Can luteal phase estradiol levels predict the pregnancy outcome in in vitro fertilization cycles of good responders whose excess embryos yield blastocysts?

Reproductive endocrinology of wild female chimpanzees (Pan troglodytes schweinfurthii): methodological considerations and the role of hormones in sex and conception

Fecal and urine samples were collected from 81 female East African chimpanzees (Pan troglodytes schweinfurthii) in three major study populations in Gombe National Park, Tanzania, and Budongo Forest Reserve and Kibale National Park, Uganda. In this study I evaluated issues related to sample storage and assay reliability, and used these methods to investigate the significance of ovarian hormone levels in terms of conception success and sexual behavior. Drying of feces proved to be an effective technique and resulted in hormonal concentrations that were significantly correlated with concentrations in frozen feces. Estimates of ovarian steroid production based on urine and fecal sampling were significantly correlated with each other. The ovarian cycle profiles obtained, which were aligned relative to sexual swelling detumescence, corroborate previous findings in wild west African chimpanzees [Deschner et al., Animal Behaviour 66:551-560, 2003] in suggesting that the fertile period is limited to the last week of tumescence, but that ovulatory timing is not as precise as previously thought. A comparison across cycles confirmed the hypothesis that higher ovarian steroid levels are associated with an increased probability of conception. Females that did conceive with relatively low hormone levels had poor reproductive outcomes. Sexual behavior was tied to the probability of conception both within and across cycles. Copulatory activity within cycles closely followed the estrogen profile and was timed to coincide, on average, with the peak fertile period of females. Further, rates of copulation were significantly higher during the fertile periods of cycles that led to conception than those that did not.

The midluteal decline in serum estradiol levels is drastic but not deleterious for implantation after in vitro fertilization and embryo transfer in patients with normal or high responses

OBJECTIVE

To determine the impact of the peak E(2) level and its midluteal decline on IVF-ET outcome in a group of normal- and high-responding patients.

DESIGN

Retrospective analysis of IVF-ET data.

SETTING

Tertiary-care, university-affiliated teaching hospital.

PATIENT(S)

A total of 100 patients aged </=38 years and receiving up to three embryos per transfer who underwent a similar standard controlled ovarian hyperstimulation for IVF-ET.

INTERVENTION(S)

Morning blood was collected on days 0 (hCG day), +9, and +14.

MAIN OUTCOME MEASURE(S)

Treatment cycle hormonal characteristics and percent midluteal E(2) decline in conception and nonconception cycles.

RESULT(S)

Among all cycles, a mean decline of 95.0% in serum E(2) was observed at the midluteal phase. No significant differences were found in various parameters comparing conception with nonconception cycles. Occurrence of conception did not correlate with the absolute E(2) level or with percent E(2) decline in good and high responders. Early spontaneous abortion occurred more frequently in high responders with >98% E(2) decline; however, the difference did not reach statistical significance.

CONCLUSION(S)

Multifactorial analysis refutes the negative role of supraphysiologic levels of E(2) on the day of hCG administration or its dramatic decline at the midluteal phase on the success rate after embryo transfer. A possibly increased rate of early spontaneous abortion in the high-response group warrants further verification.

Successful resection of a heterotopic cervical pregnancy resulting from intracytoplasmic sperm injection

OBJECTIVE

To report a case of cervical heterotopic pregnancy after IVF-ET treatment.

DESIGN

Case report.

SETTING

Private IVF center.

PATIENT(S)

A woman who had undergone controlled ovarian hyperstimulation and intracytoplasmic sperm injection-ET for primary male factor infertility.

INTERVENTION(S)

Resection of cervical heterotopic pregnancy by hysteroscopy.

MAIN OUTCOME MEASURE(S)

Successful treatment of heterotopic cervical pregnancy.

RESULT(S)

A successful pregnancy resulting in a term baby.

CONCLUSION(S)

Hysteroscopic resection can be used to treat a cervical heterotopic pregnancy.