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At least 685 records · Page 38Linked to original sources
PubMed1994

Intrauterine insemination with frozen donor sperm: a prospective randomized trial comparing three different sperm preparation techniques.

OBJECTIVE: To compare the pregnancy rates (PRs) after intrauterine insemination (IUI) with frozen-thawed donor sperm. Sperm were isolated after thawing using three different sperm preparation techniques: simple washing, Percoll density gradient, and Sephadex columns (SpermPrep Column; Fertility Technologies, Natick, MA). DESIGN: Women (n = 98) were randomized upon entry into the program into one of three different sperm preparation methods. The same sperm preparation technique was used for the woman during subsequent cycles, if pregnancy did not occur. The study was stopped when > or = 75 treatment cycles for each group were completed for analysis of PRs per treatment cycle. SETTING: All patients were treated at our private care center at the University of Texas Southwestern Medical Center. PATIENTS: Patients entering this study were spontaneously ovulating women undergoing IUI with frozen donor sperm. MAIN OUTCOME MEASURE: Pregnancy rate per cycle of timed IUI. RESULTS: After 260 cycles of insemination, the PR per cycle was 19.1% with simple washing, 16.9% with Sephadex columns, and 11.4% with Percoll density gradient. Although these results were not statistically different, Percoll density gradient had a 40% lower PR per treatment cycle compared with simple washing. However, Percoll density gradient preparation of sperm resulted in a statistically significant increase in the motility, curvilinear velocity, straight line velocity, and the number of normal heads compared with the other two treatments. CONCLUSION: Although Percoll density gradient separation of sperm results in a population of cells that is more motile and morphologically normal, this did not result in subsequent cycle fecundity. These data suggest that the reliance on the averaged values of motility, curvilinear velocity, straight line velocity and morphology may have little predictive value of the potential fertility of frozen-thawed sperm.

Adult↗
PubMed1994

Pregnancy rates after operative endoscopic treatment of total (neosalpingostomy) or near total (salpingostomy) distal tubal occlusion.

OBJECTIVE: To determine the efficacy of the endoscopic treatment of complete distal tubal occlusion or moderate to severe tubal phimosis and to analyze outcome using contemporary statistical methodologies. DESIGN: Prospective cohort analysis. SETTING: Tertiary-care institution. PATIENTS: One hundred thirteen consecutive patients undergoing a neosalpingostomy or salpingostomy. INTERVENTIONS: KTP/532 laser (Laserscope, Santa Clara, CA) laparoscopy. Additional infertility factors were treated postoperatively. MAIN OUTCOME MEASURES: Crude pregnancy rate (PR), monthly fecundity rate, monthly probability of pregnancy, cure rate, and cumulative PRs. Outcome was compared on the basis of the surgical procedure performed. The impact of endometriosis as well as other fertility factors was analyzed. RESULTS: Twenty-three patients conceived yielding a crude PR of 20.4%, a monthly fecundity rate of 2.6%, a monthly probability of pregnancy of 6.4%, and a cure rate of 52.4%. There were six ectopic pregnancies (5.3%). A significant difference was found among the cumulative pregnancy curves. The cumulative pregnancy curve for unilateral salpingostomy differed significantly from that of unilateral neosalpingostomy. Patients with endometriosis and no other infertility factors had a significantly better cumulative pregnancy curve compared with patients without endometriosis or other factors as well as compared with patients with no endometriosis but with other infertility factors. Patients undergoing bilateral neosalpingostomy had a cure rate of 9.0% whereas patients undergoing bilateral salpingostomy had a cure rate of 34.2%. CONCLUSIONS: Operative endoscopy yields PRs that are comparable to those reported in the literature for laparotomy. The presence of complete bilateral distal tubal occlusion has a negative impact on outcome.

Adult↗
PubMed1994

Outcome of thaw embryo transfer after cryopreservation of all embryos in patients at risk of ovarian hyperstimulation syndrome.

