Pregnancies achieved from oocyte, sperm or embryo donation are unique, since they have resulted from donor gametes that are immunologically foreign to the mother. Thus, studying the obstetric outcome of such pregnancies may shed some light on the pathophysiology of preeclampsia, particularly in women conceiving with donated embryos, since the entire fetal genome is allogenic in these pregnancies. In this retrospective cohort study, a total of 144 women were studied. Of these, 72 were infertility patients who had conceived as a result of sperm, ovum or embryo donation and the other 72 women were age- and parity-matched control patients who became pregnant with their own gametes, either spontaneously, or following intrauterine insemination with their partner's spermatozoa. Study patients were divided into three groups depending on the origin of the donated gametes. Group 1 consisted of pregnancies achieved by intrauterine insemination with washed donor spermatozoa (n = 33). Group 2 included women who conceived using donated oocytes (n = 27) and group 3 consisted of women who conceived as a result of embryo donation (n = 12). The incidence of pregnancy-induced hypertension in the donated gametes study group was 12.5% (9/72) compared with 2.8% (2/72) in the control group. In addition, pre-eclampsia was diagnosed in 18.1% (13/72) of the donated gametes study group compared to 1.4% (1/72) in the age- and parity-matched controls. The increased incidence of gestational hypertension in pregnancies resulting from donated gametes gives evidence for a maternal genetic component, with an equally strong fetal influence, in the complicated aetiology of gestational hypertension, and pre-eclampsia in particular.

As a consequence of multiple follicular growth during ovarian stimulation for in-vitro fertilization (IVF), follicles of varying sizes often yield oocytes that vary in maturity and morphology of the oocyte-cumulus-corona complex. The objective of this prospective study was to explore the relationship between follicular fluid aspirate volume and the oocyte's developmental potential in an IVF treatment cycle. In total 9933 follicles were studied from 400 patients who underwent 535 consecutive IVF treatment cycles at St James's University Hospital, Leeds, UK, between February 1995 and February 1996. The volume of each individual follicle aspirated was recorded and related to the probability of obtaining an oocyte, its fertilizing capacity, the cleavage rate and the quality of embryos derived. We found no statistically significant difference in oocyte recovery rates between follicles with an aspirate volume < or = 1 ml and follicles with a volume > 1 ml. Although oocytes obtained from follicles with an aspirate volume > or = 1 ml showed a significantly lower fertilization rate, they went on to cleave at the same rate as oocytes obtained from larger follicles and resulted in embryos of comparable quality. Furthermore, there was no statistically significant difference in the implantation, clinical pregnancy or live birth rates per cycle between embryos derived from follicles with an aspirate volume < or = 1 ml and those derived from follicles with an aspirate volume > 1 ml. We conclude that follicular size and the oocyte's developmental potential in the stimulated ovary are not closely related and can be independent. This is in contrast to the Graafian follicle and the pre-ovulatory oocyte in the natural cycle.

The use of gonadotrophin-releasing hormone analogues (GnRHa) has resulted in improved pregnancy rates in in-vitro fertilization (IVF) treatment cycles. Traditionally, short-acting analogues have been employed because of concerns over long-acting depot preparations causing profound suppression and luteal phase defects adversely affecting pregnancy and miscarriage rates. We randomized 60 IVF patients to receive a short-acting GnRHa, nafarelin or buserelin, or to receive a depot formulation, leuprorelin, all commenced in the early follicular phase and compared their effects on hormonal suppression and clinical outcome. We found that on day 15 of administration there was a significant difference in the suppression of oestradiol from initial concentrations, when patients on buserelin were compared with patients on nafarelin or leuprorelin (54 versus 72 and 65%; P < 0.05) and also in the number of patients satisfactorily suppressed, (80 versus 90 and 90%; P < 0.05), though there were no differences between the analogues by day 21. Similarly there was no difference in hormonal suppression during the stimulation phase or in implantation, pregnancy or miscarriage rates in comparing the three agonists. We conclude that with nafarelin and leuprorelin, stimulation with gonadotrophins may begin after 2 weeks of suppression and that long-acting GnRHa are as effective as short-acting analogues with no detrimental effects on the luteal phase.

Final maturation of the oocyte in in vitro fertilization (IVF) cycles is achieved through the administration of a timed injection of human chorionic gonadotrophin (hCG). The success of mature oocyte retrieval is dependent on serum concentrations of the hormone reaching values capable of initiating meiosis and triggering the release of the cumulus-oocyte complex into the follicular fluid. The objective of this prospective cohort study was to examine the effect of adiposity, as measured by body mass index (BMI), on serum concentrations of hCG and gonadotrophins and to relate this to IVF outcome. A comparison was also made between professionally and non-professionally administered hCG to assess any possible effect on cycle parameters. A total of 50 patients with a high BMI (> or = 26 kg m(-2)) who underwent IVF treatment at the Assisted Conception Unit, St James's University Hospital, Leeds, was recruited prospectively into the study. They were matched with 50 patients with a normal BMI (18-25 kg m(-2)) who acted as a control group. The two groups were matched for age (mean of 32 years and range of 22-42 years) and cause of infertility. Serum gonadotrophins, oestradiol and hCG concentrations, measured at the time of oocyte retrieval, and the clinical outcome of the two groups were compared. Patients with a high BMI had a significantly lower mean serum hCG concentration compared with controls (63.9 versus 99.6 iu l(-1), P < 0.0003). They also required a higher dosage of gonadotrophin (3660 versus 3007 iu) to achieve follicular maturation than the controls. Similarly, the high BMI group of patients had higher serum concentrations of follicle-stimulating hormone (FSH) (12.3 versus 11.2 iu l(-1)) and lower oestradiol (3499 versus 3506 pmol l(-1)) compared with controls. Patients with a high BMI had significantly fewer oocytes aspirated, resulting in a significant decrease in the oocyte:follicle ratio compared with controls (33.9 versus 41.7, P < 0.05). The fertilization rate (46.2 versus 61.3%, P < 0.05) and clinical pregnancy rate per cycle (26.6 versus 37.1%, P < 0.05) were also lower in the patients with high BMI compared with those with normal BMI. The administration of hCG by the patient or her partner did not have a significant effect on clinical outcome. The mean serum hCG at the time of oocyte recovery was equivalent in both groups (87.1 versus 89.7 iu l(-1)). Furthermore, the oocyte:follicle ratio (0.73 versus 0.72), fertilization rate (46.2 versus 54.2%) and clinical pregnancy rate (38.9 versus 36.5%) were similar. These findings indicate that high BMI is detrimental to the success of IVF treatment and has an important influence on the distribution and metabolism of hCG. The results also indicate that non-professional administration of hCG does not compromise cycle outcome.

Surgery for recurrent rectovaginal fistula incorporating a Surgisistrade mark mesh can be used as an innovative option.