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Chen P, Hu KL, Jin J, Chen R, Xu Q, Zhao W, Zhang R, Xing L, Zhu Y, Zhang D. Risk factors for twin pregnancy in women undergoing double cleavage embryo transfer. BMC Pregnancy Childbirth 2022; 22:264. [PMID: 35351032 PMCID: PMC8966328 DOI: 10.1186/s12884-022-04606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Two or more embryo transfers have been used to increase the success rate of live birth in traditional in vitro fertilization (IVF) strategy at the expense of increased risks of multiple pregnancy and adverse perinatal outcomes. The decision regarding the elective single embryo transfer or double embryo transfer remains inconclusive. The aim of this study was to investigate the risk factors for twin pregnancy in IVF. Methods Participants who underwent their first fresh IVF cycle where two cleavage stage embryos were transferred in Women’s Hospital of Zhejiang University between January 2010 and December 2018 were included in this retrospective cohort study. The primary outcome was twin delivery. Secondary outcomes included preterm birth and low birth weight Results Fifteen thousand four hundred fifty-nine women were available for final analysis, in which 1511 women resulted in twin delivery and 4788 women had singleton delivery. Female age over 35 was associated with reduced rates of twin pregnancy compared with female age at or less than 35 (9.5% vs 25.1%, aRR = 0.38 (0.27. 0.55)). Poor-type endometrium was associated with reduced rates of twin pregnancy (19.2% vs 27.5%, aRR = 0.75 (0.58. 0.96)). Two good-quality embryos for transfer was associated with significantly higher rates of twin pregnancy compared with one good-quality or none good-quality embryo (26% vs 12.8% vs 9.3%, aRR = 0.56 (0.45. 0.70), aRR = 0.44(0.26. 0.74)). Female age over 35 and none or one good-quality embryo for transfer were associated with reduced rate of low birth weight and preterm birth. Conclusion Women with age over 35, poor-type endometrium, one good-quality embryo or none good-quality embryo were associated with reduced rate for twin pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04606-1.
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Affiliation(s)
- Panpan Chen
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Kai-Lun Hu
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Jiani Jin
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Ruixue Chen
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Qiqi Xu
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Wei Zhao
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Runju Zhang
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Lanfeng Xing
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Yimin Zhu
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Dan Zhang
- Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, People's Republic of China.
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Maleki A, Khalid N, Rajesh Patel C, El-Mahdi E. The rising incidence of heterotopic pregnancy: Current perspectives and associations with in-vitro fertilization. Eur J Obstet Gynecol Reprod Biol 2021; 266:138-144. [PMID: 34653918 DOI: 10.1016/j.ejogrb.2021.09.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/18/2021] [Accepted: 09/26/2021] [Indexed: 12/27/2022]
Abstract
Heterotopic pregnancy is the simultaneous occurrence of an intrauterine and ectopic pregnancy. This study aims to review the current literature regarding heterotopic pregnancy with a focus on its diagnosis and associations with in-vitro fertilization (IVF). Studies have shown that ovarian hyperstimulation syndrome and multiple embryo transfer during IVF are associated with an increased risk of heterotopic pregnancy. Tubal abnormalities such as pelvic inflammatory disease and previous tubal or abdomino-pelvic surgery have also been identified as risk factors. Diagnosis is challenging as the falsely reassuring presence of an intrauterine fetus frequently delays early intervention. Treatment should be individualised, but is often prompt surgical intervention, and focuses on terminating the ectopic pregnancy while minimizing harm to the mother and intrauterine fetus.
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Affiliation(s)
- Aryan Maleki
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK
| | - Noorulain Khalid
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK
| | - Chandni Rajesh Patel
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK
| | - Essam El-Mahdi
- Department of Obstetrics and Gynaecology, Newham University Hospital, Barts Health NHS Trust, London, UK
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Sundhararaj UM, Madne MV, Biliangady R, Gurunath S, Swamy AG, Gopal IS. Single Blastocyst Transfer: The Key to Reduce Multiple Pregnancy Rates Without Compromising the Live Birth Rate. J Hum Reprod Sci 2017; 10:201-207. [PMID: 29142449 PMCID: PMC5672726 DOI: 10.4103/jhrs.jhrs_130_16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Historically, to achieve higher pregnancy rates, multiple embryos were transferred after an in-vitro fertilisation (IVF). However, this practice is being reassessed, because it leads to multiple pregnancies that is known to cause adverse maternal and fetal outcomes. AIM To compare the pregnancy outcomes in fresh IVF or intracytoplasmic sperm injection (ICSI) cycles among women undergoing elective single blastocyst transfer (eSBT) vs. those undergoing double blastocyst transfer (DBT). SETTINGS AND DESIGN It is a retrospective data analysis of 582 patients undergoing fresh IVF/ICSI cycles performed from January 2012 to June 2015. MATERIALS AND METHODS Patients, who underwent IVF/ICSI and developed more than one blastocyst, were included in the study. Donor cycles were excluded from the study. All the embryos were cultured to blastocyst stage in sequential media followed by transfer of two blastocysts (DBT) or eSBT and cryopreservation of the remaining. STATISTICAL ANALYSIS Statistical analysis was performed using chi square test. RESULTS Out of 582 patients, in 149 patients one blastocyst was transferred and in 433 patients two blastocysts were transferred. There was no statistical difference in the biochemical pregnancy rate, clinical pregnancy rate and live birth rate in both the groups. Statistics demonstrated a significant drop in miscarriage rate in eSBT group. There was no incidence of twins in eSBT group, whereas twin birth rate per clinical pregnancy was 29.02% in DBT group. CONCLUSION Single blastocyst transfer is an effective method to reduce the risk of multiple births without compromising the pregnancy outcomes. Given the promising potential of vitrification; the remaining blastocyst can be cryopreserved.