OBJECTIVE: To determine the incidence of ovarian hyperstimulation syndrome (OHSS) and subsequent pregnancy rates (PRs) if ET is delayed in patients at risk of OHSS by allocating all embryos to cryopreservation. DESIGN: Retrospective analysis of clinical and laboratory data from 724 consecutive stimulated cycles of IVF. SETTING: University hospital-based IVF program. PATIENTS: Consecutive patients undergoing IVF between September 1989 and December 1992. MAIN OUTCOME MEASURES: Fertilization rates, cryosurvival rates, subsequent PRs, and the occurrence of severe OHSS. RESULTS: Ten of the 564 patients (1.8%) who had ET in the stimulation cycle developed severe OHSS. Sixty-nine patients had all embryos frozen because of the risk of OHSS, of which one (1.4%) developed severe OHSS. The subsequent PR after thaw transfer was 25.2% per transfer, with a cumulative PR per patient after additional thaw transfers of 40.6%. CONCLUSIONS: Cryopreservation of all embryos and delayed ET in patients at risk of OHSS results in a low incidence of severe OHSS. Oocyte quality, fertilization rates, and cryosurvival of frozen embryos are equal to those for patients who have a normal stimulation profile. Subsequent thaw embryo replacements result in a satisfactory PR.

Adult↗
PubMed1995

Does intrauterine insemination offer an advantage to cervical cap insemination in a donor insemination program?

OBJECTIVE: To compare pregnancy outcome after IUI versus cervical cap insemination in a donor insemination program. DESIGN: A randomized prospective clinical trial in which patients were alternately inseminated with cryopreserved human semen using either IUI or cervical cap insemination methods. SETTING: The donor insemination program at Washington University School of Medicine. PATIENTS: Forty-two women with either isolated male factor or male factor plus corrected ovulatory dysfunction using clomiphene citrate underwent 141 cycles of donor insemination. MAIN OUTCOME MEASURES: Clinical pregnancy rates (PRs) defined as a viable intrauterine gestation > 12 weeks or delivered were compared between groups using the chi 2 test. RESULTS: Clinical PRs were significantly higher in the IUI group (16.4%) compared with the cervical cap insemination group (5.9%). The spontaneous abortion rates were similar between the IUI (1.4%) and cervical cap insemination groups (4.4%). CONCLUSIONS: These findings suggest an advantage to IUI over cervical cap insemination in a donor insemination program.

Abortion, Spontaneous↗
PubMed1995

Sperm morphology analysis (strict criteria) in male infertility is not a prognostic factor in intrauterine insemination with husband's sperm.

OBJECTIVE: To assess the prognostic value of strict sperm morphology analysis in intrauterine insemination with husband's sperm (IUI) cycles performed because of male infertility. DESIGN: Prospective study. SETTING: Academic tertiary hospital. PATIENTS: Seventy-four consecutive couples subjected to 271 IUI cycles because of male infertility. MAIN OUTCOME MEASURE: Strict morphology analysis 1 month before the beginning of IUI following the criteria of Kruger et al. RESULTS: Pregnancy and no pregnancy couples were similar regarding strict normal forms (2.85% +/- 2.07% versus 3.13% +/- 2.63%), slightly amorphous forms, and the morphology index (11.79 +/- 6.06 versus 12.04 +/- 7.13). Pregnancy rates (PRs) were similar when normal forms were <4% (39.1%) or > 4% (35.7%). The PR, although higher in the group with morphology index > 10% (41.4%) than in the group < 10% (33.3%), lacked statistical significance. In pure male infertility group, mean values of morphology were similar in pregnancy and nonpregnancy group. A not significant trend was detected toward higher PRs in morphology index > 10% (50.0%) than in the group < 10% (33.3%). CONCLUSION: Strict morphology analysis 1 month before the beginning of IUI is not a useful prognostic factor in IUI performed because of male infertility.

Adult↗
PubMed1995

Uterine preparation with estrogen for oocyte donation: assessing the effect of treatment duration on pregnancy rates.

