[The treatment research of people with different types of HPV infection in sterile patients]

OBJECTIVE

Explore the optimal treatment of infertility patients infected with different types of human papillomavirus (HPV).

METHODS

According to cervical pathology, cervical status and the procreate desire of the infertility patients, the 144 clinic cases of high-risk human papillomavirus infected infertile patients were divided into two gruoups: group with treatment and without treatment. Real-time quantitative fluorescent PCR (RT-PCR) has been employed, follow-up time is 6 months, to detect the HPV-DNA in the crevical exfoliated cells, to observe the negative conversion rate and pregnancy rate, and compare analyzed.

RESULTS

(1) In high-risk HPV infectors, the negative conversion rate of treatment group (56.67%) is higher than those in non-treatment group (50.00%); (2) The pregnancy rate of secondary high-risk HPV non-treatment group (50.00%) is higher than the treatment group. The pregnancy rate of primary high-risk HPV treatment group (31.67%) is higher than the non-treatment group (4.00%). (3) Negative conversion rate increases accordingly, on primary high-risk HPV infected groups with Leep, with single drug and with Leep combined with drug therapy. (4) The negative conversion rate and the pregnancy rate of primary high-risk HPV infected groups with surgical therapy is higher than the groups with drug therapy. Surgical + Drugs is better in the two surgical therapies.

CONCLUSION

Infertile patients should be routinely screened for cervical HPV. The primary high-risk cervical HPV infection is the etiology of infertility. Preferably, patients with primary high-risk HPV infection in cervical lesions is treated with Leep combined drugs.

[Use of recombinant human luteinizing hormone for ovulation stimulation in in vitro fertilization-embryo transfer]

OBJECTIVE

To evaluate application of recombinant human luteinizing hormone (r-hLH) used in ovarian stimulation of assisted reproductive technique and impact on outcome of pregnancy.

METHODS

From Apr. to Jul. 2009, 123 patients with low LH level (< 1 U/L) at day 3 of menstruation and down-regulation of pituitary function undergoing in vitro fertilization-embryo transfer (IVF-ET) in Reproductive Medical Center, Provincial Hospital Affiliated to Shandong University were enrolled in this study, whom were classified into 66 cases treated by r-hLH in r-hLH group and 57 cases without r-hLH treatment in non-r-hLH group. In the mean time, 145 patients with normal level of serum LH (1 - 2 U/L) not given by r-hLH treatment and undergoing IVF-ET were matched as control group. Total amount of gonadotropin, estradiol levels and LH levels on the administration of human chorionic gonadotropin (hCG), number of oocytes retrieved, number of 2PN zygotes, rate of high quality embryos, the rates of implantation and clinical pregnancy were compared among these three groups.

RESULTS

The level of serum LH on the day of hCG administration were (1.59 ± 0.77) U/L in r-hLH group, (0.54 ± 0.25) U/L in non-r-hLH group and (2.39 ± 1.01) U/L in control group, which reached statistical difference between every two groups (P < 0.05). The rates of high quality embryo were 59.36% in r-hLH group, 57.79% in non-r-hLH group, which were significantly lower than 65.94% in control group, respectively (P < 0.05). The rates of 2PN were 67.62% in r-hLH group and 68.32% in control group, which were significantly higher than 62.84% in non-r-hLH group, respectively (P < 0.05). The rates of implantation of 29.77% in r-hLH group were significantly higher than 18.26% in non-r-hLH group (P < 0.05). The total amount of gonadotropin, estradiol level on the day of hCG administration, the number of oocytes retrieved, and clinical pregnancy rate were not significantly different among those three groups (P > 0.05).

CONCLUSION

The administration of recombinant human luteinizing hormone in patients who are profoundly suppressed after down-regulation with long protocol can get more quality embryos, the higher rates of 2PN and implantation.

Impact of overweight and underweight on IVF treatment in Chinese women

OBJECTIVE

To investigate the effects of body mass index (BMI) on ovarian stimulation and the outcome of IVF or ICSI treatment in Asian population who have different characteristics of BMI from white people.

