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PubMed1992

The psychological well-being of infertile women after a failed IVF attempt: the effects of coping.

One hundred infertile women and 73 female controls completed three measures of psychological well-being (depression, self-esteem and self-confidence) on two occasions (Times 1 and 2), coinciding with the beginning and end of a failed IVF attempt by the infertile women. At Time 2, the IVF women were also asked to indicate whether they had used a number of different coping responses, in relation to dealing with their failed IVF attempt. As predicted, IVF women were more depressed and had lower self-esteem than controls prior to the treatment cycle, and both before and after the treatment cycle they were less self-confident. After the failed IVF procedure, IVF women were more depressed and had lower levels of self-esteem than they did prior to the treatment cycle. In terms of the effects of coping on the post-attempt well-being of the IVF women, the use of problem-focused coping was associated with high levels of well-being, while the use of avoidance coping and seeking social support was associated with low levels of well-being.

Adaptation, Psychological↗

PubMed1997

Should health insurance cover IVF? Issues and options.

An emotional debate has attended the question of whether health insurance should cover the cost of in vitro fertilization (IVF) for infertile couples. Some private health plans have opted to cover IVF, although most have not. Ten states have mandated that it be included or offered as a standard benefit for private health insurance plans. This article analyzes several key issues in the debate: the impact of insurance coverage; the cost-effectiveness of IVF; valuing the benefit of IVF; and adoption as an alternative. It recommends policy action in several areas: more efficiently allocating resources for IVF (by giving priority to couples with better chances of success, and by making more extensive use of facilities with higher success rates); ensuring that clear and reliable information about the effectiveness of IVF is available; and leveling the playing field between IVF and adoption.

Adoption↗

PubMed1998

Parenthood motives in IVF-mothers.

This is an exploratory study to answer two questions: (1) does in-vitro fertilization (IVF)-mothers' motivation for parenthood differ from the naturally conceiving mothers' motivation for parenthood? and (2) are IVF-mothers' parenthood motives correlated with their adjustment to parenthood (in the same way as they are for naturally conceiving mothers)? The study sample consisted of 31 mothers with a 24-30 month old, single-born child conceived by homologous IVF and a comparison group of 31 mothers with a naturally conceived child. Self-rating questionnaires were used. Overall, the parenthood motivation pattern was quite similar for IVF-mothers and mothers by natural conception. However, 'identity', 'motherhood' and 'social control' were significantly more important motives for IVF-mothers than for the naturally conceiving mothers. The two former motives remained more important for IVF-mothers when findings were adjusted for the influence of the mothers' age and educational level. Possible explanations for these findings refer to the infertility history. Overall, few correlations between parenthood motives and the adjustment to parenthood were significant, both for the IVF-mothers and for the mothers by natural conception. Further (hypothesis-testing) research is needed to support these findings.

Adaptation, Psychological↗

PubMed1993

IVF and related technology. The present and the future.

OBJECTIVE: To describe the current status of in-vitro fertilisation (IVF) and related technologies, including: the indications for the procedures and the problems associated with the use of stimulated cycles; the use of frozen embryos and donor eggs; and the newer procedures of gamete micromanipulation for male infertility, immature egg collection as a possible alternative to the stimulated cycle, and preimplantation genetic diagnosis. DATA SOURCES AND STUDY SELECTION: The clinical experience and research at Monash IVF and the Centre for Early Human Development, Monash University, were reviewed in association with key original or review articles in the world literature. DATA SYNTHESIS: Cumulative pregnancy rates for IVF and the gamete intrafallopian transfer (GIFT) procedure at Monash IVF demonstrate that 29% of IVF patients and 55% of GIFT patients will have a live baby, the average number of treatments pursued being 3.4. Analogues of gonadotrophin releasing hormone (GnRH) have improved pregnancy rates, reduced blood sampling, and prevented natural ovulation. Disadvantages of stimulated cycles include a higher risk of multiple pregnancy, a higher risk of hyperstimulation, and behavioural changes due to the effects of drugs. Natural cycles or immature egg collection at incidental laparoscopy may become alternatives to the use of the stimulated cycle. In Australia the GIFT procedure is more successful than IVF and is nearly always used if the fallopian tubes are normal. Multiple pregnancies may be reduced, particularly triplets, by reducing the number of eggs or embryos transferred to two when egg or embryo quality is high. Embryo freezing has made a small but important contribution to overall pregnancy rates by enabling patients to use excess eggs and embryos. The social and legal concerns resulting from the use of frozen embryos have required new ethical and legal considerations. Donor eggs have made a small contribution to achieving pregnancy in women with absent or inappropriate eggs and increased the chance of conception in women over the age of 40. Micromanipulation of sperm and eggs has enabled fertilisation and conception when sperm are defective in quantity or quality. Sampling of cells in early embryos enables genetic diagnosis and may be used in selecting chromosomally normal embryos in IVF procedures or in couples at risk of recessive genetic disease. CONCLUSION: Assisted reproductive technology has developed over a decade to become useful for couples with infertility which cannot be cured by simpler treatments. The birth rates are comparable to natural conception and the incidence of congenital malformation is not increased. The costs and complexity of treatment have been reduced to in turn reduce the stress and social inconvenience of therapy. Problems related to the high risk of multiple pregnancy and the use of the stimulated cycle are being reduced and new techniques for severe male infertility and the detection of genetic abnormalities in the embryo are being introduced.

