menotropins and Pregnancy--Ectopic

We report two cases of heterotopic (combined intra- and extra-uterine) pregnancy in women treated for infertility. In the first case the patient conceived following administration of human menopausal gonadotropin. In the seventh week of gestation she had a spontaneous abortion and in the eighth week required urgent laparotomy for acute abdomen due to the rupture of pregnant right tube. In the second case the patient conceived from IVF-ET; in the eighth week a salpingectomy was made. The intrauterine pregnancy continued regularly until term and the patient was delivered of a healthy baby by caesarean section. We reviewed the literature and we found that heterotopic pregnancy is an insidious disease with a constant increase of incidence, especially in infertile women submitted to therapy for ovulation induction or assisted reproductive techniques. All the patients who have risk factors should be submitted to careful controls in early pregnancy, including an ultrasound transvaginal scan.

Topics: Adult; Embryo Transfer; Female; Fertilization in Vitro; Humans; Incidence; Menotropins; Pregnancy; Pregnancy, Ectopic; Risk Factors

Although advances in earlier diagnosis have led to decreased case-fatality rates and conservative laparoscopic treatments have enabled improved outcomes, ectopic pregnancy remains a leading cause of maternal mortality and accounts for a sizable proportion of infertility and ectopic recurrence. The incidence of ectopic pregnancy, the trends observed in the last decade, reason for occurrence, and other questions regarding risk factors for this condition are discussed.

Topics: Adolescent; Adult; Age Factors; Clomiphene; Diethylstilbestrol; Fallopian Tubes; Female; Genital Diseases, Female; Humans; Intrauterine Devices; Menotropins; Pregnancy; Pregnancy, Ectopic; Racial Groups

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 determine whether luteal phase support with vaginal progesterone could improve pregnancy rates in our IVF/GIFT programme, we performed a prospective randomised controlled study. After stimulation with clomiphene citrate/human menopausal gonadotrophin, 123 women received no luteal support and 122 received progesterone pessaries 100 mg b.d. from 48 hours prior to embryo transfer and continued throughout the luteal phase. There was no difference in the pregnancy rate following IVF/ET (6/58 and 10/58 for the pessary and control group respectively), but a significantly higher rate was noted for GIFT (13/34 and 5/42 for the pessary and control group respectively; P less than 0.05). Of interest, only one of the 19 pregnancies using luteal support was extra-uterine, compared with 6/15 in the control group.

Topics: Administration, Intravaginal; Adult; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Luteal Phase; Menotropins; Pessaries; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Progesterone; Prospective Studies

To determine if the routine use of gonadotropin-releasing hormone agonists (GnRH-a) for all patients undergoing in vitro fertilization (IVF) produces any significant medical advantage.. Prospective randomized study.. Three hundred eight patients having their first ever IVF attempt.. Patients were randomly divided into four groups and received either human menopausal gonadotropin (hMG) alone for ovarian simulation (group A, n = 81); clomiphene citrate and hMG (group B, n = 77); a 3-day ultrashort course of GnRH-a and hMG (group C, n = 74); or pituitary desensitization with GnRH-a followed by hMG (group D, n = 76).. The indications for IVF and mean age of all four groups of patients were comparable. There was a significant difference in the number of embryos cleaved and transferred among the groups, but there were no significant differences in the cancellation rate, mean number of oocytes collected or fertilized, and number of cases of failed fertilization. There were also no significant differences in the pregnancy and live birth rates per cycle commenced or per embryo transfer.. The routine use of GnRH-a for all patients undergoing IVF has practical but no significant medical advantages.

Topics: Abortion, Spontaneous; Clomiphene; Delayed-Action Preparations; Drug Administration Schedule; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Prospective Studies; Triptorelin Pamoate

To determine the effect of the removal of the tube on ovarian function we studied 52 artificial reproduction technology cycles in 26 women before and after undergoing laparoscopic salpingectomy for ectopic pregnancy. Ovarian response was measured by the duration and quantity of human menopausal gonadotrophins used in the cycle, the pre-ovulatory concentrations of oestradiol, the number of oocytes retrieved, and the quality of the embryos. All parameters were compared between cycles carried out before and after salpingectomy as well as between affected and unaffected sides. Our findings show no significant difference in any of the parameters studied. We conclude that laparoscopic salpingectomy does not abate ovarian response in artificial reproduction technology cycles that follow the procedure.

