media before and after the embryo drop. The distance from the air bubble to the fundus, as seen on abdominal ultrasound, was measured at the time of transfer, and later categorized as <10 mm, 10-20 mm, and >20 mm. Clinical pregnancy was defined as gestational sac with or without cardiac activity. Logistic regression was used to analyze the impact of air bubble position on PR, adjusting for the potential confounders of age, parity and FSH, using Stata v. 8.2.Table 1Clinical Pregnancy RateNPregnancy RateORP-value95% CI<10 mm2462.5%–––10-20 mm17642.4%0.700.07∗0.4468-1.033>20 mm11538.3%0.350.02∗0.109-0.842∗As compared to <10mm, adjusted for age, parity and FSH. Open table in a new tab CONCLUSIONS: This study is the first to suggest that BT closer to the fundus is associated with higher PR. Because BT occurs close to the time of implantation, one would expect less embryo migration. Although no ectopic pregnancies occurred in our study when ET was <10 mm from the top, this outcome should be closely monitored in larger studies. OBJECTIVE: Studies examining the relationship of air bubble position to IVF cycle outcome have focused primarily on Day 3 embryo transfer, with little data existing on the optimal location for blastocyst transfer (BT). Therefore, the objective of this study was to investigate the relationship between air bubble position after BT and pregnancy rates (PR). DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All non-donor BTs by a single provider at a University center were analyzed from January 2006 through March 2008. All transfers were performed with the Tefcat catheter (Cook IVF), loaded via the “three drop procedure,” with air bubbles separating the drop of medium containing the embryos from two drops of culture media before and after the embryo drop. The distance from the air bubble to the fundus, as seen on abdominal ultrasound, was measured at the time of transfer, and later categorized as <10 mm, 10-20 mm, and >20 mm. Clinical pregnancy was defined as gestational sac with or without cardiac activity. Logistic regression was used to analyze the impact of air bubble position on PR, adjusting for the potential confounders of age, parity and FSH, using Stata v. 8.2. ∗As compared to <10mm, adjusted for age, parity and FSH. CONCLUSIONS: This study is the first to suggest that BT closer to the fundus is associated with higher PR. Because BT occurs close to the time of implantation, one would expect less embryo migration. Although no ectopic pregnancies occurred in our study when ET was <10 mm from the top, this outcome should be closely monitored in larger studies.

Luteal phase support with GnRH-a improves implantation and pregnancy rates in IVF cycles with endometrium of ≤7 mm on day of egg retrieval

BackgroundObjective: The objective of this study was to examine the use of gonadotrophin-releasing hormone agonist (GnRH-a) for luteal phase in a group of patients with thin endometrium (≤7 mm) after IVF treatment.Methods: One-hundred-and-twenty women were eligible for this study. Patients were randomly allocated into two groups: group A (n = 60) received triptorelin 0.1 mg on the day of ovum pickup (OPU), on the day of embryo transfer (ET) and three days thereafter, and group B (n = 60) received placebo. The primary outcomes were implantation and pregnancy rates.Results: Although there was no significant difference in the number of good quality embryos transferred in both groups, the implantation and pregnancy rate were significantly higher in the GnRH-a – treated group compared with placebo controls. Furthermore, Estradiol (E2), progesterone (P) levels and endometrial thickness were significantly more elevated in patients who received GnRH-a for luteal phase support.Conclusions: The administration of GnRH-a at the time of OPU significantly improves the implantation and pregnancy rates in patients with thin endometrium (≤7 mm).

