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PubMed1993

Subzonal sperm insemination and total or extreme asthenozoospermia: an effective technique for an uncommon cause of male infertility.

OBJECTIVE: To assess the value of subzonal insemination (SUZI) in cases of total or extreme asthenozoospermia. DESIGN: The results of IVF after SUZI were assessed in six cycles (four couples) with documented asthenozoospermia. SETTING: Institut de Médecine de la Reproduction, Marseille, France. PATIENTS: Four couples underwent six retrieval cycles. In all cases asthenozoospermia was total (100% of immotile spermatozoa) or extreme (5% nonprogressive motility). Oligozoospermia and teratozoospermia were ruled out in all cases. In two cases electron microscopy revealed the absence of the central singlet in the flagellum axonemal complex and in one case a major dysplasia of the fibrous sheath in the flagellum principal piece. RESULTS: The overall fertilization rate was 45%. The diploid embryo rate was 33%. Embryo quality was satisfactory. In five of six cycles, three embryos were transferred. Two triplet pregnancies were obtained corresponding to an implantation rate per transferred embryo of 40%. CONCLUSION: Total or extreme asthenozoospermia seems to be a good indication for SUZI.

Adult↗
PubMed2000

Selection of the most common chromosome abnormalities in oocytes prior to ICSI.

So far, all preimplantation genetic diagnosis (PGD) protocols in use produce results after the eggs have been fertilized. However, these approaches are not acceptable for patients with moral objections to the generation and discard of supernumerary zygotes or embryos. In these circumstances, only those oocytes to be replaced may be inseminated. The purpose of this study was to develop a PGD protocol to diagnose first polar bodies (PBs) prior to Intracytoplasmatic Sperm Injection (ICSI) in order to inseminate only those oocytes found to be chromosomally normal. PB biopsy was performed 1 hour after ovum pick up, and after fixation, the PBs were analysed by FISH and the eggs inseminated by ICSI no later than 7 hours after retrieval. One third (33.3%) of the PBs were aneuploid. Fifty-four normal and 12 non-resolved oocytes were injected by ICSI, of which 65% became 2-PN zygotes. Embryo transfer on day 2 was possible in all 10 patients (average maternal age 35.2+/-3.2, range 29-39 years), of which 6 became pregnant with 8 fetuses (28.6% or 8/28 transferred embryos). The results indicate that PB analysis of some common chromosome abnormalities is feasible within time limits imposed by ICSI insemination (6 hours or less).

Adult↗
PubMedDate not supplied

Evaluation of leptin, interleukin-1beta, tumor necrosis factor-alpha and vascular endothelial growth factor in serum and follicular fluids of women undergoing controlled ovarian hyperstimulation as prognostic markers of ICSI outcome.

BACKGROUND: Cytokines play an important but controversial role during ovarian folliculogenesis for the development of mature and fertilizable oocytes. In this study, leptin, interleukin-1beta (IL1beta), tumor necrosis factor-alpha (TNFalpha) and vascular endothelial growth factor (VEGF) in serum and follicular fluids (FF) of women undergoing ovarian hyperstimulation were evaluated as prognostic markers of the outcome of intracytoplasmic sperm injection (ICSI) cycles. MATERIALS AND METHODS: Ninety-five ICSI cycles were included in the study. The cytokines were measured in serum and FF samples with enzyme immunoassay methods. RESULTS: The cytokine concentrations in serum were not significantly correlated with the cytokine concentrations in FFs. Serum IL1beta was inversely-correlated with the number of retrieved oocytes. Serum TNFalpha was negatively-correlated with fertilization rate. In FFs, TNFalpha was positively-correlated with leptin. Leptin and VEGF in FFs were negatively-associated with pregnancy outcome. CONCLUSION: Leptin and VEGF concentrations in FFs may serve as prognostic markers of success after ovarian hyperstimulation and ICSI.