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Affiliation(s)
| | - Monali V. Madne
- Fertility Unit, Cloudnine Hospitals, Bangalore, Karnataka, India
| | - Reeta Biliangady
- Fertility Unit, Cloudnine Hospitals, Bangalore, Karnataka, India
| | - Sumana Gurunath
- Fertility Unit, Cloudnine Hospitals, Bangalore, Karnataka, India
| | - Ambika G. Swamy
- Fertility Unit, Cloudnine Hospitals, Bangalore, Karnataka, India
| | - Indu S.T. Gopal
- Fertility Unit, Cloudnine Hospitals, Bangalore, Karnataka, India
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Lee AM, Connell MT, Csokmay JM, Styer AK. Elective single embryo transfer- the power of one. Contracept Reprod Med 2016; 1:11. [PMID: 29201400 PMCID: PMC5693485 DOI: 10.1186/s40834-016-0023-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/11/2016] [Indexed: 11/15/2022] Open
Abstract
Despite the highest historical live birth success rates for couples undergoing in vitro fertilization (IVF), there has been an epidemic of iatrogenic twin and higher order gestation conceived from this treatment. Continued improvement in cryopreservation techniques have allowed preservation of supernumerary embryos for use in future cycles, and refinements in culture systems and embryo selection have resulted in the transfer of fewer embryos while maintaining favorable pregnancy rates. The voluntary transfer of a single high quality embryo, elective single embryo transfer (eSET), has significantly reduced multiple gestation rates and maximized the rate of singleton pregnancy without compromising overall success rates. Although eSET is the standard of care in several developed countries, utilization in the United States has been slow. States with mandated IVF insurance have seen decreases in preterm birth rates yielding down stream health care savings. Herein, the evolution and future applications of this practice to reduce the risk of iatrogenic twins is reviewed.
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Affiliation(s)
- Amy M Lee
- Massachusetts General Hospital Fertility Center, Vincent Memorial Obstetrics and Gynecology Service and Harvard Medical School, Boston, MA 02114 USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA 02114 USA
| | - Matthew T Connell
- Walter Reed Army Medical Center, Washington, DC USA.,Program in Reproductive and Adult Endocrinology, NICHD, National Institutes of Health, Bethesda, MD USA
| | - John M Csokmay
- Walter Reed Army Medical Center, Washington, DC USA.,Program in Reproductive and Adult Endocrinology, NICHD, National Institutes of Health, Bethesda, MD USA
| | - Aaron K Styer
- Massachusetts General Hospital Fertility Center, Vincent Memorial Obstetrics and Gynecology Service and Harvard Medical School, Boston, MA 02114 USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA 02114 USA.,Vincent Reproductive Medicine and IVF, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Yaw 10A, 55 Fruit Street, Boston, MA 02114 USA
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5
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IVF policy and global/local politics: The making of multiple-embryo transfer regulation in Taiwan. Soc Sci Med 2012; 75:725-32. [DOI: 10.1016/j.socscimed.2012.03.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 03/20/2012] [Accepted: 03/22/2012] [Indexed: 11/23/2022]
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Esfandiari N, Kapoor M, Burjaq H, Chang P, Gotlieb L, Casper RF. Monozygotic twins in infertile patients with advanced maternal age: case reports and review of the literature. Fertil Steril 2009; 92:1168.e9-1168.e12. [DOI: 10.1016/j.fertnstert.2009.05.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 05/13/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
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Esfandiari N, Claessens EA, Gotlieb L, Casper RF. Don't judge a book by its cover; a quintuplet pregnancy following transfer of five poor-quality embryos. Fertil Steril 2008; 90:2007.e13-5. [PMID: 18394609 DOI: 10.1016/j.fertnstert.2008.02.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 02/05/2008] [Accepted: 02/05/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report a case of a quintuplet pregnancy following transfer of five poor-quality cellular-stage embryos. DESIGN Case report. SETTING University of Toronto-affiliated infertility clinic. PATIENT(S) A 35-year-old female with a 2-year history of secondary infertility. INTERVENTION(S) Intracytoplasmic sperm injection and embryo transfer. MAIN OUTCOME MEASURE(S) Clinical pregnancy. RESULT(S) Quintuplet implantation with five fetal hearts. CONCLUSION(S) Because the transfer of five poor embryos resulted in a quintuplet implantation, we recommend that embryos with significant morphologic abnormalities, especially in younger patients, be considered as viable embryos with implantation potential.
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Affiliation(s)
- Navid Esfandiari
- Toronto Centre for Advanced Reproductive Technology, University of Toronto, Toronto, Canada.
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8
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Leeton J. The early history of IVF in Australia and its contribution to the world (1970-1990). Aust N Z J Obstet Gynaecol 2005; 44:495-501. [PMID: 15598283 DOI: 10.1111/j.1479-828x.2004.00305.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although Edwards and Steptoe achieved the first IVF pregnancy and birth in 1978, the majority of pioneering developments in IVF during the eighties came from Australia. They included the world's first donor egg pregnancy, the first frozen embryo pregnancy and the first IVF multiple pregnancies. Australia also produced the first national guidelines for IVF practices, the first statute legislation protecting donor gamete pregnancies, and Victoria proclaimed the first statute legislation regarding control of IVF procedures. The reporting of the outcome of all IVF pregnancies began in 1980 as another world initiative.
