Women Undergoing In Vitro Fertilization Treatment Research Articles

ORIGINAL ARTICLE: Serial Estimation of Th1:Th2 Cytokines Profile in Women Undergoing In‐Vitro Fertilization‐Embryo Transfer

ProblemTo investigate changes in the ratio of T‐cell subpopulations expressing intracellular T helper1 (Th1) and T helper 2 (Th2) cytokines in women with a history of recurrent failed implantation under going in‐vitro fertilization (IVF)‐embryo transfer.Method of studyTwenty‐eight peripheral blood samples were obtained at two time points, from 14 women undergoing IVF treatment; eight women with a history of recurrent failed implantation, who did not get pregnant in the index IVF cycle and six who had one or more previous successful IVF pregnancy and who became pregnant in the index IVF cycle. The proportion of lymphocytes expressing interferon‐gamma (IFN‐γ), tumour necrosis factor‐alpha (TNF‐α), and interleukin 4 (IL‐4) and the Th1:Th2 ratios of IFN‐γ:IL‐4, and TNF‐α:IL‐4 in T helper cells was measured by flow cytometry, in samples obtained before commencing IVF treatment and in samples obtained after ovarian stimulation (on the day of oocyte retrieval).ResultsIn samples collected during oocyte retrieval, women with a history of recurrent failed implantation had a higher IFN‐γ:IL‐4 and TNF‐α:IL‐4 ratio than the control group, (18.6 ± 9.3 versus 6.47 ± 1.68, P = 0.009) and (39.1 ± 15.7 versus 11.53 ± 3.76, P = 0.001) respectively. In women with a history of recurrent failed implantation the ratio of IFN‐γ:IL‐4 and TNF‐α:IL‐4 at oocyte retrieval was higher than pre‐treatment ratios (18.6 ± 9.3 versus 12.01 ± 9.8, P = 0.018) and 39.10 ± 15.7 versus 18.66 ± 11.42, P = 0.010) respectively, showing a Th1 bias. In women with a successful IVF the converse was true; the ratio at oocyte retrieval was significantly lower than pre‐treatment ratios (6.47 ± 1.68 versus 9.37 ± 6.8, P = 0.035) and 11.53 ± 3.76 versus 18.60 ± 12.9, P = 0.027) respectively, representing a Th2 bias.ConclusionWomen with a history of unexplained recurrent failed IVF treatment have a Th1 bias and this polarization is more enhanced following hormonal manipulations during IVF treatment. Comparing pre‐treatment ratios of IFN‐γ:IL‐4 and TNF‐α:IL‐4 to ratios obtained at oocyte retrieval may be clinically useful. Women with recurrent failed IVF have increasing ratios.

“LONGING FOR A CHILD”: PERCEPTIONS OF MOTHERHOOD AMONG ISRAELI-JEWISH WOMEN UNDERGOINGIN VITROFERTILIZATION TREATMENTS

During the last two decades, the use of reproductive technologies in Israel has been on the increase. While feminist studies on mothering inherently focus on the experiences of women who have actually achieved motherhood, perceptions of among women undergoing in vitro fertilization (IVF) treatments have received little attention. On the assumption that perceptions are intrinsic to would-be mothers' experiences, I studied biological motherhood accounts of infertile women in the context of reproductive technologies. The study involved 25 infertile, Israeli-Jewish, heterosexually married women undergoing IVF treatments a first pregnancy. A semi-structured interview was conducted to allow the women to openly discuss issues concerning their perceptions of motherhood. Research findings show that perceptions dictated two distinct categories of discourse. The first category, the obeying-the-treatment-routine discourse, surfaced from the accounts of 14 of the interviewees. Women belonging to this category adopted the dominant discourses of the pronatalist ideology prevalent in Israeli society. They were willing to cooperate with constraints imposed on them by technological practice and voluntarily assimilated various discourses of discipline for the sake of successful treatment. Underlying this approach is the message that is a superior value and that the non-impregnated female body has no rights of its own and constitutes a threat to the social order. A second discourse of emerged from the accounts of 1 1 interviewees, classified as the type. The negotiating approach was associated with female motivation to maintain an active dialogue with the hegemonic-technocratic order that demands to define motherhood. These

Subendometrial arterial spectral doppler assessment during IVF cycles and its correlation with treatment outcome

The influence of blood flow impedance in subendometrial arteries on embryo implantation rate was investigated by transvaginal sonographic examination in in vitro fertilization (IVF) cycles. A total of 39 women undergoing IVF treatment were evaluated along the treatment cycle. Power and spectral Doppler studies of subendometrial arteries were performed to calculate the pulsatility index (PI), resistance index (RI) and systolic:diastolic ratio (S:D). The correlation between these parameters and pregnancy achievement was analyzed. Patients were grouped according to whether pregnancy was achieved or not. RI and S:D did not differ between the groups along the course of treatment. In pregnant patients, the PI was significantly lower in the beginning of the cycle than on the preovulation day and ovum pickup day. PI in the beginning of the treatment was significantly lower in pregnancy cycles than in nonpregnancy ones. A lower PI on day 1 was correlated with a better chance for pregnancy. (E-mail: zvi.leibovitz@b-zion.org.il)

The Effect of Serum Concentration of Leukaemia Inhibitory Factor on In Vitro Fertilization Treatment Outcome

To evaluate the association of peripheral leukaemia inhibitory factor (LIF) levels on implantation and miscarriage rates after in vitro fertilization (IVF) treatment. Prospective observational study of 120 randomly selected women who underwent IVF treatment. The concentration of LIF in serum was determined by enzyme-linked immunosorbent assay. There was no significant differences with regard to the systemic mean LIF concentration between the pregnant (42 patients, LIF: 11.55 pg/mL +/- 5.3 S.D.) and non-pregnant (66 patients, LIF: 13.47 pg/mL +/- 5.1 S.D.) women after IVF treatment. Likewise, for those women who have positive pregnancy after IVF treatment, the systemic mean LIF levels were not significantly different between women who have an ongoing pregnancy (34 ongoing pregnancy, LIF: 11.26 pg/mL +/- 5.2 S.D.) and those who had miscarriage (eight miscarriage, LIF: 12.78 pg/mL +/- 5.6 S.D.). The systemic levels of LIF concentration have no association with implantation rate or miscarriage rate in women undergoing IVF treatment. Measuring serum LIF concentration prior to embryo transfer in IVF treatment has no predictive value of implantation rate or miscarriage rate.

Evaluation of endometrial receptivity during in‐vitro fertilization using three‐dimensional power Doppler ultrasound

To compare sonographic endometrial characteristics in in-vitro fertilization (IVF) cycles between women who conceive and those who do not. Thirty-five women undergoing IVF treatment participated in the study. Using three-dimensional (3D) power Doppler ultrasound, we assessed endometrial patterns, volume and vascularization, after follicle stimulating hormone (FSH) stimulation but before human chorionic gonadotropin (hCG) administration (referred to hereafter as 'after FSH stimulation') and again on the day of oocyte retrieval. The pregnancy rate was 37% (13/35). After FSH stimulation, 29 of the 35 women had a triple-line endometrial pattern, compared with five out of 35 on the day of oocyte retrieval. In those who had a triple-line pattern after FSH stimulation the pregnancy rate was 44.8% (13/29) and it was 0% (0/6) in those with a homogeneous pattern (chi-square test, P = 0.039). If a triple-line pattern was present on the day of oocyte retrieval the pregnancy rate was 80.0% (4/5), whereas if the pattern was homogeneous the pregnancy rate was 30.0% (9/30) (P = 0.032). There were no differences between those who conceived and those who did not in endometrial thickness, volume or vascularization on either day examined. Endometrial volume decreased significantly after hCG injection in women who conceived, but not in those who did not conceive. In both groups endometrial and subendometrial vascularization decreased after hCG injection, while the endometrial thickness remained unchanged. The existence of a homogeneous endometrial pattern after FSH stimulation seems to be a prognostic sign of an adverse outcome in IVF, while a triple-line pattern after FSH stimulation and a decrease in endometrial volume appear to be associated with conception.

Age dependent assessment of TFPI levels in follicular fluid of women undergoing IVF

Background Tissue factor pathway inhibitor (TFPI) is a multivalent Kunitz-type serine proteinase inhibitor which plays a central role in the extrinsic pathway of blood coagulation. A significant role of TFPI for the follicular development has been discussed in recent studies, and thrombotic complications during IVF procedure are a common problem. To elucidate the pathophysiological mechanisms underlying these problems, we have measured TFPI levels in human follicular fluid (hFF) of women undergoing in vitro fertilisation (IVF). Methods Total TFPI concentrations were determined in hFF of 28 women undergoing IVF treatment, 6 of whom developed an ovarian hyperstimulation syndrome (OHSS). Results and conclusions This is the first study to demonstrate an age-dependance of TFPI concentrations in hFF. Additionally, TFPI levels in hFF of women developing OHSS were determined as 323 ± 66.8 ng/mL (mean ± SD) in comparison with 279 ± 137 ng/mL for non-OHSS patients. Our findings demonstrate that, unlike the decreased TFPI levels found in OHSS patients' blood, there is no statistically significant difference in hFF TFPI levels between OHSS and non-OHSS patients. Furthermore, we could show that the outcome of the IVF procedure is not correlated with TFPI levels in hFF.