The position of diagnostic laparoscopy in current fertility practice

In everyday clinical practice, it is not always clear if and when exactly in the fertility work-up a diagnostic laparoscopy should be offered. The aim of this review is to analyse the available evidence with respect to alternative diagnostic methods for detecting tuboperitoneal infertility and with respect to the position of diagnostic laparoscopy in women with infertility. A literature search of the National Library of Medicine and the National Institutes of Health (PubMed) was performed using the key words 'diagnostic laparoscopy and infertility'. The study methodology was carefully considered in an effort to present conclusions preferably based on randomized controlled trials (RCTs). The routine use of diagnostic laparoscopy for the evaluation of all cases of female infertility is currently under debate. According to data published in retrospective non-controlled studies, diagnostic laparoscopy after several failed cycles of ovulation induction enables the detection of a significant proportion of pelvic pathology amenable to treatment. A Cochrane review has shown that laparoscopic ovarian diathermy in clomiphene-resistant polycystic ovarian syndrome is at least as effective as gonadotrophin treatment, and results in a lower multiple pregnancy rate. The role of laparoscopy before the start of treatment with intrauterine insemination is controversial, according to one RCT. In women with bilateral ultrasonically visible hydrosalpinges, two RCTs have demonstrated increased implantation and pregnancy rates in IVF cycles after salpingectomy. Although RCTs which have studied the benefit of laparoscopic surgery in moderate or severe endometriosis are still lacking, its value has generally been accepted. In conclusion, some specific clinical settings, solid evidence is available to recommend the use of diagnostic laparoscopy in current fertility practice. There is however a need for more RCTs to answer remaining questions regarding its value in the diagnosis and treatment of some patients with infertility.

Effect of Administration of Single Dose Piroxicam Before Embryo Transfer on Implantation and Pregnancy Rates in IVF Cycles

Effect of Administration of Single Dose Piroxicam Before Embryo Transfer on Implantation and Pregnancy Rates in IVF Cycles

Redefining the Relationship Between Sperm Deoxyribonucleic Acid Fragmentation as Measured by the Sperm Chromatin Structure Assay and Outcomes of Assisted Reproductive Techniques

Objective To test the hypothesis that couples with sperm chromatin structure assay (SCSA) DNA fragmentation index (DFI) values >27% would not achieve pregnancy with assisted reproductive techniques (ART) and to investigate how DFI and high DNA stainability (HDS), as measured by the SCSA, affect fertilization, cleavage, implantation, and pregnancy rates in IVF cycles. Design Prospective clinical study. Setting Academic human reproduction laboratory. Patient(s) One hundred couples undergoing IVF with conventional insemination or intracytoplasmic sperm injection. Intervention(s) Testing with SCSA was performed by SCSA Diagnostics (Brookings, South Dakota) on a semen aliquot taken from ejaculate used for ART. Main Outcome Measure(s) Relating total DFI and HDS to conventional semen parameters and cycle-specific outcomes after ART. Result(s) Nine of nineteen couples achieved clinical pregnancy when DFI was ≥27%, and 2 of 22 couples achieved clinical pregnancy when DFI was ≤9%. One of nine couples achieved clinical pregnancy with HDS >17%. The DFI was negatively correlated with sperm density ( r = −0.23, P r = −0.55, P r = −0.37, P Conclusion(s) Sperm chromatin structure assay failed to identify elevated DFI thresholds for negative pregnancy outcome after ART. Patients with low DFI (≤9%) were least likely to become pregnant, which is also contradictory to SCSA marketing, which states that DFIs of ≤15% have excellent fertility potential. Patients with HDS ≥17% had low pregnancy rates, indicating decreased fertility potential, which deserves further investigation. Larger studies are necessary to confirm that low DFI is associated with decreased fertility and, if proved, might redefine the use of the SCSA in evaluating infertility.

Effect of EmbryoGlue® - A Hyaluronan-Supplemented Transfer Medium —On the Implantation and Pregnancy Rate in IVF Cycles

