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[Oocyte removal in conjunction with pelvic microsurgery].

The paper evaluates results of gamete transfer into the oviduct or embryos into the uterus in connection with pelvic microsurgery. Between August 1981-December 1989 225 microsurgical operations have been performed in a stimulated cycle. Ovaries have been stimulated by clomiphene-citrate or in combination with human menopausal gonadotropin. The operation was timed 34 hours after application of human chorionic gonadotropin. In a group of 156 women we recovered at least one oocyte. From 77 gamete transfers into the oviduct we achieved 11 pregnancies, i.e. 14.3 per cent. 46 embryo transfers into the uterus resulted in 5 pregnancies, i.e. 10.9 per cent. From the total number of 16 pregnancies we achieved 5 deliveries, 8 clinic abortions and 3 ectopic pregnancies. The connection of sterility microsurgery with oocyte retrieval increases the success rate of operations without another stress of a patient and has also its economic significance.

Adult↗

Treatments resulting in pregnancy in nonovulating, hormone-treated oocyte recipient mares.

Synchronization of follicle growth between oocyte donor and recipient mares is difficult. To avoid this, recipient mares in a clinical program were used during a period of low follicular activity, and were treated with estrogen before transfer and progesterone after transfer. Five pregnancies were established after oocyte transfer to nonovulating, hormone-treated recipient mares. One pregnancy was lost before 30 d gestation, and the other 4 foals were carried to term. One foal died at birth. Establishment and maintenance of pregnancy in these mares indicates that nonovulating, hormone-treated mares may offer an alternative to cyclic recipients in oocyte transfer programs.

Animals↗

Monitoring early pregnancy with transvaginal ultrasound and choriogonadotrophin levels.

Serum human chorionic gonadotrophin levels were correlated with gestational sac size detected by transvaginal ultrasound in a series of 178 women undergoing in vitro fertilization. The improved resolution of transvaginal ultrasound enables pregnancy to be detected between 17 and 20 days post-ovum retrieval, when HCG levels were greater than an average threshold level of 1,300 IU/L. The lower HCG discriminatory zone enables improved evaluation of ectopic pregnancies. Also, higher HCG titres observed in multiple pregnancies enable estimation of implantation rates when more than one embryo is transferred.

Chorionic Gonadotropin↗

[Development of a method for transuterine gamete transfer--initial results].

A new method for gamete intra fallopian transfer is described by which the tubes can be catheterised via vagina, through the endometrial cavity, in order to place gametes directly to the ampullary portion of the fallopian tube without the need for an operation or anaesthesia. In a first series two clinical pregnancies resulted from 8 transuterine transfers.

Catheterization↗

Assisted reproduction technology, multiple births, and adverse perinatal outcome.

The increase in the rate of multiple pregnancies in Australia in recent years is primarily due to the use of assisted reproduction technology. Compared to singleton births, fetal, neonatal, and perinatal mortality rates are 3-6 times higher in twins and 5-15 times higher in multiple births of a higher order. Cerebral palsy rates among survivors are six times higher in twins and twenty times higher in triplets. The increased risks in multiple pregnancies are not entirely explained by their higher prematurity and low birthweight rates. In Australia, the practice of transferring more than three embryos in any one assisted reproduction technology cycle has declined in recent years and, as a result, the number of multiple pregnancies from assisted reproduction technology has also declined. Nevertheless, assisted reproduction technology pregnancies remain to have poorer than normal outcome with regards to spontaneous abortion, ectopic pregnancy, preterm birth, low birthweight, and perinatal mortality. Infants born after assisted reproduction technology have a higher neonatal morbidity rate, including a greater requirement for assisted ventilation, and a higher long-term neurodevelopmental disability rate. These adverse outcomes following assisted reproduction technology are partly due to the increased risk of multiple pregnancy and partly due to preterm and low birthweight. This fact and the lack of evidence that the transfer of more than two embryos improves pregnancy rates, make it advisable to limit the number of embryos transferred to no more than one or two per cycle.

Australia↗

Laparoscopic zygote intrafallopian transfer using augmented local anesthesia.

In this study, 29 laparoscopic ZIFTs were performed in 21 patients using local anesthesia augmented with intravenous analgesia. The technique was well tolerated; significant discomfort arose only when the fallopian tubes were manipulated and was minimized by transferring zygotes to one tube only. Seven pregnancies resulted, of which three have delivered and one is ongoing.

Adult↗

[Initial experiences with intra-tubal gamete transfer (GIFT)].

A gamete intra-fallopian transfer was performed in 13 women. In all these patients the ovulation was stimulated according to our IVF programme. For the transfer procedure we used culture medium in eight cases. This medium was replaced by follicular fluid in five other cases. Altogether the GIFT resulted in seven pregnancies, two in the culture medium group and five in the follicular fluid group. The advantages of the follicular fluid as transfer medium are discussed.

Adult↗

Recurrent cervical pregnancy after assisted reproduction by intrafallopian transfer.

BACKGROUND: Cervical pregnancy is an uncommon, yet potentially catastrophic form of ectopic pregnancy. Early diagnosis and intervention are important in avoiding short-term and long-term morbidity. Although transcervical embryo transfer is thought to increase the incidence of this phenomenon in patients undergoing in vitro fertilization, its occurrence after intrafallopian transfer is rarely seen. CASE: A 43-year-old nulliparous white female with a history of unexplained infertility experienced recurrent cervical pregnancy after two consecutive gamete/zygote intrafallopian transfer cycles. Abnormally rising beta-hCG levels combined with transvaginal sonography helped establish the diagnosis in each case. Intramuscular (IM) methotrexate combined with intra-amniotic potassium chloride successfully treated this condition initially, and IM methotrexate alone was sufficient for successful treatment in the second case. CONCLUSION: Cervical pregnancy may occur with assisted reproductive techniques involving intrafallopian transfer. Early diagnosis may be important for successful treatment of cervical pregnancy with conservative measures. Even in the case of recurrence, prompt intervention may allow for preservation of a patient's future fertility potential.

Adult↗

Trends in causes and treatment of infertility at Flinders Medical Centre, Adelaide, 1976-1989.

OBJECTIVE: To describe the causes of infertility among couples presenting to a fertility clinic over a period of 14 years. Changes in treatment methods over the same period are described. DESIGN: A retrospective analysis of records of patient age, date of first visit, duration and cause of infertility, treatment and outcome. SETTING: A fertility clinic set in a large public hospital. Patients are referred by both general gynaecologists and general practitioners. PATIENTS: From 1976 to 1989 (inclusive) 2895 couples who had engaged in unprotected intercourse for at least 12 months without conceiving attended the clinic. RESULTS: Three major diagnostic categories were considered; these embraced aetiological factors relating to semen, ovulation, and pelvic anatomy. Investigation of the causes of infertility after a couple's first visit showed these to be a semen defect in 22%, irregular cycles or anovulation in 29%, and a pelvic disorder in 57%. The incidence of semen defects as the cause remained constant between 1976 and 1989 while that of ovulation "problems" declined from 42% in 1976 to 13% in 1989. In contrast, the incidence of pelvic dysfunction increased from 40% in 1976 to 68% in 1989, predominantly due to an increased diagnosis of endometriosis. The principal treatments were ovulation induction/cycle regulation (51%), in-vitro fertilisation/gamete intrafallopian transfer (42%), and donor insemination (18%). CONCLUSIONS: Provided patient information is accurately and consistently recorded a Fertility Audit is a useful window on the activates of a Fertility Clinic and serves to highlight areas which warrant further investigation.

Adult↗