The expression of matrix metalloproteinase‐9 in human follicular fluid is associated with in vitro fertilisation pregnancy

To investigate the role of matrix metalloproteinase-9 (MMP-9) in the pre-ovulatory follicular fluid and culture media during in vitro fertilisation (IVF) cycle and to develop the zymographic pre-diagnosis marker for successful implantation and pregnancy in human IVF. Controlled clinical study. IVF Laboratory, Women's Hospital Infertility Clinic and Dongguk University, Korea. Women undergoing in vitro fertilisation treatment. Experiments were designed for controlled clinical study with women undergoing IVF treatment. MMP-9 expressions in follicular fluid and culture media samples that had been collected during transvaginal oocyte retrieval were measured using zymography. MMP-9 activities and expressions were strongly correlated to a higher rate of fertilisation and pregnancy. Fertilisation rates and ultrasonic evidence of intrauterine pregnancy by four weeks after embryo transfer. MMP-9 activity was significantly higher in the pregnant group than in the non-pregnant group (P < 0.01). In contrast, MMP-2 activity was present in the follicular fluid and culture media of all women, and no difference in its expressions was found between the pregnant and non-pregnant groups. No correlation was found between the MMP-9 expression in follicular fluid and culture media and the fertilisation rates. The expression of MMP-9 in the follicular fluid and culture media is a prerequisite for successful pregnancy in IVF cycle. The zymography of MMP-9 activity in follicular fluids of human and culture media was developed as a pre-diagnostic method and zymographic diagnosis marker for successful fertilisation, implantation and pregnancy in human IVF.

Power Doppler ultrasound assessment of ovarian perifollicular blood flow in women with polycystic ovaries and normal ovaries during in vitro fertilization treatment

To evaluate whether ovarian perifollicular blood flow (PFBF) varies by ultrasound among women with polycystic and normal ovaries undergoing in vitro fertilization (IVF). Prospective observational cohort study of women undergoing IVF treatment. Department of reproductive medicine at a university teaching hospital. Thirty four women with regular spontaneous ovulatory menstrual cycles undergoing IVF divided into two groups according to findings on a baseline transvaginal ultrasound scan: group 1 consisted of 20 women with ultrasound-evident normal ovaries (USNO group), and group 2 consisted of 14 women with ultrasound-evident polycystic ovaries (USPCO group). Serial transvaginal power Doppler ultrasound assessments throughout the follicular phase of ovarian stimulation. Ovarian PFBF and ovarian stromal artery pulsatility index. Women with USPCO had a significantly lower ovarian stromal artery pulsatility index at the time of the first ultrasound assessment before starting the FSH injections compared with USNO women. However, there was no difference in ovarian PFBF between women with USPCO and USNO during the follicular phase of ovarian stimulation for IVF. There is no difference in ovarian follicular vascularity between women with polycystic and normal ovaries during ovarian stimulation at IVF treatment.

Association between human leukocyte antigen-G genotype and success of in vitro fertilization and pregnancy outcome.

To determine if a 14-bp deletion/insertion polymorphism in the 3'-untranslated region of exon 8 of the gene encoding human leukocyte antigen (HLA)-G in a homozygous form is associated with repeated, unsuccessful in vitro fertilization (IVF) treatments, and with increased risk of recurrent spontaneous abortions (RSA), 29 white women undergoing IVF treatments, 61 RSA women and 93 fertile controls were HLA-G genotype. The HLA-G genotype, homozygous for the presence of the 14 bp sequence in exon 8, was significantly associated with reduced fertility with respect to unsuccessful IVF treatments and increased risk of recurrent miscarriage (combined P < 0.01). The 14-bp insertion/deletion polymorphism is associated with differences in HLA-G mRNA alternative splicing and levels of HLA-G. This might affect a possible immunomodulatory role of HLA-G expression in both the mother and foetus during implantation and pregnancy.

