PubMed · 4796295
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H D Hiersche. 1973. [When does life begin?].. https://pubmed.ncbi.nlm.nih.gov/4796295/
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The impact of gonadotropin releasing hormone agonist (GnRH-a) on the quality and quantity of oocytes harvested in in vitro fertilization-embryo transfer (IVF-ET) patients was studied by comparing the results for patients stimulated with gonadotropin alone and with gonadotropin plus GnRH-a. Adding GnRH-a significantly improved the viable pregnancies per transfer and reduced the spontaneous abortions, which seemed to improve oocyte quality. However, when oocyte quality was evaluated by the fertilization rate and the implantation and delivery rates per embryos transferred, there were no significant difference in the results, indicating that GnRH-a did not improve the oocyte quality. On the other hand, GnRH-a significantly increased the average number of oocytes harvested, fertilized, and transferred, and this increased number of oocytes transferred has been demonstrated to increase pregnancy and multiple-pregnancy rates. Multiple pregnancy with more embryos implanted would significantly reduce the abortion rate. Abortion rates decreased inversely to the number of embryos implanted. Our data strongly suggest that the efficacy of GnRH-a on IVF-ET patients was due more to the quantity increase than the quality of embryos transferred.
OBJECTIVE: To compare pregnancy and implantation rates in tubal and uterine transfers during a hormonal replacement cycle in an oocyte donation program. DESIGN: Prospective randomized. PATIENTS: Forty-two consecutive patients who entered an oocyte donation program. INTERVENTIONS: Twenty-two patients were assigned for uterine transfer and 20 for tubal embryo transfer (ET). RESULTS: Twenty-three pregnancies were achieved, 12 (54.5%) after uterine transfers and 11 (57.9%) after tubal transfers. Implantation rates in both groups are not significantly different (17.4% uterine transfers versus 21.5% tubal ETs). CONCLUSIONS: Our results suggest that in hormonal replacement cycles (uniform endometrial stimulation) there is no advantage in transferring embryos to the fallopian tube. Furthermore, embryo quality and endometrial receptivity appear to be significantly more important than the time of entrance of an embryo to the uterine cavity in determining its chances of implantation.
This paper reviews recent morphological work on peri-implantation endometrium collected from the Monash University In vitro Fertilization (IVF) Programme. Comparisons of endometrial tissue collected from women who had undergone different superovulation regimens demonstrated that significant structural differences could be detected by morphometry and ultrasound, but not by routine histopathology. Morphometric studies on endometrium from agonadal women receiving hormone replacement therapy demonstrated major differences between women with identical endocrine profiles. A biopsy inadvertently taken from one of these patients at the time of implantation was not of the appearance classically believed to be associated with receptivity for implantation. Studies have shown that the tight junction structure of endometrial epithelium is regulated during the menstrual cycle, suggesting that the integrity of the epithelial barrier may be important in the preparation of the endometrium for implantation.