Human in vitro fertilization employing individualized ovulation induction by human menopausal gonadotropins

Abstract

One hundred six women suffering from obstructive tubal disease not corrected by previous surgery were treated in an in vitro fertilization (IVF) program. Ovulation was induced by 3 amps of human menopausal gonadotropin (HMG)/day starting on the third day of the cycle for 5 days. In most of the patients the regimen was continued for another 1-3 days, depending on the individual's ovarian response (mean, 20 +/- 5 amps/cycle). Monitoring consisted of daily follicular ultrasonography and serum estradiol measurements. Human chorionic gonadotropin (HCG), 10,000 IU, was administered when more than two large (1.5 to 1.8 cm in diameter) follicles were visualized. Using this regimen, a mean of five follicles per woman was aspirated, from which a mean of 3.9 ova was recovered. The oocytes were pre-incubated for 8 or 24 hr, according to the morphological degree of mucification and dispersal of the oocyte-corona-cumulus complex. Following exposure to washed spermatozoa for 16 hr, a 68% fertilization rate was obtained. Oocytes were transferred into the uterus 48 hr after laparoscopy. Ninety-nine transfers (93% of the women) of 1-8 embryos (mean, 2.9/woman) were performed and resulted in 16 clinical pregnancies. No pregnancies occurred in 14 women transferred with one to three oocytes in the pronuclear stage and only one pregnancy (7.1%) was obtained in 14 women transferred with one cleaved oocyte. Over 70% of the women were transferred with two or more cleaved oocytes: in this group the pregnancy/transfer rate was 21%. Of the pregnant women 5 of 16 (31%) aborted between 6 and 10 weeks of gestation and 1 (6%) had an ectopic pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

In Vitro Fertilization: State of the Art

“…17,27 Nevertheless, in our program, only 4 out of 123 women were found to have inaccessible ovaries due to adhesions. 21 Therefore, we do not feel that it is justifiable to perform a screening laparoscopy, and in this we are in agreement with Wentz and colleagues 28 and Kerin and colleagues. 29 On the other hand, in patients undergoing repeat reconstructive surgery, we perform an ovarian suspension, preparing them for eventual IVF, by fixing the ovaries to the anterior lateral surface of the uterus, with very satisfactory results.…”

“…All patients enrolled in an IVF program must have a normal uterus, functioning ovaries, and, according to most studies, should be under 35 to 40 years old. 15 " 21 This age limit, however, should probably be re-evaluated, since it was recently shown that up to the age of 44, neither fertilization nor pregnancy rates are significantly affected. 22…”

“…Three ampules of hMG (225 IU per day) are administered beginning on day 3 of the cycle for 5 days, and 3 to 4 ampules per day are added for another 1 to 3 days, depending on the individual's response. 20,21 hMG is discontinued when at least 2 follicles larger than 1.5 cm in diameter are observed on ultrasonography and E 2 levels are in excess of 400 pg/ml. Twenty-four hours after the last hMG administration, hCG (10,000 IU) is administered as a single injection.…”

Semen Evaluation Following Preparation for in Vitro Fertilization of Human Oocytes

“…The Netherlands), according to a previously described protocol [12]. Oocytes were aspirated by laparoscopy, and 6 h later semen specimens were obtained from their male partners by masturbation following 3-5 days of sexual abstinence.…”

Urinary oestrogen levels and follicle ultrasound measurements in clomiphene induced cycles with an endogenous luteinizing hormone surge

“…In IVF programmes, where multiple follicular development is stimulated with clomiphene alone, human menopausal gonadotrophin (hMG) alone, or clomiphene plus hMG, human chorionic gonadotrophin (hCG) is usually given when the leading follicle is 5 18 mm in diameter (Edwards 1981;Buttery ef al. 1983;Garcia et al 1983;Laufer et al 1984). The natural history of such follicles without hCG has not been well described and indeed there is some continuing dispute as to whether an endogenous L H surge will occur spontaneously in hMG stimulated cycles (Ferraretti et al 1983).…”