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Spandorfer SD, Bongiovanni AM, Fasioulotis S, Rosenwaks Z, Ledger WJ, Witkin SS. Prevalence of cervical human papillomavirus in women undergoing in vitro fertilization and association with outcome. Fertil Steril 2006; 86:765-7. [PMID: 16782096 DOI: 10.1016/j.fertnstert.2006.01.051] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Revised: 01/22/2006] [Accepted: 01/22/2006] [Indexed: 01/01/2023]
Abstract
Human papillomavirus (HPV) was detected in 17 (16.0%) of 106 patients undergoing treatment for IVF. Human papillomavirus-positive women had a decreased pregnancy rate (4 of 17, 23.5%) as compared with HPV-negative women (51 of 89, 57.0%; P<.02).
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Fellman J, Eriksson AW. Stillbirth rates in singletons, twins and triplets in Sweden, 1869 to 2001. Twin Res Hum Genet 2006; 9:260-5. [PMID: 16611496 DOI: 10.1375/183242706776382356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The temporal variation in the stillbirth rates (SBR), measured as the number of stillborn per 1000 total births, among singletons, twins and triplets was studied on Swedish birth data for the period 1869 to 2001 and comparisons with data from other populations were made. Among both single and multiple births there were marked, almost monotonously decreasing trends in the stillbirth rates. Among singletons the stillbirth rate decreased from 29.5 per 1000 in the period 1869 to 1878 to 3.4 in the period 1991 to 2001. Among twins the stillbirth rate decreased from 94 per 1000 in 1869 to 1878 to a minimum of 8.2 in 1991 to 2001 and among triplets from 166 per 1000 to a minimum of 19.8. The relative declining pattern in the SBRs was almost the same, being 88% among singletons, 91% among twins and 88% among triplets. In the 1980s and 1990s the definition of the stillbirth rate was changed in many countries, including Finland, but no changes in the definition of stillbirths have been made in Sweden. The effect of the artificial reproduction techniques, including in vitro fertilization, on the rates of multiple maternities is also discussed. It was noted especially that they had a more marked effect on the triplet than on the twinning rate.
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Finnström O, Nygren NG, Olausson PO. [IVF in Sweden--continuous follow-up of children and mothers]. LAKARTIDNINGEN 2006; 103:2301-5. [PMID: 16955577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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306
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Scholtes MCW, Unterhorst E. [Results of intrauterine insemination in the Netherlands]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2006; 150:1750. [PMID: 16924953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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307
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Merkus JMWM. [Results of intrauterine insemination in the Netherlands]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2006; 150:1749; author reply 1749-50. [PMID: 16927476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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308
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Oktay K, Cil AP, Bang H. Efficiency of oocyte cryopreservation: a meta-analysis. Fertil Steril 2006; 86:70-80. [PMID: 16818031 DOI: 10.1016/j.fertnstert.2006.03.017] [Citation(s) in RCA: 407] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 03/27/2006] [Accepted: 03/27/2006] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the efficiency of oocyte cryopreservation relative to IVF with unfrozen oocytes. DESIGN Meta-analysis. SETTING Academic assisted reproduction center. PATIENT(S) Results of all reports from January 1997 to June 2005 with the patients undergoing IVF-intracytoplasmic sperm injection (ICSI) with cryopreserved cycles between 1996 and 2004 were compared with those of patients who underwent IVF-ICSI with unfrozen oocytes in 2002 and 2003 in our program. INTERVENTION(S) Mean age and number of ET cycles originating from unfrozen oocytes was matched with those for thaw cycles originating from oocytes cryopreserved with a slow-freezing (SF) protocol. Vitrification (VF) reports were not included in the comparative analysis because of a small number of pregnancies (10) before June 2005. MAIN OUTCOME MEASURE(S) The comparison of fertilization rate, clinical pregnancy, and live-birth rates per injected oocyte, clinical pregnancy and live-birth rates per transfer, and implantation rate between IVF-ICSI cycles with frozen and unfrozen oocytes. RESULT(S) Live-birth rates per oocyte thawed were 1.9% and 2.0% for SF and VF, respectively, before June 2005. Live-birth rates per injected oocyte and ET, respectively, were 3.4% and 21.6% for SF and were 6.6% and 60.4% for IVF with unfrozen oocytes. Compared to women who underwent IVF after SF, IVF with unfrozen oocytes resulted in significantly better rates of fertilization (odds ratio [95% confidence interval]); 2.22 (1.80, 2.74), of live birth per injected oocyte; 1.5 (1.26, 1.79), and of implantation; 4.66 (3.93, 5.52). These odds ratios were lower when oocyte cryopreservation success rates from 2002-2004 were compared with those for IVF with unfrozen oocytes. When the reports after June 2005 were considered, this trend did not appear to continue. With the consideration of VF reports after June 2005, however, higher pregnancy rates were achieved. CONCLUSION(S) In vitro fertilization success rates with slow-frozen oocytes are significantly lower when compared with the case of IVF with unfrozen oocytes. Although oocyte cryopreservation with the SF method appears to be justified for preserving fertility when a medical indication exists, its value for elective applications remains to be determined. Pregnancy rates with VF appear to have improved, but further studies will be needed to determine the efficiency and safety of this technique.