DESIGN

In this retrospective study, the first fresh cycles of 1107 Chinese women were classified by BMI: underweight (BMI <18.5 kg/m(2)), normal weight (BMI: 18.5-23.9 kg/m(2)) and overweight (BMI >or= 24 kg/m(2)). Dose and days of ovarian simulation, cancelled cycles and number of oocytes collected, fertilisation and embryo utilisation rates and pregnancy outcome were compared among BMI groups.

RESULTS

It showed that overweight women required more ampoules of gonadotrophin (P = 0.002) and had lower peak oestradiol concentration (P = 0.001), increased cycle cancellation due to insufficient follicle development (P = 0.018) and a higher miscarriage rate (10.5 vs. 5.4%, P = 0.018, OR = 2.006 (95% CI: 1.09-3.69, P = 0.025)) compared with normal weight women. However, no differences were found in clinical pregnancy and live-birth rates. Underweight compared with normal weight women showed no differences in ovarian stimulation and IVF outcome although the clinical pregnancy rate was lower (31.1 vs. 37.3%).

CONCLUSION

At a lower cutoff point of BMI in Chinese women, overweight is associated with increased miscarriage risks and impaired response to ovarian stimulation after IVF and ICSI.

Assessment of fertility protection and ovarian reserve with GnRH antagonist in rats undergoing chemotherapy with cyclophosphamide

BACKGROUND

Reproductive function following chemotherapy is of increasing importance given that survival rates are improving. We assessed whether a gonadotropin-releasing hormone antagonist (GnRHant; cetrorelix) could promote ovarian protection against damage due to chemotherapy.

METHODS

Forty-two female Wistar rats were used in this study. Animals were divided into four groups: group I (n=9) received placebo twice; group II (n=12) received placebo+cyclophosphamide (CPA); group III (n=12) received GnRHant+CPA; and group IV (n=9) received GnRHant+placebo. After medication, the estrous cycle was studied through vaginal smears. Rats were mated, pregnancy was documented and the number of live pups evaluated. Afterwards, rat ovaries were removed and prepared for histological studies. The ovarian cross-sectional area was measured and follicles were counted.

RESULTS

Cyclic changes in vaginal smears were observed in all but one animal after treatment, but group II had a significantly lower rate of animals with proestrus or estrus (p<0.01). The offspring was markedly reduced by CPA treatment (group II, 3.00+/-1.33 pups vs. group I, 11.44+/-0.78 pups, p<0.01) and this effect was partly reversed by pre-treatment with GnRHant (group III, 7.00+/-1.31 pups). The ovarian cross-sectional area was not significantly different between groups, neither was the number of individual follicle types. However, rats in Group IV had a higher total number of ovarian follicles than those in the control group (17.1+/-1.22 vs. 10.9+/-0.70, p<0.05).

CONCLUSION

The use of a GnRHant before CPA chemotherapy provided protection of fertility.

[Prognostic factors and reproductive outcomes of borderline ovarian tumors: a review of 186 patients]

OBJECTIVE

To determine the clinicopathological characteristics of borderline ovarian tumors and to evaluate their prognostic factors and pregnancy rates/fertility outcomes after conservative surgery.

METHODS

A total of 186 patients with borderline ovarian tumors receiving treatment at our hospital from 1990 to 2007 were retrospectively studied and followed-up post-operatively for at least six months. The effects of clinicopathological characteristics upon recurrence and mortality were analyzed by independent sample t test, Chi-square test, Kaplan-Meier and Cox proportional hazard model.

RESULTS

The median follow-up time was 44 months. One hundred and nine patients underwent conservative surgery and 77 patients underwent radical surgery. Thirty-one relapses were reported. Only 3 died of disease. As demonstrated by multivariate analysis, surgical procedure, stage and pseudomyxoma peritonei were the independent prognostic factors for recurrence.

CONCLUSION

The recurrence rate of conservative surgery is higher than that of radical surgery. However, conservative surgery is safe as it does not result in a higher mortality rate.

The associated factors to endometrial cavity fluid and the relevant impact on the IVF-ET outcome

BACKGROUND

Endometrial cavity fluid (ECF) is a fluid accumulation within the endometrial cavity. The significance of ECF remains unclear during the program of in vitro fertilization-embryo transfer (IVF-ET). The aim of the present study was to investigate the associated factors to ECF, visualized through ultrasound at the day of oocyte retrieval, and the relevant impact on the outcome of IVF-ET.

