Comparative study of ultrasonically guided percutaneous aspiration with local anesthesia and laparoscopic aspiration of follicles in an in vitro fertilization program

Twenty patients from our in vitro fertilization program were randomly divided into two groups. Ten women underwent follicular aspiration during laparoscopy while they were under general anesthesia and 10 women had an ultrasonically guided follicular aspiration with local anesthesia. All patients had mechanical infertility, and ovulation was induced with human menopausal gonadotropins. In both groups the same aspiration system with a needle of 1.4 mm inner diameter and a continuous suction at 120 mm Hg were used. In the laparoscopy group the oocyte recovery rate was 82.5% and the fertilization rate 62.5%, with one twin pregnancy; in the ultrasound group the oocyte recovery rate was 75%, and the fertilization rate 61.9%, with a singleton pregnancy. Implications of these results are discussed.

Simplification of the method of in vitro fertilization: sonographic measurements of follicular diameter as the sole index of follicular maturity

As a simplification of the in vitro fertilization (IVF) procedure, repeated sonographic scanning of follicular diameters in stimulated cycles was performed, until the largest visible follicle reached a mean diameter of at least 20 mm, at which time human chorionic gonadotropin (hCG) was administered. Follicle puncture was performed either guided by sonography or by laparoscopy 34-36 hr after the hCG injection, and following insemination oocytes were cultured for 48-60 hr before embryo transfer (ET). Serum levels of luteinizing hormone (LH), prolactin (PRL), and estradiol-17 beta (E2) at the time of hCG injection as well as follicular fluid levels of follicle stimulating hormone (FSH), LH, and PRL as well as progesterone (P), testosterone (T), and E2 at the time of puncture were determined in retrospect using specific radioimmunoassay (RIA). It was found that the knowledge of a single value of LH or E2 in serum should have been of little additional value for the decision to give hCG in all stimulation models used: clomiphene + hCG, human menopausal gonadotropin (hMG) + hCG, and clomiphene + hMG + hCG. The concentrations of the three steroids measured in follicular fluid were, in a high proportion of the follicles, within a normal range in all stimulation models. The group receiving clomiphene + hMG + hCG appeared promising through its higher proportion of estrogenic follicles. It is concluded that sonographic measurement of follicular diameters may be used as the sole index of follicular maturity in an IVF program.(ABSTRACT TRUNCATED AT 250 WORDS)

[Micromanipulatory sperm injection--a new method in the treatment of infertile males]

Three couples were selected for this preliminary sperm injection study with their consent, since in all three cases the zona free hamster egg penetration test was negative and in one couple previous attempts of in vitro fertilization were unsuccessful. Of 22 eggs, recovered from three patients, 9 from each patient 3 were injected with sperm, while the others were inseminated by the standard IVF-protocol. Before manipulating human eggs extended experiments were performed with animals eggs, so decreasing the rate of damage to under 10%. Additionally we optimized the method by using an individual adapted equipment. Manipulation was performed by penetration of the zona pellucida with a 5 to 7 mu thick injection pipet into the perivitilline space so damaging of the egg cytoplasm was avoided. This special technique for sperm injection was not used till now in this indication. From the nine eggs used in this experiment one egg developed a pronucleus and one egg developed to a four-cell stage. We could not achieve a pregnancy.

[Methodological study for human in-vitro fertilization related to maturity of gametes]

The correlations with maturity of gametes and fertilizability was studied. Specimens of semen were treated by several methods for induction of capacitation and acrosome reaction (AR). Follicular oocytes were recovered with endoscopic aspiration procedures, and divided to two groups: 1, maturing in vivo (preovulatory) and 2, immature. Immature oocytes were divided further into two subgroups: 1, germinal vesicle breakdown (GVBD) and 2, first polar body formation (FPB), after maturation culture. The sperms treated with the centrifuge-trypsinization-layering method showed a higher incidence of in-vitro fertilization (69.2%) and cleavage (51.3%) of human preovulatory eggs compared with other capacitation inducing methods. It was found that human spermatozoa that have undergone the acrosome reaction prior to zona attachment are capable of fertilizing eggs under the in vitro conditions. On the estimation of fertilizability with reference to egg maturity, 52.5% (21/40) of IMIV-GVBD and 64.7% (22/34) of IMIV-FPB eggs were fertilized. However, only 12.5% (5/40) of IMIV-GVBD and 11.8% (4/34) of IMIV-FPB eggs cleaved. These results showed that IMIV eggs had fair fertilizability, but no developmental capacity after the first cleavage. This may due to prematurity of the cytoplasm in IMIV eggs.

