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PubMed1992

Increased pregnancy failure rates after clomiphene following assisted reproductive technology.

The obstetric outcome of 1941 in-vitro fertilization (IVF) and 1436 gamete intra-Fallopian transfer (GIFT) pregnancies reported from 25 units in Australia and New Zealand have been reviewed. Recently, gonadotrophin-releasing hormone analogues (GnRHa) have replaced clomiphene as part of many ovarian stimulation protocols. Clinical abortion rates after clomiphene (24.4% for IVF; 23.0% for GIFT) were not significantly higher than after GnRHa (20.7% for IVF; 17.9% for GIFT) when IVF and GIFT data were considered separately. However, the abortion rate for combined IVF and GIFT was significantly higher after clomiphene than after GnRHa. This pattern was found for most maternal age groups and causes of infertility although differences were not significant in all categories. The combined IVF and GIFT ectopic pregnancy rate of 6.7% for clomiphene was significantly higher than 4.1% for GnRHa. Because the mechanism of action of clomiphene for oocyte recruitment during folliculogenesis means that GnRHa cannot be used with clomiphene, luteinizing hormone (LH) levels are higher in clomiphene cycles than in GnRHa cycles. Clomiphene itself could cause the increase in pregnancy wastage or increased levels of LH during follicule genesis associated with the use of clomiphene may cause the observed pregnancy failures.

Abortion, Spontaneous↗
PubMed1993

Ultrasound evidence for variability in the size and development of normal human embryos before the tenth post-insemination week after assisted reproductive technologies.

Differences in human chorionic gonadotrophin (HCG), average chorionic sac diameter, embryo/fetus crown-rump length and biparietal diameter were determined in 107 singleton pregnancies delivered after 34 weeks, whose post-insemination age was precisely known as a result of in-vitro fertilization (n = 28) or gamete intra-Fallopian transfer (n = 79). Crown-rump lengths were interpreted in relation to the developmental stage of the embryo. A 7-fold to 10-fold difference in HCG levels was observed on post-insemination days 13-16. A 2-fold to 3-fold difference occurred in average chorionic sac diameter on days 25-36. A 2-fold difference occurred in crown-rump length on seven of 10 days prior to day 44. Biparietal diameter differed by no more than 42% from day 57-68 and 20% after day 68. Chorionic sac diameter, crown-rump length, and biparietal diameter were also related to newborn weight. The results suggest firstly that marked differences occur in the rate of early human development, secondly, that the differences occur prior to day 27 when observable cardiac activity begins, and thirdly, that the differences are minimized after day 68 when the embryonic period of development is completed.

Anthropometry↗
PubMed2002

Evaluations of emotional reactions and coping behaviors as well as correlated factors for infertile couples receiving assisted reproductive technologies.

The purpose of this research was to explore the following objectives for infertile couples receiving infertility treatment: Differences between wives and husbands in their emotional reactions and coping behaviors. This research, using structured questionnaires, was based on 120 infertile couples attending the Intrauterine Insemination (IUI) or the In Vitro Fertilization-Embryo Transfer (IVF-ET) program. The research instruments consisted of Demographic Data Form, Profile of Mood States (POMS), and Ways of Coping Questionnaire. The research results showed that infertile wives experienced more emotional disturbance than husbands did, as shown in the four subscales of Tension-Anxiety, Depression-Dejection, Anger-Hostility, and Fatigue-Inertia, as well as the total scale of POMS. It was also shown that wives adopted more coping behaviors to deal with infertility and treatment than husbands did, as revealed in the subscales of Self-Controlling, Seeking Social Support and Escape-Avoidance and the total scale of the Ways of Coping Questionnaire. All of the above reached significant statistical differences. The emotional reactions of infertile couples varied with the differences in education levels, duration of treatment, number of treatments received, and numbers of existing children. The emotional reactions of infertile husbands had a significantly positive correlation with the factors Confronting, Accepting Responsibility, and Escape-Avoidance. The emotional reactions of wives had a significantly negative correlation with Positive Reappraisal. The research results can provide clinical staff with a correct understanding of the differences between husbands and wives in emotional reactions and coping behavior, as well as related factors, to help them to provide better medical treatment.

Adaptation, Psychological↗
PubMed1995

Zona manipulation in an assisted reproductive technologies (ART) programme.