METHODS

From the clinical data of 1557 infertility patients for IVF-ET program, 46 ECF patients were retrospectively selected as the ECF group; and another 134 patients with a bilateral salpingectomy and without ECF, selected as the control group. The demographics and the outcome of IVF-ET were compared between the two groups.

RESULTS

The incidence of ECF was 2.95% (46/1557). Over half (28/46, 60.87%) of ECF patients had tubal infertility. Only 12 Of 46 ECF patients (26.09%) had visible hydrosalpinx on ultrasonography before ovarian stimulation. The cycle cancellation rate (4/46, 8.69%) of ECF group was not significantly higher than that of the control group (6/134, 4.48%; P > 0.05). Reasons for cycle cancellation in both groups were all the high risk of ovarian hyperstimulation syndrome (OHSS). No significant difference was found in clinical pregnancy rate between the patients with their ECF <3.5 mm in the anterior-posterior diameter (APD) and the control group (35.48% versus 30.47%; P > 0.05). No clinical pregnancy was found among those patients with their ECF equal or higher 3.5 mm in APD.

CONCLUSIONS

It was tubal infertility, not hydrosalpinx, which was related to the development of ECF. Excessive ECF (equal or higher 3.5 mm in APD) at the day of oocyte retrieval would have a negative impact on the outcome of IVF-ET.

Reproductive performance measures among Thoroughbred mares in central Kentucky, during the 2004 mating season

REASON FOR PERFORMING STUDY

To improve efficiency at the farm level, a better understanding of how farm management factors impact reproductive performance is important.

OBJECTIVE

To assess reproductive efficiency and effectiveness among Thoroughbred mares in central Kentucky.

METHODS

A cohort of 1011 mares on 13 farms in central Kentucky was followed during the 2004 mating and 2005 foaling season. Information on farm level practices was collected via interviews with farm managers. Reproductive records were collected for each mare mated to obtain information on mare characteristics. The influence of mare age and status (maiden, foaling, barren) on Days 15 and 40 post mating pregnancy rates, foaling rates and total effective length of the mating season were assessed. The influence of stallion book size on reproductive performance measures was also examined.

RESULTS

Per season pregnancy rates on Days 15 and 40 post mating and live foal rate were 92.1, 89.3 and 783%, respectively. Per cycle rates for the same time periods were 64.0, 583 and 50.8%. There were no significant associations between stallion book size and reproductive performance outcomes. The mean +/- s.d. interval from the beginning of the mating season to the last mating of the mare was 36.5 +/- 26.1 days.

CONCLUSIONS

Mare age had a significant impact on efficiency of becoming pregnant, maintaining pregnancy and producing a live foal. Overall, fertility did not decrease among stallions with the largest book sizes. Total interval length of the mating season can be reduced if managers ensure maiden and barren mares are mated at the beginning of the season and foaling mares are mated at the earliest oestrus after acceptable uterine involution has been achieved.

POTENTIAL RELEVANCE

Measures identified in the study can be used by owners, farm managers and veterinarians to improve mare reproductive performance and identify parameters to assist with the implementation of effective culling practices.

[L-carnitine: safe and effective for asthenozoospermia]

OBJECTIVE

One of the important reasons for male infertility is asthenozoospermia, for which there is no specific cure for the time being. The authors explored the clinical effect of L-carnitine for infertile males with asthenozoospermia.

METHODS

A total of 135 patients with asthenozoospermia were randomly divided into Groups A (n = 68) and B (n = 67), the former treated with L-carnitine (2 g/d) and vitamin E, while the latter with vitamin E only, both for 3 months. All the patients received semen analyses before and after the treatment, and were observed for adverse effects. The pregnancy rates of their wives were recorded.

RESULTS

Group A showed a significantly increased percentage of forward motile sperm after the treatment (45.4% +/- 11.1%) as compared with pretreatment (28.6% +/- 9.2%) (P < 0.01), but no statistically significant differences were found in sperm density and the percentage of the sperm of normal morphology (P > 0.05). The rate of pregnancy was significantly higher in Group A (31.1%) than in B (3.8%) after the treatment (P < 0.01). No adverse events were found during the treatment.

CONCLUSION

L-carnitine, capable of significantly improving sperm motility and raising the rate of pregnancy, is a safe and effective therapeutic option for asthenozoospermia.

Comparative cost-effectiveness of three intrauterine devices: a multi-center randomized trial

OBJECTIVE

To determine the relative cost-effectiveness of three intrauterine devices (IUDs), MLCu375, TCu380A, and YuangongCu365.

METHODS

Cost-effectiveness of three IUDs, namely MLCu375, TCu380A, and YuangongCu365, was analyzed from the provider's perspective by means of a randomized trial with one-year follow-up carried out in six centers in China.

RESULTS

YuangongCu 365 had the lowest termination and pregnancy rates (4.17% and 0.54%, respectively), followed by TCu380A (8.59% and 1.11%, respectively) and MLCu375 (14.17% and 2.04%, respectively). YuangongCu365 was more effective yet more costly than the MLCu375. There was a favorably dominating trend of cost-effectiveness for TCu380A comparing with MLCu375 when taking continuation rate as the effectiveness indicator, but there was no difference in cost-effectiveness between the two IUDs when using the pregnancy avoidance rate as the effectiveness measure.

CONCLUSIONS

TCu380A is slightly more cost-effective than the MLCu375. YuangongCu365 is the most effective of the three devices and be used provided it is economically affordable. The comparative long-term safety and cost-effectiveness of these devices need to be further investigated.

Eurycoma longifolia Jack in managing idiopathic male infertility

This study investigated the effect of treatment with the proprietary standardized, water-soluble extract of the root of the Malaysian plant, Eurycoma longifolia Jack, which is thought to enhance male fertility with regard to higher semen volumes, sperm concentrations, the percentage of normal sperm morphology and sperm motility in male partners of sub-fertile couples with idiopathic infertility. A total of 350 patients were given 200 mg of the extract daily and follow-up semen analyses were performed every 3 months for 9 months. Of these 350 patients, 75 patients completed one full cycle of 3 months. Follow-up semen analyses in these patients showed significant improvement in all semen parameters. The proprietary extract of Eurycoma longifolia Jack significantly improved the sperm quality in these patients, allowing for 11 (14.7%) spontaneous pregnancies.

[Indication of metformin in the management of hormonal dysfunction secondary to polycystic ovarian syndrome: prospective comparative study of 63 cases]

BACKGROUND

Polycystic ovarian syndrome (PCOS) is the most common hormonal dysfunction in women. It's a cause of female infertility by oligoanovulation, clinical and biochemical hyperandrogenism and polycystic ovaries. Weight loss, firstly proposed in overweight or obese patient suffering from PCOS, aims to reduce hyperinsulinism and hyperandrogenism. Recently, Metformin, an insulin sensitizer, has been proposed as an alternative first line treatment for polycystic ovarian syndrome by improving hyperinsulinemia and hyperandrogenism in these women.

AIM

The aim of our study, and through a literature review, is to demonstrate if Metformin should be used as a first-line drug for infertile women with this syndrome or as an adjunction to Clomifene Citrate, the longest established treatment already used in this syndrome.

METHODS

A prospective comparative study including 63 patients with PCOS has been done during 2 years. Women were randomly allocated to clomifene + Metformin (Metformin group, Metformin took during 8 weeks, 850 mg twice a day, plus Clomifene 100 mg per day during five days) or Clomifene only (100 mg per day during five days). All patients underwent a two- month's diet.

RESULTS

The middle age was about 30.63 years and the body mass index (BMI) was about 29.88 kg/ m(2). We noticed a 6.2% weight loss in both groups (a non significant difference in p=0.04). The median of infertility period was about 2.49 years. The ovulation rate in the Metformin group was 53.12% (significant difference for inducing ovulation p=0.02) and 32.25% in Clomifene group (non-significant difference 0.07). There was also a significant difference for ongoing pregnancies (p=0.04). In fact, 11 on 32 patients (34%) achieved a full-term pregnancy in Metformin group versus only 4 ones on 31 patients (12.9%) in Clomifene group.

CONCLUSION

Our conclusion is that Metformin is an effective addition to Clomifene Citrate in term of reestablishment of ovulation and full-term pregnancies achievement, excluding ART cycles.