OBJECTIVE: To assess the effect of the duration of uterine preparation with E2 on pregnancy rates (PRs) in oocyte donation. DESIGN: A retrospective study. SETTING: IVF-ET Unit, oocyte donation program. PATIENTS: Four hundred eleven patients undergoing 865 ET cycles after oocyte donation. Uterine preparation consisted of 6 mg/d E2 valerate. The duration of treatment varied according to the availability of the oocytes for donation. Progesterone, 100 mg/d, was added upon oocyte retrieval. Patients were divided into seven groups according to the duration of uterine preparation with E2, in 5-day ranks. MAIN OUTCOME MEASURES: Pregnancy rates per ET according to the duration of uterine preparation. RESULTS: No differences were noted in the mean age, number of oocytes received, fertilization rates, or number of embryos transferred when comparing all groups. Pregnancy rates ranged from 19% to 27% for E2 treatment of 5 to 35 days. CONCLUSION: Endometrial preparation in anonymous oocyte donation programs is achieved with continuous administration of E2 until oocytes become available. Our results show that this treatment may be extended for as long as 5 weeks with no significant decrease in PRs.

Adult↗
PubMed1995

Poor fertilization may be related to oocyte or zona pellucida recognition defects specific to certain hyperstimulation regimens and limited to some males but not others: a case report.

OBJECTIVE: To determine if the controlled ovarian hyperstimulation (COH) regimen may cause sperm to appear subfertile only to improve considerably by changing the COH protocol. DESIGN: Case report with retrospective review of previous fertilization rates according to COH protocol used. MAIN OUTCOME MEASURES: Fertilization and pregnancy rates (PRs) after IVF-ET. RESULTS: Known fertile donor sperm failed to fertilize any of 11 oocytes compared with 14 of 18 for processed retrograde ejaculate using the same oocyte pool. Retrospective analysis of other cycles for different female patients but same donor found 16.6% fertilization rate whenever luteal phase leuprolide acetate (LA)-hMG regimen was used compared with 70.6% with short-flare regimen. CONCLUSION: Some COH regimens may cause oocyte or zona pellucida changes that create recognition defects for some sperm but not others. Interestingly, the sperm with the binding defect with the luteal phase LA-hMG COH protocol exhibited good fertilization rates with oocytes prepared with the short-flare protocol and demonstrated high in vivo PRs after IUI.

Adult↗
PubMed1995

Endometriosis: a stage by stage analysis--the role of in vitro fertilization.

OBJECTIVE: To investigate the impact of endometriosis stage on IVF. PATIENTS: A retrospective study of 214 patients diagnosed with endometriosis who underwent 360 cycles of IVF at The New York Hospital-Cornell Medical Center. Meanwhile, 111 pure mechanical (tubal) infertility patients treated in 160 cycles at the same time were designated as the control group for comparison. MAIN OUTCOME MEASURES: Patient's hormone and semen profiles, hormonal response and outcome to stimulation, as well as the outcome of pregnancy, abortion, and delivery rate were analyzed. RESULTS: No differences in the pregnancy outcome between the endometriosis and control groups were noted when compared among the subgroups of pure endometriosis, endometriosis plus tubal factor, endometriosis plus others (primarily endometriosis plus male factor), and control. Comparing the outcomes in pure endometriosis cases by staging, we could not find any discrepancies in terms of pregnancy rates (PRs) according to the severity of the disease. The addition of GnRH analogur down-regulation to gonadotropin stimulation resulted in an increase in PR. A relatively high delivery rate (38.9% per cycle, 41.9% per retrieval, and 43.2% per transfer) was achieved when the pure endometriosis patients were treated with concomitant leuprolide acetate down-regulation and gonadotropin. CONCLUSION: We have observed that pregnancy outcome in patients with endometriosis was not different than the outcome for patients with mechanical (tubal) infertility. There were no differences in PRs by stage of endometriosis.

Adult↗
PubMed1995

Cystic fibrosis gene mutations do not affect sperm function during in vitro fertilization with micromanipulation for men with bilateral congenital absence of vas deferens.

OBJECTIVE: To assess the effects of cystic fibrosis transmembrane-conductance regulator (CFTR) gene mutations on sperm function and fertility in men with bilateral congenital absence of the vas deferens. DESIGN: Prospective. SETTING: Division of urologic microsurgery and associated hospital-based IVF unit. MAIN OUTCOME MEASURES: Fertilization and pregnancy rates. PATIENTS: Men referred to our fertility unit for treatment of bilateral congenital absence of the vas deferens, using sperm surgically retrieved from the epididymis with IVF and micromanipulation. RESULTS: Of 45 men with bilateral congenital absence of the vas, 54% (19/35) tested were found to be carriers of CFTR gene mutations, with one compound heterozygote. Epididymal sperm from men affected with CFTR mutations fertilized 19% (29/152) of oocytes, whereas men without mutations fertilized 22% (44/204) of oocytes. Pregnancy rates (PRs) were 36% (5/14) for cycles involving men with CFTR mutations and 33% (5/15) for other patients with congenital absence of the vas deferens but without detectable CFTR mutations. CONCLUSIONS: The presence of detectable CFTR mutations does not affect fertilization rates or PRs for men with bilateral congenital absence of the vas deferens when IVF and micromanipulation are applied.

