menotropins and Fallopian-Tube-Diseases

To examine the effect of prophylactic salpingectomy in patients with hydrosalpinges on the ovarian response to stimulation prior to IVF, 26 patients were included in a study in which they acted as their own controls. They were all part of a randomized controlled study, in which they had been randomized to no surgical intervention prior to IVF. After one or two failed cycles, they underwent laparoscopic uni- or bilateral salpingectomy of their diseased tubes. The cycles before and after surgery were compared and the ovarian response was assessed as the dose and duration of gonadotrophins and the number of retrieved and fertilized oocytes. There were no significant differences in any of the measured outcomes. The increasing age between cycles did not influence the ovarian response, assessed by a comparison with two matched control groups from the same original study; 46 patients salpingectomized before IVF and 25 patients without surgery. It is concluded that removal of hydrosalpinx as a prophylactic laparoscopic procedure does not compromise ovarian function.

Topics: Adult; Aging; Embryo Transfer; Fallopian Tube Diseases; Fallopian Tubes; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Laparoscopy; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Treatment Outcome

To evaluate the impact of salpingectomy on the rates of embryo implantation and pregnancy in patients with severe, irreversible tubal factor sterility.. A retrospective study of patients with repeated failure of in vitro fertilization due to nonimplantation of the embryo. Seventy-two patients with severe and irreversible tubal factor sterility were selected following repeated failure of in vitro fertilization (IVF) due to assumed nonimplantation of the embryo: 35 underwent a salpingectomy before continuing IVF cycles and 37 continued IVF cycles without salpingectomy.. After the first IVF cycle consecutive to diagnosis of embryo nonimplantation, the implantation rate was 10.2% in the salpingectomy group and 6.1% in the group without the procedure (P = 0.5). After all IVF cycles, the rate was, respectively, 6.9% and 4.5% (P = 0.2). Salpingectomy improved the pregnancy rate (PR) per transfer (23.5% vs. 9.9%; P = 0.01). The curves of the cumulative probability of becoming pregnant show that salpingectomy resulted in pregnancy more rapidly.. Salpingectomy improves the PR per transfer in patients with severe and irreversible tubal factor sterility who have experienced repeated failure of IVF due to embryo nonimplantation. This procedure also reduces the number of IVF attempts needed to obtain pregnancy.

Topics: Adult; Embryo Implantation; Embryo Transfer; Fallopian Tube Diseases; Fallopian Tubes; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Injections, Intramuscular; Male; Menotropins; Pregnancy; Pregnancy Rate; Retrospective Studies

To examine the pituitary response in patients undergoing short-term application of the GnRH antagonist Cetrorelix in the mid-cycle phase for hypophysial suppression of premature LH surges within an IVF-program.. Twenty patients suffering from primary or secondary tubal infertility were stimulated with hMG from cycle day 2. From day 7 till ovulation induction Cetrorelix was administered in two different dose regimens (15 patients 3 mg s.c. daily; 5 patients 1 mg s.c. daily). Three hours before ovulation induction a GnRH test was performed using 25 micrograms of native GnRH and the pituitary response examined by measurement of the serum LH concentration after 30 min.. Premature LH surges could be avoided in the 3-mg group and in the 1-mg group, respectively. Due to this, none of the cycles had to be cancelled. Oestradiol profiles and ultrasound demonstrated a satisfactory follicular maturation. All patients showed pronounced suppression of the serum LH levels before ovulation induction. The mean increase of serum LH due to the performed GnRH test was 10 mIU/ml for the 3-mg group, while the average maximum in the 1-mg group was about 32.5 mIU/ml.. The pituitary response is preserved by the treatment with the GnRH antagonist Cetrorelix. The extent of suppression of the adenohypophysis, as expressed by the different reactions on GnRH test, can be modulated by the dosage administered. This should allow ovulation induction by GnRH or one of its agonists instead of hCG, which could be beneficial in patients at high risk of Ovarian Hyperstimulation Syndrome (OHSS) and those suffering from Polycystic Ovary Disease (PCOD).

