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R H Asch

Publications and source records attributed to R H Asch.

At least 19 recordsLinked to original sources
PubMed1998

Elevated basal estradiol levels have no negative prognosis in young women undergoing ART cycles.

The objective of this study was to determine the relationship between serum estradiol levels on day 2 of an in vitro fertilization and embryo transfer (IVF-ET) cycle and the chance of pregnancy and implantation rates according to age. Two hundred and forty-eight cycles of IVF-ET in patients treated with gonadotropin-releasing hormone analog (GnRHa, follicle-stimulating hormone (FSH) and human menopausal gonadotropin (hMG) were divided into several groups according to the basal serum concentrations of estradiol (E2):A < 25 pg/ml, B 26-50 pg/ml, C 51-75 pg/ml, D 76-100 pg/ml, E > 100 pg/ml. Furthermore, the patients were subdivided into two subgroups according to age: I younger; and II, older than 35 years. Pregnancy and implantation rates were analyzed for each subgroup according to basal E2 level and age. Statistical analysis was performed using analysis of variance, chi2 and Fisher's test. The number(s) of cycles for each subgroup were 164 and 84 for I and II, respectively. Even though there were no significant differences among groups for the pregnancy rates for individual groups, there was a tendency for a decreased rate with increasing levels of E2 only in women older than 35 years of age. When pregnancy rates of all women with E2 levels above 25 pg/ml were calculated, the differences between those observed in subgroup I (< or = 35 years) and II (> 35 years) was significant: p = 0.02 (38.7% vs. 18.7%, respectively). When implantation rates in the same groups and subgroups were analyzed, we found that again the differences were statistically significant: p = 0.001 (13.1%vs, 4.3% for I and II). The results of the present studies reveal that basal levels of E2 are a marker of poor prognosis for implantation and pregnancy in assisted reproduction (ART) cycles only in patients over the age of 35 years. These data cast doubt on the use of basal levels of E2 to screen women below the age of 35 prior to initiating an ART cycle. In addition, high levels of basal E2 per se may not be deleterious for reproductive efficiency in younger women, since pregnancy and implantation rates did not differ among patients younger than 35 years old (IA to E).

Adult↗
PubMed1996

Vaginal bleeding and early pregnancy outcome in an infertile population.

OBJECTIVE: Our purpose was to determine the prognostic value of vaginal bleeding in early pregnancy outcome as well as to analyze the role of cardiac activity in predicting pregnancy viability in the presence of vaginal bleeding. STUDY DESIGN: This was a cohort study of pregnancies obtained using either assisted reproductive technology (ART) or routine infertility treatment (RIT). Two hundred twenty-eight pregnant women were divided into two groups based on the presence or absence of vaginal bleeding. Successive measurements of beta-hCG levels were obtained every 2 days, starting on day 14 after ovulation or embryo transfer. All pregnancies underwent weekly transvaginal ultrasound (UTZ) examinations beginning on day 21. The occurrence of vaginal bleeding was monitored weekly. RESULTS: Seventy of the 228 patients (31%) had bleeding in early pregnancy, resulting in 31 (44%) pregnancy losses. Only 22 pregnancy losses (14%) were observed in 158 patients who did not have bleeding (P < 0.001). The abortion rate for the bleeding versus nonbleeding groups was 35 and 9%, respectively (P < 0.001). Vaginal bleeding was associated with a higher abortion rate in pregnancies following RIT than ART (51 vs 8%; P < 0.001). Fetal cardiac activity was noted by vaginal ultrasound in 189 patients. In this subpopulation, bleeding was also associated with a higher abortion rate than that in the nonbleeding group (17 vs 4%; P < 0.001). However this higher incidence was observed only in pregnancies following RIT, not ART (28 vs 5%; P < 0.001). CONCLUSIONS: Although bleeding significantly decreased the chance of a normal pregnancy outcome, more than 50% of the pregnancies did progress to term. The presence of cardiac activity in this population as a sign of fetal viability offered a better pregnancy prognosis. However, the predictive value of fetal cardiac activity was reduced in the presence of vaginal bleeding in an infertile population treated with RIT.

