Preparation For IVF Research Articles

Optimization of management of women with hypoplastic endometrium in preparation for IVF with reproductive failures

<h3></h3> В статье отображены аспекты оптимизации ведения женщин с «тонким» эндометрием и репродуктивными неудачами при подготовке к экстракорпоральному оплодотворению (ЭКО). <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Улучшить результаты лечения женщин после репродуктивных неудач, вызванных «тонким» эндометрием, на основе использования метода орошения полости матки с помощью лекарственных растворов, кавитированных низкочастотным ультразвуком, в сочетании с циклической гормонотерапией, доказать патогенетическое действие метода. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Обследованы 80 женщин с бесплодием маточного генеза, обусловленным гипоплазией эндометрия и его нерецептивностью. Пациентки разделены на две группы по 40 человек: пациенткам 1-й группы совместно с циклической гормонотерапией проводили курсы орошения полости матки с помощью растворов антисептика и цитопротектора Цитохром С, кавитированных низкочастотным ультразвуком; пациентки 2-й группы получали только циклическую гормонотерапию. <h3>РЕЗУЛЬТАТЫ</h3> Проведенное комплексное лечение с использованием курса орошения полости матки препаратами антисептика и цитопротектора, кавитированными низкочастотным ультразвуком, в сочетании с циклической гормонотерапией позволило добиться увеличения толщины слизистой оболочки полости матки и восстановления ее структуры, улучшить гемодинамические показатели маточного кровотока, а главное, повысить эффективность программы ЭКО. <h3>ЗАКЛЮЧЕНИЕ</h3> Комплексное применение кавитационного орошения полости матки у пациенток с гипопластическим эндометрием приводит к статистически значимому повышению уровня альфа-2-микроглобулина фертильности, что позволяет добиться увеличения толщины слизистой оболочки полости матки и восстановления ее структуры, улучшить гемодинамические показатели маточного кровотока.

Interest in expanded carrier screening among individuals and couples in the general population: systematic review of the literature.

Through carrier screening, prospective parents can acquire information about whether they have an increased risk of conceiving a child affected with an autosomal recessive or X-linked condition. Within the last decade, advances in genomic technologies have facilitated a shift from condition-directed carrier screening to expanded carrier screening (ECS). Following the introduction of ECS, several studies have been performed to gauge the interest in this new technology among individuals and couples in the general population. The aim of this systematic review was to synthesize evidence from empirical studies that assess the interest in ECS among individuals and couples in the general population. As the availability and accessibility of ECS grow, more couples who are a priori not at risk based on their personal or family history will be presented with the choice to accept or decline such an offer. Their attitudes and beliefs, as well as the perceived usefulness of this screening modality, will likely determine whether ECS is to become a widespread reproductive genetic test. Four databases (Pubmed, Web of Science, CINAHL, Cochrane Library) were systematically searched to identify English language studies performed between January 2009 and January 2019 using the following search terms: carrier screening, carrier testing, attitudes, intention, interest, views, opinions, perspectives and uptake. Studies were eligible for inclusion if they reported on intentions to undergo a (hypothetical) ECS test, uptake of an actual ECS offer or both. Two researchers performed a multistep selection process independently for validation purposes. Twelve empirical studies performed between 2015 and 2019 were included for analysis. The studies originated from the USA (n= 6), the Netherlands (n= 3), Belgium (n= 1), Sweden (n= 1) and Australia (n= 1). The sample size of the studies varied from 80 to 1669. In the included studies, 32%-76% of respondents were interested in a (hypothetical) ECS test, while uptake rates for actual ECS offers ranged from 8% to 50%. The highest overall uptake was observed when ECS was offered to pregnant women (50%). By contrast, studies focusing on the preconception population reported lower overall uptake rates (8-34%) with the exception of one study where women were counseled preconception in preparation for IVF (68.7%). Our findings suggest that there may be discrepancies between prospective parents' reported intentions to undergo ECS and their actual uptake, particularly during the preconception period. As ECS is a new and relatively unknown test for most future parents, the awareness and comprehension within the general population could be rather limited. Adequate pre- and post-test counseling services should be made available to couples offered ECS to ensure informed reproductive decision-making, together with guidelines for primary health care professionals. Due to restricted nature of the samples and methods of the underlying primary studies, some of the reported results might not be transferable to a broader population. More research is needed to see if the observed trends also apply to a broader and more diverse population.

