Successful pregnancies from cryopreserved human embryos produced by in vitro fertilization

Sixty-three embryos produced after in vitro fertilization in 30 infertile couples were frozen and stored. Dimethylsulfoxide was used as a cryoprotectant and embryos were frozen from the two-cell stage to early blastocyst development. Replacement occurred during spontaneous ovulatory cycles 2 to 15 months after embryo freezing. Embryo replacement was performed 3 to 6 days following identification of the luteinizing hormone surge in the spontaneous cycle. Thirty-five embryos were replaced into 25 women and two viable pregnancies resulted.

Oocyte pickup by laparoscopy replaced by transvaginal aspiration in an in vitro fertilization program

The results of laparoscopic (lap) and transvaginal (TV) oocyte pickups (OPUs) performed concurrently for in vitro fertilization in 232 consecutive treatment cycles have been reviewed. The patients were compared for age, preoperative estradiol concentration, luteal-phase support, and number of follicles aspirated and were found to be similar but were not matched for cause of infertility. The lap OPU group had more oocytes recovered per follicle aspirated (P less than 0.001), but because of a lower fertilization rate (P less than 0.01), the number of embryos transferred was similar. Nevertheless, more (P less than 0.05) pregnancies occurred in the TV OPU group. Patients were subgrouped so that comparisons of patients with the same cause of infertility, tubal disease alone, were considered. This showed that the pregnancy rate was still higher in the TV OPU group (P less than 0.05). TV OPU was less painful and not associated with increased morbidity, and since the data suggest that TV OPU was at least as successful as lap OPU, it is recommended that all oocyte pickups in the future be performed transvaginally.

Are ultrasonic-guided follicular aspiration and flushing safe for the oocyte?

Oocyte collection was carried out in 53 patients by ultrasonically guided abdominal puncture under local or epidural anesthesia. Follicles were aspirated and flushed two to six times using a syringe with culture medium. A total of 196 oocytes was collected and 84 of those (42.9%) were found in the flushes. Mechanical damage was observed in 5.1% of the oocytes. Cleavage rates in mature oocytes (157) after 48 hr in culture were similar in the aspirate group (56.5%) and in the flush group (54.2%). Ten clinical pregnancies were obtained, corresponding to a pregnancy rate of 18.9%.

The effect of serum fractions on single-cell mouse embryos in vitro

To examine the effect of various fractions of human fetal cord serum (HCS) on mouse embryos cultured in vitro, heat-inactivated HCS was separated by ultrafiltration into five distinct fractions: Fractions A, MW greater than 30,000; B, MW 30,000-10,000; C, MW 10,000-5,000; D, MW 5,000-1,000; and E, MW less than 1,000. Seven hundred twenty-eight single-cell embryos were cultured in TYH-280 medium supplemented with 8 mg/ml bovine serum albumin (BSA) and a 20% concentration of Fraction A, B, C, D, or E, whole HCS, or BSA alone. Embryos cultured with Fraction A or E or whole HCS demonstrated a significantly reduced growth rate (P less than 0.01), while embryos cultured with Fraction D demonstrated a significantly increased growth rate (P less than 0.01). Additionally, 649 single-cell embryos were cultured in medium which was supplemented with 8 mg BSA/ml and a 0, 1, 2, or 5% concentration of Fraction A or E. Fraction E displayed toxicity even at a 1% concentration (P less than 0.01), while Fraction A demonstrated growth inhibition at a 5% concentration (P less than 0.05) but increased the hatching rate at a 1% concentration (P less than 0.01). Finally, 635 single-cell embryos were cultured with four distinct fractions of HCS obtained from a Sephacryl S-200 column: Fractions I, MW 100,000; II, MW 70,000-100,000; III, MW 30,000-70,000; and IV, low molecular weight (less than 5,000).(ABSTRACT TRUNCATED AT 250 WORDS)

Attempts to stimulate multiple follicular growth for IVF by administration of pulsatile LHRH

Administration of pulsatile LHRH (14.4 microgram/pulse per 90 min) from day 5 to 9, or day 7 to 11 of the cycle following clomiphene pretreatment on days 2-6 induced multiple follicular growth for oocyte recovery for in vitro fertilisation. Administration of LHRH without clomiphene pretreatment failed to induce multiple follicular development. The same group of patients treated with clomiphene alone had fewer numbers of mature follicles, fewer oocytes recovered and less pre-embryos for transfer than when treated with clomiphene and LHRH in combination. Peak gonadotrophin release following commencement of LHRH was seen within the first 24 h of administration with a gradual fall in both LH and FSH toward baseline pretreatment values by the fourth day of administration. A discernible LH increment to LHRH was still present on the fourth day of LHRH treatment, but in many individuals no FSH increment was observed. The preovulatory oocytes recovered were predominantly mature with fertilisation rates of 70% and 85.7% for the two regimens. No pregnancy occurred in the six patients who underwent pre-embryo transfer.