The evolution of oocyte donation in China

OBJECTIVE

To review the experience with and clinical outcomes for recipients of embryos from oocytes donated under different regulatory standards in China. Initially, the oocytes were provided by one of the patient's consanguineous sisters. Then, the oocytes were obtained from another patient treated with assisted reproduction techniques (ART). Presently, oocytes thus produced are cryopreserved for at least 6months before transfer.

METHODS

The records from all women treated with ART at First Affiliated Hospital of Zhengzhou University since 2001 were reviewed and the pregnancy rates and clinical outcomes were determined for each of the 3 periods.

RESULTS

In the second period, the mean implantation and clinical pregnancy rates were significantly higher for the 22 oocyte recipients than for their donors. In the third period, the rates for the 56 recipients were compared with the 78 other regular ART patients fertilized with their own oocytes. There were 40 live births for 32 of the recipients over 28 cycles, and the rates of implantation and clinical pregnancy were much higher for the recipients than for the other ART patients (P<0.001).

CONCLUSION

Using freshly donated eggs yields a higher pregnancy rate but there is a risk of infectious disease. Using frozen oocytes can significantly decrease this risk but implantation rates are lower.

Genome-wide profiling of gene expression in the epididymis of alpha-chlorohydrin-induced infertile rats using an oligonucleotide microarray

BACKGROUND

As one of the chlorinated antifertility compounds, alpha-chlorohydrin (ACH) can inhibit glyceraldehyde-3-phosphate dehydrogenase (G3PDH) activity in epididymal sperm and affect sperm energy metabolism, maturation and fertilization, eventually leading to male infertility. Further studies demonstrated that the inhibitory effect of ACH on G3PDH is not only confined to epididymal sperm but also to the epididymis. Moreover, little investigation on gene expression changes in the epididymis after ACH treatment has been conducted. Therefore, gene expression studies may indicate new epididymal targets related to sperm maturation and fertility through the analysis of ACH-treated infertile animals.

METHODS

Rats were treated with ACH for ten consecutive days, and then each male rat copulated with two female rats in proestrus. Then sperm maturation and other fertility parameters were analyzed. Furthermore, we identified epididymal-specific genes that are associated with fertility between control and ACH groups using an Affymetrix Rat 230 2.0 oligo-microarray. Finally, we performed RT-PCR analysis for several differentially expressed genes to validate the alteration in gene expression observed by oligonucleotide microarray.

RESULTS

Among all the differentially expressed genes, we analyzed and screened the down-regulated genes associated with metabolism processes, which are considered the major targets of ACH action. Simultaneously, the genes that were up-regulated by chlorohydrin were detected. The genes that negatively regulate sperm maturation and fertility include apoptosis and immune-related genes and have not been reported previously. The overall results of PCR analysis for selected genes were consistent with the array data.

CONCLUSIONS

In this study, we have described the genome-wide profiles of gene expression in the epididymides of infertile rats induced by ACH, which could become potential epididymal specific targets for male contraception and infertility treatment.

Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women

OBJECTIVE

The aim of this study was to compare the effectiveness of myo-inositol (MYO) and metformin, in monotherapy or in association with recombinant follicle stimulating hormone (r-FSH), in the treatment of menstrual irregularities, chronic anovulation, and female infertility in patients with polycystic ovary syndrome (PCOS).

MATERIALS AND METHODS

One hundred twenty patients were randomly treated with metformin 1500 mg/day orally (n = 60), or 4 g MYO plus 400 microg folic acid daily (n = 60), continuously. If no pregnancy occurred, r-FSH (37.5 units/day) was added to the treatment for a maximum of three attempts.

RESULTS

Fifty percent of the patients who assumed metformin restored spontaneous ovulation, 18.3% of these obtained pregnancy. The remaining 42 patients were treated with metformin plus r-FSH. Pregnancy occurred in a total of 11 women (26.1%). The total pregnancy rate was 36.6%. Sixty-five percent of the patients treated with MYO plus folic acid restored spontaneous ovulation activity, 30% of these obtained pregnancy. The remaining 38 patients were treated with MYO, folic acid plus r-FSH. Pregnancy occurred in a total of 11 women (28.9%). The total pregnancy rate was 48.4%.

CONCLUSIONS

Both metformin and MYO, can be considered as first line treatment for restoring normal menstrual cycles in most patients with PCOS, even if MYO treatment seems to be more effective than metformin.