OPPORTUNISTIC INFECTIONS AND IMMUNE DEFICIENCY IN WOMEN WITH POOR IVF RESPONSE

The aim of the study is the improvement of the efficiency of IVF on the basis of the determination of immunological and infectious risk factors for miscarriage. The materials and methods. The object of research were 21 female infertility patients included in the program of ancillary reproductive technologies (ART) for the period of 2014-2016, who had in a history from one to four ineffective IVF response. The average age of studied women was 33.5±0.9 years, the number of years with infertility amounted to 7,3±1,0. In the preparation for IVF women received a complete course of general clinical examination to identify the causes of infertility. The study of the immune status was carried out with the use of one - and two-parameter phenotyping, the results included data obtained with the flow-through cytofluorometer BECKMAN COULTER EPICS XL-II (USA), treated according to standard protocols. The control group consisted of 30 fertile women. The results of the study. Infertility women planning IVF, were found to be characterized by presenting a combination of persistent opportunistic infections of herpes group: HSV and CMV. In the 90,5% of women there were identified various immunodeficiency states from both cellular and humoral immunity: the characteristic increase in the content of HLA-DR, a reduction in CD19+ cells. In primary infertility states changes in cellular immunity were more pronounced, additionally there was the decline in immunoregulatory index (IRI), the increase in the content of CD8+, CD25+, IgM. An imbalance of the immune system in women with persistence of several opportunistic infections was both more pronounced, than in cases with monoinfection and manifested by such abnormalities of cellular immunity as the gain in the content of CD8+, NK cells CD16+, CD56+, CD25+, a decline in IRI. The conclusion. In the course of the preparation for IVF in an examination mode of women with the primary infertility and the presence of markers of several opportunistic infections, it is advisable to include an evaluation of the immune status. The identification of secondary immune deficiency is an indication for inclusion of immunocorrective therapy in the comprehensive treatment.

Toward optimal set of single nucleotide polymorphism investigation before IVF

Background: At present, the patient preparation for IVF needs to undergo a series of planned tests, including the genotyping of single nucleotide polymorphism (SNP) alleles of some genes. In former USSR countries, such investigation was not included in overwhelming majority of health insurance programs and paid by patient. In common, there are prerequisites to the study of more than 50 polymorphisms. An important faced task is to determine the optimal panel for SNP genotyping in terms of price/number of SNP.Materials and methods: During 2009–2015 in the University Hospital of St. Petersburg State University, blood samples were analyzed from 550 women with different reproductive system disorders preparing for IVF and 46 healthy women in control group. In total, 28 SNP were analyzed in the genes of thrombophilia factors, folic acid cycle, detoxification system, and the renin-angiotensin system. The method used was real-time PCR.Results: A significant increase in the frequency of pathological alleles of some polymorphisms in patients with habitual failure of IVF was shown, compared with the control group. As a result, two options defined panels for optimal typing SNP before IVF were composed. Standard panel includes 8 SNP, 5 in thromborhilic factors, and 3 in folic acid cycle genes. They are 20210 G > A of FII gene, R506Q G > A of FV gene (mutation Leiden), -675 5G > 4G of PAI-I gene, L33P T > C of ITGB3 gene, -455 G > A of FGB gene, 667 C > T of MTHFR gene, 2756 A > G of MTR gene, and 66 A > G of MTRR gene. Extended panel of 15 SNP also includes 807 C > T of ITGA2 gene, T154M C > T of GP1BA gene, second polymorphism 1298 A > C in MTHFR gene, polymorphisms of the renin-angiotensin gene AGT M235T T > C and -1166 A > C of AGTR1 gene, polymorphisms I105V A > G and A114V C > T of detoxification system gene GSTP.Conclusion: The results of SNP genotyping can be adjusted for treatment tactics and IVF, and also medical support getting pregnant. The success rate of IVF is increased as the result, especially in the group with the usual failure of IVF.