Abortion, Spontaneous↗
PubMed1996

Spontaneous resolution of ectopic pregnancy in a surrogate after oocyte donation and frozen embryo transfer.

A case of tubal pregnancy in a young and healthy woman participating in a programme of in-vitro fertilization (IVF) gestational surrogacy is reported. The gestational surrogate was the 30 year old fertile sister of a 25 year old patient affected by stage 1 ovarian cancer. After mandatory oncological consultation, the donor was recommended to prospectively undergo controlled ovarian hyperstimulation cycles for embryo banking before being treated by total hysterectomy. Available embryos were cryopreserved and after adequate endometrial preparation using artificial cycles of hormone replacement therapy, three thawed frozen embryos were transferred to the surrogate. At 17 days following embryo transfer the surrogate was noted to have a negative beta-human chorionic gonadotrophin (HCG) serum concentration. All medication was suspended and a few days later normal menstrual bleeding occurred. After 2 weeks, the beta-HCG concentrations, performed as part of routine follow-up evaluation, were showing signs of trophoblast activity (236 mIU/ml). Taking into account the stable condition of the patient, a decision was made to undertake expectant management. At 43 days after embryo transfer, a complete tubal abortion was apparently seen in the posterior cul-de-sac by ultrasound associated with a subtle and short lasting pelvic pain. We stress that this ectopic gestation was able to maintain prolonged viability in conditions of absent corpus luteum and exogenous steroid supplementation.

Abortion, Spontaneous↗
PubMed1995

Enzymatic characterization of zona pellucida hardening in human eggs and embryos.

PURPOSE: To characterize possible hardening of the human zona pellucida (ZP) and evaluate the effect of culture duration, patient age, and ZP thickness, ZP of unfertilized eggs (experiment 1, n = 367; experiment 2, n = 174) and abnormal embryos (experiment 1, n = 52) were randomly designated for alpha-chymotrypsin treatment after 0, 24, 48, 72, 96, 120 h (experiment 1) and 48 h, 72 h, and 1 week (experiment 2) of in vitro culture in HTF medium supplemented with 0.5% human serum albumin. Mean ZP thickness was predetermined in experiment 2. METHODS: The dispersion of the ZP glycoproteins was assessed, and the duration of time for complete digestion was recorded as an index of ZP hardness. RESULTS: In experiment 1, enzyme digestion duration increased (P < 0.05) in the first 24 h in vitro from 18.0 +/- 2.0 to 34.6 +/- 2.5 min, and tended to decrease over the next 4 days in culture (25.2 +/- 1.3, 29.4 +/- 0.9, 27.3 +/- 0.6, 26.6 +/- 1.1, and 20.7 +/- 1.5 min on Day 2-6 ZP, respectively). Zona hardening of fertilized eggs was revealed by a longer (P < 0.01) digestion time (32.2 +/- 1.8 vs 25.8 +/- 0.6 min). CONCLUSIONS: There were significant patient-to-patient variation (16.4 +/- 0.7 to 39.6 +/- 2.2 min); however, age was not correlated to enzyme digestion duration. In experiment 2 we determined that ZP thickness (range 8.4-21.6 microns; mean 14.6 +/- 0.2 microns) was not correlated (r = 0.09) to the digestion interval (mean 24.3 +/- 0.8 min). Based on our enzymatic ZP digestion measurements, it is apparent that spontaneous zona hardening does occur within 24 h of in vitro culture, similar to levels achieved postfertilization. The data do not support, however, the concept that additional, abnormal hardening of the ZP occurs during extended culturing.

Adult↗
PubMed1995

The use of progestins for programming assisted reproductive cycles and gonadotropin-releasing hormone agonist flare-up protocols in older patients.