Adult↗
PubMed2004

Fertilization of IVF/ICSI using sibling oocytes from couples with subfertile male or unexplained infertility.

The significance of the performance of conventional in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) using sibling oocytes from couples with subfertile male or unexplained infertility was evaluated. A total of 410 sibling oocyte cumulus-corona complexes (OCCC) from 21 couples with subfertile male (group A) and 11 unexplained infertile couples (group B) were randomly divided, in order of retrieval, into two groups inseminated either by conventional IVF or by ICSI. The treatment outcomes and the influence of infertility factors on fertilization in each group were compared. The results showed that although the two pronuclear (2PN) fertilization rate per injected sibling oocytes was significantly higher after ICSI (group A: 68.2% +/- 28.8%; group B: 66.2% +/- 24.9%) than after conventional IVF (group A: 41.8% +/- 32.7%; group B: 40.1% +/- 22.1%), the other variables studied included: the fertilization rates of per allocated sibling oocytes IVF/ICSI, the fertilization rates of sibling oocytes IVF/ICSI after excluding failed IVF fertilization cycles, as well as the cleavage rates of normal fertilization were not statistically significant (P>0.05). Similarly, though the total fertilization failure rate in the IVF group (group A: 42.9%; group B: 36.4%) was significantly higher than in the ICSI group (group A: 4.8%; group B: 0), we did not cancel cycles due to the normal fertilization of sibling oocytes. Embryo transfer was possible in all 32 couples. There were 10 clinical pregnancies in the two groups. We also discovered a possible association between some semen parameters and sperm functions of group A, and women age and duration of infertility of group B and fertilization. It is suggested that adoption of the split IVF/ICSI technology in the above cases may help eliminate fertilization failures. This is also a useful method to investigate the effect of single factor on the employment of assisted reproductive technology.

Embryo Transfer↗
PubMed2006

Successful ongoing pregnancies after vitrification of oocytes.

OBJECTIVE: To demonstrate the efficiency of vitrifying mature human oocytes for different clinical indications. DESIGN: Descriptive case series. SETTING: Cryobiology laboratory, Centro Colombiano de Fertilidad y Esterilidad-CECOLFES LTDA. (Bogotá, Colombia). PATIENT(S): Oocyte vitrification was offered as an alternative management for patients undergoing infertility treatment because of ovarian hyperstimulation syndrome, premature ovarian failure, natural ovarian failure, male factor, poor response, or oocyte donation. Mature oocytes were obtained from 33 donor women and 40 patients undergoing infertility treatment. INTERVENTION(S): Oocytes were retrieved by ultrasound-guided transvaginal aspiration and vitrified with the Cryotops method, with 30% ethylene glycol, 30% dimethyl sulfoxide, and 0.5 mol/L sucrose. Viability was assessed 3 hours after thawing. The surviving oocytes were inseminated by intracytoplasmic sperm injection. Fertilization was evaluated after 24 hours. The zygotes were further cultured in vitro for up to 72 hours until time of embryo transfer. MAIN OUTCOME MEASURE(S): Recovery, viability, fertilization, and pregnancy rates. RESULT(S): Oocyte vitrification with the Cryotop method resulted in high rates of recovery, viability, fertilization, cleavage, and ongoing pregnancy. CONCLUSION(S): Vitrification with the Cryotop method is an efficient, fast, and economical method for oocyte cryopreservation that offers high rates of survival, fertilization, embryo development, and ongoing normal pregnancies, providing a new alternative for the management of female infertility.

Adult↗
PubMed2006

Reevaluation of azoospermic factor c microdeletions using sequence-tagged site markers with confirmed physical positions from the GenBank database.

OBJECTIVE: To investigate microdeletions and palindrome complexes in the azoospermic factor (AZF) c regions of the Y chromosome, by polymerase chain reaction (PCR) with sequence-tagged site (STS) markers with known physical positions, after verification of the exact physical locations of candidate STSs and exclusion of those that would give ambiguous results on PCR. DESIGN: Retrospective STS deletion study in infertile Japanese men. SETTING: University hospital and reproductive clinic. PATIENT(S): A total of 410 men with nonobstructive azoospermia and severe oligospermia (sperm concentrations of <5 x 10(6)/mL). INTERVENTION(S): Polymerase chain reaction was performed for all STS markers confirmed to be physically located in the partial AZFb and AZFc regions of the Y chromosome. All STSs were retrieved from the University of California at Santa Cruz database, and their location and specificity were verified. MAIN OUTCOME MEASURE(S): Presence or absence of appropriately sized PCR products. RESULT(S): Sixty-nine markers were retrieved, 32 of which were not specific to the long arm of the Y chromosome (Yq). The markers retained for test use were contiguous deletions classified as P1+P2 (AZFc) or P3 proximal/P1 (AZFb+c). The prevalence of accurately mapped microdeletions was 5.1% (21 of 410) in this patient population. CONCLUSION(S): Although noncontiguous deletions were observed, considerable confusion remained until the genome sequence was finally determined because many of the STSs were either repetitive sequences or polymorphic between individuals or races.

Animals↗
PubMed2001

Evidence of reduced single-stranded testicular sperm DNA from obstructive azoospermic men after 3 days of in-vitro culture.

The aim of the present study was to verify whether culturing testicular tissue, to obtain a higher percentage of motile spermatozoa and a better post-thaw recovery rate, affected the ratio between single/double-stranded sperm DNA and, consequently, DNA sensitivity to damage. Testicular biopsy samples from men with obstructive and secretory azoospermia, candidates for assisted reproductive treatment, were cultured for 72 h. The percentage of motile spermatozoa and the single/double stranded DNA ratio were assessed on the day of retrieval (day 0) and again on day 3. The single/double stranded DNA ratio was measured by the acridine orange (AO) staining method. Spermatozoa were classified as green (double-stranded chromatin) or red fluorescing (single-stranded chromatin). In obstructive azoospermia, median motility was 22% (range 10-44%) on day 0 and 50% (range 38-63%) on day 3 (P < 0.01). The median percentage of red stained spermatozoa was 53.5% (range 0.1-88%) on day 0 and 20% (range 2.7-99.9%) on day 3 (P < 0.05). No changes were observed in secretory azoospermia. The culture procedure from obstructive azoospermia not only increased the post-thaw recovery rate, as previously observed, but also reduced the portion of spermatozoa containing single-stranded DNA, thereby increasing the availability of double-stranded DNA spermatozoa for ICSI use.

Acridine Orange↗
PubMed2005

Hyaluronan and its binding proteins in the epithelium and intraluminal fluid of the bovine oviduct.

Hyaluronan (HA) is involved in several important steps of sperm storage and of fertilization. This study investigates the presence and concentration of HA in oviductal fluid (ODF), together with the localization of HA and the presence of hyaluronan-binding proteins (HABPs) in the oviductal epithelium of normally cycling dairy heifers and cows. The concentration and amount of HA in ODF, collected over the course of several oestrous cycles via catheters placed in the isthmic and ampullar tubal segments, were measured using an ELISA. The concentration and amount of HA in ODF did not vary significantly between these anatomical regions, nor between the stages of the oestrous cycle (p > 0.05), although the amount of HA seemed to peak during oestrous. The most HA per day (2.9 +/- 0.64 microg, least square mean +/- SEM) was produced on the day of ovulation, whereas the lowest amount (1.25 +/- 0.68 microg) was produced 4 days before ovulation. To investigate the localization of HA, tissue samples were retrieved at well-defined stages of the oestrous cycle and from corresponding regions of the oviduct. Sections and protein extracts from the tissue samples were studied histochemically using biotinylated HABP and immunoblotted with fluorescein isothiocyanate (FITC)-HA, respectively. Presence of HA labelling in the oviductal epithelium was restricted to the sperm reservoir, a localization that seemed to be cycle-independent. The immunoblotting of samples from the lining epithelium revealed seven bands of HABPs. We confirm that the bovine oviduct produces HA and its binding proteins, and that HA is mainly localized to the epithelium of the sperm reservoir.

Animals↗
PubMed2001

Comparison between the quality and function of sperm after semen processing with two different methods.

AIM: To compare the recovery rate of morphologically normal and chromatin condensed spermatozoa from native semen samples using the SpermPrep filtration columns and Percoll gradient centrifugation and to determine the influence of the two processing techniques on fertilization and pregnancy rates in an IVF-ET program. METHODS: Sixteen semen samples obtained from patient's husband were included in this study. Each was divided into two aliquots. The first aliquot was processed with SpermPrep filtration columns and the second, Percoll gradient centrifugation. Smears were made before and after semen processing with both methods for the evaluation of chromatin condensation (chromomycine CMA3) as well as morphology (strict criteria) of spermatozoa. One hundred and seventy oocytes were retrieved from the patients and the oocytes from each patient were subdivided into two sets: one set was inseminated using spermatozoa processed with SpermPrep and the other inseminated after semen processing with Percoll gradient centrifugation. RESULTS: The Percoll method yielded a significantly higher percentage of chromatin condensed (90.8 +/- 6.5% vs 82.3 +/- 8.8%, P = 0.017) and morphologically normal spermatozoa (12.9 +/- 7.4% vs 6.9 +/- 4.8%, P = 0.001) in comparison to SpermPrep. Whereas, sperm count recovery rate was significantly higher after the use of SpermPrep than after the Percoll gradient centrifugation. The fertilization rate was similar between the two methods. CONCLUSION: Semen processing with Percoll should be recommended for intracytoplasmic sperm injection as the natural selection is bypassed and the SpermPrep technique could be recommended for IVF and IUI programs as the sperm concentration plays a more significant role in these procedures.

Centrifugation, Density Gradient↗
PubMed1993

Intracytoplasmic single sperm injection of 1-day-old unfertilized human oocytes.

Although the average fertilization rate in most in-vitro fertilization (IVF) centres is approximately 60-70%, there are cases of complete or virtually complete fertilization failures. The aim of our work was to study the fertilization and the subsequent cleavage characteristics of 1-day-old human oocytes treated by intracytoplasmic single sperm injection (ICSI) after failing to fertilize during the standard IVF procedure. A total of 115 metaphase II 1-day-old unfertilized oocytes were collected from 23 patients. No additional treatment was applied to the oocytes or to the semen sample. A single spermatozoon from the patient's husband was injected into the cytoplasm of each of these oocytes 21-33 h after ovum retrieval. Injected oocytes were observed at 16-18 h and again 42-44 h after the ICSI procedure. Of the injected oocytes, 92% (n = 106) were intact after ICSI, 38% (n = 44) had two distinct pronuclei and there was no difference in the fertilization rate of oocytes when andrological and non-andrological patients were compared. Similarly, there was no difference in the fertilization rate after ICSI where patients with acceptable or good (> 15%) fertilization after standard IVF were compared to patients who had poor (< or = 15%) fertilization after IVF. There was no significant difference in the sperm concentration or in the progressive forward motility (a + b motility) in these groups except where a + b motility of andrological and non-andrological patients was compared. The majority (84%) of the normally fertilized oocytes cleaved and most (77%) of these embryos showed < 20% fragmentation 2 days after the ICSI procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Cellular Senescence↗
PubMed2006

Conventional in vitro fertilization versus intracytoplasmic sperm injection in patients with borderline semen: a randomized study using sibling oocytes.

