Effect of chlamydial antibodies on the outcome of in vitro fertilization (IVF) treatment

Female urogenital chlamydia: Epidemiology, chlamydia on pregnancy, current diagnosis, and treatment

Female urogenital chlamydia is a disease caused by Chlamydia trachomatis infection in the female urogenital tract. It is a common bacterial sexually transmitted disease. The bacteria is transmitted through sexual contact with an infected partner or from mother to newborn during vaginal delivery. The prevalence varies among studies and the number is possibly higher due to the lack of massive screening. Many patients were asymptomatic and still be able to transmit the disease. The undiagnosed and untreated disease could cause pelvic inflammatory disease, which leads to infertility, ectopic pregnancy, and chronic pelvic pain. The prevalence among pregnant women is similar to non-pregnant women, therefore chlamydia screening in pregnant women is highly recommended. The nucleic acid amplification test is the most reliable method for the diagnosis due to high sensitivity. The current treatment is given by prescribing antibiotics.

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Female urogenital chlamydia is caused by Chlamydia trachomatis.

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Urogenital chlamydia affects young and sexually active women.

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Female urogenital chlamydia is diagnosed through indirect methods (serology-based tests) and direct methods (culture).

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Treatment of chlamydia consists of antibiotics with doxycycline being the first-line choice.

Effect of contaminated preprocessed semen on fertilization rate and embryo quality in assisted reproductive techniques

We aimed to identify the sources and prevalence of semen contamination from mastrubation and determine the effect of bacterospermia on fertilization rate and embryo quality in standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This was a prospective controlled study, in an IVF unit of a university teaching hospital, of 93 consecutive couples undergoing IVF-embryo transfer cycles. We evaluated handwashing; semen collection and processing; and assisted reproductive technology using semen provided by masturbation. The main outcome measures were presence and type of micro-organisms in the semen samples and embryo culture medium; the effect of hand washing on rate of contamination; and the effect of semen contamination on fertilization rate and embryo quality. The first consecutive 52 men of the 93 couples were not instructed to wash their hands before masturbation, and the remainder were so instructed. Forty-nine semen cultures (94.2%) in the first group were contaminated compared to only 16 (39%) in the second (p < 0.016); 27 of the 65 positive cultures (41.5%) were contaminated by more than one organism. The most common contaminators were bacteria usually found on the skin. All but four embryo medium cultures were negative. There was no significant difference in fertilization rate and embryo quality by culture findings in either the IVF or the ICSI procedures. We found that a high percentage of manually obtained semen for standard IVF or ICSI procedures was contaminated, but this had no effect on fertilization rate and embryo quality.

Impaired implantation after in vitro fertilisation treatment associated with hydrosalpinx

OBJECTIVE

To study whether the presence of hydrosalpinx affected success after in vitro fertilisation (IVF) in women with inflammatory tubal damage.

DESIGN

Retrospective, nonrandomised study.

SETTING

University private IVF clinic with complete fertility services.

PARTICIPANTS

Two study groups (79 women with hydrosalpinges and 198 women with inflammatory tubal damage but no hydrosalpinx) and a third group (22 sterilised, previously fertile women) for comparison.

MAIN OUTCOME MEASURES

Clinical pregnancy and livebirth rates per embryo transfer cycle; implantation and live baby rates per individual embryo transferred.

RESULTS

The hydrosalpinx group had a significantly lower implantation rate per embryo (8.2%) and chance of a live baby per embryo transferred (5.6%), compared with the nonhydrosalpinx group (14.9% and 11.2%, respectively). The hydrosalpinx group also had a lower clinical pregnancy rate (23%) and live birth rate per transfer cycle (17%) compared with the nonhydrosalpinx group (30% and 26%), but these differences were not significant.

CONCLUSIONS

The presence of a hydrosalpinx halves the chance of an embryo implanting, probably due to physical or toxic chemical effects of fluid draining from the hydrosalpinx into the uterine cavity. Women with hydrosalpinges may benefit from distal salpingostomy or salpingectomy as a drainage procedure before in vitro fertilisation treatment, even though such surgery may not increase the chances of natural conception.

Short protocol of gonadotropin releasing hormone agonist administration gave better results in long protocol poor-responders in IVF-ET

OBJECTIVE

To determine the effectiveness of a short protocol (SP) of gonadotropin-releasing hormone agonist (GnRH-a) administration in patients who already had undergone at least one in vitro fertilization (IVF) and embryo transfer (ET) treatment cycle with the long protocol (LP) and had shown poor results.

METHODS

One hundred and twelve patients were studied. The E2 levels, the number of preovulatory follicles, the number of oocytes retrieved and fertilized, the number of embryos cleaved, the fertilization rate and the number of embryos transferred were calculated.

RESULTS

The values for the mentioned parameters were significantly higher in the SP than those in the LP. So were the pregnancy rates per cycle and per ET (23.2% and 24.1%, respectively) in the SP significantly (p < 0.0001) higher than those in the LP (12.5% and 13.5%, respectively).

CONCLUSION

In cases who showed poor results to the LP, instead of repeating the same protocol the SP may be substituted. This strategy may not only improve the results, but also decrease the total cost of the IVF-ET treatment.