Stimulated IVF Cycles Research Articles

Inter-Cycle Variations of Blood Flow Changes in Uterine and Ovarian Vasculature During Stimulated IVF Cycles

Inter-Cycle Variations of Blood Flow Changes in Uterine and Ovarian Vasculature During Stimulated IVF Cycles

Epididymal and testicular sperm for intracytoplasmic sperm injection in the treatment of obstructive azoospermia.

The possibility of treating male infertility because of obstructive azoospermia has been poor, but intracytoplasmic sperm injection (ICSI) has given this type of infertility sufferer a new option. In this study 13 couples with obstructive azoospermia were treated in a total of 19 stimulated IVF cycles. The men were between 27 and 45 (mean 33) years of age. Their partners, 24-39 (mean 31) years of age were treated according to routine IVF procedures, i.e. down regulation with buserelin followed by hyperstimulation with urofollitropin. Fertilization was obtained by ICSI. Two embryos were transferred on day two after the ovum pick up. Sperm were retrieved through microsurgical epididymal aspiration (MESA) in four cycles, percutaneous epididymal sperm aspiration (PESA) in three cycles and through testicular sperm extraction (TESE) in 12 cycles. The overall fertilization rate was 68%, with a cleavage rate of 82%.The fertilization rate was equal (68%) with epididymal and testicular sperm and the cleavage rate was 87%) and 80%, respectively. Embryos were obtained for embryo transfer (ET) in all cases and five pregnancies (one twin pregnancy) were established (26% per ET), three using epididymal sperm and two using testicular sperm. Infertility due to obstructive azoospermia can successfully be treated with epididymal sperm and ICSI. When epididymal sperm cannot be found sperm extracted from a testicular biopsy can be used. PESA and TESE are quicker and easier alternatives to MESA and can be performed on an outpatient basis with local anesthesia.

P-217 Inter-cycle variations of blood flow changes in uterine and ovarian vasculature during stimulated IVF cycles

P-217 Inter-cycle variations of blood flow changes in uterine and ovarian vasculature during stimulated IVF cycles

Clinical application of nonselective assisted hatching of human embryos

To evaluate the effect of nonselective assisted hatching on pregnancy rate (PR) and to provide an alternative and simplified method for clinical application of assisted hatching. Retrospective analysis of clinical data. Private infertility practice. Women from 258 consecutive stimulated IVF cycles. Assisted hatching was performed on each transferred embryo regardless of patient history, embryo morphology, or other selection criteria routinely applied to many IVF programs. Pregnancy, live birth, and implantation rates. Of 258 consecutive patients who had nonselective assisted hatching, 109 (42%) had clinical pregnancies, with 93 (36%) live births and 178 (20%) embryos implanted. Nonselective assisted hatching resulted in an acceptable PR and provided an alternative and simplified method for clinical application of assisted hatching.

Successful pregnancy outcome after cryopreservation of all fresh embryos with subsequent transfer into an unstimulated cycle

To assess the pregnancy outcome of freezing and storing all fresh embryos produced in a stimulated IVF cycle and replacing them in a subsequent nongonadotropin-stimulated cycle. Retrospective study. University-associated assisted reproductive technology program. We studied 36 patients (age range 23 to 44 years) who underwent cryopreservation of all fresh embryos in a controlled ovarian hyperstimulation (COH) cycle because of either the risk of severe ovarian hyperstimulation (24 patients, group 1) or the presence of an endometrial lining < 8 mm in thickness (12 patients, group 2). Five hundred fifty-five embryos were generated for replacement in 63 cycles. All embryos were cryopreserved in 1.5 M propanediol at the pronuclear or two-cell stage, and 264 embryos subsequently were transferred into a hormone replacement cycle (70%) or natural ovulatory cycle (30%). The average number of embryos transferred per patient was 4.2. Twenty-one clinical pregnancies were achieved, giving a pregnancy rate (PR) of 58.3% per patient (33.3% per cycle). The live birth rate was 50% per patient (28.6% per cycle). The implantation rate was 9.1%. Groups 1 and 2 had a similar PR per patient (58.3%). With 208 cryopreserved embryos remaining and considering the 33.3% PR per cycle, we expect the overall extrapolated PR to be 63.9%. This is the first series showing that freezing and storing all fresh embryos produced in a stimulated IVF cycle and replacing them in a subsequent nongonadotropin-stimulated cycle results in successful PRs. These results underlie the importance of a successful cryopreservation program in IVF and could be a possible approach to overcoming the alleged adverse effects of COH on the endometrium, thereby improving the chances of pregnancy when numerous embryos are obtained simultaneously.

Fertilization and in vitro development of cryopreserved human prophase I oocytes

To determine the potential for in vitro maturation, fertilization, and cleavage after cryopreservation of immature, prophase I human oocytes. Immature oocytes obtained in excess of the number required by the patient were randomized and cryopreserved at the prophase I stage or cultured as control. After thawing and maturation in vitro, test and control oocytes were inseminated with husband's sperm and evaluated for fertilization and cleavage in vitro. In vitro fertilization program. Consenting patients undergoing controlled ovarian hyperstimulation for the purposes of IVF. Rates of maturation to metaphase II, fertilization, and cleavage were compared between control and cryopreserved oocytes. Upon thaw, 58.5% (72/123) of prophase I oocytes were viable. Control oocytes demonstrated a 74.8% (98/131) maturation rate to metaphase II, a 56.5% (52/92) fertilization rate, and an 11.5% (6/52) blastocyst rate. Cryopreserved oocytes showed a 83.3% (60/72) rate of maturation, a 57.7% (30/52) fertilization rate, and a 3.3% (1/30) blastocyst rate. No significant differences were noted between any of these parameters. These results demonstrate that prophase I oocytes from stimulated IVF cycles are able to survive cryopreservation and resume meiosis to achieve full nuclear maturation post-thaw. In addition, cryopreserved oocytes retain the same capacity for fertilization and development as control oocytes.

Effect of cell number at freezing upon survival and viability of cleaving embryos generated from stimulated IVF cycles

The survival of cleaving embryos after freezing and thawing has been assessed. First, comparisons were made of the proportions of embryos in which all blastomeres were viable cells after thawing, following various forms of ovarian stimulation. A flare-up protocol using a GnRH-agonist (buserelin) produced significantly higher numbers of these embryos than a pituitary down-regulation protocol (P less than 0.05), though neither was significantly different from clomiphene citrate/HMG stimulation. Secondly, other parameters of embryo survival e.g. proportions with one or more surviving cells and pregnancy rates were assessed and were similar among stimulation protocols and treatments in the embryo replacement cycle. Survival of blastomeres in 2- to 8-cell embryos was inversely related to the theoretical total surface area of all blastomeres in the embryo. Thawed embryos with one or more blastomeres damaged during freezing had the same capacity to produce pregnancies as did those with all blastomeres intact. The survival of individual cells was clearly related to the stage at which the cleaving embryo is frozen, but moderate loss of cells does not significantly influence implantation.