Topics: Adult; Chorionic Gonadotropin; Estradiol; Fallopian Tube Diseases; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Hormone Antagonists; Humans; Infertility, Female; Kinetics; Luteinizing Hormone; Menotropins; Ovulation Induction; Pituitary Gland

To evaluate the impact of a short GnRH agonist (GnRH-a) protocol on follicular and luteal characteristics and treatment outcome in women undergoing IVF for isolated pure tubal occlusion.. A prospective randomized study.. Eighty patients with pure tubal occlusion undergoing IVF for the first time.. Patients in group 1 (control group) were administered hMG from day 3 of the menstrual cycle. Patients in group 2 were administered 900 micrograms/d buserelin acetate intranasally from day 1 of the menstrual cycle, followed by hMG administration from day 3. Buserelin acetate was discontinued on the day of hCG administration.. Information collected included E2 levels and follicular growth throughout cycle, amount of hMG required for stimulation, number of oocytes retrieved, fertilization, pregnancy, and cancellation rates.. The short GnRH-a protocol resulted in significantly higher E2 levels and required less hMG for stimulation. However, the number of follicles aspirated, number of oocytes retrieved, fertilization rate, number of embryos transferred, pregnancy rate, and cancellation rate in both groups were comparable.. The findings suggest that administration of a short protocol of GnRH-a to patients with pure tubal occlusion has no obvious superiority in comparison with hMG alone, except for the lower amount of hMG required for ovarian stimulation.

Topics: Administration, Intranasal; Buserelin; Chorionic Gonadotropin; Estradiol; Fallopian Tube Diseases; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Outcome; Prospective Studies

To evaluate how endometriosis affects expression of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) in granulosa cells.. Prospective study.. IVF-ET program at Osaka Medical College.. Seventeen patients with revised American Fertility Society stage IV endometriosis and 17 patients with tubal infertility and no endometriosis.. Granulosa cells obtained at oocyte retrieval were examined for VEGF and IL-6 gene expression.. Serum E(2) and P levels at hCG administration, number of oocytes, fertilization rate, high-quality embryo rate, and pregnancy rate, and expression of VEGF and IL-6 genes.. Total hMG and FSH levels were statistically significantly higher in patients with endometriosis; however, the number of retrieved oocytes and the fertilization rate were lower compared with patients with tubal infertility. Serum E(2) levels and expression of VEGF in patients with tubal infertility were statistically significantly higher than those in patients with endometriosis. Interleukin-6 gene expression did not differ between the groups.. In severe endometriosis, lower VEGF gene expression in granulosa cells may adversely affect oocyte development and maturation.

Topics: Chorionic Gonadotropin; Embryo Transfer; Endometriosis; Endothelial Growth Factors; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gene Expression; Granulosa Cells; Humans; Infertility, Female; Intercellular Signaling Peptides and Proteins; Interleukin-6; Lymphokines; Menotropins; Oocytes; Ovulation Induction; Polymerase Chain Reaction; Pregnancy; Progesterone; Prospective Studies; Reproductive Techniques, Assisted; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factors

In-vitro fertilization (IVF) is an effective infertility treatment for women with endometriosis, but most women need to undergo several cycles of treatment to become pregnant. This case-control study was designed to assess how consistently women with ovarian endometriosis respond to ovarian stimulation in consecutive treatment cycles compared to women with tubal infertility. We compared outcome measures in 40 women with a history of surgically confirmed ovarian endometriosis and 80 women with tubal infertility, all of whom had at least three IVF treatment cycles. The groups were matched for age and early follicular follicle stimulating hormone (FSH) concentration at their first IVF cycle. Outcome measures included number of follicles, number of oocytes, peak oestradiol concentration and number of FSH ampoules required per follicle. Cumulative pregnancy and live birth rates were calculated in both groups. The ovarian endometriosis group had a significantly poorer ovarian response and required significantly more ampoules of FSH per cycle, a difference that became greater with each subsequent cycle. However, cumulative pregnancy (63.3 versus 62.6% by fifth cycle) and live birth (46.8 versus 50.9% by fifth cycle) rates were similar in both groups. In conclusion, despite decreased ovarian response to FSH, ovarian endometriosis does not decrease the chances of successful IVF treatment.