In vitro fertilization at the Leiden Academic Hospital. Initial experiences

At the Leiden University Hospital the first IVF treatment was initiated November 1st, 1985. In the following year 139 cycles with ovarian stimulation have been started with 75 patients. Thirty percent of these stimulations have been cancelled before oocyte retrieval due to suboptimal response. Totally 97 pick-ups have been carried out on 65 patients resulting in 78 embryo transfers to 54 patients. Fourteen clinical pregnancies were obtained. Four ended with a first trimester abortion, one was a tubal pregnancy and 9 are ongoing or have been already delivered.

[Ovulation induction for in vitro fertilisation at the Tygerberg Hospital]

The protocol for in vitro fertilisation (IVF) at Tygerberg Hospital is presented and the results are analysed. Indications for ovulation induction for IVF included the following: (a) irreversible tubal damage; (b) infertility due to immunological factors; (c) male factor-infertility; and (d) endometriosis. A combination of human menopausal gonadotrophin (HMG) and clomiphene citrate (Clomid; Mer-National) and human chorionic gonadotrophin was used. Clomid is given in dosages of 100 mg for 5 days depending on the cycle length. Three doses of HMG (150 IU) are given on alternate days, starting on the second day of clomiphene treatment. If the leading follicle has not reached a mean diameter of 14 mm the day after the last HMG dose, another dose is given. This dosage is continued until the leading follicle reaches a diameter of 14 mm. A total of 109 cycles in 100 patients was analysed. Ova were considered to be mature as soon as the dominant follicle had reached a sonographic average diameter of 18 mm, another two follicles of 16 mm average diameter being present. Serum luteinising hormone levels were determined 4-hourly from the stage when the leading follicles exceeded an average diameter of 14 mm. In this study the pregnancy rate was 21,3% per laparoscopy and 24,4% per embryo transfer. The oestradiol levels on the 5th day of treatment have a predictive value of the length of stimulation.

A self-migration method for preparation of sperm for in-vitro fertilization

Human sperm samples (n = 211) were prepared for in-vitro fertilization (IVF) and embryo transfer by a self-migration procedure in Earle's medium containing highly purified hyaluronic acid (Hya) (MW 3,000,000) included to increase the viscosity of the medium. The method resulted in the recovery of a significantly higher percentage of motile spermatozoa compared with the traditional centrifugation method, 87.5 +/- 0.9% versus 76.1 +/- 1.3% (P less than 0.001). When comparing media with and without Hya in the self-migration method for preparation of normal sperm samples, the media containing Hya resulted in the recovery of a significantly higher percentage of motile spermatozoa, 89.0 +/- 0.8% versus 73.8 +/- 2.0% (P less than 0.001). In a group of 80 consecutive couples entering our IVF programme, sperm samples from 44 of the men were allocated at random for the self migration method in medium containing Hya and sperm samples from 36 men for preparation by centrifugation and swim-up. Significantly more pregnancies were achieved in the group prepared in medium containing Hya. It is concluded that self-migration of sperm in a medium containing Hya is simple and rapid, and results in a high recovery of motile spermatozoa which can be used for in-vitro insemination of human oocytes with favourable results.

Gamete intra-Fallopian transfer: evaluation of 100 consecutive attempts

The results of 100 gamete intra-Fallopian transfer (GIFT) procedures to treat persistent infertility are reported. Twenty-four pregnancies were achieved, of these six aborted, two were extra-uterine, two stillbirths occurred and nine patients delivered 11 healthy children (two sets of twins) and five pregnancies are progressing well, including two sets of twins. Pregnancy rate in the different groups of patients was: 28% for idiopathic infertility (n = 39), 13% for male infertility (n = 16), 22% for endometriosis (n = 27), and 29% in the presence of antisperm antibodies (n = 7). In our GIFT procedure, we place three oocytes and 50,000 to 100,000 motile spermatozoa per patient into one healthy tube, the remaining oocytes being inseminated and cultured in vitro. Of 502 oocytes recovered, 252 fertilized normally and 178 early embryos were frozen. The replacement of 41 frozen-thawed embryos resulted in five additional, ongoing pregnancies. The combined treatment by gamete intra-Fallopian transfer, in-vitro fertilization and cryopreservation increases the chance of conception.