OBJECTIVES: To determine if the use of norethisterone acetate (NET) in the previous cycle affects the ovarian response to GnRH agonist (GnRH-a) in flare-up protocols and controlled ovarian hyperstimulation in older patients. DESIGN: Retrospective analysis of the outcome of the assisted reproductive technology (ART) cycle. PATIENTS: Eighty women > 37 years old undergoing controlled ovarian hyperstimulation (COH) for a ART cycle (GIFT, IVF, zygote intrafallopian transfer). Forty received NET during the luteal phase of the previous cycle for programming the procedure and 40 did not receive NET (control group). Gonadotropin-releasing hormone agonist in follicular phase (flare-up) protocols were administered to all the patients. MAIN OUTCOME MEASURES: Cycle outcome: amount of gonadotropins used, oocyte production and quality, fertilization, and pregnancy rates. Estradiol, FSH, and LH levels the first 3 days of COH in eight patients. RESULTS: There were no differences between both groups in the cycle outcome. Estradiol levels during the first 3 days of COH were higher in the patients that did not receive NET in the previous cycle. Follicle-stimulating hormone and LH levels were similar in both groups. CONCLUSIONS: The administration of NET in the previous cycle in patients > 37 years old does not affect the ovarian response to the combination of follicular phase GnRH-a and gonadotropins for COH.

Adult↗
PubMed1995

Outcome of triplet pregnancies after assisted reproductive techniques: how frequent are the vanishing embryos?

OBJECTIVE: To assess the incidence of spontaneous embryo reduction as well as the obstetric and neonatal outcome of triplet gestations after assisted reproductive techniques (ART). METHODS: We analyzed the spontaneous outcome of 38 pregnancies in which three gestational sacs were identified with vaginal ultrasound between 21 and 28 days after ART. Weekly follow-up visits were scheduled during the first trimester until referral to a high-risk obstetrician. After delivery, each patient was interviewed individually and, if necessary, the obstetrician was contacted. RESULTS: The triplets delivery rate was 47.4%, whereas 31.6% delivered twins, 18.4% delivered singletons, and only one patient miscarried all three cases (2.6%). Finding three fetal heart beats was associated with a triplet delivery rate of 69.2%, a twin incidence of 19.2%, and a singleton birth rate of 11.6%. Embryo resorptions were observed mainly during the first 7 weeks of gestation and did not occur beyond the 14th week. The mean gestational age at delivery and neonatal birth weight were significantly lower among triplets (32.8 weeks and 1,740 g versus 35.3 weeks and 2,352 g in twins and 39.1 weeks and 3,122 g for singletons). Triplets had a 100% prematurity and cesarean section rate compared with 67% and 75% in twins and 0% and 43% in singletons, respectively. Hospitalization at the Neonatal Intensive Care Unit was required in 83% of newborn triplets, 29% of twins, and 0% of singletons, with a mean stay of 34 and 21 days for triplets and twins, respectively. One stillbirth and no neonatal deaths were reported, with an overall perinatal mortality rate of 11.9 per 1,000. CONCLUSIONS: Spontaneously, approximately 50% of triplet pregnancies will experience at least one embryo resorption. The ongoing triplets demand a complex and more expensive perinatal management, a strong argument to consider limiting the number of oocytes-embryos transferred in ART.

Birth Weight↗
PubMed1995

Increased capillary permeability induced by human follicular fluid: a hypothesis for an ovarian origin of the hyperstimulation syndrome.

OBJECTIVE: To examine the effect of follicular fluid (FF) and peritoneal fluid (PF) from patients undergoing assisted reproductive technology procedures on endothelial barrier function. This was determined in vitro by measuring the permeability of filter-grown bovine aortic endothelial cell monolayers to a permeability marker. DESIGN: Endothelial cells obtained from bovine thoracic arotas were treated with collagenase solution and plated on millicell filters, on which they formed confluent monolayers. Flux rate was determined at 60 minutes by measuring the radioactive tracer (3H mannitol) permeating from the apical to the basolateral part of the filter. Fifty-eight samples of FF and PF, both from stimulated and natural cycles were analyzed and grouped according to the number of eggs retrieved. Follicular fluid and PF samples from natural cycles were used as controls. RESULTS: There was an augmentation in the permeability rate of both FF and PF from patients undergoing controlled ovarian hyperstimulation (COH) who responded with an increasing number of eggs compared with controls (51% and 39%, respectively). When analyzing samples from patients who responded with a low number of oocytes, no significant increase was observed. CONCLUSIONS: It is known that in OHSS, the increase in capillary permeability is related to the administration of gonadotropins, and is believed to be mediated by a vasoactive substance of ovarian origin. In this study, FF and PF from patients undergoing COH showed a significant increase in the permeability rate through endothelial cells in vitro. Based on these findings, it could be hypothesized that if the same events took place in vivo, the isolation of this factor from ovarian source could be of significant importance to elucidate the pathogenesis of OHSS.