ИНДИВИДУАЛИЗАЦИЯ ОЦЕНКИ ГОРМОНАЛЬНОГО ПРОФИЛЯ ПАЦИЕНТОК С ЭНДОКРИННЫМИ ФОРМАМИ БЕСПЛОДИЯ ПРИ ПОДГОТОВКЕ К ПРОВЕДЕНИЮ ЭКО

Questions of inspection and preparation of married couples with infertility before the application of auxiliary genesial technologies (AGT) remain extremely relevant taking into account the difficult obstetric and gynecologic status of patients belonging to programs of extracorporal fertilization, age, condition of their somatic and psychological health, and also the variety of etiological and pathogenetic factors of infertility. Objective: to determine individual algorithm of the hormonal profile assessment of genesial system for women with infertility, chronic anovulation and implications of hyper-androgyny. Materials and methods. the examined patients passed complex examination of the hormonal profile of genesial system including blood test at the 3-5th and 21-23rd day of the cycle, US monitoring of the follicular apparatus and endometrium. Conclusion. as a result of stage-by-stage inspection of patients with infertility and the adequate individually selected medicamental therapy for correction of disturbances of a menstrual cycle at the preparation for IVF, pregnancy comes in 67% of cases.

High-throughput microfuidic device for motile sperm selection

Current techniques of semen processing and sperm selection used in preparation for IVF are crude and differ greatly from the natural in vivo processes. Recent studies have shown that microfluidic channels and microfluidic chips may be well-suited for sperm selection. Our aim is to develop and test new microfluidic devices in their ability to separate viable, highly motile sperm with high DNA integrity from non-motile sperm and debris.

The effect of sperm and cryoprotectant concentration on the freezing success of sex sorted ram sperm for in vitro fertilization

The current method used to sex-sort ram sperm resulted in a dilute end product. The obligatory removal of cryopreservation medium during preparation of sperm IVF further reduced sperm number. This study aimed to increase the number of viable, sex-sorted sperm available for IVF by increasing their pre-freeze concentration and assessing the cryodiluent concentration used to accommodate this change. In Experiment 1, semen was collected from Merino rams (n = 3), sex-sorted, and then frozen at concentrations of 20, 40, or 80 × 10 6 sperm/mL in three forms of tris-citrate-glucose cryodiluent containing 5% (L-Cryo), 6% (M-Cryo), and 8% (H-Cryo) (v/v) glycerol. Motility, plasma membrane and acrosome integrity, and mitochondrial activity were assessed at 0, 2, 4, and 6 h post thaw. In Experiment 2, cleavage and blastocyst development rates were compared between non-sorted and sex-sorted sperm frozen at the aforementioned concentrations (in the cryodiluent most effective in Experiment 1). In Experiment 1, total motility between 0 and 6 h was similar for all sperm concentrations when frozen using L-Cryo. Mitochondrial activity was elevated in samples frozen in L-Cryo and M-Cryo at 0 h compared to those preserved in H-Cryo for all concentrations (P < 0.05). In Experiment 2, sex-sorted sperm with a higher pre-freeze concentration yielded a higher sperm concentration after preparation for IVF (8.57 ± 1.22 sperm/mL), compared to the lowest group (2.96 ± 0.18 sperm/mL; P < 0.05). There were no significant differences between non-sorted and sex-sorted sperm for rates of embryo cleavage or development. Therefore, sex-sorted sperm was effectively cryopreserved at a higher concentration than conventionally practiced. Although this yielded a higher sperm concentration for IVF, reduced insemination volume, and increased the number of potentially fertile gametes from which to select, fertilisation rate was not significantly improved.