ObjectiveTo evaluate the effect of this hyaluronan-supplemented transfer medium “EmbryoGlue®”(Vitrolife) on the implantation and pregnancy rate in a IVF-ET program.DesignA prospective, clinical study.Materials and methods92 women came for IVF treatment were enrolled from 2004 July to 2004 November. Two women were excluded from anlysis because both received blastocyst transfer. A total of 237 day 3 embryos were transferred. They are divided into the control group and the study group which used EmbryoGlue® as transfer media.ResultsThere were no differences in patients’ age, duration of infertility, number of previous IVF attempts and the causes of infertility. The mean number of embryos transfer in the EmbryoGlue® group was 2.64 ± 1.28 vs. 2.62 ± 1.23 in the control group (P=0.92).The clinical pregnancy rate in the EmbryoGlue® group was 40% (18/45) vs. 53.3% (24/45) in the control group (P=0.16).The implantation rate was 31.1% (37/119) in the EmbryoGlue® group and 30.5% (36/118) in the control group (P=0.7).ConclusionOur data indicated that using EmbryoGlue® as transfer media was unlikely to significantly increase the implantation and clinical pregnancy rate in a day 3 ET program. Considering the high expression of receptors for hyaluronan on embryos at the expanded blastocyst stage, we suggest that EmbryoGlue® may work better on a day 5 embryo instead of a day 3 embryo. This hypothesis needs a further study to clarify the real benefit of using a hyaluronan-rich transfer medium like EmbryoGlue®. ObjectiveTo evaluate the effect of this hyaluronan-supplemented transfer medium “EmbryoGlue®”(Vitrolife) on the implantation and pregnancy rate in a IVF-ET program. To evaluate the effect of this hyaluronan-supplemented transfer medium “EmbryoGlue®”(Vitrolife) on the implantation and pregnancy rate in a IVF-ET program. DesignA prospective, clinical study. A prospective, clinical study. Materials and methods92 women came for IVF treatment were enrolled from 2004 July to 2004 November. Two women were excluded from anlysis because both received blastocyst transfer. A total of 237 day 3 embryos were transferred. They are divided into the control group and the study group which used EmbryoGlue® as transfer media. 92 women came for IVF treatment were enrolled from 2004 July to 2004 November. Two women were excluded from anlysis because both received blastocyst transfer. A total of 237 day 3 embryos were transferred. They are divided into the control group and the study group which used EmbryoGlue® as transfer media. ResultsThere were no differences in patients’ age, duration of infertility, number of previous IVF attempts and the causes of infertility. The mean number of embryos transfer in the EmbryoGlue® group was 2.64 ± 1.28 vs. 2.62 ± 1.23 in the control group (P=0.92).The clinical pregnancy rate in the EmbryoGlue® group was 40% (18/45) vs. 53.3% (24/45) in the control group (P=0.16).The implantation rate was 31.1% (37/119) in the EmbryoGlue® group and 30.5% (36/118) in the control group (P=0.7). There were no differences in patients’ age, duration of infertility, number of previous IVF attempts and the causes of infertility. The mean number of embryos transfer in the EmbryoGlue® group was 2.64 ± 1.28 vs. 2.62 ± 1.23 in the control group (P=0.92).The clinical pregnancy rate in the EmbryoGlue® group was 40% (18/45) vs. 53.3% (24/45) in the control group (P=0.16).The implantation rate was 31.1% (37/119) in the EmbryoGlue® group and 30.5% (36/118) in the control group (P=0.7). ConclusionOur data indicated that using EmbryoGlue® as transfer media was unlikely to significantly increase the implantation and clinical pregnancy rate in a day 3 ET program. Considering the high expression of receptors for hyaluronan on embryos at the expanded blastocyst stage, we suggest that EmbryoGlue® may work better on a day 5 embryo instead of a day 3 embryo. This hypothesis needs a further study to clarify the real benefit of using a hyaluronan-rich transfer medium like EmbryoGlue®. Our data indicated that using EmbryoGlue® as transfer media was unlikely to significantly increase the implantation and clinical pregnancy rate in a day 3 ET program. Considering the high expression of receptors for hyaluronan on embryos at the expanded blastocyst stage, we suggest that EmbryoGlue® may work better on a day 5 embryo instead of a day 3 embryo. This hypothesis needs a further study to clarify the real benefit of using a hyaluronan-rich transfer medium like EmbryoGlue®.

A Cocktail of GnRH Agonist and Urinary hCG to Trigger LH Surge in GnRH Antagonist -IVF Cycles Yields Higher Pregnancy Rates

Despite all the studies done so far, there is still a suspicion of lower pregnancy rates in IVF cycles in which GnRH antagonists were administered. GnRH antagonists permit the administration of GnRH agonists to trigger endogenous LH surge which could be more physiologic, so more effective. In this study, we aim to see the impact of GnRH agonist-hCG administration compared to hCG administration alone to the outcome.

Mock Embryo Transfer Prior to an In Vitro Fertilization Cycle Positively Correlates With Real Embryo Transfer

It has been demonstrated that performing a mock embryo transfer (ET) significantly improves the pregnancy rate in IVF cycles. The mock ET can be performed prior to the stimulation cycle or right before real ET. The problem of the first procedure is the possibility of variation in the uterine position and or cervico -uterine angle. The purpose of this study was to determine the consistency of the type of ET in mock ET prior to the treatment cycle with real ET.