Cystic Fibrosis↗
PubMed1995

A new system for fallopian tube sperm perfusion leads to pregnancy rates twice as high as standard intrauterine insemination.

OBJECTIVE: To evaluate the relative efficacy of a new system for fallopian tube sperm perfusion in comparison with standard IUI in controlled ovarian hyperstimulation (COH) cycles. DESIGN: Prospective randomized trial. SETTING: Ovulation induction program of a tertiary outpatient care center, Hôpital Antoine Béclère, Clamart, France. PATIENTS: We studied 74 infertile women aged 20 to 38 years undergoing 100 cycles of COH from December 1993 to May 1994 only excluding cases of age > 38 years, obstructed or severely damaged fallopian tubes, E2 levels per mature follicle < 250 pg/mL (conversion factor to SI unit, 3.671) on the day of hCG administration, spontaneous LH surge, and cases of marked sperm abnormalities. INTERVENTIONS: Controlled ovarian hyperstimulation was achieved using three types of ovarian stimulation protocols: clomiphene citrate (CC) and hMG (n = 35). hMG alone (n = 35) or GnRH agonist and FSH and hMG (n = 30). Thirty-six hours after hCG administration, patients were assigned randomly to either IUI (group A, n = 50) or fallopian tube sperm perfusion (group B, n = 50). Intrauterine insemination was performed with 0.2 mL of sperm suspension according to a standard technique. Fallopian tube sperm perfusion was performed using a simple and reliable system that ensures a good cervical seal and allows to a pressurized injection of 4 mL of sperm suspension. MAIN OUTCOME MEASURES: Feasibility of the fallopian tube sperm perfusion method, clinical pregnancy (presence of gestational sac with heart beats at 6 weeks of amenorrhea), and ongoing pregnancy rates (PRs) (> 12 weeks of amenorrhea), incidence of complications (multiple pregnancies and ovarian hyperstimulation syndrome [OHSS]). RESULTS: Overall, the new fallopian tube sperm perfusion system was simple to handle and well tolerated by patients. In group A, we observed 10 clinical pregnancies (20% per cycle) of which 7 were ongoing (14%). In group B, 20 clinical pregnancies (40% per cycle) of which 17 ongoing pregnancies (34%) were obtained. These differences were statistically significant. The prevalence of twin and three or more sac pregnancies was similar in the two groups (3/10 and 0/10, respectively, in group A, and 5/20 and 2/20, respectively, in group B). No case of moderate or severe OHSS was observed in this series. CONCLUSIONS: Our results indicate that the new system for fallopian tube sperm perfusion is not only simple and reliable but also may lead to PRs twice as high as standard IUI in COH cycles.

Adult↗
PubMed1995

Baseline cyst formation after luteal phase gonadotropin-releasing hormone agonist administration is linked to poor in vitro fertilization outcome.

OBJECTIVE: To investigate the prognostic significance of baseline ovarian cysts after luteal phase GnRH agonist (GnRH-a) administration for IVF-ET. DESIGN: All nondonor IVF-ET cycles in one program in which luteal phase GnRH-a was administered between July 1993 and January 1994 were assessed for the formation of baseline ovarian cysts defined as a mean diameter > or = 15 mm. Outcome data from the IVF cycles were compared between patients with and without baseline ovarian cysts. RESULTS: Of 78 IVF cycles, baseline cysts > or = 15 mm were noted in 26 cycles. Cycles in which cysts were formed were associated with significantly older patients with significantly higher baseline FSH values. Cycles in which cysts were present demonstrated fewer follicles, retrieved oocytes, and embryos. Cyst cycles also demonstrated a lower peak E2 level, implantation rate, and clinical pregnancy rate (PR) per initiated cycle (7.7% versus 32.7%). Cyst cycles also demonstrated a higher cancellation rate. Logistic regression modeling, accounting for age, confirmed significantly lower clinical PRs in cycles with a baseline cyst. CONCLUSIONS: Baseline cyst formation after luteal phase GnRH-a administration is both a marker for poor responders and a reliable predictor of poor stimulation and low PRs in a given IVF-ET cycle.