314 OPTIMIZING TREATMENT FOR IVF WHEN USING HEAVILY BACTERIAL CONTAMINATED SEMEN

Following semen collection, the nonspecific bacterial count is usually kept low by addition of antibiotics to the extender. Ordinary protocols for semen processing in preparation for IVF are characterized by a washing procedure, followed by spermatozoa selection by either swim-up or Percoll gradient. In this study, commercially available bovine semen to be used for IVF was found to be heavily contaminated with Escherichia coli and Leclercia adecarboxilata despite the addition of tylosin (5 mg/100 mL), gentamicin (25 mg/100 mL), spectomycin (30 mg/100 mL), and lincomycin (15 mg/100 mL) to the extender. Bacterial concentrations varied among straws examined (n = 7), ranging from 10 � 4 UFC mL-1 to 10 � 8 UFC mL-1. Noncontaminated semen from the same valuable bull, although derived from a different semen collection, was known to be used with great efficiency for IVF in a different laboratory at a very low concentration (i.e. 350 000 sperm mL-1). Therefore, to rescue the fertilizing capacity of such contaminated semen, an improved treatment was applied and compared with the ordinary semen treatment. From the previous use of semen from the same bull, a concentration of 2 million sperm/mL-1 and 20 �g mL-1 of heparin was chosen for IVF. During ordinary treatment, the semen was washed using 6 mL of fertilization medium into a 15-mL tube and subjected to centrifugation at 800 rpm for 5 min. After removal of the supernatant, the resulting pellet was layered under 1 mL of the same medium and left for 45 min in an incubator for swim-up. The supernatant was moved into a new 15-mL tube for additional centrifugation. The newly formed pellet was then resuspended for the final count and co-incubation with oocytes. With such a procedure, the bacterial contamination was found for 3 consecutive replicates in culture droplets starting at Days 3 to 4 post-IVF. In the course of 5 additional replications, the semen treatment was improved by doubling the volume for initial washing to 12 mL of fertilization medium. The resuspended pellet following the first centrifugation was equally partitioned into 6 round-bottomed tubes and left for 60 to 80 min in an incubator for swim-up. The supernatant was then moved into a new 15-mL tube for additional centrifugation and a final count. The IVF medium was supplemented with 100 IU mL-1 of penicillin G in both treatments. Following the ordinary and improved semen treatment, a large number of sperm cells were found agglutinated head-to-head. A subsequent embryo culture was performed for both treatments in SOF containing 0.025 mg mL-1 of kanamycin sulfate. When using sperm and heparin concentrations at 2 million and 20 �g mL-1, respectively, under the improved semen treatment, cleavage was 84.8%. The rates of blastocyst production at Day 7 from used cumulus-oocyte complexes and from cleavage were 29.5 and 35.9%, respectively. In conclusion, the improved washing procedure rescued valuable but heavily contaminated semen for use in IVF procedures.

Adjunctive Use of an Oral Contraceptive (OC) and a Reduced Dose of a GnRH Antagonist for COH/IUI

In preparation for IVF, a long GnRH agonist protocol provides for scheduling of procedures, synchronization of follicles, prevention of premature luteinization (PL), and prevention of premature ovulation of mature follicles. Although COH/IUI cycles are commonly started day 2 of the cycle, selection of the dominant follicle may already be underway. Pretreatment with an OC synchronizes follicles and has been shown to block the occurrence of an LH surge in a subsequent COH cycle (Gonen Y, Fertil Steril 1990). A study with COH/IUI (Manzi DL, Fertil Steril 1995) has shown that about one-third of cycles demonstrate PL, with a very low success rate and a high rate of miscarriage and improved RESULTS with use of a GnRH agonist in the next cycle. We therefore chose to evaluate COH/IUI following OC, with half of the usual dose of the GnRH antagonist, ganirelix (G) to prevent PL and premature release of follicles. Pilot trial. Thirteen women (mean age and body weight 34.5 and 136.5) with unexplained infertility or male factor with weight between 110 and 180 pounds and a day 3 FSH less than 10 IU/ml. having their first COH/IUI cycle took OC for 14 to 21 days. Beginning on the fourth day after OC, rFSH (follitropin beta), 75-225 IU was self-administered daily using a multidose pen. G, 0.125 mg, was administered each morning starting at a lead follicle mean diameter of 14 mm. HCG was given in the evening when there were at least two follicles of 17 mm mean diameter or greater, and IUI was done on the following two mornings. The mean starting dose of rFSH was 161.5 IU. G was given for a mean of 3.5 days. HCG was given after 10.1 days of stimulation with 5.9 follicles over 12 mm. Five women have ongoing pregnancies (38.5%). UTZ showed two sacs in three women, with one of those evolving to one viable fetus. Serum LH levels will be assessed. A high rate of ongoing pregnancy was achieved in this small ongoing study with COH preceded by OC and with adjunctive use of a GnRH antagonist. The high number of follicles and twin implantations are consistent with a synchronizing effect of OC and excellent oocyte quality. Based on this initial experience, we have reduced the starting dose to 75-100 IU. The low dose of FSH should offset the additional cost of G. The use of OC is also helpful in scheduling procedures around career activities. A large prospective randomized trial will be necessary to demonstrate a better clinical outcome compared with COH alone.