We investigated whether the aged oocytes maintain the ability to fuse with spermatozoa when the oocyte investment is removed. In the first study, 87 two-days-old oocytes provided from IVF-ET programme were treated with pronase to dissolve the zona pellucida. The oocytes were then inseminated with 100, 10 or 1 per microliters sperm and the incidence of monospermic and polyspermic fertilization was determined. In the second study 100 one-day-old unfertilized oocytes obtained from 18 IVF patients with "zero fertilization" at initial insemination were treated in the same way to either remove or thinning of the zona pelucida. They were then re-inseminated with 10 motile sperm per microliter of the husband. The incidence of monospermic and polyspermic fertilization were 0.0% (0/13) and 61.6% (8/14), respectively, with a sperm count of 100/microliters, 7.3% (3/41) and 31.6% (13/41) with 10/microliters, and 14.2% and 11.9% (5/33) with 1/microliter. The incidence of monospermic and polyspermic fertilization with reinsemination of one day old oocytes were 12.5% (3/24) and 25.0% (6/24) after zona removal and were 18.3% (9/49) and 10.2% (5/49) after zona thinning. The incidence of fertilization by zona removal was significantly higher than the results of conventional reinsemination (p < 0.001). It appeared that human aged oocytes maintain the ability to fuse spermatozoa after even two days. A higher rate of monospermic fertilization was obtained by carefully controlling the number of spermatozoa for insemination. We concluded that zona manipulation might improve fertilization in vitro in case of severe male factor infertility.

Female↗
PubMed1995

New reproductive technology and the family: the parent-child relationship following in vitro fertilization.

Parent-child relationships and the parents' psychosocial functioning were assessed in families with a 24-30-month-old, single born child conceived by homologous in vitro fertilization (IVF) and in a control group of families with a naturally conceived child. The investigation included behavioural observations of mother-child interactions in the home, and self-rated questionnaires. No significant multivariate group effects were found for indicators of the parent-child relationship, nor for the parents' psychosocial functioning. However, in the case of IVF the employment status of the mother was associated with her behaviour towards her child: employed IVF-mothers showed less respect for their child's autonomy compared with both nonemployed IVF-mothers and employed control mothers.

Adult↗
PubMed2005

Antral follicle count, anti-mullerian hormone and inhibin B: predictors of ovarian response in assisted reproductive technology?

OBJECTIVE: The objective of this study was to evaluate the relationship between anti-mullerian hormone (AMH), inhibin B and antral follicle count (AFC) with ovarian response. DESIGN: Retrospective study. SETTING: Fertility unit. SAMPLE: AFC was recorded, and a serum sample obtained on day 3 from all patients undergoing in vitro fertilisation (IVF). Patients were given 300 IU/L recombinant follicle stimulating hormone (FSH; Gonal F). The following day blood samples were collected. METHODS Serum samples were assayed for FSH, AMH and inhibin B using commercial immunoassay kits and oestradiol using an in house assay. MAIN OUTCOME MEASURES: Response to gonadotrophin stimulation and the number of eggs collected. RESULTS: AFC was negatively correlated to age (r=-0.426, P < 0.001). Delta inhibin B (levels of inhibin B on day 4 minus day 3) had the best association to the number of eggs collected (r= 0.533, P < 0.001) followed by basal AMH (r= 0.51, P < 0.001) and AFC (r= 0.505, P < 0.001). The number of eggs fertilised was significantly associated with basal AMH (r= 0.592, P < 0.001) and inhibin B (r= 0.548, P < 0.001). AMH with a cutoff of 0.2 ng/mL had the best sensitivity (87%) and specificity (64%) in predicting poor response. A cumulative score using basal FSH, basal AMH, delta E2 (levels of oestradiol on day 4 minus day 3), delta inhibin B, AFC and age gives the best predictive statistics to identify poor responders with 87% sensitivity and 80% specificity and a positive likelihood ratio of 4.36. CONCLUSION: Delta inhibin B had the best positive association with the number of eggs collected and basal AMH is the single best predictor of poor response. AFC has a significant association with the number of eggs collected and is predictive of clinical pregnancy. It is evident that a single parameter is of limited value in predicting ovarian response. However, we have demonstrated a cumulative score using all the above markers could be useful in predicting poor response.

Adult↗
PubMed1994

A case of successful use of reproductive technology for a couple with subfertility due to retrograde ejaculation, where artificial insemination had failed.

A case history of a couple where the infertility was due to retrograde ejaculation is presented; when conventional treatment with artificial insemination using sperm isolated from postejaculatory urine failed, IVF and GIFT technology was applied. This resulted in a pregnancy which unfortunately failed at 3 months, unrelated to the method of conception. This case report highlights the possible use of IVF/GIFT for yet another type of male subfertility.

Adult↗