Outpatient in vitro fertilization using transvaginal ultrasound-guided oocyte retrieval

Of 80 patients who initiated in vitro fertilization cycles in an integrated outpatient facility, 61 had oocyte retrievals performed under local anesthesia with ultrasound-guided transvaginal aspiration of ovarian follicles. Ten patients conceived, all in the group of 49 who had human chorionic gonadotropin (hCG)-timed retrievals. Our results indicate that in vitro fertilization can be performed to a high standard with this method, with excellent patient acceptance and reduced cost without general anesthesia, laparoscopy, or in-hospital setting.

In vitro fertilization and embryo transfer in domestic animals: applications in animals and implications for humans

Extensive research has been conducted in domestic animals, particularly in cattle, in the reproductive technologies of sperm handling, capacitation, and acrosome reaction, superovulation, and embryo handling, sexing, bisection, cryopreservation, and transfer. Because of the economic importance of cattle these technologies have been tested and improved under clinical conditions. The results of employing these procedures are available on tens of thousands of pregnancies and offspring. This information has implications in applying some of the same technologies in human reproduction. The large number of normal progeny produced in cattle after a long prenatal development period, similar to humans, provides some assurance that these technologies, carefully applied, are safe. The basis for these conclusions is documented in the publications cited in this review.

Incidence of chromosome anomalies in first-cleavage mouse embryos obtained from frozen-thawed oocytes fertilized in vitro

To assess the effect of low temperature storage on mouse oocytes we (1) examined the capacity for normal development of embryos derived from frozen oocytes fertilized in vitro after transfer to pseudopregnant foster mothers and (2) analyzed the chromosome complement at the first cleavage division. Fewer frozen than control oocytes were fertilized (36% vs 66%), but after embryo transfer the proportion of fertilized eggs that implanted (67-68%) and formed normal foetuses (50-53%) was similar in the two groups. Freezing did not affect the observed incidence of aneuploidy (1.5-3.3%). The frequency of polyploid embryos derived from frozen oocytes was almost double that of controls (15.8% vs 8.5%), but it is unclear whether this is a real effect of freezing or is an artifact produced by the chromosome preparation technique.

Importance of semen preparation in avoidance of reduced in vitro fertilization results attributable to bacteria

Although the physical treatment of semen for IVF and related procedures is sufficient to remove most organisms present in semen, the pathogenic varieties tend to be more resistant. The supplementation of oocyte culture medium with both penicillin and streptomycin was associated with the eradication of 100% of organisms in the current study. In these circumstances, the presence of pathogenic organisms in the untreated semen is not associated with reduced oocyte fertilization in vitro.

Effect of liquid storage and cryopreservation of boar spermatozoa on acrosomal integrity and the penetration of zona-free hamster ova in vitro

The effect of liquid storage and cryopreservation of boar spermatozoa on sperm motility, acrosomal integrity, and the penetration of zona-free hamster (ZFH) ova was examined. The sperm penetration assay (SPA) provides valuable information on specific events of fertilization and is a potentially useful indicator of sperm fertility. Ejaculated semen from 4 boars was subjected to 3 treatments: fresh (FRE, no storage), liquid-stored (LIS, stored at 18 degrees C for 3 days), and frozen (FRO, frozen by pellet method and stored at -196 degrees C for 3 days). A highly motile sperm population was isolated by the swim-up procedure (1 hr). FRE and LIS were incubated an additional 3 hr at 39 degrees C in a Tris-buffered medium to elicit capacitation and the acrosome reaction. Sperm motility and acrosomal integrity were assessed before and after incubation. For the SPA, sperm and eggs were incubated at 39 degrees C for 3 hr in Hams F-10 medium. Each egg was assessed for sperm penetration, sperm binding, and stage of development. Percentages of sperm motility and sperm with a normal apical ridge (NAR) prior to incubation were 78 and 78 (FRE), 75 and 69 (LIS), and 28 and 50 (FRO). After incubation, percentages of motility, NAR, and acrosome-reacted sperm were 34, 10, and 73 (FRE); 43, 24, and 51 (LIS); and 18, 13, and 59 (FRO). A somewhat higher (P less than .05) percentage of ZFH ova was penetrated by FRE (45.8) than by LIS (42.0). Penetration of ZFH ova by FRO was markedly (P less than .05) reduced (30.2). Sperm penetration was not significantly correlated with motility or acrosomal integrity before or after incubation, regardless of treatment. These data suggest that the SPA can be used in conjunction with conventional measures of semen analysis in assessing the potential fertilizing capacity of boar sperm and that liquid storage is superior to frozen storage with respect to preserving sperm fertility.