[Pregnancy after fertilization in vitro and embryo transfer]

The first 13 pregnancies established by in vitro fertilization and embryo transfer. A tubal factor was the main indication for in vitro fertilization (IVF) in 10 patients, whereas in three couples infertility was caused by the infertile sperm. The mean age and duration of infertility in female patients were 33.5 and 11.4 years, respectively. Multiple follicular growth was stimulated by either clomiphene citrate (100-150 mg during 5 days), clomiphene citrate + HMG + HCG, or HMG + HCG. Timing of ovulation was determined by assaying serum estradiol, progesterone and LH levels. The ultrasound monitoring of follicular growth was determined on a daily basis. Endogenous LH surge was observed in one patient, whereas in others 5000-10,000 IU HCG were needed to induce ovulation. All oocytes were recovered by laparoscopy. There were 3.8 oocytes per patient on an average. Fifty-six percent of oocytes were preovulatory. All oocytes were allowed to mature in vitro for 3 to 7 hours (mean 5.7 hours). The fertilization and cleavage rates were 76% and 72% respectively. Only one polyspermic fertilization was observed. Forty-five hours after the insemination the embryos between the 2-cell and 6-cell stages were reimplanted into the uterus. Using various ET cannulas, one to seven embryos per patient (2.7 embryos on the average) were replaced into the uterine cavity, 5 mm below the fundus. Only four embryo replacements were completely atraumatic. No medications were used for the luteal phase support. The corpus luteum function and early pregnancy were controlled by serial measurements of serum progesterone, estradiol and beta HCG. Three clinical miscarriages and full-term deliveries were recorded.(ABSTRACT TRUNCATED AT 250 WORDS)

[Laparoscopic aspiration of oocytes for in vitro fertilization and embryo transfer]

Within the in vitro fertilization and embryo transfer procedure, 127 laparoscopies were performed in 89 women. The only indication was tubal infertility. There were 116 gonadotropin stimulated cycles and 11 clomiphene citrate stimulated cycles. Because of a limited ovarian access laparoscopic adhesiolysis was necessary in 30%. Egg recovery amounted to 440 oocytes in 92% successful laparoscopies, which represents 4.1 oocytes per laparoscopy. This resulted in 15 pregnancies of which 3 ended with spontaneous abortion, 6 biochemical and 6 ongoing pregnancies. Two pregnancies resulted in the live birth of normal twins, and one in the birth of a healthy girl.

Three years of in vitro fertilization at Norfolk

During the 3 years from 1981 to 1983, 319 consecutive patients in 560 cycles were treated in a program of in vitro fertilization at Norfolk. All patients were stimulated by human menopausal gonadotropin supplemented by human chorionic gonadotropin. There were transfers in 429 cycles, resulting in 105 pregnancies. Over the 3-year span, the pregnancy rate by cycle was 19%; by transfer, 25%; and by patient, 33%.

The use of ovulation-inducing agents in in-vitro fertilization

In view of the increasing pregnancy rate associated with increased numbers of embryos transferred to the uterus, it is optimal to transfer more than one embryo to each patient. This requires treatment with ovulation-inducing agents to increase the number of preovulatory follicles developing. However, the degree of ovarian "hyperstimulation" must be limited to prevent subsequent luteal-phase dysfunction. In all probability, the ideal regimen for enhanced follicular recruitment to achieve these goals has not as yet been determined. Up to this time multiple different regimens have been used throughout the world, all of which have achieved an increase in the number of embryos available for uterine replacement. Unfortunately, as the degree of augmented follicular development is increased, there appears to be a progressive shortening of the luteal length. It remains to be determined whether or not this shortening of the luteal length can be overcome by pharmacologic support of the luteal phase. In addition, if all embryos recovered are to be transferred to the uterus in the treatment cycle, there is a substantial risk (ranging from 10% to 35%) that if a woman becomes pregnant, she will have a multiple pregnancy. As ethical constraints challenge the advisability of selecting only some of the available embryos for uterine replacement, the development of cryopreservation for subsequent uterine replacement appears highly desirable.