Ovarian brain-derived neurotrophic factor is present in follicular fluid from normally cycling women

Ovarian brain-derived neurotrophic factor is present in follicular fluid from normally cycling women

Mitochondrial deletions in luteinized granulosa cells as a function of age in women undergoing in vitro fertilization

Objective: To test the hypothesis that mitochondrial DNA (mtDNA) deletions are more prevalent in granulosa cells from women of advanced reproductive age than from younger women undergoing IVF. Design: Granulosa cells screened for presence or absence of the 4977-bp deletion in human mtDNA. Setting: University-based fertility clinic. Patient(s): Twenty-four women divided equally between two groups: ≤34 years old and ≥38 years old. Intervention(s): Patients were given gonadotropin stimulation in preparation for IVF with granulosa cells isolated at the time of follicular aspiration. Main Outcome Measure(s): Presence or absence of the 4977-bp deletion in human mtDNA. Result(s): Seven out of 12 women analyzed who were <38 years old and 0 out of 12 women who were >38 years old had normal mtDNA as indicated by the presence of the 4977-bp fragment. Conclusion(s): These data suggest that women over the age of 38 have granulosa cells that contain a substantial decrease in the level of normal mitochondria as compared with women ≤34 years.

DNA microarray analysis of the expression profiles of luteinized granulosa cells as a function of ovarian reserve

Objective: To examine the expression profiles of luteinized granulosa cells isolated from women with normal or diminished ovarian reserve undergoing in vitro fertilization. Design: Expression profiling by complementary DNA microarray analysis. Setting: Women undergoing in vitro fertilization-embryo transfer in a university-based fertility clinic. Patient(s): Eighteen women with normal or decreased ovarian reserve. Intervention(s): All patients were given gonadotropin stimulation in preparation for IVF with granulosa cells isolated at the time of follicular aspiration. Main Outcome Measure(s): Expression profiles of luteinized granulosa cells isolated from each woman were determined by using DNA microarray analysis. Result(s): Changes in patterns of gene expression in granulosa cells were observed between women with normal and diminished ovarian reserve. These genes included several anonymous expressed sequence tags and also expressed sequence tags that correspond to known genes. Conclusion(s): Expression profiling of granulosa cells by DNA microarray may yield signature patterns that reflect the status of ovarian reserve and the competence of granulosa cells.

The effect on IVF outcome of small intramural fibroids not compressing the uterine cavity as determined by a prospective matched control study

Several studies have reported that the presence of intramural fibroids affects conception following IVF. We attempted to corroborate or refute the conclusions relating to IVF and leiomyomas of the aforementioned studies. Women with small intramural leiomyomata (< or = 5 cm) discovered on initial pelvic sonographic studies performed in preparation for IVF were prospectively matched by age, with the next patient of the same age undergoing IVF who did not demonstrate fibroids (controls). Though no significant differences were found in outcome when comparing these two groups, there was a distinct trend for lower live delivery rates and higher miscarriage rates. These data support the conclusions of the only other prospective matched control study evaluating similar factors, i.e. that small intramural fibroids can negatively affect IVF outcome. Nevertheless, we think that a multicentre study should be conducted first before evaluating whether myomectomy improves outcome or not.