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Affiliation(s)
- John Leeton
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Melbourne, Victoria, Australia
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Dare MR, Crowther CA, Dodd JM, Norman RJ. Single or multiple embryo transfer following in vitro fertilisation for improved neonatal outcome: A systematic review of the literature. Aust N Z J Obstet Gynaecol 2004; 44:283-91. [PMID: 15281996 DOI: 10.1111/j.1479-828x.2004.00243.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the current review was to determine if single versus two or more embryos, or double versus three or more embryos, transferred to the woman of a subfertile couple at in vitro fertilisation (IVF) maximises the likelihood of pregnancy, while minimising the likelihood of multiple pregnancy and adverse sequelae. METHODS Studies were identified that reported maternal, infant and cost outcomes following embryo transfer at IVF. RESULTS Three randomised trials and 17 cohort studies were included. From two randomised trials, single embryo transfer was found to result in decreased incidence of clinical pregnancy, multiple pregnancy and low birthweight. In the cohort studies for single embryo transfer compared with transfer of two or more embryos the incidence of live birth and singleton pregnancies was unchanged, and the incidence of multiple pregnancies and low birthweight was reduced. For double embryo transfer compared with the transfer of three or more embryos, the incidence of clinical pregnancy, live birth, preterm birth and low birthweight babies was reduced. CONCLUSIONS Information on neonatal and maternal outcomes following transfer of different numbers of embryos is limited. Transfer of one embryo does not alter the likelihood of a singleton pregnancy or birth when compared to transfer of two or more embryos. Transfer of one or two embryos decreases the risk of a multiple pregnancy, preterm birth and low birthweight. Further large, well-designed randomised trials are required to provide maternal and neonatal outcomes of relevance to a couple undergoing IVF.
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Affiliation(s)
- Marianna R Dare
- Department of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
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10
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Moore ML. Preterm Labor and Birth: What Have We Learned in the Past Two Decades? J Obstet Gynecol Neonatal Nurs 2003; 32:638-49. [PMID: 14565744 DOI: 10.1177/0884217503257367] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Preterm births in the United States reached a 20-year high of 11.9% in 2001. Preterm and low-birth-weight births are the end result of multiple pathways. This article examines two decades of multidisciplinary research related to preterm birth from both individual and ecologic perspectives. The difficulties in identifying women who will have preterm birth, risk factors amenable to change in the preconception and prenatal periods, and strategies for intervention are described, along with maternal treatment to improve infant outcomes. Future directions for nursing practice and research are suggested.
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Affiliation(s)
- Mary Lou Moore
- Obstetrics and Gynecology, Wake Forest University, School of Medicine, Winston-Salem, NC 27157-1066, USA
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11
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Bonnicksen A. In vitro fertilization and public policy: turning to the consumer. POPULATION RESEARCH AND POLICY REVIEW 2001; 5:197-215. [PMID: 11659236 DOI: 10.1007/bf00136784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Lin YP, Cassidenti DL, Chacon RR, Soubra SS, Rosen GF, Yee B. Successful implantation of frozen sibling embryos is influenced by the outcome of the cycle from which they were derived. Fertil Steril 1995; 63:262-7. [PMID: 7843428 DOI: 10.1016/s0015-0282(16)57352-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To determine if the success of frozen embryos obtained from assisted reproductive technology (ART) cycles is dependent upon the outcome of the ART cycle from which they were derived and to determine if the length of time in cryostorage affects pregnancy rates (PRs). DESIGN Retrospective analysis of pregnancy outcome of consecutive frozen ETs compared with their corresponding "'fresh" cycles. SETTING University-affiliated private ART program. PATIENTS Between July 1986 and December 1992, 375 oocyte retrieval cycles had at least one subsequent frozen ET for comparison. Of the 375 patients, 94 achieved a clinical pregnancy during their fresh cycle (group A) and 281 patients did not (group B). INTERVENTIONS Frozen ETs were performed using either natural (unstimulated) cycles (n = 79) or artificial cycles (n = 296). Transfers during natural cycles were timed with a combination of serum LH levels and ultrasound (US). These transfers were performed 2 days after ovulation. Ovarian suppression with leuprolide acetate followed by sequential estrogen and P replacement were used in the artificial cycles. These transfers were performed on the 3rd day of P administration. Clinical pregnancies were defined as the presence of a gestational sac on transvaginal US. MAIN OUTCOME MEASURES Patients were compared based on the pregnancy outcome of their frozen ET cycle and fresh ART cycle. chi 2 analysis and Student's-tests were used to test for statistical significance. RESULTS Twenty-three patients (24.1%) from group A achieved a pregnancy from their frozen transfers compared with only 24 patients (8.5%) in group B who achieved a pregnancy from their frozen cycle. PRs did not differ based on the method of follicle aspiration, laparoscopy versus transvaginal US retrieval. Significantly lower PRs were noted in frozen ETs done within the first 10 months after cryopreservation compared with fresh cycle PRs. CONCLUSIONS Sibling embryos from a prior successful ART cycle are more likely to initiate a frozen pregnancy and prolonged cryostorage did not affect PRs. This higher PR probably reflects better quality in both fresh and frozen embryos. Therefore, the outcome of the initial cycle can be used to predict the success or failure of subsequent frozen transfers and oocyte-embryo quality appears to be key.