Phase II of a successful university-based in vitro fertilisation programme. Changes incorporated

the ultimate goal of any clinical programme treating infertility by means of in vitro fertilisation and embryo replacement is to maximise the number of patients who become pregnant in a treatment cycle. A 12% pregnancy rate was previously reported from this unit. Following the instigation of changes and further modifications, an overall success rate of 27% per patient was obtained in phase II. The reasons for this improved success are hard to pinpoint, but experience and changes in methodology probably play a role. These changes are described and the results discussed.

In vitro fertilization with normal development in the sheep

Ovine tubal (n = 87) and ovarian in vitro matured oocytes (n = 99) were fertilized in vitro with ejaculated spermatozoa capacitated for 8 h in modified defined medium buffered with Hepes. High levels of fertilization were obtained as assessed by development to two- to six-cell stage within 40 h (75.8% for ovulated and 62.6% for in vitro matured oocytes). Electron microscope analysis of oocytes 20-22 h after insemination indicated that in vitro fertilization approximated the in vivo events. Embryos (two- to six-cell) were transferred surgically to the oviducts of pseudopregnant rabbits. Three days later, 42 (from ovulated oocytes) and 15 (from in vitro matured oocytes) embryos were recovered; 26 (61.9%) and 10 (66.6%), respectively, had cleaved at least once. Embryos incubated in vivo (n = 20 from ovulated oocytes; n = 9 from in vitro matured oocytes) were transferred surgically to the uteri of seven and four recipient ewes resulting in four and two pregnancies, respectively, from which three and one, respectively, have been maintained (greater than 3 months). The first lamb resulting from the in vitro fertilization of an ovulated oocyte was born. In addition, six embryos (two- to four-cell) from tubal oocytes and ten embryos (two- to six-cell) from in vitro matured oocytes were directly transferred to the oviducts of two and three ewes, respectively. Two pregnancies resulting from in vitro matured fertilized oocytes are in progress (greater than 3 months).

Transvaginal recovery of oocytes for in vitro fertilization using vaginal ultrasound

Vaginal recovery of oocytes for in vitro fertilization (IVF) was performed in 75 patients using a vaginal puncture transducer. Follicles were aspirated and flushed four times using a controlled vacuum. Oocytes were collected in 74 patients and an average of 5.1 oocytes was collected per patient. An average of 8.8 follicles was aspirated per procedure, giving an oocyte recovery rate of 58% per follicle. Pregnancy was obtained in seven patients (9.3%). The only complication was bleeding from the vagina of an estimated 40 ml in one case.

Diagnostic laparoscopy v. combined screening laparoscopy and timed follicle aspiration for in vitro fertilisation

Results from ovulation induction and laparoscopic oocyte retrieval for in vitro fertilisation and embryo transfer were compared in two groups of patients to determine whether oocyte retrieval subsequent to diagnostic laparoscopy had specific advantages over combined screening laparoscopy and timed follicle aspiration. There were no statistically significant differences in any of the factors investigated in the two groups. This study was useful in demonstrating firstly that there are no absolute criteria for selection of patients for either diagnostic or combination laparoscopy. Secondly, the procedure of choice is a combined screening laparoscopy and timed follicle aspiration if a patient is willing to accept a failure rate of 7.4% (2/27 in this study) due to ovarian inaccessibility.