Redefining the relationship between sperm deoxyribonucleic acid fragmentation as measured by the sperm chromatin structure assay and outcomes of assisted reproductive techniques

To test the hypothesis that couples with sperm chromatin structure assay (SCSA) DNA fragmentation index (DFI) values >27% would not achieve pregnancy with assisted reproductive techniques (ART) and to investigate how DFI and high DNA stainability (HDS), as measured by the SCSA, affect fertilization, cleavage, implantation, and pregnancy rates in IVF cycles. Prospective clinical study. Academic human reproduction laboratory. One hundred couples undergoing IVF with conventional insemination or intracytoplasmic sperm injection. Testing with SCSA was performed by SCSA Diagnostics (Brookings, South Dakota) on a semen aliquot taken from ejaculate used for ART. Relating total DFI and HDS to conventional semen parameters and cycle-specific outcomes after ART. Nine of nineteen couples achieved clinical pregnancy when DFI was > or =27%, and 2 of 22 couples achieved clinical pregnancy when DFI was < or =9%. One of nine couples achieved clinical pregnancy with HDS >17%. The DFI was negatively correlated with sperm density (r = -0.23, P<.03) and motility (r = -0.55, P<.00), and HDS was negatively correlated with sperm density (r = -0.37, P<.00). Sperm chromatin structure assay failed to identify elevated DFI thresholds for negative pregnancy outcome after ART. Patients with low DFI (< or =9%) were least likely to become pregnant, which is also contradictory to SCSA marketing, which states that DFIs of < or =15% have excellent fertility potential. Patients with HDS > or =17% had low pregnancy rates, indicating decreased fertility potential, which deserves further investigation. Larger studies are necessary to confirm that low DFI is associated with decreased fertility and, if proved, might redefine the use of the SCSA in evaluating infertility.

Does intravaginal probiotic supplementation increase the pregnancy rate in IVF–embryo transfer cycles?

This study investigated the effect of intravaginal administration of probiotics immediately after oocyte retrieval on vaginal colonization and outcome of the IVF–embryo transfer cycle. One hundred and seventeen women who underwent ovarian stimulation and IVF were randomized immediately after oocyte retrieval into two groups: those who received intravaginal probiotics (study group, n = 50) and those who did not (control group, n = 67). Vaginal colonization with lactobacilli and pregnancy rate were compared between the two groups. No significant between-group differences were observed in patient age, oestrogen and progesterone concentrations on day of human chorionic gonadotrophin administration, number of oocytes retrieved, fertilization rate, number of embryos transferred, or pregnancy rate. The presence of lactobacilli in the vagina during oocyte retrieval or embryo transfer did not improve the pregnancy rate. Furthermore, intravaginal administration of lactobacilli following oocyte retrieval did not affect the prevalence of lactobacilli during embryo transfer, or the pregnancy rate. Intravaginal probiotic supplementation immediately after oocyte retrieval has no effect on vaginal colonization or pregnancy rate in IVF cycles.

GnRH antagonist protocol is associated with elevated levels of nitric oxide and a reduced pregnancy rate in IVF cycles

The study was designed to determine the nitric oxide (NO) levels in IVF/ICSI cycles subsequent to GnRH antagonist and GnRH agonist treatment and to explain the difference of pregnancy rate between these protocols. A prospective, randomized controlled study was performed with 20 patients treated with cetrorelix and 37 patients with buserelin. Serum and follicular levels of NO was determined with chemiluence method. The patients underwent the protocol with cetrorelix had less number of follicles (11.8±4.7 vs. 14.5±5.5, p=0.033) and lower pregnancy rate (25% vs. 56.8%, p=0.022), together with higher levels of serum NO ( p=0.008). The follicular levels of NO were associated with fragmentation degree of embryos ( p=0.030) in IVF cycles. We conclude that the GnRH antagonist protocol is associated with elevated levels of NO and a reduced pregnancy rate noted in IVF cycles. Elevated follicular levels of NO are associated with poor embryo quality.