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PubMed1998

[The effect of endometrial infection on embryo implantation in the IVF and ET program].

The results of the IVF and ET programme depend on a number of known and hitherto unknown factors. One of them is implantation of the embryo. Only 10-15% of the embryos transferred into the uterus are implanted. The most important factors affecting implantation are quality of the embryo and receptivity of the endometrium. The receptivity of the endometrium depends on hormonal changes, vascularization of the uterus, infectious environment and other factors. Part of them can be influenced to a certain extent. Infection of the endometrium as the cause of unsuccessful implantation could be resolved by therapeutic administration of antibiotics. The objective of the present work was to prove the possible effect of bacterial contamination of the endometrium on results of IVF + ET programmes. During 1996-1997 120 sterile women included in the IVF + ET programme were examined at the First Gynaecological and Obstetric Clinic (transport system-Pronatal, Prague). In all women the author performed during the cycle preceding the stimulated one (the IVF cycle proper) microabrasion of the endometrium by a method which prevents as much as possible contamination of the specimen by the endocervical flora. A smear from the endocervix and vagina was made. The samples were examined for the presence of aerobic and anaerobic flora, Chlamydiae. The endometrium was evaluated also from the histopathological aspect. Results of the examination of the endometrium: 62% of the specimens were positive on cultivation. Most frequently Pseudomonas spec. and Staph. epidermidis were found. Of 34 women who became pregnant 10 had a positive cultivation (29.4%). Of 86 women where pregnancy was not achieved, cultivation was positive in 64 (74.4%). This difference is statistically significant. The same cultivation finding from the endocervix and endometrium was observed only in 21% patients. From the trial where more than twice as many positive cultivations were recorded in non-conceptive cycles as compared with conceptive ones, the following preliminary conclusions can be drawn: 1. Elimination of endometrial infection has its place in the preparation of patients in the IVF + ET programme. 2. It is advisable to treat with antibiotics a positive cultivation of the endometrium or administer antibiotics prophylactically (62% positive) to all patients during a stimulated IVF cycle.

Adult↗
PubMed2006

Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis.

BACKGROUND: Women with endometriosis who are treated with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) have a lower pregnancy rate compared to women with tubal factor infertility. It has been suggested that the administration of gonadotrophin releasing hormone (GnRH) agonists for a few months prior to IVF or ICSI increases the pregnancy rate. OBJECTIVES: To determine the effectiveness of administering GnRH agonists for three to six months prior to IVF or ICSI in women with endometriosis. SEARCH STRATEGY: We used computer searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the National Research Register (NRR) and the MDSG Specialised Register of controlled trials. We handsearched proceedings of annual meetings of the American Society for Reproductive Medicine (ASRM) and the European Society for Human Reproduction and Embryology (ESHRE). We reviewed lists of references in original research and review articles. We contacted experts in various countries to identify unpublished trials. SELECTION CRITERIA: We included randomised controlled trials using any GnRH agonist prior to IVF or ICSI to treat women with any degree of endometriosis diagnosed by laparoscopy or laparotomy DATA COLLECTION AND ANALYSIS: Two independent review authors abstracted data (HNS and JGV). We sent e-mails to investigators to seek additional information. We assessed the validity of each study using the methods suggested in the Cochrane Handbook. The data were checked by the third review author (SD) and any disagreement was resolved by arbitration with the fourth review author (AA). We generated 2 x 2 tables for principal outcome measures. The Peto-modified Mantel-Haenszel technique was used to calculate odds ratios (OR) and assess statistical heterogeneity between studies. MAIN RESULTS: Three randomised controlled trials (with 165 women) were included. The live birth rate per woman was significantly higher in women receiving the GnRH agonist compared to the control group (OR 9.19, 95% CI 1.08 to 78.22). However, this was based on one trial reporting "viable pregnancy" only. The clinical pregnancy rate per woman was also significantly higher (three studies: OR 4.28, 95% CI 2.00 to 9.15). The information on miscarriage rates came from two trials with high heterogeneity and, therefore, results of the meta-analysis were doubtful. The included studies provided insufficient data to investigate the effects of administration of GnRH agonists on multiple or ectopic pregnancies, fetal abnormalities or other complications. AUTHORS' CONCLUSIONS: The administration of GnRH agonists for a period of three to six months prior to IVF or ICSI in women with endometriosis increases the odds of clinical pregnancy by fourfold. Data regarding adverse effects of this therapy on the mother or fetus are not available at present.

Drug Administration Schedule↗
PubMed1995

Increased incidence of cytogenetic abnormalities in chorionic villus samples from pregnancies established by in vitro fertilization and embryo transfer (IVF-ET).

We studied 201 pregnancies that were established by in vitro fertilization and embryo transfer (IVF-ET) and compared the frequency of cytogenetic abnormalities with that found in a large control population matched for indication group (advanced maternal age) and time of sampling. A total of 252 IVF-ET fetuses were cytogenetically analysed by either chorionic villus sampling (CVS; n = 80) or amniocentesis (n = 172). Eleven chromosome abnormalities were found in the CVS group (13.8 per cent); among them, a 45,X/46,X,dic(Y)(q11)/46,X,del(Y)(q11) mosaic that was found in an IVF pregnancy established by intracytoplasmic sperm injection (ICSI), four cases of trisomy 21, and three cases of trisomy 7 confined to the placenta. The results indicate a statistically significant three- to five-fold increase in both confined placental abnormalities (P < 0.008) and true fetal chromosome anomalies (P < 0.04). In the amniocentesis group, identical rates (1.7 per cent) of chromosome abnormalities were found in the IVF-ET and control groups. It is concluded that late first trimester, but not early second trimester, IVF-ET pregnancies are characterized by an increased frequency of cytogenetic abnormalities found at prenatal diagnosis.

Adult↗
PubMed1994

Subzonal insemination (SUZI) or in vitro fertilization (IVF) in microdroplets for the treatment of male-factor infertility.

PURPOSE: The results of subzonal insemination (SUZI) and in vitro fertilization with microdroplet insemination used in couples with male-factor infertility are presented. RESULTS: The total fertilization rate was 17.4% for SUZI (n = 89) and 49.3% for microdroplet IVF (n = 100). The fertilization rate for standard IVF (n = 510), not including any male-factor infertility and performed during the same period, was 73.2%. The "take-home baby rate" per started cycle and per embryo transfer (ET), respectively, was 10 and 17.6% for SUZI and 20 and 24.7% for microdrop IVF. For standard IVF these figures were 27 and 31.7%. CONCLUSION: It was concluded that microdroplet IVF can be used with good results in cases of moderate male-factor infertility. The normal (2PN) fertilization rate with the SUZI technique was only 15.1%. However, despite the low fertilization rate, SUZI should be considered when dealing with severe male-factor infertility.

Fertilization in Vitro↗
PubMed1989

[Results of concomitant psychosomatic studies of IVF patients].

The in vitro fertilization (IVF) treatment is very stressful for the couple. The emotional tension (waiting, hoping) plays a greater role than the bodily complaints (stimulation, follicle puncture). Sometimes the wish to get a child is very strong and is the motivation for IVF treatment. Psychological investigations show that IVF patients have fewer psychological complaints compared with other sterility patients; in the psychoanalytically oriented Giessen test there are no differences compared with other sterility patients. The aim of a treatment for IVF patients is the individual, medically and psychologically oriented therapy - sometimes involving the renunciation of a further IVF therapy.

Adaptation, Psychological↗
PubMed1997

An IVF fallacy: multiple pregnancy risk is lower for older women.

INTRODUCTION: Multiple pregnancy is one of the most important and preventable complications of in vitro fertilization (IVF) and embryo transfer. The general clinical practice in many IVF clinics is to transfer four or five embryos to older women if available, since pregnancy rates are lower in women older than 35 years of age. However, it is not clear whether the risk for multiple pregnancy is also lower. OBJECTIVE: Our objective was to investigate whether transferring a higher number of embryos actually improves pregnancy outcome in older women, without increasing the risk for multiple pregnancy and to investigate other factors that may affect the occurrence of multiple pregnancy. SETTING: The setting was university-based IVF program at The Toronto Hospital. DESIGN: The design was a retrospective case series. PATIENTS AND METHODS: The outcome of 1116 IVF cycles between January 1992 and December 1993 was investigated according to different age groups. MAIN OUTCOME MEASURE: The main outcome measure was multiple pregnancies. RESULTS: Seventy multiple pregnancies resulted from a total of 242 pregnancies. Overall pregnancy and multiple pregnancy rates were inversely correlated with age. However, when the data were adjusted for the number of embryos transferred, this trend disappeared. The result of multiple regression analysis showed that the multiple pregnancy rate was higher without improving the pregnancy rate when the number of embryos transferred exceeded three, regardless of the age of the patients, especially when more embryos were available than the number of transferred ones. CONCLUSIONS: The number of embryos transferred should be limited to a maximum of three regardless of the age of patients, to reduce the high frequency of multiple gestations in an IVF program.

Analysis of Variance↗
PubMed1998

Assisted hatching does not enhance IVF success in good-prognosis patients.

PURPOSE: The role of assisted hatching in good-prognosis IVF patients was evaluated in a prospective, randomized, controlled pilot study, which was followed by a retrospective observational series. METHODS: After assisted hatching was proved successful in a mouse embryo study, 20 good-prognosis IVF patients were randomly assigned to either assisted hatching (13) or no assisted hatching (7; the controls). Following this series, 27 good-prognosis IVF patients were retrospectively evaluated to determine the outcome with assisted hatching. RESULTS: In the prospective study, clinical pregnancies resulted from 3 (23%) of 13 patients in the hatching group, compared to 3 (43%) of 7 in the control group. Implantation rates were similar: 9.6% in the hatching group and 10.7% in the controls. In the retrospective series, the 11.1% implantation rate with assisted hatching was significantly less than the 42.9% implantation rate seen with traditional IVF. CONCLUSIONS: Implantation and pregnancy rates are high in young women undergoing traditional IVF. Assisted hatching is not beneficial in these patients.

Adult↗
PubMed1998

Comparison of highly purified FSH (metrodin-high purity) with pergonal for IVF superovulation.

PURPOSE: The use of highly purified follicle-stimulating hormone (Metrodin-HP) was compared with that of a preparation containing follicle-stimulating hormone and luteinizing hormone (Pergonal) for production of superovulation in an IVF program. METHODS: We used the Oxford Fertility Unit database to identify patients undergoing their first cycle of IVF, using either Metrodin-HP or Pergonal. Patients were treated with a standardized drug protocol and were stratified by age and cause of infertility. Ovarian stimulation with either Metrodin-HP (Serono Laboratories) or human menopausal gonadotropin (hMG; Pergonal; Serono Laboratories) after pituitary desensitization commenced in the midluteal phase of the preceding cycle. Monitoring was performed by ultrasound and serum estradiol measurement prior to transvaginal oocyte recovery, followed by IVF and transfer of no more than three embryos. RESULTS: For Metrodin-HP versus Pergonal, the rates of egg retrieval (98 vs 94%), fertilization (89 vs 92%), clinical pregnancy (32.9 vs 23.4%), miscarriage (4.1 vs 4.5%), live birth (26 vs 18.5%), and ovarian hyperstimulation syndrome (5.5% vs 5.9%) were similar in both groups. The apparent increase in clinical pregnancy and live birth with Metrodin-HP did not reach statistical significance. The dosages of gonadotropins used were comparable. Estradiol levels measured on day 8 of stimulation were significantly lower in the Metrodin-HP group than in the Pergonal group, but the difference did not reach statistical significance on the day of hCG administration. Significantly more follicles (greater than 12 mm) were obtained in the Metrodin-HP group, but the numbers of eggs recovered and fertilized were similar in the two groups. CONCLUSIONS: These findings demonstrate that highly purified FSH (Metrodin-HP) is as effective and successful as hMG (Pergonal) for ovarian stimulation in a standard IVF regimen. Exogenous luteinizing hormone (LH) is not required for satisfactory ovarian stimulation in IVF. Measurement of estradiol may be less helpful in the monitoring of Metrodin-HP cycles, but the level reached on the day of hCG administration can still be used to predict, and hence avoid, ovarian hyperstimulation syndrome.

Adult↗
PubMed2006

Can dissenting findings regarding the comparative effectiveness of ICSI and IVF be explained by a learning curve?

PURPOSE: To determine whether between-trial heterogeneity in relative risk of fertilisation for intracytoplasmic sperm injection (ICSI) compared to in vitro fertilisation (IVF) can be explained by learning or by between-trial variation in patient characteristics. METHODS: Systematic review and meta-analysis of trials comparing fertilisation outcomes for ICSI and IVF (without surgical sperm retrieval). Meta-regressions to identify associations between treatment effect and trial characteristics. RESULTS: Coefficients on individually significant covariates from the meta-regressions confirm that the ICSI versus IVF treatment effect is increased when patients are "unsuited for IVF" but reduced as semen quality improves and when IVF insemination concentrations are increased. However, the relative risk of fertilisation varies inversely with publication date; contrary to the hypothesised learning effect. CONCLUSION: While it is recognised that publication date might proxy for unobserved covariates, the possibility of a learning effect in favour of ICSI is not supported by the meta-regression.

Female↗
PubMed2006

Correlation of sperm DNA damage with IVF and ICSI outcomes: a systematic review and meta-analysis.

PURPOSE: To assess the effects of sperm DNA damage, as determined by the TUNEL assay and the SCSA respectively, on the outcomes of IVF/ICSI treatment. METHODS: A Medline search (from Jan 1978 to Apr 2006) was performed, together with a manual search of the bibliographies of retrieved original papers and review articles. 8 articles met all inclusion/exclusion criteria, of which, 5 used the TUNEL assay and the other 3 used the SCSA. All these articles were included in separate meta-analysis. The meta-analysis was conducted using the RevMan software with fixed-effect model or random-effects model. RESULTS: As for articles using the TUNEL assay, the pooled results of IVF outcomes indicated that the clinical pregnancy rate (RR 0.68, 95% CI 0.54 to 0.85, P = 0.006), but not the fertilization rate (RR 0.79, 95% CI 0.54 to 1.16, P = 0.23) decreased significantly for patients with high degree of sperm DNA damage compared with those with low degree of sperm DNA damage. RRs of the ICSI outcomes indicated that there was no significant difference in either fertilization rate (RR 1.03, 95% CI 0.89 to1.18, P = 0.70) or clinical pregnancy rate (RR 0.76, 95% CI 0.55 to 1.04, P = 0.09) between these two groups. As for the SCSA papers, the pooled results showed no significant effects of sperm DNA damage on the clinical pregnancy rate after IVF (RR 0.58, 95% CI 0.25 to 1.31, P = 0.19) or ICSI (RR 1.18, 95% CI 0.81 to 1.74, P = 0.38). CONCLUSION(S): Our meta-analysis indicates that sperm DNA damage, as assessed by the TUNEL assay, significantly decreases only the chance of IVF clinical pregnancy, but not that of either IVF fertilization or ICSI fertilization or ICSI clinical pregnancy. Besides, our results also reveal that sperm DNA damage, when assessed by the SCSA, has no significant effect on the chance of clinical pregnancy after IVF or ICSI treatment.

DNA Damage↗
PubMed2006

Making Muslim babies: IVF and gamete donation in Sunni versus Shi'a Islam.

Medical anthropological research on science, biotechnology, and religion has focused on the "local moral worlds" of men and women as they make difficult decisions regarding their health and the beginnings and endings of human life. This paper focuses on the local moral worlds of infertile Muslims as they attempt to make, in the religiously correct fashion, Muslim babies at in vitro fertilization (IVF) clinics in Egypt and Lebanon. As early as 1980, authoritative fatwas issued from Egypt's famed Al-Azhar University suggested that IVF and similar technologies are permissible as long as they do not involve any form of third-party donation (of sperm, eggs, embryos, or uteruses). Since the late 1990s, however, divergences in opinion over third-party gamete donation have occurred between Sunni and Shi'ite Muslims, with Iran's leading ayatollah permitting gamete donation under certain conditions. This Iranian fatwa has had profound implications for the country of Lebanon, where a Shi'ite majority also seeks IVF services. Based on three periods of ethnographic research in Egyptian and Lebanese IVF clinics, this paper explores official and unofficial religious discourses surrounding the practice of IVF and third-party donation in the Muslim world, as well as the gender implications of gamete donation for Muslim marriages.

Attitude to Health↗
PubMed1995

Interspecific transfer of IVM IVF-derived red sheep (Ovis orientalis gmelini ) embryos to domestic sheep (Ovis aries ).

Two embryo production methodologies were investigated to generate Red sheep embryos for use in an interspecific embryo transfer program. In Experiment 1, 4 multiparous female Red sheep (Ovis orientalis gmelini ) were implanted with CIDR type G devices for 11 d. Forty-eight hours prior to CIDR removal, a total of 22.5 mg bid of FSH-P was administered over a 3-d period. Laparoscopic embryo collection was performed 5 d post breeding, and embryos were transferred to domestic recipient ewes (Ovis aries and Ovis orientalis musimon ). In Experiment 2, 7 nulliparous female Red sheep were implanted with CIDR devices and injected with 200 IU of PMSG and 25 mg of FSH-P on the 8th day of implant insertion. At 60 to 70 h post PMSG/FSH-P treatment, follicular oocytes were aspirated laparoscopically. The recovered oocytes were matured in M199 (with fetal calf serum, FSH, LH, penicillin and streptomycin) at 39 degrees C in a humidified atmosphere containing 5% CO(2). At 24 h oocytes were fertilized with frozen-thawed semen at a concentration of 1.6 x 10(6) sperm/ml. The ova/embryos were placed in CR2 or BOEC culture medium at 20-22 h post IVF. Following 3 to 4 d in culture, embryos were transferred laparoscopically to the uterine horn of synchronized recipients. In Experiment 1, 4 embryos and 6 UFO were collected from 2 embryo donors, respectively. Two embryos were transferred with the aid of a laparoscope to each of 2 Rambouillet recipients, one of which gave birth to a healthy Red sheep lamb at 158 d of gestation. In Experiment2, a total of 62 oocytes was collected from 7 oocyte donors; 16 developed to the 16- to 32-cell stage and were transferred to 8 recipients. Three of these IVM-IVF embryos were transferred laparoscopically to 2 Mouflon recipients, resulting in no pregnancies. Thirteen IVM-IVF embryos were transferred to 6 Rambouillet recipients. Each of these gave birth to a single healthy Red sheep lamb. Gestation lengths of the 3 IVM-IVF lambs ranged from 152 to 162 d. This research demonstrates that when using compatible species IVM-IVF technology in conjunction with interspecific ET can lead to the production of live offspring and can be used to propagate exotic ovine species.

Journal Article↗
PubMed2005

Adjustments in IVF system for individual boars: value of additives and time of sperm-oocyte co-incubation.

In vitro fertilization (IVF) in pigs is still considered sub-optimal, due to the variable occurrence of polyspermy, variability mainly related to sperm differences. The present study was conducted in an attempt to increase the efficiency of the in vitro production of porcine embryos by optimizing the in vitro fertilization (IVF) protocol for individual males, with regard to the composition of the fertilization medium (experiments 1 and 2) and the length of gamete co-incubation time (experiment 3). A total of 5,943 COC's were in vitro matured (IVM) and inseminated with frozen-thawed spermatozoa from 2 boars (A and B). Experiment 1 determined the effect of additives caffeine (2mM), hyaluronic acid (HA; [0.5mg/mL]) and adenosine (10 microM), alone or in combination, to the IVF-medium during sperm-oocyte co-incubation. Experiment 2 tested the addition of various HA (0, 0.5, 1.0 and 1.5mg/ml) and adenosine (0, 10, 20 and 40 microM) concentrations in the fertilization medium; while experiment 3 investigated the effect of two periods of sperm-oocyte co-incubation (10 min or 6h). In the case of 10 min sperm-oocyte co-incubation, oocytes with attaching spermatozoa were further cultured in IVF-medium containing no spermatozoa until the 6h of insemination was completed. Presumptive zygotes were cultured in embryo culture medium for 12-15 h to assess fertilization parameters. In experiment 1, only caffeine significantly influenced the outcome of fertilization, albeit being a clearly boar-dependent effect. In experiment 2, similar boar differences were seen for HA supplementation while presence of exogenous adenosine did not influence fertilization parameters in either boar. The results of experiment 3 demonstrated that a short co-incubation time significantly (P<0.001) increased penetration rate and mean number of spermatozoa per oocyte (74.9+/-3.9% versus 62.7+/-3.9% and 1.5+/-3.2 versus 1.3+/-3.5 for 10 min or 6h, respectively), but reduced mono-spermy (P<0.001, 57.9+/-2.5% versus 70.0+/-2.8%) when boar A was used. However, such effects were not seen with boar B, in which sperm-oocyte co-incubation time did not affect the efficiency of fertilization. In view of the present results, a preliminary screening for each individual male is required to select optimal conditions for IVF.

Animals↗
PubMed2006

The predictive value of routine semen evaluation and IVF technology for determining relative boar fertility.

Practical techniques for assessing semen quality in order to predict male fertility are still needed. The principal objective of this experiment was to evaluate routine laboratory evaluation and in vitro fertilization (IVF) techniques as predictors of relative boar fertility using a low-dose AI protocol. Nine boars were evaluated during a 6.5+/-1 mo period, beginning at 29-32 wk of age. Ejaculates were evaluated for motility, morphology and concentration, diluted to 1.5 billion sperm in 50 mL extender, and used to breed 50+/-5 gilts over the same period. On nine occasions, a specific aliquot of the ejaculate's first sperm-rich fraction was evaluated using IVF procedures. Boars differed (P<0.001) consistently for pregnancy rate (from 73 to 98%), farrowing rate (71-98%) and total born (8.8-12.0). Routine semen evaluation and IVF parameters that presented significant differences between boars, but no differences in time and no boar by time interaction, were used to correlate in vivo fertility. A multiple regression model based on routine semen evaluation parameters accounted for up to 27 and 22% of the variation of fertility index and total piglets born, respectively, whereas male pronuclear formation rate was the IVF variable that accounted for 17 and 12% of the variation in farrowing rate and fertility index, respectively. Collectively, we inferred that the use of low sperm numbers for AI, determination of pregnancy rate at Day 30, motility of extended semen after 7 and 10d, and specific IVF parameters may be useful for identifying relatively infertile boars that are not currently excluded from use in existing commercial boar studs.

Algorithms↗
PubMed2000

Seasonal variability in fertilization and embryo quality rates in women undergoing IVF.

OBJECTIVE: IVF-ET provides unique controlled conditions for the study of seasonal influences on the human reproductive process. This study was designed to evaluate the effects of seasonality on fertilization rate, embryo quality, and conception rates. DESIGN: A retrospective observational cohort study. A chart review of all individuals undergoing IVF-ET from 1988 to 1991 at our institution was performed. SETTING: An assisted reproduction unit at a university-based tertiary medical center. PATIENT(S): 657 women, for a total of 1074 IVF-ET treatment cycles, were evaluated. From this population, we chose 305 women undergoing their first IVF-ET cycle for reasons of pure mechanical infertility. INTERVENTION(S): IVF-ET cycles. MAIN OUTCOME MEASURE(S): Seasonal variability in fertilization rates and quality-A embryo rates, and the correlation with the absolute number of light hours, as well as the influence of temperature, humidity, and other environmental parameters. RESULT(S): A significant seasonal variability in the fertilization rate and the quality-A embryo rate was demonstrated. The highest fertilization and quality-A embryo rates were observed during the spring and the lowest in the autumn. These changes correlated with the absolute number of light hours and its increment over time, but not with the temperature, humidity, or other environmental parameters. CONCLUSION(S): Seasonality seems to have a significant influence on the fertilization process and on the quality of the human embryos that are obtained in vitro, possibly because of the light/dark variations over time. If this finding is confirmed, these seasonal changes should be taken into account when evaluating infertility data and in everyday clinical practice.

Adult↗
PubMed2000

Paternal occupational exposures and embryo implantation rates after IVF.

OBJECTIVE: To investigate any influence of paternal occupational exposures on implantation rates after IVF. DESIGN: Cohort study of couples who sought IVF treatment. SETTING: University Hospital Utrecht, The Netherlands. PATIENT(S): The study population was composed of 726 couples pursuing IVF treatment. INTERVENTION(S): Only the earliest IVF treatment cycle with ET was selected for the analysis. All couples filled in a generic questionnaire on lifestyle factors and details about their occupation. In addition, more detailed exposure information was obtained for pesticides with use of job-specific questionnaires and a subsequent telephone interview. MAIN OUTCOME MEASURE(S): The implantation rate was defined as the number of gestational sacs seen with ultrasound at 6-7 weeks of pregnancy, divided by the number of embryos replaced. RESULT(S): A significantly reduced implantation rate was seen among couples with male partners working in occupations with presumably high levels of organic solvent exposure. Conversely, paternal pesticide exposure was significantly associated with an increased implantation rate. Paternal exposures to metal dust or fumes and welding fumes were not related to the probability of implantation. CONCLUSION(S): The findings suggested that paternal organic solvent exposure decreased the implantation rate among couples undergoing IVF-ET treatment.

Adult↗
PubMed2000

Initial IVF-ET experience with assisted hatching performed 3 days after retrieval followed by day 5 embryo transfer.

OBJECTIVE: To report our initial IVF-ET experience combining assisted hatching performed 3 days after oocyte retrieval with day 5 embryo transfer (ET). DESIGN: Retrospective review of 110 consecutive IVF cycles not involving donor oocytes, including 16 cycles that involved assisted hatching performed 3 days after oocyte retrieval in combination with day 5 ET. SETTING: Academic teaching hospital IVF center. PATIENT(S): Eighty-six consecutive IVF patients undergoing ET. INTERVENTION(S): Assisted hatching using acid Tyrode's solution performed 3 days after oocyte retrieval in selected cases in combination with day 3 or 5 ETs. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate per ET. RESULT(S): Of the 16 women undergoing day 5 ET following day 3 assisted hatching, 14 had a clinical pregnancy. These included 11 ongoing/delivered singletons and 2 ongoing/delivered twin pregnancies, neither of which was monochorionic. These clinical and ongoing/delivered pregnancy rates compared very favorably with those of 54% and 46%, respectively, for the 35 patients undergoing day 5 ETs without assisted hatching, even though the latter group appeared to be better IVF candidates based on the prognostic factors commonly used to predict success. CONCLUSION(S): Our experience suggests that day 3 assisted hatching followed by day 5 ET may be a useful combination in selected patients. Although not seen in our small series, an increased risk of monochorionic pregnancies remains a theoretical concern when such a combination is used, since both assisted hatching and blastocyst transfers have been independently linked to an increased risk in some reports.

Embryo Transfer↗
PubMed2003

Impact of reproductive history on in vitro fertilization and intracytoplasmic sperm injection outcome: evidence from the German IVF Registry.

OBJECTIVE: To evaluate the effect of reproductive history on the outcome of different procedures in assisted reproductive technologies (ART) comparing IVF, ICSI, and cryopreserved embryo transfer (CPE). DESIGN: Prospective registration of ART cycles and their outcomes. SETTING: One hundred three reproductive programs in Germany. PATIENT(S): Women undergoing 174,909 ART procedures from January 1998 through December 2000. INTERVENTION(S): Data analysis of reproductive history collected by the German IVF Registry; multiple logistic regression modeling of success rates. MAIN OUTCOME MEASURE(S): Effect of type of conception and outcome of previous pregnancies, duration of infertility, female's age, and type of ART on clinical pregnancy rate per retrieval. Odds ratios with 95% CIs are reported. RESULT(S): More than one previous pregnancy was negatively correlated with outcome of IVF, ICSI, or CPE. This association disappeared when female age was restricted to a maximum of 35 years. A previous pregnancy achieved by spontaneous conception had less impact on outcome of IVF, ICSI or CPE outcome than did a previous assisted conception. Previous live births and miscarriages demonstrated a statistically significant increase compared with ectopic pregnancies and induced abortions. CONCLUSION(S): Reproductive history must be considered when counseling subfertile couples. Female age, method of conception, and previous pregnancy outcome have a significant effect on IVF, ICSI, and CPE outcome.

Abortion, Spontaneous↗