Mouse embryo growth in different culture media: selection of a medium for quality control cross-testing of human in vitro fertilization conditions

A total of 2070 two-cell mouse embryos were recovered from 89 superovulated female hybrid mice. Six different culture media were tested. The various media supported mouse embryo development as follows (percentage mean +/- SD, n = 10): Hopp and Pitts medium (H&P) 87 +/- 5 Dulbecco's modified; Eagle's medium supplemented with 10% (volume/volume, v/v) fetal bovine serum (DMEM) 80 +/- 4; Ham's F-10 +/- 15.0% (v/v) human fetal cord serum (hFCS) 79 +/- 3; Whittingham's T-6 medium (WT-6) 60 +/- 4; Ham's F-10 +/- 7.5% (v/v) hFCS 55 +/- 5; Krebs-Ringer low bicarbonate buffer (KRLBB) 42 +/- 6. In H&P, DMEM, WT-6, and Ham's F-10 medium supplemented with hFCS, the pH was maintained within a narrow range of 7.30-7.45 and adequate level of oxygenation was achieved during 72 h in culture. KRLBB had poor buffering capacity and attained ineffective levels of oxygenation during culture. Superior mouse embryo development from two-cells to morulae and hollow blastocysts occurred in H&P, Ham's F-10 + 15% hFCS, and DMEM. Ham's F-10 medium supplemented with hFCS is routinely checked for its ability to support mouse two-cell embryo development to morulae and blastocysts. This is done in conjunction with H&P medium as the control.

Improvement in the quality and fertilization potential of a human sperm population using the rise technique

Semen from 63 individuals participating in an in vitro fertilization program was processed using a modified rise technique. Overall normal morphology was significantly improved in the rise (79.2%) as compared with the unprocessed sample (57.8%), and six of seven specific morphologic abnormalities were significantly reduced. Motility was significantly enhanced from 51.8% in the unprocessed samples to 89.1% in the rise samples. Spermatozoa recovered in the rise portion of the sample represented 5.9% of the total sample. Ultrastructural morphometry revealed that the rise was relatively free of abnormal sperm forms, acellular debris and non-sperm cellular elements as compared with the non-rise portion of the sample or a typical unprocessed sample. Volume density measurements demonstrated that only 18.1% of the volume of the non-rise sample was composed of normal spermatozoa compared with 83.4% of the volume of the rise. In a separate set of experiments utilizing 21 samples, the penetration of hamster eggs was significantly enhanced from 37.9% to 67.2% using spermatozoa from the initial washed sample and those from the rise, respectively. These data demonstrate the qualitative and quantitative improvements, as well as the increase in fertilizing potential, of the rise portion of the semen sample.

Serum progesterone levels in women treated with human menopausal gonadotropin and human chorionic gonadotropin for in vitro fertilization

For evaluation of the adequacy of luteal function after in vitro fertilization-embryo transfer (IVF-ET), serum progesterone (P) levels were measured on days 3, 7, and 10 after laparoscopic follicle aspiration. Fifty-six infertile patients were treated during 86 cycles with human menopausal gonadotropin-human chorionic gonadotropin (hMG-hCG) for stimulation of follicular development. Serum estradiol (E2) levels were measured daily during hMG-hCG treatment. P levels were determined in 67 cycles. The mean (+/- standard deviation [SD]) of the sums of 3 P levels was 55.63 +/- 24.13 ng/ml. There were 11 pregnancies. The mean of the sums of 3 P levels of pregnant patients was 64.45 +/- 26.23 ng/ml and of 56 nonpregnant cycles was 53.90 +/- 23.35 ng/ml. The duration of luteal phase varied from 9 days to 15 days. The mean of the sums of 3 P values of patients with different luteal phase lengths ranged from 28.8 ng/ml to 60.51 +/- 25.68 ng/ml. The mean of the sums of 3 P levels of women with normal luteal phase and that of women with luteal phase defect by endometrial biopsy study were used as controls for comparison. There was poor correlation (r = 0.3441) between E2 peak levels and P levels; the sum of 3 P levels did not indicate luteal phase inadequacy in IVF-ET patients; and the majority of the nonpregnant cycles (32/56) showed a luteal phase of 11 days or less, in spite of adequate P levels.(ABSTRACT TRUNCATED AT 250 WORDS)

The perimenopausal patient in in vitro fertilization: the use of gonadotropin-releasing hormone

The perimenopause, incipient ovarian failure, is a major problem in stimulation failures during an in vitro fertilization program. This must be recognized as not necessarily related to age but also associated with adnexal inflammatory and operative processes. Although ovulation occurs uninterruptedly, the follicle-stimulating hormone in the early follicular phase is elevated and the luteinizing hormone is normal. Characteristically, there is no estradiol response to human menopausal gonadotropin therapy or a rapid response with a premature luteinizing hormone surge. These problems sometimes may be overcome with pulsatile intravenous gonadotropin-releasing hormone therapy, 5 or 10 micrograms/90 or 120 minutes. The major therapeutic problem is in the identification of a luteinizing hormone surge in these patients. Of eight women who were treated, two failed to respond with follicular maturation, three either had no oocytes aspirated from apparently postmature follicles or had postmature oocytes; and one had treatment cancelled due to ovulation. The four latter patients may have failed because of unrecognized ovulation. In the remaining two patients, one oocyte was fertilized and transferred, and one pregnancy occurred.

Does cyclic human chorionic gonadotropin secretion indicate embryo loss in in vitro fertilization?

The human chorionic gonadotropin (hCG) beta subunit curve of normal singleton in vitro fertilization (IVF) pregnancies shows cyclic peaks during the first 56 days after embryo transfer (ET). This phenomenon is not demonstrable in normal spontaneous conceptions. The hCG curves of 151 singleton IVF pregnancies achieved by transfer of two, three, and four embryos therefore were compared statistically with the hCG curves of singleton IVF pregnancies achieved by transfer of only one embryo. The hCG levels of singleton IVF pregnancies achieved by transfer of more than one embryo had statistically higher hCG levels at 7 and 8, 19 and 20, and 37 and 38 days after ET. In a separate evaluation it was observed that declines in hCG levels of normal singleton IVF pregnancies preceded four of five first-trimester abortion incidence peaks of singleton IVF pregnancies. The observed cyclic hCG secretion may be indicative of early embryo deaths. This observation supports the contention that multiple ET results in significantly more multiple implantations than previously appreciated. Thus embryo survival in utero may represent another major contributory factor to success or failure of IVF.

Undetected ovulation in in vitro fertilization-embryo transfer patients

A retrospective evaluation was done of 102 consecutive in in vitro fertilization-embryo transfer (IVF-ET) treatment cycles that culminated in surgical intervention for oocyte pickup. In 35% of these patients, a disparity was noted in the number of mature follicles present on the day of human chorionic gonadotropin administration, compared with the day of surgery. This suggests the occurrence of undetected ovulation. An endogenous luteinizing hormone (LH) surge was detected in 14 of these patients. Another cohort showed evidence of early luteinization without a detected endogenous LH surge. Finally, a group without early luteinization was defined. Possible explanations for these outcomes and the implications for success of IVF-ET are discussed.

The successful use of human amniotic fluid for mouse embryo culture and human in vitro fertilization, embryo culture, and transfer

The development of mouse and human embryos was assessed in human amniotic fluid to determine its suitability as a culture medium for human in vitro fertilization (IVF). Two-cell mouse embryos developed to blastocysts after 72 hours at rates similar to that in Whittingham's T6 + 10% fetal calf serum. Significantly more mouse embryos hatched in amniotic fluid. No difference was found between individual patient's amniotic fluids obtained at 16 to 21 weeks' gestation. A preliminary trial comparing amniotic fluid with T6 + maternal serum in human IVF showed no significant difference in fertilization rate and embryo development during 42 to 48 hours in vitro. Expanded blastocysts were obtained in amniotic fluid after 5 days in vitro. Four pregnancies were obtained in 9 patients' transferred embryos grown in amniotic fluid and with 2 or 12 patients' transferred embryos grown in T6 + maternal serum.

[Improved implantation rate following embryo transfer in an in vitro fertilization program]

In spite of the efforts made in in-vitro fertilization and embryo transfer in recent years, little progress has so far been made with regard to the pregnancy rate. While embryo transfer rates of over 80% are now being attained, the pregnancy rate achieved with extracorporal fertilization in the majority of study groups is well under 20%. Between 1981 and May 1986, 1088 laparoscopies were performed in our study group with the aim of follicle puncture and subsequent in-vitro fertilization and embryo transfer. A total of 171 pregnancies resulted from 832 embryo transfers. The pregnancy rate has been increased since 1981 to 21.2% at present (1986). Since April 1986 we have been using a modified embryo transfer procedure: in 25 patients embryo transfer has been accomplished under barbiturate anesthesia. Twelve of these patients have become pregnant, i.e., 48% of the embryo transfers. There are signs that this embryo transfer method will lead to a distinct improvement in the pregnancy rate. An attempt should be made to confirm these provisional results in a larger collective.