OBJECTIVE: To determine whether patients with borderline semen should be treated with conventional IVF or intracytoplasmic sperm injection (ICSI). DESIGN: Randomized study. SETTING: A university medical center in The Netherlands. PATIENT(S): One hundred six couples with borderline semen who were undergoing IVF and ICSI on sibling oocytes. INTERVENTION(S): Performing IVF and ICSI on sibling oocytes. MAIN OUTCOME MEASURE(S): Fertilization and pregnancy rates. RESULT(S): One thousand five hundred eighteen oocytes were collected in 106 oocyte retrievals: 849 oocytes were randomly allocated to ICSI, of which 761 were microinjected, and 669 oocytes were randomly assigned to IVF. In 26 of the 106 patients, there was fertilization only after ICSI and not after IVF (IVF- group). The fertilization rate was 51% (92/182 oocytes). In 78 patients, there was fertilization after both IVF and ICSI (IVF+ group); the fertilization rate was 51% for both the IVF- and ICSI-treated oocytes (271/528 oocytes and 334/658 oocytes, respectively). In 2 patients, there was no fertilization after either IVF (0/6 oocytes) or ICSI (0/9 oocytes). Patients of the IVF+ group had a higher total motile sperm count after preparation than did those of the IVF- group. More high-quality embryos were obtained after ICSI in patients of the IVF+ group. In 101 patients, embryo transfer was performed: 26 in the IVF- group and 75 in the IVF+ group. No significant differences were found with regard to pregnancy rates between those two groups: pregnancy rates were 54% in the IVF- group and 48% in the IVF+ group. CONCLUSION(S): Performing ICSI on at least some of the oocytes will avoid unnecessary fertilization failure in patients with borderline semen: in this study, 26 of 104 cycles (25%) were rescued by ICSI.

Adult↗
PubMedDate not supplied

Smoking and reproduction: gene damage to human gametes and embryos.

Assisted conception is a useful methodology for detecting disturbances in clinical outcome, meiotic maturation, and genetic integrity of human gametes. Germinal cells are vulnerable to genetic damage from smoking, but can repair damage during meiosis. In ejaculated spermatozoa, repair capacity declines drastically. Smoking alters the meiotic spindle of oocytes and spermatozoa, leading to chromosome errors which affect reproductive outcomes. Smoking is associated with reduced numbers of retrieved oocytes, leading to early age of menopause. Oocyte elimination occurs preferentially during meiosis I, a period sensitive to genetic damage. Smoking inhibits embryo fragmentation; inhibition may confer survival advantage to embryos genetically altered. Smoking is associated with low sperm quality, but clinical effects are not recognized. Cadmium (a heavy metal), nicotine (a toxic alkaloid), and its metabolite cotinine, are detectable in gonadal tissues and fluids in association with smoking. Cotinine incorporates into ovarian granulosa-lutein cells, compromising the developmental potential of follicles. Benzo[a]pyrene is a carcinogenic polycyclic aromatic hydrocarbon resulting from cigarette combustion. Its reactive metabolite binds covalently to DNA, forming adducts. Smoking-related adducts were detectable in ovarian granulosa-lutein cells, oocytes, spermatozoa and preimplantation embryos. Transmission of altered DNA from smoking by spermatozoa was demonstrated in preimplantation embryos and in association with increased risk of childhood cancer.

Benzo(a)pyrene↗
PubMed2003

MTID: a database of Sleeping Beauty transposon insertions in mice.

The Sleeping Beauty (SB) transposon system provides the first random insertional mutagen available for germline genetic screens in mice. In preparation for a large scale project to create, map and manage up to 5000 SB insertions, we have developed the Mouse Transposon Insertion Database (MTID; http://mouse.ccgb.umn.edu/transposon/). Each insertion's genomic position, as well as the distance between the insertion and the nearest annotated gene, are determined by a sequence analysis pipeline. Users can search the database using a specified nucleotide or genetic map position to identify the nearest insertion. Mouse reports describe insertions carried, strain, genotype and dates of birth and death. Insertion reports describes chromosome, nucleotide and genetic map positions, as well as nearest gene data from Ensembl, NCBI and Celera. The flanking sequence used to map the insertion is also provided. Researchers will be able to identify insertions of interest and request mice or frozen sperm that carry the insertion.

Animals↗
PubMed1993

Uterine flushing: a method to recover spermatozoa and leukocytes.

The process of sperm transport from the cervix, where a leukocytic reaction is initiated, through the uterus to gain access to the site of fertilization is very poorly understood. This preliminary study was designed to utilize a uterine flushing technique to determine firstly, the number of spermatozoa that can be recovered from the uterine cavity at 4 h post-insemination, around the time of ovulation, and secondly, to establish whether the spermatozoa initiate a leukocytic response while present. Uterine flushing was carried out in 10 potentially fertile women at 4 h post-insemination with donor semen, 24-36 h after the onset of the luteinizing hormone (LH) surge. The flush fluid was analysed for the numbers of spermatozoa and leukocytes present. In 8/10 women spermatozoa were retrieved from the uterus, in consistently low numbers (median 46, range 3-415). In 5/5 women leukocytes were recovered (median, 2.75 x 10(8)/l, range 2.0 x 10(8)-12.7 x 10(8)/l) from an origin other than peripheral blood contamination. These results suggest firstly that the flushing technique was a consistent method for retrieving spermatozoa and leukocytes from the uterine cavity, secondly that only low numbers of spermatozoa can be retrieved on flushing and thirdly that the leukocytic reaction to spermatozoa extends to the uterine cavity.

Female↗
PubMedDate not supplied

Chromatin decondensation of human sperm in vitro and its relation to fertilization rate after ICSI.

The inability of sperm chromatin to decondense has been implicated in the failure of fertilization, This study was undertaken to identify the relationship between sperm chromatin decondensation in vitro after incubation with follicular fluid at various points in time and fertilization or pregnancy rates after intracytoplasmic sperm injection. Moreover, an attempt was made to determine whether this test could be used as a predictive test for the outcome of ICSI. Thirty-two infertile couples undergoing ICSI therapy were included in this prospective study. One milliter of semen from each sample was mixed with 1 mL of follicular fluid obtained from ICSI patients at the time of oocyte retrieval and incubated for 24 h. Many smears were made directly after semen liquefaction at the following time intervals: 30, 60, and 120 min and 24 h. Chromatin decondensation was evaluated with acridine orange staining. The mean percentage of uncondensed chromatin of spermatozoa in the native semen samples was 25 +/- 18.3%, which increased within 24 h to 91 +/- 9.5%. On the other hand, the fertilization and ongoing pregnancy rates were 64 +/- 21.7% and 20%, respectively. However, no correlations were found between chromatin decondensation at various point of time (30, 60, and 120 min and 24 h) and fertilization rate. No correlation was shown between the chromatin decondensation and sperm counts in the ejaculate. morphology, or the percentage of condensed chromatin. In light of this study, chromatin decondensation in vitro cannot be recommended for predicting the fertilization potential of spermatozoa and pregnancy rates in the ICSI program. Further research is necessary, especially in cases where ICSI is being considered as a therapeutic option.

Adult↗
PubMed1993

Acrosin activity in human spermatozoa in relation to semen quality and in-vitro fertilization.

Acrosin, a sperm proteinase released during acrosomal exocytosis, facilitates penetration through the oocyte vestments. The purpose of this investigation was to determine if a correlation exists between the acrosin activity of ejaculated human spermatozoa, before motility enrichment techniques, and in-vitro fertilization (IVF) success using selected (glass wool or swim-up) spermatozoa. Since all the oocytes were retrieved from women receiving exogenous hormonal stimulation and a mixed population of mature and immature oocytes were encountered, only cases with > or = 50% mature oocytes were analysed. Under these conditions, the acrosin activity was significantly greater (P < 0.01) in the ejaculates in which spermatozoa ultimately fertilized > or = 70% of the mature oocytes, than in the ejaculates in which spermatozoa ultimately fertilized < 70% of the mature oocytes. Furthermore, a strong correlation (r = 0.962, P = 0.0001) was detected between pre-IVF acrosin activity and subsequent high (> or = 70%) IVF success. Acrosin activity from normozoospermic and oligo-asthenozoospermic men was also compared and was significantly (P < 0.01) higher for the normozoospermic group. These data suggest that measurement of acrosin activity may be a valuable clinical laboratory assay for assessing the sperm fertilizing potential and that low acrosin activity is associated with abnormal semen characteristics.

