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Fertility of mares after unilateral laparoscopic tubal ligation.

OBJECTIVE: To develop a technique for laparoscopic tubal (oviductal) ligation and to evaluate pregnancy rates for mares that ovulated ipsilateral or contralateral to the ligated oviduct. STUDY DESIGN: Randomized prospective clinical trial comparing pregnancy rates after unilateral laparoscopic tubal ligation. ANIMALS: Twelve mares of light horse breeds. METHODS: One oviduct in each of 6 mares was surgically ligated with a laparoscopic technique; 6 other mares served as nonligated controls. Mares with unilateral tubal ligations (UTL) were inseminated with 500 million progressively motile sperm during 1 cycle when the dominant follicle was ipsilateral to the ligation site and 1 cycle when the dominant follicle was contralateral to the ligation site. Control mares were bred during 2 cycles regardless of the side of the dominant follicle. Pregnancy examinations were performed on days 12, 14, and 16 after ovulation by transrectal ultrasonography. RESULTS: None of the mares became pregnant when ovulations occurred from the ovary adjacent to the ligated oviduct. All 6 mares became pregnant on the first cycle when an ovulation occurred from the opposite ovary. Control mares became pregnant on 10 of 12 cycles (83.3 %). CONCLUSIONS: UTL was completely effective in preventing pregnancy when ovulation occurred ipsilateral to the ligation site. The surgical procedure did not interfere with the establishment of pregnancy when ovulation occurred from the contralateral ovary. CLINICAL RELEVANCE: UTL may be a clinically useful procedure for preparing a recipient mare for gamete intrafallopian transfer. The recipient mare could be allowed to ovulate and UTL would prevent fertilization of her oocyte but would not interfere with normal corpus luteum formation. The donor oocyte could be placed into the oviduct contralateral to the UTL site.

Animals↗

Combined electroejaculation and in vitro fertilization in the evaluation and treatment of anejaculatory infertility.

Seven couples underwent combined electroejaculation and in vitro fertilization for anejaculatory infertility after a failed regimen of electroejaculation and intrauterine insemination. Two pregnancies resulted, one proceeding to a term vaginal delivery and one ending in a 6-week spontaneous abortion. Poor sperm binding and no fertilization were seen in two of the couples. Fertilization of the oocytes but no subsequent pregnancy were seen in the other three couples. Combined in vitro fertilization and gamete intrafallopian transfer was performed in four of the couples. The combination of electroejaculation and in vitro fertilization offers the opportunity to evaluate the female pelvis, observe the sperm-oocyte interaction, and achieve a pregnancy in couples with anejaculatory infertility.

Adult↗

Triplets and quadruplets born in Victoria between 1982 and 1990. The impact of IVF and GIFT on rising birthrates.

OBJECTIVES: To examine the perinatal characteristics of all higher order multiple births (133 sets of triplets and six sets of quadruplets) in the State of Victoria between 1982 and 1990. To compare the rising higher order multiple birth rates in Victoria with those in the other States of Australia, and to assess the impact of in-vitro fertilisation (IVF) and gamete intrafallopian transfer (GIFT) on these rising birth rates. DESIGN: Retrospective review of all higher order multiple births registered in Victoria and other States of Australia between 1982 and 1990, and in particular those resulting from IVF and GIFT. DATA SOURCES: Victorian Perinatal Data Collection Unit, Australian Bureau of Statistics, National Perinatal Statistics Unit, data from Victorian IVF and GIFT units. MAIN OUTCOME MEASURES: Higher order multiple birth rates and perinatal mortality rates. RESULTS: The higher order multiple birth rates in Victoria rose from 3.5 per 10,000 in 1982 to 10.9 per 10,000 in 1990. The average perinatal mortality rates for the Victorian triplets and quadruplets born during this period were 10.8% and 25.0%, respectively. The rates of caesarean section were 70% and 83%; the proportions of deliveries in level III hospitals, 75% and 100%; and the mean maternal lengths of stay in hospital, 32 and 57 days, respectively. Endotracheal intubation was performed at birth in 18.5% of all infants. The proportions of triplet and quadruplet pregnancies in Victoria owing to IVF and GIFT rose during this period, reaching a peak of 42% in 1990. In the other States, the birth rates for higher order multiples increased at 1.8 times the rate observed for Victoria, with IVF and GIFT contributing to an estimated 43% of these conceptions between 1985 and 1989. CONCLUSION: Restrictions on the numbers of embryos/oocytes transferred during IVF and GIFT should reduce the frequency of higher order multiple births.