Low-dose metformin improves pregnancy rate in in vitro fertilization repeaters without polycystic ovary syndrome: prediction of effectiveness by multiple parameters related to insulin resistance

OBJECTIVE

Insulin resistance is associated with aging and stress, both common among patients repeatedly failing to conceive with in vitro fertilization (IVF repeaters). In the present study we examined whether low-dose metformin could improve the outcome in IVF repeaters without polycystic ovary syndrome (PCOS).

DESIGN

Study I was a preliminary clinical trial aiming at defining indications for therapy; study II was a prospective randomized study. The studies involved a university hospital and a private infertility clinic. We studied 232 women without PCOS who had failed at least twice to conceive by previous IVF. Metformin (500 mg/ day) was administered for 8 to 12 weeks before and during ovarian stimulation (metformin IVF). In study I, IVF outcomes with metformin (n = 33) were compared to outcomes without metformin of previous IVF in the same subjects. A discriminant score (DS) was determined from nine parameters assessed before metformin administration to predict achievement of ongoing pregnancy by metformin IVF. In study II (n = 199), ongoing pregnancy rates were compared prospectively between groups with/without metformin and with DS above/below 0.6647.

RESULTS

Study I. Ongoing pregnancy rate improved significantly with metformin compared with previous IVF, and pregnancy correlated significantly with a DS at an optimal threshold of 0.6647 (sensitivity, 0.90; specificity, 0.91). Study II. Ongoing pregnancy and implantation rates were significantly higher in women with a DS above 0.6647 who received metformin (56% and 33%) compared with those having a DS below 0.6647 with metformin (14% and 11%) and those having a DS above/below 0.6647 without metformin (20% and 7.1%/15% and 11%, respectively).

CONCLUSIONS

Low-dose metformin improved pregnancy rate in IVF repeaters without PCOS, probably by decreasing insulin resistance. Indication can be determined from insulin-resistance-related multiple parameters assessed before metformin administration.

[Effect of gonadotropin-releasing hormone agonist on fertility potential in patients with stage I endometriosis after laparoscopy]

OBJECTIVE

To investigate the impact on fertility potential of patients with stage I endometriosis treated by gonadotropin-releasing hormone agonist (GnRH-a) treatment followed by laparoscopy surgery.

METHODS

From Jan. 2006 to Jun. 2008, medical documents of 102 patients with minimal or mild endometriosis (stage I) treated by laparoscopy and hysteroscopy surgery and excluded the other causes of infertility were reviewed retrospectively in Peking University People's Hospital. The pelvic endometriosis lesions were destroyed by electric burning. Those patients were divided into GnRH-a treatment group (n=60) and non-GnRH-a treatment group (n=42) after surgery. The patients in GnRH-a treatment group were administered by GnRH-a injection once or twice after surgery, in the mean time, no adjuvant therapy were given for the patients in the other group. All the patients were followed-up for 24 months after surgery to evaluate the effect of postoperative GnRH-a treatment on pregnancy outcome and fertility potential (number of pregnancy per 100 women in one month, expressed as percentage).

RESULTS

The total pregnancy rate of 78% (47/60) in GnRH-a treatment group is significantly higher than 55% (23/42) in non-GnRH-a treatment group (P=0.012). There is no significant difference in spontaneous abortion rate between the GnRH-a treatment group and non GnRH-a treatment group (19% vs. 13%, P=0.465). The fecundity rate of were 6.17% in GnRH-a treatment group and 3.26% in non-GnRH-a treatment group, which the relative risk is 1.9 (95%CI: 1.1-3.0).

CONCLUSION

Low-dose GnRH-a treatment after laparoscopy can improve the pregnancy rate and fertility potential of patients with stage I endometriosis.

[Clinical application of oocyte vitrification in failed testicular sperm extraction cycles: report of 8 cases]

OBJECTIVE

To evaluate the clinical application value of oocyte vitrification in failed testicular sperm extraction cycles in non-obstructive azoospermia (NOA) patients.

METHODS

We retrospectively analyzed the clinical data of 8 women undergoing oocyte frozen-thawing cycles by vitrification because of failed testicular sperm extraction from their NOA husbands and no banked donor sperm on the day of oocyte retrieval. The oocytes were cryopreserved by vitrification with cryotop and thawed 2 months later. The surviving metaphase II (MII) oocytes were injected with the banked donor sperm of the same blood type as the husbands by intracytoplasmic sperm injection (ICSI) for fertilization. The rates of oocyte survival, fertilization, cleavage, good embryos and pregnancy were evaluated.