Chorionic Gonadotropin↗
PubMed1995

Intracytoplasmic sperm injection: achievement of high pregnancy rates in couples with severe male factor infertility is dependent primarily upon female and not male factors.

OBJECTIVE: To determine the efficacy and factors affecting outcome of intracytoplasmic sperm injection (ICSI) in patients with severe male factor infertility. DESIGN: Prospectively designed clinical trial of patients selected to participate in the study based upon the following inclusion criteria: previous total failed fertilization or unsuitable sperm parameters for conventional IVF. SETTING: Tertiary care academic center. PATIENTS: Ninety-two consecutive couples undergoing IVF therapy augmented with ICSI during April through December 1994 were studied. MAIN OUTCOME MEASURES: Fertilization and ongoing implantation and pregnancy rates (PRs). RESULTS: A total of 1,163 preovulatory oocytes were manipulated, yielding a diploid fertilization rate of 60.9%; the oocyte damage rate was 13.2%. The transfer rate was 95% with 43.1% of cycles having excess embryos that were cryopreserved. Overall, the clinical and ongoing PRs per transfer were 31.9% and 26.8%, respectively. None of the sperm parameters of the original semen analysis correlated with ICSI outcome. Female age did not affect fertilization results but had a significant impact on PR (< 34 years: 48.9%; 35 to 39 years: 22.9%; > or = 40 years: 5.9% clinical PR per transfer). CONCLUSIONS: Intracytoplasmic sperm injection offers a new and powerful therapeutic option to treat couples with severe male factor infertility associated with a variety of sperm abnormalities. An adequate female age is a pivotal factor determining a successful outcome.

Adult↗
PubMed1995

Day 3 estradiol serum concentrations as prognosticators of ovarian stimulation response and pregnancy outcome in patients undergoing in vitro fertilization.

OBJECTIVE: To test the hypothesis that elevated E2 levels on day 3 of IVF cycles without GnRH agonist (GnRH-a) are associated with reduced oocyte numbers and pregnancy rates (PRs). DESIGN: Day 3 levels of E2 and FSH were obtained from patients undergoing controlled ovarian hyperstimulation without GnRH analogue for IVF. PATIENTS: Five hundred ninety-two consecutive IVF cycles. RESULTS: Patients were grouped according to their day 3 E2 levels (< 30, 31 to 45, 46 to 60, 61 to 75, and > 75 pg/mL [conversion factor to SI unit, 3.671]). The ongoing PR per retrieval for patients with E2 levels < 30 pg/mL was significantly higher than for patients with E2 levels 31 to 75 pg/mL. There were no pregnancies if the E2 level was > 75 pg/mL. The mean number of oocytes per retrieval was significantly lower in patients from the E2 groups with E2 > 60 pg/mL compared with patients in groups with E2 < 60 pg/mL. Day 3 FSH and E2 levels also were evaluated simultaneously. In patients with the lowest levels of FSH and E2, the PR was the highest. No pregnancies occurred if the FSH level was > 17 mIU/mL (conversion factor to SI unit, 1.00) and the E2 level was > 45 pg/mL on day 3. CONCLUSIONS: For patients undergoing IVF without GnRH analogue, oocyte numbers and PRs decrease with increasing levels of day 3 E2. Combining day 3 FSH and E2 improved the prognostic ability of either of these hormones used alone.

Adult↗
PubMed1995

Comparison of sperm parameters, in vitro fertilization results, and subsequent pregnancy rates using sequential ejaculates, collected two hours apart, from oligoasthenozoospermic men.