Psychopathology, personality, and marital relationship in patients undergoing in vitro fertilization procedures

Objective: To compare the psychopathology, personality features, and marital relationships of women undergoing in vitro fertilization (IVF) with those of control patients, and to compare IVF inductees with program veterans. Design: Cross-sectional clinical study. Setting: A university hospital. Patient(s): One hundred and one women undergoing IVF treatment. Intervention(s): Psychometric tests were administered at first visit (baseline) of index treatment cycle. Main Outcome Measure(s): Achievement of pregnancy. Result(s): Women undergoing IVF show higher levels of anxiety and emotional tension than do controls. Although the infertile women showed no abnormal personality dimensions, the IVF group did have a particular psychological profile and a different marital relationship pattern when compared with the control participants. Between IVF veterans and inductees, there are significant differences with respect to psychopathology, psychological dimensions, and couple dynamics. The achievement of pregnancy is not associated with any special psychopathological, personality, or marital characteristics among the IVF women. Conclusion(s): The most crucial period in IVF procedures may immediately follow the end of the first cycle because of the high risk of patients dropping out of the program. To determine the most effective supporting therapies for women undergoing fertilization procedures it could be useful to consider the psychological and relational differences between veterans and inductees.

Colour Doppler indices of follicular blood flow as predictors of pregnancy after in-vitro fertilization and embryo transfer.

Peak systolic velocity (PSV) of individual follicles has been correlated with oocyte recovery, fertilization rate and embryo quality [in women undergoing in-vitro fertilization (IVF) and embryo transfer]. The present study assessed the role of quantitative and qualitative indices of follicular vascularity in predicting pregnancy after IVF and embryo transfer. A total of 106 women undergoing IVF treatment for infertility who were considered to be at risk of failure (>37 years of age, history of low response to gonadotrophin stimulation, or multiple failed IVF cycles) constituted the study group. PSV was measured from the three largest follicles on both the right and left ovaries on the day of human chorionic gonadotrophin (HCG) administration using an Acuson Sequoia with a 4-8 MHz transvaginal probe. The quality of follicular flow was graded from 1 to 4 according to the amount of visible colour flow around the follicle (grade 1 when one-quarter of the follicle, grade 2 when one-half, grade 3 when three-quarters, and grade 4 when the entire follicle was surrounded by colour). Clinical pregnancies resulted in 11 (10%) of the 106 high-risk women. Women who had PSV >/= 10 cm/s in at least one follicle on the day of HCG administration more often became pregnant than those with PSV <10 cm/s (P = 0.05). All pregnancies occurred in women with grade 3 or 4 follicular blood flow. Qualitative as well as quantitative measurements of follicular flow predict pregnancy after IVF and embryo transfer.

Pharmaco-economic aspects of in-vitro fertilization in Italy.

Given the higher efficacy of follitropin-beta, a new recombinant follicle stimulating hormone (r-FSH), versus urinary-FSH (u-FSH), the present study was carried out to evaluate the cost-effectiveness ratio (CER) of follitropin-beta in comparison with u-FSH in women undergoing in-vitro fertilization (IVF) in Italy. Clinical decision analysis techniques were used to retrospectively model the direct medical costs of women undergoing IVF treatment. Seven Italian experts were interviewed, using a semi-structured questionnaire, in order to adapt the results of all clinical trials to the Italian patterns of care. Three analyses were conducted considering the public, the private sectors and a mixture of them (currently representing the Italian situation). The estimated total cost of IVF treatments varies from 106.9 and 211.7 billion Lire (63.2 and 125.2 million US$) depending on setting and type of treatment. The average CER varies from 21.5 and 37.7 million Lire (12, 700 and 22,300 $US) in the different hypotheses considered. The incremental CER varies from 19.2 and 26.0 million Lire (11,300 and 15,400 $US) depending on setting and type of treatment.

Anaesthesia for assisted conception

Anaesthesia for assisted conception

Antiphospholipid antibodies in women having in-vitro fertilization.

Antiphospholipid antibodies have an established association with pregnancy complications such as recurrent miscarriage, growth retardation, placental abruption and stillbirth but their mechanism of action is unclear. We have investigated whether antiphospholipid antibodies occur more frequently in women having in-vitro fertilization (IVF) and whether their presence is associated with the likelihood of failed implantation. We studied 240 women undergoing IVF treatment who were </=38 years and had attempted fewer than three previous IVF cycles. Antiphospholipid antibodies (anticardiolipin and antiphosphatidyl serine immunoglobulin G and immunoglobulin M) were present in 36 out of 240 (15%) of the study population and were not associated with a failed IVF cycle or miscarriage. There was no association between the cause of infertility and the presence of antiphospholipid antibodies. Antiphospholipid antibodies were not detected more frequently in women with previous attempts at IVF compared with women having their first cycle, indicating that the high incidence of these antibodies is not due to the IVF treatment. There was a strong association between the presence of antiphospholipid antibodies and intrauterine growth retardation in singleton pregnancies (P < 0.005). We recommend routine screening for the presence of antiphospholipid antibodies in women having IVF in order to identify those pregnancies at increased risk of intrauterine growth retardation.