Female↗

PubMed1989

In vitro fertilization, gamete intrafallopian transfer and combined IVF-GIFT results: three-year experience at Chang Gung Memorial Hospital.

A review is presented summarizing the IVF-ET, GIFT and combined IVF-ET-GIFT experienced at Chang Gung Memorial Hospital. Since the building of an aseptic dust free laboratory next to the operation room, the clinical pregnancy rate has been 12.2% per embryo transfer in IVF-ET, 16.7% in the GIFT program and 30.0% in the combined IVF-GIFT program. The overall clinical pregnancy rate was 14.9%. The overall pregnancy rate appeared to be independent of the causes of infertility, be it tubal factor, endometriosis or unexplained infertility. It was lower in couples with male factor or combined factors. The different regimens for follicular stimulation were hMG-hCG, clomiphene-hMG-hCG and FSH-hMG-hCG. No one regimen showed a better pregnancy rate than the others. The methods of oocyte retrieval were laparascopy, laparotomy, transbladder ultrasound-guided, and transvaginal ultrasound-guided retrieval. There were 4.53 oocytes retrieved pertreatment cycle. The transvaginal ultrasoundguided oocyte retrieval has greatly simplified the procedures in the IVF-ET program. The patient selection was important not only for the indications but also for the methods of IVF-ET, GIET and combined IVF-GIFT.

Evaluation Studies as Topic↗

PubMed1995

Color-Doppler velocimetry of uterine arteries in pregnant and nonpregnant patients during multiovulation induction for IVF.

OBJECTIVES: To evaluate uterine artery resistance during multiovulation induction in relation to the implantation rate in patients attending in vitro fertilization (IVF) cycles. PATIENTS: Multiovulation induction for IVF was monitored by daily determination of the pulsatility index (PI) of the uterine arteries, obtained by a transvaginal probe (6.5 MHz) implemented with color-flow imaging. Doppler data were obtained from 5 days before hCG administration to the day of follicular aspiration. One IVF cycle was monitored in 70 patients. In 17 patients, 41 IVF cycles were monitored until a successful attempt occurred. RESULTS: In the 70 patients studied during one IVF attempt, the PI of the uterine arteries significantly varied (P < 0.001) in the different phases of the cycle. In the 24 patients who conceived, a significantly lower PI (P < 0.03) was found throughout the cycle. This result was mainly due to a highly significant difference of PI values observed the day after hCG administration (P < 0.005). In the 17 patients who conceived after 1 to 4 negative in vitro fertilizations, no significant difference in PI was observed in the uterine artery resistance in cycles in which implantation was or was not successful. CONCLUSIONS: Uterine artery resistance varies significantly during phases of the induction therapy. Uterine artery resistance is lower throughout the course of multiovulation induction in patients with higher pregnancy rates. The PI on the day after hCG administration was the best index of pregnancy rate. Low uterine artery resistance was present even in negative attempts in patients who eventually achieved a successful implantation. PI values < or = 3 can be considered a favorable prognostic factor for future IVF cycles.

Adult↗

PubMed1995

Sperm stimulants can improve fertilization rates in male-factor cases undergoing IVF to the same extent as micromanipulation by partial zona dissection (PZD) or subzonal sperm insemination (SUZI): a randomized controlled study.

PURPOSE: Our purpose was to evaluate the efficacy of direct insemination (IVF), micromanipulation by partial zona dissection (PZD), and subzonal sperm insemination (SUZI) using sperm-treated with pentoxifylline (PF) +/- 2-deoxyadenosine (2DA). RESULTS: The overall fertilization rate achieved was similar for all three fertilization techniques (33.1, 30.2, and 26.9% for IVF, SUZI, and PZD, respectively). Patients who had reduced fertilization in previous IVF attempts showed improved fertilization with sperm stimulants, either PF alone or PF in combination with 2DA in standard IVF. In certain cases, SUZI or PZD gave significantly improved fertilization rates in comparison to IVF. CONCLUSION: Selective use of sperm stimulants in IVF can achieve fertilization for the majority of male-factor cases. However, PZD and SUZI techniques are useful, especially when sperm stimulants fail to achieve fertilization or achieve poor fertilization in direct insemination.

Deoxyadenosines↗

PubMed1995

Screening of maternal sera using a mouse embryo culture assay is not predictive of human embryo development or IVF outcome.

PURPOSE: Maternal serum is commonly added to media used for human IVF but can vary widely in its ability to support the development of human embryos in vitro. The objective of this study was to determine if the screening of maternal serum with a mouse one-cell embryo culture assay would be useful in predicting human embryo development and clinical outcome following IVF. METHODS: Twenty-two individual serum samples from IVF patients were used as a supplement (7.5%) to Ham's F-10 media for culturing human embryos. All embryos were evaluated at the time of transfer for stage of development and embryo quality. Each serum sample was also tested for its ability to support mouse embryo development. One-cell embryos were recovered from superovulated female mice and cultured in serum-supplemented media. Mouse blastocyst development was assessed after 96 h of incubation. RESULTS: No correlation was found between mouse blastocyst formation and human embryo development in media supplemented with maternal sera. Similarly, there was no association between the development of mouse blastocysts and clinical outcome following IVF. A subanalysis of patients whose sera tested poorly on the mouse assay again revealed no association between mouse and human embryo development. CONCLUSION: Mouse embryo development in media containing human serum did not predict development of human embryos in vitro or clinical outcome following IVF. There would be little benefit to screening maternal sera using a mouse embryo culture system for determining its suitability for use in human IVF.

Animals↗

PubMed2004

A meta-analysis of controlled studies comparing major malformation rates in IVF and ICSI infants with naturally conceived children.

PURPOSE: To estimate the risk of major malformations in IVF and ICSI infants. METHODS: Forty-four studies published in English since 1990 where the major malformation rate for IVF or ICSI cases was compared to an appropriate control group were reviewed. Nineteen studies met all selection criteria. In addition, a quality score was developed to assess each study based on sample size, timing of diagnosis, appropriateness of control group and other factors. RESULTS: In 19 studies, the major malformation rates ranged from 0-9.5% for IVF; 1.1-9.7 for ICSI; and 0-6.9% in the control groups. When ICSI was compared to IVF, and multiple births compared to singleton, there were no statistically significant differences. When data from 16 studies involving 28,524 IVF infants and 2,520,988 spontaneously conceived controls and 7 studies involving 7234 ICSI infants and 978,078 controls were pooled, we found an overall odds ratio for the 19 studies of 1.29 (95% CI 1.01-1.67). CONCLUSIONS: The overall odds ratio of 1.29 was statistically significant at the 5% level. These results may be useful for counseling ART patients and properly designing the consent forms used for ART procedures. It is not clear whether this risk is due to the procedures used in ART. We found that some of these studies have design flaws. All of them lacked an appropriate control group, i.e. infertile patients conceiving spontaneously. These flaws may create biases that would in almost all instances increase the risk of major malformations in the study group. Further research with better designed studies will likely result in a better estimate of the risk of major malformations associated with IVF and ICSI.

Congenital Abnormalities↗

PubMed2004

The immunological profile of infertile women after repeated IVF failure (preliminary study).