RESULTS

Sixty oocytes were vitrified and 47 (78.3%) survived after thawing, of which 41 MII oocytes underwent ICSI and 33 (80.5%) of them were fertilized. The rates of cleavage and good embryos were 81.8% (27/33) and 59.3% (16/27) respectively. Fifteen of the embryos were transferred to the 8 patients, with 1.9 +/- 0.8 per cycle, of which 5 (33.3%) were confirmed by ultrasound to have been implanted and 5 resulted in clinical pregnancy (62.5%), all singleton without miscarriage. Three normal boys and 1 normal girl were already born, with the pregnancy time of (39 + 4 +/- 0.4) wk and newborn body weight of (3787.5 +/- 513.7) g, respectively.

CONCLUSION

Vitrification of oocytes in failed testicular sperm extraction cycles is a promising technique for preserving female fertility, which, with ICSI of banked donor sperm, may result in satisfactory clinical outcomes.

Effects of adding luteinizing hormone activity to gonadotropin releasing hormone antagonist protocols may differ according to age

OBJECTIVE

In spite of previous reports on the beneficial effects of adding exogenous luteinizing hormone (LH) activity to gonadotropin releasing hormone (GnRH) antagonist protocols for conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), these effects in various age groups are still controversial. This study was performed to evaluate the clinical efficacy of adding LH activity to GnRH antagonist protocols according to patient's age.

METHODS

In this medical record review, responses to controlled ovarian hyperstimulation (COH) and IVF/ICSI outcomes were compared between follicle stimulating hormone (FSH) alone and FSH supplemented with LH activity groups in women < or =35 years (n=135) and those 435 years (n=97), respectively.

RESULTS

Estradiol level on hCG day in LH-added group was higher (2.150.6+1.345.1 pg/ml vs. 1.606.2+994.6 pg/ml, P=0.011) in women < or =35 years, while it did not differ in those 435 years. Less oocytes were retrieved in LH-added group of women 435 years (8.1+6.5 vs. 5.7+3.0, P=0.013), however, this figure did not differ in those < or =35 years. Regardless of age, the clinical pregnancy rates were not different between the two groups.

CONCLUSIONS

Supplementation of exogenous LH activity to GnRH antagonist protocols affects the COH outcomes. These LH-adding effects may vary according to patient's age.

[Outcomes of ICSI with microamount frozen-thawed sperm obtained by PESA or TESA in the treatment of azoospermia]

OBJECTIVE

To investigate the effects and clinical pregnancy outcomes of intracytoplasmic sperm insemination (ICSI) with microamount frozen-thawed sperm obtained by percutaneous epididymal sperm aspiration (PESA) or testicular sperm aspiration (TESA) in azoospermia patients.

METHODS

We divided 365 azoospermia patients treated by ICSI into an experimental group (n = 123) and a control group (n = 242) , the former with microamount frozen-thawed sperm, and the latter fresh sperm obtained by PESA or TESA. The rates of fertilization, good embryos, clinical pregnancy, miscarriage, ectopic pregnancy and multiple pregnancy were analyzed and compared between the two groups.

RESULTS

With PESA, the experimental group showed no statistically significant differences from the control group in the rates of fertilization (75.67% vs 76.49%), good embryos (64.96% vs 66.09%), clinical pregnancy (55.21% vs 57.22%), clinical miscarriage (13.21% vs 12.61%), ectopic pregnancy (3. 77% vs 5.41%) and multiple pregnancy (37.74% vs 37.84%) (P > 0.05); nor with TESA (74.41% vs 76.43%, 64.63% vs 66.35%, 46.81% vs 53.39%, 18.18% vs 14.55%, 4.55% vs 1.82%, 37.74% vs 37.84%, P > 0.05). The revival rate of the frozen-thawed sperm from PESA was 70.07%, not significantly different from that of TESA (62.67%) (P > 0.05).

CONCLUSION

ICSI with frozen-thawed micro-amount sperm obtained by PESA or TESA is a safe, economic and effective method for the treatment of azoospermia. The techniques for reviving frozen sperm from PESA or TESA remain to be optimized, and whether these techniques may result in long-term genetic risks in the offspring deserves further investigation.