Factors influencing murine embryo bioassay: effects of proteins, aging of medium, and surgical glove coatings

The 2-cell murine embryo bioassay as quality control for human in vitro fertilization (IVF) was used to evaluate the effects of protein supplements, medium aging, and surgical glove coatings. Ham's F-10 medium (GIBCO, Grand Island, NY) without protein supplementation supported growth of the 2-cell embryos to blastocysts. Addition of bovine serum albumin (BSA), fetal cord serum (FCS), or maternal serum (MS) did not enhance or reduce the blastulation rates (medium alone, 89.4%; BSA, 86.4%; FCS, 90%; MS, 74.7%). Unsupplemented Ham's F-10 medium was found to contain three major peaks of approximately 50,000 daltons and several minor peaks, analyzed on high-performance liquid chromatography (HPLC) and sodium sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), suggesting the presence of protein(s) in the medium itself. The storing of medium up to 425 days at 4 degrees C affected neither the HPLC profile nor its ability to support embryo growth (blastulation rates: fresh, 84%; stored 150 to 425 days, 77.7%). The coating of surgical gloves affected embryo growth. Both talc-coated (TC) and "talc-free," starch-coated (SC) surgical gloves were found to be progressively embryotoxic when they touched the medium for increasing lengths of time, compared with uncoated latex (UL) gloves and untouched control medium. Quality control of medium preparation and handling in murine embryo bioassay is reemphasized, with requirements for protein supplementation, use of fresh medium, and possible contamination with even talc-free, SC surgical gloves reevaluated.

Transvaginal sonographically controlled ovarian puncture for oocyte retrieval for in vitro fertilization

Two hundred twenty-two patients took part in a trial of follicle puncture via the transvaginal route under sonographic control for the purpose of in vitro fertilization (IVF). Induction protocols were mainly human menopausal gonadotropin (hMG) + human chorionic gonadotropin (hCG) and clomiphene + hMC + hCG. In 79.7% oocyte aspiration could be achieved without difficulty via the transvaginal route. An average number of 4.7 oocytes per attempt was obtained; 10.7% evolutive pregnancies were obtained. No major incident was noted. This technique offers several crucial advantages: it reduces surgical risk, reduces the length of the patient's stay in hospital as well as the overall cost of the procedure, and it also makes possible puncture in some cases hitherto regarded as excluded.

Endotoxin-polluted medium in a human in vitro fertilization program

Optimal quality control measures to obtain the highest possible success rate for an in vitro fertilization and embryo transfer program is important in any program. Poor results obtained during a cycle where no pregnancies were achieved necessitated an investigation into possible causes. A suspected contamination of the multidistilled water utilized in medium preparation was confirmed. During a successful cycle with no endotoxins present, a pregnancy rate of 27.2% was achieved. This is higher than the 6.3% pregnancy rate achieved in another cycle where endotoxins were isolated in the media. This article illustrates cell morphologic and ultrastructural changes which could be ascribed to the presence of these endotoxins.

Successful fertilization, embryo development, and pregnancy in human in vitro fertilization (IVF) using a chemically defined culture medium containing no protein

A randomized control trial involving the fertilization and culture of human embryos in culture medium (T6) containing either 10% maternal serum or no protein or amino acid supplement was carried out to assess the effect of deletion from culture of all fixed nitrogen on fertilization, embryo development, and embryo viability. There was no difference in fertilization rates (68 vs 69%), development of apparently normal embryos (96 vs 97%), pregnancy rate (18 vs 14%), or birth rate (13 vs 11%) between protein-containing and protein-free media. Deletion of protein from the culture medium may enable the constitution of more appropriate and defined culture media for human in vitro fertilization (IVF).

Absence of predictive value of follicular inhibin on the results of human in vitro fertilization

During the periovulatory period, inhibin did not have a discriminant role in oocyte fertilizability. A possible role in the gonadotropin surge was not revealed by analysis at the time of follicular rupture. Furthermore, inhibin activity appears to be very low. But inhibin could still have an effect upon growth and atresia of the follicles of the following cycles.