Adult↗

Utility of fluoroimmunoassay in detecting luteinizing hormone surges in spontaneous and human menopausal gonadotropin-stimulated menstrual cycles.

Luteinizing hormone (LH) levels measured with radioimmunoassay and time-resolved fluoroimmunoassay (FIA) in 274 serum samples correlated highly, with a linear correlation coefficient of 0.934. Through the analysis of serial samples from 43 women undergoing human menopausal gonadotropin stimulation for in vitro fertilization or gamete intrafallopian transfer and seven patients monitored in spontaneous menstrual cycles for receipt of frozen embryos, we demonstrated the utility of FIA in the detection of the LH surge. This LH assay technique, which involves no radioactive isotopes, should facilitate the monitoring of ovulation induction patients in the office/ambulatory setting.

Female↗

Oocyte donation in 61 patients.

Oocyte donation was performed by gamete intrafallopian transfer in 61 women, 34 of whom were amenorrhoeic. The mean age of the donors was 32 years (range 23-38). Seventy-five treatment cycles gave 29 clinical pregnancies, of which 21 reached term, 3 continue, and 5 were lost (3 miscarriages, 1 tubal, and 1 cervical). 11 (38%) of the women who became pregnant were over 42 years old. When more than four oocytes were transferred, many of the pregnancies were multiple. 8 (38%) of the pregnancies that came to term were complicated by pre-eclamptic toxaemia. When oocytes are obtained from young women, the fertility potential is high irrespective of the recipient's age.

Administration, Sublingual↗

Influence of peritoneal fluid from spontaneous and stimulated cycles on sperm motility in vitro.

Peritoneal fluids (PFs) from spontaneous (n = 14) and gonadotrophin-stimulated cycles (n = 20) were obtained during diagnostic laparoscopy and gamete intrafallopian transfer (GIFT) procedures, respectively. The effects of these fluids on the linear component of sperm motility and on the percentage of motile spermatozoa were studied in vitro by objective motility assessments and compared to a control medium (B2-Ménézo). Overall, the two types of PFs were found to have rather similar effects on the motility parameters studied. However, the fluids from hormonally-stimulated cycles sustained motility better (i.e., sperm velocity and percentage of motile sperm) and in a rather constant manner as a function of time (narrower range distributions of the motility measurements). Furthermore, it was observed that under identical experimental conditions motility measurements depended not only on the type of PF used but also on the sperm sample. These results suggest that assisted reproduction procedures in which PF is the medium where the gametes eventually meet and interact, such as direct peritoneal insemination (DIPI) or peritoneal oocyte and sperm transfer (POST), could have different success rates if performed in spontaneous rather than in stimulated cycles. At the same time, our results may help to explain why different pregnancy rates were reported in different studies using DIP or POST.

Adult↗

Successful pregnancy in a patient with a 46,XY karyotype.

OBJECTIVE: To report a case of successful pregnancy in a patient with 46,XY karyotype with primary ovarian failure. DESIGN: Case report. SETTING: Fertility Research Center, G.G. Hospital, Chennai, Tamil Nadu, India. PATIENT(S): A 27-year-old woman with hypoplastic uterus, normal fallopian tubes on both sides, and gonadal dysgenesis. INTERVENTION(S): Chromosomal analysis, diagnostic laparoscopy, donor oocyte program, gamete intrafallopian transfer, and gonadectomy. MAIN OUTCOME MEASURE(S): Response to hormone replacement therapy and the probability of achieving a pregnancy by a tubal procedure. RESULT(S): Treatment was successful, and the patient delivered a live baby. CONCLUSION(S): A hypoplastic uterus of patients with the 46,XY karyotype can be stimulated by the use of cyclical steroid therapy to accommodate pregnancy and facilitate tubal procedures in patients with normal fallopian tubes.

Adult↗

Assisted conception using buserelin and human menopausal gonadotrophins in women with polycystic ovary syndrome.