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Affiliation(s)
- Y P Lin
- Department of Obstetrics and Gynecology, Long Beach Memorial Medical Center
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13
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Gershoni-Baruch R, Epstein R, Tzischinsky O, Lavie P, Brandes JM. Actigraphic home-monitoring of the sleep patterns of in vitro fertilization children and their matched controls. Dev Med Child Neurol 1994; 36:639-45. [PMID: 8034127 DOI: 10.1111/j.1469-8749.1994.tb11902.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The sleep patterns of 35 in vitro fertilization (IVF) children aged 19 to 57 months and their matched controls were evaluated by actigraphic home-monitoring for three consecutive nights. Actigraphic data were analysed by an automated scoring procedure developed in the authors' laboratory. There were no significant differences in activity levels between IVF multiple-birth subjects and their matched controls or between IVF singletons and their matched controls. In contrast, multiple-birth subjects had higher activity levels during sleep and lower sleep efficiency than singletons in both IVF and control groups. Sleep measures showed night-to-night stability in all groups.
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Affiliation(s)
- R Gershoni-Baruch
- Department of Obstetrics/Gynecology, Rambam Medical Center, Haifa, Israel
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14
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Michalas S, Messogitis S, Loutradis D. Fetal reduction of quintuplet pregnancy. Int J Gynaecol Obstet 1994; 44:77-8. [PMID: 7907067 DOI: 10.1016/0020-7292(94)90031-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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15
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Affiliation(s)
- D Meirow
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel
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16
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Chang JC, Sun TT, Lin YC. Simultaneous ectopic pregnancy with intra-uterine gestation after in vitro fertilization and embryo transfer. Eur J Obstet Gynecol Reprod Biol 1992; 44:157-60. [PMID: 1587382 DOI: 10.1016/0028-2243(92)90062-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A case of combined intra-uterine and tubal ectopic pregnancy is described following in vitro fertilization and the transfer of two four-cell and one two-cell embryos. This phenomenon is known to be related to ovarian stimulation by gonadotropin therapy, and there is an increased risk with tubal disease. Techniques applied at the time of embryo transfer, the use of culture medium with 50% fetal cord serum to convey the embryos to the uterus, the catheterization method, and the position of the patient during transfer are presented. The risk of multiple pregnancies and combined intra-uterine and ectopic gestations increases with numbers of transfers and large volume of transfer medium. We would therefore recommend that after IVF-ET treatment in women with tubal disease, intensive care should be taken in the early follow-up period to rule out the possibility of ectopic pregnancy. In this case, a viable ongoing intra-uterine pregnancy was confirmed after surgery for right ampullary ectopic pregnancy. And a 2,925 g male in excellent condition was delivered by Cesarean section without complications.
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Affiliation(s)
- J C Chang
- Department of Obstetrics & Gynecology, Chang Gung Memorial Hospital, Taiwan, ROC
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17
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Staessen C, Camus M, Bollen N, Devroey P, Van Steirteghem AC. The relationship between embryo quality and the occurrence of multiple pregnancies**Supported by grant 3.0036.85 from the Belgian Fund for Medical Research, Brussels, Belgium.††Presented in part at the 6th Meeting of the European Society of Human Reproduction, Milano, Italy, August 29 to September 1, 1990. Fertil Steril 1992. [DOI: 10.1016/s0015-0282(16)54911-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Abstract
The case of a 33-year-old woman who presented with abdominal pain referable to the lower abdomen is discussed. She had had an uncomplicated intrauterine abortive procedure two weeks earlier. It was determined that a ruptured ectopic pregnancy was the etiology of her abdominal pain. The rare phenomenon of combined intrauterine and extrauterine pregnancy is discussed.
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20
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21
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Chang JC, Lin YC, Sun TT. Bilateral tubal ectopic pregnancy after in vitro fertilization and embryo transfer. JOURNAL OF IN VITRO FERTILIZATION AND EMBRYO TRANSFER : IVF 1991; 8:292-6. [PMID: 1757745 DOI: 10.1007/bf01139788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J C Chang
- Department of Obstetrics & Gynecology, Chang Gung Memorial Hospital, Taiwan, R.O.C
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22
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Evans MI, Drugan A, Bottoms SF, Platt LD, Rodeck CA, Hansmann M, Fletcher JC. Attitudes on the ethics of abortion, sex selection, and selective pregnancy termination among health care professionals, ethicists, and clergy likely to encounter such situations. Am J Obstet Gynecol 1991; 164:1092-9. [PMID: 2014831 DOI: 10.1016/0002-9378(91)90592-f] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The ethical attitudes of health care providers toward abortion, sex selection, and selective termination of normal and anomalous fetuses in singleton or multiple pregnancies were evaluated by questionnaires distributed to members of the American Society of Human Genetics, the International Fetal Medicine and Surgery Society, the Society of Perinatal Obstetricians, ethicists, and clergy. Demographic characteristics of respondents exhibited a preponderance of men (76%), age greater than 40 (68%), and of United States residents (82%). Seventy-nine percent of respondents were in the medical profession. Approximately half of the respondents were Protestant, the rest being evenly distributed among Catholic, Jewish, and other religions. Acceptance of abortion for social indication varied by religion and gestational age but not by religious conviction, age, country, or gender of respondent. First-trimester abortion of a normal singleton pregnancy was considered more acceptable than selective termination of normal fetuses in multifetal gestations. Sex selection was considered unethical by most respondents. Selective termination was deemed ethically appropriate in quadruplets or multifetal gestations of more than five fetuses and in multiple pregnancies bearing one anomalous fetus. In the latter situation, acceptance increased with the severity of fetal anomalies and decreased from the first to the third trimester. The medical specialty of respondents was the only independent factor strongly associated with acceptance of selective termination by trimester, indication, and number of fetuses. Acceptance of selective termination among health care professionals appears to reflect not only perceptions of procedure-related risks and benefits in the index pregnancy but also individual training and religious beliefs.