Early follicular serum müllerian-inhibiting substance levels are associated with ovarian response during assisted reproductive technology cycles

Objective: To test the hypothesis that the concentration of early follicular phase serum müllerian-inhibiting substance (MIS) is associated with ovarian response in women undergoing ovulation induction in preparation for assisted reproductive technology (ART). Design: Retrospective analysis of frozen day 3 serum samples. Setting: Academic ART program. Patient(s): One sample of frozen day 3 serum from women with ≤6 retrieved oocytes (n = 28) compared with women with ≥11 oocytes retrieved (n = 79) in preparation for IVF. Intervention(s): None. Main Outcome Measure(s): Comparison of day 3 serum MIS levels between two groups of women. Other comparisons included maximum serum E 2 concentrations, number of retrieved oocytes, and percentage of mature oocytes between groups. Result(s): Mean serum MIS concentrations were 1.0 ± 0.4 ng/mL compared with 2.5 ± 0.3 ng/mL, or more than a 2.5-fold greater serum concentration of MIS in the group with ≥11 oocytes retrieved compared with in the group with ≤6 retrieved oocytes. Conclusion(s): These data demonstrate an association between early follicular phase serum MIS and the number of retrieved oocytes. Higher day 3 serum MIS concentrations were associated with greater number of retrieved oocytes.

Comparisons of oocyte maturation times and of three methods of sperm preparation for their effects on the production of goat embryos in vitro

Various times of in vitro maturation of oocytes, and three methods of separating spermatozoa from frozen-thawed semen (Percoll density-gradient centrifugation, swim-up, and glass-wool filtration), were compared for their effects on goat embryo production in vitro. Cumulus-oocyte-complexes (COCs) from abattoir ovaries were matured in M199 supplemented with 10% fetal calf serum and hormones. In Experiment 1, COCs were fixed at 4 h intervals from 0 to 27 h of culture to assess oocyte nuclear maturation. A higher proportion cultured for 27 h than for 24 h were in Metaphase II (27/37, 73% vs. 18/33, 55%, P < 0.05). In Experiment 2, the effects of separation methods on total numbers and numbers of membrane-intact spermatozoa, and the acrosome reaction were compared. Total numbers after Percoll density-gradient centrifugation were ∼4 times higher than after swim-up and ∼2 times higher than after glass-wool filtration (P < 0.001). Progression of the acrosome reaction was not affected differentially. In Experiments 3 and 4, after 27 h of culture the COCs were inseminated with sperm isolated by the three methods. In Experiment 3, presumptive zygotes were examined for pronucleus (PN) formation at 6, 12, 18 and 24 h post-insemination. At 12 h, male PN formation rate from Percoll-treated spermatozoa was higher than from sperm subjected to swim-up and glass-wool treatments (20/37, 54% vs. 6/37, 16% and 6/38, 16%, respectively; P < 0.001). In Experiment 4, embryos were compared for cleavage at 48 h and development into blastocysts, hatching rates and cell number at 192 h. The rates of cleavage and blastocyst formation in the Percoll-treated group were higher (P < 0.05) than in the swim-up and glass-wool groups (62% and 18% vs. 50% and 11%, and 45% and 8%, respectively). Similarly, the mean cell number in the Percoll group was higher (P < 0.05) than in the swim-up and glass-wool groups (167 ± 5 vs. 149 ± 4 and 126 ± 4, respectively). We conclude that Percoll density-gradient centrifugation is superior to the other two methods for separating goat spermatozoa from frozen-thawed semen in preparation for IVF.

Inhibin B response to EFORT is associated with the outcome of oocyte retrieval in the subsequent in vitro fertilization cycle

Objective: To examine whether the magnitude of the rise in inhibin B levels after gonadotropin challenge is associated with subsequent response to ovarian stimulation during IVF. Design: Inhibin B serum levels after EFORT (exogenous follicle-stimulating hormone ovarian reserve test). Setting: Academic clinical practice. Patient(s): Serum samples from women who had undergone ovarian reserve screening with FSH in preparation for IVF. Thirteen of these women had a poor response in IVF (canceled cycle for low estradiol and/or no oocytes retrieved), and 19 had a good response (≥10 oocytes retrieved). Intervention(s): EFORT test. Main Outcome Measure(s): Baseline (day 3) serum E 2 (bE 2), FSH (bFSH), and inhibin B (bInhB) levels and inhibin B and E 2 levels 24 hours after EFORT (ΔInhB and ΔE 2). Result(s): The mean bInhB and ΔInhB levels were significantly higher in good vs. poor responders. The odds ratio of having a good response for women with a ΔInhB of 202 pg/mL was 51.8 times (95% CI = 6.1–1,244) the corresponding odds for women with a ΔInhB of 49 pg/mL. As expected, ΔE 2 was also significantly higher in good vs. poor responders; however, combination of ΔE 2 plus ΔInhB did not improve the odds for predicting IVF response. Conclusion(s): Our data suggest that ΔInhB after EFORT may provide a method for predicting ovarian response to hyperstimulation in a subsequent IVF cycle.