Mild stimulation in assisted reproduction

The conventional ovarian stimulation protocols currently applied have several drawbacks arising from the intense ovarian stimulation and from the high financial cost. Recently, new concepts such as mild stimulation and friendly in vitro fertilisation have rapidly acquired great popularity among infertile patients although the medical world is still reluctant to apply these protocols generally. We have observed that although with soft stimulation fewer oocytes are retrieved, pregnancy rates are not affected if more than five oocytes are obtained in the follicular aspiration. Another important issue is the additional value of the embryo cryopreservation programmes that will result in cumulative pregnancy rates no different from those obtained with conventional protocols. The benefits of combining these mild stimulation protocols with a selective reduction of the number of embryos to replace have helped us in reducing the incidence of multiple pregnancies and the global cost of the treatment.

Multivitamin and micronutrient treatment improves semen parameters of azoospermic patients with maturation arrest

The study was undertaken to evaluate the efficacy of multivitamin and micronutrient supplementation in azoospermic patients with maturation arrest. A total of 35 azoospermic patients showing maturation arrest on testicular biopsy were recruited in this study. The patients were divided into two groups. Untreated group (n=11) without any treatment and treated group (n=24) who received multivitamins, micronutrients and co-enzyme Q10. The sperm concentration, motility and morphology were evaluated at monthly interval. The results showed reduction in liquefaction time and relative viscosity of the semen in the treated group. Further, in treated group there was appearance of spermatozoa (4.0 million/ml) exhibiting progressive motility (7%) and normal morphology (6%), even in the first follow up visit. The sperm count, motility and normal morphology increased significantly on subsequent visits. Within 3 months (3 visits) 2 pregnancies were reported. These observations indicate that multivitamin and micronutrient supplementation improve the qualitative and quantitative parameters of seminogram in patients with azoospermia of maturation arrest.

An observational study of assisted reproductive technology outcomes in new European Union member states: an overview of protocols used for ovarian stimulation

BACKGROUND

The development of new fertility treatment options has facilitated individualized assisted reproductive technology (ART) protocols to improve outcomes. Manufacturing improvements to recombinant human follitropin alfa have allowed precise dosing based on mass (filled-by-mass; FbM) rather than bioactivity (filled-by-bioassay; FbIU). Continued monitoring and reporting of follitropin alfa treatment outcomes in routine clinical practice is essential.

OBJECTIVE

To provide an overview of the frequency of different controlled ovarian-stimulation protocols used in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles in new European Union member states, and to provide post-registration efficacy and safety data on follitropin alfa.

RESEARCH DESIGN AND METHODS

A 2-year, prospective, observational, multicentre, Phase IV study conducted at ART clinics in the Czech Republic, Estonia, Latvia, Lithuania, Poland, Slovakia and Slovenia. Women aged 18-47 years undergoing ovarian stimulation with follitropin alfa for conventional IVF or ICSI were eligible for inclusion. The main treatment outcome was cumulative clinical pregnancy rate. Data were analysed descriptively.

RESULTS

Clinical pregnancy outcomes were available for 4055 of 4085 (99.3%) patients. In total, 1897 (46.8%) patients used follitropin alfa FbIU; 2133 (52.6%) used follitropin alfa FbM. Clinical pregnancy was achieved by 39.5% (1603/4055) of patients. A greater proportion of patients with polycystic ovary syndrome achieved a clinical pregnancy than those with endometriosis (41.8% vs 37.8%, respectively). A higher cumulative pregnancy rate was observed with the use of follitropin alfa FbM than follitropin alfa FbIU (41.3% vs 37.8%, respectively; p = 0.02).

CONCLUSIONS

This study represents the most comprehensive audit of individualized ART in clinical practice in Central and Eastern Europe. Overall, clinical pregnancy was achieved by 39.5% of patients after stimulation with follitropin alfa. The use of follitropin alfa FbM resulted in a higher cumulative pregnancy rate than did the FbIU formulation. However, limitations of the study include the observational and non-comparative study design, and descriptive nature of statistical analyses; furthermore, the study was not designed to make direct comparisons between the success rates of different ovarian-stimulation protocols.