Successful in vitro fertilization and embryo transfer in cynomolgus monkeys

We have started an in vitro fertilization program in cynomolgus monkeys in an effort to develop an appropriate animal model to improve our knowledge of early embryonic development. In 16 of 25 animals treated with menopausal gonadotropins, preovulatory follicles developed. Follicular aspiration was performed at laparotomy after human chorionic gonadotropin injection. A total of 299 follicles were aspirated, and 251 oocytes were recovered. Oocytes were cultured in 1 ml of growth medium or 100 microliter droplets of medium under mineral oil. Semen samples were obtained by electroejaculation, and the oocytes were inseminated 4 to 24 hours after aspiration. Culture under mineral oil significantly increased the fertilization and cleavage rates. Of 68 embryos produced, 24 have been used in 10 embryo transfers, resulting in two pregnancies.

Maturation and fertilization of bovine oocytes in vitro

This report is to review and summarize various aspects of maturation and fertilization of bovine oocytes. Reference also is made to other species where pertinent data for the bovine are unavailable. Finally, factors important to success of in vitro maturation and fertilization as well as applications of these procedures to the animal industry are addressed.

In vitro fertilization and embryo transfer in Pretoria

Details of the in vitro fertilization and embryo transfer programme at the Department of Obstetrics and Gynaecology of the H. F. Verwoerd Hospital and the University of Pretoria are presented. From 1 March 1982 to 30 November 1983, 67 cycles in 47 patients were induced using clomiphene citrate and human chorionic gonadotrophin (hCG) (46 patients) and human postmenopausal gonadotrophin/hCG (1 patient). In 5 patients ovum recovery was unsuccessful owing to severe adhesions. In the remaining 42 patients 59 oocyte recoveries out of a total of 62 attempts were successful, a 95% recovery rate. One hundred and seventy-nine ova were recovered (2,9 per laparoscopy), of which 143 (80%) were viable. Forty-six per cent of fertilized ova cleaved actively. Forty-one transfers of 66 embryos (average 1,6 embryos per transfer) resulted in 5 pregnancies (12% pregnancy rate per transfer). Three preclinical pregnancies aborted spontaneously. Two pregnancies are ongoing at 30 and 32 weeks' gestation. Thus, the programme has so far led to 2 third-trimester pregnancies. Consolidation and refinement of techniques should lead to a steady increase in success at this centre.

Treatment of male sperm autoimmunity by in-vitro fertilization with washed spermatozoa

Pregnancies have been achieved in two couples with prolonged infertility in whom no apparent abnormalities were found, except for the presence of seminal plasma autospermagglutinins in the male partners. Using a method previously advocated for artificial insemination by husband, the semen was collected directly into Tyrode's solution and immediately dispersed. After they were washed and resuspended in Tyrode's solution, the spermatozoa were used for the in-vitro fertilization of the wife's ova collected after induced ovulation. In a condition characterized by the difficulty of achieving sperm-ovum contact and interaction, this approach allows close monitoring of all stages of this process and appears to circumvent any expected difficulties.

[Pregnancy and birth of monozygous female twins following in vitro fertilization and embryo transfer]

The rate of identical twins after in vitro fertilisation and embryo replacement is higher than after physiological conception. The present paper reports on the first delivery of twins (identical twins) after in vitro fertilisation and embryo replacement. The in vitro fertilisation and embryo replacement of one 4-cell stage resulted in a twin pregnancy. The difficult pregnancy, early delivery and intense perinatal care of the children deserves special consideration. In addition the paper gives a survey on the present number of deliveries after in vitro fertilisation and embryo replacement given at the 3rd World Congress on In Vitro Fertilisation and Embryo Transfer at Helsinki in May 1984.

[Pregnancy following ultrasound guided transabdominal-transvesicle follicle puncture under peridural anesthesia within the scope of an IVF program]

The authors report on the case of a 28-year old married woman who was treated according to their IVF-programme after both Fallopian tubes had been removed Three embryo transfers after follicular aspiration by laparoscopy and IVF did not lead pregnancy. In a fourth attempt in May 1984 ovarian stimulation was effected via hMG (Pergonal); 10,000 IU hCG were administered on day 12 of the menstrual cycle. 35 hours later 7 oocytes were recovered via ultrasonically guided percutaneous follicular aspiration under epidural anaesthesia. 3 four-cell embryos were transferred 48 hours after insemination. 9 weeks after l.m.p. sonography showed two intrauterine gestation sacs, in each an embryo of 20 mm C-R length with heart actions and movements.