Elevated level of follicular fluid vascular endothelial growth factor is a marker of diminished pregnancy potential

Objective: To evaluate whether differences in follicular fluid vascular endothelial growth factor (FF VEGF) concentrations are observed between women achieving a clinical pregnancy and those failing to conceive. Design: Retrospective chart review and analysis of FF VEGF concentrations. Setting: University teaching center. Patient(s): Fifty-seven women ≤42 years of age undergoing follicular aspiration in preparation for IVF or GIFT. Intervention(s): Analysis of FF VEGF concentrations and chart review of a single IVF or GIFT cycle. Main Outcome Measure(s): Follicular fluid VEGF concentrations, clinical pregnancy rate, age, ampules of gonadotropins used, oocytes retrieved, peak estradiol serum concentrations, day 3 FSH levels, and fertilization rate. Result(s): Women who did not conceive had higher FF VEGF concentrations than women achieving a clinical pregnancy (4,409 + 2,387 versus 2,793 ± 1,180 pg/mL: P < .001). A negative correlation was observed between FF VEGF concentrations and peak estradiol levels and number of oocytes retrieved. A positive correlation was found for FF VEGF and patient’s age and ampules of gonadotropins used. Conclusion(s): Elevated FF VEGF concentrations are associated with poor conception rates after IVF or GIFT.

Effect of age on sperm fertility potential: oocyte donation as a model

To determine the effect of age on sperm fecundability using oocyte donation as an in vivo model. Oocyte donation and IVF programs at the Instituto Valenciano de Infertilidad. Retrospective study in which four groups of oocyte donation cycles were established according to age of the male providing the semen sample: group 1 (n = 31) < 30 years; group 2 (n = 195) 31 to 40 years; group 3 (n = 98) 41 to 50 years; group 4 (n = 21) > 51 years, the oldest being 64 years. All donated oocytes were obtained from patients < 35 years old. Male age, sperm characteristics (volume, concentration, motility, morphology), fertilization, embryo quality, pregnancy, implantation, and abortion rates among recipients. Similar sperm characteristics in fresh as well as after preparation for IVF were observed among males of different ages. Fertilization, embryo quality, pregnancy, and implantation were similar among the established groups. The mean age of the females included in each group significantly increased from group 1 to group 4. Age (up to 64 years) does not affect sperm characteristics or its ability to fertilize human eggs. Similarly, embryo development in vitro as well as implantation in recipient uteri are not affected by age of the male providing the semen sample.

Assessment of ovarian and uterine blood flow by transvaginal color Doppler in ovarian-stimulated women: correlation with the number of follicles and steroid hormone levels

To study the changes that occur in vascular resistance to flow in the utero-ovarian circulation and their correlation with the number of follicles and steroid hormone levels in patients undergoing ovarian stimulation with gonadotropin.In a prospective study, the impedance to flow in the intraovarian and uterine vessels was measured by means of transvaginal color flow Doppler imaging throughout the cycle.University-based IVF program.Eleven infertile patients undergoing ovarian stimulation with gonadotropin in preparation for IVF and ET.Intraovarian, uterine, and arcuate artery blood flow velocity waveforms, follicular growth, and serum E2 and P concentrations throughout the cycle.Pulsatility index (PI) of the intraovarian blood vessels and uterine artery decreased gradually during the follicular and luteal phase. The PI of the arcuate artery did not change significantly. The PI of the intraovarian blood vessels correlated with the number of follicles (> 15 mm; day of hCG). Serum E2 concentrations but not P demonstrated negative linear correlation with the PI of the intraovarian vessels and uterine artery.Induced cycles are associated with decreased impedance to blood flow in the utero-ovarian circulation. Intraovarian PI correlates negatively at each stage of the cycle with the eventual number of preovulatory follicles. Little or no changes are observed when the response to ovarian stimulation is poor.