OBJECTIVE: To evaluate the effect of second consecutive ejaculate collected 2 hours after the first one from infertile men on sperm quality and fertilization and pregnancy rates (PRs) in IVF. DESIGN: A prospective case-control study. SETTING: In vitro fertilization unit of a university hospital. PATIENTS: Thirty-nine consecutive infertile patients with oligoasthenozoospermia scheduled for IVF-ET. MAIN OUTCOME MEASURES: Two consecutive ejaculates were obtained 2 hours apart and were assessed for volume, sperm count, motility, morphology, and quality of swim-up fraction. The subsequent fertilization, cleavage, and PRs (as defined by the appearance of intrauterine gestational sac) were compared between the two ejaculates. RESULTS: In 28.2% of the individuals the semen analysis of the first ejaculate precluded proceeding with IVF. A statistically significant improvement was shown in sperm cell motility (31.9% +/- 20.7% versus 15.6% +/- 15.3%) and in motile count after swim-up (4.9 +/- 4.5 versus 2.6 +/- 3.1 x 10(6) sperm). No improvement could be demonstrated in sperm density or morphology. The volume of the second ejaculate was decreased significantly as compared with the first one. The fertilization rate, the cleavage rate, and PR were all increased when oocytes were exposed to sperm from the second ejaculate compared with oocytes exposed to sperm from the first ejaculate. The overall PR in our series was 25.6%. CONCLUSIONS: We suggest that in the group of infertile men with oligoasthenozoospermia, whose partners are scheduled for IVF-ET, if on the day of retrieved oocytes insemination, the ejaculate is of unacceptable quality, a second ejaculate collected 2 hours after collection of the initial ejaculate may produce a sample that exhibits improvements in both semen parameters and reproductive potential.

Adult↗
PubMed1995

The achievement of pregnancies using assisted reproductive technologies for male factor infertility after retroperitoneal lymph node dissection for testicular carcinoma.

OBJECTIVE: To evaluate the success of electroejaculation with assisted reproductive technologies (ART) in anejaculate men after retroperitoneal lymph node dissection (RPLND) for testicular cancer. DESIGN: Retrospective clinical study. SETTING: Tertiary care, university-affiliated IVF program. PATIENTS: Anejaculate men after RPLND, spouses. INTERVENTIONS: Electroejaculation, microsurgical sperm aspiration, various assisted reproductive technologies. MAIN OUTCOME MEASURES: Sperm density and motility, fertilization rate, pregnancy rate (PR). RESULTS: Compared with patients not receiving chemotherapy, patients who received chemotherapy had diminished average sperm densities and motilities (63 x 10(6) and 20% versus 101 x 10(6) 32%, respectively); decreased fertilization rates per cycle for IVF and intracytoplasmic sperm injection (ICSI) (11% versus 26%, respectively); lower PRs per cycle of hMG-IUI and IVF (14% versus 60% and 8% versus 50%, respectively). No pregnancies were achieved with natural cycle-IUI, clomiphene citrate-IUI, or GIFT. Two couples progressed to intracytoplasmic sperm injection with one achieving the successful delivery of healthy twins. The overall PR per cycle was 22%. CONCLUSIONS: Patients receiving chemotherapy had decreased sperm densities, motilities, fertilization, and PRs for each modality used. Rectal probe electroejaculation with ART can help anejaculate men after RPLND achieve biologic paternity. An early move to the more aggressive therapies (hMG-IUI, IVF, ICSI) is supported.

Adult↗
PubMed1996

Achieving multiple-order embryo transfer identifies women over 40 years of age with improved in vitro fertilization outcome.

OBJECTIVE: To define factors in patients > or = 40 years that may improve outcome and provide prognosis for success in IVF-ET. DESIGN: Retrospective. SETTING: University infertility center. PATIENTS: Patients (n = 501) undergoing IVF-ET from 1987 to 1994. INTERVENTIONS: IVF-ET (n = 713 cycles) with GnRH-analogue suppression and hMG stimulation. MAIN OUTCOME MEASURES: We evaluated data including age, diagnosis, prestimulation (day 3) FSH and E2, hMG ampules used, days of monitoring, follicle number and size, maximum E2, ova retrieved, cancellation rate, clinical pregnancy, nidation, and miscarriage rates. RESULTS: Overall, patients > or = 40 years had significantly decreased pregnancy rates (PRs), response to stimulation, and increased miscarriage rates. However, if these patients had four or more embryos transferred, their response and PRs (34.4% per ET) were not significantly different from younger women (47.7% per ET). The majority (77.8%) of pregnancies in women > or = 40 years occurred when four or more embryos were transferred. CONCLUSION: A subset (49%) of women > or = 40 years undergoing IVF-ET will respond to ovarian stimulation well enough to result in four or more embryos available for transfer with a resultant PR similar to that observed in younger patients. We recommend consideration of an attempt at IVF-ET before recommending oocyte donation.