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D'Hooghe TM, Denys B, Spiessens C, Meuleman C, Debrock S. Is the endometriosis recurrence rate increased after ovarian hyperstimulation? Fertil Steril 2006; 86:283-90. [PMID: 16753162 DOI: 10.1016/j.fertnstert.2006.01.016] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Revised: 01/17/2006] [Accepted: 01/17/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the hypothesis that the cumulative endometriosis recurrence rate (CERR) after fertility surgery for endometriosis stage III or IV is increased in women exposed to very high E(2) levels during ovarian hyperstimulation (OH) for IVF when compared with women exposed to less high E(2) levels during OH for intrauterine insemination (IUI). DESIGN Retrospective cohort study including infertility patients with endometriosis stage III or IV. SETTING Leuven University Fertility Center, between 1990 and 2001. PATIENT(S) Patients (n = 67) with endometriosis stage III (n = 45) or IV (n = 22) who underwent pelvic reconstructive surgery and subsequently started fertility treatment with either IVF only (n = 39), both IVF and IUI in different cycles (n = 11), or IUI only (n = 17). INTERVENTION(S) Life table analysis was used to calculate the CERR. MAIN OUTCOME MEASURE(S) The CERR based on histologic or cytologic proof of disease recurrence. RESULT(S) At 21 months after the start of OH the overall CERR was 31% and was significantly lower in patients treated with IVF only (7%) or women treated with both IVF and IUI in different cycles (43 %) than in those treated with IUI only (70%). At 36 months after the start of OH, the overall CERR was 63%. CONCLUSION(S) In contrast to our hypothesis, the results from this study showed that the CERR is lower after ovarian hyperstimulation for IVF than after lower-dose ovarian stimulation for IUI, suggesting that temporary exposure to very high E(2) levels in women during OH for IVF is not a major risk factor for endometriosis recurrence in women treated with assisted reproductive technology.
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Qublan HS, Eid SS, Ababneh HA, Amarin ZO, Smadi AZ, Al-Khafaji FF, Khader YS. Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure. Hum Reprod 2006; 21:2694-8. [PMID: 16835215 DOI: 10.1093/humrep/del203] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The objective of this study was to determine the incidence of undiagnosed thrombophilic factors and its relation to IVF and embryo transfer failure in women who have had three or more previous IVF-embryo transfer cycles. METHODS The study group comprised of 90 consecutive women with three or more previously failed IVF-embryo transfer cycles (group A). Two control groups were enrolled: group B (n=90) included women who have had successful pregnancy after their first IVF-embryo transfer cycle, and group C (n=100) included women who conceived spontaneously with at least one uneventful pregnancy and no previous history of miscarriage. All women were tested for the presence of inherited [factor V Leiden (FVL) mutation, prothrombin mutation, methylenetetrahydrofolate reductase (MTHFR) mutation and deficiencies in proteins S and C and antithrombin III] or acquired (lupus anticoagulant and anticardiolipin) thrombophilic factors. RESULTS An increase in the incidences of FVL, MTHFR and antiphospholipid antibodies was found in the study group compared with the two control groups. At least one inherited or acquired thrombophilic factor was detected in 68.9% of women with repeated IVF failure compared with 25.6 and 25% in the groups B and C, respectively (P<0.01). Combined thrombophilia (two or more thrombophilic factors) was significantly higher in women who have had repeated IVF failure as compared with the two control groups (35.6 versus 4.4 and 3%) (P<0.0001). CONCLUSION Thrombophilia has a significant role in IVF-embryo transfer implantation failure. Women with repeated IVF-embryo transfer failure should be screened for thrombophilia.
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Propst AM, Bates GW, Robinson RD, Arthur NJ, Martin JE, Neal GS. A randomized controlled trial of increasing recombinant follicle-stimulating hormone after initiating a gonadotropin-releasing hormone antagonist for in vitro fertilization-embryo transfer. Fertil Steril 2006; 86:58-63. [PMID: 16753156 DOI: 10.1016/j.fertnstert.2005.12.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 12/13/2005] [Accepted: 12/13/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pituitary suppression with a GnRH antagonist before IVF may result in a plateau or decrease in estradiol levels. We sought to investigate the effect of increasing recombinant FSH (rFSH) after starting a GnRH antagonist on estradiol levels, implantation rates, and pregnancy rates. DESIGN Prospective, randomized multicenter study. SETTING Military medical center and private practice. PATIENT(S) Sixty infertile women undergoing IVF who met the appropriate inclusion criteria. INTERVENTION(S) Participants were pretreated with combined oral contraceptives (COCs) and received a dose 150-300 IU of rFSH 5 days after taking their last COC. They were randomly assigned to receive their current dose of rFSH (control group) or an additional 75 IU of rFSH (step-up group) after starting a GnRH antagonist. Daily GnRH antagonist injections were started when the lead follicles were 13-14 mm in diameter and continued until hCG was given when two follicles were >or=18 mm. One to three embryos were transferred 3 or 5 days following oocyte retrieval. Women with PCOS, a body mass index >33, a day 3 FSH >14.1 mIU/mL, or prior poor stimulation were excluded. MAIN OUTCOME MEASURE(S) The primary endpoints of this pilot study were embryo implantation, pregnancy, and livebirth rates. Secondary endpoints included the amount and days of rFSH; number of days of GnRH antagonist use; estradiol levels on the day of GnRH antagonist initiation, day 1 and day 2 after initiation, and on the day of hCG; endometrial stripe thickness; number of follicles; and number of oocytes. RESULT(S) No differences were reported within the groups with respect to age, BMI, baseline FSH, use of intracytoplasmic sperm injection, vials of rFSH, number of GnRH antagonist injections, changes in estradiol patterns, or peak estradiol level. The control and step-up groups had similar pregnancies (73.3% vs. 63.3%, P=.41), clinical pregnancies (70.0% vs. 60.0%, P=.42), live births (56.7% vs. 60.0%, P=.8), and implantation rates (50.0% and 39.1%, P=.22). CONCLUSION(S) The use of rFSH and a GnRH antagonist in good candidates for IVF resulted in outstanding implantation and pregnancy rates. Increasing the dose of rFSH after starting a GnRH antagonist does not alter the estradiol response or improve the implantation and pregnancy rates.
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Escribá MJ, Bellver J, Bosch E, Sánchez M, Pellicer A, Remohí J. Delaying the initiation of progesterone supplementation until the day of fertilization does not compromise cycle outcome in patients receiving donated oocytes: a randomized study. Fertil Steril 2006; 86:92-7. [PMID: 16818032 DOI: 10.1016/j.fertnstert.2005.12.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Revised: 12/04/2005] [Accepted: 12/04/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether the initiation of P supplementation as artificial luteal phase support (day -1, day 0, or day +1 of egg donation) in extensive programs of ovum donation influences cycle cancellation, pregnancy outcome, and implantation rate in day 3 embryo transfers. DESIGN Prospective randomized trial. SETTING Oocyte donation program at the Instituto Valenciano de Infertilidad, Valencia, Spain. PATIENT(S) Three hundred recipients with normal ovarian function, absence of uterine anomalies, and undergoing their first egg donation were recruited between September 2003 and September 2004. INTERVENTION(S) A computer-based randomization divided the recipients into three groups when hCG was administered to their matched donors. The first group (group A) started P supplementation the day before oocyte retrieval; the second group (group B) started P supplementation on the day of the oocyte retrieval; and the third group (group C) started P supplementation 1 day after the egg retrieval once fertilization was confirmed. MAIN OUTCOME MEASURE(S) Implantation, pregnancy, and ongoing pregnancy rates were the primary outcome measures considered. The secondary outcome measure was the cancellation rate, especially due to fertilization failure. RESULT(S) Global cancellation rate and cancellation rate due to fertilization failure were significantly higher in group A (12.4% and 8.2%, respectively) than in group C (3.3% and 0%, respectively). Reproductive outcome was similar in all the groups except for a higher biochemical pregnancy rate in group A (12.9%) than in groups B (6.6%) and C (2.3%). CONCLUSION(S) Initiation of P on day +1 of embryo development decreases cancellation rates of day 3 embryo transfers in extensive programs of ovum donation without any deleterious effect on pregnancy outcome or implantation rate.
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Dokras A, Baredziak L, Blaine J, Syrop C, VanVoorhis BJ, Sparks A. Obstetric Outcomes After In Vitro Fertilization in Obese and Morbidly Obese Women. Obstet Gynecol 2006; 108:61-9. [PMID: 16816057 DOI: 10.1097/01.aog.0000219768.08249.b6] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In addition to numerous health detriments caused by obesity, fertility and pregnancy success may also be compromised. The aims of this study were to compare the effects of obesity and morbid obesity on in vitro fertilization (IVF) outcomes. We also investigated the effects of obesity on obstetric outcomes after IVF treatment. METHODS Retrospective study of women less than 38 years of age during their first fresh IVF cycle (January 1995 to April 2005). RESULTS A total of 1,293 women were included in the study, with 236 obese women (body mass index [BMI] = 30-39.9) and 79 morbidly obese women (BMI > or = 40). The morbidly obese group had a 25.3% IVF cycle cancellation rate compared with 10.9% in normal-weight women (odds ratio 2.73, 95% confidence interval 1.49-5.0), P < .001). Morbidly obese women without polycystic ovarian syndrome had an even higher cancellation rate (33%). Women with higher BMI required significantly more days of gonadotropin stimulation but had lower peak estradiol levels (P < .001). There were no significant differences in clinical pregnancy or delivery rates between the four BMI groups. Of the women who delivered, there was a significant linear trend for risk of preeclampsia, gestational diabetes, and cesarean delivery with increasing BMI (P < .03). CONCLUSION We report a significantly higher risk for IVF cycle cancellation in morbidly obese patients with no effect of BMI on clinical pregnancy or delivery rate. However, obese and morbidly obese subjects had a significantly higher risk for obstetric complications. This target population should be aggressively counseled regarding their increased obstetric risk and offered treatment options for weight reduction before the initiation of fertility therapy. LEVEL OF EVIDENCE II-2.
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Lee TH, Chen CD, Tsai YY, Chang LJ, Ho HN, Yang YS. Embryo quality is more important for younger women whereas age is more important for older women with regard to in vitro fertilization outcome and multiple pregnancy. Fertil Steril 2006; 86:64-9. [PMID: 16716314 DOI: 10.1016/j.fertnstert.2005.11.074] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Revised: 11/30/2005] [Accepted: 11/30/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the efficiency of embryo scoring systems for multiple pregnancy in women undergoing IVF procedures. DESIGN Retrospective record analysis. SETTING University hospital, tertiary medical center. PATIENT(S) Three hundred one patients undergoing controlled ovarian stimulation, IVF/intracytoplasmic sperm injection (ICSI), and day 3 embryo transfer. INTERVENTION(S) IVF/ICSI and embryo transfer. MAIN OUTCOME MEASURE(S) Rate of pregnancy and rate of multiple pregnancy. RESULT(S) The score of the best three embryos (Top3) was more correlated with IVF outcome than were the number of good embryos (P=.009) or the cumulative embryo score (P=.038). In the logistic regression model, Top3 was more relevant to IVF outcome and multiple pregnancy for younger patients than was age (P<.05). For older patients, age was more correlated with IVF outcome and multiple pregnancy than was embryo morphology (P<.05). CONCLUSION(S) The embryo morphology criteria can help reduce the number of embryos transferred into younger patients. We could use the age of patients as an indicator to determine the number of embryos transferred into older patients.
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315
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Clarke GN. Association between sperm autoantibodies and enhanced embryo implantation rates during in vitro fertilization. Fertil Steril 2006; 86:753-4. [PMID: 16814290 DOI: 10.1016/j.fertnstert.2006.02.089] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Revised: 02/10/2006] [Accepted: 02/10/2006] [Indexed: 11/26/2022]
Abstract
Previous investigations have demonstrated the propensity of strong IgA-class sperm autoantibodies to impede fertilization. However, because there has not been a general consensus on this issue, the aim of this retrospective analysis was to focus on the effects of different levels of IgA-class antibodies on each stage of the IVF procedure. This study has confirmed that high level IgA class antibodies significantly reduce fertilization rates but, unexpectedly, also has shown a very significant improvement in embryo implantation rates in patients with weak to moderate antibody levels. Interlaboratory prospective collaborative studies are being planned to test this preliminary observation more stringently.
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316
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Pashayan N, Lyratzopoulos G, Mathur R. Cost-effectiveness of primary offer of IVF vs. primary offer of IUI followed by IVF (for IUI failures) in couples with unexplained or mild male factor subfertility. BMC Health Serv Res 2006; 6:80. [PMID: 16796733 PMCID: PMC1543624 DOI: 10.1186/1472-6963-6-80] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 06/23/2006] [Indexed: 11/21/2022] Open
Abstract
Background In unexplained and mild male factor subfertility, both intrauterine insemination (IUI) and in-vitro fertilisation (IVF) are indicated as first line treatments. Because the success rate of IUI is low, many couples failing IUI subsequently require IVF treatment. In practice, it is therefore important to examine the comparative outcomes (live birth-producing pregnancy), costs, and cost-effectiveness of primary offer of IVF, compared with primary offer of IUI followed by IVF for couples failing IUI. Methods Mathematical modelling was used to estimate comparative clinical and cost effectiveness of either primary offer of one full IVF cycle (including frozen cycles when applicable) or "IUI + IVF" (defined as primary IUI followed by IVF for IUI failures) to a hypothetical cohort of subfertile couples who are eligible for both treatment strategies. Data used in calculations were derived from the published peer-reviewed literature as well as activity data of local infertility units. Results Cost-effectiveness ratios for IVF, "unstimulated-IUI (U-IUI) + IVF", and "stimulated IUI (S-IUI) + IVF" were £12,600, £13,100 and £15,100 per live birth-producing pregnancy respectively. For a hypothetical cohort of 100 couples with unexplained or mild male factor subfertility, compared with primary offer of IVF, 6 cycles of "U-IUI + IVF" or of "S-IUI + IVF" would cost an additional £174,200 and £438,000, representing an opportunity cost of 54 and 136 additional IVF cycles and 14 to 35 live birth-producing pregnancies respectively. Conclusion For couples with unexplained and mild male factor subfertility, primary offer of a full IVF cycle is less costly and more cost-effective than providing IUI (of any modality) followed by IVF.
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Khalaf Y, Ross C, El-Toukhy T, Hart R, Seed P, Braude P. The effect of small intramural uterine fibroids on the cumulative outcome of assisted conception. Hum Reprod 2006; 21:2640-4. [PMID: 16790615 DOI: 10.1093/humrep/del218] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of small intramural fibroids on the cumulative pregnancy, ongoing pregnancy, live birth and implantation rates after three IVF/ICSI attempts. METHODS The first three treatment cycles of women enrolled for IVF/ICSI over a 12-month period were analysed. Only patients with small (<or=5 cm) intramural fibroids not encroaching upon the endometrial cavity were included in the fibroid group. Cox's hazards regression was used to estimate the hazard ratio (HR) associated with the presence of intramural fibroids. RESULTS During the study period, 322 women without fibroids (control group) and 112 women with fibroids (study group) underwent 606 IVF/ICSI cycles. The pregnancy, ongoing pregnancy and live birth rates in the study group were 23.6, 18.8 and 14.8% compared with 32.9, 28.5 and 24% in the control group, respectively (P<0.05). Cox regression analysis showed that the pregnancy rate at each cycle was reduced by 39% (HR=0.61, 95% CI=0.39-0.95, P=0.029) in the study group compared with the control group. The cumulative ongoing pregnancy rate was reduced by 43% (HR=0.57, 95% CI=0.35-0.91, P=0.018), and the cumulative live birth rate was reduced by 47% (HR=0.53, 95% CI=0.32-0.87, P=0.013) in the study group. After adjusting for confounding variables, the presence of fibroids was found to significantly reduce the ongoing pregnancy rate at each cycle of IVF/ICSI by 40% (HR=0.60, 95% CI=0.36-0.99, P=0.048) and the live birth rate at each cycle by 45% (HR=0.55, 95% CI=0.32-0.95, P=0.03). CONCLUSION Small intramural fibroids are associated with a significant reduction in the cumulative pregnancy, ongoing pregnancy and live birth rates after three IVF/ICSI cycles.
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318
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Lahoud R, Al-Jefout M, Tyler J, Ryan J, Driscoll G. A relative reduction in mid-follicular LH concentrations during GnRH agonist IVF/ICSI cycles leads to lower live birth rates. Hum Reprod 2006; 21:2645-9. [PMID: 16785261 DOI: 10.1093/humrep/del219] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effect of early- and mid-follicular LH concentrations on the ovarian response and pregnancy outcomes was evaluated in women receiving pituitary down-regulation with a GnRH agonist and ovarian stimulation with recombinant FSH (rFSH) during IVF/ICSI treatment. METHODS Blood samples were collected prospectively from 701 cycles (560 patients) of assisted reproduction and analysed retrospectively. On the basis of LH concentrations on stimulation day 7/8, the patients were divided into two groups: LH<1.2 IU/l (n=179) and LH>or=1.2 IU/l (n=522). Cycle outcomes were also compared on the basis of a ratio of mid- to early-follicular LH concentrations (<or=0.5, n=210; >0.5, n=491). RESULTS Patients with low LH concentrations were found to have a significant reduction in the late-follicular estradiol concentrations (P<0.001), the number of oocytes retrieved (P<0.01) and the number of usable embryos (P<0.01), and they required significantly more rFSH (430 IU difference, P<0.01). These differences did not translate into a significant change in live birth rates. Conversely, a ratio of <or=0.5 mid- to early-follicular LH concentrations (a reduction of >or=50%) was associated with a significant reduction in live birth rates per embryo transfer and per cycle started (27.3 versus 19.0%, P<0.05 and 22.2 versus 15.8%, P<0.05, respectively). CONCLUSIONS Low mid-follicular levels of LH have a significant impact on ovarian response but not on live birth rates. A fall in LH level of >or=50% from the early- to mid-follicular phase resulted in a lower live birth rate.
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Estes SJ, Missmer SA, Ginsburg ES. Should a patient's own IVF physician perform the embryo transfer? J Assist Reprod Genet 2006; 23:235-9. [PMID: 16755401 PMCID: PMC3454914 DOI: 10.1007/s10815-006-9045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2005] [Accepted: 12/16/2005] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To compare pregnancy rates of embryo transfers performed by a patient's own IVF physician to pregnancy rates of embryo transfers performed by other physicians on the IVF team. METHODS Retrospective cohort study; University hospital. RESULTS A total of 3029 embryo transfers were included. 434 patients (14%) had an embryo transfer by their own IVF physician. There was no difference in pregnancy rates comparing patients who had embryos transferred by a different physician than their own IVF physician when all cycle attempts were analyzed [Odds ratio (OR) 1.1; Confidence interval (CI) 0.9-1.4]. There was no significant difference between the groups' population characteristics. A subset analysis of 1st cycle only embryo transfers (n=1416) also revealed no difference in pregnancy rates [OR 1.1; CI 0.8-1.5]. CONCLUSIONS Patients can be reassured that their chances of pregnancy are the same whether their embryo transfer is performed by their own physician or another physician in the practice.
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Esinler I, Bozdag G, Aybar F, Bayar U, Yarali H. Outcome of in vitro fertilization/intracytoplasmic sperm injection after laparoscopic cystectomy for endometriomas. Fertil Steril 2006; 85:1730-5. [PMID: 16690058 DOI: 10.1016/j.fertnstert.2005.10.076] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Revised: 10/31/2005] [Accepted: 10/31/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the impact of prior unilateral or bilateral endometrioma cystectomy on controlled ovarian hyperstimulation (COH) and intracytoplasmic sperm injection (ICSI) outcome. DESIGN Retrospective case-control study. SETTING Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Ankara, Turkey. PATIENT(S) Fifty-seven consecutive infertile patients were enrolled who had previously undergone unilateral (n = 34) or bilateral (n = 23) laparoscopic cystectomy for endometriomas more than 3 cm in diameter and underwent ICSI. The control group consisted of 99 patients with tubal factor infertility. INTERVENTION(S) Controlled ovarian hyperstimulation and ICSI. MAIN OUTCOME MEASURE(S) Cycle cancellation rate, number of oocytes, fertilization rate, embryo quality, clinical pregnancy rate (PR), and implantation rate. RESULT(S) The mean number of oocytes, metaphase II oocytes, and two-pronucleated oocytes were significantly lower in the bilateral cystectomy group compared to the unilateral cystectomy and control groups. However, all other parameters, including fertilization rate, the mean number of embryos transferred, the mean number of grade 1 embryos transferred, the clinical PR per embryo transfer, and implantation rate, were comparable among the three groups. Within the unilateral cystectomy group, the mean number of oocyte retrieved from the operated site was significantly less than in the contralateral nonoperated site. CONCLUSION(S) Laparoscopic endometrioma cystectomy does reduce the ovarian reserve. However, diminished ovarian reserve does not translate into impaired pregnancy outcome.
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Lane DE, Vittinghoff E, Croughan MS, Cedars MI, Fujimoto VY. Gonadotropin stimulation demonstrates a ceiling effect on in vitro fertilization outcomes. Fertil Steril 2006; 85:1708-13. [PMID: 16690059 DOI: 10.1016/j.fertnstert.2005.11.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Revised: 11/14/2005] [Accepted: 11/14/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the effect of number of oocytes retrieved and number of 2PN embryos developed on in vitro fertilization (IVF) outcomes. DESIGN Retrospective data analysis. SETTING University practice. PATIENT(S) Reproductive-aged women (n = 467). INTERVENTION(S) First fresh nondonor cycle of IVF. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate RESULT(S) Clinical pregnancy rates increase until age 30 (odds ratio (OR) 1.72 per year (95% confidence interval 1.19-2.49)) before demonstrating a linear decline. In subjects < 37 years old, maximal clinical pregnancy rates are seen when 20 oocytes were retrieved (OR 1.03 (0.96-1.11)), five 2-pronuclei (2PN) embryos developed (OR 1.91 (1.29-2.87)), and no more than two embryos transferred (OR 0.72 (0.56-0.92) for each additional embryo transferred > 2). In subjects > or = 37 years old, maximum clinical pregnancy rates were achieved in subjects who had ten oocytes retrieved (OR 1.09 (1.01-1.18)), 20 2PN embryos developed (OR 1.29 (1.03-1.62)), and no more than two embryos transferred (OR 0.72 (0.56-0.92) for each additional embryo transferred > 2). CONCLUSION(S) The odds of achieving a successful clinical pregnancy with IVF are greatest with retrieval of approximately 20 oocytes, transfer of no more than 2 embryos, and the development of about five 2PN embryos in women < 37 years old and ten 2PN embryos in women > or = 37 years old.
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Kwee J, Schats R, McDonnell J, Schoemaker J, Lambalk CB. The clomiphene citrate challenge test versus the exogenous follicle-stimulating hormone ovarian reserve test as a single test for identification of low responders and hyperresponders to in vitro fertilization. Fertil Steril 2006; 85:1714-22. [PMID: 16650416 DOI: 10.1016/j.fertnstert.2005.11.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Revised: 11/23/2005] [Accepted: 11/23/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study was designed to compare the exogenous FSH ovarian reserve test (EFORT) versus the clomiphene citrate challenge test (CCCT), basal FSH, and basal inhibin B, with respect to their ability to predict poor and/or hyperresponders in an IVF population. DESIGN Prospective randomized controlled trial. SETTING Fertility center of a university hospital. PATIENT(S) One hundred ten patients undergoing their first IVF cycle, randomized into two groups. INTERVENTION(S) Fifty-six patients underwent a CCCT, and 54 patients underwent an EFORT. In all patients, the test was followed by an IVF treatment. MAIN OUTCOME MEASURE(S) Ovarian response, expressed by the total number of retrieved oocytes. RESULT(S) Univariate logistic regression showed that the best predictor for poor response is the CCCT (area under receiver operator characteristic curve [ROC-AUC] = 0.87), with maximal accuracy of 0.89. Multiple logistic regression analysis did not produce a better model in terms of improving the prediction of poor response. For hyper response, univariate logistic regression showed that the best predictor is the inhibin B increment in the EFORT (ROC-AUC = 0.92) but with a low maximal accuracy of 0.78. Again, multiple logistic regression analysis did not produce a better model in terms of predicting hyper response. CONCLUSION(S) Our study, the first which compares the CCCT with the EFORT for the prediction of poor and hyperresponders, shows that the CCCT is superior for identification of low responders. The EFORT (inhibin B increment) is superior for prediction of hyper response at the cost of a high rate of false positives. Neither of the two tests seems adequate to act alone for identification of both poor and hyperresponders.
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Shen S, Rosen MP, Dobson AT, Fujimoto VY, McCulloch CE, Cedars MI. Day 2 transfer improves pregnancy outcome in in vitro fertilization cycles with few available embryos. Fertil Steril 2006; 86:44-50. [PMID: 16730718 DOI: 10.1016/j.fertnstert.2005.12.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2005] [Revised: 12/06/2005] [Accepted: 12/06/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Delaying ET to day 3 to optimize embryo selection is well accepted. However, in cases where there are not enough embryos to perform selection, it is not clear whether there is a difference in clinical outcomes with the day of ET. DESIGN Cohort study. SETTING Academic medical center. PATIENT(S) Two hundred forty-two fresh IVF/intracytoplasmic sperm injection (ICSI) cycles from 2002-2004, where all generated embryos were transferred irrespective of quality because of an extremely low number of available embryos. INTERVENTION(S) In time period 1, ET was on day 3. In time period 2, ET was on day 2. MAIN OUTCOME MEASURE(S) Patient response to stimulation was analyzed along with pregnancy outcome and implantation rate. RESULT(S) Miscarriage rates were decreased, and ongoing pregnancy rates were increased with a day 2 ET in patients <40 years of age. CONCLUSION(S) In women <40 years of age, the day of transfer is a significant predictor of clinical outcome in cases in which a low number of embryos are available for transfer. The evidence suggests that limiting embryo culture to only 2 days reduces the incidence of miscarriage and increases ongoing pregnancy rates.
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Frattarelli JL, Gerber MD. Basal and cycle androgen levels correlate with in vitro fertilization stimulation parameters but do not predict pregnancy outcome. Fertil Steril 2006; 86:51-7. [PMID: 16716312 DOI: 10.1016/j.fertnstert.2005.12.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 12/12/2005] [Accepted: 12/12/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate androgen levels before and during IVF. To assess for an association between androgen levels and IVF stimulation parameters or IVF pregnancy outcome. DESIGN Prospective cohort study. SETTING Residency-based IVF program. PATIENT(S) One hundred seventeen infertility patients. INTERVENTION(S) Androgen levels were evaluated on basal day 3 and during the IVF stimulation cycle. MAIN OUTCOME MEASURE(S) Pregnancy outcome rates and IVF stimulation parameters. RESULT(S) Mean serum androgen levels did not differ among different pregnancy outcomes. Multiple linear regression analysis revealed that body mass index (BMI) and oocyte number had a significant positive association with basal testosterone levels. Mean ovarian volume correlated negatively and follicle number correlated positively with testosterone levels on day 6 of stimulation. Peak E(2) and BMI correlated positively with testosterone on day of hCG administration. The interval change in androgen levels throughout the IVF cycle was not associated with outcome rates. Likewise, threshold analysis did not reveal any significant androgen level that affected pregnancy outcome. CONCLUSION(S) Serum androgen levels during IVF correlate with IVF stimulation parameters. However, these data do not support an influence of serum androgen levels on IVF pregnancy outcome rates.
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Wen X, Tozer AJ, Butler SA, Bell CM, Docherty SM, Iles RK. Follicular fluid levels of inhibin A, inhibin B, and activin A levels reflect changes in follicle size but are not independent markers of the oocyte's ability to fertilize. Fertil Steril 2006; 85:1723-9. [PMID: 16650414 DOI: 10.1016/j.fertnstert.2005.11.058] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Revised: 11/08/2005] [Accepted: 11/08/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the biochemical relationship between follicular/oocyte maturity and follicular inhibins and activin levels. DESIGN Prospective study. SETTING Research laboratory in university hospital. PATIENT(S) Thirty-five women undertook IVF/ICSI program. INTERVENTION(S) Individual follicular fluid aspirations, oocyte isolation, follicular fluid storage. MAIN OUTCOME MEASURE(S) Inhibin A, inhibin B, and activin A concentrations, oocyte retrieval, and fertility outcome. RESULT(S) Inhibin A, inhibin B, and activin A concentrations varied from 7.9 to 436 ng/mL, 9.7 to 786 ng/mL, and 1.7 to 267.9 ng/mL, respectively. There was no change of inhibin A concentrations, whereas inhibin B and activin A concentrations dropped dramatically as the follicles enlarged. Total follicular content of inhibin A and activin A increased, and inhibin B remained constant. Both inhibin A and inhibin B levels were significantly higher in those follicles from which an oocyte could be recovered, but they did not differ with respect to subsequent oocyte fertilization. CONCLUSION(S) Inhibin A is actively produced throughout follicular growth to retain a set concentration. In contrast, inhibin B appears not to be actively produced, and the concentration drops as follicles enlarge. Activin A concentrations also decrease, but there is some extra synthesis. Higher levels of inhibin A and B are associated with oocyte presence but not with fertilization rates.
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