Topics: Adult; Case-Control Studies; Cell Count; Chorionic Gonadotropin; Embryo Transfer; Endometriosis; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Nafarelin; Oocytes; Ovarian Diseases; Ovarian Follicle; Ovulation Induction; Pregnancy; Prospective Studies

To estimate the clinical effectiveness of in vitro fertilization treatment in patients with minimal or mild endometriosis (stages I and II) in comparison to the patients with tubal infertility in terms of fertilization, pregnancy and livebirth rates.. Retrospective analysis of the outcome of IVF-ET in 612 cycles of the patients with endometriosis (389 stimulated with HMG/HCG and 223 co-treated with GnRH-a) and in 7,339 cycles of the patients with tubal infertility (5,520 stimulated with HMG/HCG and 1,819 co-treated with GnRH-a). RESULLTS: Regardless of the type of ovarian stimulation, the fertilization rate per treated cycle was practically the same in both groups (endometriosis 81.4% vs tubal infertility 84.2%; p = 0.07). However, in the endometriosis group the pregnancy rate was higher (25.3% vs 18.9%; p = 0.000), and so was the livebirth rate (19.0% vs 14.2%; p = 0.003). Considering the type of ovarian stimulation, the fertilization rate in the endometriosis group was almost the same in the HMG/HCG (81.2%) and in the GnRH-a co-treated cycles (81.6%), and did not differ from that in the tubal infertility group (83.6% in the HMG/HCG vs 85.9% in the GnRH-a cycles). In the GnRH-a co-treated cycles the pregnancy rate and the livebirth rate were not significantly higher in the endometriosis group than in the tubal infertility group (27% and 20.2% vs 22.2% and 17.5%). In the HMG/HCG stimulated cycles the pregnancy rate was significantly higher in the endometriosis than in the tubal infertility group (24.3% vs 17.7%; p = 0.004), and so was the livebirth rate (18.4% vs 13.0%; p = 0.008).. In patients with minimal or mild endometriosis the IVF-ET procedure is at least as effective as in patients with tubal infertility.

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Endometriosis; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Retrospective Studies

To determine whether age, diagnosis, and cycle number influence cycle fecundity associated with gonadotropin-induced controlled ovarian hyperstimulation/IUI.. Retrospective analysis.. The Center for Reproductive Medicine at the Brigham and Women's Hospital, a tertiary care academic medical center.. Two hundred seventy-four women who underwent controlled ovarian hyperstimulation with gonadotropins and IUI.. Infertility treatment with gonadotropins and IUI.. Pregnancy rates according to patient age, infertility diagnosis, and number of treatment cycles.. Pregnancy rates decreased with increasing patient age. The cumulative pregnancy rates varied greatly by diagnosis from 13% for patients with male factor infertility to 84% for patients with ovulatory factor infertility. Average cycle fecundity was considerably less varied by diagnosis. All pregnancies among patients with male factor infertility and tubal factor infertility were achieved during the first two cycles.. There is a clear age-related decline in fecundity associated with gonadotropin-induced controlled ovarian hyperstimulation/IUI. Patients <40 years of age and those with male factor infertility or tubal factor infertility have a particularly poor prognosis.

Topics: Adult; Aging; Anovulation; Endometriosis; Fallopian Tube Diseases; Female; Follicle Stimulating Hormone; Humans; Infertility; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Retrospective Studies

The aim of the study was to investigate the process of glycolysis in gonadotropic, hyperstimulated, human ovarian follicles.. Follicular fluid (FF) lactate and glucose concentrations were measured in 26 patients with tubal factor infertility undergoing in vitro fertilization treatment.. The mean FF lactate and glucose concentrations were 3.17+/-0.90 mM with positive, and 3.39+/-0.91 mM with negative correlations to follicular size. FF lactate concentration correlated negatively to glucose levels.. Our study confirms in vivo the anaerobic glycolysis in gonadotropic, hyperstimulated human ovarian follicles.

Topics: Anaerobiosis; Buserelin; Chorionic Gonadotropin; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicular Fluid; Glucose; Glycolysis; Humans; Infertility, Female; Lactic Acid; Luteinizing Hormone; Menotropins; Oocytes; Ovarian Follicle; Ovulation; Prospective Studies

To determine the cost-effectiveness of infertility treatments.. Retrospective cohort study.. Academic medical center infertility practice.. All patients treated for infertility in a 1-year time span.. Intrauterine inseminations, clomiphene citrate and IUI (CC-IUI), hMG and IUI (hMG-IUI), assisted reproductive techniques (ART), and neosalpingostomy by laparotomy.. All medical charges and pregnancy outcomes associated with the treatments were obtained. Cost-effectiveness ratios defined as cost per delivery were determined for each procedure. The effects of a woman's age and the number of spermatozoa inseminated on cost-effectiveness of the procedures was also determined.. Intrauterine inseminations, CC-IUI, and hMG-IUI have a similar cost per delivery of between $7,800 and $10,300. All of these were more cost-effective than ART, which had a cost per delivery of $37,000. Assisted reproductive techniques in women with blocked fallopian tubes was more cost-effective than tubal surgery performed by laparotomy, which had a cost per delivery of $76,000. Increasing age in women and lower numbers of spermatozoa inseminated were factors leading to higher costs per delivery for IUI, CC-IUI, hMG-IUI, and ART. Use of donor oocytes reduced the cost per delivery of older women to the range seen in younger women with ART.. Our analysis supports, in general, the use of IUI, CC-IUI, and hMG-IUI before ART in women with open fallopian tubes. For women with blocked fallopian tubes, IVF-ET appears to be the best treatment from a cost-effectiveness standpoint.

Topics: Clomiphene; Cohort Studies; Cost-Benefit Analysis; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility; Infertility, Female; Insemination, Artificial, Homologous; Male; Menotropins; Ovulation Induction; Pregnancy; Reproductive Techniques

To investigate the incidence of meiotic abnormalities, aneuploidy, and prematurely condensed sperm chromosomes in failed fertilized oocytes after controlled ovarian hyperstimulation (COH).. Retrospective analysis of air-dried preparations of unfertilized oocytes.. University hospital-based infertility clinic.. Thirty-three patients undergoing IVF having only tubal factor as the cause of infertility. Twelve patients (13 cycles) underwent treatment with hMG alone (-GnRH agonist [GnRH-a]), and 21 patients (24 cycles) underwent treatment with leuprolide acetate (LA) and hMG (+GnRH-a group).. Standard IVF-ET treatment cycle for ovarian stimulation using hMG with or without LA.. The meiotic stage, ploidy, and the presence of prematurely condensed sperm chromosomes were determined in 161 air-dried preparations of unfertilized oocytes.. Significantly more unfertilized oocytes were at metaphase II in the -GnRH-a group as compared with the +GnRH-a group, with significantly fewer exhibiting meiotic aberrations. Aneuploidy rates did not differ between groups. However, significantly more oocytes in the +GnRH-a group revealed prematurely condensed sperm chromosomes than in the -GnRH-a group.. The use of GnRH-a for COH does not have an impact on aneuploidy rates in failed fertilized oocytes. However, the higher incidence of meiotic aberrations and prematurely condensed sperm chromosomes in the unfertilized population indicates that some retrieved oocytes exhibit incomplete nuclear and cytoplasmic maturation after the use of this agonist.

Topics: Adult; Chromosomes; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Leuprolide; Male; Meiosis; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Retrospective Studies; Spermatozoa

To determine Müllerian inhibiting substance (MIS) levels in follicular fluid (FF) and sera of IVF patients.. Prospective study.. Fertility center.. Sixty-six patients: 20 with tubal factor infertility, 17 with polycystic ovary syndrome (PCOS), and 29 with endometriosis.. All patients underwent ovarian stimulation with hMG and/or FSH, as well as oocyte retrieval for IVF.. Follicular fluid and serum MIS levels and oocyte fertilization rates.. Levels of MIS in FF and sera of PCOS patients were significantly higher than those in tubal factor patients: 7.01 +/- 1.52 versus 1.65 +/- 0.23 ng/mL (mean +/- SE) and 2.97 +/- 0.52 versus 0.92 +/- 0.19 ng/mL, respectively. In endometriosis patients, follicular fluid and serum MIS levels were not significantly different from those in tubal factor patients. In PCOS patients, the percentage of immature oocytes retrieved (17.9% +/- 5.0%) was significantly higher compared with tubal factor (1.5% +/- 1.0%) and endometriosis (9.2% +/- 2.3%) patients. The percentage of oocytes fertilize was significantly lower in PCOS patients (30.2% +/- 5.3%) compared with tubal factor (62.2% +/- 5.5%) and endometriosis (37.5% +/- 5.7%) patients.. Women with PCOS had higher serum and follicular fluid MIS levels, a higher percentage of immature oocytes, and lower fertilization rates than women with endometriosis or pelvic adhesions.

Topics: Adult; Anti-Mullerian Hormone; Endometriosis; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicular Fluid; Glycoproteins; Growth Inhibitors; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Prospective Studies; Testicular Hormones

To evaluate the effects of hydrosalpinx on the outcome of in vitro fertilization (IVF) treatment, a retrospective study was undertaken at a tertiary referral center for infertility.. Results of the first IVF treatment cycles in 144 patients from 1 January 1993 to 31 December 1995, who had tubal infertility only and were less than 38 years old, were reviewed. The duration/dosage of hMG used, serum estradiol level on the day of hCG, number of oocytes aspirated and fertilized, number of embryos replaced, implantation rate, clinical pregnancy rate, and pregnancy outcome were compared in patients with and without hydrosalpinx.. The mean implantation rate and clinical pregnancy rate were similar in patients with or without hydrosalpinx. Both groups had similar ovarian responses and fertilization rates. There was no increase in clinical abortion in the hydrosalpinx group but ectopic pregnancies were more common in patients with hydrosalpinx.. The presence of hydrosalpinx did not adversely affect the implantation and pregnancy rates in in vitro fertilization treatment when the results of the first cycle were compared. However, it can lead to a higher incidence of ectopic pregnancies.

Topics: Abortion, Spontaneous; Adult; Dose-Response Relationship, Drug; Embryo Implantation; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Incidence; Infertility, Female; Menotropins; Pregnancy; Pregnancy Rate; Pregnancy, Ectopic; Retrospective Studies; Treatment Outcome

Proximal tube occlusion (PTO) accounts for 20% of tubal factor cases. The classification into nodular (salpingitis isthmica nodosa or endometriosis), non-nodular (true fibrotic occlusion) and so-called pseudo occlusion (detritus, polyps, hypoplastic tubes) is essential. Using falloposcopy, PTO that is already diagnosed by laparoscopy and hysterosalpingography (HSG) can be confirmed or bypassed (false PTO); patients with false PTO were placed on a temporary waiting period. Nodular and pseudo occlusion patients were pre-treated with gonadotrophin-releasing hormone analogue (GnRH-a) for at least 6 weeks to shrink the underlying pathology, after which tubal re-catheterization was performed. In a prospective study starting in July 1993, 53 patients prediagnosed as having PTO were examined by falloposcopy. Three of these patients had non-nodular occlusion and were directed to microsurgical repair (conservative treatment not possible). A total of 19 cases revealed patent tubes with healthy mucosa and no underlying pathology (false PTO). Of the remaining 31 patients, 18 were classified as nodular and 13 as pseudo occlusion. In all of these patients at least one tube was patent after GnRH-a treatment. After a 6 month period, 37% of the false PTO patients achieved a spontaneous pregnancy (6% per cycle). The spontaneous pregnancy rate in the true PTO group was significantly lower (10% per patient, 1.6% per month; P < 0.05). Using assisted reproduction techniques, in particular gamete intra-Fallopian transfer (GIFT), as a subsequent treatment for the true PTO group, a pregnancy rate of 50% per cycle was achieved. A retrospective analysis of our entire PTO population (n = 109) showed a spontaneous pregnancy rate after achieving tubal patency (using falloposcopy and GnRH-a) that was dramatically low (1.8%), with no difference between the nodular and pseudo groups. The chance for pregnancy can be enhanced significantly (P < 0.001) using assisted reproduction techniques (GIFT) following tubal re-catheterization and GnRH-a treatment.

Topics: Buserelin; Catheterization; Fallopian Tube Diseases; Fallopian Tube Patency Tests; False Positive Reactions; Female; Follicle Stimulating Hormone; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Laparoscopy; Menotropins; Microsurgery; Pregnancy; Prospective Studies

Although amniotic fluid concentrations of cancer antigen (CA) 125 rise during the first two trimesters of pregnancy, the serum concentrations of CA125 peak during the first trimester and drop to non-pregnant values in the second and third trimester. A previous hypothesis to explain this phenomenon was that in the early first trimester decidual CA125 gains access to the maternal compartment via 'tubal reflux' and subsequent absorption by peritoneal lymphatics. However, as pregnancy advances, the decidua capsularis fuses with the decidua parietalis, thus obliterating the endometrial cavity at 10-12 weeks; the Fallopian tubes thus become functionally obstructed. To test this hypothesis, we evaluated early first trimester CA125 concentrations in women conceiving by in-vitro fertilization (IVF) and embryo transfer with patent tubes (group 1) and in those conceiving by IVF and embryo transfer with bilateral tubal occlusion (group 2). We also compared those conceiving with human menopausal gonadotrophin therapy for ovulation induction without assisted reproduction (group 3) and those conceiving without fertility drugs in assisted reproduction (group 4). Mean CA125 concentrations were similar in groups 1-3; the mean CA125 concentration in group 4 was lower but this difference was not statistically significant, probably due to the small sample size. These data do not support the concept that tubal reflux explains the rise and fall of serum concentrations of CA125, since these were equal in IVF conceptions with or without tubal patency.

Topics: CA-125 Antigen; Decidua; Embryo Transfer; Fallopian Tube Diseases; Fallopian Tubes; Female; Fertilization in Vitro; Humans; Menotropins; Ovulation Induction; Pregnancy

To examine the influence of polycystic ovarian disease (PCOD) on the levels of total renin in plasma and follicular fluid (FF) after stimulation with hMG.. Comparative study of the plasma and FF concentrations of total renin in women with and without PCOD after stimulation with hMG.. In vitro fertilization-embryo transfer program at the Department of Obstetrics and Gynecology, the University Central Hospital of Turku, Finland.. Thirty-six women undergoing IVF-ET for infertility with (n = 10) or without (n = 26) ultrasonographically diagnosed PCOD. Of the latter group, 15 women had tubal infertility, and the rest suffered from an anovulatory infertility and reacted with PCO-like ovarian response to stimulation.. The concentrations of total renin in plasma and FF, serum E2, and protein in FF.. The concentrations of plasma total renin after the gonadotropin stimulation were significantly higher in the PCOD and PCO-like groups when compared with the tubal group. The concentration of total renin in FF and the ratio of total renin per protein in FF were higher in the PCOD and PCO-like groups than in the tubal group, but the differences did not reach statistical significance. Positive correlations were found between the plasma total renin and serum E2 concentrations in the PCO-like and in the tubal group and between plasma total renin concentrations and the number of mature follicles in all groups. Follicular fluid total renin did not correlate with FF protein in any group. All findings were independent of the total hMG dosage used and the body mass index of the patients.. In the present study the concentrations of total renin in plasma were enhanced markedly after gonadotropin stimulation in women with PCOD compared with women having tubal infertility. The pattern of the hormonal secretions revealed a group of infertile patients reacting biochemically like women with PCOD.

Topics: Adult; Embryo Transfer; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicular Fluid; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Renin; Ultrasonography

To confirm successful implantation of IVF, cryopreserved human embryos after assisted hatching with acidic Tyrode's solution.. Case report.. In vitro fertilization-ET facility of a university-based practice.. A 28-year-old female with nonoperable bilateral tubal occlusion and > 1 1/2 years of primary infertility.. The patient was stimulated for egg retrieval after an hMG-controlled ovarian hyperstimulation regime. Luteal phase leuprolide acetate (1 mg) was administered SC for 10 days. The dose was then reduced to 0.5 mg, and she was given hMG and FSH IM twice daily until two lead follicles reached 20 mm average diameter. The patient was administered 10,000 IU hCG 36 hours before retrieval.. Viable pregnancy documented by ultrasound (US).. After the transfer of five cryopreserved-thawed human embryos that were subjected to assisted hatching using acidic Tyrode's solution, the patient established a triplet gestation as documented by US.. This case report demonstrates that zona drilling can be successfully applied to frozen-thawed pronuclear stage embryos that were cultured to 72 hours without damaging them, as evidenced by continued cleavage and resulting implantation.

Topics: Adult; Chorionic Gonadotropin; Cryopreservation; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Zona Pellucida

To compare the cumulative probability of pregnancy after multiple IVF cycles by age and cause of infertility.. A prospective study was done in which patients were followed from the time they registered for their first IVF cycle until they achieved a clinical pregnancy, withdrew from treatment, or study was terminated. PATIENTS, SETTING, TREATMENTS: Infertile women undergoing IVF-ET at the Cooper Institute for In Vitro Fertilization were enrolled in this study if the luteal phase leuprolide acetate (LA) and hMG controlled ovarian hyperstimulation (COH) regimen was used.. Clinical pregnancy, as determined by a positive beta-hCG level and ultrasonographic confirmation of a gestational sac, and delivery rates based on number of women with live births were compared by infertility factor and age.. The 3-month cumulative probability of pregnancy based on life table analysis was 33% in women with tubal factor who were < or = 35 years of age, 25% in women with tubal factor who were > 35 years of age, 30% for women with multiple factors who were < or = 35 years of age, and 14% for women with multiple factors who were > 35 years of age. The rate for the older women with multiple factors was significantly lower than that for the other groups. The delivery rates were lower for the women with multiple factors than for women under 35 with tubal factor only.. There is a significant effect of age and infertility factor on pregnancy and delivery rates. Physicians should consider these factors in evaluating their patients' prospects for success in IVF-ET.

Topics: Adult; Aging; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Leuprolide; Menotropins; Pregnancy; Probability

In a retrospective study (1985-1989) based on data from the Centre for Reproductive Medicine in Brussels, a total of 23 ectopic pregnancies (2.24%) occurred after 3800 embryo, zygote or gamete transfers. This number was low compared with the data published elsewhere. Tubal damage was a major risk factor towards developing an ectopic pregnancy after in-vitro fertilization and embryo transfer. The number of ectopic pregnancies after the association of clomiphene citrate and human menopausal gonadotrophin (HMG) was significantly higher in patients with tubal (7.8%) and non-tubal indications (2.1%) compared with those stimulated with gonadotrophin-releasing hormone (GnRH) and HMG (2.18% and 0.84%, respectively). The number of replaced embryos was not associated with the rate of ectopic pregnancy and neither did transfer technique (intra-uterine or intra-Fallopian transfer) influence the ectopic pregnancy rate.

Topics: Adult; Clomiphene; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy, Ectopic; Reproductive Techniques; Retrospective Studies; Risk Factors; Zygote Intrafallopian Transfer

The results of IVF in cases of tubal sterility are compared with those of surgery (macro- or micro-surgery, coelio-surgery). This analysis includes a continuous series of 1051 attempted pregnancies in 640 women (with or mixed tubal sterility with or without endometriosis). After an average 1.64 attempts per patient, 220 women had achieved 241 pregnancies (pregnancy rate: 22.9% per puncture, 34.3% per woman). Of these 241 pregnancies, there were 172 (71.8%) which continued to term, 57 (23.6%) miscarriages and 11 (4.6%) ectopic pregnancies. The pregnancies carried to term were single pregnancies in 129 cases (74.6%), twin pregnancies in 37 cases (21.4%) and triple pregnancies in 7 cases (4%). The indication of coelio-surgery (or microsurgery) is justified in young women with no history of genital tuberculosis, tubal plasty or ectopic pregnancy and presenting with purely tubal sterility with a good prognosis. Restoration of patency after tubal sterilization remains a good indication for microsurgery in young women. In all other cases, indication is for IVF from the outset.

Topics: Adult; Clomiphene; Endometriosis; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infant, Newborn; Infertility, Female; Insemination, Artificial; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Prognosis; Retrospective Studies; Triplets

To analyze risk factors for ectopic pregnancy (EP) after in vitro fertilization (IVF).. A retrospective study of IVF pregnancies was performed between November 1983 and December 1989.. This study was conducted in a tertiary care center, the Port-Royal University Hospital.. Patients' records were reviewed for 48 EP and 508 intrauterine pregnancies obtained by IVF.. Forty-six salpingectomies were performed for EP after IVF.. We evaluated the impact on the ectopic rate of tubal status, the type of ovarian stimulation and luteal phase support, and the number of embryos transferred.. Forty-three of 48 EP occurred in patients with tubal infertility. The rate of EP was significantly higher when the indication was tubal (11.1%) than when it was endometriosis (2.1%) or unexplained infertility (3.4%). Pathological findings revealed tubal lesions in all 46 salpingectomies.. Ectopic pregnancy after IVF appears related to pre-existing tubal pathology. However, routine prophylactic salpingectomy to prevent the risk of EP does not appear justified.

Topics: Adult; Embryo Transfer; Estradiol; Fallopian Tube Diseases; Fallopian Tubes; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Risk Factors

To assess predisposing factors to tubal pregnancy after in vitro fertilization-embryo transfer (IVF-ET).. Retrospective analysis of 891 ET cycles.. University-based IVF program.. All ET cycles performed in the study period were included; the indication for IVF was tubal factor in 640 (72%) and other (nontubal) factors in 251 (28%) cycles.. None.. Observing a higher than expected number of tubal pregnancies in our program; we examined subgroups to determine those at highest risk.. Tubal pregnancies comprised 12% of clinical pregnancies in the tubal factor group but only 2.6% in the cycles nontubal factor group (P less than 0.05). Of 640 ET cycles in the tubal factor group, 359 were performed in patients who had prior tubal reconstructive surgery; tubal pregnancies comprised 15.6% of the clinical gestations in this subgroup. In the remainder of the tubal factor group (no prior tubal surgery), 281 ET cycles yielded a tubal pregnancy rate of only 5.5% (P less than 0.05).. Women with prior reconstructive surgery for distal tubal disease are at highest risk of developing tubal pregnancy after IVF.

