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PubMed2002

Recombinant follicle-stimulating hormone versus human menopausal gonadotropin in the late follicular phase during ovarian hyperstimulation for in vitro fertilization.

OBJECTIVE: To study the effect of exogenous LH in the late follicular phase on ongoing pregnancies and at the different stages of IVF-ET (stimulation, fertilization, and implantation) in patients with low endogenous LH. DESIGN: Retrospective cohort study with modeling of the different phases of IVF-ET. SETTING: IVF center of the teaching hospital in Bordeaux, France. PATIENT(S): Women undergoing IVF and ICSI treatment. INTERVENTION(S): One group received recombinant FSH alone (FSH group) and the other received recombinant FSH and hMG in the late follicular phase (i.e., when the largest follicle reached 14 mm) (FSH/hMG group). MAIN OUTCOME MEASURE(S): Ongoing pregnancy, number of oocytes, and number of embryos. RESULT(S): The FSH/hMG group had a higher probability of having at least one oocyte (odds ratio [OR] = 2.75 [1.11-6.80]), of having at least one embryo after oocyte retrieval (OR = 2.84 [1.33-6.07]), and of ongoing pregnancy after ET (OR = 2.04 [0.83-5.01]), and globally had a higher probability of ongoing pregnancy (OR = 2.83 [1.19-6.71]). CONCLUSION(S): In ovarian hyperstimulation for IVF-ET, LH supplementation in the late follicular phase of women with low endogenous LH is beneficial for ongoing pregnancy by increasing the rate of success of all stages of the treatment.

Adult↗
PubMed2005

Age and ovarian reserve are distinct predictive factors of cycle outcome in low responders.

The respective roles of age and ovarian reserve in predicting IVF outcome do not seem to be equivalent, as a high pregnancy rate seems to be preserved in the youngest women, despite low ovarian recruitment. The purpose of this study was to analyse the outcome of IVF/intracytoplasmic sperm injection (ICSI) procedures according to both age and ovarian reserve of patients with a low ovarian response to stimulation. A total of 163 IVF/ICSI cycles selected by a low response were analysed. The IVF outcome differed according to the women's age, with a cut-off value at 36 years. While the number of transferred embryos was similar, the pregnancy rate (PR) was 14.6% in younger patients but 4.9% (P < 0.04) in older ones. An elevated FSH was constantly associated with a poor cycle outcome. In contrast, when the FSH was normal, PR was significantly higher (P < 0.05) in women aged <36 (23.8%) than in women aged > or =36 (6.5%). This study shows that assisted reproduction outcome in women with a low ovarian response is primarily dependent on the ovarian status. The negative influence of age is relevant in patients with normal FSH. Therefore, even if the ovarian response to stimulation is low, patients aged <36 years with a normal FSH should proceed to oocyte retrieval.

Adult↗
PubMed2003

Comparison of coasting and intravenous albumin in the prevention of ovarian hyperstimulation syndrome.

OBJECTIVE: To compare the efficacy of coasting to prevent ovarian hyperstimulation syndrome (OHSS) with i.v. albumin and to determine if different timing of gonadotropin coasting would affect the IVF outcomes. DESIGN: Retrospective study. SETTING: University hospital-based IVF program. PATIENT(S): One hundred sixty-two women undergoing IVF treatment cycles who were considered to be at high risk for developing OHSS. INTERVENTION(S): Gonadotropin administration was withheld in 60 patients: either coasting occurred before follicular maturation (early coasting subset, n = 28) or follicular maturity was attained before coasting (late coasting subset, n = 32). Outcomes were compared in 102 patients at risk for OHSS who received i.v. albumin on the day of oocyte retrieval. MAIN OUTCOME MEASURE(S): Incidence of OHSS and outcome parameters. RESULT(S): Although the fertilization rates and the incidence of OHSS did not differ significantly between the coasting and i.v. albumin groups, the mean number of oocytes retrieved, the pregnancy rates, and implantation rates were significantly lower in the coasting group. There is no statistical difference in the entire outcome examined and the incidence of OHSS between the early and late coasting subsets. CONCLUSION(S): Coasting is as effective as i.v. albumin in preventing OHSS in high-risk patients but yields inferior pregnancy rates. Early coasting is as successful as late coasting in preventing OHSS with similar IVF outcome.

Adult↗
PubMed2005

Concentrations of leptin and C-reactive protein in serum and follicular fluid during assisted reproductive cycles.

BACKGROUND: There are only a few studies that have investigated inflammatory processes during ovarian hyperstimulation, with contradictory results especially concerning outcome. The aim of the study was to investigate the inflammatory markers C-reactive protein and leptin in serum and follicular fluid and to correlate these with the outcome. METHODS: One hundred and sixty-two gonadotrophin stimulated cycles were evaluated. Serum concentrations of leptin and C-reactive protein were measured at the initiation of stimulation, on the day of hCG administration or the day before, and on the day of oocyte retrieval. They were also determined in the follicular fluid. RESULTS: Serum leptin and C-reactive protein levels increased significantly during stimulation until the day of oocyte pick up, but following different patterns. After stimulation, they correlated with each other in serum and follicular fluid, but not with estradiol or progesterone concentration, embryo quality, or the pregnancy rate. CONCLUSIONS: Leptin and C-reactive protein levels change significantly during assisted reproductive treatment. In contrast to estradiol they are, however, not a marker of success.

Adult↗
PubMed2003

Pattern of semen analysis of male partners of infertile couples at the University College Hospital, Ibadan.

OBJECTIVES: To evaluate the seminal patterns of the male partners of the infertile couples, towards identifying the possible contribution of the male factors to overall infertility problem in our environment. METHODOLOGY: The study is a descriptive analysis of the seminal patterns of the partners of the infertile couples, who presented at the Fertility Research Unit (a WHO collaborating centre) of the Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria, between 1st January 1990 and 31st December, 1999. RESULTS: Result of the seminal analysis of 824 male partners of infertile couples were retrieved for the study, of which 598 (73%) were referred for secondary infertility. Overall, 225 (27.3%) of these subjects had abnormal semen analyses, with Asthenozoospermia being the most common (27.8%) of the disorders observed. Fifty-four (6.7%) subjects of the study population had Azoospermia. The most common multiple factors abnormality in the study population was Astheno/Oligozoospermia (25.5%), while three factors defect--Oligo/Astheno/Teratozoospermia was noticed in 106 (13.1%) of the subjects. CONCLUSION: Abnormal semen quality remains a significant contribution to overall infertility in our environment and Asthenozoospermia is the most common seminal quality abnormality.

Female↗
PubMed1996

Nuclear maturity and oocyte morphology after stimulation with highly purified follicle stimulating hormone compared to human menopausal gonadotrophin.

Several studies have shown that high concentrations of luteinizing hormone (LH) in the follicular phase of stimulation can have a negative effect on oocyte quality, pregnancy rate and incidence of miscarriage. The aim of the present study was to examine the effects of highly purified follicle stimulating/hormone (FSH HP) on ovarian stimulation and particularly on nuclear maturity and morphological appearance of the oocyte in intracytoplasmic sperm injection (ICSI) therapy and to compare the results with human menopausal gonadotrophin (HMG) stimulation. For this purpose, 50 patients for ICSI (HMG: 30; FSH HP: 20) and 26 patients for in-vitro fertilization (IVF; HMG: 14, FSH HP: 12) were stimulated with either HMG or FSH HP using a short-term protocol. Patients were divided into the two groups according to the first letter of their family name. No differences were observed among the groups in relation to patient age, duration of stimulation, number of aspirated oocytes or maturity of the oocyte-cumulus complex. After removal of the cumulus-corona cells in the ICSI oocytes, a significantly higher proportion of oocytes in the FSH HP group were nuclear mature (metaphase II) than in the HMG group (FSH HP: 88.8%, HMG: 80.6%; P = 0.009). Furthermore, in the FSH HP group, significantly fewer oocytes with dark cytoplasm were observed (FSH HP: 14.4%, HMG: 22.4%; P = 0.02). Fertilization, cleavage and pregnancy rates (FSH HP 38%, HMG: 34% per retrieval) were comparable in both groups. Based on the results obtained, it can be concluded that the short-term FSH HP treatment protocol synchronizes oocyte maturation better than comparable stimulation with HMG.

Cell Nucleus↗
PubMed2004

Comparison of two different fixed doses of follitropin-beta in controlled ovarian hyperstimulation: A prospective randomized, double blind clinical trial.

A prospective randomized, double blind, single centre study was conducted to compare the efficacy, efficiency and clinical side effects of daily fixed dose regimen of either 100 IU or 200 IU of recombinant follicle stimulating hormone(rFSH) Follitropin beta in down-regulated women undergoing controlled ovarian hyperstimulation(COH) for either conventional in vitro fertilization(IVF) or intracytoplasmic sperm injection(ICSI). A total of sixty women were randomly allocated according to the criteria for the treatment by either 100 IU(n = 30) or 200 IU (n = 30) of FSH. Although more cycle cancellations due to low response were observed in the 100 IU group (n = 9 vs n = 2), two cases of mild and moderate ovarian hyperstimulation syndrome were noted in the higher dose group. Subjects in the group treated with 200 IU appeared to yield more follicles > 17 mm (4.4 vs 3.3, p = 0.05) and more oocytes compared to the group treated with 100 IU (9.2 versus 6.0 oocytes, NS). The total dosage required to develop at least three follicles according to the protocol was significantly lower in the group treated with 100 IU (1203.33 versus 2106. 67, P < 0.0001). In conclusion, a fixed daily dose of 200 IU of rFSH Follitropin beta compared to a fixed daily dose of 100 IU is more effective in terms of follicles > 17 mm development and the number of oocytes retrieved along with a lower cancellation rate, but less efficient as indicated by a higher total rFSH dose needed

Adult↗
PubMed2004

Premature luteinization defined as progesterone estradiol ratio >1 on hCG administration day seems to adversely affect clinical outcome in long gonadotropin-releasing hormone agonist cycles.

AIM: To examine the effect of premature luteinization on the outcomes in long gonadotropin-releasing hormone agonist cycles. METHODS: Two-hundred and forty-eight patients who had undergone assisted reproductive technology for infertility treatment between 2001 and 2002 were enrolled into the study. The patients were separated into two groups according to P/E2 ratios on human chorionic gonadotropin administration day. Group A consisted of the patients whose P/E2 ratio was 1 (n = 116) and Group B consisted of the patients with premature luteinization of which P/E2 ratio was > 1 (n = 132). The P/E2 ratio calculation was performed as follows: P (in ng/mL) x dagger 1,000/E2 (in pg/mL). The primary outcome measures included oocyte quality, fertilization rates and clinical pregnancy rates. RESULTS: The mean number of mature oocytes retrieved in the groups were 9.5 +/- 4.8 and 6.4 +/- 3.6, respectively, and the difference was statistically significant (P < 0.05). Although the difference between the fertilization rates in Group A and Group B was not statistically significant (P > 0.05), the clinical pregnancy rates seemed to be affected adversely in the Group B patients with premature luteinization (41.4%versus 28%, respectively; P < 0.05). CONCLUSION: Premature luteinization, defined as P/E2 > 1 on human chorionic gonadotropin administration day, in long gonadotropin-releasing hormone agonist cycles seems to adversely affect clinical outcome.

Chorionic Gonadotropin↗
PubMed2004

Day 14 maternal serum progesterone levels predict pregnancy outcome in IVF/ICSI treatment cycles: a prospective study.

BACKGROUND: Serum progesterone has been advocated as a tool in the diagnosis of early pregnancy failure. We conducted this prospective study in order to investigate the potential value of early (14 days after oocyte recovery) serum progesterone measurement, in women undergoing IVF/ICSI and receiving rectal progesterone supplements, in relation to pregnancy outcome. METHODS: 442 women consecutively treated by IVF or ICSI had serum progesterone and bhCG levels prospectively measured 14 days after oocyte retrieval (day 0). All women received natural progesterone 400 mg rectally until the pregnancy test on day 14. Pregnant women were followed up by serial transvaginal ultrasound scans to 8 weeks gestation. RESULTS: 115 women (26%) had a viable intra-uterine pregnancy at 8 weeks gestation, 80 (18.1%) had an abnormal pregnancy (biochemical, ectopic, miscarriage) and 247 (55.9%) failed to conceive. Women with on-going pregnancies had significantly higher serum progesterone levels (median: 430, 95%CI: 390-500 nmol/l) compared to those who had either an abnormal pregnancy (72, 48-96 nmol/l; P < 0.001) or failed to conceive (33, 28-37 nmol/l; P < 0.001). Receiver-operator curve analysis demonstrated that a single serum progesterone on day 14 post-oocyte retrieval, could highly differentiate between normal and abnormal pregnancies (area under the curve = 0.927, 95%CI = 0.89-0.96; P < 0.0001). CONCLUSIONS: In spite of exogenous progesterone supplementation, serum progesterone levels, from as early as 4 weeks gestation (day 14 post-oocyte retrieval) were significantly elevated and predicted women destined to have viable intra-uterine pregnancies. These high levels are suggestive that endogenous progesterone is already sufficient in viable pregnancies and that exogenous progesterone administration will not rescue a pregnancy destined to result in a miscarriage. Single serum progesterone measurement could be a useful indicator of pregnancy outcome in women undergoing IVF or ICSI treatment.

Abortion, Spontaneous↗
PubMed2005

The 2004 Italian legislation regulating assisted reproduction technology: a multicentre survey on the results of IVF cycles.

BACKGROUND: The new Italian law, passed in 2004, regulating assisted reproduction technology imposes that no more than three oocytes can be fertilized at one time and that all embryos obtained must be transferred simultaneously. Oocyte cryopreservation is allowed while embryo cryostorage is banned. The aim of this study was to evaluate the clinical impact of these limitations. METHODS: Seven Italian infertility centres were invited to collect data on IVF cycles performed over the first 4 months of application of the new legislation. As a control, all centres provided data on cycles performed in the same solar period, 1 year before. RESULTS: Data from 1861 cycles were obtained, 961 in the pre-law period and 900 in the post-law period. Pregnancy rate per oocyte retrieval and rate of multiple pregnancies in the pre- and post-law periods were 27.0 and 24.2% (P=0.18) and 25.8 and 20.9% (P=0.11) respectively. However, the prohibition to freeze embryos does appear to have markedly reduced the cumulative rate of success. CONCLUSIONS: The rate of success of IVF-ICSI cycles using fresh embryos is not significantly influenced by the new legislation while the prohibition to freeze embryos seems to result in a more relevant impact.

Adult↗
PubMed2004

Pregnancy after cryopreservation of donor oocytes and preimplantation genetic diagnosis of embryos in a patient with ovarian failure.

OBJECTIVE: To describe the successful use of preimplantation genetic diagnosis to assess the prevalence of meiotic errors after oocyte cryopreservation in an oocyte donation cycle. DESIGN: Case report. SETTING: Private IVF center. PATIENT(S): A 42.6-year-old patient with ovarian failure. INTERVENTION(S): A donor oocyte IVF cycle with cryopreservation of oocytes followed by thaw, fertilization of oocytes, preimplantation genetic diagnosis for selective aneuploidy, and ET. MAIN OUTCOME MEASURE(S): Preimplantation genetic analysis of chromosomes 13,16,18, 21,22, X, and Y with fluorescence in-situ hybridization. RESULT(S): The recipient's initial serum beta-hCG level was 196 mIU/mL 15 days after oocyte retrieval. An initial ultrasound at the sixth week of gestation revealed two gestational sacs. A second ultrasound 1 week later showed a monochorionic twin in sac A and a singleton pregnancy in sac B. Fetal cardiac activity was visualized for all gestations. CONCLUSION(S): This case illustrates the feasibility of cryopreservation of donor oocytes combined with preimplantation genetic diagnosis for clinical use in those settings where there may be an increased risk of spindle-related abnormalities.

Adult↗
PubMed2006

The optimal length of 'coasting protocol' in women at risk of ovarian hyperstimulation syndrome undergoing in vitro fertilization.

Ovarian hyperstimulation syndrome (OHSS) is a serious and potentially life-threatening complication following ovarian stimulation for in vitro fertilization (IVF). Coasting is the practice whereby the gonadotrophins are withheld and the administration of human chorionic gonadotrophin (hCG) is delayed until serum oestradiol (E2) has decreased to what is considered to be a safe level, to prevent the onset of OHSS. This study aimed to assess the length of coasting on the reproductive outcome in women at risk of developing OHSS. Coasting was undertaken when the serum E2 concentrations were > or = 17000 pmol/L but < 21000 pmol/L. Daily E2 measurements were performed and hCG was administered when hormone levels decreased to < 17000 pmol/L. Eighty-one women who had their stimulation cycles coasted were grouped according to the number of coasting days. Severe OHSS occurred in one case, which represented 1.2% of patients who underwent coasting because of an increased risk of developing the syndrome. No difference was found between cycles coasted for 1 - 3 days and cycles coasted for > or = 4 days in terms of oocyte maturity, fertilization and embryo cleavage rates. Women in whom coasting lasted for > or = 4 days had significantly fewer oocytes retrieved (P < 0.05) and decreased implantation rate (P < 0.05) compared to those coasted for 1 - 3 days. Pregnancy rate/embryo transfer and live birth rate did not differ between groups. In conclusion, coasting appears to decrease the risk of OHSS without compromising the IVF cycle pregnancy outcome. Prolonged coasting is, however, associated with reduced implantation rates, perhaps due to the deleterious effects on the endometrium rather than the oocytes.

Chorionic Gonadotropin↗
PubMed2005

[Usefulness of luteinizant hormone levels to determine the oocyte quality].

OBJECTIVE: To evaluate the luteinizing hormone serum preovulatory levels and correlate them with the embryo number and quality, and with the fertilization and clavage rates. STUDY: Prospective, descriptive and observational. MATERIAL AND METHODS: We included 286 patients that underwent to IVF-ET program, we excluded patients with no mesurement of LH preovulatory levels, or patients that in the oocyte retrieval we do not found oocytes. The protocols for pituitary inhibition were: stop Lupron, long luteal phase and GnRH antagonist, the ovarian stimulation was realized with recombinant FSH. The studied variables were: LH preovulatory levels, number and quality of oocytes, fertilization and clevage rates and embryo quality. Statistical analysis was done with p Pearson and ANOVA tests. RESULTS: The mean age for patients was 34 +/- 3.96 years, the principal factor of infertility was tubal and pelvis pathology. The mean LH preovulatory levels were 2.19 +/- 1.83 UI/L by patient, we observed a negative correlation between LH levels and number of oocytes retrieved (p = -0.157, IC 99%), and the correlation between LH levels and number of metaphase 2 oocyte was negative too (p = 0.113, IC 95%). We observed greater levels of LH (3.15 UI/L) in the degenerated oocytes during oocyte retrieval. We did not found a statistical correlation between fertilization and cleavage rates with LH levels. LH preovulatory levels of 0.85 UI/L could predict good quality oocytes with a sensitivity of 72% and specificity of 25%. CONCLUSIONS: Normogonadotrophic patients without deep suppression of gonadotrophins by the use of GnRH analogues, high LH preovulatory levels correlates with a less number of oocytes, and with degenerated oocytes. Preovulatory LH levels of 0.85 UI/L could predict good quality oocytes.

Adult↗
PubMed1984

Clinical, pathologic, and ultrastructural features of situs inversus and immotile-cilia syndrome in a dog.

Situs inversus, rhinitis, and bronchitis were diagnosed in a 7-month-old male Golden Retriever. Electron microscopic examination of tracheal and bronchial biopsy specimens revealed 9% of the cilia with abnormal axonemal pattern and 1.2% with a fibrous ring between the circle of microtubular doublets and the cell membrane. A permanent response to treatment with antibiotics was not obtained and the dog was euthanatized. At necropsy the thoracic and abdominal organs were found to be in reversed position. Microscopic examination revealed evidence of chronic bronchitis as well as cystic and distended distal tubules of the kidneys. Foci of fibrosis were observed in the renal cortex. The diagnosis was immotile-cilia syndrome.

Animals↗
PubMed1998

The effects of follicular fluid from patients with different indications for IVF treatment on the binding of human spermatozoa to the zona pellucida.

This study compared the effects of human follicular fluid (hFF) from women with endometriosis, tubal factor and male factor on the zona binding capacity of human spermatozoa. Samples of hFF were collected from 30 patients, 10 patients for each of the indications of infertility, at the time of oocyte retrieval in an in-vitro fertilization/embryo transfer programme. The hemizona binding assay (HZA) was used to assess the effect of these hFF on the zona binding potential of human spermatozoa. The mean numbers of spermatozoa bound to the zona pellucida after treating the spermatozoa with hFF from endometriosis, tubal factor and male factor were 90.5 +/- 20.9, 108.9 +/- 22.3 and 101.2 +/- 13.4 respectively. These were significantly lower than their corresponding controls, the spermatozoa of which were incubated with Earle's balanced salt solution (endometriosis 238.7 +/- 34.7; tubal factor 210.8 +/- 41.6; male factor 205.4 +/- 26.3; P <0.002). The hemizona binding index (HZI) was similar between male factor samples (52.0 +/- 6.7) and tubal factor samples (53.8 +/- 4.2). Spermatozoa incubated with hFF from endometriosis patients (36.0 +/- 4.1) had an HZI that was significantly lower than those treated with hFF from tubal factor patients (P <0.01). Probably due to small sample size, the differences in HZI between endometriosis samples and male factor samples did not reach statistical significance (P = 0.076). These data suggest that there was a stronger sperm-zona binding inhibitory effect of hFF from patients with endometriosis than from those without the disease.

Adult↗
PubMed2005

Use of follicle-stimulating hormone test to predict poor response in in vitro fertilization.

OBJECTIVE: Optimized ovarian stimulation protocols are required for the success of in vitro fertilization (IVF). The purpose of this study was to estimate whether the ovarian reserve test using exogenous follicle-stimulating hormone (FSH) could predict ovarian response in IVF. METHODS: This was a prospective observational study of 110 patients who underwent their first IVF cycle. The FSH test was administered as 150 IU of urinary FSH daily from day 3 to day 6 of the menstrual cycle preceding the IVF cycle for evaluation of the plasma estradiol level. Outcomes of IVF, including ovarian response, were analyzed. RESULTS: A negative correlation was observed between the duration of stimulation and the result of the FSH test (r = -.238, P = .014) and between the dose of FSH per retrieved mature oocyte (metaphase II oocyte) and the result of the FSH test (r = -.308, P < .001). In addition, our results showed that the result of the FSH test was significantly lower in poor responders defined by FSH of 400 IU/metaphase II oocyte or greater (207 +/- 149 compared with 293 +/- 174 pg/mL, P = .007). CONCLUSION: The FSH test can be a useful tool for determining the conditions of individualized clinical management plans and optimizing stimulation protocols in IVF.

Adult↗
PubMed2005

Does plasma insulin level affect ovarian response to exogenous administration of follicle-stimulating hormone in women without polycystic ovary syndrome?

BACKGROUND: Raised insulin levels have been shown to contribute to ovarian overproduction of androgens. Hyperinsulinemia, usually associated with polycystic ovary syndrome (PCOS), brings about greater ovarian endocrine and morphological responses to ovulation induced by follicle-stimulating hormone (FSH). This indicates that elevated levels of insulin play a role in the endocrine and paracrine control of the ovaries. OBJECTIVE: The aim of the present study was to investigate whether basal insulin levels influence ovarian response to FSH in healthy women (non-PCOS) undergoing assisted reproduction by in vitro fertilization-embryo transfer (IVF-ET). METHODS: The study included 36 consecutive women, 27-45 years old, undergoing IVF-ET for tubal-factor or male-factor infertility. Serum insulin levels were determined on the day of administration of gonadotropin-releasing hormone analog (GnRHa) and on the first day of FSH administration. RESULTS: Mean insulin levels were 6 +/- 3 and 7 +/- 3 microU/ml on the day of GnRHa and FSH administration, respectively. No correlations were found between basal insulin level, days of treatment, total FSH dose, estradiol level and the number of oocytes retrieved. CONCLUSIONS: The results of the present study show that normal levels of insulin do not seem to influence ovarian response to FSH in non-PCOS women. In all patients included in our study, serum insulin levels did not correlate with IVF stimulation data (days of stimulation, total FSH dose) nor with IVF-ET outcome. Thus the study demonstrates that, in patients who are not insulin-resistant, insulin does not correlate with ovarian response to FSH administration.

Adult↗
PubMed2002

Supraphysiological estradiol levels do not affect oocyte and embryo quality in oocyte donation cycles.

BACKGROUND: The study aim was to determine whether supraphysiological estradiol (E(2)) levels reduce oocyte/embryo quality in oocyte donation cycles. METHODS: A retrospective analysis of 330 consecutive fresh oocyte donation cycles was performed in an assisted reproductive treatment programme between January 1996 and December 2000. Throughout the study period, oocyte donors and recipients followed a standard synchronization regimen that did not vary. A serum E(2) level (peak E(2)) was obtained from all oocyte donors on the morning of HCG administration. Peak E(2) values were grouped by 33rd percentile (group I, <1500 pg/ml; group II, 1500-3000 pg/ml; and group III, >3000 pg/ml). All embryo transfers were performed on day 3 after oocyte recovery. RESULTS: Comparisons between groups revealed no significant differences in the quality of oocytes retrieved, and in fertilization rates. Higher peak E(2) levels were directly correlated with a greater number of oocytes retrieved, embryos available for transfer and cryopreservation, and higher average embryo quality scores (P < 0.005). Compared with group I, group III had significantly higher embryo implantation rates (P < 0.05). CONCLUSIONS: Sustained supraphysiological E(2) levels do not adversely affect the quality of developing oocytes and embryos. On the contrary, elevated E(2) levels are associated with a larger number of oocytes and embryos and high-grade embryos for transfer/cryopreservation and, consequently, improved implantation rates.

Adult↗