Topics: Adult; Cell Count; Embryo Implantation; Embryo, Mammalian; Estradiol; Fallopian Tubes; Female; Humans; Menotropins; Oocytes; Ovary; Pregnancy; Pregnancy, Ectopic; Reproductive Techniques

To investigate the effects of different levels of hormones on the ciliary activity of human oviducts and, consequently, to assess their possible role in tubal implantation of the fertilized egg.. Fallopian tube epithelial samples were incubated in media with the addition of Estradiol (E2), progesterone (P), human menopausal gonadotropin (hMG), LH, or pure FSH (Metrodin) in different concentrations. The ciliary beat frequency (CBF) was measured after 24 h of incubation. Then the media were exchanged to media without the addition of hormones and the CBF was measured again 24 h later by using the photoelectric technique.. University teaching hospital, IVF unit.. Twenty-four hr after the addition of P to the culture medium in concentrations of 0.5 or 1 ng/ml a significant decline of the CBF down to 63% of the control level was observed (P < 0.001) and with P in concentration of 2 ng/ml or greater, 50-70% of the cilia were paralyzed. These effects of P were found to be reversible. Incubation with E2 induced a slight increase of 4% in the mean CBF (P = 0.002). Twenty-four hr incubation with Metrodin, Pergonal, or LH did not affect ciliary motility.. Higher levels of progesterone cause ciliary dysfunction and subsequently may be a possible cause of ectopic pregnancy.

Topics: Animals; Cilia; Epithelial Cells; Estradiol; Fallopian Tubes; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Menotropins; Organ Culture Techniques; Pregnancy; Pregnancy, Ectopic; Progesterone

To determine reference values for the midluteal plasma progesterone concentration.. Retrospective analysis.. Infertility clinic at an academic medical center.. One hundred ninety-two infertile women who became pregnant after induction of ovulation with hMG.. The plasma progesterone level was measured during the midluteal phase of the hMG treatment cycle.. The midluteal plasma progesterone concentration was correlated with the outcome of the pregnancy.. In this cohort of 192 women in whom ovulation was induced with hMG and 5,000 IU of hCG, the mean midluteal plasma progesterone concentrations were 29.07 ng/mL, 25.85 ng/mL, 31.49 ng/mL, 41.39 ng/mL, and 28.64 ng/mL in all cycles that resulted in pregnancy, cycles that resulted in full-term singleton pregnancy, cycles that resulted in full-term multiple pregnancy, cycles that resulted in preterm pregnancy, and cycles that ended in miscarriage, respectively. There was no statistically significant difference in the progesterone concentration between the cycles that resulted in full-term pregnancy and those that ended in miscarriage, but there was a statistically significant difference between the cycles that resulted in singleton pregnancy and those that resulted in multiple pregnancy. The minimum value that was compatible with a full-term pregnancy in this cohort of women was 10.83 ng/mL.. In a cohort of 192 women, the minimum plasma progesterone concentration on day 7 in women who attained a full-term pregnancy after induction of ovulation with 5,000 IU of hCG was 10.83 ng/mL.

Topics: Abortion, Spontaneous; Female; Gestational Age; Humans; Infertility, Female; Luteal Phase; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Pregnancy, Multiple; Progesterone; Reference Values; Retrospective Studies

A patient is described who developed neurological signs of the left leg following transvaginal ultrasound-guided puncture. A hypodense lesion of the obturator space above the lumbosacral plexus was seen on ultrasound which could explain her signs, due to compression by a hematoma. She recovered completely.

Topics: Adult; Female; Fertilization in Vitro; Humans; Leg; Menotropins; Oocyte Donation; Paresis; Pregnancy; Pregnancy, Ectopic; Triptorelin Pamoate; Ultrasonography; Vagina

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

Cases of coexisting ovarian hyperstimulation and ectopic pregnancy are rare, and pose a difficult diagnostic problem. The routine attempts at laparoscopic diagnosis and treatment of these pregnancies may prove to be hazardous. Such cases may be better managed nonsurgically either by methotrexate or, in selected cases, by expectant management while monitoring the beta-hCG level and clinical status.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Insemination, Artificial, Homologous; Menotropins; Ovarian Cysts; Ovarian Hyperstimulation Syndrome; Pregnancy; Pregnancy, Ectopic; Ultrasonography