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Affiliation(s)
- M I Evans
- Department of Obstetrics and Gynecology, Hutzel Hospital/Wayne State University, Detroit, MI 48201
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23
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Tani H, Oda K, Schichiri K, Arakawa O, Sato Y. Combined intrauterine and tubal pregnancy after in vitro fertilization and embryo transfer. Int J Gynaecol Obstet 1990; 33:359-63. [PMID: 1979290 DOI: 10.1016/0020-7292(90)90522-m] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case of combined intrauterine and tubal pregnancy after in vitro fertilization and embryo transfer is reported. As soon as the diagnosis was made at 9 weeks gestation, the fetal heart movement of the tubal pregnancy disappeared, and the patient was managed without surgery throughout the pregnancy course. After an infant was delivered, a right salpingectomy was performed and the diagnosis was histologically confirmed. Risk factors and treatments of combined pregnancy are discussed.
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Affiliation(s)
- H Tani
- Department of Obstetrics and Gynecology, Niigata University, School of Medicine, Japan
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24
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Blankstein J, Collins RL, Easley KA, Gupta MK, Quigley MM. Combined clomiphene citrate (CC) and human menopausal gonadotropins (hMG) in a fixed schedule for follicular recruitment during in vitro fertilization: effects on premature luteinizing hormone (LH) surges. JOURNAL OF IN VITRO FERTILIZATION AND EMBRYO TRANSFER : IVF 1989; 6:121-4. [PMID: 2498445 DOI: 10.1007/bf01130741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Recognizing the association between plasma progesterone (P) and an imminent LH surge, we investigated the frequency of P elevation in our stimulation protocol (clomiphene citrate-human menopausal gonadotropins). P was measured retrospectively on the day before, the day of, and the day after human chorionic gonadotropin hCG administration. The means +/- 2 standard deviations for P were as follows: day before hCG, 0.58 +/- 0.86; day of hCG, 0.64 +/- 0.56; and day after hCG, 1.47 +/- 1.22. Seven patients (8%) had P levels greater than 2 SD above the mean. Significant P elevations prior to hCG are infrequent with this protocol, and in the few patients with raised P a trend toward lowered fertilization was noted. The low incidence of P elevation may be secondary to the administration of hCG in a timely manner on the sixth day of estradiol (E2) rise.
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Affiliation(s)
- J Blankstein
- Department of Gynecology, Cleveland Clinic Foundation, Ohio 44106
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25
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Camus M, Van den Abbeel E, Van Waesberghe L, Wisanto A, Devroey P, Van Steirteghem AC. Human embryo viability after freezing with dimethylsulfoxide as a cryoprotectant. Fertil Steril 1989; 51:460-5. [PMID: 2920845 DOI: 10.1016/s0015-0282(16)60554-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study concerns the effects of a slow freezing and thawing protocol using dimethylsulfoxide (DMSO) as a cryoprotectant on the survival and viability of 319 supernumerary human embryos produced after in vitro fertilization. One hundred twenty-one transfers were performed in a natural cycle and 18 pregnancies were achieved (15%), from which 14 were ongoing (12%). Overall, 52% of the thawed embryos retained at least 50% of their initial blastomeres intact after thawing, and were replaced. Survival was strongly correlated to prefreezing embryonic quality, as 78% of type I embryos, 55% of type II, 40% of type III, and none of type IV could be transferred. Implantations were obtained from type I embryos (21% per embryo replaced) and from type II (14.5%), whereas none of the type III embryos resulted in a pregnancy. In the authors' experience, using the DMSO protocol, the best pregnancy rates were achieved when replacing 8-cell embryos of high morphologic prefreezing quality. No statistically significant difference could be demonstrated, however, in implantation rates between 8-cell and 4-cell embryos, or between synchronously and asynchronously dividing concepti.
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Affiliation(s)
- M Camus
- Centre for Reproductive Medicine, Vrije Universiteit Brussel, Belgium
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26
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Warnes GM, Quinn P, Kirby CA, Broom TJ, Kerin JF. The effect of transferring pronuclear embryos on pregnancy outcome after in vitro fertilization. Ann N Y Acad Sci 1988; 541:465-71. [PMID: 3057997 DOI: 10.1111/j.1749-6632.1988.tb22283.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In a prospective clinical trial the pregnancy rate in patients matched for infertility status, degree of hyperstimulation, and number of oocytes recovered was unaffected by whether embryos were transferred while still pronuclear (day 1) or after they had undergone cleavage (day 2). The pregnancy rates per transfer were 27% and 22%, respectively, for the two transfer times. Unlike results of a previous study, no difference was detected in the outcome of pregnancies from the two groups.
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Affiliation(s)
- G M Warnes
- Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia
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27
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28
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29
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Tacchi D, Dunlop W. A multiple pregnancy after in-vitro fertilization. Case report. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1987; 94:1223-4. [PMID: 3426992 DOI: 10.1111/j.1471-0528.1987.tb02326.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- D Tacchi
- Department of Obstetrics and Gynaecology, Princess Mary Maternity Hospital, Newcastle-upon-Tyne
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30
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Brandes JM, Itskovitz J, Timor-Tritsch IE, Drugan A, Frydman R. Reduction of the number of embryos in a multiple pregnancy: quintuplet to triplet. Fertil Steril 1987; 48:326-7. [PMID: 3609345 DOI: 10.1016/s0015-0282(16)59366-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The technique for reduction of the number of embryos was applied in a patient who conceived following IVF and transfer of six embryos. On the 10th week of gestation, the number of embryos was reduced from five to three by an U/S-guided intra-uterine procedure. Two healthy girls and a boy were delivered in the 36th week by cesarean section. No trace of the other two fetuses was found. The moral and technical aspects of partial preventive termination of multiple pregnancy are discussed.
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31
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Affiliation(s)
- V N Bolton
- Department of Obstetrics and Gynaecology, University of Cambridge Clinical School, Rosie Maternity Hospital, England
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32
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Abstract
Involuntary infertility is an increasing problem in this era of delayed childbearing. Fortunately, many advances have been made recently in the medical and surgical treatment of infertility. This article reviews the principal aetiologies of infertility and their treatments, and focuses on the current and future uses of ovulation-inducing drugs and other infertility treatments. Proper diagnosis of anovulation and luteal phase dysfunction is discussed together with a description of conventional treatments with clomiphene and human menopausal gonadotrophins (hMG). Recent advances including the use of synthetic gonadotrophin hormone-releasing hormone (GnRH), purified human follicle stimulating hormone and a combination of GnRH and hMG are described, along with the application of the same agents for enhanced follicular recruitment for in vitro fertilisation. In addition, several promising future developments for pharmacological induction of normal ovulation are also discussed.
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33
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Abstract
The first successful attempt at deep freezing and thawing of the human oocyte is reported. A twin pregnancy was achieved after insemination and replacement in utero. The procedure involved reduction in size of the oocyte/cumulus-oophorus complex, the addition of the cryoprotectant dimethyl sulphoxide as a one-step procedure, slow cooling between -7 degrees C and -36 degrees C after ice nucleation, and rapid freezing to -196 degrees C before storage in liquid nitrogen. Thawing was achieved rapidly by warming in a 37 degrees C water-bath, followed by dilution of dimethyl sulphoxide as a single step. 80% of forty oocytes showed morphological survival after freezing and thawing. Thirty of these were inseminated; 83% retained their capacity to be fertilised, and 60% proceeded to cleavage division.
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34
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Quinn P, Kerin JF. Experience with the cryopreservation of human embryos using the mouse as a model to establish successful techniques. JOURNAL OF IN VITRO FERTILIZATION AND EMBRYO TRANSFER : IVF 1986; 3:40-5. [PMID: 3958567 DOI: 10.1007/bf01131379] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mouse embryos at the one-, two-, and eight-cell stages have been used to optimize the conditions for cryopreservation of human oocytes and embryos. For storage in glass vials using 1.5 M dimethyl sulfoxide (DMSO) as a cryoprotectant and slow cooling (approximately 0.3 degrees C/min), phosphate-buffered medium was superior to Hepes-buffered medium. Termination of slow cooling at -80 degrees C before transfer to liquid nitrogen with subsequent slow thawing (approximately 8 degrees C/min) resulted in more embryos surviving than when cooling terminated at -40 degrees C and rapid thawing (approximately 500 degrees C/min) was employed. Dilution of DMSO upon thawing with medium containing 0.5 M sucrose gave higher embryo survival rates than a stepwise (0.25 M decrements) dilution. Using these techniques, three pregnancies were established upon the transfer of 11 frozen-thawed embryos to seven patients. Rates of embryo survival using the simpler cryopreservation technique of ice-free vitrification in 0.25-ml straws have been disappointing.
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35
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Mettler L, Riedel HH, Bonhoff A, Michelmann HW. Multiple pregnancies in gonadotropin-stimulated cycles after human in vitro fertilization (IVF) and embryo replacement. EXPERIENTIA 1985; 41:1509-14. [PMID: 3935477 DOI: 10.1007/bf01964785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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36
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High incidence of preterm births and early losses in pregnancy after in vitro fertilisation. Australian in vitro fertilisation collaborative group. BMJ 1985; 291:1160-3. [PMID: 3931835 PMCID: PMC1417853 DOI: 10.1136/bmj.291.6503.1160] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A fertilisation cohort of 244 pregnancies resulting from in vitro fertilisation was reported to a national register by eight units specialising in in vitro fertilisation. Early pregnancy losses were high, with 5% tubal ectopic pregnancies, 18% biochemical pregnancies, and an incidence of spontaneous abortion of 27%. Among pregnancies of at least 20 weeks' gestation 22% were multiple, with 26 pairs of twins and four sets of triplets. The incidence of preterm births was more than three times higher than in the general population. Low birthweight rates were also higher, owing both to preterm births and to multiple pregnancies. The sex ratio and the incidence of major congenital malformations were similar to those in naturally conceived pregnancies. In this series the high fetal losses at all stages of pregnancy suggested maternal reproductive causes and should not be interpreted as being due to factors peculiar to in vitro fertilisation. Further analysis will be necessary when larger numbers are available.
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37
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Shaw RW, Ndukwe G, Imoedemhe DA, Bernard AG, Burford G. Twin pregnancy after pituitary desensitisation with LHRH agonist and pure FSH. Lancet 1985; 2:506-7. [PMID: 2863530 DOI: 10.1016/s0140-6736(85)90444-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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39
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DeCherney AH, Tarlatzis BC, Laufer N, Naftolin F. A simple technique of ovarian suspension in preparation for in vitro fertilization. Fertil Steril 1985; 43:659-61. [PMID: 3157608 DOI: 10.1016/s0015-0282(16)48514-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Because laparoscopic ovum harvest for IVF is becoming more common, efforts must be made at the time of prior infertility surgery to render the ovaries accessible for ovum recovery. In this report, a simple technique of ovarian suspension in preparation for eventual IVF is described. Seventeen infertile patients undergoing lysis of adhesions underwent ovarian suspension by plication of the suspensory ligament of the ovary with a running suture of 3-0 Prolene, thus apposing the proximal pole of the ovary to the anterior-lateral surface of the uterus. Because the fallopian tube is independent of the sutured structures, the tubal anatomy was undisturbed. Fourteen of these 17 patients have since undergone laparoscopy during IVF. In 12 cases, despite the recurrence of adhesions, the ovaries were accessible for ovum recovery from all aspects. Two patients conceived normally after the lysis of adhesions. This simplified ovarian suspension represents an effective technique for facilitating ovum recovery for IVF which may not disturb fallopian tube ovum pickup or transport mechanisms.
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40
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Quigley MM, Schmidt CL, Beauchamp PJ, Maklad NF, Berkowitz AS, Wolf DP. Preliminary experience with a combination of clomiphene and variable dosages of menopausal gonadotropins for enhanced follicular recruitment. JOURNAL OF IN VITRO FERTILIZATION AND EMBRYO TRANSFER : IVF 1985; 2:11-6. [PMID: 3926920 DOI: 10.1007/bf01130826] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A combination of clomiphene citrate and human menopausal gonadotropin was employed for enhanced follicular recruitment in an in vitro fertilization program. All patients received 50 mg of clomiphene and 1 ampule of human menopausal gonadotropin daily from cycle day 5 through cycle day 9. Follicular monitoring was begun on day 10 using a combination of ultrasound measurement of follicular size and number and determination of peripheral estradiol levels. Based on the size and number of follicles, the peripheral levels of estradiol, and the rate of follicular growth and increase in estradiol, human menopausal gonadotropin was continued at a dosage of 1 to 3 ampules/day through the day of human chorionic gonadotropin administration. Human chorionic gonadotropin was administered on the evening of the day the largest follicle reached or exceeded 20 mm in mean diameter if the estradiol levels had been rapidly rising or reaching a plateau and had exceeded a minimal level of 300 pg/ml. Using this protocol, 30 of 33 patients underwent laparoscopy, 29 patients had successful oocyte recovery, and 23 patients underwent embryo replacement, with the establishment of six clinical pregnancies.
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41
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Sondheimer SJ, Tureck RW, Blasco L, Strauss J, Arger P, Mennuti M. Simultaneous ectopic pregnancy with intrauterine twin gestations after in vitro fertilization and embryo transfer. Fertil Steril 1985; 43:313-6. [PMID: 3881297 DOI: 10.1016/s0015-0282(16)48392-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A simultaneous ectopic tubal pregnancy with viable intrauterine twin gestations after IVF-ET of five fertilized eggs is presented. Pelvic ultrasound and serial quantitative hCG levels were not helpful in the diagnosis of the tubal pregnancy. The risk of multiple pregnancies and of concomitant intrauterine and extrauterine gestations increases with transfer of a greater number of embryos. Karyotype of the tubal pregnancy was normal (46,XX).
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42
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MacLennan AH, Kerin JF, Kirby C, Grant P, Warnes GM, Cox LW, Bryant-Greenwood G, Greenwood F. The effect of porcine relaxin vaginally applied at human embryo transfer in an in vitro fertilization programme. Aust N Z J Obstet Gynaecol 1985; 25:68-71. [PMID: 3899093 DOI: 10.1111/j.1479-828x.1985.tb00608.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
It has been suggested that the polypeptide hormone relaxin is an early pregnancy factor which facilitates implantation and pregnancy maintenance. To test this hypothesis a double blind randomized placebo controlled trial was conducted where 2 mg purified porcine relaxin or distilled water was given in a vaginal gel on the day of embryo transfer and again 3 days later in a human in vitro fertilization (IVF) programme. There were 96 patients in the randomized trial and 73 patients who were treated concurrently in the same IVF programme acted as a further control group. Of the 51 patients who received relaxin, 10 pregnancies were confirmed and 8 continued successfully. In the 45 patients treated with placebo 10 pregnancies were also confirmed and 6 continued successfully. Amongst the 73 patients concurrently treated outside the trial 14 achieved a pregnancy and 10 continued to term. Thus, porcine relaxin given in these circumstances in a human IVF programme did not appear to improve or interfere with the pregnancy rate. Possible factors that affected the implantation rates in this trial are discussed.
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43
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Quigley MM, Schmidt CL, Beauchamp PJ, Pace-Owens S, Berkowitz AS, Wolf DP. Enhanced follicular recruitment in an in vitro fertilization program: clomiphene alone versus a clomiphene/human menopausal gonadotropin combination. Fertil Steril 1984; 42:25-33. [PMID: 6427027 DOI: 10.1016/s0015-0282(16)47953-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In an attempt to improve the pregnancy rate following in vitro fertilization and embryo transfer by increasing the numbers of embryos available for transfer to each patient, a prospective, randomized comparison of clomiphene citrate alone (50 mg/day, cycle days 5 to 9) with the combination of clomiphene as above plus human menopausal gonadotropin (2 ampules/day, cycle days 6, 8, and 10) was undertaken from January through April 1983, with 17 patients in each group. The combination produced increased follicular development, compared with clomiphene alone, resulting in the retrieval of more fertilizable oocytes. Two clinical pregnancies resulted in each group. These results show that a fixed combination of clomiphene and human menopausal gonadotropin produces a greater degree of enhanced follicular recruitment, resulting in the recovery of an increased number of fertilizable oocytes. The lack of a statistically significant increase in the number of embryos transferred per patient in the combination group as well as the identical number of clinical pregnancies in both groups suggests that this particular combination of clomiphene and human menopausal gonadotropin offers no advantage over the use of clomiphene alone for enhanced follicular recruitment.
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44
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Yovich JL, Stanger JD, Tuvik AI, Yovich JM. In‐vitro fertilization in Western Australia: A viable service programme. Med J Aust 1984. [DOI: 10.5694/j.1326-5377.1984.tb108289.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- John L. Yovich
- Department of Obstetrics and GynaecologyUniversity of Western Australia, King Edward Memorial HospitalSubiacoWA6008
| | | | - Ann I. Tuvik
- PIVET Laboratory Cambridge HospitalWembleyWA6014
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45
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Kerin JF, Warnes GM, Quinn P, Kirby C, Godfrey B, Cox LW. Endocrinology of ovarian stimulation for in vitro fertilization. Aust N Z J Obstet Gynaecol 1984; 24:121-4. [PMID: 6437386 DOI: 10.1111/j.1479-828x.1984.tb01471.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Understanding of the endocrinology of in vitro fertilization has advanced rapidly in the past 5 years. Despite a multitude of ovarian stimulation regimens a particular regimen has not demonstrated a marked superiority. In principle the achievement of high FSH levels during the early follicular phase to recruit a maximum number of follicles with a tolerable degree of asynchrony for final maturation is confined to a limited time span or 'FSH window' of about 3 to 4 days before negative E2 feedback induces below-threshold FSH levels, thereby condemning all subsequent follicles in that cycle to atresia. It appears that one can widen and/or amplify the 'FSH window' too far from gross hyperstimulation resulting in the recruitment of many follicles with an intolerable degree of asynchrony. This may lead to a defective endocrine environment for the oocytes contained within these follicles or an abnormal luteal environment and an increased frequency of fertilization, cleavage and implantation failure. Whichever regimen is used, the stimulation should ideally be sufficient to promote the development of at least 3 follicles beyond 18mm diameter at the time of OPU. This can be expected to result in at least 2 embryos to be available for transfer. Monitoring of follicular response by a combination of E2 and ultrasonic parameters is recommended so that the administration of HCG is given close to the anticipated endogenous rise of LH. This can be achieved by detecting a reduction in the rate of E2 rise (to plateau).(ABSTRACT TRUNCATED AT 250 WORDS)
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46
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Craft I, Porter R, Green S, Tucker M, Smith B, Twigg H, Ahuja K, Whittingham D. Success of fertility, embryo number, and in-vitro fertilisation. Lancet 1984; 1:732. [PMID: 6143059 DOI: 10.1016/s0140-6736(84)92241-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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47
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Kerin JF, Kirby C, Peek J, Jeffrey R, Warnes GM, Matthews CD, Cox LW. Improved conception rate after intrauterine insemination of washed spermatozoa from men with poor quality semen. Lancet 1984; 1:533-5. [PMID: 6142254 DOI: 10.1016/s0140-6736(84)90932-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The efficacy of high intrauterine insemination of a washed motile fraction of spermatozoa from men with poor quality semen on the day after the luteinising hormone (LH) surge was compared with that of natural intercourse based on symptothermal methods and a single act of intercourse timed on the day after the LH surge in the same 35 couples in a controlled and randomised trial of the three types of cycle. Each couple had been trying to conceive for at least 3 years, the woman being potentially fertile and the only detectable defect related to poor semen quality. After 39 intrauterine insemination cycles, 8 women conceived (all in their first insemination cycle); this procedure was significantly more successful than LH-timed intercourse (0/38; p less than 0.05) and natural intercourse timed by symptothermal methods (1/34; p = 0.022). The technique of intrauterine AIH, with a 'Tomcat' catheter, was simple, painless, and uncomplicated.
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48
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49
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Muasher SJ, Wilkes C, Garcia JE, Rosenwaks Z, Jones HW. Benefits and risks of multiple transfer with in vitro fertilisation. Lancet 1984; 1:570. [PMID: 6142290 DOI: 10.1016/s0140-6736(84)90974-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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50
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Kerin JF, Warnes GM, Quinn P, Kirby C, Jeffrey R, Matthews CD, Seamark RF, Texler K, Antonas B, Cox LW. In vitro fertilization and embryo transfer program, Department of Obstetrics and Gynecology, University of Adelaide at the Queen Elizabeth Hospital, Woodville, South Australia. JOURNAL OF IN VITRO FERTILIZATION AND EMBRYO TRANSFER : IVF 1984; 1:63-71. [PMID: 6242162 DOI: 10.1007/bf01129623] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A review is presented summarizing the in vitro fertilization experience at the University of Adelaide, Australia. Initial attempts utilizing the normal cycle were unsuccessful in obtaining a pregnancy. Since 1982 the overall ongoing pregnancy rate has been 21% per embryo transfer, 16% per laparoscopy, and 12% per treatment cycle. A detailed description of presently utilized methodology is presented.
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