OBJECTIVE: To compare the outcome of in vitro fertilisation (IVF) and gamete intrafallopian transfer (GIFT) cycles in women with or without ultrasound features of polycystic ovary syndrome (PCOS). DESIGN: A consecutive series from January to December 1989. SUBJECTS: Twenty-five women with PCOS scheduled for assisted conception. The controls were 139 women with normal ovaries. SETTING: A single centre specialist fertility unit, Manchester, UK. INTERVENTIONS: Pituitary desensitisation was with buserelin. In the PCOS group ovarian stimulation was with 1 ampoule (75 iu FSH) of hMG/day in 12 women (Group I) and two ampoules/day in 13 (Group II). The controls (Group III) were given two ampoules of hMG daily. Human chorionic gonadotrophin (hCG; 10,000 iu) was given when three follicles measured > or = 20 mm diameter. MAIN OUTCOME MEASURES: Serum oestradiol (E2) concentrations, number of follicles, clinical pregnancies, features of the ovarian hyperstimulation syndrome (OHS). RESULTS: Women with PCOS (Groups I or II) had more follicles > or = 14 mm diameter on the day of the hCG injection (P < 0.005), higher serum E2 concentrations on the day after the hCG (P < 0.05) and more oocytes retrieved (P < 0.05) than the controls. The OHS was more prevalent in those with PCOS (32% versus 6.5%; P < 0.05). The clinical pregnancy rate per embryo transfer (27% versus 22%) or gamete transfer (25% versus 39%) and the rate of spontaneous miscarriage (33% versus 12%) were not statistically different. CONCLUSIONS: The pregnancy rate and outcome of pregnancy following IVF or GIFT in women with or without PCOS are similar. Women with PCOS are at a higher risk of developing OHS.

Adult↗

The choice of the most appropriate microfertilization technique for human male factor infertility.

Comparisons were made among techniques used to treat male factor infertility. Patients with semen quality below that recognized by World Health Organization criteria as normal had a better success rate when treated by gamete intrafallopian transfer than by in vitro fertilization (25% v. 7% pregnancy rate per patient). When < 2 x 10(6) motile sperm were recovered, the fertilization rate and embryo cleavage rate were higher for microdrop insemination than for conventional insemination. When 7000-370,000 motile sperm were recovered, microdrop insemination resulted in a higher fertilization rate (46%) and a higher incidence of pregnancies (23% of patients treated) than subzonal sperm microinjection (SUSM). However, for patients with 5000-50,000 motile sperm, the immediate transfer of SUSM oocytes to the Fallopian tube increased pregnancy rates for this technique to 24% of patients treated. Direct microinjection of epididymal sperm from azoospermic men into the cytoplasm of oocytes resulted in pronuclear formation in 27% of oocytes; in comparison, pronuclear formation occurred in 5% of SUSM oocytes. These data led to formulation of a logical treatment programme for male factor infertility.

Female↗

Surrogate pregnancies in patients with Mayer-Rokitansky-Kustner-Hauser syndrome and severe teratozoospermia.

The challenge of the case presented was threefold: congenital absent uterus (Mayer-Rokitansky-KustnerHauser syndrome), a request for surrogacy, and teratozoospermia in the husband (6% normal morphology according to the Tygerberg strict criteria). Surrogacy was dealt with by means of guidelines proposed by the SA Law Commission after a surrogate mother was found. The gestational carrier was synchronized with the genetic donor with congenital absent uterus, the main aim being assisted reproduction. Two gamete intrafallopian transfer (GIFT) procedures were performed, both unsuccessful. Poor fertilization of excess GIFT oocytes was also observed. Three intracytoplasmic sperm injection procedures were then performed. The first two were unsuccessful and the third ensued in a singleton pregnancy. Hormonal support (progesterone and estradiol valerate until 12 weeks pregnancy duration) was given. The pregnancy resulted in the normal delivery of a healthy male infant at full term. Psychological support was given to mother and surrogate throughout pregnancy, as well as thereafter. The success of this case gives hope to infertile couples with severe infertility factors.

Adult↗

Conservative treatment of endometrial cancer permitting subsequent triplet pregnancy.

We report on a 28-year-old woman who received conservative treatment of endometrial carcinoma by curettage and progestins. After regression of endometrial lesions the patient's infertility was treated by gamete intrafallopian transfer (GIFT). Intact triplet pregnancy was diagnosed 3 weeks later. The patient was delivered of three infants by caesarean section following premature rupture of membranes at 30 weeks of gestation. Subsequent standard treatment of endometrial cancer by abdominal hysterectomy and bilateral salpingo-oophorectomy after 4 weeks revealed no clinical or histological evidence of persistent carcinoma. One year after surgery the patient remained without evidence of disease. We believe that individualized cancer therapy may be safely performed in carefully selected cases.

Adult↗

Are human spermatozoa separated on a Percoll density gradient safe for therapeutic use?

Motile morphologically normal human spermatozoa can be separated from semen by buoyant density centrifugation on Percoll (Pharmacia Fine Chemicals AB, Uppsala, Sweden) gradients. In this study, the authors have examined (1) the efficiency of washing procedures to remove contaminating Percoll particles from the separated spermatozoa, and (2) the potential of Percoll particles, which contain silica, to cause an inflammatory response when used for intrauterine insemination, or when introduced into the fallopian tube during gamete intrafallopian transfer (GIFT) procedures, as assessed by an intraperitoneal injection into mice. Although Percoll was phagocytosed at the injection site, and therefore cannot be presumed to be totally inert, no generalized inflammatory response was detected. A double spin and wash technique was found to remove most residual Percoll from the spermatozoa, as assessed by scanning electron microscopy. These results suggest that procedures involving the use of Percoll for the separation of human spermatozoa for in vitro fertilization, GIFT, or intrauterine insemination should include stringent washing protocols that will remove most, if not all, contaminating Percoll from the sample.

Cell Separation↗

Assisted reproductive technology in the United States: 1999 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of ART initiated in the United States in 1999. DESIGN: Data were collected electronically by using the SART Clinical Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Three hundred sixty programs submitted data on procedures performed in 1999. Data were collated after November 2000 so that the outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. RESULT(S): Programs reported initiating 88,077 cycles of ART treatment. Of these, 63,639 cycles involved IVF (with and without micromanipulation), with a delivery rate per retrieval of 29.4%; 838 were cycles of gamete intrafallopian transfer, with a delivery rate per retrieval of 27.9%; 945 were cycles of zygote intrafallopian transfer, with a delivery rate per retrieval of 29.8%. The following additional ART procedures were also initiated: 6,509 fresh donor oocyte cycles, with a delivery rate per transfer of 41.8%; 12,005 frozen embryo transfer procedures, with a delivery rate per transfer of 18.6%; 2,488 frozen embryo transfers using donated oocytes or embryos, with a delivery rate per transfer of 23.6%, and 821 cycles using a host uterus, with a delivery rate per transfer of 33.6%. In addition, 398 cycles were reported as combinations of more than one treatment type, 18 cycles as research, and 416 as embryo banking. As a result of all procedures, 21,904 deliveries were reported, resulting in 30,967 neonates. CONCLUSION(S): In 1999, more programs reported ART treatment and reported cycles increased significantly (7.5%) compared to 1998. In comparable cycle types, the overall success rate (deliveries per retrieval) increased by 0.4%, which represents an increase of 1.2% compared to the success rate for 1998.

Adult↗

Assisted reproductive technology in the United States: 1996 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States in 1996. DESIGN: Data were collected electronically using the Society for Assisted Reproductive Technology Clinical Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Three hundred programs submitted data on procedures performed in 1996. Data were collected after November 1997 so that the outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Procedural outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, and congenital abnormality. RESULT(S): Programs reported initiating 65,863 cycles of ART treatment, including frozen embryo and donor oocyte cycles. Of these. 44,647 cycles initiated were in vitro fertilization (IVF) (with and without micromanipulation) with 26.0% deliveries per retrieval; 2,879 were cycles of gamete intrafallopian transfer (GIFT) with 29.0% deliveries per retrieval; 1,200 were cycles of zygote intrafallopian transfer (ZIFT) with 30.9% deliveries per retrieval. In addition to these cycles initiated in 1996, 9,610 frozen embryo transfer procedures were initiated with 16.8% deliveries per transfer, 3,768 donor oocyte cycles were initiated with an overall success of 39.1% deliveries per transfer, 1,096 cryopreserved embryo transfers from donated oocytes procedures with an overall success of 20.8% deliveries per transfer, and 688 ART treatment cycles using a host uterus were initiated with an overall success of 31.3% deliveries per embryo transfer. Also, 1,341 cycles were reported as combinations of more than one treatment type, 19 cycles as research, 311 as embryo banking, and 304 as other (unclassified) cycle types. As a result of all procedures, a total of 14,702 deliveries were reported resulting in 21,196 neonates. CONCLUSION(S): In 1996, there were more programs reporting ART treatment and a significant (11.3%) increase in reported cycles. In comparable cycle types, overall average success rates (deliveries per retrieval) exhibited an actual increase of 3.5% (this is an increase of 15.8% when compared to the success rate for 1995).

Female↗

Elevated serum progesterone values at the time of ovulation induction in luteal leuprolide acetate-down-regulated GIFT cycles are associated with decreased clinical pregnancy rates.

PURPOSE: The effects of premature luteinization of ovarian follicles as detected by elevated progesterone values on the day of human chorionic gonadotropin induction of ovulation were evaluated in 38 consecutive gamete intrafallopian transfer (GIFT) retrieval cycles. MATERIALS AND METHODS: All patients received leuprolide acetate beginning in the midluteal phase of their prior menstrual cycle, followed by gonadotropin stimulation of folliculogenesis. At least four oocytes were transferred in each cycle. RESULTS: No significant differences in gonadotropin dosage, total number of days of gonadotropins, age, number of prior pregnancies, years of infertility since last pregnancy, total number of eggs retrieved, mature residual oocytes, fertilization of mature residual oocytes, or primary etiology of infertility were observed between groups; however, estradiol concentrations were significantly higher in the group with elevated progesterone values (2573 +/- 216 pg/ml) compared to the lower progesterone group (1925 +/- 202 pg/ml, P = 0.035) and the total number of oocytes transferred was greater in the high progesterone group (7.5 +/- 0.5) vs the low progesterone group (6.3 +/- 0.3, P < 0.038). P4 concentrations < or = 0.8 ng/ml were associated with significantly higher pregnancy rates (11/19; 57.9%) compared to progesterone concentrations > 0.8 ng/ml (5/19, 26.3%; P = 0.050). CONCLUSIONS: Premature luteinization may occur in luteal leuprolide acetate-down-regulated patients and progesterone values > 0.8 ng/ml are associated with significantly lower pregnancy rates in GIFT cycles.

Chorionic Gonadotropin↗

Assisted reproductive technology in the United States: 1998 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of ART initiated in the United States in 1998. DESIGN: Data were collected electronically by using the SART Clinical Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Three hundred and sixty programs submitted data on procedures performed in 1998. Data were collated after November 1999 so that the outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. RESULTS: Programs reported initiating 81,899 cycles of ART treatment. Of these, 58,937 cycles involved IVF (with and without micromanipulation), with a delivery rate per retrieval of 29.1%; 1,293 were cycles of gamete intrafallopian transfer, with a delivery rate per retrieval of 27.4%; 1,054 were cycles of zygote intrafallopian transfer with a delivery rate per retrieval of 29.6%. The following additional ART procedures were also initiated: 5,273 fresh donor oocyte cycles, with a delivery rate per transfer of 41.2%; 11,228 frozen embryo transfer procedures, with a delivery rate per transfer of 19.3%; 1,913 frozen embryo transfers using donated oocytes or embryos, with a delivery rate per transfer of 23.5%, and 809 cycles using a host uterus, with a delivery rate per transfer of 31.6%. In addition, 969 cycles were reported as combinations or more than one treatment type, 25 cycles as research, and 398 as embryo banking. As a result of all procedures, 20,241 deliveries were reported, resulting in 29,128 neonates. CONCLUSIONS: In 1998, there were more programs reporting ART treatment and a significant (12.1%) increase in reported cycles compared with 1997. In comparable cycle types, the actual increase in overall success rate (deliveries per retrieval) was 1.4%, which represents an increase of 4.7% compared with the success rate in 1997.

Adult↗

Fertility treatment in the forty and older woman.

PURPOSE: To determine the outcomes and logical progression of fertility treatment in women forty years and older using their own oocytes. METHODS: This was a retrospective study in which 401 completed treatment cycles in 152 women aged forty and older were reviewed. RESULTS: Assisted reproductive technology (ART) cycles (n = 58) were reviewed, comprising both in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). Intrauterine insemination (IUI) cycles (n = 343) were reviewed, consisting of 38 unstimulated natural cycle-IUI (NC-IUI), 194 clomiphene citrate-IUI (CC-IUI), and 111 injectable gonadotropins-IUI (INJ-IUI) cycles. The live birth rate of 15.5% for ART cycles was significantly higher than the live birth rate of 3.2% seen for all IUI cycles (p = 0.0007). There were no differences among treatment groups in spontaneous abortion, preterm delivery, or ectopic pregnancy rates. CONCLUSIONS: For women > or = 40 years of age who wish to use their own eggs, ART offers the best chances for conception and delivery.

Adult↗

Recent trends in assisted reproductive techniques and associated outcomes.

OBJECTIVE: We examined recent trends in success rates for assisted reproduction and determined the influence of changes in patient selection and treatment characteristics on these trends. METHODS: We collected baseline information and abstracted treatment-related details and outcomes on 1244 couples accepted for in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) at three clinics in greater Boston from 1994-1998. RESULTS: Delivery rates per initiated cycle improved significantly from 14.9% for IVF and 20.6% for GIFT in 1994-1995 to 22.5% for IVF and 28.0% for GIFT in 1997-1998 (P < or = .001). After adjusting for female age, the two treatment-related variables that appeared most likely to explain this trend were decreased use of GnRH agonists in short course (flare) regimens and increased use of highly purified forms of urinary gonadotropins. CONCLUSION: There were significant improvements in the success rates for IVF and GIFT from 1994-1998 that correlated with changes in ovulation induction regimens.

Adult↗