The objective of our study was to establish the most adequate ovarian stimulation regimen for assisted procreation in endometriotic patients. It consisted of a retrospective analysis comparing the use of the gonadotrophin-releasing hormone analogue (GnRHa) buserelin either for 3 months or for 3 weeks and continued with ovarian stimulation with human menopausal gonadotrophin (HMG), and the use of clomiphene citrate in association with HMG for in-vitro fertilization (IVF) and embryo transfer, gamete intra-Fallopian transfer (GIFT) and zygote intra-Fallopian transfer (ZIFT). A total of 145 patients with endometriosis in 174 cycles were divided into two groups according to the revised American Fertility Society staging of the disease (group A, stages 1 and 2; group B, stages 3 and 4). The use of GnRHa significantly increased the number of oocytes retrieved. GnRH analogues for 3 months gave the highest fertilization rate for groups A and B. The cleavage, pregnancy and delivery rates, although higher in the groups treated with analogues, did not reach statistical significance. A higher number of patients had an embryo transfer in the groups treated with GnRHa (P < 0.05). Treatment with GnRHa for either 3 months or for 3 weeks proved to be more efficient than clomiphene citrate-HMG for assisted procreation procedures in patients with endometriosis.

Topics: Adult; Buserelin; Cleavage Stage, Ovum; Clomiphene; Cryopreservation; Embryo Implantation; Endometriosis; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Retrospective Studies; Zygote Intrafallopian Transfer

A case of advanced ectopic pregnancy after in vitro fertilization complicated by an ovarian hyperstimulation syndrome is presented. Methotrexate was given in spite of high levels of hCG and appeared to be successful. Difficulties in the choice between surgical and conservative treatment are discussed.

Topics: Adult; Embryo Transfer; Fallopian Tubes; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Methotrexate; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Tissue Adhesions

An abdominal pregnancy after superovulation with human menopausal and chorionic gonadotropins followed by intrauterine insemination of the husband's sperm is reported. The incidence of ectopic pregnancy increases with administration of human menopausal and chorionic gonadotropins. However, the role of human menopausal and chorionic gonadotropins as a cause of abdominal pregnancy has not been delineated. It appears that ultrasonography has become one of the most important aids in the diagnosis of early abdominal pregnancy.

Topics: Abdomen; Adult; Chorionic Gonadotropin; Female; Gonadotropins; Humans; Insemination, Artificial, Homologous; Menotropins; Pregnancy; Pregnancy, Ectopic; Reproductive Techniques; Superovulation

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

The present study was performed to investigate whether determination of serum relaxin concentrations would allow assessment of the gestation further than that provided by determination of hCG. Serum relaxin concentrations were quantified in women with resorbing ectopic gestations (as documented by declining titers of beta-hCG). The control group consisted of individuals with intrauterine pregnancies. As an additional control, we studied pregnancies conceived through ovulation induction, which usually have an increased volume of relaxin-secreting luteal tissue. On days 39-70 of gestation, the mean serum relaxin concentrations were significantly lower in ten resorbing ectopic gestations (P less than .001, permutation test) than in the normal control group of 13 intrauterine pregnancies. The median serum relaxin concentrations in patients who had ovulation induction with Pergonal were substantially higher than the median for all normal controls; values in clomiphene citrate-treated patients were within the normal range. These data suggest that relaxin secretion correlates with luteal function in both normal and abnormal gestations and reflects the status of the pregnancy. Thus, relaxin may serve as a useful clinical marker.

Topics: Adolescent; Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Clomiphene; Female; Humans; Menotropins; Ovulation Induction; Peptide Fragments; Pregnancy; Pregnancy Trimester, First; Pregnancy, Ectopic; Progesterone; Relaxin

Levels of reproductive steroids and gonadotrophins were analysed retrospectively during the peri-implantation period following non-conceptional and conceptional natural cycles and in cycles associated with ovarian hyperstimulation for in-vitro fertilization or gamete intra-Fallopian transfer. In cycles not associated with conception, the luteal phase of hyperstimulated cycles (n = 100) was characterized by higher serum progesterone and oestradiol levels (P less than 0.01) and with an earlier decline in steroids than in natural cycles (n = 21). On day 11 (day of oocyte recovery = day 0), the level of progesterone in twin (n = 59) and triplet (n = 13) pregnancies was higher than singleton pregnancies (n = 176) (P less than 0.006, P less than 0.006 respectively) while those destined to abort (n = 66) had lower progesterone levels (P less than 0.01). Ectopic implantation (n = 11) had the lowest progesterone concentrations on day 11 (P less than 0.01) and this may imply a delay in corpus luteum rescue or a later implantation time than intrauterine conception.

Topics: Clomiphene; Corpus Luteum; Estradiol; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Luteal Phase; Luteinizing Hormone; Menotropins; Ovary; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Pregnancy, Multiple; Progesterone; Retrospective Studies

The number of multiple pregnancies has been increasing as a result of the relatively widespread use of drugs for induction of ovulation and assisted conception techniques. This paper details the first reported cases of triplet pregnancies occurring in consecutive IVF cycles in two patients.