OBJECTIVE: The aim of this preliminary study was to estimate the immunological profile of patients after repeated IVF failures. MATERIALS AND METHODS: Seventeen women after repeated IVF failure and 10 non-pregnant women with a history of successful IVF pregnancies were included in the study. We estimated the presence of the auto-antibodies, such as: antinuclear antibodies (ANA), antithyroid antibodies (ATA), antiphospolipid antibodies (APA), antismooth muscle antibodies (ASMA), and antisperm antibodies (ASA). Furthermore, we estimated the percentage of B-1 CD 19+5+ lymphocytes and NK cells using flow cytometry. RESULTS: In the group of patients after IVF failure the percentage of B-1 CD 19+5+ lymphocytes was higher than 1.5% and significantly higher when compared to controls. Three patients after IVF failure had elevated percentages of peripheral blood NK cells. Fourteen infertile patients after IVF failure (82.3%) had at least one abnormal result on autoimmune testing. One patient from the study group had no positive results of immunological tests. CONCLUSION: Our results suggest that immunological alterations may be involved in the etiopathogenesis of unexplained infertility. Furthermore, the results suggest that there is a need for immunological diagnostics in the group of patients with unexplained infertility A greater number of patients is needed for further investigations.

Abortion, Habitual↗

PubMed2006

[Pregnancy and birth experiences in 12 women undergoing IVF].

OBJECTIVE: Medical interventions during the perinatal period are psychologically difficult for women and research has shown this is true as well for in-vitro fertilization procedures (IVF). This study examined the impact of IVF and different medical interventions, common to both non-pathological pregnancies and IVF, through the analysis of both quantitative and qualitative data. PATIENTS AND METHODS: Twelve women undergoing IVF evaluated their experience of pregnancy and birth using measures of post-partum depression, maternal self-esteem, and semi-directive interviews. RESULTS: The results showed that the number of medical interventions is correlated with higher scores of post-partum depression as well as lowered scores in maternal self-esteem. Qualitative analyses of interviews showed that IVF has a complex and unique psychological impact. DISCUSSION AND CONCLUSION: The results of this study underline the need for specific psychological support for women undergoing IVF treatment.

Delivery, Obstetric↗

PubMed1998

In vitro fertilization and pregnancy rates: the influence of sperm motility and morphology on IVF outcome.

OBJECTIVE: To determine the relationship between sperm motility and sperm morphology parameters and IVF and pregnancy rates. DESIGN: Pre- and postpreparation analysis of semen samples from infertile couples undergoing IVF-ET. SETTING: Andrology Laboratory, Royal Maternity Hospital, Belfast, Northern Ireland. PATIENT(S): One hundred fifty couples undergoing IVF-ET treatment at the Regional Fertility Centre. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The ability of human sperm to achieve IVF and pregnancy was investigated in relation to motility parameters (assessed with computer-aided sperm analysis [Integrated Visual Optical System] and percent normal morphology (determined with the strict criteria). RESULT(S): Significant differences were observed in motility parameters and percent normal morphology in samples that achieved > or =50% fertilization compared with < or =50% fertilization and between samples that achieved a pregnancy compared with those that did not. Significant positive correlations were observed between percent progressive motility, the velocity of sperm movement, and morphology parameters and both IVF and pregnancy. CONCLUSION(S): Both sperm motility parameters and percent normal morphology are significant factors in predicting fertilization and pregnancy rates in IVF.

Adult↗

PubMed2000

Minimal stimulation IVF using clomiphene citrate and oral contraceptive pill pretreatment for LH suppression.

OBJECTIVE: To determine if oral contraceptive pill (OC) pre-treatment prior to minimal stimulation IVF using clomiphene citrate (CC) would make the procedure easier to perform by preventing the LH surge and result in pregnancy rates (PRs) comparable to stimulated IVF. DESIGN: Prospective cohort study. SETTING: Private tertiary infertility center. PATIENT(S): Thirty-two women with tubal or pelvic adhesive disease as the cause of their infertility, ovulatory cycles, under the age of 40, and no male factor. INTERVENTION(S): Two-month ovarian-hypothalamic-pituitary axis suppression with OC followed by CC 100 mg on day 3 of the cycle for 8 days, hCG administration midcycle, follicle aspiration, IVF, and embryo transfer. MAIN OUTCOME MEASURE(S): Oocytes retrieved, serum LH and estradiol levels, maturity of oocytes, fertilization rates, embryo number and quality, and PRs. RESULT(S): Thirty-six patients completed 71 stimulation cycles and 64 follicle aspirations. No LH surges occurred with a mean mature oocytes retrieved of 3.2, 90% fertilization rate, and mean 2.5 embryos transferred. Twenty-one of the 64 cycles resulted in a clinical pregnancy (32.8% PR per retrieval) with 2 other biochemical pregnancies and 3 twin gestations. This was not significantly different from the matched cohort stimulated IVF. CONCLUSION(S): Minimal stimulation IVF is a simple, low-cost, and low-risk alternative to stimulated IVF with comparable PRs.

