Translaparoscopic tubal embryo transfer: preliminary experience at National Taiwan University Hospital

Acrosin activity of human sperm did not correlate with IVF

To evaluate the predicting value of sperm acrosin activity in human, the acrosin activity index (AAI) was measured in 95 semen samples from patients participating in an IVF program. All patients had at least two mature oocytes. Of 95 patients, 84 had successful fertilization and 11 failed to fertilize all oocytes in vitro. The numbers of mature oocytes were similar between fertilization and nonfertilization groups. The mean AAI, measured using a commercially available (Accu-Sperm) acrosin activity assay, was greater in the fertilization group than in the nonfertilization group, but the difference was not significant. There was no correlation between AAI and the in vitro fertilization rate of mature oocytes. The relation between AAI and semen parameters also showed no significant difference. It would appear that measurement of AAI inaccurately reflects in vitro fertilizability of human sperm.

Sharing of human leukocyte antigens in couples with unexplained infertility affects the success of in vitro fertilization and tubal embryo transfer

OBJECTIVE

The purpose was to test further our hypothesis that genes, or genetic defects, linked to the major histocompatibility complex affect reproduction by correlating human leukocyte antigen sharing with the success or failure of in vitro fertilization and tubal embryo transfer in couples having unexplained infertility.

STUDY DESIGN

Seventy-six couples with unexplained infertility who failed superovulation and intrauterine insemination at least three times were typed for human leukocyte antigens and treated by in vitro fertilization and tubal embryo transfer. The results were correlated with the sharing of human leukocyte antigens in the couples.

RESULTS

Thirty-four of the women had successful pregnancies, 36 did not become pregnant, and six became pregnant but aborted shortly thereafter. There was a highly significant excess of human leukocyte antigen sharing in the couples who failed treatment: three of the A, B, DR, and DQ antigens (p = 0.015) or two of the B, DR, and DQ antigens (p = 0.015). No specific human leukocyte antigen alleles were present in excess.

CONCLUSIONS

Genes, or genetic defects, linked to the major histocompatibility complex significantly affect the success of in vitro fertilization and tubal embryo transfer just as they affect the prevalence of recurrent spontaneous abortion, cancer, and congenital anomalies. It appears as if the critical genes, or genetic defects, are located in the B-DR-DQ region of the major histocompatibility complex.

Effect of the number and depth of embryos transferred and unilateral or bilateral transfer in tubal embryo transfer (TET)

PURPOSE

Our purpose was to evaluate the possible effects of the number of embryos transferred, the depth of embryos placed within the tube(s), and unilateral or bilateral tubal transfer on pregnancy initiation in tubal embryo transfer (TET).

METHODS

One hundred eight consecutive TET cycles were analyzed. Oocyte retrievals were carried out by transvaginal ultrasound-guided aspiration of follicles. Forty-eight hours after oocyte retrieval, the developing embryos at the stage of two to four cells were transferred into the fallopian tube(s) by laparoscopy. A maximum of four embryos was transferred to each patient.

RESULTS

The pregnancy rates were similar among the cycles in which two, three, or four embryos were transferred. In addition, there was no significant difference in the pregnancy rate whether the embryos were deposited > 4 cm or between 3 and 4 cm into the tube(s). Although the pregnancy rate was greater in cycles of bilateral tubal transfer, the difference from that of unilateral transfers was not significant.

CONCLUSION

Our data indicate that when two to four embryos were transferred and the embryos were placed > or = 3 cm within the tube(s), unilateral or bilateral tubal transfer had little influence on the ultimate success of TET.