Acrosin↗
PubMed2001

Efficacy and safety of ganirelix acetate versus leuprolide acetate in women undergoing controlled ovarian hyperstimulation.

OBJECTIVE: To assess the efficacy, safety, and local tolerance of ganirelix acetate for the inhibition of premature luteinizing hormone (LH) surges in women undergoing controlled ovarian hyperstimulation (COH). DESIGN: Phase III, multicenter, open-label randomized trial. SETTING: In vitro fertilization (IVF) centers in North America. PATIENT(S): Healthy female partners (n = 313) in subfertile couples for whom COH and IVF or intracytoplasmic sperm injection were indicated. INTERVENTION(S): Patients were randomized to receive one COH cycle with ganirelix or the reference treatment, a long protocol of leuprolide acetate in conjunction with follitropin-beta for injection. OUTCOME MEASURE(S): Number of oocytes retrieved, pregnancy rates, endocrine variables, and safety variables. RESULT(S): The mean number of oocytes retrieved per attempt was 11.6 in the ganirelix group and 14.1 in the leuprolide group. Fertilization rates were 62.4% and 61.9% in the ganirelix and leuprolide groups, respectively, and implantation rates were 21.1% and 26.1%. Clinical and ongoing pregnancy rates per attempt were 35.4% and 30.8% in the ganirelix group and 38.4% and 36.4% in the leuprolide acetate group. Fewer moderate and severe injection site reactions were reported with ganirelix (11.9% and 0.6%) than with leuprolide (24.4% and 1.1%). CONCLUSION(S): Ganirelix is effective, safe, and well tolerated. Compared with leuprolide acetate, ganirelix therapy has a shorter duration and fewer injections but produces a similar pregnancy rate.

Adult↗
PubMed2001

A double-blind clinical trial comparing a fixed daily dose of 150 and 250 IU of recombinant follicle-stimulating hormone in women undergoing in vitro fertilization.

OBJECTIVE: To determine the efficacy and efficiency of two fixed doses of recombinant follicle-stimulating hormone (FSH) in controlled ovarian hyperstimulation. DESIGN: Randomized, double-blind clinical trial. SETTING: Fifteen IVF clinics in Argentina, Brazil, Chile, Colombia, Mexico, and Venezuela. PATIENT(S): Women between 30 and 39 years of age undergoing IVF or intracytoplasmic sperm injection (ICSI). INTERVENTION(S): Daily doses of either 150 IU or 250 IU of recombinant FSH (Puregon) until at least two follicles >or=20 mm were seen on ultrasound. MAIN OUTCOME MEASURE(S): Number of cumulus-oocyte complexes retrieved and total dose of recombinant FSH used. RESULT(S): Two hundred one women received 150 IU and 203 used 250 IU. In the low-dose group 8.9 oocytes were retrieved compared to 10.2 in the high-dose group (not significant). The 150 IU-treated women received a total of 1,589 IU and the total dose used in 250 IU treated women was 2,492 IU. Implantation rates were 10.0% in the 150 IU group and 10.9% in the 250 IU group. The vital pregnancy rates per started cycle in the low-dose and high-dose groups were 17.1% and 16.7%, respectively. Two women, both in the 250 IU group, were hospitalized because of the ovarian hyperstimulation syndrome (OHSS). CONCLUSION(S): An increase from 150 IU to 250 IU daily dose of recombinant FSH in women between 30 and 39 years of age has only limited value in augmenting ovarian response.

Adult↗