Adult↗

PubMed2000

Delayed luteo-placental shift of progesterone production in IVF pregnancy.

OBJECTIVE: To observe absolute and relative levels of progesterone, 17 alpha-hydroxyprogesterone (17-OHP) and human chorionic gonadotrophin (hCG) in in vitro fertilization (IVF) pregnancies after withdrawal of luteal support. METHOD: Single blood samples were obtained from 41 pregnant women following IVF treatment and 43 normal pregnant women at various weeks gestation within the first trimester. Progesterone, 17-OHP and hCG were measured by immunoassay. RESULTS: Serum levels of progesterone, but not of hCG, in IVF pregnancies were significantly greater than in normal pregnancies up to 8 weeks post-conception, despite discontinuing luteal support 2 weeks after conception. The ratio of progesterone to 17-OHP, a predominantly ovarian product, in normal pregnancies rose between 4 and 9 weeks but did not change over the same period in IVF pregnancies. CONCLUSION: The luteal contribution to maternal serum levels of progesterone is much higher in IVF pregnancies compared with normal pregnancies. This is sustained throughout the first trimester without the need for luteal support and obscures the placental contribution of progesterone for much longer than in normal pregnancies. Progesterone or hCG supplements may therefore be unnecessary in IVF pregnancy.

Female↗

PubMed1998

Outcome of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) using human sperm prepared via a new standardized swim-up technique fit for office use.

Objective: Recent developments in the assisted reproductive technology (ART) areas necessitate the use of new and more efficient and acceptable modes of gamete in vitro manipulation techniques. As established via the use of various forms of ART, the natural process of fertilization has been largely bypassed and the gametes are obtained and manipulated outside of the normal means of conception. For the male, improvements in sperm quality have involved the use of various techniques that aim to recover a small percentage of healthy spermatozoa that can be further used for the different ART procedures. Previous IVF results showed no differences in fertilization rates between ZSC and Percoll recovered sperm (Zarmakoupis-Zavos et al. ACOG, 1997). The current study was designed to study the fertilizing capacity of ZSC recovered spermatozoa and subsequent embryonic development and pregnancy rates established via IVF and ICSI procedures.Methods: Sperm specimens (n = 30) were prepared via the use of the standardized ZSC swim-up technique, which was designed to harvest almost all overlayered media at the end of the procedure to maximize the sperm recovery. The ZSC device consists of a column with a conical cavity where the semen is placed, and from where the sperm swim-up into the overlayered media and are subsequently recovered at the end of the procedure. Semen specimens were initially assessed and then prepared (0.5 mL each) via the ZSC swim-up technique. The enhancement of the routine semen parameters was assessed and the recovered specimens were used for either conventional IVF or ICSI.Results: The results of the fertilization and pregnancy via IVF and ICSI are shown below:The generated results point out that ZSC recovered specimens yielded acceptable levels of fertilization and pregnancy rates in our IVF and ICSI program. Furthermore, the IVF inseminations yielded higher fertilization rates with a slight increase in polyspermic oocytes when compared to the ICSI inseminations.Conclusion: The data generated in this study tend to point out that the ZSC, besides being a simple one-step standardized system, can also be effectively employed in an ART program and can generate adequate fertilization and pregnancy rates. We have previously shown that the quality and fertilizing capacity of ZSC recovered sperm is comparable to that recovered via Percoll gradients. However, the ZSC when compared to the Percoll method was less time consuming (5 minutes of actual labor) and less tedious by eliminating the dilution and centrifugation steps of Percoll preparation, since it washes the sperm while simultaneously selecting it. The ZSC is a standardized semen preparation method and could be the method of choice in an ART program.

Journal Article↗

PubMed2006

How to improve IVF-ICSI outcome by sperm selection.

In previous studies, a new IVF method of intracytoplasmic morphologically selected sperm injection (IMSI) was introduced, based on motile sperm organellar morphology examination (MSOME). It was concluded that microinjection of morphologically selected sperm cells with strictly normal nucleus, defined by MSOME, improves IVF-ICSI outcome. The aim of the present study was to confirm this conclusion in new, enlarged study groups. Comparison between 80 couples, who underwent an IVF-IMSI trial, with matched couples, who underwent a standard IVF-ICSI procedure, confirmed that pregnancy rate following IVF-IMSI was significantly higher, and abortion rate significantly lower than in the routine IVF-ICSI (60.0 versus 25.0%, and 14 versus 40% respectively, P <or= 0.05). Another comparison was performed between matched IMSI groups, where embryos were obtained from microinjection by spermatozoa with a morphologically normal nucleus ('best' group, n = 70) and a 'second best' group was selected, where embryos were obtained from microinjection of spermatozoa with minimal morphological impairment, since no other sperm cells were available. It was confirmed that microinjection by 'second best ' spermatozoa result in significantly lower pregnancy and delivery rates and significantly higher abortion rates than microinjection with 'best' spermatozoa (25.7 versus 58.2%, P <or= 0.01; 17.1 versus 52.8%, P <or= 0.01, and 33.3 versus 9.7%, P <or= 0.02 respectively). The present study has strengthened previous conclusions.

Adult↗

PubMed2002

Coarse granulation in the perivitelline space and IVF-ICSI outcome.

PURPOSE: To study the effect of the presence of coarse granules in the perivitelline space (PVS) of oocytes on embryonic development, and on implantation and pregnancy rates in IVF. METHODS: The study population included 24 patients treated during the period 1995-2000. The majority or all of their oocytes exhibited repeatedly coarse granulation in the PVS. Clinical and laboratory cycle characteristics of their 65 IVF-ICSI cycles and the resulting implantation and pregnancy rates were compared to a matched control group of 65 IVF- ICSI cycles without granulation in the PVS. RESULTS: A total of 623 oocytes were retrieved, 418 oocytes fertilized, and 246 embryos were transferred in the study group. No difference was detected between the study and control group with regard to patients' clinical data, IVF cycle characteristics, mean number of oocytes retrieved and fertilized, and mean number of embryos transferred. Only seven pregnancies were achieved in the study group, leading to pregnancy and implantation rates of 10.7 and 5.7%, respectively. Pregnancy and implantation rates were significantly higher in the control group of matched IVF-ICSI cycles without granulation in the PVS (32.5 and 11.5%, respectively). CONCLUSIONS: The presence of coarse granules in the PVS correlates with low implantation and pregnancy rates in IVF-ICSI cycles and might be regarded as a distinct entity, part of the yet poorly defined condition of "egg factor infertility."

Adult↗

PubMed2003

The effect of preincubation period of oocytes on nuclear maturity, fertilization rate, embryo quality, and pregnancy outcome in IVF and ICSI.

PURPOSE: To clarify the effect of preincubation of oocytes on the results of IVF and ICSI. METHODS: A total of 176 IVF and 64 ICSI cycles received long protocol ovarian stimulation. The oocytes were incubated for 1-8 h before insemination or sperm injection. Metaphase II (MII) percentage was evaluated in the ICSI arm; fertilization rates, embryo quality, and pregnancy outcomes were analyzed in both IVF and ICSI arms according to the preincubation period duration of oocytes. RESULTS: The MII percentage of the ICSI arm was significantly lower (P < 0.05) in the group with preincubation period of < 2.5 h. The fertilization rates in groups with preincubation for 2.5-5.5 h were significantly higher (P < 0.001) for IVF. Embryo quality and pregnancy outcomes were not significantly different between the IVF or ICSI arm. CONCLUSIONS: The preincubation of oocytes for at least 2.5 h is beneficial to both IVF and ICSI outcomes by increasing the nuclear maturity of oocytes.

Embryo, Mammalian↗