Adult↗
PubMed1995

The abnormally large follicle during controlled ovarian hyperstimulation: management and outcome of the cycle.

OBJECTIVE: To investigate if the presence of an abnormally large follicle during controlled ovarian hyperstimulation (COH) under pituitary suppression has any effect on the outcome of the cycle. DESIGN: Prospective, observational. SETTING: The reproductive endocrinology unit of a university hospital. PATIENTS: One hundred fifty patients undergoing COH for assisted reproductive techniques during a 6-month period (August 1990 to January 1991). INTERVENTIONS: Transvaginal follicular aspiration and IVF-uterine ET. RESULTS: A total of 19 cycles had abnormally large follicles identified on day 8 of the stimulation cycle after normal baseline ultrasound. Gonadotropins were continued and hCG injection was indicated when two or more follicles of the main cohort achieved a diameter of 20 to 22 mm. Twenty preovulatory oocytes were retrieved from 22 large follicles. Two were transferred for GIFT and 18 were inseminated in vitro, resulting in a 72.0% fertilization rate. The mean number of oocytes retrieved per patient was 10.9, 71.4% of which were mature with a fertilization rate of 67.7%. All these figures were comparable with the results obtained in the 131 patients of the control group undergoing IVF. No evidence of premature luteinization was observed in the study group, based on plasma P levels (x 0.83 ng/mL [conversion factor to SI unit, 3.180], range 0.31 to 1.40 ng/mL). The clinical pregnancy rate for the group with abnormally large follicles did not differ from the control group (27.8% versus 28.2%, respectively). CONCLUSIONS: The presence of an abnormally large follicle during COH under pituitary suppression does not affect the outcome of the cycle. Moreover, under these conditions, continuous gonadotropin stimulation of a follicle to diameters considerably larger than the standard ones does not have a detrimental effect on the oocyte contained in it, suggesting that oocyte aging is an independent process from follicular growth once LH surge is prevented.

Adult↗
PubMed1995

Enzymatic amplification of specific deoxyribonucleic acid sequences from single cells: evaluation of a simplified and rapid method for use in preimplantation genetic diagnosis.

OBJECTIVE: To develop a simplified polymerase chain reaction (PCR) protocol on single cells for the purpose of preimplantation genetic diagnosis. Also to evaluate a new thermal cycler, RoboCycler 40 (Stratagene, La Jolla, CA), for reducing the time to complete PCR amplification. DESIGN: PCR amplification without DNA purification or reamplification of a 149 base pair (bp) segment of the human Y chromosome was used as a model. The assay was tested in human fetal cells, single lymphocytes and single human blastomeres. RESULTS: Amplification of the 149 bp segment using fetal cells was 100% correct. Results on single lymphocytes were concordant in all but one of the 15 male cases. However, 2 of the 25 female cases were identified as male suggesting the occurrence of DNA contamination. Analysis of 61 blastomeres were concordant in 57 cases (93%); results for male blastomeres showed 12% of false negatives. No false positives were detected for female cells. Amplification using the simplified PCR protocol in combination with the RoboCycler was completed in 2 hours. CONCLUSION: These data show that this PCR assay performed directly, without DNA extraction or purification and without re-amplification is a practical and effective approach for amplification of specific DNA sequences in single cells. Furthermore, the simplified PCR protocol significantly reduced the time to complete DNA amplification. The reduced time is expected to facilitate the management of a routine program for preimplantation genetic diagnosis.

Base Sequence↗
PubMed1995

Successful fertilization, pregnancy, and birth using epididymal sperm frozen 24 hours after conventional oocyte insemination.

OBJECTIVE: To assess if epididymal sperm cryopreserved 24 hours after exposure to oocytes in conventional IVF can be successfully used for intracytoplasmic sperm injection (ICSI) in a subsequent cycle. DESIGN: Case report. SETTING: University of California, Irvine, Center for Reproductive Health. PATIENTS: Two men with obstructive azoospermia requiring microsurgical epididymal sperm aspiration, IVF, and ICSI. INTERVENTIONS: Freezing of epididymal sperm 24 hours after egg exposure in conventional IVF and subsequent use for assisted fertilization in a new cycle. MAIN OUTCOME MEASURE: Frozen-thawed epididymal sperm survivability and maintenance of fertilization and pregnancy capacity. RESULTS: At the time of sperm aspiration procedure (cycle I) a total of 30 oocytes were available for insemination. Of these, 15 were used for conventional IVF resulting in 2 embryos (13%) and 15 were used for ICSI, resulting in 3 embryos (20%). Sperm was cryopreserved 24 hours after conventional IVF and thawed 6 months later in a new cycle. Upon thawing, sperm were still found to be motile and at this time (cycle II) only assisted fertilization was used. Of 27 oocytes injected, 12 (44%) produced normal, cleaving embryos. One singleton pregnancy with the birth of a healthy infant girl was achieved after the tubal transfer of 5 embryos. CONCLUSION: The birth of a normal, healthy infant girl with epididymal sperm frozen 24 hours after exposure to oocytes in conventional IVF emphasizes the value of freezing any aliquot of epididymal sperm, even if the motility is very low, to avoid additional surgery in the male. From a basic science standpoint, this observation may renew interest in the study of sperm cryopreservation after occurrence of acrosome reaction and hyperactivation.

Cryopreservation↗
PubMed1995

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

OBJECTIVE: 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. DESIGN: Retrospective study. SETTING: University-associated assisted reproductive technology program. PATIENTS: 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. RESULTS: 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%. CONCLUSIONS: 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.

Adult↗
PubMed1995

Use of epididymal sperm for assisted reproduction in men with acquired, irreparable obstructive azoospermia.

Microsurgical epididymal sperm aspiration (MESA) and in vitro fertilization (IVF) is primarily offered to men with congenital absence of the vas deferens (CAVD). However, the IVF capacity of these epididymal sperm is low ( < 15%) and unpredictable. In this study, IVF and intracytoplasmic sperm injection (ICSI) results in patients with non-congenital, irreparable obstructive azoospermia were analysed. Thirty-three patients were evaluated for a total of 37 cycles of MESA and IVF. Most had obstruction secondary to failed vasectomy reversal and to epididymal blockage. The overall fertilization rate was 30% with regular IVF and 26% with ICSI, and six clinical pregnancies were obtained. Both rates are significantly higher than the IVF rate previously reported with sperm from men with CAVD (13%, P < 0.00001). In men with non-congenital obstructive azoospermia, a significant difference was found in the average sperm count (56.9 x 10(6) v. 12.3 x 10(6), P < 0.04) and total motile count (16.6 x 10(6) v. 1.6 x 10(6), P < 0.01) respectively for patients who achieved IVF and those who did not. It is concluded that (a) the real IVF capacity of human epididymal sperm is 30%, or 42%, if calculated only for patients who achieved fertilization, (b) this higher rate is an indirect support of the hypothesis that sperm from men with CAVD have intrinsic biochemical defects, related to cystic fibrosis mutations, responsible for their low and unpredictable IVF rate, and (c) MESA and IVF can be offered at the same time or as an alternative to patients requesting vasectomy reversal.

Adult↗
PubMed1995

Intracytoplasmic sperm injection and embryo development of human oocytes cryopreserved using 1,2-propanediol.

This study reports the subsequent embryo development of cryopreserved mature human oocytes following insemination or intracytoplasmic sperm injection (ICSI). Metaphase II oocytes were cryopreserved using a slow freezing-rapid thawing procedure employing the cryoprotectant 1,2-propanediol. The study was conducted at two centres. The normal insemination of cryopreserved oocytes was undertaken in one centre, and ICSI of cryopreserved oocytes in the other. Both methods resulted in a 50% normal fertilization rate. A low rate of abnormal fertilization was observed in the inseminated group of oocytes (5%) compared with 21% for the ICSI oocytes; this was not significantly different. Embryo development was assessed daily for 7 days. All normal fertilized cryopreserved oocytes in both groups cleaved on day 2, with a similar appearance to in-vitro fertilization and ICSI embryos. In the normal inseminated oocytes, there was a significant decrease in the number of embryos cleaving on day 3 (33%) compared with the development of ICSI oocytes, with a subsequent gradual reduction over days 4 and 5 (22 and 11% respectively) resulting in one early blastocyst on day 7 (11%). In contrast, all ICSI-generated embryos continued to cleave on day 3, with a gradual reduction over subsequent days (day 4, 86%; day 5, 57%; day 6, 43%; day 7, 29%). By day 7, two of the blastocysts had started to hatch, resulting in a 66% hatching rate of blastocysts formed from ICSI of cryopreserved oocytes. This is the first study to show normal development to the hatching blastocyst stage following ICSI of cryopreserved human oocytes.

Blastocyst↗
PubMed1995

Testosterone and androstenedione in premature ovarian failure pregnancies: evidence for an ovarian source of androgens in early pregnancy.

Numerous anecdotal reports but few scientific approaches have suggested an increase in androgens in early pregnancy. In this study we have compared the concentration of serum androgens, testosterone and androstenedione in early pregnancy, starting within the cycle of conception. We have taken the opportunity to study women with premature ovarian failure where pregnancy develops in the virtual absence of ovarian functions. This study demonstrates that the concentration of testosterone (0.29 +/- 0.04 ng/ml) and androstenedione (1.770 +/- 0.136 ng/ml) in these subjects is as low as, if not lower than, non-pregnant women (0.39 +/- 0.02 and 2.170 +/- 0.025 ng/ml), significantly increased in normal pregnancies (1.190 +/- 0.118 and 3.920 +/- 0.297 ng/ml; P < 0.05) and even further increased in human menopausal gonadotrophin-treated cycles (1.990 +/- 0.230 and 8.19 +/- 0.72 ng/ml; P < 0.05). These studies demonstrate that the ovary is a contributor to the circulating concentrations of testosterone and androstenedione starting within the cycle of conception.

Androstenedione↗
PubMed1995

Presence of thyroid antibodies in early reproductive failure: biochemical versus clinical pregnancies.

OBJECTIVE: To evaluate the clinical usefulness of thyroid antibodies in determining early pregnancy outcome. SETTING: University-based facility at the Center for Reproductive Health, University of California, Irvine. PATIENTS: Four hundred eighty-seven infertile patients that successfully conceived with assisted reproductive techniques from January 1991 to December 1992. INTERVENTIONS: An enzyme immunoassay for semiquantification of thyroglobulin (TG) and thyroid peroxidase antibodies used to determine antibody status from stored serum of these patients. MAIN OUTCOME MEASURE: Thyroid antibody status in early pregnancy. RESULTS: Of the 487 patients studied, there were 106 women who were antibody positive for anti-TG, antithyroid peroxidase, or both, and 381 who were negative. The overall incidence of positivity was 22%. In the antibody-positive group there was a 32% clinical miscarriage rate in comparison to 16% in the antibody-negative group. This did reach statistical significance. There was no significant difference between the two groups in the incidence of biochemical or ectopic pregnancies. There also was no significant difference between the groups in age, gravidity, or number of prior pregnancy losses. CONCLUSION: In our patient population, thyroid antibodies proved to be a useful marker for identifying women at risk for clinical miscarriage but they appear not to have an association with biochemical pregnancies.

Abortion, Spontaneous↗
PubMed1994

Prospective randomized comparison of human chorionic gonadotropin versus intramuscular progesterone for luteal-phase support in assisted reproduction.

OBJECTIVE: The purpose of the study was to determine the impact of two forms of luteal-phase supplementation, human chorionic gonadotropin (hCG) and progesterone (P), during gonadotropin releasing hormone agonist (GnRh-a)/controlled ovarian hyperstimulation (COH) cycles. DESIGN AND PATIENTS: The study was a prospective, randomized evaluation of 77 patients. Group 1 patients (n = 38) received 2000 IU of hCG, injected subcutaneously, on days 3, 6, 9, and 12 after transvaginal aspiration of the oocytes (TVA = day 0). Group 2 patients (n = 39) received 50-mg daily injections of intramuscular (i.m.) P from days 2 to 14 after TVA. Blood tests were performed on days 0, 5, 8, and 12 after TVA. SETTING: The in vitro fertilization program of a tertiary care institution was the study setting. MAIN OUTCOME MEASURES: The main outcome measures were (1) pregnancy and implantation rates; (2) serum estradiol (E), P, and hCG levels; and (3) occurrence of side effects. RESULTS: Clinical pregnancy and implantation rates in group 1 versus group 2 were similar (36.7 vs 35.3 and 12 vs 14%, respectively). Regardless of pregnancy occurrence, on days 8 and 12 after TVA, serum E and P levels were higher in group 1 than group 2 but the resulting E/P ratios were similar. Five of 38 patients (group 1) developed moderate to severe ovarian hyperstimulation syndrome (OHSS) right after the first or second supplementary hCG injection. In these patients, the mean serum E level on the day of hCG trigger injection was about 3250 pg/ml and the number of follicles was between 9 and 17. In 6 of 39 patients (group 2) allergic reactions were observed at the P injection sites. CONCLUSIONS: Based on our data, hCG administration as a form of luteal supplementation did not translate, in comparison to P, into significant benefits for the patients. At the same time, it significantly increased the risk of ovarian hyperstimulation. We suggest that whenever, during COH cycles, serum E levels are over 2500 pg/ml and the number of follicles exceeds 10, luteal support with hCG should be excluded.

Adult↗
PubMed1994

Correlation between epididymal length and fertilization rate in men with congenital absence of the vas deferens.

OBJECTIVE: To investigate whether the variable length of the epididymides in men with congenital absence of the vas deferens might have a correlation with IVF and pregnancy rate results. DESIGN: Microsurgical retrieval of epididymal sperm from men with congenital absence of the vas deferens and their use for IVF. SETTING: Center for Reproductive Health, University of California, Irvine, California. PATIENTS: One hundred eight men with confirmed diagnosis of congenital absence of the vas deferens enrolled in the microsurgical epididymal sperm aspiration and IVF program. INTERVENTIONS: Measurement in centimeters of the epididymal length at the time of the sperm aspiration procedure. MAIN OUTCOME MEASURE: Rates of fertilization and pregnancy according to the epididymal length. RESULTS: Three groups were identified: group I (n = 29), epididymal length between 0.5 and 1.9 cm; group II (n = 66), length between 2.0 and 4.0 cm; and group III (n = 13), length in excess of 4.0 cm. Although the aspiration site was the proximal caput for each case, patients of group III had the highest fertilization and pregnancy rate (24% and 43%, respectively). Patients with the shortest epididymis (group I) had the worst IVF outcome (fertilization rate 7% and pregnancy rate 7%) whereas in group II the fertilization rate was 13% and the pregnancy rate was 18%. CONCLUSION: This study demonstrates that epididymal sperm from men with congenital absence of the vas deferens having a longer epididymis have a better IVF rate. A long epididymis can allow [1] the arrival of more frequent waves of fresh sperm whereas in a short epididymis the system is completely congested and occupied by old and senescent sperm, [2] less obstructive damages, and [3] a back flow of biochemical factors produced in the more distal segments that could ultimately enhance the fertilization capacity of proximal epididymal sperm.

Epididymis↗