Topics: Adult; Clomiphene; Embryo Transfer; Fallopian Tube Diseases; Fallopian Tubes; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy, Tubal; Retrospective Studies

The administration of human chorionic gonadotropin to women undergoing superovulation with exogenous gonadotropins was delayed in order to document the occurrence of a surge of luteinizing hormone (LH). An LH surge was seen to occur in 10 of 10 women receiving clomiphene citrate (CC) and pulsatile human menopausal gonadotropin (hMG); in 10 of 12 women treated with pulsatile hMG alone; and in 12 of 14 women treated with single daily injections of hMG without CC. The height of the surge was attenuated in all cycles and the timing of its onset was significantly earlier among women receiving single daily injections of hMG. Possible mechanisms for these findings are discussed.

Topics: Adult; Clomiphene; Embryo Transfer; Estrone; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Male; Menotropins; Oligospermia; Ovulation; Pregnancy; Pregnanediol; Superovulation

Between 1980 and 1985, in Monash University in vitro fertilization (IVF) program, ectopic pregnancy occurred in 10 of 256 IVF pregnancies. The incidence of ectopic pregnancy between 1983 and 1984 was 4% of the total pregnancies, or 4.2% of pregnancies excluding biochemical pregnancies. The incidence of ectopic pregnancy was distributed equally across the infertility classifications (tubal, idiopathic, male factor, and mixed). There appeared to be no relationship between superovulatory methods, endocrine changes before egg recovery, laparoscopic procedures, embryo transfer procedures, and number of embryos transferred. Nine of the ten patients were classified as having either tubal factor infertility before IVF or chronic tubal inflammation, which probably existed at the time of embryo replacement. No ectopic pregnancies were recorded in the 33 pregnancies obtained with superovulation with the use of clomiphene citrate alone. We were unable to identify a major predisposing factor for ectopic pregnancy in IVF.

Topics: Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Clomiphene; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Peptide Fragments; Pregnancy; Pregnancy, Ectopic; Progesterone

Oocyte recoveries for in vitro fertilization/embryo transfer were performed in 82 cycles in 73 women. The status of the ovaries was unknown. Laparoscopy was performed and oocytes from accessible follicles aspirated. The remaining follicles were aspirated ultrasonographically. The recovery rates for laparoscopy of accessible follicles and for ultrasonographic recovery from laparoscopically inaccessible follicles were identical. In 26 patients laparoscopy only was performed. One or more oocytes was obtained in 92% of patients. In 56 cycles when laparoscopy was followed by ultrasound, one or more oocytes were recovered in 95% of patients; in 12 of these patients, three of whom achieved pregnancy, the only oocytes were recovered by the ultrasonographic means after laparoscopy had failed. This method provided an alternative to screening laparoscopy and indicated that cycles of controlled hyperstimulation could be performed with a satisfactory expectation of oocyte recovery in women in whom the state of the pelvis was unknown.

Topics: Clomiphene; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Laparoscopy; Menotropins; Oocytes; Ovulation Induction; Ultrasonography

We have presented the case of a woman with unilateral occlusion of a tube ovulated permanently on the same side. The other ovary and tube were intact. To overcome this problem, we gave full menotropic treatment to induce super-ovulation, and the patient became pregnant in the second treatment cycle. We think medical treatment should be attempted before paradoxical oophorectomy is contemplated in women with unilateral occlusion who cannot become pregnant.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Fallopian Tube Diseases; Female; Humans; Infertility, Female; Menotropins; Ovulation; Superovulation

Topics: Adult; Clomiphene; Diagnosis, Differential; Embryo Transfer; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Menotropins; Ovarian Follicle; Ovary; Ultrasonography

Topics: Attitude to Health; Clomiphene; Counseling; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteinizing Hormone; Menotropins; Menstruation Disturbances; Prednisolone; Pregnancy; Psychophysiologic Disorders; Puerperal Disorders; Self Concept