Adult↗
PubMed1996

The influence of sperm morphology and the number of motile sperm inseminated on the outcome of intrauterine insemination combined with mild ovarian stimulation.

OBJECTIVE: To determine the influence of sperm morphology and the number of motile sperm inseminated on the outcome of IUI in hMG-stimulated cycles and to establish lower limits for these variables below which the expectation of pregnancy is limited. DESIGN: Retrospective study of data from 1990 to 1992. SETTING: Tertiary referral Reproductive Medicine Unit. PATIENTS: Couples with bilaterally patent fallopian tubes, and > or = 200,000 motile sperm recovered in a trial preparation before treatment. No other semen criteria were used to exclude couples. Women were stimulated with hMG irrespective of whether they were ovulatory or anovulatory. The study comprised 163 couples who underwent 330 cycles. MAIN OUTCOME MEASURES: Pregnancy rate (PR) per cycle was related to the percentage normal sperm morphology in the fresh semen sample and the number of motile sperm inseminated after sperm preparation by swim-up or Percoll gradients. RESULTS: The overall PR was 16.1% per cycle. The PR was highest in the first cycle of treatment (21.4%) and declined in the second and third cycles. The miscarriage rate was 10.4% and the incidence of multiple pregnancies was 13.9%. Two groups of patients were defined on the basis of sperm morphology: a "poor outcome" group ( < or = 10% normal) and a "good outcome" group ( > 10% normal). The PRs in these two groups were 4.3% and 18.2%, respectively, and the cumulative PRs after three cycles were 8.3% and 40.1%, respectively. The number of motile sperm inseminated did not significantly affect the PR. CONCLUSIONS: The degree of teratozoospermia affected the PR in hMG-stimulated IUI cycles and a normal morphology value of 10% in the fresh semen distinguished couples with good and poor outcomes. In contrast, the number of motile sperm inseminated did not significantly influence IUI outcome.

Female↗
PubMed1996

The effects of prior gravidity on the outcomes of ovum donor and own oocyte cycles.

OBJECTIVE: To determine the effects of prior gravidity on hormonal parameters, medication regimen, oocyte parameters, fertilization, and clinical pregnancy rates (PRs) in donor and own oocyte cycles. DESIGN: A retrospective study of 64 first-attempt ovum donor cycles and 102 first-attempt IVF and ZIFT cycles using own oocytes conducted during a 2.5-year time period. Analyses of covariance and t-tests using gravidity of oocyte source (gravida versus nulligravida) and controlling for sperm parameters were used to assess differences in hormonal, endometrial, medication, and demographic parameters and were performed separately for donor cycles and for own oocyte cycles. SETTING: Private fertility center. PATIENTS: In ovum donation cycles, oocyte parameters, medication administered, and hormonal parameters of 64 oocyte donors between the ages of 21 and 35, 34 of whom were never pregnant, i.e., nulligravida and 30 who had ever been pregnant, regardless of the outcome of that pregnancy, i.e., gravida, were studied. In own oocyte cycles, oocyte parameters, medication administered, and hormonal parameters of 102 women, 54 nulligravida and 48 gravida, between the ages of 23 and 44 were studied. MAIN OUTCOME MEASURE: Medication requirements, hormonal response, seminal parameters, oocyte quality, fertilization, and clinical PRs. RESULTS: For patients using their own oocytes, there were no significant differences in any of the parameters studied. In contrast, compared with their nulligravida counterparts, gravida oocyte donors had fewer poor quality oocytes, had more high quality oocytes that fertilized, had a higher proportion of their oocytes fertilize, and had a higher PR per transfer. CONCLUSION: A prior history of gravidity is an important predictor of clinical pregnancy in donor oocyte cycles but not in cycles in which patients use their own oocytes. Oocyte recipients may wish to consider donor gravidity in selecting their donor.

Adult↗