Fertilization and cleavage in vitro of baboon oocytes

Female chacma baboons (Papio ursinus) were subjected to ovulation induction with clomiphene citrate and human chorionic gonadotropin. Oocytes were recovered at laparotomy and matured in vitro. Sperm was collected by electrostimulation, processed and added to oocytes in culture. Fertilization, cleavage and early pre-implantation development in vitro were recorded. Preliminary attempts to transfer embryos are described. Advantages and problems in establishing the baboon as a model for in vitro fertilization and embryo transfer are discussed.

The in vitro fertilization program in Helsinki

In the in vitro fertilization program at Departments I and II of Gynecology and Obstetrics, University of Helsinki, 57 patients were stimulated with clomiphene and hMG. Follicular growth was monitored by ultrasound and serum estradiol measurements. Laparoscopic follicular puncture was performed 36h after hCG injection. Three hundred seventy-five follicles were punctured and 227 oocytes recovered, representing an oocyte recovery rate of 61%. A total of 130 oocytes (57%) showed evidence of fertilization and 71% of the fertilized oocytes cleaved. Fifty-seven embryo transfers were carried out at the two- to eight-cell stage. Multiple embryos were transferred to 24 patients. Biochemical pregnancies were encountered in two cases; early abortions, 3-5 weeks after implantation, in two cases. One normal ongoing single pregnancy occurred from a transfer of three four-cell embryos.

In vitro fertilization and embryo transfer at North Shore University Hospital: initial experiences

No technical difficulties were encountered in visualizing follicles and obtaining aspirates at laparoscopy. At least one oocyte was aspirated in 90% of these women. While the majority of eggs inseminated subsequently cleaved (73%), no pregnancies occurred despite seemingly atraumatic embryo transfer in nearly all women. As two pronuclei were visualized in the majority of cases, one cannot invoke polyspermy as a cause of failure of subsequent embryo development; nor is it possible at this time to segregate those abnormalities in the egg, at the time of oocyte retrieval, from those encountered by normal preimplantation embryos in an abnormal uterine environment, perhaps secondary to hormonal aberrations coincident with gonadotropin stimulus.

Delaying human chorionic gonadotropin administration in human menopausal gonadotropin-induced cycles decreases successful in vitro fertilization of human oocytes

Correct timing of human chorionic gonadotropin (hCG) administration in induced cycles for in vitro fertilization is of crucial importance to oocyte maturation and normal luteal function. The purpose of this work was to compare the effect of hCG timing on follicular development, oocyte maturation, and fertilization in vitro, as well as on the pattern of luteal phase hormone secretion. Ovulation was induced in 32 normally cycling women by human menopausal gonadotropin (hMG)/hCG administration. In the first group (17 women) 10,000 IU hCG was administered 24 hours after the last injection of hMG and in the second group (15 women) 48 to 72 hours after the last hMG injection. Serum estradiol levels prior to oocyte aspiration were similar in both groups, as were the numbers of large follicles on the day of hCG administration (4.5 +/- 2.3 versus 4.1 +/- 1.9 follicles/woman, respectively). The distribution of oocyte-corona-cumulus complexes was similar in both groups and was comprised of 11% immature, 43% intermediate, and 45% mature complexes. The fertilization rate, however, was significantly (P less than 0.001) reduced in the group treated by delayed hCG injection (57% versus 84%), and the percentage of degenerated oocytes was increased (9% versus 1%). Luteal phase length as well as progesterone and estradiol levels were comparable in both groups. It is concluded that an interval longer than 24 hours between the last injection of hMG and the administration of an ovulatory dose of hCG does not affect follicular and luteal phase serum steroid patterns but may result in a decreased oocyte fertilization rate, possibly due to atretic changes in the follicles.

Analysis of 25 infertile patients treated consecutively by in vitro fertilization at Bourn Hall

Twenty-five infertile women suffering from tubal disorders were treated consecutively by in vitro fertilization over a 14-day period. Follicular growth in 24 of them was stimulated with clomiphene citrate, ovulation being induced by an endogenous surge of luteinizing hormone or an injection of human chorionic gonadotropin. One patient was given tamoxifen and had an endogenous luteinizing hormone surge. One or more oocytes were fertilized, and at least one embryo was replaced in 19 patients. Nine pregnancies were established, and eight infants have been delivered, a pregnancy rate of 36% per laparoscopy and 47% per replacement. A detailed analysis of each patient is presented.

[Use of frozen sperm for in vitro fertilization. A case report]

A case of a man with a malignant testicular tumor is reported; during the time between orchiectomy and retroperitoneal lymphadenectomy his semen was preserved and stored in liquid nitrogen (-196 degrees C). Due to postoperative ejaculation disturbance resulting in infertility of the husband, artificial insemination with cryopreserved semen was performed over a period of 9 months without leading to conception. During a laparoscopy and perturbation, which were combined with an attempt for in vitro fertilization (IVF), three oocytes were collected and fertilized in vitro by cryopreserved spermatozoa of the husband. Two days later two embryos were transferred, unfortunately resulting in a bilateral tubal pregnancy. The case report demonstrates that less than 10,000 progressively motile spermatozoa are sufficient to perform successful IVF and embryo transfer.

[The Erlangen in-vitro fertilization program--results to date]

The authors describe the development of the Erlangen in-vitro fertilisation programme during the past 2 1/2 years. Details of the instrumentarium and of the individual steps are described, such as stimulation and control of cycle, follicle puncture and embryo transfer. By 31. 3. 1984 the number of attained pregnancies increased to 43 and that of delivered infants to 27. 32 pregnancies were achieved with 226 embryo transfers. 12 healthy children have already been born. In one of the most recent series, 33 consecutive transfers resulted in 9 pregnancies. Details of the instrumentarium and technique which have contributed to obtaining the best results, are compared with the technique and results obtained by other work teams.

Fertilization of human oocytes following reinsemination in vitro

The reinsemination of human oocytes that failed to show any evidence of fertilization 12 to 14 hours after insemination was examined to determine whether this would increase success of in vitro fertilization or be of use in determining the fertilizing capacity of the husband's spermatozoa. Reinsemination with spermatozoa of a donor of known fertility resulted in a significantly higher fertilization rate than reinsemination with the husband's spermatozoa. However, the rate of the spontaneously delayed fertilization in oocytes that were not reinseminated was not significantly different from fertilization rates following reinsemination with either the donor's or the husband's spermatozoa. One pregnancy that miscarried at 12 weeks' gestation was obtained from reinseminated oocytes, and none was obtained from oocytes that were spontaneously delayed in fertilization. It is concluded that at present neither reinsemination nor embryo replacement in utero of embryos resulting from delayed fertilization is useful for human in vitro fertilization.

Pregnancy following in vitro fertilization and embryo transfer using pure human serum as culture and transfer medium

Pure heat-inactivated serum of patients adjusted to 280 mOsm was used for preincubation, insemination, and transfer of oocytes in an IVF-ET program. In patients where the oocyte recovery yielded more than two oocytes, two oocytes were chosen randomly for serum cultivation. The 15th patient of that series became pregnant after a transfer of two serum-cultured embryos. The follow-up weekly clinical investigation and ultrasound revealed a normal single pregnancy, now in the 20th week.

[Performance of laparoscopic follicle puncture and oocyte recovery for in-vitro fertilization]

In-vitro fertilisation of human egg cells and subsequent embryonal transfer offers a possibility to sterile women with oviducts incapable of functioning, to become pregnant after all. This article describes the performance of laparoscopic follicular puncture and extraction of egg cells for in-vitro fertilisation. Laparoscopic follicle puncture as described here was performed from July 1982 to March 1983 on 130 patients at the Gynaecological and Obstetric Hospital in Lübeck. 585 follicles were punctured and 404 egg cells obtained, 210 of which met the criteria of a pre-ovulatory egg cell. Of the 210 pre-ovulatory egg cells, 177 could be fertilised. In 95 patients, embryo transfer was effected in the 2-cell to 8-cell stage. The fertilisation rate obtained was 84%, with an embryo transfer rate of 71%. Since this patient group also included andrological causes of sterility, this figure can be considered quite satisfactory, which is decisively due, among other things, to the puncture technique described here. Pregnancy was attained in 14 cases so far. It is certain that the pregnancy rate can be improved still further.

Ein neuer LH-RIA-Schnelltest zur Ermittlung des LH-Peaks im Serum

A highly sensitive, easy to operate LH-RIA rapid test was developed by changing the incubation period and temperature and by reducing the standard curve to three measurement data, using commercially available reagents. The results obtained by means of the LH-RIA rapid test correlate most loosely with those of a conventional 5-hour LH-RIA. The new LH-RIA rapid test is ideally suited for LH peak search at short intervals for exact determination of the time of ovulation as part of in-vitro fertilisation or insemination.

In-vitro fertilization in Western Australia. A viable service programme

A service programme of in-vitro fertilization ( IVF ) and embryo transfer (ET) has been established in a small unit in Western Australia after a successful pilot study which was undertaken in 1981. The key features of the programme include simplified monitoring of the follicular phase of stimulated cycles; oocyte retrieval and ET are both undertaken during routine daytime work schedules. The results of the first eight months of the programme are presented, during which 13 further pregnancies were generated and 10 healthy infants were delivered (seven boys and three girls). In the last session in which 49 patients took part a mean of 2.3 mature preovulatory oocytes were collected by means of a double-lumen aspiration/flushing needle from 98% of 48 patients who reached the laparoscopy stage. Ninety-four per cent of 48 patients proceeded to embryo transfer by means of a double-catheter technique; the pregnancy rate was 20.8% per laparoscopy or 22.7% per embryo transfer.

Successful fertilization in vitro of fresh intact oocytes by perivitelline (acrosome-reacted) spermatozoa of the rabbit

The ability of supplementary rabbit spermatozoa recovered from the perivitelline space of fertilized eggs to penetrate and fertilize fresh oocytes was determined. One-cell cell embryos were recovered from superovulated does approximately 4 hours after ovulation. The perivitelline spermatozoa were released by rupturing the zona pellucida of mechanically and enzymatically denuded 1-cell embryos and then fresh cumulus-intact oocytes were added. Fertilization of fresh oocytes was evaluated by pronuclei and second polar body formation. Thirty-three of 143 oocytes (24%) were fertilized by perivitelline spermatozoa. Of these, eight (24%) progressed to normal 2-cell embryos in vitro. These data suggest that some completely acrosome-reacted perivitelline rabbit spermatozoa retain the ability to penetrate the cumulus, bind and penetrate the zona pellucida, and fuse with the vitellus of fresh intact unfertilized oocytes to initiate apparently normal embryonic development.

The development of a successful non-university-based ambulatory in vitro fertilization/embryo transfer program: phase I

Most of the current in vitro fertilization and embryo transfer (IVF-ET) programs are university-based. The establishment of a successful ambulatory IVF program in association with a busy, two-man general obstetrics-gynecologic practice is described. Seventy-one infertile couples were screened between February 1 and October 15, 1983. Forty-three couples were judged eligible for IVF-ET. Forty-three women underwent a single attempt at ET. The first 13 of these women underwent controlled ovarian hyperstimulation (COH) with 150 mg clomiphene citrate and human chorionic gonadotropin (hCG), and the remaining 30 underwent COH with human menopausal gonadotropin (hMG) and hCG. One of the 13 patients who underwent COH with clomiphene citrate conceived but subsequently miscarried early in the first trimester, for an 8% pregnancy rate. There were 12 pregnancies among the 30 patients who received hMG and hCG, for a 40% pregnancy rate. Only three of these pregnancies miscarried in the early first trimester, and three of the nine viable pregnancies are twin gestations. The possible factors responsible for the high pregnancy rate with IVF-ET, using COH with hMG and hCG, are discussed, and the feasibility of its performance in a well-controlled, non-university program is demonstrated.

[Artificial reproduction in cattle]

In the first part of the present review paper, not only the current procedures making possible artificial reproduction in cattle are stated, but also the limitations of the methods available for superovulation and sexing, low-temperature preservation and transfer of embryos. In the second part, alternative procedures are reviewed, which may be used to increase the number of embryos per dam to a further extent by methods other than superovulation. Finally, the practical use of these recently acquired methods in breeding and animal products is described.

Factors influencing the success of in vitro fertilization for alleviating human infertility

The program for in vitro fertilization at Bourn Hall began in October 1980. Various types of infertility have been treated during this time using the natural menstrual cycle or stimulation of follicular growth with antiestrogens and gonadotrophins. Follicular growth and maturation are assayed by urinary estrogens and LH, monitored regularly during the later follicular stage. Many patients had an endogenous LH surge; others needed an injection of HCG to induce ovulation. All oocytes were recovered by laparoscopy. Wide variations occurred in the time interval between the start of the LH surge and oocyte recovery and between oocyte recovery and insemination. Embryos taken between the one- and the eight-cell stage were replaced into their mother, no standard procedure being adopted for all patients. The results of all treatments including patient's responses during the follicular and luteal phases, oocyte recovery, fertilization, cleavage, replacement, implantation, abortion, and birth and the effect of factors such as replacing two or more embryos, maternal age, and previous obstetric history are described in detail. The incidence of implantation after embryo replacement improved from 16.5% initially to 30% currently. More than 118 babies have been born, and many pregnancies are continuing.

Fertilization in vitro of cattle follicular oocytes with ejaculated spermatozoa capacitated in a chemically defined medium

Cattle follicular oocytes were collected from the ovarian follicles and cultured for 28 h in m-KRB solution in a CO2 incubator (5% CO2 in air at 37 degrees C, 95% humidity). After further culture for 15-18 h with spermatozoa, 78.6% of the oocytes had matured to the second metaphase. The highest fertilization rates (36-58%) were obtained when spermatozoa were collected 1 day before insemination, kept for 14-18 h at 20 degrees C in a test tube (10 X 10(8)/ml), preincubated in m-KRB solution (1-1.2 X 10(8)/ml) in a CO2 incubator for 0-12 h, and then inseminated at a concentration of 1.5-2.0 X 10(6)/ml. The optimum period of preincubation in the CO2 incubator was 8 h: 6/15 denuded oocytes (40%) were fertilized with spermatozoa preincubated for 8 h. No polyspermic fertilization was observed in any of the 139 penetrated oocytes. When spermatozoa were preincubated in the uteri of oestrous cows and gilts for 4-4.5 h instead of the m-KRB solution, the fertilization rates were 80 and 86%, respectively. However, in this system, 13 and 24% of the penetrated oocytes were polyspermic. These results indicate that ejaculated bull spermatozoa can be capacitated in a chemically defined isotonic medium, and about half of the oocytes matured in culture are normally fertilized in vitro.

In-vitro fertilisation of oocytes from women with serum antisperm antibodies

Five women whose infertility was believed to be related primarily to their serum antisperm antibodies underwent in-vitro fertilisation and embryo transfer. Follicle growth was stimulated with clomiphene citrate, sometimes combined with human menopausal gonadotropin, and ovulation was triggered off with human chorionic gonadotropin. 20 oocytes were collected from the five patients, and 15 of these were fertilised in the presence of donor serum. All embryos developed to morphologically normal 2-cell and 4-cell embryos. All five women proceeded to embryo transfer, and two became pregnant.

[A comparative study of two-cell embryos of CBA and F1 mice in a human in vitro fertilization program]

The two-cell mouse embryo can develop in a chemically defined medium to the blastocyst stage but conditions must be strictly controlled. Fresh T6 (Whittingham's) medium is being used weekly for this purpose in our laboratory and subjected to a 5% CO2-in-air system 24 hours prior to use. Experiments were designed to determine whether two-cell embryos obtained from an F1 (CBA X C57/B1/6) X F1 cross were superior to the easily obtainable CBA X ICR cross. The aim was to get a 90% blastocyst result for use as a quality control. Eight experiments were performed over a 6-week period. The CBA two-cell embryos were compared with the F1 group under identical conditions. A total of 177 two-cell embryos were obtained from the CBA group and 214 two-cell embryos from the F1 group. In the CBA group 51 developed to the blastocyst stage (28.8%) compared with 187 in the F1 group (87.4%) (P less than 0.0001). In conclusion, it is advisable to obtain F1 mice to use weekly in the laboratory as a quality control measure. The CBA group yields poor cultures, and this leads to unnecessary laboratory confusion.

Correlation of human menopausal gonadotropin/human chorionic gonadotropin stimulation and oocyte quality in an in vitro fertilization program

One hundred forty-seven cycles in normal ovulatory patients are reported. All were stimulated with human menopausal/human chorionic gonadotropin. Three estrogen responses were identified: normal, high, and low. Patients who achieved pregnancy formed a fourth category, the pregnancy group. The number of preovulatory and immature oocytes, the preovulatory and immature oocytes that fertilized normally or abnormally, the ones that cleaved in culture, and the ones that were transferred were used as parameters to compare quality of the oocytes in each of the estrogen responders. No significant differences were found in any of them. Abnormal zonae pellucidae are described as possibly due to overmaturation of the follicle. No significant difference in the proportion of abnormal zonae in the different categories was found.