Topics: Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Menotropins; Pregnancy; Pregnancy, Ectopic; Triplets; Ultrasonography

Our study indicates that the high rate of EP in MAP(+) patients, treated with hMG/hCG, is due to the fact that it is a selected group of infertile patients with probable additional underlying tubal disease. Absence of EP in MAP(-) patients indirectly support the theory that a mechanical factor is at work. It is, therefore, our opinion, that the cause of ectopic pregnancy lies in the patient and not in the drug (hMG/hCG).

Topics: Chorionic Gonadotropin; Female; Humans; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Ectopic

A 32-year-old nulliparous woman underwent hMG induction of superovulation, started on the third day of "menses." The presence of hyperstimulation confused the clinical picture of ectopic pregnancy conceived during the previous cycle. This case illustrates that (1) the clinical findings of hyperstimulation may mask those of ectopic pregnancy; (2) the ovary is not refractory to hMG in the presence of circulating hCG; and (3) an inappropriately high beta-hCG value is suggestive of gestation initiated during a previous cycle.

Topics: Adult; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Menotropins; Ovarian Diseases; Ovary; Peptide Fragments; Pregnancy; Pregnancy, Ectopic; Superovulation

Topics: Adult; Cell Division; Female; Fertilization in Vitro; Follicular Phase; Humans; Menotropins; Oocytes; Pregnancy; Pregnancy Trimester, First; Pregnancy, Ectopic

A developing extra-uterine intra-abdominal gestation is very rare. In the literature the incidence varies from 1 : 6389 to 1 : 10,200. Our case concerns an abdominal ectopic twin gestation, exclusively in relation with the peritoneal surface, which developed normally until 13 weeks and then died.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy, Abdominal; Pregnancy, Ectopic; Pregnancy, Multiple

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

Details of 767 clinical pregnancies and 500 births from Bourn Hall are reported. All treated patients included some over 40 years old, many with ovarian or uterine defects, male infertility, etc. Patients were treated during their natural cycle or stimulated with clomiphene or clomiphene and human menopausal gonadotrophin. Follicular maturation was induced by an endogenous luteinizing hormone surge or human chorionic gonadotrophin. A maximum of three embryos were replaced, except in a few patients receiving four. Twenty-eight percent of pregnancies aborted, occurring more frequently in patients who were over 40, with a complicated obstetric history, and given clomiphene alone. Approximately 18% of fetuses 'vanished' in multi-pregnancies. Seventy-one sets of binovular twins and nine sets of triplets have been born, and seven twins and three triplets are ongoing. Seventeen and a half per cent of patients aged 39 and less with one or more replaced embryos delivered one or more children, rising to almost 25% with three replaced embryos. A mean of 1.3 children were born per delivery when three embryos were replaced. Most deliveries were by Caesarean section. There were two cases of placenta praevia, one stillbirth, four major and eight minor anomalies. All the triplets, and some twins and singletons had low birth weights and were born prematurely. The sex ratio was 247 males to 253 females.

Topics: Abortion, Spontaneous; Adult; Chorionic Gonadotropin; Clomiphene; Delivery, Obstetric; Embryo Transfer; Female; Fertilization in Vitro; Fetal Death; Humans; Infant, Newborn; Male; Maternal Age; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple

Three hundred seventy-two patients underwent laparoscopy for in vitro fertilization and embryo transfer. Of these, 156 were treated with clomiphene citrate alone, 203 with clomiphene citrate and hMG, and 13 with hMG alone. Two-hundred seventy-two of these patients underwent embryo transfer, and 55 pregnancies resulted. Of these, 30 were ongoing, 14 biochemical, 6 ectopic, and 5 aborted. Where four embryos were transferred, the pregnancy rate was found to be significantly higher than when a lesser number were transferred. When the embryos transferred were analyzed, however, it was found that fewer than 10% of all transferred embryos implanted and it was largely a function of multiple embryo transfer per patient that led to success. When the type of hyperstimulation was compared, clomiphene citrate cycles were found to be less successful in that they produced fewer oocytes and embryos than did cycles in which hyperstimulation was achieved by supplementary hMG. It is conceded that this is an overall analysis and that individuals, especially those producing twins, had more than one good embryo transferred into a receptive uterus. The data suggest that unsuccessful cycles had somewhat poorer quality embryos, nonreceptive endometria, or a combination of these factors when compared with those of the successful embryo transfer cycles. The only predictive factor as to outcome relates to the multiplicity of embryos transferred. The fact that some IVF cycles produce multiple pregnancies indicates that a predictor of embryo health is urgently required. However, until such a reliable predictor is obtained, multiple embryo transfer remains a major advance in the success of IVF and ET.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Clomiphene; Embryo Transfer; Female; Fertilization in Vitro; Humans; Laparoscopy; Menotropins; Peptide Fragments; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple

Lysis of adhesions, bilateral salpingectomy, and ovarian suspension were carried out in 54 normal ovulatory patients with long-standing infertility that was associated with severe pelvic adhesions after multiple laparotomies for reimplantation of the fallopian tubes, salpingostomy, lysis of adhesions, or severe endometriosis. Ovulation was induced in 39 patients after laparotomy for in vitro fertilization, with the use of human menopausal gonadotropin, pure follicle-stimulating hormone, and human chorionic gonadotropin. Oocyte retrieval by laparoscopy was accomplished in 37 patients, and embryo transfer was carried out in 36. Pregnancy after in vitro fertilization and embryo transfer occurred in 14 patients. Although severe adhesions recurred in four patients, a significant improvement was obtained after the procedure in the others.

Topics: Chorionic Gonadotropin; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Laparoscopy; Laparotomy; Ligaments; Menotropins; Menstrual Cycle; Ovarian Diseases; Pelvis; Pregnancy; Pregnancy, Ectopic; Reoperation; Tissue Adhesions

Topics: Adult; Clomiphene; Female; Fertilization in Vitro; Humans; Laparoscopy; Luteinizing Hormone; Menotropins; Menstrual Cycle; Oocytes; Ovarian Follicle; Pregnancy; Pregnancy, Ectopic; Suction; Ultrasonography

One hundred fifty-one cycles in 134 consecutive patients were stimulated with 150 IU of human urinary follicle-stimulating hormone (FSH) and 150 IU of human menopausal gonadotropin (hMG) on cycle days 3 and 4 and then with 150 IU of hMG daily for the purpose of multiple follicular development for in vitro fertilization (IVF). Seventy-three patients did not have a prior IVF attempt, and 61 patients in 78 cycles had prior IVF attempts at least once with their previous cycles stimulated with the same method and/or hMG and/or FSH. There was an average of three preovulatory oocytes retrieved per laparoscopy and a pregnancy rate of 27% per transfer cycle. The results were equally favorable in "new" and "old" patient cycles. The pregnancy rate increased with the transfer of two or more conceptuses of preovulatory origin. The multiple pregnancy rate, but not the abortion rate, increased with increased numbers of conceptuses transferred.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Drug Therapy, Combination; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Luteal Phase; Menotropins; Oocytes; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Progesterone; Time Factors

An anovulatory patient was treated with human menopausal gonadotropin and human chorionic gonadotropin. The patient developed severe ovarian hyperstimulation and became pregnant with an ectopic gestation after ovulation induction. Because of the presence of severe ascites and massive ovarian enlargement, it was elected to treat this patient with methotrexate therapy rather than surgery.

Topics: Chorionic Gonadotropin; Female; Humans; Menotropins; Methotrexate; Ovary; Ovulation Induction; Pregnancy; Pregnancy, Ectopic

As of March 31, 1985, 100 clinical pregnancies have been achieved since the program for extracorporeal fertilization was started in Erlangen. 531 (71%) of 768 follicular punctures resulted in an embryo transfer. The overall pregnancy rate is 13% with regard to the total number of laparoscopies and 19% with regard to the number of embryo transfer. The most effective stimulation proved to be the pure hMG regimen. Employing this protocol, we have achieved a clinical pregnancy rate after IVF and ET of 32% during the last 6 months. Oocyte recovery related to the number of patients is 97%, with laparoscopy being superior to ultrasonically guided puncture. The success rate is appreciably affected by both the number of transferred embryos and the atraumatic transfer technique. We question the rationale of supporting the luteal phase.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Clomiphene; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Germany, West; Humans; Luteal Phase; Menotropins; Pregnancy; Pregnancy, Ectopic

Topics: Chorionic Gonadotropin; Female; Humans; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Ectopic

Topics: Adult; Amenorrhea; Female; Humans; Menotropins; Ovulation; Pregnancy; Pregnancy, Ectopic

Topics: Adult; Anovulation; Body Temperature; Chorionic Gonadotropin; Estrogens; Female; Humans; Menotropins; Pregnancy; Pregnancy, Ectopic; Pregnanediol

Topics: Anovulation; Chorionic Gonadotropin; Clomiphene; Female; Humans; Menotropins; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple