Journal - Fertility and sterility (UNITED STATES )

Abstract :

OBJECTIVE: To investigate the influence of antisperm antibodies on the sperm surface on the outcome of IVF and GIFT. DESIGN: Matched controlled retrospective review of two large series. SETTING: Reproductive endocrine divisions of two level-three academic centers. PATIENTS: Twenty-nine male factor patients (38 IVF cycles) showing positive antisperm antibodies on the sperm by immunobead test treated by IVF at the Norfolk program and 56 similar patients (57 cycles) treated by GIFT at the Tygerberg program. Twenty-nine male factor patients (29 IVF cycles) with negative antisperm antibodies screening matched by wife's stimulation protocol and baseline semen analysis characteristics were used as controls in Norfolk; 56 GIFT patients (56 GIFT cycles) matched similarly were the Tygerberg controls. Study and control groups were divided according to sperm morphology pattern in normal, good, and poor prognosis subgroups for comparison. MAIN OUTCOME MEASURES: Fertilization rate of preovulatory oocytes used in IVF in Norfolk and of GIFT supernumerary preovulatory oocytes in Tygerberg; total and term pregnancy rates (PRs) and abortion rates. RESULTS: Fertilization rate was significantly lower in the IVF (41.9% +/- 2.8%) as well as in the GIFT (26.8% +/- 3.8%) (mean +/- SE) study groups than in the respective control groups (73.1% +/- 3.9% and 61.8% +/- 3.9%). Total and term PRs in IVF per cycle (21.1% +/- 6.6%; 13.2% +/- 5.5%) and per transfer (23.5% +/- 7.4%; 14.7% +/- 6.1%), and in GIFT (25.0% +/- 5.8%; 19.6% +/- 5.3%) in the study groups were also lower when compared with their control counterparts (IVF per cycle: 62.1% +/- 6.2% and 41.4% +/- 6.0%; IVF per transfer: 41.9% +/- 2.0% and 27.9% +/- 1.9%; GIFT: 31.6% +/- 6.2% and 28.1% +/- 6.0%), but the difference did not reach statistical significance. Abortion rates were similar in the IVF study group (37.5% +/- 17.1%) and its control groups (39.9% +/- 11.5%). The abortion rate in the GIFT study group was 14.3% +/- 9.4%, and no abortions were recorded in the control group (not significant). CONCLUSIONS: The presence of antisperm antibodies on the sperm surface per se impairs the outcome of assisted reproduction, mainly in terms of fertilization rate of preovulatory oocytes, and possibly in terms of total and term PRs. This holds true regardless of the impact of other semen parameters, particularly the morphology of the sperm within the semen sample.

Journal - Obstetrical & gynecological survey (UNITED STATES )

Journal - Human reproduction (Oxford, England) (ENGLAND )

Abstract :

Fifty patients [79 in-vitro fertilization (IVF) cycles] with severe male factor infertility were included in an experimental clinical trial running from October 1987 to March 1991 to assess the potential of systemic follicle stimulating hormone (FSH) treatment to improve sperm fertilizing ability in IVF. Two groups were defined: a secondary group (24 patients, 33 IVF cycles) with a history of failed fertilization in previous IVF attempts and a primary group (26 patients, 46 IVF cycles) with poor sperm parameters which suggested that fertilization would not occur according to previously established criteria. Basic semen analysis and a battery of endocrine radioimmunoassays [serum FSH, luteinizing hormone (LH), oestradiol, prolactin and testosterone] were performed in these patients. Bioactive-FSH and LH were also determined in some patients. For this study, pure FSH was administered (150 IU i.m. three times per week) for at least 3 months, after which the semen analysis and endocrine tests were repeated. Although no significant changes were observed after FSH therapy, either in the endocrine profile or in the basic semen parameters, except for FSH radioimmunoassay levels, the fertilization rate of pre-ovulatory oocytes was significantly improved from 2 to 54.4% in the secondary group; the primary group showed a 52.3% fertilization rate. Eighteen clinical pregnancies were achieved, 11 in the primary group and seven in the secondary group, giving 30 and 26% term pregnancy rates per transfer respectively. These results, which are in complete agreement with our preliminary study, re-emphasized the benefits of systemic FSH administration as an adjunct to assisted reproduction in selected cases of severe male factor infertility.(ABSTRACT TRUNCATED AT 250 WORDS)

Journal - Fertility and sterility (UNITED STATES )

Abstract :

OBJECTIVE: Experimental clinical trial assessing the potential of systemic follicle-stimulating hormone (FSH) to improve sperm fertilizing ability in in vitro fertilization (IVF). DESIGN: Retrospective clinical evaluation of severe male factor patients failing fertilization in IVF or showing severe sperm defects. SETTING: Academic tertiary clinical care unit. PATIENTS, PARTICIPANTS: Fourteen patients (41 cycles) who failed IVF, 22 patients (32 cycles) with severe quantitative and qualitative semen abnormalities indicating poor fertilization. INTERVENTIONS: Treatment: FSH 150 U IM three times a week for 3 months. MAIN OUTCOME MEASURE(s): Pretreatment and post-treatment evaluation of endocrine profile, basic semen analysis, and fertilization and pregnancy rates. Hypothesis: FSH treatment may improve spermatogenesis quality by its multiple actions on the Sertoli-gamete cell compartment without interfering with testicular hormonogenic function. RESULTS: No significant changes were observed in the endocrine profile or in semen parameters; individual cases showed improvements in sperm concentration and motility. Significant increase in fertilization rate of preovulatory oocytes was demonstrated; seven term pregnancies were achieved. CONCLUSIONS: A multicenter randomized, double-blind trial with crossover is needed to demonstrate the benefit of systemic FSH administration and if this effect is FSH exclusive.

Journal - Ginecología y obstetricia de México (MEXICO )

Abstract :

The description, evaluation and management of the main problems emerging during ovulation stimulation in the in vitro fertilization (IVF) programs, include the guidelines to apply this methodology and to select the patients; the ovarian stimulation and oocyte recovery procedures, as well as to emphasize the importance of establish and know the rejection and cancellation rates in these programs. During ovulation stimulation, abnormalities can emerge at different times of the procedure. Basal serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) levels on cycle day 3, are helpful in prediction of patients stimulation response and IVF outcome. Patients with elevated FSH levels at the beginning of the menstrual cycle present a short follicular phase with a rapid spontaneous LH surge; likewise, the predominance of LH on day 3 produces a "multi-follicular response", when the usual stimulation protocol is used. All these patients behave poorly in terms of E2 response, quality of the oocytes retrieved and pregnancy rates. If the estrogen levels are low (less than 20 pg/ml) or very high (greater than 80-100 pg/ml) on cycle day 3, the response in terms of oocyte recovery and LH levels will not be adequate. On the other hand, during the developmental and/or codominance phase of stimulation, a sudden drop of estrogens levels may occur, which can lead to the cancellation of the cycle. In this manuscript there is also a reference about ovarian stimulation protocols, as well as the use conditions for gonadotropin releasing hormone (GnRH) agonists with this purpose.(ABSTRACT TRUNCATED AT 250 WORDS)

Journal - Fertility and sterility (UNITED STATES )

Abstract :

Clinical and prognostic significance of preclinical abortions in assisted reproduction is ill defined. Strict diagnostic criteria include a transient and synchronous elevation of serum beta-human chorionic gonadotropin (hCG), estradiol, and progesterone levels 13 days after hCG administration, ending in a bleeding episode no more than 14 days after the missed period. The preclinical abortion study group (54 patients, 178 cycles) was compared with matched control groups A (54 patients, 132 cycles) and B (54 patients, 155 cycles), representing normal term pregnancies and all outcomes, respectively. Control group C included the overall population during the study period. The abortion rate per transfer (preclinical abortion and total miscarriage rates) and total pregnancy wastage in the study group were significantly higher; the ongoing pregnancy rate was significantly lower. Preclinical abortion should be considered as a true reproductive failure with similar implications.

Journal - Obstetrical & gynecological survey (UNITED STATES )

Journal - Annals of the New York Academy of Sciences (UNITED STATES )

Journal - Fertility and sterility (UNITED STATES )

Abstract :

Endometrial receptivity and pre-embryo quality are the main factors determining embryo implantation in in vitro fertilization. If one embryo implants normally and goes to term, the endometrium can be assumed to be normal. Eighty-one patients (March 1981 to 1987) had transfers of multiple pre-embryos, resulting in multiple pregnancies with at least one reaching term. The number of gestational sacs at 8 to 12 weeks of pregnancy, at 20 weeks, and the number of term pregnancies were studied longitudinally. Twelve patients (14.8%) had 2 pre-embryos transferred, 19 (23.5%) had 3, 21 (25.9%) had 4, 17 (21.0%) had 5, 9 (11.1%) had 6, and 3 (3.7%) had 7. At 20 weeks 18 patients (22.2%) had a single viable fetus, 56 (69.1%) had twins, 6 (7.4%) had triplets, and 1 (1.2%) had quadruplets. A total of 325 pre-embryos were transferred; 178 gestational sacs were observed at 8 to 12 weeks, but only 153 showed fetal heartbeat. Total embryo loss at 8 to 12 weeks was 53.0%; when the "index" embryo was excluded, it reached 61%. Regardless of the number of pre-embryos transferred, only 2.2 embryos on average were able to establish a normal pregnancy. (A)synchronism of the pre-embryos did not affect outcome. Results suggest that with normal endometrial receptivity, the implantation potential of each pre-embryo is different.